Simultaneous adrenal and retroperitoneal myelolipoma resected by laparoscopic surgery: a challenging case.

BACKGROUND: Myelolipoma is a benign neoplasm of the adrenal cortex, composed of fat and hematopoietic cells. Although myelolipoma is benign, differentiation from adrenocortical cancer may be difficult. The presence of adrenal and extra-adrenal myelolipomas simultaneously is sporadic, making it a challenging case, especially when the preoperative diagnosis is ambiguous. CASE PRESENTATION: A 65-year-old man was referred to our clinic due to a mass in the adrenal fossa. In the abdominopelvic computed tomography (CT), a well-circumscribed fat-containing 78 × 61 × 65 mm bi-lobulated mass was reported in the left adrenal fossa. The first differential diagnosis was myelolipoma. The patient was then referred to our clinic for a mass excision. He was asymptomatic and was scheduled to undergo laparoscopic-assisted adrenalectomy. After adrenalectomy and mass dissection, surprisingly, another mass was detected in the retroperitoneal area. The second mass was also dissected. The final diagnosis was myelolipoma for both masses. The patient has been symptom-free for nine months after the operation. CONCLUSION: Simultaneous adrenal and extra-adrenal myelolipoma should be considered as one of the differential diagnoses. However, because this situation is extremely rare, the probability of malignancy should be highly regarded, and we suggest an obsessive approach when approaching this condition. It is essential to manage these cases on a case-by-case basis and tailor the management concerning intraoperative biopsy, the intraoperative appearance of tumors, and the location of extra-adrenal masses.

Exposure to needle stick injuries among health care workers in hemodialysis units in the southwest of Iran: a cross-sectional study.

BACKGROUND: Needle stick injury (NSI) is the most common cause of infection with blood-borne pathogens (BBP) among healthcare workers (HCWs). This study aimed to assess the prevalence of NSI and it's contributing factors among HCWs of hemodialysis (HD) units in southwest Iran. METHODS: A cross-sectional study was performed in 13 HD centers in Shiraz, Iran. A total of 122 employees were enrolled in our study. We used self-administrated questionnaires to collect data about demographics, experiences regarding NSIs, and general health status. The statistical tests used in this study were Chi-square and Independent T-test. A P-value < 0.05 is considered significant. RESULTS: The mean age of the study population was 36.1 ± 7.8 years (72.1%: women). Exposure to NSIs was reported by 23.0% of them at least once during the previous six months. NSI prevalence was significantly higher among those with higher age (p = 0.033), work experience > 10 years (p = 0.040), and those who graduated earlier (p = 0.031). The intravenous injection was the most common procedure leading to NSI, and being in a hurry was the most common cause. The average general health was 3.7 ± 3.2, higher among those not exposed to NSI (p = 0.042). CONCLUSION: NSI is a prevalent hazard in HCWs of HD units. The high rate of NSI and unreported cases, besides the lack of adequate information, indicates the necessity of implementing protocols and strategies for improving the safety of this personnel. It is difficult to compare the result of this study with those performed among HCWs in other settings; hence, further studies are needed to determine whether HCWs of these units are more exposed to NSIs.

Ambient air pollutants and respiratory health outcomes in Tabriz and Urmia, two metropolises of Iran.

Polluted air affects human life and it is crucial to assess air pollutants to inform policy and protect human lives. In this study, we sought to assess the respiratory outcomes associated with PM10, O3, SO2, and NO2 in the Iranian population. The required data, which included concentrations of air pollutants, meteorology, and population size, were obtained from the department of environment and meteorological organizations. The validity of the data was evaluated, and appropriate calculations were conducted on the data to extract the required values and parameters for modeling (using the AirQ2.2.3). This study was conducted in two megacities of Iran (Tabriz and Urmia) with over 2 million population. The annual averages of SO2, NO2, and PM10 concentrations were 9, 73, and 43 µg/m3 in Tabriz and 76, 29, and 76 µg/m3 in Urmia, respectively. Excess deaths from respiratory diseases associated with PM10 and SO2 were estimated to be 33.1 and 1.2 cases in Tabriz and 31.6 and 24.7 cases in Urmia, respectively. The proportions of hospitalizations for chronic obstructive pulmonary disease (COPD) attributable to SO2 and NO2 in Tabriz were 0.07% and 1.61%, respectively, whereas they were 2.84% and 0.48% in Urmia. O3 had an annual average of 56 µg/m3 in Tabriz and with 44.5 excess respiratory deaths and 42.5 excess hospital admissions for COPD, it had the greatest health impacts among the pollutants studied. Findings from this study add to the growing literature, especially from developing countries, that provides insights to help authorities and decision-makers develop and implement effective interventions to curb air pollution and save lives.

Potential mechanisms of SARS-CoV-2 action on male gonadal function and fertility: Current status and future prospects.

