Urology Journal

Purpose: The aim of the study was assessment of four selected macromolecules level: osteopontin, calgranulin, uromodulin and bikunin in fresh morning urine sample in children with nephrolithiasis in the course of idiopathic hypercalciuria.
Materials and Methods: The study included 90 subjects aged from 12 months to 18 years. The study group comprised 57 subjects- children with urinary tract lithiasis in the course of idiopathic hypercalciuria and the control group - 33 healthy children with no history of urolithiasis. Determinations of osteopontin, calgranulin, uromodulin and bikunin levels in the first morning urine were performed.
Results: The study group had a significantly decreased osteopontin excretion and significantly increased bikunin
excretion, and increased, however statistically nonsignificant, calgranulin excretion in comparison with the control group. Uromodulin excretion did not differ between groups. In both groups a statistically significant positive correlation was observed between uromodulin and bikunin levels.
Conclusion: Children with urinary tract lithiasis in the course of idiopathic hypercalciuria reveal a different distribution of the study proteins than a healthy population.

Purpose: To report de novo calculi in the prostatic surgical bed as a complication of Holmium laser enucleation of the prostate (HoLEP).
Materials and Methods: Patients who underwent HoLEP and were enrolled in our Benign Prostatic Hyperplasia (BPH) Database Registry from July 2008 to December 2015 were reviewed. Cases of calculi removal in the prostatic surgical bed were identified. Clinical data, including preoperative evaluation, postoperative symptoms with a detailed history, urinalysis, pathology, cystourethroscopy, and stone analysis were collected and described.
Results: Eight patients were identified including one patient who underwent HoLEP at another hospital. Among the 877 patients in our BPH database, 7 (0.8%) underwent calculi removal in the prostatic surgical bed. Median age was 67.0 years. Median prostatic volume was 75.5mL. The most common symptom was severe stabbing urethral pain (n = 4), with a median of 13 months after HoLEP. Calculi were pedunculated in the prostatic surgical bed or in the bladder neck with a small mucosal connection. Pathology of the resected tissue showed granulation tissue
formation and dystrophic calcification.
Conclusion: Calculi in the prostatic surgical bed or the bladder neck after HoLEP have never been reported previously. Although it is very rare, recurrent urethral pain, persistent pyuria, and recurrent gross haematuria are signs for further investigation. Cystourethroscopy should be performed to rule out the presence of stones. Careful history taking and having an index of suspicion are important for the diagnosis.

Purpose: The objective was to compare the efficacy of 99mTc-MDP-BS, 18F-FDG-PET/CT and 18F-FCH-PET/CT in detecting bone metastases in prostate cancer patients.
Materials and methods: 56 patients diagnosed with prostate cancer underwent 99mTc-methylendiphosphonates bone scintigraphy (99mTc-MDP-BS) and fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) or fluorine-18-fluorocholine PET/CT (18F-FCH-PET/CT) within six weeks. There were 27 patients examined with 99mTc-MDP-BS + 18F-FDG (mean age 67.96 ± 9.04 years) and 29 patients examined with 99mTc-MDP-BS + 18F-FCH (mean age 73.93 ± 8.75 years). The R factor in scintigraphy and semi
- quantitative analysis with Standardized Uptake Value (SUV) in the PET/CT were used using semi - automatic methods of bone lesions’ contouring. The R factor was calculated as the total count rate in bone metastasis and the total count rate in contralateral area ratio. For further analysis, the mean pixel and the total surface of lesion product in scintigraphy, the Total Lesion Glycolysis (TLG) in the 18F-FDG-PET/CT and the Total Lesion Activity (TLA)
in the 18F-FCH-PET/CT were evaluated.
Results: The average maximal SUV (SUVmax) value was significantly higher in patients who underwent 18F-FCH-PET/CT than in 18F-FDG-PET/CT (5.17 ± 2.24, 3.71 ± 1.56, P < .05). The R factor differences in both groups (patients who underwent BS and 18F-FDG-PET/CT, BS and 18F-FCH-PET/CT) were insignificant (1.92
± 0.87, 2.03 ± 0.57, respectively, P > .05). There was no statistically significant correlation (Pearsons’ correlation
coefficient - Rp) between the R factor and the SUVmax within examined groups (Rp = .42; P = .31) and between the R factor and the SUVmean (Rp = .43; P = .28). A high Rp between measured total surface in the BS and volume in the PET/CT of the metastatic lesion was found. In patients who underwent BS + 18F-FDG-PET/CT and BS +18F-FCH-PET/CT, Rp equaled .95 and .70.
Conclusion: 99mTc-MDP-BS, 18F-FDG-PET/CT and 18F-FCH-PET/CT occurred as comparable imaging methods in bone metastases detection in the prostate cancer patients and provide complementary clinical conclusions.

