Urology Journal

Purpose: To evaluate the efficacy of silodosin in the medical expulsive therapy for symptomatic distal ureteral stones.

Materials and Methods: This prospectively randomized controlled trial was carried out from May 2011 to December 2014. In all, 198 patients with radiopaque distal ureteral stones <10 mm in size were eligible: 61 patients in the control group and 62 patients in the silodosin group. The silodosin group received silodosin 8 mg daily, and the control group received lactose tablets. The primary outcome was the expulsion rate. The secondary outcomes the expulsion time, analgesic consumption, lower urinary tract symptoms, colic episodes, and adverse effects. Statistical analyses were performed using a Mann-Whitney U-test and chi-square test.

Results: The final analysis was conducted with 61 control and 62 silodosin patients as the denominator in each randomization arm. The average expulsion times were 6.31 ± 2.13 days for the silodosin group and 9.73 ± 2.76 days for the control group (P < .001).

Conclusion: Treatment with silodosin proved to be safe and effective, as demonstrated by the increased stone expulsion rate, the reduced expulsion time, and the reduced analgesics consumption.

Purpose: To investigate technical problems, complications and stone clearance rate in patients with spinal neuropathy who had undergone percutaneous nephrolithotomy.

Materials and Methods: This cross-sectional study was done between 2004 and 2013 on 29 patients with both spinal cord neuropathy and kidney stones who were chosen for percutaneous nephrolithotomy in Sanandaj city, Iran. The data were obtained from patients' medical records and were documented in a researcher-made checklist. Absolute and relative frequency, mean and standard deviation were calculated.

Results: A total of 43 percutaneous nephrolithotomies were performed on 32 kidneys. In 51.7% the right kidney, in 37.9% the left kidney and in three patients (10.3%) both kidneys were involved. There were 24 patients (82.8%) with spinal cord injury. Five patients (17.2%) had spina bifida. The mean of operation time was 129.7 minutes and the mean of hospital stay was 8.3 ± 3.1 days. The mean of kidney stone size was 35.7 ± 6.1 mm (25 to 45 mm). In 58.5% of the patients, surgery lasted more than two hours. Stone clearance rates were 53.1% and 78.1% after the first and second percutaneous nephrolithotomy.

Conclusion: Although patients with spinal cord injury have problems in terms of surgery and complications, percutaneous nephrolithotomy is an appropriate and safe treatment method for their kidney stones. Pre-operative counseling with a radiologist and an anesthesiologist is recommended.

Purpose: To investigate the role of CD44, cytokeratin 20 (CK20) and survivin for the detection and prognosis of patients with urothelial carcinoma of the bladder.

Materials and Methods: The study included 82 patients who underwent transurethral resection of bladder tumors between 2009 and 2014. The patient and tumor characteristics with relevance to age, tumor size and focality, grade and stage, recurrence and progression were noted. Patients with carcinoma in situ, those who had at more than 3 sites of lesions and greater than 3 cm tumors were excluded. All cases were ex-smokers. All histological samples stained with hematoxylin and eosin were re-evaluated according to the 2004 World Health Organization/International Society of Urological Pathology (WHO/ISUP) classification system and immunohistochemically stained for CD44, CK20 and survivin.

Results: The study group comprised 57 (69.5%) males and 25 (30.5%) females with a mean age of 60 years (range, 26-87 years). All were newly-diagnosed patients with bladder tumors. Immunohistochemical evaluation revealed that there was a statistically significant correlation between the grade and stage of the tumor with CK20 and survivin positivity (P < .05). As the grade and stage increased CD44 immunoreactivity significantly decreased (P = .002, P = .0001, respectively). However, relationship of protein expressions with recurrence and progression remained insignificant (P > .05).

Conclusion: In cases of bladder urothelial carcinoma positivity for CD44, CK20, and survivin has significant relation with the tumor grade and stage while no significant relationship was determined in terms of recurrence and progression

Purpose: This study was conducted to evaluate lower urinary tract symptoms (LUTS) change in patients with localized prostate cancer after radical retropubic prostatectomy (RRP) and examine the efficacy of anticholinergic drugs to treat patients suffering from storage symptoms.

