ISSN: 1735-1308

Vol. 17 No. 6 (2020)


Purpose: To assess the diagnostic accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography
combined with the computed tomography (18F-FDG PET/CT) in the detection of recurrent or residual urinary
bladder cancer with meta-analysis.
Methods: We searched PubMed/MEDLINE, Embase, Web of Science, CBM, CNKI, VIP, and Wanfang databases
through October 2019. Two reviewers independently screened the full articles. The imaging findings were
confirmed by either histopathology or clinical follow-up. Sensitivity, specificity likelihood ratio and diagnostic
odds ratio were pooled with 95 % confidence intervals (CI). Overall test performance was summarized by a summary receiver operating characteristic (ROC) curve. The Meta-DiSc software (version 1.4) was used to perform the meta-analysis.
Results: The meta-analysis included 7 studies. The pooled sensitivity and specificity of PET/CT for the detection
of recurrent or residual urinary bladder cancer was 94.0% (95% CI: 91.0%–96.0%) and 92.0% (95% CI: 88.0%–
95.0%), respectively. Positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were 9.77 (95%
CI: 4.91–19.41), 0.99(95% CI: 0.06–0.13) and 95.09 (95% CI: 47.96–188.53), respectively. When residual urinary
bladder cancer was excluded, sensitivity changed slightly.
Conclusion: This meta-analysis suggested that the diagnostic accuracy of PET/CT was good in detecting recurrent or residual urinary bladder cancer.

Purpose: To evaluate the evidence that could help health system policy makers to approach the preference for same-gender urologists.

Methods: We performed this systematic narrative review according to the PRISMA guidelines. We searched MEDLINE, Web of science, EMBASE, CINAHL and Google Scholar for articles focused on the preference for patient-urologist gender similarity in the male-dominated department from 1999-2019. Finally, a narrative synthesis of studies meeting the inclusion and quality criteria was conducted in accordance with the nature of the evidences. We applied a thematic analysis using inductive approach for synthesizing studies employing heterogeneous research methods and designs.

Results: Of 208 titles and abstracts screened, 23 were included and three major themes including reasons, impacts, and implications were identified. Overall, patients with urologic problems prefer same gender urologists and females were more likely to prefer the same gender urologist than males. Many women delays care due to a perceived lack of female urologists. The major identified reasons for the same-gender preference are religious believes, cultural background, emotional relationship, past experiences, and sensitive examinations. The results indicate that the urologists-patients gender similarity improves the quality of primary care. Our review reveled that urologists prefer to perform more same gender-specific procedures. Besides, female urologist and residents perceived to underestimate from their male counterparts.

Conclusion: This study could help health system to honor the patient’s preference for same gender urologist. The findings may help medical education and health policy makers to move the male-dominated urology departments towards a culture supportive of female urologists.

A Systematic Review and Meta- Analysis of Green-Light Laser Vaporization for Superficial Bladder

Zhi Xu, Guifen Gan, Guojun Chen, Guanlin Wu

Urology Journal, Vol. 17 No. 6 (2020), 9 January 2021 , Page 578-586

Purpose: The related research of green-light laser vaporization in the treatment of non-muscle invasive bladder
cancer (NMIBC) is limited. This study focused on analyzing the effectiveness and safety of it from the perspective of an extensive literature review.

Methods: A comprehensive search of CNKI, WanFang, VIP, PubMed, Embase, and CENTRAL databases for photoselective vaporization of bladder tumor and transurethral resection of bladder tumor treatment of non-muscle invasive bladder cancer (NMIBC). The search included studies from January 1996 to December 2019. Two reviewers independently screened literature, extracted data, assessed the risk of bias of included studies. RevMan 5.3 software was used for Meta-analysis.

Results: A total of 18 RCTs involving 1648 patients met the predefined criteria. Meta-analysis data demonstrated that the PVBT group exhibited a significant advantage over the TURBT group in intraoperative obturator nerve reflex (RR = 0.09, 95% CI [0.04, 0.18], P< 0.001)and bladder perforation (RR = 0.14, 95% CI [0.07, 0.28], P< 0.001) and postoperative 1-year recurrence (RR = 0.52, 95% CI [0.40, 0.67], P< 0.001). The PVBT procedure has advantages over TURBT in the amount of surgical bleeding (MD = −17.27, 95% CI [−24.73, −9.81], P< 0.001) and the length of hospital stay (MD = −2.80, 95% CI [−3.82, −1.87], P< 0.001), bladder irrigation time (MD = −0.95, 95% CI [−1.49, −0.42], P< 0.001), and catheter indwelling time (MD = −2.60, 95% CI [−3.30, −1.90], P< 0.001). There was no difference between the two types of surgery in the incidence of postoperative urethral stricture (RR = 0.53, 95% CI [0.15, 1.83], P = 0.32) and the length of surgery (MD = −2.46, 95% CI [−5.37, 0.46], P = 0.10).

