فهرست مطالب
Urology Journal
Volume:13 Issue: 6, Nov-Dec 2016
- تاریخ انتشار: 1395/09/23
- تعداد عناوین: 11
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Prognostic Value of Circulating Tumor Cells in Castration Resistant Prostate Cancer: A Meta-analysisPages 2881-2888PurposeThe prognostic value of circulating tumor cells (CTC) detected in castration-resistant prostate cancer(CRPC) is currently under debate. The aim of our meta-analysis was to evaluate the prognostic effect of CTC andto elucidate whether the detection of CTC in the peripheral blood (PB) of patients diagnosed with CRPC can beused as an independent prognostic factor for survival.Materials And MethodsThe Pubmed, Science Citation Index, Cochrane Database, Embase Cell Research databaseand the references in relevant studies were systematically searched. Hazard ratios (HRs) for overall survival(OS) with 95% confidence intervals (CIs), subgroup analysis, sensitivity analysis, meta-regression analysis waspooled and publication bias were conducted.ResultsTen eligible studies enrolling 1206 patients were identified for final analysis. To decrease the heterogeneityof this meta-analysis we excluded two studies after sensitivity analysis. Remained eight studies were enrolledin the pooled analysis and the result revealed that CTC positivity (presence of 5 or more CTCs per 7.5mL PB) wassignificantly associated with a poor OS (HR = 2.76, 95%CI: 2.28-3.34, PConclusionOur study demonstrated that CTC positivity indicates poor prognosis in patients with CRPC. CTCcounts can be used as an independent prognostic factor of survival rate in patients with CRPC.Keywords: castration, resistant prostate cancer, circulating tumor cells, hazard ratios, meta, analysis, prognosis
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Pages 2889-2892PurposeTo evaluate the clinical curative effect and safety of transurethral (bipolar) plasmakinetic resection of theprostate (PKRP) combined with thulium laser in the treatment of large prostates (> 80mL).Materials And MethodsFrom January 2014 to December 2015, 61 patients with benign prostate hyperplasia(BPH) were treated with PKRP combined with thulium laser (n = 25) or PKRP only (n = 36). We retrospectivelyanalyzed the perioperative status of patients status during 3-month follow-up.ResultsThere was no significant difference between the two groups before treatment (P > .05). PKRP combinedwith thulium laser was significantly superior to PKRP in terms of surgical duration, intraoperative blood loss,postoperative bladder washing time, postoperative complications and time of hospital stay (P .05).ConclusionPKRP combined with thulium laser is superior than PKRP only for better surgical duration, lessbleeding, higher efficiency and much quicker recovery. It may be a better choice for the treatment of BPH withlarge prostate (> 80mL).Keywords: large benign prostatic hyperplasia, transurethral (Bipolar) plasmakinetic resection, thulium laser
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Pages 2893-2898PurposeNatural history and modality of treatment for asymptomatic renal calculi less than or equal to 5 millimetres in size is still unknown. Many options are available ranging from medical expulsive therapy to minimally invasive surgery. Till date no study has focussed on this very common but asymptomatic issue. Hence, this study is undertaken to evaluate efficacy of medical expulsive therapy in renal calculi less than or equal to 5mm in size.Materials And MethodsA prospective, parallel group, randomized study was carried out from 1st June 2014 to 31st May 2015, with total of 100 patients, 50 patients in each group. Patients with renal stones less than or equal to 5mm were included in the study. Group A Patients were administered medical expulsive therapy which included tamsulosin 0.4 mg daily at night time, furosemide 20mg, spironolactone 50mg in a single morning dose, and syrup potassium magnesium citrate 20Meq per dose three times a day for 12 weeks while group B patients were given placebo. The primary outcome variable was number of patients achieving clearance of stone during 12-week treatment period in both groups.ResultsNo statistically significant differences in age, gender, stone size, and calyceal stone location was found between the two treatment arms. A spontaneous stone expulsion rate of 50% (at 6 weeks) and 86 %( at 12 weeks) was noted in group A versus 28% (at 6 weeks) and 38 % (at 12 weeks) in group B. Less number of pain episodes and less analgesic medication was required in group A as compared to group B.ConclusionMedical Expulsive therapy for 12 weeks significantly improves stone free rates in renal calyceal calculi less than or equal to 5mm.Keywords: diclofenac sodium, furosemide, spironolactone, tamsulosin, urolithiasis
