Urology Journal

Purpose: To evaluate the impact of diabetes mellitus (DM) on the recovery of urinary continence (UC) after radical prostatectomy (RP).
Materials and Methods: A systematic review of English articles was performed in August 2019, following the
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Trials were identified
in a literature search of PubMed, Embase, Cochrane Library and Web of Science using appropriate search
terms. All comparative studies reporting diabetes mellitus, study characteristics, and outcome data including the relationship between diabetes mellitus and urinary continence data were included. Continence rates at different time after RP were compared. Odds ratio (OR) was used for the comparison and all the results were presented with 95% confidence intervals (CIs).
Results: Seven cohort studies comprising with 5944 participants were included, the percentage of DM patients
was 8.7%. The results showed that DM decreased urinary continence rates at 12 months after RP (OR 0.54, 95%CI 0.36 to 0.81, p = 0.003). The continence rates were not significantly different between DM and Non-DM groups at short-term (catheter removal, 3 months, 6 months) and long-term (>12 months). When stratified by the surgical approaches, the pooled results in patients who underwent robot -assisted radical prostatectomy (RARP) were similar to results of the overall analysis.
Conclusion: DM has an adverse impact on the recovery of UC during the intermediate-term after RP. Well-designed trials with strict control of confounders are needed to make results more comparable.

Purpose: To explore the association between 5α-reductase inhibitors (5ARIs) use and risk of depression based on published literature through a meta-analysis.
Materials and methods: A comprehensive literature search was conducted by searching Pubmed, Embase,
Cochrane Library, CBM, CNKI, and VIP databases up to June, 2019. Summarized risk ratios (RRs) with 95%
confidence intervals (CIs) were calculated to evaluate the strength of association between 5ARIs and depression. Subgroup analyses were performed according to population, 5ARI types, degree of depression, and publication date. Registered in PROSPERO under number CRD42018096147.
Results: A total of 6 clinical studies with 265672 participants were included in our meta-analysis. The application
of 5ARIs could significantly increase the risk of depression based on both pooled unadjusted (95% CI: 1.28-2.78,
RR = 1.89, P = .001) and multivariable adjusted RRs (95% CI: 1.01-1.17, RR = 1.09, P = .03). In subgroup analyses,
dutasteride was associated with depression significantly (95% CI: 1.37-1.70, RR = 1.53, P < .001), while
finasteride was not. As to the degree of depression, 5ARIs mainly caused mild depression (95% CI: 1.91-2.33, RR
= 2.11, P < .001), instead of moderate or severe depression.
Conclusion: We concluded that 5ARIs could potentially increase the risk of depression. Clinicians need to carefully consider the use of 5ARIs for benign prostatic hyperplasia and androgenic alopecia patients, especially those exhibiting risk factors for depression or those who have a previous history of depression. More studies with larger sample size and comprehensive study design are needed to further verify our outcomes.

Purpose: The management strategies of anticoagulant (AC) or antiplatelet (AP) therapy in the preoperative period of benign prostatic hyperplasia (BPH) is still controversial. Therefore, a meta-analysis to systematically evaluate the surgical safety for BPH patients on AC or AP therapy was performed.
Materials and Methods: The protocol for the review is available on PROSPERO (CRD42018105800). A literature
search was performed by using MEDLINE, Web of Science, PubMed, Cochrane library, and Embase.
Summarized odds ratios (OR), mean difference (MD) and 95% confidence intervals (CI) were used to assess the
difference in outcomes.
Results: We identified 13 trials with a total of 3767 patients. An intragroup significant difference was found in
bleeding complications and blood transfusions when undergoing transurethral resection of the prostate (TURP). For laser surgery, the intragroup significant difference was found in the result of blood transfusion. Bridging therapy would not cause a higher risk of bleeding complications and blood transfusion during the perioperative period. Besides, no difference existed in operation time, catheterization time, hospitalization, and thromboembolic events.
Conclusion: Patients with BPH on perioperative AC/AP therapy would have a risk of postoperative hemorrhage
after TURP or laser treatments. To reduce the risk of hemorrhage, bridging therapy could be a good choice.