Conclusion: Our systematic review and meta-analysis suggests that PVBT is better than TURBT as an alternative treatment for patients with NMIBC in safe aspect. However, whether it is equally effective in terms of oncological control remains to be elucidated, and additional high quality RCTs are needed to confirm our findings.


Feasibility of Percutaneous Nephrolithotomy in Positive Urine Culture: A Single Center Retrospective Study

Ivan Gorgotsky, Dmitry Shkarupa, Andrey Shkarupa, Nadezhda Yarova, Denis Suchkov

Urology Journal, Vol. 17 No. 6 (2020), 9 January 2021 , Page 587-591

Purpose: To determine the efficacy and safety of PCNL in patients with positive urine culture without an any other risk factors prior to surgery, and to define an optimal pre-operative antibiotic regimen for these patients.

Materials and methods: The study included 269 consecutive PCNL cases. These cases were divided into 2 groups according pre-operative urine culture results: sterile (group 1, n=166) and positive (group 2, n=103). Patients with risk factors linked to infection complications were excluded from study. All patients underwent PCNL in the prone position. In group 1, the antibiotic regimen included parenteral injection 30 minutes prior to operation and for 3 days after surgery. Group 2 was given antibiotics 24 hours before PCNL as well as 30 minutes before PCNL and then for 3 days following surgery. On the first day after the operation low dose CT and common blood count were performed on all patients to determine residuals, hematomas, blood loss, and inflammatory markers. 

Results:  Mean age, stone size, failed ESWL, and prior nephrostomy tube insertion were higher in group 2. Although rate of pre-stented patients was equal in groups. No significant differences were observed between group 1 and 2 in regard to operative time (74,3±26,9 vs 70,2±26,5  min, P=.52), length of stay (3,9±1,2 vs 3,8±1,6 days, P=.24), SIRS (6,0% vs 7,8% patients, P=.07), and leukocyte levels exceeding  10*10*9 (77 (46,4%) vs 49 (47,6%) P=.11). Moreover, there was no sepsis or hemotransfusion in either group. Stone-free rates were also similar (78,9% vs 77,7%, P=.35).

Conclusion: 24-hours continuous antibiotic administration before the operation (paying respect to specific resistance bacterial features) can be considered as alternative to 1-week treatment and allow to perform PCNL with sufficient safety in selected patients. Infected urine is not an independent risk factor of post-operative infections complications after PCNL in low risk patients with kidney stones.


Purpose: To compare the erectile function and urinary continence of patients after single-port transvesical laparoscopic radical prostatectomy (STLRP) with intrafascial endoscopic extraperitoneal radical prostatectomy (IEERP).

Materials and Methods: Patients treated with STLRP (35) or IEERP (52) were recruited from September 2013 to June 2017. At baseline preoperatively and 2-year follow-up postoperatively, sex and continence assessments were performed by International Index of Erectile Function-6 (IIEF-6) and daily pads, respectively.

Results: The sexual function at 3 months after RP declined obviously. 71.4% (STLRP) and 38.5% (IEERP) patients recovered potency at 6 months postoperatively (P < .01). 82.9% (STLRP) and 59.6% (IEERP) patients recovered potency at 2 years postoperatively (P < .05). 97.1% (STLRP) and 75.0% (IEERP) patients recovered continence (0 pad/day) at 3 months postoperatively (P < .01). Continence achieved 100.0% at 2 years after RP in both groups.

Conclusion: Patients receiving STLRP may obtain better and faster postoperative functional recovery than the ones receiving IEERP. As an exploratory research, STLRP may be another effective treatment for organ-confined prostate cancer.


Comparison of the Efficacy of Local Anesthesia Methods and Caudal Regional Anesthesia in Prostate Biopsy Applied Under Transrectal Ultrasonography: A Randomized Controlled Study

Sahin Pasali, Cuneyt Ozden, Yalcin Kizilkan, Suleyman Camgoz, Semih Baskan, Samet Senel, Doruk Demirel, Cevdet Serkan Gokkaya

Urology Journal, Vol. 17 No. 6 (2020), 9 January 2021 , Page 597-601

Purpose: To evaluate the efficacy of caudal regional anesthesia and local anesthesia methods in prostate biopsy applied under transrectal ultrasonography.

