ISSN: 1735-1308

Instant 2022

REVIEW


Alternative Medical Interventions Versus Conventional Treatment of Renal Colic: An Updated Systematic Review and Network Meta-Analysis

Ghazal Seghatoleslami, Mohammad Sadegh Sanie Jahromi, Roohie Farzaneh, Sara Rahsepar, Mehrdad Malekshoar, Majid Vatankhah, Reza Akhavan, Bita Abbasi, Hossein Akhavan, Samaneh Abiri, Lohrasb Taheri, Navid Kalani, Mahdi Foroughian, Arman Hakemi

Urology Journal, , , Page 7204
https://doi.org/10.22037/uj.v19i.7204

Purpose: To systematically review the recent alternative medical interventions on renal colic pain and compare their efficiency with conventional treatments.


Materials and Methods: This was a systematic review and network meta-analysis (NMA) study, based on the PRISMA guidelines on online databases of PubMed, Scopus, and web of science. We quarried these databases with relevant keywords for clinical trial studies that aimed at reducing renal colic pain in patients refereeing to the ED from after January 2011 to February 2022. Randomized clinical trials that used the Visual Analogue Scale (VAS) for assessment of the renal colic pain before and after medical interventions on adult patients were included in this study. NMA was conducted based on the continuous values of the mean difference of the pain after 30 and 60 minutes of the medication administration.


Results: Twenty-four studies that were meeting the inclusion criteria were included in our review with 2724 adult participants who were mostly male. Study arms included conventional medications (NSAID, Opioid, paracetamol), ketamine, MgSo4, desmopressin, and lidocaine.  Based on the qualitative synthesis, ten studies (41.7%) did not find significant differences between conventional and alternative treatments. Also, there is no agreement on some more recent medications like using ketamine or desmopressin while MgSO4 and lidocaine use are supported by most studies.  NMA revealed that desmopressin is significantly having worse pain reduction properties. NMA did not show any difference between ketamine, lidocaine, and MgSo4, versus the conventional treatment.


Conclusion:  To conclude, lidocaine and MgSo4 might be good alternative treatments for renal colic when conventional treatments are contraindicated or pain is not responding to those. Ketamine might be indicated in patient-based circumstances. Desmopressin may be agreeably avoided in further research or clinics.  

ORIGINAL PAPER (ENDOUROLOGY AND STONE DISEASE)


A Safe and Effective Two-Step Tract Dilation Technique in Totally Ultrasound-Guided Percutaneous Nephrolithotomy

Shao-Wei Dong, Su-Wei Hu, Shih-Ping Liu, Chia-Chang Wu, Chu-Tung Lin, Kuan-Chou Chen, Chen-Hsun Ho

Urology Journal, , , Page 7205
https://doi.org/10.22037/uj.v19i.7205

Purpose: To evaluate the safety and the efficacy of a radiation-free 2-step tract dilation technique in totally ultrasound-guided percutaneous nephrolithotomy (PCNL).


Materials and Methods: From Oct 2018 to Mar 2020, we prospectively and consecutively enrolled 18 patients with 19 kidney units with urolithiasis. The nephrostomy tract was established by the following four steps: 1) ultrasound-guided renal puncture, 2) first-stage serial dilation to 16 Fr with Amplatz dilators, 3) check and adjustment of the partially dilated tract with a ureteroscope, 4) second-stage dilation with a 24-Fr balloon dilator.


Results: The median age was 62.0 [IQR 11.0] years, and 11 (61.1%) were male. The median stone size was 3.3 [3.6] cm2, and stone laterality was almost equal over both sides. Successful tract establishment on the first attempt without fluoroscopy was achieved in 18 (94.7%) operations. The median tract establishment time was 10.4 [4.9] mins, and the median operation time was 67.0 [52.2] mins. The median hemoglobin drop was 1.0 [1.1] g/dL, and none required blood transfusion. Three (15.8%) developed fever. Pleural injury occurred in two (10.5%) operations (both had supracostal puncture), and one required drainage with pigtail. Stone-free status was achieved in 15 (77.8%) operations at 3 months postoperatively.


Conclusions: Herein we present a radiation-free 2-step tract dilation technique, which is characterized by ureteroscopic check of the partially dilated tract in between the first dilation with serial fascial dilators and the second dilation with balloon. Our data suggest that it is a safe and effective method.

