ISSN: 1735-1308

Vol. 15 No. 3 (2018)

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Effect of Polygonum Aviculare L. on Nephrolithiasis Induced by Ethylene Glycol and Ammonium Chloride in Rats

Jamileh Saremi, Hossein Kargar Jahromi, Mohammad Pourahmadi

Urology Journal, Vol. 15 No. 3 (2018), 3 May 2018 , Page 79-82

Purpose: Nephrolithiasis is a common urinary tract disease, in addition to the pain and treatment costs, there may be significant complications resulting from the stones. This study intended to investigate the effects of Polygonum Aviculare L. aqueous extract (PAE) on urolithiasis induced by ethylene glycol (EG) and ammonium chloride (AC) in rats.
Materials and methods: Sixty-four male Wistar rats were randomly divided into eight groups (n = 8). Rats in the normal control group (I) received no treatment. The sham groups (III and IV) were given PAE. at 100 and
400 mg/kg by gavage for 28 days. The disease control group (II), the prevention groups ( V and VI), and the therapeutic groups (VII and VIII), received 1% EG and .25 AC in their drinking water for 28 days. The prevention groups (from the start of EG administration), and the therapeutic groups (from the 14th day of EG administration),
received PAE at 100 and 400 mg/kg by gavage. At the end of the experiment, kidneys were examined for CaOx deposits and tubulointerstitial changes.
Results: The number of CaOx crystals and tubulointerstitial changes increased significantly in group II rats compared to groups I, III, and IV (P < .001). The number of CaOx crystals (P < .001) and tubulointerstitial changes (P < .001) in the prevention groups, and the number of CaOx crystals (P < .05) and interstitial changes (P < .05) in
the therapeutic groups declined significantly compared to group II.
Conclusion: Results show aqueous extract of Polygonum Aviculare L. is effective in the prevention and treatment of kidney stones.

The Evaluation of the Result of Warm Normal Saline Irrigation in Ureteral Endoscopic Surgeries: A Randomized Clinical Trial

Mohammad Ali Mohammadzadeh Rezaei, Alireza Akhavan Rezayat, Mahmoud Tavakoli, Lida Jarahi

Urology Journal, Vol. 15 No. 3 (2018), 3 May 2018 , Page 83-86

Purpose: Transurethral lithotripsy (TUL) is a major modality for the endoscopic management of ureteral stones.
Ureteral spasm makes access for ureters difficult, which causes impaction of the ureteroscope, ureteral dislodge,
and a low success rate of endoscopic surgeries. This study described the outcomes of a new endoscopic surgical
experience by use of 40-degree warm saline irrigation during TUL compaired with routine ambient air irrigation
in TUL.
Materials and methods: In this randomized clinical trial from 2014 to 2015, 150 patients with ureteral stone with
balanced randomization were divided into two parallel groups. Patients underwent TUL in the first group with
20–25 degree saline irrigation and in the second group with 40-degree saline irrigation. One surgical team with the
same semi-rigid instrument performed all TULs and the other steps were similar in both groups. Complete stone
fragmentation was measured as the primary outcome and the duration of procedure, retrograde stone migration and
all and any intraoperative complications were the secondary measurements.
Result: While comparing warm saline irrigation with cold saline irrigation, the rate of access to upper ureter was
95% versus 72%, stone retropulsion frequency was 10.7% versus 30.7% and the stone-free rate was 96% versus
76% respectively (P < .05). There was no ureteroscope impaction and ureteral dislodge in both groups.
Conclusion: Using warm saline irrigation in endoscopic surgeries results in better surgical outcomes including
a lower ureteral spasm rate, greater ureteral muscle relaxation and better access to the upper ureteral zone, and a
lower rate of complications, such as ureteroscope impaction, ureteral dislodge and stone retropulsion.

