Novel treatment for glance necrosis due to priapism; presentation and review of literature.

INTRODUCTION: Glans necrosis in association with priapism is very rare and its appropriate treatment is not known. There is a secondary cause in most cases. CASE DESCRIPTION: We treated a 65-year-old man with priapism and glans necrosis using a closed shunt (Winter), continuous penile irrigation with normal saline, and heparin for 48 h and waited for the necrotic area to resolve spontaneously. The treatment outcome was much better compared to previous cases in whom open surgery, irrigation with pure normal saline, and/or resection of the necrotic area were performed. CONCLUSION: In cases with priapism and glans ischemia, we recommend treating the condition with continuous covernose irrigation with heparinized saline and avoiding open surgery.

Hematuria and its repetition after initial control in patients receiving anti-coagulant: A prospective observational study.

OBJECTIVES: Although Gross hematuria in patients receiving anticoagulants is not very common, it is one of the most common reasons of consulting with urologists. It is recommended to investigate urinary tract malignancies but simultaneous approach to anticoagulation and hematuria so as the optimum balance could be attained, is not clearly defined in the literature yet. We aim to answer pitfalls of hematuria management in anticoagulant receiving patients in this manuscript. MATERIALS AND METHODS: In a prospective case control study during 2017-2019, we observed and collected the data of patients receiving anticoagulant therapy and suffered from gross hematuria with coagulation parameters in prophylactic or therapeutic range in an academic hospital affiliated to Tehran University of Medical Sciences. SPSS 24th version was used for descriptive analysis of collected data. RESULTS: Sixty-six patients encountered hematuria while receiving anticoagulant therapy. Although hematuria was more common in male patients, its recurrence was higher in female patients. It started mostly in first 72 h of therapy and was anticoagulant-dose dependent. Degree of hematuria was mostly mild or moderate by visual estimation and controlled easily by holding the anticoagulant therapy for less than 2 days. Anti-platelet therapy, urinary catheterization and patient's activity did not have any effect on re-bleeding rate. CONCLUSION: Considering the fact that ruling out the urinary tract malignancy is mandatory in these patients, moderate and severe hematuria can be controlled simply by short term holding the anticoagulant therapy while continuing antiplatelet therapy albeit there is possibility to continue them in mild cases. Removing urinary catheters and decreasing the patient's mobility are not recommended. In order to decrease the recurrence of hematuria, re-establishing anticoagulation with LMWH and non-Vitamin D dependent oral agents rather than continuing Heparin and Warfarin might be helpful.

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.

Testis biopsy in absolute head teratospermia: Is it a logical option?

INTRODUCTION: Absolute head teratospermia (100% abnormal head morphology) is associated with poor fertility and assisted reproductive techniques results. We aimed to find if it is possible to bypass this disorder using sperm retrieved by testis biopsy. METHODS: Multiple testis biopsies were performed in patients with infertility and absolute head teratospermia who were not able to provide semen on the injection day from 2006 to 2018. Then, the found sperms were evaluated based on being proper or not proper for intracytoplasmic sperm injection. RESULTS: Only 2 patients, of a total of 22 (9%), had relatively proper sperms for microinjection. DISCUSSION: There is no benefit to performing testis biopsy in non-azoospermic patients with absolute abnormal head morphology.

A comprehensive review of adult enuresis.

Nocturnal enuresis (NE) is a combined symptom of nocturia and urinary incontinence. In this review, we aim to summarize the current literature on NE in terms of its definition, diagnosis, and management. Recommended diagnostic evaluation of NE includes a focused history and physical examination, urinalysis, and when indicated, ultrasound examination, flow rate, urine volume chart, urodynamics, and cystoscopy. Therapeutic options include lifestyle modification and medications (i.e., desmopressin and anticholinergics).

Extraction of trapped double J in ureteroscope: a novel technique.

INTRODUCTION: Urological endoscopes and percutaneous devices are expensive and their maintenance and cleaning need special attention. Sometimes urologists can help repairing their devices. CASE DESCRIPTION: During taking out a Double J, Double J was trapped in the working channel of ureteroscope unintentionally. It was not possible to take it out by pushing methods. Finally, Double J was pulled out by a changed nephrostomy needle to a small curve hook. CONCLUSIONS: Using the hand-made hook to pull out a trapped Double J from ureteroscope does not destroy the device.

