Urology Journal

Purpose: To compare the efficacy of different treatment strategies for distal ureteral stones smaller than 10 mm.

Material and Methods: A total 127 patient were included in the study. Based on the treatment modality , patients  were  divided into three groups. Patients in group 1 only received conventional treatment including daily hydration of 2500 mL, ciprofloxacin, diclofenac sodium and a spasmolytic agent; group 2 patients received conventional treatment (daily hydration of 2500 mL, ciprofloxacin, diclofenac sodium and a spasmolytic agent) and tamsulosin 0.4 mg orally daily for 4 weeks; and group 3 patients underwent ureteroscopy. Patients were further subdivided into 2 categories based on maximum stone diameter: category A (less than 5 mm) and category B (5.0-9.9 mm). Following treatment, all groups were compared in terms of stone-free rate and time to expulsion.

Results: Following treatment, the stone-free rates for groups 1, 2 and 3 were 48.7%, 59.5% and 95.6%, respectively (P < .0001). The mean expulsion times for groups 1, 2 and 3 were 15.3 ± 5.33, 15.1 ± 5.5  and 1.95 ± 2.2 days, respectively (P < .001). Compared to the other treatments, the stone-free rate and mean expulsion time in the ureteroscopy group were significantly increased and decreased, respectively.

Conclusion:

There are several treatment options for distal ureteral stones. Based on our data,we conclude that  ureterorenoscopy  should be the standard of care for distal ureteral stones smaller than 10 mm. 

Purpose: To evaluate the percutaneous access outcomes and complications following percutaneous nephrolithotomy (PCNL) that was obtained by sonographer or urologist at a single academic institution.

Material and Methods: A retrospective chart review of 259 patients who underwent PCNL was performed. Patients were stratified according to percutaneous access by sonographer (group 1) or urologist (group 2) in 174 and 85 patients, respectively. Demographic, stone characteristics, operative variables, percutaneous access complications and stone-free rates were compared between groups.

Results: The major complication rate and minor complication rate, mean blood loss and rates of blood transfusion were comparable between groups. Compared with urologist, sonographer preferred

to choose subcostal rib puncture instead of intercostal rib puncture. The lower calyx was the most frequent site of target calyx puncture in group 1 (165 cases, 94.8%), while the percentage of lower calyx in group 2 was 82.3% (72 cases) (P = .001). The overall stone-free rates were significantly higher in group 2 than that in group 1 (90.6% vs. 79.9%, P = .03). In group 1, 23 cases (13.2%) needed post-operative extracorporeal shock wave lithotripsy (SWL), while, the percentage of post-operative SWL in group 2 was only 4.7% (4 cases) (P = .035).

Conclusions: Renal access in PCNL can be safely and successfully obtained by both sonographer and urologist. Infracostal and lower calyx access in our study has poor stone-free rates and sonographer

prefers infracostal and lower access. We encourage urologists establish renal access by themselves during PCNL.

Abstract

Purpose: To determine the frequency of human leukocyte antigen (HLA)-B5 in patients with bladder cancer compared with normal population.

 Materials and Methods: In this cross sectional study, from November 2009 until November 2010, 35 patients with pathologic diagnosis of bladder cancer who referred to urology clinic of Razi Hospital were studied. Also, 130 healthy transplant donation volunteers who referred for HLA-typing to Guilan Blood Transfusion Organization, were selected. Inclusion criterion was pathologic diagnosis of bladder cancer regardless of stage and grade of tumor. Exclusion criteria were presence of other urologic diseases. The information of these cases was extracted from medical records, collected and analyzed.

 Results: HLA-B5 was positive in 34.3% of the patient group and in 39.2% of the controls. Statistical analysis showed no significant association between HLA-B5 and bladder cancer (P = .15). There were no significant differences between grade (P = .107) and relapse (P = .327) of bladder tumor with presence of HLA-B5.

 Conclusion: There was no significant association between HLA-B5 and bladder cancer. The grade and the relapse of tumor had no association with presence or absence of HLA-B5.

Purpose: We report the results of pediatric retroperitoneoscopic renal ablative surgeries, which

were performed with only three trocars.

Materials and Methods: We retrospectively reviewed the charts of children who underwent laparoscopic

urological procedures on the upper urinary tract at our institution between 2006 and 2012.

These procedures consisted of nephrectomies, nephroureterectomies and heminephroureterectomies.

The operations were performed retroperitoneoscopically with three trocars. The specimens

were removed intact through the primary trocar site.

