Percutaneous Nephrolithotomy with and without Retrograde Pyelography: Preliminary Results of a Randomized Controlled Trial

Ali Tabibi, Hamed Akhavizadegan, Kia Noori Mahdavi, Mohammad Najafi Semnani, Mojgan Karbakhsh Davari, Ali Reza Niroomand

Urology Journal, Vol. 2 No. 3 (2005), 28 Ordibehesht 2009, Page 132-136

Introduction: Since the introduction of percutaneous nephrolithotomy (PNL), many modifications to entering the pyelocalyceal system have been made. One alternative is to insert a needle pointed to an opaque stone as a landmark. The aim of this study was to compare the outcomes of managing kidney calculi by PNL with and without retrograde pyelography.

Materials and Methods: In this randomized controlled trial, 55 candidates for PNL with a single opaque kidney calculus in the calyx alone, the pelvis alone, or both the calyx and the pelvis were assigned into 2 groups. Twenty-seven patients underwent PNL with a ureteral catheter, and 28 patients underwent PNL without a ureteral catheter. Clinical outcomes were compared between the 2 groups using plain radiographs taken on the first day after the procedure.

Results: Patients had similar distributions regarding sex, age, operative time, hospital stay, past surgical history on the kidneys, and stone size. There was a significantly greater decrease in postoperative hemoglobin level in patients having PNL with a ureteral catheter (P < .001) than in those having the procedure without a ureteral catheter. No differences were seen among patients in the 2 groups in terms of stone-free rate, and number of patients with insignificant residue, and those needing extracorporeal shock wave lithotripsy, a second PNL procedure, or transurethral lithotripsy.

Conclusions: Percutaneous nephrolithotomy without ureteral catheterization has specific benefits: urine leakage is lower and there is no need to perform cystoscopy. Patients with a single kidney calculus are good candidates for PNL without previous ureteral catheter insertion.


Comparative Evaluation of Urinary Bladder Cancer Antigen and Urine Cytology in the Diagnosis of Bladder Cancer

Mohammadali Zargar, Mohammadjavad Soleimani, Mohammadkazem Moslemi

Urology Journal, Vol. 2 No. 3 (2005), 28 Ordibehesht 2009, Page 137-140

Introduction: The diagnostic value of the urinary bladder cancer (UBC) antigen as a tumor marker is not clear yet. We designed this study to compare the accuracy of the UBC antigen and voided urine cytology in patients with bladder cancer.

Materials and Methods: Fifty-four consecutive patients admitted for a diagnostic workup for bladder cancer were enrolled. Two voided urine samples were taken for urinalysis, both before performing cystoscopy. The samples were examined for urinary urine cytology and UBC antigen. Cystoscopy was done. Resection of pathologic lesion, if any, or random biopsies of multiple foci of the bladder was performed. The results of the diagnostic tests were compared with the pathology examination results.

Results: Of 54 patients, 31 had histologically confirmed transitional cell carcinoma. Results were positive for UBC antigen in 28 and for urine cytology in 16 patients. Sensitivities and specificities were 74.2% and 78.3% for UBC antigen, 48.4% and 95.7% for urine cytology, and 87.1% and 73.9% for combined UBC antigen and cytology, respectively. Positive and negative likelihood ratios were 3.42 and 3.03 for UBC antigen, 11.3 and 1.85 for urine cytology, and 3.34 and 5.73 for combined UBC antigen and cytology, respectively.

Conclusion: The UBC antigen test had acceptable sensitivity and specificity in our study. However, results of voided urine cytology are significantly more reliable. A combination of tumor markers may help diagnose new tumors and lower the requirements for cystoscopy during follow-up. Further studies are warranted to find a more accurate noninvasive test or a complex of tests comparable with cystoscopy for diagnosis of bladder cancer.

