ISSN: 1735-1308

Instant 2021


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.

Introduction: Radical open nephroureterectomy (ONU) with bladder cuff excision (BCE) is the traditional gold standard approach for management of high-risk non-metastatic upper tract urothelial cancer. ONU involves two separate procedures; the nephrectomy and distal ureterectomy, with each of these parts being able to be performed with an open or minimally-invasive approach. Multiple approaches have been described for the resection of the distal ureter and bladder cuff after mobilization of the kidney and upper ureter.

Materials and Methods: A Medline search of the literature including relevant articles up to March, 2020 was performed. Search terms included “nephroureterectomy”, “upper tract urothelial carcinoma”, “upper urinary tract carcinoma OR UTUC”, “open OR conventional OR ONU OR conventional”, “robotic-assisted nephroureterectomy OR RANU”, “laparoscop* OR LNU OR LRNU” and “minimally-invasive nephroureterectomy”. Original articles, case series and review articles were included.

Results: There are no randomised studies. Various techniques have been described to manage the distal ureter during nephroureterectomy. This review provides an overview of these techniques. The perioperative and oncological outcomes following open versus endoscopic techniques and minimally invasive techniques have been described. Although endoscopic approaches have more favourable perioperative outcomes, this comes at the expense of increased risk of tumour spillage and recurrence compared to the traditional open approaches. Minimally-invasive techniques (laparoscopic and robotic-assisted NU) largely have superior perioperative outcomes versus their open NU counterparts, with comparable oncological outcomes.

Conclusion: Current non-randomised evidence is open to selection bias and is insufficient to support or refute endoscopic management of the distal ureter as an alternative to open bladder cuff excision. The optimal approach to nephroureterectomy and management of the distal ureter continues to remain a surgical dilemma.


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

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

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.

Is 10/12 Fr Ureteral Access Sheath more Suitable for Flexible Ureteroscopic Lithotripsy?

Wenfeng Li, Yuanshen Mao, Yufei Gu, Chao Lu, Xin Gu, Bao Hua, Weixin Pan, Qinghong Xi, Zhong Wang

Urology Journal, , 23 February 2021 , Page 6620

Purpose: To choose the ideal UAS size for an unstented ureter in flexible ureteroscopic lithotripsy.

Materials and Methods: A retrospective case-control study was conducted with patients treated with flexible ureteroscopic lithotripsy for renal calculi from 2005 to 2020. The patients were divided into two groups: smaller (10/12 Fr) vs. larger (12/14 Fr) calibre UAS. The outcome was the insertion success rate, systemic inflammatory response syndrome (SIRS) complication rate after the operation, ureteral wall injury, operative time, and stone-free rate.

Results: Of the 1573 patients enrolled, 10/12 Fr UAS was used in 957 (Group A); 12/14 Fr UAS was used in the remaining patients (Group B). The insertion success rate was significantly better in Group A (91.2% vs. 86.9%, P = .006), with no significant difference between the groups regarding the stone-free rate, postoperative pain, operative time and hospital stay. The severity of ureteral visible lesions with 10/12 Fr UAS was significantly lower than that with larger UASs (80.1% vs 85.2%, P = .000). Despite no significant difference in the incidence of SIRS between the two groups, the incidence of SIRS in the 10/12 Fr group showed a sharp increase with stones >2 cm (17.0% vs. 8.5%, P = 0.037).

Conclusion: The use of 10/12 Fr UAS had an advantage for the insertion success rate, avoiding ureteral wall injury and not increasing postoperative infectious complications in flexible ureteroscopic lithotripsy. We recommend the use of smaller calibre (10/12 Fr) UAS in patients with renal calculi < 2 cm.

Purpose: To investigate whether a Percutaneous nephrostomy (PCN) has any impact on the success rate of shock wave lithotripsy (SWL) and to estimate the probability of stone-free in SWL patients with upper ureter stones.

Materials and Methods: Overall, 236 patients who underwent SWL for upper ureter stones between 2015 and 2019 were evaluated. Forty-nine patients who underwent PCN during SWL were identified. Medical data of the patients were retrospectively reviewed, and possible prognostic features were evaluated.

Results: Out of all patients, 147 patients were selected through propensity score matching. There were no significant differences between the PCN and no PCN groups, except for a lower stone-free rate (55.1% vs. 74.5%, p = .018) and one-session success rate (24.5% vs. 50.0%, p = .003) in the PCN group. In univariate analysis, a younger age, the female sex, a smaller size of stone, lower mean stone density (MSD), and absence of PCN were positive predictive factors of being stone-free in patients who underwent SWL. In multivariate analysis, a smaller size, lower MSD, and absence of PCN were positive predictive factors of being stone-free in patients who underwent SWL.

Conclusion: Stone size, MSD, and PCN were prognostic factors that influence the outcome of SWL. The presence of PCN during SWL is associated with adverse success rates in patients with upper ureter stones.

Risk Factors for Failure of Endoscopic Management of Stone-related Ureteral Strictures

Teruaki Sugino, Kazumi Taguchi, Shuzo Hamamoto, Tomoki Okada, Masahiko Isogai, Yutaro Tanaka, Rei Unno, Yasuhiro Fujii, Takashi Hamakawa, Ryosuke Ando, Atsushi Okada, Takahiro Yasui

Urology Journal, , 23 February 2021 , Page 6697

Purpose: To investigate factors determining the outcomes of endoscopic management for stone-related ureteral stricture.

Materials and Methods: Data of patients who underwent endoscopic surgery for ureteral stricture due to stones from January 2016 to April 2020 were retrospectively analyzed. We compared cases successfully treated with endoscopic surgery with cases that resulted in failure. We focused on factors associated with treatment success, including cause and length of stricture, methods of stricture treatment, surgical time, and duration of hydronephrosis before the treatment. Treatment success was defined as improvement in hydronephrosis status.

Results: Nineteen patients were treated for stone-related ureteral stricture. Hydronephrosis was successfully improved in 12 patients (63.2%). Seven patients with failed endoscopic management had ureteroscopic lithotripsy-related stricture, whereas 3/12 (25.0%) patients with ureteroscopic lithotripsy-related stricture and 7/12 (58.3%) patients with impacted stone-related stricture were successfully treated by endoscopic management (P = .004). The prevalence of stricture length > 15 mm was significantly higher in the patients with failed management than in the patients with successful management (71.4 vs 16.6%, P = .046). Intraoperative endoscopic observation demonstrated that the mucosa of the ureteroscopic lithotripsy-related stricture had ischemic appearance with relatively long stricture length (P = 0.13) compared to the impacted stone-related stricture. No association was observed between treatment outcome and method of endoscopic management, including laser incision, balloon dilation, or both.

Conclusion: Ureteroscopic lithotripsy as a cause and stricture length > 15 mm could affect the success rate of endoscopic management of ureteral stricture. In such cases, reconstructive management should probably be considered in the early stages.

