Urology Journal
Volume:18 Issue: 3, May-Jun 2021

To explore the efficacy of 5-ARIs in PCA (Prostate Cancer).

Searching through the major medical databases such as PubMed, Science Citation Index, EMBASE, Medline, Web of Science, Cochrane Library for all published studies in English until 2018. The following search terms were used: “Finasteride”, “dutasteride”, “5α reductase inhibitors”, “5-ARIs”, “prostate cancer”, “prostate neoplasm” and the additional related studies were manually searched. Newcastle-Ottawa Scale (NOS) assessed the qualities of studies, and the outcome measures were observed by RR or OR with 95% CIs.

We included 9 eligible studies for analyses from 2011 to 2017. We found that 5-ARIs group may have fewer progression (OR = 0.48 95%CI: 0.37-0.61 P < 0.00001, I2=4% p = 0.39) and lower pathological progression (OR = 0.46; 95%CI: 0.29-0.73; p = 0.001, I2=0% p = 0.45), compared with control groups. However, the OS did not show significant difference between two groups (OR=1.10; 95%CI:0.90-1.35; P = 0.35, I2 = 93% P < .00001 ).

The use of 5-ARIs could prevent progression in PCA patients both clinical and pathological.

 Nephrolithiasis is a rare complication in transplanted kidneys and limited information is available about its therapeutic options. This study aimed to review the conservative management of urinary lithiasis and its outcomes in renal transplanted patients.

 A systematic review and meta-analysis of the scientific literature were performed in the Medline, Scopus, and Embase databases. Inclusion criteria were studies which include patients with kidney stones in transplanted kidney no matter de-novo or donated stones and use conservative treatment for all or part of their patients. Exclusion criteria were bladder & ureteral stones, full text unavailable, conference paper.  (from January 1st, 1980, to the 19th May 2020). The results of included studies, in the final analysis, were combined using a random-effect model and using metaprop method prevalence and 95% CI of renal stone were reported.

  A total of 8 studies (14988 transplant patients) met the inclusion criteria for the final analysis. A total of 195 patients suffered from renal stone and the prevalence of renal stone was 1.3% (95% CI: 0.89% - 1.7%). The mean age of these patients was 43 years. analysis, the prevalence of conservative treatment in 195 patients was 35% (95% CI: 19%-51%). The mean stone size ranged from 0.29 cm to 1 cm. Three studies reported a stone-free rate of %100. Except for two studies that did not report complications, other studies reported zero percent.

 More than one-third of nephrolithiasis were conservatively managed in transplanted patients. Despite limited data, conservative treatment could be done in less than 4 mm stones with high Stone Free Rate (SFR) and very low complications.

Until recently, the urine of healthy individuals was assumed to be sterile. However, improvement of bacterial detection methods has debunked this assumption. Recent studies have shown that the bladder contains microbiomes, which are not detectable under standard conditions. In this review, we aimed to present an overview of the published literature regarding the relationship between urinary microbiota and functional disorders of the genitourinary system.

We searched Medline, PubMed, Embase, The Cochrane library and Scopus to identify RCTs published, with MeSH and free keywords including microbiota, bladder pain syndrome, prostatitis, kidney stone disease, and bladder cancer until September 2020. Randomized controlled trials investigating microbiome and lower urinary tract symptoms were included. Non-randomized trials, cross-over trials and pooled studies were excluded. The articles were critically appraised by two reviewers.

The urine microbiome is a newly introduced concept, which has attracted the attention of medical researchers. Since its recent introduction, researchers have conducted many fruitful studies on this phenomenon, changing our perspective toward the role of bacteria in the urinary tract and our perception of the genitourinary system health.

A deeper understanding of the urinary microbiome can help us to develop more efficient methods for restoring the microbiota to a healthy composition and providing symptom relief. Modification of the urinary microbiome without antibiotic use can be a possible venue for future research.

 Due to high prevalence of urolithiasis, endourologic interventions have increased for the treatment of
patients with urinary stones. During fluoroscopy-guided percutaneous nephrolithotomy (PCNL), the surgeon and the patient are exposed to X-ray and its harmful effects. This study aimed to assess the reduction of the radiation dose received by surgeons and patients after using a new shielding method.