Results: A total of 30 retroperitoneoscopic ablative surgeries were performed in 13 girls and 17

boys. The mean patient age was 7.8 ± 4.3 years (range, 1-14 years). The interventions consisted of

nephrectomy in 10 cases (33.3%), nephroureterectomy in 17 cases (56.6%) and heminephroureterectomy

in 3 (10%) cases. The open conversion rate was 3.3% (1/30). The difference between the

initial 10 cases and the latter 20 cases, in terms of mean operative time, was statistically significant

(144.5 vs. 115.78 minutes, respectively, P = .031). Apart from 3 nephroureterectomies, all of the

procedures (86.6%) were completed successfully using three trocars only, without the need for a

separate extraction incision. The patients were hospitalized for a mean duration of 2.2 days (range,

2-4 days). None of the patients required blood transfusion. We did not encounter any major perioperative

or postoperative complication.

Conclusion: Retroperitoneoscopic renal ablative surgery is a safe and effective treatment alternative

for a variety of upper urinary tract disorders in children.

Abstract

Purpose: To describe our technique and experience with retroperitoneoscopic upper pole nephroureterectomy in duplex kidney, focusing on the role of dilated upper ureter.

Materials and Methods: From November 2004 to August 2011, retroperitoneoscopic upper pole nephroureterectomy was performed in 31 patients with a duplex kidney by a single, experienced laparoscopic surgeon. We developed our own surgical technique to suit this technically challenging procedure. Follow-up studies were performed using renal ultrasonography, intravenous urography (IVU) and/or dimercaptosuccinic acid (DMSA) renal scan in all patients at 3 months postoperatively and annually thereafter.

Results: All procedures were completed laparoscopically without conversion to open surgery and blood transfusion. The mean operative time was 106 (90-157) min. The estimated blood loss was < 50 mL in all cases. The mean postoperative hospital stay was 4.2 (3-7) days. Perioperative complications were limited to 1 case of peritoneal tear during a procedure and 1 case of transient postoperative fever. No major intraoperative and postoperative complication occurred. With the mean follow-up period of 41 months (range 3 to 80), no case was observed to have functional loss of the remaining lower moiety on postoperative IVU or DMSA renal scan.

Conclusion: Retroperitoneoscopic upper pole nephroureterectomy using our technique is safe and effective.

Abstract

Purpose: To present the safety and surgical outcomes of the initial series of mini-laparoscopic live donor nephrectomy and graft outcomes in related recipients.

Materials and Methods: From January 2012 through July 2012, fifty patients underwent mini-laparoscopic live donor nephrectomy. Two 3.5 mm trocars were inserted above and lateral to the umbilicus for grasping and scissoring. One 5 mm trocar with a camera was inserted in the umbilicus and an 11 mm trocar was inserted through fascia from a 6-8 cm Pfannenstiel incision for bipolar coagulation, kidney extraction, and vascular clip applier.

Results: Mean age of donors was 28 ± 4.2 (range, 21-39) years. Mean operative time from trocar insertion was 145.8 (range, 85-210) minutes. No major perioperative or postoperative complications occurred. The average decrease in hemoglobin level was 1.14 (range, 0.32-1.8) mg/dL and no one required blood transfusion. Mean warm ischemia time was 4.41 (range, 2.35-9) minutes. Mean hospital stay was 2.2 (range, 2-5) days. Mean follow-up time of the recipients was 215 (range, 130-270) days. The mean serum creatinine level of the recipients at discharge time and the last follow-up visit was 1.38 mg/dL and 1.22 mg/dL, respectively.

Conclusions: While the primary purpose of this technique is to make donor nephrectomy less invasive and more cosmetic, it is also comfortable for the laparoscopist surgeons because it is nearly similar to standard laparoscopy. A randomized controlled trial with a large sample size, long-term follow-up, and comparison with standard laparoscopy are necessary to present more definitive data about this technique.

Abstract

Purpose: Meatal stenosis is still a common problem in tubularized incised plate urethroplasty.

In this study, we aimed to seek for a relationship between the size of urethral catheter and meatal stenosis formation in children undergoing tubularized incised plate urethroplasty.

Materials and Methods: We retrospectively reviewed 83 children who underwent tubularized incised plate urethroplasty for hypospadias. The whole group was classified into the groups A and B based on the catheter size. One group (group A) consisted of 44 patients (mean age, 4.82 ± 3.83 years) with tubularized neourethra over a 6 Fr catheter, while the other group (group B) included 39 patients (mean age, 5.19 ± 3.83 years) with tubularized neourethra over a 8 Fr catheter.

Results: There were no significant differences between the groups according to their age, location of urethral meatus, dehiscence and urethrocutaneous fistula formation. Meatal stenosis formation in group B was markedly higher than that in group A. Number of meatal dilatation was higher in group B compared to group A.

