ISSN: 1735-1308

Instant 2021

REVIEW


Purpose: To evaluate whether additional PFMT, which began before radical prostatectomy and resumes immediately after catheter removal, will significantly improve urinary incontinence after RP.


Materials and Methods: We reviewed articles obtained from MEDLINE, CENTRAL, EBSCOHost, CINAHL, and Elsevier from July – August 2020, which compared preoperative PFMT with postoperative PMFT or non-PFMT, with continence incidence parameters. There were no restrictions on the definition of incontinence, treatment regimens, and radical prostatectomy surgical approach. The risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool. A meta-analysis was also carried out to pool the effect estimates.


Results: We included 12 eligible studies in this review, 11 of which we included in the meta-analysis. The PFMT initiated preoperatively significantly reduced the incidence of persistent urinary incontinence at 1, 3, and 6 months postoperatively with an OR of 0.58 (95% CI, 0.41–0.81), 0.57 (95% CI, 0.43–0.74), and 0.38 (95% CI, 0.17-0.83). There was no difference in improvement in patients' incontinence at 12 months postoperatively [OR = 1.31 (95% CI, 0.65-2.63)].


Conclusion: PFMT initiated before radical prostatectomy significantly reduced the incidence of urinary incontinence in the first, third, and sixth months postoperatively. At 12 months postoperatively, additional preoperative PFMT did not cause a significant difference in urinary incontinence incidence.

Assessment of the Prognostic Effect of Blood Urea Nitrogen to Serum Albumin Ratio in Patients with Fournier’s Gangrene in a Referral Center

Farzad Allameh, Saeed Montazeri, Vahid Shahabi, Seyyed Ali Hojjati, Amir Alinejad Khorram, Zahra Razzaghi, Sahar Dadkhahfar

Urology Journal, , 23 February 2021 , Page 6556
https://doi.org/10.22037/uj.v18i.6556

Purpose: To assess the prognostic effect of blood urea nitrogen to serum albumin ratio in patients with Fournier’s gangrene (FG) in a referral center in order to reduce the mortality of FG patients.


Materials and Methods: Patients with FG were admitted and enrolled consecutively in this study from March 2008 to April 2020. Statistical analysis was done to evaluate the differences between the two groups and to identify the best cutoff value to predict mortality and the need for intensive care.


Results: Of all 114 patients, 46 patients (40.35%) died in the course of hospitalization and 40 entered the study. No variable manifested a notable difference except for the BUN to albumin ratio, which was significantly different (P-value = 0.045). The ratio of BUN to albumin was not associated with any other variables and was independently a predictor of death in FG patients.


Conclusion: The ratio of BUN to albumin was significantly different among deceased and survived patients with FG. Therefore, more studies with a larger sample size are still needed to access this parameter properly.

Background: Lower urinary tract dysfunction (LUTD) is the most common problem of the referral children to the pediatric urology clinics. If this condition does not treat early in life, it will be a lifelong problem. During recent decades, electrical stimulation therapy has been expanded and extensively used for the treatment of LUTD in both adults and children. The aim of this review is to suggest clinicians an updated understanding of effects of interferential (IF) electrical stimulation therapy in management of LUTD in children.


Materials and methods: The search was performed in databases of Medline, PubMed, Google Scholar, ,and Scopus for information about  IF electrical stimulation and its application using search words such as “ IF electrical stimulation”, “transcutaneous IF electrical stimulation” ,  “IF therapy ” , “ electrical stimulation”, “voiding dysfunction” , “ LUTD”, “ urinary incontinence” and “ children”. As this review focuses on the answer of this question “Does transcutaneous IF electrical stimulation has effect on management of LUTD in children?” we included the reference list of articles identified by this search strategy and selected those we judged relevant according to our keywords. Clinical trial studies that publishing in English were included. Categorical data were reported as frequencies and percentages.


Results: Eleven studies were included in this review. The success rate of IF therapy in these studies has been reported from 61% to 90% of children with LUTD and urinary incontinence.


Conclusion: IF electrical stimulation is an effective, safe and reproducible option to manage LUTD and urinary incontinence in children.

Purpose: Transmembrane serine protease 2 (TMPRSS2) facilitates SARS-CoV-2 cellular entry. Androgens regulate this protein and may increase the risk of COVID-19. Therefore, androgen deprivation therapy (ADT) may protect patients with prostate cancer from SARS-CoV-2 infection or decrease the severity of the disease. Therefore, we conducted a meta-analysis to study the effect of androgen deprivation therapy (ADT) on COVID-19 in patients with prostate cancer.


