فهرست مطالب
Urology Journal
Volume:17 Issue: 2, Mar-Apr 2020
- تاریخ انتشار: 1399/01/30
- تعداد عناوین: 22
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Pages 109-117Purpose
Radical nephrectomy (RN) and partial nephrectomy (PN) are widely used for early-stage renal cell carcinoma (RCC). However, the results were inconsistent while comparing the efficiency of RN and PN. This study aimed to assess the perioperative effectiveness of RN and PN for treating RCC.
Material and MethodsPubMed, Embase, and the Cochrane Library electronic database were searched for studies on adults with RCC comparing RN and PN published until September 2019. The perioperative efficacy and safety outcomes were calculated using odds ratio (OR) and standard mean difference (SMD) with 95% confidence intervals (CIs) for dichotomous and continuous data, respectively. Subgroup analysis were conducted based on tumor stage and surgery methods for evaluation of the treatment effect on specific subsets.
ResultsA total of 23 studies involving 30,018 patients with RCC were included in this meta-analysis. Notably, RCC treated with PN was associated with low incidences of hospital mortality (OR: 0.58; 95% CI: 0.38–0.89; P = 0.013) and reoperation rate (OR: 0.74; 95% CI: 0.58–0.95; P = 0.016) as compared to RN. However, PN was associated with an increased risk of overall postoperative complications (OR: 1.40; 95% CI: 1.17–1.68, P < 0.001), postoperative hemorrhagic complications (OR: 1.92; 95% CI: 1.28–2.87, P = 0.002), and urinary fistula (OR: 17.65; 95% CI: 5.35–58.30, P < 0.001) as compared to RN.
ConclusionThese findings suggested that PN was associated with lower incidences of hospital mortality and reoperation rate, whereas RN was associated with fewer complications
Keywords: meta-analysis, nephron-sparing surgery, radical nephrectomy, renal cell carcinoma, systematic review -
Pages 118-123Purpose
We aimed to identify the prevalence and risk factors of three outcomes after stone removal following treatment for obstructive acute pyelonephritis (APN) associated with urinary tract calculi: immediate postoperative febrile urinary tract infection (UTI), stone recurrence, and APN recurrence during the follow-up period.
Materials and MethodsWe retrospectively reviewed the charts of 107 patients who underwent stone removal following treatment for obstructive APN associated with urinary tract calculi. Logistic regression analysis was used to identify the factors that contributed to postoperative febrile UTI after stone removal. Cox proportional hazard analyses were used to identify the factors contributing to stone recurrence and APN recurrence during the follow-up period.
ResultsPostoperative febrile UTI was observed in 23 out of 107 patients (21.5%). Multivariate logistic regression analysis revealed that female sex (P = .02) and having multiple stones (P < .01) were independently significant predictors of postoperative febrile UTI. One-year recurrence-free survival rates of stone disease and APN were 76.1% and 82.5%, respectively. Multivariable cox proportional hazard analyses revealed that presence of residual fragments was the only significant risk factor for stone recurrence (P < .01) and marginally significant for APN recurrence (P = .05).
ConclusionPatients presenting with obstructive APN frequently develop postoperative febrile UTI after active stone removal with the risk factors being female sex and having multiple stones. Residual fragments after stone removal in patients with obstructive APN can cause urolithiasis and APN recurrence, indicating that complete removal of stone fragments ? 4 mm is imperative to the disease management.
Keywords: lithotripsy, postoperative complications, pyelonephritis, retrospective studies, risk factors, urolithiasis -
Pages 124-128Purpose
Percutaneous nephrolithotomy (PCNL) is the preferred surgical treatment in many cases of kidney stones which is performed in different positions such as prone, lateral, and supine. This study was designed to evaluate whether patient position (lateral versus . prone) has an effect on the need for analgesia and onset of pain after surgery.
