REVIEW


5α-Reductase Inhibitors Could Prevent the Clinical and Pathological Progression of Prostate Cancer: A Meta-analysis

Yue Yang, Haifeng Hu, Hanchao Zhang, Zhengdao Liu, Faliang Zhao, Jin Yang, Guobiao Liang

Urology Journal, Vol. 18 No. 03 (2021), 21 July 2021 , Page 247-251
https://doi.org/10.22037/uj.v18i.4831

Purpose: To explore the efficacy of 5-ARIs in PCA (Prostate Cancer).


Methods: Searching through the major medical databases such as PubMed, Science Citation Index, EMBASE,
Medline, Web of Science, Cochrane Library for all published studies in English until 2018. The following search
terms were used: “Finasteride”, “dutasteride”, “5α reductase inhibitors”, “5-ARIs”, “prostate cancer”, “prostate
neoplasm” and the additional related studies were manually searched. Newcastle-Ottawa Scale (NOS) assessed the qualities of studies, and the outcome measures were observed by RR or OR with 95% CIs.


Results: We included 9 eligible studies for analyses from 2011 to 2017. We found that 5-ARIs group may have
fewer progression (OR = 0.48 95%CI: 0.37-0.61 P < 0.00001, I2=4% p = 0.39) and lower pathological progression
(OR = 0.46; 95%CI: 0.29-0.73; p = 0.001, I2=0% p = 0.45), compared with control groups. However, the OS did
not show significant difference between two groups (OR=1.10; 95%CI:0.90-1.35; P = 0.35, I2 = 93% P < .00001 ).


Conclusion: The use of 5-ARIs could prevent progression in PCA patients both clinical and pathological.

The Prevalence of Renal Stones and Outcomes of Conservative Treatment in Kidney Transplantation: A Systematic Review and Meta-Analysis

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

Urology Journal, Vol. 18 No. 03 (2021), 21 July 2021 , Page 252-258
https://doi.org/10.22037/uj.v18i02.6531

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


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


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


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

Urinary Microbiome and its Correlation with Disorders of the Genitourinary System

Aida Javan Balegh Marand, Gommert A van Koeveringe, Dick Janssen, Nafiseh Vahed, Thomas-Alexander Vögeli, John Heesakkers, Sakineh Hajebrahimi, Mohammad Sajjad Rahnama’i

Urology Journal, Vol. 18 No. 03 (2021), 21 July 2021 , Page 259-270
https://doi.org/10.22037/uj.v16i7.5976

Purpose: Until recently, the urine of healthy individuals was assumed to be sterile. However, improvement of
bacterial detection methods has debunked this assumption. Recent studies have shown that the bladder contains microbiomes, which are not detectable under standard conditions. In this review, we aimed to present an overview of the published literature regarding the relationship between urinary microbiota and functional disorders of the genitourinary system.


Methods: We searched Medline, PubMed, Embase, The Cochrane library and Scopus to identify RCTs published,
with MeSH and free keywords including microbiota, bladder pain syndrome, prostatitis, kidney stone disease, and bladder cancer until September 2020. Randomized controlled trials investigating microbiome and lower urinary tract symptoms were included. Non-randomized trials, cross-over trials and pooled studies were excluded. The articles were critically appraised by two reviewers.


Conclusion: The urine microbiome is a newly introduced concept, which has attracted the attention of medical
researchers. Since its recent introduction, researchers have conducted many fruitful studies on this phenomenon,
changing our perspective toward the role of bacteria in the urinary tract and our perception of the genitourinary system health.


Result: A deeper understanding of the urinary microbiome can help us to develop more efficient methods for
restoring the microbiota to a healthy composition and providing symptom relief. Modification of the urinary microbiome without antibiotic use can be a possible venue for future research.

ORIGINAL PAPER (ENDOUROLOGY AND STONE DISEASE)


Reduction of Radiation Dose Received by Surgeons and Patients During Percutaneous Nephrolithotomy: A New Shielding Method

Shahriar Amirhasani, Rezgar Daneshdoost, Seyed Habibollah Mousavi-bahar, Karim Ghazikhanlou-sani, Roya Raeisi

Urology Journal, Vol. 18 No. 03 (2021), 21 July 2021 , Page 271-276
https://doi.org/10.22037/uj.v16i7.5200

Purpose: Due to high prevalence of urolithiasis, endourologic interventions have increased for the treatment of
patients with urinary stones. During fluoroscopy-guided percutaneous nephrolithotomy (PCNL), the surgeon and the patient are exposed to X-ray and its harmful effects. This study aimed to assess the reduction of the radiation dose received by surgeons and patients after using a new shielding method.


