مجله تحقیقات در ارولوژی
سال پنجم شماره 2 (پاییز و زمستان 1400)

Urological surgery could be an unpleasant experience for patients due to the need for exposure of the patient's genital area. The present study aimed to determine the effect of gender matching of urological patients and the surgery team on anxiety, shame, and vital signs.

This quasi-experimental study was conducted in Shahid Beheshti Hospital, Hamadan, Iran, in 2021. A total of 160 patients were selected via convenience sampling and randomly divided into control and intervention groups (n=80 in each group). The patients in the control group were admitted to the operating room as usual, but the gender of the surgical team was matched with the patients of the intervention group. The data were collected using the Vital Signs Flow Sheet, Spielberger's State Anxiety Inventory, and Cook’s Internalized Shame Scale and finally analyzed in SPSS software (version 16).

Based on the findings of this study, the two groups were homogeneous in terms of demographic and clinical characteristics (P>0.05). At the beginning of the study, there was no significant difference between the two groups in terms of variables of vital signs, anxiety, and internalized shame (P>0.05). After admission to the operating room, the rate of vital signs, except for temperature, was significantly lower in the intervention group than in the control group (P<0.05). Moreover, the level of anxiety and shame of the intervention group was significantly lower than the control group (P<0.05).

If gender of patients is matched with the surgical team, the patients will feel less ashamed and anxious, and the level of vital signs will be closer to normal.

Testicular sperm can be successfully recovered by testicular sperm extraction (TESE) and used for intracytoplasmic sperm injection. Disturbance in the testicular blood barrier can lead to the production of anti-sperm antibodies (ASA). This prospective study aimed to determine changes in the level of anti-sperm antibodies in TSTE surgery.

In this prospective longitudinal study, 20 patients undergoing TESE surgery were included via purpose-based and accessible sampling. Patients were operated on according to the same surgical procedure. Firstly, demographic data, such as age, were recorded. The amount of anti-sperm antibodies was checked before surgery, and the patients were followed up for one month, and this amount was measured again after the end of one month. The changes in antibodies were investigated before and after one month. In addition, the relationship of the level of antibodies with demographic data and the type of disease was investigated. Anti-sperm antibodies in this study was investigated using Mixed Antiglobulin Reaction (MAR) and Immunobead Test (IBT) methods, and the type of antibody measured was IgG type. The abnormal level of IgG anti-sperm antibody was considered greater than or equal to 10%, signifying that more than or equal to 10% of the sperms are covered by IgG. Finally, the obtained results were analyzed in SPSS software.

The findings of this research pointed out that the levels of abnormal antisperm antibody 5% and 20% before and after TESE surgery, respectively. Based on the results of the chi-square test, these changes were significant. In addition, age and body mass index had no significant relationship with the level of anti-sperm antibody.

As evidenced by the obtained results, the TESE surgery can increase serum ASA levels; nonetheless, it is suggested to assess this issue in future studies in a higher statistical population. One of the limitations of the present study was the lack of examination of the sexual partners of the study subjects. It is suggested to measure the ASA level in couples before and after the intervention due to the importance of the study in the fertility chances of the subjects and examine the correlation of ASA changes with semen analysis parameters.

Ureteropelvic junction obstruction (UPJO) is one of the most common congenital urinary tract abnormalities, which if left untreated can lead to impaired renal function. There is controversy over when is the best time for surgery (early or delayed). Therefore, we decided to design a study based on our clinical experience to evaluate the success rate of pyeloplasty in different age groups.

In this cross-sectional study, 110 patients who underwent pyeloplasty in Shahid Beheshti Hospital, Hamedan, Iran, from 2014 to 2019 were studied. A total of 26 patients were excluded from the study due to bilateral obstruction, or other concomitant urological disorders. We retrospectively reviewed the medical records of patients to collect demographic characteristics, clinical presentation, postoperative complications, anteroposterior pelvic diameter, parenchymal thickness, and the success rate of pyeloplasty.

Of 84 patients studied, 61 (72.6%) were male and 23 (27.4%) were female. Regarding the age of the patients, 22 (26.2%) individuals were less than 3 months old, 30 (35.7%) between 3 months to 1 year old, and 32 (38.1%) more than 1 year old. In total, surgery was successful in 72 (85.7%) patients. The success rates in the age groups of less than 3 months, 3 to 12 months, and more than 12 months were 90.9%, 86.7%, and 81.2%, respectively (P=0.598). It was found that APD decreased significantly after the surgery in all age groups (P=0.001), this change was significantly seen in the age group of less than 3 months (P=0.016). The most common complication was fever reported in 9.5% of the patients.

The findings of the present study showed that early pyeloplasty surgery in infants and children with a diagnosis of high-grade UPJO could lead to improve morphological indices of the kidney and prevent complications.

Abdominal trauma is one of the most common causes of death in trauma patients, occurring in 20% of cases. Kidney damage is the most common complication of non-penetrating abdominal trauma. In patients with abdominal trauma, it is important to diagnose and treat possible abdominal injuries. The presence of hematuria and clinical examinations often have little sensitivity and specificity to diagnose the intra-abdominal injury. Although Computed Tomography (CT) scan is the standard diagnostic method for abdominal trauma, it has its own drawbacks, including radiation. On the contrary, ultrasound is a cheaper, more repetitive, and non-invasive procedure. The present study aimed to determine the diagnostic value of Focused Assessment with Sonography for Trauma (FAST) scan and ultrasound by a radiologist in comparison with abdomen and pelvis CT scan with intravenous (IV) contrast in determining the severity of kidney damage in patients with microscopic hematuria due to non-penetrating abdominal and pelvic trauma.

