مجله تحقیقات در ارولوژی
سال چهارم شماره 2 (پاییز و زمستان 1399)

Male chronic pelvic pain syndrome (CPPS) is a prevalent condition and a disabling disorder with a significant impact on quality of life. There is no standard protocol for the treatment of this condition. This study was conducted to acquire a comprehensive view in the diagnosis and treatment of males with CPPS.

A total of 41 articles from 1975 to 2019 that discussed diagnosis, treatments and controversies of the male CPPS were reviewed using PubMed and MEDLINE websites.

Diagnosis of CPPS is typically based on patient history, symptoms and exclusion of other causes of these symptoms. Multimodal therapy is more effective than single therapy. Treatment should start with least invasive modality. Good interaction between the patient and physician is an important point in therapy and consultation with other specialists if necessary.

To manage this condition a multidisciplinary approach with multimodal therapy associated with good interaction between patient and physician appears to give the patient the best chance for treatment.

The aim of this study was to assess the effect of diabetes mellitus on Prostate Specific Antigen (PSA) serum levels among diabetic males without urinary tract complaints.

This is a case-control study conducted on 75 diabetic cases and 75 age-matched non-diabetic ones in 2016-17. Patientschr('39') demographics including age, duration of diabetes mellitus, presence of diabetic nephropathy, serum PSA (total and free) were recorded and cases were compared with controls.

Diabetic patients and controls were not statistically different regarding their age (P=0.61). Level of total and free PSA and their ratio were significantly less in diabetic group (P<0.001). Pearson coefficient correlation test showed no statistical association between duration of diabetes mellitus with PSA indices (P>0.05). There was significant association between HbA1C with total and free PSA and their ratio. Insulin therapy was in association with total and free PSA and their ratio (P<0.05) but oral remedies were not (P>0.05).

Diabetic persons have lower levels of all PSA indices. Findings of this study showed inverse statistical association of HbA1C with PSA indices while no association was found with duration of diabetes. PSA indices were significantly lower among patients under insulin therapy but no difference was found considering routine oral therapies.

In the activity-based costing method, first the activities are identified and then the cost of the service is calculated by calculating direct and indirect costs. The aim of this study was to determine the cost of fistula implantation service for hemodialysis patient in Golestan Hospital of Ahvaz.

The present study is a quantitative and applied study. In this study, the cost of fistula implantation service for hemodialysis patient was calculated using activity-based costing (ABC) method in Golestan Hospital in Ahvaz, Iran, in 2020. The data required to investigate the research topic were collected through checklists and interviews with staff involved and observation of service delivery activities. Finally, based on the surgery performed, the time spent in the operating room, the people involved in the surgical process, and the resources consumed, the average cost of a blood dialysis access surgery was estimated.

The results of the study showed that the cost of fistula creation service in hemodialysis patients was calculated at 7476060 Rials, of which 45.99% was related to equipment depreciation cost, 35.74% to space and building costs, 15.01% to personnel costs, 2.93% to the medication and 0.31% of the cost to the energy carriers. The service tariff is 1223100 Rials, which has a certain loss compared to the cost price of the service.

In this study, the major part of the cost of fistula in a dialysis patient was the cost of equipment with 45.99% of the total cost. The results showed that by employing specialized personnel for the correct use of equipment and devices, the cost of service can be reduced.

In cases with previous negative biopsies and a persistently elevated prostate-specific antigen (PSA) level, one of the best method for the definitive diagnosis of prostate cancer is the use of transurethral resection of the prostate (TURP). Therefore, this study aimed to compare the pathology results after the biopsy of such patients with the results obtained from TURP or open prostatectomy. 

This cross-sectional descriptive study included 95 patients referred to Shahid Beheshti Hospital, Hamadan, Iran, during 2014-19. The participants were selected by a census with a mean age of 68.81±8.38 years with total PSA>3 ng/ml and benign primary biopsy. Following that, they underwent TURP surgery. Data were extracted from hospital archives and recorded in the designed checklist. The variables including age, total and free PSA amount, prostate volume, frequency of biopsy, and the results of TURP or prostatectomy were examined in this study. Student t-test and non-parametric test of Mann-Whitney were used to analyze the data (P< 0.05).

Out of 95 patients studied after TURP or prostatectomy, 4.2% (n=4) of the cases were reported with cancer, and 25% (n=1), 50% (n=2), as well as 25% (n=1) of the patients, had Gleason scores of 5, 6, and 9, respectively, all of which were reported in the initial BPH biopsy. There was no statistically significant difference between cancer and non-cancer groups in terms of age, serum PSA, and prostate volume (P>0.05).