Purpose: To evaluate of the presence of a median lobe(ML) affect perioperative complications, positive surgical margins(PSM), biochemical recurrence(BCR) and urinary continence(UC) following robotic-assisted radical prostatectomy(RARP).

Materials and Methods: Data of 924 consecutive patients who underwent RARP for prostate cancer (PCa) and who have at least 1-year follow-up were evaluated retrospectively. All patients were divided into two groups: Group 1(n=252) included patients with ML and Group 2 (n=672) included patients without ML. The primary endpoint of this study was to compare complication rates between two groups. The secondary endpoints were to compare PSM, BCR and UC rates.

Results: Both groups were statistically similar in terms of demographics and variables about PCa. Mean prostate volume was higher in Group 1 vs. Group 2 (69± 31 vs. 56±23 mL, p<.001). Total operative time was longer in Group 1 vs. Group 2 (144±38 vs. 136±44 min, p=.01). Biochemical recurrence, PSM, perioperative and postoperative complication rates of our population were 13.6%, 14.9%, 1.7% and 8.7%, respectively. There were no statistical differences in terms of perioperative complication, PSM and BCR rates between the groups(p>0.05). At the first month after RARP, total continence rate was statistically significant lower in Group 1 vs. Group 2 (49.2% and 56.5%, p=.03), respectively. However, there were no significant differences in terms of continence rates at 3rd month, 6th month and 1^st-year follow-up.

Conclusions: Due to our experience, the presence of ML does not seem to affect perioperative complication, intraoperative blood loss, PSM and BCR following RARP. However, the presence of ML seems to be a disadvantage in gaining early UC following RARP.

Purpose: There is a lack of reporting of the bladder cuff pathology in the literature and ongoing debate regarding the role of bladder cuff excision (BCE) in the prognosis in patients with upper tract urothelial carcinoma (UTUC). We aimed to know the risk factors, the survival, and the clinical course of such pathology.
Materials and Methods: The study was retrospective, from 1983-2013 on 305 patients who had diagnosed with UTUC. Patients were managed by radical open/ laparoscopic nephroureterectomy with bladder cuff excision. The tumor was staged using 1997 TNM classification and the 3-tiered WHO grading system was used for grading. Patients who found to have a malignant bladder cuff on the final pathology were further analyzed for the risk factors for such disease and its effect on survivaltheir outcomes.
Results: 13/ 281 (4.6%) cases were found to have malignant bladder cuff. Regarding tumor stage; one case was diagnosed with Tis, eight had T1 and four cases had T2 malignant bladder cuff. All cases were with pure ureteric or multifocalcentric tumors, and none had pure pelvicalyceal tumors (p = .001).
Local recurrence at the surgical site and distant metastasis were significantly higher among patients with malignant bladder cuff (p = .001 and .002 respectively), and the last sustained its significance in multivariate analysis. Those patients had a poor prognosis when compared to non-malignant bladder cuff cases (Log Rank test, p = .001)
Conclusion: Ureteric tumor is the only independent risk factor for malignant bladder cuff at the final pathology and is associated with increased risks for invasive bladder tumor, distant metastasis and poor survival in comparison with non-malignant bladder cuff. In a clinical implementation, BCE is considered as a mandatory step in management of ureteric tumors, while it could be omitted in pure and low grade renal pelvis tumors.

