فهرست مطالب
Urology Journal
Volume:12 Issue: 6, Non-Dec 2015
- تاریخ انتشار: 1394/10/22
- تعداد عناوین: 16
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Pages 2387-2390PurposeThe aim of this study was to investigate the anti-urolithiasis effects of aqueous extracts of Malva neglecta Wallr on ethylene glycol and ammonium chloride induced kidney stones in a rat model.Materials And MethodsA total number of 64 male Wistar rats were randomly divided into eight groups equally: group I (normal control), group II (disease control), groups III and IV (sham), groups V and VI (preventive groups), and groups VII and VIII (curative groups). Group I received tap drinking water, groups III and IV were given intra-peritoneal injections of 200 and 800 mg/kg aqueous extracts for 28 days. Groups II, V, VI, VII, and VIII received 1% ethylene glycol plus 0.25% ammonium chloride in drinking water for 28 days. Groups V and VI were given intra- peritoneal injections of 200 and 800 mg/kg aqueous extracts for 28 days and groups VII and VIII received intra-peritoneal injections of 200 and 800 mg/kg aqueous extracts from the 14th day of the experiment. After 28 days the kidneys were removed and observed for calcium oxalate (CaOx) deposits and tubulointerstitial changes.ResultsThe extract significantly decreased CaOx deposits and tubulointerstitial damage in the preventive groups (P <. 001). In curative groups, a low dosage of extract, reduced kidney oxalate deposits and tubulointerstitial damage (P <. 05). In addition a significant decrease was observed in crystal deposition and tubulointerstitial damage in high dosed group (P <. 001). However, high dosed preventive and curative groups seemed to be more effective (P ≤. 001).ConclusionMalva neglecta Wallr has beneficial effects on preventing and treating CaOx deposition and decreasing tubulointerstitial damage on a dosage dependent manner. These effects may be due to the components presented in this plant such as saponins, flavonoids, mucilage, and phenolic compounds.Keywords: animals, calcium oxalate, ethylene glycol, kidney, drug effects, kidney tubules, pathology, rats, treatment outcome, urolithiasis, chemically induced, drug therapy
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Pages 2391-2395PurposeWe aimed to investigate relationship between metabolic syndrome and calcium-oxalate stone formation.Materials And MethodsBetween January 2008 and February 2015 we retrospectively investigated biochemical parameters and anthropometric characteristics (height, weight, and waist circumference) of 198 patients who had calcium-oxalate stones and we also randomly selected 200 participants who had no history of urolithiasis as the controls.ResultsThe presence of obesity increased the risk of calcium stones in both men (P =. 003, OR = 2.92) and women (P =. 03, OR = 2.18). Diabetes was significantly correlated to the risk of calcium stones (P =. 04, OR = 1.94). However, when calculated separately for men and women, diabetic men had a higher risk of calcium-oxalate stone disease (P =. 04, OR = 2.59), but diabetic women did not (P >. 05). Hypertension also significantly increased the risk of calcium stones when compared with normotensive individuals (P =. 0001, OR = 3.03).ConclusionThe risk for the development of calcium-oxalate stone disease is most significantly associated with the patient's body mass index and the presence of hypertension.Keywords: metabolic syndrome, epidemiology, outcome assessment, prevalence, risk assessment, urolithiasis, etiology
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Pages 2396-2399PurposeTo investigate the extent of renal arterial injury incurred by different size of nephrostomy tracts from 10 French (F) to 32F in vitro porcine kidney.Materials And MethodsTo simulate the technique of percutaneous nephrostomy we set up 12 groups of different size nephrostomy tracts from 10F to 32F, including 40 nephrostomy tracts in each group. Digital subtraction angiography (DSA) was used to inspect and analysis of arterial injury.ResultsWhen the size of nephrostomy tracts is increased from 10F to 32F, the degree of arterial injury is also aggravated. With 14F compared to 24F, the number of nephrostomy tracts with serious arterial injury was 12 (12/40) and 23 (23/40), respectively (P <. 05). With 18F compared to 30F, the number of nephrostomy tracts with serious arterial injury was 16 (16/40) and 30 (28/40), respectively (P <. 01).ConclusionWhen the size of nephrostomy tract is increased, the degree of renal arterial injury is also heightened. When 18F tracts was compared to 30F tracts and 14F tracts compared to 24F tracts, obvious reduction of arterial injury is observed.Keywords: nephrostomy, percutaneous, kidney, angiography, digital subtraction, hemorrhage, animal
