REVIEW


Purpose: Transmembrane serine protease 2 (TMPRSS2) facilitates SARS-CoV-2 cellular entry. Androgens regulate this protein and may increase the risk of COVID-19. Therefore, androgen deprivation therapy (ADT) may protect patients with prostate cancer from SARS-CoV-2 infection or decrease the severity of the disease. Therefore, we conducted a meta-analysis to study the effect of androgen deprivation therapy (ADT) on COVID-19 in patients with prostate cancer.
Methods: We systematically searched PubMed, Embase, Scopus, and Cochrane databases. All records underwent a two-step screening process to identify the eligible studies. The registered PROSPERO number of this study was CRD42021228398. We evaluated the effect of ADT on the risk of infection, hospitalization, ICU admission, and mortality.
Results: Six studies met inclusion criteria and were evaluated in this study. We performed meta-analysis on four eligible studies. The overall incidence of COVID-19 was 2.65% among patients with prostate cancer receiving ADT. COVID-19 mortality rate was about 22.7% in ADT (+) patients. ADT did not decrease the risk of any of the major outcomes; infection risk (OR= 0.63, 95% CI= 0.27- 1.48, P = 0.29), hospitalization rate (OR= 0.51, 95% CI= 0.10- 2.53, P = 0.41), ICU admission (OR= 1.11, 95% CI= 0.43- 2.90, P = 0.82), and mortality risk (OR= 1.21,
95% CI= 0.34- 4.32, P = 0.77).
Conclusion: We did not observe a protective effect on the risk of infection, hospitalization, ICU admission, and
mortality in patients receiving ADT; therefore, it should not be considered as a prophylactic or treatment for
COVID-19. On the other hand, ADT did not increase the mortality and morbidity of COVID-19 and should be
considered a safe treatment for patients with prostate cancer during the pandemic. Further studies are necessary to confirm our findings.

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


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


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


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

ORIGINAL PAPER (ENDOUROLOGY AND STONE DISEASE)


Purpose: To investigate the preoperative and intraoperative potential risk factors associated with miniaturized
percutaneous nephrolithotomy (mPCNL) fever in the treatment of patients with large renal stones.
Materials and Methods: All patients with renal stones larger than 2.5 cm, who had undergone mPCNL, were
included in the period between April 2018 and September 2019. Logistic regression analyses were performed to
identify clinical variables associated with post-operative fever (>38°C).
Results: A total of 53 patients were enrolled for whom the median maximal stone length was 3.08 cm. 24 (45%)
patients had a fever after mPCNL. Significantly more patients with urine WBC ≥ 27(/HPF) had a fever after surgery (p = 0.004). No significant between-group differences in urine cultures were found for the fever and non-fever groups (p = 0.094). Stepwise and multivariable logistic regression analyses all revealed that urine WBC ≥ 27(/HPF) is the only risk factor for developing post-mPCNL fever. Based on the highest body temperature, all of the patients were assigned into no fever, mild fever (37.5 ≤ Temp < 38.0), and fever groups, and an ordinal logistic regression analysis still supported the premise that the result of urine analysis is strongly associated with post-mPCNL fever.
Conclusion: Large renal stones are challenging to treat and associated with severe complications. Approximately 45% of large renal stone patients treated via mPCNL developed a fever. Urine WBC can easily and directly predict
the risk of fever.

Purpose: Tranexamic acid is a fibrinolysis suppressor that is used for a variety of bleeding control procedures such as hematuria, surgery bleeding, and trauma caused bleeding. The advantages of using the tranexamic acid are bleeding control and less need for blood transfusion.


Materials and Methods:  This double blind clinical trial was conducted on 108 patients in Imam Khomeni Hospital, Urmia, Iran 2013-14. The control and intervention groups consisted of 54 randomly selected participants each. The intervention group received 1gr of intravenous tranexamic acid with initiation of surgery and 500mg orally each 8hrs afterwards up to three days. The control group received placebo capsules containing starch of the same form.


Results: The mean term of hospitalization in the intervention group was significantly shorter than that of the control group (P<0.001). The difference between the two groups in terms of preoperative hemoglobin was not significant. However, the decrease in postoperative hemoglobin, intraoperative hemoglobin count in washing liquid, and hemoglobin count in the intervention group were significantly different from those of the control group (P<0.001).