Purpose: (i) to assess the quality of health websites on kidney transplant and (ii) to evaluate the accessibility of these websites and their concordance with the existing guidelines.
Materials and Methods: The terms “kidney transplantation” and “renal transplantation” were searched in the three most popular search engines Google, Yahoo, and Bing. 58 unique websites were eligible for the analysis . The Websites accessibility was evaluated using the AChecker tool. Kruskal–Wallis test was performed to examine any significant difference between accessibility issues across different domains. The eligible websites were screened
for quality based on the HONcode of conducts. Moreover, the daily traffic data of each website was determined by Alexa. The correlation of known accessibility problems with website popularity was examined too.
Result: The main reported known problems belonged to “scripts must have functional text,” “text equivalents,” “accessible forms,” and “text links for server-side image map”. Although the mean accessibility errors in governmental (10.25 ± 7.274) and organizational (12.31 ± 9.469) websites were less than those in the other domains, the differences were not significant (P = 0.60). Findings showed no significant correlation (P > 0.05) between
the extent of known problems (16.50 ± 12.18) and Alexa ranking (253675.07 ± 534690.947). Furthermore, most websites on kidney transplant were not certified by the HONcode.
Conclusion: The health websites designers should be aware of accessibility problems, because there is a growing population of potential users with disabilities. This study indicated the need to ensure the compliance of kidney transplant websites with accessibility guidelines such as Section 508. Furthermore, most surveyed websites were of poor quality and unreliable. Therefore, physicians should warn their patients about unqualified online health information and guide them to websites which are more reliable.

Purpose: The purpose of this study was to identify the risk factors for everolimus discontinuation in kidney transplant recipients converted to everolimus with calcineurin inhibitor (CNI) minimization at a late post-transplant stage.
Materials and Methods: An observational retrospective cohort study was conducted on a total of 38 recipients of kidney transplantation at our institution from June 2012 to March 2015 who were converted from antimetabolites to everolimus at a late post-transplant stage and followed for 1 year. We divided the patients into two groups to evaluate the factors affecting everolimus discontinuation after conversion: everolimus continuation group (n = 23), patients in whom everolimus maintained, and everolimus discontinuation group (n = 15), patients in whom everolimus were stopped within 1 year after conversion.
Results: Age at conversion was significantly older in the everolimus discontinuation group compared to the everolimus continuation group (57.9 ± 12.0 years in the everolimus discontinuation group vs 45.7 ± 11.2 years in the everolimus continuous group; P = .0062). Multivariate cox proportional hazard regression analysis revealed that age at conversion significantly correlated with everolimus discontinuation (P = .012). Receiver operating characteristic curve of age at conversion showed that the cut-off value was 55 years old for the everolimus discontinuation group [area under curve 0.804, 95% confidence interval (0.654-0.954), sensitivity 86.7%, specificity 65.2%].
Conclusion: Our results indicated that late conversion to everolimus with CNI minimization in elderly recipients older than 55 years of age may be associated with more frequent adverse events and discontinuations.

Purpose: Hypospadias is a common developmental anomaly of the male external genitalia. In previous studies conducted on West European, Californian, and Han Chinese populations the relationship between polymorphic variants of the diacylglycerol kinase kappa (DGKK) gene and hypospadias have been reported. The aim was to study the possible associations between polymorphic variants of the DGKK gene and hypospadias using an independent sample of the Polish population.
Materials and Methods: Ten single nucleotide polymorphisms in DGKK, which were reported to have an impact on the risk of hypospadias in other populations, were genotyped using high-resolution melting curve analysis in a group of 166 boys with isolated anterior (66%) and middle (34%) forms of hypospadias and 285 properly matched controls without congenital anomalies.
Results: Two DGKK variants rs11091748 and rs12171755 were associated with increased risk of hypospadias in the Polish population. These results were statistically significant, even after applying the Bonferroni correction for multiple comparisons (P < .005). All the tested nucleotide variants were involved in haplotype combinations associated with hypospadias. The global p-values for haplotypes comprising of rs4143304-rs11091748, rs11091748-rs17328236, rs1934179-rs4554617, rs1934183-rs1934179-rs4554617 and rs12171755-rs1934183-rs1934179-
rs4554617 were statistically significant, even after the permutation test correction.
Conclusion: Our study provides strong evidence of an association between DGKK nucleotide variants, haplotypes and hypospadias susceptibility.

