فهرست مطالب

Urology Journal - Volume:15 Issue: 2, Mar-Apr 2018

Urology Journal
Volume:15 Issue: 2, Mar-Apr 2018

  • تاریخ انتشار: 1397/02/03
  • تعداد عناوین: 15
|
  • Ahsen Karagozlu Akgul, Dursun Unal, Murat Demirbas, Sedat Oner, Murat Ucar, Korhan Akgul, Muhammet Guzelsoy, Murat Aydos Pages 1-5
    Purpose
    Percutaneous renal puncture (PRP) is one of the most important and critical step of urology, especially while performing percutaneous nephrostomy and percutaneous nephrolithotomy (PCNL). In the learning period of this procedures, there is a need for validated, effective, economical models for such training. This study describes a simple non - biological model for learning PRP. The aim was to determine the effectivity of this model as a training and assessment tool, and to assess its cost relative to other models.
    Materials And Methods
    We designed a training box, made of foam and rubber with two open sides and performed radiopaque pelvicalyceal system maquettes to insert inside it. Experts in PCNL (i.e., > 100 cases) and
    novices (i.e., pediatric surgeons and urologists without PCNL experience) performed percutaneous renal puncture. Novices performed a pre -test and a post - test (i.e., after 2 hour training). Data recorded were total procedure time, X - ray exposure time, and number of puncture attempts. Experts who performed PRP successfully were asked to
    rate the model using a questionnaire.
    Results
    Five experts and 21 novices completed the study. Four experts rated the model as an "excellent" (score 5) training and assessment tool; one expert rated these as "very good" (score 4). Comparisons of novice's pre - and post - test median results revealed significant skill acquisition with shorter procedure time, less X - ray exposure, and fewer attempts for successful puncture (all P
    Conclusion
    This new non - biological training model is an effective training tool that helps learners improve skills in PRP. The model is simple to construct, economical, and highly re-useable compared to others. It provides good visibility and imaging, is portable, and could be used widely in training centres.
    Keywords: education, model, percutaneous, kidney, training
  • Jun Young Hong, Dong Hoon Lee, In Ho Chang, Sung Bin Park, Chan Woong Kim, Byung Hoon Chi Pages 6-9
    Purpose
    Low-dose non-enhanced computed tomography (LDCT) has been shown to provide low radiation exposure with proper diagnostic accuracy compared to standard dose non-enhanced computed tomography (SDCT) in patients with renal colic. The goal of our study is to estimate the accuracy of LDCT and SDCT interpretation by emergency medicine residents who primarily treated patients with renal colic.
    Materials And Methods
    Thirty sample images of both LDCT and SDCT from renal colic patients were extracted from January 2013 to December 2015 in a tertiary teaching hospital. Five emergency medicine residents interpreted
    60 image samples over a time span of 3 weeks. The presence of a ureteric stone, the stone’s size and location, and signs of obstruction were recorded in the reports. A total of 300 reports were compared with formal readings
    by a radiologist. The inter-observer agreement and kappa value were calculated for comparative analysis.
    Results
    Identification of ureteric stones showed almost perfect inter-observer agreement on SDCT (kappa value: 0.93), and the percentage of agreement was 96.7%. However, on LDCT, the inter-observer agreement was substantial (kappa value: 0.73), and the percentage of agreement was 88.0%.
    Conclusion
    Using SDCT, emergency medicine residents had almost perfect inter-observer agreement in interpreting the CT images of patients with renal colic compared to a radiologist. However, when using LDCT, they had a lower inter-observer agreement.
    Keywords: emergency department, non-enhanced computed tomography, radiation dose, renal colic, urolithiasis
  • Won Ik Seo, Jong Kyou Kwon, Pil Moon Kang, Wansuk Kim, Jang Ho Yoon, Taek Sang Kim, Jae Seung Chung, Cheol Kyu Oh Pages 10-15
    Purpose
    As with other areas, there have been many efforts for minimally invasive surgery in varicocelectomy. We present our initial experience with laparoscopic varicocelectomy with a two-port scarless periumbilical mini-incision.
    Materials And Methods
    The study enrolled 18 patients who underwent laparoscopic varicocelectomy with a twoport scarless periumbilical mini-incision from February 2012 to April 2013. The laparoscopic varicocelectomy was performed using two 5-mm ports at periumbilical sites in skin creases. Here, the surgical procedure is introduced and the outcomes of the case series are summarized. We reviewed other laparoscopic techniques and compared them with our technique.
