ISSN: 1735-1308

May-June 2014
Vol. 11 No. 3 (2014)


Percutaneous Nephrolithotomy: Is Distilled Water as Safe as Saline for Irrigation?

Mohammad Mehdi Hosseini, Abbas Hassanpour, Farhad Manaheji, Alireza Yousefi, Mohammad Hassan Damshenas, sezaneh Haghpanah

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1551-1556


Purpose: To compare dilutional effect of distilled water with saline solution as an irrigation fluid in percutaneous nephrolithotomy (PCNL).

Materials and Methods: Three hundred twenty eight adult patients (191 men, 137 women) who were candidates for PCNL were randomly assigned into two groups (distilled water, n = 158, group 1; saline solution, n = 162, group 2). Stone size, operation time, irrigation fluid volume, blood hemoglobin level, urea nitrogen, creatinine, sodium and potassium levels were checked before and at 6 and 12 hours after operation.

Results: The mean age of the patients was 37.8 years, and the mean stone diameter was 31.5 mm. There was no clinical case of transurethral resection (TUR) syndrome. Serum sodium depletion was significantly more in group 1 than group 2 (P < .0001). Group 1 had significant decreased post-operative serum sodium levels (P < .0003). Similarly in group 2, postoperative serum sodium levels were significantly lower than the preoperative concentration (P < .01), but it was not the same 6 hours after the operation (P = .23). Serum sodium concentrations remained within normal limits in all cases, without causing clinical signs and symptoms of hyponatremia.

Conclusion: We found that distilled water is safe irrigation fluid for PCNL in adults. In addition, it is more available and cost effective.

Percutaneous Nephrolithotomy Success Rate and Complications in Patients with Previous Open Stone Surgery

Mohammadhatef Khorrami, Mazaher Hadi, Mehrdad Mohammadi Sichani, Kia Nourimahdavi, Mohammad Yazdani, Farshid Alizadeh, Mohammad-hosein Izadpanahi, Farhad Tadayyon

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1557-1562


Purpose: To determine the effect of previous single or multiple open stone surgeries on percutaneous nephrolithotomy (PCNL) results and complications.

Materials and Methods: We reviewed medical records of 1422 patients who had been undergone PCNL in our institute between 1998 and 2011 by the same surgeon. Patients were divided into 3 groups. The first group included patients with no history of previous ipsilateral open stone surgery (n = 711). Patients in second group had been undergone only one open stone surgery before PCNL (n = 405) and patients with more than one previous open stone surgery were placed in third group (n = 306). We compared operation duration, stone free rate (SFR), number of  attempts to access the collecting system and intraoperative and postoperative complications between 3 groups.

Results: There were no differences in sex, body mass index, stone burden and laterality between 3 groups. Operation time was significantly shorter in the first group (P = .000) while there was no statistically significant differences in operation duration between second and third groups (> .973). The number of attempts to enter the collecting system was significantly lower in the first group in comparison to other two groups (P = .00). We didn’t find significant differences between 3 groups in hospital stay, SFR, intraoperative and postoperative complications.

Conclusion: Our findings demonstrated that PCNL can be performed in patients with one or more open stone surgery history successfully without further complications.

Can We Reduce Secondary Surgical Interventions and Length of Hospitalization in Percutaneous Nephrolithotomy?

Hasan Deliktas, Onur Yapici, Utku Ozen, Engin Yalcin, Hayrettin Sahin

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1563-1568


Purpose: To evaluate the success and complication rates of percutaneous nephrolithotomy (PNL) operations and to determine the effect of postoperative late removal of an open-end ureter catheter on hospital stay and on secondary interventions.

Materials and Methods: The records of 198 patients (97 female, 101 male) who had PNL between May 2009 and February 2012 were retrospectively reviewed. The open-end ureter catheter which was placed during the operation was removed at the end of the operation in the first 53 patients ( group 1) and 12 hours after the nephrostomy catheter in 145 patients ( group 2).

Results: PNL intervention was performed in 198 patients with a mean age of 40.83 ± 13.64 years and mean stone load of 9.82 ± 5.37cm2 (range 2 to 26 cm2). When clinically insignificant stone pieces < 4 mm were accepted as successful, the total success rate was 80.80 % (79.2% in group1 and 81.4% in group 2, P = .50). The hospitalization period was significantly reduced in group 2 (3.45 ± 0.95 days vs. 2.61 ± 0.65 days; P = .006). While secondary surgical intervention was not necessary in any of the patients in group 2 (0.0%), but 4 patients (7.5%) required ureterorenoscopy plus double-J stent placement following the primary procedure in group 1 (P = .006).

