Procedure-Specific Thromboprophylaxis in Urological Surgeries: A Narrative Review.

PURPOSE: Postoperative pulmonary embolism is a leading cause of mortality in patients undergoing major urologic surgeries, presenting a complex challenge in balancing the risks of venous thromboembolism (VTE) and perioperative bleeding. This study examines the current evidence on thromboprophylaxis in urological procedures, focusing on procedure-specific considerations. METHODS: Literature on thromboprophylaxis in urological procedures was reviewed during the past decade. RESULTS: Various mechanical thromboprophylaxis methods, such as compression stockings, pneumatic compression devices, foot pumps, mobilization, and exercises, are available preventive measures. Additionally, unfractionated heparin (UFH) and low molecular weight heparin (LMWH) are commonly used pharmacological agents for VTE prevention, with the choice between mechanical, pharmacological, or combined approaches tailored to individual patient characteristics and surgical requirements. Patient risk stratification into low, medium, and highrisk categories based on age, BMI, and VTE history guides the selection of thromboprophylaxis strategies. Surgical procedures are categorized as oncological or non-oncological, with uro-oncological surgeries posing a higher VTE risk than non-oncological procedures. Consequently, a combination of pharmacological and mechanical prophylaxis is typically recommended for uro-oncological patients, while pharmacological prophylaxis is reserved for high-risk individuals undergoing non-oncological surgeries. Mechanical prophylaxis is advised for high-risk patients undergoing procedures with elevated VTE risk. CONCLUSION: This study summarized an optimal thromboprophylaxis protocol taking into account patient risk factors and the specific urological procedure.

Assessment of the Quality of YouTube Educational Videos on Laparoscopic Right Adrenalectomy and Laparoscopic Partial Nephrectomy Surgeries.

Introduction: Despite the considerable studies conducted on the quality of YouTube surgical videos as an educational resource in other surgical fields, there have been no such studies in the field of laparoscopic urology so far. Considering the great sensitivity in these procedures and the necessity of identifying the mistakes in these videos, we aimed to evaluate the quality of YouTube educational videos on laparoscopic right adrenalectomy and laparoscopic partial nephrectomy surgeries. Materials and Methods: In this descriptive cross-sectional study, 131 YouTube educational videos on laparoscopic right adrenalectomy and laparoscopic partial nephrectomy surgeries were reviewed. Two researchers familiar with laparoscopic urological surgery reviewed the videos based on the LAP-VEGaS checklist. A third professor reviewed the videos on which there were disagreements. Results: In the majority of the videos, the title was chosen accordingly and the surgeon was introduced appropriately. Furthermore, in most of the videos, patient anonymity was respected. The mean score of the videos was equal to 74.3 ± 5.4, the maximum score being 17 and the minimum 1. The average score of the partial nephrectomy videos was obtained as 98.3 ± 5.74, whereas the average score for adrenalectomy videos was 47.3 ± 4.5. The overall average score of the studied videos was 74.3 ± 5.40. Conclusion: The results of our study suggest that most of YouTube videos on laparoscopic right adrenalectomy and laparoscopic partial nephrectomy surgeries are used for educational purpose. These YouTube videos are suboptimal in educational aspect and students should be advised to use them with caution.

Translation and Validation of the Persian Version of the Wisconsin Stone Quality of Life Questionnaire.