Purpose: The paper focuses on the relationship of risk factors and metabolic disorders with mineralogical composition of calculi, age and gender of calcium oxalate stone formers.
Materials and Methods: Stone mineralogical composition, 24 hour biochemistry and pH-profile of urine were examined for sixty four stone formers using powder X-ray diffraction, spectrophotometric and potentiometric techniques.
Results: The analysis indicated that 44 % of calculi were composed of pure calcium oxalate monohydrate, whereas other 56 % contained both monohydrate and dihydrate or usually their mixtures with hydroxyl apatite. Hypocitraturia, hypercalciuria and hyperuricosuria were identified as the most frequent disorders. Patients with pure calcium oxalate stones and calcium oxalate mixed with apatite revealed different patterns including age, acid-base balance of urine, calcium, citrate excretion etc.
Conclusions: Our results demonstrate that most patients simultaneously reveal several risk factors. The special attention should be paid to normalize the daily citrate, calcium and urate excretion. High risk patients, such as postmenopausal females or stone formers with a high apatite content require a specific metabolic evaluation towards in highlighting abnormalities associated with stone formation.

Does Mild Hydronephrosis Induced by Full-Bladder Improve Outcomes in Patients Undergoing Shock Wave Lithotripsy for Lower Calyceal Stones?: A Prospective Randomized Study

Ismet Ayd?n Hazar, Basri Cakiroglu, Orhun Sinanoglu, Feride Sinem Akgün, Ersan Arda, Ilkan Yuksel, Hakan Akdere

Urology Journal, Vol. 15 No. 3 (2018), 3 May 2018 , Page 92-95

Purpose: To compare the outcomes, sessions and shock wave numbers in patients undergoing standard procedure shock wave lithotripsy (SWL) and patients undergoing SWL with mild hydronephrosis induced by full-bladder
following oral hydration before SWL procedure for lower calyceal stones.
Materials and Methods: Between January 2014- January 2016 a total of 371 patients who underwent SWL, for lower pole calyceal stones ? 2 cm, were included into the study. 127 patients were treated in the supine position (Group A), 123 in the prone position (Group B) and 121 in the prone position with full bladder and mild hydronephrosis checked by ultrasound before procedure (Group C). There were 286 men and 85 women with a mean ± SD age of 36 ± 11 years
Results: The mean (SD) stone sizes within the group A, group B and group C were 11 mm (±3 mm), 12 mm (±4.1 mm) and 11 mm (± 3.8 mm) respectively. No significant difference was found in age (P = .18) and stone size between 3 groups (P = .07). The median interquartile range (IQR) number of shocks within the group A, group B and group C were 7600 (3855), 6500 (4300) and 6700 (4915) respectively. Significant difference was found in number of shock waves among 3 groups (P < .01). The difference between groups according to stone expulsion rate was
found significant in all sessions (P = .01).
Conclusion: The present study suggests that mild hydronephrotic status induced by full-bladder before SWL can lower cost and patient discomfort by decrease in number of sessions and increase in stone clearance.


Purpose: In this retrospective study, we aimed to investigate the prognostic effect of body mass index (BMI) in localized renal cell carcinoma (RCC) cases who underwent surgical treatment. Furthermore, the assessment of various patient and tumor characteristics and surgical methods on survival has been identified as additional targets.
Materials and Methods: Three hundred and eighty patients with localised, non-metastatic, unilateral RCC who underwent radical or partial nephrectomy in our clinic between January 2007 and December 2016 were enrolled in this study. Age, gender, height, weight, BMI, operation type and method, pathology results and tumor stage of the patients were recorded. Patients were divided into 3 groups according to body mass index (BMI): Normal weight
(< 25 kg/m2), overweight (25-30 kg/m2) and obese (>30 kg/m2) as groups 1, 2 and 3, respectively. We analyzed the relation between the BMI, gender, smoking, hypertension, type and method of surgical treatment, histologic subtype, tumor stage, estimated glomerular filtration rate (eGFR) and cancer-specific (CSS) and recurrence free survival (RFS). All data analysis was performed using SPSS® Statistical Software for Windows (Version 13.0) and a P value less than 0.05 was considered to be significant.
Results: The effect of BMI on both CSS and RFS was statistically significant (P < .001). There was also a significant relation between smoking, operation type (partial/radical), eGFR and tumor stage and CSS and RFS.
Conclusion: Our findings show that overweight and obese RCC patients according to the BMI have a more favorable
prognosis. Multicenter, prospective studies with more cases and longer oncological follow-up period are needed to support these findings.

