ISSN: 1735-1308

2019

REVIEW


Association of Transforming Growth Factor-Beta1 rs1982073 Polymorphism with Susceptibility to Acute Renal Rejection: a Systematic Review and Meta-Analysis

Farzaneh Najafi, Seyed Alireza Dastgheib, Jamal Jafari-Nedooshan, Mansour Moghimi, Naeimeh Heiranizadeh, Mohammad Zare, Elham Salehi, Hossein Neamatzadeh

Urology Journal, 2019, 5 January 2019
https://doi.org/10.22037/uj.v0i0.5437

Purpose: The association of rs1982073 (codon 10) polymorphism at Transforming Growth Factor- ?1 (TGF-?1) gene with acute renal rejection (ARR) has been reported by several studies. However, the results were controversial. To derive a more precise estimation of this association, a meta-analysis was performed.

Methods: The eligible literatures were identified through PubMed, Scopus, Web of Science, EMBASE, SciELO, WanFang, and CNKI databases up to July 01, 2019. The pooled odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were used to calculate the strength of the association.

Results: A total of 23 case-control studies with 795 ARR cases and 1,562 non-AR controls were selected. Pooled data revealed that there was no significant association between TGF-Beta1 codon 10 polymorphism and an increased risk of ARR in the overall population (C vs. T: OR=0.908, 95% CI 0.750-1.099, p=0.322; CT vs. TT: OR=1.074, 95% CI 0.869-1.328, p=0.507; CC vs.TT: OR=0.509, 95% CI=0.738-1.253, p=0.770; CC+CT vs. TT: OR = 0.917, 95% CI 0.756-1.112, p = 0.376, and CC vs. CT+TT: OR=0.995, 95% CI 0.809-1.223, p=0.959). Moreover, stratified analysis revealed no significant association between the TGF-?1 rs1982073 polymorphism and ARR risk by ethnicity and cases type (recipient and donor).

Conclusions: The current meta-analysis demonstrated that the TGF-?1 rs1982073 polymorphism was not significantly associated with increased risk of ARR. However, studies with a larger number of subjects among different ethnic groups are needed to further validate the results.

Purpose To assess the diagnostic accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography combined with the computed tomography (18F-FDG PET/CT) in the detection of recurrent or residual urinary bladder cancer with meta-analysis.

Methods We searched PubMed/MEDLINE, Embase, Web of Science, CBM, CNKI, VIP, and Wanfang databases through October 2019. Two reviewers independently screened the full articles. The imaging findings were confirmed by either histopathology or clinical follow-up. Sensitivity, specificity likelihood ratio and diagnostic odds ratio were pooled with 95 % confidence intervals (CI). Overall test performance was summarized by a summary receiver operating characteristic (ROC) curve. The Meta-DiSc software (version 1.4) was used to perform the meta-analysis.

Results The meta-analysis included 7 studies. The pooled sensitivity and specificity of PET/CT for the detection of recurrent or residual urinary bladder cancer was 94.0% (95% CI: 91.0%–96.0%) and 92.0% (95% CI: 88.0%–95.0%), respectively. Positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were 9.77 (95% CI: 4.91–19.41), 0.99(95% CI: 0.06–0.13) and 95.09 (95% CI: 47.96–188.53), respectively. When residual urinary bladder cancer was excluded, sensitivity changed slightly.

Conclusion This meta-analysis suggested that the diagnostic accuracy of PET/CT was good in detecting recurrent or residual urinary bladder cancer.

Purpose: To evaluate the evidence that could help health system policy makers to approach the preference for same-gender urologists.

Methods: We performed this systematic narrative review according to the PRISMA guidelines. We searched MEDLINE, Web of science, EMBASE, CINAHL and Google Scholar for articles focused on the  preference for patient-urologist gender similarity in the male-dominated department from 1999-2019. Finally, a narrative synthesis of studies meeting the inclusion and quality criteria was conducted in accordance with the nature of the evidences. We applied a thematic analysis using inductive approach for synthesizing studies employing heterogeneous research methods and designs.

 

Results: Of 208 titles and abstracts screened, 23 were included and three major themes including Reasons, Impacts, and Implications were identified. Overall, patients with urologic problems prefer same gender urologists and females were more likely to prefer the same gender urologist than males. Many women delays care due to a perceived lack of female urologists. The major identified reasons for the same-gender preference are religious believe, cultural background, emotional relationship, past experiences, and sensitive examinations. The results indicate that the urologists-patients gender similarity improves the quality of primary care. Our review reveled that Urologists prefer to perform more same gender-specific procedures. Beside, Female urologist and residents perceived to underestimate from their male counterparts.

 

Conclusion: This study could help health system to honor the patient’s preference for same gender urologist. The findings may help medical education and health policy makers to move the male-dominated urology departments towards a culture supportive of female urologists.

OBJECTIVE:


To evaluate the impact of diabetes mellitus (DM) on the recovery of urinary continence (UC) after radical prostatectomy (RP).


METHODS:


Trials were identified in a literature search of PubMed, Embase, Cochrane Library and Web of Science using appropriate search terms. All comparative studies reporting diabetes mellitus, study characteristics, and outcome data including the relationship between diabetes mellitus and urinary continence data were included. Continence rates at different time after RP were compared. Odds ratio (OR) was used for the comparison and all the results were presented with 95% confidence intervals (CIs).


RESULTS:


7 cohort studies comprising with 5944 participants were included, the percentage of DM patients was 8.7%. The results showed that DM increased urinary incontinence risk at 12 months after RP (OR 0.54, 95%CI 0.36 to 0.81, ????=0.003). The continence rates were not significantly different between DM and Non-DM groups at short-term (catheter removal, 3 months, 6 months) and long-term (>12 months). When stratified by the surgical methods, the pooled results showed similar results in patients who underwent robot -assisted radical prostatectomy (RARP).


CONCLUSION:


DM has an adverse impact on the recovery of UC during the intermediate-term after RP. Well-designed trials with strict control of confounders are needed to make results more comparable.

Purpose: The safety and feasibility of percutaneous nephrolithotomy (PCNL) compared with retrograde intrarenal surgery (RIRS) are debated. This systematic evaluation was performed to obtain comprehensive evidence with regard to the treatment outcomes of PCNL compared with RIRS for management of renal stones in patients with solitary kidney.


Material and Methods: A systematic search of Medline, Embase, Pubmed, Web of Science, CNKI, Scopus and the Cochrane Library was performed to identify studies that compared PCNL with RIRS for management of renal stones in patients with solitary kidney and published up to Aug 2019. Outcomes of interest included perioperative variables, complications, and stone-free rate (SFR).


Results: Four studies assessing PCNL vs. RIRS for renal stones larger than 2cm were included for meta-analysis. Although patients underwent PCNL have higher initial SFR than RIRS (OR: 3.72, 95% CI:2.38 to 5.83; P<0.001), patients underwent RIRS have less intraoperative blood loss (dropped Hb: WMD= 3.49 g/L, 95% CI:2.83 to 4.15; P<0.001), lower blood transfusion rates (OR= 5.31, 95% CI:1.36 to 20.68; P=0.02), and higher incidence rate of steinstrasse (OR:0.20, 95% CI:0.04 to 0.91; P=0.04). All the other calculated results including operation time (WMD: -9.87 minute, 95% CI:-30.11 to 10.37; P=0.34), final SFR (OR:1.65, 95% CI:0.80 to 3.42;P=0.18) and overall complications (OR:1.22, 95% CI:0.78 to 1.93; P=0.38) are similar between the two groups.


Conclusion: Our results indicate that PCNL has higher initial SFR than RIRS in the treatment of renal stones larger than 2cm in patients with a solitary kidney, the overall complications were similar in both groups. However, RIRS, with less blood loss and transfusion rate, may be an alternative in selected patients. But we need to pay more attention to the incidence rate of steinstrasse after RIRS.


Purpose: We aimed to compare the safety and efficacy between laparoscopic transperitoneal ureterolithotomy (LTU) and laparoscopic retroperitoneal ureterolithotomy (LRU) in the treatment of large (>10mm) and proximal ureteral stones.


Materials and Methods: Electronic databases, including PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus searched through December 2019. Comparative studies were comparing two approaches included. The primary outcome was a single-procedure success rate; the secondary outcomes included operative time, hospital duration, and complications (according to the Clavien-Dindo Grade). Newcastle–Ottawa scale (NOS) and the modified Jadad scale was used to evaluate the quality of the included studies.  The Egger's test estimated publication bias. The meta-analysis was performed by Review Manager 5.3 and STATA 15.0.


Results: 7 studies, involving 125 participants in LTU group and 128 in LRU group, were included in the study. The results suggested that both single-procedure success rate and the rate of postoperative paralytic ileus were significantly higher in LTU group than in LRU group (95.2% vs 87.5%, 95% CI: .00-.16, RD = .08, P = .04; 10.4% vs 0, 95% CI: .02- .19, RD = .10, P = .02, respectively). No publication bias of the primary outcome was observed with the Egger’s test (P = .117). No significant differences were noted in terms of operative time and hospital duration (95% CI: -18.95-8.80, MD = -5.08, P = .47; 95% CI: -.98- .58, MD = -.20, P = .61, respectively). Additionally, according to Clavien-Dindo Grade, the rates of major complications (>= Grade 3a) including open conversion (.8% vs 5.5%, 95%CI: -.11- .01, RD = -.05, P = .12), stone migration (8.1% vs 6.7%, 95% CI: -.08- .11, RD = .02, P = .76), vascular injury (5.4% vs 0, 95%CI: -.03- .14, RD = .05, P = .21) and ureteral stricture (1.3% vs 5.3%, 95% CI: -.11- .02, RD = -.04, P = .20), were comparable between two groups.


Conclusion: In the treatment of large and proximal ureteral calculi, LTU has a significantly higher single-procedure success rate and a higher rate of postoperative paralytic ileus than LRU. However, the complication was well-tolerated. The small sample size and limited, including studies, were the main limitations.


