فهرست مطالب

Urology Journal - Volume:3 Issue: 1, Winter2006

Urology Journal
Volume:3 Issue: 1, Winter2006

  • 80 صفحه،
  • تاریخ انتشار: 1385/02/25
  • تعداد عناوین: 15
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  • Canda Ae, Kirkali Z Page 1
    Introduction
    The aim of this review is to provide an update on the current management of renal cell carcinoma (RCC) and targeted molecular therapy for metatstatic RCC.
    Materials And Methods
    A Pubmed database search was performed using the keywords “renal cell carcinoma, treatment, management, localized disease, metastatic disease and targeted therapy” covering 1995 to 2006. The most recent articles published having clinical relevance were reviewed for the preparation of this paper.
    Results
    Surgery is considered as the only curative treatment for localized RCC. Currently, open radical nephrectomy is mainly performed in patients with large tumor size, locally advanced tumors and tumor thrombus extending into the vena cava. Nephron sparing surgery (NSS) is the most commonly performed procedure with excellent local cancer control in small, resectable renal tumors. Increasingly, laparoscopy is being performed and now recommended for early-stage RCCs unsuitable for NSS. Laparoscopic radical nephrectomy seems to be providing long-term cancer control comparable to open radical nephrectomy. Laparoscopic NSS is now available particularly in patients with a relatively small and peripheral renal tumor. The current therapy for metastatic RCC is inadequate and surgery is an important component of the treatment with combined immunotherapy in which response rates remain at about 15% to 25%. In the past several years, significant advances in the underlying biological mechanisms of RCC development have permitted the design of new molecularly targeted therapeutics such as antibodies, tumor vaccines, anti-angiogenesis agents and small molecule tyrosine kinase inhibitors in order to improve treatment options.
    Conclusion
    Surgery is the only curative treatment for localized RCC and NSS cures most of the patients with early-stage disease. Currently laparoscopy is recommended for early-stage RCCs unsuitable for NSS. Better understanding of the molecular pathways of carcinogenesis in RCC leads to the discovery of new drugs which can prolong survival in metastatic RCC.
  • Geavlete P., Seyed Aghamiri Sa, Multescu R Page 15
    Introduction
    Our goal was to investigate the efficacy of flexible ureteroscopy (FU) in the treatment of pyelocaliceal calculi.
    Materials And Methods
    Between September 2002 and December 2004, a total of 41 patients with multiple (23 cases), pelvic (7 cases), and inferior caliceal (11 cases) SWL-resistant calculi underwent FU. We used a 7. 5-F flexible ureteroscope with pressure irrigation and electro-hydraulic lithotripsy. The fragments were retrieved with triradiate graspers or tipless baskets.
    Results
    A double J stent had been previously placed in 34% of the patients. Dilation of the ureteral orifice was necessary in 9. 8%. The location of the calculi was renal pelvis, inferior calyx, and pelvis and calyxes in 7, 11, and 23 patients, respectively. The median operative time was 64 minutes for pyelocaliceal, 46 minutes for pelvic, and 39 minutes for inferior caliceal calculi. Complete stone clearance or good fragmentation (fragments less than 3 mm) was obtained in 71% of patients (57% for pyelocaliceal, 87% for pelvic, and 71% for inferior caliceal calculi). A successful outcome was achieved in 78%, 72%, and 49% for calculi sized 10 mm or smaller, 11 mm to 20 mm, and greater than 20 mm, respectively. Two or more procedures were required in 11 patients (27%). The complication rate was 7. 3% (hematuria, persistent renal colic, and hyperthermia).
    Conclusion
    Our experience shows that FU can be an effective approach in selected patients, especially those with kidney calculi that are resistant to SWL. However, percutaneous approach is a better alternative for calculi greater than 20 mm. ژ
  • Endourology and Stone Diseases: Editorial Comment
    Basiri A Page 19
  • Ahmadnia H., Younesi Rostami M., Yarmohammadi Aa, Parizadeh Smj, Esmaeili M., Movarekh M Page 20
    Introduction
    We sought to evaluate the safety and efficacy of percutaneous cystolithotripsy in children.
    Materials And Methods
    Thirty children (27 boys and 3 girls; mean age, 6.06 ± 2.64 years; range, 1.5 to 12 years) with bladder calculi underwent percutaneous stone removal. The mean size of the largest diameters of the calculi was 24.8 ± 8.47 mm (range, 13 mm to 50 mm). Under general anesthesia, a 1-cm incision was made 1 to 2 cm above the pubic symphysis. A 26-F nephroscope was introduced into the bladder following tract dilation, and the calculi were removed. If the calculi were larger than 1 cm, fragmentation was performed. The procedure was done without fluoroscopy. Finally, a urethral catheter was placed for 48 hours.
    Results
    All patients became stone free. The mean operative time was 23.13 ± 8.38 minutes (range, 12 to 40 minutes). All patients were discharged 24 hours after operation, except 1, who was hospitalized 2 more days for suprapubic pain and severe irritating symptoms. No significant intraoperative or postoperative complications were seen.
