Urology Journal
Volume:16 Issue: 5, Sep-Oct 2019

This study reviewed the efficacy and safety of the microsurgical subinguinal varicocelectomy (MSV) with and without testicular delivery (TD) for varicocele patients.

A systematic literature search was conducted in EMBASE, PubMed, MEDLINE, Cochrane databases, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), and Google Scholar databases to identify relevant studies that reported MSV with and without TD for varicocele patients published in English or Chinese up to October 2018. The Newcastle-Ottawa Scale (NOS) and the Jadad scores were used to evaluate the methodological quality of all the included studies. We also used the Cochrane Collaboration’s tool for assessing risk of bias for each study. The Review Manager Software version 5.3 was used to conduct data analysis.

Four RCTs and three retrospective studies consisting of 993 patients were included. Meta-analysis results indicated that both of the two treatments were effective and safe. MSV with TD had a lower recurrence rate (OR = 0.20, 95% CI: 0.06 - 0.65, P = .007, I2 = 0%) and postoperative serum testosterone level (MD = -39.07, 95% CI: -51.95 - -26.18, P = .00001, I2 = 0%) compared with MSV without TD but was associated with higher postoperative complications rate (OR=7.35, 95% CI: 2.92-18.53, P < .0001, I2 = 0%). We found no significant differences in operation time (MD = 12.46, 95% CI:0.11-24.81,P= .05, I2 = 87%), sperm concentration (MD = 3.73, 95% CI: -2.88 - 10.35, P = .27, I2 = 81%), sperm motility (MD = 10.96, 95% CI: -11.93 - 33.86, P = .35, I2 = 99%), and pregnancy rate(OR = 0.65, 95% CI: 0.37- 1.16, P = .15, I2 = 0%).

This meta-analysis compared efficacy and safety of MSV with and without TD for varicocele patients. MSV with TD was associated with a higher postoperative complication rate but lower recurrence rate and postoperative serum testosterone level than MSV without TD. In terms of preoperative serum testosterone leve

Nocturnal enuresis is one of the most common diseases in children, which can affect their mental health. The aim of the present study is to determine the prevalence of nocturnal enuresis in Iranian children through systematic review and meta-analysis.

The present study was conducted through systematic review and meta-analysis of studies during March 2000- July 2018. Articled related to the subject were reviewed by searching the Medline (PubMed), Scopus, ScienceDirect, SID, Magiran, Barakat, and Google Scholar databases where the heterogeneity of studies was investigated using I2 index. The data analysis was then carried out using Comprehensive Meta-Analysis software.

15 articles with a sample size of 16614 individuals aged 3 to 18 years entered the meta-analysis process. The overall prevalence of nocturnal enuresis in children of Iran was 10.2% (95% CI: 7-14.8%). The highest and lowest prevalence of nocturnal enuresis was seen in children living in Tehran 28.5% (95% CI: 16.1% -45.4) and Tabriz 1.8% (95% CI: 1.2-2.8%), respectively. The findings of the present study revealed that the prevalence of nocturnal enuresis in children decreases with enlargement of the sample size. In addition, the prevalence of nocturnal enuresis grows with an increase in the years of research, which is statistically significant (P < 0.05).

Considering the high prevalence of nocturnal enuresis in the current study, health policy makers need to raise the awareness of families by taking efficient and effective policies.

To share our multicenter experience using a safe and effective method for treating large proximal ureteral calculus by simultaneous supine percutaneous nephrolithotomy (sPCNL) and retrograde ureterolithotripsy (URSL) in the Galdakao-modified supine Valdivia position.

Between December 2014 and August 2017, all patients with large proximal ureteral stones (> 15 mm) who underwent simultaneous sPCNL and retrograde URSL at three medical centers were retrospectively reported. The ureter stone was pushed back (retrograde) with the ureteroscope and was retrieved using forceps with a nephroscope through an Amplatz sheath. Surgical methods and outcomes were described to improve our experience and management of large proximal ureteral calculi.