Safety of Surgery in benign Prostatic Hyperplasia Patients on Antiplatelet or Anticoagulant Therapy: A Systematic Review and Meta-Analysis

Liang Xiong Fa, Wu Wei Zhou, Huang Ya Peng, Zhang Shi Ke, Huang Jian, Zeng Tao, Zhong Fang Ling, Lai Yong Chang, Duan Xiao Lu, Cai Chao, Alberto Gurioli, Deng Tuo, Wu Wen Qi

Urology Journal, 2019, 5 January 2019 , Page 5974
https://doi.org/10.22037/uj.v16i7.5974

Purpose: The management strategies of anticoagulant (AC) or antiplatelet (AP) therapy in the preoperative period of benign prostatic hyperplasia (BPH) is still controversial. Therefore, a meta-analysis to systematically evaluate the surgical safety for BPH patients on AC or AP therapy was performed.


Materials and Methods: The protocol for the review is available on PROSPERO (CRD42018105800). A literature search was performed by using MEDLINE, Web of Science, PubMed, Cochrane library and Embase. Summarized odds ratios (OR), mean difference (MD) and 95% confidence intervals (CI) were used to assess the difference in outcomes.


Results: We identified 13 trials with a total of 3767 patients. Intragroup significant difference was found in bleeding complications and blood transfusions when undergoing transurethral resection of the prostate (TURP). For laser surgery, the intragroup significant difference was found in result of blood transfusion. Bridging therapy would not cause higher risk of bleeding complication and blood transfusion during perioperative period. Besides, no difference existed in operation time, catheterization time, hospitalization and thromboembolic events.


Conclusion: Patients with BPH on perioperative AC/AP therapy would have a risk of postoperative hemorrhage after TURP or laser treatments. To reduce the risk of hemorrhage, bridging therapy could be a good choice.

ORIGINAL PAPER (ENDOUROLOGY AND STONE DISEASE)


Purpose: To review the safety and effectiveness of tubeless percutaneous nephrolithotomy (PCNL) with an externalized ureteral catheter (EUC) compared with standard PCNL with nephrostomy tube and tubeless PCNL with double-J (DJ) stent following uncomplicated PCNL and the absence of residual stones.

Materials and Methods: Patients with kidney stones who underwent uncomplicated PCNL between January 2000 to December 2017 and had no residual stones were retrospectively evaluated. The 766 patients were divided into standard PCNL with nephrostomy tube (group 1; 350 patients), tubeless PCNL with DJ stent (group 2; 189 patients), and tubeless PCNL with EUC (group 3; 227 patients). Demographic characteristics, stone-related factors, perioperative and postoperative parameters were analyzed.

Results: Demographic and stone-related characteristics were comparable. The differences in the mean operative time and complication rates were not significant. Postoperative hospitalization period was shorter in group 3 (3.19 ± 2.2 days) compared with group 1 (4.12 ± 2.4 days; p < .001) but not to that of group 2 (3.44 ± 2.8 days; p = .680). Postoperative pain score was lower in group 3 (3.24 ± 1.1) compared with both group 1 (6.36 ± 1.7; p < .001) and group 2 (4.85 ± 1.1; p < .001). Urine leakage complication was lower in group 3 (0.4%) compared with group 1 (2.9%, p = .038) but not to that of group 2 (0.5%; p = .897).

Conclusions: Tubeless PCNL is effective and safe for uncomplicated PCNL in the absence of residual stones. Tubeless PCNL with EUC is associated with decreased pain, hospitalization time, and urine leakage compared with standard PCNL. However, it is only associated with decreased pain when compared with tubeless PCNL with DJ stent.

Cost-effectiveness of Medical Expulsive Therapy with ?-blockers for Large Distal Ureteral Stones in China

Yucong Zhang, Wei Ouyang, Wei Ouyang, Heng Li, Heng Li, Haoran Liu, Haoran Liu, Peng Yuan, Peng Yuan, Hongyan Lu, Hongyan Lu, Xifeng Sun, Xifeng Sun, Zhangqun Ye, Zhangqun Ye, Jinchun Xing, Jinchun Xing, Zhiqiang Chen, Zhiqiang Chen, Hua Xu, Hua Xu

Urology Journal, 2019, 5 January 2019
https://doi.org/10.22037/uj.v0i0.5433

Purpose: To assess the cost-effectiveness of medical expulsive therapy (MET) versus observation for large distal ureteral stones in China and provide preliminary evidence for the determination of the course of MET by mathematical estimation.

Materials and Methods: With linear success rate assumptions, a decision tree was constructed by TreeAge Pro 2011 software. The stones passage rates after observation or receiving 0.4 mg daily tamsulosin were estimated according to a large randomized clinical trial (RCT). The costs of ureteroscopy, drugs and examinations were estimated according to related price from pharmacies or hospitals, or the guidance price published by the government. MET was also compared with observation by the sensitivity analysis. The effectiveness of MET or observation was presented by quality-adjusted life-day. Mathematical estimation of stone expulsion time was made by using a decision-analytic Markov model under the assumption that the daily stone expulsion probability is constant.

Results: In China, the MET was associated with a $295.1 cost advantage over observation. The cost of ureteroscopy has to decrease to $77.8 to reach cost equivalence between observation and MET. Observation is cost-effective only if ureteroscopy is very cheap or the difference of stone expulsion rates is insignificant. The estimated expulsion time was much longer than those reported in above mentioned RCT.

Conclusion: Due to the high cost of ureteroscopy, MET showed a cost advantage over observation in treating distal ureteral stones in China. The daily stone passage rate was inconstant. More studies are needed to find the appropriate duration of MET.

Purpose: To investigate the safety and efficacy of Single Percutaneous Tract Combined with Flexible Nephroscopy in the Management of 2-4 cm renal calculi.

Materials and Methods: We retrospectively analysed the treatment data of patients with 2-4 cm renal calculi from June 2010 to June 2017. The data included 217 cases of percutaneous nephrolithotomy (PNL), 441 cases of retrograde intrarenal surgery (RIRS) and 217 cases of single-access percutaneous nephrolithotomy combined with flexible nephroscopy (PNCFN). The collected data were analyzed..

Results:

A total of 875 cases were studied, with an average age of 42.35 ± 10.29 years. Group PNCFN showed the highest stone-free rates (SFRs)(73.7 vs 66.7 vs 80.2, P=.00), best patient satisfaction (89.84 vs 87.23 vs 92.29, P=.00). The length of stay was shorter in group RIRS than other two groups (5.22 vs 5.65 vs 3.72, P=.00). Haemoglobin decrease (> 10 g/L) was higher in group PNL than that in group RIRS and group PNCFN (P=.012). Hospitalization fees (RMB) were Increased in group PNCFN compared with that in group PNL and group RIRS (34563.45 vs 21334.69 vs 33343.16, P=.000). Treatment protocols of PNL decreased from 17.51% to 9.22%, those for RIRS from 5.22% to 17.69%, peaking at 2012, PNCFN from 8.29% to 15.67% showed a rapid growth trend.

Conclusion: The percutaneous nephrolithotomy combined with flexible nephroscopy treatment on renal calculi of 2-4 cm was associated with higher stone-free rates and better patient satisfaction than RIRS and PNL. Comprehensive consideration and conservative use for RIRS treatment of 2-4 cm renal stones.

Laparoscopic Pyelolithotomy for the Management of Large Renal Stones with Intrarenal Pelvis Anatomy

Nasser Simforoosh, Mohammad Hadi Radfar, Reza Valipour, Mehdi Dadpour, Amir Hossein Kashi

Urology Journal, 2019, 5 January 2019
https://doi.org/10.22037/uj.v0i0.5576

Purpose: The role of laparoscopic pyelolithotomy in the management of renal stones is evolving. One of the challenges in LPL for renal stones are patients with intrarenal pelvis. Here we present our experience with laparoscopic pyelolithotomy for the management of renal stones with intrarenal pelvis anatomy.

Materials and Methods: Patients candidate for laparoscopic pyelolithotomy from February 2014 to March 2015 were included. Intrarenal pelvis was defined as > 50% of renal pelvis area contained inside renal parenchyma.  Laparoscopic pyelolithotomy was done by transperitoneal approach. Residual stones were checked by computed tomography and/or intravenous pyelography and ultrasonography 6 weeks after the operation.

Results: 28 patients were included in this study. The mean±SD of patients’ age was 45.8±12.5 years. 19 patients (68%) were male. Stone locations were pelvis, multiple and staghorn in 22, 3, and 3 patients respectively. The mean±SD of operation duration was 160±48 minutes. Residual stones were observed in 3 patients with multiple (n=2) or staghorn (n=1) stones. Urinary leak was observed in 3 patients and was managed conservatively in 2 patients. In one patient ureteral stent was inserted by cystoscopy. No conversion to open surgery or re-operation occurred.

Conclusion: Laparoscopic pyelolithotomy is a feasible operation for patients with renal stones and intrarenal pelvis in centers with adequate experience in laparoscopy. However, the success of LPL decreases in patients with multiple stones and intrarenal pelvis.

Purpose: To determine the efficacy and safety of PCNL in patients with positive urine culture without an any other risk factors prior to surgery, and to define an optimal pre-operative antibiotic regimen for these patients.

Materials and methods: The study included 269 consecutive PCNL cases. These cases were divided into 2 groups according pre-operative urine culture results: sterile (group 1, n=166) and positive (group 2, n=103). Patients with risk factors linked to infection complications were excluded from study. All patients underwent PCNL in the prone position. In group 1, the antibiotic regimen included parenteral injection 30 minutes prior to operation and for 3 days after surgery. Group 2 was given antibiotics 24 hours before PCNL as well as 30 minutes before PCNL and then for 3 days following surgery. On the first day after the operation low dose CT and common blood count were performed on all patients to determine residuals, hematomas, blood loss, and inflammatory markers. 

Results:  Mean age, stone size, failed ESWL, and prior nephrostomy tube insertion were higher in group 2. Although rate of pre-stented patients was equal in groups. No significant differences were observed between group 1 and 2 in regard to operative time (74,3±26,9 vs 70,2±26,5  min, P=.52), length of stay (3,9±1,2 vs 3,8±1,6 days, P=.24), SIRS (6,0% vs 7,8% patients, P=.07), and leukocyte levels exceeding  10*10*9 (77 (46,4%) vs 49 (47,6%) P=.11). Moreover, there was no sepsis or hemotransfusion in either group. Stone-free rates were also similar (78,9% vs 77,7%, P=.35).

