Urology Journal
Volume:17 Issue: 4, Jul-Aug 2020

A variety of studies have evaluated the association of polymorphisms at endothelial nitric oxide synthase (eNOS) gene with risk of prostate cancer. However, the results remain inconclusive. This meta-analysis was per - formed to derive a more precise estimation between eNOS polymorphisms and prostate cancer risk.

A comprehensive literature search was conducted using PubMed, EMBASE, Wed of Science, Elsevier, Cochrane Library, SciELO, SID, WanFang, VIP, CBD and CNKI database up to March 20, 2020. Odds ratios with 95% confidence intervals were used to assess the strength of the associations.

A total of 22 case-control studies including 12 studies with 4,464 cases and 4,347 controls on +894G>T, five studies with 589 cases and 789 controls on VNTR 4a/b, and five studies with 588 cases and 692 controls on -786T > C were selected. Overall, pooled data showed a significant association between eNOS 894G>T, VNTR 4a/b, and -786T > C polymorphisms and an increased risk of prostate cancer in the global population. When strat - ified by ethnicity, a significant association was found between eNOS +894G>T and -786T>C polymorphisms and risk of prostate cancer in Caucasians.

Our results indicated that eNOS 894G>T, VNTR 4a/b, and -786T>C polymorphisms were associated with risk of prostate cancer in the global population as well as Caucasian population.

In the present study, a systematic review and meta-analysis was conducted to determine the prevalence of infertility in Iran.

A search of studies was performed in June 2019 on Scopus, PubMed, Web of Science (WOS), Scientific Information Database (SID), Magiran, Irandoc and Google scholar using keywords related to infertility. The search for articles was limited to those published over the past 20 years in Persian and English lan - guages. In this research, only population-based studies were included.

The results of the analysis showed that the overall prevalence of infertility was 7.88%, 95% CI: 5.61- 10.51. The prevalence of primary and secondary infertility after sensitivity analyses was 3.09%, 95% CI: 2.27- 4.02 and 2.18%, 95% CI: 1.56-2.89, respectively. The slope of meta-regression line showed that the prevalence of primary ( P = .7) and secondary infertility ( P = .4) is rising with a slow slope in Iran.

It is emphasized that the results of this study are related to the areas where investigations have been conducted and that there is high heterogeneity in findings. Given that information is not available in all parts of Iran, a population-based study or the design and implementation of further research is suggested.

The aim of the study was to evaluate the predictive value of nephrolithometric scoring systems used to predict the complexity of renal stones for the outcomes of retrograde intrarenal surgery (RIRS).

A total of 81 patients who underwent RIRS for nephrolithiasis between January 2013 and October 2017 were reviewed in this retrospective study. Guy’s Stone Score (GSS), the S.T.O.N.E., Clinical Research Office of the Endourologic Society (CROES), and Seoul National University Renal Stone Complexity (S-ReSC) nephrolithometry scores were assessed by same researcher for each patient from preoperative non-con - trast enhanced computed tomography scans. These nephrolithometric scores, stone characteristics and complica - tions were compared in patients with/without residual stone.

The median (IQR) age of patients (37 female/44 male) was 45 (20) years. The median (IQR) stone bur - den was 139.4 (125.4) mm 2 and the mean Hounsfield unit (HU) value was 1034.46 ± 239.56. The stone burden, S.T.O.N.E. and S-ReSC scores were statistically significantly higher and the CROES score was significantly lower in patients with a residual stone ( p < 0.001, for all). The incidence of residual stones was statistically significantly higher in patients with Grade 3 GSS ( p = 0.018). While S.T.O.N.E., S-ReSC and CROES were significantly cor - related with stone-free rates, GSS failed to correlate with stone-free status. According to the receiver operating characteristic (ROC) curve analysis, the predictive value of stone burden was higher for residual stones, compared to S-ReSC scoring ( p < 0.05).

Nephrolithometric scoring systems nomograms used to predict the PCNL success were not superior to stone burden in predicting the RIRS success

To evaluate the safety and efficacy of discharging patients on the first postoperative day after an uncom - plicated percutaneous nephrolithotomy (PCNL).

After an uncomplicated successful PCNL without significant residual stone (>5mm) or any complication up to the first postoperative day, we randomly assigned patients into two groups—Group 1: over - night surgery, and Group 2: routine discharge after three days. Patients with significant residual stone on control fluoroscopy were excluded. Ninetyeight and 102 patients were assigned to groups 1 and 2, respectively. Serum Hemoglobin and creatinine were evaluated before the operation as well as the first postoperative day. Stone free status was evaluated using ultrasound and KUB radiography at the first postoperative day.