The Association of A Number of Risk Factors With Depression in Patients With Prostate Cancer Undergoing Androgen Deprivation Therapy

Chang Hee Kim, Kwang Teack Kim, Jin Kyu Oh, Kyung Jin Chung, Tae Beom Kim, Han Jung, Sang Jin Yoon, Khae Hawn Kim

Urology Journal, Vol. 15 No. 3 (2018), 3 May 2018 , Page 104-108

Purpose: To identify factors affecting depressive symptoms in patients undergoing androgen-deprivation therapy (ADT) to treat prostate cancer.
Materials and Methods: The patients with prostate cancer visiting the psychiatry department without referral because of depressive symptoms while undergoing ADT participated. To assess depressive symptoms, the Beck Depression Inventory (BDI) was used. To identify the risk factors affecting depressive symptoms, univariate regression and multiple linear regression analyses were implemented.
Results: The mean (± SD) age, age when initiating ADT, duration of ADT, serum testosterone level and BDI scores of participants (n = 45) were 73.9 ± 7.9 years, 72 ± 8.5 years, 33 ± 31.6 months, 214.9 ± 219.5 ng/dL and 18 ± 13.5 points. The androgen dependent and independent were 26 and 9 patients. Eight of these androgen-independent patients underwent concurrent chemotherapy. Twenty-one patients were treated with bicalutamide and 24 with leuprolide. Of the clinical variables affecting BDI scores, the type of ADT drug (P < 0.001), serum testosterone level (P = 0.003), and age at diagnosis (P < 0.001) were significant.
Conclusion: Efforts to diagnose and treat depression appropriately, especially if depressive symptoms change in patients undergoing ADT to treat prostate cancer who are using an LHRH agonist (leuprolide), have low testosterone
level, or are older at the age when initiating ADT.


Pudendal Nerve Block Versus Penile Nerve Block in Children Undergoing Circumcision

Ayse Cigdem Tutuncu, Pinar Kendigelen, Gulruh Ashyyeralyeva, Fatis Altintas, Senol Emre, Rahsan Ozcan, Guner Kaya

Urology Journal, Vol. 15 No. 3 (2018), 3 May 2018 , Page 109-115

Purpose: Penile nerve block is the most popular nerve block for the circumcision in pediatric patients. This study aimed to compare the analgesic efficiency of penile nerve block and the pudendal nerve block on postoperative pain and additional analgesic requirements in children undergoing circumcision.
Material and Methods: This prospective randomized double-blind study enrolled 85 children, aged 1 to10 years, undergoing circumcision. The patients were randomly divided into two groups either receiving dorsal penile block group (PNB-Group) or pudendal nerve block (PDB-Group). In the PNB-Group, 0.3 ml/kg 0.25 % bupivacaine was used; and, in the PDB-Group, 0.3 ml/kg bupivacaine was applied with nerve stimulator at a concentration of 0.25%. In the postoperative period, the modified CHEOPS pain scale scoring and additional analgesic demand were evaluated at the 5th and 30th minutes and at the 1st and 2nd hours. The subsequent pain evaluations were made by the parents at home, at the postoperative 6th, 12th, 18th and 24th hours.
Results: Seven patients were excluded from the study, and seventy eight patients were evaluated for analysis. Patients in PDB-Group had significantly lower postoperative pain intensity and lower mCHEOPS scores (3.83 ± 0.98) when compared to the PNB-Group (6.47 ± 0.91) (P < .01) at all measurement times and none of patients in PDB-Group had additional analgesic requirements up to 24 hours. Patients in the PNB-Group had significantly more analgesic requirements at all measurements times except at the 1st, 2nd, 24th hours. 3.8%, 30.8%, 46.2% and 59% of the patients in the PNB group needed additional analgesia respectively at 5th, 6th, 12th and 18th hours.
Conclusion: Pudendal nerve block provided additional analgesic free period and had better analgesic efficiency compared to the penile nerve block lasting until 24 hours after operation.