Characteristics of Double-J Stent Encrustations and Factors Associated with their Development

Jian Huang, Weizhou Wu, Shike Zhang, Yapeng Huang, Tao Zeng, Lingyue An, Yeping Liang, Jinkun Huang, Hans-Göran Tiselius, Guohua Zeng, Wenqi Wu

Urology Journal, , 23 February 2021 , Page 6578

Purpose: To evaluate the chemical composition of double-J stent encrustation and to assess risk factors associated with their development.
Materials and Methods: Patients who had double-J stents removed between July 2016 and June 2017 were recruited for this study prospectively. The clinical features of the patients were recorded and the composition of encrustation material was analyzed by infrared spectroscopy.

Results: Encrustments from a total of 372 double-J stents was collected. The mean age of patients was 50.4±13.1 years and deposits possible to analyze were obtained from 228 males (61.3%) and 144 females (38.7%). Calcium oxalate monohydrate was the most common constituent of stone and encrustments. The encrustation rate of vesical coils was significantly higher than that of renal coils (P<0.001). There was no significant difference in chemical composition between stone and encrustation regarding renal (P=0.086) and vesical coils (P=0.072). The only predictive risk factor for development of encrustation on double-J stents was indwelling time. This phenomenon was observed in both renal (P<0.001) and vesical coils (P=0.021). Interestingly, patient with chronic kidney disease (CKD) was associated with less risk of encrustation on both renal (P<0.001) and vesical coils (P=0.001).

Conclusion: The chemical composition of double-J stent encrustation was the same as the urinary stone. The prevention strategy for stone composition is also suitable for the prevention of encrustation of double-J stent. The only predictive factor for double-J stent encrustation was the indwelling time. CKD patient was shown to be less risk for the development of encrustation.   

Purpose: To investigate the preoperative and intraoperative potential risk factors associated with miniaturized percutaneous nephrolithotomy (mPCNL) fever in the treatment of patients with large renal stones.

Materials and Methods: All patients with renal stones larger than 2.5 cm, who had also undergone mPCNL, were included in the period between April 2018 and September 2019. Logistic regression analyses were performed to identify clinical variables associated with post-operative fever (>38°C).

Results: A total of 53 patients were enrolled for whom the median maximal stone length was 3.08 cm. 24 (45%) patients had a fever after mPCNL. Significantly more patients with urine WBC ³ 27(/HPF) had a fever after surgery (p = 0.004). No significant between-group differences in urine cultures were found for the fever and non-fever groups (p=0.094). Stepwise and multivariable logistic regression analyses all revealed that urine WBC ³ 27(/HPF) is the only risk factor for developing post-mPCNL fever. Based on the highest body temperature, all of the patients were assigned into no fever, mild fever (37.5£ Temp < 38.0), and fever groups, and an ordinal logistic regression analysis still supported the premise that the result of urine analysis is strongly associated with post-mPCNL fever.

Conclusion: Large renal stones are challenging to treat and associated with severe complications. Approximately 45% of large renal stone patients treated via mPCNL developed a fever. Urine WBC can easily and directly predict the risk of fever.


Comparison of the Effect of Steroids on the Treatment of Phimosis according to the Steroid Potencies

Jae-Wook Chung, Hyun Tae Kim, Se Won Jang, Yun-Sok Ha, Tae-Hwan Kim, Tae Gyun Kwon, Jun Nyung Lee

Urology Journal, , 23 February 2021 , Page 6574

Purpose: This study aimed to evaluate the outcomes of topical steroid therapy according to potency as the first-line treatment for boys with symptomatic phimosis.

Materials and Methods: From April 2017 to March 2019, we retrospectively reviewed 45 boys with severe phimosis (Kikiros retractability grade 4 or 5) who presented with phimosis-related complications. During the first year of the study period, methylprednisolone aceponate (MPA, Advantan®, potent topical steroid) was administered in 24 boys. Hydrocortisone butyrate (HCB, Bandel®, moderately potent topical steroid) was administered in 21 boys in the subsequent period. Topical steroids were administered for 4–8 weeks in all patients. Success of the therapy was determined by two conditions at 3 months after therapy: achieving Kikiros grade 3 and less with disappearance of symptoms.

Results: Of 45 boys, 35 (77.8%) achieved success of the therapy. Mean age was 46.64±22.42 months. Recurrence of phimosis with clinical complications was confirmed in three of 35 patients with initial success (8.6%) during the follow-up period. All boys with recurrence showed remission after additional topical steroid therapy. Success rate of the MPA group was higher than that of the HCB group (91.7% and 61.9% respectively, P = .029). Side effects associated with the topical steroid application were not observed in all children.

Conclusion: Topical steroid application is an effective and safe procedure as first-line treatment in symptomatic boys with severe phimosis. Moreover, the potency of topical steroids for the treatment of phimosis is considered a factor affecting the success rate.

Purpose: Retrospective comparative study of the efficacy of extravesical non-dismembered common sheath ureteral reimplantation (ECSR) versus intravesical common sheath ureteral reimplantation (ICSR) techniques for the correction of vesicoureteral reflux (VUR) in complete duplex systems.

Material and Methods: Between 2010 and 2019, ECSR was performed in 38 children (8 bilaterally), and the mean ages at presentation and at surgery were 31 and 57 months, respectively. The ICSR technique was performed in 25 units (25 patients). Voiding cystography and ultrasound of the kidney and bladder were performed 3 and 12 months postoperatively. We analyzed the surgical outcomes for both groups.

Results: The mean follow-up times for the ECSR and ICSR groups were 15 and 18 months, respectively. The success rate of the ECSR group was 93.5% at 3 months, improving to 95.7% at an average of one year; the rate of the ICSR group was 96% at 3 months and was the same after one year, with no significant difference between the two groups (p = .66). Postoperative complications were compared in the ECSR and ICSR groups: transient contralateral VUR was seen in 5 renal units versus 4, de novo hydronephrosis was seen in 3 units versus 2, and UTIs were observed in 3 patients versus 4.

Conclusion: Both (ECSR) and (ICSR) surgeries are highly successful for the correction of VUR in uncomplicated complete duplex systems. The results of the extravesical approach are comparable with those of the intravesical technique with less morbidity and a shorter hospital stay. Thus, ECSR is our preferred technique when open surgical repair is indicated. ICSR should be reserved for complicated duplex systems necessitating concomitant reconstructive surgery.

Purpose: To determine hypospadias repair's cosmetic and functional outcome concerning the urethral plate width and glanular width.

Materials and Methods:  A prospective study including 38 patients. The urethral plate width (UPW) was measured preoperatively. The cosmetic outcome was evaluated by hypospadias objective penile evaluation [HOPE] score, and the urinary stream evaluated functional outcome. We included boys with distal penile hypospadias and excluded recurrent cases with severe chordee. All patients were operated on by Snodgrass tubularized incised plate repair (TIP); they were followed up for one year. Success was defined as slit-shaped meatus at the tip of the glans without fistula.

Results: The mean age of surgery was 4.5 ± 2.1 years. UPW was < 8 mm in 24 patients (63.2 %) (Group A), while 14 patients (36.8 % ) (Group B) had a UPW ≥ 8 mm. Overall, the mean ± SD of UPW was 4.84 ± 1.29 mm. The mean ± SD of GW was 9.52 ± 1.56 mm. Overall success was documented in 35/38 patients (92.1 %). No significant relation was founded between the complications and UPW of the patients (p-value = 0.7). Overall, the mean ± SD HOPE score was 39.1 ± 8.83. A significant relation was found between the cosmetic outcome of the two groups and the HOPE score (p-value = 0.02).