Risk factors for Infectious Complications of Ureteroscopy after Obstructive Acute Pyelonephritis

Katsuhiro Ito, Toshifumi Takahashi, Shinya Somiya, Toru Kanno, Yoshihito Higashi, Hitoshi Yamada

Urology Journal, , , Page 7241
https://doi.org/10.22037/uj.v19i.7241

Objectives: To identify risk factors for infectious complication of ureteroscopy after obstructive acute pyelonephritis (OAPN).


Patients and Methods: This single-center, retrospective cohort study (#20200002, retrospectively registered in February 1st, 2020) included patients who underwent emergency drainage for OAPN and subsequently underwent ureteroscopic stone removal between January 2006 and December 2020. Multivariable analysis was conducted using demographic and stone-related factors to determine those that could predict postoperative febrile urinary tract infection (UTI).


Results: Overall, 432 patients underwent ureteroscopy after OAPN. The stone-free rate was 84.3%, whereas the overall and major complication rates were 17.6% and 3.2%, respectively. A total of 70 (16.2%) patient developed febrile UTI, among whom 34 (7.9%) and 11 (2.5%) developed sepsis and severe sepsis, respectively. Multivariable analysis identified diabetes mellitus [odds ratio (OR) 1.98, 95% confidence interval (CI) 1.05–3.74], duration from drainage to surgery >1 month (OR 2.28, 95% CI 1.20–4.74), and simultaneous retrograde intrarenal surgery (OR 2.96, 95% CI 1.35–6.48) as significant risk factors for UTI. After dividing patients into low- (0), intermediate- (1), and high- (2–3) risk groups according to the number of factors they had, the risk of postoperative UTI was 6.3%, 14.5%, and 27.7%, respectively (p for trend <0.001).


Conclusions: Patients who underwent ureteroscopy after OAPN were at risk for postoperative UTI, despite its efficacy. Simultaneous retrograde intrarenal surgery should be carefully planned, especially for patients with diabetes mellitus or extended surgery wait times.

Purpose: To evaluate risk factors and outcomes of Pulmonary Complications (PCs) in Percutaneous Nephrolithotomy (PCNL) under Spinal anesthesia (SA).


Material and method: 286 patients who underwent PCNL under SA between 2017 and 2021 were identified retrospectively and divided into group 1 (clinically significant PCs) and group 2 (no clinically significant PCs). Demographic, preoperative, and intraoperative variables and postoperative outcomes were compared between both groups. Independent risk factors for PCs were evaluated by univariable and multivariable logistic regression analyses.


Results: PCs were noted in 90 patients (31.5%). Advanced age (P = .011), high body mass index (BMI) (P < .001) and the presence of chronic obstructive pulmonary disease (COPD) (P < .001) were risk factors for PCs.


Conclusion: SA is an effective method of anesthesia for all PCNL patients and carries a lower rate of PCNL-associated PCs. Risk factors for PCs after PCNL were advanced age, obesity, and preoperative COPD.


 

Purpose: To investigate the impact of learning curve (LC) on flexible ureterorenoscopy (f-URS).


Methods: Patients who underwent kidney stone surgery in urology clinic from tertiary health care institution with f-URS were enrolled in the study. Patient characteristics, the properties of kidney and kidney stones were recorded. Also, f-URS-related parameters, hospitalization time, success of procedure and complications were noted. Patients were categorized equally into 4 groups, as the first 20 f-URS cases in Group 1, and the last 20 f-URS cases in Group 4. Groups were compared according to patient preoperative parameters, intraoperative outcomes, success rate and complication rate.


Results: Time from the induction of anaesthesia to insertion of flexible ureterorenoscope was 18.6 min in group 1 and 17.2 min in group 2; then it significantly decreased to 15.0 min for cases 40 through 60 and 12.4 min for cases 60 through 80 (p=0.001). Operation time in group 3 and group 4 was significantly shorter then group 1 and group 2 (p=0.001). Also, fluoroscopy time was significantly longer in group 1 (82.9 second) and reached a plateau in group 3 (50.3 second) and group 4 (41.7 second) (p=0.001). Additionally, after the 20th case, we achieved significantly higher success rate in comparison to the first 20 cases (65% in group 1, 85% in group 2, 85% in group 3 and 90% in group 4, p=0.001).


Conclusion: Flexible ureterorenoscopy is a surgery that requires high technique and experience. The present study found that success of f-URS reached satisfactory levels after 20th cases. In addition, 40 cases may be enough for surgical proficiency regarding decreases in preparation time, operation time and fluoroscopy time.

