Urology Journal

Purpose: The incidence of ureteral injury is increasing due to extensive application of the endourological procedures. In the present study, we evaluated the accuracy of imaging studies in predicting length of defect in patients with ureteral injury.

Methods: We reviewed data of all consecutive patients who underwent endourological management for ureteral injury in our institution from Jan 2020 to Jan 2023, to assess the accuracy of radiological evaluations in determining the length of ureteral defect. We compared the radiological imaging results with intraoperative findings to determine its diagnostic accuracy.

Results: We report data on accuracy of preoperative imaging and outcomes of endourological management in 5 patients who presented with apparently long ureteral defects in preoperative radiological evaluations following ureteral injury. The mean age was 42[30.5-42.5]. three of five were male. The mean time from injury to ureteroscopic management was 12.5±7.5 days. The mean follow up time was 7.3±2.2 months.  Our experience showed that radiological evaluations have the potential to overestimate the length of defect.

Conclusion: Radiological evaluations following ureteral injury have the potential to overestimate the length of defect and therefore endoscopic evaluations and intraoperative imaging studies are necessary to accurately determine the length of defect and appropriate management. However, endourological management is safe and efficient in treating patients with short segment ureteral defect/injury.

Purpose: Percutaneous nephrolithotomy (PCNL) has undergone extensive modification to reduce complications. One of the recent advances in minimally invasive procedures is the advent of ultra-mini PCNL (UM-PCNL), which provides miniaturized access to the kidney. However, the specific instruments applied in UM-PCNL may not be found in centers with limited resources. This study evaluated the safety, feasibility, results, and short-term complication rates of performing UM-PCNL using a semi-rigid ureteroscope in preschool children.

Materials and Methods: Between September 2013 and September 2021, a total of 68 patients, including 42 boys and 26 girls with a mean age of 3.2 ± 2.4 years, underwent UM-PCNL with a 4.5French tip ureteroscope instead of an ultra-mini nephroscope in children aged less than 7 years old. The procedure was done under general anesthesia in the prone position. The nephrostomy tract was dilated to 12F. Stones were fragmented using a pneumatic lithotripter. Irrigation was done with normal saline.

Results: The early stone-free rate (SFR) was 91%, and the short-term total SFR was 97%. No statistically significant difference was found in pre-operative and post-operative Hb, BUN, Cr, Na⁺, and K⁺. Fever (11 patients) and ileus (5 patients) constituted the majority of complications, and only one patient required a blood transfusion. None of the cases undergoing UM-PCNL with this method required a re-do PCNL.

Conclusion: Our experience shows that with sufficient experience in handling semi-rigid ureteroscopes, urologists practicing in centers with limited resources could perform UM-PCNL with relatively favorable outcomes.

Purpose: Prostate cancer (PCA) is the second most common malignancy in Western countries. Long non-coding RNAs are new markers in disease diagnosis. Our aim of this study was to investigate liquid biopsy biomarkers with high specificity and sensitivity for early diagnosis of PCA patients in Iran.

Materials and methods: Blood specimens were collected from 29 PCA, 32 benign prostate hyperplasia (BPH), and 29 control (CTRL) individuals. Real-time PCR analyzed expression amounts of PSA, ARLNC1, UCA1, and PCA3. The ROC curve (receiver operating characteristic curve) analysis evaluated the diagnostic power of the examined molecules for PCA.

Results: There was a significant upregulation of PCA3 in PCA and BPH groups compared to the controls (p values for PCA3=< 0.001 and BPH vs. CTRL = 0.0015) while there was no significant difference between PCA and BPH individuals. A significant upregulation of ARLNC1 was seen in BPH group compared to the controls (p value=0.0042). Also, PCA3 expression level showed a significant relationship with prostate volume.

There was no significant difference in UCA1 and PSA expression levels among the three groups (>0.05). The PCA3/PSA ratio was significantly increased in PCA and BPH individuals vs. the CTRL group with high sensitivity and specificity. The gene expression of PCA3 and ARLNC1 in the BPH group showed a significant relationship with age.

Conclusion: Our findings showed that in the diagnosis of prostate cancer, measuring the expression of PCA3, PSA, and ARLNC1 genes is necessary to determine the health, benign, or cancerous status of patients' prostate. Also, selecting the PCA3/PSA ratio provides a new approach for diagnosing this cancer if confirmed in a larger clinical sample size and functional studies.