Conclusion: We suggest that the tubularization of urethral plate over a small-sized (6 Fr) catheter, regardless of the age of the patients, prevents meatal stenosis by reducing foreign body reaction and pressure injury and by hindering secondary healing.

Abstract

Purpose: To evaluate the effectiveness of Otis urethrotomy combined with six weekly urethral dilations until 40 French (Fr) in the treatment of women with urodynamic diagnosis of bladder outlet obstruction (BOO).                                       

 Materials and Methods: Women diagnosed with lower urinary tract symptoms underwent urodynamic evaluation. Severity of symptoms and quality of life were assessed with international prostate symptom score (IPSS) and quality of life (QoL) questionnaires. Bladder outlet obstruction was defined as the presence of two or more of the following: maximum flow rate (Qmax) < 12 mL/s, detrusor pressure at maximum flow (PdetQmax) > 50 cmH₂O and urethral resistance factor (URF) greater than 0.2. Ten out of 25 women diagnosed with BOO met the criteria. All women underwent Otis urethrotomy to 40 F and six-week urethral dilations until 40 F. After six months all patients underwent free uroflowmetry. Moreover post voiding residual (PVR), IPSS-QoL were recorded.

 Results: Six months post-operatively there was a significant improvement in all parameters: IPSS = 13.5 vs. 22.5 (P = .001), QoL = 3 vs. 5 (P = .001), voided volume = 312 mL vs. 216 mL (P = .055), Qmax = 27.5 mL/s vs. 12 mL/s (P = .001), and PVR = 27.5 mL vs. 170 mL (P = .005). Five women had close follow up during an average of 82 months. They maintained improved QoL (P < .005) and low PVR (P < .002). All other parameters lost their statistical significance.

Conclusion: The described therapeutical modality seems to improve all clinical and urodynamic parameters in women with evidence of BOO not related to detrusor sphincter dyssynergia or obvious functional and anatomical pathology.

Abstract

PURPOSE: This study evaluates the efficacy of Vacuum constrictive device (VCD) and the reasons for its failure.

 Materials and Methods: In this cross-sectional study, 1500 men with organic erectile dysfunction(ED) were enrolled from July 2003 to July 2010. The treatment efficacy was analyzed using International Index of Erectile Function (IIEF) and questioning patient's partner regarding the man's ability to perform vaginal penetration (APVP). The patient's spouses, who responded negatively to APVP, were evaluated by a midwife for virginity, vaginal atrophy and abstained sex.

 Results: Totally 1310 (87.4%) patients attained full erection at first training session, remaining188 (12.6%) were able to have full erection one week after practicing with VCD, 1419 (94.6%)were able to have successful intercourse and responded positively to APVP, 81 (5.4%) were unable to have intercourse as stated by their wife's (negative response to APVP) that in 43 (53%),30 (37%), and 8 (9.8%) cases the causes of failures were their wife's virginity, sex abstinence, and senile vaginal atrophy, respectively. Regarding erectile issue of IIEF scores in patient's responded positive to APVP there were significant improvement from the scores of 9.3 ± 3.0 to 27.5 ± 5.0 after treatment (P < .05). 

Conclusion: With proper training and appropriate devices, VCD could induce sufficient erection in all patients. VCD in patients with virgin wife is ineffective, and female factors affect on success rate in VCD therapy. 

Abstract

PURPOSE: To evaluate the link between rheumatoid arthritis (RA) and female sexual functioning. 

Material and Methods: A total of 32 women with RA and 20 healthy age matched controls were enrolled in this study. The participations are asked to complete Female Sexual Function Index (FSFI), The Short form 36 (SF-36) Health Survey and Beck Depression Inventory (BDI) questionnaires. 

Results: The groups were comparable in terms of demographic characteristics. The women with RA represented significantly worse sexual functioning in category of desire, arousal, lubrication, orgasm, satisfaction domain and total FSFI score compared with healthy women (P = .0001, P = .0001, P = .0001, P = .0001, P = .022 and P = .0001, respectively). The mean BDI scores for the patients with RA were greater than control group (P = .036). Women with R  Aalso had significantly lower quality of life (QoL) parameters: physical functioning, limitations  due to physical health, pain, general health, vitality and limitations due to emotional problems compared with healthy women (P = .0001, P = .0001, P = .028, P = .002, P = .001 and P =.0001, respectively). 

Conclusion: The present study shows that a significant percent of patients with RA had sexual dysfunction and also deterioration in QoL.

