Urology Journal
Volume:17 Issue: 1, Jan-Feb 2020

Isothermic irrigation decreases the reduction in core temperature and shivering in patients undergoing transurethral resection of prostate gland but this effect has not been studied in patients undergoing endoscopic urethral stone treatment surgery. The current study is designed to study the effect of isothermic hydration on core temperature in patients scheduled for endoscopic urethral stone treatment surgery under spinal anesthesia.

Sixty patients allocated randomly into two groups. In GroupW (n = 30) irrigation fluid at 37°C was used whereas at room temperature in GroupRT (n = 30). Spinal anesthesia was performed at L3-L4 interspace with 15mg of hyperbaric bupivacaine. Core temperature, shivering, and hemodynamic parameters were measured every minute until 10th minute and five minute intervals until the end of operation. Shivering and surgeon comfort was also recorded. The primary outcome was the core temperature at the end of surgery. Frequencies, means, standard deviations, percentages, chi-square tests, independent samples t-test, and Mann Whitney U tests were used where eligible for the statistical analysis.

Baseline core temperature was 36.6 ± 0.4°C in GroupW and 36.6 ± 0.5°C in GroupRT (P = .097) which decreased to 36.0 ± 0.5°C and 35.2 ± 0.7°C respectively (P = .018) at the end of operation. Shivering was observed in 36.7% (n = 11) in GroupRT and 6.7% (n = 2) in GroupW (P = .012). Hemodynamic parameter changes and demographic data were not significant between groups.

Isothermic irrigation decreases both the reduction in core temperature and the incidence of shivering while increasing the surgeon comfort.

There is conflict of evidence regarding whether absence of hydronephrosis is a risk factor for bleeding in percutaneous nephrolithotomy (PNL). Moreover, among the stone complexity scoring systems used for PNL (Guy’s stone score, the S.T.O.N.E. nephrometry and the CROES nomogram), only the S.T.O.N.E. nephrometry score incorporates hydronephrosis as a risk factor. Therefore, this study aimed to compare perioperative outcomes according to the presence or absence of hydronephrosis in percutaneous nephrolithotomy (PCNL) patients and to investigate whether absence of hydronephrosis is a risk factor for blood transfusion rate.

281 patients who had undergone PCNL between December 2009 and April 2017 were divided according to the absence or presence of hydronephrosis (group I and group II, respectively). Perioperative outcomes were compared between the two groups. A multivariable regression analysis was performed to investigate whether hydronephrosis was a risk factor for blood transfusion rate.

Patients without hydronephrosis showed significantly longer operation time and admission period, lower stone-free rate and higher blood transfusion rate compared to patients with hydronephrosis (p < 0.05, p = 0.002, p = 0.011, and p < 0.05, respectively). Multivariate logistic regression analysis showed that hydronephrosis was a significant risk factor for blood transfusion (OR, 95% CI and p value was 0.353, 0.163-0.761 and 0.008, respectively).

Based on the results of the current study, we found that absence of hydronephrosis was a significant risk factor for blood transfusion in conventional PCNL.

To explore the feasibility and safety of ambulatory mPCNL (mini percutaneous nephrolithotomy) on upper urinary tract calculi.

Clinical data of 18 patients who received ambulatory mPCNL during Auguest 2017 to January 2018 and 23 patients who were treated with routine inpatient mPCNL of the corresponding period were collected. All the patients included received 16Fr channel PCNL under the guidance of Doppler ultrasound. A 6Fr double J stent was placed in the ureter for internal drainage, and either an indwelling 14Fr open nephrostomy tube was placed or the puncture channel was filled with absorbable hemostatic materials alone, depending on the bleeding condition of the puncture channel and the intraoperative conditions. Preoperative parameters and surgery time, complications, total hospitalization costs and hospital stay time between the two groups were compared.

Preoperative parameters regarding age (P = 0.057), sex distribution (P = 0.380), ASA score (P = 0.388), Calculi CT value (P = 0.697), and the S.T.O.N.E. score (P=0.122) were comparable between the two groups. Maximum diameter of calculi (cm) of the conventional hospitalization group, however, was larger than the ambulatory surgery group (P = 0.041). There were no significant differences in the mean surgery time (P = 0.146), postoperative hemoglobin drop (P = 0.865), Calculi-free rate on the next day after surgery (P = 0.083) and postoperative fever rate (P=0.200) between the two groups. With regard to tubeless rate (P < 0.001), total hospitalization costs (P = 0.003) and hospital stay time (P < 0.001), there were significant advantage favoring ambulatory mPCNL.