A total of 31 patients underwent simultaneous sPCNL and retrograde URSL. The mean patient age, stone size, operating time, and postoperative hospital stay were 57 years (range, 32–74 years), 20.1 mm (range, 15.0–37.9 mm), 81 minutes (range, 30–150), and 3.2 days (range, 2–7 days), respectively. There were 10 modified Clavien grade I and five grade II complications. No blood transfusions were necessary in this series. All patients were treated with double-J stents without a nephrostomy tube. Only one patient did not achieve stone-free status because of the strict stone impaction into the ureteral wall. This patient received auxiliary URSL after two months. Thereafter, the overall stone-clearance rate at three months was 100%.

Our preliminary data showed that this modified method is safe and effective for treating large proximal ureteral stones.

To evaluate the risk factors for urinary tract infection (UTI) after retrograde intrarenal surgery (RIRS).

A retrospective evaluation of the records of patients who underwent RIRS from January 2013 to September 2016 was performed. All interventions were done by the same surgeon and by applying the same technique.

111 patients were included in the study with a mean age of 47.5 years (range: 14-84 years). Postoperative infection rate was 12.6% (n= 14). SWL, preoperative double J stent insertion, localization, gender, and the operation side had no impact on origination of infectious complications (P > .05 for all). Preoperative infection history (P = .002, OR=7.96, %95CI: 2.0- 30.5), comorbidity score (P = .008, OR=7.79, CI%95: 1.7- 35.5), and residual fragments (P = .045, OR=5.12, CI%95: 1.03 – 25.36) were found to be the significant risk parameters of postoperative infectious complications.

To reduce UTI complications, it is necessary to pay attention to patients with comorbidities, prescribe appropriate prophylactic antibiotic therapy for those who have urinary tract infection history and help patients to achieve stone free status.

To evaluate the efficacy and reliability of fluoroscopy-free retrograde intrarenal surgery.

A retrospective evaluation was made of the data of 226 patients who underwent RIRS as kidney stone treatment between May 2015 and May 2017. When evaluation was made acccording to the exclusion criteria, the study continued with a total of 190 patients including 103 in whom fluoroscopy was used (Group 1) and 87 who underwent a fluoroscopy-free procedure (Group 2).

Group 1 patients comprised of 56 males and 47 females with a mean age of 41.5 ± 13.9 years. Group 2 patients comprised of 48 males and 39 females with a mean age of 42.6 ± 15.2 years. The mean stone size was 14.3 ± 2.7 mm in Group 1 and 14.1 ± 2.8 mm in Group 2. The mean operating time was calculated as 63.6 ± 8.2 minutes in Group 1 and 65.7 ± 9.7 minutes in Group 2. In Group 1, the success rate was determined as 83.5% on postoperative day 1 and as 92.2% in the postoperative first month. In Group 2, these rates were 81.6% and 90.8% respectively. No statistically significant difference was determined between the groups in respect of stone size (P= .752), operating time (P = .108) and postoperative first day (P = .732) and first month success rates (P = .724).

Fluoroscopy-free RIRS is a surgical technique with a high rate of success that can be applied safely to be able to protect patients at high risk of radiation and the surgical team, particularly in centers with high patient circulation.

This study was conducted to compare the success rate and complications of percutaneous nephrolithotomy (PCNL) and laparoscopic ureterolithotomy for the treatment of large proximal ureteral stones.

In this prospective cohort study, the success rate and complications in 52 patients undergoing PCNL in Hamadan's Shahid Beheshti Hospital and 55 patients undergoing laparoscopic ureterolithotomy in Tehran's Shahid Labbafinejad Hospital were compared. All patients had large proximal ureteral stones.

In the PCNL group, the mean age was 47.78 ±16.72 years, 75% were male, and 50% of calculi were on the upper right side and the rest on upper left side. The mean duration of surgery was 32 ± 9.4 minutes and success rate 100%. The mean stone size was 18.33 ± 2.63 mm in PCNL group and 21.29 ± 2.18 mm in laparoscopy group which was significantly different (P <.001). In the laparoscopy group, the mean age of patients was 42.92 ± 16.10 years and 83.6% were male. In this group, 46.6% of calculi were on the right side and the rest were on the left side. The mean duration of surgery was 107.43 ± 22.86 minutes and success rate was 100%. There was not a statistically significant association between surgical technique and age, gender, stone location, mean hospital stay length after surgery, degree of hydronephrosis and success rate (P >.05). However, surgery duration was significantly shorter in the PCNL group compared to the laparoscopy group (P <.001) and the decrease in hemoglobin, hematocrit and serum urea level was more pronounced in the PCNL group than in the laparoscopy group.