PURPOSE: Patients with kidney stones have a lower quality of life (QOL) than healthy patients; however, treatment guidelines neglect their QOL. Wisconsin stone QOL test (WIS-QOL) is the first specific questionnaire for urolithiasis patients. This study evaluated the reliability and validity of the translated Persian version of the WIS-QOL questionnaire in patients with kidney stones. MATERIAL AND METHODS: All patients (> 18 years old) with a history of urolithiasis were included in this cross-sectional. The WIS-QOL questionnaire was translated depending on Hutchinson's guideline. Effects of urolithiasis on the patient's social activity, emotions, disease, and vitality were evaluated. Pearson Correlation and Cronbach's alpha test were used to assess the validity and reliability of the questionnaire. All data were analyzed by SPSS software version 26.0. RESULTS: Among 154 urolithiasis patients, 94 (61%) were males, and 60 (39%) were females. The mean age was 50.4 years (SD: ± 13.6), and the mean QOL score was 84.7 (SD: ±21.8). For each question, the numerical value of the Pearson Correlation Coefficient has been compared with the numerical value, and the validity of the questionnaire was confirmed. The overall Cronbach's alpha was 0.94 for all four areas of the questionnaire, so the reliability of the questionnaire in Persian was confirmed. CONCLUSION: The present study showed the reliability and validity of the Persian version of the WIS-QOL questionnaire in symptomatic urolithiasis patients. The present study showed the status and impact of urolithiasis on QOL however, longitudinal and prospective studies should be done to specify changes over time.

Assessment of health equity consideration in Cochrane systematic reviews and primary studies on urolithiasis.

Background and Aims: Health injustice is defined as "unnecessary, preventable, unjustified and unfair health differences." One of the most important scientific sources on the prevention and management of urolithiasis are Cochrane reviews in this field. Given that the first step in eliminating health injustice is to identify the causes, the aim of the present study was to evaluate equity considerations in Cochrane reviews and the included primary studies on urinary stones. Methods: Cochrane reviews on kidney stones and ureteral stones were searched through the Cochrane Library. The included clinical trials in each of the reviews published after 2000 were also collected. Two different researchers reviewed all the included Cochrane reviews and primary studies. The researchers reviewed each PROGRESS criteria independently (P: place of residence, R: race/ethnicity/culture, O: occupation, G: gender, R: religion, E: education, S: socioeconomic status, S: social capital and networks). The geographical location of the included studies was categorized as low-income, middle-income and high-income countries, based on the World Bank income criteria. Each PROGRESS dimension was reported for both the Cochrane reviews and the primary studies. Results: In total, 12 Cochrane reviews and 140 primary studies were included in this study. None of the included Cochrane reviews had specifically mentioned the PROGRESS framework in the Method section whereas gender distribution and place of residence were reported in two and one reviews, respectively. In 134 primary studies at least one item of PROGRESS was reported. The most frequent item was gender distribution, followed by place of residence. Conclusion: According to the results of this study, the authors of Cochrane systematic reviews on urolithiasis, and researchers who have conducted such trials, have rarely considered health equity dimensions when designing and performing their studies. Therefore, researchers worldwide should be motivated to study populations from low-income countries with low socioeconomic status in addition to different cultures, ethnicities, and so forth. Furthermore, RCT reporting guidelines such as CONSORT should include health equity dimensions and the editors and reviewers of scientific journals should encourage researchers to further emphasize on health equity in their studies.

Pharmaceutical industry funding and chemotherapy trials for prostate cancer: A systematic review.

INTRODUCTION: Clinical trials are increasingly supported by industries while previous studies have shown that industry-supported studies have more favorable results than studies with other sources of funding. In the present study, we investigated the association of industrial funding on the results of clinical trials regarding chemotherapy in prostate cancer. METHODS: A systematic literature search was performed in the Cochrane Library, MEDLINE, and EMBASE to identify clinical trials comparing chemotherapy with treatments such as hormone therapy, surgery, radiotherapy, and placebo in patients with metastatic or non-metastatic prostate cancer. Data were extracted by two reviewers on the financial resources and the positive or negative results of chemotherapy in each study. The quality of articles was evaluated and compared based on Cochrane Critical Appraisal Tool. The trials were divided into two groups; industry funded and those not funded by industry. Association of industry funding and positive outcome was presented as odds ratio. RESULTS: In this study, out of the 91 studies, 80.2% were funded by pharmaceutical companies and 19.8% were funded by government agencies. The end result of 61.6% of the studies funded by pharmaceutical companies was an increase in survival due to chemotherapy, whereas only 27.8% of the studies sponsored by government agencies reported positive results (P-value=0.010). In fact, industry-funded trials more often presented statistically significant positive results for survival (OR: 4.17; CI, 1.34-12.99). In general, there was no significant difference in the degree of bias between the two groups. CONCLUSION: According to this study, despite of the similar quality of studies funded by pharmaceutical companies and government agencies, positive results were more common in studies related to pharmaceutical companies. Therefore, this point should be taken into account when making a decision on the best treatment approach.

