Best Reviewer


The Effect of Folate and Folate Plus Zinc Supplementation on Endocrine Parameters and Sperm Characteristics in Sub-Fertile Men: A Systematic Review and Meta-Analysis

Morvarid Irani, Malihe Amirian, Ramin Sadeghi, Justine Le Lez, Robab Latifnejad Roudsari

Urology Journal, Vol. 14 No. 5 (2017), 29 August 2017, Page 4069-4078

Purpose: To evaluate the effect of folate and folate plus zinc supplementation on endocrine parameters and sperm characteristics in sub fertile men.
Materials and Methods: We conducted a systematic review and meta-analysis. Electronic databases of Medline, Scopus , Google scholar and Persian databases (SID, Iran medex, Magiran, Medlib, Iran doc) were searched from 1966 to December 2016 using a set of relevant keywords including “folate or folic acid AND (infertility, infertile, sterility)”.All available randomized controlled trials (RCTs), conducted on a sample of sub fertile men with semen analyses, who took oral folic acid or folate plus zinc, were included. Data collected included endocrine parameters and sperm characteristics. Statistical analyses were done by Comprehensive Meta-analysis Version 2.
Results: In total, seven studies were included. Six studies had sufficient data for meta-analysis. “Sperm concentration was statistically higher in men supplemented with folate than with placebo (P < .001)”. However, folate supplementation alone did not seem to be more effective than the placebo on the morphology (P = .056) and motility of the sperms (P = .652). Folate plus zinc supplementation did not show any statistically different effect on serum testosterone (P = .86), inhibin B (P = .84), FSH (P = .054), and sperm motility (P = .169) as compared to the placebo. Yet, folate plus zinc showed statistically higher effect on the sperm concentration (P < .001), morphology (P < .001), and serum folate level (P < .001) as compared to placebo.
Conclusion: Folate plus zinc supplementation has a positive effect on sperm characteristics in sub fertile men. However, these results should be interpreted with caution due to the important heterogeneity of the studies included in this meta-analysis. Further trials are still needed to confirm the current findings.

An Up-to-date Meta-analysis of Coffee Consumption and Risk of Prostate Cancer

Jiadong Xia, Jie Chen, Jian-Xin Xue, Jie Yang, Zeng-Jun Wang

Urology Journal, Vol. 14 No. 5 (2017), 29 August 2017, Page 4079-4088

Purpose: Results of the association between coffee consumption (CC) and the risk of prostate cancer (PC) are still controversy. Based on published relevant studies, we conducted an up-to-date meta-analysis to investigate
this issue.
Materials and Methods: The protocol used in this article is in accordance with the PRISMA checklist. Eligible studies were screened and retrieved by using PUBMED and EMBASE as well as manual review of references up to July 2016. We calculated the pooled relative risk (RR) with 95% confidence interval (CI) with random effect models. The dose-response relationship was assessed by generalized least-squares trend estimation analysis.
Results: Totally, we included twenty-eight studies (14 case-control and 14 cohort studies) on CC with 42399 PC patients for the final meta-analysis. No significant association of PC was found for high versus non/lowest
CC, with RR = 1.07 (95% CI: 0.96-1.18). In subgroup meta-analysis by study design, there were no significant positive associations between CC and PC in case-control studies (RR = 1.19, 95% CI: 1.05-1.35) or in the cohort studies (RR = 0.97, 95% CI: 0.84-1.12). Additionally, RR with different quality of studies were respectively 1.15 (95% CI: 0.99-1.34) and 1.28 (95% CI: 1.03-1.58) for high and low quality in the case-control studies; while were respectively 1.02 (95% CI: 0.88-1.20) and 0.81 (95% CI: 0.57-1.14) in the cohort studies. When analyzed by geographic area, we found no association between CC and PC, with RR = 1.06 (95% CI: 0.86-1.30) for 10 studies from Europe, 1.06 (95% CI: 0.94-1.20) for 13 studies conducted in America; 1.12 (95% CI: 0.70-1.79) for 4 studies
from Asia. However, in subgroup analysis by subtype of the disease, there was a significant negative (beneficial) association in the localized PC (RR = 0.90, 95% CI: 0.84-0.97), but not for the advanced PC (RR = 0.90, 95%
CI: 0.70-1.16). Additionally, RR = 0.99 (95% CI: 0.98-0.99) for an increment of one cup per day of coffee intake shows significant association with the localized PC.
Conclusion: Our results indicate that CC has no harmful effect on PC. On the contrary, it has an effect on reducing the localized PC risk. Further prospective cohort studies of high quality are required to clarify this relationship.