PCNL and laparoscopic ureterolithotomy met with the same success rate in the treatment of upper large ureteral stones. However, the two methods should be utilized depending on the hospital facilities and equipment, surgical team qualifications, and patient conditions.

To investigate the prognostic role of time to castration resistance(TTCR) in patients who have received solely Docetaxel chemotherapy regimen(DCR) for castration resistant prostate cancer(CRPC).

Between Jan 2004 and Dec 2015, data of 162 patients who have received DCR for CRPC were gathered. Patients were divided into three groups according to TTCR: Group 1(≤ 12 months), group 2(13-24 months), and group 3(>24 months). Data of age, clinical stage, Gleason grade(GG), previous treatments, site of metastases, Prostate-specific antigen (PSA) values, TTCR, overall survival, biochemical progression free survival(PFS) and PSA response to docetaxel were recorded.

The mean age of the 162 patients was 74.4 ± 8.5 years. Data on mean age, type of castration, adding estramustine to docetaxel, secondary hormonal manipulation, Gleason grade, clinical T stage at initial diagnosis and site of metastases were comparable between three groups. PSA values were higher in group 1 than other groups. PSA response to docetaxel was 59.2% in all patient and it was worse in group 1 than other groups (P = .009). Two years overall survival rates were 7.6%, 25% and 32.3% in group 1, 2 and 3, respectively. Median survival rates were 7, 14 and 23 months in group 1, 2 and 3, respectively, and this difference was statistically significant (P=.016). On multivariate analysis, TTCR was found to be independent prognostic factor for overall survival and response to docetaxel treatment.

To evaluate on a large group of patients whether Mantoux tuberculin skin test (TST) result is associated with BCG immunotherapy effectiveness and whether it can predict occurrence of moderate to severe toxicity.

We analysed group of 823 patients with intermediate and high risk NMIBCs who were treated with BCG. The study included 412 patients with the history TST and 411 without TST. A standard dose of Statens Serum Institute tuberculin RT23 was used. The reaction was read 48-72 hours later by evaluating the diameter of palpable induration. The size of the induration was considered positive when the measurement was greater than or equal to 6 mm and excessively positive when bigger than 26 mm. Whole BCG immunotherapy schedule consisted of 27 instillations.

The patients were followed for median 61 months. The 5-year recurrence and progression free survival (RFS, PFS) did not differ between the groups in both total study population and in tumour subgroup analysis. TST result in both total study population and in subgroups was not statistically associated with RFS, PFS and cancer specific survival. The moderate-to-severe toxicity was observed in 181(44%) TST patients, and in 196(47%) patients without TST. Incidence of toxicity was not statistically different and also not statistically associated with TST result in any of the tumour subgroups of TST group.

This study shows, that TST does not have value in prediction of bladder cancer recurrence, progression nor cancer specific survival. Also it doesn’t have a value in predicting therapy toxicity.

To evaluate the role of Interleukin-6 (IL-6) single nucleotide polymorphisms in prostate cancer (PCa) and benign prostate hyperplasia (BPH).

We genotyped two IL-6 intronic variants (rs1800795 and rs2069845) in PCa cases, BPH cases and healthy men referred to Labbafinejad and Shohadaye Tajrish Medical Centers using tetra ARMS-PCR method.

The study included 130 PCa cases, 200 BPH cases and 200 healthy men. The C allele of rs1800795 was associated with PCa risk in the assessed population (OR (95% CI) = 1.45 (1.06-1.98)). However, the frequency of rs2069845 variants was not significantly different between PCa, BPH and control groups. The A C haplotype (rs2069845 and rs1800795 respectively) was associated with PCa and BPH risk (OR (95% CI) = 1.67 (1.12- 2.48); OR (95% CI)= 1.78 (1.25 – 2.54)). Besides, the A G haplotype (rs2069845 and rs1800795 respectively) has a protective effect against both PCa and BPH in the assessed population (OR (95% CI) = 0.63 (0.46-0.87); OR (95% CI)= 0.6 (0.45-0.79)).

Consequently, the results of the current study provide further evidence for contribution of IL-6 in prostate cancer.

