مجله تحقیقات در ارولوژی
سال ششم شماره 2 (پاییز و زمستان 1401)

Today, bladder cancer causes a lot of mortality and morbidity and imposes huge costs directly and indirectly on society. With the expansion of new treatment methods and the changes these methods bring to the quality of life and longevity of patients, physical disorders are also increasing among these patients.

In the present study, 487 patients with bladder cancer were assigned to three groups of non-surgical treatment, orthotopic, and conduit surgery techniques, and each group of patients was examined 1-2 months before the start of treatment and 6-8 months after that using the Hospital Anxiety and Depression Scale (HADS) questionnaire.

In this study, the prevalence of mood disorders in the conduit surgery group increased from 55.07% before surgery to 79.12% after surgery, which was statistically significant (P=0.003). Nonetheless, there was no significant increase in the other two groups. In the investigation of anxiety disorders, the prevalence of anxiety disorders increased from 22.79% to 43.68% in the conduit surgery group, which was statistically significant (P=0.0016).

According to the nature of the disease, before starting the treatment of these patients, by conducting psychological counseling and providing sufficient information to the patients, the necessary preparation should be created in the patients to accept the side effects caused by the treatment and reduce its psychological burden, which greatly improves the treatment results.

Sexual desire disorder can be defined as a decrease in sexual feelings, thoughts, and fantasies. This research aimed to compare the effectiveness of Transcranial Direct Current Stimulation treatment on sexual desire disorder in men and women.

The statistical population of the present study consisted of all individuals who suffered from the problem of decreased sexual desire, and for this purpose, were referred to medical centers in Tabriz, Iran, and were diagnosed with the disorder of decreased sexual desire. The research method was semi-experimental with a pre-test and post-test design. The research sample included 40 men and women who suffered from decreased sexual desire and were purposefully selected and were randomly assigned into two groups, including 20 people in the first test group (tDCS) and 20 people in the control group. Halbert's test was used to collect data before and after the intervention. Two-variable covariance analysis and SPSS software (version 26) were used to test the research hypotheses.

The average of the tDCS group and control groups showed that the independent variable was significantly effective on the dependent variable (P=0.0001).

The obtained results showed that the tDCS treatment method reduces the sexual desire disorder of overweight men. It had an effective libido disorder and its effectiveness was different between men and women. This difference indicates that Women have a better result than men from treatment.

Treatment of some limited kidney neoplasms is a partial kidney resection called a partial nephrectomy. One of the concerns in partial nephrectomy is severe and uncontrolled hemorrhage that sometimes results in kidney removal. Cryosurgery is one of the less invasive methods for the management of small kidney lesions, during which the controlled freezing of unwanted tissues will eventually lead to necrosis and gradual destruction of the lesion.The advantages of the cryosurgery method are easy implementation, no thermal ischemia damage during the operation, and no need to cut and suture the kidney parenchyma.

In this experimental intervention research, the caudal pole of the left kidney of 9 adult female rabbits was subjected to cryogenic partial nephrectomy through a lateral laparotomy. Rabbits were evaluated by ultrasound on 1, 3, 7, 14, 21, and 28 days after surgery to record and observe the extent of kidney damage and healing in the Sagittal and Dorsal sections. Several parameters, such as kidney length dimensions, size of the caudal cortex, and cranial cortex of the kidney, were measured and recorded.

Kidney length on days 1, 21, and 28 was significantly less than day 0. On the 7th day after surgery, 2 separate areas, damaged and frozen necrotic tissue (caudal cortex) and healthy and normal kidney tissue were visible. The size of the caudal cortex from day 14 onwards was significantly less than day 0. The process of significant changes in the caudal cortex of the kidney started from day 14 of surgery and the border between dead and living tissue (Line of Demarcation) was distinguishable as a transition zone. On the 21st day after surgery, both the length of the kidney and the caudal cortex decreased significantly compared to day 0. Gradual loss of the caudal pole of the kidney (caudal cortex, the place where cryosurgery was performed directly) showed the applicability of cryosurgery in surgeries during which the tumor was removed (tumor ablation). On the 28th day after surgery, due to gradual necrosis and the loss of the caudal pole of the kidney, the kidney looked like a bitten apple, and the results of changes in the dimensions of the kidney (caudal cortex and length of the kidney) indicated necrosis of the caudal pole of the kidney, which finally led to the shrinking of the kidney.