Purpose: NTrap® stone entrapment and extraction device (NTrap®) is a device used to extract and remove stones from the urinary tract and to minimize retrograde stone migration during ureterolithotripsy (URS). This study aimed to evaluate the efficacy and safety of NTrap® in URS.
Methods: From Jan 2014 to June 2017, 148 patients underwent URS with the aid of NTrap® (Group A), and 209
patients underwent standard URS without any anti-retropulsion device (Group B). Their demographics, operation time, complications, stone migration rate, and stone-free rate (SFR) were recorded for comparison.
Results: Compared with group B, Group A had a significantly shorter operative and lasering time (P = 0.003,
P<0.001, respectively). There was no significant difference between the 2 groups in overall complications, a decrease in mean hemoglobin, and length of stay (LOS) (P = 0.426, P = 0.097, P = 0.058, respectively). The incidence of stone migration was significantly lower in Group A than Group B (P = 0.035). The postoperative auxiliary procedure rate (in patients with stones retropulsion during the operation) was significantly lower in Group A compared to Group B (P = 0.024). The SFR was considerably higher in Group A than Group B (P = 0.009).
Conclusion: URS, with the aid of NTrap®, is an effective and safe method for treating ureteric stones. It may
prevent stones from retropulsion and shorten the operative time.

Purpose: Partial adrenalectomy (PA) is an emerging modality typically performed for the treatment of hereditary and sporadic bilateral tumors, to reduce the risk of adrenal failure. In this study, we evaluated the recurrence and functional outcomes after partial and total adrenalectomy (TA).

Materials and methods: From March 2005 to July 2018, 284 patients with functional tumor or > 5 cm adrenal
mass underwent clipless and sutureless laparoscopic partial or total adrenalectomy (PLA and TLA). Patients with
a pathological diagnosis of pheochromocytoma, Cushing or Conn’s disease and more than two year follow up
were included in this study. Pre-operative and operative variables were collected retrospectively and functional
outcomes and recurrence were gathered prospectively.

Results: One hundred forty patients (mean age: 43±5.1years) were included in the study. PLA and TLA were performed for pheochromocytoma (total n=78; PLA=12 (15%), TLA=66 (85%)), Cushing syndrome (toal n=17; PLA
= 4 (24%), TLA = 13 (76%)), and Conn’s disease (total n=45; PLA=7 (16%), TLA=38 (84%)). In pheochromocytoma
patients, improvement of hypertension, palpitation, and headache was not different between patients who
underwent PLA versus TLA (all P > 0.05). Two recurrences were observed in patients with pheochromocytoma
who had undergone TLA. In patients with Cushing disease, central obesity, fascial plethora, and hypertension were improved in all patients six months after treatment, muscle weakness was improved one year after surgery, and acne and hyperpigmentation only improved two years after surgery. The length of time for resolution of symptoms was not different in patients who underwent PLA versus TLA. In Conn’s disease hypertension was resolved in all patients and no patient required potassium supplements post-operatively. In follow up no recurrence was observed in patients with a pathological diagnosis of Cushing or Conn’s disease.

Conclusion: In our experience, PLA can provide excellent control of the symptoms parallel with TLA and with no
statistically significant difference in recurrence making PLA an attractive option in patients with an adrenal mass.

Purpose: This study aimed to explore the security and feasibility of three-dimensional (3D) printing technology-
assisted laparoscopic cryoablation to treat small renal tumors.

Patients and Methods: Four patients recruited from our hospital from April 2016 to August 2017 underwent 3D
printing technology-assisted laparoscopic cryoablation. Three-dimensional reconstruction technology was used to mimic cryoablation treatment before operations to determine the number of needles needed for the operation and the depth and angle required for needle insertion into the tumor to preserve nephron integrity. CT scans were used to assess the treatment’s efficacy after operation during regular follow-up.