Conclusion: 24-hours continuous antibiotic administration before the operation (paying respect to specific resistance bacterial features) can be considered as alternative to 1-week treatment and allow to perform PCNL with sufficient safety in selected patients. Infected urine is not an independent risk factor of post-operative infections complications after PCNL in low risk patients with kidney stones.

Purpose: This study aimed to investigate the efficacy and safety of febuxostat in patients with radiolucent nephrolithiasis.

Materials and Methods: From March 2016 to June 2018, data of 96 patients with radiolucent nephrolithiasis and hyperuricemia who referred to the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. These patients were divided into allopurinol 300mg/d (control), febuxostat 40mg/d (F40) and 80mg/d (F80) groups respectively. All patients took potassium citrate as a combination treatment and had been followed up for at least 6 months. Before treatment and on the day of the 1st, 3rd and 6th month, complete blood count, serum uric acid (sUA), hepatic and renal function as well as ultrasound were carried out, arthritic and gastrointestinal symptoms were monitored. Computed tomography was measured before treatment and 6 months after medication.

Results: 31, 29 and 30 patients were included in the final analysis of treatment efficacy respectively. Compared with allopurinol group, F40 group showed no difference in urate-lowering effect, while F80 had the best effect across all the visits (P<0.01). At 6th month, 25(83.3%) cases of F80 group achieved sUA<6mg/dL, which was better than allopurinol group (18 cases, 58.1%) and F40 group (17 cases, 58.6%). In the dissolution effect of radiolucent calculi, F80 had the best effect, followed by F40 and then allopurinol (P<0.05). No statistical difference was observed in adverse events among three groups.

Conclusion: Febuxostat significantly decreased sUA, promoted radiolucent stone dissolution and reduced the total stone number, whereas it didn’t increase the adverse events.

Purpose: NTrap® stone entrapment and extraction device (NTrap®) is a device used to extract and remove stones from the urinary tract and to minimize retrograde stone migration during ureterolithotripsy (URS). This study aimed to evaluate the efficacy and safety of NTrap® in URS.

Methods: From Jan 2014 to June 2017, 148 patients underwent URS with the aid of NTrap® (Group A), and 209 patients underwent standard URS without any anti-retropulsion device (Group B). Their demographics, operation time, complications, stone migration rate, and stone-free rate (SFR) were recorded for comparison.  

Results: Compared with group B, Group A had a significantly shorter operative time and lasering time (P=0.003, P=0.000, respectively). There was no significant difference between the 2 groups in overall complications, a decrease in mean hemoglobin, and length of stay (LOS) (P =0.426, P =0.097, P =0.058, respectively). The incidence of stone migration was significantly lower in Group A than Group B (P=0.035). The postoperative auxiliary procedure rate (in patients with stones retropulsion during the operation) was significantly lower in Group A compared to Group B (P=0.024). The SFR was considerably higher in Group A than Group B (P=0.009).

Conclusion: URS, with the aid of NTrap®, is an effective and safe method for treating ureteric stones. It may prevent stones from retropulsion and shorten the operative time. 

Purpose: To explore the clinical efficacy of ureteroscopic occluder and stone retrieval basket combined with holmium laser in the treatment of upper ureteral calculi.


Materials and Methods: This retrospective study included 103 patients treated with ureteroscopic holmium laser lithotripsy for upper ureteral stones. Patients were divided into two groups based on the device applied during lithotripsy: group 1 for the occluders (52 cases), and group 2 for the stone retrieval baskets (51 cases). The stone upward migration rate, stone-free rate, and complication rate during or after surgery were compared.


Results: The operation time was 45 ± 7 min in the occluder group and 43 ± 5 min in the basket group (P = .111). There was no significant difference between the stone retropulsion rate (13% vs. 16%, P = .787). The successful one-time stone-free rate was 92% vs. 94% (P = .999) respectively. Furthermore, there was no significant difference in the hospitalization time (P = .581) and postoperative complication rate (P = .715) between 2 groups.


Conclusion: The treatment of upper ureteral calculi with ureteroscopic occluder and stone retrieval basket combined with holmium laser lithotripsy can both effectively prevent intraoperative stone retropulsion, improve the success rate of one-time lithotrips. The occluder was more cost-effective than the stone retrieval basket, yet it was a more desired choice for over dilated ureters.

Purpose: To investigate the safety and efficacy of Minimally Invasive Percutaneous Nephrolithotomy (MPCNL) combined with Vacuum-assisted Access Sheath in the treatment of obstructive calculous pyonephrosis.


Materials and Methods: Seventy-six patients with obstructive calculous pyonephrosis, who were planned to receive MPCNL, were randomly divided into two groups. Group A was treated with Amplatz sheath combined with Cyberwand double probe ultrasound lithotripsy, and group B was treated with Vacuum-assisted Access Sheath (VAAS, ClearPetra, Well lead Medical) combined with holmium laser lithotripsy. The primary outcome was the operation successful rate. Other perioperative, and postoperative data such as operation time, stone free rate and complications were compared between groups.


Results: Single 20F access sheath was established in all cases. All patients underwent one-stage procedure. Compared with group A, group B had a higher initial stone-free rate (84.2% vs 63.1%, P= .037). The operation time of group B was 56.3 ± 19.83 min, significantly shorter than that of group A at 70.4 ± 14.83 min. The complication rate of B group was 15.8%, which was lower than that of group A (P= .035 ). Five patients (15.8 %) of group B had a postoperative fever (>38.5 ºC) (Clavien grade 2) that required additional antibiotics; whereas 8 patients (21.1 %) of group A (P= .361). There was no blood transfusion in group A, and one case in group B required transfusion.


Conclusion: One-stage MPCNL combined with Vacuum-assisted Access Sheath and holmium laser lithotripsy is a simple, safe, effective, and ergonomically practical method for selected patients with obstructive calculous pyonephrosis.

ORIGINAL PAPER (LAPAROSCOPIC AND ROBOTIC UROLOGY)


Robot-assisted Laparoscopic Pyeloplasty in Adults: A Comparison Analysis of Primary versus Redo Pyeloplasty in a Single Center

Najib Isse Dirie, Mahad A Ahmed, Mohamed Abdulkadir Mohamed, Zongbiao Zhang, Shaogang Wang

Urology Journal, 2019, 5 January 2019 , Page 5257
https://doi.org/10.22037/uj.v16i7.5257

Purpose: Approximately 10% of all primary pyeloplasty will require at least one secondary intervention. Our aim was to analyze whether secondary repair will pose additional challenges during robotic pyeloplasty compared with the primary pyeloplasty.


Material and Methods: 114 patients who underwent robot-assisted laparoscopic pyeloplasty (RALP) between February 2015 and August 2018 were retrospectively reviewed. Patients were divided into; primary and secondary repair pyeloplasty. The demographics, intraoperative parameters, postoperative parameters, and success rate of these two groups were collected and compared. Primary RALP data were further stratified into those who previously underwent ipsilateral endourological surgeries (IES) at the obstruction site and those who did not, to evaluate the effect of IES has on the outcome of RALP. Success was defined as symptomatic and radiological relief.


Results: Of the 114 patients, five complicated cases (three horseshoe kidneys, one duplicated system, and one retrocaval ureter) were excluded from the comparison. The remaining 96 primary and 13 secondary repairs were compared. Intraoperative and postoperative parameters showed no significant difference between the two groups. The results of 99 patients (87 vs. 12 in primary vs. secondary, respectively) were available after 27.5 months mean follow-up. The overall success was 92%, 8 patients failed (5 vs. 3 in primary vs. secondary, respectively) and required further surgical interventions.


Conclusion: Though surgically challenging with increased recurrence rates according to the literature we reviewed. However, our data failed to show any significant difference between the primary and redo RALP perhaps due to the smaller size in the redo RALP group.

ORIGINAL PAPER(UROLOGICAL ONCOLOGY)


Objective: To determine disease-related predictors for the occurrence of prostate specific antigen (PSA) failure in Iranian prostate cancer patients who underwent radical prostatectomy.

Methods: In this cohort study, we enrolled eligible patients with prostate cancer who underwent radical prostatectomy at our center between 2001 and 2018. The primary endpoint was the incidence of postoperative biochemical failure, defined as two consecutive PSA levels >= 0.2 ng/dl. Patients with TNM stage >= III, Gleason score >=8, or baseline PSA above our calculated cut-off level were considered as high risk. Kaplan–Meier survival method and Cox proportional hazards regression analysis were used for determining the biochemical relapse-free survival and its predictors.

Results: Data of 959 patients (age=61.2 ± 6.4 years) were analyzed with a median follow up of 36 months (range 6 months to 18 years). A total of 97 patients (10.1%) developed biochemical failure at the time of analysis who had a significantly older age and longer follow-up duration (P=0.024 and P<0.001, respectively). Preoperative PSA level of 8.85 mg/dl could predict the occurrence biochemical failure with a sensitivity of 83.2% and specificity of 39.2% (Area under the curve=0.601, 95% CI: 0.541-0.662; P=0.001). In the multivariate analysis, higher preoperative PSA, Gleason score?8, and high-risk TNM stage were independent predictors for biochemical relapse (P=0.029, P=0.001, and P=0.008, respectively).

Conclusion: Preoperative PSA, Gleason score, and TNM stage were independent predictors for biochemical failure following radical prostatectomy in prostate cancer patients. We also determined a lower cut-point for PSA that could predict biochemical failure.

 

Purpose: To evaluate the efficacy of caudal regional anesthesia and local anesthesia methods in prostate biopsy applied under transrectal ultrasonography.

Matherials and Methods: This prospective study included a total of 160 patients randomly separated into 4 equal groups as intrarectal local anesthesia (IRLA), periprostatic local anesthesia (PPLA), combined local anesthesia (IRLA+PPLA), and caudal regional anesthesia (CRA). The patients were evaluated using the pain scores on a visual analog scale.

Results: The pain score during anesthesia induction was significantly higher in the CRA group than in the IRLA and IRLA+PPLA groups (p<0.001). The pain score during entry of the probe to the rectum and movement was significantly lower in the CRA group than the IRLA groups (p=0.014). The pain score on penetration of the needle to the prostate and at 30 mins after the biopsy was significantly higher in the IRLA group (p<0.001). At 2 hours after the biopsy, the pain score in the CRA group was significantly lower than IRLA groups (p=0.015).

Conclusion: The PPLA alone can be applied more quickly than CRA, causes less pain during the application, and has similar efficacy in reducing pain during and after the prostate biopsy procedure.

