Urology Journal

Purpose: We aimed to describe the natural history of stone fragments ? 7 mm that remained after retrograde intrarenal
surgery (RIRS) in long-term follow-up.

Materials and Methods: We retrospectively reviewed 142 medical records of patients who had residual fragments
(RFs) ? 7 mm after RIRS. Patients were divided into 2 groups according to the size of RFs as ? 4 mm (group 1)
and 5 – 7 mm (group 2). Patients’ demographic data, stone characteristics, perioperative data and complications
were recorded. Re-growth of RFs, spontaneous passage, renal colic, infection and re-operation rates were our main
variables.

Result: A total of 142 patients (86 in group 1 / 56 in group 2) were followed for mean 54.45 ± 14.24 and 56.22 ±
10.28 months. Mean size of RFs was 2.85 ± 1.22 mm in group 1 and 6.81 ? 2.21 mm in group 2. Mean number of
RFs were 1.1 ± 0.2 in group 1 and 2.4 ± 1.6 in group 2 (P = .035). Spontaneous passage rate of RFs were 30.23%
and 17.85% in group 1 and 2, respectively (P = .032). No difference was observed in the re-growth rate of RFs
between the two groups (P = .094). Although no difference was observed in re-growth of RFs between the groups,
patients in group 2 were more likely to experience stone-related events such as renal colic and re-intervention rate
(P = .034, P = .029; respectively).

Conclusion: Our results demonstrate that RFs > 4 mm take higher risk in terms of stone-related events and should
be followed up more closely.

Purpose: Nowadays, there are many physical and chemical methods available for urinary stone analysis. According to the latest guidelines, infrared spectroscopy (IR) or x-ray diffraction (XRD) are the two preferred methods in this issue. Therefore, we decided to do a practical comparison between the two above-mentioned techniques with a reference method in order to set up a proper analysis method in our clinical laboratories.

Materials and Methods: A total of 60 kidney stones were obtained at Labbafinejad hospital through open surgery or percutaneous nephrolithotomy. Then stone analysis techniques included both a morphological examination by SEM (Scanning Electron Microscopy) and internal structure analysis by EDAX (Elemental distribution analysis X-ray), XRD, IR and wet chemical analysis. SEM together with EDAX (SEM-EDAX) was considered as reference methods.

Results: The results of XRD had the highest agreement with SEM-EDAX analysis (93%), while the total agreement of FTIR and wet chemical analysis was 81% and 71% respectively. The agreement of FTIR for calcium oxalate stones was acceptable (90%), but for uric acid and cystine stones was challenging (65% and 76% respectively).

Conclusion: Our results revealed that XRD is more reliable than FTIR; but considering cost issues, FTIR is more suitable for routine clinical laboratory. Moreover, wet chemical analysis, which is routinely used in our laboratories is insufficient for stone analysis and it is mandatory to be replaced by techniques that are more accurate.

Objective: To introduce flexible ureterorenoscopy with holmium laser lithotripsy in the management of symptomatic caliceal diverticular calculi.

Materials and Methods: The records of 26 patients who underwent flexible ureterorenoscopy and lithotripsy with holmium laser to manage symptomatic caliceal diverticular calculi from January 2012 to June 2016 were retrospectively reviewed.

Result: Flexible ureterorenoscopy lithotripsy was successfully placed in all 26 patients. Twenty-two cases accepted lithotripsy at the same time, and the success rate was 84.6%. The stone-free rate was 76.9%.The mean operative time was 48 ± 16 minutes. The mean hospital stay was 4.8 ± 1.6 days. There was no evidence of stone regrowth or recurrence at a mean follow-up of 11.5 months.

Conclusion: Flexible ureterorenoscopy with holmium laser lithotripsy is safe and effective, and it can be offered as a first line therapy for symptomatic caliceal diverticular calculi.

Purpose: We aimed to find out if there was any difference between intramuscular and intravenous administration of lornoxicam in terms of efficacy and side effects.