Results: The operation was performed successfully in all cases and all patients recovered without major complications. The operation times ranged from 106 to 118 minutes and blood loss ranged from 50 to 100 mL. The follow-up times were between 8-16 months and the mean time was 13.3 months. Follow-up surveys were conducted regularly based on a standard outpatient protocol. Results showed no abnormal reinforcing signals in cryoablation treated areas.
Conclusion: 3D printing technology-assisted laparoscopic cryoablation is a feasible method for the treatment of renal tumors and may be a way to better preserve nephrons, especially in elderly patients and/or those with comorbidities.

Purpose: To explore the association between MEG3 polymorphisms and the risk of prostate cancer in the Chinese Han population.

Materials and Methods: Two MEG3 single-nucleotide polymorphisms (SNPs) (rs11627993 C >T rs7158663
A>G) were genotyped in a case-control study in which 165 prostate cancer patients and 200 healthy controls were recruited by a Real-Time Polymerase Chain Reaction (PCR) with the TaqMan assay. The odds ratios (ORs) and 95% confidence intervals (CIs) were used to estimate the strength of association.
Results: No statistically significant differences were found in the allele or genotype distributions of the MEG3
rs11627993 C >T and rs7158663 A > G polymorphisms among cases or healthy control subjects (rs11627993: CC
vs CA: 95% CI = 0.54-1.95, ORs = 1.03; CC vs AA: 95% CI = 0.67-2.54, ORs = 1.30 ; CC/CA vs AA: 95% CI = 0.81-1.98, ORs = 1.26 , P = .29 ; C vs A: 95% CI = 0.85-1.57, ORs = 1.16, P = .35; rs7158663: AA vs AG: 95% CI = 0.76-5.08, ORs = 1.97, AA vs GG: 95% CI = 0.57-3.29, ORs = 1.37; AA/AG vs GG : 95% CI = 0.56-1.32, ORs = 0.86, P = .49; A vs G: 95% CI = 0.69-1.39, ORs = 0.98, P = .91) Further stratified analysis detected no significant association.

Conclusion: The MEG3 polymorphisms (rs11627993 C>T and rs7158663 A>G) does not influence the susceptibility
to prostate cancer.

Purpose: The effects of metformin on prostate volume and prostate-specific antigen (PSA) were investigated.

Materials and Methods: We enrolled 384 newly diagnosed diabetes mellitus (DM) patients and 152 controls
all of whom were >50 years into our prospective cross-sectional observational study. The first group contained
patients receiving metformin only, the second group patients were taking a mixture of medications, including metformin plus other oral anti-diabetics, and the third was the control group. Before beginning treatment, body mass indices (BMI) of all cases were obtained. Prostate volumes were evaluated using transabdominal ultrasonography at the sixth and twelfth months. Insulin, glycosylated hemoglobin (HbA1C), insulin sensitivity index (ISI), insulin-rich growth factor (IGF-1), PSA, free PSA, and total testosterone levels were measured.
Results: The differences in BMI between the first and third groups were statistically significant (P < 0.05). There
were no statistical differences among the groups in terms of prostate volumes (P > 0.05). The differences between the groups for insulin, HbA1C, ISI, IGF-1 (somatomedin), PSA, free PSA, and total testosterone levels were not statistically significant (P > 0.05). Free PSA and total testosterone levels in groups 1 and 2 were not statistically different at the beginning of treatment and the sixth month (p >0.05), but within groups 1 and 2, only PSA levels were different at the start of the study until completion. No differences were seen in the third group.
Conclusion: Metformin appears to cause a decrease in PSA levels. The mechanism and any effects on prostate
tissue will be studied in future randomized, prospective studies.