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Pages 2400-2403PurposeSingle port laparoscopic varicocelectomy had been introduced to treat varicocele. As the special instrument with three ports was a bit larger for children, a modified technique of single incision with two trocars was attempted in our department. The study was designed to compare it with the traditional laparoscopic method via three ports.Materials And MethodsTwelve boys of 14 varicoceles were admitted to accept laparoscopic varicocelectomy of single incision with two trocars. Thirty-two patients of 33 varicoceles with traditional three-port laparoscopy were reviewed as control. Data were collected to compare within the two groups.ResultsAll procedures were completed successfully in both groups. No significant difference in terms of patient’s age, operative time, blood loss, analgesic requirement, hospital stay or complication.ConclusionThe technique of laparoscopic varicocelectomy of single incision with two trocars was safe and effective. With the benefit of cosmetic appearance, it could be more satisfying.Keywords: laparoscopy, adolescent, vascular surgical procedures, methods, postoperative complications, treatment outcome, urologic surgical procedures
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Pages 2404-2409PurposeProstate cancer (PCa) poses a significant health problem in developed countries. Prostate specific antigen (PSA) based screening for PCa is controversial and large trials have failed to show a significant reduction in prostate-specific mortality and all-cause mortality. Considering the contradictory data on PCa screening, current guidelines emphasize shared decision making. Physicians are the ones in charge of helping patients with informed decision making, so we conducted this study to find out what urologists would do for themselves as patients.Materials And MethodsUrologists attending the 15th congress of Iranian Urological Association were invited to participate in a questionnaire-based survey on PCa screening. A total of 184 physicians completed the questionnaire.ResultsOf participants 76.8% declared that they would like to be screened. 69.3% of those in favor of screening did not consider digital rectal examination (DRE) as part of their screening program. 62.8% of the urologists willing to be screened chose serial PSA as their follow up method in case their PSA level came above normal ranges, and 35.8% preferred to be biopsied.ConclusionUrologists tend to prefer PSA screening despite the current controversy about its usefulness. Most of the urologists practicing in Iran do not choose DRE as part of their screening program. Large high quality studies conducted in other countries are needed to look into urologist's attitudes towards PCa screening, and to investigate their preferences in order to understand the rationale behind their decisions.Keywords: practice guidelines as topic, prostate, prostate, specific antigen, prostatic neoplasms, diagnosis, health knowledge, attitudes, practice
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Comparison of Non-Hilar Clamping Simple Enucleation and Enucleo-Re¬section of Exophytic Renal TumorsPages 2410-2416urpose: To retrospectively evaluate our institutional experience with non-hilar-clamping simple enucleation (SE) and enucleoresection (ER) for the treatment of exophytic renal tumors regarding their oncological outcomes.Materials And MethodsWe retrospectively evaluated patients treated between 2006 and 2013 for clinical exophytic T1-T2a renal tumors using open nephron-sparing surgery.ResultsA total of 33 patients underwent SE and 39 underwent ER. The mean tumor size was 38.7 mm. None of the patients had positive surgical margins. No local recurrences were observed during the postoperative follow-up period (mean 40.7 ± 23.4 months); however, ipsilateral adrenal and contralateral kidney metastasis was detected in one of the patients. There was no statistically significant difference in the R.E.N.A.L Nephrometry Score, operative time, or intraoperative blood loss in the non-hilar-clamping SE and ER groups (P >. 