Evaluating Expression and Potential Diagnostic and Prognostic Values of Survivin in Bladder Tumors: A Preliminary Report

Seyyed Djavad Mowla, Mojtaba Emadi Baygi, Seyyed Amirmohsen Ziaee, Parvaneh Nikpoor

Urology Journal, Vol. 2 No. 3 (2005), 28 Ordibehesht 2009, Page 141-147

Introduction: Survivin, an inhibitor of apoptosis (IAP), has been reported to be capable of regulating both cellular proliferation and apoptotic cell death. Survivin expression has been described during embryonic development and in adult cancerous tissues, with greatly reduced expression in adult normal differentiated tissues, particularly if their proliferation index is low. In the present study,the expression and potential diagnostic and prognostic value of survivin in bladder tumors was evaluated.

Materials and Methods: Primary and recurrent bladder tumor specimens were obtained from patients referred to the Shaheed LabbafinejadMedical Center in Tehran, Iran.Total RNA was isolated from frozen tissues, reverse transcribed and amplified by means of a nested polymerase chain reaction technique.

Results: Survivin was detected in 3 cases of primary tumors (42.8%) and 6 cases of recurrent tumors of bladder (60%). Survivin-?Ex3 expression was seen in 41.2% of the 17 cases with bladder cancer.

Conclusion: Our findings suggest that the expression of survivin and survivin-?Ex3 is well associated with invasive and more-aggressive forms of bladder cancer. Our data also indicate that the presence of survivin-?Ex3 is better correlated with tumorigenesis of bladder cancer compared with survivin expression.


Asymptomatic Bacteriuria in Users of Intrauterine Devices

Masoumeh Fallahian, Esmat Mashhady, Zohreh Amiri

Urology Journal, Vol. 2 No. 3 (2005), 28 Ordibehesht 2009, Page 157-159

Introduction: The aim of this study was to compare the frequency of asymptomatic bacteriuria in women who use intrauterine devices (IUDs) as a contraceptive method with subjects who use tubal ligation (TL).

Materials and Methods: A cohort study was conducted on women who were candidates for IUD insertion or TL (control). The patients were followed for 3 months, and urine cultures were assessed for bacteriuria at the end of the study.

Results: Overall, 131 women (mean age, 31.9 ± 4.25 years) in the IUD group and 78 (mean age, 32.1 ± 4.0years) in the control group were studied. The parity score was 2 or more in 72% of the women in the IUD group and in 74% of the controls. The average intercourse frequency was twice per week in 82% of IUD users and 80% of controls. Fifty-seven percent of the women in the IUD group and 55% of the women in the control group had graduated secondary school (high school). Asymptomatic bacteriuria was detected in 13 IUD users (9.9%) and in 1 woman (1.3%) in the control group (risk ratio = 7.74, confidence interval: 1.03 to 58.03; P = .019). The detected microorganism in the urine culture was Escherichia coli in 12 IUD users and in 1 patient in control group. Klebsiella was found in 1 IUD user.

Conclusion: Use of an IUD is a risk factor for urinary tract infection and should be considered, especially in women with recurrent urinary tract infections.


Can Thymic Tissue Induce Tolerance to Kidney Allografts?

Saeed Shakeri, Alireza Aminsharifi, Abdolaziz Khezri, Ahmad Monabbati, Nader Tanideh

Urology Journal, Vol. 2 No. 3 (2005), 28 Ordibehesht 2009, Page 148-152

Introduction: The aim of this study was to investigate the beneficial effect of donor thymic tissue to induce tolerance in thymokidney allografts, transplanted to thymectomized cross-bred canines.

Materials and Methods: Seven pairs of transplant donors and recipients were selected from 3- to 4-month-old cross-bred canines with major histocompatibility complex (MHC) mismatches. Recipients underwent partial thymectomy 4 weeks before transplantation and received an autologous thymic graft under the renal capsule, which had been engrafted in the donors 3 months before transplantation (thymokidney). Successful engraftment with evidence of thymocyte development in the donors was determined by gross and histologic examination at the time of transplantation. Biopsy specimens were obtained at the transplant day and 3 months after transplantation and were studied histologically for evidence of hyperacute or acute rejection.

