Urology Journal

PURPOSE: To provide key evidence-based strategies to improve outcomes of radiofrequency ablation and limit recurrences of small renal tumors. MATERIALS AND METHODS: The literature was searched via OvidSP MEDLINE from 1997 to current using MeSH terms. All levels of evidence and types of reports were reviewed. RESULTS: We comprehensively reviewed technical issues, mechanisms, imaging criteria, ablative success, enhancement within one month, contraindications, oncological efficacy, morbidity rates, and follow-up strategies. CONCLUSION: The technique is safe and effective. Tumors < 2.5 cm are statistically most likely to remain disease-free. Anterior tumors are contraindicated. Strict follow-up is needed to detect failures, most of which occur within 3 months and can be easily salvaged with repeat radiofrequency ablation. Homogeneous enhancement within 1 month is not necessarily a failure, and tends to disappear after 4 to 6 weeks. Multi-disciplinary meetings must occur to discuss each case prior to treatment.

PURPOSE: To investigate the association between SPP1 gene polymorphisms and nephrolithiasis. MATERIALS AND METHODS: A total of 65 pediatric patients and 50 healthy controls were enrolled in this study. Two known polymorphisms of the SPP1 gene, c.240T > C and c.708C > T nucleotide substitutions, both of which were also known as synonymous aminoacid polymorphisms, D80D and A236A, respectively, at SPP1 gene cDNA level were investigated. SPP1 gene polymorphism was evaluated using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism method. RESULTS: In c.240T > C polymorphism, C allele frequency [Odds Ratio (OR), 2.13; 95% Confidence Interval (CI), 1.170 to 3.880; P = .013] and CC genotype distribution (OR, 2.946; 95% CI, 0.832 to 10.431; P = .094) and in c.708C > T polymorphism, T allele frequency (OR, 2.183; 95% CI, 1.197 to 3.980; P = .011) and TT genotype distribution (OR, 3.056; 95% CI, 0.861 to 10.839; P = .084) were found to be higher in the patient group. CONCLUSION: SPP1 polymorphisms were found to be associated with nephrolithiasis and it may be suggested that SPP1 gene polymorphism could be a useful marker for evaluation of the early genetic risk factor in childhood nephrolithiasis.

PURPOSE: To determine whether pre-ureteroscopic stone extraction (USE) evaluation by intravenous urography (IVU) can change the clinical decision made on the basis of a plain X-ray of the kidneys, ureters, and bladder (KUB) plus an ultrasonography in the case of ureteral calculi. MATERIALS AND METHODS: From October 2005 to November 2007, 139 USE candidates were selected based on ultrasonography and KUB, and were randomly divided into two groups. Each group was assessed by an expert urologist to decide about the treatment plans. Thereafter, all the patients underwent an IVU pre-operatively and were evaluated for the second time by the other urologist considering IVU. Presence of a hydronephrotic kidney on the ultrasonography, existence of a density in the probable tract of the ureter on KUB, and previous episodes of renal colic were considered as inclusion criteria. Exclusion criteria were non-opaque stones on KUB, hypersensitivity to contrast media, and serum creatinine > 1.5 mg/dL. RESULTS: On the basis of ultrasonography and KUB assessment, all of the patients were identified candidate for USE. According to secondary IVU-based planning, of 139 patients, 127 (91.3%) required USE, 10 (7.1%) ureteroscopy, and 2 (1.4%) non-operative treatment. About 8.7% of treatment plans was changed by IVU, which was not statistically significant (P = .35). Positive predictive value of ultrasonography plus KUB to diagnose a ureteral stone which needed USE was 92.8% while IVU is the gold standard (95% confidence interval: 92.38 to 93.22). CONCLUSION: Intravenous urography is not useful enough to be performed routinely before entire USEs.

PURPOSE: To evaluate the efficacy of laparoscopic nephroureterectomy and open bladder cuff excision for management of upper urinary tract urothelial carcinoma. MATERIALS AND METHODS: Twenty-two patients with upper urinary tract urothelial carcinoma, who had undergone laparoscopic nephroureterectomy and open bladder cuff excision between September 2004 and October 2010, were studied retrospectively. Operation time, blood loss, analgesic dose, and complications were recorded. Local and port site recurrence, distant metastasis, and survival rate were also evaluated. RESULTS: Patients consisted of 18 men and 4 women, with the mean age of 64.1 years (range, 52 to 83 years). Right upper urinary tract was the involved site in 12 patients and left in 10 patients. Mean operation time was 216 minutes (range, 145 to 395 minutes) and mean hospital stay was 4.3 days. Mean follow-up period was 36.57 months (range, 6 to 65 months). No trocar site recurrence occurred. Three-year overall survival and metastasis-free survival were 95% and 90%, respectively. CONCLUSION: Laparoscopic nephroureterectomy along with open bladder cuff excision harbors an advantage of laparoscopy concomitant with simplicity and safety of open excision of distal ureter and bladder cuff through the same inevitable incision that is needed for specimen retrieval, without adding any more morbidity to the patient, a win-win radical surgery.

