Urology Journal
Volume:4 Issue: 2, Spring 2007

Penile amputation is a rare urologic condition for which immediate surgical replantation is warranted. The surgical technique used for repair has been modified and refined. Our aim was to assess the effects of several interventions and management for amputated penis after replantation. We searched the MEDLINE (January 1966 to May 2007), EMBASE (January 1988 to January 2007), CINAHL (January 1982 to January 2007), PsycLIT (January 1984 to January 2007), ERIC (January 1984 to January 2007), and the bibliographic data of relevant articles; hand-searched conference proceedings; and contacted investigators to locate studies. All reported cases of penile replantation were studied. We assessed all titles, abstracts, and extracted data from the articles identified for inclusion. Outcome measures included cosmetic outcomes, acceptability, operative time, restoration of erectile function, sensibility of the glans, and long-term outcomes. Eighty patients had undergone penile replantation. There was considerable variation in the interventions, patients, and outcome measures. The majority of the reported cases in this area continue to be of moderate quality, although more recent cases have been of higher quality in terms of both patients'' demographics and surgical techniques. Data were not available in all of the cases for many of the outcomes expected to be reported. There were several important variations in the cases studied. The value of the various microsurgical techniques for replantation of the penis remains uncertain. Meticulous microsurgical techniques by experienced surgeons can reduce skin, urethra, and graft loss complications and produce a functional organ; nonetheless, such complications are still highly prevalent.

Penile amputation is a rare urologic condition for which immediate surgical replantation is warranted. The surgical technique used for repair has been modified and refined. Our aim was to assess the effects of several interventions and management for amputated penis after replantation. We searched the MEDLINE (January 1966 to May 2007), EMBASE (January 1988 to January 2007), CINAHL (January 1982 to January 2007), PsycLIT (January 1984 to January 2007), ERIC (January 1984 to January 2007), and the bibliographic data of relevant articles; hand-searched conference proceedings; and contacted investigators to locate studies. All reported cases of penile replantation were studied. We assessed all titles, abstracts, and extracted data from the articles identified for inclusion. Outcome measures included cosmetic outcomes, acceptability, operative time, restoration of erectile function, sensibility of the glans, and long-term outcomes. Eighty patients had undergone penile replantation. There was considerable variation in the interventions, patients, and outcome measures. The majority of the reported cases in this area continue to be of moderate quality, although more recent cases have been of higher quality in terms of both patients'' demographics and surgical techniques. Data were not available in all of the cases for many of the outcomes expected to be reported. There were several important variations in the cases studied. The value of the various microsurgical techniques for replantation of the penis remains uncertain. Meticulous microsurgical techniques by experienced surgeons can reduce skin, urethra, and graft loss complications and produce a functional organ; nonetheless, such complications are still highly prevalent.

For tissue engineering of the urinary tract system, cell culture requires to be established in vitro and an appropriate matrix acting as cell carrier should be developed. The aim of the present study was to assess the proliferation quality of mouse urothelial cells on 3 natural matrixes of human amniotic membrane (AM), peritoneum, and omentum, and to compare them with collagen matrix. Mouse urothelial cells were isolated by collagenase IV, and the urothelial cells (105 cells per milliliter) were cultured on the AM, peritoneum, omentum, and collagen. The pattern of growth and asymmetric unit membrane formation were analyzed by histologic examination and immunocytochemistry on the detached urothelium with pancytokeratin and uroplakin III, respectively. Electron micrographs were taken and cell layers, organelles, desmosomes, and junctions were studied. Immunocytochemistry of cultivated cells confirmed the urothelial cells phenotype. Up to 4 cell layers were obtained on the AM and 1 to 2 layers on the peritoneum. Distribution of the urothelial cells on the omentum was not favorable, which was due to its large pores. Cell proliferation started later on the AM (7th day) compared to collagen (3rd day). Also, apoptosis started later on the AM (after 14 days) compared to collagen (7 days). These results showed that the AM can act as a cell carrier for culture of the urothelial cells, and its exceptional properties such as having various growth factors, availability, and cost-effectiveness make it a unique biological matrix for urothelial culture.

