A case of splenogonadal fusion accompanied by accessory spleen in a 4-year-old boy.

Splenogonadal fusion (SGF) is a rare benign malformation in which spleen is aberrantly attached to the gonads or mesonephric derivatives. This entity often presents with scrotal mass, inguinal hernia, or cryptorchidism. Herein, we report our experience with a boy who presented with a scrotal enlargement which later turned out to be SGF. Moreover, an accessory spleen was unexpectedly found in the left inguinal canal. To the best of our knowledge, this is the first report of SGF and accessory spleen in the literature. Although rare, SGF should be included in the complete differential diagnosis list of scrotal masses, especially in children. The use of frozen section pathology if available would aid the surgeon in avoiding unnecessary orchiectomy in small testicular masses of benign origin.

Inter-observer agreement on varicoceles diagnosis among patients referred to Shiraz Namazi Hospital.

BACKGROUND: Varicocele is the collection of dilated veins of pampiniform plexus which is the most common cause of infertility occurred in 35-40% of infertile men. Despite all the diagnostic tools exist for varicocele diagnosis; still, a physical examination is the first step. OBJECTIVE: This study was done to determine the inter-observer agreement on varicoceles diagnosis. MATERIALS AND METHODS: In this cross-sectional study, two expert examiners evaluated 93 men with infertility, scrotal pain, and enlarged scrotum for the presence of varicocele. The urologists examined patients independently in two separate rooms. The inter-observer agreement on varicocele grading analyzed by the Spearman Rho correlation coefficient. RESULTS: The grading of varicocele were similar in 34 (36.5%) and 59 (63.4%) cases in the left and right side, respectively with correlation coefficient of 0.65 (0.51-0.75) and 0.25 (0.04-0.43), respectively. It implies that inter-observer agreement was substantial for left varicocele assessment and moderate for right varicocele assessment. CONCLUSION: Physical exam is the essential diagnostic tool for varicocele. As long as the observers educated with the same standard method the disagreements reduced to the negligible extent.

The frequency of follicle stimulating hormone receptor gene polymorphisms in Iranian infertile men with azoospermia.

BACKGROUND: Azoospermia is the medical condition of a man not having any measurable level of sperm in his semen. Follicle stimulating hormone (FSH) is a member of the glycoprotein hormone family that plays an important role in human reproduction because of its essential role in normal spermatogenesis. Various Single Nucleotide Polymorphisms (SNPs) have been reported within FSH receptor (FSHR) gene that may affect the receptor function. OBJECTIVE: The present study aimed to investigate the correlation between two FSHR SNPs at positions A919G, A2039G, and susceptibility to azoospermia in a group of Iranian azoospermic men. The association between FSH levels within the sera and A919G and A2039G alleles and genotypes were also investigated. MATERIALS AND METHODS: This case control study was performed on 212 men with azoospermia (126 non-obstructive and 86 obstructive) and 200 healthy Iranian men. Two FSHR gene SNPs were genotyped using PCR-RFLP method. The relationship between FSH levels within the sera and A919G and A2039G alleles and genotypes were also investigated. RESULTS: Statistical analysis indicated that at A919G position, AA genotype and A allele were more frequent in obstructive azoospermia cases compared to non-obstructive or normal men (p=0.001). Regarding A2039G polymorphisms, no significant difference was observed between both azoospermia groups and the controls. The mean level of serum FSH was higher in the non-obstructive men compared to the obstructive patients (23.8 versus 13.8, respectively, p= 0.04). CONCLUSION: The results of the present study indicated that the genetic polymorphisms in the FSHR gene might increase the susceptibility to azoospermia in Iranian men.

Pregabalin role in inhibition of morphine analgesic tolerance and physical dependency in rats.