Materials and Methods: This study was a single-blind parallel-group randomized clinical trial. A total of 51 patients who were diagnosed with acute renal colic at our clinic were included in the study. Pain severity prior to treatment was rated using the Visual Analogue Scale (VAS). Patients were randomized into 2 groups: Group 1 (n = 27) received intramuscular 8mg lornoxicam and Group 2 (n=24) received intravenous 8mg lornoxicam. Pain severity was reassessed 30 minutes after the treatment. Pre- and post-treatment VAS scores and the mean change
in the VAS scores of the 2 groups were statistically compared.

Results: The mean VAS scores decreased significantly from 7.65 to 2.07 in Group 1, from 7.96 to 1.38 in Group 2, and from 7.79 to 1.75 in total (P < 0.001). No statistically significant difference was observed between Groups 1 and 2 in terms of VAS score reduction (P = 0.128). None of the patients suffered any side effects except for 1 (2%) patient who had dyspepsia.

Conclusion: Parenteral lornoxicam provides significant pain relief in patients with acute renal colic. However, no significant difference was found between intramuscular and intravenous administration in terms of analgesic efficacy.

Purpose: Nephrostomy tract creation is a key step to perform a successful percutaneous nephrolithotomy (PCNL). In an attempt to improve the conventional technique of the tract dilation, a Chinese one-shot dilation was developed and compared with the sequential fascial dilation.

Materials and Methods: We retrospectively reviewed medical records of 116 patients who had undergone 116 PCNL in our department from January 2012 to December 2012. The nephrostomy tracts had been created by using Chinese one-shot (one-shot group, 59 cases) or sequential fascial dilation technique (sequential group, 57 cases). Tract creation time, hemorrhage loss, overall renal function, tract dilation failure and major complications were compared between the two groups.

Results: The one-shot group had a significantly shorter mean (SD) tract creation time (1.9±0.4 vs 4.6±0.9 min, P<0.001) and lower mean (SD) decrease in hemoglobin concentration (0.59±0.32 vs 0.68±0.37 g/dL, P=0.0009) compared to the sequential group, respectively. There were no significant differences in mean (SD) value changes of pre- and post-operative serum creatine concentrations (4.6±11.3 vs 4.9±14.7 ?mol/L, P=0.259) between the one-shot and sequential group. No tract dilation failure or major complications occurred in both of the groups.

Conclusion: This study demonstrated that the Chinese one-shot dilation technique is as safe and feasible as the conventional sequential fascial dilation. Furthermore, a greater reduction in tract creation time and blood loss was achieved using this technique.

Purpose: To evaluate the feasibility and effectiveness of two-stage laparoscopic repair for two-level ureteral strictures.

Materials and Methods: From October 2010 to January 2017, 8 patients with two-level ureteral strictures, which were located in upper and lower ureter, received two-stage laparoscopic repair in our institution. Laparoscopic ureteroureterostomy was conducted for the upper ureteral strictures in first stage and 8 weeks later laparoscopic
ureterovesical reimplantation was performed for lower stricture after the patency of upper lesion was confirmed by antegrade ureteropyelography. The kidney was drained by a nephrostomy tube during the interval period of two operations.

Result: All the operations were performed successfully without intraoperative complications except one patient converted to open surgery during second-stage operation. For first-stage surgery, mean operating time was 120.88 ± 16.88 min, mean blood loss was 89.38 ± 13.74 mL, and mean duration of postoperative hospitalization was 3.63
± 0.74 days. While in second-stage surgery, mean operating time took 125.25 ± 17.00 min, mean blood loss was 65.63 ± 10.16 mL, and mean duration of postoperative hospitalization was 3.62 ± 1.41 days.. On ureteropyelography 10 weeks after second-stage surgery, the contrast medium flowed from kidney down into bladder unrestrictedly and the patency of entire ureter was restored in all patients. During the follow-up, one female was observed kidney atrophy with ureteral calculus formed on the lesion side, and was successfully treated by ureteroscopic
lithotripsy. No sign of stricture recurrence was found on other patients.

Conclusion: Two-stage laparoscopic repair is a feasible and effective treatment for two-level ureteral strictures.
But its indication is relatively narrow and confined to ureteral strictures located in two sites with sufficient interval
distance and minor stricture length.