Our aim was to evaluate blind puncture in percutaneous nephrolithotomy (PCNL) for decreasing the risk of radiation. One hundred candidates for PCNL were randomly assigned into 2 groups. Blind access was performed for the patients in group 1 and the standard access using fluoroscopy for those in group 2. In group 1, displacement of the targeted calyx in the prone position was estimated by fluoroscopy comparing to the image on intravenous urography. Puncture of the calyx was attempted 3 cm to 4 cm below the marked site of the targeted calyx with a 30° angle. If the access to the collecting system was felt and urine came out, the site of puncture would be controlled by fluoroscopy. If the access failed, we would repeat puncturing up to 5 times. The mean time to access was 6.6 ± 2.1 minutes and 5.5 ± 1.7 minutes in groups 1 and 2, respectively (P =. 008). The mean time of radiation exposure was 0.95 ± 0.44 minutes in group 2. A successful puncture to the targeted calyx was achieved in 50% and 90% of the patients in groups 1 and 2, respectively (P <. 001) and a successful calculus removal in 62% and 100% of the patients in groups 1 and 2 (P <. 001). Although about half of the patients benefited from blind access in our study, this technique can not be solely relied on, and fluoroscopy or ultrasonography should be available for prevention of complications.

The aim of this study was to investigate the effects of the ethanolic extract of Nigella sativa L (NS) seeds on kidney calculi in rats. Thirty-two Wistar rats were randomly divided into 4 groups: group A received tap drinking water for 30 days (intact control). Groups B, C, and D received 1% ethylen glycol for induction of calcium oxalate calculus formation. As the preventive, and treatment subjects, rats in groups C and D received ethanolic extract of NS, 250 mg/kg, in drinking water since day 0 and day 14, respectively. Urine was collected on days 0, 7, 14, and 30 of the study period. After 30 days, the kidneys were removed and prepared for histologic evaluation of calcium oxalate deposits. Urine calcium oxalate concentrations were determined by atomic absorption. The number of CaOx deposits was significantly greater in group B (P =. 001). Calcium oxalate concentrations in the urine on days 14 and 30 increased significantly in group B and were higher than those in group C (P =. 006 and P =. 002, respectively). Urine oxalate concentration in group D decreased on day 30 and was lower than that in group B (P =. 04). Treatment of rats with ethanolic extract of NS reduced the number of calcium oxalate deposits in a group of rats that received ethanolic extract of NS. The NS could also lower the urine concentration of calcium oxalate. We suggest further studies on the therapeutic and preventive effects of the NS on kidney calculus formation in human.

The aim of this study was to evaluate the frequency of urinary tract infection (UTI) in neonates with prolonged jaundice. Newborn infants with jaundice lasted more than 2 weeks were included in this study. Patients who had other signs or symptoms were excluded. Workup of prolonged hyperbilirubinemia was performed, including direct Coomb''s test, blood group of the neonate and the mother, complete blood count, blood smear, glucose-6-phosphate dehydrogenase (G6PD), reticulocyte count, serum level of bilirubin (unconjugated and conjugated), thyroid function tests (serum thyroxine [T4] and thyroid-stimulating hormone), urinalysis, and suprapubic urine culture. Pediatric nephrologists carried out further investigation including kidney function tests, renal ultrasonography, voiding cystourethrography, and Technetium Tc 99m dimercaptosuccinic acid renal scintigraphy for patients with a positive urine culture for microorganisms. Of 100 neonates who were evaluated, 43 were boys and 57 were girls. All of the neonates were breastfed. Six suffered from UTI (4 boys and 2 girls). Reflux was detected on voiding cystourethrography in 1 and cortical defect in the kidney on renal scan in 2 boys. In our region, with a high rate of breastfeeding, UTI remains as an important cause of prolonged jaundice. Despite the high rate of urogenital system abnormality accompanied by neonatal UTI, there was not a significant difference between the signs and symptoms of jaundice in patients with and without UTI. Performing urine cultures should be considered as a routine procedure in the evaluation of every infant with prolonged jaundice.