This forward-looking study was conducted on patients with blunt abdominal trauma with hematuria in Hamadan Besat Educational and Medical Center in 2018 and 2019. The sampling was performed by census method based on inclusion and exclusion criteria. Patient demographic information, as well as accident information that led to abdominal trauma, were recorded in a checklist. All participants were trained by a third-year emergency medicine assistant and then by a third- or fourth-year radiology assistant via FAST ultrasound to diagnose free abdominal fluid. In the next step, all participants were examined after IV contrast injection using a CT scan device. Finally, the data were analyzed in SPSS software (version 22) using appropriate statistical methods.

In this study, 60 eligible patients, including 47 males (78.4%) and 13 females (21.6%), with a mean age of 36.75±17.81 years, were examined. The percentage of agreement between the FAST ultrasound findings performed in the emergency and radiology departments was 93.3%. The agreement between the two methods was significant, with a coefficient of 0.837 (P<0.001). Sensitivity (75 and 80), specificity (100 and 92.5), positive (100 and 84.2) and negative (88.8 and 90.2) predictive values, as well as the accuracy (91.6 and 88.3) of FAST ultrasound, in both emergency and radiology groups were acceptable in comparison with CT scan.

As evidenced by the obtained results, it can be concluded that ultrasound is a reliable tool for examining patients with abdominal trauma with suspected kidney damage.

The increasing incidence of chronic kidney disease around the world highlights the need for more attention and appropriate actions to enhance therapeutic outcomes and improve patients’ quality of life. This study aimed to evaluate the efficacy of a program to promote medication adherence among hemodialysis patients using the Capability, Opportunity, and Motivation-Behavior (COM-B) model.

The present study was a quasi-experimental interventional study conducted on 140 chronic kidney patients referred to the Dialysis ward of Imam Reza Hospital (Kermanshah, Iran) divided into two groups of 70 patients as intervention and control during 2021. The program was developed by conducting a needs assessment based on the COM-B model and evaluating it in two stages, before and three months after the implementation. Data were collected by a questionnaire based on the COM-B model and analyzed using the SPSS software (version 16).

After the implementation of the program, the components of capability and medication adherence behavior had a significantly higher average rank in the intervention group. The effect sizes of the intervention components, including capability, opportunity, motivation, and medication adherence behavior, were calculated to be 0.69, 0.19, 0.23, and 0.43, respectively.

Considering the effect sizes of each component, especially behavior, it seems that the developed program based on the COM-B model has enough efficiency and that the employed model is effective for developing programs to promote medication adherence.

Varicocele is the most prevalent clinical condition in infertile men. The exact mechanism of varicocele that causes testicular dysfunction is not fully known. This study, therefore, aimed to determine the prevalence of impotence and testosterone levels before and after varicocelectomy in patients referred to Sina Hospital (Tehran, Iran) from 2018 to 2019.

This study was conducted on 115 patients, selected through available sampling, who had varicocele and were candidates for varicocelectomy. A checklist of demographic characteristics was completed before and three months after the surgery. Clinical examination and ultrasound were performed before and three months after the surgery to determine the grade of varicocele and blood test to examine the serum level of testosterone. Afterward, the data were entered into the SPSS software (version 26) for statistical analyses.

The mean testosterone levels before and after the surgery had a significant difference of about 124 ng/dL (23.6±7.8% on average). Erectile dysfunction significantly improved three months after surgery. The number of severe and moderate erectile dysfunctions was significantly reduced, and the number of mild or no erectile dysfunction significantly increased.

In general, it can be concluded that varicocelectomy surgery in people with varicocele can increase serum testosterone levels. It can also be said that varicocelectomy surgery can significantly improve sexual satisfaction and erectile dysfunction in people with varicocele, compared to preoperative conditions.

The quality of life of infertile couples has not been sufficiently considered due to its nature and the complexity of its relationship with the psychological status of individuals. Therefore, this study aimed to determine the quality of life and its related factors among infertile couples referred to Fatemieh Hospital in Hamadan, Iran.

This cross-sectional study was performed on 303 infertile couples referred to Fatemieh Hospital, Hamadan, Iran, in 2019. The participants were selected by simple random sampling and entered into the study. Data collection tools included demographic characteristics form and a quality of life questionnaire (SF-36). Data were analyzed by SPSS software (version 24) using the Pearson correlation test, independent t-test, and one-way ANOVA.

The mean age of the participants was 30.94±6.21 years. Moreover, 37.3% of the study participants reported 2-4 years of infertility, and 59.4% of them did not use any of the assisted reproductive methods, such as IUI and IVF. The results showed that 68.2% of the participants obtained the maximum achievable score of total quality of life indicating a relatively favorable quality of life among infertile couples in Hamadan. There was also a significant relationship between income and quality of life (P<0.05).

The results of this study showed that the quality of life of infertile couples in Hamadan is relatively desirable. However, more careful planning seems necessary to improve their quality of life.

We report a case of successfully transplanting a cadaveric donor kidney with three large cysts into a 54-year-old man. The donor was a 53‑year‑old male with a history of ischemic heart disease for two months and intracranial hemorrhage as the cause of death. Three 8-, 4-, and 2-cm cysts were identified in the upper and middle poles of the deceased donor’s kidney. Before transplantation, the large cysts were unroofed from the allograft. Postoperatively, the patient had a satisfactory urine output, and the serum creatinine level was 1.9 mg/mL at the time of hospital discharge, which fell further to 1.02 mg/dL three months after transplantation. Donor kidneys with large bilateral cysts can be effectively transplanted and should not be refused for use.