05). During the third postoperative month, the estimated glomerular filtration rate (eGFR) levels in the SE group were significantly reduced compared with the preoperative eGFR levels (P =. 046).ConclusionSE and ER with non-hilar clamping are safe, acceptable approaches for treating exophytic renal tumors.Keywords: carcinoma, renal cell, surgery, follow, up studies, kidney neoplasms, mortality, nephrectomy, adverse effects, organ sparing treatments, methods, glomerular filtration rate
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Pages 2417-2421PurposeTo evaluate the clinical efficacy of bladder hydrodistention and intravesical sodium hyaluronate in the treatment of interstitial cystitis (IC).Materials And MethodsTwenty-one patients with IC received intravesical sodium hyaluronate therapy under nerve block or intravenous anesthesia. Bladders were perfused with 100 cmH2O perfusion pressure and expanded for 10 min and were later injected with 40 mg/50 mL sodium hyaluronate through the catheter. After 1 h, the perfusion fluid was released. Perfusion was applied once per week, 4 to 6 times as a course of treatment.ResultsUnder anesthesia, the average bladder capacity was 191.62 ± 88.67 mL, and after bladder expansion, the bladder capacity reached 425.33 ± 79.83 mL (P =. 000). There were 2 suspected bladder ruptures after bladder expansion at 6.5 min and 7.2 min. After 10 min of bladder expansion, there were 19 cases of significantly gross hematuria. After treatment, the catheters of 17 patients were removed at 24 h; for the 2 cases of hematuria, catheters were removed at 72 h and for the 2 cases of suspected bladder rupture, catheters were removed after 4 days. After catheter removal, the pain threshold significantly decreased, and the maximum urinary output increased slightly. Compared with values before treatment, the day before the second injection of sodium hyaluronate, the frequency of urination decreased significantly (32.8 vs. 18.5 times/24 h), the maximum urinary output increased significantly (86.7 vs. 151.9 mL), the pain decreased significantly (8.7 vs. 3.0), and the OLeary-Sant IC score and quality of life score were significantly decreased (30.0 vs. 17.0 and 5.9 vs. 2.4, respectively) (P =. 000).ConclusionBladder hydrodistention under anesthesia for patients with severe intractable IC produces immediate effectiveness; sodium hyaluronic infusion can alleviate frequent urination and pain, and the efficacy was positively correlated with the duration of treatment.Keywords: anesthesia, cystitis, interstitial, therapy, female, prospective studies, urinary bladder, dilatation, methods, treatment outcome, lower urinary tract symptoms, etiology
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Pages 2422-2427PurposeTo evaluate and compare the outcomes of benign, primary vesicovaginal fistulas (VVFs) treated using the transabdominal transvesical technique and the transvaginal technique without tissue interposition.Materials And MethodsA total of 53 consecutive women with VVF who were treated between September 1999 and October 2014 were evaluated retrospectively. Patients with a malignant etiology and/or prior irradiation were excluded because they required a more complex repair. In the first group, the repair was performed using the transabdominal transvesical technique (n = 28). After one of our fellows had completed his urogynecology training, he began to perform the repairs using the transvaginal technique (n = 25). All included VVF patients were treated without a tissue interposition.ResultsVesicovaginal fistula repair was performed in 53 patients, with a mean age of 41.4 ± 15.2 years. There was no significant difference in terms of the patient's age, fistula size, and the number of deliveries between the groups. All cases failed in terms of conservative management. The size of the fistulas ranged from 15 to 20 mm. The admission time was between 3 days and 21 years, and it was longer in less educated patients. The success rate was 96.4% (27/28) in the transabdominal transvesical group and 100% (25/25) in the transvaginal group (P = 1.00). The hospitalization period and complications were significantly reduced in the transvaginal group (P =. 