ISSN: 1735-1308

REVIEW


5α-Reductase Inhibitors Could Prevent the Clinical and Pathological Progression of Prostate Cancer : A Meta-analysis

Yue Yang, Hanchao Zhang, Zhengdao Liu, Faliang Zhao, Haifeng Hu, Jin Yang, Guobiao Liang

Urology Journal, , 23 February 2021 , Page 4831
https://doi.org/10.22037/uj.v18i.4831

Purpose:To explore the efficacy of 5-ARIs in PCa


Methods:  Searching through the major medical databases such as PubMed, Science Citation Index, EMBASE, Medline, Web of Science, Cochrane Library for all published studies in English until 2018. The following search terms were used: “Finasteride”, “dutasteride”, “5α reductase inhibitors”, “5-ARIs”, “prostate cancer”, “prostate neoplasm” and the additional related studies were manually searched. Newcasle-Ottawa Scale (NOS) assessed the qualities of studies, and the outcome measures were observed by RR or OR with 95% CIs.


Results: we conducted 9 eligible studies for analyses from 2011 to 2017. We found that 5-ARIs group may have fewer progression ( OR =0.48 95%CI: 0.37-0.61; P<.00001, I2=4%, P=.39) and lower pathological progression (OR=0.46; 95%CI: 0.29-0.73; P=.001, I2=0%  P=.45 ) ,compared with control groups. However, the OS did not show significant difference between two groups (OR=1.10; 95%CI:0.90-1.35; P=.35,I2=93% P<.00001 ).


Conclusion: The use of 5-ARIs could prevent progression in Pca patients both in clinical and pathological.

ORIGINAL PAPER (ENDOUROLOGY AND STONE DISEASE)


Purpose:  To evaluate the stone-free rates, quality of life, complications, use of fluoroscopy, analgesic requirements, a hospital stay following the management of lower calyceal with two different techniques (Mini Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery) in a prospective manner.


Material and Methods: 50 patients with a diagnosis lower pole 1-2 cm stone were included into the study and were randomized into two groups.(Mini PCNL n: 25) ( RIRS n: 25). Safety and efficacy of both methods along with some other certain related factors were comparatively evaluated in both groups.


Results: There was no significant difference between preoperative stone size, stone to skin distance, hemogram and creatinine values, need for analgesic drug, patients' replies to visual analog scale (VAS). The duration of both the hospital stay and the exposure to fluoroscopy, hematocrit decrease due to hemorrhage, complication rates were significantly higher in cases undergoing mini PCNL when compared to RIRS. Additionally, any significant difference was not observed with respect to the stone-free rates. Despite an increase in quality of life following the both type operations was noted; there was no significant difference in the quality of life between the patients in both groups.


Conclusion: Our findings demonstrated that both surgical techniques are the feasible alternatives in the minimal invasive treatment of lower pole stones. Although there was no meaningful difference in stone-free rates between two groups; complications, use of fluoroscopy, bleeding and duration of hospital stay were noted to be significantly higher in cases treated with mini PCNL.

Purpose: The cumulative effect of measurable parameters on proximal ureteral stone clearance followed by the shock wave lithotripsy was assessed via the application of an artificial neural network.


Methods and patients: From January 2015 to January 2020, 1182 patients with upper ureteral stone underwent extracorporeal shock wave lithotripsy (ESWL) with supine position. The corresponding significance of each variable inputted in this network was determined by means of Wilk’s generalized likelihood ratio test. If the connection weight of a given variable can be set to zero while maximizing the accuracy of the network classification, the variable is not considered an important predictor of stone removal.


Results: A total of 1174 cases (excluding 8 cases) were randomly assigned into a training group (813 cases), testing group (270 cases), and keeping group (91 cases). We evaluated artificial neural network analysis to the stone clearance rate of the training group, with a predictive accuracy of 93.2% (482/517 cases). While the predictive accuracy of the stone clearance rate of the training group was 75.3% (223 cases/296 cases). The order of importance of independent variables was stone length > course (d) > patient’s age > Stone Width > PH value.


Conclusion: The neural network possess a huge prediction potential for the invalidation of ESWL.

ORIGINAL PAPER(UROLOGICAL ONCOLOGY)


Purpose: It has been shown that the Copper and Zinc contribute to the structure of the antioxidant enzymes. In addition NRF-2 and KEAP-1 complex have powerful effect on the intracellular organization of the antioxidants. We evaluated the relation of Copper, Zinc, NRF-2 and KEAP-1 complex regarding to the oxidative stress with tumor stage - grade in patients with bladder cancer.


