Feasibility and Safety of Ultrasonography Guidance and Flank Position during Percutaneous Nephrolithotomy.

PURPOSE: Percutaneous nephrolithotomy is generally performed using fluoroscopy, which is associated with exposure to radiation. Another drawback of fluoroscopic guided percutaneous nephrolithotomy is the prone position, which is not suitable for all patients. In this study we evaluated the feasibility, safety and efficacy of ultrasound guided percutaneous nephrolithotomy with the patient in the flank position. MATERIALS AND METHODS: A total of 603 patients with a mean ± SD age of 50.9 ± 13 years were included in this study from December 2010 to July 2016. Access to the collecting system and tract dilation were performed under ultrasound guidance. Perioperative data on the stone-free rate, operative time, length of stay and complication rates were recorded. RESULTS: Successful access was achieved in all but 1 patient. Mean operative time was 56.6 ± 6.5 minutes. Complete stone clearance was achieved in 529 patients (87.7%) and Clavien-Dindo grade 3 complications were noted in 17 (2.8%). Blood transfusion was necessary in 43 patients (7.1%). However, bleeding was self-limited in all cases and did not require angioembolization. CONCLUSIONS: To our knowledge this is the largest series of ultrasound guided percutaneous nephrolithotomy with the patient in the flank position. Unlike in other studies we used this procedure in all patients irrespective of stone burden, renal anomaly and body habitus. Ultrasound guided percutaneous nephrolithotomy has outcomes comparable to those of conventional percutaneous nephrolithotomy and it is not associated with radiation exposure. Furthermore, anesthesia while in the flank position might be less harmful in some patients, including those with obesity or cardiopulmonary comorbidities.

Does Significant Weight Loss After Bariatric Surgery Affect Sexual Function and Urinary Symptoms? An Iranian Study.

INTRODUCTION: For sexual dysfunction and lower urinary tract symptoms (LUTS), obesity is identified as an independent risk factor. The current study aimed to evaluate the effect of significant rapid weight loss by bariatric surgery on LUTS and sexual function among men and women with class III obesity. METHOD: A group of patients who were planned to undergo bariatric surgery was enrolled in the study. Male patients were given the International Index of Erectile Function (IIEF) and the International Prostate Symptom Score (IPSS) questionnaires. In the female group, they filled in the female sexual function index (FSFI) and the International Consultation on Incontinence Questionnaire short form (ICIQ-SF) questionnaires. Patients were followed up 1 year after their bariatric surgery. RESULTS: All questionnaires were completed by eighty-one patients. (mean age ± SD: 39.4 ± 9.2 years; mean body mass index (BMI) ± SD: 47.15 ± 5.4 kg/m2). The total score of the IPSS questionnaire decreased from 5.83 ± 3.01 preoperatively to 2.37 ± 1.66 postoperatively. The weight loss caused significant improvement in the storage phase of LUTS domains, but there were no considerable changes in the voiding phase. In the IIEF questionnaire, domains of sexual desire, overall satisfaction, and orgasmic function improved significantly. There was not a significant change in any FSFI domains after bariatric surgery. Mean ICIQ-SF decreased, but it was not substantial. CONCLUSION: Bariatric surgery can significantly improve the storage phase in men, but not the voiding phase. Sexual desire, orgasmic function, and overall satisfaction were significantly improved in men. No significant improvement in sexual function and UI in women was observed.

Type 2 calyceal diverticulum with an unusual appearance in the lower pole of the kidney.