Purpose: The first purpose of this study was to reveal factors affecting the postoperative development of systemic inflammatory response syndrome (SIRS) in patients undergoing standard percutaneous nephrolithotomy (PNL) for renal stones. The second purpose was to determine the role of the preoperative platelet-to-lymphocyte ratio (PLR) and the neutrophil-to-lymphocyte ratio (NLR) in the prediction of SIRS.
Matarials and Methods: In total, 192 patients who had undergone conventional PNL for renal stones from 2013 to 2015 were included in the study. SIRS developed postoperatively in 41 (21.3%) patients. The patients were divided into SIRS and non-SIRS groups, and the effects of the PLR, NLR, and other demographic and operative data were investigated to predict the development of SIRS. Variables significant in the univariate analysis were evaluated using a multiple logistic regression model to determine the independent risk factors for developing SIRS after PNL.
Results: Univariate analysis revealed significant differences in the preoperative PLR (P < .001), preoperative NLR (P = .018), number of access sites (P < .001), mean renal parenchymal thickness (P = .02), operative time (P < .001), decrease in hemoglobin (P = .016), length of hospital stay (P < .001), stone-free status (P = .023), and complication rate between the two groups of patients. However, multivariate analysis showed that only the PLR and the number of access sites were independent factors affecting the development of SIRS. When the PLR cut-off value was 114.1, development of SIRS was predicted with 80.4% sensitivity and 60.2% specificity.
Conclusion: The preoperative PLR is an effective and inexpensive biomarker with which to predict SIRS after PNL. In particular, we recommend close monitoring of patients with a PLR of >114.1 because of the possible
development of serious complications.

The Association of Household Food Insecurity and the Risk of Calcium Oxalate Stones

Hamid Shafi, Ahmad-Reza Dorosty Motlagh, Mohammad Bagherniya, Atefeh Daeezadeh, Mohammad Safarian

Urology Journal, Vol. 14 No. 5 (2017), 29 August 2017, Page 4094-5000

Purpose: Food insecurity has been defined as ‘limited or uncertain availability of nutritionally adequate and safe foods’, which associated with adverse health consequences in human. Another alarming condition, which is related to several comorbidities is kidney stone. This study aimed to determine the association of household food insecurity and developing kidney stones (calcium oxalate) in adults referred to medical centers of Babol.
Materials and Methods: This case-control study included 200 participants 18-65 years of ages (100 cases, 100 controls). An 18-items food insecurity questionnaire (USDA), a valid and reliable 147-item food frequency questionnaire (FFQ) and demographic characteristics were obtained via interviewing.
Results: Sixty eight percent of cases and 40% of controls were food insecure, respectively. Food insecurity was significantly associated with the risk of kidney stone (P < .05). Furthermore, body mass index (BMI) and family history of kidney stone were significantly associated with the risk of kidney stones (P < .05).
Conclusion: Food insecurity and BMI were significantly associated with the kidney stone, which shows the importance of availability of nutritionally adequate and safe foods in prevention of the kidney stone.

Different Approaches to Detect “Nanobacteria” in Patients with Kidney Stones: an Infectious Cause or a Subset of Life?

Hani Ansari, Abbas Akhavan Sepahi, Mohsen Akhavan Sepahi

Urology Journal, Vol. 14 No. 5 (2017), 29 August 2017, Page 5001-5007

Purpose: This research focused on the detection of nanobacteria in kidney stones of 30 Iranian patients without adding fetal bovine serum (FBS) to the culture media.
Materials and Methods: Nanobacteria were isolated from a nephro-ureterolithiasis extract of the urinary tract and kidney of patients and were cultured in the laboratory. The growth of nanobacteria was monitored using a spectrophotometer, and with inverted microscopy technique, their crystallization was analyzed after two days. The images from atomic force microscopy (AFM), transmission electron microscopy (TEM) and scanning electron microscopy (SEM) indicated the morphology and demonstrated the size of the cultured nanobacteria which is between 60 and 160 nm. Fourier transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD) were used to study the chemical composition, surface functional groups and crystal structure of the igloo-like nanobacteria shell. FTIR spectra in the
region of 1000 to 1200 cm-1 and the XRD peaks provided evidence that the main components of the nanobacteria shell were apatite-based compounds.
Results: Nanobacteria infected all the 27 patients with apatite kidney stone, and none of the three patients who had uric acid kidney stone were infected as confirmed by the cultivation of the stones samples. The results showed that nanobacteria might play a fundamental role in the formation of apatite-based kidney stones.
Conclusion: The biomineralization ability of nanobacteria may lead to calcification of the soft tissues, which in turn may result in other diseases. It is also suggested that nanobacteria may be a factor in calcification-related diseases and disorders with poorly characterized etiologies. This research with its different approaches, clarified significant doubts that nanobacteria act as contaminant, warranting continued investigation of its role in other diseases.


