فهرست مطالب محمدرضا محمدی فلاح

The aim of the present study was to compare graft survival and patient survival between diabetic and non-diabetic patients in the Imam Khomeini Hospital Transplant Center, during the years 2001 to 2011. This study was a retrospective cohort study. We used Kaplan-Meier test to calculate the patient and graft survival and t-test to compare continuous variables, Fisher exact test and x2 test to compare categorical data. The mean duration of follow-up in patients with diabetes and nondiabetes was 37.09 ±53.15 and 34.49 ±62 months. five and 10 year patient survival rate among diabetic patients were 79 and 74.29%, while among non-diabetic patients were 89.28 and 81.01%, respectively. Five and 10 year graft survival rate among diabetic patients were 80 and 59.04%, respectively, and among non-diabetic patients were 84.35 and 77%. In this study, patient survival rate in diabetic and non-diabetics were significantly different (p=0/000), indicating the need for follow-up and ongoing management of diabetes after transplantation. There was no significant difference between graft survival rate in diabetic patients (p=0.243). The results showed transplantation is the best trapotic choice for diabetic patients.

Renal cysts are common disorders in adults. Traditionally، symptomatic patients with renal cysts are treated with percutaneous aspiration with or without using sclerosing agent. However، the recurrence rate is high in this procedure. Thus، we assessed the long-term outcomes of laparoscopic decortication of simple renal cysts from the clinical and radiologic points of view. From April 2004 to July 2008، twenty seven symptomatic patients with simple renal cyst treated with laparoscopic decortication، where the wall of renal cysts resected. Complex renal cysts were excluded from the study. Vang Baker criteria were used for estimation of the severity of pain before and after operation. Radiologic improvement was considered، when، there wasn''t any evidence of recurrence in CT scan taken long time after surgery. Among twentyseven patients treated with laparoscopy، %92. 5 of patients had symptomatic improvement and %96. 2 had radiological improvement after follow up for 22 months (3-32 months). According to our study، laparoscopic decortication، as a less invasive method، has a high success rate in the treatment of symptomatic renal cysts.

Endoscopic electro-coagulation method has been suggested for the treatment of vesicoureteral reflux (VUR) in recent years. The aim of the present study was to evaluate the efficacy and postoperative complications of endoscopic electro-coagulation method in patients with VUR. Thirty patients with VUR were operated via endoscopic electro-coagulation. At the first phase of study (3-6 months after surgery) patients were followed up to evaluate early complications and operation success. At the second phase, the operated patients were followed up to evaluate the late complications within three years after surgery. The results showed that 69.8% of the patients were cured completely. Early complications consisted of irritative symptoms and hematuria which were relieved few days after surgery. Twenty patients were followed for 3 years and no late complication was seen and operational permanency was 100%. The endoscopic electro-coagulation method is less invasive and has similar outcome to other VUR endoscopic surgery methods.

When medical therapy is ineffective or does not exist for a particular adrenal disease, surgery becomes necessary. The introduction of laparoscopic adrenalectomy has revolutionized adrenal surgery and largely supplanted the open approach. In this series we introduced three cases of aldosterone producing adenoma and pheochromocytoma which underwent laparascopic adrenalectomy. To the best of our knowledge, this surgical procedure was done for the first time in our educational center in west Azarbayjan. We describe three cases and procedural details of a minimally invasive laparoscopic adrenalectomy- two patients with pheochromocytoma and one patient with primary hyperaldostronism- that was performed at Imam Khomaini hospital in Urmia. The procedure required specifically trained, advanced laparoscopic surgery team and showed remarkable advantages in comparison with open procedure in terms of blood loss, shorter hospital stay, rapid healing and return to normal function. We believe that such minimally invasive laparoscopic procedures should be carried out in other health care centers throughout this country so that patients may benefit from this proven role in patient care.