A 45-year-old woman presented to our clinic with intermittent left flank pain. The family physician referred her for renal cystic mass with a calcified appearance. The non-contrast spiral abdominal computed tomographic (CT) scan demonstrated the mass-like cystic lesion with a densely calcified lesion in the lower pole of the kidney. A detailed history revealed that she underwent shock wave lithotripsy (SWL) for the lower pole renal stone one year ago. After SWL, the stone fragments migrated to the dependent diverticulum region and produced the misleading appearance of a Bosniak type III lesion. Contrast-enhanced computed tomography (CT) scan was done for further evaluation, and finally, the diagnosis of the calyceal diverticulum was confirmed in the lower pole of the kidney. Calyceal diverticula are the outpouching of the pyelocalyceal system lined by non-secretory transitional epithelium. It is a rare condition that occurs in less than 0.5% of the population. Most patients are asymptomatic and have been discovered incidentally in routine imaging modalities. As most of the patients are asymptomatic, many do not need intervention. However, in some instances, patients present with flank pain, hematuria, urinary tract infection, and stone formation in the diverticulum. They are in the differential diagnosis of renal cystic lesions such as simple renal cyst, renal cortical abscess, and parapelvic cyst. In renal cystic lesion besides of simple renal cyst or renal cystic mass, we should keep the differential diagnosis of the calyceal diverticulum type 2, especially in patients that underwent SWL for renal stones; the fragmented residual stone may have migrated to this dilated region and produce the deceptive appearance of a Bosniak type III lesion.

Comparison of spermatic and peripheral blood gases and their correlation with spermogram pattern and varicocele grade in patients with a varicocele.

The relationship between infertility and varicocele is still a controversial topic. This study aimed to find the association between the venous blood gas (VBG) pattern of the spermatic veins and peripheral veins with varicocele grade and spermogram variables in infertile patients. A total of 47 patients with a varicocele were enrolled in this study. Blood samples were drawn simultaneously from the spermatic vein and a peripheral vein. The pH, partial pressure of oxygen, the partial pressure of carbon dioxide, oxygen saturation, and bicarbonate values of these samples were analysed. The mean age of participants was 30.48 ± 6.08. The mean volume of semen was 3.92 ± 1.57 mL, and the mean semen pH was 7.88 ± 0.22. The pH was higher (p < 0.01) in the spermatic vein compared with the peripheral vein. However, level of other parameters including pO2 (p = 0.662), pCO2 (p < 0.001), HCO3 concentration of serum (p < 0.01), and base excess (p = 0.172) were lower in the spermatic vein in comparison with the peripheral vein. Correlations between VBGs determinants of the varicocele patients' spermatic vein and sperm morphology and motility were insignificant. In conclusion, although the clinical significance of VBGs is evident, there are limited studies that investigated the VBGs in varicocele patients. We should consider that the deviation in blood gases may be the missing piece in the puzzle to understand the pathophysiology of varicocele. By knowing the pathophysiology more precisely, we can better decide the ideal treatment option for the patients.

A Retroperitoneal Mass Encasing the Renal Hilum Presenting as a Parapelvic Tumor: A Case Report with Laparoscopic Resection Approach.

Retroperitoneal masses are a rare condition that may be discovered incidentally in routine abdominal imaging. These lesions are commonly asymptomatic but may be associated with intestinal obstruction and rarely presented with acute abdomen. They may originate from the retroperitoneal organs, including the genitourinary or gastrointestinal tract, or originate primarily from retroperitoneal space, such as retroperitoneal fat, muscle, nervous system, and lymphatic system. The malignant masses are more common than benign masses, and sarcoma is the most malignant tumor in this space. We present a case with the hilar lesion of the left kidney that was managed with laparoscopic resection. The laparoscopy revealed that the mass completely enclosed the left renal hilum, but the mass was excised without any complication. The final pathologic report revealed a benign mesenteric cyst. Although most of the retroperitoneal mass had a malignant etiology, in cystic lesions in the renal hilar area, the benign mesenteric cyst may keep in mind the differential diagnosis of a mass in this anatomic region.

Ultrasound Guided Percutaneous Nephrolithotomy in Mesh-Repaired Incisional Hernia.

