Effects of L-Carnitine and Coenzyme Q10 Supplementation on Lower Urinary Tract Symptoms in Men with Benign Prostatic Hyperplasia: A Randomized, Controlled, Clinical Trial.

The prevalence of benign prostatic hyperplasia (BPH) and its associated lower urinary tract symptoms (LUTS) increases with age. Considering that BPH drug treatment is associated with complications, this study aimed to investigate the effects of L-carnitine (LC) and Coenzyme Q10 (CoQ10) supplementation as an adjunct therapy to finasteride in the management of LUTS in older men affected with BPH. Fifty eligible volunteers (25 per group) were randomly assigned to either intervention (finasteride + LC and CoQ10 supplements) or control (finasteride + placebo) groups. International prostate symptom score (IPSS), international index of erectile function (IIEF), quality of life index (QoL), as well as serum levels of Prostate-specific antigen (PSA), were assessed. Prostate ultrasound evaluation was also performed, before and after 8 wk of intervention. Supplementation with LC and CoQ10 led to a significant decrease in prostate volume (p < 0.001) as well as a significant increase in IIEF (p < 0.001), compared to the control group. However, there were no significant between-group differences in IPSS (p = 0.503), QoL scores (p = 0.339), and PSA levels (p = 0.482). CoQ10 and LC supplements might be beneficial in combination with standard therapies in the management of BPH and its related complications.

An Investigation of the Pathology Report of Bladder Cancer Patients with Radical Cystectomy in Southern Iran, 2013-2018: A Cross-Sectional Study.

Background: The oncological outcomes of bladder cancer are directly associated with disease pathology and surgical technique. Therefore, we investigated the pathologic factors of radical cystectomy (RC) specimens. Methods: In this retrospective study, 365 patients who underwent RC between March 2013 to March 2018 in hospitals affiliated to Shiraz University were enrolled. The patients' clinicopathological parameters, such as tumor type, tumor grade, carcinoma in situ, lymph node (LN) involvement, lymphovascular invasion (LVI), perineural invasion (PNI), and age, were recorded from their pathology reports. For comparison of variables, an independent t test was used. P < 0.05 was regarded as significant. The statistical software SPSS version 22 was used to examine the data. Results: The participants' mean age was 64.52 ± 11.54 years, and 320 (87.7%) patients were men and 45 (12.3%) were women. The mean dissected LN was 9.69 ± 8.70 nodes and 1.06 ±3.49 of the dissected LNs were involved by tumor. PNI and perivesical invasion were presented in 148 (40.5%) and 96 (26.3%) patients, respectively. Ureteral, urethral, and prostate involvements were seen in 23 (6.3%), 50 (13.7%), and 66 (18.1%) patients. Most patients had pathologic tumor stage 2 (36.4%). Factors such as LVI, PNI, perivesical invasion, and prostate involvement, were strongly correlated with positive LN (P ≤ 0.05). Conclusion: The examination of the RC specimen is critical for patient care, outcome, and justification of adjuvant therapy. Factors such as LVI, perineural invasion, perivesical invasion, and prostate involvement were strongly correlated with positive LN.

Renal capsule for augmentation cystoplasty in canine model: a favorable biomaterial?

PURPOSE: To evaluate effectiveness of canine renal capsule for augmentation cystoplasty. MATERIALS AND METHODS: Ten adult dogs participated in this study. After induction of anesthesia each animal underwent bed side urodynamic study, bladder capacity and bladder pressure was recorded. Then via mid line incision abdominal cavity was entered, right kidney was identified and its capsule was dissected. Bladder augmentation was done by anastomosing the renal capsule to the bladder. After 6 months bed side urodynamic study was performed again and changes in bladder volume and pressure were recorded. Then the animals were sacrificed and the augmented bladders were sent for histopathology evaluation. RESULTS: Mean maximum anatomic bladder capacity before cystoplasty was 334.00±11.40cc which increased to 488.00±14.83cc post-operatively (p=0.039). Mean anatomic bladder pressure before cystoplasty was 19.00±1.58cmH2O which decreased to 12.60±1.14cmH2O post-operatively (p=0.039). Histopathology evaluation revealed epithelialization of the renal capsule with urothelium without evidence of fibrosis, collagen deposits or contracture. CONCLUSIONS: Our data shows that renal capsule is a favorable biomaterial for bladder augmentation in a canine model.

Intrarenal epidermoid cyst mimicking a cystic renal cell carcinoma: A case report and review of literature.