Purpose: Muscle-invasive bladder cancer (MIBC) is associated with disease progression and metastasis leading
to poor prognosis. Current chemotherapy approaches have not adequately increased patient survival. Therefore, in this study, tissue proteome of patients with MIBC was performed to introduce possible protein candidates for bladder cancer prognosis as well as targeted therapy.
Materials and Methods: After obtaining tumoral and non-tumoral tissues of MIBC patients, and normal bladder tissue of non-bladder cancer patients, two-dimensional gel electrophoresis (2-DE) and liquid chromatography-mass spectrometry (LC-MS/MS) were used to analyze tissue proteome. Gelsolin-like Actin-capping (CAPG) protein was further examined using Real-time PCR and western blot analysis.
Results: The 2-DE analysis and LC-MS/MS identified CAPG protein as differentially expressed protein in tumor
and non-tumor tissues of bladder cancer compared with normal tissues. Western blot analysis showed the CAPG overexpression in tumor tissues compared with normal tissues in a stage-dependent manner. Correspondingly, Real- time PCR showed a higher mRNA expression in tumoral bladder tissues than normal ones. CAPG mRNA overexpression had significantly a positive relation with tumor size (P = 0.019), the TNM staging (P = 0.001), and tumor differentiation (grade) (P = 0.006). Patients with lower levels of CAPG had higher recurrence-free survival in comparison with patients with higher levels (P = .027).
Conclusion: CAPG overexpression was correlated with size, stage, grade, and shorter time to recurrence of bladder
cancer. Therefore, CAPG overexpression could be related to poor prognosis of bladder cancer. These results
suggest that CAPG may be considered as a prognostic factor and also for targeted therapy in bladder cancer. Moreover,
it could be concluded that cancerous and noncancerous tissues of MIBC have the same protein expression
because 2-DE results showed the CAPG expression in cancer and adjacent cancer tissues of bladder while CAPG
was not detectable in normal tissues of bladder.

Purpose: To present the medium-term results for the modified Lich-Gregoir (LG) reimplantation technique in the treatment of unilateral primary vesicoureteral reflux (VUR) by comparing patients under and over 12 months of age.

Materials and Methods: Data for patients who underwent modified LG surgery between January 2006 and December 2018 were retrospectively reviewed from the hospital data-recording system and patients under the age of 18 years were included in the study. After exclusion criteria, 55 patients in total were included in advanced analysis. The patients were grouped as ≤12 months and >12 months. Demographic characteristics, operative, and postoperative follow-up data were comparatively analyzed.

Results: The mean±SD (range) of age was 10.4 ± 2.8 (6-12) and 41.4 ± 18.5 (13-96) months in the ≤12 months and >12 months groups, respectively. Mean operation time and hospitalization time were not significant between the groups. Mean follow-up times were 39.5 ± 14.1 and 38.4 ± 13.2 months, in the ≤12 months and >12 months groups, respectively. There was no difference in terms of complications between the groups and all of the complications in both groups were in grade 1 category according to the Modified Clavien complication classification. One (6.6%) patient in the ≤12 months group and 3 (7.5%) patients in the >12 months group had late (>30 days) febrile UTI, but none of them had a recurrence of VUR. Febrile infection did not recur during the follow-up period in these patients. While recurrent VUR was not seen in any patient in the ≤12 months group (success: 100%), it was observed in 2 (5%) patients in the >12 months group (success rate: 95%) (p = 0.38).

Conclusion: The open LG ureteral reimplantation technique is an effective procedure for the treatment of unilateral primary VUR in children both under 12 months and over 12 months of age with minor morbidity.

Purpose: Vesicoureteral reflux (VUR) is the most common risk factor of urinary tract infection in children. Currently, diagnosis of VUR depends on invasive imaging studies, with a high radiologic burden. Therefore, different biomarkers have been introduced for the evaluation of these patients. The objective of this study was to identify alteration of urinary interleukins (ILs) excretion in children with primary VUR and renal parenchymal damage, for further clinical application.
Materials and methods: Urinary concentrations of IL-1α, IL-1β, IL-6, and IL-8 were evaluated in 34 children
with VUR (cases) and 36 without VUR (control), during 2018-2019. Urinary concentrations of IL-1, IL-1, IL-6
and IL-8 were measured, using polyclonal antibody ELISA kit, and standardized to urine creatinine (Cr). Patients
with infectious or inflammatory disorders, urolithiasis, immune deficiency, acute or chronic kidney disease, and
secondary VUR were excluded from the study.
Results: Mean age of cases (36.00 ± 27.66) had no significant difference with the control (32.86±29.31) group
(p=0.44). The majority of patients had moderate VUR (58.8%), followed by severe (35.3%) and mild (5.9%)
grades. Urinary concentration of all ILs/Cr were significantly higher in patients with VUR, compared with those
without VUR. There was no significant correlation between urine ILs/Cr with age, gender, serum electrolytes,
urine specific gravity, renal ultrasound, laterality or severity of VUR, and DMSA renal scan. All urine ILs/Cr had
acceptable sensitivity and accuracy for workup of children with primary VUR.
Conclusion: Urine IL-1α, IL-1β, IL-6 and IL-8/Cr were sensitive and accurate additionary screening biomarkers
in children with primary VUR.