Pregabalin is recently proposed as analgesic or adjuvant in pain management. While previous preclinical investigations have evaluated pregabalin-opioid interactions, the effect of pregabalin on opioid tolerance and dependency has not yet been studied. Here we evaluated the effects of different doses of pregabalin (50, 100 and 200mg/kg, s.c.) on morphine-induced tolerance and dependency in rats. Adult male Wistar rats were rendered tolerant to analgesic effect of morphine by injection of morphine (10mg/kg, s.c.) twice daily for 7 days. To develop morphine dependence, rats were given escalating doses of morphine. To determine the effect of pregabalin on the development of morphine tolerance and dependence, different doses of pregabalin were administrated before morphine. The tail-flick and naloxone precipitation withdrawal tests were used to evaluate the degree of tolerance and dependence, respectively. Chronic morphine-injected rats showed significant decrements in the percentage maximum possible effect (%MPE) of morphine on the days 5 and 7 (32.5%±3.5, 21.5%±4, respectively) compared to the first day (100%) which showed morphine tolerance. Pregabalin 200mg/kg completely prevented the development of morphine tolerance. In addition, concomitant treatment of morphine with pregabalin attenuated almost all of the naloxone-induced withdrawal signs which include weight loss, jumping, penis licking, teeth chattering, wet dog shakes, rearing, standing, sniffing, face grooming and paw tremor. These data show that pregabaline has a potential anti-tolerant/anti-dependence property against chronic usage of morphine. Therefore, pregabalin appears to be a promising candidate for the treatment of opioid addiction after confirming by future clinical studies.

Success rate and patients' satisfaction following intradetrusor dysport injection in patients with detrusor overactivity: a comparative study of idiopathic and neurogenic types of detrusor overactivity.

PURPOSE: To evaluate the efficacy of intradetrusor Dysport (a type of botulinum toxin type A) injection in patients with idiopathic or neurogenic detrusor overactivity, who were refractory to antimuscarinic drugs, and to compare the efficacy of Dysport injection in both groups. MATERIALS AND METHODS: Twelve patients with neurogenic detrusor overactivity (NDO) and 18 patients with idiopathic detrusor overactivity (IDO) participated in this study. All the patients received intravesical injection of 500 units of Dysport. They were followed up for 3 months after injection with maximum cystometric capacity, maximum detrusor filling pressure, and number of catheterization or pad usage. RESULTS: After 3 months, the mean maximum cystometric capacity increased from 109.36 ± 24.11 mL to 266.81 ± 97.18 mL (P = .000) in the NDO group and from 192.24 ± 36.21 mL to 272.61 ± 63.37 mL (P = .000) in the IDO group. The mean maximum detrusor filling pressure decreased from 48.14 ± 26.51 cmH2O to 28.91 ± 9.01 cmH2O (P = .005) in the NDO group and from 39.22 ± 9.92 cmH2O to 29.64 ± 10.14 cmH2O (P = .003) in the IDO group. CONCLUSION: Intradetrusor Dysport injection improved urodynamic parameters and quality of life (QoL) in both groups significantly. We did not find significant difference in QoL or urodynamic parameters between both groups.

Clitoromegaly caused by cavernous hemangioma: A rare case report and review of the literature.

Hemangioma is a common benign neoplasm, but a location such as the clitoris is very rare. However, it is very important to differentiate clitoral hemangioma from enlargement of the clitoris secondary to androgen excess. To the best of our knowledge, only three cases of clitoromegaly caused by cavernous hemangioma have been reported in the English literature. Herein, we report our experience with a 16-year-old girl who presented with clitoromegaly and normal hormonal assay that turned out to be clitoral cavernous hemangioma after pathologic examination of the clitoral mass.

Intrascrotal solitary neurofibroma: A case report and review of the literature.

Solitary Neurofibroma of the scrotum is an extremely rare benign tumor, particularly when it is not associated with neurofibromatosis type I. To the best of our knowledge, less than 10 cases have been reported in the English literature. Herein, we report a 52-year-old man with the diagnosis of scrotal solitary neurofibroma.

