Urology Journal
Volume:3 Issue: 4, Autumn 2006

Department of Urology, Hackensack University Medical Center and UMDNJ New Jersey Medical School, Hackensack, NJ and Section of Urology, VA New Jersey Health Care System, East Orange, New Jersey, USAUrology and Nephrology Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran Abstract: We reviewed the most recent advances in the genetics of male infertility focusing on karyotypic abnormalities, obstructive azoospermia, and idiopathic hypogonadotropic hypogonadism. To update our previous review, we searched the literature using PubMed and skimmed articles published from January 1998 to November 2006. There were 52, 30, and 41 relevant articles to our subject on karyotypic abnormalities, obstructive azoospermia, and idiopathic hypogonadotropic hypogonadism. The full texts of these articles and their bibliographic information were reviewed and a total of 93 were used to contribute this review. The frequency of sperm aneulpoidy in karyotypic abnormalities such as 47,XXY and 47,XYY is higher than that in the healthy individuals, but transmission of the abnormalities to the offspring is rare and the outcomes of assisted reproductive techniques are encouraging. Mutations in the cystic fibrosis gene are detectable in up to 80% of men with congenital bilateral absence of the vas deferens. However, there is a considerable diversity among different populations and the role of other potential causes is not ruled out yet. Autosomal and X-linked genetic aberrations in men with idiopathic hypogonadotropic hypogonadism are now well known. As hormone replacement therapy can provide the chance of fathering in these patients, the risk of mutations'' transmission, especially the autosomal dominant ones, is high. In the recent decade, a parallel progress has been made in the genetics of men with azoospermia and the treatment modalities for these patients. Assisted reproductive techniques can help most of the patients, but there are several genetic abnormalities that must be considered before decision making for treatment of their infertility.

The aim of this study was to evaluate the diagnostic value of antegrade flexible cystoscopy in pelvic fracture urethral distraction defects (PFUDD). Between 1999 and 2004, a total of 111 patients with PFUDD were evaluated by antegrade flexible cystoscopy. The flexible cystoscope was introduced into the posterior urethra and the area was evaluated for any probable fistula, false passages, or displacement of the posterior urethra. For preventing misalignment, flexible cystoscope was also used during the urethroplasty to open the posterior urethra at its exact distal point. Posterior urethra ended distal to the external sphincter in 16 patients (14.4%). Five (4.5%) and 9 (8.1%) patients had severe displacement of the posterior end of the urethra and bladder neck false passage, respectively. Prostatic urethrorectal fistula was detected in 1 patient. Another 1 patient had bladder rhabdomyoma. Flexible cystoscopy is a valuable procedure in the evaluation of the bladder, the bladder neck, and the posterior urethra in patients with urethral distraction defects and complements voiding cystography before the surgery. It is also helpful for showing the exact distal point of the proximal urethra during urethroplasty in cases with displaced posterior urethra.

The aim of this study was to evaluate the effect of distilled water as an irrigation fluid for percutaneous nephrolithotomy (PCNL) on the serum concentrations of sodium. A total of 30 patients with kidney calculi underwent tubeless PCNL using distilled water as the irrigation fluid. During the procedure, intravenous Ringer lactate solution was used if necessary. The patients received infusion of two-thirds dextrose 5% and one-third normal saline solution postoperatively. Four blood samples were taken to determine serum sodium and potassium levels at admission, just before the operation, after the operation, and on the first postoperative day. The mean distilled water used was 8.1 L (range, 5.6 L to 11.2 L). Target and complete stone-free rates were 100% and 80%, respectively. None of the patients developed hyponatremia. The mean serum levels of sodium (meq/L) were 141.5 (range, 140 to 143), 140.7 (range, 125 to 159), 139.7 (range, 125 to 164), and 138.9 (range, 125 to 146), respectively (P =. 005). Comparing every 2 samples, a significant difference was seen only between samples 1 and 4 (P =. 005). Serum levels of potassium were all in normal range and there was no difference between the 4 samples (P =. 12). Our findings showed that using distilled water as an irrigation fluid during PCNL does not result in a clinically significant decrease in the serum level of sodium and can be used if necessary. However, evaluation of the serum sodium level on the postoperative day is mandatory.