Conclusion: PNL is a safe procedure with a high success rate and a short hospitalization period. There was a significant decrease in the hospitalization period and secondary surgical intervention rates with the postoperative late removal of the open-end ureter catheter.

Capsulotomy for Treatment of Compartment Syndrome in Patients with Post Extracorporeal Shock Wave Lithotripsy Renal Hematomas: Safe and Effective, But Also Advisable?

Andreas Al Ghazal, Thomas J. Schnoeller, Christian Baechle, Julie Steinestel, Florian Jentzmik, Sandra Steffens, Christian Hirning, Mark Schrader, Andres J. Schrader

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1569-1574


Purpose: To examine whether surgical decompression of hematomas by capsulotomy can help to improve long-term renal function following extracorporeal shock wave lithotripsy (SWL).

Materials and Methods: This study retrospectively identified 7 patients who underwent capsulotomy for post SWL renal hematomas between 2008 and 2012. The control group comprised 8 conservatively treated patients. The median follow-up time was 22 months.

Results: The two groups were comparable in age, gender, body mass index, risk factors for developing hematomas (renal failure, urinary flow impairment, indwelling ureteral stent and diabetes mellitus) and the selected SWL modalities. Hematoma size was also similar. However, significantly more patients in the surgical group had purely intracapsular hematomas (85.7% vs. 37.5%) without a potentially pressure-relieving capsular rupture. There were no significant differences in the post-interventional drop in hemoglobin, rise in retention parameters or drop in glomerular filtration rate (GFR). No capsulotomy-related complications were observed, but surgery required a significantly longer hospital stay than conservative management (median, 9 days vs. 5 days). The two groups also showed comparable recovery of renal function at long-term follow-up (median change in GFR from baseline, 97.1% and 97.8%, respectively).

Conclusion: Since renal function did not differ between the two treatment groups, the conservative management remains the standard treatment for post-SWL renal hematoma.

One-Shot Dilation in Modified Supine Position for Percutaneous Nephrolithotomy: Experience From Over 300 Cases

Youness El Harrech, Najib Abakka, Jihad El Anzaoui, Omar Goundale, Driss Touiti

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1575-1582


Purpose: To evaluate the feasibility, safety and efficacy of one-shot dilation (OSD) in modified supine position percutaneous nephrolithotomy (PCNL).

Materials and Methods: A total of 320 PCNL in a total of 291 patients were performed between October 2008 and July 2011. There were no specific exclusion criteria. Patients with kidney anomalies or solitary kidney, with history of renal surgery or extracorporeal shockwave lithotripsy (SWL), those with staghorn calculi or needing more than one access, were eligible for inclusion. Data collected included patient demographics and stone characteristics, access time, radiation exposure, total operating time, preoperative and postoperative hemoglobin concentrations, tract dilatation failures, complications and transfusions.

Results: Mean stone size was 38 mm (16-110 mm). The mean time access was 2.1 min (range 0.7-6.2 min). Tract dilatation fluoroscopy time was 25 ± 17 sec. The targeted calix could be entered with a success rate of 97.81%. The mean hemoglobin decrease was –1.17 g/dL ± 0.84. There were no visceral, pleural, collecting systems or vascular injuries. Major complications included, transfusion in 4 (1.25%) patients, pseudoaneurysm with persistent bleeding necessitating nephrectomy in 1 (0.3%) patient and two deaths (0.62%) after surgery. There was no significant difference in successful access and complications between patients with and without previous open surgery and in those with or without staghorn stones (P > .05).

Conclusion: The use of one shot and modified supine position combines the advantages of these both methods including less radiation exposure and shorter access and operative time. The one shot dilation is safe, easy to learn, cost effective and offers a potential alternative to the standard devices particularly in developing countries.

Evaluation of Safety and Efficacy of Open Mini-Access Ureterolithotomy in the Era of Minimally Invasive Surgery

Sholay Kangjam Meitei, Bijit Lodh, Somarendra Khumukcham, Sandeep Gupta, Kaku Akoijam Singh, Rajendra Singh Sinam

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1583-1588


Purpose: To evaluate the effectiveness and safety evaluation of mini-access ureterolithotomy in the management of ureteric calculus.

Materials and Methods: This was a cross-sectional study conducted at Department of Urology, Regional Institute of Medical Sciences, Imphal. A total number of one hundred and forty three patients with radiologically confirmed ureteral calculus (size > 1 cm) were enrolled in this study.