Methods: We systematically searched PubMed, Embase, Scopus, and Cochrane databases. All records underwent a two-step screening process to identify the eligible studies. The registered PROSPERO number of this study was CRD42021228398. We evaluated the effect of ADT on the risk of infection, hospitalization, ICU admission, and mortality.


Results: Six studies met inclusion criteria and were evaluated in this study. We performed meta-analysis on four eligible studies. The overall incidence of COVID-19 was 2.65% among patients with prostate cancer receiving ADT. COVID-19 mortality rate was about 22.7% in ADT (+) patients. ADT did not decrease the risk of any of the major outcomes; infection risk (OR= 0.63, 95% CI= 0.27- 1.48, P= 0.29), hospitalization rate (OR= 0.51, 95% CI= 0.10- 2.53, P= 0.41), ICU admission (OR= 1.11, 95% CI= 0.43- 2.90, P= 0.82), and mortality risk (OR= 1.21, 95% CI= 0.34- 4.32, P= 0.77).


Conclusion: We did not observe a protective effect on the risk of infection, hospitalization, ICU admission, and mortality in patients receiving ADT; therefore, it should not be considered as a prophylactic or treatment for COVID-19. On the other hand, ADT did not increase the mortality and morbidity of COVID-19 and should be considered a safe treatment for patients with prostate cancer during the pandemic. Further studies are necessary to confirm our findings.

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.

Therapeutic and Preventive Effects of Aqueous Extract of Date Palm (Phoenix dactylifera L.) Pits on Ethylene Glycol-Induced Kidney Calculi in Rats

Pouria Mohammadparast Tabas, Hamed Aramjoo, Ali Yousefinia , Mahmoud Zardast, Mohammad Reza Abedini, Mohammad Malekaneh

Urology Journal, , 23 February 2021 , Page 6530
https://doi.org/10.22037/uj.v18i.6530

Introduction: Urinary tract stones are one of the most common diseases in the urinary tract. Lack of kidney stone treatment causes irreparable damages to the kidneys, which has many harmful effects. Date palm pits are recommended in traditional medicine as an effective drug in the treatment of kidney stones. The aim of this study was to investigate the effect of aqueous extract of date palm pits on kidney stones induced by ethylene glycol in male rats.


Methods: In this study, 40 rats were classified into five groups (n = 8), including the healthy group receiving normal water, the negative control group, the therapeutic groups with doses of 150 mg/kg and 300 mg/kg, and the prevention group with a dose of 300 mg/kg. In order to induce kidney stones, ethylene glycolated water (1%) was used as drinking water in the studied groups. Blood and urine of rats were collected on days 14 and 28 of the study to assess urinary parameters of calcium, creatinine, uric acid and phosphorus, and serum parameters of blood urea nitrogen, creatinine, uric acid, calcium, and phosphorus. Also, the kidneys of rats were removed from the body on day 28 of the study and were given to a pathologist for examination.


Results: Results of serum parameters shows that the use of date palm pits extract in the treatment and prevention groups with a dose of 300 mg/kg significantly (P < .05) has reduced the levels of blood urea nitrogen, uric acid, calcium, creatinine and phosphorus. Also, the results of urinary parameters show that the use of the extract caused a significant decrease (P < .05) in creatinine, uric acid and calcium in the prevention group and a significant decrease (P < .05) in creatinine and uric acid in the therapeutic group with a dose of 300 mg/kg. Pathological results show a decrease in the number and size of calcium oxalate crystals in renal tubules in the treatment and prevention groups in a dose-dependent manner.


Conclusion: The results of this study showed that the use of aqueous extract of date palm pits has been effective in the treatment and prevention of kidney stones induced by ethylene glycol in rats.

Purpose: To explore the risk factors and predictive factors of systemic inflammatory response syndrome (SIRS) after flexible ureteroscopy (fURS) for upper urinary tract stones.


Materials and Methods: Patients experienced fURS from January 2014 to September 2019 were retrospectively analyzed, which were divided into the SIRS group and non-SIRS group. Clinical data of all patients, including gender, age, American society of anesthesia score, diabetes, etc., were collected. Univariate and multivariate logistic regression was used to determine the independent risk factors for SIRS after fURS, and the receiver operating characteristic (ROC) curve was drawn to verify the validity of results. In addition, patients from October 2019 to January 2020 were prospectively collected to verify the results.


