فهرست مطالب

Urology Journal - Volume:5 Issue: 1, Winter 2008

Urology Journal
Volume:5 Issue: 1, Winter 2008

  • 66 صفحه،
  • تاریخ انتشار: 1387/03/01
  • تعداد عناوین: 14
|
  • Safarinejad Mr Page 1
  • Khoshdel Ar, Carney Sl Page 3
    Introduction
    Cardiovascular disease is still a major cause of mortality in kidney transplant patients. This is partially attributed to the nonclassic cardiovascular risk factors including arterial stiffness, an established independent predictor of mortality in several patient populations.
    Materials And Methods
    An extensive search was performed to review the evolution process of the method for arterial stiffness assessment and sphygmology and their applications in chronic kidney disease before and after kidney transplantation.
    Results
    Despite a marked change in methodology from the ancient medical practice to the current modern medicine, noninvasive assessment of arterial stiffness is still based on pulse analysis. Currently, pulse wave velocity, augmentation index, and pulse wave reflection are preferred indexes for arterial stiffness. Increased arterial stiffness has been reported in diabetes mellitus, hypertension, chronic kidney disease, cardiovascular disease, and elderly, and reduction of arterial stiffness is a key element for efficacy of the treatment and mortality reduction.
    Conclusion
    Noninvasive assessment of arterial stiffness is suggested as a part of clinical assessment for kidney transplant recipients and donors and facilitates defining high-risk patients for development of cardiovascular disease. A combination of techniques is recommended for this purpose.
  • Kumar P Page 15
    Introduction
    Fluoroscopy-guided intervention during percutaneous nephrolithotomy (PCNL) has become the order of the day. During this procedure, both the patient and the physician are exposed to some radiation. Measurement of radiation doses in patients and personnel are important. Patient radiation doses are used for comparison with other centers for achieving the best possible radiation practice. In addition, there are performance checks for the fluoroscopy machines so that x-ray emitting machines should work at the optimum level ie, producing good images at minimum possible radiation doses.
    Material And Methods
    This is a review of literature and discussion on radiation dose to patients and personnel, and on basic radiation safety tenets and their application in urological interventions of PCNL procedure.
    Results
    Radiation doses during PCNL have gone down over the time due to advances in technology. However, as radiation is hazardous, there is no room for complacency. A hospital’s medical physicist may ensure even further reduction of x-ray dose by carrying out regular dosimetry and quality assurance tests on the fluoroscopy machines. A survey meter may provide an easy and quicker but not-so-accurate method for occupation exposure determination.
    Conclusion
    The practice of PCNL procedures seems to be quite safe with radiation point of view. The quick, easy, and economical method of estimation of radiation dose using survey meter may need further calibration with the standard thermoluminescence dosimetry method. Setting optimum x-ray parameters, incorporation of filters, and quality assurance tests are a few areas where medical physicists may help in further reduction of radiation doses.
  • Darabi Mahboub Mr, Shakibi Mh Page 24
    Introduction
    The aim of this study was to evaluate percutaneous nephrolithotomy (PCNL) in the patients with solitary kidneys.
    Materials And Methods
    Between 1995 and 2005, we had 11 patients with a solitary kidney and kidney calculi who underwent PCNL at our center. Tubeless and standard PCNLs were performed in 3 and 7 patients. In 1 patient, we could not achieve access to the system due to the stricture of the infundibulum.
    Results
    The calculi were extracted or fragmented successfully in 10 patients. In 2 patients with residual calculi, a double-J catheter was inserted and extracorporeal shock wave lithotripsy (SWL) was performed. Retroperitoneal hematoma was detected in 3 cases by ultrasonography 1 week after the procedure, which was treated conservatively. Also, fever occurred in 3 patients after the procedure which was treated successfully. The patients were discharged on the 3rd and 4th postoperative days.
    Conclusion
    Although PCNL is accompanied by the risk of complications such as severe bleeding that may result in kidney loss in patients with a solitary kidney, the rate of success and complications seem to be similar to the other patients if careful operation and correct selection of candidates are done. Therefore, we recommend cautious performance of PCNL in patients with solitary kidneys.
  • Etemadian M., Haghighi R., Madineay A., Tizeno A., Fereshtehnejad Sm Page 28
    Introduction
    We present our experience in continuing percutaneous nephrolithotomy (PCNL) versus delayed PCNL when purulent fluid is aspirated during access to the pyelocaliceal system.
    Materials And Methods
    This randomized controlled study was carried out on patients who had purulent urine in the pyelocaliceal system at the initial puncturing during PCNL. Patients with recent untreated urinary tract infection, thick or foul pus in aspirated urine, fever, and immunocompromised condition were excluded. Thirty-one patients were randomly divided into 2 groups. In group 1, PCNL was continued, but in group 2, nephrostomy tube was placed and PCNL was performed 10 days later after documented sterile nephrostomy urine. The preoperative and postoperative findings were compared.