OBJECTIVES: To describe our technique of percutaneous nephrolithotomy (PNL) in patients with mesh-repaired flank incisional hernia. Polypropylene mesh which is used for fascia strengthening in hernia repair elicits intense inflammatory reaction and the consequent fibrosis alters the characteristics of abdominal wall. Thus, prior history of flank hernia repair with mesh may result in percutaneous nephrolithotomy failure. MATERIALS AND METHODS: Demographic data, renal stones characteristics, and any complication during surgery and follow-up of patients who were treated by PNL during 2011 to 2020 and had mesh in their flank region were collected. RESULTS: Percutaneous nephrolithotomy was performed without any problem in 8 patients with guide of ultrasonography. CONCLUSION: Based on our experience, ultrasound-guided PNL is feasible and hypothetically superior to fluoroscopy in such circumstances.

How a renal artery aneurysm may mimic renal stone?

Renal artery aneurysm is a rare condition. Most patients are asymptomatic. This case presented to the emergency with colicky pain and underwent left transurethral lithotripsy for left ureteral stone, due to simultaneous renal stone candidates for percutaneous nephrolithotomy. In the review of the imaging, we found a large renal artery aneurysm, so vascular surgery consult was done and the patient managed with coil embolization Misdiagnosis of this condition could be led to life-threatening bleeding if percutaneous nephrolithotomy was done. It is recommended that renal artery aneurysm should be considered in the differential diagnosis of renal rim-like opaque lesions.

Premature ejaculation and serum leptin level: a diagnostic case-control study.

INTRODUCTION: Premature ejaculation (PE) is regarded as the most common male sexual disorder. To date, there is no accurate and objective diagnostic test for PE. AIM: To determine the diagnostic value of serum leptin level for PE. METHODS: In a case-control design, the serum leptin level of 46 PE patients referred to our outpatient clinic were determined and compared with 44 control patients referred to the same clinic with the complaint of nephrolithiasis. PE was defined based on the Diagnostic and Statistical Manual of Mental Disorders IV criteria and an intravaginal ejaculatory latency time of less than a minute. MAIN OUTCOME MEASURES: Serum leptin level and presence of PE. RESULTS: The PE patients had significantly higher serum leptin levels (8.3+/-3 ng/mL) than the controls (3.3+/-1 ng/mL) (P<0.001). Sensitivity and specificity for the test as a predictive diagnostic tool for PE were 80.4% and 97.7%, respectively, at the cutoff value of 6.3 ng/mL. CONCLUSIONS: According to our results, leptin level in patients with PE was significantly higher than in the control subjects. More studies are necessary to determine the value of serum leptin as a diagnostic tool for PE.

The relationship between serum and urinary Fetuin-A levels and kidney stone formation among kidney stone patients.

INTRODUCTION: Mineralization inhibitors are required to prevent the precipitation of minerals and inhibit the formation of kidney stones and other ectopic calcifications. In laboratory studies, Fetuin-A as a glycoprotein has inhibited hydroxyapatite precipitation in calcium and phosphate supersaturated solutions; however, information about patients with kidney stones is limited. The aim of this study was to investigate the association of serum and urinary Fetuin-A levels with calcium oxalate kidney stones. MATERIAL AND METHODS: In this case-control study, 30 patients with kidney stones and 30 healthy individuals without any history of urolithiasis who were referred to the urology ward of Sina Hospital of Tehran, Iran, in 2015 were entered into the study. All patients underwent computerized tomography scans. After collecting demographic information, serum and urine levels of Fetuin-A and some other calcification inhibitors and promoters, were measured and compared using T-test, Mann-Whitney and logistic regression between the two study groups. RESULTS: Patients with kidney stones, on average, had lower levels of Serum Fetuin-A (1522.27 ±755.39 vs. 1914.64 ±733.76 µg/ml; P = 0.046) as well as lower levels of Urine Fetuin-A (944.62 ±188.5 vs. 1409.68 ±295.26 µg/ml; P <0.001). Multivariate logistic analysis showed that urinary calcium and serum creatinine are the risk factors and Fetuin-A is a urinary protective factor for kidney stones. CONCLUSIONS: PFC Our study showed that patients with kidney stones had lower serum and urinary levels of Fetuin-A. In the logistic regression model, urinary Fetuin-A was reported as a protective factor for kidney stones.

