PURPOSE: Our aim was to review the spectrum of usual and unusual clinical and morphologic findings observed in mixed epithelial and stromal tumor of the kidney (MEST). MATERIALS AND METHODS: On the basis of MEDLINE database searches, we assessed all aspects of MEST or adult mesoblastic nephroma since the first report in 1997 till the end of 2009. RESULTS: Mixed epithelial and stromal tumor is a relatively rare and distinct neoplasm of the kidney that should be distinguished from other renal neoplasms. Although the overall prognosis is favorable, recurrence and malignant transformation of MEST can occur CONCLUSION: It is difficult to distinguish benign or malignant nature on imaging studies.



Comparison of Intranasal Desmopressin and Intramuscular Tramadol Versus Pethidine in Patients with Renal Colic

Samad Hazhir, Yadollah Ahmadi Asr Badr, Javad Nasiri Darabi

Urology Journal, Vol. 7 No. 3 (2010), 15 Shahrivar 2010, Page 148-151

PURPOSE: To study the safety and efficacy of intranasal desmopressin and intramuscular tramadol versus pethidine for treatment of renal colic. MATERIALS AND METHODS: A total of 90 adult patients who presented with renal colic to the emergency wards were recruited in this study. The patients were randomly assigned to receive 100 mg intramuscular tramadol, 40 ?g intranasal desmopressin, or 40 ?g intranasal desmopressin plus 100 mg intramuscular tramadol. The severity of the pain was assessed using Visual Analogue Scale. RESULTS: The studied patients consisted of 49 men and 41 women with the mean age of 35.20 ± 13.26 years (range, 16 to 82 years). There was no statistically significant difference regarding the mean age (F [2, 89] = 2.98, P = .056) and gender differences (x2 = 3.3, df = 2, P = .19) in three groups. There was also no statistically significant difference considering pain relief in 3 studied groups (P = .2). CONCLUSION: We concluded that narcotics such as pethidine cannot be replaced by tramadol in patients with renal colic, but tramadol, desmopressin,or both in combination can reduce pethidine requirement.


Laparoscopic Bilateral Retroperitoneal Lymph Node Dissection in Stage II Testis Cancer

Abbas Basiri, Mohammad Asl-Zare, Mehrdad Mohammadi Sichani, Hooman Djaladat

Urology Journal, Vol. 7 No. 3 (2010), 15 Shahrivar 2010, Page 157-160

PURPOSE: We report our experience with laparoscopic bilateral retroperitoneal lymph node dissection (RPLND) in 4 patients with stage II testis cancer. MATERIALS AND METHODS: Between January 2002 and January 2009, 4 patients with stage II testis cancer underwent laparoscopic bilateral RPLND. In 2 patients, laparoscopic bilateral RPLND was performed for residual mass post-chemotherapy. We performed classic bilateral RPLND without patient repositioning. RESULTS: The procedure was done uneventfully without any major perioperative complication. The demanding part was contralateral, depending side dissection, which was accomplished with the help of a bowel retractor. Patient repositioning was not necessary. CONCLUSION: Laparoscopic bilateral RPLND can be performed efficiently and safely in stage II testis cancer, without need to repositioning and placement of trocar in contralateral side.

Primary Left Upper Quadrant (Palmer’s Point) Access for Laparoscopic Radical Prostatectomy

?lter Tüfek, Haluk Akp?nar, Cüneyd Sevinç, Ali R?za Kural

Urology Journal, Vol. 7 No. 3 (2010), 15 Shahrivar 2010, Page 152-156

PURPOSE: Although Palmer’s point approach is described for upper urinary tract laparoscopy, we use this technique routinely for robotic and standard laparoscopic radical prostatectomy and we describe our experience with this approach. MATERIALS AND METHODS: Since 2004, Palmer’s point Veress entry has been used to create pneumoperitoneum in 126 robotic and 21 standard laparoscopic radical prostatectomies. On the left side, a 2-mm transverse skin incision was made 3 cm below the left costal margin on the midclavicular line. Through this incision, a Veress needle was inserted to create pneumoperitoneum.RESULTS: The mean patients’ age and body mass index were 59.7 years (range, 37 to 73 years) and 27.92 kg/m2 (range, 22 to 39 kg/m2), respectively.Thirty-eight patients had prior abdominal operations. The mean number of punctures performed was 1.08 per case. In 93 % of the subjects, Veress needle was inserted during the first attempt. The mean time to establish pneumoperitoneum was 5.63 minutes (range, 4 to 8 minutes). No major entrance injuries occurred. CONCLUSION: Palmer’s point upper quadrant Veress needle access may be a safe and effective method of establishing pneumoperitoneum in patients subjected to robotic and standard laparoscopic radical prostatectomy.


