Urology Journal

Purpose: To evaluate the prevalence and type of rigid ureteroscopy complications and suggest a new method for ureteral avulsion prevention. Materials and Methods: Between March 2002 and March 2009, we retrospectively evaluated 2955 patients who had undergone diagnostic or therapeutic ureteroscopy for asymptomatic hematuria, migrated ureteral stent, or transurethral lithotripsy. They were enrolled from four hospitals in Ahvaz, Iran. Results: Complications were encountered in 241 (8%) patients, including transient hematuria (4.2%), mucosal erosion (1.4%), stone migration (1.3%), ureteral perforation (1.2%), and fever and/or sepsis (1.0%). Ureteral avulsion occurred in 6 (0.2%) patients. Mostly, complications were managed conservatively, using ureteral stenting. Ureteral avulsions were managed using a new technique. Conclusion: In our series, the complication rate is comparable with the literature. A new technique was used in case of ureteroscope entrapment in the ureter, to lessen the occurrence of ureteral avulsion.

Purpose: To investigate the therapeutic effects of the aqueous extract of Petroselinum Sativum aerial parts and roots on kidney calculi. Materials and Methods: Thirty-six male Wistar rats were randomly assigned into 6 groups and treated for 30 days. Group A served as normal control and group B received 1% ethylene glycol in drinking water. Groups C, D, E, and F received 1% ethylene glycol from day 0 and were used as the treatment subjects. Rats in groups C and D received 200 and 600 mg/kg body weight of aerial parts aqueous extract, respectively, and those in groups E and F received 200 and 600 mg/kg body weight of root aqueous extract in drinking water, respectively, from the 14th day of the experiment. Results: On the 14th and 30th days of the experiment, serum level of magnesium (1.71 ± 0.12 and 3.81 ± 0.25, respectively) decreased significantly while serum level of calcium (10.45 ± 0.26 and 11.33 ± 0.18, respectively) increased significantly in group B compared with the control group (14th day: magnesium = 2.87 ± 0.17 and calcium = 8.80 ± 0.00 and 30th day: magnesium = 6.01 ± 0.00 and calcium = 8.30 ± 0.22; P < .001). In the treatment groups of C, D, E, and F, the number of deposits decreased significantly compared with group B on the 30th day (P < .001). The weight of the kidneys increased significantly in group B (2.01 ± 0.17) compared with the control group (1.52 ± 0.07) and decreased significantly in treatment groups (P < .05). Conclusion: Petroselinum Sativum has a therapeutic effect on calcium oxalate stones in rats with nephrolithiasis and reduces the number of calcium oxalate deposits.

Purpose: To assess the accuracy of voided urine cytology versus urinary nuclear matrix protein 22 (NMP22) qualitative assay in the diagnosis of various grades and stages of recurrent bladder transitional cell carcinoma (TCC). Materials and Methods: From July 2007 to February 2009, all patients with history of superficial bladder TCC were included in this multi-center study. Each patient provided three serial voided urine samples for cytologic examination and one sample for the NMP22 qualitative assay prior to urethrocystoscopy. The sensitivity and specificity of urine cytology and the NMP22 test were determined. Results: The sensitivities of the NMP22 test and cytology for detection of recurrence were 78.8% and 44.2%, respectively (P = .001), while the specificities were 69.6% and 83.7%, respectively (P = .019). The NMP22 test showed significantly higher sensitivity than cytology in detecting recurrences in low-risk and intermediate-risk groups. Conclusion: The NMP22 assay could be used for detection of superficial bladder cancer, especially in low- and intermediate-risk groups; however, the value of the test is limited by its low specificity.

Purpose: To determine the pattern and outcome of renal tumors in young adults in a large surgical series in Pakistan. Materials and Methods: We retrospectively analyzed 133 young adults (age: ≥ 16 to ≤ 40 years) with 136 renal tumors, who underwent surgical treatment for suspected renal cancer from 1994 till 2010. The clinical and pathological parameters were determined and their impact on final outcome was analyzed.  Results: The mean age of the patients was 33.3 ± 6.2 years. Of 136, 121 (88.9%) renal tumors were malignant and 15 (11%) were benign. Among malignancies, 76 (62.7%) patients had stage I or II tumors, 22 (18.1%) stage III, and 23 (19%) stage IV at surgery. The overall cancer-specific survival for malignant tumors at 1, 5, and 10 years was 97%, 83%, and 83%, whereas the cancer-free survival (CFS) was 80%, 63%, and 37%, respectively. Patients with age ≤ 35 years had 1 and 5-year CFS of 83% and 71%, respectively, as compared with 76% and 49% for patients > 35 years (P = .02; odds ratio = 2.3; P = .03). Regarding tumor size, 1 and 5-year CFS for tumors ≤ 10 cm was 93% and 75%, while tumors > 10 cm showed CFS of 56% and 41%, respectively (P = .0001; odds ratio = 4.2; P = .0001). For stage I tumors, CFS at 1 and 5 years was 98% and 84%; for stage II, 82% and 63%; and for stage III, 62% and 50%, respectively. One-year survival for stage IV was 48% only (P = .0001). Conclusion: A wide heterogeneity of renal tumors is seen in young adults with delayed presentation.

