Does the Prone Position During the Shockwave Lithotripsy of Kidney Stones Improve the Stone-Free Rate? Results from a Randomized Clinical Trial

Abdolreza Mohammadi, Leonardo Oliveira Reis, Alireza Khajavi, Leila Zareian Baghdadabad, Seyed Mohammad Kazem Aghamir

Urology Journal, Vol. 20 No. 03 (2023), 21 Ordibehesht 2023, Page 136-143

Objective: This study aimed to evaluate the impact of the skin-to-stone distance in the supine and prone positions on the outcome of shockwave lithotripsy of kidney stones.
Methods: In a prospective randomized clinical trial study, 81 patients that candidates for shockwave lithotripsy (SWL) of kidney stones were randomly divided into two groups to perform SWL in the prone position (40 patients) or conventional supine position (41 patients). Demographic data, stone characteristics, skin–to–stone distances (SSD) in CT, SSD during SWL with an ultrasound probe in prone and supine positions, total shock wave rate, total energy (kilovolt), visual analog scale (VAS), complications (Clavien-Dindo scale system), and SWL success rate evaluated in two intervention and control groups. All statistical analysis was performed by independent T-test, Chi-Square test, Fisher exact test, paired T-test, and SPSS 22.0 software for windows.
Results: There were no significant differences between demographic characteristics, SWL sessions, the median number of SWLs, the median SWL time, median total energy, VAS, and complications in the two groups. The SFR was numerically higher in the prone SWL group than in the supine SWL group (80% vs. 73.2%) but was not significantly different (P = 0.468).
Also, the inline ultrasound (US) measuring of the SSD in the prone position was significantly different from US SSD measures in the supine position in the two groups (Ps = 0.001 and 0.024). The mean SSD was lower in the US measurement during the SWL process that measured in supine and prone position than the CT measurement (73.5 vs. 101.1), which means the routine SSD measured by CT scan is higher than SSD in the US probe measurement during SWL.
Conclusion: The prone position SWL modification could be effective in obese patients with a BMI of more than 30 and increase the stone-free rate (P=0.039) with a similar safety profile and comparable VAS score. It seems the SSD measured by the ultrasound is a more accurate dynamic measurement during the SWL and needs to define the SSD according to the SSD calculation by the US probe of the therapy head. SFR was numerically higher in the prone compared with the supine treatment groups


Laparoscopic Simple Prostatectomy: A Single Center Experience with A Long-Term Follow Up

Robin Zeder, Stefan Heidler, Thomas Alber, Orietta Dalpiaz

Urology Journal, Vol. 20 No. 03 (2023), 21 Ordibehesht 2023, Page 144-147

Purpose: The aim of this retrospective study is to assess the long-term outcomes and safety of laparoscopic simple prostatectomy.

Material and Methods: Between 2012 and 2019 80 patients with prostates volumes ≥ 80 mL were treated with laparoscopic simple prostatectomy at our department. Uroflowmetry, post void residual volume and standardized questionnaires were assessed pre- and postoperatively.

Perioperative complications were categorized using the Clavien-Dindo classification.

Results: The mean specimen weight was 83 grams, and the mean operation time was 156 minutes. At a mean follow-up time of 40 months patients showed a significant improvement of Qmax (P = .002), IPSS (P < .001) and QoL (P < .001). Post void residual volumes decreased significantly.

Complications occurred in 11 patients (13.8%), nine had mild (grade 1 - 2) and two had severe (grade 3b - 4a) complications. One conversion to open surgery due to massive prostatic adherence from previous abscess formation was recorded and one patient needed blood transfusion intraoperatively.

Conclusion: laparoscopic simple prostatectomy is an effective and safe procedure for large volume prostate glands with a significant and stable long term symptoms improvement.


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.

Discriminant Efficacy of mpMRI for Variant Pathology Associated with Prostate Adenocarcinoma

Hikmet Köseoğlu, Halime Çevik Cenkeri, Tolga Eroğlu, Berrin Yalçın

Urology Journal, Vol. 20 No. 03 (2023), 21 Ordibehesht 2023, Page 157-161

Purpose – Implementation of multiparametric magnetic resonance imaging (mpMRI)  for prostate adenocarcinoma’s variant pathology requires awareness. The aim of this retrospective study was to investigate the discriminant efficacy of multiparametric magnetic resonance imaging modality for variant pathology associated with prostate adenocarcinoma.