Materials and MethodsPatient with confirmed kidney stones (size ? 2 cm) who were candidates for PCNL were enrolled in this study. The required biochemical analyses were performed preoperatively. All patients underwent spinal anesthesia by the same anesthesiologists and then were randomly divided into two separate groups as lateral (L) and prone (P) positions. The operations’ start and end time, required time for proper access into target calyces, additional need for analgesic or cardiac drugs, duration of analgesia, and onset of pain after PCNL were carefully recorded and then compared between the two groups.
ResultsIn total, 51 patients were evaluated of whom 39 were men and 12 were women. Mean duration of analgesia after PCNL surgery in P group (173 ± 8 min) was significantly longer than in L group (147±12 min) (P = .001). Furthermore, the amount of ephedrine usage in L group (3.6 ± 1.5mg) was significantly lower than in the P group (16.4 ± 12mg), suggesting more hemodynamic variations in the P group during the operation.
ConclusionOur randomized control trial study shows that choosing the optimal position in the PCNL technique depends on patient's condition. If hemodynamic control is of matter to the anesthesiologist, then lateral position is more appropriate. However, if control of pain and longer time of analgesia are important, prone position may be preferred.
Keywords: analgesia, lateral position, percutaneous nephrolithotomy, prone position -
Pages 129-133Purpose
In this retrospective study, we aimed to comparatively evaluate the efficacy and safety of RIRS procedure on an age-based manner in patients younger and above 65 years.
Materials and MethodsA total of 165 patients undergoing RIRS procedure for renal stones were divided into two groups on an age-based manner namely; Group 1 (n=122) patients aging < 65 years and Group 2 (n=43) patients aging above 65 years. Demographic and clinical data regarding the stone free rates, complication rates and need for secondary procedures were retrospectively evaluated.
ResultsOf all the patients undergoing RIRS for kidney stones, 122 were below the age of 65 (73.9%) and 43 were above the age of 65 (26.1%). Mean age value for the patients aging more than 65 years was 74.16 ± 5.03 years and in addition to higher percentage of comorbidities, serum creatinine levels as well as ASA scores were also higher in this group when compared with younger counterparts. Although there was no statistically significant difference with respect to the operative duration, stone-free rates (SFR) and hospitalization period between the two groups, both complication rates and the need for additional interventions were higher in the older patient group (p = 0.038; p = 0.032). All complications noted in the both groups were minor (Grade I) complications according to the Clavien classification system.
ConclusionRIRS procedure can be applied as an effective and safe treatment alternative for the minimal invasive management of renal stones in relatively older patients (> 65 years) with similar hospitalization as well as stone free rates noted in the younger patients. No procedure related severe complication was noted in these cases.
Keywords: geriatric patients, renal stones, RIRS -
Pages 134-138Purpose
To explore whether sexual intercourse is beneficial to the clinical outcome of SWL for ureteral calculi of 7-15 mm in the distal ureter.
Materials and MethodsBetween March 2016 and January 2017, 225 patents with a stone (7-15 mm) in distal ureter were randomly divided into three groups after SWL: Group 1 was asked to have sexual intercourse at least three times a week, Group 2 was administered tamsulosin 0.4 mg/d and Group 3 was received standard therapy alone and served as the controls. Stone free rate, time to stone expulsion, pain score at admission, number of hospital visits for pain and steinstrasse were recorded in 2 weeks.
Results70 patients in Group 1, 71 patients in Group 2 and 68 patients in Group 3 were enrolled to the study. At the end of the first week and the second week, the stone free rates for Group 1 (68.6%, 80.0%) and Group 2 (69.0%, 81.7%) were approximately the same, but were significantly higher than Group 3 (50.0%, 63.2%) (P = .031, P = .022). The VAS scores of Groups 1 and 2 were slightly higher than those of Group 3 (P = .233). The number of patients in Group 3 who visited the emergency room for pain was significantly higher than in the other two groups (P = .015). At the end of the second week, the incidence of steinstrasse in Groups 1 and 2 was significantly lower (2.9%, 2.8% vs 11.8%) (P = .034).