Number of tracts or stone size: which influences outcome of percutaneous nephrolithotomy for staghorn renal stones?.

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is the recommended first-line treatment for staghorn stones. To achieve complete stone clearance, PCNL may require using multiple tracts. OBJECTIVE: To evaluate outcome of PCNL in patients with staghorn calculi and its correlation with the number of tracts and stone features. MATERIALS AND METHODS: One hundred consecutive patients with staghorn renal stone who underwent PCNL were included in the study. Perioperative and postoperative features were recorded. Correlation of the variables with number of tracts and stone size was assessed. RESULTS: Mean age (± SD) was 49.6 ± 14.7 years. Our patients were ASA class I. The mean cumulative stone burden was 365.9 ± 156.5 mm(2). The mean number of tracts was 2.4 (range: 1-7), and stone-free rate was 83%. The stone-free rate (p = 0.026) and hospital stay (p = 0.005) correlated with stone size, but not with number of tracts. Postoperative fever correlated with stone size (p = 0.017) and number of tracts (p = 0.037). CONCLUSION: PCNL using multiple tracts seem to be effective and safe in treatment of staghorn calculi. Most outcome measures correlated with stone size rather than number of tracts.

Castleman disease mimicking an adrenal tumor: A case report.

Castleman disease is a benign complex lymphoproliferative disease. The most common site is the mediastinum. In this paper, we present a case of Castleman disease in the adrenal gland, as a very rare region. A 29-year-old woman was referred to our clinic due to a well-defined right adrenal mass. She underwent laparoscopic adrenalectomy with the transperitoneal approach. Microscopic histopathology confirmed the hyaline vascular type of Castleman disease. In conclusion, Castleman's disease, as a rare disorder, must be considered in the differential diagnosis of an adrenal mass especially in cases with an enhancing well-defined, nonfunctional solid adrenal mass with lymphadenopathy.

Publication Bias in Urology Systematic Reviews and Meta-Analyses.

Background Publication bias is one of the most important biases in systematic reviews and meta-analyses. This bias occurs when the results of an article affect its publication, in other words positive or significant findings are more likely to be published than the other probable results. Previous studies have shown that publication bias has been a matter of concern in the meta-analysis and systematic reviews conducted in some medical fields.  There is not a study that has evaluated the status of publication bias assessment in urology systematic reviews. We decided to assess the status of publication bias evaluation in systematic reviews and meta-analyses published in high impact urology journals.   Methods This cross-sectional study was performed on 200 systematic reviews and meta-analysis published in four top urology journals based on their impact factor (European Urology, The Journal of Urology, BJU International and Prostate Cancer and Prostatic Diseases). Two independent reviewers performed data extraction about publication bias evaluation in included systematic reviews.   Results From the 200 included studies only 65 (32.5%) evaluated the publication bias in the review process and 31 reviews had reported publication bias in their study. Visual inspection of a funnel plot was the most frequent method used for evaluation of publication bias (61 from 65, 93.85%); this method was used alone in 34 articles and in combination with other methods in 27 papers.   Conclusion The present study confirms that publication bias was formally evaluated in a small number of reviews and meta-analysis published in urology journals, therefore, this may be a risk factor that could decrease the robustness of outcomes and results of these studies. It seems that there is an essential need for authors, reviewers, and editors to pay better attention to evaluation of publication bias besides reporting it based on the aforementioned reporting guidelines.