Results: The mean age of male and female patients was 44.97 ± 11.24 and 43.89 ± 14.49 years, respectively. In the majority of cases stone was in the upper ureter irrespective of the side. The stone size ranged from 10 to 30 mm in diameter. The most common indication for open mini-access ureterolithotomy in the present study was impacted large stone (45%). The mean operation duration was 25.39 ± 5.11 min, with an incision length of 4.78 ± 0.25 mm; the estimated blood loss was 50.55 ± 8 mL and none of the patient’s required post-operative blood transfusion. The overall complication rate was 5.6%.

Conclusion: Open mini-access ureterolithotomy is a safe procedure with fewer complications and cosmetically acceptable results. Although in this minimally invasive era, the specific indications for open stone surgery are a few, but when the situation mandates, an open mini-access ureterolithotomy might be considered the best option.

Reduced Radiation Fluoroscopy Protocol during Retrograde Intrarenal Surgery for the Treatment of Kidney Stones

Mustafa Kirac, Abdulkadir Tepeler, Cagri Guneri, Senad Kalkan, Sina Kardas, Abdullah Armagan, Hasan Biri

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1589-1594


Purpose: To discuss whether fluoroscopic imaging is essential during the ureteroscopic treatment of  kidney stones in an effort to diminish radiation exposure.

Materials and Methods: Seventy-six patients with kidney stones were treated with retrograde intrarenal surgery (RIRS). In the operation room, a mobile C-arm fluoroscopy system was ready to use in case fluoroscopic imaging was needed. The manipulations were performed with tactile and visual cues. The perioperative and postoperative parameters were retrospectively evaluated.

Results: The mean age of the patients was 39.9 ± 13.8 years. The mean stone size was 14.1 ± 4.1 mm. The insertion of the access sheath was performed over the guidewire under single shoot fluoroscopic imaging in all patients. Additional fluoroscopic imaging was required to localize the stone (n = 2) and to determine the collecting system anatomy (n = 2) for 4 (5.2%) patients with previous renal surgery and severe hydronephrosis. Stone-free status was accomplished in 63 (82.9%) patients.

Conclusion: The RIRS with low-dose fluoroscopy protocol for kidney stones can be safely and effectively performed in patients with no special circumstances such as anatomical abnormalities or calyceal diverticular stones.


Hand-Assisted, Conventional and Laparoendoscopic Single-Site Surgery for Partial Nephrectomy without Ischemia Using a Microwave Tissue Coagulator

Tetsuo Nozaki, Yoshihiro Asao, Tomonori Katoh, Kenji Yasuda, Hideki Fuse

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1595-1601


Purpose: We report our experience of minimally invasive partial nephrectomy without ischemia using a microwave tissue coagulator (MTC) for hand-assisted laparoscopic partial nephrectomy (HALPN), conventional laparoscopic partial nephrectomy (CLPN), and laparoendoscopic single-site surgery for partial nephrectomy (LESSPN). We retrospectively compared the results of these techniques to better define the individual role and the benefits.

Materials and Methods: From July 2005 to September 2012, 28 patients with small and exophytic renal tumors underwent HALPN (n = 12), CLPN (n = 10) and LESSPN (n = 6). In these procedures, the surgeon used an MTC for circumferential coagulation around the tumor. After coagulation, the tumor was resected without renal pedicle clamping.

Results: The mean operative time was 259, 194 and 174 min for the HALPN, CLPN and LESSPN groups respectively. Two patients (one in HALPN group and one in LESSPN group) converted to laparotomy due to an inability to maintain hemostasis; however, there were no conversions to ischemic partial nephrectomy or radical nephrectomy. No differences between HALPN, CLPN and LESSPN were noted in terms of estimated blood loss, measured analgesic requirements, outcomes, or complications.

Conclusion: We believe that these techniques are feasible and that they minimize the risk of unexpected collateral thermal damage by appropriate MTC needle puncture. When deciding to use HALPN, CLPN or LESSPN, our findings suggest that the choice of surgical approach should depend on the patient’s individual circumstance.


Prevalence of Urinary Incontinence and Lower Urinary Tract Symptoms in School-Age Children

Ipek Ozunan Akil, Dilek Ozmen, Aynur Cakmakci Cetinkaya

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1602-1608


Purpose: To investigate the prevalence of lower urinary tract symptoms (LUTS) and urinary incontinence (UI) in elementary school aged children in Manisa.

Materials and Methods: Dysfunctional Voiding and Incontinence Scoring System (DVIS) which was developed in Turkey is used. A total of 416 children, 216 (51.9%) male and 200 (48.1%) female were recruited in this study.

Results: Mean age of children was 10.35 ± 2.44 years (median10 years). Daytime UI frequency was 6.7% (28 child), nocturnal incontinence 16.6% (69 child) and combined daytime and nocturnal incontinence 4.1% (17 child). There was no statistically significant difference in the prevalence of nocturnal and or daytime UI between male and female gender. Mean DVIS score was 2.65 ± 3.95 and gender did not affect total DVIS points. The mean ages of achieving daytime bowel and bladder control were all significantly correlated with DVIS points. DVIS points were positively correlated with the history of UI of the family. Total points were increased when the father was unemployed.