Conclusion: The pre-incision urethral plate width and glanular width were not correlated with the TIP outcome. A better HOPE score is associated with a wide urethral plate.


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

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

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

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

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

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.

Purpose: Fournier’s gangrene (FG) is a serious, aggressive, and often fatal multi-organism infection that affects the soft tissues of the perineum, rectum, and external genitalia. This study aimed to analyse the treatment’s strategies of FG.

Materials and Methods: This was a retrospective study of 35 patients with a diagnosis of FG admitted between 2016 and 2021. The diagnosis of FG was established on a clinical basis. Data on patient’s age, sex, comorbidities, laboratory results (C-reactive protein (CRP), white blood cell (WBC), hematocrit (HCT), platelets (PLT), sodium, potassium, creatinine, procalcitonin, international normalized ratio (INR), and gangrene culture), extent of resection, antibiotics used, and hospitalisation time were obtained. The extent of resection was assessed on a scale of 1–5.

Results: The study group consisted of all men (n=35) aged 24–85 (mean, 58) years. In 13/35 (37%) patients, hyperbaric oxygen therapy (HBOT) combined with negative-pressure wound therapy (NPWT) was used as a treatment for wound healing in Fournier’s syndrome (group 1), and in 22/35 (63%) patients, open standard wound care was used (group 2). There were no fatalities in group 1, but four deaths (18%) were noted in group 2. The median extent of resection was 3 in group 1 and 2 in group 2. There was a correlation between the extent of resection and use of HBOT combined with NPWT. The hospitalisation time was much shorter in group 2 (mean, 23 days) than in group 1 (mean, 26 days).

Conclusion: HBOT and NPWT (group 1) showed advanced wound healing with a high efficiency rate. The longer median hospitalisation time in this group may be related to the severity of injury. 

Urine Biomarkers for the Diagnosis of Bladder Cancer: a Network Meta-Analysis

Ying Dong, Ting Zhang, Xining Li, Feng Yu, Hongwei Yu, Shenwen Shao

Urology Journal, , 23 February 2021 , Page 6254

Purpose: To identify effective urine biomarkers for bladder cancer diagnosis.

Materials and Methods: This meta-analysis was conducted following the guidelines of the Meta-Analyses (PRISMA) statement. Relevant studies were searched from the PubMed, Embase, and Cochrane Library databases. Heterogeneity tests were performed using Q statistics and I2 tests to determine the use of the random or fixed effects model. A direct comparison meta-analysis and network meta-analysis were conducted. The effect values are presented as odds ratios and 95% confidence intervals. Sensitivity analysis and consistency tests were performed.

Results: Fifty-eight studies with 12,038 participants were included. Direct comparison meta-analysis showed statistically significant differences in bladder cancer antigen (BTA) trak vs. nuclear matrix protein 22 (NMP22), BTA stat vs. urine cytology (UC), and fluorescence in situ hybridization (FISH) vs. UC, among the sensitivity indicators. Among the specificity indicators, there were statistically significant differences in BTA trak vs. UC, ImmunoCyt (immunocyte) vs. NMP22, and BTA stat vs. FISH. Among the positive predictive indicators, NMP22 vs. UC, BTA stat vs. UC, and FISH vs. NMP22 showed statistically significant differences. Among the negative predictive indicators, the differences in FISH vs. UC, FISH vs. NMP22, and hyaluronidase 1 (HYAL-1) vs. UC were statistically significant. Among the accuracy indicators, FISH vs. NMP22, FISH vs. UC, and HYAL-1 vs. UC showed statistically significant differences. Network meta-analysis showed that HYAL-1, urothelial carcinoma associated 1 (UCA1) and survivin had the highest sensitivity, while UC had the lowest sensitivity. The specificity of UC, FISH, and HYAL-1 was the highest, while that of UCA1 was the lowest. In terms of positive predictive indicators, UC, FISH, and HYAL-1 had the highest positive predictive value, while the BTA group had the lowest positive predictive value. In terms of negative predictive indicators, HYAL-1, UCA1, and survivin had the highest negative predictive value, while UC had the lowest negative predictive value. In terms of accuracy indicators, HYAL-1, UCA1, and survivin had the highest accuracy, while UC had the lowest accuracy.

Conclusion: HYAL-1 and survivin are suitable urine biomarkers for bladder cancer diagnosis.

Predictors of Secondary Bladder Cancer in Patients with Prostate Cancer Treated with Brachytherapy: A Single-institution Study of a Japanese Cohort

Kiyoshi Takahara, Makoto Sumitomo, Masayuki Ito, Fumitaka Ito, Masashi Nishino, Takuhisa Nukaya, Masashi Takenaka, Kenji Zennami, Kosuke Fukaya, Manabu Ichino, Naohiko Fukami, Hitomi Sasaki, Mamoru Kusaka, Shinya Hayashi, Hiroshi Toyama, Ryoichi Shiroki

Urology Journal, , 23 February 2021 , Page 6718

Purpose: The incidence of secondary bladder cancer after treatment for localized prostate cancer (PCa) remains unclear. In this study, PCa cases treated with brachytherapy (BT) were evaluated to assess the incidence of a second malignancy of bladder cancer in a Japanese cohort.

Materials and Methods: Overall, 969 patients treated with BT at our hospital between July 2006 and January 2019 were included in the study cohort. The incidence and predictors of secondary bladder cancer were also assessed.

Results: The incidence of secondary bladder cancer was 1.5% (n = 14). Of the seven factors (age, pretreatment PSA, Gleason score, cTNM stage, prostate volume, total activity, and combined external beam), prostate volume and total activity showed significant differences between the cohorts with and without secondary bladder cancer (P = .03 and P = .001, respectively). Upon comparison of the seven parameters for the 969 patients treated with BT, we found that only the total activity factor was affected by the incidence of secondary bladder cancer in the multivariate analysis (P = .007).

Conclusion: The incidence of secondary bladder cancer was evaluated after BT for PCa. Total activity was associated with the incidence of secondary bladder cancer in Japanese patients who received BT.

Purpose: Bladder cancer is a common cancer in the world with the highest rates in Southern and Western Europe, North America, and Western Asia. It imposes a high economic burden to the health care system globally. The objective of this study is to provide the incidence of bladder cancer and its geographic distribution in Iran in 2014, 2015 and 2016.

Results: We registered 5817, 5662 and 6630 new bladder cancer cases in 2014, 2015 and 2016, respectively with men counting 82% of cases in every year. The ASR of bladder cancer in total Iranian population was 8.50 (95% CI: 8.28-8.72), 8.05 (95% CI: 7.83-8.27) and 8.74 (95% CI: 8.52-8.96) per 100,000 in those years. The male to female ratio was 5 every year. Kerman has the highest ASR in each of the years, respectively 15.49, 13.07 and 12.46, and Ilam has the lowest ASR during 2014 to 2015, respectively 4.27 and 3.50, and Sistan and Baluchestan has the lowest rate in 2016 (ASR:3.56) in both sexes.