Evaluating the efficacy of bimanual compression of abdomen-flank to control postoperative bleeding after percutaneous nephrolithotomy: A randomized clinical trial.

PURPOSE: To investigate the influence of bimanual compression of abdomen-flank to control bleeding after completion of percutaneous nephrolithotomy (PCNL) including tubeless PCNL. MATERIALS AND METHODS: This study is a parallel-group randomized clinical trial with 1:1:1 randomization. Ninety patients who were candidates for PCNL during July to October 2019 were enrolled. After completion of PCNL operation, patients were randomized into three groups to receive bimanual abdomen-flank compression for 0, 3, and 7 min by the operating surgeon with the opening of sealed envelopes (groups 0, 3, and 7 min afterwards). Preoperative, 24, and 48 h postoperative hemoglobin (Hb) and electrolytes were collected. The primary endpoint of interest was the comparison of 48-h blood loss across study groups. Secondary endpoints included the percent drop in 24- and 48-h Hb, transfusion rates, and operation complications. This trial is registered at www.irct.ir with the following number: IRCT20190618043925N1 on 18 July 2019. RESULTS: There was no statistically significant difference in study groups regarding stone mass, stone location, access location, and patients' age (all p > 0.05). The medians (IQR) of 48-h blood loss were 490 mL (105-916), 338 mL (160-933), and 413 mL (71-650) in groups of 0, 3, and 7 min. The percent drop in 24-h postoperative Hb relative to preoperative Hb were 11.5 ± 8.6% versus 9.2 ± 7.3% versus 9.3 ± 6.8% (p = 0.44) and relative values for the percent drop in 48-h Hb relative to preoperative Hb were 8.6 ± 8.7% versus 9.5 ± 9.9% versus 7.2 ± 9.6% (p = 0.63) in groups of 0, 3, and 7 min respectively. Transfusion was needed in four patients in group 0 min, five patients in group 3 min, and three patients in group 7 min. CONCLUSIONS: The results of this study reveal that postoperative bimanual compression of abdomen-flank has no statistically significant influence on the control of bleeding after PCNL operations.

Vaginal bleeding as primary presentation of renal cell carcinoma.

Vaginal metastases from renal cell carcinoma has been recorded as extremely rare. We present a patient with vaginal bleeding as primary manifestation of renal cell carcinoma. A 40-year-old woman presented to a local private clinic with intermittent vaginal bleeding for approximately one month. Gynecological examination revealed a mass on the vaginal wall at approximately 8 o'clock. She underwent dilation and curettage (D&C) and mass excision. Microscopic histopathology and immunohistochemical stains showed vaginal metastases of clear cell RCC. The patient was referred to our urology clinic. Magnetic Resonance Imaging (MRI) of abdomen and pelvic showed a well-defined solid mass lesion measuring 16 × 12 × 11 cm in left kidney. Patient underwent left side radical nephrectomy through a left subcostal intraperitoneal incision. Histopathological results and metastasis workup confirmed the diagnosis of RCC with solitary metastatic vaginal lesion. After radical nephrectomy, she was treated with Sunitinib. No local relapse or distant metastasis was recognized 5 months after radical nephrectomy. In conclusion, the incidence of RCC metastasis to the vagina is extremely rare; but, in cases of vaginal bleeding or lesions we have to keep in mind the possibility of metastatic RCC.

Introducing the POPVESL Score for Intrarenal Vascular Complications of Percutaneous Nephrolithotomy: Experience from a Single high-volume Referral Center.