Matherials and Methods: This prospective study included a total of 160 patients randomly separated into 4 equal groups as intrarectal local anesthesia (IRLA), periprostatic local anesthesia (PPLA), combined local anesthesia (IRLA+PPLA), and caudal regional anesthesia (CRA). The patients were evaluated using the pain scores on a visual analog scale.

Results: The pain score during anesthesia induction was significantly higher in the CRA group than in the IRLA and IRLA+PPLA groups (p<0.001). The pain score during entry of the probe to the rectum and movement was significantly lower in the CRA group than the IRLA groups (p=0.014). The pain score on penetration of the needle to the prostate and at 30 mins after the biopsy was significantly higher in the IRLA group (p<0.001). At 2 hours after the biopsy, the pain score in the CRA group was significantly lower than IRLA groups (p=0.015).

Conclusion: The PPLA alone can be applied more quickly than CRA, causes less pain during the application, and has similar efficacy in reducing pain during and after the prostate biopsy procedure.

Incidence, Gleason Score and Ethnicity Pattern of Prostate Cancer in the Multi-ethnicity Country of Iran During 2008-2010

Abbas Basiri, Babak Eshrati, Ali Zarehoroki, Shabnam Golshan, Nasser Shakhssalim, Alireza Khoshdel, Amir Hossein Kashi

Urology Journal, Vol. 17 No. 6 (2020), 9 January 2021 , Page 602-606

Purpose: To investigate the geographical incidence, and grade of prostate cancer in Iran during 2008-2010 and evaluate its relationship with ethnicity.

Materials and Methods: Data was extracted from the nationwide Iranian cancer registry system during 2008-2010. Pathologies and grade was extracted from scanned reports of patients’ pathologies by a urologist.

Results: The average 3-year age standardized incidence rate of prostate cancer during the study period was 11.52 per 100000 males. The age standardized incidence rates for Persian, Arab, Turkish and Turkmen, Lor, Kurd and Baluch ethnicities were 13.5, 9.3, 7.9, 7.9, 7.2 and 2.1 per 100000, respectively. Poisson regression analysis revealed a statistically significant difference in incidence of prostate cancer in Baluch ethnicity (P=0.028) and a near significant difference for incidence of prostate cancer in Turk-Turkmen and Kurd ethnicity (P=0.067 and P=0.082) in comparison with Persian ethnicity. The median Gleason score distribution of prostate cancer was not concordant to the age standardized incidence rates. 97% of all pathologies were adenocarcinoma of the prostate followed by malignant carcinoma (1.9%), and transitional cell carcinoma (1.1%).

Conclusion: The incidence of Prostate cancer was different between Baluch and Fars ethnicities in Iran. The lowest ASR of PCa was observed in Baluch ethnicity, however the possibility of underreporting due to less access in Baluch ethnicity cannot be ruled out. The Gleason distribution pattern was not concordant to the incidence distribution of Prostate cancer.

Robot Assisted Radical Cystectomy Outcomes in Micropapillary and Plasmacytoid Variants

Erdem Koç, Bahri Gök, Berrak Gumuskaya, Ali Fuat Atmaca, Abdullah Erdem Canda, Mevlana Derya Balbay

Urology Journal, Vol. 17 No. 6 (2020), 9 January 2021 , Page 607-613

Purpose: To compare the patients who underwent robot assisted radical cystectomy (RARC) and extended pelvic lymph node dissection (EPLND) and whose pathology result was reported as micropapillary variant (MV), plasmacytoid variant (PV) and pure urothelial carcinoma (PUC).

Materials and Methods: The data of 133 patients who underwent RARC and EPLND with the postoperative pathology results reported as MV, PV and PUC were analyzed. According to the postoperative pathology results, patients were divided into two groups in initial analyses as variant pathologies group (n=14) and PUC group (n=119). In secondary analyses, patients were divided into three groups as MV group (n=7), PV group (n=7) and PUC group (n=119). The operative data, oncologic outcomes and complications were compared between the groups.

Results: Median operation time and estimated blood loss were significantly increased in variant pathologies group (P <0.001 and P = .001, respectively). The postoperative pathological T stage, positive surgical margin rate and lymph node involvement were also significantly increased in variant pathologies (P = .001, P = 0.004, P <0.001, respectively). Kaplan-Meier analysis revealed significant decrease in OS and CSS times in PV group compared to PUC group (P = .048 and P = .016, respectively).

