Urology Journal

Purpose: Hemodialysis is the common kidney replacement therapy in Iran. Doing an adequate and effective dialysis can improve patients' quality of life and reduce kidney failure complications. Additionally, dialysis quality is an important factor in reducing mortality in patients with chronic kidney failure. This systematic review has investigated the adequacy of dialysis in studies done on hemodialysis patients of Iran.

Materials and Methods: All articles related to the dialysis adequacy in hemodialysis patients in English and Farsi (contemporary Persian) were identified by searching the related keywords in various electronic databases. According to the inclusion criteria 21 studies were identified. The results were analyzed using Stata software version 11.

Results: A number of 6677 patients had been enrolled in 21 studies that were chosen for this systematic review. Based on the random effects model, the overall dialysis adequacy (KT/V) (K: clearance of urea, T: duration of dialysis, V: distribution of urea) more than 1.2 and confidence interval were 36.3% and 46.2-26.4, respectively. Also, based on random effects model more than 65% urea reduction ratio in all studies was 28.8% and the confidence interval was 43.3-14.4.

Conclusion: KT/V and urea reduction ratio were much less desirable in hemodialysis patients and the dialysis quality was also undesirable. It seems that inadequate dialysis prescription, use of inappropriate filters, low pump speed (blood flow speed), and the short duration and few times of dialysis are the major causes of this inadequacy.

Purpose: To compare the outcome of percutaneous nephrolithotomy (PCNL) using split or intact Amplatz sheath.

Materials and Methods: Seventy two patients who underwent PCNL were randomly divided into two groups; PCNL using intact (group 1) and split (group 2) Amplatz sheath. Preoperative data, operative time, largest extracted stone size, fluoroscopy and lithotripsy time, and serum biochemistry tests before and after PCNL were evaluated.

Results: Preoperative features and stone size were not significantly different between the groups. There were no significant differences in complications and postoperative changes in hemoglobin and serum electrolytes. Stone free rate in group 2 (88.1%) was insignificantly higher than group 1 (83.3%) (p = .05), but in staghorn stones and stones larger than 1000 mm2, stone free rate in group 2 was significantly higher than group 1 (82% vs. 72%). The mean extracted stone size in group 2 (150 ± 49) was significantly larger than group 1 (40 ± 16 mm2) (p < .005). The mean operative, lithotripsy and fluoroscopy times were significantly longer in group 1.

Conclusion: Using split Amplatz sheath in PCNL facilitates extraction of larger stone fragments which could contribute to shorter fluoroscopy, lithotripsy and operative times.

Purpose: Little is known about whether migrants retain the risk of urolithiasis seen in their indigenous populations. We sought to evaluate the risk of renal colic between different ethnic groups among a diverse population in London.

Materials and Methods: Data on a cohort of 100 consecutive patients presenting to our emergency department with acute renal colic over a 6 month period was collected retrospectively. Data was extracted from electronic patient record review, trust data and the 2011 census. Risk ratios were calculated and comparisons between groups were made with Chi-Squared test using SPSS.

Results: The odds of renal colic among Turkish (odds ratio (OR) 6.57, 95% confidence interval (CI) 3.31-13.04, P < .001), Bulgarian (OR 4.94, 95% CI 1.82-13.44, P = .001), Romanian (OR 4.53, 95% CI 2.10-9.77, P < .001), Indian (OR 2.42, 95% CI 1.17-4.98, P = .013) and Pakistani (OR 2.25, 95% CI 1.38-3.67, P = .001) patients were significantly higher than the population average. The odds of colic among Black-Caribbean (OR 0.27, 95% CI 0.07 - 1.07, P = .045), Black-African (OR 0.27, 95% CI 0.07-1.07, P = .046), White-British (OR 0.44, 95% CI 0.30 - 0.66, P < .001) patients were significantly lower than the general population.

Conclusion: This study suggests that migrants from countries known to have higher incidence of urolithiasis tend to retain this increased risk once in London. Such ethnic groups may benefit from targeted intervention to reduce the incidence of stone disease. Further research is needed with greater numbers in a range of populations to confirm this hypothesis.

Purpose: To evaluate the utility and safety of laparoendoscopic single-site surgery (LESS) in comparison with conventional laparoscopic (CL) surgery for the treatment of upper urinary tract stones.