Ultrasonographic Screening of Newborns for Congenital Anomalies of the Kidney and the Urinary Tracts

Yilmaz Tabel, Zehra Sule Haskologlu, Hakki Muammer Karakas, Cengiz Yakinci

Urology Journal, Vol. 7 No. 3 (2010), 15 Shahrivar 2010, Page 161-167

PURPOSE: To search for the efficiency of scanning the newborns with routine urinary system ultrasonography. MATERIALS AND METHODS: Urinary ultrasonography has been carried out on 721 infants born in or brought to our hospital. During the study, name, sex, week of birth, presence of antenatal diagnosis or urinary tract infections, and pathologies in examinations of the babies were recorded. Ultrasonography analysis was done with a scanner by a radiologist. Patients identified to have pathology, were watched closely in pediatric nephrology clinic, and advanced visualizations and treatments were carried out. RESULTS: Seventy-six infants (10.5%) had congenital anomalies of the kidney and the urinary tracts that prompted medical and/or surgical intervention. Of whom, 32 were diagnosed with antenatal ultrasonography and 44 during their initial postnatal ultrasonography screening. The most frequent identified pathology was hydronephrosis, in particular physiologic hydronephrosis (35.8%). The most frequent congenital urinary anomaly which caused hydronephrosis was ureteropelvic obstruction. CONCLUSION: It is suggested to apply the urinary ultrasonography scanning to all the infants that are born or brought to the university hospital. If possible, it is to be considered to include urinary ultrasonography scanning in newborn scanning programs.


Genetic Aberrations of the K-ras Proto-oncogene in Bladder Cancer in Kashmiri Population

Mahoor S. Nanda, A. Syed Sameer, Nidda Syeed, Zaffar A. Shah, Imtiyaz Murtaza, Mushtaq A Siddiqi, Arif Ali

Urology Journal, Vol. 7 No. 3 (2010), 15 Shahrivar 2010, Page 168-173

PURPOSE: To assess the frequency of specific point mutations in the K-ras gene in a group of Kashmiri patients with bladder cancer. MATERIALS AND METHODS: We analyzed the incidence of K-ras exon 1 gene mutations in tumors and surgical margins in 60 patients with transitional cell carcinoma of varied clinical stages and histological grades using the polymerase chain reaction-single strand conformation polymorphism and DNA sequencing. RESULTS: A significant correlation was found between the K-ras, the lymph node status, and tumor recurrence (P < 0.05). Also, smokers and patients with higher tumor grade showed a significantly higher relative risk of developing K-ras mutations than the normal ones. CONCLUSION: K-ras exon 1 gene mutations were found with low frequency in the bladder cancer tumors from Kashmir valley, which suggests that K-ras gene might be involved in a sub-set of bladder tumors, but it needs further investigation on a larger cohort sample to authenticate the current findings.


Erectile Function and Dysfunction Following Low Flow Priapism: A comparison of Distal and Proximal Shunts

Ali Tabibi, Hamidreza Abdi, Nastaran Mahmoudnejad

Urology Journal, Vol. 7 No. 3 (2010), 15 Shahrivar 2010, Page 174-177

PURPOSE: To compare erectile function following low flow priapism in patients undergoing distal and proximal shunts. MATERIALS AND METHODS: From January 1995 to December 2005, we retrospectively studied 16 patients who presented to our medical center with refractory priapism. Of 16 patients, 5 underwent Winter shunt, while El-Ghorab procedure was performed for 7 patients and the remaining 4 underwent Grayhack shunt. Erectile function was assessed in a minimum follow-up of 2 years (range, 2 to 10 years) using erectile dysfunction (ED) intensity scale [Total score: 5 to 10 (severe ED); 11 to 15 (moderate ED); 16 to 20 (mild ED); and 21 to 25 (no ED)]. RESULTS: The mean patients’ age was 40.62 ± 15.27 years. Mean duration of priapism was 51.12 ± 37.99 hours. Of 4 patients (25%) who underwent proximal shunt (Grayhack procedure), 2 (50%) were impotent, 1 had potency, and the other one achieved some penile erection with administration of oral sildenafil. Of 5 patients (31.25%) who underwent Winter procedure, 1 died because of metastatic bladder cancer and of 4 remainders, 2 (50%) had normal erectile function, but 1 patient suffered from recurrent priapism. Of 7 patients (43.75%) who underwent El-Ghorab procedure, 1 was lost for follow-up and of remaining 6 patients, 2 (33.3%) had normal erectile function and 4 (66.6%) were impotent. No surgical complication was seen. Median lag time from priapism till surgery for patients with and without ED was 48 and 26 hours, respectively (P = .22). CONCLUSION: Grayhack shunt is a safe surgical procedure without any major complications and with lower ED rate. Grayhack shunt might be considered as treatment of choice for refractory low flow priapism.