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Pages 2899-2902PurposeTo investigate the influence of stone opacity in plain radiography on stone free rate and complications ofpercutaneous nephrolithotomy (PCNL).Materials And MethodsA number of 101 patients who underwent PCNL between July-September 2015 wereprospectively included. Stone opacity was judged on preoperative plain Kidney-Ureter-Bladder X-ray. Stone freerate was evaluated two weeks after the operation by ultrasonography and KUB.ResultsThere were 61 patients with opaque stones and 40 patients with non-opaque stones. The age, body massindex, preoperative creatinine, history of stone surgery, and stone size was not statistically different betweenpatients with opaque and non-opaque stones. Neither operation duration nor access numbers were statisticallysignificant between opaque and non-opaque stones. The frequency of stone free patients in opaque stones and nonopaquestones were 55/61 (90%) and 30/40 (75%) respectively (P = .04) The magnitude of hemoglobin drop inopaque stones and non-opaque stones were 1.9 ± 1.2 mg/dL versus 2.9 ± 1.7 mg/dL (P = .005).ConclusionThe stone free rate is lower and the magnitude of bleeding is higher in PCNL of non-opaque stoneswhen compared to opaque stones if rigid instruments are used for nephroscopy.Keywords: nephrolithiasis, opacity, percutaneous nephrolithotomy, stone free rate
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Pages 2903-2907PurposePartial nephrectomy is the gold standard treatment for small kidney masses. Data on the comparison oflaparoscopic (LPN) versus open partial nephrectomy (OPN) are based on retrospective studies. Thus, we plannedto compare these two techniques in a prospective trial.Materials And MethodsThe study population consisted of patients over 18 years old with single renal mass of≤ 4 cm. Patients were divided into two groups considering their preference. Study arms were matched accordingto age, gender, tumor size and location and renal nephrometry score. Mean operation time, warm ischemia time,hospital stay, peri-operative complications and changes in glomerular filtration rate (GFR) after 1 month were recordedand compared in two groups. Patient's satisfaction score, visual analogue scale and narcotics use to controlpost-operative pain were also studied.Results34 and 31 patients underwent LPN and OPN, respectively. There was no significant difference betweenOPN and LPN regarding hospital stay (4.1 versus 4.6 days; P = .37), mean hemoglobin drop (2.17 and 1.96 g/dL;P = .62), changes in GFR and positive margin (1 versus 3 p=.40). LPN was accompanied with longer mean surgerytime (180 min versus 127 minutes; PConclusionThis clinical trial shows that LPN has some benefits over OPN, including decreased post-operativepain and higher patient satisfaction. However, extra caution should be considered in the issue of tumor margin andurinary leakage in LPN.Keywords: kidney neoplasms, laparoscopy, nephron sparing surgery, open partial nephrectomy
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Pages 2908-2910PurposeTo assess the success and complication rates of glanular hypospadias or dorsal hood deformity surgery,using a modified Firlit's technique without glanuloplasty.Materials And MethodsBetween May 2013 and December 2015, 41 patients with glanular hypospadias or dorsalhood deformity without hypospadias and mild ventral chordee underwent surgery. Thirty-eight who completedthe 1 week and 6-month follow-up were retrospectively evaluated. Exclusion criteria were complete absence ofcorpus spongiosum resulting in very thin distal urethra, moderate to severe ventral chordee or deep urethral platethat seemed to be better served by tubularization techniques. Modified Firlit's technique (a submeatal inverted Vincision in addition to the classic technique) was applied to all patients.ResultsThe mean age was 20.4±13 months (range: 6-52 months). The only complication was a narrow-bandventral skin necrosis in 1 patient (2.6%) that was replaced by new skin growth without need for further intervention.No other complications including unresolved chordee, urethrocutaneous fistula, meatal stenosis, hematoma,infection or post-operative bleeding was observed. Defining the satisfactory result as the glanular position of themeatus and the absence of residual chordee, all patients had satisfactory outcome.ConclusionModified Firlit's technique is a simple method with excellent cosmetic results and low complicationrate that avoids unnecessary glans dissections. When prepucioplasty is not desired, this technique can be consideredas a viable option.Keywords: children, chordee, hypospadias, Firlit's technique