Conclusion: The highest incidence of bladder cancer was observed in Central, southern and northwestern parts of Iran. Through the analysis of the incidence patterns and the identification of risk factors associated with it, steps can be taken towards prevention and control measures.

Prognostic Significance of the Neutrophil-to-Lymphocyte Ratio in Patients with Non-Muscle Invasive Bladder Cancer treated with Intravesical Bacillus Calmette–Guérin and the Relationship with the CUETO Scoring Model

Jae-Wook Chung, Jin Woo Kim, Eun Hye Lee, So Young Chun , Dong Jin Park, Kyeong Hyeon Byeon, Seock Hwan Choi, Jun Nyung Lee, Bum Soo Kim, Hyun Tae Kim, Eun Sang Yoo, Tae Gyun Kwon, Yun-Sok Ha, Tae-Hwan Kim

Urology Journal, , 23 February 2021 , Page 6765

Purpose: In this study, we evaluated the predictability of a modified Club Urológico Español de Tratamiento Oncológico (CUETO) scoring model and preoperative neutrophil-to-lymphocyte ratio (NLR) in patients with non-muscle invasive bladder cancer (NMIBC).

Materials and Methods: From August 2005 to May 2016, a total of 281 patients received intravesical bacillus Calmette–Guérin therapy after transurethral resection of a bladder tumor. The pathologic stage of all patients was Ta or T1. Of 281 patients, 84 (29.9%) experienced recurrence and 14 (5.0%) developed progression. The mean follow-up period was 46 months. The cut-off value for NLRs was 2.29.

Results: One hundred-eight patients (38.4%) displayed a high NLR (> 2.29). In Kaplan–Meier curve analysis, a high NLR was associated with lower recurrence-free survival (RFS) (P < .001) and progression-free survival (PFS) (P = .002). CUETO scores were associated with RFS (P < .001), but not with PFS (P = .423). A combination of NLRs and the CUETO risk model correlated with RFS (P < .001) and PFS (P = .002). In multivariate analysis, female gender, concomitant carcinoma in situ (CIS), tumor number >3, recurrent tumors, and a high NLR were independent factors predicting recurrence (all P < .05). Concomitant CIS, recurrent tumors, and a high NLR were independent factors for predicting progression (all P < .05).

Conclusion: In patients with NMIBC, an NLR >2.29 was identified as a significant factor for predicting tumor recurrence and progression. Inclusion of preoperative NLR enhanced the accuracy of the CUETO model to predict disease progression.

The Role of Pentraxin-3, Fetuin-A and Sirtuin-7 in the Diagnosis of Prostate Cancer

Özer Güzel, Arzu Kösem, Yılmaz Aslan, Ahmet Asfuroglu, Melih Balci, Cagdas Senel, Altug Tuncel

Urology Journal, , 23 February 2021 , Page 6626

Purpose: Prostate canceris the most commonly diagnosed type of cancer and one of the leading causes of cancer-related death in men.Numerous efforts have been made to improve existing diagnostic methods and develop a new biomarker to identify patients with prostate cancer. In line with current literature, we preferred new serum-based biochemical markers as Pentraxin-3, Fetuin-A and Sirtuin-7 in the present study.

Materials and Methods: A total of 174 patients aged 42-76 years were included in the study. Patients with prostate cancer (n=38) were enrolled as Group 1 and patients with benign prostatic hyperplasia (n=136) as Group 2. The serum levels of Pentraxin-3, Fetuin-A and Sirtuin-7 levels were compared between the groups.

Results: The mean age of the patients was 61.9±7.6 years (p= .001). The mean serum Prostate Specific Antigen levels 32.0±59.6 (2.6-336) ng/mL and 10.0±11.3 (2.5-77.4) ng/mL in Group 1 and 2, respectively (p= .029). The mean serum levels of Pentraxin-3 and Fetuin-Ain Group 1 were statistically significantlydifferent from Group 2(3.3±4.4 ng/mL vs 1.8±2.4 ng/mL, p= .002 and 466.8±11.0 µg/mL vs 513.3±11.0 µg/mL,p= .041,respectively). There was no significant difference between Group 1 and 2 according to serum levels of Sirtuin-7 (12.7±8.2 ng/mL vs 12.7±12.4 ng/mL respectively, p= .145).

Conclusion: Pentraxin-3, Fetuin-A and Sirtuin-7 may be effective in the diagnosis of prostate cancerin light of the current literature.In this study, it was found that Pentraxin-3 and Fetuin-A were significantly different in the diagnosis of prostate cancer.Larger-scale prospective studies are needed to determine the importance of Pentraxin-3 and Fetuin-A in the diagnosis of prostate cancer.

Purpose: Cytoreductive nephrectomy (CN) was considered a well-established treatment modality for patients with metastatic renal cell carcinoma (RCC) in the interferon era. However, its role after the introduction of multiple targeted therapies is less well established. Herein, We evaluated the effect of CN on overall survival (OS) on patients with RCC who were identified through the Surveillance, Epidemiology, and End Results database (SEER).

Materials and Methods: A total of 5,483 patients with metastatic RCC were identified from 2010 to 2016 using the SEER database. Factors pertaining to the following variables were collected: presence or absence of CN; age; gender; grade; status of metastasis to bone, liver, lung and brain; tumor stage; nodal status; histological subtypes; and chemotherapy status. Subjects who had CN were matched with those who did not in all previously mentioned covariates using inverse probability weighting. These weights were then used in adjusted Cox regression models to report doubly robust estimates.

Results: CN was associated with 67% reduction in the hazards of death. Advanced T-stage, N1 disease, advanced tumor grade, non-clear histology and metastasis to bone, liver, lung or brain are independent risk factors for death. Patients with T4 disease benefited less of CN compared to those with T1 disease, while higher number of metastatic sites didn’t predict worse outcome among those who had CN.

Conclusion: CN could provide a survival advantage in favorable risk patients with RCC in the era of targeted therapy.

Purpose: To explore the ccRCC clinical and immune characteristics correlated with IL-23 expression level and build pre-operative prediction models based on contrast CT scans.

Materials and Methods: The study included the cancer genome atlas kidney renal clear cell carcinoma cases to build a bioinformatics cohort. The cases with qualified contrast CT images were selected as radiographic and radiomics cohort. The IL-23 expression level groups were defined by median-based thresholding. The clinical characteristics were compared between groups. The impacts of IL-23 on immune microenvironment composition were measured via the CIBERSORT. Two radiologists evaluated the pre-operative contrast CT images. The radiomics features were automatically extracted. IL-23 group-specific radiographic and radiomics features were collected and used for prediction model establishment via Orange Data Mining Toolbox. P < 0.05 was set as statistically significant.

Results: For total, 530 ccRCC cases were included. The IL-23 group was significantly associated with survival, histologic grade, AJCC tumor stage, AJCC cancer stage, and plasma calcium level. Except for Treg and other T cells, IL-23 showed correlation with NK cell, mast cell, monocyte infiltration. Axial length was the only significant radiographic measurement between IL-23 groups. The radiomics features established an IL-23 group prediction model with the highest 10-fold cross-verification AUC of 0.842.