Detection of recurrent bladder cancer: NMP22 test or urine cytology?

PURPOSE: To assess the accuracy of voided urine cytology versus urinary nuclear matrix protein 22 (NMP22) qualitative assay in the diagnosis of various grades and stages of recurrent bladder transitional cell carcinoma (TCC). MATERIALS AND METHODS: From July 2007 to February 2009, all patients with history of superficial bladder TCC were included in this multi-center study. Each patient provided three serial voided urine samples for cytologic examination and one sample for the NMP22 qualitative assay prior to urethrocystoscopy. The sensitivity and specificity of urine cytology and the NMP22 test were determined. RESULTS: The sensitivities of the NMP22 test and cytology for detection of recurrence were 78.8% and 44.2%, respectively (P = .001), while the specificities were 69.6% and 83.7%, respectively (P = .019). The NMP22 test showed significantly higher sensitivity than cytology in detecting recurrences in low-risk and intermediate-risk groups. CONCLUSION: The NMP22 assay could be used for detection of superficial bladder cancer, especially in low- and intermediate-risk groups; however, the value of the test is limited by its low specificity.

Renal parenchymal damage after percutaneous nephrolithotomy with one-stage tract dilation technique: a randomized clinical trial.

PURPOSE: To compare the effects of one-stage vs gradual dilation techniques during percutaneous nephrolithotomy (PCNL) on postoperative renal scar formation and overall renal function. PATIENTS AND METHODS: Of 152 adult patients who underwent surgery during the study period, 48 were randomized into two groups. In group 1 (n=19), gradual tract dilation with Alken metallic dilators was used, and in group 2 (n=29), one-stage tract dilation was used. We compared patient demographics, intraoperative and preoperative parameters, postoperative overall renal function, and renal scar formation on the target renal pole. RESULTS: Access time (P=0.001; 95% confidence interval [CI]: 3.19-6.30) and radiation exposure during access (P=0.03; 95% CI: 0.03-0.66) were significantly shorter in group 2. In group 1, the decrease in mean technetium-99m dimercaptosuccinic acid (99m-Tc DMSA) uptake from 44.1±20.1% to 43.4±19.6% 4 weeks postoperatively (-0.7%±0.5%; P=0.27; 95% CI: -0.56-1.93) was not significant. In group 2, however, there was a significant decrease in post-PCNL 99m-Tc DMSA uptake 2 (-2.4±0.3%, from 50.1±13.5% to 47.7±13.8%; P=0.001; 95% CI: 1.13-3.66). Four weeks after surgery, new scar formation or progression of the preoperative scar at the site of access were seen in 14 of 29 (48.3%) patients who were treated with one-stage dilation whereas only 2 of 19 (11.0%) patients who were treated with gradual dilation developed new scarring at the access site (P=0.007). CONCLUSION: Although the one-stage tract dilation technique reduced radiation exposure and access time, in the short term, it may cause more parenchymal damage than the gradual dilation technique.

Epidemiology of erectile dysfunction in hemodialysis patients using IIEF questionnaire.

Erectile dysfunction (ED) is defined as the inability to attain or maintain an erection sufficient for satisfactory sexual performance. This cross-sectional study was conducted on patients on hemodialysis (HD) in Shiraz, Iran, using the International Index of Erectile Dysfunction questionnaire for determination of the frequency and severity of ED in these patients. We used the Chi-square, Mann-Whitney, Kruskal-Wallis and Pearson's correlation coefficient tests for statis-tical analysis. A total of 73 patients were enrolled into this study. The mean score of ED was 10.3 ± 6.3 (total score 25). The prevalence of ED of various degrees was 87.7%. There was a significant correlation between different degrees of ED and age (P = 0.002); it was significantly higher in patients older than 50 years (P = 0.005). Also, ED was more common in patients whose Kt/V was <1.2 (P = 0.04). Our study suggests that ED is a major health concern in patients on HD. Improvement of ED may improve their quality of life. Our results can give the basic data for future research in this field.