Materials and Methods: In this study, the dose of radiation exposure by the surgeon and patient during PCNL
under fluoroscopic procedure with conventional shielding methods was compared to a new shielding method designed by the researcher. For this purpose, shields and lead cones with a thickness of 0.5 mm were used. Also, to evaluate the dose of radiation received by surgeons and patients in different parts of the body, thermoluminescent dosimeters (TLD) were used.


Results: By using the new shielding method, a 37 ± 2% reduction was found in the dose exposure as compared
to the conventional shielding method. The maximum reduction in radiation dose was specified to the surgeon's
hands, while the lowest reduction in radiation dose was related to the surgeon's thyroid gland. The maximum and minimum reductions in radiation exposure for patients were specified to patients' feet and chest respectively.


Conclusion: There is a significant difference between the total dose received by the surgeons and the patients
following the use of the new shielding method and the standard shielding method. The new shielding method can
reduce 37 ± 2% of the x-ray received by the patient and the surgeon during fluoroscopy-guided PCNL.

Introducing the POPVESL Score for Intrarenal Vascular Complications of Percutaneous Nephrolithotomy: Experience from a Single high-volume Referral Center

Pejman Shadpour, Naser Yousefzadeh Kandevani, Robab Maghsoudi, Masoud Etemadian, Nasrollah Abian

Urology Journal, Vol. 18 No. 03 (2021), 21 July 2021 , Page 277-283
https://doi.org/10.22037/uj.v16i7.5997

Purpose: Percutaneous-nephrolithotomy (PCNL), is the current modality of choice for large renal stones. Delayed post-op bleeding may herald pseudo aneurysm (PA) or arteriovenous fistula (AVF) necessitating costly and inconsistently available angioembolization, or prolonged hospitalization. The goal of this study is to identify criteria that may predict response to conservative therapy, for delayed bleeding from post PCNL intrarenal vascular lesions.


Materials and methods: We reviewed all data on patients re-admitted for post PCNL gross hematuria at our high volume center between 2011 and 2016. Perioperative findings, factors related to the stone and management details, were subjected to multifactorial analysis. Logistic regression for multivariable analysis and ROC curves to find thresholds predicting mandatory angioembolization.


Results: Of 4403 PCNLs, 83 (1.9%) with delayed bleeding were diagnosed with intrarenal vascular lesions: Arteriovenous fistulas in 54 (AVF, 65%) and pseudoaneurysm in 29 (PA, 35%). Overall 49 (59%) responded to
conservative management but 34 (41%) eventually required angioembolization. On multivariable analysis, predictive factors for poor response to conservative treatment were requiring transfusion beyond initial stabilization, pseudoaneurysm, history of open renal surgery, longer interval-to-second-admission, and size of vascular lesion. The proposed POPVESL score (short for Post PNL Vascular Embolization selection) when below 11, correctly predicts success of conservative management with 81.6% sensitivity & 100% specificity.


Conclusion: Our findings including the proposed POPVESL score have the potential for clinical application and
enhancing practical guidelines on the management of post-PCNL bleeding.

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

Volkan Selmi, Unal Oztekin, Mehmet Caniklioglu, Levent Isikay

Urology Journal, Vol. 18 No. 03 (2021), 21 July 2021 , Page 284-288
https://doi.org/10.22037/uj.v18i.6442

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


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


Results: The study was conducted with 142 patients; 102 males and 40 females. The mean age of the population was 46.61 ± 14.58 years. The number of stones was 1.27 ± 0.67. The mean constant value of energy needed per mm3xHU for urinary stones was 22.87 milliwatt.


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

ORIGINAL PAPER (LAPAROSCOPIC AND ROBOTIC UROLOGY)


Purpose: The aim of this study was to evaluate the efficacy of transvesical open prostatectomy (OP) compared
with transurethral resection of the prostate (TURP) in patients with benign prostate hyperplasia (BPH) with a
prostate weight of 40-65 grams. The short-term and long-term complications of these two procedures were also
assessed.