Purpose: There are two brands of BotulinumtoxinA(BTXA) that commonly used in treatment of Lower Urinary Tract Disease: OnabotolinumtoxinA(Ona-BTXA) and AbobotulinumtoxinA (Abo-BTXA). The present study was conducted to assess the potential therapeutic and adverse effect of Abo-BTXA or Dysport   for IC/BPS.

Materials and Methods: Twenty-two out of 52 women diagnosed with IC/BPS who were refractory or had a low response to oral treatments of IC/BPS after 6 months, were included in the study. The end-point was O'Leary-Sant Score (OSS) including “symptoms” and “problem” indexes (ICSI and ICPI respectively) assessment after 1,3and 6 months after Abo-BTXA injection. Each patient underwent cystoscopy and immediately after hydrodistention received intratrigonal injections of 300 IU of Abo-BTXA (Dysport®) in30sites. The effect and side effects of this treatment over time have been investigated. Complications including high post void residual urine (PVR), bladder rupture, and urinary tract infections (UTI) were also assessed.

Results: The mean age of patients was 46.2±13.7 years and median OSS was 27.8±5.8.: After single injection ICSI, ICPI and total OSS significantly reduced in 1, 3, and 6 months follow up; rate of decrease   total OSS was 39.5%, 36%, 18%, respectively. Its effect lasted up to six months and started to decrease after 1 months (p-value<0.05). Complications included urinary retention (PVR>200ml), bladder rupture, and UTI in 13.5%, 4.3%, and 18% of the patients, respectively.

Conclusion: intravesical injection of 300IU Abo-BTX(Dysport) could be a useful approach for the treatment of patients with refractory IC/BPS in a period of six months.

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

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

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

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

Purpose: Generating functional gametes for patients with male infertility is of great interest. We investigated different cultural systems for proliferation of SSCs derived from obstructive azoospermic patients.

Materials and Methods: Testicular cells were obtained from men with obstructive azoospermia. After enzymatic digestion process, cells were assigned to various groups: culture of SSCs in the dish without cover (control group), co-culture of SSCs with infertile Sertoli cells (I), co-culture of SSCs with fertile Sertoli cells (II), culture of SSCs on nanofiber (covered with laminin) (III), culture of testicular cell suspension (IV). Then cells were cultured and colony formation, gene-specific methylation (by MSP), quantitative genes expression of pluripotency (Nanog, C-Myc, Oct-4) and specific germ cell (Integrin α6, Integrin β1, PLZF) genes were evaluated in five different culture systems.

Results: Our findings indicate a significant increase in the number and diameter of colonies in IV group in compare to control group and other groups. Expression of germ specific genes in IV group were significantly increased (P ≤ 0.05) and levels of expression of pluripotency genes were significantly decreased in this group (P ≤ 0.05) compared with other groups. Gene-specific pattern of methylation of examined genes showed no changes in culture systems during the culture era.

Conclusion: A microenvironment capable of controlling the proliferation of cell colonies can be restored by testicular cell suspension.

Purpose: Using a rat model of hyperinsulinemia, the present study investigated the role of p-ERK1/2 in benign prostatic hyperplasia (BPH).