In situ reversed ileocystoplasty for less invasive augmentation cystoplasty: an experimental study.

PURPOSE: To evaluate the application of a reversed intact ileal patch for augmentation cystoplasty in terms of improvements in bladder urodynamics and to eliminate the need for bowel anastomosis in an experimental model. METHODS: 12 cross-bred adult dogs were used for reversed seromuscular ileocystoplasty with intact bowel segment. The procedure was comprised of selecting a 7- to 10-cm ileal loop from about 20 cm proximal to the ileocecal valve. The seromuscular layer of the ileal loop from its antimesenteric aspect was sutured to the bladder mucosa of the previously bivalved bladder with running stitches. RESULTS: 10 animals survived and completed their 4-week follow-up period. Postoperative urodynamic study revealed a 26% increase of mean maximal cystometric capacity [from 226 to 285 ml (p = 0.002)] and a significant increase in mean bladder compliance [from 11.8 to 17.8 ml/cm H(2)O (p = 0.002)]. Mean maximal detrusor filling pressure decreased significantly from 20 to 16.1 cm H(2)O (p = 0.011). Histopathologic examination of the augmented bladder showed complete epithelialization of the serosal surface of ileum with layers of transitional urothelium. CONCLUSIONS: The early results of this less invasive technique were promising in terms of improvements in bladder urodynamic variables and growth of transitional urothelium. Longer follow-up is necessary to show the durability of these effects.

Preventive role of exogenous testosterone on cisplatin-induced gonadal toxicity: an experimental placebo-controlled prospective trial.

OBJECTIVE: To test the preventive role of exogenous T on spermatogenesis after cisplatin chemotherapy. DESIGN: Placebo-controlled study. SETTING: The animal laboratory of a medical university. ANIMAL(S): Eighty-eight male BALB/c mice were divided into three groups; each group was subdivided into four groups. INTERVENTION(S): Subgroups a received two or three cycles of cisplatin (2.5 mg/kg for 5 days + 16 days of recovery), subgroups b received the same chemotherapy regimen with adjuvant high-dose T enanthate (5 mg/100 g body weight) starting 1 week before chemotherapy and repeated every 21 days during chemotherapy, subgroups c received only high-dose T enanthate at the same dosage and intervals; subgroups d received a placebo. MAIN OUTCOME MEASURE(S): Testis spermatogenesis function was evaluated after 35 days (short term, group I) or 105 days (long term, groups II and III) of recovery, after the final dose of cisplatin, by histopathology and sperm count. RESULT(S): Testis tissue destruction and a significant dose-dependent decrease in spermatogenesis were identified in subgroups a. Both recovered partially during long-term recovery. Exogenous high-dose T caused damage to spermatogenesis, which was reversible (subgroups c). Adjuvant treatment with T had no additive long-term effect in animals treated with low-dose cisplatin (two cycles). However, a significant long-term preventive effect of T was seen in animals receiving high-dose cisplatin (three cycles). CONCLUSION(S): Hormonal intervention with exogenous T during chemotherapy had promising effects on spermatogenesis in mice receiving high-dose chemotherapy (regimens frequently used clinically). It had no additive long-term effects in animals receiving low-dose regimens.

Hybrid natural orifice transluminal endoscopic surgery for nephrectomy with standard laparoscopic instruments: experience in a canine model.

