Organochlorine and organophosphorus pesticides and bladder cancer: A case-control study.

BACKGROUND: Exposure to pesticides is associated with an increase in the incidence of cancer. We aimed to investigate the association of serum organochlorine pesticides (OCPs) and organophosphorus pesticides (OPs) levels and GSTM1/GSTT1 gene polymorphism with bladder cancer (BC). METHODS: This study was performed on 57 patients with BC and 30 controls (C). Acetylcholinesterase (AChE) activity, arylesterase activity of paraoxonase-1 (ARE), total antioxidant capacity (TAC), and malondialdehyde (MDA) levels were determined in serums of all participants. Genomic DNA was extracted using the salting out method and GSTM1/GSTT1 gene polymorphisms were examined by multiplex polymerase chain reaction assay. Measurement of OCPs (α-hexachlorocyclohexane [α-HCH], ß-HCH, γ-HCH, 2,4-dichlorodiphenyltrichloroethane [2,4-DDT], 4,4-DDT, 2,4- dichlorodiphenyldichloroethylene [2,4-DDE], and 4,4-DDE) in serum was carried out using an FID-equipped gas-chromatography system. RESULTS: AChE activity was significantly lower, ARE activity and TAC were declined but it was not statistically significant, however, α-HCH, γ-HCH, 4,4-DDE, 2,4-DDT, and 4,4-DDT pesticides, and MDA were significantly higher in BC patients compared with the control subjects. Also, a positive correlation was found between the number of smoked cigarettes and the years of smoking with BC development. There was no association between GSTM1/GSTT1 gene polymorphisms and OCPs in BC patients. CONCLUSION: Due to the higher levels of some OCPs in the BC patients, along with the reduction in AChE activity and increased MDA levels, it may be concluded that OCPs and OPs play an important role in the induction of BC in southeastern Iran.

The Therapeutic Effects of Intracavernosal Plaque Excision in Peyronie's Disease: A None Grafting or Tunical Excising Procedure.

BACKGROUND: Current surgical treatments in Peyronie's disease are accompanied by complications such as penile shortening, loss of sensation, erectile dysfunction and recurrence of disease. The aim of this study was the evaluation of clinical results of intracavernosal plaque excision in Peyronie's disease. METHODS: The operation was performed on 35 men. It was consisted of incising the tunica albuginea parallel to the plaque and through this incision, and the plaque was removed from the inside surface without excision or replacing the underlying tunica albuginea by grafts. All patients were evaluated before and periodically within 12 months after the surgery with measurement of penile length, curvature angle in the rigidity phase, and sexual satisfaction. RESULTS: The mean age of patients was 51.4±5.3 years (range 42-59 years). The angle of penile curvature was 25-45° (mean=35°). Thirty patients (86%) obtained a nearly complete straightening of penis. All patients restored their previous penile length without any disorder of sensation within the glans penis and expressed improvement of sexual activity. CONCLUSION: Intracavernosal plaque excision is a simple, easy and minimal invasive method that does not result in penile shortening, loss of sensation or erectile dysfunction. In properly selected patients, this technique can lead to acceptable elimination of penile curvature and sexual satisfaction.

Penile fracture and its treatment: is retrograde urethrograghy necessary for management of penile fracture?

OBJECTIVE: Penile fracture, being defined as rupture of the tunica albuginea of the corpus cavernosum, is uncommon. Here, we analyze findings on our patients during a 10-year period and evaluate the role of retrograde urethrography. METHODS: From February 2002 to April 2012, 116 patients were admitted with penile fracture at Ghaem Medical Center. Patient history and physical examination were taken at their admittance to detect probable urethral injury. Before surgery, retrograde urethrography was performed in all patients. The size and site of the tunical rupture were recorded. Then the rupture of tunica albuginea was sutured with nonabsorbable (3-0 nylon) sutures and the ties were placed on the internal surface (continuous method). All patients were followed up for 12 months. RESULTS: Patients' mean age was (32.78 ± 10.61) years and ranged (16-62) years. The mechanism of trauma was sexual intercourse in 103 patients (89%) and masturbation in 13 patients (11%). The most common site of injury found after exploration was right (55%) and lateral (74%) of the corpus cavernosum. The size of the tunical rupture was from 0.5 to 3.0 cm (mean 1.88 ± 0.72). Three of the patients had Marphan's syndrome. Urethral injury was detected by retrograde urethrography in 4 patients (3%) who had macroscopic hematuria and urethrorrhagia. During 12 months follow-up, no complication was seen. CONCLUSION: There is no need to perform retrograde urethrography unless the patients have gross hematuria or urethrorrhagia. The key to success in treatment of penile fracture is to achieve a rapid diagnosis based on history and a physical examination, avoid unnecessary imaging tests and perform immediate surgery to reconstruct the site of injury.