The novel coronavirus was recognised in December 2019 and caught humanity off guard. The virus employs the angiotensin-converting enzyme 2 (ACE2) receptor for entry into human cells. ACE2 is expressed on different organs, which is raising concern as to whether these organs can be infected by the virus or not. The testis appears to be an organ enriched with levels of ACE2, while the possible mechanisms of involvement of the male reproductive system by SARS-CoV-2 are not fully elucidated. The major focus of the present studies is on the short-term complications of the coronavirus and gains importance on studying the long-term effects, including the possible effects of the virus on the male reproductive system. The aim of this review was to provide new insights into different possible mechanisms of involvement of male gonads with SARS-CoV-2 including investigating the ACE2 axis in testis, hormonal alterations in patients with COVID-19, possible formation of anti-sperm antibodies (ASA) and subsequently immunological infertility as a complication of SARS-CoV-2 infection. Finally, we suggest measuring the sperm DNA fragmentation index (DFI) as a determiner of male fertility impairment in patients with COVID-19 along with other options such as sex-related hormones and semen analysis. Invasion of SARS-CoV-2 to the spermatogonia, Leydig cells and Sertoli cells can lead to sex hormonal alteration and impaired gonadal function. Once infected, changes in ACE2 signalling pathways followed by oxidative stress and inflammation could cause spermatogenesis failure, abnormal sperm motility, DNA fragmentation and male infertility.

Are herbal medications, with possible beneficial effects for benign prostatic hyperplasia, better to be continued during the COVID-19 pandemic?

Different strategies have been proposed to treat cytokine storm syndrome (CSS), the final deadly complication of COVID-19. One approach is to target CSS by blocking the interleukin-6 (IL-6) pathway. A promising group of medications blocking the IL-6 pathway is α-blockers, such as prazosin. First, we hypothesized that Panax ginseng, commonly known as ginseng, can be an effective therapeutic agent in preventing CSS due to its blocking activity on alpha-1 adrenergic receptors (α1-AR). Furthermore, we suggested that herbs with 5α-reductase inhibitory effects, such as Saw palmetto, Nettle root, soya, black pepper, and green tea, can have debilitating impacts on pulmonary function since they can lead to impairment of the lung's ability to regenerate. Thus, we encourage the prospective studies to explore the potential effect of herbal medications, with possible beneficial effects for benign prostatic hyperplasia, during the COVID-19 pandemic since they are commonly consumed.

Has the COVID-19 pandemic affected ureteral stone management in pregnant women? A retrospective single-center study.

INTRODUCTION: This study aimed to evaluate the effect of coronavirus disease (COVID-19) on the patients' referral in the pregnant population and also investigate each treatment approach's advantages and disadvantages for acute renal colic in pregnancy. METHODS: In this retrospective study, we included all pregnant women with ureteral stones referred to a referral center between January 2019 and March 2021. RESULTS: Among 53 pregnant women, 18 (33.9%) were on conservative therapy, which passed the stone without any complications. Double J stent or nephrostomy tube insertion was done for 24 patients (45.2%). Seventeen of these patients (70.8%) presented post-surgical complications, including hematuria (29.2%), pyelonephritis (20.8%), and lower urinary tract symptoms (20.8%). Transurethral lithotripsy (TUL) was done in 11 patients (20.7%). Only one of these patients developed hematuria following TUL. Thus, in our population study, double J stent or nephrostomy insertion was associated with a higher chance of postoperative complications than TUL (p-value = 0.001). Thirty-six patients were referred within 13 months before the entry of COVID-19, while 17 were referred during a similar approximate duration after the COVID-19 entry into the country. Only the initial presentation had a significant difference between these two periods (p-value = 0.034). CONCLUSIONS: When conservative treatment fails, we recommend TUL as the second-line treatment over temporary procedures, such as double J stent or nephrostomy insertion. Of note, in a group of patients with an emergent clinical setting, including active infection, deteriorating renal function, signs of preterm labor, solitary kidney, etc., double J or nephrostomy tube insertion remains the preferred management method for its fast resolution of obstruction and infection. Besides, a decrease in visits with an increase in complicated cases after COVID-19 was observed, maybe due to a delay in referring.

Multiple pyonephrotic compartments with different microorganisms and an infected "calcium milk" in a patient with bilateral obstructive uropathy: A challenging case.