Purpose: This study aimed to explore the security and feasibility of three-dimensional(3D) printing technology assisted laparoscopic cryoablation to treat small renal tumors.

Patients and Methods: 4 patients recruited from April 2016 to August 2017 in our hospital underwent this operation. Three-dimensional reconstruction technology was used to mimic cryoablation treatment before operations in terms of how many needles this process needed and the depth and angle required to insert the needles into the tumor to precisely reserve nephrons. CT scan was used to assess the effect of the treatment after operation in regular follow-up.

Results: All cases were performed this operation successfully and recovered without major complications. The operation time were range from 106 to 118 minutes; the blood lose were range from 50 to 100ml. The follow-up time were between 16-8 months, and the mean time was 13.3 months. Follow-up survey was conducted regularly based on a standard protocol in outpatient. The results showed no abnormal reinforcing signals in cryoablation treated areas.

Conclusion: 3D printing technology assisted laparoscopic cryoablation is a feasible method to treat renal tumors, which maybe a better way to preserve nephrons, especially for those elderly and/or comorbid patients.


Randomized, Double-blind Pilot Study of Nanocurcumin in Bladder Cancer Patients Receiving Induction Chemotherapy

Saleh Sandoughdaran, Abolfazl Razzaghdoust, Ali Tabibi, Abbas Basiri, Nasser Simforoosh, Bahram Mofid

Urology Journal, 2019, 5 January 2019
https://doi.org/10.22037/uj.v0i0.5719

Purpose: To evaluate the feasibility and potential efficacy of nanocurcumin supplementation in patients with localized muscle-invasive bladder cancer (MIBC) undergoing induction chemotherapy.

Materials and methods: In this double-blind, placebo-controlled trial, 26 MIBC patients were randomized to receive either nanocurcumin (180 mg/day) or placebo during the course of chemotherapy. All patients were followed up to four weeks after the end of treatment to assess the complete clinical response to the chemotherapy as primary endpoint. Secondary endpoints were the comparisons of chemotherapy?induced nephrotoxicity, hematologic nadirs, and toxicities between the two groups. Hematologic nadirs and toxicities were assessed during the treatment.

Results: Nanocurcumin was well tolerated. The complete clinical response rates were 30.8 and 50% in the placebo and nanocurcumin groups, respectively. Although nanocurcumin was shown to be superior to placebo with respect to complete clinical response rates as the primary endpoint, there was no significant difference between the groups (p = 0.417). No significant difference was also found between the two groups with regard to grade 3/4 renal and hematologic toxicities as well as hematologic nadirs.

Conclusion: These preliminary data indicate the feasibility of nanocurcumin supplementation as a complementary therapy in MIBC patients and support further larger studies. Moreover, a substantial translational insight to fill the gap between the experiment and clinical practice in the field is provided.

Incidence, Gleason Score and Ethnicity Pattern of Prostate Cancer in the Multi-ethnicity Country of Iran During 2008-2010

Abbas Basiri, Babak Eshrati, Ali Zarehoroki, Shabnam Golshan, Nasser Shakhssalim, Alireza Khoshdel, Amir Hossein Kashi

Urology Journal, 2019, 5 January 2019
https://doi.org/10.22037/uj.v0i0.5618

Purpose: To investigate the geographical incidence, and grade of prostate cancer in Iran during 2008-2010 and evaluate its relationship with ethnicity.

Materials and Methods: Data was extracted from the nationwide Iranian cancer registry system during 2008-2010. Pathologies and grade was extracted from scanned reports of patients’ pathologies by a urologist.

Results: The average 3-year age standardized incidence rate of prostate cancer during the study period was 11.52 per 100000 males. The age standardized incidence rates for Persian, Arab, Turkish and Turkmen, Lor, Kurd and Baluch ethnicities were 13.5, 9.3, 7.9, 7.9, 7.2 and 2.1 per 100000, respectively. Poisson regression analysis revealed a statistically significant difference in incidence of prostate cancer in Baluch ethnicity (P=0.028) and a near significant difference for incidence of prostate cancer in Turk-Turkmen and Kurd ethnicity (P=0.067 and P=0.082) in comparison with Persian ethnicity. The median Gleason score distribution of prostate cancer was not concordant to the age standardized incidence rates. 97% of all pathologies were adenocarcinoma of the prostate followed by malignant carcinoma (1.9%), and transitional cell carcinoma (1.1%).

Conclusion: The incidence of Prostate cancer was different between Baluch and Fars ethnicities in Iran. The lowest ASR of PCa was observed in Baluch ethnicity, however the possibility of underreporting due to less access in Baluch ethnicity cannot be ruled out. The Gleason distribution pattern was not concordant to the incidence distribution of Prostate cancer.

Purpose: Several studies have compared the short-term outcomes of extraperitoneal robot-assisted laparoscopic radical prostatectomy (EP-RALP) and transperitoneal RALP (TP-RALP). The study was designed to evaluate the long-term outcomes of the two methods.


Materials and Methods: A prospective, non-randomized study was conceived. The demographics and operative outcomes of patients with prostate cancer undergoing RALP from September 2016 to January 2017 at our center were included.


Results: A total of eighty-six patients were enrolled. Thirty-seven patients underwent EP-RALP, and forty-nine patients received TP-RALP. No significant difference was observed in age, body mass index, pathological T stage, pathological N stage, M stage, 2014 International Society of Urological Pathology group, comorbidities or American Society of Anesthesiologists score. A lower preoperative prostate-specific antigen (PSA) was detected in the EP-RALP group. No significant differences were observed in overall operation time, robotic console time, surgical margin status, postoperative hospitalization time, drop of hemoglobin and complications, except that patients with EP-RALP had a shorter time to first exsufflation after surgery than those with TP-RALP (41.35 vs. 51.80 h, P < .001). Postoperative PSA until 12 months was deemed comparable in both groups. Complete continence until 12 months after surgery was desirable but not significantly different between two groups (75.0% in EP- RALP vs. 86.7%. in TP-RALP, P = .179).


Conclusion: The long-term outcomes of EP-RALP were analogous to those of TP-RALP. Therefore, EP-RALP is an alternative approach for patients with localized prostate cancer.


Keywords: prostate cancer; robot-assisted prostatectomy; extraperitoneal approach; transperitoneal approach; enhanced recovery after surgery

Comparison of the Diagnostic Performance of PI-RADS V1 and PI-RADS V2 for the Detection of Prostate Cancer: A Meta-Analysis Study

Ying He, Ruochen Cong , Jie Zhou, Zhenyu Xu , Jushun Yang, Lin Wang, Jing Xiao , Bosheng He

Urology Journal, 2019, 5 January 2019 , Page 5532
https://doi.org/10.22037/uj.v16i7.5532

Purpose: In order to comprehensively determine the diagnostic accuracy of the Prostate Imaging Reporting and Data System version 1 (PI-RADS V1) and PI-RADS version 2 (PI-RADS V2) in prostate cancer (PCa) diagnosis.


Materials and Methods: The literatures were screened from the databases, including the Pubmed, Embase, Web of science and Cochrane Library up to January 20th, 2020. The meta-analysis was conducted by Meta-DiSc and quality assessment was performed by using the QUADAS. Furthermore, the sensitivity, specificity, likelihood ratio (LR), diagnostic odds ratio (DOR), as well as receiver operating curve (ROC) related to diagnostic accuracy were pooled.


Results: A total of 6 articles containing 814 participants (379 patients) were included in the study. For PI-RADS V1, the combined sensitivity, specificity, PLR, NLR and DOR were 0.82 (95% CI: 0.77-0.85), 0.81 (95% CI: 0.77-0.85), 4.58 (95% CI: 2.55-8.22), 0.24 (95% CI: 0.18-0.34) and 24.00 (95% CI: 10.38-55.51). With regard to PI-RADS V2, the combined sensitivity, specificity, PLR, NLR and DOR were 0.88 (95% CI: 0.84-0.91), 0.81 (95% CI: 0.77-0.84), 4.34 (95% CI: 1.98-9.49), 0.16 (95% CI: 0.08-0.32) and 33.39 (95% CI: 15.05-74.05), respectively. Furthermore, except that the sensitivity of PI-RADS V2 was significantly greater than that of PI-RADS V1 (P=0.027), there was no remarkably difference in other indicators for the diagnosis of PCa between the two versions.


Conclusion: Both PI-RADS V1 and PI-RADS V2 showed good diagnostic performance for PCa diagnosis; moreover, there was no difference in the diagnostic effect between them.

Purpose: To report the 1-year functional outcomes, oncologic outcomes, and postoperative complications in patients who underwent modified robot-assisted radical prostatectomy (RARP) procedures for achieving early recovery of continence and potency postoperatively.


Materials and Methods: This study included 165 patients who underwent RARP. Overall, 98 patients underwent RARP using our modified detrusorrhaphy and intrafascial nerve-sparing techniques (group 1) and 67 underwent standard RARP (group 2). Continence and potency rates were assessed at 1 week, 1, 3, 6, and 12 months after RARP. Oncologic outcomes comprised positive surgical margins (PSMs) and biochemical recurrence (BCR) rate.


Results: The continence rates were 61.2% and 6.0%, 72.5% and 11.9%, 79.6% and 20.9%, 91.8% and 58.2%, and 97.9% and 74.6% at 1 week, 1, 3, 6, and 12 months in group 1 and 2, respectively. The potency rates were 66.3% and 11.9%, 78.6% and 38.8%, 85.7% and 50.8%, 92.9% and 70.2%, and 95.9% and 79.1% at 1 week, 1, 3, 6, and 12 months in group 1 and 2, respectively. Overall postoperative complication rates (< 10%) were similar between the  groups. The PSMs rate was 17.4% and 16.4% in the two groups. The rate of PSMs in the cohort of patients with stage pT2 disease decreased to 13.6% and 12.5% in groups 1 and 2,  respectively. BCR rate was 5.1% and 6.0% in groups 1 and 2, respectively.


Conclusion: The use of detrusorrhaphy and intrafascial nerve-sparing techniques is safe and feasible, with our results demonstrating early return to continence and potency. Further studies should be conducted.

Objectives: The effects of metformin on prostate volume and prostate-specific antigen (PSA) were investigated.