Purpose: To evaluate the correlation of Bcl-2 and Bax protein expressions with biochemical failure-free survival in patients with advanced or metastatic prostate carcinoma (PCa) undergoing androgen deprivation therapy. Materials and Methods: This retrospective study was performed on patients with locally advanced (≥ T3) or metastatic PCa, who were referred to Omid Hospital between years 2003 and 2007. All subjects had undergone androgen deprivation therapy. Samples were analyzed immunohistochemically for Bax and Bcl-2 expression. The H-score was calculated for each sample based on intensity and percentage of stained cells. H-score > 50 was considered positive. Results: Thirty-seven patients (13 metastatic and 24 locally advanced) were eligible for analysis. Thirty-six (97.3%) samples were positive for Bax and 26 (70.3%) for Bcl-2 expression. The median H-score for Bax and Bcl-2 was 200 (range, 40 to 300) and 85 (range, 0 to 220), respectively. While there was no correlation between Bax expression and Gleason score, high Bcl-2 expression (H-score > 85) was significantly associated with Gleason score > 7 (P = .004). The median time to progression in the advanced and metastatic groups was 22 (range, 10 to 37) months and 16 (range, 9 to 26) months, respectively. High Bcl-2 expression (P = .01) and prostate-specific antigen > 20 ng/mL (P = .01) were significant predictors of lower biochemical progression-free survival. Conclusion: High Bcl-2 expression was associated with higher Gleason scores and lower biochemical-free survival in patients with advanced PCa undergoing androgen deprivation therapy.

Purpose: To describe mini-laparoscopic donor nephrectomy (MLDN). In this novel approach, we used 3.5 mm trocars in usually visible parts of the abdomen. Materials and Methods: A 27-year-old man underwent MLDN. The first trocar was placed transumblically, which is used for videoscope. Two 3.5 mm trocars were placed above and lateral to the umbilicus and were used for grasping and scissoring. A 10-mm trocar was placed through fascia within pfannenstiel incision, which is also used for the kidney extraction. The site of this trocar will be covered later by hair growth. This trocar is used for vascular clipping. Results: Mini-laparoscopic donor nephrectomy was done successfully. Operation time was 135 minutes and warm ischemia time was 5 minutes. Patient was discharged from the hospital in 36 hours. No peri-operative complication occurred. Nadir serum level of creatinine in the recipient was 0.8 mg/dL. Conclusion: Mini-laparoscopic donor nephrectomy can be a good alternative to standard laparoscopic donor nephrectomy, giving an excellent cosmetic result. This technique is more ergonomic and user-friendly compared to laparoendoscopic single-site surgery (LESS) techniques.

Purpose: To evaluate both morphology of the urethra and its supporting structures using endovaginal magnetic resonance imaging (EV-MRI) and the grade of the bladder neck prolapsus using dynamic pelvic MRI (DP-MRI) in women with stress urinary incontinence (SUI). Materials and Methods: We compared 25 women with SUI and 8 controls according to the different layers of the urethra, the degree of distortion in the periurethral, paraurethral, and pubourethral ligaments, the vesicourethral angle, the retropubic space, and the thickness of the puborectal muscle. The SUI group was also evaluated according to the number of deliveries and degree of the bladder neck prolapsus. Results: Significant differences were found in the thickness of each three layers of the urethra between the two groups (P < .05). There was a significantly higher pubourethral ligament distortion (P = .024) and larger vesicourethral angle (P = .000) in women with SUI. In women with SUI, there was no significant relationship between the number of deliveries and the degree of the bladder neck prolapsus (P > .05). Conclusion: The combined usage of the EV-MRI and DP-MRI can provide complementary information concerning certain structural abnormalities with specific dysfunction, such as vesicourethral angle increase and pubourethral ligament distortion in patients with SUI.

