REVIEW


Association of Transforming Growth Factor-β1 rs1982073 Polymorphism with Susceptibility to Acute Renal Rejection: a Systematic Review and Meta-Analysis

Farzaneh Najafi, Seyed Alireza Dastgheib, Jamal Jafari-Nedooshan, Mansour Moghimi, Naeimeh Heiranizadeh, Mohammad Zare, Elham Salehi, Hossein Neamatzadeh

Urology Journal, Vol. 18 No. 01 (2021), 17 March 2021 , Page 1-10
https://doi.org/10.22037/uj.v0i0.5437

Purpose: The association of rs1982073 (codon 10) polymorphism at Transforming Growth Factor- β1 (TGF-β1)
gene with acute renal rejection (ARR) has been reported by several studies. However, the results were controversial. To derive a more precise estimation of this association, a meta-analysis was performed.
Methods: The eligible literatures were identified through PubMed, Scopus, Web of Science, EMBASE, SciELO,
WanFang, and CNKI databases up to July 01, 2019. The pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were used to calculate the strength of the association.
Results: A total of 23 case-control studies with 795 ARR cases and 1,562 non-AR controls were selected. Pooled
data revealed that there was no significant association between TGF-β1 codon 10 polymorphism and an increased risk of ARR in the overall population (C vs. T: OR=0.908, 95% CI 0.750-1.099, p = 0.322; CT vs. TT: OR=1.074, 95% CI 0.869-1.328, p = 0.507; CC vs.TT: OR=0.509, 95% CI=0.738-1.253, p = 0.770; CC+CT vs. TT: OR =
0.917, 95% CI 0.756-1.112, p = 0.376, and CC vs. CT+TT: OR=0.995, 95% CI 0.809-1.223, p = 0.959). Moreover,
stratified analysis revealed no significant association between the TGF-β1 rs1982073 polymorphism and ARR
risk by ethnicity and cases type (recipient and donor).
Conclusion: The current meta-analysis demonstrated that the TGF-β1 rs1982073 polymorphism was not significantly
associated with increased risk of ARR. However, studies with a larger number of subjects among different
ethnic groups are needed to further validate the results.

Purpose: We aimed to compare the safety and efficacy between laparoscopic transperitoneal ureterolithotomy (LTU) and laparoscopic retroperitoneal ureterolithotomy (LRU) in the treatment of large (>10mm) and proximal ureteral stones.
Materials and Methods: Electronic databases, including PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus were searched through December 2019. Comparative studies comparing the two approaches were included. The primary outcome was a single-procedure success rate; the secondary outcomes included operative time, hospital duration, and complications (according to the Clavien-Dindo Grade). Newcastle–Ottawa scale (NOS) and the modified Jadad scale were used to evaluate the quality of the included studies. The Egger's test estimated publication bias. The meta-analysis was performed by Review Manager 5.3 and STATA 15.0.
Results: Seven studies, involving 125 participants in LTU group and 128 in LRU group, were included in the study. The results suggested that both single-procedure success rate and the rate of postoperative paralytic ileus were significantly higher in the LTU group than in the LRU group (95.2% vs 87.5%, 95% CI: .00-.16, RD = .08, P = .04; 10.4% vs 0, 95% CI: .02- .19, RD = .10, P = .02, respectively). No publication bias of the primary outcome was observed with the Egger’s test (P = .117). No significant differences were noted in terms of operative time and hospital duration (95% CI: -18.95-8.80, MD = -5.08, P = .47; 95% CI: -.98- .58, MD = -.20, P = .61, respectively). Additionally, according to Clavien-Dindo Grade, the rates of major complications (>= Grade 3a) including open conversion (.8% vs 5.5%, 95%CI: -.11- .01, RD = -.05, P = .12), stone migration (8.1% vs 6.7%, 95% CI: -.08- .11, RD = .02, P = .76), vascular injury (5.4% vs 0, 95%CI: -.03- .14, RD = .05, P = .21) and ureteral stricture (1.3% vs 5.3%, 95% CI: -.11- .02, RD = -.04, P = .20), were comparable between the two groups.
Conclusion: In the treatment of large and proximal ureteral calculi, LTU has a significantly higher single-procedure success rate and a higher rate of postoperative paralytic ileus than LRU. However, the complication was well-tolerated. The small sample size and limited, including studies, were the main limitations.