 In this study, the dose of radiation exposure by the surgeon and patient during PCNL
under fluoroscopic procedure with conventional shielding methods was compared to a new shielding method designed by the researcher. For this purpose, shields and lead cones with a thickness of 0.5 mm were used. Also, to evaluate the dose of radiation received by surgeons and patients in different parts of the body, thermoluminescent dosimeters (TLD) were used.

 By using the new shielding method, a 37 ± 2% reduction was found in the dose exposure as compared
to the conventional shielding method. The maximum reduction in radiation dose was specified to the surgeon's
hands, while the lowest reduction in radiation dose was related to the surgeon's thyroid gland. The maximum and minimum reductions in radiation exposure for patients were specified to patients' feet and chest respectively.

 There is a significant difference between the total dose received by the surgeons and the patients
following the use of the new shielding method and the standard shielding method. The new shielding method can
reduce 37 ± 2% of the x-ray received by the patient and the surgeon during fluoroscopy-guided PCNL.

Percutaneous-nephrolithotomy (PCNL), is the current modality of choice for large renal stones. Delayed post-op bleeding may herald pseudo aneurysm (PA) or arteriovenous fistula (AVF) necessitating costly and incon-sistently available angioembolization, or prolonged hospitalization. The goal of this study is to identify criteria that may predict response to conservative therapy, for delayed bleeding from post PCNL intrarenal vascular lesions.

We reviewed all data on patients re-admitted for post PCNL gross hematuria at our high volume center between 2011 and 2016. Perioperative findings, factors related to the stone and management details, were subjected to multifactorial analysis. Logistic regression for multivariable analysis and ROC curves to find thresholds predicting mandatory angioembolization.

Of 4403 PCNLs, 83 (1.9%) with delayed bleeding were diagnosed with intrarenal vascular lesions: Ar-teriovenous fistulas in 54 (AVF, 65%) and pseudoaneurysm in 29 (PA, 35%). Overall 49 (59%) responded to conservative management but 34 (41%) eventually required angioembolization. On multivariable analysis, pre-dictive factors for poor response to conservative treatment were requiring transfusion beyond initial stabilization, pseudoaneurysm, history of open renal surgery, longer interval-to-second-admission, and size of vascular lesion. The proposed POPVESL score (short for Post PNL Vascular Embolization selection) when below 11, correctly predicts success of conservative management with 81.6% sensitivity & 100% specificity.

Our findings including the proposed POPVESL score have the potential for clinical application and enhancing practical guidelines on the management of post-PCNL bleeding.

In this study, we aimed to find a more accurate predicting constant value of energy per mm3xHounsfield Unit (HU) to ablate urinary stones by endoscopic stone treatment.

The files of 142 patients who underwent rigid or flexible ureteroscopic laser lithotripsy in our clinic between December 2018 and March 2020 were evaluated retrospectively. Total energy administered for the ablation of the stone was obtained from the registry of the Ho:YAG laser and recorded to the follow-up forms. The constant value was calculated for each stone, and the final mean value was figured out by calculation of the mean of all constant values.

The study was conducted with 142 patients; 102 males and 40 females. The mean age of the population was 46.61 ± 14.58 years. The number of stones was 1.27 ± 0.67. The mean constant value of energy needed per mm3xHU for urinary stones was 22.87 milliwatt.

This study was conducted to report a predictive constant value and is the very first study evaluating the energy prediction per mm3xHU. The data of the study showed that the constant value is 22.87 mW/mm3xHU. Urologists may estimate the required energy and plan the surgery according to the outcomes of the study. As a future aspect of our study, the constant value may represent predictive information about the time and accuracy of the operation.

The aim of this study was to evaluate the efficacy of transvesical open prostatectomy (OP) compared with transurethral resection of the prostate (TURP) in patients with benign prostate hyperplasia (BPH) with a prostate weight of 40-65 grams. The short-term and long-term complications of these two procedures were also assessed.