ConclusionAt least three sexual intercourses per week after SWL can effectively improve the stone free rate, reduce the formation of steinstrasse and relieve renal colic. It provides a choice for urologists in the SWL treatment of lower ureteral calculi.
Keywords: shockwave lithotripsy, sexual intercourse, tamsulosin, ureteral stone, pain -
Pages 139-142Purpose
With the invention of miniature devices, it has been advised to apply less aggressive methods for the management of upper urinary tract stones, especially in children. In the recent years, ultra-mini percutaneous nephrolithotomy (UMP) has been used for the treatment of upper urinary tract stones in order to perform surgeries with less complications and more acceptable outcomes. Results reported from different medical centers have been promising.
Materials and MethodsTwenty-two children aged less than 8 years old with upper urinary stones sized between 10-20 mm underwent UMP. Inclusion criteria was solitary unilateral kidney stone, stone size between 10-20 mm, normal renal function tests, absence of any congenital malformations, and history of previous ESWL failure. Data including age, sex, side of kidney involvement, size of stone, location of stone, duration of surgery, duration of hospitalization, stone composition, need for blood transfusion, damage to adjacent organs, postoperative fever, septicemia after surgery, need for narcotics, further need for a complementary method, stone-free rate, pre and post-operative hemoglobin levels, and urinary leakage from the access tract were extracted from patients' medical files and were recorded.
ResultsThe mean age (± standard deviation) of children was 5.22 (±1.57) years. Fourteen (63.6%) patients were male. Fifteen (68.2%) renal stones were located in the right kidney, and 82% of patients had pelvis stones. 13 (59%) patients’ stones were composed of calcium oxalate. Stone-free rate was 95.5%. In none of the cases urinary leakage, septicemia after surgery, injury to adjacent organs, and need for blood transfusions was reported.
ConclusionUltra-mini percutaneous nephrolithotomy is an efficient and safe method for treating urinary stones sized between 10-20 mm in children.
Keywords: Ultra-mini Percutaneous Nephrolithotomy_Upper urinary stone less than 20 mm_children under 8 years_Iran -
Pages 143-145Purpose
Laparoscopic adrenalectomy (LAD) is considered the gold standard surgical method for resecting adrenal tumors. To date, only few small studies have investigated the safety of clipless laparoscopic adrenalectomy in which the adrenal vessels were controlled by the LigaSure system or bipolar coagulation. The aim of the present study was to evaluate the safety and feasibility of sutureless and clipless laparoscopic adrenalectomy operations performed in our center.
Materials and MethodsAll patients with functional adrenal tumors, nonfunctional adrenal tumors larger than 5 cm and secondary adrenal metastases from the kidneys, lungs or breasts who had underwent an LAD procedure between 2012 to 2019 were included in our study. In all of the cases, complete coagulation of adrenal veins was achieved through bipolar cautery and no vascular staplers, clips or other energy sources were used for controlling the adrenal vessels whatsoever. Outcomes of interest included operation time, length of hospital stay, changes of serum hemoglobin level, and occurrence of major complications.
ResultsOf a total 251 patients, unilateral right and left-side adrenalectomy was performed in 168 and 67 cases, respectively, and 16 cases had underwent bilateral adrenal resection. The mean age (SD) of patients was 40.7 (13.6) years old at the time of operation and the mean size (SD) of the adrenal lesions was 5.2 (3.1) cm as measured by the greatest diameter. Histological examination showed that the most common pathology of the resected adrenal glands was pheochromocytoma (n=78). None of the laparoscopic operations required a conversion to open surgery. Also, major bleeding or other serious complications did not occur in any of the cases either intraoperatively or postoperatively.