Purpose: The external physical vibration lithecbole (EPVL) is a new device that accelerates the discharge of urinary stones by changing the patient's body position and providing multi-directional simple harmonic waves. It is clinically employed to improve the stone-free rate (SFR). However, it is not widely accepted in clinical practice due to the lack of high-level evidentiary support and a standard protocol. The present meta-analysis aims at the evaluation of the efficacy and safety of EPVL treatment in improving the SFR.
Methods: This study was a systematic review and meta-analysis. A systematic literature review was conducted
using PubMed, Scopus, Embase, Medline, the Web of Science, and the Cochrane Library to find randomized controlled trials (RCTs) as recent as April 2020 that evaluated the efficacy and safety of EPVL treatment for patients with stones/residual stones in the upper urinary tract. Results: In total, 7 prospective studies with 1414 patients were included. Compared with patients in the control group, patients treated with an EPVL (the intervention group) had higher SFRs (95% CI: 0.59-0.86, RR = 0.71, P = .0004) and lower complication rates (95% CI: 1.37-3.12, RR = 2.07, P = .0006). In a subgroup analysis based on previous surgery (ESWL, RIRS), the intervention group had an improved SFR as compared to the control group (95% CI: 0.59-0.95, RR = 0.75, P = .02; 95% CI: 0.56-0.73, RR = 0.64, P < .00001, respectively). In a subgroup analysis based on stone location, the SFRs for stones in the upper/middle/lower calyx and renal pelvis were significantly higher in the intervention group than in the control group: for residual stones in the upper and middle calyx, 95% CI: 0.63-0.98, RR = 0.79, and P = .03; for residual stones in the lower calyx, 95% CI: 0.54-0.75, RR = 0.64, and P < .00001; for residual stones in the renal pelvis, 95% CI: 0.47-0.79, RR = 0.61, and P = .0002. However, the SFRs for ureter stones were not significantly different between groups (95% CI: 0.82 -1.05, RR = 0.93, P = .23).
Conclusion: The external physical vibration lithecbole can effectively improve the SFR after ESWL and RIRS
without significant side effects, especially for residual stones in the upper/middle/lower calyx and renal pelvis.

Comparison of the Diagnostic Performance of PI-RADS V1 and PI-RADS V2 for the Detection of Prostate Cancer: A Meta-Analysis

Ying He, Ruochen Cong , Jie Zhou, Zhenyu Xu , Jushun Yang, Lin Wang, Jing Xiao , Bosheng He

Urology Journal, Vol. 18 No. 01 (2021), 17 March 2021 , Page 28-34
https://doi.org/10.22037/uj.v16i7.5532

Purpose: In order to comprehensively determine the diagnostic accuracy of the Prostate Imaging Reporting and Data System version 1 (PI-RADS V1) and PI-RADS version 2 (PI-RADS V2) in prostate cancer (PCa) diagnosis.
Materials and Methods: The literatures were screened from the databases, including the Pubmed, Embase, Web of science and Cochrane Library up to January 20th, 2020. The meta-analysis was conducted by Meta-DiSc and quality assessment was performed by using the QUADAS. Furthermore, the sensitivity, specificity, likelihood ratio (LR), diagnostic odds ratio (DOR), as well as receiver operating curve (ROC) related to diagnostic accuracy were pooled.
Results: A total of 6 articles containing 814 participants (379 patients) were included in the study. For PI-RADS
V1, the combined sensitivity, specificity, PLR, NLR and DOR were 0.82 (95% CI: 0.77-0.85), 0.81 (95% CI: 0.77-
0.85), 4.58 (95% CI: 2.55-8.22), 0.24 (95% CI: 0.18-0.34) and 24.00 (95% CI: 10.38-55.51). With regard to PIRADS
V2, the combined sensitivity, specificity, PLR, NLR and DOR were 0.88 (95% CI: 0.84-0.91), 0.81 (95%
CI: 0.77-0.84), 4.34 (95% CI: 1.98-9.49), 0.16 (95% CI: 0.08-0.32) and 33.39 (95% CI: 15.05-74.05), respectively.
Furthermore, except that the sensitivity of PI-RADS V2 was significantly greater than that of PI-RADS V1 (P =
0.027), there was no remarkably difference in other indicators for the diagnosis of PCa between the two versions.
Conclusion: Both PI-RADS V1 and PI-RADS V2 showed good diagnostic performance for PCa diagnosis; moreover, there was no difference in the diagnostic effect between them.

ORIGINAL PAPER (ENDOUROLOGY AND STONE DISEASE)


Single Percutaneous Tract Combined with Flexible Nephroscopy in the Management of Kidney Stones 2-4 cm: Better Options of Treatment Protocols

Xiaobo Zhang, Jie Gu, Xiong Chen, Yuanqing Dai, Mingquan Chen, Sheng Hu, Zhenyu Liu, Dongjie Li

Urology Journal, Vol. 18 No. 01 (2021), 17 March 2021 , Page 35-40
https://doi.org/10.22037/uj.v0i0.5427