Materials and Methods: In this retrospective study, we included 160 consecutive patients with BPH who had
undergone TURP (n=80) or OP surgery (n=80) from 2006 to 2017. Inclusion criteria were positive history of BPH,
definite indication for prostatectomy, and prostate weight between 40 to 65 grams. Patients were evaluated for
duration of hospitalization, need for re-operation, short-term and long-term postoperative complications, urinary flow rate, peak flow rate (Q max) and international prostate symptom score (IPSS).


Results: The mean age ± Standard Deviation (SD) of patients’ age was 62.4 ± 3.7 and 67.2 ± 4.6 years in the TURP and OP groups, respectively. Four (5%) and seven (8.7%) patients required transfusion in the TURP group and OP groups, respectively. Dysuria was significantly more frequent in the TURP group from week two to 12 months after surgery as compared with the OP group (P < .001). Hemodynamic changes and decrease in serum sodium level were not reported in either group. However, the urinary retention and need for urinary catheterization in the first year was significantly different between the two groups with 10 cases (12.5%) in the TURP group and no cases in the OP group (P<0.001). The need for reoperation in the TURP group was reported (27 procedures on 19 patients) (33.7%) of patients. Furthermore, retrograde ejaculation (RE) was reported in 65 (81.2%) and 80 patients (100%) of the TURP and OP group, respectively.


Conclusion: Despite the fact that TURP is the standard method of treatment for BPH when the prostate weighs
between 40-65 grams, the results of our study showed that OP is a more efficient and safe surgery for these patients and is associated with less complications. Furthermore, the need for re-operation seems to be higher in patients with TURP.

ORIGINAL PAPER(UROLOGICAL ONCOLOGY)


Randomized, Double-blind Pilot Study of Nanocurcumin in Bladder Cancer Patients Receiving Induction Chemotherapy

Saleh Sandoughdaran, Abolfazl Razzaghdoust, Ali Tabibi, Abbas Basiri, Nasser Simforoosh, Bahram Mofid

Urology Journal, Vol. 18 No. 03 (2021), 21 July 2021 , Page 295-300
https://doi.org/10.22037/uj.v0i0.5719

Purpose: To evaluate the feasibility and potential efficacy of nanocurcumin supplementation in patients with localized muscle-invasive bladder cancer (MIBC) undergoing induction chemotherapy.


Materials and Methods: In this double-blind, placebo-controlled trial, 26 MIBC patients were randomized to receive either nanocurcumin (180 mg/day) or placebo during the course of chemotherapy. All patients were followed up to four weeks after the end of treatment to assess the complete clinical response to the chemotherapy as primary endpoint. Secondary endpoints were the comparisons of chemotherapy‐induced nephrotoxicity, hematologic nadirs, and toxicities between the two groups. Hematologic nadirs and toxicities were assessed during the treatment.


Results: Nanocurcumin was well tolerated. The complete clinical response rates were 30.8 and 50% in the placebo and nanocurcumin groups, respectively. Although nanocurcumin was shown to be superior to placebo with respect to complete clinical response rates as the primary endpoint, there was no significant difference between the groups (p = 0.417). No significant difference was also found between the two groups with regard to grade 3/4 renal and hematologic toxicities as well as hematologic nadirs.


Conclusion: These preliminary data indicate the feasibility of nanocurcumin supplementation as a complementary
therapy in MIBC patients and support further larger studies. Moreover, a substantial translational insight to fill the
gap between the experiment and clinical practice in the field is provided.

Pseudocapsule of Small Renal Cell Tumors: CT Imaging Spectrum and Correlated Histopathological Features

Gang Li, Xianqi Lu, Yunsheng Ding, Qiang Luo, Liang Xu, Dongsheng Zhu, Changyi Quan

Urology Journal, Vol. 18 No. 03 (2021), 21 July 2021 , Page 301-306
https://doi.org/10.22037/uj.v16i7.5907

Purpose: To systematically analyze histopathologic features of pseudocapsule in small renal cell tumor (diameter≤4cm), assess the integrity of pseudocapsules by Computed Tomography (CT), and provide theoretical basis for the safety of nephron sparing surgery.


Materials and Methods: The pathological data of 116 patients who underwent surgery with clear cell renal cell carcinoma admitted from May 2010 to October 2017 were retrospectively analyzed. All patients underwent a CT scan of the abdomen including an unenhanced and triple-phase (arterial, nephrographic and excretory) post contrast series."All patients underwent a CT scan of the abdomen including an unenhanced and triple-phase (arterial, nephrographic and excretory) post contrast series."All patients underwent a CT scan of the abdomen including an unenhanced and triple-phase (arterial, nephrographic and excretory) post contrast seriesAll patients underwent a CT scan of the abdomen including an unenhanced and three-phase (arterial, nephrographic and excretory) post contrast series. Thorough gross examination and histological sections were used to determine the integrity of the pseudocapsule by two uropathologists. The consistency between pathological findings and CT imaging were evaluated by Kappa consistency test.