Material and Methods: Between June 2011 and May 2012, 20 patients with upper urinary tract stones were included in this prospective randomized study. The patients were assigned into the LESS group or CL group in a one-on-one manner using a random table. The clinical parameters were evaluated in the immediate postoperative period, and the stone clearance rate was evaluated via non-contrast computer tomography at one month postoperatively.

Results: There were no significant differences in patient demographics or preoperative stone sizes between the two groups. The perioperative parameters, including operative time, estimated blood loss, postoperative pain scores, length of hospital stay, and changes in renal function, were comparable. No transfusions or open conversions were required in either group. The incidence of residual stones was lower in the LESS group (1 case) than in the CL group (2 cases). However, this difference was not statistically significant.

Conclusions: For large and impacted upper ureteral stones, the effectiveness and safety of LESS were equivalent to those of CL. Further randomized control trials with larger sample sizes are needed to strengthen the conclusions of this study.

Purpose: In this study, we evaluated the prognostic significance of the ABO blood type in patients with renal cell carcinoma (RCC) who had undergone partial or radical nephrectomy.

Materials and Methods: Information on the ABO blood type was obtained from 1750 patients with RCC. A total of 1243 men and 507 women (mean age, 55.41 ± 12.43 years) with RCC who had undergone partial or radical nephrectomy were enrolled in this study. The median follow-up duration was 35.0 months (interquartile range [IQR], 16.0-67.0). During the follow-up period, 271 patients experienced RCC recurrence, and 137 patients died from RCC.

Results: Type A was the most common blood type (568, 32.5%), followed by type O (525, 30.0%), type B (464, 26.5%), and type AB (193, 11.0%). Generally, blood type was not associated with any clinicopathological factors. Unlike blood type O, the multivariate analysis of progression-free survival (PFS) showed that blood type non-O (A, B, and AB) was an independent prognostic factor for a worse outcome (95% confidence interval [CI]: 1.24- 2.37, hazard ratio [HR] = 1.71, P = .001; 95% CI: 1.08-2.13, HR = 1.51, P = .016; 95% CI: 1.03-2.43, HR = 1.58, P = .037, respectively). Cancer-specific survival (CSS) analysis showed that blood type A was an independent factor associated with a worse prognosis for CSS (95% CI: 1.05-2.64, HR 1.66, P = .031, respectively).

Conclusion: The ABO blood type is significantly associated with PFS and CSS in patients with RCC following partial or radical nephrectomy. Blood type non-O (A, B, and AB) is an independent prognostic factor for a worse PFS outcome, and blood type A is an independent factor associated with a worse CSS prognosis.

Purpose: Human polyomaviruses (PV) has been associated with oncogenicity; however, the association between human bladder cancer and PV remains inconclusive. Moreover, whether PV has the interaction with p53 in tumorigenesis and their prognostic significance on human bladder cancer has yet to be determined.

Materials and Methods: Bladder tumor specimens and clinical parameters from 74 patients with urothelial carcinoma were collected. Immunohistochemical analysis using monoclonal antibodies specific to PV large tumor antigen (TAg) and p53 protein was performed to investigate the involvement of PV in human bladder tumorigenesis and the prognostic significance of TAg and p53 expressions using Cox proportional hazards model.

Results: The mean age of the 74 patients at diagnosis was 64 years and 61 (82.4%) were male. The expression of PV TAg protein was found in 45 (60.8%) tumor samples, but was not correlated with the expression of p53 (P = .280). The detection of PV TAg was significantly associated with tumor stage (P = .001) but not decreased overall survival (OS) or cancer-specific survival (CSS) (P = .661 and .738, respectively). However, the p53 overexpression was significantly associated with decreased CSS (P = .028). In multivariate Cox proportional hazards analysis, age and p53 overexpression were predictors of OS (P = .026) independently of tumor stage and CSS (P = .042), respectively.

Conclusion: We found that PV, which was detected in a significant percentage of tumor specimens, may be an important co-factor in the tumorigenesis of the bladder in humans. However, only p53 overexpression was associated with predicting CSS independently of tumor stage.

Purpose: To evaluate the role of Doppler ultrasonography (DUS) in diagnosing pediatric testicular torsion (TT), and its diagnostic accuracy, and helping clinicians increase specificity and decrease negative exploration rates.

Materials and Methods: We performed a retrospective study of all consecutive patients with acute testicular symptoms referring to our pediatric emergency department (ED) from January 2010 to December 2013.