The stone and patient characteristics were not different in two groups. The preoperative change in the hemoglobin and creatinine levels were not significantly different between the two groups. Nine patients (9.2%) in Group 1 and five (4.9%) in Group 2 were readmitted because of complications (mainly hematuria) ( P = .23). Of the readmitted patients, five in Group 1 (55%), and three in Group 2 (60%) received blood transfusion ( p = .87). in these patients, group 1 received 1.6 ± 0.51 units of blood compared with 1.93 ± 0.25 in group 2 ( P = .07). All the readmitted patients did well with conservative therapy with no need for angioembolization.

In uncomplicated PCNL with no significant residual stone, discharging the patient on the first post - operative day is safe. The outcome is comparable to a routine three-day hospital stay.

To investigate the clinical efficacy and safety of ultrasound-guided percutaneous nephrolithotomy (PCNL) assisted by a puncture frame.

Clinical data of 106 patients with nephrolithiasis who underwent ultrasound-guided per - cutaneous nephrolithotomy from October 2016 to December 2017 in our hospital were analyzed retrospectively. The channels were established by the assistance of the puncture frame.

The mean puncture time was 35 ± 18 seconds, the puncture was performed 1.3 ± 0.9 times on average. The puncture was successfully performed at first attempt in 73 cases. The mean operation time was 67.3 ± 39.2 min, and the mean intraoperative blood loss was 48 ± 22 mL. The stones were located on the left in 50 (47.2%) cases, and on the right in 56 (52.8%) cases. Channels were established through the upper, middle and lower calyces of the kidney in 78 (73.6%), 20 (18.9%), and 8 (7.5%) cases, respectively. The puncture sites were located on the upper and lower of 12th rib in 81 (76.4%) and 25 (23.6%) cases. Intraoperative and postoperative blood transfu - sion was given in four cases. Pleural injury occurred in two cases, and hydropneumothorax occurred in one case in whom closed thoracic drainage was performed. The stone free rate after a single surgery was 87.7% (93/106).

Establishing a percutaneous nephrolithotomy access tract under ultrasound guidance using the punc - ture frame is an efficacious and safe approach.

To report clinical, histopathological, and treatment features of small cell carcinoma of (SmccB) bladder during 7 years in a referral center.

The clinical, histopathological features, treatment modalities, and outcome of all patients with bladder SmccB treated between 2009 and 2016 who were managed in Hasheminejad Kidney Center (HKC) were retro - spectively collected.

Thirteen patients were diagnosed and managed with SmccB. The average age of patients was 64.92 years. For each patient, 8 markers were used for IHC staining on average. Neuroendocrine markers such as CD 56, Neu - ron Specific Enolase, Synaptophysin, and Chromogranin were found in a significant percentage of patients (69%, 38%, 54%, and 31% respectively). Patients were managed with TURBT alone (N=3), chemotherapy after TURBT (N=4), chemotherapy plus radical surgery (N=4) and radical surgery alone (N=2). The best clinical result was seen in chemotherapy received patients with or without radical surgery. The mean(SE) of survival rate in patients who received only chemotherapy alone was 42.4 (10.0) months, while in those who were managed with chemotherapy plus radical surgery it was 47.7 (10.1) months.

In our center immunohistochemistry was needed for definitive diagnosis in 17/19 samples. Misdi - agnosis happened in two samples without IHC request. We think that use of immunohistochemistry should be mandatory for diagnosis of SmccB to exclude misdiagnosis. Chemotherapy is the most important part of treatment and the addition of radical surgery can slightly improve patients’ survival.

We aimed to investigate the correlation between presence of inflammation and pathology upgrading/ upstaging in patients with prostate cancer.

A retrospective study was accomplished on 315 patients with prostate cancer, eligible for active surveillance except prostate-specific antigen (PSA) level (PSA<30ng/dL), who underwent radical prostatec - tomy between 2005 and 2015. Patients were divided into two groups based on needle biopsy: A; with evidence of inflammation (chronic prostatitis) and B; without inflammation. The frequency of upstaging and upgrading in both groups was compared in different ranges of PSA level (<10, 10-20 and 20-30ng/dL). Upgrading/Upstaging was defined as increase from one prognostic grade group to another. Statistical analyses were performed to investigate the relation between inflammation and upgrading/upstaging.