Conclusion: MV and PV are rarely seen variant pathologies with higher pathological T stages. RARC is a minimally invasive surgical technique that can be performed successfully by an experienced surgical team with low morbidity rates and similar oncological results, even in challenging cases.


Microorganisms and Antibiotic Profile of the Subpreputial Space in Uncircumcised Boys

Selamettin Demir, Cennet Ragbetli, Nazim Abdulkadir Kankilic, Abdullah Yildiz, Alper Bitkin

Urology Journal, Vol. 17 No. 6 (2020), 9 January 2021 , Page 614-619

Purpose: This study investigates the frequency of isolated microorganisms and the antimicrobial resistant pattern of inner foreskin and smegma in prepubertal children.

Materials and Methods: This comparative cross-sectional study was conducted between March and November 2019, where 132 prepubertal boys, who were scheduled to receive religious circumcisions at our outpatient clinic, were examined. The patients were divided into the following groups based on the presence of smegma in their subpreputial space: Group I (with smegma, n=58) and Group II (without smegma, n=74). Sterile stuart transport swabs (Advanced Diagnostic Research, Mediko Kimya, Turkey) were taken from the smegma or the subpreputial space (glans surface and inner foreskin) using aseptic techniques and then the swab samples were immediately transported by sterile stuart transportation for microscopy, culture identification, and antibiographic resistance testing by conventional test methods and automated systems (VITEK II, Biomerieux, France) to the Microbiological Laboratory of our hospital.

Results: 48 bacteria isolated from 39 boys in Group I comprised 28 gram-positive species (58.3%) and 20 gram-negative species (41.7%). The most commonly isolated gram-negative bacterium was Proteus mirabilis (45%) while most positive was Staphylococcus hominis (42.9%). In Group II, 68 boys had 103 bacterial isolates in the glans comprising 81 gram-positive species (78.6%) and 22 gram-negative species (21.4%). The most commonly isolated gram-negative bacterium was Proteus mirabilis (42.9%) while the most positive were Enterococcus faecalis (40.7%) and S. hominis (42.9%)

Conclusion: The subpreputial space of uncircumcised boys is colonized by various types of uropathogens resistant to multidrug drugs. Smegma does not pose additional risks to microbiological colonization in children.


Investigating Risk Factors for the Development of BK Virus Infection in Kidney Transplant Recipients in Guilan Province during 2007-2015

Masoud Khosravi, Mahlagha Dadras, Ali Monfared, Siamak Granmaieh, Mohammad Shenagari Rashti, Soheil Soltanipour, Gholamreza Mokhtari

Urology Journal, Vol. 17 No. 6 (2020), 9 January 2021 , Page 620-625

Purpose: Polyomavirus nephropathy has been recognized as an important cause of silent loss of kidney transplant function in up to 50% of kidney recipients (1). The present study aimed to evaluate the risk factors associated with BK virus infection in kidney transplant recipients.

Materials and Methods: Clinical information, urinary Decoy cells, and blood polymerase chain reaction (PCR) tests were collected for polyomavirus infection in 223 kidney transplant recipients undergoing surgery at Razi hospital at Guilan University of Medical Sciences between 2007 and 2015. Kidney biopsies were performed in patients with BKPyV- DNAemia more than 10,000 Copies/ml or increased plasma creatinine.

Results: Among 223 patients, 116 (52%) were male. The mean age of participants was 49.57±13.48 years. Out of 223 participants, 41 (18.4%) had Decoy cells in their urine, and 182 (81.6%) did not, 15 of whom (6.7%) had viral genome in their blood. Only did 3 patients out of 10 have BK Virus nephropathy in their kidney biopsy. Among risk factors, it was found that post-transplant duration (P< 0.001) and the use of anti-thymocyte globulin (P= 0.001) were the most significant risk factors for finding decoy cells in patients’ urine.

Conclusions: Post-transplant time, particularly the first 6 months, was found as the most important risk factor for the reactivation of polyomavirus infection in our patients because of strong immunosuppression and use of anti-thymocyte globulin (for prophylaxis or rejection treatment). It is concluded that kidney transplant recipients should be monitored in episodically after transplantation.


