Urology Journal

Introduction: The aim of this study was to determine the correlation between histological subtype, size, grade, and stage of the kidney tumors and to investigate whether a correlation exists between the size of the kidney tumor and its behavior.

Materials and Methods: Between 1996 and 2004, we had 212 patients with radical or partial nephrectomy due to a kidney tumor at Shaheed Labbafinejad Medical Center. Their pathologic blocks were re-evaluated with consideration of their tumor size and pathologic features.

Results: Of 212 pathologic blocks, 17 (8%) were benign and 195 (92%) were malignant masses including 179 renal cell carcinoma (RCC) tumors. Malignant tumors were slightly greater compared with the benign ones (P = .10). There was no significant relation between the size of tumor and the histological subtype. Significant relations between the size of the kidney tumor and the nuclear grade (P = .007), clinical symptoms (P = .02), and extracapsular extension (P < .001) were observed. In smaller RCC tumors (< 4 cm), extracapsular extension (stages T3 and T4) was rare (1 in 29).  However, smaller RCC tumors were not significantly different from those larger than 4 cm regarding the nuclear grade, symptoms, and histological subtypes.

Introduction: The aim of this study was to examine the efficacy and safety of intravesical Bacillus Calmette-Guerin (BCG) in the treatment of refractory interstitial cystitis (IC).

Materials and Methods:  Thirteen patients with refractory IC were enrolled in the study. They were scheduled to receive 6 weekly courses of treatment with intravesical BCG. Variables including the frequency, nocturia, urgency, pelvic pain, dyspareunia, dysuria, IC symptom index, IC problem index, and average voided volume were assessed every 6 months after the BCG therapy.

Results: Thirteen patients received the complete course of intravesical BCG therapy. Twenty-four months after the treatment a mean improvement of 51.9% was seen in frequency (P = .001), 43.2% in nocturia (P = .002), 28.7% in urgency (P = .004), 43.1% in pelvic pain (P = .001), 58.3% in dyspareunia (P = .003), 6.5% in dysuria (P = .16), 57.7% in the O’Leary-Sant IC symptom index (P = .001), and 61.8% in the O’Leary-Sant IC problem index (P = .001) scores. A significant improvement was seen in the mean average voided volume at the 24th follow-up month (89.5%; P = .001).

Conclusion: Intravesical BCG is a relatively effective treatment in patients with refractory IC. Its efficacy seems to be modest and lasts for at least 24 months in majority of the patients. It is also safe and well tolerated.

Introduction: The aim of this study was to evaluate the frequency of bacteriuria in pregnant women referred to the medical centers of Tabriz, Iran, for prenatal care.

Materials and Methods: A total of 1100 healthy pregnant women who were referred to 50 medical centers in Tabriz for a regular prenatal care were evaluated for bacteriuria.

Results: The frequency of asymptomatic bacteriuria was 6.1%. Maternal age was lower in the women with a positive urine culture (P = .02). Asymptomatic bacteriuria had no relationship with gestational age, parity, level of education, and body mass index.

Conclusion: We found a relatively high rate of bacteriuria in our cohort of asymptomatic pregnant subjects, especially the younger ones. For prevention from the complications of the asymptomatic bacteriuria in pregnant women, such as pyelonephritis, hypertension, preeclampsia, low birth weight, prematurity, septicemia, and even maternal and neonatal death, it is recommended to perform urine culture as a routine evaluation during the pregnancy.

Introduction: Advances in surgical techniques and immunosuppressive therapy have improved the survival and quality of life in organ transplant patients. Thus, the number of organ transplant women at their reproductive age has also increased. We sought to investigate the allograft and obstetric outcomes in pregnant kidney recipients.

Materials and Methods: Seventy-four kidney recipient women with 95 conceptions during their posttransplant period were evaluated. Pregnancy outcome, kidney allograft function, and maternal, fetal, and neonatal complications were evaluated in these patients.

Results: The mean interval between kidney transplantation and pregnancy was 41.0 ± 9.5 months. Twenty-three pregnancies (24.2%) were unsuccessful due to abortion and stillbirth. The mean birth weight was 2385.0 ± 161.7 g and 45 newborns (62.5%) had a birth weight less than 2500 g (low birth weight). The mean Apgar score of the live babies was 7.9 ± 0.7. Forty-four (61.1%) babies were admitted to neonatal intensive care unit and early neonatal death happened in 4 (5.5%). Fifteen mothers (15.78%) had an uneventful perinatal period. The most common maternal complications in the 95 pregnancies were anemia in 62 (65.3%) and preeclampsia in 45 (47.4%). Three patients 3 (3.2%) lost their graft and 6 (6.3%) had impaired kidney allograft function 2 years after pregnancy.

Conclusion: Pregnant kidney allograft recipients should be considered as high-risk patients needing special care under the supervision of a team of obstetricians and nephrologists.

Introduction: We evaluated erectile function of men with coronary artery disease (CAD) and the relation between the degree of erectile dysfunction (ED) and the extent of coronary artery stenosis on cardiac angiography.

Materials and Methods: Nondiabetic men with CAD documented by angiography were evaluated for ED. Erectile function was assessed by a 5-item version of the International Index of Erectile Dysfunction, the Sexual Health Inventory for Men (SHIM).