Purpose: To investigate the safety and efficacy of single percutaneous tract combined with flexible nephroscopy in the Management of 2-4 cm renal calculi.
Materials and Methods: We retrospectively analysed the treatment data of patients with 2-4 cm renal calculi
from June 2010 to June 2017. The data included 217 cases of percutaneous nephrolithotomy (PNL), 441 cases of
retrograde intrarenal surgery (RIRS) and 217 cases of single-access percutaneous nephrolithotomy combined with flexible nephroscopy (PNCFN). The collected data were analyzed.
Results: A total of 875 cases were studied, with an average age of 42.35 ± 10.29 years. Group PNCFN showed the highest stone-free rates (SFRs)(73.7 vs 66.7 vs 80.2, P = .00), best patient satisfaction (89.84 vs 87.23 vs 92.29,
P = .00). The length of stay was shorter in the RIRS group relative to the other two groups (5.22 vs 5.65 vs 3.72,
P = .00). Haemoglobin decrease (> 10 g/L) was higher in group PNL than that in group RIRS and group PNCFN
(P = .012). Hospitalization fees (RMB) were Increased in group PNCFN compared with that in group PNL and
group RIRS (34563.45 vs 21334.69 vs 33343.16, P = .000). Treatment protocols of PNL decreased from 17.51%
to 9.22%, those for RIRS from 5.22% to 17.69%, peaking at 2012, PNCFN from 8.29% to 15.67% showed a rapid
growth trend.
Conclusion: The percutaneous nephrolithotomy combined with flexible nephroscopy treatment on renal calculi of 2-4 cm was associated with higher stone-free rates and better patient satisfaction than RIRS and PNL.

Febuxostat Promoted Dissolution of Radiolucent Nephrolithiasis in Patients with Hyperuricemia

Mao Yunhua, Zhang Hao, Li Ke, Huang Wentao, Li Xiaokang, Situ Jie

Urology Journal, Vol. 18 No. 01 (2021), 17 March 2021 , Page 41-46
https://doi.org/10.22037/uj.v0i0.5564

Purpose: This study aimed to investigate the efficacy and safety of febuxostat in patients with radiolucent nephrolithiasis.
Materials and Methods: From March 2016 to June 2018, data of 96 patients with radiolucent nephrolithiasis and hyperuricemia who referred to the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. These patients were divided into allopurinol 300mg/d (control), febuxostat 40mg/d (F40) and 80mg/d (F80) groups respectively. All patients took potassium citrate as a combination treatment and had been followed up for at least 6 months. Before treatment and on after 1st, 3rd and 6th month, complete blood count, serum uric acid (sUA), hepatic and renal function as well as ultrasound were carried out. Arthritic and gastrointestinal symptoms were also monitored. Computed tomography was performed before treatment and 6 months after medication.
Results: Compared with allopurinol group, F40 group showed no difference in urate-lowering effect, while F80
had the best effect across all the visits (P<0.01). At 6th month, 25(83.3%) cases of F80 group achieved sUA<6mg/
dL, which was better than allopurinol group (18 cases, 58.1%) and F40 group (17 cases, 58.6%). In the dissolution effect of radiolucent calculi, F80 had the best effect, followed by F40 and then allopurinol (P<0.05). No statistical difference was observed in adverse events among three groups.
Conclusion: Febuxostat significantly decreased sUA, promoted radiolucent stone dissolution and reduced the total stone number, whereas it did not increase the adverse events.

Laparoscopic Pyelolithotomy for the Management of Large Renal Stones with Intrarenal Pelvis Anatomy

Nasser Simforoosh, Mohammad Hadi Radfar, Reza Valipour, Mehdi Dadpour, Amir Hossein Kashi

Urology Journal, Vol. 18 No. 01 (2021), 17 March 2021 , Page 47-51
https://doi.org/10.22037/uj.v0i0.5576

Purpose: The role of laparoscopic pyelolithotomy (LPL) in the management of renal stones is evolving. One of
the challenges in LPL for renal stones is patients with intrarenal pelvis. Here we present our experience with laparoscopic pyelolithotomy for the management of renal stones with intrarenal pelvis anatomy.
Materials and Methods: Patients candidate for laparoscopic pyelolithotomy from February 2014 to March 2015
were included. Intrarenal pelvis was defined as > 50% of the renal pelvis area contained inside renal parenchyma. Laparoscopic pyelolithotomy was done by transperitoneal approach. Residual stones were checked by computed tomography and/or intravenous pyelography and ultrasonography 6 weeks after the operation.
Results: 28 patients were included in this study. The mean±SD of patients’ age was 45.8±12.5 years. 19 patients
(68%) were male. Stone locations were pelvis, multiple, and staghorn in 22, 3, and 3 patients respectively. The
mean±SD of operation duration was 160±48 minutes. Residual stones were observed in 3 patients with multiple
(n=2) or staghorn (n=1) stones. Urinary leak was observed in 3 patients and was managed conservatively in 2
patients. In one patient ureteral stent was inserted by cystoscopy. No conversion to open surgery or re-operation occurred.
Conclusion: Laparoscopic pyelolithotomy is a feasible operation for patients with renal stones and intrarenal
pelvis in centers with adequate experience in laparoscopy. However, the success of LPL decreases in patients with multiple stones and intrarenal pelvis.