Purpose: Chronic inflammation is an important factor in the etiology of prostate cancer. Macrophage migration inhibitory factor (MIF) plays an important regulatory role in inflammatory responses. The aim of this study was to investigate the potential association between MIF-173 G/C polymorphism, and both biological behavior and incidence of prostate cancer.

Materials and Methods: Analysis of polymorphic variants for MIF was performed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method in 128 subjects with prostate cancer and 135 controls.

Results: The frequency of MIF-173 *C allele was significantly (OR = 2.18, 95% CI = 1.32-3.61) higher in patients with prostate cancer (19.5%) than in healthy individuals (10%). Prostate cancer patients with Gleason scores ? 7 had higher frequency of MIF-173 *C allele than Gleason scores < 7 (86.1% vs. 27.1%, P = 0.003, OR = 3.18, 95%
CI = 1.46-6.95). The frequency of MIF-173 *C allele was significantly different in patients with T1, T2 and ?T3 clinical stages of prostate cancer (15.2% vs. 42.6% and 47.8%, P = 0.003).

Conclusion: Our data suggest that MIF-173 polymorphisms may be associated with a higher incidence of prostate cancer compared to controls. We believe that MIF-173 GC+CC genotype can be used as a predictive factor for aggressive behavior of prostate cancer including pathological stage and Gleason scores as well as metastatic potential.

Purpose: To compare the prediction accuracy of the European Organization for Research and Treatment of Cancer (EORTC) and the Spanish Urology Association for Oncological Treatment (CUETO) risk tables in all non-muscle invasive bladder cancer patients.

Material and Methods: Recurrence and progression-free survival of all patients were assessed according to the EORTC and the CUETO risk tables for each patient and the concordance index was used to indicate discriminative ability. Statistical analyses were performed, at 1 and 5 years, to the whole group and separately to those treated or not treated with bacillus Calmette-Guerin (BCG) .

Results: The study included 400 patients. One-year BCG maintenance therapy was applied to 181 patients (45.3%). The recurrence rate was higher than in CUETO, and similar to EORTC. The EORTC was determined to provide better discrimination than CUETO in the whole patient group and in those treated or not treated with BCG. The concordance indices for these groups were 0.777, 0.705; 0.773, 0.669; and 0.823, 0.758, respectively . The progression rate was similar in this study to the rate defined in both risk tables. The discrimination power was similar
in EORTC and CUETO for all the groups. The concordance indices were 0.801, 0.881; 0.915, 0.930; and 0.832, 0.806, respectively.

Conclusion: The EORTC has more power than CUETO to discriminate each recurrence risk group and both risk tables can successfully discriminate progression risk groups in all patients.

Purpose: It remains unclear whether laparoscopic radiofrequency ablation (RFA) for primary treatment of small renal masses is similar to partial nephrectomy (PN) in terms of long-term oncological and renal function outcomes. We reviewed the long-term outcomes for patients with T1a renal masses treated with either laparoscopic RFA or
PN.

Materials and Methods: This retrospective single-center study on 115 patients who were treated by laparoscopic RFA or PN for small (<4 cm) renal masses between January 2005 and October 2014 at Chungnam National University Hospital. Estimated glomerular filtration rate (eGFR) was measured before and 1–2 weeks after surgery and at last follow-up. The laparoscopic RFA and PN groups were compared in terms of clinical characteristics data and change in eGFR after surgery using the Chi-squared test or Student’s t-test. Survival data were analyzed using the
Kaplan-Meier method and the log-rank test.

Results: Of the 115 patients, 62 and 53 underwent laparoscopic RFA and PN, respectively. Their mean (range) follow-up duration was 60 (30–104) and 68 (30–149) months, respectively (P = 0.092). The RFA patients were older (P = 0.023) and had smaller tumors (P = 0.000). RFA associated with shorter operation and hospitalization times and less perioperative blood loss (all P<0.001). The groups did not differ in terms of change in eGFR 1–2 weeks after surgery (P = 0.252) or at the last follow-up (P = 0.395) or 5 year survival rates (P = 0.360).