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Pages 2911-2915PurposeThis study aims to determine extracorporeal shock wave lithotripsy (ESWL)-induced renal tubular damageand the affecting factors by measuring urinary beta2microglobulin (β2M) excretion.Materials And MethodsThis is a cross-sectional study conducted on 91 patients with renal stones who underwentESWL during 2012. Urinary beta2microglobulin was measured immediately before and after the procedure foreach patient and analyzed based on different variables to evaluate factors affecting ESWL-induced renal tubularinjury.ResultsMean ± SD urinary beta2-microglobulin values, before and after ESWL were 0.08 ± 0.07 and 0.22 ± 0.71mg/dL respectively, the average difference between which was equal to 0.14 ± 0.07 mg/dL. These figures exhibiteda 166.66% rise in the urinary β2M concentration after ESWL which was statistically significant (PConclusionUrinary excretion of beta2-microglobulin increased significantly immediately after ESWL. Thesechanges could indicate that ESWL is a contributing factor to renal tubular damage. It also seems that in patientswith hypertension and a previous history of ESWL the likelihood of this injury is higher than others.Keywords: acute kidney injury, beta2, microglobulin, extracorporeal shock wave lithotripsy, urinary stone
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Pages 2916-2919PurposeAdrenal gland injury (AGI) caused by trauma may cause bleeding and life-threatening problems in children.The objective of this study was to analyze the prevalence of AGI in final diagnoses of trauma.Materials And MethodsThe records of 458 patients with abdominal trauma (out of a total 8,200 pediatric patientswith trauma of any sort), who were referred to our clinic between January 2009 and July 2014, were reviewed retrospectively.The numbers of patients with AGI and their ages, gender, trauma patterns, affected organs, pediatrictrauma scores (PTSs), and injury severity scores (ISSs) were recorded, as well as the associated ultrasound (US)and tomographic scan data, treatments, and complications. Computed tomography (CT) scans obtained after traumawere subjected to both primary and secondary evaluation.ResultsIn total, 28 patients with AGI were detected; their average age was 8.54 ± 4.09 (3-17) years. Twenty(71%) patients were male and 8 (29%) were female. Nineteen (68%) patients had fallen from heights; the mostcommonly injured organs were the kidneys, spleen, and lungs. Injuries were right-sided in 26 (92.9%) patients.The mean ISS was 13.2 (range 5-50) and the mean PTS 8.6 (range 0-11). Seven patients had ISS > 16 and ninehad PTSConclusionWe recommend calculation of the PTS, as well as other trauma scores, when pediatric patients sufferingmultiple or blunt abdominal trauma(s) present to the emergency . In addition, we believe that in children withtrauma involving the liver, spleen or kidneys, careful evaluation using a CT scan would increase the diagnosis ofAGI and reveal a realistic rate of AGI in trauma cases.Keywords: adrenal gland injury, blunt abdominal trauma, diagnosis, pediatric, prevalence
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Pages 2920-2926PurposeTo compare monotherapy with tadalafil or tamsulosin and their combination therapy in men with benignprostatic hyperplasia and erectile dysfunction by comparing IPSS score, prostate volume and Qmax and someother outcomes.Materials And MethodsThis randomized, single-blind, paralleled group clinical trial was done in 2013 on patientswho had referred to our hospital in Tehran. All patients with lower urinary tract symptoms, benign prostatichyperplasia and any grade of erectile dysfunction were recruited. They were randomly divided into three groups(61 participants in each group): Group A received 20 mg/daily tadalafil; Group B received 0.4 mg/daily tamsulosin;Group C receieved a combination of 0.4 mg/daily tamsulosin and 20 mg/daily tadalafil. Primary outcomeswere prostate volume, prostate specific antigen, post-void residual volume, IPSS score, LUTS severity, Qmax,IIEF and erectile dysfunction severity and secondary outcome was complications.ResultsThe mean ± SD of ultrasonographic prostate volume was 61.4 ± 15.1 mL and prostate specific antigenlevel was 2.4 ± 1.9 ng/dl. Post-void residual level was significantly different before and after the treatment, exceptfor group A. Also, this group had no meaningful difference compared to the other groups in this regard (P > 0.05).There were significant differences between pre- and post-treatment international prostate symptom scores in eachgroup (PConclusionCombination of tamsulosin and tadalafil can improve international prostate symptom scores, internationalindex of erectile function questionnaire scores and Qmax in patients with lower urinary tract symptoms andbenign prostatic hyperplasia to more degrees than their separate use. This combination is recommended becauseof its synergistic effects, well toleration and safety.Keywords: benign prostate hyperplasia, erectile dysfunction, tadalafil, tamsulosin
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