Conclusion: The findings showed that tranexamic acid decreased bleeding during PCNL and the need for blood transfusion. It also decreased the hospitalization term.

Therapeutic and Preventive Effects of Aqueous Extract of Date Palm (Phoenix dactylifera L.) Pits on Ethylene Glycol-Induced Kidney Calculi in Rats

Pouria Mohammadparast Tabas, Hamed Aramjoo, Ali Yousefinia , Mahmoud Zardast, Mohammad Reza Abedini, Mohammad Malekaneh

Urology Journal, Vol. 18 No. 06 (2021), , Page 612-617
https://doi.org/10.22037/uj.v18i.6530

Introduction: Urinary tract stones are one of the most common diseases in the urinary tract. Lack of kidney stone treatment causes irreparable damages to the kidneys, which has many harmful effects. Date palm pits are recommended in traditional medicine as an effective drug in the treatment of kidney stones. The aim of this study was to investigate the effect of aqueous extract of date palm pits on kidney stones induced by ethylene glycol in male rats.


Methods: In this study, 40 rats were classified into five groups (n = 8), including the healthy group receiving normal water, the negative control group, the therapeutic groups with doses of 150 mg/kg and 300 mg/kg, and the prevention group with a dose of 300 mg/kg. In order to induce kidney stones, ethylene glycolated water (1%) was used as drinking water in the studied groups. Blood and urine of rats were collected on days 14 and 28 of the study to assess urinary parameters of calcium, creatinine, uric acid and phosphorus, and serum parameters of blood urea nitrogen, creatinine, uric acid, calcium, and phosphorus. Also, the kidneys of rats were removed from the body on day 28 of the study and were given to a pathologist for examination.


Results: Results of serum parameters shows that the use of date palm pits extract in the treatment and prevention groups with a dose of 300 mg/kg significantly (P < .05) has reduced the levels of blood urea nitrogen, uric acid, calcium, creatinine and phosphorus. Also, the results of urinary parameters show that the use of the extract caused a significant decrease (P < .05) in creatinine, uric acid and calcium in the prevention group and a significant decrease (P < .05) in creatinine and uric acid in the therapeutic group with a dose of 300 mg/kg. Pathological results show a decrease in the number and size of calcium oxalate crystals in renal tubules in the treatment and prevention groups in a dose-dependent manner.


Conclusion: The results of this study showed that the use of aqueous extract of date palm pits has been effective in the treatment and prevention of kidney stones induced by ethylene glycol in rats.

ORIGINAL PAPER (LAPAROSCOPIC AND ROBOTIC UROLOGY)


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

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

Urology Journal, Vol. 18 No. 06 (2021), , Page 618-622
https://doi.org/10.22037/uj.v18i.6629

Purpose: To compare the treatment outcomes of robotic retroperitoneal lymph node dissection (R-RPLND) versus laparoscopic RPLND (L-RPLND) for clinical stage I non-seminomatous germ cell testicular tumors (NSGCTs).
Materials and Methods: We retrospectively reviewed the data of patients with stage I NSGCTs who underwent
robotic or laparoscopic RPLND between 2008 and 2017. Perioperative data and oncologic outcomes were reviewed and compared between the two groups. Progression-free survival was analyzed using Kaplan-Meier survival curves and compared between two groups.
Results: A total of 31 and 28 patients underwent R-RPLND and L-RPLND respectively. The preoperative characteristics of the patients were comparable in the two groups. Patients in R-RPLND group had significantly shorter median operative time (140 vs. 175 minutes, P < .001), a shorter median duration to surgical drain removal (2 vs. 4 days, P = .002) and a shorter median postoperative hospital stay (5 vs. 6 days, P = .001). There were no statistical differences in intra- and post-operative complication rate between the groups and the oncologic outcomes were similar in the two groups.
Conclusion: In expert hands, R-RPLND and L-RPLND were comparable in oncological parameter and morbidity
rate; R-RPLND showed superiority in operation duration, median days to surgical drain removal and postoperative
hospital stay for stage I NSGCTs. Multicenter and randomized studies with good power of study and sufficient
follow-up duration are required to validate our result.

