narjes saberi

The choice between using the internal or external iliac arteries to supply a transplanted kidney poses a dilemma during renal transplantation. As the internal iliac artery branches to the genital tract, cutting it could potentially result in sexual dysfunction. The purpose of this study was to compare the effects of these two surgical methods on sexual function.

122 sexually active male patients under the age of sixty were randomly divided into two groups: the internal iliac anastomosis group and the external iliac artery anastomosis group. Before surgery and one year after the procedure, patients completed the International Index of Erectile Function-15 questionnaire (IIEF- 15), and the difference in scores of each domain was measured.

Statistically, kidney transplantation improved all domains of IIEF in both groups, except for erectile function in patients who underwent internal iliac artery anastomosis group. Additionally, there were significant differences between the two groups in the domains of erectile function (p-value=0.04) and overall satisfaction (p-value = 0.002), while other domains such as orgasmic function, sexual desire, and intercourse satisfaction did not show any statistically significant differences.

In conclusion, the choice between using the internal or external iliac artery for arterial anastomosis during kidney transplantation does not significantly impact graft function. However, it may negatively affect erectile function in patients who undergo internal iliac artery anastomosis. 

Labial adhesion (LA) is rarely observed in postmenopausal women. There is no uniform consensus regarding the etiology of the LA, yet. It may present with different urinary or vaginal symptoms. We herein report the clinical symptoms, management and follow-up of eight postmenopausal patients with LA and a brief review of the literature.

We reported the presenting complaints, treatment and surgical outcomes of eight postmenopausal patients, diagnosed with LA. The mean age and follow-up were 55 years (range: 42-69) and 27 months (range:18-36), respectively. All patients were either virgins or did not have sexual intercourse for years. The increasing number of adults LA case reports highlights the importance of conducting a thorough genital examination in all females with hypoestrogenic state and voiding complaints, especially those who are not sexually active. Placing separate absorbable sutures at the introitus area, prolonged use of topical estrogen and maintaining sexual contact or vaginal cones may help to reduce the early recurrence.

The surgical technique can be considered a safe, effective and durable method for the treatment of LA in postmenopausal women.

Management of the posterior urethral valve (PUV) is a clinical challenge in pediatric urology. We report the results of a modified valve ablation method without using a pediatric resectoscope and thermal energy. Patients were selected from children with PUV who were referred to the pediatric urology clinic of Shahid Labbafinejad Hospital, Tehran, Iran, and have undergone endoscopic valve ablation surgery between May 2019 to May 2021. Ten male patients with PUV underwent mechanical valve ablation without the use of the conventional pediatric resectoscope, and thermal energy was replaced by a 6F semi-rigid urethroscope and 3Fr ureteral catheter. Patients were assessed both pre-and postoperatively using serum creatinine, urinary tract ultrasound imaging, and voiding cystourethrography. The mean age was 23.88±30.13 months (range= 25 days to 8 years). Four out of 10 patients (40%) had elevated serum creatinine, and seven had unilateral or bilateral hydroureteronephrosis (70%). No major complications were reported according to Clavien–Dindo Classification System. The level of serum creatinine, the grade of hydroureteronephrosis, and the ratio of the prostatic urethra to anterior urethra diameter in postoperative voiding cystourethrography were decreased. A decrease in serum creatinine level occurred in patients after valve ablation, but this decrease was not statistically significant (P=0.059). The decrease in hydroureteronephrosis grade on the right (P=0.006) and left (P=0.022) was statistically significant. There was no evidence of urethral stenosis or need for repeating resection. It can be concluded that our mechanical valve ablation method might be a safe and effective technique for PUV ablation.