Results: The mean diameter of tumor was 3.0cm, range (2.6 ± 0.8) cm. On CT the pseudocapsule can present with one of the three following feathers:1) A regular and distinct halo; 2)lobulated clear margins;3) blurred margins. On histopathology, complete psuedocapsule was found in 85 tumors, incomplete psuedocapsule in 25 and no psuedocapsule was found in 6 tumors; CT scan findings demonstrated a regular halo in 82 tumors, lobulated clear margins in 26 and blurred margins in 8 tumors(Kappa=0.833,P=0.000).


Conclusions: Most small renal cell tumors have an obvious psuedocapsule. Preoperative determination of the psuedocapsule’s integrity is particularly important. CT scan can reliably evaluate the tumor margins and demonstrate the psuedocapsule when present. The imaging results are well correlated with the pathologic findings.

Needle Tip Culture after Prostate Biopsy: A Tool for Early Detection for Antibiotics Selection in Cases of Post-Biopsy Infection

Ian Seng Cheong, Yuh-Shyan Tsai, Chun-Hsiung Kang, Yeong-Chin Jou, Pi-Che Chen, Chang-Te Lin

Urology Journal, Vol. 18 No. 03 (2021), 21 July 2021 , Page 307-313
https://doi.org/10.22037/uj.v16i7.5912

Purpose: To investigate biopsy needle tip culture after prostate biopsies for bacteria prediction and antibiotics selection.


Materials and Methods: From May 2017 to April 2019, 121 patients who underwent a prostate biopsy were enrolled. All biopsy needle tips were sent for aerobic and anaerobic culture. Patients were divided into positive and negative culture groups. Perioperative data were recorded and compared between the two groups. The culture time and susceptibility of febrile patients were analyzed. Blood cultures were conducted for all patients who experienced fever after biopsy. The time and results of the needle and blood cultures were recoded for descriptive analysis.


Results: There were 59 (48.8%) positive needle cultures. Other than fever (p = 0.023), there were no statistical significances in clinical data between the two groups. Fever occurred in eight patients, and seven febrile patients had positive needle cultures, six of whom had positive blood cultures. These six needle and blood cultures were consistent with the susceptibility test results. As compared to the waiting time for blood cultures, target antibiotics were administered at an average of 48.0 h earlier based on needle cultures. None of the patients with positive anaerobic cultures developed a fever, while all eight febrile patients had negative anaerobic cultures.


Conclusion: Fevers developed at statistically significant higher rate among those who had positive needle cultures. Needle and blood cultures were consistent with the susceptibility test results. Needle cultures can help us administer target antibiotics earlier to febrile patients without the need to wait for blood cultures.

Purpose: To report the 1-year functional outcomes, oncologic outcomes, and postoperative complications in patients who underwent modified robot-assisted radical prostatectomy (RARP) procedures for achieving early recovery of continence and potency postoperatively.


Materials and Methods: This study included 165 patients who underwent RARP. Overall, 98 patients underwent RARP using our modified detrusorrhaphy and intrafascial nerve-sparing techniques (group 1) and 67 underwent standard RARP (group 2). Continence and potency rates were assessed at 1 week, 1, 3, 6, and 12 months after RARP. Oncologic outcomes comprised positive surgical margins (PSMs) and biochemical recurrence (BCR) rate.


Results: The continence rates were 61.2% and 6.0%, 72.5% and 11.9%, 79.6% and 20.9%, 91.8% and 58.2%, and 97.9% and 74.6% at 1 week, 1, 3, 6, and 12 months in group 1 and 2, respectively. The potency rates were 66.3% and 11.9%, 78.6% and 38.8%, 85.7% and 50.8%, 92.9% and 70.2%, and 95.9% and 79.1% at 1 week, 1, 3, 6, and 12 months in group 1 and 2, respectively. Overall postoperative complication rates (< 10%) were similar between the  groups. The PSMs rate was 17.4% and 16.4% in the two groups. The rate of PSMs in the cohort of patients with stage pT2 disease decreased to 13.6% and 12.5% in groups 1 and 2,  respectively. BCR rate was 5.1% and 6.0% in groups 1 and 2, respectively.