ConclusionClipless and sutureless laparoscopic adrenalectomy seems to be feasible and safe for removing adrenal tumors. Moreover, bipolar cautery is associated with an acceptable outcome for vessel closure
Keywords: laparascopic adrenalectomy, clipless, sutureless, laparoscopy, adrenal tumors, adrenalectomy -
Pages 146-151Purpose
To retrospectively determine whether recovery of urinary continence after radical prostatectomy is associated with the preoperative length of membranous urethra (MU), the amount of rhabdosphincter and the length of MU removed with the prostate.
Materials and MethodsThe study cohort comprised 179 consecutive patients who underwent laparoscopic radical prostatectomy (LRP: n = 98) and robot-assisted radical prostatectomy (RARP: n = 81) at Wakayama Medical University between July 2010 and May 2014. The length of MU was measured by preoperative MRI. The amount of resected rhabdosphincter and the length of resected MU were assessed in hematoxylin and eosin sections at the apical margin of prostate specimens. Patient-reported urinary continence status was determined at 3, 6, 12 and 24 months postoperatively, with urinary continence considered as 0-1 pads/day. Kaplan-Meier analysis and the log-rank test were used to compare time to urinary continence recovery. Multivariate Cox regression analyses were performed to determine the predictors of urinary continence.
ResultsRARP vs LRP (p = 0.02) and shorter length of resected MU (p = 0.01) showed significantly better postoperative continence recovery by log-rank test. Nerve-sparing, preoperative length of MU, and amount of resected rhabdosphincter did not significantly correlate with continence recovery. Only the length of resected MU was the independent factor for predicting postoperative urinary continence by multivariate Cox regression analysis (hazard ratio 0.84, p = 0.01).
ConclusionThese results demonstrated that the length of resected MU measured by specimen was an independent predictor of urinary incontinence after radical prostatectomy. Care should be taken to preserve maximal length of MU for optimal continence outcomes
Keywords: Membranous urethral length, Radical Prostatectomy, Urinary Incontinence -
Pages 152-155Purpose
To investigate the safety of electrocoagulation and thulium laser (Tm-laser) sealing methods of distal ureter resection during radical nephroureterectomy (NFU) in a porcine model.
Methods9 pigs were used in the study: 6 were used to measure the bursting pressure (BP) and 3 were used to measure the highest pressure during NFU. Twelve ureters were to measure BP after being sealed by electrocoagulation or Tm-laser (n = 6, each). Six experimental NFUs were performed in 3 pigs to measure the intraluminal pressure of all procedures.
ResultsThe mean BP in the electrocoagulation group (104.3 ± 25.0 cmH2O) was similar to that of the Tm-laser group (74.8 ± 23.3 cmH2O, P > .05). The peak intraluminal pressure (35.9 ± 7.6 cmH2O) during NFU was significantly lower than the BP (P < .05).
ConclusionThe effectiveness of the sealing was confirmed using both electrocoagulation and Tm-laser during NFU.
Keywords: bursting pressure, distal ureter, bladder cuff resection electrocoagulation, experimental porcine model, Pluck technique, thulium laser -
Pages 156-163Purpose
Autophagy plays a critical role in PCa development. DAXX has a potent pro-survival effect by enhancing cell growth in PCa via suppression of autophagy. Here, we depicted a network governed by DAXX and SPOP by which the autophagy pathway is suppressed through the ubiquitination and modulation of key cellular signaling pathways mediators including LAMP2 and RARRES1.
Materials and MethodsThrough network-based bioinformatics approaches, the expression levels of DAXX, RARRES1, LAMP2, and SPOP genes was assessed in 50 PCa tissues and 50 normal adjacent from the same sample as well as 50 benign prostatic hyperplasia (BPH) tissues by quantitative RT-PCR. The normal adjacent tissues were taken from regions more than 5mm away from the bulk of those tumor tissues with clearly distinct margins. RNA extraction, cDNA synthesis and Real-time Quantitative RT-PCR were done for assessment of gene expression. To evaluate the primary gene network centered on autophagy pathway, according to the Query-dependent weighting algorithm, these two networks were integrated with Cytoscape 3.4 software.
