Urology Journal

Laparoscopic stone surgery was historically recommended only for cases involving concomitant ureteropelvic junction obstruction (UPJO), congenital abnormalities, or when other endourological procedures had failed as an alternative to open surgery. However, recent randomized clinical trials and meta-analyses involving patients with normal anatomy and large renal stones have shown that laparoscopic pyelolithotomy (LPL) has a higher success rate and lower complication rates compared to the gold standard, percutaneous nephrolithotomy (PCNL). Furthermore, stone recurrence appears to be lower following LPL compared to PCNL. Therefore, we suggest that current guidelines for stone treatment reconsider laparoscopy as an effective primary treatment for large kidney stones, rather than simply viewing it as an alternative option. Nonetheless, careful case selection and the surgeon's experience are critical for the success of this treatment.

Purpose: Percutaneous nephrolithotomy (PCNL) has undergone extensive modification to reduce complications. One of the recent advances in minimally invasive procedures is the advent of ultra-mini PCNL (UM-PCNL), which provides miniaturized access to the kidney. However, the specific instruments applied in UM-PCNL may not be found in centers with limited resources. This study evaluated the safety, feasibility, results, and short-term complication rates of performing UM-PCNL using a semi-rigid ureteroscope in preschool children.
Materials and Methods: Between September 2013 and September 2021, a total of 68 patients, including 42 boys and 26 girls with a mean age of 3.2 ± 2.4 years, underwent UM-PCNL with a 4.5French tip ureteroscope instead of an ultra-mini nephroscope in children aged less than 7 years old. The procedure was done under general anesthesia in the prone position. The nephrostomy tract was dilated to 12F. Stones were fragmented using a pneumatic lithotripter. Irrigation was done with normal saline.
Results: The early stone-free rate (SFR) was 91%, and the short-term total SFR was 97%. No statistically significant difference was found in pre-operative and post-operative Hb, BUN, Cr, Na+, and K+. Fever (11 patients) and ileus (5 patients) constituted the majority of complications, and only one patient required a blood transfusion. None of the cases undergoing UM-PCNL with this method required a re-do PCNL.
Conclusion: Our experience shows that with sufficient experience in handling semi-rigid ureteroscopes, urologists practicing in centers with limited resources could perform UM-PCNL with relatively favorable outcomes.

Purpose: Prostate cancer (PCA) is the second most common malignancy in Western countries. Long non-coding RNAs are new markers in disease diagnosis. Our aim of this study was to investigate liquid biopsy biomarkers with high specificity and sensitivity for early diagnosis of PCA patients in Iran.
Materials and methods: Blood specimens were collected from 29 PCA, 32 benign prostate hyperplasia (BPH), and 29 control (CTRL) individuals. Real-time PCR analyzed expression amounts of PSA, ARLNC1, UCA1, and PCA3. The ROC curve (receiver operating characteristic curve) analysis evaluated the diagnostic power of the examined molecules for PCA.
Results: There was a significant upregulation of PCA3 in PCA and BPH groups compared to the controls (p values for PCA3=< 0.001 and BPH vs. CTRL = 0.0015) while there was no significant difference between PCA and BPH individuals. A significant upregulation of ARLNC1 was seen in BPH group compared to the controls (p value = 0.0042). Also, PCA3 expression level showed a significant relationship with prostate volume.
There was no significant difference in UCA1 and PSA expression levels among the three groups (> 0.05). The
PCA3/PSA ratio was significantly increased in PCA and BPH individuals vs. the CTRL group with high sensitivity and specificity. The gene expression of PCA3 and ARLNC1 in the BPH group showed a significant relationship with age.
Conclusion: Our findings showed that in the diagnosis of prostate cancer, measuring the expression of PCA3, PSA, and ARLNC1 genes is necessary to determine the health, benign, or cancerous status of patients' prostate. Also, selecting the PCA3/PSA ratio provides a new approach for diagnosing this cancer if confirmed in a larger clinical sample size and functional studies.

Purpose: Simple epididymal cysts (EC) are rare in childhood and are mostly diagnosed at puberty. Although there is no consensus on the treatment, a conservative approach is generally preferred. To evaluate patients diagnosed with EC at our clinic in terms of presenting symptoms, diagnosis, and treatment methods.
Materials and Methods: Data of patients treated for epididymal cysts at our institution between March 2012 and March 2023 were retrospectively analyzed in terms of age, symptomatology, diagnostic method, treatment method, and outcomes. In all cases, the diagnosis of EC was based on physical examination with scrotal ultrasonography (US) confirmation.
Results: A total of 1829 patients underwent scrotal Doppler US, and EC was detected in 72 patients (10.7%). The median follow-up period of the 43 patients was 21.7 (6-80 months). Of these, 9 were bilateral (12.5%). The mean age of the patients at presentation was 14.8 years. Forty-one patients had scrotal pain, 12 had scrotal swelling, and 19 incidentally had EC. The cysts were between 1.2- 37 mm. Only 3 (4.1%) patients required surgical excision due to persistent pain.
Conclusion: EC is a benign lesion, and treatment approaches are usually conservative. Surgical excision is recommended for patients with persistent scrotal pain or an acute scrotum.