Abstract

PURPOSE: To describe peculiarities of pendulous urethral stricture in South Western Nigeria and  how prevalent social and environmental factors have made longitudinal distal penile island flap the preferred option for reconstruction of pendulous urethral stricture in such a poor  resource  community.

Materials and Methods: All patients presenting with stricture located in the pendulous urethra in 3 hospitals in south western Nigeria, over a 5 year period were interviewed and had  urethral reconstruction using longitudinal distal penile fascio-cutaneous island flap under spinal anesthesia. 

 Results: Thirty four cases were treated by this method during this period. Complications were found in 4 patients (11.8%) which include urethrocutaneous fistula, penile skin necrosis and wound infection. All cases had satisfactory overall outcome.

 Conclusion: Longitudinal penile fascio-cutaneous flap remains a viable option for a single stage repair of urethral stricture especially in poor resource communities.  

Abstract

Purpose: Insulin-like growth factors (IGFs) have potent mitogenic and antiapoptotic effects on prostate tissue, whereas free IGF-1 is responsible for its metabolic effects but its role in benign prostatic hyperplasia (BPH) is unclear.

Material and Methods: Plasma and prostatic fluid levels of free IGF-I were determined from the fasting bloods of 35 BPH cases admitted for treatment and 35 randomly selected population controls.

Results: Prostatic fluid free IGF-1 concentrations did not differed significantly between two groups (P = .23). There was also no statistical difference in serum free IGF-1 levels between these groups. There was also no correlation between prostatic fluid free IGF-1 and serum prostate specific antigen (PSA) levels and prostate volume. When compared with control group, mean IPSS scores and prostate volumes of BPH group were significantly high, while mean maximum measured flow rate (Qmax) and international prostate symptom score (IPSS) and quality of life (QoL) scores were significantly low (P < .05).

Conclusion: Our study shows that free IGF-I is not associated with BPH risk. Further investigation is needed to elucidate the role of the free IGF-1 in BPH.

Abstract

Purpose: Uroflowmetry is frequently used and simple urodynamic test, but it may be affected by various factors. Voiding position is one of the factors that can change the results.

We tried to compare the uroflowmetric parameters in sitting and standing positions during urination.

Material and Methods: A total of 198 patients were enrolled to the study. All patients underwent an uroflowmetry in standing and sitting position at late afternoon (2-4 PM) of two corresponding days with a gravimetric uroflowmeter (Uroscan, Aymed, Turkey). A transabdominal ultrasonography was used to evaluate post voiding residue (PVR). All uroflowmetric parameters and PVR were compared with paired t test or Wilcoxon signed rank test.

Results: The median age of study population was 58.0 (36-69) years. There was no statistically significant difference at voided volume of patients in standing and sitting position as it was 271.5 ± 81.8 mL and 274.8 ± 82.4 mL, respectively (P = .505). Mean maximum flow rate (Qmax) during urination at standing position was 15.3 ± 6.7 mL/s while it was 15.0 ± 7.0 mL/s at sitting position (P = .29). Mean average flow rate in standing position was 8.60 ± 4.0 mL/s and 8.25 ± 3.8 mL/s in sitting position (P = .054). There was a statistically significant difference between the median post-voiding residues in standing and sitting urination which was 29.5 (0-257) mL in standing and 47.5 (2-209) mL in sitting position (P < .0001). Other uroflowmetric parameters (time to maximum flow and voiding time) was not statistically different between groups.

Conclusion: There are no clinically important uroflowmetric differences between voiding in sitting and standing positions so voiding position may be left to personal preferences during

uroflowmetric evaluation.

Abstract

Purpose: To develop a simple non-invasive method to assess the efficacy of a cell based therapy for treating stress urinary incontinence (SUI).

Materials and Methods: In this study, skeletal myoblasts were used as candidate therapy to reverse SUI. The SUI model was created in rats using periurethral injection of botulinum-A toxin injection. Two weeks later, the rats were administered saline and the level of continence in each botulinum-A toxin treated and control animals was assessed by the extent of voiding using metabolic cages. To determine the efficacy of myoblasts to reverse SUI, botulinum-A toxin treated incontinent rats were injected with either cultured human skeletal myoblasts or with buffered saline (sham control). Two weeks post implantation, the extent of continence was evaluated as mentioned above.

Results: The difference in void volume between botulinum-A toxin -treated and control rats were significant. Histological analysis of the urethra showed remarkable atrophy of the muscular layer. A significant reversal (P = .025) in the volume of voiding was observed in cell-implanted rats as compared to sham injected rats. Histological analysis of the urethra implanted with myoblasts showed recovery of the atrophied muscular layer in comparison to sham control. Immunofluorescence analysis of the cell injected tissues confirmed the presence of human myoblasts in the regenerated area.