Materials and Methods: Among 50 patients who underwent RRP for prostate cancer, 40 who did not undergo additional treatment that might affect their urination pattern were included in the analysis. The International Prostate Symptom Score (IPSS), quality of life (QoL) score, and uroflowmetry were analyzed prior to RRP and 12 months after RRP. Twelve months after RRP, patients desiring improvement of storage symptoms were administered anticholinergic drugs for 6 months; the effects of such treatments were analyzed 3 and 6 months later.

Results: Preoperatively and at 12 months after surgery, the mean IPSS for patients were 10.9 ± 6.7 and 9.2 ± 5.7, respectively. The mean IPSS for patients desiring improvement of storage symptoms before and after administration of medication were 9.7 ± 5.9 and 9.0 ± 4.4, respectively. In particular, the mean storage symptom composites improved significantly after administration of medication. There were no statistically significant differences in frequency between baseline and 3-month, but frequency was improved significantly after 6 months. Urgency and nocturia were improved significantly after 3 months.

Conclusion: In patients undergoing RRP, urinary symptoms change over time, with worsening storage symptoms. Our results suggest that, in patients who had discomfort with storage symptoms after RRP, anticholinergic drugs significantly improved symptoms and QoL.

Purpose: We investigated the utility of urinary nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) levels as non-invasive markers for diagnosis and evaluation of treatment efficacy in children with overactive bladder (OAB).

Materials and Methods: This prospective study included 24 children with OAB and 30 healthy controls. At the time of diagnosis, micturition disorder symptom scores (MDSS) were determined, blood and urine samples were collected, and anticholinergic therapy was initiated. Clinical responses were evaluated, at the third and sixth month of treatment, by MDSS and urinary NGF, BDNF, and creatinine levels.

Results: The patient group had significantly higher urine NGF/Cr ratio (975 ± 827 and 159 ± 84, respectively, P < .001) and BDNF/Cr ratio (5.98 ± 5.78 and 0.81 ± 0.70, respectively, P < .001) before treatment. Significantly decreased BDNF/Cr ratio was found at the sixth month (5.98 ± 5.78 and 2.24 ± 0.98, respectively, P = .004). NGF/Cr > 360 was found to have 87.5% sensitivity and 100% specificity, and BDNF/Cr > 1.288 was found to have 87.5% sensitivity and 83.3% specificity for OAB diagnosis.

Conclusion: In conclusion, urine NGF/Cr and BDNF/Cr ratios may be useful markers for diagnosis of OAB. The BDNF/Cr ratio was found to be more significant in monitoring treatment response.

Purpose: To assess the reproducibility of the Valsalva leak point pressure (VLPP) based on urodynamics in females with stress urinary incontinence (SUI).

Materials and Methods: From October 2008 to December 2009, 65 consecutive women with urodynamically confirmed SUI underwent duplicate VLPP measurements. The intra-individual reproducibility of the VLPP recording obtained by one urologist was determined. The two observations were separated by a 10-min interval.

Results: The differences between the repeated measurements were not significant (initial vs. repeat VLPP, 84.8 ± 19.9 vs. 86.7 ± 20.3 cmH2O; P = .094). Repeated VLPP measurements were reproducible. Defining intrinsic sphincter deficiency (ISD) as VLPP < 60 cmH2O, the diagnosis of ISD changed between successive tests in three cases (from 55 to 89, 58 to 64, and 61 to 55 cmH2O).

Conclusion: In female SUI, the VLPP is a reproducible method for evaluating urethral resistance. For VLPP < 90 cmH2O, the diagnosis of ISD changed in repeated measurements in some patients; therefore, other clinical findings must be considered when deciding on a treatment method.

Purpose: Nuclear factor kapa b (NFKB) is a transcription factor that is required for cytokine-mediated induction of the human inducible nitric oxide synthase (iNOS) gene. Recent studies have shown that in the pathophysiology of ischemia-reperfusion (IR) injuries NFKB is involved. In our study we aimed to determine the efficacy of the selective NFKB inhibitor, pyrrolidium dithiocarbamate (PDTC), on long-term histological damage in testicular IR injuries.

Materials and Methods: Twenty-one adult male Wistar albino rats were divided into 3 equal groups. In groups 1-2, the left testes in rats underwent 4 hours of 720° experimental torsion. In group 2, PDTC (100 mg/kg) was administered intraperitoneally in the last 1 hour before detorsion; and group 3 underwent a sham operation. All rats underwent bilateral orchiectomy 45 days after the experiment. The testes weights were measured and compared to the other groups and their contralateral values. Testes samples were fixed with Bouin solution for histological (Johnsen score) and immunohistochemical examination. Immunohistochemically iNOS and an active subunit of NFKB, p65 were evaluated using mouse primary monoclonal antibodies and were evaluated semi quantitatively.