Materials and Methods:: We enrolled 384 newly diagnosed diabetes mellitus (DM) patients and 152 controls all of whom were >50 years into our prospective cross-sectional observational study. The first group contained patients receiving metformin only, the second group were taking a mixture of medications, including metformin plus other oral anti-diabetics, and the third was the control group. Before beginning treatment, body mass indices (BMI) of all cases were obtained. Prostate volumes evaluated using transabdominal ultrasonography at the sixth and twelfth month. Insulin, glycosylated hemoglobin (HbA1C), insulin sensitivity index (ISI), insulin-rich growth factor (IGF-1), PSA, free PSA, and total testosterone levels were measured.


Results: The differences in BMI between the first and third group were statistically significant (p <0.05). There were no statistical differences among the groups in terms of prostate volumes (> 0.05). The differences between the groups for insulin, HbA1C, ISI, IGF-1 (somatomedin), PSA, free PSA and total testosterone levels were insignificant (p >0.05).


Free PSA and total testosterone levels in groups 1 and 2 were not statistically different at the beginning of treatment and the sixth month (p >0.05), but within groups 1 and 2, only PSA levels were different at the start of the study until completion. No differences were seen in the third group.


Conclusion: Metformin appears to cause a decrease in PSA levels. The mechanism and any effects on prostate tissue will be studied in future randomized, prospective studies.

Discrepancy between Needle Biopsy and Radical Prostatectomy Gleason Score among Patients with Prostate Cancer

Amir Reza Abedi, Abbas Basiri, Nasser Shakhssalim, Ghazal Sadri, Mahsa Ahadi, Seyyed Ali Hojjati, Samad Sheykhzadeh, sajjad askarpour, Saleh Ghiasy

Urology Journal, 2019, 5 January 2019 , Page 5985
https://doi.org/10.22037/uj.v16i7.5985

Purpose: Gleason score (GS), as well as other prognostic and diagnostic modalities, can predict the possibility of tumor growth and metastasis during the life of patients with prostate cancer. Based on the prostate biopsy GS, clinicians choose the most appropriate therapy for managing patients. The objective of this cross-sectional study was to determine the discrepancy between needle biopsy and radical prostatectomy GS and to identify its predictive factors among the Iranian population.


Materials and Methods: A total of 1147 patients who underwent radical prostatectomy from 2009 to 2019 were initially enrolled in this study. After consideration of the inclusion and exclusion criteria, 439 patients were finally included. The demographic variables and clinical data including age, PSA level, prostate volume, PSA density, GS derived from ultrasonography-guided core needle biopsy specimen, and GS derived from radical prostatectomy specimen were collected from the medical records of patients with prostate adenocarcinoma and were reviewed by a urology resident. Statistical analysis was done by using the Social Sciences Software version 21.


Results: The average age of patients was 64.5 years (range 48‐84 years), and the average preoperative PSA level was 14.8 ng/mL. On histopathological examination, no changes in GS were observed in 237 (53.9%) patients, whereas GS was upgraded in 144 (32.8%) patients and downgraded in 58 (13.2%) patients at radical prostatectomy. The number of patients who had extracapsular extension, seminal vesicle invasion and positive lymph nodes was significantly higher in the upgraded group compared with the non-upgraded group. 


Conclusion: In this study, there was a steady decrease in GS upgrading with the prostate size extending up to 49.7 g. There was also an association between downgrading and extending prostate size. Due to the greater risk of high-grade disease in men with small prostates, smaller prostate bulks are most probably upgraded after radical prostatectomy. A higher maximum percentage of involvement per core was an independent predictive factor of upgrading from biopsy grade 1 to grade ≥ 2. Our study showed that patients’ age was not predictive of upgrading, which is consistent with other studies. Also, we demonstrated a non-significant relationship between PSA level and upgraded GS. Findings in this study did not demonstrate a significant relationship between PSA level and upgrading.

ORIGINAL PAPER (PEDIATRIC UROLOGY)


Safety and Efficiency of Pyeloplasty in The First Six Weeks of Infants' Life

Serdar Moralioglu, Aysenur Cerrah Celayir, Oktav Bosnali, Osman Zeki Pektas

Urology Journal, 2019, 5 January 2019
https://doi.org/10.22037/uj.v0i0.5531

Purpose: The aim of this study was to assess the safety and the efficiency of pyeloplasty in infants with ureteropelvic junction obstruction (UPJO) in the first six weeks of their life.

Materials and Methods: Clinical records of the patients who had surgery during first six weeks of life for UPJO between June 2009 and June 2014 were analysed retrospectively.

Results: In this period, twenty-six dismembered pyeloplasties were performed in twenty-four patients on mean operation age of 27.3 ± 10.2 days (range 8-42 days). On the first postnatal ultrasound all twenty-six renal units had SFU-4 hydronephrosis. Mean preoperative and postoperative anterior-posterior pelvic diameter and parenchymal thickness were 33.1 ± 8.9mm (range 14-49mm), 3.2 ± 1mm (range 1-4,6mm) and 14.7 ± 6.6mm (range 6-27mm) and 7.8 ± 1.9mm (range 3.0-10.4mm), respectively. The differences between preoperative and postoperative parenchymal thickness and anterior-posterior pelvic diameter were statistically significant (P ? 0.0001). Preoperative MAG3 dynamic renal scintigraphy showed obstructive pattern on the diuretic renogram in 26 units. Mean preoperative and postoperative differential renal function on dynamic renal scintigraphy of the effected renal unites was 46 ± 15 and 44 ± 15, respectively. Postoperative drainage was normal on dynamic renal scintigraphy in 25 (96.2%) of the 26 units, redo-pyeloplasty was needed in only one unit (3.8%).

Conclusion: In conclusion, patient selection and timing of surgery are very important in the protection of renal function in newborn with UPJO. In our opinion, if there is indication for surgery, early surgical intervention should not postpone in this period. Surgical treatment of UPJO during first six weeks of life is safe and effective.

Purpose: Vesicoureteral reflux (VUR) is the most common risk factor of urinary tract infection in children. Currently, diagnosis of VUR depends on invasive imaging studies, with high radiologic burden. Therefore, different biomarkers have been introduced for evaluation of these patients.The objective of this study was to identify alteration of urinary interleukins (ILs) excretion in children with primary VUR and renal parenchymal damage, for further clinical application.


Materials and methods: Urinary concentrations of IL-1α, IL-1β, IL-6, and IL-8 were evaluated in 34 children with VUR (cases) and 36 without VUR (control), during 2018-2019. Urinary concentrations of IL-1, IL-1, IL-6 and IL-8 were measured, using polyclonal antibody ELISA kit, and standardized to urine creatinine (Cr).


Patients with infectious or inflammatory disorders, urolithiasis, immune deficiency, acute or chronic  kidney disease, and secondary VUR were excluded from the study.


Results: Mean age of cases (36.00±27.66) had no significant difference with the control (32.86±29.31) group (p=0.44).  The majority of patients had moderate VUR (58.8%), followed by severe (35.3%) and mild (5.9%) grades. Urinary concentration of all ILs/Cr were significantly higher in patients with VUR, compared with those without VUR. There was no significant correlation between urine ILs/Cr with age, gender, serum electrolytes, urine specific gravity, renal ultrasound, laterality or severity of VUR, and DMSA renal scan.


All urine ILs/Cr had acceptable sensitivity and accuracy for workup of children with primary VUR.


Conclusion: Urine IL-1α, IL-1β, IL-6 and IL-8/Cr were sensitive and accurate additionary screening  biomarkers in children with primary VUR.

ORIGINAL PAPER (FEMALE UROLOGY)


Purpose: Pelvic organ prolapse is a common condition  as a consequence of the pelvic floor support weakness. This study evaluated the clinical results of treating the high stage prolapse of the anterior vaginal wall using a trans-obturator approach and the native vaginal wall tissue.


Methods: This was a prospective analysis of 94 patients with anterior vaginal wall prolapse stage ≥ Ⅲ. They underwent surgery with the trans-obturator approach using the native vaginal wall tissue. The objective primary outcome was evaluated according to the pelvic organ prolapse staging system (POP-Q). The subjective primary outcome was evaluated with pelvic floor distress inventory (PFDI-20) and pelvic floor impact questionnaire (PFIQ-7) questionnaires. The secondary outcomes were post-surgery complications.


Results: Totally, 85 of 94 patients were followed up for a mean of 38.2 ± 4 months. The objective anatomical success rate was 90.58%. PDFI-20 and PFIQ-7 scores had improved (P= 0.001). The complications were minor (G1) according to the Clavien-Dindo classification (8.2 %). complained of de novo frequency and urgency which was resolved two months after the surgery. At one year follow up 3 out of 8 patients with clinical SUI underwent transvaginal repair with the Poly propylene mini sling mesh.


Conclusion: The midterm results of the surgical repair of the high stage anterior vaginal wall prolapse are promising with a new surgical technique by trans-obturator approach and native vaginal wall as the supportive layer

Association between Hyposensitivity of C-fiber Afferents at The Proximal Urethra and Storage/voiding Dysfunction in Female Patients with Detrusor Overactivity

Osamu Ichiyanagi, Ken-ichi Nishimoto, Akira Nagaoka, Sei Naito, Mayu Yagi, Masaki Ushijima, Tomoyuki Kato, Norihiko Tsuchiya

Urology Journal, 2019, 5 January 2019 , Page 5515-5515
https://doi.org/10.22037/uj.v16i7.5515

Purpose: We examined the associations between urethral sensation and storage/voiding function in female patients with detrusor overactivity (DO) by measuring urethral current perception threshold (CPT).

Materials and Methods: We retrospectively investigated the medical records of 27 consecutive patients with lower urinary tract symptoms who underwent cystometry, uroflowmetry (UFM), and urethral CPT tests from 2000 to 2015. Patients were classified into 2 groups: with/without DO. Seven DO-negative cases were selected as normal controls on cystometrogram (CMG) matching the inclusion criteria: bladder compliance ?12.5 mL/cmH2O, volume <275 mL at first sensation, and no comorbidities possibly influencing micturition. Finally, 17 patients were included. Urethral CPT was evaluated with intraurethral square-wave impulses at 3 Hz to stimulate C-fibers. Urethral loss coefficient (LC), reflecting urethral resistance during voiding, was calculated by curve-fitting a mathematical model to a UFM waveform.