ORIGINAL PAPER(UROLOGICAL ONCOLOGY)


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

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

Urology Journal, Vol. 18 No. 06 (2021), , Page 623-632
https://doi.org/10.22037/uj.v18i.6254

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


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


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


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

Cytotoxic Effect of Saffron Stigma Aqueous Extract on Human Prostate Cancer and Mouse Fibroblast Cell Lines

Hassan Ahmadnia, Jamshid Tabeshpour, Mehdi Younesi Rostami, Ehsan Mansourian, Alireza Akhavan Rezayat, Azam Brook

Urology Journal, Vol. 18 No. 06 (2021), , Page 633-638
https://doi.org/10.22037/uj.v16i7.6331

Purpose: Several lines of experimental evidence have shown that saffron has anticarcinogenic effects. This study aimed at evaluating the possible anticancer effect of saffron stigma aqueous extract on human prostate cancer (PC3) and mouse fibroblast cells (L929) as non-cancerous control cells.
Materials and Methods: Saffron stigma aqueous extract at concentrations of 100, 200, 400, 600, 800, 1600 and
3200 μg/mL were prepared. PC3 and L929 cells were incubated with different concentrations of saffron extracts
in different time intervals (24, 48, 72, 96 and 144 hours). MTT assay was used for each cell line to investigate the
cytotoxic effect of saffron. Morphological alterations were also observed under light inverted microscope.
Results: In fibroblast cell line after 24 hours, Saffron extract did not affect significantly the normal cells and they were intact in morphologic view. After 96 hours in the cells with highest concentration (1600 μg/mL), cell death and cellular form changes as well as severe granulation was observed. In prostate cell line after 24 hours, the only changes were observed in cells with the concentration of 1600 μg/mL. The cells were granulated and the form of the cells were spherule. After 72 hours, in group with the concentration of 1600 μg/mL, severe granulation was observed and the cell count decreased and some cells were dead.
Conclusion: Saffron aqueous extract has an in vitro inhibitory effect on the proliferation of human prostate cell
and mouse L929 cells which is dose-dependent.

Discrimination of Patients with Prostate Cancer from Healthy Persons Using a Set of Single Nucleotide Polymorphisms

Mir Davood Omrani, Hossein Mohammad-Rahimi, Abbas Basiri, Milad Fallahian, Rezvan Noroozi, Mohammad Taheri, Soudeh Ghafouri-Fard

Urology Journal, Vol. 18 No. 06 (2021), , Page 639-645
https://doi.org/10.22037/uj.v18i.6337

Purpose: Prostate cancer is the second cancer diagnosed in males. It accounts for about 4% of cancer-related
mortality in men. Several genetic polymorphisms in different genes have been identified that alter the risk of this kind of malignancy.
Materials and methods: We used the random forest (RF) algorithm for prediction of prostate cancer risk in Iranian population using 13 different single nucleotide polymorphisms (SNPs) in four genes (ANRIL, HOTAIR, IL-6 and IL-8). The samples were divided into a training set (n=320) and a test set (n=80) to evaluate the generalization power for training algorithm. For hyper-parameters tuning, we used randomized search with 5-fold cross-validation for the following hyper-parameters: (1) Number of trees or estimators in the forest (set from 3 to 500); (2) The maximum number of leaf nodes (set from 2 to 32); (3) The maximum number of features used for the best split (set from 5 to 13); and (4) Using bootstrap samples in the trees building (True or False). Accuracy, sensitivity, specificity, and F1-score in both training and test sets were reported.
Results: The most important SNP was ANRIL-rs1333048: A/A (Gini index= 0.096) followed by ANRIL-
rs10757278: G/G (Gini index= 0.059). Training Dataset Outcomes were as follow: Accuracy: 0.896, Sensitivity:
0.85, Specificity: 0.944 and F1 Score: 0.891. Test Dataset Outcomes were as follow: Accuracy: 0.787,
Sensitivity: 0.775, Specificity: 0.800 and F1 Score: 0.784. The AUC Scores were 0.966 and 0.841 for training and
test datasets, respectively.
Conclusion: The proposed panels of SNPs can predict risk of prostate cancer in Iranian population with appropriate accuracy.