The Effect Of Preoperative Gabapentin on Pain Severity After Posterior Urethral Surgery: A Randomized, Double-Blind, Placebo-Controlled Study

saleh ghiasy, Ali Tayebi-azar, Amin Alinezhad, Morteza Fallah-karkan, Hojat Salimi, Seyyed Ali Hojjati, Jalil Hosseini

Urology Journal, Vol. 17 No. 6 (2020), 9 January 2021 , Page 626-630

Purpose: Prevention and treatment of urethroplastic postoperative pain is a major challenge in post-surgery care. gabapentin can treat postoperative pain by preventing excessive sensitivity to the central nervous system. we have tried to compare the effect of gabapentin with the placebo on reducing the pain associated with posterior urethroplasty in patients.

Material and Method: This prospective, randomized, double-blind study was scheduled in Shohad e Tajrish hospital where a single dose of Gabapentin was compared with placebo given to patients preoperatively. In this study,100 patients with posterior urethral stricture were included for surgery with 50 patients in each arms .All patients underwent posterior urethroplasty. After surgery, the pain level is assessed and evaluated by the visual analog scale in two hours,four hours, six hours,eight hours, twelve hours, and 24 hours after the operation.

Result: In this study, there was a significant difference in the pain level that was evaluated by the visual analog scale in two hours, four hours, six hours, eight hours, twelve hours, and 24 hours after the surgery (p.value <0.001). We also found a significant decrease in morphine consumption in the gabapentin group vs the placebo group. (p.value <0.001)

The post-surgery assessments showed significant lower adverse effects such as vomiting, nausea, drowsiness, and pruritus in the gabapentin group vs. placebo group.

Conclusion: The consequences of this study revealed that gabapentin effective in controlling posterior urethroplasty postoperative pain, consumption of opioid, nausea, vomiting, drowsiness, and pruritus compared with the placebo group.


Association between Hyposensitivity of C-fiber Afferents at The Proximal Urethra and Storage/voiding Dysfunction in Female Patients with Detrusor Overactivity

Osamu Ichiyanagi, Ken-ichi Nishimoto, Akira Nagaoka, Sei Naito, Mayu Yagi, Masaki Ushijima, Tomoyuki Kato, Norihiko Tsuchiya

Urology Journal, Vol. 17 No. 6 (2020), 9 January 2021 , Page 631-637

Purpose: We examined the associations between urethral sensation and storage/voiding function in female patients with detrusor overactivity (DO) by measuring urethral current perception threshold (CPT).

Materials and Methods: We retrospectively investigated the medical records of 27 consecutive patients with lower urinary tract symptoms who underwent cystometry, uroflowmetry (UFM), and urethral CPT tests from 2000 to 2015. Patients were classified into 2 groups: with/without DO. Seven DO-negative cases were selected as normal controls on cystometrogram (CMG) matching the inclusion criteria: bladder compliance ?12.5 mL/cmH2O, volume <275 mL at first sensation, and no comorbidities possibly influencing micturition. Finally, 17 patients were included. Urethral CPT was evaluated with intraurethral square-wave impulses at 3 Hz to stimulate C-fibers. Urethral loss coefficient (LC), reflecting urethral resistance during voiding, was calculated by curve-fitting a mathematical model to a UFM waveform.

Results: Urge incontinence (UI) was observed in 7 DO-positive patients, but not in those with normal CMG. Urethral CPT and LC were significantly higher in patients with DO than in those with normal CMG. Median urethral CPT significantly increased in patients with both DO and UI than in those without these symptoms (p<0.005). CPT values were correlated with the volume at first sensation (?=0.53, p<0.05) and LC (?=0.59, p<0.05). LC was not calculated in 3 cases due to poor curve-fitting.

Conclusions: In females, urethral C-fiber afferents may become hyposensitive as the detrusor becomes overactive with UI in the storage phase. During voiding, C-fiber hyposensitivity may relate to increased functional resistance of the urethra to urine outflow.


Correlation Between Protamine-2 and miRNA-122 in Sperm from Heroin-addicted Men: A Case-Control Study

Zohreh Nazmara, Mohammad Najafi, Mansoureh Movahedin, Zahra Zandiyeh, Peymaneh Shirinbayan, Hamid reza Asgari, Mohsen Roshanpajouh, Chad B. Maki, Zahra Bashiri, Morteza Koruji

Urology Journal, Vol. 17 No. 6 (2020), 9 January 2021 , Page 638-644

Purpose: Recreational use of illicit drugs is one of the main factors affecting male fertility. However, the mechanisms of heroin smoke-associated damage to mature spermatozoa are still completely unknown. The aim of this study was to concomitantly examine the levels of protamine-2 gene and protein concentrations, the amount of miRNA-122 in seminal plasma and semen analysis findings in heroin-addicted men.