Purpose: To evaluate urodynamic parameters that may serve as predictors of treatment efficacy with Onabotulinumtoxin-A (onaBoNT-A) in patients with neurogenic lower urinary tract dysfunction (NLUTD).
Materials and Methods: Patients with NLUTD who received 200 IU onaBont-A injections were included in the study. Urodynamic parameters and the correlations between these parameters and treatment outcomes were analyzed. The primary endpoints were changes in the daily pad usage, and the secondary endpoint was to demonstrate the relationship between duration of treatment efficacy of onabotulinumtoxin-A with preoperative urodynamic parameters in patients with NLUTD.
Results: The data of 74 patients were analyzed retrospectively, and 66 (89%) patients benefited from onaBoNT-A treatment. A negative correlation was observed between the number of pads changed per day and maximum cystometric capacity (MCC) (p = 0.024, r = -0.277). A positive correlation existed between the duration of treatment efficacy of onaBoNT-A and change in detrusor pressure during filling cystometry (ΔPdet) (p = 0.018, r = 0.291), whereas a negative correlation was noted with bladder compliance (p = 0.035, r = -0.260). Any additional indicator of its urodynamic efficacy showing a correlation with the number of pads changed per day has not been identified yet.
Conclusion: OnaBoNT-A injections effectively manage NLUTD, with MCC being a potential predictor of treatment response. Other urodynamic parameters showed limited predictive value. Patients with lower MCC experienced greater improvements in reducing the number of pads used following treatment. High ΔPdet and low bladder compliance were associated with treatment benefits persisting for longer periods of time.

Purpose: Examine the prevalence of erectile dysfunction and ejaculatory dysfunction among COVID-19 recovered patients and whether this condition improved over time. The retrospective study of 50 male patients who have recovered from COVID-19 infection previously hospitalized in dr. H Abdul Moeloek General Hospital between March 2020 – March 2021.
Materials and Methods: All of these patients were evaluated in terms of erectile and ejaculation function via phone interview. The International Index of Erectile Function 5 (IIEF-5) and Male sexual health questionnaire ejaculatory dysfunction (MHSQ-EJD) were used to assess the erectile function and ejaculatory dysfunction. Statistical analysis was performed to evaluate whether there was a difference between IIEF-5 & MHSQ-EJD scores within 6 months, 6 to 12 months, and >24 months after COVID-19 infection.
Results: The prevalence of ED was 70% and EJD was 2 % during 0-6 months after COVID-19 infection. Mean age and BMI were 50.4 ± 8.5 years and 23.6 ± 1.6 kg/m2 respectively. There are 26 patients (52%) had an educational background lower than bachelor’s degree and 24 patients (48%) had an educational background of bachelor’s degree or higher. It was reported that 4 patients (8%) had Diabetes Mellitus and 12 patients (24%) had Hypertension. Most were active smokers (74%) and 2 patients (4%) had reported as active alcohol drinkers. There was a statistically significant IIEF-5 scores difference between three periods of time (p <0,001).
Conclusion: The prevalence of Erectile Dysfunction was high in COVID-19 recovered patients. There was a temporary erectile dysfunction and ejaculatory dysfunction among COVID-19 patients.

Purpose: Benign prostatic hyperplasia (BPH) is a condition commonly observed in elderly males, leading to lower urinary tract symptoms and potential complications. Surgical procedures primarily include transurethral resection of the prostate (TURP) and plasmakinetic resection, with their effectiveness under active research and clinical interest.
Materials and Methods: This retrospective cohort study compared the impacts of plasmakinetic resection and conventional TURP on clinical symptoms and quality of life in patients with benign prostatic hyperplasia. It encompassed surgical duration, postoperative complications, urodynamic parameters, quality of life scores, sexual function, and long-term outcomes.
Results: Postoperative symptom improvements, including International Prostate Symptom Score (IPSS) and Quality of Life (QoL) score, were significantly higher in the plasmakinetic resection group (P = 0.033 and P = 0.003, respectively). Urodynamic parameters such as peak flow rate (P = 0.008), post-void residual volume (P = 0.044), and Qmax (P = 0.012) also showed significant improvements. Quality of life assessments, including (EuroQol-5 Dimensions)EQ-5D scores (P = 0.003), general health perception (P = 0.009), sexual function (P = 0.011), and overall satisfaction (P = 0.004) favored plasmakinetic resection. Plasmakinetic resection resulted in better outcomes for continence and sexual function. Long-term outcomes at 1 year post-operation, including IPSS scores (P = 0.006) and overall satisfaction (P = 0.002), were significantly better in the plasmakinetic resection group. No significant differences were observed in health care resource utilization.
Conclusion: The study suggests that plasmakinetic resection offers advantages over conventional TURP in symptom relief, quality of life, continence, sexual function, and long-term results for patients with BPH.

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