For patients with simple upper urinary tract calculi and relatively good performance status, ambulatory mPCNL is feasible as it’s equally safe and efficient as compared with routine inpatient mPCNL. Moreover, ambulatory mPCNL decreases hospitalization costs and hospital stay time. Nevertheless, perioperative management should be carefully conducted, and well-designed studies are warranted.

The aim of this study was to investigate the effects of listening to different music types during extracorporeal shock wave lithotripsy (SWL) on the patients’ pain control, anxiety level, and satisfaction.

This study was a prospective single-blinded, paral lel-group randomized clinical trial with balanced ran domization [1:1]. A total of 150 patients who underwent first-session SWL were included in the study. The patients were randomly divided in to five groups (30 participants in each group) as follows: headphones were not put on and no music was played in Group 1 (control group); headphones were put on but no music was played in Group 2; Turkish art music was listened to with headphones in Group 3; Western classical music was listened to with headphones in Group 4; thetype of music the patient liked was listened to with headphones in Group 5. Demographic data related to patients and procedure, State-Trait Anxiety Inventory-State Anxiety (STAI-SA), Visual Analog Scale (VAS) scores, willingness to repeat procedure (0: never 4: happily), and patient satisfaction rates (0: poor 4: excellent) were recorded immediately after the procedure.

There was a statistically significant difference between groups in terms of median VAS scores (7, 6, 4.5, 5, and 4, respectively, P < .001), whereas the VAS scores in Groups 3, 4, and 5 were significantly lower than those in Group 1 and 2 (P < .001). The median STAI-SA scores between the groups were significantly different (45, 45, 42, 45, and 40, respectively, P < .001), while the anxiety levels in Groups 3, 4, and 5 were significantly lower than those in Group 1 (P = .008, P = .018, and P < .001, respectively). Moreover, there were statistically significant differences between the groups in terms of willingness to repeat the procedure and patient satisfaction rates (P < .001).

Music therapy during SWL reduced the patients' pain and anxiety scores, moreover listening to the patient’s preferred music type provided greater satisfaction. Listening to the patient’s preferred music type could be standardized and routinely used during SWL.

Radical prostatectomy is one of the most common urological surgeries. Inguinal hernia is a well-known complication of radical prostatectomy. There are many controversies about selection of surgical techniques for repair of inguinal hernia. Traditionally laparoscopic approach was contraindicated for patients with history of lower abdominal surgery, but recent studies showed that it could be safe and successful and even has some advantages over open repair. In this prospective study we evaluated outcomes of laparoscopic hernia repair in patients who previously underwent radical prostatectomy.

In this prospective study, 34 consecutive patients diagnosed with inguinal hernia after radical retropubic prostatectomy underwent laparoscopic transabdominal inguinal repair and followed up for outcomes and complications.

The surgery duration was 167.44 ± 52.85 min (75-230 min). No intraoperative complications occurred. Patients were discharged within 20.79 ± 4.76 hours (12-34 hours). 69.8% of cases (30 patients) needed analgesic administration. No conversion to open surgery occurred. There were 9.3% (4 hernias) hernia recurrences. We followed patients for 9.9 ± 5.33 months (2-19 months).

It is concluded that TAPP for inguinal hernia repair after radical prostatectomy has good results and is effective. But according to rate of recurrence, its safeness is conflicting. We notice no major complication in our patients during the time of follow up. This may be due to safety of the operation in the proposed patients.

The neutrophil-to-lymphocyte ratio (NLR), as an indicator of the systemic inflammatory response, predicts adverse outcomes in many malignancies. We investigated its prognostic significance in patients with nonmetastatic renal cell carcinoma.

We retrospectively evaluated data of 196 consecutive non-metastatic RCC patients who underwent radical or partial nephrectomy between 2010 and 2012 at a single center. Overall survival (OS) was assessed using the Kaplan-Meier method and compared using the log-rank test. We applied univariate and multivariate Cox regression models to evaluate the prognostic value of dichotomized NLR for OS.

At a median follow up of 68 months, high NLR (≥ 2,69) correlated with worse survival outcome (P = .006 in log-rank test) and higher tumor stage (P = .035). Univariate and multivariate analysis identified elevated NLR (P = .039), as well as age (P = .002), high Fuhrmann grade (P = .002) and high pathologic T stage (P < .001), as significantly associated with overall survival.

In our cohort, an elevated neutrophil-to-lymphocyte ratio is significantly associated with worse OS on univariate and multivariate analysis. Consequently, the NLR is an easily acquired biomarker, which may be useful in pretreatment patient risk stratification.