Results: Of 401 men, 186 (46.4%) had ED (SHIM score, 21 or less). Men with ED were more likely to have more than 1 stenotic cardiac vessel (P < .001). The mean SHIM score was 20.9 ± 7.6, 12.9 ± 9.2, and 14.3 ± 9.1 for men with 1-, 2-, and 3-vessel disease, respectively (P < .001). Multivariate analysis showed that only the SHIM score had a relationship with the number of involved vessels (P < .001); the SHIM score was lower and ED was more frequent in men with more than 1 vessel involvement. Forty-one patients (19.1%) without ED and 45 (24.2%) with ED had a positive history of myocardial infarction (P = .21). Symptoms of ED had appeared prior to CAD detection in 78 out of 189 patients (41.9%) with a mean time interval of about 23 months (range, 10 to 36 months).

Conclusion: Our finding showed that the prevalence of ED is relatively high in patients with CAD, and has a relationship with the extent of CAD. Furthermore, ED may occur before CAD with an average interval of 2 years.

Introduction: The aim of this study was to evaluate varicocele patients’ brothers to determine whether they are at a higher risk of varicocele than the general population of men.

Materials and Methods: A total of 56 patients with varicocele and their 131 brothers (> 16 years old) were evaluated. The brothers had no complaints of infertility, pain, or cosmetic problems. They were all examined for varicocele. One hundred and fifty men who referred for employment medical examinations were considered as the control group.

Results: Of the subjects, 39 (69.6%) had grade III varicocele. Sixty (45.8%) of the brothers had varicocele. The grade of varicocele was III in 16 (26.7%) brothers. In the control group, varicocele was present in 15 (10%) which was grade III in 5 (33.3%). The frequency of varicocele was 4.5-fold greater in the brothers of the patients than the controls (P < .001). Also, the frequency of grade III varicocele was significantly more than grades I and II in the patients in comparison with their brothers and controls with varicocele (P < .001). There was no significant difference in the grades between the controls and the patients’ brothers (P = .31). The frequency of bilateral varicocele was not statistically different between the three groups (P = .14).

Conclusion: Our findings showed that a significant increase is seen in the prevalence of varicocele in the patients’ brothers compared to men in the general population, warranting evaluation of the first-degree relatives of men who present with varicocele.

Introduction: The aim of this study was to evaluate diuresis renography with an intravenous injection of furosemide 20 minutes after administering the radiopharmaceutical (F+20 protocol) or 15 minutes before (F-15 protocol) in patients with upper urinary tract dilatation.

Materials and Methods: Twenty-one patients with pyelocaliceal system dilatation, but not ureteral dilatation, on ultrasonography were evaluated. The patients underwent diuresis renography using the F+20 and F-15 protocols. Renal scan findings and kidney split function were recorded. Then, the patients underwent surgical or conservative treatment according to their clinical conditions and imaging results. Follow-up was done 3 and 6 months postoperatively by physical examination, intravenous urography, and diuresis renography.

Results: Eleven patients (52.4%) had complete obstruction in both protocols of renography, and 5 (23.8%) had an equivocal result in the F+20 and an obstructive pattern in the F-15. These patients underwent surgical operation. In 3 patients (14.3%), both protocols demonstrated a normal urinary tract. In 2 patients (9.5%), a nonobstructive response in the F+20 and an equivocal result in the F-15 were seen. One of them underwent surgical operation because of impaired kidney function during the follow-up and 1 was treated conservatively. Overall, obstruction was found in 16 out of 21 patients (76.2%) by the F-15 protocol, while it was found in 11 (52.4%) by the F+20 protocol (P = .01). The mean kidney split function was 55.15% ± 7.82% and 54.81% ± 6.87% in F+20 and F-15 protocols, respectively (P = .45).

Introduction: We retrospectively reviewed clinical records of 11 patients with hydatid cyst of the urinary tract admitted to our institution from 1998 to 2005.

Results: The chief complaint was flank pain in 7 patients (63.6%). Hydaturia was not seen in any of our patients. Ten patients had renal involvement and 1 had a retrovesical hydatid cyst. Eosinophilia was detected in 2 of 11 patients who were tested. A positive indirect hemagglutination test was seen in 4 of 7 patients and a positive Casoni test in 1 of 2. Intravenous urography revealed caliceal distortion in 6 patients (54.5%), caliectasis in 3 (27.3%), and nonfunctioning kidney in 2 (18.2%). Ultrasonography showed a complex cyst in all of the patients. Computed tomography demonstrated multivesicular cystic structure in 4 patients (36.4%), complex cyst in 4 (36.4%), and a simple cyst in 3 (27.3%). Definite diagnosis was made only after surgical operation. We performed nephrectomy in 2 patients (18.2%), partial nephrectomy in 2 (18.2%), cystectomy plus marsupialization in 5 (45.4%), and retrovesical surgery in 1 (9.1%). One patient refused surgical treatment. There was no perioperative major complication.

Introduction: Microchimerism has become a familiar term in the past few years. Many groups all over the globe, specializing in a diverse array of basic and medical sciences, have turned their attention to microchimerism, its possible role in disease or repair, and its mechanism of action in the host body. We reviewed the current knowledge about this novel term.

Materials and Methods: We search the PubMed, using all the derivatives of chimera. All papers and their bibliographic information published by December 2005 were reviewed and 61 were selected.

Results: Microchimerism is the presence of foreign or nonhost cells in a body. These are cells that live, differentiate, and persist in the host body by definition. These cells can enter the host body in a variety of manners. The most familiar aspect is microchimerism resulting from organ transplant. For many years now scientists have been debating over the interpretation of this phenomenon. We know that donor cell engraftment in the recipient body is a sign of transplantation success. What this means is that the body has developed tolerance toward the foreign organ and created a chimer.

Conclusion: How long this chimeric state will last, whether these cells will induce or be induced to create a chronic complication in the long run, or will these genetically distinct cell types live peacefully in one body to the end of the host’s  life are the essence of the ongoing discussion and what probes researchers to continue their search.