The aim of this study was to evaluate the outcome in patients with renal cell carcinoma (RCC) and the inferior vena cava (IVC) or the right atrium tumor thrombus that were treated with radical nephrectomy and thrombectomy. Eleven of a total of 105 patients who underwent radical nephrectomy due to RCC had tumor thrombus extended to the IVC and/or the right atrium. We evaluated the surgical techniques used and the perioperative mortality and morbidity in these patients. The median age of the patients was 47 years (range, 16 to 59 years). They all underwent radical nephrectomy with cavotomy, tumor thrombus removal, and lymphadenectomy. Eight patients underwent extracorporeal circulation and hypothermic circulatory arrest; 2, temporary venovenous bypass by chevron incision and median sternotomy; and 1, only chevron incision with mobilization of the right lobe of the liver and cross-clamping proximal to the tumor thrombus and cavotomy. In 1 case, a solitary liver metastasis was excised and the patient died within 30 days postoperatively because of massive hemorrhage due to liver metastatectomy. Two patients had invasion to the IVC wall and 7 had pathological lymph node involvement. Four patients were tumor free (follow-up range, 9 to 18 months) and 7 died due to multiple metastases during the follow-up. This study supports the role of extensive surgical treatment as the best initial management of patients with renal cancer extended to the IVC only in highly selected cases.

The aim of this study was to evaluate the levels of p53 protein in serum and urine samples of patients with bladder transitional cell carcinoma (TCC) and their relation with the overexpression of p53 in the tumoral tissue. A total of 39 patients with bladder TCC were evaluated for p53 protein in their serum and urine samples and the overexpression of this marker in their tumoral tissue. Of 39 patients with bladder TCC, 29 (74.4%) had tissue specimens positive for p53 protein overexpression, 20 (51.3%) had p53 protein in their serum samples, and 27 (69.2%) had this protein in their urine samples. A positive immunohistochemical finding was more common in higher grades of the bladder tumor (P =. 03), but not in higher stages (P =. 07). Eighteen of 20 patients (90%) with a positive serum for p53 showed protein overexpression in the tumoral tissue of the bladder (P =. 03). Of 27 patients with a positive urine sample, 25 (92.6%) had p53 overexpression in their bladder tissue, and of the remainder 12 patients with a negative p53 protein in their urine samples, 8 (66.7%) had no evidence of p53 protein overexpression in their tumoral tissue (P <. 001). The grade and stage of tumor had no correlation with serum or urinary p53. According to our findings, a positive serum or urine sample for p53 protein is highly associated with the overexpression of p53 protein in the tumoral tissue of patients with bladder TCC.

Department of Urology, Shohada-e-Tajrish Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, IranUrology and Nephrology Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran Abstract: The aim of this study was to evaluate the effect of immediate intravesical instillation of mitomycin C after transurethral resection of bladder tumor (TURBT) in patients with low-risk superficial transitional cell carcinoma (TCC). A total of 43 patients with low-risk superficial bladder cancer were randomly assigned into two groups after the surgery; 22 patients in group 1 were treated by immediate instillation of mitomycin C after TURBT, and 21 patients in group 2 received placebo. The two groups were compared using urine cytology and cystoscopy during the 24 postoperative months. Recurrence within the first 3 months was reported in none of the patients in group 1 and 5 in group 2 (P =. 02). Of these, 4 had recurrence of tumor in the primary site. At 12 and 24 months, there were 1 patient (4.5%) in group 1 and 8 (38.1%) in group 2 with recurrence (P =. 007). We had no patients with multifocal recurrence in group 1, but 3 (14.2%) in group 2. Nine-month tumor-free survival rate was 95% in group 1. Three-, 6-, 9-, and 12-month tumor-free survival rates in group 2 were 76%, 71%, 66%, and 62%, respectively (P =. 007). None of the patients in group 1 and 3 in group 2 (14.3%) experienced some degrees of tumor progression (P =. 06). Immediate instillation of mitomycin C after TURBT seems to be effective in the recurrence reduction and increase of recurrence-free interval at least in short term.