Materials and Methods: A total of 52 patients (32 bladder cancer and 20 control group) were included to the study. The demographic properties of groups were identical. Serum NRF-2, KEAP-1, Cu and Zn levels were compared by ELISA method between the groups and tissue NRF-2, KEAP-1, Cu and Zn levels were evaluated also by ELISA method at cancer patients.

ORIGINAL PAPER (FEMALE UROLOGY)


Role of Urodynamics Study in the Management of Pelvic Organ Prolapse in Women

Azar Daneshpajooh, Mahboubeh Mirzaei, Tania Dehesh

Urology Journal, , 23 February 2021 , Page 6408
https://doi.org/10.22037/uj.v18i.6408

Objectives: Pelvic organ prolapse (POP) and lower urinary tract symptoms (LUTS) usually coexist and are common among women. Since the efficacy of urodynamic studies (UDS) in evaluating these conditions is subject to controversy, this study aimed to assess the accordance between urodynamic findings and LUTS and to determine the importance of UDS in women with POP.


Methods: This cross-sectional study was conducted on women over 18 years with symptomatic POP referred to the female urology clinic of Kerman University of Medical Sciences, Kerman, Iran, during 2017-2018. Patients who met the inclusion criteria were included in the study with informed consent. The Pelvic Floor Disability Index (PFDI-20) was completed for each patient. Pelvic examination was performed using the Pelvic Organ Prolapse Quantification System (POPQ). Subsequently, multi-channel UDS was performed, and the findings were analyzed in SPSS 20, using Chi-square or Fisher’s test.


Results: A total of 200 women with symptomatic POP were included in the study. Stress, urge, and mixed urinary incontinence showed significant accordance with the urodynamic findings (urodynamic stress incontinence and/or detrusor overactivity). However, there was no significant relationship between urinary voiding LUTS and urodynamic findings.


Conclusion: UDS should be performed for selective patients with POP. According to the results of the present study, UDS can help us provide consultation for POP patients with voiding LUTS. However, in POP patients with urinary incontinence, this test cannot provide further information and should be performed based on the patient’s condition.

ORIGINAL PAPER (ANDROLOGY)


Effects of Sertraline on Spermatogenesis of Male Rats and its Reversibility after Terminating the Drug

Hamidreza Ghorbani, Alireza Akhavanrezayat, Lida Jarahi, Bahram Memar, Sakineh Amouian, Armin Attaranzadeh, Sadegh Ebrahimi

Urology Journal, , 23 February 2021 , Page 6458
https://doi.org/10.22037/uj.v18i.6458

Purpose: The purpose of this research was to studding the effects of Sertraline on spermatogenesis of male rats and whether these probable effects are constant or provisional after terminating the drug.


Materials and Methods: In this study, 32  two-month old male Wistar albino rats were equally divided into the Sertraline-treated and the control groups. The drug group was gavaged with Sertraline daily while the control group was gavaged with water at the same volume. After 80 days, half of the rats in each group were selected randomly for hormonal evaluations and bilateral orchiectomy. Histological and hormonal evaluations were performed. The remaining half of rats were kept alive for 90 more days without intervention and then underwent hormonal evaluation and bilateral orchiectomy in a similar fashion.


Results: There was no difference between the testes histology and pathology of the sertraline-treated and the control groups.  There was a significant decrease in serum FSH in the Sertraline-treated group compared to the control group (P <0.05). However, this decline appeared to be reversible following termination of exposure to Sertraline. FSH returned to pretreatment levels in the remaining treated rats following 90 days of treatment cessation.


 Conclusion: Within the time-frame studied, Sertraline can induce transitory changes in serum FSH of male rats without concomitant spermatogenic changes within the testes.  This hormonal change appears to be reversible following withholding of Sertraline. The long-term effect of Sertraline usage on hormonal status and spermatogenesis in rats needs further investigation. 

CASE REPORT


Successful Penile Replantation With Cavernoglandular Shunt Procedure In Urban Setting: A Case Series

Exsa Hadibrata, Awang Dyan Purnomo, Mars Dwi Tjahjo, Andrian Rivanda, Ahmad Farishal

Urology Journal, , 23 February 2021 , Page 6495
https://doi.org/10.22037/uj.v18i.6495

Purpose: Traumatic penile amputation is a rare case with various etiologies. Penile reconstruction using replantation technique should be performed to prevent the decline of patients quality of life even in areas with limited facilites.