The mean age of the patients was 68.2 years and the mean PSA level was 10.2 ng/mL. Chronic prostatitis was identified in 82 of 315 cases therefore upgrading/upstaging were seen in only three patients (3.7%) while 39 of 233 (16.7%) patients without inflammation had upgrading/upstaging in final pathology ( P = 0.003). Other vari - ables including the patient's PSA before surgery, PSA density, and the presence of hypoechoic areas in ultrasound had a significant relationship with the incidence of postoperative upgrading/upstaging. Among studied variables, presence of inflammation in biopsies was found to be the most important predictor of upstaging/upgrading (OR: 0.205).

Our data demonstrated that patients with concurrent prostatitis and PCa may have a better prognosis even if the PSA level is higher than 10ng/mL

Prostate cancer is a major worldwide health concern with up to 60% of patients experiencing biochemi - cal relapse after radical treatment. Introduction of prostate-specific membrane antigen (PSMA)-based radiotracers for imaging and therapy had gained increasing attention in recent years. Positron emission tomography (PET) imaging with Ga68 PSMA is the most promising technique, but PSMA-based radiotracers SPECT imaging with low dose of 177Lu-PSMA when PET imaging is not available may also be considered. The goal of the study is to evaluate the sensitivity of 177Lu_psma for detection of metastatic sites in patients with biochemical relapse and negative conventional (MRI, MRS, CT scan and bone scintigraphy) imaging.

26 patients with biochemical recurrence after curative (surgery and/or radiotherapy) thera - py, which had previous negative imaging as pelvic CT scan, pelvic MRI, MRS and bone scan, were enrolled in this clinical imaging approach between 2015 and 2017.After injection of 5 mCi (185MBq)177Lu-PSMA-617, diagnos - tic planar whole body scan and SPECT study was obtained after 3 hours, 24 hours and 72 hours. The images were analyzed visually by an expert nuclear medicine physician for the presence of active regional or distant lesions. Results were then prospectively checked by new CT scan images as a control.

A total of 26 patients, with a mean age of 70 years (range: 46 to 89 years) were included in this study. The overall detection rates were 38.5% (10 out of 26 patients). Most common site of detected lesions was lung in 6 patients, abdominal lymph nodes in 2 and mediastinum in another 2 patients.

177Lu-PSMA SPECT scan can help detecting metastatic lesions in more than one third of patients with biochemical recurrence and negative conventional investigations, when 68Ga- PSMA PET is not available.

Recent studies reported that the presence of metabolic syndrome is closely correlated with impaired kid - ney function after living donor nephrectomy. Since the measurement of body mass index cannot differentiate the amount of body adipose tissue from total body weight, body mass index is not a reliable parameter for determining metabolic syndrome. In the present study, we investigated the correlation between body adipose tissue and kidney function recovery following living donor nephrectomy.

The patients who underwent living kidney donor nephrectomy consequently from July 2016 through December 2017 were enrolled in the study. We preoperatively measured the visceral (VAdT), ret - roperitoneal (RPAdT), and subcutaneous (SCAdT) adipose tissue volume by a computed tomography scan. Body mass index, adipose tissue measurements, and postoperative estimated glomerular filtration rate (eGFR) were evaluated.

The decrease between preoperative eGFR, and the first day, the first month and the sixth month eGFR after surgery were statistically significant ( P = .001; P = .001; P = .001, respectively). The negative correlation between VAdT/SCAdT measurements and changes in eGFR at the first and the sixth postoperative month com - pared to preoperative eGFR were statistically significant ( P = .049; P = .041, respectively). Additionally, RPAdT measurements and changes in eGFR at the first and the sixth postoperative month compared to preoperative eGFR (decreasing as RPAdT value increased) were statistically significant ( P = .035; P = .026, respectively).

According to a preoperative computed tomography scan, VAdT, RPAdT, and VAdT-to-SAdT ratio can predict impaired kidney function recovery. Furthermore, RPAdT measurement is a new variable to predict the impaired kidney function after living donor nephrectomy.

Surgical repair of post-traumatic complex urethral stricture poses a major challenge to urologists. Here, we report six patients with irreparable urethral strictures who were successfully treated by using the appendix as conduit for urinary diversion.

Six patients who had underwent urinary diversion using an appendix during 2015 to 2019 were included in our study. All patients had a history of one or more failed attempts of urethral reconstruction in the past. Mean follow-up for patients was 29 months. Continency was defined as being completely dry for at least 3 hours.