Psychometric properties of the Iranian version of the premature ejaculation diagnostic tool.

INTRODUCTION: Premature ejaculation (PE) is one of the most prevalent male sexual problems. The Premature Ejaculation Diagnostic Tool (PEDT) is a suitable patient-reported outcome measure for the assessment of PE. AIM: To examine the psychometric proporties of a translated and culturally adapted version of the PEDT in a sample of Iranian men suffering from PE. METHODS: Two independent samples were compared, one including patients with PE based on the DSM-IV-TR criteria (n = 269) and the other including healthy men without PE (n = 289). A backward-forward translation procedure was used to translate the PEDT into Persian. Both samples were asked to fill in the PEDT twice-at baseline and 4 weeks later. MAIN OUTCOME MEASURES: Internal consistency, test-retest reliability, convergent validity, factor structure, measurement invariance across sexual health status (i.e., between men with and without PE). RESULTS: Mean ages of men without and with PE were 34.9 and 35.3 years, respectively. Cronbach's alpha coefficient for the total PEDT score was 0.89. All items and the total score were remarkably consistent between the two measurement points. All five PEDT items correlated at r = 0.40 or greater with their own scale, indicating good convergent validity. There was a high and significant correlation (r = -0.82, P < 0.001) between the PEDT score and IELT. Healthy men reported lower scores (fewer complaints) on the PEDT compared with the PE group. A single-factor model was found to be best-fitting in the exploratory factor analysis; this was confirmed by confirmatory factor analysis. The PEDT was invariant across sexual health status and perceived similarly by men with and without PE. CONCLUSION: The results provide evidence for good reliability and validity of the Iranian version of the PEDT. The questionnaire therefore represents a suitable tool for screening PE in Iranian men. Pakpour AH, Yekaninejad MS, Nikoobakht MR, Burri A, and Fridlund B. Psychometric properties of the Iranian version of the Premature Ejaculation Diagnostic Tool. Sex Med 2014;2:31-40.

The role of hypothyroidism in male infertility and erectile dysfunction.

PURPOSE: To evaluate the effect of hypothyroidism on erectile function and sperm parameters. MATERIALS AND METHODS: This study was conducted on 24 patients with hypothyroidism and 66 normal individuals. Serum levels of hormones, including thyroid stimulating hormone (TSH), thyroxin (T4), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), and testosterone, were measured and semen analysis was done in all the participants. Erectile function was evaluated using International Index of Erectile Function (IIEF-5) questionnaire. RESULTS: The mean IIEF-5 total score was 11.75 [95% confidence interval (CI): 9.70 to 13.79) and 20.81 (95% CI: 20.02 to 21.6) for hypothyroid group and normal subjects, respectively (P = .005). Furthermore, serum concentrations of PRL and seminal parameters were significantly different between two groups (P < .001). CONCLUSION: Hypothyroidism adversely affects erectile function and sperm parameters, including sperm count, morphology, and motility. In patients with sperm abnormalities and erectile dysfunction, measurement of thyroid hormones is recommended.

Peri-ictal urinary dysfunction in patients with epilepsy: a cross-sectional study.