Nail penetrating trauma: a rare cause of vesicovaginal fistula.

Vesicovaginal fistula (VVF) may be caused by prolonged obstructed labor, gynecologic, urologic, or other pelvic surgery, malignancy, radiation, infection and trauma. Here we report a case of VVF caused by nail penetrating trauma in a young woman with genital bleeding after first intercourse. This is a rare etiology of VVF. We also explain the operative technique used to repair the fistula.

Bilateral laparoscopic gonadectomy in a patient with complete androgen insensitivity syndrome and bilateral sertoli-leydig cell tumor: a case report and brief review of the literature.

INTRODUCTION: Complete androgen insensitivity syndrome (previously called testicular feminization) is specified by a 46 XY karyotype and negative sex chromatin, bilateral undescended testes, female genitalia appearance, and lack of mullerian derivatives. CASE PRESENTATION: A 28-year-old woman with complete (severe) androgen resistance underwent prophylactic laparoscopic bilateral gonadectomy because of the eventually increased risk of gonadal malignancy. Although the gonads appeared grossly normal, microscopic examination revealed bilateral well differentiated sertoli-leydig cell tumor (SLCT). DISCUSSION: Our Medline search revealed that this is the first reported case of bilateral sertoli-leydig cell tumor (SLCT) in androgen insensitivity syndrome.

Angiofibroma of the vulva.

BACKGROUND: Cellular angiofibroma is a benign and rare tumor. It usually arises in middle-aged women and involves the vulva. Complete local excision of the tumor is the best cure, and, usually, there is no recurrence after surgery. CASE REPORT: We describe a 20-year-old woman with a painless, growing vulvar mass who presented about 3 years ago. Her past medical history was negative for oral contraceptives, tobacco, and alcohol, and there were no similar lesions in her family history. A physical examination revealed two masses on the right and the left labia majora and similar lesions on the left axilla and both breasts. An uncomplicated simple resection of the vulvar masses was done in the operating room. There was no evidence of recurrence 12 months after surgery. Histopathologic examination revealed that the findings were consistent with the diagnosis of the cellular angiofibroma. Based on our knowledge, this patient is the youngest case of vulvar angiofibroma. The lesions were large and symmetrical (on both labia majora), although they differed in size. Extravulvar (breast and axilla) lesions were also noteworthy in this patient.

Simultaneous right retroperitoneal schwannoma and left renal hydatid cyst.

Retroperitoneal schwannomas are quite rare tumors. Isolated renal hydatid cyst is also rare, and it forms 2-4% of hydatid disease. Because of their infrequent occurrence, nonspecific signs and symptoms, and lack of distinguishing radiologic features, we report herein a case of right retroperitoneal mass in a 26-year-old woman which was found to be benign schwannoma following a percutaneous core needle biopsy and a large cortical cyst in the lower pole of the left kidney which was diagnosed as isolated renal hydatid cyst following exploration.

Percutaneous treatment of bladder stones in children: 10 years experience, is blind access safe?

PURPOSE: Bladder stones are more commonly found in children from developing countries. Open cystolithotomy or transurethral cystolithalopaxy are the traditional treatments but a percutaneous approach has been advocated. We present our experience with percutaneous cystolithotomy in children with bladder stones without any ultrasonic or fluoroscopic guidance. MATERIALS AND METHOD: From April 2001 to October 2011, a total of 147 children (135 boys and 12 girls) with a mean (range) age of 4.07 (1-12.5) years underwent percutaneous cystolithotripsy (PCCL). The mean (range) stone diameter was 2.74 (0.8-5) cm. 138 children (94 %) had a solitary stone while nine (6 %) had more than one stone. The main component of the stones was calcium oxalate in 70 patients (48.6 %). RESULTS: All children were stone-free after one PCCL; no recurrent stones developed. The mean (range) PCCL procedure time was 29.6 (12 to 48) min and intraoperative blood loss was scant. Perioperative complications were few. The mean (range) hospital stay was 1.2 (1-3) days. CONCLUSIONS: Blind access PCCL (without any ultrasonic or fluoroscopic guidance) is a facile and safe approach for removing stones in the pediatric bladder stones. Advantages include the lack of ionizing radiation, no need for opacification by iodine contrast media and low relative cost. We recommend this minimally invasive technique for management of large bladder stones (larger than 1 cm) in children. To our knowledge, this is the largest single-center series reported on percutaneous cystolithotripsy of endemic bladder stones in children.