Evaluation of PAWP and PLC? Expression in Infertile Men with Previous ICSI Fertilization Failure

Nahid Azad, Hamid Nazarian, Leila Nazari, Marefat Ghaffari Novin, Abbas Piryaei, Mohammad Hassan Heidari, Reza Masteri Farahani, Seyedeh Susan Sadjadpour

Urology Journal, Vol. 15 No. 3 (2018), 3 May 2018 , Page 116-121

Purpose: The aim of this study was to evaluate postacrosomal sheet WW domain binding protein (PAWP) and phospholipase C ? (PLC?) protein expression in patients with fertilization failure.
Materials and Methods: Semen samples were collected from 15 fertile men (control group) and 15 patients with previous fertilization failure following ICSI (FF group) and were analyzed according to World Health Organization (WHO) criteria. The mean percentages of PAWP and PLC? positive sperm and the total level of PAWP and PLC? proteins were assessed using immunofluorescence staining.
Results: A significantly lower level and lower percentage of PAWP positive sperm in patients with fertilization failure was found compared to the control group (P = 0.01 and P = 0.03, respectively). The mean percentage of
PLC? positive sperm and level of PLC? protein were significantly lower in FF group compared to the control group (P = 0.0003 and P = 0.04, respectively). Significant positive correlations was observed between PAWP and PLC? positive sperms (r = 0.4, P = 0.008) and also total level of expression of PLC? and PAWP proteins (r = 0.4, P = 0.02) in all participants in the study.
Conclusion: This is the first study that evaluates two main candidates for sperm-borne oocyte activating factors (SOAFs) simultaneously in patients with fertilization failure. Considering lower expression of PAWP and PLC? proteins in such patients, it seems like both factors might have the potential to be considered as SOAFs and diagnostic markers for the oocyte activation ability.

Artificial Neural Network for the Prediction of Chromosomal Abnormalities in Azoospermic Males

Emre Can Akinsal, Bulent Haznedar, Numan Baydilli, Adem Kalinli, Ahmet Ozturk, O?uz Ekmekçio?lu

Urology Journal, Vol. 15 No. 3 (2018), 3 May 2018 , Page 122-125

Purpose: To evaluate whether an artifical neural network helps to diagnose any chromosomal abnormalities in azoospermic males. Materials and Methods: The data of azoospermic males attending to a tertiary academic referral center were evaluated retrospectively. Height, total testicular volume, follicle stimulating hormone, luteinising hormone, total testosterone and ejaculate volume of the patients were used for the analyses. In artificial neural network, the data of 310 azoospermics were used as the education and 115 as the test set. Logistic regression analyses and discriminant analyses were performed for statistical analyses. The tests were re-analysed with a neural network. Results: Both logistic regression analyses and artificial neural network predicted the presence or absence of chromosomal abnormalities with more than 95% accuracy. Conclusion: The use of artificial neural network model has yielded satisfactory results in terms of distinguishing patients whether they have any chromosomal abnormality or not.