00 and P =. 004, respectively). No patients converted from a transvaginal to a transabdominal repair. There was only one recurrence in the transabdominal transvesical group.The patients were followed up for 1 year.ConclusionTransvaginal repair of benign, primary VVFs is more advantageous than transabdominal transvesical repair. There was a significant decrease in the hospitalization period and complications rates using the transvaginal technique without tissue interposition.Keywords: vesicovaginal fistula, surgery, retrospective studies, treatment outcome, gynecologic surgical procedures, methods
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Pages 2434-2435PurposePeyronie's disease (PD) is a condition of middle aged men and frequently accompanied by erectile dysfunction (ED) which was attributed to penile deformity, vascular pathology and psychological components. The implantation of semi-rigid penile prosthesis allows for these patients to undergo a simple procedure aimed at correction both penile deformity and ED. The aim of this study was to investigate surgical and clinical outcomes and patient satisfaction rate at long term follow-up after semi-rigid penile prosthesis implantation (PPI) in men with PD and ED.Materials And MethodsA total of 66 patients with mean age of 49.2 (range, 30-76) years old underwent semi-rigid PPI between 1995 and 2006. Genesis (Coloplast®) was used for implantation in a standard manner by penoscrotal approach without using any graft and remodeling technique. In all patients, dilatation of corpora was performed without any difficulty and straightening of the penis was achieved. A retrospective review of clinical database and prospective telephone survey were conducted in all patients.ResultsThe mean follow-up time was 9.7 years (range, 6 to 17). There wasnt any clinical infection and complication during follow-up period. Fifty-nine patients were sexually active at the time of the interview. None of the patients reported residual curvature. The overall patient satisfaction was 91.5% (54 patients). Primary reasons for dissatisfaction were decreased penile length and prosthesis problems.ConclusionBased on our results semi-rigid PPI is effective and easy procedure for treatment of men with PD and ED without any complication and with high patient satisfaction rate in long-term follow up period.
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Pages 2436-2443PurposeTesticular sperm extraction (TESE) for intracytoplasmic sperm injection (ICSI) was first introduced for the treatment of non-obstructive azoospermia. This study was conducted to detect predictive factors affecting the success of microTESE.Materials And MethodsWe retrospectively evaluated the results of 191 cases who underwent microTESE. For each patient, the testicular volume, endocrine profile [follicle stimulating hormone (FSH), luteinizing hormone (LH), free testosterone (FT), total testosterone (TT)], serum inhibin B level, karyotype analysis, and Y chromosome microdeletions were recorded, and all data were analyzed to detect any predictors. The receiver operating characteristic curve, two-sample t-test and regression analysis were used for the statistical analysis.ResultsThe mean age of the patients was 34.4 ± 5.6 years. Sperm retrieval was successful in 104 (54.5%) patients, and there was no sperm in 87 (45.5%). Seven factors including, testicular size, Johnson score, Y chromosome microdeletion, and serum FSH, LH, FT and TT levels were different between the successful and unsuccessful groups. Six patients had Klinefelter syndrome, and ten patients (5.2%) had a Y chromosome microdeletion (5 AZF-c, 1 AZF-b, 2 AZF-bc, 1 AZF-abc, and 1 AZF-ac). The Johnson score, TT level, family history and Y chromosome microdeletions were determined to be independent predictive factors for sperm found. According to the testicular histology, the sperm-found ratios were 36%, 48.6%, and 95.5% in the sertoli cell only syndrome, maturation arrest, and hypospermatogenesis groups, respectively.ConclusionAccording to our results, the Johnson score, TT level, family history-related infertility, and Y chromosome microdeletions were determined to be independent predictive factors for sperm found.