Results: We analyzed 1091 patients, with a mean age of 9 years. DUS was performed in 498 patients (40.8%); 107 patients (8.8%) underwent surgery and 41 patients (3.3%) had a TT. The following clinical findings were collected: presence of scrotal pain, erythema and swelling, spermatic cord pain and abnormal cremasteric reflex. The clinical findings significantly associated with TT were spermatic cord pain (OR = 37, 95% CI: 11.9-111.1, P < .001) and abnormal cremasteric reflex (OR = 47.6, 95% CI: 13.5-166.6, P < .001); the presence of swelling resulted confounding (OR = 2.3, 95% CI: 0.7-8.4, P < .001). Scrotal pain was not significantly associated with TT (P = .9), while erythema made TT unlikely (OR = 0.22, 95% CI: 0.07-0.7, P = .0445). In all cases the DUS significantly increased the predictivity.

Conclusion: TT was present in 3.3% of patients presenting with testicular symptoms. The predictivity based on clinical findings resulted high and the negative exploration rate for TT was 62%. DUS increased the predictivity in all patients.

Purpose: To compare clinical and urodynamic study (UDS) findings in Iranian women with mixed or stress UI (Urinary Incontinence).

Materials and methods: A total of 132 patients with either stress or mixed type of UI were enrolled. After accurate examination, data regarding age, parity, mode of delivery and menopausal state were recorded. Furthermore the presence and severity of UI was evaluated with empty bladder supine stress test (ESST) and cough test in supine and standing positions in all patients. Eligible cases underwent UDS evaluation by an expert urologist using a standardized protocol.

Results: Stress and mixed UI were found in 33 (25%) and 99 (75%) patients respectively. By considering clinical evaluation as gold standard, sensitivity, specificity, positive and negative predictive value of urodynamic study were 83.4%, 30.4%, 43.4% and 80% for detecting stress UI and 96.1%, 35.6%, 34.7%, 96.2% for detecting mixed UI respectively. No correlation was noted between ESST or cough test results and Valsalva leak point pressure (VLPP) values in patients with stress UI, however ESST was correlated with VLPP values in patients with mixed UI.

Conclusion: Despite a relatively high sensitivity, the specificity was low and urodynamic evaluation seems to be of limited value in the assessment of UI in female patients.

Purpose: To evaluate postoperative results of laparoscopic varicocelectomy using bipolar electrosurgery and analyze semen according to the grade of varicocele after surgery.

Materials and Methods: In a six-year period, 416 men with clinical varicocele and impaired semen parameters or infertility underwent laparoscopic varicocelectomy using bipolar electrosurgery. All patients were assessed for hydrocele and recurrence of varicocele six months and one year after the procedure. Semen analyses were obtained before and after the surgery and were compared according to the clinical grade of varicocele.

Results: Seven patients (1.7%) had right side, 391 (94%) had left side and 18 (4.3%) had bilateral varicoceles. Varicocele grades I, II and III were detected in 113 (27.1%), 232 (55.7%) and 71 (17%) patients respectively. Abdominal wall emphysema and pneumoscrotum were developed in 19 (4.5%) and 11 (2.6%) cases. Recurrence rate was significantly higher in grade III varicocele (P < .001). In patients with varicocele grades of I and II, sperm concentration, motility and morphology significantly improved six months after surgery (P < .05). In patients with grade III varicocele, only sperm concentration improved (P < .05). Sperm motility and morphology did not show any significant change after one year.

Conclusion: Laparoscopic varicocelectomy using bipolar cautery is a safe, feasible and cost-effective technique with few complications. It significantly improves sperm parameters. A follow up program for at least one year after the surgery seems reasonable to detect recurrent cases. The study shows that increase in clinical varicocele grade can cause irreversible deleterious effects on sperm motility and morphology. So, earlier treatment is recommended.

Strictures of the urethra are the most common cause of obstructed micturition in younger men and there is frequent recurrence after initial treatment. Currently, routine repeated dilations, including intermittent self-catheterisation (ISC) are prescribed by urologists to prevent urethral stricture recurrence. There is, however, no high level evidence available supporting the effectiveness of practicing these painful techniques. Balancing efficacy, adverse effects and costs, we hypothesize that active surveillance is a better option for preventing stricture recurrence as compared with routine repeated dilations. However, well designed, adequately powered multi-center trials with comprehensive evaluation are urgently needed to confirm our hypothesis.