Conclusion: Laparoscopic RFA for small renal masses was comparable to PN in terms of oncological and functional outcomes and associated with shorter operative and hospitalization times and less perioperative bleeding.

Purpose: Researchers reported that, MYNN rs10936599 polymorphism is in strong or moderate linkage disequilibrium with SNPs within the 3q26.2 chromosomal regions that also include the TERC gene. In addition, it has been reported that MYNN rs10936599 had a strong cumulative association with bladder cancer risk, and TERC gene suppresses cell growth in bladder cancer cell lines. Therefore, we aimed to determine whether polymorphisms of MYNN rs10936599 and TERC rs2293607 play any roles for bladder cancer in the Turkish population in this study.

Materials and Methods: In this case-control study, 70 patients and 150 controls were investigated. Genotyping analysis was performed by polymerase chain reaction, restriction fragment length polymorphism and DNA sequencing techniques.

Results: Genotype distribution between study groups for MYNN rs10936599 SNP was significantly different (P = .001); although there was no difference in genotype distribution for TERC rs2293607 SNP. In addition, patients with CT genotype and CT+TT genotype combination of MYNN SNP have a decreased risk for bladder cancer. Two times increased risk ratio on development of bladder cancer was obtained for CC genotype of the SNP (P = .001). Besides, it was found that genotype combination of GG+AG/CC versus AA/CC genotypes (TERC/MYNN)
showed stronger correlation. We observed that statistically significant relationship between the C-G haplotypes of two polymorphisms and bladder cancer risk (P = .0001).

Conclusion: At the end of the study, we suggested that there may exist an association between a combination of MYNN rs10936599 and TERC rs2293607 polymorphisms and development of bladder cancer in Turkish population.

Purpose: Considering the importance of treatment decisions for prostate cancer (PCa) and the utility of Gleason scoring system (GS) in this field, we aimed to assess the percent of agreement and disagreement between needle biopsy (NB) Gleason score and radical prostatectomy (RP) specimen Gleason score.

Materials and Methods: In this retrospective study, consecutive patients with PCa, who underwent NB and subsequently RP were enrolled. GS of both NB and RP specimens were recorded for each patient. Patients were classified according to the GS as low-grade (? 3+3), intermediate-grade (3+4 and 4+3), and high-grade (GS?8-10). The levels of agreement and discrepancy of NB GS was compared to its corresponding RP GS using Kappa coefficient of agreement. Over-grading and under-grading of NB GS were also determined.

Result: A total of 100 embedded RP and corresponding NB were analyzed. The rate of discrepancy for group and individual scoring of GS was 41% and 56%, respectively. The rate of under and over-grading was 34% and 7%, respectively. Kappa value for group and individual scoring was .443 (95%CI: .313 - .573) and .411 (95%CI: .291 - .531), respectively.

Conclusion: The findings of our study indicate that though the agreement between NB GS and RP GS are fair to moderate, but the feature of discrepancy, i.e. under-grading in low and intermediate grades and over-grading in high grades of NB GS, could help us in making more appropriate clinical decision especially considering other biochemical and pathological factors such as the level of PSA or peri-neural invasion.

Purpose: Obturator nerve block (ONB) has been performed in surgeries of transurethral resection of bladder tumors (TUR-BT) for the prevention of the development of obturator muscle contraction. Currently, classic and inguinal approaches are frequently being used. In the present study, we aimed to compare the success rate, performance speed, and complication risks of both approaches.

Materials and Methods: Sixty-six patients who underwent TUR-BT under spinal anesthesia were randomly selected, and ONB was performed on the tumor location side using classic (n = 33) or inguinal (n = 33) approaches. Ten milliliters of 0.25% bupivacaine were administered using a peripheral nerve stimulator in both approaches.
Two endpoints were defined in the study: Primary endpoint; the duration of the determination of the obturator nerve and number of interventions when each participant is assessed in at the end of the ONB procedure. Secondary endpoint; development of contractions, and complications each participant is assessed during the TUR-BT and 24 hours after ONB. (Clinical Trial Registration Number: ACTRN12617001050347)