 Purpose: The aim of this study is to explore the normal external urethral meatal and glans closure line in normal boys, and to investigate the correlation between these glans biometrics and the age of the participants.

Material and Method: 103 male children were asked to participate in the study during ritual circumcision. Par­ents of 94 of them (mean age 5.9 years, range 0.6–13) accepted while remaining 9 did not. Glans biometrics were measured using digital calipers.

Result: 100% of the study participants had a vertical slit-like meatal opening located at the tip of the glans. The length of the meatal opening was 5.3 (± 1) mm and of ventral glans closure was 4.8 (±1.1) mm. Significant cor­relation between both the external meatal opening and closure lines lengths and age was observed. Moreover, the meatal opening size was correlated to the glans closure line as well (r = 0.36, confidence interval 0.14–0.54, P < .001).

Conclusion: The site and size of the meatus opening in normal male children is consistent, and ventral glans clo­sure is equal to or slightly less than meatal length. These findings could aid in glanular reconstruction configuration during hypospadias surgery.

Purpose: Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are common medical problems, particularly
among older women. In this study, we aim to explore the relationship between the neurotransmitter nNOS in the vaginal epithelium, and the occurrence of SUI and changes of nNOS levels according to menopausal status.
Matherials and Methods: Fourty women were enrolled. The patients were divided into four groups according to menstruaiton status and SUI. The vagina specimens were taken during transobturator tape application. The specimens were examined pathologically in terms of n-NOS expression. nNOS expression was compared between SUI and control groups. The results were evaluated statistically.
Result: Epithelial total nNOS score in group 1 and group 3 were 2.4 ± 0.5 and 1.4 ± 0.5 respectively (P = .003). Stromal total nNOS score was found 2.2 ± 0.4 in group 1 and 1.3 ± 0.5 in group 3 (P = .001). Epithelial total nNOS score in group 2 and group 4 were 4.4 ± 0.5 and 3.5 ± 0.5 respectively (P = .003). Stromal total nNOS score was found 4.4 ± 0.5 in group 2 and 3.6 ± 0.5 in group 4 ( P = .006).
Conclusion: Our results show that expression of nNOs in the anterior vaginal epithelium decreased significantly in the SUI group. Altough our findings indicate important results, well designed further studies are needed to comprehend the role of NOS pathways better in SUI pathophysiology.

Purpose: Premature ejaculation (PE) is a prevalent disorder in males leading to sequelae such as lack of self-confidence,
anxiety, depression and unsatisfactory intercourse for these men and their partners. The aim of this study was to evaluate the relationship between ejaculation and physical activity.
Materials and Methods: Group 1 comprised 112 participants who took regular physical activity and Group 2 comprised 126 participants with a sedentary lifestyle. The participants were 18-45 years old, same ethnic origin, insame location and had regular sexual activity for at least 6 months. A comparison was made by metabolic equivalents (MET), premature ejaculation diagnostic tool (PEDT) and intravaginal ejaculatory latency time (IELT).
Result: The mean age of Groups 1 and 2 was 25.34 years (range, 18-41 years) and 28.49 years (range, 19-45 years), respectively (P = .21). The mean PEDT score was 6.18 in Group 1, and 10.02 in Group 2. Significant differences were found between Groups 1 and 2 (P = .001). The mean MET score of Group 1 was 3448.23 METmin/week (3012-4496 MET- min/week) while the MET score of Group 2 was 201.87 MET- min/week (66-744 MET- min/week) (P = .001). The mean IELT of Groups 1 and 2 were 316.42 s (120-1530 s) and 189.32 s (20-450 s), respectively. The mean IELT was significantly higher in Group 1 (P = .001).
Conclusion: The study results demonstrated that PE was less frequent in men that perform regular physical activity
compared to those with a sedentary lifestyle. It can be assumed that regular physical activity may be effectual in gaining a sexual life of higher quality. Prospective studies with longitudinal data are needed to further understand the potential relationship between regular physical activity and premature ejaculation.