ORIGINAL PAPER (LAPAROSCOPIC AND ROBOTIC UROLOGY)


Robot-assisted Laparoscopic Pyeloplasty in Adults: A Comparison Analysis of Primary versus Redo Pyeloplasty in a Single Center

Najib Isse Dirie, Mahad A Ahmed, Mohamed Abdulkadir Mohamed, Zongbiao Zhang, Shaogang Wang

Urology Journal, Vol. 18 No. 01 (2021), 17 March 2021 , Page 52-57
https://doi.org/10.22037/uj.v16i7.5257

Purpose: Approximately 10% of all primary pyeloplasties will require at least one secondary intervention. Our aim was to analyze whether secondary repair will pose additional challenges during robotic pyeloplasty compared with the primary pyeloplasty.
Material and Methods: 114 patients who underwent robot-assisted laparoscopic pyeloplasty (RALP) between February 2015 and August 2018 were retrospectively reviewed. Patients were divided into; primary and secondary repair. The demographics, intraoperative parameters, postoperative parameters, and success rate of these two groups were collected and compared. Primary RALP data were further stratified into those who previously underwent ipsilateral endourological surgeries (IES) at the obstruction site and those who did not, to evaluate the effect of IES has on the outcome of RALP. Success was defined as symptomatic and radiological relief.
Results: Of the 114 patients, five complicated cases (three horseshoe kidneys, one duplicated system, and one retrocaval ureter) were excluded from the comparison. The remaining 96 primary and 13 secondary repairs were compared. Intraoperative and postoperative parameters showed no significant difference between the two groups. The results of 99 patients (87 vs. 12 in primary vs. secondary, respectively) were available after 27.5 months mean follow-up. The overall success was 92%, 8 patients failed (5 vs. 3 in primary vs. secondary, respectively) and required further surgical interventions.
Conclusion: Though surgically challenging with increased recurrence rates according to the literature we reviewed. However, our data failed to show any significant difference between the primary and redo RALP perhaps due to the smaller size in the redo RALP group.

ORIGINAL PAPER(UROLOGICAL ONCOLOGY)


The Role of 68GA-PSMA PET/CT Scan In Patients with Prostate Adenocarcinoma who Underwent Radical Prostatectomy

Mehmet Hamza Gultekin, Emre Demirci, Fethi Ahmet Turegun, Levent Kabasakal, Onur Erdem sahin, Meltem Ocak, Bulent Onal, Ahmet Erozenci

Urology Journal, Vol. 18 No. 01 (2021), 17 March 2021 , Page 58-65
https://doi.org/10.22037/uj.v16i7.6165

Purpose: To determine whether a 68Ga-PSMA PET/CT scan evaluation before radical prostatectomy (RP) is an
effective imaging modality for clinical local and lymph node (LN) staging compared with the pathological results.
Materials and Methods: We performed a preoperative 68Ga-PSMA PET/CT scan in 51 patients with prostate
cancer (PCa), who were scheduled for an RP operation between January 2014 and June 2016 in our clinic. The
correlation between the RP pathology and the results of the 68Ga-PSMA PET/CT scan was investigated.
Results: When the 68Ga-PSMA PET/CT scan results were evaluated according to the risk groups, intraprostatic
activity was found in 5 of 12 patients (41.7%) in the low-risk group, 15 of 19 patients in the intermediate risk group (78.9%), and 90% patients in the high-risk group. The 68Ga-PSMA PET/CT scan sensitivity, specificity, positive and negative predictive values and accuracy were calculated as 58.2%, 75.3%, 84.4%, 44%, and 63%, respectively for intraprostatic tumor localization; 68.4%, 75%, 61.9%, 80%, and %72.6%, respectively for extracapsular extension; 63.6%, 92.3%, 70%, 90%, and 86%, respectively for seminal vesicle involvement; 50%, 100%, 100%, 88%, and 89.3%, respectively for LN metastasis.
Conclusion: The 68Ga-PSMA PET/CT scan accurately demonstrates intraprostatic tumor localization in high-risk
group and presence of seminal vesicle involvement, which can help to accurately detect the target lesion before
prostate biopsy. In addition, with its high sensitivity and specificity values, 68Ga-PSMA PET/CT is a valuable imaging method for the assessment of LN metastasis in intermediate- and high-risk groups and also provides accurate nodal staging before RP.