The endocrine therapy is effective for patients with advanced prostate cancer, but the disease eventually becomes refractory to treatment. The aim of this study was to investigate prognostic factors and to develop a risk stratification model for survival in patients with advanced prostate cancer undergoing endocrine therapy.

This study included 197 patients with stage IV prostate cancer who were treated with endocrine therapy as primary treatment at Tokyo Medical University, Tokyo, Japan, between January 1999 and November 2012. Prognostic values including baseline clinical laboratory values before endocrine therapy for stage IV prostate cancer were examined. Patients (n = 30) who were not followed or for whom data were unavailable or who were treated with radiotherapy were excluded from the study. Excluding these patients, we retrospectively analyzed 167 patients who were treated with endocrine therapy as the primary treatment. Disease-specific survival (DSS) was evaluated using the Kaplan-Meier method, and prognostic factors were identified using the Cox proportional hazard model analysis.

In univariate analyses, patients with a performance status (PS) ≥ 2, platelet count ≥ 3.0× 105 µ/L, prostate specific antigen (PSA) > 50 ng/mL, alkaline phosphatase (ALP) > 350 U/L, lactate dehydrogenase (LDH) > 240 IU/L, and Gleason score (GS) ≥ 8, hemoglobin (Hb) < 12 g/dL, extent of disease (EOD) ≥ 3 and poorly differentiated adenocarcinoma showed significantly lower DSS than their respective counterparts. Neutrophil-to-Lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and white blood cell (WBC) count were not significantly associated with DSS. In a multivariate Cox proportional hazard model, PS and platelet count were independent prognostic factors. Based on the hazard rate (HR) calculated by the following formula: HR = exp (0.82 × PS + 1.38 × platelet count) patients were stratified into 3 risk groups. The differences in DSS rates among the 3 groups were statistically significant.

These results suggest that PS and platelet count are independent prognostic factors and that a combination of these factors can be used to stratify metastatic prostate cancer patients treated with endocrine therapy according to their DSS risk.

One of the most frequent complications after circumcision by thermocautery is phimosis. In this study, we aimed to present the functional and cosmetic results of the modified sleeve technique for the correction of this iatrogenic phimosis.

The study group included iatrogenic phimosis cases who underwent circumcision using thermocautery during the last eight years. Initially, steroid creams were applied on these patients for six weeks. Patients who did not respond to this treatment underwent surgery using the modified sleeve technique. Control visits were performed at the first and fourth postoperative weeks.

A total of 32 patients with a median age of 5.1 ± 1.1 years out of 13285 circumcisions by thermocautery were included in the study. No positive treatment outcomes were obtained by topical steroids, and all patients proceeded to surgery by modified sleeve technique. Median operative time was 25 ± 2.3 minutes. Cosmetic and functional outcomes were satisfactory in all cases.

There is no place for topical steroids in management of iatrogenic phimosis after thermocautery, thus early surgery is advised to avoid emotional stress. Our modified sleeve technique can achieve maximum cosmetic and functional outcomes without leading to extreme shortening of the penile skin and mucosa.

Delayed graft function (DGF) is a form of acute renal failure which results in increased post-transplantation allograft immunogenicity and risk of rejection episodes in addition to decreased long-term survival. Its incidence and risk factors have been extensively studied, especially after deceased donation. However until now, only few data has been published on DGF in living donor kidney transplant recipients. The present study was performed to investigate the frequency and risk factors of DGF among living- kidney transplant recipients.

In this retrospective study, 500 living kidney transplant recipients recruited and data collected from hospital registries in three countries (Iran, Kingdom of Saudi Arabia (KSA) , and Kuwait ).

Incidence of DGF revealed to be %95) %2.3 CI: %3.6-%0.9). DGF group showed significant older age for the recipients and in “without DGF” group, there were more females, and lower weight for the recipients. It was found that patients with DGF had longer pre transplant dialysis duration, cold ischemic and anastomosis time during surgery .

DGF after living-donor kidney transplantation is a multifactorial complication which donor, recipient, and technical factors would lead toward. Consideration and optimization of these risk factors may drive through better long-term patient and graft outcomes in living kidney transplant recipients.

The aim of the present study was translation, cross cultural adaptation and face validity evaluation of the Persian version of Patient-Reported Outcome Measure for Urethral Stricture Surgery (USS-PROM) Questionnaire.

This study was assessed: translation, translation quality, reverse translation and comparison of the English version, content validity, internal consistency and stability. Content validity presents by index of content validity (CVI) and the content validity ratio (CVR). Internal consistency reliability was tested by Cronbach’s α, and test-retest reliability was evaluated by Intraclass Correlation Coefficient (ICC) assessed by Guttman two way mixed absolute agreements.