PURPOSE: To evaluate the prevalence of peri-ictal urinary symptoms and their association with seizure type in patients with epilepsy. MATERIALS AND METHODS: A total of 115 patients with epilepsy were recruited consecutively from neurology clinic between January 2006 and January 2008. Peri-ictal period was defined as the period ranging from 2 minutes prior to seizure attack up to 48 hours after it, and post-ictal period was the time up to 48 hours after regaining consciousness. Peri-ictal urinary complaints were gathered with interview and data were analyzed using Pearson's Chi-square, Fisher's Exact test, and independent sample t test. RESULTS: The study population consisted of 57 (49.5%) men and 58 (50.4%) women, with the mean age of 26.83 ± 10.01 years. The frequency of at least one urinary symptom in studied patients was 39.1%. Incontinence, frequency, urgency, retention, and hesitancy were reported by 28 (24.3%), 14 (12.2%), 19 (16.5%), 10 (8.7%), and 8 (7%) patients, respectively. Women expressed more symptoms than men and a higher frequency of peri-ictal retention. Although overall urinary complaints were more frequent in patients with partial seizures, there was a higher frequency of urgency in patients with partial seizure (P = .037). Furthermore, apart from retention, there was no significant correlation between peri-ictal urinary symptoms and the patients' age. CONCLUSION: Our findings suggest that peri-ictal urologic dysfunction is a common problem among patients with epilepsy and post-ictal urinary retention might also be considered as a post-ictal deficit (Todd's deficit).

Intraurethral instillation of ketamine for male rigid cystoscopy.

PURPOSE: This study was conducted to examine the efficacy of ketamine along with lidocaine gel for instillation in the male urethra for easiness of outpatient rigid cystoscopy, as compared with only using lidocaine gel. PATIENTS AND METHODS: A total of 60 consecutive men who were scheduled to undergo rigid cystoscopy were randomly assigned to receive either 10 mL of 2% lidocaine gel combined with 2 mL normal saline, or 10 mL of 2% lidocaine gel combined with 2 mL ketamine (100 mg). Hemodynamic changes and the level of pain perception of patients at the beginning, during, and after every procedure in both groups were recorded by using the visual analogue scale. RESULTS: There were no significant differences in hemodynamic changes between the two groups; however, the perception of pain was significantly decreased when lidocaine was used in conjunction with ketamine, most notably during the first 5 minutes of cystoscopy. CONCLUSIONS: Instillation of lidocaine gel in conjunction with ketamine in the urethra could decrease pain perception and make men undergoing outpatient rigid cystoscopy more comfortable during the procedure.

Oral lesions in kidney transplant patients.

INTRODUCTION: Oral hygiene in kidney transplant recipients contributes to maintenance of the transplanted organ and its function. Thus, an investigation of oral lesions could be counted as a notable work. These patients have the potential to be involved with lesions developed as a result of the administration of immunosuppressive drugs. The aim of this study was to investigate oral lesions in a group of kidney transplant recipients. MATERIALS AND METHODS: The present study was a cross-sectional research on 100 patients with a kidney transplant for at least 3 months. Oral mucosa was assessed clinically for any lesion. Additional data on systemic diseases, transplant duration, and medications were recorded. RESULTS: Twenty-four percent of the patients had at least 1 oral lesion. The most common lesion was oral candidiasis in 16% of the participants (13 cases of acute pseudomembranous and 3 cases of chronic oral candidiasis). Gingival enlargement was seen in 7% of the kidney transplant recipients, and 2% had a coated tongue. CONCLUSIONS: Elimination of oral fungal lesions in kidney transplant recipients is highly recommended. We hope this study can shed light on this particular aspect of healthcare in kidney transplant recipients.

Serum selenium level and prostate cancer: a case-control study.