Result: General anesthesia was applied to the five patients in the classic ONB group who detected diffuse or bilateral tumors. These patients were excluded from the study. Contractions developed in 4 patients in each group, no statistically significant difference was detected between the groups (14.3%, n = 4 versus 12.1%, n = 4) (P = 1.00). No complications were detected in both groups during the TUR-BT and 24 hours after ONB. We found that the inguinal approach provided a statistically significant advantage regarding the number of punctures (1.9 ± 0.9 versus
1.5 ± 0.7) (P = .036), and duration of the procedure (99.1 ± 48.4 seconds versus 76.0 ± 31.9 seconds) (P=.029) compared with the classic approach.

Conclusion: Although complications and success rates were similar in both groups, the inguinal method may be a
better approach because it is faster and requires fewer punctures.

Purpose: Infra-vesical obstruction is uncommon in infants and generally due to urethral valves. Congenital urethral strictures (CUS), instead, defined as a concentric narrowing of the urethral lumen, are exceedingly rare in infants.

Materials and Methods: We reviewed our experience with 7 patients treated at our institution for CUS <age of 1-year. The study is a retrospective review of 7 patients treated for CUS diagnosed <age 1-year during a 10-year period.

Result: In a single patient, the urethral stricture was an isolated condition, 3 had a Prune Belly Syndrome (PBS) and the remaining 3 had an Ano-Rectal Malformation (ARM). Four patients had upper tract dilatation detected on prenatal ultrasound. Five patients had upper tract dilatation on postnatal ultrasound. Five patients had impaired renal function at diagnosis and 3 required renal transplantation eventually. On micturating cystourethrography, all strictures were located in the anterior urethra and 4 cases had associated vesicoureteral reflux. In all cases, but one urinating via a patent urachus, initial management included insertion of a supra-pubic catheter. Subsequently, the CUS could be treated by dilatation or endoscopic incision in the 3 patients with Prune belly syndrome, whereas 3 of the remaining 4 required a formal urethroplasty.

Conclusion: Diagnosis and treatment of CUS in infants and children remain difficult to standardize. At presentation, urinary diversion is key to avoid progressive renal damage in infants that can already have an impaired renal function. Anterior strictures in patients with PBS are likely to be fixed with progressive dilatation. In other patients, instead, urethroplasty should be considered. A formal vesicostomy or, if possible, an urethrostomy can allow temporizing final surgery. A major problem we experienced in the treatment of CUS is that the small endoscopic
instruments required in this age group make urethral instrumentation more difficult and less effective than in older
children and adults.

Purpose: The aim of the study was to examine the prevalence of redo-ureteroneocystostomy (redo-UNC) in pediatric vesicouretheral reflux (VUR) patients following open UNC and factors associated with redo-UNC.

Material and methods: Data on 122 patients who underwent open UNC for VUR were analyzed in this retrospective case–control study. The patients were divided into a successful initial UNC group (UNC group, control) and an unsuccessful initial UNC group (redo-UNC group, case). The following variables were analyzed: sex, age, dysfunctional voiding, laterality of VUR (unilateral or bilateral), VUR grade, etiology of VUR (primary or secondary), relative renal function on renal scintigraphy, and surgical technique. The use of the following procedures in the initial UNC was recorded: an endoscopic subureteric injection(ESI) and ureteral tapering.

Results: In our clinic, 122 patients (177 ureters), with an average age of 55.7 ± 41.2 months (range, 1–18 years) underwent open UNC for VUR between November 2005 and June 2014. Of these,67 (55%) had unilateral VUR, and 55 (45%) had bilateral VUR. There were 127 (71.8%) cases of grade 4–5 reflux. Postoperatively, hydronephrosis was noted in 19 (15.6%) patents. Ten (8.2%) patients underwent redo-UNC. In eight cases (6.5%), redo-UNC was performed because of ureterovesical (UV) junction obstruction.In the other two cases (1.7%), redo-UNC was due
to high-grade reflux. There were no statistically significant differences between the redo-UNC and UNC groups in any of the variables studied.

