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Comparison of percutaneous nephrolithotomy and retrograde intrarenal surgery in treating 20-40 mm renal stones

Gokhan Atis, Meftun Culpan, Eyup Sabri Pelit, Cengiz Canakci, Ismail Ulus, Bilal Gunaydin, Asif Yildirim, Turhan Caskurlu

Urology Journal, Vol. 14 No. 2 (2017), 16 March 2017, Page 2995-2999

Purpose: To compare the outcomes of percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in treating renal stones between 20 and 40 mm in diameter.
Materials and Methods: 146 patients, who were treated with RIRS and 146 patients, who were treated with PCNL for renal stones between 20 and 40 mm in diameter were compared retrospectively using a matched-pair analysis. The operative and post-operative outcomes of both groups were analyzed retrospectively.
Results: The mean age, gender, body mass index and stone laterality were similar between the groups. The mean stone size was 28.39 ± 4.67 mm for the PCNL group and 25.08 ± 6.07 mm for the RIRS group (P =.21). The mean operative times were statistically longer in the RIRS group, whereas the fluoroscopy times, hospitalization times and post-operative visual analogue scores were statistically higher in the PCNL group. The stone- free rates (SFR) after a single procedure were 91.7% in the PCNL group and 74% in the RIRS group (P = .04). After auxiliary procedures, the overall SFRs reached 94.4% for the PCNL group and 92.3% for the RIRS group (P = .52). No major complications were observed for both groups. Minor complication (Clavien 1-3) rates were 6.8% and 3.4% for the PCNL and RIRS group, respectively (P =.18).
Conclusion: RIRS has some advantages over PCNL such as shorter hospitalization times, shorter fluoroscopy times and less post-operative pain in treating renal stones between 20 and 40 mm in diameter. However, PCNL has a higher SFR with only a single session.

Comparison of Success Rate in Complete Supine Versus Semi Supine Percutaneous Nephrolithotomy: (The first pilot study in randomized clinical trial)

Siavash Falahatkar, Ali Ghasemi, Keivan Gholamjani Moghaddam, Samaneh Esmaeili, Ehsan Kazemnezhad, Seyed Naser Seyed Esmaeili, Reza Motiee

Urology Journal, Vol. 14 No. 2 (2017), 16 March 2017, Page 3000-3007

Purpose: To compare outcomes and complications of percutaneous nephrolithotomy (PCNL) in the complete supine versus semi supine position in order to select the best position.
Materials and Methods: In this clinical trial, between July 2011 and May 2014, a total of 44 patients who presented for PCNL were prospectively enrolled and randomly divided into 2 groups [complete supine (n=22), and
semi supine (n = 22)]. The results in both positions were compared regarding the complexity and outcomes. Stone
free rate was considered as a main target of the study. However, it was the first study to focus on overlapping the vertebral density during the access.
Results: The two groups were comparable in age, gender, body mass index, and preoperative glomerular filtration rate, hemoglobin and creatinine. The mean operative time was significantly shorter for complete supine versus semi supine (36.68 ± 14.12 min versus 47.50 ± 16.45 min, P = .024). At the angle of 0?, overlapping with the spine occurred in 7 patients (31.8%) in semi supine group and just in 1 patient (4.5%) in complete supine group. Also, overlapping with the edge of bed occurred in 10 cases (45.5%) of complete supine and 1 (4.5%) of semi supine; the differences were statistically significant (P = .023, P = .002, respectively). No significant difference was found between the two groups in terms of stone free rate and complications.
Conclusion: Although, we had to convert two cases from semi supine into the complete supine position but we have demonstrated that PCNL in both positions is safe, effective and suitable for the patients. The stone free rate was similar in both groups. But the complete supine position is associated with a significantly shorter postoperative hospital stay and operative time, which may improve ease and safety of PCNL for patients.