Herein we report a case of Kimura’s disease with unusual manifestations. A 46-year- old Chinese man presented with mass in scrotum which gradually increased in size for approximately 7 years. A computerized tomographic scan of abdomen revealed a soft-tissue density shadow in scrotum and enlargement of lymph nodes in groin and retroperitoneum. The scrotal mass was excised and the biopsy specimen revealed angiolymphoid hyperplasia with infiltration of eosinophils. In conclusion, clinical doctors should pay attention that the patient with eosinophilia and scrotal mass could be indicative for Kimura’s disease.

Male sling for urinary incontinence is usually accompanied by very good results, with a small number of complications,
but, when appear, they may be redundant. Voluminous urethral stone developed on suburethral sling as a result of sling erosion into the proximal urethra is an extremely rare complication (following the analysis of cases published on the internet, the authors of this article no longer identified another similar case). We present the case of a patient who presented in our clinic for severe and permanent urinary incontinence, perineal discomfort
and pain that was influenced by position. His past medical history showed polytrauma with lumbar fracture and medullary involvement (34 years ago) and transobturator suburethral sling surgery for urinary incontinence about 6 years ago in another urology unit, without relieving symptoms. Imaging investigations have showed a voluminous urethral stone developed on polypropylene sling and another small stones in that area. Stones surgical extraction was performed by perineal approach (together with the mesh), proximal urethra was closed after excision to apparently healthy urethral tissue (to prevent possibility of later severe incontinence) and a permanent suprapubic cystostomy catheter was inserted. Patient is dry at follow-up visits (at 1 and 3 months) and he reported significant improvement in quality of life. The case is spectacular due to the rarity of the complication presented, patient developingurethral erosion without clinical manifestations to suggest this matter (infection or fistula), the symptoms being absent for a long time.

Purpose: To assess early and late-term outcomes of patients who had undergone pelvic exenteration and simultaneous fecal and urinary diversion with plain wet colostomy (PWC) or double-barrelled wet colostomy (DBWC).
Materials and Methods: The medical records of all patients who had undergone pelvic exenteration and urinary diversion between 2006 and 2017 at our hospital were reviewed retrospectively.
Results: In total, 15 patients with a mean age of 56 ± 13 years were included in the study. Simultaneous urinary and fecal diversions were carried out as PWC (n = 8), or DBWC (n = 7). No significant differences were found between PWC and DBWC groups in terms of operation time (373.7 ± 66.5 versus 394.2 ± 133.2 min, P = .955), estimated blood loss (862.8 ± 462.4 versus 726.2 ± 489.4 mL, P = .613), length of hospital stay (13.2 ± 9.1 versus 14.1 ±6.9 days), early complications (25% versus 28.6%, P = 1.0) and late term complications (37.5% versus 42.9%, P = 1.0). The rate of recurrent pyelonephritis in PWC group was higher than DBWC group but not statistically significant (37.5% versus 14.3%, P = .569). Overall survival (OS) of the patients was 385 ± 91 days. There was no difference between OS of patients with PWC and DBWC (414 ± 165 versus 352 ± 70 days, P = .618).
Conclusion: PWC and DBWC are valid options for creating simultaneous urinary and fecal diversion after extensive pelvic surgery in patients with short life expectancy. DBWC might be superior to PWC in terms of decreased risk of recurrent pyelonephritis.