Key Clinical Message: This case highlights the diagnostic pitfalls that can occur when evaluating complex cystic renal masses. Distinguishing epidermoid cysts from renal cell carcinoma is difficult but imperative to guide conservative management when appropriate, avoiding unnecessary nephrectomy. Abstract: Renal epidermoid cysts are extremely rare, with only 12 cases reported in the literature. Their radiographic features often resemble cystic renal cell carcinoma, frequently prompting unnecessary nephrectomy. A 64-year-old man with a history of nephrolithiasis presented with left flank pain and hematuria. Imaging revealed a complex cystic renal mass suspicious for renal cell carcinoma. Following left radical nephrectomy, histopathology examination revealed a benign epidermoid cyst. Renal presentation of epidermoid cyst poses unique diagnostic and therapeutic challenges. Possible pathogenesis includes ectopic epidermal implantation during embryogenesis or squamous metaplasia following chronic irritation or deficiency. Radiographic distinction from concerning entities like renal cell carcinoma is difficult but imperative to avoid extensive surgery. This case highlights the diagnostic pitfalls and management considerations for renal epidermoid cysts. Additional study of clinical and imaging factors that distinguish epidermoid cysts from renal cell carcinoma can guide conservative management when appropriate, avoiding unnecessary nephrectomy for benign disease.

Ureterocalicostomy Using Native Ureter in an Allograft Kidney: A Case Report.

Ureteral obstruction is the most common complication of renal transplant. It is managed through minimal invasive procedures or open surgeries. Herein, we report the procedure and clinical outcomes of a case of ureterocalicostomy with lower pole nephrectomy in a patient with extensive ureteral stricture after renal transplant. Based on our search, there are 4 cases of ureterocalicostomy in allograft kidney in the literature, and only 1 of these included the application of partial nephrectomy. We offer this rarely applied option for those cases with extensive allograft ureteral stricture and very small, contracted, and intrarenal pelvis.

Distal ureteral calculi in a patient with ileal conduit and urinary diversion treated via antegrade ureteroscopic lithotripsy: A case report.

Ureteral calculi management in patients with urinary diversion is challenging for most urologists. The surgeon should consider the patient's diversion type, BMI, stone size and location, and his/her experience with the procedure. We report an 85-year-old ileal conduit diversion man presented with ureteral calculi and treated via antegrade ureteroscopic lithotripsy.

The effect of retroperitonealization of ureteroileal anastomosis on perioperative complications of radical cystectomy with ileal conduit urinary diversion.

BACKGROUND: Radical cystectomy (RC) has been considered the standard management of muscle-invasive bladder cancer. Despite the improvements in surgical techniques and perioperative care, RC is still associated with high perioperative morbidity and mortality. OBJECTIVE: This study aims to evaluate the effect of retroperitonealization of ureteroileal anastomosis on perioperative complications of RC with ileal conduit urinary diversion. PATIENTS AND METHODS: This is a retrospective cohort study. We reviewed medical charts of 876 patients who underwent RC between 2016 and 2021. Based on the inclusion and exclusion criteria, 748 patients entered the study. According to retroperitonealization of the ureteroileal anastomosis, patients were categorized into two groups (group I without retroperitonealization of the ureteroileal anastomosis and group II with retroperitonealization of the ureteroileal anastomosis). Patients' characteristics and occurrences of any complications and high-grade complications were compared between these groups. RESULTS: In comparing the complication categories between the two groups, fewer patients in group II suffered from gastrointestinal, urinary, and cardiac events (p values were 0.018, 0.021, and 0.013, respectively). Moreover, fewer patients in group II experienced any complications and high-grade complications (p values were < 0.001 and < 0.001, respectively). The length of hospital stay was also significantly shorter in group II (p < 0.001). CONCLUSIONS: RC is associated with comparatively high perioperative morbidity and mortality. In the present study, 61% of the patients experienced at least one complication postoperatively. Retroperitonealization of the ureterointestinal anastomosis may decrease perioperative adverse events of RC with ileal conduit urinary diversion.

Pelvic retroperitoneal pleomorphic hyalinizing angiectatic tumor: A case report and review of literature.

Pleomorphic hyalinizing angiectatic tumor (PHAT) is a rare tumor of the soft tissue, usually located in lower extremities. There are rarely tumors reported in other anatomic locations. Herein, we report retroperitoneal PHAT in a male patient. A 41-year-old man was referred to our clinic due to an incidentally found retroperitoneal mass. Computed tomography (CT) scan showed a solid hypoechoic lesion containing fat component and calcified elements measuring about 80*72*45 mm in the right lower quadrant (RLQ) of the abdomen. Magnetic resonance imaging (MRI) showed circumscribe lesion measuring about 60 x 48 mm with partial enhancement and fat component. In pelvic exploration, a large mass was found that had encased the right external iliac artery and vein. Therefore, the mass and its surrounding iliac vessels were excised and removed en block. Then, the external iliac vessels were reconstructed with Gortex graft. No recurrence was found in 1 month and 3 months post-operation follow up. We report a pelvic retroperitoneal PHAT as a rare location of this tumor. It seems that PHAT must be considered in differential diagnosis in patients with soft tissue tumors in the pelvic cavity.

