Nephro-Urology Monthly
Volume:15 Issue: 1, Feb 2023

 Urinary tract infection (UTI) is one of the most common childhood infections. Urinary tract infections are divided into simple and complex types. If the bladder infection is not treated, it can cause secondary kidney infections, such as acute pyelonephritis, which can lead to kidney scar or permanent kidney damage. A significant percentage of patients of any age are re-infected after antimicrobial treatments during the first six months after the first period of UTI.

 This research aimed to investigate the risk factors affecting UTI in infants and children hospitalized in Arak Amir Kabir Hospital in 2017-2018 to prevent UTI and its secondary complications.

 In this cross-sectional study, the data collection tool was a validated questionnaire to gather the child's demographic characteristics, including age, sex, type of nutrition, circumcision, age of circumcision, as well as information about fetal birth weight, chronic maternal diseases such as diabetes and stress, and residence place. The content validation method was used to determine the validity of the checklist, and the test-retest was used for reliability. Data were analyzed by SPSS version 22 software.

 Sixty four percent of children had the normal ultrasound, while 22% had hydronephrosis and nephrolithiasis on ultrasound. The average thickness and size of the right kidney were 71.75 and 9.11, and those of the left kidney were 9.11 and 9.50, respectively. The most common microorganism was Escherichia coli.

 Given the importance of prevention and timely diagnosis and treatment of UTI to prevent kidney injuries, it is necessary to find UTI risk factors as the first step to preventing children from secondary kidney injuries.

 Percutaneous nephrolithotomy (PCNL), established in the 1970s, has replaced open surgery for large stones. Extracorporeal shock wave lithotripsy (ESWL), once the preferred first-line treatment for small-to-medium-sized renal stones, has a questionable charm owing to patient reluctance for repeated treatments and hospitalizations since ESWL has a reduced stone-free rate (SFR). Flexible ureterorenoscopy, also referred to as RIRS, originally applied in the management of lower pole stones resistant to ESWL, is increasingly being used as a primary modality to manage lower pole stones, and it may potentially achieve higher SFR than ESWL and lower morbidity than PCNL for patients with low-volume stone diseases.

 Observations were made to compare ESWL, mini PCNL, and RIRS in managing lower pole renal calculi of < 1.5 cm.

 This observational study encompassed all patients with lower pole renal stones with < 1.5 cm diameter and < 1000 HU density who underwent mini PCNL, RIRS, or ESWL from January 2020 to July 2021. There were 40, 60, and 60 patients in the RIRS, mini PCNL, and ESWL groups, respectively, for all of whom preoperative CT urogram was performed. The patients were informed of the procedures, and their informed consent was obtained. The stone-free rates of the three modalities were compared, and the outcomes were statistically analyzed.

 The mean stone sizes in the present study were 12.99 × 3.56 mm in mini PCNL, 10.62 × 2.51 mm in RIRS, and 10.93 × 3.13 mm in ESWL. The mini PCNL group's SFR was significantly higher than those of other groups: 59 (98.3%) in mini PCNL, 34 (85%) in RIRS, and 46 (76.7%) in ESWL (P = 0.002). Out of the 60 patients in the mini PCNL group, only one (1.7%) required an ancillary procedure, while only six (10%) out of 40 patients in the RIRS group and 11 (18.33%) out of 60 patients in the ESWL group required the ancillary procedure (P = 0.031).

 For lower pole renal calculi < 1.5 cm, mini PCNL has the highest SFR, followed by RIRS and ESWL, in sequence. The ancillary procedure rate was 18.33% in the ESWL group, which was higher than those of mini PCNL (1.7%) and RIRS (10%).

Urethral cancer is one of the rarest cancers. This study reported four cases treated in our department during the last two years. The patients’ medical histories differed and showed various symptoms and courses of illness. Each patient was treated surgically and received additional treatment. Two patients had pelvic injuries recorded in their medical history. One patient had progressive cancer on the basis of condyloma. The late diagnosis was a significant problem. None of the patients presented distal metastasis at the time of diagnosis, but the local advancement was significant. The courses of disease were aggressive in all patients. This study also reviewed the literature concerning primary male urethral cancer regarding the course of the disease and possible treatment methods.

 The efficacy and quality of hemodialysis (HD) are closely related to the dialyzer characteristics.

 This study aimed to determine the efficacy and complications of modified polyethersulfone (m-PES) -1.5 hollow fiber filters in comparison to conventional filters during HD.

 This non-inferiority crossover randomized clinical trial was performed in adult dialysis units at three HD centers within May 2019 to March 2020. The patients were randomly enrolled in two groups. Group A was first put on HD for six sessions with a low or high flux smart flux filter (m-PES-1.5 hollow fiber), which was made in Italy by Medica S.P.A. Group. Group B was hemodialyzed with a corresponding low or high flux filter made in Iran by Meditechsys Company. After a two-week clearance phase, the patients were dialyzed for six sessions with the opposite filter of the first six sessions. Laboratory variables, such as blood urea nitrogen and creatinine, were measured. Kt/V (i.e., a measurement of HD efficacy) and urea reduction ratio (URR) were calculated. Additionally, blood pressure was monitored.