Results: Urge incontinence (UI) was observed in 7 DO-positive patients, but not in those with normal CMG. Urethral CPT and LC were significantly higher in patients with DO than in those with normal CMG. Median urethral CPT significantly increased in patients with both DO and UI than in those without these symptoms (p<0.005). CPT values were correlated with the volume at first sensation (?=0.53, p<0.05) and LC (?=0.59, p<0.05). LC was not calculated in 3 cases due to poor curve-fitting.

Conclusions: In females, urethral C-fiber afferents may become hyposensitive as the detrusor becomes overactive with UI in the storage phase. During voiding, C-fiber hyposensitivity may relate to increased functional resistance of the urethra to urine outflow.

ORIGINAL PAPER (ANDROLOGY)


Purpose: In this study the role of nicotine (NCT) administration on the intensity of rat testicular tissue alterations induced by quinine (QU) was evaluated. 


Materials and Methods: Forty adult Wistar rats were divided into four groups. Control (CON), NCT administrated (4 mg/kg) (NCT), QU treated (25 mg/kg for 7 days) (QU), and nicotine with quinine received (NCT+QU). After 28 days, serum testosterone and malondialdehyde (MDA) levels were measured. Testes and epididymides samples were prepared for determining tissue MDA levels, histomorphometry, microscopic indices of spermatogenesis, immunohistochemistry of p53 and sperm analysis.


Results: Testosterone levels were decreased significantly (P=.0004) in treated groups compared to CON group. Serum MDA levels were increased significantly (P=.0004) in NCT and QU groups compared to CON group. Tissue MDA levels were increased significantly (P=.0012) in NCT+QU group in comparison to CON group. These parameters were changed significantly in NCT+QU group compared to QU group. Seminiferous tubules diameter was decreased significantly (P < .0001) in treated groups compared to CON group and in NCT+QU group compared to QU group. The height of germinal epithelium was decreased significantly (P=.0001) in NCT and NCT+QU groups compared to CON and QU groups. The number of Sertoli cells, spermatocytes and spermatids was decreased significantly in treated groups compared to CON group. The number of spermatogonia was decreased significantly (P=.0017) in NCT and NCT+QU groups compared to CON group. The number of Sertoli cells, spermatogonia and spermatocytes was decreased significantly in NCT+QU group compared to QU group. All indices of spermatogenesis were decreased in treated groups compared to CON group. The lowest mean of these indices was observed in NCT+QU group. The sperm viability was decreased significantly (P < .0001) in treated groups compared to CON group. Sperm count and motility were decreased significantly in NCT and NCT+QU groups compared to CON group. All experimental groups showed the over-expression of p53 compared to CON group.


Conclusion: The administration of nicotine could be involved in the exacerbation of testicular tissue alterations related to quinine therapy.

Correlation between Protamine-2 and miRNA-122 in Sperm from Heroin-Addicted Men: a Case-Control Study

Zohreh Nazmara, Mohammad Najafi, Mansoureh Movahedin, Zahra Zandiyeh, Peymaneh Shirinbayan, Hamid reza Asgari, Mohsen Roshanpajouh, Chad Maki, Zahra Bashiri, Morteza Koruji

Urology Journal, 2019, 5 January 2019 , Page 5747
https://doi.org/10.22037/uj.v16i7.5747

Purpose: Recreational use of illicit drugs is one of the main factors affecting male fertility. However, the mechanisms of heroin smoke-associated damage to mature spermatozoa are still completely unknown. The aim of this study was to concomitantly examine the levels of protamine-2 gene and protein concentrations, the amount of miRNA-122 in seminal plasma and semen analysis findings in heroin-addicted men.


Materials and Methods: In a case control study, twenty-four fertile men that lacked any recreational drug abuse were considered as the healthy group, and 24 addicted men who used only heroin for at least four months were selected as the addicted group. Semen samples were gathered by masturbation after 2 - 5 days of sexual abstinence. Following the preparation of a semen analysis by computer-assisted sperm analysis according to WHO (2010), the level of protamine-2 gene expression in sperm and miRNA-122 in seminal plasma was measured using real-time sqPCR. Also, protamine-2 protein concentrations were quantified by nuclear protein extraction, SDS-Page and western blotting.


Results: Among the studied variables, body mass index (27.75±0.88 vs. 22.30±0.36, p=0.001), seminal pH (7.79±0.06 vs. 7.58±0.06, p=0.003), white blood cell count in semen (1.69±0.41 vs. 8.61±1.73, p=0.001), motility (65.51±2.57 vs. 41.96±3.58, p=0.001) and survival rate (87.41±1.00 vs. 71.50±4.59, p=0.002) of sperm cells was significantly different between the healthy and addicted groups. In addition, the levels of protamine-2 gene and protein expression in the addicted group (0.05±0.02 and 0.10±0.02, respectively) were significantly lower than the healthy group (3.59±0.94 and 0.27±0.06, respectively) (p=0.002 and p=0.017, respectively). Seminal miRNA-122 levels in addicted men (3.51±0.73) were statistically higher than in healthy men (1.52±0.54) (p=0.034). However, there were some significant relationship between the studied parameters and addiction (p<0.05).


Conclusion: This is one study on human infertility that evaluates the effects of heroin on protamine deficiency and seminal small RNAs expression levels. Heroin abuse may lead to male infertility by causing leukocytospermia, asthenozoospermia, protamine deficiency, and seminal plasma miRNA profile alteration.

ORIGINAL PAPER (RECONSTRUCTIVE SURGERY)


Major Complications after Male Anti-IncontinenceProcedures: Predisposing Factors, Management and Prevention

Miklos Romics, Gergely Bánfi, Attila Keszthelyi, Hans Christoph Klingler, Tibor Szarvas, Marcell Szász, Péter Nyirády, Attila Majoros

Urology Journal, 2019, 5 January 2019
https://doi.org/10.22037/uj.v0i0.5712

PURPOSE: Significant post-prostatectomy incontinence (PPI) is a crippling condition and managed best through sling or artificial urinary sphincter (AUS) implantation. These procedures are often associated with complications requiring surgical intervention. The aim of our retrospective study was to evaluate the occurrence of major complications and identify risk factors.      
MATERIALS AND METHODS: Between 2010 and 2018 ninety-one patients have been implanted with sling (22; 24.2%) or AUS (69; 75.8%) in our department.  The cases where surgical revision was needed were examined regarding the etiology (mechanical failure (MF), urethral erosion (UE), urethral atrophy (UA), surgical site infection (SSI), combined reasons (COMB) and analyzed, using 16 possible perioperative risk factors.

RESULTS: Surgical intervention was carried out by 19 / 91 (20.9%) patients. (In 16 / 69 cases after AUS (23.1%), 3 / 13 after slings (23%)). The indication was in 6 (31.6%) cases MF, in 3 (15.8 %) COMB, in 4 (21.1%) UE, in 5 (26.3 %) SSI, in 1 (5.2%) UA. The type of reoperation was either explantation (12 / 19), system replacement (6 / 19), or cuff replacement (1 /19). Regarding the surgical intervention requiring complications only preoperative bacteriuria (P = .006) and postoperative surgical site oedema (P = .002) proved to be independent predictive factors. 
CONCLUSION: Preoperative bacteriuria and surgical site oedema seemed to be good predictors for obligate surgical revision. Patients with AUS were more prone to have major complications. In most cases it was mechanical failure, infection or erosion. By reducing the frequency of these risk factors we might be able to decrease the amount of complications.

 

Efficacy Of Preoperative Gabapentin on Pain Severity after Posterior Urethral Surgery:A Randomized, Double-Blind, Placebo-Controlled Study

saleh ghiasy, Ali Tayebi-azar, Amin Alinezhad, Morteza Fallah-karkan, Hojat Salimi, Seyyed Ali Hojjati, Jalil Hosseini

Urology Journal, 2019, 5 January 2019
https://doi.org/10.22037/uj.v0i0.5598

Purpose: Prevention and treatment of urethroplastic postoperative pain is a major challenge in post-surgery care. gabapentin can treat postoperative pain by preventing excessive sensitivity to the central nervous system. we have tried to compare the effect of gabapentin with the placebo on reducing the pain associated with posterior urethroplasty in patients.


Material and Method: This prospective, randomized, double-blind study was scheduled in Shohad e Tajrish hospital where a single dose of Gabapentin was compared with placebo given to patients preoperatively. In this study,100 patients with posterior urethral stricture were included for surgery with 50 patients in each arms .All patients underwent posterior urethroplasty. After surgery, the pain level is assessed and evaluated by the visual analog scale in two hours,four hours, six hours,eight hours, twelve hours, and 24 hours after the operation.


Result: In this study, there was a significant difference in the pain level that was evaluated by the visual analog scale in two hours, four hours, six hours, eight hours, twelve hours, and 24 hours after the surgery (p.value <0.001). We also found a significant decrease in morphine consumption in the gabapentin group vs the placebo group. (p.value <0.001)


The post-surgery assessments showed significant lower adverse effects such as vomiting, nausea, drowsiness, and pruritus in the gabapentin group vs. placebo group.


Conclusion: The consequences of this study revealed that gabapentin effective in controlling posterior urethroplasty postoperative pain, consumption of opioid, nausea, vomiting, drowsiness, and pruritus compared with the placebo group.

CASE REPORT


Traditionally, the standard treatment of bladder-prostate rhabdomyosarcoma (BP-RMS) is being implemented to be total cystoprostatectomy and urinary diversion. However, current multimodal treatment approaches emphasize the importance of bladder-sparing surgery.

In this case series, it was aimed to indicate the results of the laparoscopic bladder-sparing approach of two pediatric patients with BP RMS. They have admitted to the emergency department due to acute urinary retention (AUR). The tumors located in the prostate causing AUR were detected by Magnetic resonance imaging (MRI) and the pathological diagnosis was confirmed by biopsy. The patients were managed in a prosperous manner by implementing laparoscopic surgery with the cause of detection of a significant decrease in the size as well as the enhancement pattern of the tumors following neoadjuvant chemotherapy. No urinary incontinence, tumor recurrence or metastasis was observed at 36 and 28 months follow-up in case 1 and case 2, respectively.