Mini-percutaneous nephrolithotomy via ultrasound guidance in transplanted kidney: a report of two cases.

Urolithiasis is a rare but familiar problem in transplanted kidney patients, with a prevalence rate between 0.23-6.3%. Minimally invasive percutaneous nephrolithotomy (mini-PCNL) is a revised technique that uses a miniature endoscope through a small access sheath and is associated with minor bleeding risk. Only a few cases of mini-PCNL via ultrasonography (US) guidance in transplanted kidneys have been published. We present a 23-year-old female and a 34-year-old man who presented with obstructive uropathy due to impacted stones in their transplanted kidneys. Firstly, the nephrostomy tube was inserted. Then, they underwent mini-PCNL via US guidance. Puncturing the pyelocaliceal system was achieved via a 3.5 MHz US probe. Procedures were performed with a one-shot dilatation technique and a 15-Fr rigid nephroscope. In conclusion, we suggest that if an experienced urologist performs it, the US-guided mini-PCNL is safe and effective in patients with transplanted kidneys.

Retroperitoneal mass, a rare manifestation of mucinous adenocarcinoma of appendix: A case report.

The retroperitoneum (RP) might be affected by a variety of infections, inflammations, and tumors, including benign and malignant ones. Although primary malignant tumors are the most prevalent ones in this anatomic area, metastatic and invasive tumors rarely involve the retroperitoneum. Gastrointestinal stromal tumors (GISTs) are considered as the most common tumors that invade the retroperitoneum, but, to the best of our knowledge, it is the first time a surgery team has encountered the appendiceal tumor as a huge retroperitoneal mass. A 68-year-old man was referred to the emergency department with abdominal distension and weight loss. In his course of hospitalization, a huge right retroperitoneal mass was detected by a computed tomography (CT) scan; after that, the patient underwent laparotomy, evacuation of massive mucinous tissue located in the right retroperitoneum, and right hemicolectomy due to appendiceal tumor. The histopathological examination showed "mucinous appendiceal neoplasm." This is the first case study showing the invasion of an appendiceal tumor through the visceral peritoneum into the retroperitoneum, so an invasion of the peritoneal tumor to the retroperitoneum should be considered when a urologist approaches retroperitoneal masses.

Is COVID-19 a risk factor for progression of benign prostatic hyperplasia and exacerbation of its related symptoms?: a systematic review.

BACKGROUND: To explore the potential mechanisms of SARS-CoV-2 in targeting the prostate gland, leading to exacerbation of benign prostatic hyperplasia (BPH) symptoms and greater risks of BPH complications such as acute urinary retention. METHODS: A categorized and comprehensive search in the literature has been conducted by 10 April 2021 using international databases including PubMed, Embase, Web of Science, Scopus, and Cochrane Library in line with the PRISMA guidelines recommendations. PICO strategy was used to formulate the research question. The following terms were used: urology, COVID-19, coronavirus, BPH, inflammation, androgen receptors, LUTS, IPSS, PSA, and SARS-CoV-2 or a combination of them. Studies with irrelevant purposes and duplicates were excluded. The selected studies were performed on humans and published in English. RESULTS: The research revealed 89 articles. After title screening and considering exclusion criteria, 52 papers were included for the systematic review. BPH is a common condition affecting older men. SARS-CoV-2 infects the host cell by binding to angiotensin converting enzyme 2 (ACE2). A hyperactivated RAS system during infection with SARS-CoV-2 may lead to activation of pro-inflammatory pathways and increased cytokine release. Thus, this virus can lead to exacerbation of lower urinary tract symptoms (LUTS) and trigger inflammatory processes in the prostate gland. Since androgen receptors (AR) play an important role in the BPH pathophysiology and infection with SARS-CoV-2 may be androgen-mediated, BPH progression and its related symptoms can be a complication of COVID-19 through AR involvement and metabolic disturbances. CONCLUSIONS: Based on the current findings, SARS-CoV-2 can possibly damage the prostate and worsen BPH and its related LUTS through ACE2 signaling, AR-related mechanisms, inflammation, and metabolic derangement. We encourage future studies to investigate the possible role of COVID-19 in the progression of BPH-related LUTS and examine the prostatic status in susceptible patients with relevant available questionnaires (e.g., IPSS) and serum biomarkers (e.g., PSA).