ORIGINAL PAPER(UROLOGICAL ONCOLOGY)


Purpose: This study aimed to examine whether preoperative Prostate Imaging Reporting and Data System v2 (PI-RADS v2) can predict pathological extracapsular extension (EPE) after radical prostatectomy. We also studied the preoperative factors which can predict EPE.


Materials and Methods: In our institute, 294 patients underwent robot assisted radical prostatectomy (RARP) between December 2012 and August 2016. In this era, we performed MRI after biopsy to determine clinical stage before surgery. PI-RADS v2 scores were retrospectively reviewed using biparametric MRI and EPE in pathological mapping of resected specimens for each lobe.


Results: In the excised specimen, EPE was observed in 73 lobes (12%). The percentage of EPE by PI-RADS v2 score was score ‘1’: 6% (17/297 lobes), ‘2’: 3% (1/33 lobes), ‘3’: 12% (8/67 lobes), ‘4’: 19% (27/139 lobes), and ‘5’: 38% (20/52 lobes). The higher the PI-RADS score, the higher the percentage of EPE (P <0.01). When classified as PI-RADS score ≥4 and <4, the positive predictive value (PPV) was 24.6% (47/191 lobes, 95%CI: 0.187 – 0.313) and negative predictive value (NPV) was 93.5% (371/397 lobes, 95%CI: 0.906 – 0.957). By multivariate analysis, positive biopsy core percentage ≥60%, and PI-RADS score ≥4 were independent factors for predicting EPE. The positive rate of EPE in lobes with zero, one and two factors (PI-RADS ≥4 and positive biopsy core percentage ≥60%) was 4%, 19%, and 38%, respectively.


Conclusion: PPV and NPV of PI-RADS ≥4 for predicting pathologic EPE were 24.6% and 93.5%, respectively. PI-RADS ≥4 and positive biopsy core percentage ≥60% were independent risk factors for predicting EPE. The positive rate of EPE in lobes with zero, one and two factors (PI-RADS ≥4 and positive biopsy core percentage ≥60%) was 4%, 19%, and 38%, respectively.

Purpose: To investigate the potential relationship between differential gene expression, biological function enrichment and disease prognosis affecting the sensitivity of prostate cancer radiotherapy by bioinformatics analysis.


Materials and Methods: Retrieve and obtain data on differential gene expression of prostate cancer radiosensitivity in the GEO database (GSM3954350, GSM3954351, GSM3954352), GER2 tool to screen and analyze the differential genes, Enrichr database for enrichment analysis of GO and KEGG, use Cytoscape software builds protein-protein interaction (PPI) networks and analyzes key genes.


Results: A total of 7043 differentially expressed genes were screenedout, including 3842 high expression genes and 3199 low expressed genes. The top 20 differentially expressed genes were selected for further analysis. Their biological functions are mainly enriched in the following aspects:“Cell communication” and “Signal transduction”; cytological components are mainlylocated outside the cell; molecular functions are enriched in structural molecular activity, receptor binding, serine-like peptidase activity, etc. The KEGG enrichmentanalysisshowedthat the differentially expressed genes were mainly enriched in the mismatch repair pathway, non-homologous terminal binding pathway and so on.Survival analysis showed that VGF gene was associated with the prognosis of prostate cancer patients receiving radiotherapy, and high expression of VGF significantly reduced progression-free survival(PFS) in these patients(HR=4.84, 95% CI: 1.34-17.5, P= .016).


 


Conclusion:This study identified key genes associated with radiation sensitivity in prostate cancer and verified the relationship between the VGF gene and patient prognosis

Intravesical Gemcitabine versus Intravesical Bacillus Calmette-Guerin for the Treatment of Intermediate-Risk Non-Muscle Invasive Bladder Cancer: A Randomized Controlled Trial

Anahita Ansari Djafari, Babak Javanmard, Mohammadreza Razzaghi, Seyyed Ali Hojjati, Zahra Razzaghi, Saba Faraji, Amirhossein Rahavian, Maryam Garoosi

Urology Journal, , , Page 7194
https://doi.org/10.22037/uj.v19i.7194

Purpose: The most common adjuvant therapy known for non-invasive muscle bladder cancer (NMIBC) is intravesical Bacillus Calmette-Guerin (BCG). Intravesical chemotherapy drugs like gemcitabine can also be used post-TURBT, which is considered as a good alternative for BCG, or can be used as a second-line treatment. Due to the common side effects of BCG, the use of chemotherapy drugs as intravesical treatments is currently increasing.