Materials and Methods: In a case control study, twenty-four fertile men that lacked any recreational drug abuse were considered as the healthy group, and 24 addicted men who used only heroin for at least four months were selected as the addicted group. Semen samples were gathered by masturbation after 2 - 5 days of sexual abstinence. Following the preparation of a semen analysis by computer-assisted sperm analysis according to WHO (2010), the level of protamine-2 gene expression in sperm and miRNA-122 in seminal plasma was measured using real-time sqPCR. Also, protamine-2 protein concentrations were quantified by nuclear protein extraction, SDS-Page and western blotting.

Results: Among the studied variables, body mass index (27.75±0.88 vs. 22.30±0.36, p=0.001), seminal pH (7.79±0.06 vs. 7.58±0.06, p=0.003), white blood cell count in semen (1.69±0.41 vs. 8.61±1.73, p=0.001), motility (65.51±2.57 vs. 41.96±3.58, p=0.001) and survival rate (87.41±1.00 vs. 71.50±4.59, p=0.002) of sperm cells was significantly different between the healthy and addicted groups. In addition, the levels of protamine-2 gene and protein expression in the addicted group (0.05±0.02 and 0.10±0.02, respectively) were significantly lower than the healthy group (3.59±0.94 and 0.27±0.06, respectively) (p=0.002 and p=0.017, respectively). Seminal miRNA-122 levels in addicted men (3.51±0.73) were statistically higher than in healthy men (1.52±0.54) (p=0.034). However, there were some significant relationship between the studied parameters and addiction (p<0.05).

Conclusion: This is one study on human infertility that evaluates the effects of heroin on protamine deficiency and seminal small RNAs expression levels. Heroin abuse may lead to male infertility by causing leukocytospermia, asthenozoospermia, protamine deficiency, and seminal plasma miRNA profile alteration.


Renal Parenchymal Volumetric Expansion Assessed by CT Imaging After Laparoscopic Cyst Decortication

Mehmet Hamza Gültekin, Ahmet Yalcin, Guven Erbay

Urology Journal, Vol. 17 No. 6 (2020), 9 January 2021 , Page 645-649

Purpose: To delineate the expansion of the renal parenchyma using volumetric CT imaging before and after the laparoscopic cyst decortication procedure and to determine the possible associations between parenchymal expansion and laboratory parameters and cyst volume.

Materials and Methods: Thirty-five patients that underwent laparoscopic cyst decortication were included in this prospective study. Abdominal contrast-enhanced CT was performed in all patients in the preoperative and postoperative period. Semi-automatic volume quantification was undertaken offline, and renal parenchymal volumes before and after cyst decortication, as well as serum creatinine and estimated glomerular filtration rate (eGFR) were compared.

Results: The changes in serum creatinine and eGFR in the postoperative period were non-significant. The mean postoperative renal parenchymal volumes were higher compared to the preoperative measurements for both observations (P = .014 and .034 for the first and second measurements, respectively). There was no correlation between the volumetric change and the cyst volume (r = -0.18, P = .560).

Conclusion: In patients undergoing laparoscopic cyst decortication, post-operative parenchymal expansion can be detected using volumetric CT imaging to confirm the immediate benefits of the procedure.

Anastomosing Hemangioma Incidentally Found in Kidney or Adrenal Gland: Study of 10 Cases and Review of Literature

Jun Zhou, Xiaoqun Yang, Luting Zhou, Ming Zhao, Chaofu Wang

Urology Journal, Vol. 17 No. 6 (2020), 9 January 2021 , Page 650-656

Purpose: To describe and report a series of renal and adrenal anastomosing hemangioma (AH) and to investigate its distinctive clinicopathologic features and review its clinical data available in the literature.

Materials and Methods: Clinical data of 10 AHs were retrospectively studied. Imaging and histologic features were re-evaluated and summarized. Immunostaining markers were performed include CD31, CD34, ERG, Fil-1, D2-40, AE1/AE3, SMA, CD10, HHV8, S100, Ki-67. A follow-up of all cases was performed. Other AHs published in PubMed and Web of Science were reviewed.

Results: All of 10 AHs were found incidentally, containing 5 female and 5 male patients (median, 48.5 years; mean, 51.7 years) and involved unilateral kidney (n=7) and adrenal glands (n=3) respectively. All lesions were well-defined in Imaging and histologic examination. AHs were morphologically characterized by prominent anastomosing vascular channels without evidence of infiltration to surrounding normal tissues and significant cellular atypia. CD31, CD34, ERG were positive and Ki-67 showed typically low (?3%). All Patients underwent a mass resection and none of them had evidence of recurrence. Together with other cases published, the AHs showed distinctive clinicopathologic features with an excellent prognosis.