PURPOSE: Percutaneous-nephrolithotomy (PCNL), is the current modality of choice for large renal stones. Delayed post-op bleeding may herald pseudo aneurysm (PA) or arteriovenous fistula (AVF) necessitating costly and inconsistently available angioembolization, or prolonged hospitalization. The goal of this study is to identify criteria that may predict response to conservative therapy, for delayed bleeding from post PCNL intrarenal vascular lesions. MATERIALS AND METHODS: We reviewed all data on patients re-admitted for post PCNL gross hematuria at our high volume center between 2011 and 2016. Perioperative findings, factors related to the stone and management details, were subjected to multifactorial analysis. Logistic regression for multivariable analysis and ROC curves to find thresholds predicting mandatory angioembolization. RESULTS: Of 4403 PCNLs, 83 (1.9%) with delayed bleeding were diagnosed with intrarenal vascular lesions: Arteriovenous fistulas in 54 (AVF, 65%) and pseudoaneurysm in 29 (PA, 35%). Overall 49 (59%) responded to conservative management but 34 (41%) eventually required angioembolization. On multivariable analysis, predictive factors for poor response to conservative treatment were requiring transfusion beyond initial stabilization, pseudoaneurysm, history of open renal surgery, longer interval-to-second-admission, and size of vascular lesion. The proposed POPVESL score (short for Post PNL Vascular Embolization selection) when below 11, correctly predicts success of conservative management with 81.6% sensitivity and 100% specificity. CONCLUSIONS: Our findings including the proposed POPVESL score have the potential for clinical application and enhancing practical guidelines on the management of post-PCNL bleeding.

Best time to wait for the improvement of the sperm parameter after varicocelectomy: 3 or 6 months?

OBJECTIVE: To estimate the duration of time required following varicocelectomy to wait for the improvements of semen parameters. Therefore, we characterized the changes with the time in sperm parameters in men after varicocelectomy. MATERIALS AND METHODS: In this prospective cohort study we included consecutively observed men who underwent varicocelectomy between September 2017 and September 2018 in a referral academic hospital. Clinical data of the patients, as well as their semen parameters, were measured before surgery and at 3 and 6 months afterward. RESULTS: In this study, a total of 100 men with average age of 29.5 ± 6.2 years were included. Mean sperm concentration and sperm motility significantly improved by 3 (p < 0.05), but not by 6 months following varicocelectomy. The semen volume and sperm with normal morphology were the same before and after surgery (p > 0.05). There was no statistically significant difference in the improvement of semen parameters when comparing 6 months to 3 months postoperatively (p > 0.05). CONCLUSIONS: Sperm parameters (concentration and motility) improve by 3 months after varicocelectomy without further improvements. Consequently, physicians should decide quickly after 3-month of varicocelectomy if surgery has been not helpful and then plan other therapies, like assisted reproductive technology (ART) for managing infertility in couples.

Transobturator tape and mini-sling methods in stress urinary incontinence: Results of a randomized clinical trial.

BACKGROUND: Stress urinary incontinence is one of the most common types of incontinence in premenopausal women, accounting for almost 50% of such cases. Mid-urethral slings are currently the most widely used surgical method for stress urinary incontinence. This study aimed at comparing the efficacy, complications, urodynamic changes and the sexual function status between mini-sling surgery and transobturator tape to help us select the best method in such patients. METHOD: In this randomized controlled trial, 80 cases were studied and randomly assigned to either the mini-sling or transobturator tape group (n = 40). A full medical history was taken and the Q.tip and cough tests were performed for each patient to record their urinary incontinence and hypermobility. Abdominal and pelvic ultrasound study was requested by specifying PVR and urodynamic testing. The International Consultation on Incontinence Modular Questionnaire-6 was filled by the patients and the Female Sexual Functioning Index questionnaire by the physician. The patients were followed-up 8 weeks after discharge by urodynamic tests, ultrasound study, and the International Consultation on Incontinence Modular Questionnaire test. RESULTS: The mean age, body mass index, and parity were not significantly different between the two groups. The mean surgical time, amount of bleeding, hospitalization period, and pain index were significantly less in the mini-sling group. The International Consultation on Incontinence Modular Questionnaire and Female Sexual Functioning Index indices before and after surgery showed no significant difference between the two groups. The difference in urodynamic test parameters was also insignificant. CONCLUSION: In the mini-sling method which is a less invasive method compared to transobturator tape, the intraoperative bleeding, surgical time, hospitalization period, pain, and surgical complications were far less while its efficacy was similar to transobturator tape; therefore, it is recommended in treating stress urinary incontinence among women.

