مجله تحقیقات در ارولوژی
سال ششم شماره 1 (بهار و تابستان 1401)

Prostate cancer is one of the most common cancers in men, which causes many deaths every year. P53 suppressor protein is one of the indicators the high level of which in the serum of cancer people is related to a decrease in the growth rate of cancer cells that prevents the development of cancer. There is evidence that exercise can alter p53 levels. This study aimed to investigate the effect of 8 weeks of resistance training on P53 gene expression in prostate cancer patients.

The statistical population of this randomized clinical trial included men aged 50 to 65 years with prostate cancer. In total, 40 people were selected by convenience sampling and randomly divided into two groups. The first group was subjected to resistance training, and the second group was regarded as a control. The training protocol included a period of resistance training. The obtained data were analyzed in SPSS software (version 20) at a significance level of P≤0.05.

Based on the findings, before the intervention, the serum level of P53 was not statistically and significantly different between the two groups (P≤0.05). However, after 8 weeks of intervention, there was a significant difference before and after the intervention in the resistance training group in terms of the value of this variable (P=0.000); however, it showed no significant difference in the control group after 8 weeks (P≤0.05).

According to the findings, resistance training increases the serum level of P53 suppressor protein in patients with prostate cancer, and as a result, control and help in the treatment of this cancer.

Chronic kidney disease is a progressive and irreversible disorder that causes the loss of kidneys and the accumulation of various toxins in the body. Kidney transplantation is the definitive treatment for this disease, while hemodialysis is the most common one. Research has been carried out on the effectiveness of aerobic and anaerobic exercise in increasing the level of dialysis adequacy, preventing anemia, controlling blood pressure, and reducing the complications of hemodialysis. This study was conducted to determine the effect of aerobic exercise on dialysis adequacy in patients undergoing hemodialysis treatment.

This controlled clinical trial study was conducted on 20 end-stage renal disease patients referring to Shahid Beheshti Hospital in Hamadan in 2022. The subjects were randomly divided into control and experimental groups. The first blood sample was taken from the participants 24 h before the start of the first training session. Aerobic exercises were held for 24 sessions over 8 weeks.

The dialysis quality of patients in the experimental group increased significantly, compared to the control group, after 8 weeks of aerobic exercises (P<0.05).

Aerobic exercise led to the improvement of dialysis quality and phosphorus and potassium levels in renal patients.

Surgical correction of hypospadias is one of the most common pediatric surgeries. Due to the several methods of hypospadias operations, the evaluation of results has always been challenging. Several questionnaires have been designed to reduce the discrepancy in the reports of hypospadias surgery, and the HOPE questionnaire is one of the most common. Based on our search, the reliability and validity of the Persian version of the HOPE (Hypospadias Objective Penile Evaluation) questionnaire have not been assessed yet.

In this cross-sectional study, firstly, the questionnaire "Objective evaluation of penis in hypospadias" was translated by two urologists and an English language expert familiar with medical concepts according to the Backward-Forward translation method into Persian and then again into English, and finally, the questionnaire was sent to experts and compared with the original questionnaire. The quality of translation and content were finalized and corrected. Thereafter, in order to check the form and content validity, the questionnaire was sent to eight experts, and the content validity indices and its content validity ratio were calculated. In order to check the reliability-stability of the re-test, two questionnaires, including images after hypospadias surgery of 42 patients, were delivered to eight specialists in pediatrics, urology, and pediatric surgery to determine the score at a time interval of one week, and finally, the data were analyzed in SPSS software (version 23) using the test-retest method. The Intraclass Correlation Coefficient (ICC) index and its confidence interval were calculated by the scores obtained from twice answering the instrument for each factor and the entire questionnaire. In order to determine internal consistency and reliability, Cronbach's alpha coefficient was calculated for each factor and the entire questionnaire.

In our study, intraclass correlation coefficient values for inter-rater reliability in the HOPE score were calculated at 0.89, indicating the high reliability of this questionnaire in Persian. The internal consistency of the Persian version of the HOPE scale was confirmed, rendering a Cronbach's alpha coefficient of 0.98.

The good validity and reliability of the HOPE scoring system in Persian support its use as a standard objective outcome measure of the cosmetic result after hypospadias surgery.

Venous thromboembolism (VTE) is the most important non-surgical complication in patients undergoing major urological surgery. Pulmonary embolism is the most common cause of death after urological surgery. Several clinical practice guidelines have been presented in different countries to prevent VTE, reduce the risk of VTE, and minimize the risk of bleeding. In Iran, there is no local clinical guideline for the prevention of VTE in urological surgery patients. Therefore, the present study aimed to review the clinical guidelines available in the world regarding thromboprophylaxis in urological surgery patients and present a summary.

The latest version of all available clinical guidelines related to VTE prophylaxis in urological surgeries until 2022 was searched using Medline (by PubMed), Google Scholar, Embase, and Trip database. After selection, each clinical guideline was reviewed by two researchers and a summary of their recommendations was presented.

During the database search, four clinical guidelines were included in this study. Among the present guidelines, only the European Urological Association guideline was appropriate for patients undergoing urological surgery, and the other three guidelines were related to hospitalized patients or those who underwent other surgeries, which in some parts addressed urological patients. According to the guidelines, the prevention methods of VTE prophylaxis are mechanical and pharmaceutical.