This study was conducted to compare the level of knowledge of medical interns who have gone through the urology course during their externship with interns who have not gone through the urology course during their externship. In this cross-sectional study that was conducted in the year 2021 at the Isfahan University of Medical Sciences, Isfahan, Iran, 97 medical interns entered in September 2014, 38 of whom underwent a neurosurgery course and 59 underwent a urology course and the level of public awareness about renal colic It was studied in them. The total evaluation score in the neurosurgery group was 71.79±13.93 and the urology group was 85.83±7.19, and the students who completed the urology course were significantly higher than the average (P-value<0.001). The average percentage of correct answers to questions in the field of ​​differential diagnosis was 25.39±4.55, the field of ​​use of painkillers was 78±19.77, and the field of ​​emergency intervention was 83.3%±18.41 in all students. The average percentage of correct answers to the differential diagnosis questions in the neurosurgery and urology groups was 22.5±5.15 and 27.25±2.9, respectively, and the difference between the two groups was significant (P-value<0.001). The findings of the present study show that the medical students who completed the urology course during the externship have a higher level of knowledge about renal colic than the students who completed the neurosurgery course.

Nephrogenic adenomas in children, similar to adults, are rare benign lesions that often occur in patients with a history of previous surgery or chronic irritation of the urinary tract. These lesions often appear with hematuria and appear as polypoid or papillary lesions in cystoscopy and may have a differential diagnosis with malignant lesions. Most of the patients have a history of bladder augmentation, recurrent urinary tract infections, and urinary stones. So far, no case of nephrogenic adenoma has been reported in children following vesicostomy site prolapse.

Case Report: 

We report a case of nephrogenic adenoma in the bladder of a 2-year-old boy with a history of vesicostomy and vesicostomy prolapse and repeated surgery on the bladder. Vesicostomy was performed due to bilateral vesicoureteral reflux and posterior vesicoureteral valve. After performing two surgeries to correct the vesicostomy site, the vesicostomy was closed at the age of 18 months following resection of the posterior urethral valve, and in the follow-up ultrasound at the age of 2 years, a 2 cm mass was seen in the posterior wall of the bladder, and in the pathology report of the resected mass Nephrogenic adenoma is reported.

Prolapse of the vesicostomy and continuous irritation of the bladder mucosa can cause nephrogenic adenoma in the child's bladder.

Many attempts have been made in the history and philosophy of science to suppose machines as human beings. Sometimes they are attributed mind, sometimes emotion, and sometimes intelligence. All this is to make the border between humans and machines as narrow as possible, so that one day they may unite. But this effort can be made in another direction. It is possible to bring humans closer to the machines as much as possible with a systematic view, which is what the cybernetic perspective has done. This approach has played a significant role in the emergence of artificial intelligence studies and along with the two approaches of computationalism and representationalism has been able to introduce artificial intelligence as the most important and functional field of science to the world.

Retropubic midurethral sling (MUS) is safe and effective surgery used for the treatment of stress urinary incontinence in women. Bladder neck perforation is a rare intraoperative complication. If this complication missed in intraoperative cystoscopy may have serious morbidity. A 52‑year‑old woman underwent a retropubic MUS. She presented with early and unusual symptoms such as suprapubic and labial cellulitis and urine leakage through the suprapubic incision 1 week after surgery which was due to a missed bladder neck perforation during surgery. In cystoscopy after MUS revealed mesh traversing the bladder neck and it was removed. The missed bladder perforation may have early and unusual symptoms and cystoscopy must be done more carefully and obsessively in patients with risk factors.

There are two brands of BotulinumtoxinA(BTXA) that are commonly used in the treatment of Lower Urinary Tract Disease: OnabotolinumtoxinA(Ona-BTXA) and AbobotulinumtoxinA (Abo-BTXA). The present study was conducted to assess the potential therapeutic and adverse effects of Abo-BTXA or Dysport for interstitial cystitis/bladder pain syndrome (IC/BPS).

Twenty-two out of 52 women diagnosed with IC/BPS who were refractory or had a low response to oral treatments of IC/BPS after 6 months, were included in the study. The end-point was O'Leary-Sant Score (OSS) including “symptoms” and “problem” indexes (ICSI and ICPI respectively) assessment after 1,3and 6 months after Abo-BTXA injection. Each patient underwent cystoscopy and immediately after hydrodistention received intratrigonal injections of 300 IU of Abo-BTXA (Dysport®) in 30 sites. The effect and side effects of this treatment over time have been investigated. Complications including high post void residual urine (PVR), bladder rupture, and urinary tract infections (UTI) were also assessed.