Treatment of ureteral stones: A prospective randomized controlled trial on comparison of Ho:YAG laser and pneumatic lithotripsy.

OBJECTIVES: To study the treatment of ureteric stones by HO:YAG laser lithotripsy and pneumatic lithotripsy and to evaluate the results of the two treatment modalities to assess effectiveness and complications. MATERIALS AND METHODS: Over 1-year period, a total of 79 patients with 82 ureteral stones were randomized into two groups. In group 1 (39 cases with 41 ureteral stones) ureteroscopic HO:YAG laser lithotripsy was performed using a rigid 8 Fr-ureteroscope (LL group). In group 2 (40 cases with 41 ureteral stones) pneumatic lithotripsy was performed in like manner. Efficacy safety and complications in both groups were analyzed. RESULTS: A total of 79 patients with 82 calculi were treated. Two cases in LL group and one in PL group had bilateral ureteral stones. Mean stone size was 12.07 mm in LL group and 10.2 mm in PL group. Stones located in lower ureter in 30 cases on LL group and 29 cases in PL group. Proximal migration of stone occurred in 1 case on LL group and in 3 cases on PL group. Successful fragmentation occurred in 37 cases on LL group and in 30 cases on PL group. Stone-free rate after 1 month in the base of Kidney Ureter Bladder (KUB) and sonography was 95% in LL group and 80.5% in PL group. Ureteral perforation, urinoma, and urosepsis were not seen in both groups. CONCLUSION: HO:YAG laser has advantages over PL in high efficacy of stone fragmentation and a low-retrograde migration of ureteral stone treatment. Other complication of ureteral stone treatment with LL and PL are the same and very rare.

Comparing the Efficacy of Tolterodine and Gabapentin Versus Placebo in Catheter Related Bladder Discomfort After Percutaneous Nephrolithotomy: A Randomized Clinical Trial.

PURPOSE: The purpose of this study was to compare the efficacy of tolterodine and gabapentin vs placebo in catheter related bladder discomfort (CRBD) following percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: This study was a double-blind parallel group randomized clinical trial. Patients who were candidates of PCNL were enrolled. Patients were randomized to treatment groups of tolterodine 2 mg orally (PO) (group T, n = 50), gabapentin 600 mg PO (group G, n = 50), and placebo (group P, n = 70) 1 hour before operation using balanced block randomization. The primary endpoint of interest was visual analog pain scale in 1, 3, 12, and 24 hours after the operation. Secondary endpoints included rescue analgesic use (opioid and nonopioid). RESULTS: The frequency of severe CRBD in 1,12, and 24 hours after the operation was 4%, 4%, and 6% in group T vs 4%, 0%, and 2% in group G vs 47%, 14%, and 6% in the P group (p < 0.001). The number of paracetamol injections for CRBD in the T and G groups was significantly lower than the placebo group (1.8 ± 0.8 vs 1.8 ± 0.7 vs 3.6 ± 0.7, p < 0.001). Likewise the number of pethidine injections in the T and G groups was significantly lower than the placebo group (0.42 ± 0.54 vs 0.68 ± 0.62 vs 2.4 ± 0.64, p < 0.001). In patients with history of Double-J insertion, the severity of CRBD was lower in all treatment groups. CONCLUSIONS: Preoperative administration of oral tolterodine or gabapentin reduces postoperative CRBD and the need for rescue analgesics as much as 24 hours after surgery. Patients with history of Double-J insertion experience less CRBD.

Management of Colon Perforation During Percutaneous Nephrolithotomy: 12 Years of Experience in a Referral Center.