Single Umbilical Stoma for Bilateral Ureterostomy after Radical Cystectomy

Abbas Basiri, Mohammad Hossein Soltani, Nasser Shakhssalim, Hamid Reza Shemshaki, Pouria Rezvani, Milad Bonakdar Hashemi

Urology Journal, Vol. 18 No. 06 (2021), , Page 646-651
https://doi.org/10.22037/uj.v18i.5857

Purpose: Cutaneous ureterostomy after radical cystectomy is less preferred compared with other permanent urinary diversions due to bilateral stomas. Single umbilical stoma for bilateral ureterostomy (SUSBU) may be a
choice, in this study we reviewed the outcomes of SUSBU in seventeen patients who underwent radical cystectomy.
Methods and Materials: This was a case-series study conducted from April 2016 to Dec 2017. Seventeen male
patients with confirmed PT2 bladder urothelial carcinoma who were not suitable for performing conduit or orthotopic urinary diversion, including those with high-risk patients underwent single umbilical stoma for bilateral ureterostomy after radical cystectomy. All patients were prospectively followed up for 24 months ± 2 months, this study was done in a teaching center mainly by senior residents.
Results: The mean age of patients was 68.6 ± 6.41 years. The mean length of operation time was 176.7 ± 15.1 minutes (from intubation to extubation from anesthesia). Sixteen patients were diagnosed with PT2 and one patient had a PT4 diagnosis. The decrease in hemoglobin level after surgery was 1.72 mg/dl ± 0.35 and creatinine increased by 0.15 ± 0.05 mg/dl. None of our patients had oliguria. One case developed constipation and no gas passing, with the suspicion of obstruction, underwent abdominal exploration, however, no obstruction or urine leakage was found and the patient was treated conservatively. One patient developed a fever during admission, in which atelectasis was identified as the cause. One patient underwent a second operation because of fascia dehiscence.
Conclusion: It seems that this technique is suitable for high-risk patients with acceptable operating time, surgical complications, and fast recovery after the operation and one ureterostomy bag instead of two one’s comparing to bilateral cutaneous ureterostomy.

ORIGINAL PAPER (PEDIATRIC UROLOGY)


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

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

Urology Journal, Vol. 18 No. 06 (2021), , Page 652-657
https://doi.org/10.22037/uj.v18i.6574

Purpose: This study aimed to evaluate the outcomes of topical steroid therapy according to potency as the first-line treatment for boys with symptomatic phimosis.
Materials and Methods: From April 2017 to March 2019, we retrospectively reviewed 45 boys with severe phimosis (Kikiros retractability grade 4 or 5) who presented with phimosis-related complications. During the first year of the study period, methylprednisolone aceponate (MPA, Advantan®, potent topical steroid) was administered in 24 boys. Hydrocortisone butyrate (HCB, Bandel®, moderately potent topical steroid) was administered in 21 boys in the subsequent period. Topical steroids were administered for 4–8 weeks in all patients. Success of the therapy was determined by two conditions at 3 months after therapy: achieving Kikiros grade 3 and less with disappearance of symptoms.
Results: Of 45 boys, 35 (77.8%) achieved success of the therapy. Mean age was 46.64±22.42 months. Recurrence
of phimosis with clinical complications was confirmed in three of 35 patients with initial success (8.6%) during the follow-up period. All boys with recurrence showed remission after additional topical steroid therapy. Success rate of the MPA group was higher than that of the HCB group (91.7% and 61.9% respectively, P = .029). Side effects associated with the topical steroid application were not observed in all children.
Conclusion: Topical steroid application is an effective and safe procedure as first-line treatment in symptomatic
boys with severe phimosis. Moreover, the potency of topical steroids for the treatment of phimosis is considered a
factor affecting the success rate.