Laparoscopic bladder-sparing approaches may have an advantage in patients with BP RMS to decrease morbidity and mortality related to radical surgery. To our knowledge, these are the first cases of laparoscopic bladder-sparing approach in the treatment of pediatric prostate-derived embryonal RMS (PDERMS).

This report is about the effectiveness of sacral neuromodulation in a 32-year-old woman with a history of augmented cystoplasty who required clean intermittent catheterization. She had referred to our center with a medical history of bilateral vesicoureteral reflux because of neuropathic lower urinary tract dysfunction. We successfully did a sacral neuromodulation on her which lead to a promising result.

Laparoscopic pyelolithotomy has recently been introduced for renal stones. However, the use of this technique is limited in patients with history of extensive abdominal surgeries. We present a case of right side staghorn renal stone with history of abdominal open cystectomy who underwent laparoscopic pyelolithotomy with uneventful outcome.

Here, we report a case of a 73-year-old man with a history of hepatocellular carcinoma. Follow-up abdominal computed tomography showed a 1.7-cm-sized hyperenhancing mass in the right paracolic gutter, suspicious of metastasis. Histologic and immunohistochemical study of the resected specimen revealed extragenitourinary ectopic prostatic tissue. Since ectopic prostatic tissue is very rare, preoperative diagnosis is difficult but important for avoiding unnecessary treatment or patient anxiety. Here, we present a rare case of ectopic prostatic tissue in the right paracolic gutter.

Background: This study presents initial experience in endoscopic meatal dilatation of obstructive ureterocele in adult patients.

Surgical technique: During cystourethroscopy, we tried to find the orifice of ureterocele, passed a guide wire and introduce an 8 Fr ureteroscope in to the ureterocele orifice, going up to the renal pelvis as under vision dilatation of ureterocele meatus. Two Double-J stent were inserted and remained for six weeks to keep the meatus dilated. Adverse effect of endoscopic management was decreased due to minimal anatomic changes.

Results: Patients’ symptoms were relieved and no evidence of new onset vesico-ureteral reflux and obstruction were seen after up to one-year follow-up.

Conclusion: Endoscopic meatal dilatation of stenotic ureterocele in adult patients is safe and effective thus, try to find the orifice of ureterocele is suggested.

Persistent müllerian duct syndrome (PMDS) in the majority of cases is discovered during surgery for inguinal hernia or cryptorchidism. A transverse testicular ectopia (TTE) with cryptorchidism may be very rarely associated to PMDS. Assuming that müllerian remnants have a very low malignant degeneration potential if compared to the malignancy risk of an undescended and not relocated testis, we describe a simplified surgical technique of orchiopexy that avoids an extensive anatomical dissection, in this way minimizing the risk of losing the deferential blood supply to the testis.

Appendiceal conduit: A novel technique to be applied after radical cystectomy: A case study report

emadoddin Moudi, Seyyed Hosein Ghasemi Shektaie, Ghasem Rostami

Urology Journal, 2019, 5 January 2019 , Page 5513-5519
https://doi.org/10.22037/uj.v16i7.5513

This paper introduces a novel technique, known as appendiceal conduit. It could be used as an alternative for ileal conduit and cutaneous ureterostomy, ultimately applied after radical cystectomy. The six-month follow-up indicated that the patient had appendix-stoma as nipple without any stenosis, nor did he have any hydronephrosis, as confirmed by abdominal sonography.

Mesothelioma in Situ of the Spermatic Cord Arising from a Patent Processus Vaginalis: A Case Report

Yasuyuki Kobayashi, Yumiko Yasuhara, Hiroki Arai, Masahito Honda, Masataka Hiramatsu, Sho Goya

Urology Journal, 2019, 5 January 2019 , Page 5421
https://doi.org/10.22037/uj.v16i7.5421

Mesothelioma is an aggressive tumor originating from mesothelial cells. Mesothelioma of the spermatic cord is a very rare disease, and the most common presentation of this disease is that of aggressive mesothelioma with no description of mesothelioma in situ. We report an extremely rare case of mesothelioma in situ of the spermatic cord arising from a patent processus vaginalis. To our best knowledge, this is the first report of this finding. The identification of a patent processus vaginalis and investigation of single-layered atypical mesothelial cells led to the final diagnosis.

LETTER


Clinical Features Deserve Consideration for a Urologist in COVID-19.

Mohammad Nadjafi-Semnani, Nasser Simforoosh, Nahid Ghanbarzadeh, Ali Nadjafi-Semnani

Urology Journal, 2019, 5 January 2019
https://doi.org/10.22037/uj.v16i7.6080

We have studied up-to-date knowledge about the clinical feature of the Novel coronavirus pandemic worth consideration by the urologist. PubMed database, the United States centers for disease control and prevention (CDC), and the World Health Organization (WHO) websites were also accessed. A staging system introduced by Siddiqi et al. for the COVID-19 is acknowledged. Hemodialysis centers are high-risk zones in the outbreak of a COVID-19 epidemic. Symptoms and signs, clinical features, and laboratory findings of the renal transplant patients are almost similar to non-transplanted patients.

INTRODUCTION: On 11 March 2020, the World Health Organization (WHO) declared a pandemic. Since then hospitals have reduced inpatient and outpatient workflow and cancelled or suspended all non-emergent and routine surgical procedures. Our objective is to determine whether, during the COVID-19 period, there has been any modification in urological services.


MATERIALS AND METHODS: We retrospectively studied the data from January-May 2020 and 2019 about the variables: number of operations, waiting list, visits in outpatient department, bladder instillations and urological emergencies and admission rates.


RESULTS: Cancer cases high-risk for stage progression and surgical emergencies, were elected to proceed directly to treatment. The number of the operations was reduced by 43-65% from March-May 2020. Our surgical list had a waiting time of 6-8 weeks before the pandemic and now the waiting time has expanded to 12 weeks. Urological emergencies were reduced about 23-57%. Admission rates were dropped 10-51%. Visits in outpatient clinics were reduced 100-50% and outpatient procedures for elective cases were all deferred. Unfortunately, the hospital did not offer synchronous telehealth appointments. Bladder instillations of BCG or chemotherapeutics were not suspended but start of new cases had a delay of 2-3 weeks. There were no cases of COVID-19 in our department.


CONCLUSION: All the variables of our urologic practice were affected during the COVID era. The impact of the reduced model of outpatient and inpatient workflow on the health of our patients is unknown. However, longer waiting lists are expected. It is obvious that healthcare providers should adopt a new healthcare model.

UNCLASSIFIED


Purpose: This study was conducted to determine the effects of tamsulosin and diclofenac sodium use on patients' pain perception after ureteral stents removal.

Materials and Methods: This study was a randomized control trial with double-blinded design. Eighty patients who underwent ureteral stent removal surgery at Kardinah Hospital, Tegal during January to March 2017 were divided into four groups. The experimental group was administered by analgesic for two days, (A) placebo tid, or (B) diclofenac sodium 50 mg bid, or (C) tamsulosin 0.2 mg sid, or (D) combination of tamsulosin and diclofenac sodium. Analgesic effects were assessed with the Visual Analog Scale (VAS). Relationships among variables were assessed using one-way ANOVA and post hoc tests.

Results: The surgical procedure for ureteral stent removal consisted of 48 (60%) male and 32 (40%) female. The average age of group A, B, C, and D were 51.0, 51.9, 47.6, and 47.3 years, and the average stent dwell times was 6.3 weeks. VAS values of the entire experimental group were lower than the control group on the first day until the second day after the stent removal procedure (p <0.05). In the experimental group, there was no difference between group B and C (p> 0.05). Group D showed better analgesic effects than group B and C (p <0.05). There were no severe side effects found in whole cases.

Conclusion: The result shows that combination therapy of diclofenac sodium and tamsulosin is better in reducing the pain after ureteral stent removal compared to the admission of a single placebo, tamsulosin, and diclofenac sodium therapy.

 

Purpose: To delineate the expansion of the renal parenchyma using volumetric CT imaging before and after the laparoscopic cyst decortication procedure and to determine the possible associations between parenchymal expansion and laboratory parameters and cyst volume.

Materials and Methods: Thirty-five patients that underwent laparoscopic cyst decortication were included in this prospective study. Abdominal contrast-enhanced CT was performed in all patients in the preoperative and postoperative period. Semi-automatic volume quantification was undertaken offline, and renal parenchymal volumes before and after cyst decortication, as well as serum creatinine and estimated glomerular filtration rate (eGFR) were compared.

Results: The changes in serum creatinine and eGFR in the postoperative period were non-significant. The mean postoperative renal parenchymal volumes were higher compared to the preoperative measurements for both observations (P = .014 and .034 for the first and second measurements, respectively). There was no correlation between the volumetric change and the cyst volume (r = -0.18, P = .560).

Conclusion: In patients undergoing laparoscopic cyst decortication, post-operative parenchymal expansion can be detected using volumetric CT imaging to confirm the immediate benefits of the procedure.

Validation of the Persian Version of the National Institute of Health Chronic Prostatitis Symptom Index

Farzad Allameh, Mohammad Mersad Mansouri Tehrani, Mohammad Ali Tasharrofi, Mohammad Ali Ganji Jameshouran

Urology Journal, 2019, 5 January 2019
https://doi.org/10.22037/uj.v0i0.5444

Objectives: To compose a comprehensible and fluent Persian translation of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and to determine its linguistic validity in a Persian sample population.

Methods: The standard double-back translation method, provided by the previous studies were utilized by three professional linguists to translate the English version of the NIH-CPSI to Persian, and a group of 10 urologists further reviewed and translated questionnaire. The questionnaire was then presented to the sample study, comprised of 60 men with CP/CPPS and 60 controls with adverse urological history, and the collected data was analyzed through IBM-SPSS software to test its validity, evaluative, and discriminatory power, psychometric qualities and internal consistency.

Results: A total of 80 subjects (42 CP/CPPS patients and 38 healthy controls) were considered eligible for this study. The total Persian NIH-CPSI scores and each subdomain showed significant difference (P < 0.001) between the two study groups, indicating a satisfactory discriminant validity for the index. Psychometric analysis established the index to benefit from a high internal consistency. The translation was also considered by both the subjects and the physicians to be easily comprehensible.

Conclusion: The Persian NIH-CPSI is a reliable and valid instrument for evaluating CP/CPPS symptoms in general population, while also benefitting from high discriminatory power, and can be utilized with ease in both clinical practice and laboratory studies.