Decrease of Preoperative Serum Albumin-to-Globulin Ratio as a Prognostic Indicator after Radical Cystectomy in Patients with Urothelial Bladder Cancer

Jeong Seock Oh, Dong Jin Park, Kyeong-Hyeon Byeon, Yun-Sok Ha, Tae-Hwan Kim, Eun Sang Yoo, Tae Gyun Kwon, Hyun Tae Kim

Urology Journal, Vol. 18 No. 01 (2021), 17 March 2021 , Page 66-73
https://doi.org/10.22037/uj.v16i7.6350

Purpose: This study aims to evaluate whether preoperative serum albumin-to-globulin ratio (AGR) could predict the prognosis of patients with urothelial bladder cancer (UBC) after radical cystectomy (RC).
Materials and Methods: A total of 176 patients with UBC who underwent RC in a tertiary hospital between 2008
and 2019 were retrospectively analyzed. The AGR was calculated as albumin/(total protein − albumin). In addition, the AGR was divided into two groups for the time-dependent receiver operating characteristic curve (ROC) analysis. Survival was estimated using the Kaplan–Meier analysis and compared using the log-rank test. Cox proportional- hazards models were used for multivariate survival analysis.
Results: The best cutoff AGR value for metastasis prediction was 1.32 based on the ROC curve analysis. Patients
who had lower pretreatment AGR (<1.32) values composed the low-AGR group (n = 57; 32.4%). On the other
hand, the remaining patients (n = 119; 67.6%) composed the high-AGR group. The patients in the low-AGR group had more advanced stage tumors compared with the patients in the high-AGR group. The Kaplan–Meier curves revealed that the patients in the low-AGR group had significantly lower rates of metastasis-free survival (MFS) and cancer-specific survival (CSS). The multivariate Cox regression analysis showed that preoperative AGR was an independent prognostic factor for MFS and CSS.
Conclusion: In this single-institution retrospective study, lower preoperative AGR values demonstrated a poor
prognostic effect on MFS and CSS in patients with UBC who underwent RC.

A Modified Partın Table to Better Predict Extracapsular Extensıon in Clinically Localized Prostate Cancer

Erkan Merder, Ahmet Arıman, Fatih Altunrende

Urology Journal, Vol. 18 No. 01 (2021), 17 March 2021 , Page 74-80
https://doi.org/10.22037/uj.v16i7.6477

Purpose: Prediction of extracapsular extension (ECE) before radical prostatectomy in clinically localized prostate cancer (PCa) is very important for clinical practice. ECE affects our decision on treatment strategy. The aim of this study is to identify the predictors of ECE, determine cut-off values, and compare them with the accuracy of Partin Table parameters to improve tumor staging in clinical practice.
Materials and Methods: 374 patients with clinically localized PCa who underwent open radical retropubic prostatectomy (RRP) were included in this study. Gleason Score (GS), age, digital rectal examination (DRE), prostate specific antigen (PSA), prostate specific antigen density (PSAD), free PSA, Free/Total PSA, prostate volume (PV), number of cores involved, tumor length, and tumor percentage in maximum involved core in biopsy were investigated.
Results: PSAD, tumor percentage, and tumor length are predictive factors of ECE. The cut-off values of PSA,
PSAD, maximum tumor length, and maximum tumor percentages in predicting ECE are: > 8.90 ng/mL, > 0.26
ng/mL2, >5mm, and >50%, respectively. The cut-off values for Partin extraprostatic extension (EPE) and organ
confined (OC) disease are >29% and ≤ 64%, respectively.
Conclusion: Partin tables could better predict extracapsular extension in clinically localized PCa if they include
PSAD, tumor percentage, and tumor length. The cut-off values of these predictive factors can be beneficial in
treatment strategies and in the decisions of lymphadenectomy and nerve-sparing surgery at radical prostatectomy.

ORIGINAL PAPER (PEDIATRIC UROLOGY)


Safety and Efficiency of Pyeloplasty in The First Six Weeks of Infants' Life

Serdar Moralioglu, Aysenur Cerrah Celayir, Oktav Bosnali, Osman Zeki Pektas

Urology Journal, Vol. 18 No. 01 (2021), 17 March 2021 , Page 81-85
https://doi.org/10.22037/uj.v0i0.5531

Purpose: The aim of this study was to assess the safety and the efficiency of pyeloplasty in infants with ureteropelvic junction obstruction (UPJO) in the first six weeks of their life.
Materials and Methods: Clinical records of the patients who had surgery during first six weeks of life for UPJO
between June 2009 and June 2014 were analysed retrospectively.
Results: In this period, twenty-six dismembered pyeloplasties were performed in twenty-four patients on mean
operation age of 27.3 ± 10.2 days (range 8-42 days). On the first postnatal ultrasound all twenty-six renal units had SFU-4 hydronephrosis. Mean preoperative and postoperative anterior-posterior pelvic diameter and parenchymal thickness were 33.1 ± 8.9mm (range 14-49mm), 3.2 ± 1mm (range 1-4,6mm) and 14.7 ± 6.6mm (range 6-27mm) and 7.8 ± 1.9mm (range 3.0-10.4mm), respectively. The differences between preoperative and postoperative parenchymal thickness and anterior-posterior pelvic diameter were statistically significant (P ˂ 0.0001). Preoperative MAG3 dynamic renal scintigraphy showed obstructive pattern on the diuretic renogram in 26 units. Mean preoperative and postoperative differential renal function on dynamic renal scintigraphy of the affected renal units were 46 ± 15 and 44 ± 15, respectively. Postoperative drainage was normal on dynamic renal scintigraphy in 25 (96.2%) of the 26 units, redo-pyeloplasty was needed in only one unit (3.8%).
Conclusion: In conclusion, patient selection and timing of surgery are very important in the protection of renal
function in newborn with UPJO. In our opinion, if there is indication for surgery, early surgical intervention should not postpone in this period. Surgical treatment of UPJO during first six weeks of life is safe and effective.