ResultsWe found that in PCa tissues the DAXX expression level was significantly increased (P < 0.001) and the expressions of SPOP, RARRES1, and LAMP2 were significantly down-regulated, when compared to both control groups including normal adjacent and BPH tissues. Moreover, significant correlations were observed between expression levels of all four genes. Additionally, ROC curve analysis revealed that LAMP2 had the most sensitivity and specificity.
ConclusionThese findings suggest that the contribution of SPOP, DAXX, RARRES1, and LAMP2 together could be a putative regulatory element acting as a prognostic signature and therapeutic target in PCa.
Keywords: prostate cancer, autophagy, gene regulatory network, SPOP, DAXX, RARRES1, LAMP2 -
Pages 164-168Purpose
To discuss whether concealed penis after circumcision lowers perimeatal urethral and glanular sulcus uropathogenic bacterial colonization in healthy boys with no urinary tract problems and prevents attacks of febrile urinary tract infections in non-healthy boys with defined urinary tract abnormalities.
Materials and MethodsThis case-control study was conducted in Ibn-i Sina Hospital and retrospectively collected data of 471 boys were analyzed. All patients were scanned for any urinary tract abnormality and those with any defined abnormalities were classified as non-healthy group. (123 patients) Non-healthy patients were divided into two subgroups as concealed (n:31) and non-concealed (n:92) penis after circumcision. Healthy patients with no urinary problems were divided into three groups as circumcised without concealed penis (n:144), with concealed penis after circumcision (n:104) and uncircumcised control group (n:100). Bacterial cultures were obtained from both periurethral meatal and glanular sulcus areas by adhering strictly to the rules of obtaining bacterial culture to avoid false-positive or negative culture results. Also only uropathogenic bacterias were evaluated, irrelevant results were excluded.
ResultsMean age was similar in healthy population. Comparison of three groups showed that there was a significant difference in both cultures.(P = .026 for periurethral meatal region, P = .039 for glanular sulcus region) In post hoc analysis, non-concealed group had a lower rate of culture positivity in both areas compared to other groups. Mean age was also similar in non-healthy population. Mean follow-up period was 18.2 months. Patients with concealed penis after circumcision had a significantly higher number of febrile UTI attacks (20 attacks in 8 patients vs 7 attacks in 5 patients) compared to non-concealed group. (P = .019) All febrile UTI attacks except one in this group occurred below the age of 12 months. A total of 10 patients in both healthy and non-healthy groups had postoperative hemorrhage after circumcision and only 1 patient had a wound infection.
ConclusionConcealed penis after circumcision does not lower perimeatal urethral and glanular sulcus uropathogenic bacterial colonization in healthy patients and does not protect unhealthy patients from febrile urinary tract infection attacks. If circumcision is planned, concealed penis should be avoided and also parents should be informed about the possible risks due to concealed penis before the procedure, particularly in patients with urinary tract abnormalities.
Keywords: circumcision, colonization, glans, urethral, urinary tract infection -
Pages 169-172Purpose
To evaluate the clinical effects of open pyeloplasty via a mini flank incision in the treatment of infants with ureteropelvic junction obstruction (UPJO).
Materials and MethodsWe retrospectively analyzed 85 cases of infants with UPJO in our hospital from Jan. 2015 to Jan. 2018. The cases were divided into two groups according to the procedure: open pyeloplasty (n=45) and laparoscopic pyeloplasty (n=40). After 12~24 months of follow-up, the clinical effects of the two groups were compared.
ResultsThere was no significant difference in age between the two groups (P = .1). The operation time, postoperative fasting time and the indwelling time of the perirenal drainage tube in the open group were shorter than those in the laparoscopic group (68.0 ± 15.3 minutes versus 79.6 ± 18.8, P = .002; 5 ± 1 hours versus 14 ± 8.2 hours, P =.001; 2.8 ± 0.8 days versus 3.7 ± 1.3 days, P = .001, respectively), and there was no significant difference in the volume of intraoperative bleeding (2.1±0.9 versus 2.2±0.6, P=.55). The number of recurrences and complications in both groups were 0 versus 2 (P = .22) and 5 versus 7 (P = .40), respectively.