In this retrospective study, we included 160 consecutive patients with BPH who had undergone TURP (n=80) or OP surgery (n=80) from 2006 to 2017. Inclusion criteria were positive history of BPH, definite indication for prostatectomy, and prostate weight between 40 to 65 grams. Patients were evaluated for duration of hospitalization, need for re-operation, short-term and long-term postoperative complications, urinary flow rate, peak flow rate (Q max) and international prostate symptom score (IPSS).

The mean age ± Standard Deviation (SD) of patients’ age was 62.4 ± 3.7 and 67.2 ± 4.6 years in the TURP and OP groups, respectively. Four (5%) and seven (8.7%) patients required transfusion in the TURP group and OP groups, respectively. Dysuria was significantly more frequent in the TURP group from week two to 12 months af-ter surgery as compared with the OP group (P < .001). Hemodynamic changes and decrease in serum sodium level were not reported in either group. However, the urinary retention and need for urinary catheterization in the first year was significantly different between the two groups with 10 cases (12.5%) in the TURP group and no cases in the OP group (P<0.001). The need for reoperation in the TURP group was reported (27 procedures on 19 patients) (33.7%) of patients. Furthermore, retrograde ejaculation (RE) was reported in 65 (81.2%) and 80 patients (100%) of the TURP and OP group, respectively.

Despite the fact that TURP is the standard method of treatment for BPH when the prostate weighs between 40-65 grams, the results of our study showed that OP is a more efficient and safe surgery for these patients and is associated with less complications. Furthermore, the need for re-operation seems to be higher in patients with TURP.

To evaluate the feasibility and potential efficacy of nanocurcumin supplementation in patients with lo-calized muscle-invasive bladder cancer (MIBC) undergoing induction chemotherapy.

In this double-blind, placebo-controlled trial, 26 MIBC patients were randomized to re-ceive either nanocurcumin (180 mg/day) or placebo during the course of chemotherapy. All patients were followed up to four weeks after the end of treatment to assess the complete clinical response to the chemotherapy as primary endpoint. Secondary endpoints were the comparisons of chemotherapy‐induced nephrotoxicity, hematologic na-dirs, and toxicities between the two groups. Hematologic nadirs and toxicities were assessed during the treatment.

Nanocurcumin was well tolerated. The complete clinical response rates were 30.8 and 50% in the placebo and nanocurcumin groups, respectively. Although nanocurcumin was shown to be superior to placebo with respect to complete clinical response rates as the primary endpoint, there was no significant difference between the groups (p = 0.417). No significant difference was also found between the two groups with regard to grade 3/4 renal and hematologic toxicities as well as hematologic nadirs.

These preliminary data indicate the feasibility of nanocurcumin supplementation as a complementary therapy in MIBC patients and support further larger studies. Moreover, a substantial translational insight to fill the gap between the experiment and clinical practice in the field is provided

To systematically analyze histopathologic features of pseudocapsule in small renal cell tumor (diameter ≤ 4cm), assess the integrity of pseudocapsules by Computed Tomography (CT), and provide theoretical basis for the safety of nephron sparing surgery.

The pathological data of 116 patients who underwent surgery with clear cell renal cell carcinoma admitted from May 2010 to October 2017 were retrospectively analyzed. All patients underwent a CT scan of the abdomen including an unenhanced and three-phase (arterial, nephrographic and excretory) post contrast series. Thorough gross examination and histological sections were used to determine the integrity of the pseudo-capsule by two uropathologists. The consistency between pathological findings and CT imaging were evaluated by Kappa consistency test.

The mean diameter of tumor was 3.0cm, range (2.6 ± 0.8) cm. On CT the pseudocapsule can present with one of the three following feathers:1) A regular and distinct halo; 2) lobulated clear margins;3) blurred margins. On histopathology, complete psuedocapsule was found in 85 tumors, incomplete psuedocapsule in 25 and no psuedo-capsule was found in 6 tumors; CT scan findings demonstrated a regular halo in 82 tumors, lobulated clear margins in 26 and blurred margins in 8 tumors(Kappa = 0.833, P = 0.000).