Conclusion: UI negatively influences health related quality of life of the family and child, so it is important that awareness of the UI and symptoms of lower urinary tract dysfunction.


Comparison of 12- and 16-Core Prostate Biopsy in Japanese Patients with Serum Prostate- Specific Antigen Level of 4.0-20.0 ng/mL

Yasuhide Miyoshi, Masahiro Furuya, Jun-ichi Teranishi, Kazumi Noguchi, Hiroji Uemura, Yumiko Yokomizo, Shinpei Sugiura, Yoshinobu Kubota

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1609-1614


Purpose: In the present study, we compared 12- with 16-core biopsy in patients with prostate- specific antigen (PSA) levels of 4.0-20.0 ng/mL.

Materials and Methods: Between 2003 and 2010, 332 patients whose serum PSA level was between 4.0 and 20.0 ng/mL underwent initial transrectal ultrasound (TRUS)-guided needle biopsy. Of those patients, 195 underwent 12-core biopsy and 137 underwent 16-core biopsy.

Results: In the 12-core prostate biopsy group, 66 (33.8%) patients were found to have prostate cancer. On the other hand, in the 16-core prostate biopsy group of 137 patients, 61 (44.5%) were found to have prostate cancer. Among all patients, the prostate cancer detection rate was slightly higher in the 16-core biopsy group than in the 12-core biopsy group. Moreover, in patients with prostate volume > 30 mL or PSA density (PSAD) < 0.2, the prostate cancer detection rate was significantly higher in the 16-core biopsy group than in the 12-core biopsy group. There was no significant difference in pathological tumor grade, indolent cancer probability, or biopsy complication rate between the two groups.

Conclusion: In order to detect prostate cancer, 16-core prostate biopsy is safe and feasible for Japanese patients with serum PSA level of 4.0-20.0 ng/mL.

Pre-Operative Tumor Localization and Evaluation of Extra-Capsular Extension of Prostate Cancer: How Misleading Can It Be?

Raymond Wai-man Kan, Chi-fai Kan, Lap-yin Ho, Steve Wai-hee Chan

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1615-1619


Purpose: To verify the accuracy of transrectal ultrasound-guided prostatic biopsy (TRUS Bx), magnetic resonance imaging (MRI) and their combination in evaluating the laterality of prostate cancer and to determine the accuracy of MRI in assessing extra-capsular extension of prostate cancer.

Materials and Methods: We retrospectively reviewed our past 100 consecutive series of radical prostatectomy performed between February 2010 and April 2012 at our institution. Their TRUS Bx and MRI results were compared with the pathology of the radical prostatectomy specimens. For tumor localization, we calculated the accuracies in unilateral diseases, bilateral diseases, overall accuracies and Cohen Kappa concordance coefficient of TRUS Bx, MRI and their combination. For the assessment of extra-capsular extension, we calculated the sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy, likelihood ratio positive and likelihood ratio negative of MRI.

Results: Eighty-two percent of our radical prostatectomy specimens had bilateral tumor involvement and 32% had extra-capsular extension. The accuracies of TRUS Bx in unilateral disease, bilateral disease and overall accuracy were 15.2%, 91.4% and 43.6%, respectively. The accuracies of MRI in unilateral disease, bilateral disease and overall accuracy were 11.1%, 66.7% and 38.9%, respectively. When combining the assessment of TRUS Bx and MRI, the accuracies in unilateral disease, bilateral disease and overall accuracy were 16.7%, 75% and 55.6%, respectively. The Cohen Kappa concordance co-efficient of TRUS Bx, MRI, and combination of them were 0.1165, -0.2047 and -0.1084, respectively. The positive predictive value, negative predictive value, sensitivity, specificity, overall accuracy, likelihood ratio positive and likelihood ratio negative of MRI in assessing extra-capsular extension were 33.3%, 69.8%, 5.9%, 94.9%, 67.9%, 1.16 and 0.99, respectively.

Conclusion: TRUS Bx, MRI, and their combination had poor concordance and limited accuracies in assessment of the laterality of tumor involvement. The combination of TRUS Bx and MRI offered a better of accuracy when compared to either modality alone. MRI was a specific, but not sensitive tool in assessing the presence of extra-capsular extension.