Material and Methods: We report three cases of total penile amputation in children after circumcision, who were successfully replanted by macro-surgical technique and cavernoglandular shunt procedure.


Results: Postoperative follow-up showed promising results with good micturition, erectile function, cosmetic, and minimal complications.


Conclusion: Matters affecting the successful penile replantation in macro-surgical techniques have been discussed. In addition, we also highlight the potential of cavernoglandular shunt procedure that can be used as an alternative treatment for penile replantation in limited facilities.

Robotic Excision of the Vagina in a 46 XX DSD Male Patient. First Pediatric Report

Giovanni Torino, Ottavio Adorisio, Giovanni Cobellis, Francesca Mariscolo, Antoni Zaccara

Urology Journal, , 23 February 2021 , Page 6470
https://doi.org/10.22037/uj.v18i.6470

The Disorders of Sex Differentiation (DSD) represent a wide range of congenital anomalies of the genitalia. Surgical treatment of these cases may become a challenge. We present a case of a 16-year-old boy with 46 XX DSD, SRY negative, presented with persistent dribbling incontinence, recurrent UTI and perineal pain. Past medical history included right orchiectomy, laparoscopic excision of uterus, fallopian tubes and left streak gonad at another institution at the age of 2 years. The native vagina was left in place. VCUG confirmed the presence of the residual vagina (8 cm in maximum length), connected with the bulbar urethra. Robotic-assisted laparoscopy of the vagina was performed with satisfying short and long-term results.

UNCLASSIFIED


Purpose: The present study aims to assess and compare the effects of carvedilol and terazosin plus enalapril on lower urinary tract symptoms (LUTS), the urine flow, and blood pressure (BP) in patients with moderate hypertension (HTN) and benign prostatic hyperplasia (BPH).


Materials and Methods: In this randomized crossover trial, a total of 40 men with HTN and LUTS symptoms were enrolled. The first group was treated with carvedilol, and the second one received terazosin plus enalapril. After eight weeks of treatment, the patients experienced a one-month washout period, and the treatments changed and continued for eight weeks. To diagnose BPH in the study, the international prostate symptom score (IPSS) questionnaire was used. Moreover, the prostate-specific antigen (PSA), the post-void residual (PVR) urine volume, and the maximum urinary flow rate (Q-max using the uroflowmetry test) were measured.


Results: Effect assessment results in this crossover trial illustrated neither carryover effects nor significant treatment effects on all primary outcomes (P > 0.05). Moreover, the results for the period effect indicated a significant reduction in BP (systolic and diastolic), PVR, and IPSS, yet a significant raise in Qmax.


Conclusion: The effects of carvedilol are similar to those of the combination of terazosin and enalapril in patients with moderate HTN and BPH in controlling LUTS. Carvedilol could be used as an appropriative drug in patients with moderate HTN and cardiac problems with LUTS of BPH. Further studies are recommended to be conducted to investigate and compare the efficacy of carvedilol with that of other alpha-blockers with a larger sample size and over a longer period of time.

Purpose: To evaluate the safety and efficacy of holmium LASER resection of the bladder tumor (HoLRBT) vs. transurethral resection of bladder tumor (TURBT) as the first treatment modality for non-muscle-invasive bladder cancer (NMIBC).


Materials and Methods: Eighty-eight patients with primary non-muscle invasive bladder cancer were allocated randomly in two groups who were treated with HoLRBT or TURBT. The intraoperative and postoperative characteristics and complications of the HoLRBT and TURBT groups were compared. The data of operation time, obturator nerve reflex rate, bladder perforation, bladder irrigation, catheterization time, hospital stay, and 1, 3, 6, 12, 18 months recurrence free survivals were considered in two groups.


Results: There was not significant difference in operative duration among the two groups. Compared with the TURBT group, HoLRBT group had less intraoperative and postoperative complications, including obturator nerve reflex, transient hematuria and postoperative bladder irritation. There were no significant differences among the two groups in the transfusion rate and occurrence of urethral strictures. Patients in the HoLRBT group had less catheterization and hospitalization time in comparison to those in the TURBT group. There were no significant differences in the overall recurrence rate among the TURBT and HoLRBT groups.


Conclusion: HoLRBT can be regarded as a safe and efficient method with several advantages over TURBT. HoLRBT can be used as an alternative procedure for TURBT in patients with non-muscle invasive bladder cancer.