Urology Journal
Volume:2 Issue: 4, Autumn 2005

This review evaluates the most recent knowledge regarding surgical management of stress urinary incontinence. A comprehensive MEDLINE search was performed, limited to those articles published from 1995 to 2005; 470 articles were reviewed. The most relevant of which were considered, and additional ones were selected by reviewing these studies’ bibliographies. Overall, 53 articles were selected and used in this study. Few randomized controlled trials have been done. The best results of retropubic procedures are seen when the intrinsic urethral sphincter is competent and its effectiveness is sustained in the long term. A laparoscopic approach, although less popular and with a lower short-term cure rate, is an alternative. Sling surgeries can be the first-line treatment for all types of stress urinary incontinence. Autologous grafts are still considered the gold standard, but synthetic materials such as tension-free tape have comparable results with standard open retropubic procedures. Still, long-term–cure and complication rates have not yet been elucidated. Using urethral bulking agents is the least invasive approach, applicable in both intrinsic sphincter deficiency and urethral hypermobility. However, it has a poor long-term outcome and necessitates repeat injections. Long-term data suggest that Burch colposuspension and sling procedures produce similar objective cure rates. New synthetic suburethral slings such as tension-free vaginal tape have gained popularity in recent years. Complications of traditional and newer suburethral slings are declining, but they still occur and often are associated with serious morbidity. New therapies should be studied in randomized clinical trials and compared with conventional approaches.

The goal of this study was to investigate the effect of transurethral resection of the prostate and open prostatectomy on the serum prostate-specific antigen (PSA) level in men with benign prostatic hyperplasia. Serum prostate-specific antigen levels were determined before and 6 months after operation in 86 patients with benign prostatic hyperplasia who had undergone transurethral resection of the prostate or open prostatectomy. We measured the prostate volume by means of transrectal ultrasonography and weighed the surgical specimen. Changes in serum PSA levels and their correlation with prostate volume and the resected prostate weight were evaluated. Of 86 patients, 45 underwent transurethral resection of the prostate and 41 underwent open prostatectomy. Mean PSA levels were reduced by 67.4 % (range, 0.40 ng/mL to 7.60 ng/mL) in the patients who had undergone transurethral resection of the prostate and 80.7% (range, 1.00 ng/mL to 14.50 ng/mL) in the patients with open prostatectomy. Removal of 1g of prostate tissue reduced serum PSA levels by an average of 0.15 ng/mL in those who underwent transurethral resection of the prostate and 0.10 ng/mL in those treated with open prostatectomy (P =. 018). Forty patients (88.9%) in the group who underwent transurethral resection of the prostate and 39 (95.1%) in the open prostatectomy group exhibited a postoperative PSA level of less than 2.00 ng/mL (P =. 20). A modified reference range seems necessary for the screening of prostate cancer via PSA level in men who have undergone prostatectomy for benign prostatic hyperplasia.

Serum prostate-specific antigen (PSA) is still the simplest marker for early diagnosis and follow-up of prostate cancer. Because racial differences in PSA levels have been found, we performed this study to determine the reference level of serum PSA for men in Yasuj, in southwest Iran. Men aged 40 years and older who had been referred to any of the Yasuj hospitals for a blood cell count for any reason were randomly selected. Those with a history of prostate cancer, prostatitis, urinary tract infection, bladder outlet obstruction, or transurethral procedures were excluded. Blood samples were taken, and PSA levels were measured. Prostate-specific antigen levels in the 95th percentile were 1.35 ng/mL, 1.85 ng/mL, 3.2 ng/mL, and 4.4 ng/mL for men aged 40 to 49, 50 to 59, 60 to 69, and older than 69 years, respectively. Mean serum PSA levels were 0.7 ng/mL, 0.9 ng/mL, 1.6 ng/mL, and 2.2 ng/mL, respectively. A comparison of our results with those from studies in the United States and Japan shows that the reference PSA level in our society is significantly lower than that for white and black Western men, and slightly lower than that for Japanese men. Although we examined men with no history of prostate cancer, cancer was not ruled out by diagnostic test; hence, our results may be overestimated. Further investigations in Iran are warranted.