Comparing Supportive Properties of Poly Lactic-Co-Glycolic Acid (PLGA), PLGA/Collagen and Human Amniotic Membrane for Human Urothelial and Smooth Muscle Cells Engineering

Farzaneh Sharifiaghdas, Mohammad Naji, Reza Sarhangnejad, Sareh Rajabi - Zeleti, Hamid Mirzadeh, Mojgan Zandi, Mahdi Saeed

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1620-1628


Purpose: To compare human urothelial and smooth muscle cells attachment and proliferation using three different matrices; poly lactic-co-glycolic acid (PLGA), PLGA/collagen and human amniotic membrane (hAM).

Materials and Methods: Human urothelial and smooth muscle cells were cultured and examined for expression of urothelium (pancytokeratin and uroplakin III) and smooth muscle cells [desmin and alpha smooth muscle actin (α-SMA)] markers. Cells were cultured on three scaffolds; PLGA, PLGA/collagen and hAM. Thereafter, they were analyzed for cell growth on days 1, 3, 7, 14 and 21 after seeding by 3-(4, 5-dimethylthiazole-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. Scaffolds were fixed and processed for hematoxylin and eosin (H&E) staining and immunohistochemistry against their cell specific markers after 7 and 14 days of culture.

Results: MTT assay results revealed that collagen has improved cell attachment features of PLGA and led to significant increase of MTT signal in PLGA/collagen compared to PLGA (< .001) and hAM (P < .001). hAM was a weaker matrix for both cell types as demonstrated in MTT assay and scanning electron microscope (SEM) images. SEM micrographs showed normal phenotype and distribution on PLGA and PLGA/collagen. In the same line, cells formed a well-developed layer either on PLGA or PLGA/collagen, which maintained expression of their corresponding markers.

Conclusion: Our findings demonstrated significant improvement of cell attachment and growth achieved by collagen coating (PLGA/collagen) compared to PLGA and hAM. hAM despite of its natural entity was a weaker matrix for bladder engineering purposes.


Long-Term Follow-Up on the Effects of Sigmoid- Rectal Pouch for Urinary Diversion

Bin Sun, Jing-Min Yan, Jian-Ye Li, He-Qing Guo, Quan Hong, Zhi-Yong Yao, Gao-Biao Zhou, Guang-Xin Pan, Xian-Chu Li

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1629-1635


Purpose: The aim of this study was to investigate the long-term clinical effects of sigmoidrectal pouch for urinary diversion.

Materials and Methods: A total of 45 patients, including 40 males and 5 females, underwent sigmoid-rectal pouch procedure. The patients aged from 38 to 70 years with a mean age of 59 years. The postoperative follow-up ranged from 6 months to 19 years with an average of 6 years. Postoperative continence and voiding were analyzed, urinary reservoir pressure was measured and the complications of upper urinary tract were determined. The index of quality of life (QoL) in the International Prostate Symptom Score (IPSS) was used to evaluate the degree of satisfaction to urinate.

Results: Forty patients had slight incontinence in the early postoperative stage and could control urination well 30 days postoperatively. The volume of pouch was 270-600 mL with an average of 375 mL. The basic pressure during filling period was 6-20 cmH2O with an average 15 cmH2O, the maximum filling pressure was 15-30 cmH2O with an average 26 cmH2O. The compliance of sigmoid-rectal pouch was fine with an average of 30 (range 18-40) mL/ cmH2O. There were no severe complications such as hyperchloremic acidosis or retrograde pyelonephritis. Six patients had slight hydronephrosis. The index of QoL were 0-2 in 20 patients, 3 in five patients and 4 in two patients.

Conclusion: The sigmoid-rectal pouch operation was simple and acceptable by surgeons and patients. It may be an ideal urinary diversion for patients with muscle-invasive bladder cancer, especially for patients on whom urethrectomy should be done.




Purpose: Nocturia is the main cause of disturbance of sleep maintenance and negatively impacts quality of life (QoL). We assessed the effects of the ?1-adrenoceptor antagonist, tamsulosin, on nocturia and quality of sleep, for the treatment of lower urinary tract symptoms (LUTS) in women with a maximal flow rate (Qmax) less than 15 mL/sec.

Materials and Methods: From January 2008 to December 2009, women with LUTS [Qmax ? 15 mL/s, International Prostate Symptom Score (IPSS) ? 8] and nocturia (void/night ? 1) were selected for this study. Two hundred ninety six patients completed voiding diary, a questionnaire on the Medical Outcomes Study (MOS) sleep scale and underwent follow-up evaluation after 4 weeks of treatment (tamsulosin, 0.2 mg, once daily). Effectiveness was assessed by analysis of the IPSS, the bother score, the Qmax, and postvoid residual urine (PVR).