Extravesical Common Sheath Ureteral Reimplantation Versus Intravesical Techniques for Refluxing Duplex Systems in Children

Hamdy A. Aboutaleb, Tamer A. Abouelgreed, Moamen M. Amin, Mohamed F. Sultan

Urology Journal, Vol. 18 No. 06 (2021), , Page 658-662
https://doi.org/10.22037/uj.v18i.6740

Purpose: Retrospective comparative study of the efficacy of extravesical non-dismembered common sheath ureteral reimplantation (ECSR) versus intravesical common sheath ureteral reimplantation (ICSR) techniques for the correction of vesicoureteral reflux (VUR) in complete duplex systems.
Material and Methods: Between 2010 and 2019, ECSR was performed in 38 children (8 bilaterally), and the
mean ages at presentation and at surgery were 31 and 57 months, respectively. The ICSR technique was performed in 25 units (25 patients). Voiding cystography and ultrasound of the kidney and bladder were performed 3 and 12 months postoperatively. We analyzed the surgical outcomes for both groups.
Results: The mean follow-up times for the ECSR and ICSR groups were 15 and 18 months, respectively. The
success rate of the ECSR group was 93.5% at 3 months, improving to 95.7% at an average of one year; the rate of the ICSR group was 96% at 3 months and was the same after one year, with no significant difference between the two groups (p = .66). Postoperative complications were compared in the ECSR and ICSR groups: transient contralateral VUR was seen in 5 renal units versus 4, de novo hydronephrosis was seen in 3 units versus 2, and UTIs were observed in 3 patients versus 4.
Conclusion: Both (ECSR) and (ICSR) surgeries are highly successful for the correction of VUR in uncomplicated
complete duplex systems. The results of the extravesical approach are comparable with those of the intravesical
technique with less morbidity and a shorter hospital stay. Thus, ECSR is our preferred technique when open
surgical repair is indicated. ICSR should be reserved for complicated duplex systems necessitating concomitant
reconstructive surgery.

ORIGINAL PAPER (RECONSTRUCTIVE SURGERY)


Is there a Difference in Platelet-Rich Plasma Application Method and Frequency to Protect Against Urethral Stricture?

Arif Aydin, Mehmet Giray Sonmez, Pembe Oltulu, Rahim Kocabas, Leyla Ozturk Sonmez, Hakan Hakki Taskapu, Mehmet Balasar

Urology Journal, Vol. 18 No. 06 (2021), , Page 663-669
https://doi.org/10.22037/uj.v16i7.6100

Purpose: To determine the efficacy of instillation frequency and submucosal injection of platelet-rich plasma
(PRP) after urethral trauma to prevent urethral inflammation and spongiofibrosis.
Materials and Methods: Sixty-five rats were used in the study; 50 rats were randomized into 5 groups with 10
rats in each group and 15 rats were allocated for PRP preparation. The urethras of all rats were traumatized with a pediatric urethrotome knife at 6 and 12 o’clock positions, except in the sham group. Group 1 was the sham group and had only urethral catheterization daily for 15 days, Group 2 was given 0.9% saline (physiologic saline [(UI+PS]) once a day after urethral injury (UI+ PS), Group 3 was injected with PRP submucosally after urethral injury, Group 4 was given PRP once a day as intraurethral instillation using a 22 Ga catheter sheath with urethral injury, and Group 5 was given PRP twice a day as intraurethral instillation using a 22 Ga catheter sheath with urethral injury. Each administration of PRP was administered as 300 million platelets/150 microliters. On day 15, the penises of the rats were degloved to perform penectomy. Histopathologic evaluation was made for spongiofibrosis, inflammation, and congestion in vascular structures.
Results: When the sham group, UI+PS, UI+PRPx1, UI+PRPx2 and UI+PRPs groups are compared in total, there
were significant differences identified for parameters other than edema. When the UI+PS, UI+PRPx1, UI+PRPx2
and UI+PRPs groups are compared, the UI+PS group was observed to have significantly more inflammation (mucosal inf. 2.42 ± 0.53) and spongiofibrosis (2.42 ± 0.53). All the PRP groups were identified to have significantly less mucosal inflammation (UI+PRPs 1 ± 0, UI + PRPx1; 1.4 ± 0.51, PRPx2; 1.33 ± 0.5) and spongiofibrosis (UI+PRPs; 1.57 ± 0.53, PRPx1; 1.2 ± 0.42, PRPx2; 1.55 ± 0.52). The group with the lowest spongiofibrosis was the PRPx1 group.
Conclusion: This study showed that PRP significantly reduced mucosal inflammation and spongiofibrosis, independent of the administration route, when applied to the urethra after urethral trauma.