This study was performed to evaluate the frequency of skin lesions in kidney transplant recipients. A total of 681 kidney transplant recipients were followed at Shaheed Labbafinejad transplant center in Tehran, Iran. Skin lesions were evaluated, and diagnoses were made clinically and confirmed by lesion smear, tissue biopsy, tissue culture, and serologic examinations, as indicated. Skin lesions were found in 54 patients (7.9%), and their frequencies were as follows: dermatomal herpes zoster (18 patients, 2.6%, 13 men and 5 women), herpes simplex infection of face and lips (15 patients, 2.2%, 5 men and 10 women), chickenpox (6 patients, 0.9%, 5 men and 1 woman), Kaposi''s sarcoma (5 patients, 0.7%, 3 men and 2 women), warts (4 women, 2 of whom had genital warts), pyoderma gangrenosum (1 man, 0.14%), multiple fungal abscesses of the leg (1 man, 0.14%), mucormycosis (1 man, 0.14%), and molluscum contagiosum (1 man, 0.14%). Moreover, 2 women (0.3%) had generalized herpes simplex lesions. Frequencies of herpes zoster (3.5%), herpes simplex (2.5%), and human papillomavirus (0.6%) infections in our kidney transplant recipients were low. We recommend that all kidney transplant candidates be evaluated and immunized for herpes zoster virus before transplantation, all herpetic-form lesions of these patients be reported to physicians (even mild lesions), and finally, that all human papillomavirus lesions be diagnosed and treated promptly to prevent more serious lesions such as malignancies.

The purpose of this study was to compare the short-term and long-term kidney transplant outcomes in diabetic and nondiabetic patients. We studied all kidney recipients in Golestan hospital, Ahwaz, from 1995 to 2003. The patients were divided into two groups of diabetic and nondiabetic, and 1-year, 2-year, and 5-year survival rates of the patient and the kidney were evaluated. We also evaluated and compared the causes of death between these two groups. There were 50 diabetic patients with a mean age of 51 years, and 350 nondiabetic patients with the mean age of 29 years old (P =. 03). One-year, 2-year, and 5-year graft survival rates were 90% versus 91.5%, 86% versus 89%, and 76% versus 83% in diabetic and nondiabetic patients, respectively (P =. 19). The patient survival rates were 92% versus 93%, 88% versus 91%, and 76% versus 84% in diabetic and nondiabetic patients, respectively. The most common cause of death was myocardial infarction in diabetic patients (50%), and septicemia among the nondiabetic ones (50%). The most common cause of kidney allograft loss was patient''s death (75%) in diabetic patients and kidney rejection (40%) in nondiabetics. Long-term kidney transplantation results have been significantly improved comparing with other studies. Thus, kidney transplantation is recommended as the treatment of choice in diabetic patients with end-stage renal disease. However, a complete evaluation of cardiac problems for these patients is recommended before the surgery.

In this retrospective study, we reviewed the outpatient data of patients with premature ejaculation to investigate the association of that disorder with irritable bowel syndrome and a positive history of enuresis. All patients with premature ejaculation who had presented to the author''s office from March 2002 to June 2003 were selected. Their medical records were reviewed, and data including symptoms of irritable bowel syndrome, history of enuresis, and psychologic disorders were collected. The results of our analysis were compared with the worldwide reported prevalence of enuresis and irritable bowel syndrome in the male general population. Forty-one consecutive patients were asked whether they had ever experienced irritable bowel syndrome, enuresis, psychologic problems, and/or the feeling of tickling or sexual pleasure at ejaculation. Of those 41 patients, 18 reported the symptoms of irritable bowel syndrome (43.9% versus 10% in the general population; P <. 001). A reliable answer about the history of enuresis was obtained from 35 patients, 14 of which had experienced that disorder (40% versus 10% in the general population; P <. 001). Of those 35 patients, 6 (17.4%) had experienced both irritable bowel syndrome and enuresis. Twenty-two of 37 patients (59.5%) reported psychologic problems including stress, agitation, and obsession-compulsive disorder. The results of this study suggest the association of premature ejaculation with irritable bowel syndrome and enuresis, which in turn may indicate that those disorders share a common neurologic pathophysiology. A special attention of the physicians to the symptoms of these diseases together may be of great help for the patients.