Conclusion: The clear cell renal cell carcinoma IL-23 expression level had prognosis and immune microenvironment correlation and could be predicted by pre-operative radiomics features.

Purpose: Transperineal template prostate biopsies (TPTPB) are now increasingly commonly performed for the diagnosis of prostate cancer. TPTPB are traditionally performed under general anaesthetic. However, this poses a significant strain on hospital theatre capacity. As such, local anaesthetic (LA) TPTPB are becoming more popular. We describe a novel technique in performing the standard TPTPB under LA in the outpatient setting.

Materials and Methods: Between February 2019- February 2021, 254 consecutive men (median age 69; range: 44-80 years) with a median PSA of 8.7 ng/ml (range: 2.2-76) underwent L/A TPTPB using our novel technique. This is whereby 50mls of 1% prilocaine was injected partially around the perineal skin and partially deep bilateral periprostatic areas. Multiple simultaneous prostate biopsies were then taken with the standard template grid and stepper.

Results: A total of 250/254 (98.4%) men underwent successful L/A TPTPB with a median visual analogue pain score of 4 (range: 2-8). The median prostate volume was 49cc (range: 14-240cc). The median number of cores taken were 18 (range: 14-24). A total of 163/250 men (65.2%) had a positive histology for prostate cancer with a median of 5 cores being involved with prostate cancer (range: 1-18). In addition, 101/163 men (62.0%) diagnosed with prostate cancer had either Gleason score 3+4=7 or greater. None experienced urosepsis and only 2/250 men (0.8%) had temporary urinary retention.

Conclusion: Our novel LA technique in performing the standard TPTPB is safe, feasible and well tolerated and associated with a high rate of prostate cancer detection.

An Update on Biochemical and Genomic Markers for Prostate Cancer

Siavash Falahatkar, Gholamreza Mokhtari, Madjid Momeni-Moghaddam , Mojtaba Teimoori, Hamidreza Baghani Aal , Ardalan Akhavan, Reza Falahatkar, Samaneh Esmaeili

Urology Journal, , 23 February 2021 , Page 6828

Purpose: Detecting prostate cancer, developing therapeutic plans after negative biopsies, and prognosis-based patient counseling can be challenging for many urologists dealing with prostate cancer-specific antigens. New Biomarkers advances made improvement for prediction of responses to therapeutic option and can tell us about survival and recurrence. In this review, we have assessed current and upcoming biomarkers that are opening a new era in diagnosing the disease.

Materials and Methods: We conducted a comprehensive literature review of studies describing prostate cancer biomarkers. Two independent investigators searched PubMed, Embase, Web of Science, and Cochrane Databases to identify biomarkers in prostate cancer conducted a literature review.

Results: Recently, combining prostate cancer-specific biomarkers into a single test has gained increasing attention, especially since the introduction of genomic and molecular tools. The development of the Prostate Health Index (PHI), SelectMDx, and Confirm MDx have shown promising results for prostate cancer detection, in addition to risk stratification and biopsy avoidance.
Conclusion: Despite major improvements and innovations in prostate cancer biomarkers, application in current clinical practice is limited. However, these biomarkers have an important role in determining risk, preventing unnecessary prostate biopsies, and predicting prognoses. Additional confirmatory studies will be needed to fully understand the impact of prostate cancer-specific biomarkers.

DNA Hypermethylation af a Panel Of Genes as an Urinary Biomarker For Bladder Cancer Diagnosis

Petros Georgopoulos, Maria Papaioannou, Soultana Markopoulou, Aikaterini Fragou, George Kouvatseas, Apostolos Apostolidis

Urology Journal, , 23 February 2021 , Page 6743

Purpose: Several studies have shown frequent changes in DNA methylation in bladder cancer (BCa), which vary among different geographical areas. The aim of this study is to examine the diagnostic accuracy of a panel of DNA methylation biomarkers in a Greek clinical setting contributing to the development of a universal panel of urine biomarkers.

Materials and Methods: Individuals with primary BCa and control individuals matching the gender, age and smoking status of the cancer patients were recruited. DNA methylation was assessed for the gene promoters of RASSF1, RARB, DAPK, TERT and APC in urine samples collected by spontaneous urination using quantitative Methylation Specific PCR (qMSP). All genes had been previously separately associated with BCa.

Results: Fifty patients and 35 healthy controls were recruited, with average age of 70.26 years and average smoking status of 44.78 pack-years. In the BCa group, DNA methylation was detected in 27 (61.4%) samples. RASSF1 was methylated in 52.2% of samples. Only 3 (13.6%) samples from the control group were methylated, all in the RASSF1 gene promoter. The specificity and sensitivity of this panel of genes to diagnose BCa was 86% and 61% respectively. The RASSF1 gene could diagnose BCa with specificity 86.4% and sensitivity 52.3%.

Conclusion: Promoter DNA methylation of this panel of five genes could be further investigated as urine biomarker for the diagnosis of BCa. The RASSF1 could be a single candidate biomarker for predicting BCa patients versus controls. Studies are required in order to develop a geographically adjusted diagnostic biomarker for BCa.


Robotic versus Laparoscopic Retroperitoneal Lymph node Dissection for Clinical Stage I Non-seminomatous Germ Cell Tumor of Testis: A Comparative Analysis

Yansheng Xu, Hongzhao Li, Baojun Wang, Liangyou Gu, Yu Gao, Yang Fan, Yuanxin Yao, XengInn Fam, Xin Ma, Xu Zhang

Urology Journal, , 23 February 2021 , Page 6629

Purpose: To compare the treatment outcomes of robotic retroperitoneal lymph node dissection (R-RPLND) versus laparoscopic RPLND (L-RPLND) for clinical stage I non-seminomatous germ cell testicular tumors (NSGCTs).

Materials and Methods:

We retrospectively reviewed the data of patients with stage I NSGCTs who underwent robotic or laparoscopic RPLND between 2008 and 2017.  Perioperative data and oncologic outcomes were reviewed and compared between the two groups. Progression-free survival was analyzed using Kaplan-Meier survival curves and compared between two groups.


A total of 31 and 28 patients underwent R-RPLND and L-RPLND respectively. The preoperative characteristics of the patients were comparable in the two groups. Patients in R-RPLND group had significantly shorter median operative time (140 vs. 175 minutes, P < .001), a shorter median duration to surgical drain removal (2 vs. 4 days, P = .002) and a shorter median postoperative hospital stay (5 vs. 6 days, P = .001). There were no statistical differences in intra- and post-operative complication rate between the groups and the oncologic outcomes were similar in the two groups.


In expert hands, R-RPLND and L-RPLND were comparable in oncological parameter and morbidity rate; R-RPLND showed superiority in operation duration, median days to surgical drain removal and postoperative hospital stay for stage I NSGCTs. Multicenter and randomized studies with good power of study and sufficient follow-up duration are required to validate our result.


Purpose: To evaluate the ability of bacterial scatter diagrams generated from the automated urine particle analyzer (UF-1000i, Sysmex, Kobe, Japan) in pre-estimate the treatment efficacy of oral cefalexin in treating women with uncomplicated urinary tract infection (uUTI).