Most small renal cell tumors have an obvious psuedocapsule. Preoperative determination of the psue-docapsule’s integrity is particularly important. CT scan can reliably evaluate the tumor margins and demonstrate the psuedocapsule when present. The imaging results are well correlated with the pathologic findings.

To investigate biopsy needle tip culture after prostate biopsies for bacteria prediction and antibiotics selection.

From May 2017 to April 2019, 121 patients who underwent a prostate biopsy were enrolled. All biopsy needle tips were sent for aerobic and anaerobic culture. Patients were divided into positive and negative culture groups. Perioperative data were recorded and compared between the two groups. The culture time and susceptibility of febrile patients were analyzed. Blood cultures were conducted for all patients who ex-perienced fever after biopsy. The time and results of the needle and blood cultures were recoded for descriptive analysis.

There were 59 (48.8%) positive needle cultures. Other than fever (p = 0.023), there were no statistical significances in clinical data between the two groups. Fever occurred in eight patients, and seven febrile patients had positive needle cultures, six of whom had positive blood cultures. These six needle and blood cultures were consistent with the susceptibility test results. As compared to the waiting time for blood cultures, target antibiotics were administered at an average of 48.0 h earlier based on needle cultures. None of the patients with positive an-aerobic cultures developed a fever, while all eight febrile patients had negative anaerobic cultures.

Fevers developed at statistically significant higher rate among those who had positive needle cultures. Needle and blood cultures were consistent with the susceptibility test results. Needle cultures can help us adminis-ter target antibiotics earlier to febrile patients without the need to wait for blood cultures.

To report the 1-year functional outcomes, oncologic outcomes, and postoperative complications in pa-tients who underwent modified robot-assisted radical prostatectomy (RARP) procedures for achieving early recov-ery of continence and potency postoperatively.

This study included 165 patients who underwent RARP. Overall, 98 patients underwent RARP using our modified detrusorrhaphy and intrafascial nerve-sparing techniques (group 1) and 67 underwent standard RARP (group 2). Continence and potency rates were assessed at 1 week, 1, 3, 6, and 12 months after RARP. Oncologic outcomes comprised positive surgical margins (PSMs) and biochemical recurrence (BCR) rate.

The continence rates were 61.2% and 6.0%, 72.5% and 11.9%, 79.6% and 20.9%, 91.8% and 58.2%, and 97.9% and 74.6% at 1 week, 1, 3, 6, and 12 months in group 1 and 2, respectively. The potency rates were 66.3% and 11.9%, 78.6% and 38.8%, 85.7% and 50.8%, 92.9% and 70.2%, and 95.9% and 79.1% at 1 week, 1, 3, 6, and 12 months in group 1 and 2, respectively. Overall postoperative complication rates (< 10%) were similar between the groups. The PSMs rate was 17.4% and 16.4% in the two groups. The rate of PSMs in the cohort of patients with stage pT2 disease decreased to 13.6% and 12.5% in groups 1 and 2, respectively. BCR rate was 5.1% and 6.0% in groups 1 and 2, respectively.

The use of detrusorrhaphy and intrafascial nerve-sparing techniques is safe and feasible, with our results demonstrating early return to continence and potency. Further studies should be conducted.

Among the more serious problems in urological interventions among the pediatric age group is the requirement of general anesthesia. The advantages of removing a double-J stent (DJS) without anesthesia in uret-eroneocystostomy (UNC) operations among children were investigated in this study.Patients and

In all, 25 patients who underwent UNC surgery between November 2016 and November 2018 were retrospectively divided into two groups according to the method used for the removal of the DJS. In Group 1, the stent was tied to the urethral catheter by a suture and retrieved postoperatively on the fourth day with-out anesthesia and cystoscopy. In Group 2, we inserted the stent according to the classical method with no suturing to the catheter and removed it 3 to 4 weeks after the first operation, with cystoscopy under anesthesia.

A total of 16 girls and 9 boys were included in the study. The mean age was 4.3 and 6.3 years in groups 1 and 2, respectively. We did not observe statistically significant difference between the groups in long-term renal function or hydronephrosis regression.