Our aim was to evaluate the efficacy of a tubed buccal mucosal graft in repeat urethroplasty for patients with urethral stricture and failed previous operations. Ten patients (aged 12 to 47 years) with urethral stricture were entered into the study. All had a history of failed previous urethroplasties, and 5 had failed internal urethrotomies too. Repeat urethroplasties were performed by excising the fibrous tissue around the stricture; buccal mucosa was then harvested from the inner cheek, made into graft tubing, and interposed into the defect. The patients were followed at 1, 6, and 12 months. The procedure was technically successful in all the patients. The mean operative time was 150 minutes. The stricture sites were in the posterior urethra in 8 and the anterior urethra in 2 patients. The mean urethral defect length was 4.9 cm. The primary etiology was pelvic fracture in 7 patients. Strictures recurred postoperatively in 3 patients, all of whom had a urethral defect longer than 5 cm, and 2 of whom had more than 1 previous failed urethroplasties (compared with 1 out of 7 in the successful cases). Urinary flow rate increased significantly (from 0 to 10.4 ± 7.33 mL/s) postoperatively (P =. 018). Longer strictures produced signifcantly poorer graft urethroplasty outcomes (P =. 001). Urethroplasty with buccal mucosal grafts is tough, resilient, easy to harvest, and it leaves no scar. It appears to be an optimal substitute for anterior and posterior urethral strictures longer than 3 cm.

We report the results of treatment of posterior urethral rupture (PUR) by primary realignment with some modifications of the technique. In this prospective study, 25 patients (mean age, 33.5 years; range, 18 to 70 years) in whom PUR had been proved underwent primary urethral realignment. All patients were evaluated postoperatively for urinary incontinence, erectile dysfunction, and urethral stricture. They were followed for a mean of 20 months (range, 9 to 27 months). In 20 of 25 patients (80%), posterior urethral rupture was associated with pelvic fractures and in 2 (8%), bladder rupture also was present. None of the patients had urinary incontinence. Six patients (24%) had evidence of postoperative stricture that required urethral dilatation and/or direct vision internal urethrotomy in 2 or 3 procedures under local anesthesia. Erectile dysfunction (which all responded to sildenafil) was reported by 4 patients (16%) as a decreased quality of erection. We believe that primary realignment of PUR is a simple procedure associated with low morbidity. It is recommended for patients who are stable and have no other significant intra-abdominal and pelvic organ injuries.

We assessed the effect of different positions of voiding on uroflowmetry findings in healthy men and in patients with benign prostatic hyperplasia (BPH). Ten men with symptomatic BPH and 10 healthy men were enrolled in this study. Urodynamic study was done for each subject in 3 positions: standing, crouching (the position used in the Iranian style toilets), and sitting. The following urodynamic parameters were studied: voided urine volume, residual urine volume, total flow time, flow time, maximum flow rate, average flow rate, delay to start voiding, and maximum flow time. There were no significant differences between the 3 voiding positions and urodynamic parameters of healthy men. In men with BPH, the postvoid residual urine volume was significantly lower in the sitting position compared with the crouching and standing positions (67 mL versus 130 m/L and 130 mL; P <. 001). The median average flow rate was 2.5 mL/s in the crouching, 3.5 mL/s in the sitting, and 3 mL/s in the standing positions (P =. 016). Also, delay to start voiding was longest in the crouching position (6.5 seconds, 6 seconds, and 5 seconds in the crouching, sitting, and standing positions; P =. 011). Voided urine volume, total flow time, flow time, maximum flow rate, and maximum flow time were not different among the 3 positions. In patients with BPH, voiding position may affect urodynamic parameters and the physician’s decisions. Further studies are needed to elucidate the effects of voiding position on urodynamic parameters.