Results: The mean number of voids per night was 2.66 ± 1.3, and the total IPSS and bother scores were 15.2 ± 8.9 and 3.4 ± 1.2, respectively. Clinical parameters, including the IPSS, the bother score, the Qmax and the PVR, improved significantly from baseline after treatment (P < .05). The change in nocturia was -1.12 (P < .05). Concerning sleep quality, the sleep problem index showed a significant decrease. Among the items on the sleep subscale, sleep disturbance, somnolence, and sleep adequacy were significantly changed (P < .05).

Conclusion: The ?1-adrenoceptor antagonist tamsulosin significantly improved nocturia and sleep quality as well as LUTS in women with low Qmax.


Expression and Function of Muscarinic Subtype Receptors in Bladder Interstitial Cells of Cajal in Rats

Yingbing Wu, Chang Shi, Jianping Deng, Xin Zhang, Bo Song, Longkun Li

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1642-1647


Purpose: To locate the muscarinic (M) M2 and M3 receptors in bladder interstitial cells of Cajal (ICCs) and to determine the effects of M2 and M3 agonists on bladder ICCs.

Materials and Methods: A total of 30 adult male Sprague-Dawley rats weighing 225-250 g were used in this study. Double-labeled fluorescence of muscarinic receptors and c-kit was performed for co-localization. To evaluate the effect of muscarinic agents on the excitation of  bladder ICCs, we analyzed the inward current of bladder ICCs using the whole-cell patch clamp. The effect of muscarinic agents on the carbachol-induced inward currents was evaluated with the whole-cell patch clamp.

Results: M2 and M3 receptors were confirmed in the stroma ICCs in rats' bladders with double-labeled immunofluorescence. Spontaneous action potential was observed in freshly isolated bladder ICCs. The carbachol-induced inward Ca2+ current in ICCs can be blocked by atropine. The M2 receptor antagonist methoctramine (1 μM) showed a weak inhibitory capability on the inward Ca2+ current [from 74.8 ± 9.6 to 63.3 ± 13.8 Pascal (pA), n = 12, P = .03]. While the M3 receptor antagonist 4-diphenyl-acetoxy-N-methyl-piperidine methiodide (4-DAMP) (1 μM) significantly inhibited the inward Ca2+ current (from 78.4 ± 11.2 to 17.3 ± 7.9 pA, n = 12, P < .001).

Conclusion: Bladder ICCs express M2 and M3 cholinergic receptors. Most muscarinic cholinergic receptor antagonists, especially the M3 antagonists, can effectively inhibit the carbamylcholine- induced inward current of bladder ICCs.



Recruiting Testicular Torsion Introduces an Azoospermic Mouse Model for Spermatogonial Stem Cell Transplantation

Saeid Azizollahi, Reza Aflatoonian, Mohamad Ali Sedigi-Gilani, Mohamad Asghari Jafarabadi, Babak Behnam, Gholamabbas Azizollahi, Morteza Koruji

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1648-1655


Purpose: To investigate the long-term effect of testicular torsion on sperm parameters and testis structure in order to introduce a novel mice azoospermic model for spermatogonial stem cell transplantation.

Materials and Methods: Unilateral testicular torsion was created. The animals were divided into two groups each containing 15 mice. They underwent 2 and 4 hours of unilateral testicular ischemia, respectively. All animals in this experiment were aged matched. The experimental (n = 5) groups were studied 2, 4 and 10 weeks after testicular ischemia reperfusion. Moreover, the left testes and epididymis were removed for sperm analysis and for weight and histopathological evaluation. Finally isolated spermatogonial stem cells were transplanted in the testes that underwent 2 hours of ischemia reperfusion, two weeks post-surgery.

Results: All the investigated parameters demonstrated a sharp decline at 2, 4 and 10 weeks after testicular torsion, whereas 2-hour ischemia was found to be less injurious in testicular tissue structure. Two months after xenotransplantation, the transplanted cells were localized in the basal of the seminiferous tubules of the recipient ischemic testes.

Conclusion: Torsion can cause permanent azoospermia in mouse. Also Testicular torsion 2 weeks after the 2 hours ischemia reperfusion may prove useful for recipient preparation for SSCs transplantation in mouse.


Reconstruction of Urethral Strictures in Patients with a Long History of Blind Urethral Dilatation

Ivan M. Ignjatovic, Ivica Stojkovic, Dragoslav Basic, Jablan Stankovic, Milan Potic, Ljubomir Dinic

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1660-1665


Purpose: To compare urethral reconstructions in patients after several years with or without blind urethral dilatation.

Materials and Methods: A retrospective study of 107 patients with urethral reconstructions was performed. Sixty patients with a long history of blind urethral dilatation (group 1) were compared with 47 patients without prior dilatations (group 2).