The mean age of patients was 46.2 ± 13.7 years and the median OSS was 27.8 ± 5.8.: After a single injec-tion ICSI, ICPI, and total OSS significantly reduced in 1, 3, and 6 months follow up; rate of decreased total OSS was 39.5%, 36%, 18%, respectively. Its effect lasted up to six months and started to decrease after 1 month (p-value < 0.05). Complications included urinary retention (PVR > 200ml), bladder rupture, and UTI in 13.5%, 4.3%, and 18% of the patients, respectively.

Intravesical injection of 300IU Abo-BTX(Dysport) could be a useful approach for the treatment of patients with refractory IC/BPS in a period of six months.

Recurrent bacterial cystitis is a common infection in women and there are concerns about its antibiotic therapy. Platelet rich plasma has antimicrobial and tissue repairing effects. We investigated the effect of platelet rich plasma as an intravesical therapy to prevent recurrence of bacterial cystitis.

Thirty women with a history of recurrent bacterial cystitis were randomly assigned into two groups: 1) platelet rich plasma and 2) control groups. The first group received 10 mL of platelet rich plasma with intravesical instillation plus 40 mL of normal saline. The control group only received 50 mL of normal saline. We did the instillation once a week for four weeks in both groups. We followed up the participants two and 12 months after the last instillation with a questionnaire (the international consultation on incontinence questionnaire in overactive bladder) and result of their urine culture.

A significant decrease was observed in the number of bacterial cystitis recurrences in the platelet rich plasma group compared to the control group 12 months after the instillation (4 vs. 1, P = 0.004). Also, there was a significant improvement in the questionnaire’s score two (3.6 ± 2.58 vs. 0.66 ± 1.63, P = 0.002) and 12 months (3.4 ± 2.77 vs. 0.006 ± 1.83, P < 0.001) after instillation in the platelet rich plasma group compared to control group. There was no adverse effect 12 months after instillation.

Platelet rich plasma can significantly decrease the recurrence of bacterial cystitis up to a year after instillation without any side effect

Labial adhesion (LA) is a rare clinical entity in postmenopausal women. Estrogen deficiency and lack of sexual activity are probable contributing causes. Voiding dysfunction due to LA is even rarer in postmenopausal women, and only a few studies have previously reported such occurrence. A 62-year-old virgin postmenopausal woman presented to the Al-Zahra Hospital (Isfahan, Iran) with a 5-year history of voiding dysfunction and recurrent urinary tract infection. Despite multiple medical visits, no genital examination was ever performed by a medical practitioner, mainly due to the patient’s refusal to be examined by a male physician. On physical examination, we observed extensive LA with only a small opening. Surgical separation of the labia was performed and subsequently, the urinary tract symptoms were completely resolved. Herein, we present a case of LA causing urinary problems in a virgin postmenopausal woman. The case underlines the importance of the genital examination of female patients with urinary tract symptoms.

The aim was to study the effectiveness and safety of a modified technique that employs a four‑arm polypropylene (PP) mesh (NAZCA‑TC) to treat pelvic organ prolapse (POP) and concurrent stress urinary incontinence (SUI) simultaneously.

This prospective follow‑up study was conducted on fifty SUI women with concurrent high‑grade (greater than Stage 2) anterior vaginal wall and/or uterine prolapse who were referred to Al‑Zahra and Noor Hospitals in Isfahan and underwent surgery using the NAZCA‑TC, Promedon, Argantina kit. The POP‑Quantification system was employed for staging POP before and after surgery. To evaluate lower urinary tract symptoms (LUTS) and patients’ quality of life, a stress test and the short form of International Consultation on Incontinence Questionnaire of Female Lower Urinary Tract Symptom were used. Patients were followed up and assessed at 6 weeks, 6 months, and 1, 2, and 3 years after surgery.

The mean age of patients was 58.2 ± 10.2 years. There was a great reduction (88.6%) in POP staging after surgery. The success rate of SUI treatment was significantly high (83.5%). During 3 years of postoperative follow‑up, mesh erosion occurred in 18%, 5 patients (10%) presented with mesh erosion in the first years after operation, 16% reported significant groin or pelvic pain, and 10% required sling release.

A single vaginal incision and using two less percutaneous access sites with the PP meshes were effective for treating patients with concurrent POP and SUI but have a high rate of postsurgery erosion rate.