Conclusion: The use of detrusorrhaphy and intrafascial nerve-sparing techniques is safe and feasible, with our results demonstrating early return to continence and potency. Further studies should be conducted.

ORIGINAL PAPER (PEDIATRIC UROLOGY)


Objective:  Among the more serious problems in urological interventions among the pediatric age group is the requirement of general anesthesia. The advantages of removing a double-J stent (DJS) without anesthesia in ureteroneocystostomy (UNC) operations among children were investigated in this study.


Patients and Methods: In all, 25 patients who underwent UNC surgery between November 2016 and November 2018 were retrospectively divided into two groups according to the method used for the removal of the DJS. In Group 1, the stent was tied to the urethral catheter by a suture and retrieved postoperatively on the fourth day without anesthesia and cystoscopy. In Group 2, we inserted the stent according to the classical method with no suturing to the catheter and removed it 3 to 4 weeks after the first operation, with cystoscopy under anesthesia.


Results: A total of 16 girls and 9 boys were included in the study. The mean age was 4.3 and 6.3 years in groups 1 and 2, respectively. We did not observe statistically significant difference between the groups in long-term renal function or hydronephrosis regression.


Conclusion: We consider that the removal of a stent placed in pediatric intravesical UNC operations without anesthesia and cystoscopy is less invasive and affords safety and long-term results comparable to the standard method.

ORIGINAL PAPER (FEMALE UROLOGY)


Assessing the Reliability and Validity of the Persian Version of the Chronic Pelvic Pain Questionnaire in Women

Mahboubeh Mirzaei, Azar Daneshpajooh, Mohammadali Bagherinasabsarab, Fatemeh Bahreini, Fatemeh Yazdanpanah

Urology Journal, Vol. 18 No. 03 (2021), 21 July 2021 , Page 326-329
https://doi.org/10.22037/uj.v16i7.6212

Purpose: There is a need for developing a standard and approved tool to assess chronic pelvic pain (CPP) in Iranian women. The aim of this study was to investigate the reliability and validity of the Persian version of the pelvic pain and urinary/frequency (PUF) questionnaire in Iranian women with CPP.


Materials and Methods: This cross-sectional study was performed on 50 females with CPP referred to the urology clinic of Kerman University of Medical Sciences from 2018 to 2019. Initially, the PUF questionnaire was translated into Persian and then back translated into English. The face validity of the tool was evaluated by being tested on 50 patients who had different literacy levels to ensure its understandability and acceptability by patients. The construct validity was evaluated through both exploratory and confirmatory factor analyses. The internal consistency was also analyzed by determining Cronbach's alpha coefficient and test-retest method.


Results: The Persian version of the questionnaire was compatible with the original English version. The Kisser sampling adequacy index was calculated on the data before extracting the factors indicating good factor accessibility of the questionnaire statements. The construct validity of the questionnaire was confirmed using exploratory and confirmatory factor analyses. The internal consistency parameters were also acceptable. Cronbach's alpha coefficient of the whole questionnaire, as well as the coefficients of the "signs/symptoms" and "unpleasant feelings" domains were 77%, 74%, and 78%, respectively.


Conclusion: The developed Persian version of the PUF questionnaire retrieved a good validity and reliability.

ORIGINAL PAPER (ANDROLOGY)


The Effect of L-Carnitine and Coenzyme Q10 on the Sperm Motility, DNA Fragmentation, Chromatin Structure and Oxygen Free Radicals During, before and after Freezing in Oligospermia Men

Negin Chavoshi Nezhad, Zakaria Vahabzadeh, Azra Allahveisie, Khaled Rahmani, Amir Raoofi, Mohammad Jafar Rezaie, Masoumeh Rezaei , Maria Partovyan

Urology Journal, Vol. 18 No. 03 (2021), 21 July 2021 , Page 330-336
https://doi.org/10.22037/uj.v16i7.6400

Purpose: The aim of the present study is to assess the effect of L-carnitine and Coenzyme Q10 (CoQ10) on human sperm motility, DNA fragmentation, chromatin structure, and reactive oxygen species (ROS) during, before and after freezing in oligospermia men.