Association between Inflammation and Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia

Qiang Zhang, Shiyu Pang, Shiyu Pang, Yinglang Zhang, Yinglang Zhang, Kang Jiang, Kang Jiang, Xuetao Guo, Xuetao Guo

Urology Journal, 2019, 5 January 2019
https://doi.org/10.22037/uj.v0i0.5462

Purpose: To evaluate the association between inflammation in prostatic tissue/serum sample and BPH-LUTS

Patients and methods: The prostatic tissue and serum sample were collected from 183 patients who underwent transurethral plasmakinetic resection of the prostate (TUPKRP).  The association between inflammation detected on prostatic tissues/ serum sample and LUTS related parameters, including International Prostate Symptom Score (IPSS) and peak flow rate (Qmax) were analyzed with SPSS version 13.0, and P-value <0.05 was chosen as the criterion for statistical significance.

Results: There was a positive association between prostate tissue inflammation and LUTS. The differences of IPSS, VSS and SSS were seen with the increasing in grade of prostate tissue inflammation (P<.001; .001; =.014, respectively). Qmax and IPSS 12months after surgery were better in no inflammation group (P=.016; .031).Logistic regression analysis revealed a statistically association between the NEUT%?NLR and prostate tissue inflammation (P=.010; .004), but ROC curve showed the NEUT%, NEUT and NLR area under curve (.526; .452; .513, respectively) were calculated as <0.600. Patients with Qmax over 7.12 had more WBC count in peripheral blood (7.56±1.77 VS 6.37±1.86, P=.026). The NLR was significantly higher in the group of IPSS over 20 and AUR presence (P=.018; .017).The NEUT%, LYMPH%, LYMPH and NLR showed a statistically significance in different obstruction classification (P=.047; .046; .028; .014, respectively).

Conclusion: There was correlation between chronic Inflammation and LUTS related to BPH. The patient without inflammation could acquire more sustained and steady relief than those with inflammation in LUTS related to BPH after TUPKRP.

Purpose: To describe and report a series of renal and adrenal anastomosing hemangioma (AH) and to investigate its distinctive clinicopathologic features and review its clinical data available in the literature.

Materials and Methods: Clinical data of 10 AHs were retrospectively studied. Imaging and histologic features were re-evaluated and summarized. Immunostaining markers were performed include CD31, CD34, ERG, Fil-1, D2-40, AE1/AE3, SMA, CD10, HHV8, S100, Ki-67. A follow-up of all cases was performed. Other AHs published in PubMed and Web of Science were reviewed.

Results: All of 10 AHs were found incidentally, containing 5 female and 5 male patients (median, 48.5 years; mean, 51.7 years) and involved unilateral kidney (n=7) and adrenal glands (n=3) respectively. All lesions were well-defined in Imaging and histologic examination. AHs were morphologically characterized by prominent anastomosing vascular channels without evidence of infiltration to surrounding normal tissues and significant cellular atypia. CD31, CD34, ERG were positive and Ki-67 showed typically low (?3%). All Patients underwent a mass resection and none of them had evidence of recurrence. Together with other cases published, the AHs showed distinctive clinicopathologic features with an excellent prognosis.

Conclusion: Renal or adrenal AH is a very rare vascular tumor. They have distinctive histologic features and a favorable prognosis. Its frequently mimicking well-differentiated angiosarcomas easily result in unnecessary overtreatment in clinical practice. To be acquainted with this entity serves to avoid misdiagnosis.

Changes in Apoptosis-related Proteins in the Urothelium of Rat Bladder Following Partial Bladder Outlet Obstruction and Subsequent Relief

Jong Mok Park, Ji Yong Lee, Yong gil Na, Ki Hak Song, Jae sung Lim, Seung Woo Yang, Seung-Hwan Lee, Gun-Hwa Kim, Ju Hyun Shin

Urology Journal, 2019, 5 January 2019
https://doi.org/10.22037/uj.v0i0.5799

Purpose: Partial bladder outlet obstruction (PBOO) induces sustained bladder over-distension, leading to ischemia/reperfusion (I/R)-related oxidative damage of the urothelium via apoptosis. The present study aimed to investigate the sequential course of apoptosis in the urothelium of rat bladder and identify the changes in apoptosis-related proteins during PBOO and subsequent relief. 

Materials and Methods: The study was conducted using 60 female Sprague-Dawley rats divided into three groups: sham-operated, PBOO only, and PBOO plus subsequent relief. PBOO was induced for 2 weeks, and then the obstruction was relieved by removal of the ligature. The urothelium was assessed by a histological analysis, and expression levels of apoptosis-related proteins were detected by quantitative PCR and immunoblotting.

Results: Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL)-positive cells were significantly increased in the PBOO only group when compared with the sham-operated group, and decreased in the PBOO relief group when compared with the PBOO group (P < 0.001). From the quantitative PCR and the western blot analyses, expression of Bax, caspase-3, P38, and Jnk was significantly increased in the PBOO group (P < 0.001). However, expression of Erk, Bcl-2 significantly decreased in the PBOO group (P < 0.001). The expression of Erk and Bcl-2 significantly increased in the PBOO relief group when compared with the PBOO group (P < 0.001). In comparison to the sham-operated group, expression levels of survivin significantly increased in both the PBOO and PBOO plus relief groups (P < 0.001). In addition, the expression levels were significantly different between the PBOO and PBOO plus relief groups (P < 0.001).

Conclusion: PBOO induced apoptosis of urothelium is related to alterations in the MAPK signaling pathways and apoptosis-related protein change. These results may also suggest that the pro-survival Erk signaling cascade and the expression survivin are activated in response to ischemic bladder injury and associated with initiation of bladder restoration in PBOO and subsequent relief. However, the mechanism of survivin as anti-apoptotic protein in ischemic bladder injuries remains unclear.

Purpose: To analyze the predictive factors causing ischemic priapism following penile doppler ultrasonography (PDU) with intracavernosal papaverine injection

 

Materials and methods: Medical records of 467 patients who underwent PDU examination following intracavernosal papaverine injection for erectile dysfunction (ED) between 2009 and 2017 were retrospectively reviewed. Patients with hematological disease anamnesis, patients taking phosphodiesterase-5 inhibitor, patients with intracavernosal injection therapy anamnesis and patients who underwent PDU with other intracavernosal vasodilator drugs other than papaverine were excluded from the study. The remaining 268 patients were divided into two groups as priapism (38 patients) and non-priapism (230 patients). The groups were compared in terms of demographic data, American Society of Anesthesiologists (ASA) score, comorbidities, international index of erectile dysfunction (IIEF) score and PDU results. The significant parameters were analyzed with binary logistic regression analysis. The receiver operating analysis was used to obtain cut-off, sensitivity and specificity values for the independent predictive factors. 

 

Results: The age, ASA score, diabetes mellitus, IIEF score, duration of ED, peak arterial and peak end diastolic venous flow values in the 20th minute were significantly different in the two groups (p<0.001). Binary logistic regression analysis found age, duration of erectile dysfunction, IIEF score, peak arterial flow and venous flow rate in the 20th minute were predictive variables for the occurrence of priapism.

 

Conclusions: Young patients, patients with good IIEF score, patients with ED for a short time, and patients with normal peak arterial and venous flows are more prone to developing post-papaverine ischemic priapism.

Background: Obturator nerve reflex is the surgery treatment side effect in patients with bladder cancers. This study is run to determine the obturator Nerve reflex by Thulium laser versus monopolar Transurethral Resection of Bladder Tumors (TURBT).


Materials and methods: After clinical trial approval code receiving IRCT20190624043991N4, one hundred and eighty-nine patients with bladder tumors from 2010 to 2016 were assessed and among them, 35 patients were randomly assigned into two groups in a blinded manner; the first group (16 patients) received thulium laser and the second group (19 patients) were patients undergoing monopolar transurethral resection of bladder tumor after spinal analgesia. Clinical data, including different variables such as; age, tumor characteristics, gender, operation duration, types of leg jerking, and some intraoperative complications, were recorded. The site of the obturator nerve was determined by nerve stimulation, anatomical landmarks, and ultrasonography. Leg jerking was compared in both groups.


Results: Of the 35 patients, 28 cases were male and 7 cases were female. The mean age was 62.0±6.9 (40-75) years in the Thulium laser group and 64.0±7.1 (41-77) years in the monopolar TURBT group. The mean operation time was no different between the two groups significantly (P > 0.05). Leg jerking was reported in 25% and 63.1% of the patients in Thulium laser and monopolar TURBT groups, respectively (P<0.05).


Conclusion:  Thulium laser is a more feasible and effective method to prevent leg jerking in patients with bladder cancer; so, it is recommended more than monopolar Transurethral.

Role of p-ERK1/2 in Benign Prostatic Hyperplasia during Hyperinsulinemia

Yong-Zhi Li, Ben-Kang Shi, Jing-Yu Li, Xing-Wang Zhu, Jia Liu, Yi-Li Liu

Urology Journal, 2019, 5 January 2019 , Page 5694
https://doi.org/10.22037/uj.v16i7.5694

Purpose: Using a rat model of hyperinsulinemia, the present study investigated the role of p-ERK1/2 in benign prostatic hyperplasia (BPH).


Materials and Methods: Forty male Sprague-Dawley rats were randomly selected and assigned to four groups: high fat diet (HFD)+BPH (n=10), HFD (n=10), BPH (n=10), and control (n=10) groups. Hyperinsulinemia was induced by HFD feeding, while BPH was induced using testosterone propionate. Plasma glucose, plasma insulin and bodyweight were examined weekly. Immunohistochemistry (IHC) and western blot analysis were used to analyze the expression of ERK1/2 and p-ERK1/2 in rat prostates.


Results: Plasma glucose and plasma insulin levels were significantly greater in the HFD+BPH and HFD groups, when compared to the other two groups (P<0.05). Prostate weights were significantly greater in the HFD+BPH, HFD and BPH groups, than in the control group (P<0.05). IHC and western blot analysis revealed that p-ERK1/2 expression was greater in the HFD+BPH group than in the other three groups (P<0.05).


Conclusion: Androgens plus a hyperinsulinemic condition induced by HFD can result in prostatic cell hyperplasia, and this mechanism may be correlated to the upregulation of p-ERK1/2. Further investigations of this possibility are required.