Electrocautery resection, shaving with a scalpel, and podophyllin: a combination therapy for giant condyloma acuminatum.

Giant condyloma acuminatum (also known as Buschke-Löwenstein tumor) is a rare disease, for which the treatment of choice is still controversial. In the case described in this report, we used a combination of electrocautery and a surgical scalpel to resect a huge genital wart, followed by long-term local treatment with podophyllin. This procedure was relatively fast, easy to perform, involved minimal bleeding, and did not result in any complications. Moreover, combination therapy enabled us to avoid deep resection of the lesion and consequently, sexual function was preserved completely.

Age at diagnosis in bladder cancer: does opium addiction play a role?

BACKGROUND: Bladder cancer is a major health problem, especially among men. Opium addiction can be an important risk factor. One important question is whether it can affect the age of onset of bladder cancer .We performed this study to evaluate this question. MATERIALS AND METHODS: In a cross-section study, records of patients diagnosed with bladder carcinoma in Shahid Labbafinejad Medical Center, within 1999-2008 were included. Data were extracted from records regarding age at onset, gender, smoking status, and opioid addiction and analyzed with SPSS 13. RESULTS: Within 10 years, 920 cases were diagnosed with bladder cancer of which 97 percent were transitional cell carcinoma. In 698 cases, opium addiction status was recorded in 21.3% (n=149). Age at diagnosis was 59.7±11.51 (median: 60) among opioid addicts which was significantly lower than non- addicts (63.1±13.65, Median: 65) (P<0.001). CONCLUSIONS: Opium addiction can decrease the age of onset of bladder cancer.

A hard mass discovered in the corpus spongiosum after difficult urethral catheterization: two case reports.

Male urethral catheterization is a common procedure rarely causing complications. Difficult urethral catheterization, however, can be problematic for both clinician and patient, leading to unexpected complications. This article will present two unreported cases of urethral trauma during difficult catheterization that resulted in the development of a hard, tumor-like mass in the corpus spongiosum. This is a rare complication that if not recognized might lead to unnecessary invasive interventions for the patient.

Benefit of sperm freezing before radical orchiectomy.

A patient with a unilateral testis tumour who had been treated with radical orchiectomy was referred to our centre. He was oligospermic before orchiectomy and needed chemotherapy because of abnormal tumour markers after the aforementioned operation. He did not have any sperm suitable for freezing. Because of a lack of information about the spermatogenic abilities in the other testis, it is advisable to freeze sperm prior to orchiectomy at least in patients with semen analysis disorders.

Percutaneous nephrolithotomy with and without retrograde pyelography: a randomized clinical trial.

OBJECTIVE: Since the introduction of percutaneous nephrolithotomy (PCNL), many changes have been added regarding the entrance to pyelocalyceal system such as insertion of the needle pointed to an opaque stone as a guided landmark. We aim at comparing the outcomes of managing renal calculi with and without retrograde pyelography. MATERIALS AND METHODS: In a randomized clinical trial, 55 cases with opaque renal calculi candidates for PCNL with stone in one calyce, in the pelvis or both in one calyce and the pelvis simultaneously were included in a nine-month study. They were randomized into 2 groups, noncatheterized (n = 28) and catheterized (n = 27), called intervention and control groups, respectively. RESULTS: The 2 groups had similar distributions regarding gender, age, duration of operation, length of hospital stay, past history of any surgical procedures on kidney, and stone size. Outcome (residual stone based on aforementioned management) was evaluated with plain X-ray on the morning following the operation. Postoperative hemoglobin decrease was significantly higher in controls than in the intervention group (p < 0.001) (with no clinical significance). No difference in outcome, postoperative fever, duration of surgery, duration of hospital stay and radiation exposure was observed between the 2 groups. CONCLUSION: Our findings showed no differences in major clinical outcomes between the 2 groups (with and without catheter insertion for retrograde pyelography).

Gil-vernet anti-reflux surgery and primary vesicoureteral reflux in women.