Results: A total of 369 patients were retrospectively included. Univariate analysis showed significant differences in postoperative stone residuals (P = 0.039), preoperative neutrophil/ lymphocyte ratio (NLR) (P < 0.001), and lymphocyte/monocyte ratio (LMR) (P = 0.001) between two groups. Further, preoperative NLR and postoperative stone residuals were independent according to multivariate logistic regression analysis. The optimal cut-off value of preoperative NLR by ROC curve was 2.61, and the area under ROC curve was 77.9%. Prospective analysis based on 53 patients showed that the incidence of SIRS in patients with NLR > 2.61 was significantly higher than that in other patients. (RR = 4.932, P = 0.040).


Conclusion: Preoperative NLR can be used as a predictive factor for SIRS in patients with fURS according to our study. It may provide an evidence for clinicians to make preoperative decisions or medical plans.

Effect of a Probiotic Supplement Containing Lactobacillus Acidophilus and Bifidobacterium Animalis Lactis on Urine Oxalate in Calcium Stone Formers with Hyperoxaluria: A Randomized, Placebo-controlled, Double-blind and In-vitro Trial

Sanaz Tavasoli, Saba Jalali, Mohammad Naji, Nasrin Borumandnia, Ghazaleh Shakiba Majd, Abbas Basiri, Kianaoush Khosravi Darani, Dina Karamad, Maryam Tajabadi-Ebrahimi, Maryam Taheri

Urology Journal, , 23 February 2021 , Page 6789
https://doi.org/10.22037/uj.v18i.6789

Purpose: To determine the effect of a probiotic supplement containing native Lactobacillus acidophilus (L. acidophilus) and Bifidobacterium animalis lactis (B. lactis) on 24-hour urine oxalate in recurrent calcium stone formers with hyperoxaluria. Moreover, the in-vitro oxalate degradation capacity and the intestinal colonization of consumed probiotics were evaluated.


Materials and Methods: The oxalate degrading activity of L. acidophilus and B. lactis were evaluated in-vitro. The presence of oxalyl-CoA decarboxylase (oxc) gene in the probiotic species was assessed. One hundred patients were randomized to receive the probiotic supplement or placebo for four weeks. The 24-hour urine oxalate and the colonization of consumed probiotics were assessed after weeks four and eight.


Results: Although the oxc gene was present in both species, only L. acidophilus had a good oxalate degrading activity, in-vitro. Thirty-four patients from the probiotic and thirty patients from the placebo group finished the study. The urine oxalate changes were not significantly different between groups (57.21 ± 11.71 to 49.44 ± 18.14 mg/day for probiotic, and 56.43 ± 9.89 to 50.47 ± 18.04 mg/day for placebo) (= .776). The probiotic consumption had no significant effect on urine oxalate, both in univariable (= .771) and multivariable analyses (P = .490). The consumed probiotics were not detected in the stool samples of most participants.


Conclusion: Our results showed that the consumption of a probiotic supplement containing L. acidophilus and B. lactis did not affect urine oxalate. The results may be due to a lack of bacterial colonization in the intestine.

Purpose: Tranexamic acid is a fibrinolysis suppressor that is used for a variety of bleeding control procedures such as hematuria, surgery bleeding, and trauma caused bleeding. The advantages of using the tranexamic acid are bleeding control and less need for blood transfusion.


Materials and Methods:  This double blind clinical trial was conducted on 108 patients in Imam Khomeni Hospital, Urmia, Iran 2013-14. The control and intervention groups consisted of 54 randomly selected participants each. The intervention group received 1gr of intravenous tranexamic acid with initiation of surgery and 500mg orally each 8hrs afterwards up to three days. The control group received placebo capsules containing starch of the same form.


Results: The mean term of hospitalization in the intervention group was significantly shorter than that of the control group (P<0.001). The difference between the two groups in terms of preoperative hemoglobin was not significant. However, the decrease in postoperative hemoglobin, intraoperative hemoglobin count in washing liquid, and hemoglobin count in the intervention group were significantly different from those of the control group (P<0.001).


Conclusion: The findings showed that tranexamic acid decreased bleeding during PCNL and the need for blood transfusion. It also decreased the hospitalization term.

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.

Prognostic value of HPV DNA in Urothelial Carcinoma of the Bladder: A Preliminary Report of 2-Year Follow-up Results

Mehmet Sarier, Sibel Süremen Usta, Hasan Turgut, Sefa Alperen Öztürk, Ahmet Soylu, Mestan Emek, Erdal Kukul, Hakan Bozcuk, Nevgun Sepin

Urology Journal, , 23 February 2021 , Page 6429
https://doi.org/10.22037/uj.v18i.6429

Purpose: The association between the human papillomavirus (HPV) and anogenital carcinomas is well established. However, despite its anatomic adjacency, the relationship between HPV and urothelial carcinoma of the bladder (UCB) is less clear. Recent meta-analysis and case-control studies demonstrated a significant relationship between the presence of HPV DNA and UCB. The aim of this clinical study was to compare the 2-year follow-up results of HPV-positive and HPV-negative UCB patients to evaluate the prognostic value of HPV DNA positivity in UCB.