Materials and Methods: Semen was collected from 30 oligospermic men, who referred to infertility clinic of Beasat Hospital in Sanandaj, Iran. The samples of each individual were divided into 8 equal parts: 1. control group before freezing; 2. incubated with L-carnitine; 3. incubated with coenzyme Q10; 4. incubated with the combination of L-carnitine + CoQ10; 5. control freezing group; 6. the experimental freezing group with L-carnitine; 7. the experimental freezing group with coenzyme Q10 and 8. the experimental freezing with the combination of L-c + CoQ10. Sperm motility was assessed by WET MOUNT method. DNA fragmentation was evaluated by SCD (Sperm Chromatin Desperation), ROS, was evaluated by quantitative fluorescence reaction, and chromatin deficiency was determined by chromatin staining (CMA3).


Results: Antioxidant treatments, significantly reduced the number of ROS + in the pre and post freezing groups. Significant improvement was seen in the sperm motility of class B in the pre freezing groups with L-carnitine. Antioxidants also reduced the percentage of DNA fragmentation and protamine deficiency in pre-and post-freezing.


Conclusion: Addition of Coq10 and L-carnitine to human sperm medium significantly reduced the number of ROS. This reduction in ROS reduced sperm damage during cryopreservation.

UNCLASSIFIED


Purpose: The present study aims to assess and compare the effects of carvedilol and terazosin plus enalapril on lower urinary tract symptoms (LUTS), the urine flow, and blood pressure (BP) in patients with moderate hypertension (HTN) and benign prostatic hyperplasia (BPH).


Materials and Methods: In this randomized crossover trial, a total of 40 men with HTN and LUTS symptoms were enrolled. The first group was treated with carvedilol, and the second one received terazosin plus enalapril. After eight weeks of treatment, the patients experienced a one-month washout period, and the treatments changed and continued for eight weeks. To diagnose BPH in the study, the international prostate symptom score (IPSS) questionnaire was used. Moreover, the prostate-specific antigen (PSA), the post-void residual (PVR) urine volume, and the maximum urinary flow rate (Q-max using the uroflowmetry test) were measured.


Results: Effect assessment results in this crossover trial illustrated neither carryover effects nor significant treatment effects on all primary outcomes (P > 0.05). Moreover, the results for the period effect indicated a significant reduction in BP (systolic and diastolic), PVR, and IPSS, yet a significant raise in Qmax.


Conclusion: The effects of carvedilol are similar to those of the combination of terazosin and enalapril in patients with moderate HTN and BPH in controlling LUTS. Carvedilol could be used as an appropriative drug in patients with moderate HTN and cardiac problems with LUTS of BPH. Further studies are recommended to be conducted to investigate and compare the efficacy of carvedilol with that of other alpha-blockers with a larger sample size and over a longer period of time.

CASE REPORT


Primary Epidermoid Cyst of the Clitoris in Adult Female Population: Three Case Reports and Introducing a Safe Surgical Approach

Nastaran Mahmoudnejad, Peyman Mohammadi Torbati, Alireza Zadmehr

Urology Journal, Vol. 18 No. 03 (2021), 21 July 2021 , Page 343-346
https://doi.org/10.22037/uj.v16i7.6348

Epidermoid cyst (EPC) of the clitoris is a very rare cause of non-hormonal acquired clitoromegaly. Clitoral EPCs are extremely uncommon without prior history of genital surgery, trauma, circumcision, or piercing. Surgical removal with special care to avoid compromising neurovascular bundle of the clitoris is the preferred treatment. To our best knowledge, only three cases of adult female clitoral EPC without history of genital surgery, female circumcision, or medications including oral or implantable contraceptives have been reported. Herein, we describe three cases of primary EPC of the clitoris, their management, unique histopathology report, safe surgical approach, and their follow up course.

LETTER


A survey on Current Procedural Terminology (CPT) by Iranian Urological Association

Farzad Allameh, Abbas Basiri, Amir reza Abedi, Seyyed Mohammad Ghahestani, saeed montazeri, Vahid Fakhar

Urology Journal, Vol. 18 No. 03 (2021), 21 July 2021 , Page 347-348
https://doi.org/10.22037/uj.v16i7.6445

Purpose: The purpose of Current Procedural Terminology (CPT) is to offer a universal language to describe medical services. The elaborate systems designed by high-income countries are not fully applicable in ones with limited resources. Therefore, in the current study we aimed to ask urologists' opinion about deploying relative value units in valuation of medical services in Islamic republic of Iran.


