Urology Journal
Volume:6 Issue: 2, Spring 2009

This systematic review was performed to determine the clinical value of percutaneous nephrolithotomy in the supine position in comparison with the convention of performing the procedure in the prone position. A systematic review of the medical literature was conducted searching for studies on percutaneous nephrolithotomy in the supine position, limited to publications appeared in the PubMed between 1980 and July 2008. Non-English articles were considered if deemed relevant by providing additional data. In the retrieved articles, reference lists were hand-searched to identify additional relevant articles. There were 9 original articles on percutaneous nephrolithotomy in the supine position. Five studies were retrospective and 4 were prospective, of which only 1 was a well-designed randomized controlled trial published in 2008. The success rate of the procedure was reported between 69.6% and 95%. The risk of requiring blood transfusion was between zero and 8%. Duration of hospital stay was variable, but generally less than that in the prone position. No colon perforation was reported. In carefully selected patients with uncomplicated urinary calculi, percutaneous calculus removal in the supine position can yield similar outcomes to that in the prone position.

Two common polymorphisms in cytochrome P450; family 1, subfamily A, polypeptide 1 (CYP1A1); have been implicated as a risk factor of prostate cancer, but individual studies have been inconclusive or controversial. We reviewed studies on CYP1A1 polymorphisms in patients with prostate cancer. The strategy searching in the PubMed was based on combinations of prostate cancer, CYP1A1, CYP1A1 gene polymorphism, and genetic susceptibility. The last search update was May 2008. The retrieved articles and their bibliographies of were evaluated and reviewed independently by 2 experts. We shortlisted 19 studies, of which 14 on sporadic prostate cancer were analyzed. Overall, 2573 patients with prostate cancer and 2576 controls were analyzed. The random effects odds ratio was 1.350 (95% confidence interval, 1.110 to 1.641; P =. 003) for T/C polymorphism and 1.085 (95% confidence interval, 0.863 to 1.364; P =. 49) for A/G polymorphism. The A/G polymorphism was not associated with increased risk of prostate cancer. However, the T/C polymorphism showed conflicting results in different studies, while overall, this polymorphism showed significant effects on the susceptibility to prostate cancer. There was no significant between-study heterogeneity for both polymorphisms with respect to distribution of alleles. This meta-analysis suggests that while the CYP1A1 T/C polymorphism is likely to considerably increase the risk of sporadic prostate cancer on a wide population basis, the A/G polymorphism may not influence this risk. However, the association of polymorphisms may be significant with respect to smoking history, diet habits, ethnicity, and race.

Our aim was to assess the accuracy of radiological characteristics observed by the urologist in estimating the success rate of extracorporeal shock wave lithotripsy (SWL) in patients with kidney calculi. Patients with kidney calculi sized 10 mm to 15 mm who underwent SWL in our center were enrolled. One urologist estimated the success chance of SWL based on plain abdominal radiography. Accordingly, the patients were categorized into 2 groups with more than 75% chance of fragmentation (group 1) and with 50% to 75% estimated chance of fragmentation (group 2). Factors used for estimation included calculus shape, homogeneity, and density as compared with the adjacent 12th rib. The estimations were compared with the resulted stone-free rate after a 3-month follow-up. A total of 137 patients were studied, of whom, 92 (67.2%) were categorized in group 1 and 45 (32.8%) in group 2, before the lithotripsy. Successful treatment was recorded in 101 patients (73.7%). Eighty-five patients with favorable estimated chance of successful lithotripsy (92.4%) had successful SWL, and 29 with less favorable estimate (64.4%) did not have successful fragmentation following 2 sessions of SWL (P <. 001). The sensitivity and specificity of radiological parameters for prediction of treatment success were 84.2% and 80.6%, respectively. We found that certain radiographic features of urinary calculi such as calculus density, as compared with the adjacent bone, and calculus shape could have predictive impression for the success rate of SWL.

Cardiac arrhythmias are a well-recognized complication of anesthesia for laparoscopy. The aim of this study was to evaluate the efficacy of atropine sulfate for prevention of bradyarrhythmia during laparoscopic surgery. Sixty-four candidates for urological laparoscopic surgery were randomly assigned into 2 groups to receive either atropine sulfate or hypertonic saline solution (as placebo), intravenously 3 minutes before induction of anesthesia for the laparoscopic procedure. Then, all of the patients underwent anesthesia intravenous sodium thiopental and atracurium, followed by isoflurane or halothane inhalation. Heart rate and blood pressure were recorded preoperatively in the recovery room, preoperatively in the operation room, after induction of anesthesia, after induction of pneumoperitoneum, and postoperatively. A significant decreasing trend was seen in the heart rates during the operation in patients without atropine sulfate. Nine of 32 patients (28.1%) in this group developed bradycardia, while none of the patients with atropine sulfate prophylaxis had bradycardia perioperatively (P <. 001). The mean decreases in systolic blood pressure between induction of anesthesia and pneumoperitoneum were 15.7 ± 10.2 mm Hg in group 1 and 23.5 ± 9.8 mm Hg in group 2 (P <. 001). The mean decreases in diastolic blood pressure between these two measurements were 8.7 ± 5.2 mm Hg in group 1 compared to 12.1 ± 6.2 mm Hg in group 2 (P =. 001). This study suggests that routine prophylaxis with an anticholinergic agent might be helpful in prevention of sinus bradycardia during urological laparoscopic surgery