 A total of 40 patients were entered into the final analysis. No matter which filter was used, no statistically significant differences were observed in URR, creatinine, Kt/V, and blood pressure at different times during dialysis between the two types of filters. Packaging problems (P < 0.001) and blood clotting (P = 0.009) were two more frequent complications in the m-PES group.

 This study showed that smart flux m-PES-1.5 hollow fiber filters are similar to Meditechsys Company filters.

 Men’s sexual health is one of the main aspects of their lives. Male sexual dysfunction (SD) includes a wide range of sexual impairments and is not limited to premature ejaculation (PE) and erectile dysfunction (ED). ED can be a life-changing issue that might be mixed up with male sexual impotence characterized by PE and ED.

 The objectives of this study were to estimate the prevalence of sexual dysfunction and its associated factors among the Iranian male population.

 This is a cross-sectional study for which data was collected from a nationwide reproductive morbidities project among males in Iran. To do so, 2296 men aged 25 - 60 years were selected from four provinces by cluster sampling. Statistical analysis was done in SPSS (18.0.0)

 The prevalence of severe/medium SD and severe SD were 66.9% and 18.1%, respectively. The prevalence of low sexual satisfaction, low sexual desire, and dissatisfaction with the length of intercourse before orgasm were 9.5%, 9%, and 12%.

 Sexual dysfunction is highly likely prevalent among less educated, unemployed men with a history of chronic diseases. Various educational programs to raise awareness are thoroughly recommended.

 There has been a rise in the reappearance of multidrug-resistant Gram-negative bacteria in recent years. Using polymyxins, such as colistin, as a last-line treatment for these infections has led to renewed interest in the toxic effects of this drug.

 In this case report, we present neurological signs and symptoms developed in a patient with a history of cervical cancer four to five hours after receiving colistin for treating a urinary tract infection caused by MDR Pseudomonas aeruginosa with a colony count of > 100,000/L. These signs and symptoms included lower limb hemiparesis, facial paresthesia, decreased deep tendon reflexes, and tinnitus, which were resolved on their own 24 hours after discontinuation of the drug. Antibiotic therapy was continued with pipractate and ciprofloxacin instead. The patient got discharged in stable condition after negative urine culture results.

 Interstitial cystitis (IC) is a chronic, debilitating bladder disease that primarily affects middle-aged women and significantly affects their quality of life. Bladder hydrodistention is the usual therapeutic and diagnostic procedure, but symptoms tend to relapse. Adding hyaluronic acid to hydrodistention has been shown to improve the outcomes.

 To compare the therapeutic effects of bladder hydrodistention alone or with intravesical cystistat (40 mg of sodium hyaluronate in a 50 mL vial) in treating IC/bladder pain syndrome (IC/BPS).

 This randomized controlled clinical trial was conducted in Imam Reza Hospital of Mashhad in 2017. Twenty-four female IC/BPS patients were selected using clinical examinations and the O`Leary-Sant IC questionnaire to evaluate treatment effects. Patients with a history of other diseases related to the urogenital system and urination frequency less than eight times a day were excluded. The control group (n = 12) underwent hydrodistention under general anesthesia, and the intervention group (n = 12) received intravesical cystistat in addition to hydrodistention weekly for four weeks, followed by monthly for two months.

 In the control group, the mean baseline score of the questionnaire was 33.2 ± 1.9 and reached 33.9 ± 2.6 after three months, showing no significant change. In the intervention group, the mean baseline score of the questionnaire was 32.6 ± 3.6 and reached 6.4 ± 12.4 at the end of the third month, which indicates a significantly better improvement (P < 0.001). In this study, the disease symptoms resolved in 83.3% of the intervention group after three months of treatment, while the controls did not improve.

 Based on our study, intravesical instillation of cystistat is effective in treating patients with IC/BPS and has significantly better effects than hydrodistention alone.

 Evidence shows that spinal anesthesia can alter the penile length and penile engorgement and the fact that patients undergoing spinal anesthesia may experience erectile dysfunction. We hypothesized that spinal anesthesia would not result in altered penile length; however, it can lead to temporary erectile dysfunction.

 A total of 73 patients referred to our hospital for endoscopic urological surgeries underwent either spinal anesthesia (SA, n = 37) or general anesthesia (GA, n = 36). We measured patients’ penile length in both stretched and flaccid states during surgery and compared changes in penile length between the SA and GA groups. We assessed erectile function in patients through a standard questionnaire one month and three months after the surgery.

 No significant difference was observed in penile length during and two weeks after surgery between the SA and GA groups (P > 0.05). Regarding erectile function, we observed a significant difference in the international index of erectile function (IIEF)-5 score between the two study groups one-month after surgery (P < 0.05). However, there was no significant difference between the SA and GA groups three months after the surgery. Spinal anesthesia had no significant effect on penile length during and two weeks after surgery compared to general anesthesia.

 Patients undergoing SA may experience transient erectile dysfunction one month after surgery; however, they may develop transient erectile dysfunction, which is recovered three months after surgery.