    Results
    There were 16 and 15 patients in groups 1 and 2, respectively. All patients had negative urine cultures for microorganisms, preoperatively. The purulent aspirated fluid was infected in 43.8% and 40.0% of the patients in groups 1 and 2, respectively. Postoperative fever was seen in 25.0% and 26.7% of the patients, respectively. No statistical differences were observed between the two groups in terms of bacteriuria, bacteremia, positive calculus cultures, or stone-free rates, and duration of hospitalization between groups 1 and 2, respectively. More analysis with linear regression model showed that postoperative positive blood culture (P <. 001), fever (P =. 001), and postoperative positive urine culture (P =. 02) correlated with duration of hospitalization.
    Conclusion
    In the absence of untreated recent UTI and aspiration of thick or foul pus, continuing PCNL can be safe while purulent urine is encountered.
  • Zargar, Shoshtari Ma, Soleimani Mj, Salimi H., Mehravaran K Page 34
    Introduction
    In a retrospective study, we evaluated the frequency, clinical presentation, and management of lymphocele in kidney transplant recipients operated on in a single center.
    Materials And Methods
    Between September 1984 and June 2005, we had 2147 kidney transplantations from living donors. During the follow-up period, ultrasonography was performed in symptomatic patients and those with elevated serum creatinine level postoperatively. Other radiological procedures were done in complicated cases. Patients with lymphocele were treated by percutaneous drainage with or without injection of sclerotizing agent (povidone iodine). If recurrence occurred, surgical intraperitoneal drainage was performed. In cases with multiloculated collection or inappropriate access for percutaneous drainage, the primary approach was surgical intraperitoneal drainage.
    Results
    Symptomatic lymphocele collection was seen in 17 kidney recipients of our series (0.8%; 95% confidence interval, 0.4% to 1.2%). It presented with elevation of serum creatinine concentrations (47.1%), pain and abdominopelvic swelling (29.4%), and lower extremity edema (23.5%). Percutaneous drainage was used for the treatment of lymphocele in 11 patients, but recurrence occurred in 7 (63.6%). These cases were treated with open surgical drainage. In 6 patients, the primary approach was surgical intraperitoneal drainage, because of multiloculated collection or inappropriate access for percutaneous drainage. All of the patients were treated successfully and no graft loss occurred during the follow-up period.
    Conclusion
    Symptomatic lymphocele is an uncommon complication after kidney transplantation. Surgical intraperitoneal drainage is the most effective approach for the management of symptomatic lymphocele.
  • Roshani A., Falahatkar S., Khosropanah I., Asghari Golbaghi Mr, Kiani Sa, Akbarpour M Page 37
    Introduction
    Vasectomy is the safest and most reliable method of all the contraception methods, but azoospermia is not achieved immediately by this method. We decided to determine whether irrigation of the vas deferens with sterile water or hypertonic saline solution irrigation during vasectomy would reduce the time needed to obtain azoospermia.
    Materials And Methods
    A total of 126 fertile men presented for vasectomy were divided in 3 groups. No-scalpel vasectomy was done for all of the participants and irrigation of the vas deferens was carried out during the procedure in 2 groups with either sterile water or hypertonic saline solution (9 g/L sodium chloride solution). Forty-two participants underwent vasectomy without irrigation. Semen analysis was performed at 4, 8, 12, and 16 weeks after vasectomy.
    Results
    Azoospermia was achieved in all of the men with sterile water after 12 weeks, while at the end of the study (16 weeks) it was achieved in 37 (88.1%) of those with saline solution and in 11 (26.2%) of those without irrigation. There were significant differences in the rates of azoospermia between the participant with sterile water and saline solution at 8 weeks (38.1% versus zero; P <. 001), 12 weeks (100% versus 30.9%; P <. 001), and 16 weeks (100% versus 88.1%; P =. 02). No pregnancy developed during the follow-up and no complication was reported.
    Conclusion
    Vasal irrigation with sterile water and hypertonic saline solution during vasectomy were effective in removing sperm from the distal vas and increasing the rate at which men achieved azoospermia. Sterile water was a promising option with no complications.
  • Akgul T., Karakan T., Ayyildiz A., Germiyanoglu C Page 41
    Introduction
    We evaluated the efficacy of citalopram and sertraline in the treatment of premature ejaculation (PE).
    Materials And Methods
    Of 101 married men with PE, 80 were eligible and consented to participate in this randomized controlled trial. Erectile dysfunction and administration of drugs for the treatment of PE were the exclusion criteria. The patients were evaluated using index of premature ejaculation (IPE) questionnaire and were randomly assigned into groups 1 (sertraline) and 2 (citalopram). They received one of these drugs for 8 weeks and then were re-evaluated by the IPE. Pretreatment and posttreatment results were compared within and between the study groups.