Methods – Consecutive 247 prostate cancer patients who underwent radical prostatectomy in our university-based hospital between October 2014 and October 2019, were retrospectively reviewed. Data of mpMRI-associated contrast enhancements, T2 signals, apparent diffusion coefficients (ADC), ages and PSA values were compared. Clinical and demographic data of patients were noted including associated variant pathologies and reports of preoperative mpMRI images.

Results – Among the patients, 63 (26%) had variant pathology and 14 (22%) had mpMRI before primary prostate biopsy. The group with variant pathology and the control group had similar perfusion curves and increased contrast when compared for mpMRI parameters, but different ADC values for each of the adjusted b-values for 400, 800 and 1400.

Conclusion – Our study demonstrates that mpMRI appears to have no role in distinguishing rare variant pathologies associated with prostate adenocarcinoma despite different ADC values.


Analysis of The Curative Effect of Tubularized Incised Plate Urethroplasty for Distal Hypospadias With The Dysplastic Corpus Spongiosum Covering Technique

Linghua Ji, Shuqing Chen, Yuehua Chen, Jun Zhao, Qiyou Yin, Hua Xian, Wenliang Ge

Urology Journal, Vol. 20 No. 03 (2023), 21 Ordibehesht 2023, Page 162-166

Purpose: To investigate the use of tubularized incised plate (TIP) urethroplasty for distal second- and third-degree hypospadias to free the dysplastic forked corpus spongiosum and Buck’s fascia, which are used as a covering material for the new urethra, thereby reducing the incidence of urinary fistula and other complications in the coronal sulcus.

Materials and Methods: Clinical data of 113 patients with distal hypospadias treated with TIP urethroplasty from January 2017 to December 2020 were retrospectively analyzed. The study group comprised 58 patients (use of dysplastic corpus spongiosum and Buck’s fascia to cover the new urethra), and the control group comprised 55 patients (use of dorsal Dartos fascia to cover the new urethra).

Results: All children were followed up for more than 12 months. In the study group, 4 patients developed urinary fistulas, 4 developed a urethral stricture, and no case developed glans fissure. In the control group, 11 patients developed urinary fistulas, 2 developed a urethral stricture, 3 developed a glans cracking.

Conclusion: Using the dysplastic corpus spongiosum to cover the new urethra increases the amount of tissue in the coronal sulcus and reduces the incidence of urethral fistula, but it may increase the incidence of urethral stricture.


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, Vol. 20 No. 03 (2023), 21 Ordibehesht 2023, Page 167-172

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.

Predictor Factors of Female Sexual Distress in a Population-Based Sample of Iranian Women: a Path Analysis

Fatemeh Bayat, Giti Ozgoli, Zohreh Mahmoodi, Malihe Nasiri

Urology Journal, Vol. 20 No. 03 (2023), 21 Ordibehesht 2023, Page 173-180

Purpose: To investigate the direct and indirect effects of demographic characteristics, relationship satisfaction, and psychological factors on female sexual distress (FSD) using path analysis.

Materials and Methods: This study was conducted in two stages. Initially we obtained the FSD predictor factor's conceptual model through a literature review and expert panel. In the Second stage, a population-based cross-sectional study on 207 non-pregnant and married women (without any age restriction) in Zanjan, Iran was conducted. FSDs-R, FSFI-6, DASS-21, and GEMREL Standard questionnaires and the demographic researcher-made questionnaire were used in this study. The data undergone path analysis based on the initial conceptual model.

Results: Sexual function (SF) had the strongest relationship with FSD from the direct path (β = -.49) and overall effect (β = -.58). The highest indirect effect belonged to depression-anxiety-stress level (β = .284) mediated by SF (β = -.42) and relationships satisfaction with spouse (β = -.20). Age difference (β = -.13) and relationships satisfaction with spouse (β = -.19) had only a direct effect on FSD. Marriage Duration had only indirect effect on FSD through mediating role on SF (β = -.26) and depression-anxiety-stress level (β = -.15).