The aim of our study is to evaluate the feasibility and effectiveness of robotic partial nephrectomy performed with segmental clamping of tumor-feeding arteries.

Thirty-six patients with renal tumor who underwent robotic partial nephrectomy with segmental renal artery clamping were included in this study. Prospectively recorded patient demographics, mean operation time, estimated blood loss, warm ischemia time, length of hospital stay, pre- and postoperative renal functions and oncological outcomes were analyzed retrospectively. All complications were graded based on the modified Clavien-Dindo classification system. Surgical success was defined as no conversion from segmental artery clamping to the main renal artery clamping.

Mean tumor size was 40 mm and, R.E.N.A.L nephrometry score was 6.74. Mean operation time, estimated blood loss and warm ischemia time were 162 min, 236 ml, and 16 min, respectively. Five postoperative complications were observed. There were no significant differences in terms of renal functional outcomes before and after surgery (P = .18). Of 36 patients, 34 were completed successfully; however, main renal artery clamping was required in two patients due to excessive bleeding from the tumor bed. The success rate of the segmental renal artery clamping technique was determined as % 94.4 (34/36) in our study.

Segmental renal artery clamping may be considered as a reliable and effective surgical method for vascular control during robotic partial nephrectomy. For this technique, tumor characteristics and intrarenal vascular anatomy should be precisely evaluated by the preoperative contrast-enhanced computerized tomography with 3-D reconstruction.

Vesicourethral anastomosis (VUA) represents a challenging step of open radical prostatectomy (ORP) because of limitation of space in the depth of male pelvis, lack of control on knots during tightening which subsequently causes inadequate coupling of VUA or breakdown of knots, and also extremely difficult reapplication of sutures. To facilitate this step of ORP, we have developed a simple and reproducible technique and reported our 8-year experience.

We used two extra-long DeBakey tissue forceps to approximate the bladder neck to the urethral stump. We found it more beneficial than Babcock clamp especially in obese patients with excess fatty tissue in the pelvic area. In this technique, the surgeon's assistant creates more space for the surgeon’s hand by sweeping the fatty tissue away from the anastomotic area and then pushes the reconstructed bladder neck down while the sutures are being tied.

We analyzed data from 200 patients with prostatic cancer who underwent open radical prostatectomy performed from 2009 to 2017. There were only 2 sutures disrupted during knot tying. In two cases (1%), drain output was more than 30 mL/day on postoperative day 2 and drainage was left in place for a longer duration. With the help of medications, time voiding and dedicated pelvic floor exercise whenever needed,.the goal of full urinary continence (0- 1 pad/day) was achieved in 85%, 94% and 98% of patients immediately after catheter removal, 3 months and 6 months after surgery, respectively. Eight patients (4%) developed urethral stricture.

The surgical technique has been shown to be an independent predictor of urinary continence. We introduce a new simple modification of vesicourethral anastomosis during RP. Using this technique; in addition to reducing anastomotic disruption rate and increasing knot tying control, postoperative urinary continence after ORP may also be improved.

Hypospadias is a congenital anomaly that includes defi cient ventral structure of the penis. Proximal hypospadias cases make up 20% of all hypospadias cases. The choice of operative technique for hypospadias repair depends on the severity, and it is influenced by the surgeon’s experience and perception of where priorities should lie. Several other factors interact to determine the type of repair, such as meatal site, presence of chordee, availability of the prepuce, and quality of the urethral plate and in addition surgeon’s experience affects the type of repair.

The treatment records of 42 penoscrotal and perineal hypospadias cases that were treated in our clinic from 1998 to 2017 were reviewed retrospectively. Cases with penoscrotal and perineal meatus were included in the study at the beginning of the urethroplasty. All cases had surgical intervention via Hinderer’s technique.

Acceptable cosmetic results were obtained in 37 (85%) patients with an objective scoring system (HOSE) for evaluating the results of hypospadias surgery score. The mean score after surgery was 14.8. Fistula and wound breakdown occurred in 7 out of the 42 cases.

In conclusion, the modified Hinderer's technique is a safe and reliable technique for both proximal and perineal hypospadias. Low com

This clinical study evaluated the effect of autologous muscle-derived cell (MDC) injection for the treatment of female patients with pure stress urinary incontinence (SUI).