Materials and Methods: 117 intermediate-risk NMIBC cases were included in this study. All the patients underwent TURBT surgery and received 1 gr intravesical gemcitabine immediately after performing the surgery. The patients were then divided into two groups, either receiving intravesical gemcitabine or intravesical BCG weekly for 6 weeks. The patients were followed up with cystoscopy.


Results: Most patients were men who had smoking risk factors. The youngest patient was 36 years old and the oldest one was 88 years old. The rate of side effects in the group receiving gemcitabine (13.6%) was much lower than the group receiving BCG (44.8%). (P-value = 0.016). The recurrence rate during a one year period was lower in the group consisting of patients receiving gemcitabine compared to the group receiving BCG (19 patients vs. 23 patients) (p-value = 0.401)


Conclusion: The efficacy of intravesical gemcitabine and intravesical BCG was almost equal in the treatment of intermediate-risk NMIBCs. The adverse effects of gemcitabine were found to be significantly lower than BCG. Due to causing fewer complications, gemcitabine can be known as a good alternative, especially among elderly patients with comorbidities.

Oncological Outcomes of Patients with Non-Clear Cell Renal Cell Cancers: Subtypes of Unclassified and Translocation Renal Cell Cancers

Fatih Gokalp, Serdar Celik, Tevfik Sinan Sozen, Abdurrahim Haluk Ozen, Guven Aslan, Volkan Izol, Sumer Baltaci, Talha Muezzinoglu, Bulent Akdogan, Evren Suer, Ilker Tinay

Urology Journal, , , Page 7091
https://doi.org/10.22037/uj.v19i.7091

Purpose: We aimed compare oncological outcomes in the two rare subtypes, unclassified renal cell cancer (unRCC) and translocation RCC (tRCC), vs clear cell RCC (ccRCC).


Materials and Methods: Between 2004 and 2019, from Turkish Urooncology Society Database, we identified 2324 patients for histological subtypes including 80 unRCC (3.4%), 19 tRCC (0.8%) and 2225 ccRCC (95.8%).


Results: The overall (15.8%) and cancer-specific mortalities (11.1%) were found to be higher in tRCC group and the recurrence free mortality (13.8%) was found to be higher in unRCC group. Larger pathological tumor size (p=0.012) and advanced pathological T stage (p=0.042) were independent predictive factors on overall mortality in patients with unRCC tumors.


Conclusion : The oncological outcomes of the unRCC and tRCC are worse than ccRCC and pathological tumor size and pathological stage are predictive factors for mortality in the unRCC.

Purpose: This study aimed to evaluate the predictive factors for perioperative and long-term renal functions after nephron-sparing surgery (NSS).


Materials and Methods: The clinical records of 379 patients who underwent NSS for a single renal tumor with a normal contralateral kidney between 2009 and 2016 were retrospectively analyzed. After surgery, the occurrence of acute kidney injury (AKI) within 7 days and the progression of chronic kidney disease (CKD) 5 years later were assessed using serum creatinine (S-Cr) levels. Perioperative AKI was defined as an increase in the S-Cr level by ≥ 0.3 mg/dL or 1.5–1.9 times the baseline value. CKD was defined as the estimated glomerular filtration rate (eGFR) decreasing from > 60 mL/min/1.73 m2 to < 60 mL/min/1.73 m2.


Results: Changes in the eGFR were assessed during 5 years after surgery. Among 379 patients, 81 (21.4%) patients presented diabetes mellitus (DM), and 30 (7.92%) experienced uncontrolled DM. The AKI occurrence and CKD progression were observed in 50 (13.2%) patients and 79 (20.8%) patients, respectively. Multivariable analyses revealed that female gender (95% confidence interval [CI]: 0.16–0.91, odds ratio [OR] = 0.39, P = 0.029), uncontrolled DM (95% CI: 1.05–6.60, OR = 2.63, P = 0.039), and intermediate NePhRO score (95% CI: 1.07–3.80, OR = 2.02, P = 0.03) were associated with perioperative AKI. In addition, old age (95% CI: 1.10–1.18, OR = 1.14, P < 0.001) and uncontrolled DM (95% CI: 1.84–11.4, OR = 4.57, P = 0.001) were associated with long-term CKD progression.


Conclusion: Uncontrolled DM is the only predictive factor for perioperative and long-term renal functions after nephron-sparing surgery.