We consider that the removal of a stent placed in pediatric intravesical UNC operations without anes-thesia and cystoscopy is less invasive and affords safety and long-term results comparable to the standard method.

There is a need for developing a standard and approved tool to assess chronic pelvic pain (CPP) in Irani-an women. The aim of this study was to investigate the reliability and validity of the Persian version of the pelvic pain and urinary/frequency (PUF) questionnaire in Iranian women with CPP.

This cross-sectional study was performed on 50 females with CPP referred to the urol-ogy clinic of Kerman University of Medical Sciences from 2018 to 2019. Initially, the PUF questionnaire was translated into Persian and then back translated into English. The face validity of the tool was evaluated by being tested on 50 patients who had different literacy levels to ensure its understandability and acceptability by patients. The construct validity was evaluated through both exploratory and confirmatory factor analyses. The internal con-sistency was also analyzed by determining Cronbach's alpha coefficient and test-retest method.

The Persian version of the questionnaire was compatible with the original English version. The Kisser sampling adequacy index was calculated on the data before extracting the factors indicating good factor accessi-bility of the questionnaire statements. The construct validity of the questionnaire was confirmed using exploratory and confirmatory factor analyses. The internal consistency parameters were also acceptable. Cronbach's alpha co-efficient of the whole questionnaire, as well as the coefficients of the "signs/symptoms" and "unpleasant feelings" domains were 77%, 74%, and 78%, respectively.

The developed Persian version of the PUF questionnaire retrieved a good validity and reliability

The aim of the present study is to assess the effect of L-carnitine and Coenzyme Q10 (CoQ10) on human sperm motility, DNA fragmentation, chromatin structure, and reactive oxygen species (ROS) during, before and after freezing in oligospermia men.

Semen was collected from 30 oligospermic men, who referred to infertility clinic of Beasat Hospital in Sanandaj, Iran. The samples of each individual were divided into 8 equal parts: 1. control group before freezing; 2. incubated with L-carnitine; 3. incubated with coenzyme Q10; 4. incubated with the combination of L-carnitine + CoQ10; 5. control freezing group; 6. the experimental freezing group with L-carnitine; 7. the experimental freezing group with coenzyme Q10 and 8. the experimental freezing with the combination of L-c + CoQ10. Sperm motility was assessed by WET MOUNT method. DNA fragmentation was evaluated by SCD (Sperm Chromatin Desperation), ROS, was evaluated by quantitative fluorescence reaction, and chromatin deficiency was determined by chromatin staining (CMA3).

Antioxidant treatments, significantly reduced the number of ROS + in the pre and post freezing groups. Significant improvement was seen in the sperm motility of class B in the pre freezing groups with L-carnitine. Antioxidants also reduced the percentage of DNA fragmentation and protamine deficiency in pre-and post-freezing.

Addition of Coq10 and L-carnitine to human sperm medium significantly reduced the number of ROS. This reduction in ROS reduced sperm damage during cryopreservation. 

The present study aims to assess and compare the effects of carvedilol and terazosin plus enalapril on lower urinary tract symptoms (LUTS), urine flow, and blood pressure (BP) in patients with moderate hypertension (HTN) and benign prostatic hyperplasia (BPH).

In this randomized crossover trial, a total of 40 men with HTN and LUTS symptoms were enrolled. The first group was treated with carvedilol, and the second group received terazosin plus enalapril. After eight weeks of treatment, the patients experienced a one-month washout period, and the treatments changed and were continued for eight weeks. To diagnose BPH in the study, the international prostate symptom score (IPSS) questionnaire was used. Moreover, the prostate-specific antigen (PSA), the post-void residual (PVR) urine volume, and the maximum urinary flow rate (Q-max using the uroflowmetry test) were measured.

Effect assessment results in this crossover trial illustrated neither carryover effects nor significant treat-ment effects on all primary outcomes (P > 0.05). Moreover, the results for the period effect indicated a significant reduction in BP (systolic and diastolic), PVR, and IPSS, yet a significant raise in Qmax.

