Nephro-Urology Monthly
Volume:8 Issue: 6, Nov 2016

Hemodialysis is the most common renal replacement therapy in patients with end stage renal disease (ESRD)..
The present study compared the performance of various parametric models in a survival analysis of hemodialysis patients..
This study consisted of 270 hemodialysis patients who were referred to Imam Khomeini and Fatima Zahra hospitals between November 2007 and November 2012. The Akaike information criterion (AIC) and residuals review were used to compare the performance of the parametric models. The computations were done using STATA Software, with significance accepted at a level of 0.05..
The results of a multivariate analysis of the variables in the parametric models showed that the mean serum albumin and the clinic attended were the most important predictors in the survival of the hemodialysis patients (P Parametric models may provide complementary data for clinicians and researchers about how risks vary over time. The Weibull model seemed to show the best fit among the parametric models of the survival of hemodialysis patients..

Protein-energy malnutrition is a common problem in hemodialysis patients and has different outcomes such as reduced quality of life, longer hospitalization time, lower dialysis adequacy, and higher mortality rate. Investigation of dialysis adequacy is an important method for assessing hemodialysis patients, and improving the dialysis adequacy is an important healthcare team goal..
The present study aims to investigate and compare the effects of BCAA and ISO-WHEY oral nutritional supplements on dialysis adequacy..
In a clinical trial study, 66 hemodialysis patients were randomly divided into three groups: Group A (n = 22), Group B (n = 22), and Group C or the control group (n = 22). In Groups A and B, as prescribed and controlled by nutritionists and nephrologists, respectively, ISO-WHEY and BCAA protein powder were used for 2 months on a daily basis. For all groups, before intervention and 1 and 2 months after intervention, the dialysis adequacy was measured using URR and Kt/V. Finally, the data were analyzed using IBM SPSS Statistics Base 21.0 software..
Out of 66 patients, 61 (19 in Group A, 20 in Group B, and 22 in Group C) completed the study period, and before intervention, all groups were equal in terms of quality and quantity variables (P > 0.05). After intervention, there was a significant difference between the three groups with regard to the variables of dialysis adequacy based on Kt/V and URR to independent-t test and repeated measures ANOVA (P Results show that the intake of oral nutritional supplements leads to an improvement in the dialysis adequacy of hemodialysis patients. Therefore, the use of nutritional supplements along with patient's training and regular consultation will be helpful in improving the nutritional status, dialysis adequacy, and eventually the quality of life..

Religious coping is known as a main resource influencing how individuals cope with the complications and stressors of chronic disease..
The aim of this study was to assess the relationship between religious coping and quality of life among hemodialysis patients..
This cross-sectional study was conducted in Qom, Iran, from June 2012 to July 2013. Ninety-five end-stage renal disease (ESRD) patients undergoing hemodialysis were selected via the convenience sampling method. Data were collected via a questionnaire comprising items on sociodemographic information, quality of life, the anxiety and depression scale, and religious coping. Following this, the data were analyzed using descriptive statistics and logistic regression analysis..
The mean age of patients was 50.4 (standard deviation [SD] = 15.7) years, and most were male (61%). The mean score for positive religious coping was 23.38 (SD = 4.17), while that for negative religious coping was 11.46 (SD = 4.34). It was found that 53.6% of patients had higher than the mean score of positive religious coping, while those with negative religious coping made up 37.9%. Negative religious coping was associated with worse quality of life, including physical functioning (odds ratio [OR] = 0.72; P = 0.009), role physical (OR = 0.79; P = 0.04), vitality (OR = 0.62; P = 0.005), social functioning (OR = 0.69; P = 0.007), and mental health (OR = 0.58; P = 0.01) after controlling for sociodemographic, clinical, and anxiety and depression variables..
The results indicated that patients with negative religious coping abilities were at risk of a suboptimal quality of life. Incorporating religious support in the care of hemodialysis patients may be helpful in improving quality of life in this patient population. Further longitudinal studies are needed to determine whether these associations are causal and the direction of effect..