Results: Testicular weights and Johnsen scores in ipsilateral testes were 0.67 ± 0.85, 1.54 ± 0.11, 1.84 ± 0.64 and 1.63 (1-4), 6.94 (4-10), 5.29 (1-9) in the torsion, sham and PDTC groups, respectively. In contralateral testes the same values were 1.74 ± 0.84, 1.59 ± 0.13, 1.50 ± 0.54 and 5.38 (2-8), 7.17 (5-10), 6.30 (4-9). Testicular weights and Johnsen scores were significantly different in the ipsilateral torsion group (P < .05). In the PDTC group testicular weights and Johnsen scores were similar with the control group (P > .05). Immunohistochemically there was marked staining in the iNOS and p65 expressions in the torsion group compared with group 2 and 3. In rats administered PDTC, iNOS and p65 expressions were significantly reduced compared with the torsion group. There were no significant differences between the histological and immunohistochemical results of groups 2 and 3.

Conclusion: This data suggests that IR induces iNOS expressions through the activation of NFKB, p65. The NFKB pathway plays major role in testicular reperfusion injuries. It is possible to prevent reperfusion injuries using selective the NFKB inhibitor.

Purpose: This study examined the effect of mesenchymal stem cells' conditioned media on the severity of acute kidney injury.

Materials and Methods: Acute kidney injury was induced in male rats with 100 mg/kg of gentamicin for six consecutive days intraperitoneally. After inducing the standard model of acute kidney injury, the conditioned medium of 5 × 106 cells was calculated for each kilogram of body weight of the rats. Then, it was injected in three different injection patterns other than the baseline injection of gentamicin. The rats were randomly divided into four groups: control group (n = 18) that did not receive any treatment, gentamicin group (n = 18) that received gentamicin at a dosage of 100 mg/kg for six consecutive days intraperitoneally, sham group (n = 54) that received gentamicin for six consecutive days, and an experimental group (n = 54) that received gentamicin for six consecutive days. Serum biochemical analysis and histological changes were studied and analyzed in all groups.

Results: Although human mesenchymal stem cells' conditioned media did not improve serum and tissue markers in the treatment groups, a relative improvement was observed in some indicators of tissue damage.

Conclusion: Secretory factors of human mesenchymal stem cells can be partly protective against gentamicin-induced nephrotoxicity.

Purpose: To investigate the association between metabolic syndrome (MetS) and the predictors of the progression of benign prostatic hyperplasia (BPH) and the corresponding frequency and severity of lower urinary tract symptoms (LUTS).

Materials and Methods: A total of 530 men with moderate to severe International Prostate Symptom Score (IPSS) > 7 were recruited in the present study. The predictors for clinical BPH progression were defined as the total prostate volume (TPV) ≥ 31 cm3, prostate-specific antigen level (PSA) ≥ 1.6 ng/mL, maximal flow rate (Qmax) < 10.6 mL/s, postvoid residual urine volume (PVR) of ≥ 39 mL, and age 62 years or older. LUTS were defined according to the IPSS and MetS with the National Cholesterol Education Program-Adult Treatment Panel III guidelines. The Mantel-Haenszel extension test and the multivariate logistic regression analyses were used to statistically examine their relationships.

Results: The percentage of subjects with ≥ 1 predictors for clinical BPH progression, the percentage of subjects with a TPV ≥ 31 cm3, the percentage of subjects with a PVR ≥ 39 mL, and the percentage of subjects with a Qmax < 10.6 mL/s increased significantly with the increasing in the number of MetS components (all P < .05). After adjusting for age and serum testosterone level, the MetS were independently associated with the presence of TPV ≥ 31 cm3 (OR = 17.030, 95% CI: 7.495-38.692). Moreover, MetS was positively associated with the severity of LUTS (P < .001) and voiding scores (P < .001), and each individual MetS component appeared as an independent risk factor for severe LUTS (IPSS > 19, all P < .001).

Conclusion: Our data have shown that the MetS significantly associated with the predictors for clinical BPH progression and the frequency and severity of LUTS, especially the voiding symptoms. The prevention of such modifiable factors by promotion of dietary changes and regular physical activity practice may be of great importance for public health.