The effects of carvedilol are similar to those of the combination of terazosin and enalapril in patients with moderate HTN and BPH in controlling LUTS. Carvedilol could be used as an appropriative drug in patients with moderate HTN and cardiac problems with LUTS of BPH. Further studies are recommended to be conducted to investigate and compare the efficacy of carvedilol with that of other alpha-blockers with a larger sample size and over a longer period of time

Epidermoid cyst (EPC) of the clitoris is a very rare cause of non-hormonal acquired clitoromegaly. Clitoral EPCs are extremely uncommon without prior history of genital surgery, trauma, circumcision, or piercing. Surgical removal with special care to avoid compromising neurovascular bundle of the clitoris is the preferred treatment. To our best knowledge, only three cases of adult female clitoral EPC without history of genital surgery, female circumcision, or medications including oral or implantable contraceptives have been reported. Herein, we describe three cases of primary EPC of the clitoris, their management, unique histopathology report, safe surgical approach, and their follow up course.

We read the article entitled ‘’Retrograde Intrarenal Surgery vs. Percutaneous Nephrolithotomy vs. Extracorporeal Shock Wave Lithotripsy for Lower Pole Renal Stones 10-20 mm: A Meta-analysis and Systematic Review’’ published in Urology Journal (1). The topic is still hot in urology regarding lower pole kidney stones in 10-20 mm diameters. Although extracorporeal shock wave lithotripsy (ESWL), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are the available options for the patients with lower pole renal stones 10-20 mm diameter, the decision making among the methods is still controversy. This manuscript is valuable in this regard. At the present manuscript, the authors prepared a very comprehensive meta-analysis of existing evidence to quantify and compare the safety and efficacy of PCNL, RIRS and ESWL for lower pole renal stones 10-20mm. They emphasized the longer operative time of PCNL and RIRS compared to ESWL. They also reported a higher stone-free rate, the lower retreatment rate and auxiliary procedure following PCNL with the longest hospital stay for PCNL. When it comes to ESWL, the lowest SFR, the higher retreatment rate and auxiliary procedure rate, but a shorter operative time and the shortest hospital stay was reported. The authors indicated stone to skin distance (SSD) as an unfavourable factor for ESWL. This issue is also reported in current literature. SSD was calculated by measuring the distance from the stone to the skin in three angles (0°, 45° and 90°) and the cut-off value for SWL failure was reported in a wide-scale from 100 mm to 119 mm(2,3). At the present study, the authors presented 10 mm as a predictive value for the criteria of SWL failure. This statement seems to be not correct totally also 10 mm is an impossible value for SSD. In our opinion, it was caused by a misspelling, and a correction may be informative for the readers.

Chronic prostatitis/Chronic pelvic pain syndromes (CP/CPPS) are a widespread pathology with unknown etiology without a proved treatment algorithm. Neurologic, endocrine and immune systems, and oxidative stress, infections are ranked in the physiopathology.Anogenital distance (AGD) as a marker for the degree of antenatal exposure of androgens that link to some disor-ders of androgen-sensitive tissues especially of urogenital system. In this study, we aimed a construct a hypothesis that improper development of perineum and pelvic bottom due to the insufficient embryologic androgen exposure, which can be detected by reduced AGD, can form histologic/clinic CP in adulthood through the physical forces that resulted in stretched prostate via chronic hypoxia induced oxidative stress and failed immune mechanisms. AGD, unlike the previous published ones, suggested as a real physical scale to detect narrowed pelvic bottom other than an endocrine related biomarker.

Intermittent catheterization has been introduced as a lifesaving management strategy in cases of bladder neuromuscular dysfunction both in adults and children. Surprisingly there are scarce data or even clear professional opinions about interval and frequency of catheterization attempts in children. This may have a considerable impact specially in children with vastly variable bladder capacity and function. We tried to throw light on this problem, suggest a simple estimation and propose a more frequent catheterization schedule than commonly perceived, as an either temporizing or extenuating resort before cystoplasty in some cases.