Purpose: The study is intended to identify the independent predictors of clinical T1 (cT1) renal cell carcinoma upstaging to pathological T3a (pT3a) and construct the predictive nomogram model.


Methods: The data of cT1 renal cell carcinoma was collected from patients who were treated in the Second Hospital of Tianjin Medical University from January 2010 to December 2016. Mann–Whitney U and chi-square tests were performed to analyze continuous and categorical variables respectively. Univariate and multivariate logistic regression were used to identify the predictors of upstaging. Kaplan-Meier method, log-rank test and Cox regression were performed to analyze survival materials.


Results: Among 1,376 cT1 renal cell carcinoma patients, 75 patients were observed upstaging to pT3a, accounting for 5.5%. There were 6 potential predictors of upstaging, i.e age, clinical symptom, tumor size, Fuhrman grade, tumor necrosis and tumor edge regularity. The 5-year recurrence free survival probabilities of upstaging and non-upstaging patients were 73.3% and 91.1%, respectively and upstaging was an independent predictor of recurrence free survival. Two predictive nomograms were constructed and the C-index of them were 0.842 and 0.806, and the calibration curve and decision curve analysis showed highly clinical accuracy of the nomograms.


Conclusion: Two nomogram models were built to predict the probability of cT1 renal cell carcinoma upstaging to pT3a with highly accuracy and specificity. Upstaging was an independent risk factor of recurrence free survival for cT1 renal cell carcinoma patients.

ORIGINAL PAPER (LAPAROSCOPIC AND ROBOTIC UROLOGY)


A A Multicenter, Prospective, Non-randomized Study Evaluating Surgical hand Preparation between Double-Gloving and Single-Gloving for Preventing Postoperative Infection in Robotic and Laparoscopic Minimally Invasive Surgeries

Takashi Nagai, Kazumi Taguchi, Teruki Isobe, Nayuka Matsuyama, Tatsuya Hattori, Rei Unno, Taiki Kato, Toshiki Etani, Takashi Hamakawa, Yasuhiro Fujii, Yosuke Ikegami, Hiroyuki Kamiya, Shuzo Hamamoto, Akihiro Nakane, Ryosuke Ando, Tetsuji Maruyama, Atsushi Okada, Noriyasu Kawai, Takahiro Yasui

Purpose: This study aimed to analyze a feasible and suitable surgical precautionary preparatory technique. The techniques of double-gloving with hygienic hand wash (DH) and single-gloving with surgical hand wash (SS) were compared for their ability to prevent postoperative infection in robotic and laparoscopic minimally invasive surgeries.


Materials and Methods: A prospective, non-randomized, multicenter study was conducted between January 2016 and June 2020. We divided the robotic and laparoscopic cases into two groups: DH and SS. Data on infectious outcomes were collected. Propensity score matching was performed to control for operative characteristics between the two groups. The primary endpoint was the presence of fever and surgical site infections (SSIs) indicating postoperative infection.


Results: Among four medical centers, seven surgeons were allocated to either the DH or the SS group. A total of 221 and 251 patients underwent DH and SS, respectively. Propensity score matching, which included 171 cases from each group, showed that the incidence of fever during hospitalization was significantly lower in the DH group than that in the SS group (11.7% vs. 23.4%, p=0.007). Multivariable analysis revealed that DH was associated with a reduced odds ratio for developing postoperative fever during hospitalization (risk ratio: 0.49, p=0.043). No differences were found in SSI before and after hospitalization between the two groups.


Conclusion: DH resulted in less postoperative fever and had a comparable effect in preventing SSIs. This procedure could be an alternative to the SS protocol in some minimally invasive surgeries.

Laparoscopic vs Open Extravesical Ureteral Reimplantation in Pediatric Population: A Single-Center Experience

David Fernández-Alcaráz, José Iván Robles-Torres, Carlos García-Hernández, Andrés Heriberto Guillén-Lozoya, Sergio Landa-Juárez

Urology Journal, , , Page 7217
https://doi.org/10.22037/uj.v19i.7217

Purpose: To evaluate the safety and efficacy of conventional laparoscopic vs open Lich-Gregoir ureteral reimplantation in pediatric vesicoureteral reflux.


Material and methods: A retrospective study was conducted in a tertiary care hospital. Patients with vesicoureteral reflux who underwent open or laparoscopic Lich-Gregoir ureteral reimplantation from 2013-2020 were included.  The primary outcome was resolution of reflux. Complications and perioperative characteristics were evaluated. The outcomes between open and laparoscopic surgery were analyzed.