OBJECTIVE: To review the results of Gil-vernet anti-reflux surgery in adult female patients suffering from primary vesicoureteral reflux. MATERIAL AND METHODS: A total of 39 women with a diagnosis of primary vesicoureteral reflux who were surgically treated at our medical center using the Gil-vernet anti-reflux method between 1995 and 2004 were included in the study. Data concerning gender, age, pre- and postoperative symptoms, reflux grading and the outcome of surgery were reviewed. RESULTS: Thirty-nine females (mean+/-SD age 29.19+/-10 years; range 18-65 years) with a total of 49 refluxing renal units were studied. The Gil-vernet technique was effective in eliminating reflux in 48/49 renal units (97.95% success rate) and 38/39 patients (97.43% success rate). The chief complaints of the patients were resolved after surgery in 87.17% of cases. CONCLUSION: Gil-vernet anti-reflux surgery had a high success rate in adult female patients.

Percutaneous nephrolithotomy with and without retrograde pyelography: a randomized clinical trial

OBJECTIVE: Since the introduction of percutaneous nephrolithotomy (PCNL), many changes have been added regarding the entrance to pyelocalyceal system such as insertion of the needle pointed to an opaque stone as a guided landmark. We aim at comparing the outcomes of managing renal calculi with and without retrograde pyelography. MATERIALS AND METHODS: In a randomized clinical trial, 55 cases with opaque renal calculi candidates for PCNL with stone in one calyce, in the pelvis or both in one calyce and the pelvis simultaneously were included in a nine-month study. They were randomized into 2 groups, noncatheterized (n = 28) and catheterized (n = 27), called intervention and control groups, respectively. RESULTS: The 2 groups had similar distributions regarding gender, age, duration of operation, length of hospital stay, past history of any surgical procedures on kidney, and stone size. Outcome (residual stone based on aforementioned management) was evaluated with plain X-ray on the morning following the operation. Postoperative hemoglobin decrease was significantly higher in controls than in the intervention group (p < 0.001) (with no clinical significance). No difference in outcome, postoperative fever, duration of surgery, duration of hospital stay and radiation exposure was observed between the 2 groups. CONCLUSION: Our findings showed no differences in major clinical outcomes between the 2 groups (with and without catheter insertion for retrograde pyelography).

Fever after percutaneous nephrolithotomy: contributing factors.

BACKGROUND AND PURPOSE: The exact mechanism of fever and urosepsis after percutaneous procedures has not been established. This research studied the frequency of fever after percutaneous nephrolithotomy (PCNL) and the contributing factors. METHODS: In a cross-sectional study, from September 2003 to March 2004, all 217 patients with nephrolithiasis treated with PCNL at the Labbafinegad Specialized Urology Center were studied. Data were collected before, during, and after surgery. RESULTS: The frequency of fever after PCNL was 25.8% (n=56) although in 62.2% of the cases (n=135), no prophylactic antibiotics had been administered. The mean durations of hospitalization in patients with and without fever were 5.4+/-2.3 and 3.4+/-1.7 days, respectively (p=0.001). Significant correlations were observed between fever and female sex (p=0.005), positive urine culture (p=0.02), and nephrostomy tube insertion (p=0.041). Other variables did not prove to be significant. In logistic regression analysis, female sex and nephrostomy tube insertion were independently related to post-operative fever. CONCLUSION: Although a considerable proportion of our patients had not received prophylactic antibiotics, the rate of fever after PCNL was no higher than is reported in the literature. Use of only a short course of antibiotics before surgery for staghorn stones did not result in a higher rate of fever. Female sex created a higher risk for fever, probably because of the greater propensity to urinary tract infection. The significant relation of a nephrostomy tube to fever could be attributed to its role as a foreign body or to use in more complicated cases.

Effect of allopurinol in chronic nonbacterial prostatitis: a double blind randomized clinical trial.