Ultrasonographic study of kidney injury and healing showed that cryosurgery, in addition to tumor ablation, would also have the ability to remove peripheral tissues (partial nephrectomy).

Selective serotonin reuptake inhibitors (SSRIs) are effective in patients with premature ejaculation (PE), but the effect of combination therapy with tadalafil as a phosphodiesterase-5 inhibitor (PDE5I) and sertraline (an SSRI) in these patients has been less studied. The aim of this study was to evaluate the safety and efficacy of tadalafil with sertraline compared with sertraline and placebo.

107 patients with lifelong PE and no erectile dysfunction (ED) and an intravaginal ejaculation latency time (IELT) of less than 60s were treated for 6 weeks. Subjects were randomly divided into two groups: the placebo group (n=51) and the tadalafil group (n=51), who received  sertraline 50 mg daily plus placebo on demand or sertraline 50 mg daily plus tadalafil 10 mg on demand . Premature ejaculation profile (PEP) and IELT were used to evaluate PE. The change in mean IELT, mean change in all four measures of PEP, and adverse effects in 2 groups were recorded.

Mean IELT before and after treatment was 35 .29sand 87 .55s, respectively, in the placebo group (P<0 ,0001) and 40 .1s and 153.63s, respectively, in the tadalafil group (P<0 .0001). Mean IELT improved significantly in the tadalafil group compared with the placebo group (113.53s vs. 52.25s, P<0.0001). All four measures of PEP scores also improved in the tadalafil group compared with the placebo group. Drug-related adverse events occurred more frequently in group B than in group A.

Combination therapy with tadalafil and sertraline in the treatment of premature ejaculation is more effective than sertraline alone despite more side effects.

Most forgotten ureteral stents (FUS), especially those more than one year old, require additional procedures, such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, and percutaneous nephrolithotomy (PCNL) or a combination of the above. Due to the importance of incrustation and complications of FUS on the kidney, which imposes a high financial burden on patients and the medical system, this study aimed to investigate the management of forgotten double-J ureteral stents.

All patients who referred to Shahid Hashminejad and Firouzgar hospitals in Tehran, Iran from April 2020 to April 2022 due to a delay in removal of double-J ureteral stent for more than 3 months were included in the study. Patient information, including demographic and clinical data, was extracted from their files and entered into the checklist. Encrustation was graded based on the forgotten, encrusted, calcified (FECal) criteria. Written consent was obtained from all the patients.

In total, 70 patients and 89 procedures were examined. The mean age of the patients was 46.36±16.72 years, 84.3% of whom were male. The mean indwelling time of FUS was 13.17 months. The most common presenting complaints included dysuria (52.9%) and frequency (48.6%). It is noteworthy that 77.9% of patients had hydronephrosis and 25.7% had UTI. Moreover, 65.2% of patients were informed about the timely removal of ureteral stent. The most used procedures for FUS removal were ureteroscopy (53.9%), transurethral lithotripsy (32.6%), and PCNL (13.5%). The majority of incrustations (55.1%) were classified as grade 1 and 22.5% as grade 2.

The results of this study showed that the endourologic treatment of forgotten ureteral stents in one session was feasible and safe. However, additional treatments, such as ESWL and PCNL, were sometimes needed, although finally these patients were managed endourologically.

Renal colic caused by urolithiasis is among the common causes of severe pain and referral to the emergency rooms. Using a multimodal method in controlling this type of pain with available anesthetics such as ketamine can help relieve pain, increase satisfaction, and reduce hospitalization.