Prognostic Role of Lymphovascular Invasion in Patients with Urothelial Carcinoma of the Upper Urinary Tract

Manel Mellouli, Slim Charfi, Walid Smaoui, Rim Kallel, Abdelmajid Khabir, Mehdi Bouacida, Mohamed Nabil Mhiri, Tahya Sellami Boudawara

Urology Journal, Vol. 14 No. 5 (2017), 29 August 2017, Page 5008-5012

Purpose: To evaluate the impact of lymphovascular invasion on the prognosis of patients treated for upper urinary tract urothelial carcinomas.

Materials and methods: Clinical records of 49 patients treated surgically at our institute for upper urinary tract urothelial carcinomas were reviewed retrospectively. LVI was defined as the presence of cancer cells within an endotheluim-lined space without underlying muscular walls. Actuarial survival curves were analysed by Kaplan-Meier method. Multivariate analysis was performed using Cox’s proportional hazard model.

Results: Median follow-up was 32 months. Lymphovascular invasion was present in 26 (53%) patients. Lymphovascular invasion was associated with higher pathological tumor stage (pT) and higher tumor grade. The disease-free and overall survival rates of the patients with lymphovascular invasion were significantly worse than those of the patients without lymphovascular invasion (p < 0.001 and p = 0.027 respectively). Multivariate analysis revealed that lymphovascular invasion as well as tumor grade and pathological tumor stage were significant prognostic
factors for disease-free and overall survival.

Conclusion: The presence of lymphovascular invasion was a strong predictor of a poor outcome for UTUC. This finding could help identify patients at greater risk for disease recurrence who would benefit from close follow-up and early adjuvant therapy.


A Comparative Study on the Clinical Efficacy of Two Different Disposable Circumcision Suture Devices in Adult Males

Junwen Shen, Jihan Shi, jianguo Gao, Ning Wang, Jianer Tang, Bin Yu, Weigao Wang, Rongjiang Wang

Urology Journal, Vol. 14 No. 5 (2017), 29 August 2017, Page 5013-5017

Purpose: We evaluated the safety and efficacy of two different kinds of disposable circumcision suture devices in adult men.
Materials and Methods: Adult male patients (n = 179; mean age: 23.7 years) with redundant prepuce and/or phimosis were included in a clinical trial from July 2015 to August 2016. Patients were divided into 2 groups: group A using the Langhe disposable circumcision suture device (n = 89), and group B using the Daming disposable circumcision suture device (n = 94).
Results: Intraoperative and postoperative bleeding were more serious in the group A of disposable circumcision suture device compared with the group B of disposable circumcision suture device (4.21 ± 1.31 ml) versus (2.56 ± 1.45 ml). Patients in the group B of disposable circumcision suture device had a longer swelling time (group A versus group B: 11.7 ± 0.9 days versus 14.5 ± 1.4 days), the postoperative pain score in the 7 days after surgery (group A versus group B: 2.9 ± 0.9 versus 3.8 ± 1.5), and higher postoperative infection rate (group A versus group B: 4.7% versus 13.8%), the differences were statistically significant (p < 0.05).
Conclusion: postoperative complications of the two kinds of disposable circumcision suture devices are different. We should pay attention to the risk of postoperative bleeding when the patients use the Langhe disposable circumcision suture device, while the patients who use the Langhe disposable circumcision suture device will have a longer healing time, and postoperative pain and the risk of infection cannot be ignored after the surgery.


Differences in Poly(ADP-ribose) Polymerase1- (PARP1-) and Proliferative Cell Nuclear Antigen (PCNA) Immunoreactivity in Patients Who Experienced Successful and Unsuccessful Microdissection Testicular Sperm Extraction Procedures

Süleyman Akarsu, Baris Büke, Seren Gülsen Gürgen, Serkan Akdemir, Funda Gode, Merve Biçer, Mustafa Agah Tekindal, Ahmet Zeki Isik