Results: At 90 days after the operation, all 7 juvenile thymic grafts had developed with normal thymic structure under the renal capsule. Hyperacute rejection was not observed in allografts, and all of them were functioning until the end of follow-up; however, all of the allografts showed acute cell-mediated rejection 3 months after transplantation.

Conclusion: No tolerance was induced by vascularized donor thymokidneys in MHC-mismatched canines. The advantages of tolerance over chronic immunosuppression are so great that a potentially tolerogenic approach such as thymic transplantation would seem worthy of further investigations on large animal models. To evaluate the beneficial effects of thymic tissue in tolerance induction, utilizing a short course, low-dose adjuvant immunosuppressant to this regimen and/or application of in-bred MHC-matched canines is suggested.

The Effect of Garlic on Cyclosporine-A–Induced Hyperlipidemia in Male Rats

Ali Taghizadeh Afshari, Alireza Shirpoor, Ehsan Dodangeh Balakhani

Urology Journal, Vol. 2 No. 3 (2005), 28 Ordibehesht 2009, Page 153-156

Introduction: Cyclosporin A (CsA) is a potent immunosuppressive drug. However, it has adverse effects that include elevation of plasma low-density lipoprotein (LDL). This study was designed to determine the effect of garlic on CsA-induced hyperlipidemia in male rats.

Materials and Methods: Baseline serum blood samples from forty 10-month-old, male Wistar rats were obtained. They received intraperitoneal (IP) injection of CsA (25 mg/kg) for 28 days. Blood samples were again obtained after the 28-day treatment. Sixteen of 40 rats showed increased serum LDL levels. These 16 were divided into 2 groups of 8 rats each. In the first (experimental) group, 8 rats received garlic (tablets, 400 mg/d), CsA (25 mg/kg IP), and regular diet for 28 days. In the second (control) group, 8 rats received the same regimen without the garlic tablets. At the end of the experiment, blood samples were taken from animals in both groups, and LDL levels were assessed.

Results: The mean baseline LDL level in animals in the control group was 17.75 ± 4.1 mg/dL. This increased to 21.5 ± 1.6 mg/dL after 28 days of CsA administration. After 28 more days, the mean LDL level increased to 25.4 ± 4.9 mg/dL (P = .004). In animals in the experimental group, the baseline LDL level was 23.8 ± 3.7 mg/dL, which increased to 31.3 ± 1.6 mg/dL after the first 28 days (P < .001). After the second 28 days, it decreased to 26.0 ± 4.8 mg/dL (P = .06), and among 4 animals, the LDL level decreased more than 49%.

Conclusion: In a Wistar rat model, animals given cyclosporin A subsequently treated with garlic demonstrated reduced LDL levels compared with controls. This treatment may be useful in patients receiving organ transplantations.


Preoperative Corporal Biopsy as a Predictor of Postoperative Results in Venoocclusive Erectile Dysfunction

Mohammadreza Nikoobakht, Ali Saraji, Alimohammad Meysamie

Urology Journal, Vol. 2 No. 3 (2005), 28 Ordibehesht 2009, Page 160-164

Introduction: Our aim was to investigate the association of corporeal cavernosal pathology with venoocclusive erectile dysfunction (ED) and whether preoperative corporeal biopsy can help predict postoperative results.

Materials and Methods: A total of 36 patients with venoocclusive ED underwent corporeal cavernosal biopsy and venous ligation. Preoperative assessment included complete physical examination, international index of erectile dysfunction (IIEF) scoring, nocturnal penile tumescence, penile Doppler ultrasonography, cavernosography, and, if needed, cavernosometry. Three months after surgery, all patient parameters were reevaluated and compared with the preoperative results. Biopsy results of 43 patients with penile fracture were used for controls.