A total of 20 women with SUI received transurethral injections of autologous MDCs. Baseline and follow-up evaluations consisted of physical examinations (cough stress tests), one-hour pad test, Incontinence Impact Questionnaire-7 (IIQ-7), and Urogenital Distress Inventory (UDI-6) scoring. The patients were followed one week as well as 1, 3, 6, 9, 12, and 24 month(s) after the procedure. Multichannel urodynamic study were performed before and 24 months after the intervention. The incidence and severity of adverse events (AE) were also recorded at each follow-up visit.

A total of 20 eligible female patients with the chief complaint of SUI that was unresponsive to conservative management, was enrolled in the trial, 17 of whom completed all follow-up visits. At 12th months, 10 (59%) patients had complete response, whereas 2 (12%) and 5 (29%) patients had partial and no response, respectively. At 24th months, relapse of SUI in 5 out of 10 complete responders (29%) and 2 out of 2 partial responders to the treatment, respectively. The intervention produced no serious AE during the trial.

According to our results, though obtained from a limited number of patients, MDC therapy was a minimally invasive and safe procedure for treatment of female patients with pure SUI. However, currently, the efficacy of this type of treatment for SUI is not sufficiently high and multi-center randomized clinical trials are required to be conducted before reaching a concrete conclusion.

The aim of this study was to evaluate expression of Post-Acrosomal WW Binding Protein (PAWP) in infertile men with low and high fertilization post ICSI and also globozoospermic men.

Semen samples were collected from 18 infertile men with previously failed or low fertilization (< 25%) post ICSI, 10 men with high fertilization (>50%) post ICSI, 15 globozoospermic men, and 21 fertile individuals. Then, expression of PAWP was assessed at RNA with quantitative Real Time PCR.

Relative expression of PAWP in sperm was significantly (P < .05) lower in infertile men with globozoospermia (41.5 ± 5.7) or low fertilization rate (43.3±10.4) compared to fertile (138.8 ± 17.3)or men with high fertilization (211.6 ± 75.6). In addition, a significant positive correlation (r = 0.628; P = .001) was observed between percentage of fertilization with the relative expression of PAWP.

Considering solid recent evidences regarding PLCζ as the main sperm factor involved in oocyte activation, therefore co-localization of PLCζ with PAWP in perinuclear theca may account for the above observation and it is likely that PAWP may have other functions and/or it may assist PLCζ.

In this study, we aimed to evaluate the effects of antioxidants including Vitamin E-Selenium-Folic acid (Vit E -Se- FA) on semen parameters following varicocelectomy (VCT).

Sixty patients from 64 infertile male patients diagnosed with varicocele (VC) who underwent sub-inguinal VCT were included in the study. Following sub-inguinal VCT, the patients were randomized into two groups: 30 receiving Vit E-Se-FA supplementation for six months, and 30 as the control group with supplemental treatment. The post-operative semen parameters of Vit E-Se-FA receiving group were compared with control group at the end of experiment. The sperm count, percentage of motile and abnormal sperms were considered.

There were statistically significant differences in terms of count (P = .031) and motility (P = .01) of sperm after six months of receiving Vit E-Se-FA supplementation comparing with control group.

Vit E-Se-FA supplementation can improve sperm parameters (count and motility of sperm) after VCT.

The present study was conducted to investigate the influence of hemicastration and age at hemicastration on the contralateral testis weight and function/testosterone production.

64 Wistar-derived male rats were divided randomly into 4 groups. Group 1 was named immature intervention, group 2 immaturecontrol, group 3 mature intervention, and group 4mature control. In group 1, rats were hemicastrated at 30 days of age (prepubertal). In group 2, sham surgery (midscrotal incision) was performed atthe same age. In group 3, rats were hemicastrated at 70 days of age (postpubertal) and in group 4,sham surgery was done at the same age. Twenty days after the first surgery, contralateral orchiectomy wasperformed in intervention groups and controls underwent random orchiectomy (left or right). Blood sampling for evaluation of serum testosterone was performed just before second surgery.