Results: The type of surgery planned according to urethrography and endoscopy findings was appropriate in 37/60 (61.6%) patients in group 1 and in 39/47 (83%) patients in group 2 (P < .03). Anastomotic repairs were more frequent among the patients in group 2 (P < .001). Eighty five out of 107 patients were available for the 24 months follow-up. The success rate was higher in group 2 (91.4%) than patients in group 1 (70%) (P < .04). The greatest improvement in symptoms and quality of life occurred three months after the surgery (P < .05). Postoperative infection was persistent in 20/107 (18.7%) patients.

Conclusion: Urethral strictures with a long history of blind dilatation are separate entity. They are more difficult to image, require more augmentation and staged procedures and have a lower success rate.


Role of Frozen Section Examination in the Management of Testicular Nodules: A Useful Procedure to Identify Benign Lesions

Giorgio Bozzini, Barbara Rubino, Serena Maruccia, Carlo Marenghi, Stefano Casellato, Stefano Picozzi, Luca Carmignani

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1687-1691


Purpose: To assess the validity of frozen section examination (FSE) on testis nodules.

Materials and Methods: A series of 86 preselected patients with testicular nodules were recruited in this study. Nodules smaller than 2 cm had been surgically removed and biopsies of the margins performed. Larger nodules were just biopsied. Orchiectomy was the treatment of choice for malignant lesions and stromal tumors. Conservative surgery was performed on 2 previously monorchid patients with Leydig cell tumor because of the presence of just one testis. Conservative surgery was the treatment of choice for benign lesions in 32 cases.

Results: At FSE we observed that nodules were malignant germinal tumors in 47% of the cases, stromal tumors in 7% of the cases, benign lesions in 45% of the cases and doubtful for lymphoproliferative lesion in 1 case. The diagnosis made by FSE were confirmed in the definitive ones in all of them, we reported just 2 cases of Leydig cell tumor and benign fibrosis lesion. In these 2 cases, definitive histology of the collected specimens revealed areas of Leydig cell hyperplasia and seminomatous foci, respectively.

Conclusion: Our data suggest that FSE is a valid tool to discriminate between benign and malignant neoplastic lesions, particularly when an adequate sample is available.


Intravesical explosion is an extremely rare event during TURP.(1) Though previously reported , all the cases were dealt by immediate laparotomy and bladder repair.(1) To our knowledge this is the first case where laparoscopy has been offered as a treatment option.

Donor Specific Antibodies Median Fluorescence Intensity Levels Are the Best Indicator for Monitoring Desensitization Treatment in Kidney Transplant

Francisco Boix, Santiago Llorente, Anna Mrowiec, Jorge Eguia, Ruth López-Hernández, Maria Victoria Bernardo, María Rosa Moya-Quiles, José A. Campillo, Alfredo Minguela, Luisa Jimeno, María R. Álvarez- López, Manuel Muro

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1695-1698




The Whitaker Test

Richard B. Johnston, Christopher Porter

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1727-1730

Purpose: The Whitaker test was conceived and developed by Roger H. Whitaker (May 25, 1939) while he was a resident at Cambridge University in the late 1960s and early 1970s. The test combines a urodynamic study with antegrade pyelography to measure the pressure differential between the renal pelvis and the bladder. The test can differentiate between patients with residual or recurrent obstruction and those with dilatation secondary to permanent changes in the musculature.

Materials and Methods: We present the history of the Whitaker test and its place in modern practice.

Results: It is useful in evaluating patients with questionable ureteropelvic or ureterovesical junction obstruction and primary defects in the ureteral musculature. It can also be used to determine when percutaneous nephrostomy tubes can be safely discontinued in postoperative patients.

Conclusion: The merit of the Whitaker test in comparison to other less invasive tests, specifically diuretic renography, is the subject of much debate. However, such debate erroneously presupposes that the tests are directly comparable, which they are not. The correct use for the Whitaker test is to assesses potential upper tract obstruction in equivocal cases and should only be utilized when equivocal results are obtained by other less invasive tests, obstruction is suspected in a poorly functioning kidney, a negative renogram with colic, intermittent obstruction, and percutaneous access already exists and the cause of dilatation needs investigating.

 Purpose: Circumcision is one of the historical surgical procedures. Some sources throughout the history contain various definitions about different circumcision methods. we described the details of the method, and aimed to remind the possibility of contemporary usage.

Materials and Methods: We compared circumcision chapters of Sabuncuoglu and Zahrawi to explain the historical origin of Sabuncuoglu's favorite circumcision method.

Results: We found a method which might be summarized as "knotting with rope technique" in one of historical textbooks named as Cerrahiyyetul Haniyye (Imperial Surgery) written by Serefeddin Sabuncuoglu (1385-1468?) in 1465.