The present study showed that there is only one clinical guideline that has provided specific recommendations for urological surgeries, and other clinical guidelines have not specifically addressed these patients. A review of the aforementioned guidelines (whether specific to urology patients or not) showed a dearth of evidence and research on urological surgery patients, and decision-making is not easily possible in many cases. The results of the present study can be a step for the adaptation and approval of valid global guidelines and their use in our country. Moreover, due to the lack of clinical guidelines in Iran, the summary of the recommendations of this study can be used for clinical purposes.

Treatment with Extracorporeal Shock Wave Lithotripsy (ESWL) is a low-cost method with a short hospitalization period. However, several complications have been reported for this method. This study was designed to investigate the efficiency and side effects of ESWL.

In a cross-sectional study, all available files of cases in the stone crusher unit were evaluated according to the inclusion and exclusion criteria from April 2013 to April 2016. Preliminary information before lithotripsy, including patients' demographic characteristics and also treatment success, and complications, was assessed.

The success rate of ESWL was 81.4%, which had no significant relationship with gender, age, and body mass index. The mean size of the stones was 10.9±5.4 mm, which was associated with the success rate. In terms of stone location, the highest frequency was observed in the right lower calyx, followed by the left pelvis. The most common complications were ecchymosis (84.3%), hematuria (20.6%), and severe pain (15.3%). There was a significant difference in the incidence of complications in patients with different stone sizes (p<0.01). The occurrence of complications had a significant relationship with the location of the stone (p<0.01). Stones located in the pelvis and lower calyces caused the most complications.

The results showed that ESWL had a high success rate and was a suitable method for the treatment of urinary stones. The success rate was associated with the stone size, which, therefore, is an important factor in choosing this approach.

Patients who have nephrolithiasis and are candidates for operation may have symptomatic or asymptomatic bacteriuria, which should be treated before any surgical intervention. We evaluated our patients for the prevalence of bacteriuria before surgical intervention.

Between March 2020 and March 2022, a total of 832 patients (489 men and 343 women) with a mean age of 38.4 years, who were candidates for renal stone surgery, were evaluated by tests, including complete blood count, urine analysis, and preoperative culture. In this study, we recorded the bacteriuria (symptomatic or asymptomatic).

Of 832 patients, 594 had the first episode of stone formation and 238 had recurrent diseases. Of these, 784 patients were scheduled for percutaneous nephrolithotomy and 48 patients for open nephrolithotomy. Overall, in the preoperative urine analysis test, 56 cases of bacteriuria were reported, of which 22 cases had positive urine cultures. Of the positive culture cases, 14 were recurrent and 8 were patients who had kidney stones for the first time. The most common microorganism was Escherichia coli (n=15), followed by Klebsiella (n=4), Proteus (n=2), and Pseudomonas (n=1). Only 8 of these patients had symptoms and the rest were asymptomatic. All of these patients received a course of oral antibiotics before the operation.

Bacteriuria is a common finding in patients with nephrolithiasis that seems to be more common in recurrent diseases; therefore, urine culture and appropriate treatment are mandatory before any intervention to prevent serious complications, such as infection, sepsis, and mortality.

Renal colic is one of the common causes of abdominal pain in pregnant women. The present study aimed to evaluate the outcome of renal colic during pregnancy in our referral center.

From March 2015 to March 2020, a total of 228 pregnant patients were referred to the emergency unit with renal colic. Most of them were managed conservatively; nonetheless, some of them were complicated and needed more procedures.

Of 228 patients, 179 patients had only microscopic hematuria and mild hydronephrosis with small or no stone in ultrasonography. They responded to conservative management and were discharged. Moreover, 26 patients had ureteral stones smaller than 6 mm that were passed with medical therapy. A number of 11 patients were in the third trimester with ureteral stone and/or renal stone for which percutaneous nephrostomy was applied. In addition, 12 patients who had large distal ureteric stones underwent ureteroscopy and stent insertion. A number of 24 patients that were in the first or second trimester had an internal stent (15 patients) or nephrostomy (9 patients) until the delivery of their fetus. Finally, three patients in the second trimester did not tolerate/accept complicated stent or nephrostomy, so they had intractable colic. After explaining all the possible complications and obtaining written informed consent, they were scheduled for urgent percutaneous nephrolithotomy with ultrasonographic guidance in a flank position.

Renal colic in pregnancy is common and mostly managed conservatively; however, in some cases, the patients may need nephrostomy tube insertion, ureteroscopy, and stent insertion. Extracorporeal shock wave lithotripsy is contraindicated, and percutaneous nephrolithotomy is not recommended as the first opinion in pregnancy unless in an urgent situation.

Bladder cancer is one of the most common malignancies of the urinary system. An important source of health disparities is related to early cancer detection strategies. The present study aimed to determine the inequality in bladder cancer screening uptake.

The current cross-sectional study was conducted on 1,760 subjects from the urban population over 30 in Kermanshah. The adjusted odds ratio was used to show the relationship between bladder cancer screening uptake and different subgroups. The concentration index and concentration curve were used to quantify and analyze inequality in bladder cancer screening uptake.

The history of bladder cancer screening uptake was 1.02% (1.18% in men and 0.88% in women). The mean age of bladder cancer screening uptake was 56.18 years (standard deviation 12.60 years). The highest percentage of bladder cancer diagnostic test uptake pertained to participants who had a positive family history of bladder cancer (23.33%). The concentration index for bladder cancer screening uptake was estimated at 0.238 (P<0.073). The adjusted odds ratio demonstrated that the wealthy group had 10.25 times as many bladder cancer screening uptake as the poor participants.

The odds ratio of bladder cancer screening uptake in the rich group was more than 10 times that of the participants in the poor group. Health resources should be directed to help reduce disparities and provide services to those most in need.