The present study was conducted as a double-blind clinical trial. A total of 44 patients with renal colic with the American Society of Anesthesiologists (ASA) class 1 were divided into intervention and control groups. Pethidine (1mg/kg) was administered to both groups. In the intervention group, oral ketamine (0.5 mg/kg) dissolved in 5% dextrose was prescribed, and in the control group, 5% dextrose serum (0.1 ml/kg) was used. Pain intensity was measured by the numeric rating scale before the treatment and half, one, two, and three hours after the intervention.

The mean age of the intervention group was 35.2, and the control group was 38.9 (P=0.092). The average amount of pethidine consumed in the intervention group was 94 mg, and in the control group was 89 mg, and no significant difference was observed between the two groups (P=0.095). In the intervention group, 27.3% and in the control group, 72.7% needed additional pethidine (P=0.000). In first, second, and third hours after the treatment, the intensity of pain in the intervention group was lower than the control group, and only in the third hour this difference was statistically significant (P=0.03).

In patients with renal colic, adding oral ketamine to intravenous pethidine statistically significantly reduces the consumption of opioid, increases patient satisfaction, and reduces pain intensity three hours after treatment. Therefore, oral administration of ketamine is suggested as an adjunctive drug to relieve the pain of renal colic in hospital emergency.

Prostate cancer is currently the second most common cancer among men worldwide. Given the prevalence of this disease and the costs imposed on society for its diagnosis and treatment, awareness of diagnostic and therapeutic modalities, and factors influencing their outcomes is of particular importance.

This prospective study aimed to investigate the diagnostic accuracy of 99mTc- PSMA scan and 99mTc-MDP Bone scan in 40 patients with prostate cancer and bone metastases. The study was conducted between 2020 and 2023, and the results were compared based on the tissue differentiation of cancerous tissues.

Data analysis revealed that the diagnostic accuracy of 99mTc- PSMA scan and 99mTc-MDP Bone scan for grade groups 1-5 ranged from 95.4% to 100% and 95.4% to 100%, respectively. However, none of the results were statistically significant. Specifically, the 99mTc- PSMA scan demonstrated diagnostic accuracy percentages of 100%, 98.7%, 96.1%, 96.6%, and 95.4%, respectively, for grade groups 1 to 5. Similarly, the diagnostic accuracy of 99mTc-MDP Bone scan for grade groups 1 to 5 was 100%, 96.3%, 98.7%, 96.6%, and 95.4%, respectively.

The statistical analysis of the data suggests that tissue differentiation of prostate cancer does not impact the diagnostic accuracy of 99mTc- PSMA scan and 99mTc-MDP Bone scan. Moreover, the Gleason score of tissue samples did not affect the differentiation of cancerous tissues by the scans. Therefore, the findings suggest that 99mTc- PSMA scan and 99mTc-MDP Bone scan can provide accurate diagnostic results for prostate cancer patients with bone metastases, regardless of the tissue differentiation or Gleason score.

Nowadays, Percutaneous Nephrolithotomy (PCNL) is popular all over the world and has replaced open surgery for renal and upper ureteral stones. Despite the few complications and less invasiveness of this surgical method, undesirable events, such as damage to the intra-abdominal organs, including the colon, are a constant concern of surgeons. The present study aimed to investigate the position of the colon in relation to the kidney in the lateral, prone, and supine positions in patients who were candidates for PCNL surgery.

During 12 months, all adult patients who were candidates for PCNL surgery were subjected to computed tomography (CT) scan without contrast in lateral, prone, and supine positions, and the relevant findings related to age, gender, body mass index (BMI), and past surgical history were collected and analyzed.

A total of 260 patients, including 129 men and 131 women, were included in the study. The mean age of the patients was 46.95 years (the age range: 21-72). The highest frequency of colon position in prone, semi-supine, complete supine, and lateral positions, respectively, in 122 (49.92%), 186 (71.54%), 169 (65%), and finally 129 (49.62%) patients was anterior to the kidney. In this study, only one case of colon perforation was reported among the 260 patients studied, and the position of the colon was anterior to the kidney in the prone position in that patient.

As evidenced by the obtained results, a CT scan without contrast is recommended due to its non-invasiveness to determine the position of the colon, especially in different positions, to minimize iatrogenic complications in PCNL surgery.