Urology Journal, Vol. 14 No. 5 (2017), 29 August 2017, Page 5018-5022

Purpose: The aim of this study is to evaluate expression of deoxyribonucleic acid (DNA) synthesis and repair markers in testicular tissues of azoospermic men in whom sperm retrieval could and could not be achieved as a result of microdissection testicular sperm extraction (micro-TESE) procedure.
Materials and Methods: In this prospective cohort study, testicular tissues were retrieved from 60 Non-obstructive Azoospermia (NOA) patients who underwent micro-TESE procedure. These patients were divided into two
groups: micro-TESE positive group, which included 30 NOA patients from whom sperm could be extracted via micro-TESE procedure; and micro-TESE negative group, which included 30 NOA patients from whom sperm retrieval could not be achieved via micro-TESE procedure. Expression and distribution patterns of poly(ADP-ribose) polymerase-1 (PARP-1) and proliferative cell nuclear antigen (PCNA) in extracted tissues were assessed
by immunohistochemical staining to reveal any differences in DNA synthesis and repair between the two groups.
Results: Micro-TESE positive group exhibited significantly stronger immunoreactivity for both PCNA and PARP-1 (P = .001 and P = .001 respectively). The results of this study reveal that both DNA synthesis and repair markers were expressed strongly in patients who experienced successful micro-TESE procedure.
Conclusion: Although further studies are needed to support these findings, PARP-1 and PCNA expression in testicular tissues of NOA patients could be promising predictive factors for micro-TESE procedure success.

Impact of Four Week Swimming Exercise with Alpha-Tocopherol Supplementation on Fertility Potential in Healthy Rats

Abolfazl Kalantari, Abbas Saremi, Nader Shavandi, Ali Foroutan Nia

Urology Journal, Vol. 14 No. 5 (2017), 29 August 2017, Page 5023-5026

Purpose: The aim of this study was to evaluate the effect of 4 week intensive swimming exercise and alpha-tocopherol supplementation on testicular oxidative stress and spermatogenesis in rats.
Materials and Methods: 40 male rats were randomly assigned to Control (C), Sham (S), Exercise (E) and Exercise + supplement (ES) groups. Exercise training performed for 4 weeks (1session/day, 6days/week). Each session included 180 minutes of swimming. In ES group, alpha-ocopherol was injected at a dose of 50 mg/kg/day. 48 hours after last training session, all rats were killed and gonads of them were removed from their body for histological and biochemical assays. All statistical analysis was performed by SPSS 16. P values less than 0.05 were considered as statistically significant.
Results: Total testicular antioxidant capacity increased significantly in E (P = .003) and ES groups (P = .001) whereas there was no significant difference between C and E group in testicle Malondialdehyde (a lipid peroxidation marker) level (P = .999) and spermatogenesis quality (P = .381). Testicle Malondialdehyde level decreased (P = .009) and spermatogenesis quality was improved significantly in ES group (P = .001).
Conclusion: Alpha-tocopherol supplementation is effective in order to improve spermatogenesis process in athletes who exercise with high intensity.


Retained Surgical Gauze Presenting With Gross Hematuria: A Case Report

Babak Javanmard, Mohammad Reza Yousefi, Behrouz Fadavi, Morteza Fallah Karkan

Urology Journal, Vol. 14 No. 5 (2017), 29 August 2017, Page 5027-5029

Gossipyboma is a mass which is made around a cotton sponge or abdominal compress retained in a patient during surgery accidentally. Patients manifest with either acute or chronic symptoms due to complications. Here in we
reported an 89-year-old man case of transvesical migration of gossipyboma who presented with gross hematuria with a history of transvesical prostatectomy 6 years ago. Patient underwent exploratory laparotomy with repairing of the bladder and peritoneum. He had no complications during surgery and was subsequently discharged.

Staged Bilateral Laparoscopic Adrenalectomy for Infantile ACTH-independent Cushing’s Syndrome (Bilateral Micronodular Non-pigmented Adrenal Hyperplasia): A Case Report

Nasser Simforoosh, Maryam Razzaghy Azar, Mohmmad Hossein Soltani, Mona Nourbakhsh, Hamidreza Shemshaki

Urology Journal, Vol. 14 No. 5 (2017), 29 August 2017, Page 5030-5033

ACTH-independent Cushing’s syndrome is an uncommon disorder in children. While laparoscopic adrenalectomy is well-established in adults, it is rarely used in infants and is associated with some concerns. A seven-month infant was referred to our hospital due to progressive signs and symptoms of Cushing’s syndrome. Laboratory data confirmed ACTH-independent hypercortisolism. No history of exogenous corticosteroid contact was observed. The patient underwent left transperitoneal laparoscopic adrenalectomy when she was 7 months old, nevertheless,
complete response was not seen. The patient underwent right laparoscopic adrenalectomy (contra-lateral adrenal gland) when she was 20 months old. The signs and symptoms of Cushing’s syndrome began to resolve and serum and urine cortisol levels became normal 3 months after the second surgery. laparoscopic adrenalectomy is safe and feasible in infants, and in this case, relieved patient of the symptoms and saved her life.