Methods: The study included patients with stage pTa and pT1 UCB who underwent polymerase chain reaction (PCR) analysis of HPV DNA between January 1 and November 30, 2018. Based on their PCR results, 19 HPV-positive and 38 HPV-negative UCB patients who had regular follow-up in our clinic were evaluated in terms of tumor recurrence and disease progression over a 2-year follow-up period.


Results: There was no significant difference between the groups in terms of age, follow-up time, smoking, or tumor grade (P= .576, P= .368, P= .080, and P= .454). Tumor recurrence was observed at least once in 47.3% (n=9) of the 19 HPV-positive patients and 36.8% (n=14) of the 38 HPV-negative patients (P= .445). There was no difference in disease progression between the groups during follow-up.


Conclusion: In our sample of UCB patients, the presence of HPV DNA was associated with a trend toward higher recurrence rate during the 2-year follow-up, though the difference was not statistically significant. No difference in disease progression was observed based on HPV DNA positivity.

Purpose: To compare the efficacy and complication rate of monthly instillations of Bacillus Calmette-Guerin (BCG) as maintenance therapy in intermediate and high risk Non-Muscle Invasive Bladder Cancer (NMIBC) patients with the current standard Southwest Oncology Group (SWOG) protocol.


Materials and Methods: In this observational retrospective study, 40 intermediate and high risk NMIBC patients, receiving standard BCG maintenance regimen, were compared with another 40 NMIBC patients, undergoing monthly intra-vesical instillations of BCG with regard to recurrence, progression and major and minor adverse effects.


Results: The two groups were similar in their basic characteristics except for the older age in the monthly instillation group ( 70.95±9.66 years vs. 64±8.8, p=0.001). Study objectives between the monthly instillation group and the standard group, including recurrence ( 17.5 % vs. 25%, p= 0.34) and  progression rate ( 7.5% vs. 10%, p=0.54) did not show statistically significant difference. Major and minor complication rate also did not show any difference between the two groups.


Conclusion: In addition to the currently recommended standard protocol of BCG maintenance therapy, our study shows that the monthly regimen can be recommended in intermediate and high risk NMIBC patients without compromising the efficacy of the treatment.

Discrimination of Patients with Prostate Cancer from Healthy Persons Using a Set of Single Nucleotide Polymorphisms

Mir Davood Omrani, Hossein Mohammad-Rahimi, Abbas Basiri, Milad Fallahian, Rezvan Noroozi, Mohammad Taheri, Soudeh Ghafouri-Fard

Urology Journal, , 23 February 2021 , Page 6337
https://doi.org/10.22037/uj.v18i.6337

Purpose: Prostate cancer is the second cancer diagnosed cancer in males. It accounts for about 4% of cancer-related mortality in men. Several genetic polymorphisms in different genes have been identified that alter the risk of this kind of malignancy.


Materials and methods: We used the random forest (RF) algorithm for prediction of prostate cancer risk in Iranian population using 13 different single nucleotide polymorphisms (SNPs) in four genes (ANRIL, HOTAIR, IL-6 and IL-8). The samples were divided into a training set (n=320) and a test set (n=80) to evaluate the generalization power for training algorithm. For hyper-parameters tuning, we used randomized search with 5-fold cross-validation for the following hyper-parameters: (1) Number of trees or estimators in the forest (set from 3 to 500); (2) The maximum number of leaf nodes (set from 2 to 32); (3) The maximum number of features used for the best split (set from 5 to 13); and (4) Using bootstrap samples in the trees building (True or False). Accuracy, sensitivity, specificity, and F1-score in both training and test sets were reported.


Results: The most important SNP was ANRIL-rs1333048: A/A (Gini index= 0.096) followed by ANRIL-rs10757278: G/G (Gini index= 0.059). Training Dataset Outcomes were as follow: Accuracy: 0.896, Sensitivity: 0.85, Specificity: 0.944 and F1 Score: 0.891. Test Dataset Outcomes were as follow: Accuracy: 0.787, Sensitivity: 0.775, Specificity: 0.800 and F1 Score: 0.784. The AUC Scores were 0.966 and 0.841 for training and test datasets, respectively.