Conclusion:  Among the predictor factors investigated in this study, sexual dysfunction is the most important predictor of FSD. In addition; men older than their spouses, longer marriage duration, relationship dissatisfaction with the spouse and higher rate of depression-anxiety-stress have positive correlation with SD. Therefore, we should offer a combination of the mentioned factors in providing care for women with SD.


Prospective Investigation on the Paternity Intention and Affecting Factors in 84 Post-treatment Testicular Cancer Patients

Serkan Yenigurbuz, Caner Ediz, Yunus Emre Kizilkan, Serkan Akan, Mehmet Pehlivanoglu, Muhammed Cihan Temel, Hasan Huseyin Tavukcu, Tuna Erturk, Omer Yilmaz

Urology Journal, Vol. 20 No. 03 (2023), 21 Ordibehesht 2023, Page 181-186

Purpose: to investigate the factors affecting post-treatment paternity intention in patients followed up after the diagnosis of testicular cancer and to make recommendations for the early postoperative period based on the identified factors.

Materials and Methods: This prospective descriptive study included total 185 patients who presented to our outpatient clinic between February 2000 and July 2020 who had radical orchiectomy due to suspected testicular cancer based on physical examination and other assessments. Contact information was found for 88 of 185 patients, and accordingly, the patients were reached by one-to-one phone calls. Upon literature review, a questionnaire consisting of 10 previously validated items was developed by the researchers. The patients were compared by separating them into two groups composed of patients with (Group 1) and without (Group 2) paternity intention.

Results: A total of 84 patients participated in the study, and the participation rate was 95.5%. It was found that 19 of 32 (38%) patients with paternity intention already had children. Only 21 (40%) of 52 patients without paternity intention were married. The mean age was 26.65 (18–39) years in Group 1, while it was 28.73 (19–45) years in Group 2. Tumor volume and serum tumor markers were higher in Group 2 than in Group 1. Parameters such as testicular side in which the tumor was located, smoking status, undescended testis history, and postsurgical chemotherapy history were not statistically significant difference between the two groups.

Conclusion: The major findings included that the young aged, unmarried, and serious testicular cancer (Tumor volume and serum tumor markers were higher) can be affecting factors for testicular cancer patients’ paternity intention. Early psychological counseling about paternity may be useful for testicular cancer patients.


Perioperative Outcomes of Inguinal Hernioplasty along with Holmium Laser Enucleation of the Prostate (HoLEP)

Carlos Ignacio Calvo de la Barra, Juan Cristobal Bravo Izurieta, Renato Navarro Capone, Rodrigo Cañas Ramirez, Felipe Pasten Alcaina, Ignacio San Francisco Reyes

Urology Journal, Vol. 20 No. 03 (2023), 21 Ordibehesht 2023, Page 187-190

Purpose: Inguinal hernias and benign prostatic hyperplasia (BPH) can coexist in about one fifth of patients undergoing BPH surgery. There is scarce evidence about performing laser enucleation along with open inguinal hernia repair. Our goal is to describe the perioperative outcomes of performing both surgeries in the same operating session compared to doing HoLEP alone.

Materials and Methods: A retrospective analysis of patients undergoing HoLEP and hernioplasty with mesh in the same anesthetic time (group B) at an academic center was conducted. They were compared to a randomly picked control group of patients submitted to HoLEP alone (group A). Preoperative, operative and postoperative features were compared among both groups.

Results: 107 patients submitted to HoLEP alone were compared to 29 combined approach patients (HoLEP + hernia repair). Patients in group A were found to be older and had larger prostates. Group B showed a significant longer operative time. Length of stay and duration of catheter was comparable among groups. In multivariate analysis, the combined approach was not associated to a higher complication rate.

Conclusion: Performing benign prostatic hyperplasia surgery with HoLEP in conjunction with open inguinal hernioplasty is not related to a higher length of stay or a significantly increased risk of morbidity.