Purpose: To evaluate the effect of low-dose dopamine administration on the early function of the kidney in unrelated kidney donors after transplantation. Materials and Methods: In this double-blinded clinical trial, 60 adult kidney donors and 60 recipients, younger than 50 years old, were studied. Donors and recipients were randomly divided into two groups; group 1 received dopamine 3 µg/kg/min and group 2 received similar regimen of placebo. During the first 3 days postoperatively, serum levels of urea and creatinine as well as urine output and early kidney function were compared between two groups. Results: Serum levels of creatinine and urea and urine output during the first three days after the operation did not differ statistically significantly between two groups (P = .549, P = .306 and P = .375, respectively). Early kidney function was better significantly in group 1 (5.3 ± 3.2 versus 8.6 ± 8.0 hours; P = .048). Conclusion: Premedication of the kidney transplant donors with low-dose dopamine accelerates early kidney function after transplantation, but has no effect on the hemodynamic status and serum levels of creatinine and urea in the donors.

Purpose: To evaluate the effect of hypothyroidism on erectile function and sperm parameters. Materials and Methods: This study was conducted on 24 patients with hypothyroidism and 66 normal individuals. Serum levels of hormones, including thyroid stimulating hormone (TSH), thyroxin (T4), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), and testosterone, were measured and semen analysis was done in all the participants. Erectile function was evaluated using International Index of Erectile Function (IIEF-5) questionnaire. Results: The mean IIEF-5 total score was 11.75 [95% confidence interval (CI): 9.70 to 13.79) and 20.81 (95% CI: 20.02 to 21.6) for hypothyroid group and normal subjects, respectively (P = .005). Furthermore, serum concentrations of PRL and seminal parameters were significantly different between two groups (P < .001). Conclusion: Hypothyroidism adversely affects erectile function and sperm parameters, including sperm count, morphology, and motility. In patients with sperm abnormalities and erectile dysfunction, measurement of thyroid hormones is recommended.

Purpose: To investigate the feasibility and safety of using biocompatible, nanofibrous electrospun polycaprolactone (PCL) and combination of polylactic acid (PLLA) and PCL mats in a canine model. Materials and Methods: Plasma-treated electrospun unseeded mats were implanted in three dogs. The first dog was sacrificed after 3 months and the second and third ones after 4 months, and then, the graft was examined macroscopically with subsequent morphological and histochemical evaluation. Results: Both films showed high levels of cell infiltration and tissue formation, but body response to PLLA/PCL mat in comparison to PCL mat was very low. All three implantation models showed the same light microscopic morphology, immunohistochemistry, and scanning electron microscopy results; nevertheless, only the PCL/PLLA model showed favorable clinical results. Conclusion: Based on these data, nanofibrous PLLA/PCL scaffolding could be a suitable material for the bladder tissue engineering; however, it deserves further investigations.

Purpose: To determine the anatomical landmark within the internal oblique muscle. Materials and Methods: In a prospective study, the abdominal wall was examined for internal oblique muscle land marks in 900 patients undergoing laparatomy. Results: There was a fat line at anterior superior iliac spine level to access the underlying layers and then to the abdominal cavity. Conclusion: A fat triangle within the internal oblique muscle provides a suitable region of surgical incision at the lower part of the abdominal wall.

Purpose: To review different aspects of the bladder involvement in Behcet’s disease as a rare complication. Materials and Methods: We searched PubMed, Ovid, and Google Scholar for Behcet’s and neuro-Behcet’s disease and neurogenic and neuropathic bladder, bladder involvement, voiding dysfunction, and urologic manifestations. Fourteen full-texts and one abstract were retrieved. Results: Most involved patients are young to middle-aged men. Both bladder filling and emptying problems can be seen, with the storage symptoms being the most common finding. Sphincter function could be normal, dyssynergic, or deficient. The most common urodynamic finding is detrusor overactivity. In cystoscopic examination, ulcers or nodules due to vasculitis can be seen, which along with neurologic causes give rise to the voiding symptoms. The rate of cancers does not increase in Behcet’s disease. Surgery and chemotherapy are tolerated well. However, radiotherapy may be associated with increased complication rates. Conclusion: Treatment plan should be tailored according to the specific type of the bladder involvement. Periodic re-evaluation is required because of the changing nature of the bladder behavior.