Renal transplantation is the treatment of choice for chronic renal failure. Using an appropriate and fine ureterovesical anatomizes technique can prevent most complications regarding this aspect of transplantation. Extravesical ureteroneocystostomy is becoming more popular in renal transplantation because of ITS few complications and technical ease. This low complication rate is due to limited bladder dissection and shorter urethral segment required from the donor. In this study, we evaluated a comparison between Barry and Barry-Tagochi ureteroneocystostomy techniques in a group of renal transplant recipients. Method and Materials: From September 2004 to March 2007, we recorded all urological complications after renal transplantation in a sort of renal transplant recipient. They were operated by Barry-Tagochi or Barry ureteroneocystostomy techniques. We followed them up to 12 mouths. For the following complications including: urinary fistula, urethral stenosis and vesicoureteral reflux and complicated hemturia. From a total number of 198 patients 100 Barry-Tagochi and 98 Barry anatomizes were performed. The incidence of urological complications in Barry-Tagochi and Barry reimplantetion techniques were 4(4%) and 5(5.1%) respectively. The difference was not statistically significant (P=0.71). Urinary leakage occurs in one person in each group (%).and urethral obstruction occurred in 3 patients in each group (%).No complicated hematuria or symptomatic VUR happened in patients in each groups. The mean urethral anatomists time was recorded about 8.26±2.28 minutes (range 4-16 minutes) for Barry- Tagochi and 9.9± 3.34 minutes (range 5-20 minutes) for Barry procedure, with a significant difference (P=0.0001). After VCUG mild to moderate reflux was noted in 2(4%) of 50 transplant patients in Barry- Tagochi group. No treatment was required for a total number of 50 these patients. Our study proved that Barry –Tagochi extravehicular ureteroneocystostomy could be a rapid and simple method, without significant incidence of urological complication. This technique has become the choices of urethra vesicle anatomists during renal transplantation in our centre.

Impacted distal ureteral stone have always been controversial on the choice of treatment. This study aims to evaluate the effect of tamsulosin (non selective alpha 1-blocker) in medical expulsion therapy of distal ureteral stones. 96 patients with UVJ or distal ureteral stones (size between 3-6 mm) were randomly divided into two groups. Group 1 (46 patients – the control group) received only indomethacin (100 mg /PRN). Group 2 (50 patients) received indomethacin and tamsulosin (0.4 mg daily). All patients were questioned about the episodes of ureteral colic, dose of Indomethacin, rate and time of spontaneous passage of stones. Patients were followed for 28 days. 30 of 46 patients (62.5%) in the control group and 41of 50 patients (82%) in tamsulosin group had spontaneous stone passage during 28 days. The expulsion rate were not significantly different between 2 groups (P>0.05). Stone expulsion time was 8.03±4.7 days in control group and 5.07±3.7days in tamsulosin group. This difference was statistically significant (P<0.05). The control group had more ureteral colic episodes and more indomethacin use rather than tamsulosin group. This difference was statistically significant (P=0.05). Tamsulosin decreases the duration of stones passage, severity of pain and use of analgesics in conservative management of distal ureteral stones, but doesn’t increase the frequency of spontaneous passage of the distal ureteral calculi significantly.

Prostate cancer is the most common male malignancy. Today, patients are screened with PSA and DRE, and in the presence of high PSA level (>4 ng/ml) or abnormal DRE finding, TRUS guided biopsy of prostate is performed for definitive diagnosis. Since multiple factors cause serum PSA to rise such as prostate massage, biopsy, inflammation we evaluated the effect of intravesical BCG therapy on serum PSA level. 66 patients with a history of superficial bladder tumor who had primary normal PSA level (<4 ng/ml) and normal DRE findings entered the study and underwent TURBT. Two weeks after the surgery intravesical BCG therapy was conducted weekly for 6 weeks, PSA level was checked before each session and after 3 months of the last one. Any rise in PSA level 2 folds of the baseline or PSA level more than 4 ng/ml was considered significant and the patients followed by TRUS guided biopsy of prostate 15 patients (22%) had significant rise in serum PSA level with mean of 2.3 ng/ml (range 0.1-10.3 ng/ml). In 10 patients (15.1%) PSA increased to more than 4 ng/ml but returned to basal level within 3 months. In the remaining 5 patients, doubled PSA level did not return to normal level after 3 months but finally decreased in 2 of them. Mean time of PSA level rise was 1.8 weeks (range 1-3 weeks). DRE findings were normal in 7 of 10 patients with PSA more than 4 ng/ml and all of 5 patients with doubled PSA. One patient had right lobe nodule and two had enlarged prostate gland. Six of the patients underwent TRUS guided biopsy, while the results were granulomatous prostatitis in 2 and normal prostatic tissue in the rest. Intravesical BCG therapy increases serum PSA level transiently which usually normalizes within 3 months. For PSA rising to last longer, TRUS guided biopsy looks wise.