Mean age of patients was 40.1 years old (range: 20-70 years). Intermittent catheterization through the conduit was easily performed for every patient without any stomal stenosis. Mild stomal incontinence only oc - curred in one case which was resolved after a few months. All patients were continent during day and night.

Based on the results of our study, Mitrofanoff’s technique is a valuable procedure for managing pa - tients with serious complicated urethral strictures who cannot be treated with common standard approaches

Stem cell factor receptor (c-kit) plays a crucial role in regulating proliferation and survival of germ cells. The aim of this study was to find the correlation between the number of c-kit positive germ cells, testicular asym - metry and histological grade in varicocele affected testis samples of adolescents.

Twenty testicular biopsy samples of adolescents affected by varicocele and eight normal control testes were included. The relationship between percentage of testicular asymmetry, number of tubular c-kit positive germ cells and severity of spermatogenic failure was assessed.

The mean (SD; median) histological grade for spermatogenic failure in controls was 1.37(0.52; 1), while in the varicocele group, it was 2.70(1.08; 3) ( P = .0052). Mean(SD; median) number c-kit positive germ cells in the control group were 20.1(2.52; 20), while in the varicocele group it was 12.35(7.16; 12.5) ( P = .0059). Spearman test documented a significant positive correlation between percentage of hypotrophy and histological grade of spermatogenic failure (r = 0.5544 , 95% CI: 0.1345 to 0.8055, P = .0112) but a negative correlation with the num - ber of c-kit positive cells (r = - 0.5871, 95% CI: - 0.8219 to -0.1817, P = .0065). Moreover, a significant negative correlation was found between grade of histological changes and number of c-kit positive germ cells ( P < .0001).

A significant correlation between hypotrophy, histological lesions and c-kit positive germ cells exists in varicocele testes. This finding suggests a possible role for c-kit in the pathogenesis of germ cell impairment in varicocele. Histological changes and lack of c-kit germ cells were also noted in testes not displaying hypotrophy. We believe that reliable markers should be found as better predictors of testicular function in adolescent with varicocele.

To compare the effects of microfluidic sperm sorting, density gradient and swim-up methods on the oxidative reduction potential (ORP) of split semen samples from a single patient population.

A prospective controlled study was conducted to compare the effects of three different semen processing methods using split semen samples from the same population of infertile men. The primary out - come was the ORP. Secondary outcomes were the sperm concentration, progressive motility rate and total sperm motility.

A total of 57 split semen samples were included in this study. The ORP was significantly lower in the microfluidic group compared to the density gradient and swim-up groups ( P < 0.05). The ORP/sperm concentra - tion ratio was significantly lower in the microfluidic and density gradient groups compared to the swim-up group ( P < 0.05). Total sperm concentration was significantly higher in the density gradient group than the microfluidic and swim-up groups ( P < 0.05). Motility was significantly higher in the microfluidic and swim-up groups than the density gradient group ( P < 0.05). The progressive motile sperm rate was significantly higher in the microfluidic and swim-up groups than the density gradient group ( P < 0.05).

Microfluidic sperm sorting was better for selecting highly motile sperm and yielded a lower ORP than conventional sperm preparation methods

Laparoscopy surgery is the gold standard for the treatment of aldosterone-producing adenomas (APA). However, the effectiveness between laparoscopic total and partial adrenalectomy is controversial. Therefore, we retrospectively analyzed the postoperative and follow-up outcomes of these two procedures.

A total of 96 APA patients underwent laparoscopic surgery in our hospital between Jan - uary 2012 and December 2017. A total of 65 patients who underwent laparoscopic partial adrenalectomy (group 1) were compared with 31 patients who underwent laparoscopic total adrenalectomy (group 2). The mean follow-up time was 32.3 months and 40.8 months, respectively. Patient’s preoperative characteristics, date during surgery, and postoperative clinical results of the two groups were analyzed.

In both groups of patients, laparoscopic adrenalectomy was successfully carried out. The laparoscopic partial adrenalectomy group had a shorter operation time when compared to total adrenalectomy ( P = .01). How - ever, patients in the laparoscopic total adrenalectomy group were older ( P = .04) and had a higher proportion of multiple adenomas ( P = .01) compared to partial adrenalectomy. Five patients (7.7%) who underwent partial ad - renalectomy did not show improvement in hypertension and/or serum potassium below normal levels, and review of plasma aldosterone concentration (PAC) and/or computerized tomography (CT) indicated that surgery was not successful in these patients. All 31 patients who underwent total adrenalectomy showed improvement or recovery from hypertension, and all PAC and serum potassium levels returned to normal levels after surgery.