Conclusion: This circumcision method is not used currently. In addition this method has not been defined in the history of medical literature yet.




The Value of Neutrophil Elastase in Diagnosis of Type III Prostatitis

Changhai Yang, Zhichun Dong, Liming Li

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1666-1672


Purpose: To explore the value and significance of neutrophil elastase (NE) in diagnosis of type III prostatitis.

Materials and Methods: The prospective study recruited 123 patients diagnosed with type III prostatitis (IIIA, 36 cases; IIIB, 87 cases) and 84 healthy controls, between April 2008 and July 2012. NE concentrations in expressed prostatic secretions (EPS), EPS routine examination, bacterial culture and The National Institute of Health Chronic Prostatitis Symptom Index (NIHCPSI) score were detected in all the subjects. Difference of NE, CPSI score, and withe blood cell (WBC) count between 2 or more than 2 groups and relationships between NE concentrations and WBC count were all analyzed.

Results: There was significant difference in levels of NE (P < .05) between IIIA and IIIB groups, and obviously positive correlation between the level of NE and number of leukocyte in type IIIA prostatitis group was observed (P < .05). The values of CPSI score between IIIA and IIIB groups was statistically significant (P = .037). The levels of leukocyte mount, NE and CPSI were statistically significant between IIIA and the control group (P < .05). NE concentration and CPSI score were statistically significant between IIIB and control group (P < .05), while the numbers of leukocyte was not statistically significant (P = .360).

Conclusion: The level of NE in EPS is a significant indicator in diagnosis of type IIIA and IIIB prostatitis.


Purpose: To compare the efficacy and safety of single (tamsulosin) and double dose (tamsulosin + alfuzosin) alpha-blocker therapy for treating catheterized patients with acute urinary retention (AUR) due to benign prostatic hyperplasia (BPH).

Materials and Methods: Seventy patients with AUR due to BPH were catheterized and randomized into two groups: the single dose group (0.4 mg tamsulosin, 35 patients) and the double dose group (0.4 mg tamsulosin + 10 mg alfuzosin, 35 patients). The catheter was removed after 3 days, and the patients were put on trial without catheter (TWOC).

Results: Seventy males (mean age, 71.2 years) were randomly assigned to receive double or single dose alpha-blocker (35 patients per group). The intent-to-treat population consisted of 70 males. Twenty-seven individuals in the double dose group and 19 in the single dose group did not require re-catheterization on the day of the TWOC (77% and 54%, respectively; P = .003). Success using free-flow variables was also higher in the males who received double dose alpha-blocker compared with single dose therapy (48% vs. 40%; P = .017).

Conclusion: TWOC was more successful in males treated with double dose alpha-blockers, and the subsequent need for re-catheterization was also reduced. The side-effect profiles were similar in the single and double dose alpha-blocker groups and were consistent with the known pharmacology. These results state that double dose alpha-blocker treatment can be recommended for treating males after catheterization for AUR, which may reduce the need for re-catheterization.


Biaxial Mechanical Properties of Human Ureter under Tension

Aisa Rassoli, Mohammad Shafigh, Amirsaeed Seddighi, Afsoun Seddighi, Hamidreza Daneshparvar, Nasser Fatouraee

Urology Journal, Vol. 11 No. 3 (2014), 9 July 2014 , Page 1678-1686


Purpose: The Mechanical properties of the ureteral wall may be altered by certain diseases such as megaureter. Ureter compliance and wall tension alterations can occur, leading to some abnormalities such as reflex mechanisms. Familiarizing with the mechanical properties of the ureter can help us advance in the understanding of urinary tract diseases.

Materials and Methods: A constitutive model that can predict the mechanical response of ureteral tissue under complex mechanical loading is required. Parameters characterizing the mechanical behaviour of the material were estimated from planar biaxial test data, where human ureter specimens were simultaneously loaded along the longitudinal and circumferential directions.

Results: The biaxial stress-stretch curve was plotted and fitted to a hyperelastic four-parameter Fung type model and five-parameter Mooney-Rivlin model. The average strength in the longitudinal direction was 3.48 ± 0.47 MPa and 2.31 ± 0.46 MPa (P <.05) for the circumferential direction.In the Fung model the value of parameter a2 (0.699 ± 0.17) was higher than a1 (0.279 ± 0.07), which may be due to the collagen fiber orientation’s preference along the longitudinal axis.

Conclusion: According to this study, it seems that ureter tissue is stiffer in the longitudinal than in the circumferential direction and maybe the collagen fiber are along the axial axes. Also the specimens showed some degree of anisotropy.