Toxoplasma gondii has worldwide distribution and is one of the most prevalent infectious agents in humans..
The aim of this study was to determine the prevalence of anti-Toxoplasma gondii antibodies in hemodialysis patients with chronic kidney disease (CKD) in the hemodialysis unit of Fatemeh Zahra hospital at the Mazandaran University of Medical Sciences in Sari, Iran..
Seventy-three patients with CKD and 145 healthy volunteers were assessed for anti-Toxoplasma gondii (IgG, IgM, and IgA) antibodies using a conventional ELISA technique..
The anti-Toxoplasma gondii IgG antibody was detected in 80.8% of the cases in the patient group, while 31.5% of the cases in the CKD patient group and 31.8% in the control group were found to be positive for the anti-Toxoplasma gondii IgA antibody. All the patients in the CKD group were negative for the anti-Toxoplasma gondii IgM antibody, although 2.76% of the healthy volunteers were found to be positive. The present study suggests that there was no significant difference between the hemodialysis patient group and the healthy volunteers..
The epidemiological data collected in this study could serve as a reference for future studies and may be useful in developing preventive and educational strategies, and consequently reducing healthcare expenditure..

Urethrocutaneous fistula (UCF) is the most prevalent complication after hypospadias repair surgery. Many methods have been developed for UCF correction, and the best technique for UCF repair is determined based on the size, location, and number of fistulas, as well as the status of the surrounding skin..
In this study, we introduced and evaluated a simple method for UCF correction after tubularized incised plate (TIP) repair..
This clinical study was conducted on children with UCFs ≤ 4 mm that developed after TIP surgery for hypospadias repair. The skin was incised around the fistula and the tract was released from the surrounding tissues and the dartos fascia, then ligated with 5 - 0 polydioxanone (PDS) sutures. The dartos fascia, as the second layer, was covered on the fistula tract with PDS thread (gauge 5 - 0) by the continuous suture method. The skin was closed with 6 - 0 Vicryl sutures. After six months of follow-up, surgical outcomes were evaluated based on fistula relapse and other complications..
After six months, relapse occurred in only one patient, a six-year-old boy with a single 4-mm distal opening, who had undergone no previous fistula repairs. Therefore, in 97.5% of the cases, relapse was non-existent. Other complications, such as urethral stenosis, intraurethral obstruction, and epidermal inclusion cysts, were not seen in the other patients during the six-month follow-up period..
This repair method, which is simple, rapid, and easily learned, is highly applicable, with a high success rate for the closure of UCFs measuring up to 4 mm in any location..

One of the issues in prostatectomy surgery is bleeding. Although tranexamic acid (TRA) is an antifibrinolytic agent for reducing bleeding, controversies surround its use..
In this study, the effect of local administration of TRA on reducing bleeding during prostatectomy surgery was evaluated..
A total of 186 patients who underwent prostatectomy surgery were assessed in this clinical trial study. Patients were divided randomly into two groups. After prostate removal, TRA (500 mg TRA with 5 mL total volume) to the intervention group and normal saline to the control group were sprayed with the same volume. At the end of surgery, the prescribed blood bags were measured and recorded. Hemoglobin and platelet levels were recorded 6 hours after the test. Moreover, the amounts of blood inside the blood bags in the first 24 hours, the second 24 hours, and the total length of hospital stay were recorded and compared in each group..
By comparing the measured values before and after surgery, we found that the amounts of hemoglobin, hematocrit, and platelet decreased. The mean blood loss in the intervention group was recorded at 340 mL and that in the control group was 515 mL. The maximum bleeding in the control group was almost twice as much as that in the intervention group. Blood loss in the intervention group with the administration of TRA was significantly lesser than that in the control group (P = 0.01). The decrease in platelet level in the intervention group was significantly lower than that in the control group (P = 0.03)..
The present study showed that local administration of TRA significantly reduces bleeding after prostatectomy surgery and is effective in preventing postoperative hemoglobin decrease..