Conclusion: The proposed panels of SNPs can predict risk of prostate cancer in Iranian population with appropriate accuracy.

The Role of Kallikrein10 (KLK10) Polymorphism in Prostate Cancer Susceptibility

Seda Güleç Yılmaz, Faruk Yencilek, Asıf Yıldırım, Fatma Tuba Akdeniz, Altay Burak Dalan, Zerrin Barut, Turgay İsbir

Urology Journal, , 23 February 2021 , Page 6425
https://doi.org/10.22037/uj.v18i.6425

Purpose: The present study aims to investigate the potential role of Kallikrein 10 (KLK10) genotype and allele frequencies in predisposition to prostate cancer.


Materials and Methods: KLK10 (rs7259451) gene polymorphisms were determined by real-time polymerase chain reaction analysis in patients with prostate cancer (n=69) and controls (n=76).


Results: KLK10 gene frequencies were significantly different in the case and control groups (P = .028). GG carriers were significantly higher in the control group (P = .034), whereas TT carriers were higher in the prostate cancer group (P = .033). Furthermore, The patients with GG genotype had the lowest PSA levels while TT carriers had the highest (P = .005).


Conclusion:  According to the results, we suggested that carrying variant T allele and also carrying homozygote TT genotype could be a potential risk, while ancestral homozygote GG genotype and G allele are risk reducing factors for prostate cancer.

Single Umbilical Stoma for Bilateral Ureterostomy after Radical Cystectomy

Abbas Basiri, Mohammad Hossein Soltani, Nasser Shakhssalim, Hamid Reza Shemshaki, Pouria Rezvani, Milad Bonakdar Hashemi

Urology Journal, , 23 February 2021 , Page 5857
https://doi.org/10.22037/uj.v18i.5857

Purpose: Cutaneous ureterostomy after radical cystectomy is less preferred compared with other permanent urinary diversions due to bilateral stomas. Single umbilical stoma for bilateral ureterostomy (SUSBU) may be an alternative choice to, in this study we reviewed the outcomes of SUSBU in seventeen patients who underwent radical cystectomy.


 


Methods and Materials: This was a case-series study conducted from April 2016 to Des 2017. Seventeen male patients with confirmed PT2 bladder urothelial carcinoma who were not suitable for performing conduit or orthotopic urinary diversion, including those with high-risk patients underwent single umbilical stoma for bilateral ureterostomy after radical cystectomy. All patients were prospectively followed up for 24 months ± 2 months, this study was done in teaching center mainly by senior residents.


 


Results: The mean age of patients was 68.6 ± 6.41 years old. Mean length of operation time was 176.7 ± 15.1 minutes (from intubation to extubation from anesthesia). Sixteen patients were diagnosed with PT2 and one patient had PT4 diagnosis. The decrease in hemoglobin level after surgery was 1.72 mg/dl ± 0.35 and creatinine increased by 0.15 ± 0.05 mg/dl. None of our patients had oliguria. One case developed constipation and no gas passing, with the suspicion of obstruction, underwent abdominal exploration, however, no obstruction or urine leakage was found and the patient was treated conservatively. One patient developed fever during admission, in which atelectasis was identified as the cause. One patient underwent a second operation because of fascia adherence.


 


Conclusion: It seems that this technique is suitable for high risk patients with acceptable operating time, surgical complications and fast recovery after operation and one ureterostomy bag instead of two one’s comparing to bilateral cutaneous ureterostomy.

The Association of Cell Surface Fibromodulin Expression and Bladder Carcinoma

Ali-Ahmad Bayat, Niloufar Sadeghi, Ali Salimi, Ghazaleh Fazli, Mohammad Reza Nowroozi, Solmaz Ohadian Moghadam, Amin Radmanesh, Mohsen Tabasi, Ali Reza Sarrafzadeh, Omid Zarei, Hodjattallah Rabbani

Urology Journal, , 23 February 2021 , Page 6461
https://doi.org/10.22037/uj.v18i.6461

Background: Fibromodulin (FMOD) is a secretory protein which is considered a major component of extracellular matrix. Its dysregulation in different types of cancer implies it as a promising target for cancer therapy. Within the scope of its rather wide expression in different tumors, we studied expression of FMOD and effect of anti-FMOD antibody in bladder cancer cells in order to identify new target for diagnostic and therapeutic interventions. We report here for the first time the expression of FMOD in bladder cancer cell lines in comparison to the normal cell line and tissues.