OBJECTIVE: The aim of this study was to demonstrate the feasibility of hybrid natural orifice transluminal endoscopic surgery (NOTES) nephrectomy with standard laparoscopic instruments through a modified vaginal trocar in a canine model. MATERIALS AND METHODS: Ten cross-bred adult female dogs were used for right (n = 4) and left (n = 6) transvaginal nephrectomy. After transumbilical peritoneoscopy, a laparoscopic transvaginal trocar was introduced through the posterior vaginal fornix under direct vision. Using a 10-mm working laparoscope lens with a 3-mm working channel as endovision via the umbilical port and the transvaginal port, triangulation and dissection of the kidney and its hilum were performed. The renal artery and vein were closed with Hem-o-lok clips transvaginally. At the end of the procedure, after snaring the kidney in an endobag, the specimen was retrieved through a colpotomy incision by extending the vaginal port site. RESULTS: All procedures were completed without need for conversion. The mean operative time was 101 minutes (75-135 minutes). The mean preoperative/postoperative hemoglobin was 12.01/11.7 g/dL and intraoperative blood loss was minimal. The mean size of the removed kidneys was 9.1 x 5.1 cm and the mean weight was 98.5 g (90-115 g). Exploration of the abdomen and vagina after 1 month showed complete healing of the colpotomy incision with no visceral injury. There were no significant adhesions or fibrotic changes in the renal fossa. CONCLUSION: Hybrid NOTES nephrectomy is technically feasible in canine model with a standard laparoscopic setup and instruments. This study may remove barriers for further investigational work with NOTES technique, especially with a view to adapting it for use in low-resource centers, while offering a strategy to help surgeons train with this novel technology.

Application of appendicular-based cecal flap for less invasive augmentation cystoplasty: a novel technique.

OBJECTIVES: To evaluate the use of a new modified technique for augmentation cystoplasty on selected cases, both in terms of improvements in bladder urodynamics and creating an ideal conduit for clean intermittent catheterization. METHODS: Ten patients suffering from intractable low-compliance bladder and reasonable capacity underwent appendicular-based cecal flap augmentation cystoplasty. The procedure comprised the isolation of a 10 to 12 x 3 to 5-cm cecal flap on the base of the appendicular pedicle, by which the bladder was augmented and the appendix was brought out through the abdominal wall for catheterization. Without any bowel anastomosis, the cecal anterior wall was repaired. RESULTS: After a mean follow-up of 23.8 months, 9 of 10 patients became continent. Postoperative urodynamic study revealed a 53.8% increase in mean maximal cystometric capacity (from 171.4 to 263.7 ml; p = 0.012) and a 7.7-fold increase in mean bladder compliance (from 3.39 to 26.66 ml/cm H(2)O; p = 0.012). Mean maximal detrusor filling pressure decreased by 79% (from 62.2 to 13 cm H(2)O; p = 0.012). Renal function remained stable in all patients. Appendicular stoma was easy to catheterize, and no stomal stenosis occurred during the follow-up period. CONCLUSIONS: Early results of this less invasive technique could be promising in patients with high filling pressure and acceptable maximum bladder capacity.

Evaluation of plasma interleukin-8 concentration in patients with prostate cancer and benign prostate hyperplasia.

BACKGROUND: Prostate specific antigen (PSA) has been used as a screening test for the early detection of prostate cancer (PC) for many years. Although the introduction of PSA test led to a considerable increase in reported prostate cancer cases, there is still some controversy over the sensitivity and specificity of this marker in distinguishing PC patients from those with benign prostate hyperplasia (BPH), the most common benign prostate condition. OBJECTIVE: An attempt is made to elucidate if the plasma level of Interleukin 8 (IL-8) could be used effectively as a marker for the detection of prostate cancer. METHODS: Plasma levels of IL-8 and PSA were measured in two groups of 40 BPH and PC patients using enzyme-linked immunosorbent (ELISA) and radioimmunoassay (RIA) techniques, respectively. In addition IL-8 levels in PC3 and DU145 cell line supernatants were measured by ELISA technique. RESULTS: The concentration of IL-8 in the plasma of PC patients was not significantly higher than the BPH subjects. Although, a correlation between plasma IL-8 concentration and the Gleason score of PC patients was found, no indicated correlation was detected between the concentration of IL-8 or PSA and age of the patients in both groups. DU145 and PC3 cell lines produced and secreted IL-8 in the media. CONCLUSION: Data of this investigation collectively conclude no correlation between IL-8 concentration in PC and BPH patients.