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Pages 2447-2451PurposePharmacologic effects of nicotine are multifaceted and complicated. Despite numerous studies, the effect of smoking on lower urinary tract functions, have not been yet studied in detail. In this study, we aimed to investigate the effects of smoking addiction on lower urinary tract and sexual functions on the basis of respiratory functions.Materials And MethodsA total of 186 male patients who have been evaluated between May 2014 and January 2015 were recruited in this study. Smoking history, respiratory symptoms, respiratory function tests, uroflowmetry parameters relating to lower urinary tract symptoms (LUTS), prostate volume, post-voiding residual urine volume and sexual functions of patients have been retrospectively investigated.ResultsWe determined that as the mean number of cigarettes smoked daily increases, post-void residual urine volume and International Prostate Symptom Score (IPSS) also increase. Moreover in accordance with this finding, mean urinary flow rates and quality of life scores were statistically significantly decreased. In smoking addicts who have high mean package/year, post-void residual urine volume and IPSS levels were increased but proportionately maximum urinary flow rate and average urinary flow rate plus quality of life scores were found to be statistically significantly decreased. In patients with forced expiratory volume in first second:forced vital capacity (FEV1/ FVC) ratio less than 80%, mean urinary flow rates were found to be statistically significantly low. Also, we determined that in smoking addicts who have high mean package/year, erectile functions were statistically significantly impaired.ConclusionWe showed negative impacts of smoking addiction on LUTS, patient's quality of life, and sexual functions.Keywords: risk factors, smoking, adverse effects, lower urinary tract symptoms, etiology, urinary bladder
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Pages 2452-2456PurposeTransurethral resection of the prostate (TURP) is considered gold standard for surgical treatment of benign prostatic hyperplasia (BPH). In this study, we aimed to compare post-operative clinical outcomes and adverse effects between monopolar and bipolar TURPs.Materials And MethodsThe study included 590 patients who underwent TURP by a single urologist (E.H.) between June 2006 and June 2014 with a diagnosis of BPH. Patients were divided into two groups as monopolar TURP (group 1, n = 300) and bipolar TURP (group 2, n = 290). Patients receiving oral anticoagulants or aspirin and those with prostate cancer diagnosis were not included in the study. Data regarding pre-operative age, International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post voiding residual urine volume (PVR), serum prostate specific antigen (PSA) levels and prostate volume (Vp) of the patients were gathered from medical records. Groups were compared in terms of catheterization, operation time, hemoglobin (Hb) decrease, and IPSS, Qmax, and PVR values at post-operative 12th month follow-up visit.ResultsFrom pre-operative to post-operative period, IPSS, Qmax and PVR showed significant improvements within both groups (P <. 001). When groups were compared with each other, bipolar TURP group had significantly lesser catheterization time and hemoglobin decrease than monopolar TURP group, while no significant differences were detected regarding all other variables.ConclusionBipolar and monopolar TURPs are both effective and safe treatment modality for BPH. Bipolar TURP is superior to conventional monopolar TURP in terms of catheterization time and Hb decrease.Keywords: prostatic hyperplasia, surgery, prospective studies, transurethral resection of prostate, methods, electrosurgery, adverse effects, hot temperature, electrocoagulation, instrumentation
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Pages 2457-2461PurposeTo design a whole-kidney a cellular matrix scaffold using peristaltic pump perfusion and to ascertain the retention of extra cellular proteins by the scaffold.Materials And MethodsMale Sprague-Dawley (SD) rats weighing 200-250 g were used. Intravenous catheters were inserted into the renal artery followed by perfusion of decellularization solution using a peristaltic pump. After decellularization, the acellular matrix was observed under a microscope after hematoxylin and eosin (H&E) staining and a fluorescence microscope after 4′,6-diamidino-2-phenylindole (DAPI) staining. Immunohistochemistry was used to identify the composition of kidney acellular matrix.ResultsThe result of H&E and DAPI staining demonstrate the removal of cellular material in kidney a cellular matrix. Immunohistochemistry confirmed the conservation of the natural expression of extra cellular matrix proteins including collagen types I and IV, fibrin and laminin.ConclusionPeristaltic pump perfusion enables successful preparation of renal a cellular matrix, to retainthe criticalproteins of natural extra cellular matrix. The resulting kidney a cellular matrix represents an ideal natural scaffold for renal tissue engineering.Keywords: disease models, animal, kidney, metabolism, rats, in vitro techniques, infusion pumps