    Results
    The mean patient age was 34.8 years. Of the 18 patients, 15 had grade 3 varicoceles. The mean operating time was 62.5 minutes. Postoperatively, the scrotal pain level decreased immediately from a mean VAS score of 6.3 to 4.4 and then to 1.7 by 24 hours postoperatively. The mean hospital stay was 2.8 days. Complications included one hydrocele and two recurrent varicoceles. The operating time decreased as the surgeon’s experience increased.
    Conclusion
    Laparoscopic varicocelectomy with a two-port scarless periumbilical mini-incision is a feasible technique that can be mastered relatively easily. Prospective and comparative studies are required to validate this new technique.
    Keywords: Laparoscopy, Minimal invasive surgery, Scar, Umbilicus, Varicocele
  • Yi Cai, Han-Zhong Li, Yu-Shi Zhang Pages 16-20
    Purpose
    To compare the long-term clinical and oncologic outcomes in patients treated with laparoscopic partial nephrectomy (LPN) and laparoscopic radial nephrectomy (LRN) for clinical T1b renal cell carcinoma.
    Materials And Methods
    We retrospectively reviewed the records of all patients who underwent LPN or LRN for a single clinical T1b tumor between January 2005 and January 2012, an actual follow-up of 2-year or greater was available in 39 and 160 after LPN and LRN, respectively. Survival was calculated using the Kaplan-Meier method. Multivariable Cox regression analysis was done to assess predictors of survival.
    Results
    The two cohorts of patients were similar in age, sex, body-mass index and preoperative eGFR. There were no differences in tumors size (4.97 vs 5.29cm, P = .08), and pathological stage distribution between the two cohorts. The median follow-up after LPN and LRN were 67 (range: 18-118) and 70 (19-120) months, respectively. For LPN versus LRN, 5-years overall and cancer specific survival rates were 93.33% vs 85.69% and 96.00% vs 91.35%, respectively. For LPN versus LRN, 10-years overall and cancer specific survival rates were 85.56% vs 73.41% and 88.00% vs 82.85%, respectively. On multivariate analysis, patients’ age, ASA score and pathological stage were the major factors affecting overall survival, and patients’ age and pathological stage were associated with cancer specific survival. The percent decrease in glomerular filtration rate was significantly lower in the LRN group at early and last followup.
    Conclusion
    LPN is an effective treatment option in appropriately selected patients with cT1b RCC. It provides 5-year, 10-year overall survival and cancer specific survival comparable to those of LRN as well as better preservation of renal function than LRN. Overall survival and cancer specific survival are associated with nonmodifiable factors but not by the choice of operative technique.
    Keywords: renal cell carcinoma, T1b, laparoscopy, partial nephrectomy
  • Derya Karasu, Canan Yilmaz, Seyda Efsun Ozgunay, Isra Karaduman, Demet Ozer, Mete Kaya Pages 21-26
    Purpose
    To investigate the effects of ketamine騧嫎襚 and propofol뇫宫橷 anesthesia on surgical site hemorrhage during circumcision procedures.
    Materials And Methods
    The boys undergoing circumcision surgery were included in the study. The patients were divided into two groups. In Group 1 (n = 50), 0.01 mg/kg midazolam and 2 mg/kg IV ketamine were administered. In Group 2 (n = 50), 1 ?g/kg fentanyl, 1 mg/kg lidocaine 2%, and 2–3 mg/kg IV propofol were administered, and patency of airway was ensured with a laryngeal mask airway. The intraoperative bleeding scale was recorded during the procedure to evaluate surgical site bleeding. Hemorrhage was checked for the first three hours using the postoperative bleeding scale to follow the amount of hemorrhage.
    Results
    Intraoperative bleeding scores were significantly higher in Group 1 as compared to Group 2. However, there was no significant difference between the groups regarding frequency of postoperative hemorrhage. The
    mean blood pressure values measured at 5th, 10th, 15th minutes and recovery room were significantly higher in Group 1.
    Conclusion
    The intraoperative bleeding scores were significantly higher with ketamine騧嫎襚 compared to propofol뇫宫橷. On the other hand this hemorrhage can be controlled easily with appropriate hemostasis, and the amount of blood loss was not clinically significant. We think that our study makes a positive contribution to the literature about the effects of anesthetics on the surgical site bleeding during circumcision.