The aim of this study was to clarify the role of PTEN gene in progression of prostate cancer. A total of 51 formalin-fixed paraffin-embedded specimens of prostate cancer were analyzed for PTEN mutations. Tissue microdissection and polymerase chain reaction/single-strand conformation polymorphism methods were used. Clinical and pathologic data of the patients were reviewed with regard to PTEN mutation. The Gleason score (GS) was less than 7 in 29 (56.8%), 7 in 11 (21.6%), and greater than 7 in 11 (21.6%). Tumor stage was IIa, IIb, IIc, and IV in 14 (27.4%), 4 (7.8%), 21 (41.2%), and 12 (23.6%) patients, respectively. Eleven of 12 stage IV tumors had metastases at the time of presentation. Six of 51 cases (11.6%) showed mutation in PTEN which had involved exones 1, 2, and 5. Two of these cases had localized and the others had advanced prostate cancer. One case of the tumors with PTEN mutation had a GS of 7 and 5 had GSs greater than 7. Patients with a positive mutation of PTEN had a significantly greater GS (P <. 001), lower survival rate (P =. 001), higher tendency to metastasis (P =. 002), and higher prostate-specific antigen (P =. 03). Cox proportional hazard model showed that only GS was significantly correlated with mortality (P =. 03). Patients with prostate cancer who had PTEN mutation had also a significantly greater GS, poorer prognosis, and higher rate of metastasis. However, this mutation cannot predict the prognosis and the GS is a more precise factor.

HER-2 is a proto-oncogene of the tyrosine kinase receptor family on chromosome 17. Overexpression of this gene affects the growth and prognosis of some tumors. This study was performed to evaluate the expression of the HER-2 gene in patients with prostate cancer and its relation with the Gleason score. Pathology specimens of all men with prostate cancer who had undergone radical prostatectomy without any supportive treatment were studied. The Gleason scores of the specimens and the expression of HER-2 gene were examined. The expression of HER-2 was scored between zero and 3+ in accordance with the HercepTest method. Patients with scores of 2+ and 3+ were considered to be positive for HER-2 overexpression. Of 150 cancerous prostate specimens evaluated, 20 (13.3%) were positive for HER-2 gene overexpression. A weakly positive HER-2 overexpression (2+) was seen in 15 of them (75%) and the remaining 5 (25%) were strongly positive. The Gleason score was not different between the HER-2-postitive and HER-2-negative patients (P =. 08). Fourteen out of 97 patients (14.4%) with a Gleason score less than 7 and 6 out of 53 (11.3%) with scores of 7 or greater were positive for HER-2 overexpression. The frequency of HER-2 gene overexpression is not very high in our patients with prostate cancer, and we failed to show any association of HER-2 expression and the Gleason score.

The aim of this study was to evaluate atherosclerotic changes in the carotid artery following kidney transplantation. Twenty-six nonsmoker kidney allograft recipients who did not have cardiovascular disease or diabetes mellitus were enrolled in the study. The carotid intima-media thickness (IMT) was measured at 12 points using B-mode ultrasonography. The mean of the measured values was considered as the patient’s IMT. We followed the patients and changes in the carotid IMT were evaluated every 2 months up to the 6th posttransplant month. The mean age of the patients at transplantation was 41.5 ± 11.1 years. The mean baseline IMT was 0.84 ± 0.22 mm. During the follow-up period it reached 0.85 ± 0.22 mm, 0.87 ± 0.23 mm (P =. 01), and 0.88 ± 0.24 mm (P =. 002) after 2, 4, and 6 months, respectively. The IMT measures significantly correlated with the age and body mass index. Using the IMT cutoff points of 0.75 mm for stroke and 0.82 mm for MI, we found that 57.7% and 68% of the patients were at the risk of stroke at baseline and 6 months after transplantation (P <. 001). Also, 46.2 % of the patients were at the risk of MI at baseline that rose to 53.8% at the end of the study (P <. 001). Atherosclerosis is an early event after kidney transplantation even in asymptomatic patients and those without major risk factors such as cardiovascular disease, diabetes mellitus, and smoking. Early diagnosis and treatment of atherosclerosis is of utmost importance.