Although both surgical procedures were technically safe and feasible, laparoscopic partial adrenalec - tomy showed a higher failure rate (7.7%) for patients with APA. Therefore, choosing laparoscopic partial adrenal - ectomy requires careful consideration, and we selected laparoscopic total adrenalectomy in patients with unilateral APA.

To evaluate the effect of different enucleation techniques on operation time, enucleation efficacy and postoperative results.

178 HoLEP cases performed by two senior surgeons were evaluated retrospectively. All patients were evaluated for age, IPSS, preoperative PSA, prostate size, maximum flow rate (Qmax) postvoid re - sidual volume (PVR), enucleation time, morcellation time, enucleated tissue weight, enucleation ratio (enucleated tissue weight/prostate volume) and enucleation time efficacy (enucleated weight/enucleation time). Patients were categorized into three groups according to performed enucleation techniques; Retrograde Low Tension (RLT) two-lobe, traditional three-lobe, and en bloc techniques. IPSS, Qmax, PVR and transient urine leakage (TUL) were evaluated during postoperative follow up. All preoperative, intraoperative and postoperative results were compared between 3 groups.

Mean age was 70.52 (52-85) years. Baseline data were comparable between groups. Enucleation time was significantly shorter in RLT two-lobe (median; 50, 60 and 60 min; RLT two-lobe, traditional three-lobe, and en bloc HoLEP techniques, respectively. ( P = .031). Morcellation time was comparable between groups ( P = .532). No significant difference was observed between morcellated prostate weights ( P = .916) Significant improvements in IPSS, Qmax, and PVR were noted in all groups ( P < .001). TUL was significantly increased in en bloc technique ( P = .034). Postoperative stricture rates were similar between groups. ( P = .769)

Shorter enucleation time was observed in the RLT HoLEP technique and increased TUL rate was observed in the en bloc technique.

To evaluate the effect of a new mesenchymal stem cell type derived from the neonatal bladder (nMSC-B) on diabetic bladder dysfunction (DBD).

nMSC-B were harvested from neonatal male Sprague-Dawley rat’s bladder and expand - ed in culture. nMSC-B were transferred to Type-1 diabetic rats which were induced by a single dose 45 mg/kg Streptozocin (STZ). Stem cells were transferred via intraperitoneally (IP) (DM-IP group, n:6) and by direct injec - tion to the detrusor (DM-D group, n:6) at 12th week following diabetes and compared with Phosphate Buffered Saline (PBS) injected diabetic rats (DM-PBS group, n:6) and age-matched PBS injected non-diabetic normal rats (NR-PBS group, n:6). All rats were evaluated histopathologically and functionally four weeks after the stem cell treatment.

nMSC-B showed improvement in both voiding function and bladder structure. The maximum voiding pressure (MVP) values in the DM-PBS group were lower compare to DM-IP, DM-D and NR-PBS groups (13.27 ± 0.78 vs 16.27 ± 0.61, 28.59 ± 2.09, 21.54 ± 1.00, respectively, P < .001). There was a significant improvement for MVP values in stem cell-treated groups. Immunohistochemical examination revealed decreased bladder smooth muscle (SM), increased fibrosis and desquamation in urothelia in diabetic groups compared to normal group(P < .001). We detected recovery in the stem cell groups. This recovery was more evident in DM-D group. No statisti - cal difference was observed in SM and fibrosis between DM-D and NR-PBS groups (P = .9).

It was shown that nMSCBs provided amelioration of DBD. We think that nMSC-B constitutes an effective treatment method in DBD

Paragangliomas are tumors that arise from autonomic nervous system. Non-functioning bladder paraganglioma is rare and usually misdiagnosed. Here we describe a case of a 45-year-old man with primary urinary bladder para - ganglioma. The patient had no active signs and symptoms, and histological and immunohistological examinations of a transurethral resection specimen confirmed correct diagnosis. After successful transurethral resection of the tumors, the patient showed no signs of recurrence at one-year follow-up.

Nowadays there is not any specific technique for repairing the recurrent urethral stricture with retained urethral stent. We report a 49 year-old man with history of end to end urethroplasty 11 years ago who was referred with ure - thral stricture. He refused to undergo urethroplasty again, so the stricture was managed by Uventa stent insertion which failed after six months. Finally the patient underwent end to end urethroplasty with complete excision of the obstructed urethra, stent and surrounding periurethral fibrosis. End to end urethroplasty post Uventa stent stricture is an available option with good postoperative outcomes.