ConclusionOpen pyeloplasty via a mini flank incision has the advantages of being minimally invasive, safe, effective, and easy to master, and it requires a short operation time. It is a reasonable option for the treatment of infants with UPJO despite this era of minimally invasive surgery.
Keywords: Ureteropelvic junction obstruction, Pyeloplasty, Minimally invasive, Infant -
Pages 173-179Purpose
The ureteric stent can be attached to the Foley catheter in kidney transplantation to exclude cystoscopy for its removal. It is rarely practiced in renal transplantation. There has been no randomized trial to evaluate the outcome of this procedure on major urologic complications.
Materials and MethodsOne hundred sixty-three kidney transplant patients were randomized into an intervention group in which the stent was attached to the Foley catheter and removed together and a control group in which stent was removed by cystoscopy. In both groups, stents were removed around the 8th post-operative day.
ResultsFrom March 2016 to June 2017, out of 234 kidney transplants performed in our center, one hundred Sixty-three (69.6%) patients met the study inclusion criteria. 91patients (55.8%) were allocated to the intervention group. Mean days before JJ removal for intervention and control groups (“per-protocol” group) were 8.08 ± 1.52 and 8.57 ± 1.58, respectively (P = .09). There was no difference between groups regarding major urologic complications (P = .679). Visual analog scale pain scores were significantly higher in the control group (p = .001). The procedure reduced 63-120 USD from the cost of operation in the intervention group.
ConclusionIn selected kidney transplant patients, attaching stent to the Foley catheter and removing both of them early may be a safe maneuver regarding major urological complications, reduces pain, and eliminates the cost of cystoscopy.
Keywords: cystoscopy; double-J-stent; kidney transplantation; stent; ureteric stentingKeywords: Stent, kidney transplantation, cystoscopy -
Pages 180-184Purpose
The aim of this study aim is to clarify the relationship between Overactive bladder syndrome (OAB) and severity of lower extremity ischemia by using Fontaine classification system.
Materials and MethodsPatients who were diagnosed with lower extremity arterial disease were enrolled into the study. The Fontaine score of each patient was taken and all patients completed the validated Turkish version of OAB-V8 questionnaire. Body mass index, serum creatinine, blood urea nitrogen, cholesterol and fasting plasma glucose levels were measured. The patients were divided into two groups. Patients with OAB-V8 score above 8 were enrolled into group 1 and patients with OAB-V8 score under 8 were enrolled into group 2.
ResultsAt the end of study period, 181 patients who met the inclusion criteria were enrolled into the study. Patients with OAB ? 8 score (n= 79) were compared with patients with OAB < 8 score (n= 102). The mean age and the mean BMI were significantly higher in patients with OAB ? 8 (P = .001 and P = .001, respectively). Also, HDL- cholesterol level was found significantly lower in group 1 patients (P= .001). Multivariate regression analysis showed that presence of Fontaine score ? class 2b, age ? 60 years, BMI ? 30 kg/m2 , and HDL-cholesterol levels < 60 mg/dL were predictive factors for OAB.
ConclusionThe present study demonstrated that incidence of OAB is higher in patients with severe lower extremity ischemic symptoms, older age, high BMI, and lower HDL-cholesterol level.
Keywords: atherosclerosis, Fontaine classification, OAB-V8 form, overactive bladder, urgency -
Pages 185-191Purpose
Chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS) is a nonspecific pelvic pain in the absence of signs of infection or other obvious local pathology for at least three of the last 6 months. Evidence for treatment approach is limited. So the aim of this study is to investigate the effect of extracorporeal shock wave therapy (ESWT) combined with pharmacotherapy in the treatment of CP/CPPS.