Forty males with history of urethroplasty and mean age of 41.4 ± 9.08 (range of 19 to 52) years old were enrolled. In the case of mean scores of difficulty from the 16 translated items, 80% had easy translation. In terms of translation quality, 92% were the satisfactorily clear. In terms of similar concept, 92% were satisfactory. The overall quality of the translation was satisfactory at 88%. The translated questionnaire has a good internal consistency (Cronbach's alpha as 0.84). CVI and the CVR, test-retest ICC evaluation were appropriate/acceptable in all questions. The questionnaire ICC was .791(CI 95%, .678-.876). Two main different aspects of the questionnaire consisted of urinary symptoms (question 1-10) and Quality of life (question 11-15). Cronbach's alpha were .800 and .671 respectively.

The Persian version of the questionnaire has acceptable cultural adaptation and face validity. Further studies should be done using this translated tool to determine its applicability in the urethroplasty patients.

The most common option for the management of urethral stricture (US) is direct visual internal urethrotomy (DVIU), because it is an easy and minimally invasive technique but the low success and high recurrence rates of this technique make urologists research for different types of therapeutic alternatives in stricture treatment. In this study we aimed to compare the internal urethrotomy with amplatz dilation for the treatment of male US.

A total of sixty patients, who have been operated due to urethral stricture were enrolled into this study. Group 1 was treated with amplatz renal dilators and the group 2 was treated with cold knife urethrotomy. All patients were evaluated for Qmax preoperatively and at the first, 3rd, 9th and 12th months postoperatively.

In the 3 month uroflowmetry results, mean Q max values were 15.6 ± 2 ml/sec in amplatz group and 15.5 ± 1.6 ml/sec in DVIU group. There was no statisticaly difference between the two groups. However the Q max values in the postoperative 9 and 12 months were significantly decreased in the DVIU group. In the DVIU group 9 recurrences (36%) appeared and 2 of these reccurrences were in the first 3 months, whereas in the amplatz group no recurrences appeared in the first 3 months. The urethral stricture recurrence rate up to the 12 month follow up was statistically significant for group 1 when it is compared with group 2.

In our experience, amplatz dilation is a good option as the initial treatment for urethral stricture.

To evaluate the long-term outcome of synthetic mesh use in the treatment of women with Pelvic organ prolapse (POP).

We evaluated the outcome of synthetic mesh implantation by vaginal surgery method in 153 women (mean age of 9.31±53.66 years) with POP grade >2 in the anterior compartment. Demographic findings, baseline symptoms as well as subjective and objective outcome were recorded during the follow-up period of 11.33±36.89 months.

POP relapse occurred in %3.3 indicative of %96.7 anatomical success rate. Patients’ common baseline findings were frequency (%72.5), stress and urge incontinence (%59.5 and %47.7). Subjective outcome were vaginal pain (%13.7), dyspareunia (%9.2) and tension feeling (%8.5), while objective outcomes were mesh exposure (%3.9), urge incontinence (%11.1) and vaginal infection (%1.3). Stress incontinence was completely treated following surgery. There was significant improvement in dyspareunia, vaginal pain, urge and stress incontinence (all p < 0.001) and fecal incontinence (p = 0.02). After surgery, %88.42 were satisfied of the surgery outcome.

POP surgery with synthetic mesh has acceptable results, considerable improvement in symptoms and high rate of satisfaction during follow-up; however, side effects are not uncommon but tolerable.

This study aimed to investigate the protective effect of Gallic acid (GA) on the cyclophosphamide (CP) toxicity induced in the reproductive system.

After a pilot study for dose responses of gallic acid, forty adult male NMRI mice were divided into 5 groups (n=8): control, sham (NaCl Serum: 0.2mL per day), CP (15 mg kg1- per week; IP), GA (12.5 mg kg1- per day ; IP) and GA (12.5 mg kg1- per day ; IP) +CP(15 mg kg1- per week; IP). After treatment, the left testis was detached and used for histological examination and right testis used for malondialdehyde (MDA) measures. Left caudal epididymis was placed in the Ham’s F10 medium and released spermatozoa were used in order to analyze sperm parameters. Sperm DNA fragmentation was assessed by Sperm Chromatin Dispersion (SCD) method.

In the CP group, there was a significant increase in the sperm DNA fragmentation (% 23.91 ± 57.89) compared with control group (% 10.27 ± 24.52). That was significantly improved by GA (12.5 mg kg1- per day ; IP) in GA+CP group (% 8.85 ± 28.4) compared to CP group (p< .001). A significant increase was reported about MDA levels in CP group (2.59 ± 6.26) in compared with the control group (2.05 ± 4.30), But GA (1.33 ± 3.24) decreased it in GA+ CP group (p< .01). The histopathological investigation revealed marked testicular atrophy in CP group, whereas GA diminished these deviations (P< .05).