Purpose: The purpose of this combination research was to examine the relationship between systemic inflammation and the risk of prostate cancer (PCa) through the National Health and Nutrition Examination Survey (NHANES) cross-sectional study and two-sample Mendelian randomization (MR) analysis.

Materials and Methods: We incorporated NHANES data spanning the years 2001 to 2010, with exposure as systemic inflammation, evaluated using systemic immune-inflammation index (SII) and outcome as PCa, and performed multivariate logistic regression and restricted cubic spline (RCS) to test the correlation between SII and PCa. Further, two-sample MR was used to identify causal associations between specific immune cells and PCa.

Results: A total of 7706 participants (age≥40 years) were included in the analysis in the cross-sectional study, including 350 PCa cases, 7356 controls. Higher SII levels were associated with increased odds of PCa (P<.05). The odds ratio (OR) for PCa was 1.51 (95% CI 1.09-2.08) for the highest versus lowest quartile of SII levels in the fully adjusted model. Also, the RCS analysis showed a threshold effect, with SII levels above 8.90 associated with increased odds of PCa. In addition, MR results suggested a causal relationship between CD62L- monocyte, CD62L- HLA DR+ monocyte, CD14+ CD16+ monocyte, CD62L- Dendritic Cell, Monocytic Myeloid-Derived Suppressor Cell, CD28- CD8dim T cell, CD39+ resting CD4 regulatory T cell and PCa (P<.05).

Conclusion: This combination analysis provides evidence for a significant causal relationship between systemic inflammation and PCa risk. These findings highlight systemic inflammation and inflammatory immune responses as potential modifiable risk factors for PCa.

Purpose: Our study aimed to evaluate the genetic etiology of treatment-resistant nocturnal enuresis in children who have undergone at least 6 episodes of behavioral therapy, urotherapy, alarm therapy, and medical treatment.

Materials and Methods: A total of 21 patients were included in the study. Inclusion criteria for the study comprised children aged 5-18 years diagnosed with treatment-resistant enuresis according to the International Children’s Continence Society (ICCS) guidelines. The capture-based Sophia Hereditary Disease Panel by Sophia Genetics was used specifically for nocturnal enuresis, consisting of a panel of 19 genes (AGXT, AQP2, AVPR2, BNC2, CLCNKB, DLG3, ELN, FA2H, FAM20A, FOXP1, HPSE2, KCNJ10, MLXIPL, NPHP3, RNF168, SLC12A3, SLC25A13, SLC5A2, SMARCA2).

Results: Patients were analyzed for genetic variations in genes associated with nocturnal enuresis, including AGXT, AQP2, AVPR2, BNC2, CLCNKB, DLG3, ELN, FA2H, FAM20A, FOXP1, HPSE2, KCNJ10, MLXIPL, NPHP3, RNF168, SLC12A3, SLC25A13, SLC5A2, and SMARCA2. No pathogenic changes potentially explaining the etiology of the disease were detected in 20 patients. One patient exhibited a variant in the AQP2 gene at hg19:Chr12:50344908 exon 1, c.295G>A locus, classified as a Variant of Uncertain Significance (VUS) according to the American College of Medical Genetic and Genomics (ACMG) 2015 guidelines. The AQP2 gene is associated with autosomal dominant and autosomal recessive inherited nephrogenic diabetes insipidus (type 2) in the OMIM (Online Mendelian Inheritance in Man) database.

Conclusion: Our study resembles studies indicating that nocturnal enuresis cases do not have a monogenic etiology but occur with multifactorial effects and have a weak correlation between genotype and phenotype.

Purpose: Simple epididymal cysts (EC) are rare in childhood and are mostly diagnosed at puberty. Although there is no consensus on the treatment, a conservative approach is generally preferred. To evaluate patients diagnosed with EC at our clinic in terms of presenting symptoms, diagnosis, and treatment methods.

Materials and Methods: Data of patients treated for epididymal cysts at our institution between March 2012 and March 2023 were retrospectively analyzed in terms of age, symptomatology, diagnostic method, treatment method, and outcomes. In all cases, the diagnosis of EC was based on physical examination with scrotal ultrasonography (US) confirmation.