Application of amniotic membrane as xenograft for urethroplasty in rabbit.

OBJECTIVES: Uroepithelium repair has always been the subject of discussion in urology surgeries. Using human amniotic membrane allograft has already proved to be useful in other fields. In this study, we use amniotic membrane to repair uroepithelium injuries in rabbits. METHODS: Twenty healthy rabbits underwent surgery to induce a 10-mm incision, 10 mm from the meatus on ventral part of the urethra. Then a 5 x 10 mm patch of amniotic membrane was sutured to the incised urethra. All of the rabbits were catheterized for a week and then the patches were removed. The rabbits were studied for a month for any signs of infection and fistula formation. RESULTS: All samples revealed complete re-epithelialization of reconstructed urethra by transitional epithelium. There was one case of infection and following fistula (5%). There were two cases of urethral strictures (10%). CONCLUSION: The result from this study suggests that amniotic membrane is an inexpensive, easy, and biodegradable graft with very little antigen effect which seems to be the ideal solution for urethroplasty.

Early results of a new open surgical technique for treatment of uretero-pelvic junction obstruction.

OBJECTIVE: Here we report our initial experience with a new open surgical technique for treating uretero-pelvic junction obstruction (UPJO). METHODS: One centimeter distal to the site of the uretero-pelvic junction (UPJ) stenosis, a longitudinal incision of about 15 mm was made over the lateral side of the ureter. The renal pelvis was evacuated. Simultaneously, an oblique incision was made over the posterior and anterior walls of the renal pelvis. The most dependent point over the renal pelvis was sutured to the distal end of the ureterotomy incision. The anterior edge of the pyelotomy incision was anastomosed to the anterior edge of the ureterotomy incision and the posterior edge was anastomosed to the posterior edge of the ureterotomy incision. When the pyeloplasty was completed, the UPJ, accompanied by the proximal 1 cm of the ureter and excessive parts of the renal pelvis, was excised. RESULTS: In 21 (92%) out of 23 patients, the surgical technique was successful. CONCLUSIONS: This technique results in predictably good outcomes and has the advantages of the dismembered method. It seems to be a valuable alternative treatment for UPJO.

Can thymic tissue induce tolerance to kidney allografts?

INTRODUCTION: The aim of this study was to investigate the beneficial effect of donor thymic tissue to induce tolerance in thymokidney allografts, transplanted to thymectomized cross-bred canines. MATERIALS AND METHODS: Seven pairs of transplant donors and recipients were selected from 3- to 4-month-old cross-bred canines with major histocompatibility complex (MHC) mismatches. Recipients underwent partial thymectomy 4 weeks before transplantation and received an autologous thymic graft under the renal capsule, which had been engrafted in the donors 3 months before transplantation (thymokidney). Successful engraftment with evidence of thymocyte development in the donors was determined by gross and histologic examination at the time of transplantation. Biopsy specimens were obtained at the transplant day and 3 months after transplantation and were studied histologically for evidence of hyperacute or acute rejection. RESULTS: At 90 days after the operation, all 7 juvenile thymic grafts had developed with normal thymic structure under the renal capsule. Hyperacute rejection was not observed in allografts, and all of them were functioning until the end of follow-up; however, all of the allografts showed acute cell-mediated rejection 3 months after transplantation. CONCLUSION: No tolerance was induced by vascularized donor thymokidneys in MHC-mismatched canines. The advantages of tolerance over chronic immunosuppression are so great that a potentially tolerogenic approach such as thymic transplantation would seem worthy of further investigations on large animal models. To evaluate the beneficial effects of thymic tissue in tolerance induction, utilizing a short course, low-dose adjuvant immunosuppressant to this regimen and/or application of in-bred MHC-matched canines is suggested.