    Keywords: circumcision, hemorrhage, ketamine, midazolam, propofol
  • Predrag Ilic, Mirjana Jankovic, Maja Milickovic, Slobodan Dzambasanovic, Vladimir Kojovic Pages 27-32
    Purpose
    To compare the holmium-laser puncture and electrosurgery-incision in neonates with intravesical ureterocele.
    Materials And Methods
    We retrospectively analyzed the results of laser-puncture of ureterocele (LP group) in 12 patients (mean age 9.8 days, range 4-28) and electrosurgery-incision in 20 patients (ES group) (mean age 10.2 days, range 6-28), treated at our institution. Patients had their records reviewed for preoperative findings, endoscopic procedure description, and postoperative outcomes.
    Results
    There was the need for retreatment in one (8.3%) patient in LP group and in four (20%) patients in ES group (P = .626). Duration of general anesthesia in LP and ES groups was 16 (range, 10-24) minutes and 15 (range, 10-20) minutes, respectively (P = .355). There was no statistically significant difference in terms of hospitalization (LF group one day, ES group 1.35 days) (P = .286). Complications were not found in LP group. There were two (10%) patients with pyelonephritis after the treatment in ES group (P = .516). After one month, obstruction was observed on ultarsound examination in one (8.3%) and two (10%) patients, respectively. After three months, obstruction
    was not found in any patient in both groups. After six months, vesicoureteral reflux was found in one (8.3%) patient after laser-puncture of the ureterocele and in 13 (65%) patients after electrosurgery-incision (P = .003).
    Conclusion
    Both laser-puncture and electrosurgery-incision endoscopic techniques are highly effective in relieving the obstruction. There is no significant difference regarding hospitalization, need for retreatment and the occurrence of complications. The incidence of de novo vesicoureteral reflux is significantly lower in patients treated with holmium-laser, as well as the need for upper pole partial nephrectomy.
    Keywords: ureterocele, neonates, laser puncture, electrosurgery incision
  • Jalil Hosseini, Farzen Soleimanzadeh Ardebili, Behrouz Fadavi, Hamidreza Haghighatkhah Pages 33-37
    Purpose
    Although improvements in urological function have been less challenged, concern about andrological problems following urethral stricture surgeries has been growing in recent years. The aim of this study is to evaluate the role of the anastomotic urethroplasty itself on erectile function in patients with posterior urethral injuries.
    Materials And Methods
    In this prospective cohort study, patients with urethral strictures referring to Tajrish Hospital during October 2013 to August 2016 for anastomotic urethroplasty, were included. All subjects underwent radiologic studies along with rigid and flexible cystoscopy before surgery. Erectile function was evaluated before surgery (twice, addressing pre-traumatic and pre-operational conditions) and after surgery (3 and 6 months post-operatively) via IIEF-5 erectile function questionnaire and color Doppler ultrasound assessment of penile
    vasculature.
    Results
    A total of 65 patients with an average age of 30.6 ± 6.1 years were included. A significant decline was observed in erectile function of patients after the injury based on IIEF-5 questionnaire filled twice separately addressing patient conditions before and after trauma (mean IIEF score 23.15 ± 0.93 to 13.45 ± 5.43, P = .001).
    There was also a significant difference in erectile function of subjects with pelvic fractures compared to those without pelvic fractures (10.43 ± 3.78 vs. 18.96 ± 3.18 P = .001). Univariate and multivariate analyses showed that urethroplasty itself does not significantly affect erectile function in patients according to penile color Doppler ultrasonography (peak cystolic velocity at cavernosal arteries before and after surgery: right 26.87 ± 6.93 vs26.16 ± 6.53 respectively and left 27.23 ± 5.21 vs 26.52 ± 4.38 respectively) and IIEF-5 erectile function questionnaire (13.12 ± 5.38 vs. 13.54 ± 5.44; P = .26).
    Conclusion
    The results of this study showed that urethroplasty does not significantly affect erectile function in patients with urethral strictures. The marginal results showing a negatively affected erectile function in patients
    with complex strictures may be attributed to a real impact of the surgery in this subgroup or lower number of these cases in our study.