Cryptozoospermia (CO) is a situation in which spermatozoa cannot be observed in a fresh semen sample unless an extended centrifugation and microscopic search are performed. CO patients are suggested to use only intracytoplasmic sperm injection (ICSI) as infertility treatment. But still there is debate about the choice of sperm source in cryptozoospermic men candidate for ICSI..
This study was conducted to evaluate fertility outcomes in men with idiopathic cryptozoospermia who were treated using ICSI with freshly ejaculated sperm and testis sperm extraction (TESE) or percutaneous epididymal sperm aspiration (PESA)..
In this prospective cohort study carried out in an academic institution, 83 out of 92 couples with cryptozoospermia undergoing their first ICSI cycle were recruited. These patients were randomly allocated to two groups: group one (n = 42) who produced freshly ejaculated sperm and, group two (n = 41) who produced a sample by TESE or PESA. The groups were analyzed and compared in terms of fertilization rate, cleavage rate, embryo quality, implantation rate, and clinical pregnancy rate..
There was a significant difference in fertilization rate, embryo quality, implantation rate, and pregnancy rates between the group of surgically extracted sperm and those of naturally ejaculated sperm using conventional ICSI (P Sperm quality extracted by percutaneous PESA and TESE procedures increases fertility outcomes compared to naturally ejaculated sperm in men with idiopathic CO. More specifically, embryo quality, which is most relevant to fertility outcome, improved when surgically extracted sperm was used for ICSI..

Prostate cancer is a neoplasm with a variable natural history and clinical behavior. There is much debate on the use of inherited genetic information in clinical application including risk assessment and treatment decisions. This study was performed to evaluate the relationship between clinical parameters of prostate cancer (PSA, Gleason score, and metastasis) and expression of NKX3.1, AMACR, TMPRSS2-ERG, ERG, and SPINK1 genes..
Newly diagnosed cases of prostate cancer were selected for this study. Thirty four tissue samples were obtained via open radical prostatectomy and 9 samples were obtained via needle biopsy. Each tissue sample was sectioned into two parts, one used for detection of malignant changes and Gleason score determination, and the other immersed in RNA later solution (Qiagen). The expression of NKX3.1, AMACR, TMPRSS2-ERG, ERG, and SPINK1 genes were assessed by real-time PCR assay. Correlation between expression of each gene and PSA level, Gleason score, and presence of metastasis were examined..
A total number of 43 specimens were studied, from which 9 were obtained from patients with metastatic prostate cancer. The expression of five examined genes had no correlation with PSA level and Gleason score. The expression of AMACR decreased in metastatic prostate cancer (P = 0.02). The expression of other genes showed no difference between metastatic and non-metastatic tumors (P > 0.1)..
Genetic information combined with clinical data can be useful in risk assessment and treatment planning. Based on the results of the current study, the decreased expression of AMACR was a sign of poor prognosis..

According to recent studies, prostate cancer is the second most common cancer among Iranian men. Radical prostatectomy has been considered the gold standard treatment in patients with clinically localized prostate cancer. Gleason score, PSA density, and PSA velocity are some of the parameters used to predict adverse pathologic features..
The aim of this study was to evaluate the prognostic value of PSA density and Gleason score in predicting adverse pathologic features in patients with localized prostate cancer who undergo radical prostatectomy..
We conducted a cross-sectional study of 105 patients with localized prostate cancer who underwent radical prostatectomy between 2006 and 2013. We recorded Gleason scores and PSA levels, in addition to the results of pathological evaluations after radical prostatectomy, including prostate volume, stage, LNI (lymph node involvement), SVI (seminal vesicle invasion), and extraprostatic extension (EPE). Data were analyzed using SPSS version 21..
Mean PSA density was 0.27 (0.17 SD). The frequencies of EPE, SVI, and LNI were 21.9, 16.2, and 2.9, respectively. The Mann-Whitney U-test demonstrated a significant correlation between PSA density and adverse pathologic features (EPE, SVI, and LNI)..
PSA, PSA density, and Gleason score should be considered together in order to more accurately predict the adverse pathologic features of prostate cancer..

Retroperitoneal fibrosis (RPF) is a rare condition with an unclear etiology, presenting with the development of aberrant chronic nonspecific fibroinflammatory tissue in the retroperitoneal space, which can result in entrapment and obstruction of the retroperitoneal structures. RPF is a subtype of chronic periaortitis, and can be divided into two types: primary (or idiopathic) and secondary. RPF is usually idiopathic, but can also be secondary to malignancies, certain drugs, infections, surgery, and trauma. The systemic clinical manifestations are nonspecific and include low-grade fever, fatigue, anorexia, weight loss, and myalgia. We report five patients admitted to our hospital with clinical, laboratory, imaging, and pathologic findings compatible with RPF, and we describe their treatment and follow-up. We were suspicious that the impurities of some types of opium have an important role in the pathogenesis of RPF. Some of our patients used opium again after the follow-up period; however, they used a different type with a different origin, and we were surprised to see that RPF did not form again..