Purpose: We have previously demonstrated that transperineal template prostate biopsy (TPTPB) has a significantly higher cancer detection rate compared to transrectal ultrasound guided (TRUS) biopsy in biopsy naive men with a PSA < 20 ng/mL. We, therefore, performed a prospective study to determine whether TPTPB is still superior to TRUS biopsy in the detection of prostate cancer in men with persistently elevated PSA after one previous negative set of TRUS biopsies.
Materials and Methods: 42 patients with a background of one previous negative set of TRUS biopsy, persistently elevated PSA (but < 20 ng/mL) and benign feeling digital rectal examination (DRE) underwent simultaneous standard 12-core TRUS biopsy and 36-core TPTPB under general anaesthesia. We determined the prostate cancer detection rate between the two diagnostic modalities.
Results: Mean age was 65 years (range: 50-75), mean prostate volume was 59 cc (range: 21-152), mean PSA is 8.3 ng/L (range: 4.4-19), mean time difference between the study and the previous TRUS biopsy was 33 months (range: 1-150) with mean PSA velocity of 0.7 ng/mL/year (range: 0-8). Out of the 42 patients, 22 (52%) had benign pathology. Of the 20 patients (48%) diagnosed with prostate cancer, 4 (10%) had positive results in both TRUS biopsy and TPTPB, 1 (2%) had positive result in TRUS biopsy with negative TPTPB, while 15 (36%) had negative TRUS biopsy with positive TPTPB. Hence, TRUS biopsy detected cancer in 5/42 (12%) patients versus (19/42) 45% detected by TPTPB (P < 0.01). 13/19 (68%) of cancers detected by TPTPB had Gleason score ≥7. A total of 82/141 (58%) of positive cores was found in the anterior zone. One patient (2%) experienced urosepsis, 2 (5%) temporary urinary retention, 14 (34%) mild haematuria and 13 (32%) haematospermia.
Conclusion: TPTPB still shows a significantly higher prostate cancer detection rate compared to TRUS biopsy (12% versus 45%, P < 0.01) in men with a previous set of negative TRUS biopsy, persistently elevated PSA (but < 20 ng/mL) and benign feeling prostate on DRE.


Bolus Injection Versus Infusion of Furosemide in Kidney Transplantation: A Randomized Clinical Trial

Afshar Zomorrodi, Hassan Mohammadipoor Anvari, Farzad Kakaei, Farzin Solymanzadeh, Esmaeil Khanlari, Amin Bagheri

Urology Journal, Vol. 14 No. 2 (2017), 16 March 2017, Page 3013-3017

Purpose: Furosemide is commonly administered to increase the urinary output in patients with transplanted kidneys. This study compared the two administration routes of furosemide (bolus versus infusion) in kidney transplanted patients.
Materials and Methods: Fifty patients who had undergone kidney transplantation in 2015 in a hospital in Tabriz, Iran, were included in this clinical trial. They were divided into two groups: bolus (120 mg stat) and infusion (4 mg/minute) groups. The primary outcome was urine onset time. Secondary outcomes were urine output volume, vital signs (blood pressure, heart rate), and electrolyte level (creatinine, blood urea nitrogen, sodium and potassium). After arterial and venous anastomoses, arterial clamp removal time and diuresis onset were recorded. Finally, the
urinary output volumes of both groups were measured with regular urine bags for an hour after anastomosis. Then it was repeated each three hours for 24 hours, and eventually two and three days thereafter. Finally, all data were statistically analyzed.
Results: Around 72% of the patients were men (mean age of 37.15 ± 14.67 years). Urine output was higher in bolus group but it was not statistically significant. Diuresis duration was measured after arterial declamping and its averages were 5.41 ± 3.7 minutes and 9.36 ± 7.65 minutes in bolus and infusion groups, respectively (P = .040). Furosemide bolus injection and infusion had no significant effect on creatinine, blood urea nitrogen, sodium and potassium.
Conclusion: Furosemide bolus injection can reduce diuresis onset time compared to furosemide infusion.