Methods: A peptide-based produced anti-FMOD murine monoclonal antibody (mAb) (clone 2C2-A1) was applied for evaluation of FMOD expression in bladder cancer and normal tissues by immunohistochemistry (IHC) staining. Furthermore, the expression of FMOD was examined in human bladder cell lines, 5637 and EJ138, as well as a non-cancerous human cell line, human fetal foreskin fibroblast (HFFF), by immunocytochemistry (ICC) and flow cytometry. The apoptosis induction of anti-FMOD mAb was also evaluated in bladder cancer cells.


Results: IHC and ICC analyses revealed that the qualitative expression of FMOD in bladder cancer tissues and cell lines is higher than in normal tissues and cell lines. Flow cytometry analyses revealed that 2C2-A1 mAb could recognize FMOD expression in 84.05 ± 1.85%, 46.1 ± .4% , and 2.56 ± 1.26% of 5637, EJ138, and HFFF cells, respectively. An effective apoptosis induction was detected in 5637 and EJ138 cells with no significant effect on HFFF cell.


Conclusion: To our knowledge, this is for the first time reporting surface expression of FMOD in bladder cancer. This significant surface expression of FMOD in bladder cancer with no expression in normal bladder tissues and the capacity of inducing apoptosis through directed targeting of FMOD with specific monoclonal antibody might candidates FMOD as a diagnostic marker as well as a potential immunotargeting with monoclonal antibody.

Purpose: In spite of extraordinary developments in diagnostic and treatment methods for prostate cancer (PCa), the reason for this disease is not known. Our study aimed to compare men in the PCa group with a control group in terms of sexual behavior like partner numbers and ejaculation frequency, and inflammatory parameters examined in serum.


Material and Methods: This study was performed prospectively between 2013 and April 2020 and the record system was kept by a single doctor. Patients were prospectively recorded by a single person. Patients with diagnosis of PCa were compared with a control group in terms of sexual behavior and in terms of inflammatory parameters like neutrophil lymphocyte ratio (NLR, neutrophil count/lymphocyte count), systemic inflammatory index (SII, neutrophil count x platelet count/lymphocyte count).


Results: In this study, median marriage age was 18 ± 6 years in the control group and 20 ± 2.97 in the PCa group (P = .001). The median lifelong partner number was observed to be 1 ± 1 in the control group and 1 ± 9 in the PCa group (median ± IQR). Additionally, lifelong median ejaculation frequency was determined as 12 ± 5 for controls and 10 ± 4 for the PCa group. Inflammatory markers examined in serum and SII scores were observed to be statistically significantly increased in the cancer group.


Conclusion: The sexual behavior and inflammatory parameters among patients with PCa diagnosis were identified to be significantly high compared to the control group and appear to be possible correctable risk factors. Informing men about sexual behavior from an early age and taking precautions for people at risk in the early period may be protective against this disease.

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. 

ORIGINAL PAPER (RECONSTRUCTIVE SURGERY)


The Whitaker Test in the Follow-up of Complex Upper Urinary Tract Reconstruction: Is It Clinical Useful or Not

Xinfei Li, Kunlin Yang, Weijie Zhu, Yuke Chen, Yang Yang, Peng Zhang, Juan Wu, Pengjie Wu, Shiliang Wu, Xuesong Li, Liqun Zhou

Urology Journal, , 23 February 2021 , Page 6277
https://doi.org/10.22037/uj.v18i.6277

Purpose: To evaluate the feasibility and guiding significance in postoperative management of the Whitaker test after complex reconstruction of the upper urinary tract.


Materials and Methods: Patients who underwent complex ureteral reconstruction and received the Whitaker test after surgery between December 2018 and December 2019 were included. We judged it abnormal that the renal pelvis pressure was higher than 22 cmH2O or the pressure difference was greater than 15 cmH2O. The results were used as a reference for removing the nephrostomy tube. Based on whether the renal pelvic pressure was higher than 22 cmH2O, the patients were divided into the elevated pelvis pressure group and the normal group. Follow ups at 1 month and every 3 months were collected.


Results: A total of 19 patients were included. Fifteen patients did not present obvious abnormalities. One patient suffered from contrast infiltrating into the renal parenchyma, and the pressure was higher than 15 cmH2O. Ureteral stent implantation was performed. The other 3 patients had either elevated pelvis pressure or insufficient image, 2 of which prolonged the duration of nephrostomy tubes. The median follow-up time was 12.6 months. CTU/MRU after removing nephrostomy tubes indicated improved/stable hydronephrosis in all patients. The creatinine in the elevated pelvis pressure group was higher than that in the normal group (91.4 ± 27.6 vs 86.7 ± 16.5 μmol/L, P = .782), and the eGFR was lower (76.0 ± 14.0 vs 81.8 ± 24.1 mL/min/1.73m2, P = .695), but without significant difference. The change in creatinine during follow-up in the elevated renal pelvic pressure group was significantly different from that in the normal group (-13.6 ± 1.0 vs -0.2 ± 10.6 umol/L, P = .047).