    Results
    A total of 80 patients entered and completed the study. The mean age of the patients was 38.4 ± 7.7 in group 1 and 37.5 ± 6.9 in group 2 (P =. 60). The mean pretreatment IPE scores were 21.4 ± 1.8 and 20.9 ± 1.3 in the patients of groups 1 and 2, respectively (P =. 23). After 8 weeks, significant improvement was seen in both groups in terms of the IPE questionnaire results (39.8 ± 1.4; P <. 001 and 39.5 ± 2.9; P <. 001, respectively). However, the treatment response was not different between the 2 groups (P =. 50). No serious adverse effects were detected in any of the patients and both drugs were tolerated well.
    Conclusion
    Citalopram and sertraline are safe and effective in patients with PE. Additionally, we failed to find any difference between the effects of these two drugs in the treatment of this condition.
  • Yazdani M., Shahidi S., Shirani M Page 46
    Introduction
    The aim of this study was to evaluate diagnostic value of urinary polymerase chain reaction (PCR) in urogenital tuberculosis (UTB).
    Materials And Methods
    In 33 patients with confirmed diagnosis of UTB by urine culture and/or acid-fast staining, clinical symptoms and laboratory and radiological findings were evaluated. For each patient, 3 consecutive urine samples were examined by PCR for Mycobacterium tuberculosis and the results were compared with the standard microbiological methods and radiological findings.
    Results
    The mean interval between the appearance of the symptoms and the diagnosis was 12.3 ± 12.2 months. Symptoms were irritative bladder symptoms such as dysuria and diurnal or nocturnal frequency (51.5%), flank pain (27.3%), microscopic hematuria (18.2%), gross hematuria (9.1%), and suprapubic pain (9.1%). The laboratory findings included hematuria (27.3%), pyuria (12.1%), and hematuria with pyuria (48.5%). Diagnosis of UTB was made in 19 patients by positive urine culture for MT in 19 patients (57.6%), positive acid-fast staining in 6 (18.2%), and both in 8 (24.2%). Intravenous urography showed abnormal findings in 16 patients (61.5%), including pyelocaliceal dilatation (26.9%), ureteral stricture and hydroureter (23.1%), multiple small caliceal deformities (15.4%), severe parenchymal destruction (11.5%), autonephrectomy (11.5%), and calcification (7.7%). Urinary PCR was positive in 16 patients (48.5%) and in 10 (62.5%) with abnormal findings on intravenous urography.
    Conclusion
    A high index of suspicion is necessary for diagnosis of UTB even in patients with nonspecific manifestations. Urinary PCR is recommended for instant diagnosis and screening before further examinations, but it cannot be the sole diagnostic modality for diagnosis of UTB.
  • Simforoosh N., Soufi Majidpour H., Basiri A., Ziaee Sam, Behjati S., Mohammad Ali Beigi F., Aminsharifi Ar Page 50
    Introduction
    The purpose of this study was to evaluate the short-term and long-term results of laparoscopic adrenalectomies carried out in our center.
    Materials And Methods
    A total of 67 laparoscopic adrenalectomies were performed during the 10 years between 1995 and 2005 at Shahid Labbafinejad Medical Center. A transperitoneal lateral approach was used in 65 (97.0%) of the patients, and retroperitoneal approach was used in 2 (3.0%). The clinical characteristics and the outcomes were reviewed in a retrospective study.
    Results
    Indications for laparoscopic adrenalectomy in our patients were as follows: pheochromocytoma in 28 patients (41.8%), aldosterone-producing adenoma in 15 (22.4%), pseudocyst in 6 (9.0%), Cushing syndrome (macronodular adrenocortical hyperplasia) in 5 (7.5%), nonfunctioning adenoma (incidentaloma) in 5 (7.5%), myelolipoma in 2 (3.0%), almost normal adrenal tissue in 2 (3.0%), adrenal cyst in 2 (3.0%), adenocarcinoma in 1 (1.4%), and schwannoma in 1 (1.4%). The mean operative time for unilateral cases was 149.0 ± 36.1 minutes. The mean intraoperative blood loss was 126 ± 36 mL. Conversion rate to open surgery was 7.5%. Reoperation due to hemorrhage was performed in 1 patient.
    Conclusion
    Laparoscopic adrenalectomy is a safe procedure in some adrenal tumors and a reasonable option for selected large adrenal tumors when complete resection is technically feasible and there is no evidence of local invasion.
  • Ziaee Sam, Javaherforooshzadeh A Page 55
  • Heinrich E., Gattenloehner S., Mueller, Hermelink Hk, Michel , Schoen G Page 57
  • Rafique M Page 60