Conclusion: Renal or adrenal AH is a very rare vascular tumor. They have distinctive histologic features and a favorable prognosis. Its frequently mimicking well-differentiated angiosarcomas easily result in unnecessary overtreatment in clinical practice. To be acquainted with this entity serves to avoid misdiagnosis.

Hydatid Cyst Treatment and Management in Retroperitoneal Organs; Is Percutaneous Drainage an Option?

Yunus Emre Göger, Mehmet Serkan Ozkent, Mehmet Aykut Yıldırım, Suleyman Bakdık, Mehmet Giray Sönmez, Cengiz Kadiyoran, Mehmet Balasar, Murat Cakir

Urology Journal, Vol. 17 No. 6 (2020), 9 January 2021 , Page 657-663

Purpose: To evaluate patients who cyst hydatid (CH) in their retroperitoneal space and organs in order to determine a standard treatment option for CH.

Materials and Methods: The files of 56 patients who were treated for CH in our clinic were evaluated retrospectively. All patients underwent either percutaneous drainage (PD) or surgery. Patients were divided into two groups as PD (Group one) and surgery groups (Group two). Preoperative and postoperative results were compared statistically.

Results: 31 of 56 patients were male. Mean age of the patient was 39.7 (10–85). 16 patients had been treated with PD and 40 with different surgical interventions such as total cystectomy, partial cystectomy, partial nephrectomy, total nephrectomy, surrenalectomy, and laparoscopic partial surrenalectomy. Patients’ followed up was 18 months (6-38m). Relapse was seen in 1 patient who underwent PD. On comparing the results, hospitalization period was prolonged in the surgical group with enlarged cyst presence.

Conclusion: CH presence in the retroperitoneal area is rare. PD, a minimally invasive method, has the potential to be the standard treatment option as it can be performed safely in selected patients. However, currently surgical treatment is considered as the first treatment option after CH diagnosis.


Urinary Human Kidney Injury Molecule1- (hKIM1-) is not Increased in Patients with Renal Cell Carcinoma

Lukasz Bialek, Slawomir Poletajew, Michal Niemczyk, Katarzyna Czerwinska, Mateusz Nowak, Anna Sadowska, Tomasz Borkowski, Piotr Radziszewski, Jakub Dobruch, Piotr Kryst

Urology Journal, Vol. 17 No. 6 (2020), 9 January 2021 , Page 664-666

Purpose: Human Kidney Injury Molecule-1 (hKIM-1) was proposed as urinary biomarker of renal cell carcinoma (RCC). The aim of the study was to validate urinary hKIM-1 as a biomarker of RCC.

Material and methods: Forty-six participants were enrolled into the study, including 30 patients with clear-cell or papillary RCC and 16 matched patients in the comparison group. Preoperative urinary hKIM-1 levels were measured using commercially available ELISA kit and normalized to urinary creatinine levels.

Results: The concentrations of urinary hKIM-1 normalized to urinary creatinine in patients with RCC and comparison group did not differ significantly (1.35 vs. 1.32 ng/mg creatinine, p=.25). There was also no difference in urinary hKIM-1 concentration regarding stage or grade of renal cancer. Additional analysis of patients without chronic kidney disease (defined as eGFR ≥60mL/min/1.73m²) also did not reveal significant difference in urinary hKIM-1 concentrations between the groups (1.54 vs. 1.37; p=.47).

Conclusion: Results of our study do not confirm recent suggestions that urinary hKIM-1 may be a biomarker of RCC.

Urinary Stone Location with Ureteral Stents in Place: Always on the Move, and not Where you Would Expect

Manolis Pratsinis, Ahmet Cevdet Tekin, Valentin Zumstein, Sabine Güsewell, Hans-Peter Schmid, Dominik Abt, Patrick Betschart

Urology Journal, Vol. 17 No. 6 (2020), 9 January 2021 , Page 667-670

Purpose: To assess migration of urinary stones with ureteral stents in place.

Materials and Methods: We performed a retrospective analysis of stone characteristics and locations in patients treated with secondary retrograde intrarenal surgery for symptomatic urinary stones at our institution. We analyzed 393 patients with a median age of 53 years and a median stone size of 7 mm. Stone location was assessed at ureteral stent insertion and four weeks later prior to stent removal and retrograde intrarenal surgery (RIRS).