ORIGINAL PAPER (FEMALE UROLOGY)


Purpose: To evaluate the ability of bacterial scatter diagrams generated from the automated urine particle analyzer (UF-1000i, Sysmex, Kobe, Japan) to pre-estimate the treatment efficacy of oral cefalexin in treating women with uncomplicated urinary tract infection (uUTI).
Materials and Methods: Over 3 years, women 20-80 years old with symptoms suggestive of uUTI (Urinary Tract Infection Symptoms Assessment symptom score, ,UTISA > 3) and bacteriuria (bacterial count ≥ 100/uL) were enrolled. After informed consent, patients took cephalexin 500mg 4 times/day for 7 days. The voided urine specimens were classified into rods or cocci/mixed group automatically through the built-in software of the UF1000i. Patients were followed up with UTISA on the 3rd day after treatment and returned to the clinic on the 7th day and followed for additional UTISA and urine analysis. Symptom and laboratory improvement were defined as UTISA < 4 and bacterial count < 100/uL, respectively, on the 7th day.
Results: Of 99 women (age: 49.91 ±15.32 years) eligible for analysis, 80 were classified as having urine that contained rods and 19 as cocci/mixed. Symptom improvement was observed in 62 women in the rods group and 11 women in the cocci/mixed group (p = 0.08). Laboratory improvement was noted in 64 women in the rods group and 10 women in the cocci/mixed group (p = 0.01). On day 7, treatment success with both symptom and laboratory improvement was more observed in rods than in cocci/mixed group (61.3% vs. 26.3%, p < 0.01).
Conclusion: The automatic urine particle analyzer can pre-estimate the treatment response of antibiotics in women with uUTI.

ORIGINAL PAPER (ANDROLOGY)


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

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

Urology Journal, Vol. 18 No. 06 (2021), , Page 675-681
https://doi.org/10.22037/uj.v18i.6503

Purpose: The prevalence of erectile dysfunction in men is increasing. As well, the prevalence of diabetes, as one of the causes of sexual dysfunction, is rising in many countries. Due to the failure of common therapies in some patients with sexual dysfunction, it is necessary to develop an effective alternative treatment, such as stem cell therapy, for this problem.
Materials and Methods: In this randomized single-blinded clinical trial, 20 diabetic patients with erectile dysfunction, who were resistant to common treatments, were selected and divided into two groups of intervention and control (n=10 per group). Autologous mesenchymal stem cells (MSCs) were extracted from oral mucosa and then infused via intracavernosal injection (50-60 ×106 cells) to the participants of the intervention group. Normal saline was injected in the control group. The patients were followed up with the International Index of Erectile Function (IIEF5) questionnaire, as well as color Doppler duplex ultrasound. Peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) were determined three and six months after the interventions.
Results: The mean IIEF5 scores in the intervention group were 7.2 ± 2.1, 9.2 ± 3.4, and 10.6 ± 4.7 before, three months, and six months after the injection, respectively, showing a significant ascending trend (P = 0.01). Comparing the intervention and control groups, there was a significant difference in the IIEF5 score change during six months after the injection (P = 0.02). Regarding the PSV and RI of penis vessels, there were no statistically significant differences between the two groups. However, these parameters showed upward and improving trends in the intervention group.
Conclusion: Intracavernosal injection of stem cells improved sexual function and PSV and RI indices of penile arteries in diabetic patients.