Materials and Methods: Forty male Sprague-Dawley rats were randomly selected and assigned to four groups: high fat diet (HFD)+BPH (n=10), HFD (n=10), BPH (n=10), and control (n=10) groups. Hyperinsulinemia was induced by HFD feeding, while BPH was induced using testosterone propionate. Plasma glucose, plasma insulin and bodyweight were examined weekly. Immunohistochemistry (IHC) and western blot analysis were used to analyze the expression of ERK1/2 and p-ERK1/2 in rat prostates.

Results: Plasma glucose and plasma insulin levels were significantly greater in the HFD+BPH and HFD groups, when compared to the other two groups (P<0.05). Prostate weights were significantly greater in the HFD+BPH, HFD and BPH groups, than in the control group (P<0.05). IHC and western blot analysis revealed that p-ERK1/2 expression was greater in the HFD+BPH group than in the other three groups (P<0.05).

Conclusion: Androgens plus a hyperinsulinemic condition induced by HFD can result in prostatic cell hyperplasia, and this mechanism may be correlated to the upregulation of p-ERK1/2. Further investigations of this possibility are required.

Purpose: Partial bladder outlet obstruction (PBOO) induces sustained bladder over-distension, leading to ischemia/reperfusion (I/R)-related oxidative damage of the urothelium via apoptosis. The present study aimed to investigate the sequential course of apoptosis in the urothelium of rat bladder and identify the changes in apoptosis-related proteins during PBOO and subsequent relief. 

Materials and Methods: The study was conducted using 60 female Sprague-Dawley rats divided into three groups: sham-operated, PBOO only, and PBOO plus subsequent relief. PBOO was induced for 2 weeks, and then the obstruction was relieved by removal of the ligature. The urothelium was assessed by a histological analysis, and expression levels of apoptosis-related proteins were detected by quantitative PCR and immunoblotting.

Results: Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL)-positive cells were significantly increased in the PBOO only group when compared with the sham-operated group, and decreased in the PBOO relief group when compared with the PBOO group (P < 0.001). From the quantitative PCR and the western blot analyses, expression of Bax, caspase-3, P38, and Jnk was significantly increased in the PBOO group (P < 0.001). However, expression of Erk, Bcl-2 significantly decreased in the PBOO group (P < 0.001). The expression of Erk and Bcl-2 significantly increased in the PBOO relief group when compared with the PBOO group (P < 0.001). In comparison to the sham-operated group, expression levels of survivin significantly increased in both the PBOO and PBOO plus relief groups (P < 0.001). In addition, the expression levels were significantly different between the PBOO and PBOO plus relief groups (P < 0.001).

Conclusion: PBOO induced apoptosis of urothelium is related to alterations in the MAPK signaling pathways and apoptosis-related protein change. These results may also suggest that the pro-survival Erk signaling cascade and the expression survivin are activated in response to ischemic bladder injury and associated with initiation of bladder restoration in PBOO and subsequent relief. However, the mechanism of survivin as anti-apoptotic protein in ischemic bladder injuries remains unclear.

Persistent müllerian duct syndrome (PMDS) in the majority of cases is discovered during surgery for inguinal
hernia or cryptorchidism. A transverse testicular ectopia (TTE) with cryptorchidism may be very rarely associated
to PMDS. Assuming that müllerian remnants have a very low malignant degeneration potential if compared to
the malignancy risk of an undescended and not relocated testis, we describe a simplified surgical technique of
orchiopexy that avoids an extensive anatomical dissection, in this way minimizing the risk of losing the deferential
blood supply to the testis.

This study presents initial experience in endoscopic meatal dilatation of obstructive ureterocele in adult patients. During cystourethroscopy, we tried to find the orifice of ureterocele, passed a guide wire and introduce an 8 Fr ureteroscope in to the ureterocele orifice, going up to the renal pelvis as under vision dilatation of ureterocele meatus. Two Double-J stent were inserted and remained for six weeks to keep the meatus dilated. Adverse effect of endoscopic management was decreased due to minimal anatomic changes. Patients’ symptoms were relieved and no evidence of new onset vesico-ureteral reflux and obstruction were seen after up to one-year follow-up. Endoscopic meatal dilatation of stenotic ureterocele in adult patients is safe and effective thus, trying to find the orifice of ureterocele is suggested.