INTRODUCTION: The management protocol for colon perforation during percutaneous nephrolithotomy (PCNL) is controversial because of the scarcity of reported cases and their management diversity. We present our management experience of colon perforation during PCNL. MATERIALS AND METHODS: All PCNL operations between April 2004 and September 2016 in our center (N = 11,376) were reviewed for the occurrence and management of colon perforation. We typically performed PCNL with insertion of nephrostomy tube before mid-2007. After mid-2007, we typically performed tubeless PCNL and inspected access tract for evidence of organ injury especially colon perforation during nephroscope removal. RESULTS: Seventeen colon perforations happened during the study period. The first three cases were diagnosed postoperatively and in two patients open surgery was employed for treatment. The next 14 cases were diagnosed intraoperatively (n = 12) or in the early postoperative period (n = 2) and were managed by broad spectrum antibiotics, bowel rest, and urinary Double-J and Foley's catheter insertion. Percutaneous retroperitoneal drain was inserted for only one patient after intraoperative diagnosis of colon perforation. The other 13 patients were managed without insertion of such drains. For one patient, postoperative insertion of retroperitoneal drain was attempted because of collection of urine. In other patients (n = 12), the management was effective with no need for an operation. Complications according to Clavien-Dindo grade in these 17 patients were grades II, IIIa, and IIIb in 13, 1, and 3 patients, respectively. CONCLUSIONS: Colon perforation during PCNL that is diagnosed intraoperatively or in the early postoperative period can be managed conservatively. It seems possible not to insert colostomy or retroperitoneal drains in stable patients with early or intraoperative diagnosis. In cases of delayed diagnosis, or deterioration of the patient on tubeless management, the standard protocol should be performed including insertion of colonic or retroperitoneal drain or surgery especially in patients with signs or symptoms of peritonitis or persistent fever.

Effects of electromagnetic waves emitted from 3G+wi-fi modems on human semen analysis.

OBJECTIVE: The purpose of this study was to evaluate the effects of 3G+wifi modems on human sperm quality.A total of 40 semen specimens were gathered between March and September 2015, from healthy adult men. METHODS: The sperm samples were divided into two groups - 3G+wi-fi exposed and unexposed groups. In the unexposed group, the specimens were shielded by aluminum foil in three layers and put into an incubator at a temperature of 37°C for 50 minutes. The exposed group was positioned in another room in an incubator at a temperature of 37°C for 50 minutes. A 3G+wi-fi modem was put into the same incubator and a laptop computer was connected to the modem and was downloading for the entire 50 minutes.Semen analysis was done for each specimen and comparisons between parameters of the two groups were done by using Kolmogorov-Smirnov study and a paired t-test. RESULTS: Mean percentage of sperm with class A and B motility were not significantly different in two groups (p = 0.22 and 0.54, respectively). In class C, it was significantly lower in the exposed group (p = 0.046), while in class D it was significantly higher (p = 0.022).Velocity curvilinear, velocity straight line, velocity average path, mean angular displacement, lateral displacement and beat cross frequency were significantly higher in the unexposed group. The limitation was the in vitro design. CONCLUSIONS: Electromagnetic waves (EMWs) emitted from 3G+wi-fi modems cause a significant decrease in sperm motility and velocity, especially in non-progressive motile sperms. Other parameters of semen analysis did not change significantly.EMWs, which are used in communications worldwide, are a suspected cause of male infertility. Many studies evaluated the effects of cell phones and wi-fi on fertility. To our knowledge, no study has yet been done to show the effects of EMWs emitted from 3G+wi-fi modems on fertility.Our study revealed a significant decrease in the quality of human semen after exposure to EMWs emitted from 3G+wi-fi modems.

The Association of Stone Opacity in Plain Radiography with Percutaneous Nephrolithotomy Outcomes and Complications.