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

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

Urology Journal, Vol. 18 No. 06 (2021), , Page 682-687
https://doi.org/10.22037/uj.v18i.6515

Purpose: To investigate the effect of short abstinence on sperm function tests and semen parameters.
Materials and methods: This prospective study included 65 male patients with increased DNA injury in their
ejaculated sperm and a history of recurrent pregnancy loss and/or assisted reproductive techniques failures. The effects of antioxidants medical therapy and short abstinence on semen quality were assessed (TUNEL test and CMA3 staining).
Results: Antioxidants have statistically significant effects on mean sperm concentration (untreated, 67.51 ± 44.40 million/ml, vs. treated, 56.09 ± 37.85 million/ml; P-value=0.005) and mean TUNEL score (untreated, 24.56% ± 9.49%, vs. treated, 20.64% ± 10.28%; P-value = 0.013). Moreover, a short abstinence period might have positive effects as shown on the TUNEL assay (20.64% ± 10.28 vs. 17.38% ± 8.59 ; P-value = 0.028) and CMA3 staining (47.79% ± 20.78, vs. short 41.92% ± 18.49; P-value = 0.019), when considering all study subjects. However, different results were obtained using more precise analysis based on a TUNEL cutoff score of 20%. The analysis showed that short abstinence might improve sperm DNA integrity in patients with TUNEL score > 20% (mean TUNEL score from 27.85% ± 8.32% to 19.14% ± 8.90% ; P-value =0.001%). However, it might have deleterious effects on sperm DNA integrity in patients with TUNEL score < 20% (mean TUNEL score from 11.89% ± 3.21% to 15.17% ± 7.79%; P-value = 0.045%)
Conclusion: Our results showed that short abstinence may not be beneficial in all infertile males, and it should
only be used in selected patients with abnormal DNA integrity.

UNCLASSIFIED


Purpose: Obturator nerve reflex is the surgery treatment side effect in patients with bladder cancers. This study
was run to determine the obturator nerve reflex by Thulium laser versus monopolar Transurethral Resection of
Bladder Tumors (TURBT).
Materials and methods: After receiving the approval code IRCT20190624043991N4, one hundred and eightynine patients with bladder tumors from 2010 to 2016 were assessed, and among them, 35 patients were randomly assigned into two groups in a blinded manner; the first group (16 patients) received thulium laser and the second group (19 patients) were patients undergoing monopolar transurethral resection of bladder tumor after spinal analgesia. Clinical data, including different variables such as; age, tumor characteristics, gender, operation duration, types of leg jerking, and intraoperative complications, were recorded. The site of the obturator nerve was determined by nerve stimulation, anatomical landmarks, and ultrasonography. Leg jerking was compared in both groups.
Results: Of the 35 patients, 28 cases were male, and 7 points were female. The mean ± SD (range) of age was 62.0 ± 6.9 (40-75) years in the Thulium laser group and 64.0 ± 7.1 (41-77) years in the monopolar TURBT group. The mean operation time was not different between the two groups significantly (P > 0.05). Leg jerking was reported in 25% and 63.1% of the patients in Thulium laser and monopolar TURBT groups, respectively (P < 0.05).
Conclusion: Thulium laser is a more feasible and effective method to prevent leg jerking in patients with bladder cancer; so, it is recommended more than monopolar Transurethral.

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

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

Urology Journal, Vol. 18 No. 06 (2021), , Page 693-698
https://doi.org/10.22037/uj.v18i.6489

Purpose: Greenlight laser is a mini-invasive technique used to treat Benign Prostatic Obstruction (BPO). Some of the advantages of GreenLight photoselective vaporization (PVP) are shorter catheterization time and hospital stay compared to TURP. Post-operative acute urinary retention (pAUR) leads to patients' discomfort, prolonged hospital stay and increased health care costs. We analyzed risk factors for urinary retention after GreenLight laser PVP.
Materials and Methods: In a multicenter experience, we retrospectively analyzed the onset of early and late
post-operative acute urinary retention in patients undergoing standard or anatomical PVP. The pre-, intra- and
post-operative characteristics were compared betweene patients who started to void and the patients who developed post-operative urinary retention.
Results: The study included 434 patients suitable for the study. Post-operative acute urinary retention occurred in 39 (9%). Patients with a lower prostate volume (P < .001), an adenoma volume lower than 40 mL (P < .001), and lower lasing time (P = .013) had a higher probability to develop pAUR at the univariate analysis. The multivariate logistic regression confirmed that lower lasing time (95% CI: 0.86-0.99, OR = 0.93, P = .046) and adenoma volume (95% CI: 0.89–0.98, OR = 0.94, P = .006) are correlated to pAUR. Furthermore IPSS ≥ 19 (95% CI: 1.19- 10.75, OR = 2.27, P = .023) and treatment with 5-ARI (95% CI: 1.05-15.03, OR = 3.98, P = .042) are risk factors
for pAUR.
Conclusion: In our series, post-operative acute urinary retention was related to low adenoma volume and lasing time, pre-operative IPSS ≥ 19 and 5-ARI intake. These data should be considered in deciding the best timing for urethral catheters removal.