    Keywords: erectile dysfunction, reconstructive surgical procedures, urethral stricture, urethroplasty, urethral transection
  • Masoud Delashoub, Mojtaba Ziaee, Arash Khorrami, Seyed Mahdi Banan-Khojasteh Pages 38-43
    Purpose
    Fibrates are drugs widely used for the treatment of hyperlipidemic disorders. Previous studies on a novel analogue of clofibrate, called silafibrate, have shown good lipid lowering effects. This study was designed to assess the role of silafibrate as a peroxisome proliferator-activated receptors (PPARs) agonist on sperm health and spermatogenesis in adult male rats.
    Material and
    Methods
    Seventy male Wistar rats were randomly allocated into 7 groups: Cl-10, Cl-20, and Cl-40 mg/kg/day (clofibrate); Si-10, Si-20, and Si-40 mg/kg/day (silafibrate); and C, control. After a 28-day treatment, all rats were euthanized. Blood samples were taken for determination of testosterone, total antioxidant capacity, levels of malondialdehyde, and oxidized low-density lipoprotein. Reproductive organs were dissected and spermatozoa collected from the epididymis for analysis.
    Result
    Sperm parameters (count, motility, viability, and morphology) and total serum testosterone decreased significantly in clofibrate-treated (20 and 40 mg/kg) rats (P
    Conclusion
    We conclude that PPARs agonists have significant adverse effect on sperm viability, motility, and total serum testosterone, and could be harmful for sperm parameters and male reproductive function in rats.
    Keywords: clofibrate, silafibrate, spermatogensis, rats
  • Maryam Vaezjalali, Helia Azimi, Seyed Masoud Hosseini, Afsoon Taghavi, Hossein Goudarzi Pages 44-48
    Purpose
    BK virus (BKV) has a worldwide seroprevalence in humans. Based on sequences of the major capsid proteins, i.e. viral protein 1 (VP1), there are four BKV genotypes. Each genotype has its own subtypes, and was shown to be circulating independently in the human population. The aim of this study was to determine BKV genotypes and subtypes among Iranian patients with prostatic cancer, benign prostatic hyperplasia, and kidney transplantation.
    Materials And Methods
    BKV DNA was extracted from prostatic cancers and benign prostatic hyperplasia blocks and also urine of kidney transplantation patients. BKV (VP1) gene was amplified partially (327nt) by homemade polymerase chain reactions and subjected for sequencing and phylogenetic analysis. Bioedit version 7.0 and Mega version 5.0 were used for sequence analysis and for comparing the results with world-driven BKV sequences.
    Results
    All of BKV VP1 genes which were derived from Iranian patients were classified with subtype 1b2 strains from Germany and Turkey. Predicted amino acid sequences from the studied region of VP1 showed that all of these nucleotide diversities could change amino acid sequence numbers 60, 68, 72, 73 and 82 among VP1.
    Conclusion
    The interesting point was that genetic analysis of derived sequences showed a different feature of genetic diversity among Iranian sequences. This feature has not been reported yet. This characteristic feature of Iranian BKV VP1 gene provides a unique cluster of sequences in phylogenetic tree.
    Keywords: BK virus, agnoprotein, genotype, prostate cancer, benign prostatic hyperplasia
  • Roman Zachoval, Vladimir Borovicka, Tomas Marada, Ondrej Viklicky, Jiri Fronek, Jan Krhut, Libor Janousek, Janka Slatinska, Petr Nencka Pages 49-54
    Purpose
    This work investigated the effects of diuresis, duration of dialysis and age on lower urinary tract function in urologically healthy males on the waiting list for kidney transplant.
    Materials And Methods
    The study included all men who had kidney transplants at our centre between January 2009 and December 2014 who had normal urological findings prior to inclusion on the list. Diuresis, the duration of haemodialysis, age, and parameters of function of the lower urinary tract as determined by filling and voiding cystometry were evaluated.
    Results
    The study included 127 men (median age, 59 years; median diuresis, 250 mL; median duration of dialysis, 469.5 days). We found that greater diuresis was accompanied by significantly higher FDV, FDV/Cmax, NDV,Cmax and compliance and by significantly lower Pdet.max, PdetQmax and BOOI. Longer duration of dialysis was accompanied by significantly lower FDV, NDV and Cmax, compliance and Qmax.p and with significantly higher Pdet.max, PdetQmax and BOOI. Older age was associated with significantly higher Pdet.max and with significantly lower compliance. Worsening of the basic parameters of the storage function of the lower urinary tract occurred when diuresis decreased to 500–750 mL, when the duration of dialysis was one year and when patients were older than 54 years.