Results: The mean follow-up was 49.0 ± 24.1 months. The mean age of the patients with ED was 32.1 ± 8.6 years. Venous leakage was clearly revealed by cavernosography in all patients, preoperatively. The IIEF score and peak systolic velocity of the cavernosal artery in the patients did not differ postoperatively. The mean end diastolic velocity (EDV), however, decreased from 11.0 cm/s to 5.1 cm/s (P = .023). Only 2 patients had satisfactory penile rigidity after venous ligation, 2 were helped by intracorporeal injection to achieve full rigidity, and 1 used oral sildenafil to achieve full rigidity. Pathologically, 23 patients had a slight decrease of cavernosal smooth muscle cells, while in 9 patients, the cavernosal smooth muscles were markedly decreased and replaced by collagen fibers. Four patients had normal histologies, and all responded either partially or completely to surgical therapy. In the control group, 41 of 43 patients had a normal histologies, and 2 had a slight decrease of smooth muscle cell mass.

Conclusion: Decreased cavernosal smooth muscle mass may impair erectile function. Its association with venoocclusive ED may be a poor prognostic factor of the outcome of surgical therapy. For the preoperative evaluation of patients, we propose cavernosal biopsy.


Early versus Delayed Internal Urethrotomy for Recurrent Urethral Stricture after Urethroplasty in Children

Seyyed Yousef Hosseini, Mohammad Reza Safarinejad

Urology Journal, Vol. 2 No. 3 (2005), 28 Ordibehesht 2009, Page 165-168

Introduction: Our aim was to evaluate the results of early versus delayed internal urethrotomy for management of recurrent urethral strictures after posterior urethroplasty in children.

Materials and Methods: Twenty boys with proven posterior urethral strictures were treated by perineal posterior urethroplasty. Of these, 12 required internal urethrotomy. Each radiograph demonstrated a patent but irregular urethra with a decrease in diameter at the point of repair (fair results). Patients were then divided into 2 groups: 6 underwent early (within 6 weeks from urethroplasty), and 6 underwent delayed (after 12 weeks from urethroplasty), internal urethrotomy with the cold knife as a complementary treatment. The groups were comparable in terms of patient age, etiology of the primary urethral stricture, number of recurrences, length and site of the actual stricture, and preoperative maximum flow rate. Mean follow-up was 5 years.

Results: Kaplan-Meier analyses showed that the stricture-free rate was 66.6% after early, and 33.3% after delayed, internal urethrotomy (P = .03).

Conclusion: Early internal urethrotomy should be considered in boys with recurrent urethral stricture after urethroplasty.



Congenital Urethral Anomalies in Boys. Part II

Abdolmohammad Kajbafzadeh

Urology Journal, Vol. 2 No. 3 (2005), 28 Ordibehesht 2009, Page 125-131

Introduction: In the second part of this article, congenital urethral anomalies other than posterior urethral valve were reviewed.

Materials and Methods:  The anomalies considered in the current review were anterior urethral valve, lacuna magna, syringocele, Cobb's collar, duplication of urethra, megalourethra, and prostatic urethral polyps. The literature was extensively reviewed concerning the presentations, diagnosis, different types of treatment modalities, morbidity, mortality, and new concepts for the above disorders.

Result: Anterior urethral valves or diverticula are the most prevalent congenital anomalies of anterior urethra. The lacuna magna is the largest depression in the dorsal aspect of the fossa navicularis. It is demonstrable on a well-performed voiding cystourethrography of the distal urethra. The dilated Cowper's gland duct is the other missed diagnosed anomaly of the urethra in boys. The congenital narrowing of the bulbar urethra with a variable clinical presentation and obstruction grade and different types of anterior urethral obstruction are the most common presentation of these anomalies. However, other symptoms or signs including, hematuria, bloody spotting on underwear, discomfort or sever pain in the vicinity of the glance, interrupted voiding, infection, bulging of anterior urethra, enuresis, and postvoiding dribbling are the only nonspecific manifestations of these disorders.

Conclusion: All of these disorders are demonstrable on a well-performed voiding cystourethrography of the distal urethra. The urologist must be aware about these uncommon congenital anomalies and the anterior urethra should be carefully evaluated for such anomalies. Diagnosis of these entities is elusive unless the physician is looking for them. Nonspecific symptoms mentioned here besides radiographic findings can be a valuable clue for diagnosis.