Conclusion: This simplified method of in vivo testing can serve as a tool to test the efficacy of new therapies for treating SUI.

Abstract

Purpose: To determine the attitudes and beliefs of Iranian urologists toward Evidence Based Medicine (EBM) and investigation of the barriers of evidence based practice (EBP).

Materials and Methods: A self- administrated, Likert scale questionnaire designed in Persian and filled up by censuses selected urologist from Iranian Urology Association (IUA). Data were entered to Predictive Analytics Soft Ware version 18.0 and descriptive statistics were obtained for all parts of the questionnaire.

Results: A total of 111 out of 500 Iranian urologists who attended in IUA annual meeting, responded to the questionnaires. Mean attitude score of respondents was 30.4 (SD: 5.7, range 16-40). Attitude score showed statistically significant association to previous participation in EBM workshops (P = .01). Of participants 96% believed EBP will improve patient care and 76.2% of them appreciated the impact of use of research utilization and application of evidence based guidelines on clinical decision making and the outcome of surgery. The main barriers to EBP stated as lack of time (64.8%), facilities (53.4%), and training in EBM (29.4%).

Conclusion: The urologists have positive attitudes towards EBP. However, regarding lack of time, pre-appraised databases or EBP guidelines can be helpful. Evidence based workshops and familiarity with evidence databases is recommended for Iranian urologists. In addition, health care system and policy makers could play a major role to provide a culture of EBP.

Abstract

Purpose: To evaluate the use of desipramine in the treatment of overactive bladder (OAB).

Materials and Methods: We retrospectively evaluated 43 patients who were treated with desipramine for OAB refractory to antimuscarinic therapy. These OAB patients were stratified

by the presence or absence of bladder pain.

Results: Forty-three patients were evaluated with a mean follow up time of 12.2 ± 4.6 months. The mean age of the patients was 71 ± 16 years. Twelve patients (28%) discontinued desipramine, 9 due to perceived lack of efficacy, 2 due to central anticholinergic side effects, and 1 due to the development of oropharyngeal sores. Patients were stratified into two subgroups

based upon treatment with desipramine for OAB alone (n = 29) or OAB and bladder pain (n = 14). There was no difference between the groups in regard to sex (P = .34), prior history of radiation (P = .19), side effects (P = .16), and specifically evaluated central anti-cholinergic side effects (P = .66). There was no statistical difference in the self-reported success rate of the medication (P = .48). In the OAB plus bladder pain subgroup, 71% of patients reported improvement in their pain. Overall, 13 (30%) patients had history of prior pelvic radiation and 10 of those (77%) reported improvement with desipramine.

Conclusion: Desipramine is a potential useful treatment for patients with OAB. In addition, it can be used in patients with OAB and bladder pain and patients with complex OAB such as OAB caused by pelvic radiation.

Purpose: The study focus is on the quantitative achievements in urology education and growth trends in urologic surgical workforce and fellowships by gender since 1979.

Materials and Methods: This comprehensive national quantitative study was performed in Iranian Academy of medical science. The first hand data gathered from The Iran Specialty Training Council of and also from Medical Council of Iran.

Results: Over the period 1979 to 2012, the numbers of resident's admission in urology/ fellowships have increased from 5 to 51 and from 0 to 24 respectively, and graduated urologists of national programs has grown from 5 (14%) in 1979 to 47 (100%) in 2012. Iranian urologists workforce haves increased from 315 in 1979 to 1637 in 2012. In 1979, there was 1 urologist for every 117,460 population, while in 2012 there was 1 urologist for every 46120 population. Iran Urologists to population rate is 1:46120. These statistics represents significant improvement from 34 years ago. Number of female urologists has progressively increased from 1 in 1979 (0%) to 110 (7%) in 2012. Urology fellowships are offered in 6 fields since 1994 in Iran. The number of trained fellowships grew sharply and reached to 221 in 2012.

Conclusion: The current urology training is successful to improve urology health care. Along with expansion of urology and fellowship training, the number of Iranian female urologists significantly increased. To our knowledge Iran had the greatest growth rate of female urologist training in the Middle East, and is comparable with those in the most progressed countries in the world.

Abstract

Duplication of the renal collecting system is the commonest major congenital malformation of the urinary tract, with an incidence of 1% among live births. Antenatal diagnosing of renal duplication and an associated ureterocele is infrequent. We report four cases of prenatally diagnosed unilateral duplication of the renal collecting system. In two of them, the renal duplication was associated with an ectopic ureterocele.