Materials and Methods: Over 3 years, women 20-80 years old with symptoms suggestive of uUTI (Urinary Tract Infection Symptoms Assessment symptom score, ,UTISA > 3) and bacteriuria (bacterial count ≥100/uL) were enrolled. After informed consent, patients took cephalexin 500mg 4 times/day for 7 days. The voided urine specimens were classified into rods or cocci/mixed group automatically through the built-in software of the UF1000i. Patients were followed up with UTISA on the 3rd day after treatment and returned to the clinic on the 7th day and followed for additional UTISA and urine analysis. Symptom and laboratory improvement were defined as UTISA <4 and bacterial count <100/uL, respectively, on the 7th day.

Results: Of 99 women (age: 49.91 ±15.32 years) eligible for analysis, 80 were classified as having urine that contained rods and 19 as cocci/mixed. Symptom improvement was observed in 62 women in the rods group and 11 women in the cocci/mixed group (p=0.08). Laboratory improvement was noted in 64 women in the rods group and 10 women in the cocci/mixed group (p=0.01). On day 7, treatment success with both symptom and laboratory improvement was more observed in rods than in cocci/mixed group (61.3% vs. 26.3%, p<0.01).

Conclusion: The automatic urine particle analyzer can pre-estimate the treatment response of antibiotics in women with uUTI.

Purpose:  Urinary incontinence (UI) is a fundamental health problem, can occur at any age but is especially common in older women. Depression and anxiety are also considerable problems for the elderly. UI is one of the geriatric syndromes that are thought to be related to depression and quality of life (QOL).

Materials and methods: This prospective study was conducted for a period of 2 months from February 2020 to April 2020. Women who applied to the outpatient clinic of geriatrics with UI symptoms were taken into the study. The type of UI was determined by using the 3 Incontinence Questions (3IQ). Only patients with urge incontinence were included in the study. Patients were evaluated for QOL, anxiety, depression, disability, and geriatric syndromes before and after treatment. Data analysis was done by using SPSS version 22.

Results: The study population was 42 women; the mean age was 69.7 +/- 4.3 years.  QoL, anxiety, and depression symptoms, and ADL were revealed to be improved after treatment. ICIQ-SF, I-QOL, and HADs scores were associated with UI treatment when evaluated with one-way MANOVA (F [4, 79] =3.25, p=0.00, Wilk's Λ=0.859, partial η2=0.14).

Conclusion: UI is a common problem in the elderly. Patients usually hesitate to tell this complaint to even doctors. That situation affects their physical and psychological condition negatively. In this study, we reached that anticholinergic treatment (fesoterodine) improved ADL, QoL, and psychological symptoms. Those findings represented us that proper treatment of UI is critical for healthy aging. 

Purpose: Neurogenic lower urinary tract dysfunction (NLUTD) is one of the most challenging problems in urology. In recent years, Onabotulinum toxin A (Botox) is considered a second-line treatment in these patients. This study aimed to evaluate the clinical effects of Abobotolinum toxin A (Dysport) into the bladder and urethra.

Materials and Methods: We classified our patients with NLUTD into three groups: neurogenic detrusor overactivity (group 1), detrusor sphincter dyssynergia (group 2), and patients with both symptoms (group 3). The severity of the patient’s symptoms was assessed using the Urinary Distress Inventory- Short form (UDI-6), urodynamic study, and post-void residual urine (PVR) at baseline. After injection of Dysport, the patients evaluated by the change in UDI-6 score, PVR, and the patient’s general satisfaction. In group 1, 500-900 U diluted Dysport injected intra-vesical. If associated with detrusor sphincter dyssynergia (group 3), 100 U diluted Dysport injected peri-urethral. In group 2, only 100 U diluted Dysport injected peri-urethral.

Results: Data from 52 women with NLUTD were analyzed. The mean age was 51.3 ± 21.6 years. The prevalence of detrusor overactivity and the value of Q max was more in group 1. However, the amount of PVR was more in groups 2 and 3. The overall success rate was acceptable in all three groups. In addition, there were significant improvements in UDI-6 parameters.

Conclusion: Peri-urethral injection of Abobotolinum toxin A is effective and safe. However, the selection of the patients and the dose of toxin needs more studies.


the Short Abstinence May Have Paradoxical Effects On Sperms With Different Level Of DNA Integrity: A Prospective Study

Serajeddin Vahidi, Nima Narimani, Taha ghanizadeh, Fatemeh Yazdinejad, Maryam Emami, Kaveh Mehravaran, Hossein Saffari, Farhood Khaleghimehr, Laleh Dehghan Marvast

Urology Journal, , 23 February 2021 , Page 6515

Purpose: To investigate the effect of short abstinence on sperm function tests and semen parameters

Materials and methods: This prospective study included 65 male patients with increased DNA injury in their ejaculated sperm and a history of recurrent pregnancy loss and/or assisted reproductive techniques failures. The effects of antioxidants medical therapy and short abstinence on semen quality were assessed (TUNEL test and CMA3 staining).

Results: Antioxidants have statistically significant effects on mean sperm concentration (untreated, 67.51 ± 44.40 million/ml, vs. treated, 56.09 ± 37.85 million/ml; P-value=0.005) and mean TUNEL score (untreated, 24.56% ± 9.49%, vs. treated, 20.64% ± 10.28%; P-value =0.013).

Moreover, a short abstinence period might have positive effects as shown on the TUNEL assay (20.64% ± 10.28  vs. 17.38% ±8.59 ; P-value =0.028) and CMA3 staining  (47.79% ± 20.78, vs. short 41.92% ± 18.49; P-value =0.019), when considering all study subjects. However, different results were obtained using more precise analysis based on a TUNEL cutoff score of 20%. The analysis showed that short abstinence might improve sperm DNA integrity in patients with TUNEL score > 20% (mean TUNEL score from 27.85% ± 8.32% to 19.14% ± 8.90%  ; P-value =0.001%). However, it might have deleterious effects on sperm DNA integrity in patients with TUNEL score < 20% (mean TUNEL score from 11.89% ± 3.21% to 15.17% ± 7.79%;P-value =0.045%)

Conclusions: Our results showed that short abstinence may not be beneficial in all infertile males, and it should only be used in selected patients with abnormal DNA integrity.

The Effect of Intracavernosal Injection of Stem Cell in the Treatment of Erectile Dysfunction in Diabetic Patients; A Randomized Single-Blinded Clinical Trial

Mahboubeh Mirzaei, Mohammadali Bagherinasabsarab, Hamid Pakmanesh, Reza Mohammadi, Mohammad Teimourian, Yunes Jahani, Alireza Farsinejad

Urology Journal, , 23 February 2021 , Page 6503

Purpose: The prevalence of erectile dysfunction in men is increasing. As well, the prevalence of diabetes, as one of the causes of sexual dysfunction, is rising in many countries. Due to the failure of common therapies in some patients with sexual dysfunction, it is necessary to develop an effective alternative treatment, such as stem cell therapy, for this problem.

Materials and Methods: In this randomized single-blinded clinical trial, 20 diabetic patients with erectile dysfunction, who were resistant to common treatments, were selected and divided into two groups of intervention and control (n=10 per group). Autologous mesenchymal stem cells (MSCs) were extracted from oral mucosa and then infused via intracavernosal injection (50-60 106 cells) to the participants of the intervention group. Normal saline was injected in the control group. The patients were followed up with the International Index of Erectile Function (IIEF5) questionnaire, as well as color Doppler duplex ultrasound. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) were determined at three and six months after the interventions.