Gallic acid can modify the reproductive toxicity of cyclophosphamide in NMRI mice and increase the antioxidant capacity of testis tissue.

Today, the majority of medical graduates in countries such as the UK, the US or Germany are female. This poses a major problem for workforce planning especially in urology. We here use first the first time the previously established Brüggmann Groneberg (BG) index to assess if female academic career options advance in urology.

Different operating parameters (student population, urology specialist population, urology chair female:male (f:m) ratio) were collected from the Federal Office of Statistics, the Federal Chamber of Physicians and the medical faculties of 36 German universities. Four time points were monitored (2010 ,2005 ,2000 and 2015). From these data, female to male (f:m) ratios and the recently established career advancement (BG) index have been calculated.

The German hospital urology specialists’ f:m ratios were 499) 0.257 female vs. 1944 male) for ,2015 0.195 for 0.133 ,2010 for 2005 and 0.12 for 2000. The career advancement (BG) index was 0.0007 for ,2000 0,0005 for 0.094 ,2005 for 2010 and 0.073 for 2015. The decrease from 2010 to 2015 was due to an increase in the f:m ratio of hospital urologists and female medical students.

The BG index clearly illustrated that there is an urgent need for special academic career funding programs to counteract gender problems in urology. The BG index has been shown to be an excellent tool to assess female academic career options and will be very helpful to assess and document positive or negative changes in the next decades

Ischemia-reperfusion (IR) causes various damage in renal tissues. The aim of the present study was to evaluate the renoprotective effect of phosphodiesterase 5 inhibitor (PDE5I) on IR induced renal injury in a rat model.

Thirty adult male, -12week-old, Sprague-Dawley rats were divided into three groups. Renal IR injury was induced by occlusion of the bilateral renal pedicle for 45 min followed by reperfusion for 24 h. The rats were sacrificed for collecting blood and tissue specimens. IR rats were administered daily oral Tadalafil (group I) or no pills (group II), while sham-operated animals were treated with no pills (sham group). The pill was diluted with distilled water and administered to rats for 15 days, orally. Renal histopathology, function, proinflammatory and inflammatory cytokines and mediators were assessed by serum creatinine, western blot assay and immunohistochemistry.

Compared with sham group, rats that underwent renal IR operation exhibited a significant increase in concentration in serum creatinine (P < .01) and tissue pro-inflammatory and inflammatory mediators. In group I, however, tadalafil significantly suppressed elevation of the serum creatinine and increased the levels of endothelial nitric oxide synthase and decreased the level of intercellular adhesion molecule1- (ICAM1-) compared to group II (P < .05). Moreover, tadalafil prevented IR-induced expression of pro-inflammatory mediators such as monocyte chemotactic protein1- (MCP1-) (P < .05).

Tadalafil significantly promotes functional recovery after renal IR injury and effectively inhibits the induction of pro-inflammatory and inflammatory mediators. The results substantiate Tadalafil as a protective agent against IR-induced renal injury

We investigated treatment satisfaction with flexible-dose fesoterodine in patients with overactive bladder (OAB) who were dissatisfied with previous anticholinergic therapy.

The subjects were prescribed fesoterodine 4 mg for 4 weeks and fesoterodine 4 mg or 8 mg for another 8 weeks. The primary end point of this study was patients’ satisfaction after 12 weeks of fesoterodine treatment on a five-point Likert scale. Secondary end points included a change in the number of daytime micturition, urgency incontinence episodes, urgency episodes, and nocturnal micturition in a -24hour period from baseline to final assessment.

Overall, 84 patients were assigned to the treatment group in this study and 63 patients completed the -12week treatment course. A final fesoterodine dose of 4 mg and 8 mg was used by %71.4) 45) and %28.6) 18) patients, respectively. The satisfaction and dissatisfaction rates at 12 weeks were %69.9 and %14.2, respectively. Mean changes in the daytime micturitions (4.72 ± 9.73 vs. 2.86 ± 7.76), urgency episodes (5.68 ± 7.73 vs. ± 3.71 4.09), and nocturnal micturitions (1.36 ± 2.13 vs. 1.12 ± 1.68) in 24 hours improved significantly with flexibledose fesoterodine treatment (P < .05). Most adverse events were mild and none were severe.

The flexible dose fesoterodine represents an alternative treatment modality in patients with OAB who are dissatisfied with previous anticholinergic therapy in Korea.