Conclusion: Redo-UNC was required in 10 (8.2%) of cases after UNC. Age, sex, laterality of VUR, VUR grade,
existence of primary or secondary VUR, relative renal function on renal scintigraphy, UNC technique, ESI procedure,
and ureteral tapering were not risk factors for redo-UNC in our series.

Purpose: To evaluate the efficacy of therapy with spirulina supplement on semen parameters in patients with idiopathic male infertility.

Materials and Methods: A total of 40 men with idiopathic infertility were randomly assigned into two groups. Group A received 2 g spirulina supplement as well as conventional regimen for the treatment of infertility selected by their physician (220 mg/day zinc sulfate, 500mg/day L-carnitine, and 50 mg/day clomiphene) during 12 weeks
of the study, while group B received placebo plus conventional therapy during the study period. Semen parameters were analyzed at baseline and at the end of the study as a primary endpoint. The secondary endpoint was the rate of pregnancy occurring in the patients. wives.
Result: No significant differences in semen parameters were observed between the spirulina and control groups [count (16.43 vs. 46.00, P = .164), motility (51.00 vs. 48.7, P = .008), and morphology (47.50 vs. 15.00, P = NA)]. Our results showed a pregnancy rate of 5% in the spirulina group versus 0% in the control group.

Conclusion: This pilot randomized trial provides initial evidence on the possible beneficial effects of spirulina mainly in patients with impaired sperm motility or morphology. Due to the limited sample size, further larger randomized trials not only at the level of semen parameters but at the scope of paternity are required to confirm
these potential benefits.

Plasmacytoid urothelial carcinoma is a rare and aggressive form of urothelial carcinoma characterized with delayed presentation and poor prognosis. Very few cases of this carcinoma have been reported in the literature. Here, we report and discuss two cases of bladder plasmacytoid urothelial carcinoma of a 57-year-old male presented with renal colic, and a 33-year-old female presented with macroscopic hematuria. Pathologic examinations of the transurethral biopsies revealed urothelial carcinoma with plasmacytoid appearance. Subsequently, immunohistochemical
evaluation showed positive expression of epithelial markers and CD138. Additionally, losing of the membranous expression of E-cadherin verified the diagnosis of plasmacytoid urothelial carcinoma.

Genitourinary hemangiomas are very rare. To our knowledge few cases of female urethral hemangiomas have been reported and presenting cases are the first reports in Iran.
They should be considered as differential diagnosis of any female patient with microscopic or gross hematuria or bloody urethral discharge, especially when other parts of urinary system are radiologically intact. Thorough physical examination of genital area is highly recommended in order not to miss any urethral lesions. Herein we report two cases of female urethral cavernous hemangioma, their management and a review of literature.

Introduction: Testicular torsion is an emergency at any age; the aim of this study is to evaluate the role of mean platelet volume to assess the viability of the testes before surgery

Materials and methods: We retrospectively analysed the medical records of consecutive patients who underwent surgical exploration for acute scrotal pathology between January 2014 and December 2016 in our institution.

Patients: were divided into two groups (detorsion of testes and orchyectomy); a third group was created as control group. All patients underwent blood exam before surgery; inclusion and exclusion criteria were created. We also evaluated the association between mean platelets volume and the testicular recovery during surgery

Result: After reviewing medical charts following the inclusion and exclusion criteria, 8 patients were enrolled in
Group 1 and 11 patients in Group 2. 33 healthy controls were enrolled in Group 3. MPV value in Group 1 resulted
significantly different (p < 0.01) from the value in Group 2 and 3. The duration of symptoms was shorter than
6 hours in 4/8 (50%) patients in Group 1; this early referral to hospital allowed prompt detorsion and testicular
recovery. In these “early-presenting” patients, MPV value was significantly lower than in patients with torsion of
testicular appendage (p = 0.01) and in controls (p = 0.001).
Conclusion: MPV could be a useful adjunct in diagnosing TT, aiding its differential diagnosis with Torsion of the
testicular appendage. The lower MPV value in “early-presenting” patients with TT suggests a role in predicting the
testis viability, and therefore the appropriate treatment.