The aim of this study was to analyze the results of vesicostomy in children as a protector of the upper urinary tract and assess the adjustments taken by the caregivers. Twenty-one children who had undergone vesicostomy with the Blocksom technique were evaluated. Their mean age was 3.7 years (range, < 1 to 10 years). The evaluation consisted of kidney function tests, cystography, and analysis of complications. Twenty parents or caregivers were interviewed about their attitudes towards vesicostomy and its outcomes. The main causes of the vesical dysfunction were posterior urethral valve in 7 (33.3%) and myelomeningocele in 5 patients (23.8%). Ten children (58.8%) showed improvement and 7 (41,2%) showed cure. Hydronephrosis observed in 17 children was alleviated or cured following the procedure. Kidney function, tested by creatinine clearance calculation, remained stable or improved in 20 patients (95.2%). Episodes of urinary tract infection and vesicoureteral reflux lowered in 8 of 21 (38.1%) and 10 of 14 patients (71.4%), respectively. Subjective evaluation of 20 cases showed that 18 children (90.0%) remained dry during the day and 14 caregivers/parents (70.0%) felt they had acquired the skills necessary to handle a patient with vesicostomy. The mean global rate of satisfaction of the results of the surgery ranging from 0 (worst result) to 10 (best result) was 8.7. Vesicostomy is a simple surgery that protects the upper urinary tract, decreases hydronephrosis, and improves kidney function. There was adequate adjustment to vesicostomy and a positive global evaluation as reported by the parents and caregivers

Survivin, a novel inhibitor of apoptosis, is re-expressed in a vast majority of human cancers and is widely considered as a diagnostic marker of cancers. Survivin protein regulates both cell division and apoptosis. There are at least 5 spliced variants of the gene with different subcellular localization and anti-apoptotic property. We examined the expression pattern of survivin and its 2 spliced variants, survivin-?Ex3 and survivin-2B, and their prognostic values in archival collections of formalin-fixed paraffin-embedded samples of bladder tumors. Total RNA from formalin-fixed paraffin-embedded samples (51 samples from 30 patients with bladder cancer and 5-year follow-up) were extracted and analyzed by semiquantitative reverse transcriptase polymerase chain reaction technique. Tissue distribution and subcellular localization of survivin protein in tumor tissues was also examined by immunohistochemistry. The expression of survivin, survivin-?Ex3, and survivin-2B were detected in 66.6%, 47.8%, and 54.7% of the specimens, respectively. The expression of survivin and survivin-?Ex3 were preferentially elevated in tumors with higher grades, whereas survivin-2B expression was lower in high-grade tumors (P =. 04). A reverse correlation was observed between survivin-2B expression and high-grade tumors. Immunohistochemistry results also confirmed the nuclear localization of survivin protein within tumoral cells. We were successful in detecting the expression of survivin and its variants in formalin-fixed paraffin-embedded bladder samples. Furthermore, our results showed that overexpression of survivin and survivin-?Ex3 in bladder tumors correlates with poor prognosis of bladder cancer. We suggest that survivin and its variants are suitable prognostic markers of bladder tumors.

Metaplasia is a reversible change in which one adult cell type is replaced by another adult cell type. Our aim was to determine the frequency and outcome of metaplasia in specimens from needle biopsies of the prostate and its relation with clinical findings. Among 1566 prostate specimens referred to 2 pathology centers of Tehran, we studied on cases with a diagnosis of metaplasia, during a 2-year period. The clinical and laboratory data of the patients with metaplasia were collected, and they were followed-up for 2 years. Age, serum total and free prostate-specific antigen levels, ultrasonography findings, and results of digital rectal examination were recorded at baseline and the follow-up period. Ten prostate specimens (0.6%) had metaplasia, of which 6 were transitional and 4 were squamous metaplasia. Serum total PSA levels ranged from 0.7 ng/mL to 14.5 ng/mL, and free PSA levels ranged from 0.1 ng/mL to 1.3 ng/mL in the patients with metaplasia. None of the patients developed carcinoma of the prostate during the 2-year follow-up, and no significant changes were seen in the follow-up studies. Metaplasia of the prostate are often associated with BPH. Clinical findings on DRE and TRUS resemble those found in benign lesions of the prostate, such as BPH. We found no sign of developing malignancy in our 2-year follow-up. However, in the differential diagnosis of this benign lesion, malignant lesions, such as squamous cell carcinoma or urothelial transitional cell carcinoma, should also be taken into consideration.