The aim of this study was to evaluate the plasma levels of hypoxanthine (HX) and xanthine in the renal vein blood samples for prediction of delayed graft function (DGF). Two blood samples were taken from 47 kidney recipients, intraoperatively. The first sample was obtained from a peripheral vein before vascular anastomosis and the second from the allograft renal vein, 15 minutes after the anastomosis. Purine metabolites including xanthine and HX were measured and their associations with operative time, anastomosis time, frequency of clamping, urine output, and DGF were evaluated. The mean levels of xanthine and HX were 0.12 ± 0.10 mg/L and 0.37 ± 0.17 mg/L in the first plasma samples, respectively. Thirty patients (63%) had no significant changes in neither of their purine metabolite levels and 17 (37%) had higher levels of HX, but not xanthine, in their second samples. Only anastomosis time had a significant relation with the level of the metabolites (P =. 04). Three patients (10%) with no changes in the metabolites and 5 (29.4%) with higher HX levels had DGF (P =. 12). The anastomosis time and frequency of vascular clamping were higher and the urine output after the anastomosis was lower in the patients with DGF. Cold ischemia in kidney transplantation causes a mild increase in the HX concentration indicative of short-term ischemia effects on the cell metabolism. But it cannot predict DGF. Anastomosis time, frequency of clamping, and urine output after the anastomosis are more sensitive indices.

The aim of this study was to evaluate the frequency of skin diseases in kidney transplant recipients. This cross-sectional study was performed on 233 kidney transplant recipients in Ekbatan Hospital of Hamedan in 2004. The patients were examined by a dermatologist and diagnosis was made on the basis of clinical observations. Biopsies and scraping of the lesions were taken whenever necessary. Of the patients, 226 (97%) suffered from one or more skin lesions. The most common lesions were drug related, including hypertrichosis, gingival hyperplasia, acne, and cushingoid feature which were detected in 86.7% of the patients. Also, infectious and premalignant or malignant lesions (actinic keratosis, squamous cell carcinoma, and basal cell carcinoma) were seen in 48.9% and 14.2% of the patients. The mean duration of immunosuppressive therapy was significantly higher in patients with infectious skin diseases (P <. 001). Skin lesions are a significant problem in kidney transplant recipients. A careful monitoring of these patients is recommended in order to detect these lesions in early stages and treat them.

The aim of this study was to evaluate the attitudes of the residents of Ahwaz toward organ donation after brain death. A total of 1000 people between 15 and 70 years of age were selected by cluster sampling in Ahwaz, south-west of Iran. A questionnaire was designed about the attitudes of the interviewees toward organ donation after brain death by themselves and by their family members, demanding compensation for organ donation, and the need for consent or testimony. Of the participants, 75% were pro organ donation, while 22% were against it and the remaining 3% had no specific idea. Age, sex, and occupation did not influence the attitudes; however, the ethnicity, educational level, economic status, and having a loved one in need of organ transplantation significantly increased the willingness of these people for organ donation (P <. 05). Regarding the issue of demanding compensation for organ donation, 27% of the participants were in favor of the idea and 73% disagreed. A higher proportion of the participants with higher educational levels believed in organ donation without any consent or testimony (P =. 02). According to our study, many people are pro organ donation after death. It is necessary to have a regular program for these people to give them the opportunity to register and receive a donation card. For the people who do not have the tendency for the matter, we had better try to increase their knowledge by educational programs and provide sufficient information.

The aim of this study was to evaluate erectile dysfunction (ED) in hemodialysis patients and the factors influencing ED after a successful kidney transplantation. A total of 64 patients on hemodialysis were evaluated before and 6 months after the kidney transplantation. They were all recipients of their first kidney allografts from living unrelated donors and had a functional kidney allograft during the follow-up. The 5-item version of the International Index of Erectile Function (IIEF-5) was used to assess their erectile function. A group of age-matched controls were compared with them before transplantation. The effects of pretransplant IIEF-5 score, age at transplantation, the artery used for anastomosis, and duration of the dialysis prior to transplantation on ED were also studied. Fifty-six of the patients (87.5%) and 23 of the controls (35.9%) had ED (P <. 001). The prevalence of ED was 87.5% in the hemodialysis patients. There was no relationship between the duration of dialysis and the severity of ED. Successful transplantation improved IIEF-5 score significantly (13.6 ± 5.2 before and 19.2 ± 5.0 after transplantation; P <. 001). Based on the IIEF-5 scores, the severity of ED increased in 6 (9.4%) patients; 8 (12.5%) experienced no change in their erectile function; and 50 (78.1%) reported an improved erectile function. Preoperative IIEF-5 score and age at transplantation had statistically significant associations with ED improvement (P <. 001; P =. 02). Erectile dysfunction is highly prevalent in hemodialysis patients and significantly improves after successful kidney transplantation. Younger patients with a less severe ED have the most improvement after transplantation.