Results: A total of 110 patients and 150 ureters were included. The mean age was 4.5 years ± 3.4 and 73.6% were females. A total of 125 ureters (83.3%) underwent laparoscopic and 25 (16.6%) open Lich-Gregoir vesicoureteral reimplantation (5:1 Ratio). Resolution was reported in 112 (89.6%) for laparoscopy and 21 (84%) for open surgery (P = .42). Mean surgical time for laparoscopy and open surgery were 142.4 min ± 64.4 and 153 min ± 40, respectively (P =.29). Mean bleeding (9.5 mL ± 11.2 vs 29.6 mL ± 22.8) and length of hospital stay (2.4 days ± 2.3 vs 5.05 ± 3.1) were significantly higher with open surgery (P < .001). No significant difference in complications was reported between open surgery (32%) and laparoscopic approach (22.4%) (P = .305).


Conclusion: Conventional laparoscopic vesicoureteral reimplantation with the Lich-Gregoir technique has an acceptable success rate comparable with open surgery, with shorter hospital stay, less bleeding, and less need of transfusion.

Comparison of Incision Types Used for Kidney Extraction in Laparoscopic Donor Nephrectomy: A Retrospective Study

Selçuk Şahin, Osman Özdemir, Mithat Ekşi, İsmail Evren, Serdar Karadağ, Deniz Noyan Özlü, Ali İhsan Taşçı

Urology Journal, , , Page 7233
https://doi.org/10.22037/uj.v19i.7233

Objective: Laparoscopic donor nephrectomy (LDN) is the most commonly used method for kidney removal in kidney transplantation and, various incisions are used for kidney extraction. In this study, we aimed to compare the results of LDN operations using iliac fossa incision and Pfannenstiel incision.


Material and Method: LDN cases performed in our institute between June 2016 and February 2020 were retrospectively analyzed. Patients with previous abdominal surgery, bleeding coagulation disorders, ectopic kidneys and patients who were converted to perioperative open surgery were excluded. Demographic data of the patients, operation times, warm ischemia times, complications were recorded and the patients were divided into two groups according to incision types.


Results: After the inclusion and exclusion criteria, 203 patients were included in the study. Iliac fossa incision was used in 65% of the patients and the Pfannenstiel incision was used in in 35% of the patients to remove the donor’s kidney. There was no difference in age, body mass index, gender, and Charlson Comorbidity Index (CCI) scores between the two groups. Operation time and warm ischemia time were significantly longer in the Pfannenstiel group (p=0.001 and p=0.016 respectively). There was no significant difference between the two groups in terms of bleeding amount, length of hospital stay, need for narcotic analgesic, visual analog scale scores and postoperative complications.


Conclusion: Both types of incisions can be used successfully and safely for the extraction of the kidney in LDN. Although WIT and operation time has been observed to be longer when a Pfannenstiel incision is made, complications and analgesic use are not different between Pfannenstiel incisions and iliac fossa incisions.

ORIGINAL PAPER (FEMALE UROLOGY)


Purpose: Stress urinary incontinence (SUI) is prevalent among elderly women. This study aimed to discuss the potential of muscle-derived stem cells (MDSCs)-based therapy in treating SUI by exploring the effect of Insulin-like growth factor-1 (IGF-1) on transplanted MDSC and urethral sphincter function.


Materials and Methods: Bilaterally pudendal nerve-transected (PNT) female rats were divided into four groups: sham, PNT+ phosphate buffered solution (PBS) injection, PNT+IGF-1/MDSCs and PNT+ green fluorescent protein (GFP)/MDSCs. IGF-1 was expressed in MDSCs by lentiviral vector. Viable MDSCs were detected by laser scanning confocal microscopy (LSCM). The expression of Myosin heavy chain (MyHC), vascular endothelial growth factor (VEGF), VEGF receptor 2 (VEGFR-2), microvessel density (MID) and urethral resistance function were assessed.


Results: IGF-1 promoted the survival and differentiation of MDSCs. IGF-1-expressing MDSCs facilitated local angiogenesis and muscle fiber regeneration, and alleviated symptoms of SUI.


Conclusions: IGF-1-expressing MDSCs may be used as a novel treatment for patients with SUI.

Purpose: To investigate the long-term effects of transurethral bladder neck incision (TUBNI) for female primary bladder neck obstruction (PBNO).


