Urology Journal

PURPOSE: To compare and evaluate the mostly used methods of urinary stone analysis. MATERIALS AND METHODS: We searched PubMed and Google Scholar for “urolithiasis, nephrolithiasis, renal stone, and kidney stone” combined with “stone analysis, spectroscopy, X-ray diffraction, chemical analysis, mass spectrometry, and laser-induced breakdown spectroscopy, review article, and quality control assessment.” RESULTS: We identified 24 articles about reviews of the principles of stone analysis techniques and their quality control trials. Seven articles were not in English language; hence, were omitted from this review. The remaining 17 articles and their related references were studied thoroughly. There are various chemical and physical techniques available for urinary stone analysis. The correct stone analysis has to identify not only all stone components, but also the molecular structure and crystalline forms of them with the exact quantitative determination of each component. CONCLUSION: The knowledge of urinary stone composition is important for understanding pathophysiology, choice of treatment modality, and prevention of recurrences of urolithiasis, but up to now, a standard method has not been defined. Although there are many techniques available for identifying the urinary stone composition and structure, no single method can provide all the requiring information. Therefore, a combination of structural and morphological tests is needed for this purpose.

PURPOSE: To revise the predictive factors for intra-operative complications of rigid ureteroscopy in the treatment of ureteral calculi. MATERIALS AND METHODS: During a 15-year period (1993 to 2008), a total of 1496 consecutive patients who had undergone 1660 ureteroscopy procedures were retrospectively reviewed. After exclusion of the cases for diagnostic purposes, diseases other than ureteral calculi, and repeated ureteroscopy procedures, 1189 patients were left as the study population. Those patients were then divided into two groups based on the presence of the complications: complication–positive (group 1, n = 57) and complication–negative (group 2, n = 1132). Both groups were statistically compared regarding patients’ age and gender, stone surface area, lateralization and localization of the stone, impaction of the stone, type of the ureteroscope, necessity of ureteral orifice dilation, and use of a catheter during and after the procedure. Furthermore, the effect of leaving the fragmented stones in situ small enough to pass spontaneously (break’n’leave) on occurring of the complications has been investigated. RESULTS: The complication rate was recorded as 4.7%. Success rate after a single intervention was 86.3%, whereas increased to 94.1% after ancillary procedures. Stone surface area, lateralization, and type of lithotripter used were comparable between the groups, but impacted stones and the stones located at the upper ureters were associated with significantly increased complication rates. Furthermore, significantly less complication has been observed in cases where we performed break’n’leave. Furthermore, multivariate analysis revealed that stone impaction and failure to adhere to the “break’n’leave” principle were the independent predictors of occurring of the complications. CONCLUSION: Ureteroscopy is safe and effective in the treatment of ureteral calculi. Careful attention for the patients having a potential for occurrence of the complications and selection of the techniques are of importance for reducing untoward events.

PURPOSE: To evaluate the safety and efficacy of pediatric percutaneous nephrolithotomy (PCNL) using adult sized instruments in the management of pediatric urolithiasis. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 38 children younger than 15 years who had undergone 45 PCNLs with adult sized instruments in our center between August 2007 and February 2010. RESULTS: There were 26 boys and 12 girls, with a mean age of 8.4 ± 4.24 years (range, 12 months to 13 years). Twelve patients had complete staghorn stone. Mean stone burden was 2.93 ± 0.89 cm. The tract was dilated between 26 and 30 F. Standard PCNL was performed in 8 patients and tubeless PCNL in the next 37 subjects. Simultaneous transurethral lithotripsy was done in 9 patients. Stone clearance rate was 67%. Mean pre and postoperative hemoglobin levels were 12.67 ± 1.7 and 11.39 ± 1.6 g/dL, respectively. Mean hospitalization was 3.5 ± 1.1 days. Eight subjects had postoperative fever beyond day 1. Blood transfusion was required in only one patient. In one patient (3 years old) with a staghorn stone, hyponatremia and seizure occurred, which were treated consevatively without any adverse sequela. There was a significant difference in hospital stay between tubeless and standard PCNL groups (P < .02). CONCLUSION: We concluded that PCNL using adult sized instruments was relatively safe in children, with a clearance rate of 67%. We suggest prospective randomized studies to compare mini-perc and adult sized instruments use in pediatric PCNL.