Purpose: The aim of this study was to evaluate pediatric posterior urethral fibroepithelial polyps, their diagnosis and endoscopic treatments with suprapubic assisted transurethral polyp excision which is described by us.


Materials and Methods: We reviewed the charts of patients (n=6) who underwent suprapubic percutaneous assisted cystoscopic excision for posterior urethral fibroepithelial polyp from 2014 to 2019. Their data were retrospectively reviewed in terms of clinical features, diagnostic methods, endoscopic approaches, and postoperative results.


Results: The 6 patients, the mean age of 3 years (4 months-6 years), with a solitary polyp of posterior urethra diagnosed and removed by suprapubic percutaneous assisted cystoscopic excision in five years. The most common complaint was urinary tract infection (n:3). The urethral polyps were diagnosed by ultrasound and cystoscopy. There was no intraoperative or postoperative complication except for one patient with bleeding from the trocar site. All of the specimens after histopathology examinations showed fibroepithelial polyps and no recurrence was seen.


Conclusion: Posterior urethral polyps may cause obstructive effect in the urinary tract. The treatment should be performed with the least possible invasive method without injuring urethral wall.  We believe that suprapubic percutaneous assisted cystoscopic resection, described by us is an easy, reliable and effective method for treatment procedure of posterior fibroepithelial urethral polyps.

ORIGINAL PAPER (RECONSTRUCTIVE SURGERY)


Major Complications after Male Anti-Incontinence Procedures: Predisposing Factors, Management and Prevention

Miklos Romics, Gergely Bánfi, Attila Keszthelyi, Hans Christoph Klingler, Tibor Szarvas, Marcell Szász, Péter Nyirády, Attila Majoros

Urology Journal, Vol. 18 No. 01 (2021), 17 March 2021 , Page 92-96
https://doi.org/10.22037/uj.v0i0.5712

Purpose: Significant post-prostatectomy incontinence (PPI) is a crippling condition and managed best through
sling or artificial urinary sphincter (AUS) implantation. These procedures are often associated with complications requiring surgical intervention. The aim of our retrospective study was to evaluate the occurrence of major complications and identify risk factors.
Materials and Methods: Between 2010 and 2018 ninety-one patients have been implanted with sling (22; 24.2%) or AUS (69; 75.8%) in our department. The cases where surgical revision was needed were examined regarding the etiology (mechanical failure (MF), urethral erosion (UE), urethral atrophy (UA), surgical site infection (SSI), combined reasons (COMB) and analyzed, using 16 possible perioperative risk factors.
Results: Surgical intervention was carried out by 19 / 91 (20.9%) patients. (In 16 / 69 cases after AUS (23.1%), 3 /
13 after slings (23%)). The indication was in 6 (31.6%) cases MF, in 3 (15.8 %) COMB, in 4 (21.1%) UE, in 5 (26.3
%) SSI, in 1 (5.2%) UA. The type of reoperation was either explantation (12 / 19), system replacement (6 / 19), or
cuff replacement (1 /19). Regarding the surgical intervention requiring complications only preoperative bacteriuria (P = .006) and postoperative surgical site oedema (P = .002) proved to be independent predictive factors.
Conclusion: Preoperative bacteriuria and surgical site oedema seemed to be good predictors for obligate surgical
revision. Patients with AUS were more prone to have major complications. In most cases it was mechanical failure,
infection or erosion. By reducing the frequency of these risk factors we might be able to decrease the amount of
complications.

ORIGINAL PAPER (FEMALE UROLOGY)


Purpose: Pelvic organ prolapse is a common condition as a consequence of the pelvic floor support weakness. This study evaluated the clinical results of treating the high stage prolapse of the anterior vaginal wall using a trans-obturator approach and the native vaginal wall tissue.


Methods: This was a prospective analysis of 94 patients with anterior vaginal wall prolapse stage ≥ Ⅲ. They underwent surgery with the trans-obturator approach using the native vaginal wall tissue. The objective primary outcome was evaluated according to the pelvic organ prolapse staging system (POP-Q). The subjective primary outcome was evaluated with pelvic floor distress inventory (PFDI-20) and pelvic floor impact questionnaire (PFIQ-7) questionnaires. The secondary outcomes were post-surgery complications.


Results: Totally, 85 of 94 patients were followed up for a mean of 38.2 ± 4 months. The objective anatomical success rate was 90.58%. PDFI-20 and PFIQ-7 scores had improved (P = 0.001). The complications were minor (G1) according to the Clavien-Dindo classification (8.2 %). At one year follow up 3 out of 8 patients with clinical SUI underwent transvaginal repair with the Poly propylene mini sling mesh.