Materials and MethodsWe retrospectively reviewed seventy women diagnosed with bladder neck obstruction by video-urodynamic study (VUDS). TUBNI was performed for each patient, with incisions made at 2 different sites on the bladder neck. Postoperatively, patients were assessed by international prostate symptom score (IPSS), quality of life (QOL) and uroflowmetry.


 ResultsFollow-up data were available for 4-108 months (median 42 months) postoperatively. During follow-up, the IPSS, QOL, time to maximum uroflow rate, postvoid residual urine volume decreased significantly after TUBNI compared with preoperative [13.0 (10.0, 15.0) versus 3.0 (3.0, 8.0), P<.001], [5.0 (5.0, 5.0) versus 2.0 (1.0, 3.0), P<.001], [9.0 (5.0, 37.0) versus 6.1 (4.2, 8.7), P<.001], [77.5 (23.5, 165.8) versus 0.0 (0.0, 30.0), P<.001]. The maximum uroflow rate, average uroflow rate and the voided volume increased significantly compared with preoperative [7.0 (4.0, 10.3) versus 19.8 (12.8, 25.2), P<.001], [3.0 (2.0, 5.0) versus 8.0 (4.9, 10.7), P<.001] and [156.5 (85.0, 211.3) versus 261.3 (166.2, 345.6), P<.001]. Several complications were identified after surgery, including bladder neck reobstruction, urethral stricture, and stress urinary incontinence, the corresponding number was 5 (7.1%), 7(10%) and 7(10%). Successful operation was achieved in 60/70 (85.7 %) patients.


ConclusionPBNO is a very rare yet easily treatable condition. VUDS is the primary diagnostic tool for the diagnosis of  bladder neck obstruction in women, while TUBNI can effectively relieve obstruction symptoms and improve the quality of life for patients.

Comparison of the Effectiveness of Pre-urodynamic Single-dose Levofloxacin with Post-urodynamic Levofloxacin for Three Days Related to the Incidence of Urinary Tract Infection: A Randomized Control Trial

Harrina Erlianti Rahardjo, Fina Widia, Mega Anara Manurung, Indra Wicaksono, Soefiannagoya Soedarman, Haryo Prakoso Adhi Purwanto, Ahmad Aulia Rizaly, Kevin Leonardo, Andika Afriansyah

Urology Journal, , , Page 7288
https://doi.org/10.22037/uj.v19i.7288

Purpose: The current study aims to compare the effectiveness of pre-urodynamic single-dose levofloxacin and post-urodynamic levofloxacin for three days related to the incidence of urinary tract infections post-urodynamic examination.


Materials and Methods: This is a single-blind randomized clinical trial conducted in three outpatient urology centers in Jakarta: Cipto Mangunkusumo General Hospital, Siloam Asri Hospital, and Persahabatan General Hospital using a consecutive sampling method between July 2019 - February 2022. The outcome of the study is the incidence of urinary tract infections in both treatment groups. Urinary tract infection was defined as a patient with one or more clinical symptoms of lower urinary tract infection and one or more urinalysis parameters positive for urinary tract infections. Chi-square was used to evaluate the association where p < 0.05 was used to determine statistical significance.


Results: A total of 126 patients (63 patients in each arm) were included in the evaluation and analysis. Overall, urinary tract infections were detected in 25 cases (19.8%), 12 patients from the pre-urodynamic antibiotic group (9.5%) and 13 patients from the post-urodynamic antibiotic group (10.3%) (P = .823). E.coli was the most common bacteria found in the urine culture.


Conclusion:There is no significant difference between a single dose of 500 mg of Levofloxacin administered one hour before the urodynamic study and a once-daily dose of 500 mg of Levofloxacin for three days following the urodynamic study related to urinary tract infections prevention post-urodynamic examination.

Effect of Rectal Midazolam on Pain, Stress, and Cooperation of Patient during Urodynamic Test in Women: A Randomized Clinical Trial

Narjes Saberi, Aygineh Hayrabedian, Hamid Mazdak, Razieh Hassannejad, Mahtab Zargham, Mehrdad Mohammadi Sichani, Mahboubeh Mirzaei

Urology Journal, , , Page 7261
https://doi.org/10.22037/uj.v19i.7261

Purpose: The urodynamic study is an invasive test, and causes pain and stress in the patient. We have investigated the effect of rectal midazolam sedation on the pain, stress, and cooperation of women performing urodynamic study. 