Results: The mean IIEF5 scores in the intervention group were 7.2 ± 2.1, 9.2 ± 3.4, and 10.6 ± 4.7 before, three months, and six months after the injection, respectively, showing a significant ascending trend (p value = 0.01). Comparing the intervention and control groups, there was a significant difference in the IIEF5 score change during six months after the injection (p value = 0.02). Regarding the PSV and RI of penis vessels, there were no statistically significant differences between the two groups. However, these parameters showed upward and improving trends in the intervention group.

Conclusion: Intracavernosal injection of stem cells improved sexual function and PSV and RI indices of penile arteries in diabetic patients.

Evaluation of Sperm Parameters and DNA Integrity Following Different Incubation Times in PVP Medium

Ali Nabi, Farahnaz Entezari, Seyed Mohsen Miresmaeili, Serajoddin Vahidi, Keivan Lorian, Fatemeh Anbari, Leila Motamedzadeh

Urology Journal, , 23 February 2021 , Page 6936

Purpose: Polyvinylpyrrolidone (PVP) is a chemical material used in intracytoplasmic sperm injection (ICSI) program.  The aim of this study was to investigate the ideal time that sperm can be safely incubated in PVP with less structure and DNA damage.

Method: Thirty-one Oligoasthenoteratospermia (OAT) samples were used. Sperm samples were prepared by discontinuous density-gradients method and incubated in 10% PVP at different time intervals (0, 5, 10, 15, 20, and 30 min). The effect of PVP was assessed on sperm DNA fragmentation and viability via SCD assay and Eosin–nigrosin staining respectively.

Results: Data showed there was a significant increase in sperm DNA fragmentation at 10 min compared to 0 min. The viability rate also significantly reduced at 10 min  compared to 0 min.

Conclusion: As a result, sperm samples could be incubated with PVP for less than 10 min.  While prolonged incubation may significantly damage the sperm DNA integrity and viability.

Purpose: The purpose of this study was to compare the effectiveness of Dapoxetine, and Paroxetine as well as Dapoxetine/Tadalafil and Paroxetine/Tadalafil combinational therapies, for the treatment of patients with premature ejaculation.

Materials and Methods: In this clinical trial study, 120 patients with premature ejaculation were randomly divided into 4 groups: The first group was treated with Paroxetine (Pa), while the second group received Dapoxetine(Da). The third group received Paroxetine combined with Tadalafil(PT) whereas the fourth group treatment involved the use of Dapoxetine and Tadalafil(DT) for one month. In the next 2 and 4 weeks, the cases were evaluated in terms of ejaculation duration, frequency of intercourse per week, and drug side effects.

Results: The mean age of the Da, Pa, PT, DT groups was 32±6.9, 32.4±7.2, 31.6±1.9, and 32.9±7.7, respectively. There was a significant difference between the Da and DT groups (p = .029) in the ejaculation latency in the 4-week follow-up. In the two weeks follow-up, a significant difference was observed between DA and DT (p = 0.043), Pa and PT (p = 0.006), and Pa and DT groups (p= 0.004) in terms of ejaculation latency. Four weeks after the intervention, a significant difference was detected in the intercourse frequency of Da and PT groups (p =0.033), Pa and PT groups (p =0.043), Pa and DT groups (p =0.02), and Da and DT groups (p=0.016).

Conclusion: Combination therapy (Tadalafil plus Paroxetine or Dapoxetine) was more effective in IELT (Intra ejaculation latency time) than mono-therapy especially in younger patients despite its slightly more side effects.


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

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.


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

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.


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

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

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.

As world is going through the COVID-19 pandemic, the mass vaccination of newly approved vaccines for COVID-19 has begun around the world. There has been some concern among the vaccine recipients regarding the potential effect of vaccine on male fertility. Does COVID-19 affect the male reproductive health? Does COVID-19 vaccine impair the sperm parameters?


The terminology of gonadal dysgenesis conditions is considerably abstruse and variable. Despite some efforts in the 2006 Chicago Consensus Statement on DSD , it is still difficult to assign a category and name for some distinct conditions in this document. The rest of the literature has used redundant and variable words, e.g. partial, pure, and complete gonadal dysgenesis suffering equivocality and redundancy, aggravating this inconclusiveness. We attempted to highlight this problem and propose an easier terminology blueprint.



The terminology of gonadal dysgenesis conditions is considerably abstruse and variable. Despite some efforts in the 2006 Chicago Consensus Statement on DSD , it is still difficult to assign a category and name for some distinct conditions in this document. The rest of the literature has used redundant and variable words, e.g. partial, pure, and complete gonadal dysgenesis suffering equivocality and redundancy, aggravating this inconclusiveness. We attempted to highlight this problem and propose an easier terminology blueprint.



We read the article in your journal titled “Comparison of Supracostal and Infracostal Access For Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis” by Zhaohui H. et al (1). The article conducts a comprehensive meta-analysis of existing evidence to quantify and compare the safety and efficacy of supracostal and infracostal access for percutaneous nephrolithotomy. This question is clear and important in clinical practice. This is a meaningful article. However, we would like to raise our concerns about the correct quotation of references in the article.

This article is very meaningful, but the authors of this article seem to be a little careless. And if the researchers can revise these points that we mentioned. The article will be a higher quality paper.


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

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.

Post-Operative Acute Urinary Retention After Greenlight Laser. Analysis Of Risk Factors from A Multicentric Database.

Davide Campobasso, Anna Acampora, Cosimo De Nunzio, Francesco Greco, Michele Marchioni, Paolo Destefanis, Vincenzo Altieri, Franco Bergamaschi, Giuseppe Fasolis, Francesco Varvello, Salvatore Voce, Fabiano Palmieri, Claudio Divan, Gianni Malossini, Rino Oriti, Lorenzo Ruggera, Agostino Tuccio, Andrea Tubaro, Giampaolo Delicato, Antonino Laganà, Claudio Dadone, Luigi Pucci, Maurizio Carrino, Franco Montefiore, Stefano Germani, Roberto Miano, Salvatore Rabito, Gaetano De Rienzo, Antonio Frattini, Giovanni Ferrari, Luca Cindolo

Urology Journal, , 23 February 2021 , Page 6489

Purpose: Greenlight laser is a mini-invasive technique used to treat Benign Prostatic Obstruction (BPO). Some of the advantages of GreenLight photoselective vaporization (PVP) are shorter catheterization time and hospital stay compared to TURP. Post-operative acute urinary retention (pAUR) leads to patients' discomfort, prolonged hospital stay and increased health care costs. We analyzed risk factors for urinary retention after GreenLight laser PVP.

Materials and Methods: In a multicenter experience, we retrospectively analyzed the onset of early and late post-operative acute urinary retention in patients undergoing standard or anatomical PVP. The pre-, intra- and post-operative characteristics were compared betweene patients who started to void and the patients who developed post-operative urinary retention.