Materials and MethodsIn this randomized clinical trial, 31 patients with CP/CPPS were investigated in two groups: the intervention group (n=16) was treated with a combination of an alpha-blocker, an anti-inflammatory agent, a muscle relaxant and a short course of antibiotic in combination with 4 sessions of focused ESWT (a protocol of 3000 impulses, 0.25 mJ/mm2 and 3 Hz of frequency). The control group (n=15) received the aforementioned pharmacotherapy with 4 sessions of sham-ESWT . Follow-up was performed 4 and 12 weeks following ESWT by using the Visual Analogue Scale (VAS), International index of Erectile function (IIEF) 5, National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) and International Prostate Symptom Score (IPSS) questionnaires. Post void residual (PVR) urine and maximum flow rate (Qmax) were also assessed in both groups.
ResultsThe patients mean age was 43.7 ±12.6 years. In both groups, the mean scores of NIH-CPSI (total and sub-domains) and VAS showed statistically significant improvements after 4 and 12 weeks compared to the baseline (P < .001). In the intervention group, IPSS (mean difference: 4.25) and Qmax (mean difference: 2.22) were also significantly improved (P < .001). There was a significant improvement in NIH-CPSI (mean difference: 1.1) and VAS scores (mean difference: 1.1) in the intervention group as compared to the control group (P < .01). Qmax, PVR and IIEF score were not statistically different in the two groups.
ConclusionESWT in combination with pharmacotherapy could improve the treatment outcome in patients with CP/CPPS.
Keywords: chronic pelvic pain syndrome, erectile dysfunction, extracorporeal shock wave therapy, pain manage-ment, prostatitis -
Pages 192-197Purpose
To evaluate ciprofloxacin resistance (CR) and extended-spectrum beta-lactamase (ESBL) positivity in the rectal flora, antibiotic prophylaxis received, and post-biopsy infectious complications in patients undergoing prostate biopsy.
Material &MethodsRectal swab samples collected from 99 patients suspected of prostate cancer two days before prostate biopsy were tested for microbial susceptibility and ESBL production. All patients were given standard ciprofloxacin and ornidazole prophylaxis. Ten days post-biopsy, the patients were contacted by phone and asked about the presence of fever and/or symptoms of urinary tract infection.
ResultsEscherichia coli (E.coli) was the most common isolate detected in 82 (75%) of the rectal swab samples. Ciprofloxacin resistance was detected in 33% and ESBL positivity in 22% of the isolated E.coli strains. No microorganisms other than E.coli were detected in blood, urine, and rectal swab cultures of patients who developed post-biopsy complications. CR E.coli strains also showed resistance to other antimicrobial agents. The lowest resistance rates were to amikacin (n = 2, 7.4%) and nitrofurantoin (n = 1, 3.7%). Seven patients (7.6%) developed infectious complications. There was no significant difference in probability of hospitalization between patients with CR strains (14.3%) and those with ciprofloxacin-susceptible strains (14.3% vs. 4.7%; p = 0.194). However, strains that were both CR and ESBL-positive were associated with significantly higher probability of hospitalization compared to ciprofloxacin-susceptible strains (28.6% vs. 3.8%; p = 0.009).
ConclusionThe higher rate of infectious complications with CR and ESBL-positive strains suggests that the agents used for antibiotic prophylaxis should be reevaluated. It is important to consider local resistance data when using extended-spectrum agents to treat patients presenting with post-biopsy infectious complications.
Keywords: ciprofloxacin resistance, ESBL, infective complications, prostate biopsy -
Pages 198-203Purpose
To investigate the possibility of bridging long ureteral defects by longitudinal clipping and mucosal stripping of the pedicled segment of ileum (CMSPI).