Materials and Methods: At the present randomized clinical trial (RCT) from January to July of 2021 a total of 84 women were prospectively randomized to undergo urodynamic study with or without sedation. The primary outcome of interest was experienced pain during urodynamic study. In the intervention group, after monitoring baseline vital signs (heart rate, blood pressure, O2 saturation), sedation was done with rectal midazolam at a dose of 0.3 mg/kg (maximum 15 mg). Completing the procedure, after recovery from sedation patients were asked to fill a self-assessed visual analog pain scale (VAS, 0-10), 5-point visual stress scale (1-5) and, patient collaboration level during urodynamic study was evaluated by nurse with a researcher-made tool (0-3). In the control group test was performed in routine practice with no sedation. Baseline vital signs measured pre and intra-procedural time, as well as their experienced pain, stress, and cooperation levels were recorded. 


Results: 84 female cases were evaluated. In terms of comparison of changes in pre and intra-test physiologic parameters, results showed that there were no significant differences between the two groups for all physiologic parameters: SBP, DBP, PR, SpO2. Analysis of the pain score showed that it was lower in the intervention group, and there was a significant difference in pain score between the two groups (P =.024). While the stress and corporation scores were not reported statistically significant (P=.388 and P=.955, respectively).


Conclusion:  Sedation with rectal midazolam in adult women before UDS is safe and effective in reducing pain but is not effective in reducing stress and increasing cooperation. The amount of pain based on the visual analog pain scale is mild and although this method is safe, its use routinely is not recommended.

CASE REPORT


Intravascular tumor extension in the major renal veins or their tributaries, as a rare but important clinical entity that can change the disease stage, prognosis, and approach to treatment. There is limited literature on the obstruction of renal vein and IVC by tumor thrombus in other types of renal tumors that are not of RCC type. We presented four different renal tumor cases with the presence of gross renal vein or IVC thrombosis.


Although the incidence of renal vein and IVC tumor thrombus might be suggestive of (often diagnosed as) RCC, the possibility of other non-RCC renal tumors should be included in the differential diagnosis.

LETTER


Publication Bias in Urology Systematic Reviews and Meta-Analyses

Amirmahdi Khayyamfar, Sepehr Khosravi, Robab Maghsoudi, Behnam Shakiba

Urology Journal, , , Page 7319
https://doi.org/10.22037/uj.v19i.7319

Background


Publication bias is one of the most important biases in systematic reviews and meta-analyses. This bias occurs when the results of an article affect its publication, in other words positive or significant findings are more likely to be published than the other probable results. Previous studies have shown that publication bias has been a matter of concern in the meta-analysis and systematic reviews conducted in some medical fields.  There is not a study that has evaluated the status of publication bias assessment in urology systematic reviews. We decided to assess the status of publication bias evaluation in systematic reviews and meta-analyses published in high impact urology journals.


 


Methods


This cross-sectional study was performed on 200 systematic reviews and meta-analysis published in four top urology journals based on their impact factor (European Urology, The Journal of Urology, BJU International and Prostate Cancer and Prostatic Diseases). Two independent reviewers performed data extraction about publication bias evaluation in included systematic reviews.


 


Results


From the 200 included studies only 65 (32.5%) evaluated the publication bias in the review process and 31 reviews had reported publication bias in their study. Visual inspection of a funnel plot was the most frequent method used for evaluation of publication bias (61 from 65, 93.85%); this method was used alone in 34 articles and in combination with other methods in 27 papers.


 


Conclusion


The present study confirms that publication bias was formally evaluated in a small number of reviews and meta-analysis published in urology journals, therefore, this may be a risk factor that could decrease the robustness of outcomes and results of these studies. It seems that there is an essential need for authors, reviewers, and editors to pay better attention to evaluation of publication bias besides reporting it based on the aforementioned reporting guidelines.


 

 we present a case  of bladder and rectum perforation due to dislodgement of leg brace during holmium laser lithotripsy. A 66-year-old man admitted to the hospital due to "intermittent pain in the left lumbar region for more than 30 days" and was performed with Holmium laser lithotripsy  after routine perioperative preparation.The right leg brace suddenly fell off during the operation, and  caused perforations in  the posterior wall of the bladder and the anterior wall of the rectum. we finally treated the rectal perforation with enteroscopic titanium clip closure and bladder perforation with indwelling catheter. The patient was discharged after the urinary catheter was removed two weeks after surgery.