Results: The study included 434 patients suitable for the study. Post-operative acute urinary retention occurred in 39 (9%). Patients with a lower prostate volume (P < .001), an adenoma volume lower than 40 mL (P < .001), and lower lasing time (P = .013) had a higher probability to develop pAUR at the univariate analysis. The multivariate logistic regression confirmed that lower lasing time (95% CI: 0.86-0.99, OR = 0.93, P = .046) and adenoma volume (95% CI: 0.89–0.98, OR = 0.94, P = .006) are correlated to pAUR. Furthermore IPSS ≥ 19 (95% CI: 1.19-10.75, OR = 2.27, P = .023) and treatment with 5-ARI (95% CI: 1.05-15.03, OR = 3.98, P = .042) are risk factors for pAUR.

Conclusion: In our series, post-operative acute urinary retention was related to low adenoma volume and lasing time, pre-operative IPSS ≥ 19 and 5-ARI intake. These data should be considered in deciding the best timing for urethral catheters removal.

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

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.

Short-term Outcomes of Water Vapor Therapy (Rezūm) for BPH/LUTS in the First Czech Cohort

Roman Wasserbauer, Dalibor Pacik, Gabriel Varga, Vitezslav Vit, Jiri Jarkovsky, Michal Fedorko

Urology Journal, , 23 February 2021 , Page 6843

Purpose: To evaluate the short-term results of water vapor therapy (Rezūm) for BPH/LUTS in the first cohort of Czech patients.

Materials and methods: Patients with BPH and moderate to severe LUTS (N = 76) who underwent Rezūm treatment from December 2019 to July 2020 were included in the prospective study. Prior to the procedure, they completed the IPSS and OABv8 questionnaires and underwent uroflowmetry, transrectal ultrasound of the prostate, and PSA sampling. The parameters before and 3 months after the procedure were compared and statistically evaluated.

Results: The study protocol was completed by 92% of patients (N = 70). We observed a significant increase in Qmax (median 17.7 vs. 8.8 mL/s, P < .001), Qave (9 vs. 4.5 mL/s, P = .001) and voided volume (241 vs. 171 mL, P < .001) and a significant reduction in post-void residual (average 17.5 vs. 67.7 mL), prostate volume (39.3 vs. 62.3 mL) and total PSA (median 1.9 vs. 2.5 ng/mL, resp. P values < .001). There was also a significant decrease in OABv8 score (average 7.6 vs. 16.6, P < .001) and IPSS QoL (1.6 vs. 4.0, P = .037). The improvement in the IPSS score was apparent, yet statistically insignificant (6.8 vs. 16, P = .079).

Conclusion: Water vapor therapy is an effective and safe method of BPH/LUTS treatment in the short-term.

The effect of Melatonin on Improving the benign Prostatic Hyperplasia Urinary Symptoms, a Randomized Clinical Trial

Amirreza Fotovat, Bahram Samadzadeh, Mohsen Ayati, Mohammad Reza Nowroozi, Seyed Ali Momeni, Samira Yavari, Ali Nasseri, Laleh Sharifi

Urology Journal, , 23 February 2021 , Page 6761

Purpose: to investigate the effect of melatonin along with tamsulosin in the improving the BPH urinary symptoms.

Materials and Methods: A total of 108 men with BPH symptoms, age of ≥50 years, and International Prostate Symptom Score (IPSS) ≥8 entered into the parallel group randomized, double-blind clinical trial with balanced randomization. Treatment group received of 3mg melatonin plus 0.4mg tamsulosin and control group received placebo plus 0.4mg tamsulosin. Patients and physicians were concealed by sealed and opaque envelopes. Symptoms were assessed at baseline and 1 month after treatment. Finally all scores at the initial and end of the study compared and analyzed using SPSS software.

Results: This study showed that adding melatonin to classic treatment of BPH patients with tamsulosin could significantly reduce the likelihood of nocturia by 2.39 times (95% CI: 1.07-5.32, OR = 2.39, p = 0.033) and could also reduce the frequency of urination by 2.59 times (95% CI: 1.15-5.84, OR = 2.59, p = 0.021). There was no statistically significant difference between the two groups in IPSS, intermittency, incomplete emptying, straining, urgency, and weak stream.

Conclusion: Melatonin plus tamsulosin treatment is associated with a significant improvement of nocturia and frequency in patients with benign proststic hyperplasia. However, it is necessary to do more studies.

An investigation into the Effects of Intravenous Vitamin C on Pulmonary CT Findings and Clinical Outcomes of Patients with COVID 19 Pneumonia A Randomized Clinical Trial

Shabnam Tehrani, Davood Yadegarynia, Alireza Abrishami, Hamideh Moradi, Babak Gharaei, Masoomeh Rauofi , Fatemeh Maghsoudi Nejad, Shahnaz Sali, Neda Khabiri

Urology Journal, , 23 February 2021 , Page 6863

Purpose:In late December 2019, a series of unexplained cases of pneumonia were reported in Wuhan, China. On January 12, 2020, the World Health Organization temporarily named the virus responsible for the emerging cases of pneumonia as the 2019 coronavirus. Acute respiratory distress syndrome (ARDS) due to Covid-19 has rapidly spread around the world, and while no specific treatment or vaccine has been reported, mortality rates remain high. One of the suggested treatments for cellular damage in the pathogenesis of ARDS caused by the coronavirus is the administration of high doses of intravenous vitamin C. Considering the paucity of literature on the therapeutic effects of high doses of intravenous vitamin C in patients with ARDS resulting from the coronavirus, this study was conducted to assess this therapeutic supplement in these patients.

Materials and Methods: This study was performed as a single-center clinical trial in patients with a documented diagnosis of COVID-19 pneumonia. 54 eligible patients with moderate to severe COVID-19 symptoms, based on specific inclusion and exclusion criteria, were included in the investigation and randomly divided into two groups. The control group consisted of 26 patients who received standard treatment, whereas the treatment group was comprised of 18 patients administered intravenous vitamin C at a dose of 2 g every 6 hours for 5 days in addition to standard treatment. Demographic characteristics, underlying diseases, length of hospital stay, and mortality rates were reviewed and collected. Oxygen saturation, respiratory rates, serum C Reactive Protein (CRP) levels, lymphopenia and lung parenchymal involvement on CT were investigated at the time of admission and on the sixth day after hospitalization. Finally, all variables were analyzed with IBM SPSS Statistics 23 software and a significant statistical difference was defined for all variables, P <0.05.

Results: Of these variables, the amount of oxygen saturation in the vitamin C group increased significantly from 86±5% on the first day of hospitalization to 90±3% on the sixth day of hospitalization (P value=0.02). Also, the respiratory rate in the vitamin C group decreased significantly from 27±3 on the first day of hospitalization to 24±3 on the sixth day of hospitalization (P value=0.03). Lung CT scans of patients in the two groups reported by two radiologists were also compared. Based on the report of the radiologists, the rate of lung involvement in the vitamin C group was significantly lower than in the control group at the end of treatment (P value=0.02).

Conclusion: Due to the effectiveness of high doses of intravenous vitamin C on reducing lung involvement and improving clinical symptoms, further studies with a larger sample size are recommended to demonstrate the effects of this drug supplement.