To date, little information exists regarding urogenital diseases in those who have been exposed to sulfur mustard (SM). We report the self-reported history of urologic conditions and findings on physical examination in a group of male veterans 19 to 26 years after exposed to high-dose sulfur mustard. Data on urologic health conditions of a nationwide health survey were used in this study. This survey included all 289 Iranian male veterans who had been exposed to high doses of SM between 1983 and 1989. Demographic data, exposure-related data, health status, and also self-reported lifetime history of urologic conditions were analyzed. History of benign prostatic hyperplasia, recurrent urinary tract infections, pyelonephritis, urinary calculi, kidney failure, and urogenital neoplasms were specifically concerned. The mean age of the veterans was 45.0? 7.5 years (range, 30 to 75 years). An interval of 19 to 26 years had passed from exposure to SM. Fifty veterans (17.3%) had a positive history of urinary calculi, 25 (8.7%) had recurrent urinary tract infections, 5 (1.7%) had BPH, and 2 (0.7%) had kidney failure. None of them had experienced urogenital malignancies. Neither recurrent urinary tract infections nor urinary calculi were significantly associated with age, medications and their doses, or SM-induced late complications in other organs. This study adds the prevalence of self-reported urologic conditions to our limited knowledge on SM-exposed veterans’ health condition, without finding any link neither to demographic, nor to the severity of health complications related to the SM exposure.

Persistent urine leakage is common following iatrogenic urinary collecting system injuries. Management of a urine leak usually includes manipulations such as catheter drainage, ureteral stenting, and percutaneous nephrostomy placement. The aim of this study was investigation the potential beneficial effect of desmopressin in reduction of urinary leakage duration. Fifteen patients with incisional urinary leakage were enrolled in this study. They had undergone pyeloplasty (n = 9), pyelolithotomy (n = 4), and ureterocaliceal anastomosis (n = 1). All of them had ureteral stenting or nephrostomy catheters, and urinary leakage had lasted for at least 15 days. Seven patients received desmopressin spray, 1 puff, twice a day, from the 16th days of urinary leakage, and 8 patients (control group) did not receive any medical treatment. The duration of urinary leakage was compared between the two groups. The patients were 5 women and 10 men with the median age of 37 years (range, 26 to 58 years). None of the patients had urinary obstruction. There were no significant differences in age and sex distribution between the two groups. The mean urinary leakage duration was 28.7 ± 7.2 days in the patients of desmopressin group and 47.7 ± 8.8 days in those of the control group (P =. 04). Our study showed that desmopressin can reduce the duration of incisional urinary leakage. We conclude that patients with prolonged urinary leakage after pyelocaliceal surgery who does not respond to surgical urinary drainage may benefit from desmopressin

Esophageal atresia is often associated with other anomalies. Hereditary and environmental factors may influence the incidence of associated anomalies, particularly of the urogenital system. We had 63 neonates with esophageal atresia admitted to 2 centers in Hamadan, Iran, from 2002 to 2008. They were 38 girls (60.3%) and 25 boy (39.7%). Tracheoesophageal fistula was present in 54 neonates (85.7%), and other associated anomalies in 10 (15.9%). Cardiac anomalies were found in 7 neonates; anorectal anomalies, in 4; urinary tract anomalies, in 2; and limb anomaly, in 1. Urinary tract anomalies (3.2%) were bilateral polycystic kidney in 1 neonate and unilateral hydronephrosis due to ureteropelvic junction obstruction in another. Both neonates with urinary tract anomalies were female and both had tracheoesophageal fistula, as well. Many of the associated congenital abnormalities influence the management protocol of esophageal atresia, and therefore, should be detected as soon as possible after birth

In the third part of this article on Avicenna’s Canon of Medicine, diseases of the bladder other than bladder calculus are reviewed. Avicenna covers topic on bladder infection, pelvic abscess, urethritis, cystitis, prostatitis, bladder tumors, bladder dysfunction, urinary retention, and neurogenic bladder. The interesting point is that 10 centuries ago, Avicenna had described almost all diseases of the blabber. Avicenna’s Canon of Medicine is a comprehensive book on semiology of bladder diseases. His approach to diagnoses complies with the modern methodology, and even in some interventions such as routes of drug administration and catheterization, his points are astonishing.