PURPOSE: To report our initial experience with laparoendoscopic single-site (LESS) nephrectomy using a GelPOINT single port and standard laparoscopic instruments. MATERIALS AND METHODS: Laparoendoscopic single-site transperitoneal nephrectomy was done for 6 adult patients with a poorly functioning small or hydronephrotic kidney. The procedure was done with the GelPOINT system, which consisted of a wound retractor (Alexis) and GelSeal cap. Standard laparoscopic instruments were used and the renal pedicle was controlled with 10-mm Hem-o-Lok clips. RESULTS: The participants were 3 men and 3 women with the median age of 29.5 years. Laparoendoscopic single-site nephrectomy was successfully done in all the patients without any major complications. Median operation time was 110 minutes (range, 90 to 130 minutes). There was no need for blood transfusion in any patient. The recovery phase was uneventful and all the patients were discharged after a median hospital stay of 2.5 days (range, 2 to 3 days). Renal function remained stable in all the patients after the operation. The incision site healed well on postoperative follow-up. CONCLUSION: Our initial experience with LESS nephrectomy was successful with the use of a GelPOINT single port and standard laparoscopic instruments. This report may remove barriers to further work with the LESS technique and may offer a strategy to help surgeons gain experience with this novel technology.

PURPOSE: To compare the kidney tumor size on radical nephrectomy pathology specimen with size estimated by computed tomography (CT) scan and ultrasonography. MATERIALS AND METHODS: The tumor size on pathology specimen of 40 patients who had undergone radical nephrectomy at our center from March 2003 until March 2009 was compared with pre-operative CT scan and ultrasonography findings. The paired t test was used to compare the means. RESULTS: The participants included 40 patients, 25 men and 15 women, with the mean age of 64.12 ± 10.75 years (range, 42 to 79 years). All tumors were renal cell carcinoma. Mean tumor size on pathology specimen was 6.2 ± 1.1 cm. Mean tumor size estimated by pre-operative CT scan and ultrasonography was 7.34 ± 1.83 cm and 7.4 ± 1.96 cm, respectively (P = .001). Tumor stage did not affect this significant difference. There was not any significant difference between tumor size estimated by CT scan or ultrasonography (P = .39). CONCLUSION: Computed tomography scan and ultrasonography both may overestimate renal tumor size. This point must be considered in clinical staging and treatment selection. Multicenter prospective comparison is suggested.

PURPOSE: To determine the probability of having prostate cancer (PCa) using the combination of serum level of prostate-specific antigen (PSA) and age. MATERIALS AND METHODS:  A total of 160 patients and 190 controls were enrolled in this hospital-based case-control study. Using a logistic regression model and the odds ratio of age and PSA level, the probability of PCa was estimated based on serum level of PSA and age of the participants. RESULTS: The mean age of patients with PCa and benign prostatic hyperplasia (BPH) was 67.75 ± 8.81 and 62.07 ± 8.71 years, respectively (P < .000). Using univariate analysis, we found that increase in life decades of the cases almost doubles the risk of having PCa (odds ratio = 1.95; P = .00), and the probability of developing cancer may increase by 74% in ketchup consumers. After multiple variable regressions, it was revealed that the odds of developing PCa increase by 90% only for every decade, and other variables did not have any significant association with PCa. CONCLUSION: In clinical practice, PSA level combined with the age at presentation can be used as predictors of PCa probability and the necessity of biopsy.

PURPOSE: To evaluate the efficacy and safety of combination treatment with thalidomide and taxotere in patients with hormone-resistant prostate cancer. MATERIALS AND METHODS: This clinical trial was performed on 16 patients with hormone-resistant prostate cancer. RESULTS: Mean age of the participants was 72.7 ± 5.39 years (range, 65 to 85 years). In 94% of patients who received the drug combination, prostate-specific antigen level decreased more than 50%. The mean time to progression was 15 months and mean survival time was 23 months. This combination therapy had some adverse events. CONCLUSION: Addition of anti-angiogenic agents, such as thalidomide, can improve therapeutic outcome in this group of patients.