Conclusion: Postoperative Whitaker test can help judge whether nephrostomy could be removed. Elevated pressure in upper urinary tract after reconstruction suggests the need to prolong the time of the nephrostomy tube or even re-intervene. Proper management for patients with elevated renal pelvis pressure can help restore the renal function.

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 Mariscoli , Antonio 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.

Off Clamping Laparoscopic Resection of An Extreme Rare Renal Mesenchymal Tumor: An Angiomyolipoma of Renal Capsule

Nasser Simforoosh, Milad Bonakdar Hashemi , Arsalan Aslani, Sahand Mohammadzadeh

Urology Journal, , 23 February 2021 , Page 6512
https://doi.org/10.22037/uj.v18i.6512

Objective: Renal mesenchymal tumors are described as neoplasms with vascular, fibrous and adipose tissues. The renal lipoma is extremely rare renal mesenchymal tumor, typically originating from renal capsule and it is usually presented as well circumscribed homogenous fat containing mass. Angiomyolipoma (AML) is the most common benign mesenchymal renal tumor which is composed mature epithelioid cell. The renal AML usually presented as exophytic, non-infiltrative and fat contain tumor. The well differentiated renal retroperitoneal liposarcoma and lipoma seems to misdiagnosed by exophytic renal angiomyolipoma but the renal AML usually arise from renal parenchyma with characteristic images.


Case presentation: A 37-year-old woman came to our clinic with rapid growth renal mass and pain. The spiral abdominopelvic computed tomography scan (CT-scan) showed well circumscribed hypoheterodense fat containing mass near to middle pole of right kidney with minimal fat stranding without neovascularity and cortical defect. The Patient underwent off clamping laparoscopic resection of renal mass with pre-operative impression: liposarcoma versus lipoma of kidney. The cross-section of the surgical specimen revealed irregular lobulated fatty tissue with hemorrhagic streaks. Definite diagnosis was made by immunohistochemistry study. Spindle cells and epithelioid cells are diffusely and strongly positive for α-smooth muscle actin. The perivascular cells and epithelioid cells are positive for HMB-45 and Melanin. The immunostaining pattern was compatible with angiomyolipoma that originated from renal capsule.


Conclusion: In our experience, the rapid growth mass that is accompanied by pain draws the attention to malignant process. The renal AML rarely arise from renal capsule without characteristic images so having high doubt may lead to pre-operative diagnosis.

LETTER


Implementation of Telemedicine in Indonesian Urology Practice During COVID-19 Pandemic: a National Survey

Faridz Albam Wiseso, Ahmad Zulfan Hendri, Sakti Ronggowardhana Brodjonegoro

Urology Journal, , 23 February 2021 , Page 6772
https://doi.org/10.22037/uj.v18i.6772

Background: The pandemic of COVID-19 is nowhere from over, which pushes us to adapt to it.  Social distancing rules were applied to restrict the people and prevent virus transmission. Despite these restrictions, the patient's care should not be compromised. Doctors are encouraged to technologically improve themselves to get used to the utilization of telemedicine.


Methods: We conducted an online survey of urology specialists and urology residents throughout the country. The survey was accompanied by the Indonesian Urological Association, and the survey was opened for one month and sent by email to all members of the association.


Results: A total of 50 urologists and 182 urology residents participated. Almost half (48%) currently do not have facilities to hold a telemedicine practice in their institution, and 14% reported inadequate facilities. The majority reveals that the barrier to conducting this method was due to insufficient facility. Other issues like insurance coverage and patient's interest in telemedicine, the risk of patient's data leak, and the urologist's lack of interest in telemedicine might also be challenging. Despite some doubts, in sum, more than half have thought that telemedicine would keep utilized although the pandemic is resolved.


Conclusions: We are currently learning the novel telemedicine implementation and some challenges still need to be resolved. Starting from the regulation and legal protection fundamentally, and the health insurance coverage needs to be determined. After all, the low interest in adopting this method has become the greatest barrier.