Selenium is a potential chemopreventive agent against prostate cancer. This study sought to evaluate and compare the serum selenium level in men with newly diagnosed prostate cancer and noncancerous patients. Between 2005 and 2006, this prospective case-control study was performed on patients referred to Sina and Imam University hospitals, Tehran, Iran; it included 62 men with clinicopathologically confirmed diagnosis of prostate cancer (case group) and 68 men with no detectable prostate cancer [normal digital rectal examination and prostate-specific antigen (PSA) level] or any other malignant disease (control group). The serum selenium level was assessed using Zeeman graphite furnace atomic absorption spectrometer (Varian Company, Australia). The mean serum selenium level in the case and control group was 66.3 +/- 17.7 microg/l and 77.5 +/- 22.5 microg/l, respectively (P = 0.002). Serum selenium was inversely associated with prostate cancer risk. After adjustment for age, body mass index (BMI), and smoking, the odds ratio was 0.16 and 95% confidence intervals were 0.06 to 0.47 (P trendq = 0.001) comparing the highest with the lowest tertile (> or = 89.3 microg/l). No correlation was observed between serum selenium level and age, BMI, or PSA level. In conclusion, serum selenium levels in prostate cancer cases were lower than in controls, which supports the hypothesis that selenium may protect against prostate cancer.

Transureteral lithotripsy versus extracorporeal shock wave lithotripsy in management of upper ureteral calculi: a comparative study.

INTRODUCTION: Our aim was to compare transureteral lithotripsy (TUL) and extracorporeal shock wave lithotripsy (SWL) in the management of upper ureteral calculi larger than 5 mm in diameter. MATERIALS AND METHODS: Patients who had upper ureteral calculi greater than 5 mm in diameter were enrolled in this clinical trial. The calculi had not responded to conservative or symptomatic therapy. Semirigid ureteroscopy and pneumatic lithotripsy were used for TUL in 52 patients and SWL was performed in 48. Analysis of the calculi compositions was done and the patients were followed up by plain abdominal radiography and ultrasonography 3 month postoperatively. RESULTS: The stone-free rates were 76.9% in the patients of the TUL group and 68.8% in the patients of the SWL group. These rates in the patients with mild or no hydronephrosis were 85.7% and 59.1% for the SWL and TUL groups, respectively. In the TUL group, half of the patients with no hydronephrosis developed upward calculus migration. The stone-free rates were 75.0% and 89.3% for the patients with moderate hydronephrosis and 70.0% and 100.0% for those with severe hydronephrosis in the SWL and TUL groups, respectively. All of the failed cases were treated by double-J stenting and TUL or SWL successfully. There were no serious complications. Upward calculus migration after TUL was more frequent in cases with no hydronephrosis or mild hydronephrosis (41.0%). CONCLUSION: Upper ureteral calculi smaller than 1 cm can be safely and effectively managed using semirigid ureteroscopy and pneumatic lithotripsy. However, the SWL approach has still its role if an experienced endourologist is not available.

Epidemiology of urogenital trauma in Iran: results of the Iranian National Trauma Project.

INTRODUCTION: We report the incidence, distribution, etiology, and outcome of the urogenital trauma in 8 major cities of Iran according to the database of national trauma project. MATERIALS AND METHODS: Between 2000 and 2004, we prospectively collected the data of all the traumatic patients hospitalized for more than 24 hours in 8 cities (Tehran, Mashad, Ahwaz, Shiraz, Tabriz, Qom, Kermanshah, and Babol). We analysed the data taken from 17,753 trauma admissions. Patients with sustained urogenital traumas were identified and studied. RESULTS: A total of 175 patients (0.98%) had injuries to the urogenital system. Male to female ratio was 4. The patients' mean age was 25 +/- 16 years (range, 2 to 80 years). Of 175 patients, 159 (90.9%) had blunt trauma and 16 (9.1%) had penetrating trauma. Road traffic accident was the most common cause of trauma (65.1%). The most common injured organs were the kidney in 61.1% and the bladder in 13.7%. One hundred and forty-two patients (81.1%) had associated intra-abdominal injuries and 129 (73.7%) had other accompanying injuries. Sixty (34.2%) patients required surgical intervention. Nine patients (5.2%) died due to the severity of the injuries. All patients who died had severe injuries (Injury Severity Score >12). CONCLUSION: In Iran, blunt traumas including road traffic accidents are the main cause of urogenital traumas. The majority of the patients with urogenital trauma have multiple injuries and require a multidisciplinary approach.