PURPOSE: To investigate the influence of stone opacity in plain radiography on stone free rate and complications ofpercutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: A number of 101 patients who underwent PCNL between July-September 2015 wereprospectively included. Stone opacity was judged on preoperative plain Kidney-Ureter-Bladder X-ray. Stone freerate was evaluated two weeks after the operation by ultrasonography and KUB. RESULTS: There were 61 patients with opaque stones and 40 patients with non-opaque stones. The age, body massindex, preoperative creatinine, history of stone surgery, and stone size was not statistically different betweenpatients with opaque and non-opaque stones. Neither operation duration nor access numbers were statisticallysignificant between opaque and non-opaque stones. The frequency of stone free patients in opaque stones and nonopaquestones were 55/61 (90%) and 30/40 (75%) respectively (P = .04) The magnitude of hemoglobin drop inopaque stones and non-opaque stones were 1.9 ± 1.2 mg/dL versus 2.9 ± 1.7 mg/dL (P = .005). CONCLUSION: The stone free rate is lower and the magnitude of bleeding is higher in PCNL of non-opaque stoneswhen compared to opaque stones if rigid instruments are used for nephroscopy.

Management of ureteropelvic junction obstruction in horseshoe kidneys by an assortment of laparoscopic options.

INTRODUCTION: We report our experience with laparoscopic management of ureteropelvic junction obstruction in horseshoe kidneys. METHODS: Between February 2004 and March 2014, 15 patients with horseshoe kidneys and symptomatic ureteropelvic junction obstruction underwent laparoscopic management at our national referral centre. Depending on the anatomy and presence of obtrusive vessels or isthmus, we performed either dismembered, Scardino or Foley YV pyeloplasty, or Hellstrom vessel transposition. Patients were initially evaluated by ultrasonography, then diuretic scintiscan at 4 to 6 months, and followed by yearly clinical and sonographic exams. RESULTS: This study included 11 male and 4 female patients between the ages of 4 to 51 year (average 17.7). The left kidney was involved in 12 patients (80%). Operation time was 129 minutes (range: 90-186), and patients were discharged within 2.8 days (range: 1-6). Although 8 (53.3%) patients had crossing vessels, of which 6 required transposing, the Hellstrom technique was solely used in 3 cases, of which notably 1 case failed to resolve and required laparoscopic Hynes within the next year. Eight cases underwent dismembered pyeloplasty, 2 Foley YV, 1 Scardino flap and 1 required isthmectomy and vessel suspension. At the mean follow-up of 60 (range: 18-120) months, the overall success rate was 93.3%. CONCLUSIONS: To our knowledge, this represents the largest report on laparoscopic pyeloplasty for horseshoe kidneys, providing the longest follow-up. Our findings confirm prior reports supporting laparoscopy and furthermore show that despite the prevalence of crossing vessels, transposition alone is seldom sufficient.

Opioid-sparing effect of intravenous paracetamol after percutaneous nephrolithotomy: a double-blind randomized controlled trial.

PURPOSE: To evaluate meperidine-sparing effect of intravenous (IV) paracetamol in patients undergoing percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: One hundred patients who underwent PCNL were randomized to paracetamol (n=50) and placebo (n=50) groups. Patients received 100 mL of physiologic saline with or without 1 g IV paracetamol every 8 hours after PCNL up to 24 hours in the paracetamol and placebo groups, respectively. Patients in both groups received intramuscular meperidine in case of unrelieved pain. The visual analog scale (VAS) was used to evaluate pain intensity scores in the postoperative period. Total meperidine consumption, mean VAS score in the first 6 and 24 hours, demographic variables, operative variables, and side effects were recorded. RESULTS: The mean VAS pain intensity scores at 6 and 24 hours were 50.22 and 41.32 mm in the paracetamol and 75.29 or 65.5 mm in the placebo group (P<0.001). The mean consumed meperidine dose was 54.40 mg and 77.60 mg in the paracetamol and placebo groups, respectively (P<0.001). CONCLUSION: In this study, IV paracetamol significantly reduced total meperidine consumption and pain intensity scores compared with placebo. IV paracetamol can be an effective and safe part of multimodal analgesia regimes for postoperative pain management after PCNL.