Conclusion: The midterm results of the surgical repair of the high stage anterior vaginal wall prolapse are promising with a new surgical technique by trans-obturator approach and native vaginal wall as the supportive layer.

ORIGINAL PAPER (ANDROLOGY)


Administration of Nicotine Exacerbates the Quinine-induced Structural and Functional Alterations of Testicular Tissue in Adult Rats: An Experimental Study

Davoud Kianifard, Seyyed Maysam Mousavi Shoar, Ahmed Aly, Leila Kianifard, Farhad Rezaee

Urology Journal, Vol. 18 No. 01 (2021), 17 March 2021 , Page 103-110
https://doi.org/10.22037/uj.v16i7.5884

Purpose: In this study the role of nicotine (NCT) administration on the intensity of rat testicular tissue alterations induced by quinine (QU) was evaluated.
Materials and Methods: Forty adult Wistar rats were divided into four groups. Control (CON), NCT administrated (4 mg/kg) (NCT), QU treated (25 mg/kg for 7 days) (QU), and nicotine with quinine received (NCT+QU). After 28 days, serum testosterone and malondialdehyde (MDA) levels were measured. Testes and epididymides samples were prepared for determining tissue MDA levels, histomorphometry, microscopic indices of spermatogenesis, immunohistochemistry of p53 and sperm analysis.
Results: Testosterone levels were decreased significantly (P = .0004) in treated groups compared to CON group.
Serum MDA levels were increased significantly (P = .0004) in NCT and QU groups compared to CON group. Tissue MDA levels were increased significantly (P = .0012) in NCT+QU group in comparison to CON group. These
parameters were changed significantly in NCT+QU group compared to QU group. Seminiferous tubules diameter decreased significantly (P < .0001) in treated groups compared to CON group and in NCT+QU group compared to QU group. The height of germinal epithelium decreased significantly (P = .0001) in NCT and NCT+QU groups compared to CON and QU groups. The number of Sertoli cells, spermatocytes, and spermatids decreased significantly in treated groups compared to CON group. The number of spermatogonia decreased significantly (P = .0017) in NCT and NCT+QU groups compared to CON group. The number of Sertoli cells, spermatogonia, and spermatocytes decreased significantly in NCT+QU group compared to QU group. All indices of spermatogenesis decreased in treated groups compared to CON group. The lowest mean of these indices was observed in NCT+QU group. The sperm viability decreased significantly (P < .0001) in treated groups compared to CON group. Sperm count and motility decreased significantly in NCT and NCT+QU groups compared to CON group. All experimental groups showed the over-expression of p53 compared to CON group.
Conclusion: The administration of nicotine could be involved in the exacerbation of testicular tissue alterations
related to quinine therapy.

UNCLASSIFIED


Purpose: This study was conducted to determine the effects of tamsulosin and diclofenac sodium use on patients' pain perception after ureteral stents removal.
Materials and Methods: This study was a randomized control trial with double-blinded design. Eighty patients
who underwent ureteral stent removal surgery at Kardinah Hospital during January to March 2017 were divided
into four groups. The following medications were administered for two days, (A) placebo tid, or (B) diclofenac
sodium 50 mg bid, or (C) tamsulosin 0.2 mg sid, or (D) combination of tamsulosin and diclofenac sodium. Analgesic effects were assessed with the Visual Analog Scale (VAS). Relationships among variables were assessed using one-way ANOVA and post hoc tests.
Results: The surgical procedure for ureteral stent removal consisted of 48 (60%) male and 32 (40%) female. The
average age of group A, B, C, and D were 51.0, 51.9, 47.6, and 47.3 years, and the average stent dwell time was
6.3 weeks. VAS values of the entire experimental group were lower than the control group on the first day until the second day after the stent removal (p < 0.05). In the experimental group, there was no difference between group B and C (p > 0.05). Group D showed better analgesic effects than group B and C (p <0.05). No severe side effects were observed.
Conclusion: The result shows that combination therapy of diclofenac sodium and tamsulosin is better in reducing the pain after ureteral stent removal compared to the admission of a single placebo, tamsulosin, or diclofenac sodium therapy.

Validation of the Persian Version of the National Institute of Health Chronic Prostatitis Symptom Index

Farzad Allameh, Mohammad Mersad Mansouri Tehrani, Mohammad Ali Tasharrofi, Mohammad Ali Ganji Jameshouran

Urology Journal, Vol. 18 No. 01 (2021), 17 March 2021 , Page 117-121
https://doi.org/10.22037/uj.v0i0.5444