    Conclusion
    Percutaneous suprapubic cystolithotripsy is an efficient and safe technique for treating bladder calculi in children. We recommend this technique for treating large bladder calculi (larger than 1 cm) in children.
  • Pourmand G., Pourmand Mr, Salem S., Mehrsai Ar, Taheri Mahmoudi M., Nikoobakht Mr, Ebrahimi R., Saraji A., Moosavi S., Saboury B Page 23
    Introduction
    We evaluated the posttransplant complications resulting from infections and their association with graft function, immunosuppressive drugs, and mortality.
    Materials And Methods
    A total of 142 kidney allograft recipients were followed for 1 year after transplantation. The patients’ status was assessed during regular visits, and data including clinical characteristics, infections, serum creatinine level, acute rejection episodes, immunosuppressive regimen, graft function, and mortality were recorded and analyzed.
    Results
    Infections occurred in 77 patients (54%). The lower urinary (42%) and respiratory (6.3%) tracts were the most common sites of infection. The most frequent causative organisms were Klebsiella in 34 (24%) and cytomegalovirus in 25 patients (18%). Wound infection occurred in 7 patients (5%). The mortality rate was 7.7% and infection-related death was seen in 5 patients (3.5%) who developed sepsis. Graft loss was seen in 16 patients (11%), of whom 2 developed cytomegalovirus infection, 2 experienced urinary tract infection, and 5 developed sepsis and died. Mycobacterial and hepatitis C infections were noticeably rare (0.7% and 2.8%, respectively).
    Conclusion
    This study showed that infections are important causes of morbidity and mortality during the posttransplant period. We recommend that serologic tests be performed before and after transplantation to recognize and meticulously follow those who are at risk. In our study, high-risk patients were those with elevated serum creatinine levels who received high doses of immunosuppressive drugs. As the urinary tract is the most common site of infection, early removal of urethral catheter is recommended to reduce the risk of infection.
  • Salsabili N., Mehrsai Ar, Jalalizadeh B., Pourmand G., Jalaie S Page 32
    Introduction
    Our aim was to investigate sperm nuclear chromatin condensation and its correlation with semen parameters and vitality test in infertile patients with spinal cord injury (SCI), varicocele, and idiopathic infertility.
    Materials And Methods
    Sperm chromatin condensation was determined by aniline blue staining in 22 SCI-injured infertile men, 20 with varicocele, and 28 with idiopathic infertility. The results were compared with the semen analysis parameters and the hypo-osmotic swelling test results. Three grades of staining for sperm heads were distinguished: unstained, showing sperm maturity (G0); partially stained (G1); and completely stained, showing sperm immaturity (G2). The total score was calculated as: (G0 * 0) + (G1 * 1) + (G2 * 2).
    Results
    In all groups, the total staining score was higher than 75%, corresponding to a high degree of immaturity of sperm. Patients with SCI had a less sperm nuclear chromatin condensation and chromatin stability than patients with idiopathic infertility and varicocele (total scores, 98% versus 89% and 88%, respectively; P <. 01). All of the patients had normal hypo-osmotic swelling test results. Sperm counts for all patients were within the reference range. The mean percentages for normal motility and morphology of the sperm were 15.5% and 15% for patients with SCI, 43% and 15% for patients with varicocele, and 62.5% and 54% for patients with idiopathic infertility. There was no correlation between sperm nuclear chromatin condensation and semen analysis parameters.
    Conclusion
    Aniline blue staining for sperm nuclear chromatin condensation is a method independent of semen analysis and demonstrates the internal structural defects of sperm. This method may have a predictive value in assessing fertility.
  • Omrani , Samadzadae S., Bagheri M., Attar K Page 38
    Introduction
    Although assisted reproduction techniques are used extensively in Iran, screening for Y chromosome microdeletions before intracytoplasmic sperm injection is often undervalued. Our aim was to investigate Y chromosome microdeletions in men with idiopathic azoospermia or severe oligospermia.
    Materials And Methods
    In 99 selected patients with azoospermia or severe oligospermia and elevated levels of follicle-stimulating hormone and luteinizing hormone in combination with low serum testosterone levels, 20 pairs of sequence-tagged site-based primer sets specific for the Y microdeletion loci were analyzed. Primers were chosen to cover azoospermia factor (AZF) regions as well as deleted in azoospermia (DAZ) and the sex-determining region on Y chromosome (SRY) genes. Also, 100 healthy men served as a control group.
    Results
    Twenty-four patients (24.2%) had microdeletions in AZF genes, but no microdeletions were found in men in the control group. In 15 patients (62.5%), 1 deletion was found. Six patients (25%) had 2, and 3 (12.5%) had 3 deletions. The deletions mainly comprised the AZFc region (in 21 of 24 patients; 87.5%), which corresponds to the DAZ gene. Deletions in AZFb were found in 7 patients (29.2%), and 4 (16.7%) had deletions in the proximal part of AZF regions near SRY gene. No microdeletions were seen in the AZFa or SRY gene.
    Conclusion
    Our results emphasize that Y chromosome microdeletion analysis should be carried out in all patients with idiopathic azoospermia or severe oligospermia who are candidates for intracytoplasmic sperm injection.