Is perioperative intravesically applied antibiotic solution effective in the prophylaxis of urinary tract infections after renal transplantation?

OBJECTIVES: To evaluate the efficacy of intravesically applied amikacin for the prophylaxis of urinary tract infections (UTIs) occurring in the first 3 months after kidney transplantation. METHODS: In a prospective, randomized, controlled trial, 200 consecutive renal transplant recipients were randomly divided into two equal groups. The bladders of the first group, the amikacin group, were filled with saline solution containing amikacin (1 g in adults and 30 mg/kg in pediatric patients) whereas the bladders of the patients of the second group, the control group, were filled with saline solution. Patients were followed up for 3 months after transplantation with urine cultures to evaluate the prevalence of posttransplantation UTIs in both groups. RESULTS: The overall incidence of UTIs was found to be significantly lower in the amikacin group (25 vs. 49%; p = 0.0007). In addition, male patients, patients with end-stage renal disease due to glomerulonephritis, patients receiving renal transplantation for the first time, or those from the amikacin group receiving a living-related graft had a significantly lower incidence of UTIs than their counterparts in the control group (p < 0.05). UTIs were most frequently caused by Escherichia coli (28.9%). CONCLUSIONS: Perioperative bladder irrigation with amikacin solution significantly decreases the overall incidence of UTIs in the first 3 months after kidney transplantation.

Ten-year graft survival of deceased-donor kidney transplantation: a single-center experience.

BACKGROUND: Kidney transplantation is the treatment of choice for end-stage renal disease that restores the patients' quality of life and reduces the morbidity and mortality rates induced by renal failure and its complications. However, after transplantation the organ and patient survival rates are important issues of interest in many centers worldwide. SUBJECTS AND METHODS: This is a historical cohort study planned to determine the organ survival rate after kidney transplantation from deceased donor during a period of 10 years (March 1999-March 2009) in Shiraz Transplant Center, Namazi Hospital, Shiraz, Iran. We tried to clarify the probable contributory risk factors implicating in graft loss. Kaplan-Meier method was used to determine the survival rate. Log-rank test was used to compare survival curves, and Cox regression model to define the hazard ratio and for modeling of factors implicating in survival rate. RESULTS: Mean follow-up period was 37.54 +/- 28.6 months. Allograft survival rates at 1, 3, 5, and 9 years after kidney transplantation from deceased donor (calculated by Kaplan-Meier method) was found to be 93.7, 89.1, 82.1, and 80.1%, respectively. Duration of dialysis before operation and creatinine level at discharge were showed to be the most important factors influencing survival rate of renal allograft. CONCLUSION: Overall long-term graft survival in our cohort is satisfactory and comparable with reports from large centers in the world. Duration of dialysis before operation and creatinine level at discharge are the only independent factors that could correlate with long-term graft survival in our cohort.

Bilateral renal cell carcinoma of the native kidneys in a 16-year-old boy: Report of a rare case and review of the literature.

Bilateral renal cell carcinoma is rare and most commonly occurs in patients with background of hereditary and genetic diseases. Occurrence of bilateral renal cell carcinoma in native kidneys of a renal transplant patient is even more uncommon, and less than 10 cases have been reported in the English literature. Herein, we report our experience with the youngest renal transplant patient ever reported with bilateral renal cell carcinoma, who presented with intractable urinary tract infection. We also will review all of the reported cases of bilateral renal cell carcinoma in the last 20 years in the English literature according to the presentations, treatment modalities, prognosis, and graft outcome.

Gene Expression of Toll-Like Receptors 2 and 4 in Renal Transplant Rejection.

OBJECTIVES: Toll-like receptors are a crucial part of the innate immune system and have a pivotal role in the acquired immunity system. Studies have shown that Toll-like receptors 2 and 4 are important during the transplant process. Therefore, we analyzed the gene expression of Toll-like receptors 2 and 4 in cases of renal transplant rejection. We measured the messenger RNA expression levels of Toll-like receptors 2 and 4 in renal transplant rejection recipients compared with nonrejection recipients. MATERIALS AND METHODS: We enrolled 151 deceased-donor kidney transplant recipients, whom we divided into 2 groups: 101 nonrejection recipients and 50 recipients with acute allograft rejection. We collected 3 mL of blood (treated with ethylenediaminetetraacetic acid) from each patient. Ribonucleic acid extraction and complementary DNA synthesis were conducted for all samples, and the constructed complementary DNAs were used for real-time polymerase chain reaction analysis. RESULTS: We measured gene expression levels of Toll-like receptors 2 and 4 in renal transplant recipients with acute allograft rejection and in recipients who did not experience acute renal allograft rejection, and the results showed that messenger RNA expression levels for both Toll-like receptors 2 and 4 were significantly increased in the acute rejection group compared with the nonrejection group. CONCLUSIONS: Toll-like receptors 4 and 2 could increase the risk of acute rejection after renal transplant and could be defined as a risk factor for rejection. Further studies are recommended.