PURPOSE: To investigate the effects of the hydroalcoholic extract of Hypericum perforatum (H. perforatum) leaves on the kidney calculi in rats. MATERIALS AND METHODS: Fifty-two Wistar male rats were randomly divided into 4 groups: Groups 2, 3, and 4 received ethylene glycol (EG) 1% + ammonium chloride (0.5%)-added drinking water as a stone inducer. The H. Perforatum solution was fed at the same time of EG application and was repeated once for two days until the end of the experimental period. Group 1 (control; n = 10) was provided free access to food and normal drinking water. Group 2 (EG; n = 12) received EG-ammonium chloride-added drinking water and was fed with normal chow. Groups 3 and 4 (n = 15), as EG-treatment groups, received H. Perforatum in low (300 mg/kg) and high (500 mg/kg) doses, respectively. After 28 days, the kidneys were removed and prepared for histologic evaluation of calcium oxalate deposits. RESULTS: Urine level of free calcium in groups EG and EG + H. perforatum (300 mg/kg) and phosphorous in EG + H. perforatum (500 mg/kg) significantly decreased compared to controls (P < .01; P < .05; and P < .05, respectively). Treatment of the rats with high dose of H. Perforatum (500 mg/kg) markedly reduced decrementing effect of EG on serum level of free calcium (P < .05). Histological experiments showed that chronic feeding of H. perforatum (300 and 500 mg/kg, orally) could significantly reduce the size and number of calcium oxalate deposits in EG group. CONCLUSION: Chronic treatment of rats with hydroalcoholic extract of H. perforatum reduced the size and number of calcium oxalate deposits in EG-induced calculi.

PURPOSE: To evaluate the outcome of laparoscopic retroperitoneal lymph node dissection (LRPLND) using bipolar electrocoagulation instead of clipping the lymphatic vessels. MATERIALS AND METHODS: Between August 2002 and April 2008, a total of 13 patients underwent transperitoneal LPRLND for nonseminomatous germ cell tumor of the testis. In this experience, in contrast to other techniques, we did not use clips for ligation of the lymphatic vessels; instead, we used bipolar cautery for coagulation of the lymphatic vessels. We followed up the patients for lymphocele formation or lymphatic leakage using abdominal computed tomography scan. RESULTS: Mean age of the patients was 24.2 years (range, 19 to 39 years). Six tumors were on the left side and 7 on the right. Pathological stage was ? in 12 patients and ?A in one. The mean follow-up period was 29.9 months (range, 3 to 70 months). No re-operation was required. There was no prolonged lymphatic leakage or lymphocele formation during the follow-up period. CONCLUSION: Our study demonstrates that using bipolar electrocoagulation instead of clips, for sealing of the lymphatic vessels during LRPLND, does not hamper the outcome of the procedure. This should be further evaluated in randomized clinical trials with more subjects.

PURPOSE: To measure the level of inter/intra-observer reproducibility among pathologists as far as Gleason scoring of adenocarcinoma of the prostate is concerned. MATERIALS AND METHODS: A total of 101 prostate biopsy slides, diagnosed with adenocarcinoma of the prostate by five pathologists from different education centers, were exposed to Gleason scoring. Two months later, the slides were re-examined by three of the same pathologists. Thereafter, the kappa was calculated for the data provided in the first and second reports of each pathologist and compared between pathologists. RESULTS: Inter-observer reproducibility was inappropriate, but intra-observer diagnostic reproducibility was almost perfect with a corresponding percentage of agreement of 85.2%. CONCLUSION: The inter-observer reproducibility was poor.

PURPOSE: To evaluate the effectiveness of 2 more core prostate biopsy protocol in detecting the prostate cancer (PCa) by comparing 10-core prostate biopsy with 12-core according to the prostate-specific antigen (PSA) level and the prostate volume. MATERIALS AND METHODS: A total of 474 men with elevated serum levels of PSA between 2.5 and 20.0 ng/mL, regardless of abnormal finding on digital rectal examination and transrectal ultrasonography, received transrectal ultrasound-guided prostate biopsies. The patients were prospectively randomized to undergo 10-core (group 1, n = 351) or 12-core (group 2, n = 123) biopsy. The PCa detection rates were assessed and compared according to the serum level of PSA and prostate volume. RESULTS: Of 474 men, 128 (27.0%) were diagnosed with PCa. The PCa detection rates of 10-core and 12-core biopsies were 26.4% and 28.4%, respectively (P = .378). There was no difference in cancer detection rates according to PSA level in both groups. Comparing the cancer detection rates according to the prostate volume (< 40 mL and ≥ 40 mL), the patients with prostate volume ≥ 40 mL showed higher cancer detection rates in 12-core biopsy group (26.9%) compared with 10-core biopsy group (16.4%) (P < .05). CONCLUSION: The overall cancer detection rates showed no differences in both groups. But the 12-core biopsy was a more efficient method in men with a prostate volume of  ≥ 40 mL, compared to the 10-core biopsy.