Gender Preferences for Urologists: Women Prefer Female Urologists

Kim Sun-Ouck, Taek Won Kang, Dongdeuk Kwon

Urology Journal, Vol. 14 No. 2 (2017), 16 March 2017, Page 3018-3022

Purpose: To investigate patients' preferences for the gender of their urologist.
Materials and Methods: Patients who visited a urologic center were asked to complete a self-administered questionnaire on the preferences for the gender of their urologist as well as on their age, education level and employment status.
Results: Of 270 respondents, 144 subjects (53%) had a preference for the gender of their urologist, whereas 126 subjects (47%) had no preference. Among 154 female respondents, 56 (36.4%) patients had no preference;
96 (62.3%) patients had preferences for female urologists; and only 2 (1.3%) patient preferred male urologists. Among 116 male respondents, 70 (60.3%) patients had no preference; 30 (25.9%) patients had preferences for male urologists; and 16 (13.8%) preferred female urologists. Of patients that did express a preference, 87.5% (126/144) preferred the same gender urologist, with 65.2% (30/46) of male patients preferring male urologists and 97.9% (96/98) of female patients preferring female urologists (p < .001). However, age and education level were
not correlated with gender preference.
Conclusion: More than half the female participants had a preference for the same gender of urologist, whereas the majority of male participants expressed no preference for the gender of their urologist. Furthermore, gender preference was not correlated with age and education level.


Increased Level of c-kit in Semen of Infertile Patients with Varicocele

Guorong Jin, Jianrong Liu, Qin Qin, Songdan Gao, Fang Zhang, Yuehong Ma, Caiyun Ding, Lina Dong, Haizhen Yin, Yimin Wang

Urology Journal, Vol. 14 No. 2 (2017), 16 March 2017, Page 3023-3027

Purpose: Varicocele is the most common risk factor for male infertility, however, not all males with varicocele experience infertility. In fact, most patients with varicocele have normal spermatogenesis. The molecular mechanism of varicocele-associated infertility is yet to be completely understood. The aim of this study is to assess the association of a number of fertility regulatory factors on varicocele associated infertility and to throw light on the mechanism of varicocele-associated infertility.
Materials and Methods: Semen from 30 infertile patients with varicocele and 30 fertile men with varicocele were collected. The concentrations of the following factors in seminal plasma were determined by ELISA: follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), androgen binding protein (ABP), transferrin (Trf), inhibin B (INHB) and stem cell factor (SCF). The expression level of c-kit in seminal precipitate of patients with varicocele was detected by real-time PCR.
Results: The concentrations of sexual hormones, FSH, LH and T, had no differences between infertile patients with varicocele and fertile men with varicocele (P > 0.05). Factors secreted by Sertoli cells, ABP, Trf, INHB and
SCF, showed no significant differences between the two groups (P > 0.05). Interestingly, the expression of c-kit was significant higher in infertile patients with varicocele than that in fertile men with varicocele (P < 0.01).
Conclusion: Neither the sexual hormones nor the Sertoli cells was responsible for the infertility induced by varicocele.
The aberrant expression of c-kit in infertile patients with varicocele may provide new insight into the mechanism of varicocele-associated infertility.


Huge Renal Hydatid Cyst- an Unusual Presentation: A Case Report

Jamal Jafari Nodoushan, Samad Zare, Seyed Mostafa Tabatabaei, Mojtaba Babaei Zarch, Fatemeh Imani, Fatemeh Ehsani

Urology Journal, Vol. 14 No. 2 (2017), 16 March 2017, Page 3040-3042

Isolated renal hydatid cyst is a rare entity accounting for only 2-4% of cases. A 60-year-old male presented to our clinic complaining of pain in right flank. He had a history of eating raw sheep liver. Imaging revealed an expansive cystic mass measuring approximately
300×180 mm in the right side of abdomen. The patient was treated by open surgery in combination with perioperative chemotherapy with albendazol. In this case, we reported an unusual presentation of hydatid cyst disease. Physicians should be aware of its clinical presentations and complications.

