ISSN: 1735-1308

Instant 2021

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.

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.

The prevalence of renal stone and outcomes of conservative treatment in kidney transplantation: A systematic review and meta-analysis

Alimohammad Fakhr Yasseri, Mohammad Saatchi, Fatemeh Khatami, Hossein Dialameh, Hormat Rahimzadeh, Seyed Mohammad Kazem Aghamir

Urology Journal, , 23 February 2021 , Page 6531
https://doi.org/10.22037/uj.v18i02.6531

BackgroundNephrolithiasis is a rare complication in transplanted kidneys and limited information is available about its therapeutic options. This study aimed to review the conservative management of urinary lithiasis and its outcomes in renal transplanted patients.


Methods


 A systematic review and meta-analysis of the scientific literature were performed in the Medline, Scopus, and Embase databases. Inclusion criteria were studies which include patients with kidney stones in transplanted kidney no matter de-novo or donated stones and use conservative treatment for all or part of their patients. Exclusion criteria were bladder & ureteral stones, full text unavailable, conference paper.  (from January 1st, 1980, to the 19th May 2020). The results of included studies, in the final analysis, were combined using a random-effect model and using metaprop method prevalence and 95% CI of renal stone were reported.


Results


 A total of 8 studies (14988 transplant patients) met the inclusion criteria for the final analysis. A total of 195 patients suffered from renal stone and the prevalence of renal stone was 1.3% (95% CI: 0.89% - 1.7%). The mean age of these patients was 43 years. analysis, the prevalence of conservative treatment in 195 patients was 35% (95% CI: 19%-51%). The mean stone size ranged from 0.29 cm to 1 cm. Three studies reported a stone-free rate of %100. Except for two studies that did not report complications, other studies reported zero percent.


Conclusion


More than one-third of nephrolithiasis were conservatively managed in transplanted patients. Despite limited data, conservative treatment could be done in less than 4 mm stones with high Stone Free Rate (SFR) and very low complications.

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.

Prediction Of The Energy Required for Ho:YAG Laser Lithotripsy Of Urinary Stones

Volkan Selmi, Unal Oztekin, Mehmet Caniklioglu, Levent Isikay

Urology Journal, , 23 February 2021 , Page 6442
https://doi.org/10.22037/uj.v18i.6442

Purpose: In this study, we aimed to find a more accurate predicting constant value of energy per mm3xHounsfield Unit (HU) to ablate urinary stones by endoscopic stone treatment.


Material And Methods: The files of 142 patients who underwent rigid or flexible ureteroscopic laser lithotripsy in our clinic between December 2018 and March 2020 were evaluated retrospectively. Total energy administered for the ablation of the stone was obtained from the registry of the Ho:YAG laser and recorded to the follow-up forms.
 The constant value was calculated for each stone, and the final mean value was figured out by calculation of the mean of all constant values.


Results: The study was conducted with 142 patients; 102 males and 40 females. The mean age of the population was 46.61 ± 14.58-year-old. The number of stones was 1.27 ± 0.665. The mean constant value of energy needed per mm3xHU for urinary stones was 22.87 milliwatt.


Conclusion: This study was conducted to report a predictive constant value and is the very first study evaluating the energy prediction per mm3xHU. The data of the study showed that the constant value is 22.87 mW/mm3xHU. Urologists may estimate the required energy and plan the surgery according to the outcomes of the study. As a future aspect of our study, the constant value may represent predictive information about the time and accuracy of the operation.

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.

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.

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.

LETTER


Chronic prostatitis/Chronic pelvic pain syndromes (CP/CPPS) are a widespread pathology with unknown etiology without a proved treatment algorithm. Neurologic, endocrine and immune systems, and oxidative stress, infections are ranked in the physiopathology.


Anogenital distance (AGD) as a marker for the degree of antenatal exposure of androgens that link to some disorders of androgen-sensitive tissues especially of urogenital system. In this study, we aimed a construct a hypothesis that improper development of perineum and pelvic bottom due to the insufficient embryologic androgen exposure, which can be detected by reduced AGD, can form histologic/clinic CP in adulthood through the physical forces that resulted in stretched prostate via chronic hypoxia induced oxidative stress and failed immune mechanisms. AGD, unlike the previous published ones, suggested as a real physical scale to detect narrowed pelvic bottom other than an endocrine related biomarker.

Is Uro-oncological Surgery Safe During the COVID-19 Pandemic? Comparative Morbidity and Mortality in Patients Undergoing Surgery 2019-2020

Juan Cristóbal Bravo, Renato Navarro, P Rojas, Laura Hinrichs, Maximiliano Schalper, Alvaro Zuñiga, Ignacio San Francisco

Urology Journal, , 23 February 2021 , Page 6711
https://doi.org/10.22037/uj.v18i.6711

Introduction: The SARS-CoV-2 infection has resulted in an unprecedented pandemic. Patients undergoing surgery are a group at risk of exposure. Also, patients with ongoing infection undergoing surgery may be more susceptible to developing complications. There is no significant data on surgical safety in the pandemic period.


Material and Methods: Observational study based in a prospective database of urological oncological surgery. Data were obtained during the 2020 mandatory confinement period compared to the same period in 2019. The records were reviewed 45 days post-surgery. The objective was to compare surgical morbidity and mortality during the pandemic versus an average year in urological cancer surgery.


Results: During confinement period (2020), 85 patients underwent uro-oncology surgery, while in 2019, during the same period, 165. The Clavien-Dindo morbidity ≥3 in 2020 was 2.3% (n=2), and in 2019, it reached 6% (n=10). In 2020, 9 patients were readmitted (10.5%). One patient (1.1%) was re-interfered, with a perioperative mortality of 1.1%. In 2019, 21 patients (12.7%) were readmitted. Seventeen patients (10.3%) were re-interfered, with a perioperative mortality of 1.8%. The median number of days hospitalized was 2 (IQR=2) in 2020 and 3 (IQR=3) in 2019. No significant differences were found in population or morbimortality, except for reoperation in a normal year.


Conclusion: Postoperative morbidity and mortality reported are lower than those shown in the literature concerning COVID-19 and similar to that historically reported by our centers. This study suggests that it is safe to operate patients with urological cancer following the appropriate protocols during a pandemic.

Living Donor Kidney Transplantation: Global and Regional Trend

Mohammad Nadjafi-Semnani, Nasser Simforoosh, Ali Nadjafi-Semnani

Urology Journal, , 23 February 2021 , Page 6820
https://doi.org/10.22037/uj.v18i.6820

Request for kidney transplantation (K.T.) is increasing rapidly because of the worldwide pandemic of end-stage renal disease, and the most critical issue is organ shortage. The available deceased donors will not resolve the continuing scarcity of organs. It is now professionally and ethically acknowledged and is vital to pay money to the donors for excluding disincentives of living organ donation. Living organ donation should be a vital part of the K.T. Program of any country.

Abstract:


Intermittent catheterization has been introduced as a lifesaving management strategy in cases of bladder neuromuscular dysfunction both in adults and children. Surprisingly there are scarce data or even clear professional opinions about interval and frequency of catheterization attempts in children. This may have a considerable impact specially in children with vastly variable bladder capacity and function. We tried to throw light on this problem, suggest a simple estimation and propose a more frequent catheterization schedule than commonly perceived, as an either temporizing or extenuating resort before cystoplasty in some cases.

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.

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.