PURPOSE: To compare two matched groups of men with bladder transitional cell carcinoma (TCC) who underwent prostate-sparing cystectomy (PSC) or conventional radical cystoprostatectomy (CRC). MATERIALS AND METHODS: Twenty-three men who have undergone PSC with the diagnosis of bladder TCC (Ta–T2) from 2003 to 2008 in Tehran, Iran were included in the study as the experimental group. The control group composed of 27 men with comparable tumor characteristics and age range, who had non-nerve-sparing radical cystoprostatectomy and orthotopic ileal W pouch reconstruction in the same center. All the procedures were performed by the same surgical group under the supervision of different attending staff. RESULTS: Mean follow-up period was 39 months in PSC and 35 months in CRC group. The 5-year overall survival was 47% and 30% in PSC and CRC groups, respectively. Median survival was 48 months in PSC and 36 months in CRC group, using Kaplan-Meier survival analysis (P> .05). Impotence was observed in 16.6% in PSC and in 83.3% in CRC group (P = .002). Mean International Index of Erectile Function-5 score of the PSC group was 19.8 compared with 5.7 in the CRC group (P = .003). Only one patient in each group was completely incontinent. Urethral anastomosis stricture occurred in 2 patients in CRC group. CONCLUSION: Patients who underwent PSC did not show decreased overall survival compared to CRC, which provided better functional results.

PURPOSE: To validate the Persian version of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) as a standard questionnaire for assessment of urinary incontinence (UI). MATERIALS AND METHODS: After translation and back translation of the questionnaire, the harmonized translation was pre-tested in a pilot study on 28 patients. The final Persian version of the ICIQ-UI SF was administered to 123 consecutive patients aged ≥ 16 years complaining of UI. The psychometric aspects of the questionnaire, such as reliability and construct validity, were assessed and compared with full urodynamics study’s findings as the gold standard diagnostic test. RESULTS: Mean age of the participants was 46.30 ± 13.14 years (range, 16 to 72 years). Based on ICIQ-UI SF, the prevalence of mixed urinary incontinence, stress urinary incontinence and urgency urinary incontinence was 35%, 34.1%, and 30.9%, respectively. Cronbach’s alpha coefficient was calculated 0.75, which indicates the high reliability of this questionnaire in determination of UI. The obtained Weighted Kappa Index in determining the value of the test-retest was 0.70, and Pearson Correlation Coefficient was calculated 0.93 and intra-class correlation coefficient was 0.84. CONCLUSION: Persian version of ICIQ-UI SF is a simple, valid, and reliable method for evaluation of patients with UI. Significant correlation exists between ICIQ-UI SF score and urodynamics parameters.

PURPOSE: To determine the association of prostate-specific antigen (PSA) 158A/G polymorphism with clinicopathologic characteristics of the disease and prostate cancer (PCa) risk. MATERIALS AND METHODS: Two hundred and six subjects, including 95 patients with PCa and 111 subjects with benign prostatic hyperplasia (BPH), were recruited in this study. Genotyping was performed by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism method. RESULTS: Presence of GG genotype significantly increased the risk of PCa more than 2-fold compared to AG genotype (adjusted odds ratio = 2.4; P = .03). The percentages of G alleles of polymorphisms in patients with PCa were more than that in ones with BPH (odds ratio = 1.2; P = .7). CONCLUSION: The GG genotype of PSA 158A/G polymorphism is a predisposing factor for PCa. But no association was observed between alleles and grade, stage, or age of diagnosis. Similarly, the rs266882 polymorphism was not associated with PSA plasma levels.

PURPOSE: To evaluate the long-term results of adult circumcisions performed by plastic clamp technique as well as the effects on sexual function. MATERIALS AND METHODS: A total of 186 adult males with the mean age of 21.2 ± 2.8 years who presented to our clinic for circumcision between February 2007 and January 2010 were included in the study. Safety and acceptability of circumcision with plastic clamp technique as well as its effects on sexual functions were analyzed with a mean follow-up period of 30.4 ± 14.2 months (range, 12 to 52 months). RESULTS: The mean duration of circumcision and removal of the clamp were 3.1 ± 1.1 minutes and 16 ± 7 seconds, respectively. The total complication rate was 2.15%. Wound dehiscence (1.07%), infection (0.54%), and bleeding (0.54%) were the encountered complications. Complete wound healing was observed at a mean of 25.5 ± 4.6 days. We did not encounter any penile deformity or other long-term complications. Circumcision did not adversely affect the sexual drive or ejaculation based on the brief male sexual function inventory scores. Erectile function and overall satisfaction improved following circumcision. CONCLUSION: Circumcision performed by plastic clamp technique in adult males had a low early complication rate with no long-term complications and caused improvement in some of the sexual functions. We suggest the utilization of this technique as an easy and a safe way of circumcising adult males.