Huge vaginal wall Mullerian cyst mimicking high stage pelvic organ prolapse

Farzaneh Sharifiaghdas, Nastaran Mahmoudnejad, Maede Mohseni

Urology Journal, , 23 February 2021 , Page 6872
https://doi.org/10.22037/uj.v18i.6872

Vaginal Mullerian cysts are usually small and asymptomatic. Occasionally, they are enlarged and mimic other anatomical disorders, such as anterior vaginal wall prolapse, middle compartment defects (enterocele, apical vaginal wall prolapse) or urethral diverticulum.  Herein we report a female case with a huge vaginal wall Mullerian cyst which was initially misdiagnosed as stage 4 cystocele. Pelvic MRI and cysto uerthroscopy revealed no communication between the cyst and adjacent structures. The cyst was completely excised through a vaginal approach. The pathologic evaluation revealed a benign Mullerian cyst lined with mucinous epithelium. Diagnostic approach to space occupying lesions in the vaginal cavity needs assessment by history, physical examination and appropriate imaging which are essential to prevent misdiagnosis and mistreatment.

UNCLASSIFIED


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.

Purpose: This study aims to evaluate the effects of action research on neobladder function training in patients with orthotopic ileal neobladders.


Methods: A total of 68 patients with orthotopic ileal neobladders were randomly divided into two groups: a control group (31 patients) and an experimental group (37 patients). Patients in the control group received neobladder function training, while patients in the experimental group received neobladder function training based on the action research method. The effects of neobladder function training in all patients were evaluated after three months.


Results: (1) The differences between the two groups in micturition time interval, urine volume per time, number of incidences of nocturia, and urinary continence rate (day time and night time) were statistically significant (P < 0.05). (2) Compared to the control group (241.6 ± 42.3 mL, 15.1 ± 4.9 mL/s, 23.1 ± 9.9 cmH2O, 63.6 ± 22.3 mL), the bladder capacity (292.6 ± 66.9 mL), maximum urinary flow rate (19.2 ± 6.5 mL/s), and bladder detrusor pressure (31.2 ± 11.4 cmH2O) of the experimental group increased, while the residual urine volume (47.2 ± 21.1 mL) decreased (P < 0.05).


Conclusion: Neobladder function training based on the action research method can improve the neobladder function of patients with orthotopic ileal neobladders.

A Proposal for Data Registry system for Urologic Cancers in Iran

Fatemeh Simforoosh, Nasser Simforoosh, Mehdi Dadpour, Mohammad Hadi Radfar

Urology Journal, , 23 February 2021 , Page 6790
https://doi.org/10.22037/uj.v18i.6790

Purpose: Data registries are organized systems that facilitate collection, storage, and analysis of data related to a specific disease in a defined population. Here we introduce a data registry system which was designed to cover the four most common urologic cancers (prostate, bladder, renal and testis).


Materials and methods: All contributing centers can enter data into the system after logging in with their unique usernames and passwords. In this system, the information of each individual patient will be entered in several structured forms covering various steps of management of the patients.


Results: Our proposed registry is an interactive, web-based database designed to collect complete data of patients with common urological cancers. We devised a council that functions as the central committee that will initiate, supervise, and monitor all steps of the projects including data collection, data audit, as well as data analysis and publication. To facilitate manuscript publication, the system will provide assistance and support throughout all the steps of statistical analysis and manuscript preparation.


Conclusion: This proposed registry can have a national target and is designed to provide evidence-based information that could support strategic planning and national multi-centric studies.

Materials and Methods


The expression of NPM1 was analyzed by PCR and Western blot. NPM1 silencing bladder cancer cells (T24/DDP Lv-NPM1, PUMC-91/DDP Lv-NPM1) and overexpressing bladder cancer cells (T24/DDP Lv5-NPM1, PUMC-91/DDP Lv5-NPM1) were established by lentivirus and limited dilution method. The efficiency of gene interference was detected by fluorescence microscopy and Western blot. The migration ability and invasion ability of tumor in vitro were analyzed by wound healing assay and transwell cell invasion test, and the tumorigenic ability in vivo was judged by nude mouse tumorigenicity assay.


Results


Compared with the corresponding negative control group, both NPM1 silencing cell lines T24/DDP Lv-NPM1 and PUMC-91/DDP Lv-NPM1 showed strong migration ability and high invasive ability. At the same time, there was no significant difference in migration ability and the invasive cells proportion between NPM1 overexpressing cell line and related negative control group. NPM1 silencing bladder cancer cells had obvious tumorigenicity in vivo.


Conclusion


NPM1 silencing cells had significant migration and invasion ability. The silencing of NPM1 will accelerate tumorigenicity of drug resistant bladder cancer. Differential expression of NPM1 is of great value in monitoring the progression of drug-resistant bladder cancer.