  • Zargar Shoshtari Ma, Mirzazadeh M., Banai M., Jamshidi M., Mehravaran K Page 44
    Introduction
    We evaluated the efficacy and safety of radiofrequency-induced thermotherapy of the prostate in patients with benign prostatic hyperplasia (BPH).
    Materials And Methods
    Radiofrequency-induced thermotherapy of the prostate was performed under local anesthesia in 24 patients (median age, 67 years) with BPH. The International Prostate Symptom Score (IPSS) score, maximum flow rate, postvoid residual urine volume, and prostate volume were measured preoperatively and 4 months postoperatively.
    Results
    Nine patients (37.5%) had urinary retention preoperatively. One patient (4.2%) required transurethral resection of the prostate due to retention despite improved symptoms, and 2 (8.3%) needed an alpha-blocker, postoperatively. The success rate was 87.5% after 4 months follow-up. All patients were catheter-free after the procedure. The mean IPSS score decreased from 26.08 +- 3.9 to 13.33 +- 4.69 (P <. 001), and the mean maximum flow rate increased from 4.63 +- 4.4 mL/s to 13.21 +- 4.28 mL/s (P <. 001). The mean prostate volume and mean residual urine volume were 46.38 +- 16.8 mL and 160 +- 57 mL, which decreased to 39.6 +- 16 mL (P =. 009) and 61.46 +- 17.45 mL (P =. 003), respectively. Fever, dysuria, and perineal pain (in 9 patients; 37.5%) were improved with conservative therapy. Retrograde ejaculation, erectile dysfunction, and urinary incontinence were not reported.
    Conclusion
    Radiofrequency-induced thermotherapy of the prostate is a new, safe, and effective treatment for BPH. This technique is carried out under local anesthesia and mild sedation with little bleeding. It is especially appropriate for patients who present as high risk for general anesthesia.
  • Amjadi M., Madaen Sk, Pour, Moazen H Page 49
    Introduction
    Bladder emptying in crouching position is a conventional way in many eastern countries. Our aim was to evaluate uroflowmetry parameters as an index of obstruction severity in standing and crouching positions and comparison of them in patients with bladder outlet obstruction symptoms.
    Materials And Methods
    Uroflowmetry in standing and crouching positions was done in 83 patients with bladder outlet obstruction symptoms due to benign prostatic hyperplasia (BPH). The patients were 50 years old or older and their maximum flow rate in standing position was less than 15 mL/s. The maximum flow rate, average flow rate, maximum flow time, and postvoid residual urine volume were measured and recorded. The results in standing and crouching positions were compared.
    Results
    The mean maximum flow rate and mean average flow rate in crouching position increased 86% and 51%, respectively (P <. 001; P =. 012), while mean maximum flow time and postvoid residual volume decreased 40% and 46%, respectively (P <. 001; P <. 001). These changes were also significant in patients with maximum flow rates of less than 10 mL/s and 10 mL/s to 15 mL/s in standing position, except for the maximum flow time in the latter group.
    Conclusion
    A more complete emptying of bladder in crouching position in patients with BPH can be attributed to the increased bladder pressure due to a good transmission of intra-abdominal pressure and a complete and coordinated relaxation of pelvic floor muscles. This position can help improve patients'' symptoms.
  • Rajaie Esfahani M., Momeni A Page 54
    Introduction
    Our aim was to compare transabdominal ultrasonography (US) and intravenous urography (IVU) in the evaluation of patients with hematuria.
    Materials And Methods
    Two hundred patients with hematuria were assessed by US and IVU, and if needed, by cystoscopy, ureteroscopy, and CT scan, to determine the definite cause of hematuria. The results of US and IVU were compared according to the definite diagnoses.
    Results
    Of 97 patients with microscopic hematuria, 44 (45%) had a documented cause for hematuria, and of 103 patients with gross hematuria, 76 (74%) had a definite disorder (P <. 001). Urinary calculi were found in 105 patients, 93 (88.5%) and 73 (69.5%) of which were detected by US and IVU, respectively (P <. 001). There were 3 and 6 cases of kidney and bladder neoplasms, respectively, all of which were revealed by US, but only 2 renal tumors were detectable on IVU. Ultrasonography had a higher sensitivity than IVU for diagnoses of kidney calculi, lower ureteral calculi, and urologic neoplasms (95.3% versus 65.1% for kidney calculi, P =. 039; 89.7% versus 69.2% for lower ureteral calculi, P <. 001; and 100% versus 22.3% for urologic neoplasms, P <. 001), but in calculi of the middle and upper ureter and of the whole ureter, there were no differences between US and IVU.
    Conclusion
    Our results are in favor of using US in the initial evaluation of hematuria. However, we must choose our diagnostic tool according to the patient''s condition and suspected disorders causing hematuria.
  • Miscellaneous: Editorial Comment
    Basiri A Page 60
  • Aliasgari M., Ghadian Ar Page 61
  • Editorial Comment
    Shadpour P Page 63
  • African Journal of Urology
    Page 65
  • Errata
    Page 70