Materials and MethodsTen beagle dogs (five males and females aged 2-3 years) were used to model a defect of the entire ureter. An ileal segment was selected, and half of the intestinal segment was longitudinally resected, without mesenteric resection. The intestinal mucosa was removed. Then, the ileum was sutured to form a tube connecting the renal pelvis to the bladder. A 5F ureter stent was inserted into the ileum and removed 4 weeks after surgery. Intravenous urography (IVU) was used to observe the reconstructed ureters at 6 and 12 weeks after the operation. Blood samples were collected before surgery and during each radiological examination to assess electrolyte and renal function. Five dogs were randomly euthanized after each IVU. After macroscopic analysis, hematoxylin-eosin (H&E) staining was performed to observe the microscopic changes in the reconstructed ureter.
ResultsAll dogs were in good condition after surgery. Changes in blood electrolyte and renal function after surgery were not significant (Cl- P = .595; Ur P = .852). IVU demonstrated no ureteral obstruction or extravasation of the contrast agent; however, mild hydronephrosis were observed in three dogs. Macroscopic analysis indicated that the reconstructed ureter was intact without strictures. H&E showed that no mucosal structure was present on the luminal surface.
ConclusionCMSPI is feasible for bridging long ureteral defects and has shown good efficacy in this preliminary study.
Keywords: ureteral defect, ureteral reconstruction, ureteral replacement, ileal ureter, reconstructive urology -
Pages 204-209Purpose
The study aimed to compare the therapeutic effects of iPSC-derived MSCs (iPSC-MSCs) and adult MSCs for acute kidney injury (AKI) therapy.
Materials and MethodsModel rats with ischemia/reperfusion (I/R)-induced AKI were randomly divided into three groups (n=15 for each group) to receive transplantation of iPSC-MSCs, adult MSCs, or the saline control. After transplantation, engraftment and differentiation of both iPSC-MSCs and adult MSCs were detected in the transplanted sites. Serum creatinine and blood urea nitrogen (BUN) for renal function evaluation were measured, and histological assays were performed as well.
ResultsCompared with the saline control, both iPSC-MSCs and adult MSCs significantly (p<0.05 or 0.01) improved the renal function. Furthermore, iPSC-MSCs showed comparable effects in ameliorating tissue damage, reducing cell apoptosis and promoting vascularization with adult MSCs.
ConclusionThis study compared the therapeutic effects of iPSC-MSCs and adult MSCs for AKI treatment. Both iPSC-MSCs and adult MSCs were observed with comparable effects in repair of AKI. The results indicated that iPSC-MSCs may serve as an alternative source of MSCs for stem cell-based therapy for AKI therapy
Keywords: acute kidney injury, induced pluripotent stem cells, mesenchymal stem cells, paracrine effects, stem cell-based therapy -
Pages 210-212
The presented case describes a 53-year-old male who had been treated for non-specific cutaneous lesions for two months without any improvement. He was referred to our department after developing an erosive penile ulcer. Investigation for sexually transmitted diseases and Mycobacterium tuberculosis ended with negative results. Penile ulcer biopsy suggested the diagnosis of Wegener’s granulomatosis (WG). The patient presented with upper respiratory tract symptoms during this period. Measuring antineutrophil cytoplasmic antibodies (c-ANCA), confirmed the diagnosis. Immunosuppressive therapy was initiated and resulted in a favorable response
Keywords: antineutrophil cytoplasmic antibodies, penile ulcer, Wegener's granulomatosis -
Pages 213-214
Today, there are several methods to repair colon and rectal injury such as primary repair, stoma, resection with anastomosis and damage control only. To our best knowledge, there is no definite method published in literature about iatrogenic rectal injury during perineal urethroplasty in children. Here, we explain two 10 and 12-year old boys with iatrogenic rectal injury during perineal urethroplasty who underwent primary repair. Based on our experience, primary repair of rectum in such condition is feasible, successful and can be a good choice to avoid placing colostomy and secondary repair.
Keywords: complication, rectal injury, perineal urethroplasty, primary repair