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

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

Urology Journal, Vol. 18 No. 06 (2021), , Page 699-702
https://doi.org/10.22037/uj.v18i.6843

Purpose: To evaluate the short-term results of water vapor therapy (Rezūm) for BPH/LUTS in the first cohort of
Czech patients.
Materials and methods: Patients with BPH and moderate to severe LUTS (N = 76) who underwent Rezūm
treatment from December 2019 to July 2020 were included in the prospective study. Prior to the procedure, they
completed the IPSS and OABv8 questionnaires and underwent uroflowmetry, transrectal ultrasound of the prostate, and PSA sampling. The parameters before and 3 months after the procedure were compared and statistically evaluated.
Results: The study protocol was completed by 92% of patients (N = 70). We observed a significant increase in
Qmax (median 17.7 vs. 8.8 mL/s, P < .001), Qave (9 vs. 4.5 mL/s, P = .001) and voided volume (241 vs. 171 mL,
P < .001) and a significant reduction in post-void residual (average 17.5 vs. 67.7 mL), prostate volume (39.3 vs.
62.3 mL) and total PSA (median 1.9 vs. 2.5 ng/mL, resp. P values < .001). There was also a significant decrease in
OABv8 score (average 7.6 vs. 16.6, P < .001) and IPSS QoL (1.6 vs. 4.0, P = .037). The improvement in the IPSS
score was apparent, yet statistically insignificant (6.8 vs. 16, P = .079).
Conclusion: Water vapor therapy is an effective and safe method of BPH/LUTS treatment in the short-term.

CASE REPORT


Off Clamping Laparoscopic Resection of An Extreme Rare Renal Mesenchymal Tumor: An Angiomyolipoma of Renal Capsule

Nasser Simforoosh, Milad Bonakdar Hashemi , Arsalan Aslani, Sahand Mohammadzadeh

Urology Journal, Vol. 18 No. 06 (2021), , Page 703-705
https://doi.org/10.22037/uj.v18i.6512

Renal mesenchymal tumors are described as neoplasms with vascular, fibrous, and adipose tissues. The renal
lipoma is an extremely rare renal mesenchymal tumor, typically originating from renal capsule and it is usually
presented as well circumscribed homogenous fat containing mass. Angiomyolipoma (AML) is the most common benign mesenchymal renal tumor which is composed of mature epithelioid cells. The renal AML usually presented as exophytic, non-infiltrative, and fat contain tumor. The well differentiated renal retroperitoneal liposarcoma and lipoma seem to be misdiagnosed by exophytic renal angiomyolipoma but the renal AML usually arises from renal parenchyma with characteristic images. A 37-year-old woman came to our clinic with rapid growth renal mass and pain. The spiral abdominopelvic computed tomography scan (CT-scan) showed well-circumscribed hypoheterodense fat-containing mass near to middle pole of the right kidney with minimal fat stranding without neovascularity and cortical defect. The Patient underwent off-clamping laparoscopic resection of renal mass with pre-operative impression: liposarcoma versus lipoma of the kidney. The cross-section of the surgical specimen revealed irregular lobulated fatty tissue with hemorrhagic streaks. Definite diagnosis was made by immunohistochemistry study. Spindle cells and epithelioid cells are diffusely and strongly positive for α-smooth muscle actin. The perivascular cells and epithelioid cells are positive for HMB-45 and Melanin. The immunostaining pattern was compatible with angiomyolipoma that originated from renal capsule. In our experience, a rapid growing mass that is accompanied by pain draws the attention to malignant process. The renal AML rarely arises from renal capsule without characteristic images so having high doubt may lead to proper pre-operative diagnosis.