In patients whose PSA levels persistently increase despite previous negative biopsies, the TURP or open prostatectomy method can be used to diagnose prostate cancer more accurately.

Despite the widespread use of Bacillus Calmette-Guérin (BCG) for the treatment of superficial bladder tumors, recurrence and treatment failure is common among a significant proportion of patients..In this regard the addition of finasteride to BCG treatment may increase the effectiveness of bladder cancer treatment. The present study aimed to assess the effectiveness of finasteride in patients with bladder cancer undergoing BCG therapy

In this retrospective cohort study, 70 men with bladder cancer who were treated with BCG alone (control group, n=35) and BCG with finasteride (case group, n=35) in Shahid Beheshti Hospital in Hamadan from 2018 to 2019 were compared in terms of treatment efficacy. Data were analyzed by SPSS software (version 21) at a 95% confidence interval.

The mean duration of follow-up was 2.29±1.55 years; moreover, , the mean age scores of patients in the case and control groups were reported as 66.00±8.95 and 62.94 ±13.69 years, respectively (P=0.273). The frequency rates of recurrence of bladder cancer in patients receiving BCG with finasteride and BCG alone were obtained at 17.1% and 31.4%, respectively (P=0.163). The mean recurrence times were as 8.50 and 7.27 months in the case and control groups, respectively (P=0.404).

As evidenced by the obtained results in patients with bladder cancer, the addition of
 finasteride tablets to the BCG treatment regimen reduces the frequency and effectiveness of the disease.

Circumcision is one of the most important and well-known surgical procedures in the world. This clinical trial was performed to evaluate the advantages and disadvantages of ring circumcision in two groups: under one year and over one year.

In this study, 1904 children were circumcised during the years 1396 to 1399 in Shahid Beheshti Hospital in Hamadan and Sheikh Al-Rais Clinic. These children were divided into two groups: under one year and one  to three years( 952 cases in each group). Local anesthesia with 2% lidocaine was used in all children. The two groups were visited on the second day and the second week after circumcision in terms of complications and beauty of the surgery site. Parents were also justified in terms of complications and necessary actions.

In this study, there was no case of Meatal stricture in these patients. In the group under one year, three cases of infection occurred (0.003%) which improved with antibiotic treatment. In both groups under one year and one to three years, a total of 5 cases (three cases in under one year and two cases in one to three years group) of bleeding occurred, which were controlled by the initial measures of bleeding. The average ring fall time in children under one year was 8±1 days and in children one to three years was 9±1 days. Also, five cases of glans edema( two cases in under one year group and three cases in one to three group)  were seen, which were quickly removed by cutting on the fibrin ring at 3, 6 ,9 and 12 ochr(chr('39')39chr('39'))clock.

Awareness of the complications of circumcision and its treatment methods are important factors in the success of this method.

Urology is a branch of medicine that focuses on diseases of the urinary tract of men and women and the reproductive system in men. The first step of the diagnosis process in the health system is general practitioners, so it is necessary to evaluate the general practitioners’ knowledge level about the common urological disease to take the requisite training.

In this study, an online questionnaire was prepared and distributed to value general practitioners’ knowledge about bladder cancer, circumcision, kidney cancer, prostate diseases, Urinary tract infections, testicular diseases, and kidney and urinary tract stones.

This study involved 165  general practitioners, of whom 75.7% were medical graduates, and the rest were Interns. The level of knowledge of the subjects in the evaluated area including bladder cancer, circumcision, kidney cancer, prostate diseases, Urinary tract infections, testicular diseases, and kidney and urinary tract stones; was equal to was 65.87%, 65.5%, 48.25%, 55.62%, 57%,55.62%, and 63.43% respectively.

In conclusion, the average knowledge of general practitioners about the common urological disease in the present study was 58.75%, and this indicates the dominance of general practitioners in half of the common urological diseases.

46 XX male DSD which was previously named “de la Chapelle” syndrome is a rare disorder found in every 20000 infant males. Sixty to ninety percent of 46-XX males are fully virilized and have normal genitalia except small testicles. This report explains a 40 year-old infertile man presented with small testes and azoospermia but no signs of undervirilization. His had hypergonadotropic hypogonadism. Lymphocytes were cultured in GibcoTM RPMI Medium 1640 for 7 days for karyotyping which revealed 46XX. In conclusion, not to miss genetic defects like 46, XX male DSD, karyotype test should be considered in cases with atrophic testicles plus azoospermia even in adult men.