In this study, we aimed to compare helical CT scan with routine imaging modalities (IVP and/or retrograde pyelography) in patients with acute flank pain and non-diagnostic findings in KUB and ultrasonography. During a five month period, 32 patients referring to the emergency center with acute flank pain, and having nondiagnostic KUB and ultrasonography were selected for the study. All patients underwent regular diagnostic procedures. IVP and retrograde pyelography were done when necessary and Helical CT scan without oral or IV contrast media as well. The results were reported by a radiologist positive and an urologist as well. Results included observation of stone plus its secondary signs. Merely positive secondary signs without finding any stones were considered negative. Any other pathologies resulting in acute flank pain e.g. UPJO, tumor, and strictures presumed as a positive result as well. Among 32 patients, 25 entered the study, in 7 patients no pathologies were found - stone or other, and the resulting lack of gold-standard made us put them off. Of the remaining 25, five had pathology other than stone. One case was of ureteral stricture with polyp and 4 cases of UPJO. Helical CT scan was precise in accurate diagnosis of all 25 patients. In one occasion, the study continued with oral and IV contrast CT. Helical CT scan is more accurate than other imaging tools in diagnosing radiolucent stones and other causes of acute flank pain. Also CT scan can definitely rule out a urologic origin of acute flank pain. While suspicion remains about causes other than stone, oral, and IV contrast enhanced CT increases the accuracy. Finally, when there is a contraindication for using contrast media, non- contract helical CT poses as a double value. We propose using non-contrast helical CT as the next step for patient with non - diagnostic KUB and ultra sonograpic findings.

Urologic complications occur in 1% to 30% of patients in different series. These complications are ureteral necrosis and stricture, urinary leakage, renal pelvis necrosis, ureterovesical stenosis and symptomatic ureterovesical reflux. Ureteropyelostomy with using the recipient’s ureter is one of options for management of ureteral complication after renal transplantation. We present our experience in managing ureteral complication after renal transplantation in 7 patients through performance of ureteropyelostomy using the recipient’s ureter. from Feb 2005 to Feb 2005, 128 renal grafts were performed at our hospital. An exteravesical reimplantation technique (barry or barry_tagochi ureterovesical anastomosis) was used. Ureteropyelostomy using the recipient’s own ipsilateral ureter were performed in 7 cases. Mean time between transplantation and ureteropyelostomy, kidneys sonography and Cr before and after surgery, leakage, flank pain, fever, symptomatic UTI, and history of failed operation were reviewed. Imaging shows uvj stenosis in 4 patiants, ureteral necrosis in 2 case, and upj obstruction in1 case. Mean time between transplantation and ureteropyelostomy was 72 days. Mean Cr before and after surgery was 4.4 and 2.2 respectively. Comparison of graft sonography before and 1 month after the surgery showed improvement of hydronephrosis in 6 patiants and its diminishing in 1 case. In native kidney no new hydronephrosis was shown. None of the patient had flank pain, leakage, and wound infection. Symptomatic UTI was seen in 1case that improved with medical therapy. Pyonephrosis with fever occurred in 1 patiant who had sever hydronephrosis in native kidney before surgery. Ureteropyelostomy with using the recipient’s native ureter is a safe and effective treatment for management of ureteral complication after renal transplantation.

Renal transplantation is the choice of treatment for chronic renal failure. Applying suitable ureterovesical anastomosis technique can prevent most risks for kidney graft. Extravesical ureteroneocystostomy is becoming popular in renal transplantation because of the low complication rate and technical ease. This decrease in complication was due to limited bladder dissection and the need for a shorter ureteral segment from the donor. We evaluated the incidence of urologic complications by using Barry-Tagochi ureteroneocystostomy in 114 cases of renal transplantation. We recorded all urological complications after preforming extravesical Barry-Tagochi (new technique) ureteroneocystostomy in the recipient kidney that was developed from Sep 2004 to Sep 2005 (mean follow-up 12 mouths). The urological complications included complicated hemturia, urinary fistula, ureteral stenosis, VUR, and operative time. All patients underwent baseline VCUG and ultrasonography within 3-6 months of transplantation and as clinically indicated The incidence of urological complications was 6 (5.25%) patients that included one urinary leakage (0.86%) and four ureteral stenosis (3.5%) which the ureters required reimplantation, with one complicated hematuria (0.86%) and with any symptomatic VUR, range of operative time was 4 minutes (mean 8.15). Mild reflux was noted in 2 patients in VCUG and reoperation was not required. Extravesical Barry-Tagochi (new technique) ureteroneocystostomy is a simple and rapid technique with acceptable urologic complications so this technique is the first choice of our center.