PURPOSE: To compare sexual function between two groups of women who had normal vaginal delivery (NVD) and planned cesarean section (PCS). MATERIALS AND METHODS: In this cross-sectional study, two groups of healthy women, with antenatally normal singleton pregnancies at term, who underwent NVD (n = 114) or PCS without labor (n = 99), have been retrospectively studied. Sexual function of participants was assessed using physician-administered Female Sexual Function Index (FSFI) questionnaire before pregnancy and 6 and 24 months after delivery. Primary outcome measures were questions 3 to 6 and 14 to 16 from FSFI questionnaire. Secondary outcome measures included the remaining items. RESULTS: There were no significant differences regarding six domains of sexual function, including desire (P = .55), arousal (P = .39), lubrication (P = .45), orgasm (P = .36), pain (P = .74), and satisfaction (P = .39) between the two groups. Eighty percent of women who had undergone vaginal delivery complained from hypotonic pelvic floor muscles. CONCLUSION: We believe that PCS is not preferred to NVD in regard to preserving normal sexual functioning.

PURPOSE: To evaluate the effects of varicocelectomy on semen parameters, pregnancy rates, and live birth in couples with first term recurrent miscarriage. MATERIALS AND METHODS: One hundred and thirty-six women with recurrent miscarriage were recruited into this study. All of the husbands had normal semen parameters according to World Health Organization criteria and clinical varicocele. In order to evaluate the causes of recurrent pregnancy loss, we looked for chromosomal abnormalities and endocrine, chronic inflammatory, and infectious diseases. Both groups were well matched according to male/female age, varicocele grade, and smoking history. These couples were assigned randomly into two groups: group one (n = 68), in which male partners underwent varicocele repair, and group two (n = 68), which underwent expectant therapy. All of the couples were followed up monthly up to 12 months. All of the women who conceived were followed up until delivery. In each 3-month follow-up visits, two semen analyses were performed. RESULTS: Mean sperm concentration, sperm progressive motility, and sperm with normal morphology improved significantly after elapsing 6 months from varicocelectomy by 75.0%, 15.9%, and 14.3%, respectively, versus the expectant group (P < .01). The overall pregnancy rate was 44.1% and 19.1% within a 12-month period in groups 1 and 2, respectively (P = .003). Of women who conceived in groups 1 and 2, 13.3% and 69.2% developed miscarriage (P = .001). Sperm density/mL (r = 0.072; P = .001), time elapsed from varicocelectomy (r = 0.068; P = .001), and female age (r = -0.062; P = .002) were three most significantly related independent factors to pregnancy rate by multiple regression analysis. CONCLUSION: Varicocelectomy improves semen quality, increases pregnancy rate, and decreases miscarriage rate significantly. Further controlled studies to confirm our results seem warranted.

PURPOSE: To describe the results of penile hypospadias repair using the Snodgrass method with buccal mucosa graft (BMG), supported by double dartos flap as a second layer. MATERIALS AND METHODS: In a prospective cohort study, 21 consecutive patients underwent hypospadias repair using the Snodgrass method and BMG as the urethral plate, with the addition of double dartos flap for covering the neourethra. Patients were followed up, and outcomes and complications were recorded. RESULTS: The mean age of the patients was 6.57 ± 3.69 years (range, 2 to 15 years) and the mean follow-up period was 8.42 ± 2.19 months (range, 6 to 12 months). The following minor complications, not requiring additional intervention, were recorded: 2 subjects developed slight chordee < 30 degrees; 2 developed wound infection; and 1 had meatal stenosis postoperatively. Only one patient required additional surgical intervention resulting in a success rate of 95%. No urethrocutaneous fistula occurred in our subjects. CONCLUSION: Fortifying a combination of BMG and Snodgrass method with double dartos flap decreases the rate of complication in hypospadias repair significantly.