Complications of Transverse Distal Penile Island Flap: Urethroplasty of Complex Anterior Urethral Stricture

Abimbola O. Olajide, Abdulkadir A. Salako, Ademola A. Aremu, Amogu K. Eziyi, Folakemi O. Olajide, Oluseyi O. Banjo

Urology Journal, Vol. 7 No. 3 (2010), 15 Shahrivar 2010, Page 178-182

PURPOSE: To report the complications of transverse distal penile island flap urethroplasty for urethral reconstruction in adult patients with long/ multiple segments anterior urethral stricture. MATERIALS AND METHODS: This prospective study was carried out on 55 patients with complex anterior urethral stricture to study complications of transverse distal penile island flap urethroplasty in two teaching hospitals between June 2002 and December 2008. Pre-, intra- and postoperative information were collected on a pro forma to generate data, which was analyzed. RESULTS: The patients’ mean age was 43.83 years (range, 19 to 73 years). The leading etiology of the stricture was urethral inflammation (76.4%) with the commonest complication being infection: wound infection in 9.1%, urosepsis in 3.6%, and epididymo-orchitis in 1.8% of the subjects. CONCLUSION: Transverse distal penile island flap urethroplasty has a remarkable outcome in treatment of a long/multiple segment urethral stricture with few manageable complications.


Effects of Isosorbide Dinitrate on the Urinary Flow Rate in Patients With Benign Prostatic Hyperplasia

Ali Roshani, Iraj Khosropanah, Mohammad Salehi, Alireza Noshad Kamran

Urology Journal, Vol. 7 No. 3 (2010), 15 Shahrivar 2010, Page 183-187

PURPOSE: To compare the immediate effects of a systemic nitric oxide (NO) donor with placebo on the uroflowmetric parameters in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: Eighty patients with the mean age of 61.5 years (range, 49 to 74 years) who suffered from BPH were enrolled in the study. We examined peak flow rate, average flow rate, and residual urine in all the patients. Then, patients were randomized to receive either 20 mg sublingual isosorbide dinitrate (ISDN) (n = 40) or placebo (n = 40) 20 minutes prior to the second uroflowmetry, which was performed one day after the first test. RESULTS: The mean peak flow rate increased from 7.6 ± 0.41 mL/s to 10.2 ± 0.54 mL/s (P = .013) in the ISDN group, while it increased +0.40 mL/s in the placebo group (P > .05). Mean residual urine volume decreased significantly from 51 ± 3.1 mL to 29 ± 2.9 mL and from 56 ± 4.1 to 51 ± 2.6 in the ISDN (P = .02) and the placebo groups (P > .05), respectively. At baseline, the mean arterial pressure was 95 ± 2.1 mmHg and under the influence of the NO-donor, it decreased to 83 ± 1.9 mmHg, which was significant (P < .001). No significant changes of micturition parameters were found in the placebo group. CONCLUSION: Organic nitrates influence micturition parameters in patients with BPH. This new approach could offer a potential pharmacological option to treat obstructive lower urinary tract symptoms.

Safety and Efficacy of Clomiphene Citrate and L-Carnitine in Idiopathic Male Infertility: A Comparative Study

Mahmoudreza Moradi, Asaad Moradi, Mohsen Alemi, Hassan Ahmadnia, Hossein Abdi, Alireza Ahmadi, Shahrzad Bazargan-Hejazi

Urology Journal, Vol. 7 No. 3 (2010), 15 Shahrivar 2010, Page 188-193

PURPOSE: To compare the effects of L-carnitine with clomiphene citrate in idiopathic infertile men. MATERIALS AND METHODS: Fifty-two men with idiopathic infertility were recruited in this randomized controlled trial. They were randomly assigned into 2 treatment groups, group 1 (n = 20) and group 2 (n = 32), who received L-carnitine 25 mg/day and clomiphene citrate 2 gr/day, respectively, for a period of 3 months. RESULTS: Comparing the effect of L-carnitine and clomiphene on sperm parameters before and after the treatment, both medications had influence on sperm count and motility (P = .01). L-carnitine significantly increased the semen volume (P = .001), while clomiphene citrate was significantly associated with the motility percentage and normal morphology (P = .008). CONCLUSION: It seems that the use of clomiphene citrate and L-carnitine, either individually or in combination, as the first step of idiopathic male infertility treatment is reasonable, safe, and effective.