Results: Migration of urinary stones was seen in 33.1% of the patients with an indwelling ureteral stent. Stones with caudal migration were smaller for any given initial position. 7.1% of the stones were located at one of the three sites of narrowing at initial presentation, this percentage increased to 18.8% at the time of stone extraction. Stone composition did not affect stone migration.

Conclusion: Radiographic imaging prior to retrograde intrarenal surgery is recommended due to the migration of urinary stones with indwelling ureteral stents. The most appropriate surgical approach can be devised depending on stone localization.


Mesothelioma in Situ of the Spermatic Cord Arising from a Patent Processus Vaginalis: A Case Report

Yasuyuki Kobayashi, Yumiko Yasuhara, Hiroki Arai, Masahito Honda, Masataka Hiramatsu, Sho Goya

Urology Journal, Vol. 17 No. 6 (2020), 9 January 2021 , Page 671-673

Mesothelioma is an aggressive tumor originating from mesothelial cells. Mesothelioma of the spermatic cord is a very rare disease, and the most common presentation of this disease is that of aggressive mesothelioma with no description of mesothelioma in situ. We report an extremely rare case of mesothelioma in situ of the spermatic cord arising from a patent processus vaginalis. To our best knowledge, this is the first report of this finding. The identification of a patent processus vaginalis and investigation of single-layered atypical mesothelial cells led to the final diagnosis.

This report is about the effectiveness of sacral neuromodulation in a 32-year-old woman with a history of augmented cystoplasty who required clean intermittent catheterization. She had referred to our center with a medical history of bilateral vesicoureteral reflux because of neuropathic lower urinary tract dysfunction. We successfully did a sacral neuromodulation on her which lead to a promising result.


The Impact of the COVID-19 Pandemic on Urology Practice in Indonesia: A Nationwide Survey

Nur Rasyid, Ponco Birowo, Dyandra Parikesit, Fakhri Rahman

Urology Journal, Vol. 17 No. 6 (2020), 9 January 2021 , Page 677-679

Purpose. This study aimed to investigate the impact of COVID-19 on urology practice in Indonesia.

Material and Methods. This was a cross-sectional study using web-based questionnaire (Survey Monkey), which was distributed and collected within a period of three weeks. All practicing urologists in Indonesia were sent an e-questionnaire link via E-mail, WhatsApp Messenger application, and/or short message service, and the chief of residents in each urology centre distributed the e-questionnaire to urology residents.

Results. The response rate was 369/485 (76%) among urologists and 220/220 (100%) among urology residents. Less than 10 percent of the responses in each section were incomplete. There are 35/369 (9.5%) of urologists and 59/220 (26.8%) of urology residents had been suspected as COVID-19 patients, of whom seven of them were confirmed to be COVID-19 positive. The majority of urologists (66%) preferred to continue face-to-face consultations with a limited number of patients, and more than 60% of urologists preferred to postpone the majority (66%) or all elective surgery. Most urologists also chose to postpone elective surgery in patient with COVID-19-related symptoms and patient who required post-operative ICU-care. Urologist and urology residents reported high rates of using personal protective equipment, except for medical gowns and N95 masks, which were in short supply. Several uro-oncology surgeries were considered to be the top priority for Indonesian urologist during COVID-19 epidemic period.

Conclusion. The COVID-19 pandemic has caused a decline in urology service in both outpatient clinic and surgery services with uro-oncological procedure as a priority to conduct.


Guidelines for Urological Surgeries in the COVID-19 Pandemic: Is it Time for Revision?

Seyyed Mohammad Ghahestani, Kashi AH

Urology Journal, Vol. 17 No. 6 (2020), 9 January 2021 , Page 560-561

In this correspondence the authors try to show that guidelines and recommendations including what was published by EAU rapid reaction group must be further updated and tailored according to different epidemiologic data in different countries. The authors assign the countries worldwide in three categories. First category comprises countries that experience the secondary surges smoother than the first one. The second category include countries with stronger or -merging and rising-secondary surges and the third category encompasses countries with successful initial response and secondary stronger but still more controllable surges. Authors proclaim that after passing the first baffling impact we find out that postponement strategies preached in many of these scout treatises are no more suitable at least for the countries delineated in the second category and can culminate in performance of procedures in worse. The authors proffer Iranian Urology Association COVID-19 Taskforce Pamphlet(IUA-CTP) as a paragonic document mentioning it’s the time we must recognise the wide variability of the situation in different regions and any advisory position must consider this huge variance in epidemiologic profile.