A Case Report of Human Infection with Dioctophyma Renale from Iran

Roghayeh Norouzi, Arman Manochehri, Mustafa Hanifi

Urology Journal, Vol. 14 No. 2 (2017), 16 March 2017, Page 3043-3045

A 75-year-old man from Kurdistan province, western part of Iran was diagnosed with a mass in the right kidney by ultrasound and computed tomography. In operation, a parasitic helminth, 30 cm long and 1.2 cm in diameter consistent with D. renale was found in the right kidney. Microscopic examination revealed that the male Dioctophyma renale. Following removal of worm, the symptoms completely resolved within a few hours. Generally, parasitism by D. renale in human is a necropsy finding, nevertheless imaging techniques as ultrasound and computed tomography have been proven to be important tool to achieve diagnosis.


The Effect of Urinary Catheters on Microbial Biofilms and Catheter Associated Urinary Tract Infections

Sahra Kirmusaoglu, Seyhun Yurdugül, Ahmet Metin, Suphi Vehid

Urology Journal, Vol. 14 No. 2 (2017), 16 March 2017, Page 3028-3034

Purpose: The aims of this study were to determine relationship between biofilm producer microorganisms attached to urinary catheters (UCs) and urinary catheter-associated urinary tract infections (CAUTIs), to determine the rate of CAUTI development and the relationship between CAUTI and catheterization period in catheterized patients.
Materials and Methods: Urinary catheters from 143 inpatients who were hospitalized in Abant Izzet Baysal University Hospital Urinary Service, and urine samples of these patients before and after catheterization of urinary
catheter were collected. Culture-based microbiological evaluation of urinary catheters removed from inpatient and urine samples collected from inpatients were performed before and after catheterization of urinary catheter to identify various organisms and determine biofilm production by them.
Results: The incidence of CAUTIs was 13% (18/143) in catheterized inpatients. Biofilm producer microorganisms such as Escherichia coli (E. coli ), Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis that were isolated from UCs removed from inpatients were found to cause CAUTI (P < .001).
Conclusion: Incidence of CAUTIs is increased by the usage of UCs and prolonged catheterization period.

Purpose: In overactive bladder (OAB) patients with systemic diseases, dry mouth tends to be more prominent owing to the effects of systemic diseases or related medications. We evaluated how systemic diseases affect dry mouth before and after anticholinergic treatment.
Materials and Methods: OAB patients were enrolled in this study. The patients were divided according to the presence or absence of systemic diseases. Patients with systemic diseases were sub-grouped by the number of systemic diseases (only one or more than one disease). OAB symptoms score (OABSS), visual analogue scale (VAS) score for dry mouth, and body mass index (BMI) were measured. The statistical assessments were done
with independent T-tests and ANCOVAs.
Results: One hundred and four OAB patients were enrolled in this study. Seventy (67.3%) patients had systemic diseases and thirty-four (32.7%) patients did not. Age and BMI were higher in the systemic diseases group. The baseline VAS score of OAB in the systemic diseases group (15.9 ± 19.5) was higher than that in the OAB without systemic diseases group (4.1 ± 6.4) (P = .002). Even after age and BMI adjustment, the difference was significant. The follow-up VAS score was also different (P = .028), but the change in VAS score was not different (P = .280). In a sub-analysis, the change in VAS score in the group with two or more systemic diseases (23.6 ± 18.1) was higher than that in the group with only one systemic disease (12.5 ± 13.2) (P = .012).
Conclusion: The severity of xerostomia after treatment with anticholinergics in OAB increases in patients with one systemic disease parallel to its severity before starting treatment. However, in patients with two or more systemic disease the magnitude of change in xedrostomia score is higher that we would expect in patients with no or one systemic diasese.