Objectives: To compose a comprehensible and fluent Persian translation of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and to determine its linguistic validity in a Persian sample population.
Methods: The standard double-back translation method, provided by the previous studies were utilized by three professional linguists to translate the English version of the NIH-CPSI to Persian, and a group of 10 urologists further reviewed and translated questionnaire. The questionnaire was then presented to the sample study, comprised of 60 men with CP/CPPS and 60 controls with adverse urological history, and the collected data was analyzed through IBM-SPSS software to test its validity, evaluative, and discriminatory power, psychometric qualities and internal consistency.
Results: A total of 80 subjects (42 CP/CPPS patients and 38 healthy controls) were considered eligible for this
study. The total Persian NIH-CPSI scores and each subdomain showed significant difference (P < 0.001) between
the two study groups, indicating a satisfactory discriminant validity for the index. Psychometric analysis established the index to benefit from a high internal consistency. The translation was also considered by both the subjects and the physicians to be easily comprehensible.
Conclusion: The Persian NIH-CPSI is a reliable and valid instrument for evaluating CP/CPPS symptoms in general
population, while also benefitting from high discriminatory power, and can be utilized with ease in both clinical
practice and laboratory studies.

Chronic Kidney Disease in Iran: First Report of the National Registry in Children and Adolescences

Neamatollah Ataei, Abbas Madani, Seyed Taher Esfahani, Hasan Otoukesh, Nakysa Hooman, Rozita Hoseini, Mojtaba Fazel, Ali Derakhshan, Alaleh Gheissari, Hadi Sorkhi, Arash Abbasi, Daryoosh Fahimi, Fatemeh Ghane Sharbaf, Fakhrossadat Mortazavi, Behnaz Falakaflaki, Ahmad Ali Nikibakhsh, Simin Sadeghi Bojd, Seyyed Mohammad Taghi Hosseini Tabatabaei, Kambiz Ghasemi, Ali Ahmadzadeh, Parsa Yousefichaijan, Afshin Safaei Asl, Baranak Safaeian, Salman Khazaei, Leila Hejazipour, Abolhassan Seyed Zadeh, Fatemeh Ataei

Urology Journal, Vol. 18 No. 01 (2021), 17 March 2021 , Page 122-130
https://doi.org/10.22037/uj.v16i7.5759

Purpose: Knowing the epidemiological aspects of chronic kidney disease (CKD) in children is crucial for early
recognition, identification of reversible causes, and prognosis. Here, we report the epidemiological characteristics of childhood CKD in Iran.
Materials and Methods: This cross-sectional study was conducted during 1991 - 2009. The data were collected
using the information in the Iranian Pediatric Registry of Chronic Kidney Disease (IPRCKD) core dataset.
Results: A total of 1247 children were registered. The mean age of the children at registration was 0.69 ± 4.72
years (range, 0.25 –18 years), 7.79 ± 3.18 years for hemodialysis (HD), 4.24 ± 1.86 years for continuous ambulatory peritoneal dialysis (CAPD), and 3.4±1.95 years for the children who underwent the renal transplantation (RT) (P < .001). The mean year of follow-up was 7.19 ± 4.65 years. The mean annual incidence of CKD 2–5 stages was 3.34 per million age-related population (pmarp). The mean prevalence of CKD 2–5 stages was 21.95 (pmarp). The cumulative 1-, 5-, and 10-year patients' survival rates were 98.3%, 90.7%, and 84.8%, respectively. The etiology of the CKD included the congenital anomalies of the kidney and urinary tract (CAKUT) (40.01%), glomerulopathy (19.00%), unknown cause (18.28%), and cystic/hereditary/congenital disease (11.14%).
Conclusion: The incidence and prevalence rate of pediatric CKD in Iran is relatively lower than those reported in
Europe and other similar studies. CAKUT was the main cause of the CKD. Appropriate management of CAKUT
including early urological intervention is required to preserve the renal function. Herein, the long-term survival rate was higher among the children with CKD than the literature.

CASE REPORT


Appendiceal Conduit: A Novel Technique to be Applied After Radical Cystectomy: A Case Report

Emadoddin Moudi, Seyyed Hosein Ghasemi Shektaie, Ghasem Rostami

Urology Journal, Vol. 18 No. 01 (2021), 17 March 2021 , Page 131-133
https://doi.org/10.22037/uj.v16i7.5513

This paper introduces a novel technique, known as appendiceal conduit. It could be used as an alternative for ileal conduit and cutaneous ureterostomy, ultimately applied after radical cystectomy. The six-month follow-up indicated that the patient had appendix-stoma as nipple without any stenosis, nor did he have any hydronephrosis, as confirmed by abdominal sonography.

Ectopic Prostatic Tissue in the Right Paracolic Gutter: A Case Report

Bokung Ahn, Youngseok Lee, Ki Choon Sim, Jeong Hyeon Lee

Urology Journal, Vol. 18 No. 01 (2021), 17 March 2021 , Page 134-135
https://doi.org/10.22037/uj.v0i0.5593

Ectopic prostatic tissue (EPT) is fairly uncommon; however, when reported, it is most often found in the male genitourinary tract. Since extragenitourinary EPT is very rare, it is extremely difficult to properly diagnose preoperatively.(1-3) This article describes a unique case of EPT found in the right paracolic gutter.