The mean testis weight (1692 ± 26.7 in group 1 versus 1375 ± 39.7 in group 2; P < .001 and 1760 ± 26.6 in group 3 versus 1425 ± 44.9 in Group 4; P < .001) and the mean testicular weight (mg) per 100 g of body weight (735.8 ± 82.3 in group 1 versus 634.8 ± 84.8 in group 2; P = .005 and 652.4 ± 61.4 in group 3 versus 572.6 ± 97.7 in group 4; P = .03) were significantly greater in hemicastrated rats as to their controls. Also, these parameters was greater in prepubertal group than postpubertalhemicastrated rats. There was no appreciable difference in serum testosterone levels across the 4 groups (P = .77).

Our research demonstrated that hemicastration results in compensatory hypertrophy of the remaining testis and it decreases as the animals age. Hemicastration does not lead to reduction in serum testosterone levels and the remaining testis can retrieve a normal serum testosterone level.

To evaluate whether maternal body mass index (BMI), visceral adipose tissue (VAT) thickness, and subcutaneous adipose tissue (SAT) thickness have effects on maternal pelvicalyceal system dilatation, which develops during pregnancy.

Between April 2018 and November 2018, a total of 120 pregnant women aged between 18-35 years in their third trimester were included in this prospective observational study. For each pregnant woman, SAT and VAT thicknesses were measured and renal sonography was performed by the same radiologist and obstetric ultrasound was performed by the same obstetrician. Nine patients were excluded from the study because their maximal caliceal diameters were less than 5 mm. Ultimately, 111 patients were divided into three groups according to the maximal calyceal diameter (MCD).

Asymptomatic hydronephrosis was diagnosed in 108/111 (97.3%) of the patients. There were 53 patients in group 1 (MCD of 5-10 mm), 39 patients in group 2 (MCD of 10-15 mm), and 19 patients in group 3 (MCD of >15 mm). There were statistically significant differences in terms of maternal SAT and VAT thickness between the groups (P = .001). There were also statistically significant differences between the groups for the estimated fetal weight and birth weight (P = .024, P = .003, respectively). In the correlation analysis, there was a negative correlation between maternal SAT thickness, VAT thicknesses, BMI, and maximal calyceal diameter (P = .001).

In this study, relationships between maternal BMI, VAS thickness, SAT thickness, the estimated fetal weight, birth weight, and renal pelvicalyceal dilatation have been shown. Increasing maternal adipose tissue may have a protective effect of mechanical pressure of growing uterus on the ureters.

Hepatoid adenocarcinoma (HAC) is an uncommon tumor with morphological resemblance to hepatocellular carcinoma. HAC of the adrenal glands is extremely rare. Here, we report the case of an 83-year-old man with adrenal HAC who presented with a greatly increased preoperative serum alpha-fetoprotein level (> 24,200 ng/mL). The findings of magnetic resonance imaging and contrast-enhanced abdominal computed tomography revealed a large mass occupying the left adrenal gland region as well as thrombosis of the renal vein extending into the inferior vena cava. Subsequently, the adrenal HAC was treated by surgical resection and targeted sorafenib therapy. However, the patient died 9 months later because of systemic metastasis of the tumor. In conclusion, adrenal HAC with inferior vena cava tumor thrombosis is extremely rare and challenging to diagnose and treat. Pathological and immunohistochemical examination are helpful for diagnosis and surgical excision is the main strategy for treating the tumor.

Congenital stricture, specifically with manifestation in adulthood is extremely a rare cause of urethral stricture and is not associated with known etiologies. It was first described by Cobb et al., and to our knowledge only 5 families were reported in English literatures to have familial urethral stricture. We report two families with urethral stricture including five male patients referred to our tertiary reconstructive urology department during 1994 to 2017. The age and severity of symptoms at presentation are variable; as are the surgical interventions required. There are no phylogenetic, familiar or racial relationship between the two families described.

To present a case of recurrent gross hematuria after transurethral resection of the prostate that was refractory to endoscopic and open hemostatic interventions at the bladder neck and prostatic fossa. After performing angiographic evaluation of the pelvic vessels and finding the pseudoaneurysm, percutaneous embolization of arterial supply of the pseudoaneurysm was done. The location and type of lesion were successfully determined by angiography and controlled by angio-embolization of the internal pudendal artery. It seems that angiography can be helpful in the diagnosis and management of refractory bleeding after prostatectomy.