Bilateral renal lymphangiomatosis: sonographic findings.

Renal lymphangiomatosis is an exceedingly rare disorder characterized by developmental malformation of the lymphatic system surrounding the kidneys. We report a case of bilateral renal lymphangiomatosis in a 21-year-old man who underwent abdominal sonographic examination that revealed numerous cystic areas of various sizes around both kidneys with extension along the renal hilum. Subsequent abdominal CT examination demonstrated bilateral, multilocular, fluid-filled cystic masses with thin walls in the perirenal and peripelvic region. MRI of the patient revealed bilaterally enlarged kidneys with multiple hyperintense lesions in both perirenal spaces and the peripelvic area on T2-weighted images. These cystic spaces appeared hypointense on T1-weighted images with no enhancement in postcontrast images. The diagnosis of renal lymphangiomatosis was made based on typical imaging findings.

Primary renal pelvis and ureter squamous cell carcinoma (SCC): a rare case report and review of literature.

Primary renal squamous cell carcinoma (SCC) is a very rare upper urinary tract neoplasm. Renal SCC has a poor prognosis because it usually presents in advanced stages. We report a 64-year-old woman with a right paravertebral mass; after right radical nephroureterectomy and salpingo-oophorectomy, pathologic examination revealed primary SCC.

Constipation, the sole presentation of primary renal carcinoid tumor: A case report.

Primary renal carcinoid tumors are quite rare. The pathogenesis of these tumors is unknown due to lack of enterochromaffin cells in the kidney. Because of nonspecific clinical manifestations and radiologic features, they are commonly misdiagnosed. Hence, Primary renal carcinoid tumors should be considered in differential diagnosis of any renal mass. In the present case, a 26-year-old woman was presented with a renal mass and constipation. After partial nephrectomy, diagnosis of carcinoid tumor was confirmed.

Extravesical seromuscular ureteroneocystostomy: an effective and simple operation for treatment of vesicoureteral reflux.

PURPOSE: To evaluate the success rate of extravesical seromuscular ureteroneocystostomy in the treatment of children with vesicoureteral reflux (VUR). PATIENTS AND METHODS: In a prospective study from August 2005 to January of 2006, 15 patients (11 girls, 4 boys), median age of 9.5 years (range: 1-24 years), with high-grade VUR underwent operation. Urinary tract ultrasonography and voiding cystoureterography (VCUG) were the main diagnostic tools to detect VUR before the operation and at 3 months after the operation. RESULTS: No VUR was detected at evaluation of 3-month postoperative VCUGs (14 cases, 93%). However, one child (7%) still had persistent VUR. This patient underwent reoperation and the length of the seromuscular tunnel was increased more with a favorable result. The overall success rate of this technique was about 93%. CONCLUSION: Extravesical seromuscular ureteroneocystostomy is simple and effective method for the treatment of VUR in children.

Ischemic preconditioning protects the dog kidney from ischemia-reperfusion injury.

OBJECTIVE: To evaluate the effects of unilateral ischemic insult and ischemic preconditioning (IPC) on renal histology in a canine model. METHODS: 30 dogs were randomized into 4 groups. In group A (5 male controls) and group B (5 female controls), ischemia was induced by clamping both left renal arteries for 40 min. Dogs in group C (10 male cases) or group D (10 female cases) underwent 5 min of arterial clamping and 10 min of declamping prior to the final 40-min ischemia induction. Renal biopsy was prepared 48 h later and microscopically examined. RESULTS: The control groups (A and B) developed 40% frank necrosis, 60% moderate injury, and there was no intact renal tissue in this group with no difference between sexes. The IPC groups (C and D) revealed 55% moderate injury and 45% normal pathology; however, there was no frank necrosis among them. Better IPC protection in the female group was not statistically significant. CONCLUSION: An IPC schedule of 5-min ischemia and 10-min reperfusion improves ischemia-reperfusion injury from subsequent prolonged ischemia in a canine model.