INTRODUCTION AND IMPORTANCE: If the surgeon encounters frank pus, he is advised to limit the procedure to efficient drainage of the infected compartment of the urinary tract either by double J stent insertion or percutaneous nephrostomy and abort and postpone the definitive stone treatment until the infection is treated. CASE PRESENTATION: We present a highly complex case of an elderly female with multiple obstructing stones in the left kidney and ureter, with complete staghorn stones in the right kidney. While this scenario was already complex by virtue of the stone burden alone, which demands the combination of multiple stone treatment techniques, it was further complicated by compartmental infections in various parts of the kidneys with different microbes necessitating repeated abortion of procedures. As often in elderly patients, there was no rise of inflammatory markers, and bladder urine cultures were repeatedly negative. Moreover, a rare form of infection was encountered, namely "calcium milk" in the form of a radio-opaque lower pole abscess on the right. CLINICAL DISCUSSION: We discuss the etiology, treatment, and management of pyonephrosis and remind the need to always take it into account and react accurately when encountering infected space behind obstruction during minimally invasive surgeries in urolithiasis. CONCLUSION: Hidden microorganisms with different entities should be considered during surgical management of urinary stones. Complete drainage and appropriate antibiotic therapy are the cornerstones of treating this condition.

Comparison of post-urethroplasty complication rates in pediatric cases with hypospadias using Vicryl or polydioxanone sutures.

Objective: Hypospadias is a common congenital problem among male newborns. Both rapid absorbable sutures (polyglactin, Vicryl) and delayed absorbable sutures (polydioxanone, PDO) are used in hypospadias repair based on the surgeon's preference. This study was conducted to compare post-urethroplasty complication rates in pediatric patients with hypospadias using Vicryl or PDO sutures. Methods: This is a retrospective study which was designed and performed on 583 children aged 1-7 years old who had undergone hypospadias repair from January 2012 to December 2018. Required data were obtained from the patients' medical records. Results: Overall, post-surgical complications were observed in 60 (10.3%) patients comprising urethro-cutaneous fistula (n=39, 6.7%), meatal stenosis (n=10, 1.7%), urethral stricture (n=7, 1.2%), and glans dehiscence (n=4, 0.7%). The mean age of the children with complications was 3.0±1.3 years. According to Kaplan-Meier estimate, the interval between surgery and development of complications was significantly shorter in the Vicryl group (p=0.037). Overall, complications were more prevalent in Vicryl suture than PDO suture (15.1% vs. 5.3%, p<0.001). Regression model revealed that in comparison to the distal type, proximal hypospadias (odds ratio [OR]:103.9, 95% confidence interval [CI]: 32.2-334.9, p<0.001) and mid-shaft hypospadias (OR: 82.9, 95% CI: 25.9-264.6, p<0.001) while using Vicryl suture instead of PDO suture (OR: 62.4, 95% CI: 21.2-183.8, p<0.001) increased the odds of developing post-urethroplasty complications. Conclusion: We suggest PDO suture in the repair of hypospadias due to its lower complication rate, especially in cases of proximal and mid-shaft hypospadias which can get more complicated than the distal type.

Peritoneal perforation and peritonitis after antegrade double-J stent insertion: A case report and review of the literature.

Penetration of peritoneal cavity during antegrade double-J (DJ) stenting is rare. A 52-year-old woman presented with signs of peritonitis for 3 days after left PCNL. Abdominal CT scan revealed a perforation of the peritoneum by the distal coil of DJ stent, which was reinserted into the bladder by ureteroscopy.

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).

Kidney Transplant and Autosomal Recessive Polycystic Disease: A Case Report and Literature Review of 2 Brothers.

Autosomal recessive polycystic disease is a rare hepatorenal disorder. End-stage renal disease and liver fibrosis are serious presentations of this disease. Here, we report 2 brothers with autosomal recessive polycystic disease who presented with abnormal abdominal protrusion and hepatosplenomegaly during infancy and eventually underwent renal transplant. Congenital hepatic fibrosis and nephromegaly followed by renal failure developed, after which renal transplant was successfully performed. The remaining compli-cation after transplant was hematemesis and melena due to esophageal varices. Autosomal recessive polycystic disease has a broad spectrum of symptoms; similar pre-sentations with manifestations in siblings may explain some unknown genetic causes of this rare disease.

Pharmacotherapeutic approach toward urological medications and vaccination during COVID-19: a narrative review.

One year after the prevalence of the novel coronavirus pandemic, some aspects of the physiopathology, treatment and progression of coronavirus 2019 disease (COVID-19) have remained unknown. Since no comprehensive study on the use of urological medications in patients with COVID-19 has been carried out, this narrative review aimed to focus on clinically important issues about the treatment of COVID-19 and urologic medications regarding efficacy, modifications, side effects and interactions in different urologic diseases. In this review, we provide information about the pharmacotherapeutic approach toward urologic medications in patients with COVID-19 infection. This study provides an overview of medications in benign prostatic hyperplasia, prostate cancer, impotence and sexual dysfunction, urolithiasis, kidney transplantation and hypertension as the most frequent diseases in which the patients are on long-term medications. Also, the effect of urologic drugs on the efficacy of vaccination is briefly discussed.