Results: A total of 1829 patients underwent scrotal Doppler US, and EC was detected in 72 patients (10.7%). The median follow-up period of the 43 patients was 21.7 (6-80 months). Of these, 9 were bilateral (12.5%). The mean age of the patients at presentation was 14.8 years. Forty-one patients had scrotal pain, 12 had scrotal swelling, and 19 incidentally had EC. The cysts were between 1.2- 37 mm. Only 3 (4.1%) patients required surgical excision due to persistent pain.

Conclusion: EC is a benign lesion, and treatment approaches are usually conservative. Surgical excision is recommended for patients with persistent scrotal pain or an acute scrotum.

Objective: Penile torsion is a counterclockwise rotational anomaly of the penile shaft or glans. We aimed to evaluate the results of dorsal dartos flap rotation technique in children with isolated penile torsion.

Materials and Methods: 5470 boys who applied to our clinic between 2012 and 2022 for circumcision were evaluated for congenital isolated penile torsion. They were classified according to the degree and direction of torsion and clinical findings were analyzed.  According to the degree of torsion, penile degloving or dorsal dartos flap rotation technique with circumcision was performed. Patients whose torsion corrected after penile degloving were excluded from the study. The results of dorsal dartos flap rotation technique were evaluated. 

Results: Congenital isolated penile torsion ≥60° was identified in 1.04 % (n=57) of the children. Eight patients whose torsion corrected after penile degloving were excluded from the study. 49 patients who underwent dorsal dartos flap rotation had a mean age of 4.94 years (1-9) and a mean operation time of 29.9 min (20-40). The mean degree of torsion was 77.6° (60-110). The mean operation times in the < 90° and ≥ 90° dorsal dartos flap groups were statistically significant (p<0.05).  Residual torsion was statistically significant in the < 90° and ≥ 90° dorsal dartos flap groups (p<0.05).  At the postoperative 1st and 6th month follow-ups, torsion less than 10 degrees was observed in 3 patients who underwent dorsal dartos flap rotation technique. No residual torsion was observed in other patients.

Conclusion: Isolated penile torsion cases should not be overlooked during circumcision.  It seems possible to obtain successful results with dorsal dartos flap rotation in moderate and severe torsions.

Penile incarceration with a foreign body is a rare urological emergency necessitating prompt intervention. We present a 59-year-old patient who entrapped penis and right testicle with metal thread reducer for sexual arousal four days prior to admission to Emergency room. Ultrasound revealed significantly reduced Color Doppler signal in right testicle and completely absent signal in penile artery. After admission metal reducer was removed using a hacksaw in analgosedation. Magnetic resonance imaging showed penile ishemic changes. Patient had reduction of penile swelling and parts of the skin highly suspected of necrosis recovered fully with preserved sensations. Despite penile ischemia on magnetic resonance imaging patient had full recovery obtaining normal erections. Patient was discharged six days after admission, presenting with  normal International Index Erectile Function on follow up exam.    

Purpose: Examine the prevalence of erectile dysfunction and ejaculatory dysfunction among COVID-19 recovered patients and whether this condition improved over time. The retrospective study of 50 male patients who have recovered from COVID-19 infection previously hospitalized in dr. H Abdul Moeloek General Hospital between March 2020 – March 2021.

Materials and Methods: All of these patients were evaluated in terms of erectile and ejaculation function via phone interview. The International Index of Erectile Function 5 (IIEF-5) and Male sexual health questionnaire ejaculatory dysfunction (MHSQ-EJD) were used to assess the erectile function and ejaculatory dysfunction. Statistical analysis was performed to evaluate whether there was a difference between IIEF-5 & MHSQ-EJD scores within 6 months, 6 to 12 months, and >24 months after COVID-19 infection.

Results: The prevalence of ED was 70% and EJD was 2 % during 0-6 months after COVID-19 infection. Mean age and BMI were 50.4 ± 8.5 years and 23.6 ± 1.6 kg/m2 respectively. There are 26 patients (52%) had an educational background lower than bachelor’s degree and 24 patients (48%) had an educational background of bachelor’s degree or higher. It was reported that 4 patients (8%) had Diabetes Mellitus and 12 patients (24%) had Hypertension. Most were active smokers (74%) and 2 patients (4%) had reported as active alcohol drinkers. There was a statistically significant IIEF-5 scores difference between three periods of time (p <0,001).