    Conclusion
    In healthy male patients on the waiting list for kidney transplant, there were connections between the occurrence of dysfunctions of the lower urinary tract and diuresis, duration of dialysis and age. Patients should be monitored for dysfunctions of the lower urinary tract before and after transplantation.
    Keywords: age, diuresis, dialysis, kidney transplant, lower urinary tract dysfunction, male, waiting list
  • Turgay Turan, Bulent Erol, Ismail Ulus, Erdem Guven, Turhan Caskurlu Pages 55-57
    penile amputation is a rare injury that occurs most frequently because of self-mutilation in patients suffering from psychotic problems, especially schizophrenia. Less frequent reasons for penile amputation are non-self-mutilation, trauma due to an industrial or traffic accident, incidents during circumcision, hypospadias repair or surgery for bladder extrophy, surgical resection for malignancy, strangulation by hair coil, and penetrating injuries during war. Surgical techniques for penile reconstruction continue to evolve. However, because of the complexity of the penis, repairing and reconstructing this organ remains a great challenge for surgeons, anatomically, functionally, and aesthetically.
    Treatment and care vary depending on the severity of the lesions, the delay in seeking consultation, and the patient’s mental state. The goal of penile reconstruction is to restore urinary and sexual functions with cosmetically acceptable results. Ideally, surgical repair should be immediate, to preserve as much viable tissue as possible.
    This is because no other tissue in the body has the characteristics, in terms of elasticity, texture, and color, to be considered an ideal candidate for genital reconstruction. For penile amputation, microvascular replantation can be preferred as one of the treatments(1). When primary repair with genital tissue is not feasible, skin grafts and various pedicle and free flaps can be used for reconstruction.
    We report a case of criminal penile amputation that was restored by radical penile crural dissection and use of a radial forearm free flap (RFFF) to cover the corpus cavernosum.
    Keywords: reconstruction, penis, amputation, flap
  • Abbas Basiri, Mohammad Nadjafi Semnani, Hamed Mohseni Rad Pages 58-60
    enile amputation is a rare injury that occurs most frequently because of self-mutilation in patients suffering from psychotic problems, especially schizophrenia. Less frequent reasons for penile amputation are non-self-mutilation, trauma due to an industrial or traffic accident, incidents during circumcision, hypospadias repair or surgery for bladder extrophy, surgical resection for malignancy, strangulation by hair coil, and penetrating injuries during war. Surgical techniques for penile reconstruction continue to evolve. However, because of the complexity of the penis, repairing and reconstructing this organ remains a great challenge for surgeons, anatomically, functionally, and aesthetically.
    Treatment and care vary depending on the severity of the lesions, the delay in seeking consultation, and the patient’s mental state. The goal of penile reconstruction is to restore urinary and sexual functions with cosmetically acceptable results. Ideally, surgical repair should be immediate, to preserve as much viable tissue as possible.
    This is because no other tissue in the body has the characteristics, in terms of elasticity, texture, and color, to be considered an ideal candidate for genital reconstruction. For penile amputation, microvascular replantation can be preferred as one of the treatments(1). When primary repair with genital tissue is not feasible, skin grafts and various pedicle and free flaps can be used for reconstruction.
    We report a case of criminal penile amputation that was restored by radical penile crural dissection and use of a radial forearm free flap (RFFF) to cover the corpus cavernosum.
    Keywords: Transplantation, urolithiasis
  • Tae Nam Kim, Chan Ho Lee, Seung Ryong Baek, Kyung Min Lee, Sangmin Choe, Nam Cheol Park, Hyun Jun Park Pages 61-63
    Penile glans ischemia or necrosis developing after internal pudendal arterial embolization is very rare; no relevant report has yet appeared. A 53-year-old male who visited our emergency room because of massive urethral bleeding was diagnosed with an internal pudendal artery-urethral fistula; he underwent selective embolization of the internal pudendal artery. However, unexpected penile glans ischemic necrosis developed after embolization. We successfully treated the patients with intravenous infusion of alprostadil, oral pentoxifylline and tadalafil.
    Keywords: glans_penis_necrosis_embolization_phosphodiesterase 5 inhibitor
  • Abdol-Mohammad Kajbafzadeh, Behnam Nabavizadeh Pages 66-67