INTRODUCTION: The exact mechanism of chronic nonbacterial prostatitis has not been yet elucidated and the outcome with the current management is dismal. In this trial, we studied the effect of allopurinol in the treatment of this disease. MATERIALS AND METHODS: In this randomized double blind controlled trial, a calculated sample size of 56 were grouped into "intervention group" who received allopurinol (100 mg tds for 3 months) with ofloxacin (200 mg tds) for 3 weeks (n = 29) and "control group" who received placebo tablets with ofloxacin (n = 27). Patients' scores based on the National Institute of Health Chronic Prostatitis Symptom Score were recorded before therapy and then every month during the study. A four-glass study was performed before intervention and after 3 months. RESULTS: The 2 groups were similar regarding outcome variables. In the first month of study, a significant but similar improvement in symptom scores was observed in both groups. Microscopic examination of prostate massage and post-massage samples were also similar in both groups. No side effects due to allopurinol were observed in patients. CONCLUSION: We did not find any advantage for allopurinol in the management of chronic prostatitis versus placebo in patients receiving routine antibacterial treatment.

Effect of allopurinol in chronic nonbacterial prostatitis: a double blind randomized clinical trial

INTRODUCTION: The exact mechanism of chronic nonbacterial prostatitis has not been yet elucidated and the outcome with the current management is dismal. In this trial, we studied the effect of allopurinol in the treatment of this disease. MATERIALS AND METHODS: In this randomized double blind controlled trial, a calculated sample size of 56 were grouped into "intervention group" who received allopurinol (100 mg tds for 3 months) with ofloxacin (200 mg tds) for 3 weeks (n = 29) and "control group" who received placebo tablets with ofloxacin (n = 27). PatientsÆ scores based on the National Institute of Health Chronic Prostatitis Symptom Score were recorded before therapy and then every month during the study. A four-glass study was performed before intervention and after 3 months. RESULTS: The 2 groups were similar regarding outcome variables. In the first month of study, a significant but similar improvement in symptom scores was observed in both groups. Microscopic examination of prostate massage and post-massage samples were also similar in both groups. No side effects due to allopurinol were observed in patients. CONCLUSION: We did not find any advantage for allopurinol in the management of chronic prostatitis versus placebo in patients receiving routine antibacterial treatment.

A novel surgical technique to localize small enteropouch fistula.

BACKGROUND: One of the rare complications of ileal neobladder after radical cystectomy is pouch-to-intestine fistula. There isn't a classic method to intraoperative diagnosis of small fistula. CASE PRESENTATION: An entero-pouch fistula was occurred in a patient after radical cystectomy with ileal orthotopic pouch. Because of failed conservative management, the patient was candidate for surgery. The hidden small fistula in the small intestine was diagnosed by high intraluminal hydrostatic pressure (by intraluminal saline injection). CONCLUSION: Intraoperative diagnosis the intestinal opening of a small fistula is very important. At the time of surgery if the fistula tract becomes open (during releasing the adhesions), it may leak in the peritoneum in postoperative period. Intraluminal high pressure is a useful method for intraoperative small hidden intestine opening.

Percutaneous nephrolithotomy with and without retrograde pyelography: preliminary results of a randomized controlled trial.

INTRODUCTION: Since the introduction of percutaneous nephrolithotomy (PNL), many modifications to entering the pyelocalyceal system have been made. One alternative is to insert a needle pointed to an opaque stone as a landmark. The aim of this study was to compare the outcomes of managing kidney calculi by PNL with and without retrograde pyelography. MATERIALS AND METHODS: In this randomized controlled trial, 55 candidates for PNL with a single opaque kidney calculus in the calyx alone, the pelvis alone, or both the calyx and the pelvis were assigned into 2 groups. Twenty-seven patients underwent PNL with a ureteral catheter, and 28 patients underwent PNL without a ureteral catheter. Clinical outcomes were compared between the 2 groups using plain radiographs taken on the first day after the procedure. RESULTS: Patients had similar distributions regarding sex, age, operative time, hospital stay, past surgical history on the kidneys, and stone size. There was a significantly greater decrease in postoperative hemoglobin level in patients having PNL with a ureteral catheter (P < 0.001) than in those having the procedure without a ureteral catheter. No differences were seen among patients in the 2 groups in terms of stone-free rate, and number of patients with insignificant residue, and those needing extracorporeal shock wave lithotripsy, a second PNL procedure, or transurethral lithotripsy. CONCLUSION: Percutaneous nephrolithotomy without ureteral catheterization has specific benefits: urine leakage is lower and there is no need to perform cystoscopy. Patients with a single kidney calculus are good candidates for PNL without previous ureteral catheter insertion.