Mesalazine: A Novel Etiology For Drug-Induced Urinary Calculi

Blaise Corbery, Souhil Lebdai, Shahed Borojeni, Pierre Bigot, Abdel-Rahmène Azzouzi, Thibaut Culty

Urology Journal, Vol. 15 No. 3 (2018), 3 May 2018 , Page 132-133

We report the case of a 23-year-old woman treated by mesalazine for ulcerative colitis and who subsequently presented recurrent renal colic due to mesalazine urinary stones. This is the second case described in the literature.
Mesalazine stones are soft, friable and have an orange-beige color. They are not visible on non-contrast computed tomography (CT). Their diagnosis is based on morpho-constitutional analysis and CT-urography. Patients treated
by mesalazine who present renal colic should undergo CT-urography in order to make the diagnosis.

Though previous major abdominal surgery and pelvic irradiation may be a significant drawback of subsequent laparoscopic procedure, technological advances such as better visualization and more controlled finer movements
of robotic arms allowing better dissection in robotic-assisted laparoscopic surgery may reduce some of these challenges. However, limited data are available on the effect and safety of robotic surgery in these patients. The aim of this case report is to present efficacy and safety of robot assisted radical prostatectomy in a patient who has rectal and concurrent prostate cancer with the history of abdominoperineal resection, pelvic irradiation and adjuvant

First Experience of Inserting a Metallic Mesh Stent (Uventa Stent) in Malignant Ureteral Obstruction in Iran

Mohammad Ali Ghaed, Maziar Daniali, Mohammad Ebrahimian

Urology Journal, Vol. 15 No. 3 (2018), 3 May 2018 , Page 137-139

Malignant ureteral obstruction is usually caused by an extrinsic compression including intra-abdominal cancers. One of the treatment modalities decompressing the obstruction is applying stent to open the ureter. Metallic Stent is an effective instrument which we used for the first time in Iran in our patient who had a metastatic colon cancer
with a single kidney and we used a Novel, Double-Layered, Coated, Self-expandable Metallic Mesh Stent (Uventa Stent) to keep the ureter open. After six months of follow up with ureteroscopy, there was no obstruction any more.

An Unusual Complication of Suprapubic Catheter Migration into the Left Ureter

Wang Shuaibin, Mu Haiqi, Feng Qin, Yu Haifeng

Urology Journal, Vol. 15 No. 3 (2018), 3 May 2018 , Page 140-142

Suprapubic cystostomy is a widely employed procedure that is used to drain the bladder. Despite being a safe procedure, suprapubic cystostomy has been reported to present multiple intra- and postoperative complications. Serious and unusual complications can occur during changing of the suprapubic catheter (SPC) in patients with neuropathic bladder. In this work, we report an elderly patient with neuropathic bladder suffering from an unusual complication involving migration of the SPC into the ureter during changing of the SPC, leading to ureteric obstruction and left pyelonephritis.



Introduction: Postoperative pain from male circumcision (MC) is common especially in the sleep-related erection period. This study aims to explore the effect of interrupted rapid eye movement (IREM) sleep on relieving SRE-related incision pain and the improvement of other clinical outcomes.
Materials and Methods: This simple randomized controlled study was conducted between May and November 2016. Approval was obtained from the local ethical committee on 5 May 2016. Ninety participants who underwent male circumcision were divided into the interrupted rapid eye movement sleep group and the control group. The times and the cumulative time of erection-related moderate and severe pain in minutes at night for 3 days after the operation were observed and compared. We also compared the condition of the incision swelling and healing.
Sleep time at night was used to evaluate the safety of interrupted rapid eye movement sleep.
Results: For the first 3 days after the operation, the times of sleep-related erection pain were significantly decreased in the IREM sleep group (P = .010). Five patients reported that there was no pain during night. The cumulative time of erection-related moderate and severe pain was statistically decreased in the interrupted rapid eye movement sleep group (P = .034). After 3 days, there was no moderate and severe pain related to sleep-related erection in the 2 groups. There were no significant differences in incision swelling (P = .768), healing (P = .626), and sleep time (P = .231).
Conclusion: Interrupted rapid eye movement sleep is an effective, simple, and free treatment to relieve incision pain of sleep-related erections.