Conclusion: The prevalence of Erectile Dysfunction was high in COVID-19 recovered patients. There was a temporary erectile dysfunction and ejaculatory dysfunction among COVID-19 patients.

Purpose: Estrogen receptor (ER) genes play key roles in male and female reproduction. Non-obstructive azoospermia (NOA) and severe secretory oligozoospermia (SOL) are the most severe and complex conditions impacting male fertility. This meta-analysis aimed to study the association between PvuII ( rs2234693, 397T>C ), XbaI ( rs9340799, 351G>A ), AluI (1730G>A, rs4986938), and RsaI (1082G>A, rs1256049) polymorphisms and spermatogenic failure.

Materials and Methods: The literature in PubMed, Medline, Embase, Web of Science, Cochrane Library, China Science and Technology Journal Database, WanFang data, and China National Knowledge Infrastructure databases were systematically searched, and a meta-analysis was conducted to investigate the association between polymorphism in estrogen receptors and spermatogenic failure. According to a set criterion, 10 studies were included for analyses.

Results: ER α XbaI polymorphism was a decreased risk of NOA. The ER α PvuII polymorphisms does not associate with NOA and SOL. ER β AluI polymorphism increased the risk of NOA in Caucasian population. ER β RsaI polymorphism was a decreased risk of NOA and SOL in Caucasian males.

Conclusion: The ER α XbaI and ER β RsaI polymorphisms are associated with the risk of NOA and SOL.

Purpose: Working during non-traditional hours is becoming more prevalent in modern societies and presents a significant hurdle to an individual's circadian rhythm. We examined the bladder health of shift workers in the United States by analyzing information obtained from the National Health and Nutrition Examination Survey.

Materials and methods: National Health and Nutrition Examination Survey (NHANES) datasets from 2005 to 2010 were utilized. Regression analysis were used to assess the association between shift work and bladder health (stress incontinence, urge incontinence and nocturia) by adjusting age, race, education, smoking, and so on.

Results: The percentage of non-Hispanic Black individuals was notably higher among shift workers (25.8% vs. 17.8%). Among shift workers, there was a lower percentage of individuals with a college degree (or higher) compared to day workers. Shift work has been found to be associated with nocturia in men (unadjusted model: OR=1.2, 95%CI=1.0-1.5, p=0.038). However, the adjusted results indicate that the connection is not statistically significant (Adjusted II model: OR=1.2, 95%CI=1.0-1.5, p=0.105). Similarly, no statistically significant association was observed between shift work and nocturia in women. There was also no significant relationship between shift work and Stress Urinary Incontinence (SUI) in men or women. The results from Adjusted II indicate a substantial association between shift work and the prevalence of Urgency Urinary Incontinence (UUI) in women (OR=1.2, 95%CI=1.0-1.5, p=0.041).

Conclusion: Results of this cross-sectional study indicated that shift work was associated with a higher risk of UUI in women. Further research is needed to explore the relationship.

Purpose: To assess the efficacy and safety of very low-power Holmium Laser Enucleation of the Prostate (HoLEP) on a 30-W holmium laser source.

Materials and Methods:  With the approval of the local ethics committee, we retrospectively analysed 60 patients treated with HoLEP. There were 30 patients in the low-power (LP) group and 30 patients in the very low-power (VLP) group. For the LP group, we used a 60-W holmium laser machine. Throughout the en bloc process, we used laser settings of 2 J and 20 Hz. We used a 30-W low-power holmium source in the VLP group. We used laser settings of 2 J and 10 Hz. All patients were operated on by an experienced surgeon. We evaluated the surgical parameters and practicality of the low-power laser vs. the very low-power laser.

Results: All patients underwent successful HoLEP in the very low-power group; it was not necessary to increase the output of the laser in any case. Mean preoperatively estimated prostate volume was 88.1 mL (range, 30-300 mL). Mean enucleation time and enucleation efficiency were 67.9 min (range, 25–150 min) and 0.99 gm/min (range, 0.8–1.8 gm/min), respectively. No patient required blood transfusion postoperatively. No stress urinary incontinence (SUI) was observed in the 3rd month postoperative follow-up.

Conclusion: The use of a low-power laser source is encouraging for the learning curve of new surgeons who will begin HoLEP surgery; it can facilitate the adoption of HoLEP in developing countries, where the initial capital investment may be a major obstacle.