Materials and Methods: A group of appointed urologists first selected 15 urological surgeries as exemplar urological procedures. Next, urologists around the country were asked to fill out an online questionnaire comparing these procedures with standard one (varicocelectomy). Then, mean scores of four categories (Difficulty, duration, adverse events and legal issues) were determined separately for each of the 15 procedures. Subsequently, mean score for each surgery was measured using the calculated mean scores of the four aforementioned categories.


Results: 273 urologists completed an online questionnaire. All of the calculated codes were higher compared to the current codes. Urethroplasty showed the least increment with 25.22 equivalent to 51.69% while extracorporeal shock wave lithotripsy showed the most increment of 63.59 equivalent to 114.37%.


Conclusion:  Although CPT is an important tool in valuation of medical services, making modifications to it, especially in low-to-middle-income countries seems necessary. In this survey, we aimed to evaluate current surgical codes for urological procedures based on urologists' opinion. All of the calculated codes were higher compared with current codes. This, indicated the necessity of making changes in relative value units of urological procedures.

Prostate Cancer (PCa) is the most prevalent cancer in men. Radical Prostatectomy (RP) as a primary definitive treatment may be followed by adjuvant or salvage radiotherapy. However, there are some uncertainties about receiving immediate adjuvant radiation after RP in men with adverse pathological features versus early salvage radiation therapy. Decipher is a novel genomic classifier and almost all studies have confirmed Decipher as a reliable predictor of metastasis, recurrence and mortality. With the aid of Decipher, clinicians are able to determine the need for adjuvant versus salvage radiotherapy. Decipher has the potential to reduce decisional conflicts in clinical recommendations, and is cost-effective. However, further investigations are required to prove Decipher’s role in clinical outcome improvement in patients receiving Decipher-based course of treatment compared with those receiving usual care.


 

We read the article entitled ‘’Retrograde Intrarenal Surgery vs. Percutaneous Nephrolithotomy vs. Extracorporeal Shock Wave Lithotripsy for Lower Pole Renal Stones 10-20 mm: A Meta-analysis and Systematic Review’’  published in Urology Journal (1). The topic is still hot in urology regarding lower pole kidney stones in 10-20 mm diameters.  Although extracorporeal shock wave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are the available options for the patients with lower pole renal stones 10-20 mm diameter, the decision making among the methods is still controversy. This manuscript is valuable in this regard.


 At the present manuscript, the authors prepared a very comprehensive meta-analysis of existing evidence to quantify and compare the safety and efficacy of PCNL, RIRS and ESWL for lower pole renal stones 10-20mm.  They emphasized the longer operative time of PCNL and RIRS compared to ESWL. They also reported a higher stone-free rate, the lower retreatment rate and auxiliary procedure following PCNL with the longest hospital stay for PCNL. 


When it comes to ESWL, the lowest SFR, the higher retreatment rate and auxiliary procedure rate, but a shorter operative time and the shortest hospital stay was reported. The authors indicated stone to skin distance (SSD) as an unfavourable factor for ESWL. This issue is also reported in current literature. SSD was calculated by measuring the distance from the stone to the skin in three angles (0°, 45° and 90°) and the cut-off value for SWL failure was reported in a wide-scale from 100 mm to 119 mm(2,3).


At the present study, the authors presented 10 mm as a predictive value for the criteria of SWL failure. This statement seems to be not correct totally also 10 mm is an impossible value for SSD. In our opinion, it was caused by a misspelling, and a correction may be informative for the readers.

Can Short Anogenital Distance Cause Chronic Prostatitis?

Ayhan Verit, Fatma Ferda Verit

Urology Journal, Vol. 18 No. 03 (2021), 21 July 2021 , Page 353-354
https://doi.org/10.22037/uj.v18i.6687

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


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

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

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

Urology Journal, Vol. 18 No. 03 (2021), 21 July 2021 , Page 355-357
https://doi.org/10.22037/uj.v18i.6711

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


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


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


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

Living Donor Kidney Transplantation: Global and Regional Trend

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

Urology Journal, Vol. 18 No. 03 (2021), 21 July 2021 , Page 359-361
https://doi.org/10.22037/uj.v18i.6820

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

Intermittent Catheterization Frequency and Interval in Children: Are We Clear Enough?

Seyyed Mohammad Ghahestani, Sara Karimi

Urology Journal, Vol. 18 No. 03 (2021), 21 July 2021 , Page 362-363
https://doi.org/10.22037/uj.v18i.6827

Abstract:


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