Endovisually guided zero radiation ureteral access sheath placement during ureterorenoscopy.

BACKGROUND: Almost all endourologic procedures use fluoroscopic imaging in some steps, which exposes both the patient and the surgical team to considerable amounts of radiation. Primary reports on results of a simple direct visual endoscopic access sheath placement technique which does not use fluoroscopy at all are presented. MATERIAL AND METHODS: First a semi-rigid ureteroscopy was carried out up to the renal pelvis, then the access sheath (36 cm, 11/13 Fr) without the obturator was placed over a 7.5 Fr semi-rigid ureteroscope and ureteroscopy was repeated over the guide wire to the point where the sheath could be inserted without force as if the ureteroscope would act as the guide wire (rod), which is controlled under direct endoscopic vision. RESULTS: Eighty-eight cases out of 106 procedures were successful regarding the insertion of the ureteral access sheath (UAS) under direct vision using a 36 cm 13/11 Fr sheath. Fourteen ureters had non-negotiable strictures needing stenting for passive dilation. The mean time for UAS insertion was 19 s. The stone free-rate was 78.12%. Among our 106 cases, there were six cases of the upper tract urothelial cancers. CONCLUSION: Ureteral access sheath placement could be safely performed using a semi-rigid ureteroscope under direct visual control and resulted in shorter operative time, without radiation exposure during the RIRS procedure of both the patient and the surgery team.

Primary Report of Totally Tubeless Percutaneous Nephrolithotomy Despite Pelvi-calyceal Perforations.

PURPOSE: Nephrostomy tube insertion and/or a ureteral stent placement is advised when pelvi-calyceal perforations are encountered during percutaneous nephrolithotomy (PNL) nevertheless totally tubeless PNL is a possible exit strategy in percutaneous renal surgery therefore case series on the short term clinical outcomes of noninvasive management of iatrogenic pelvicalyceal perforations encountered during PNL is presented. PATIENTS AND METHODS: During retrospective analysis of 1271 PNL procedures, 25 incidents of accidental ureteral catheter/ jj stent dislodgement during first 24 post-operative hours were identified in patient who had pelvi calyceal perforations and had no nephrostomy tube (tubeless). Thirteen patients could not be re-stented nor a nephrostomytube could have been placed for them mainly due to patient refusal or comorbid conditions. The main outcome was rate of successful noninvasive management. RESULTS: Eighteen Patients bearing mucosal tears (grade I trauma) or visible peri-pelvic fat (grade II) successfully recovered without need for ureteral stenting or nephrostomy (72.0%). In seven (28.0%) cases of extension of the perforation into the peri-pelvic fat (grade III), either nephrostomy insertion or JJ stenting was needed for resolution of fever and urinoma. The major limitation was the necessity to exclude patients and manage them in the standard fashion according to clinical guidelines. CONCLUSION: Iatrogenic perforations of the collecting system are quite diverse in terms of severity that result in different natural histories and not all might need urinary diversion via nephrostomy or ureteral stenting.Low grade perforations may be successfully managed in totally tubeless fashion nevertheless further prospective investigations seem warranted.

Concomitant anterior and posterior urethral valves in pediatrics: A single center experience over 12 years and long-term follow up after endoscopic treatment.

OBJECTIVE: To report our 12-year experience with endoscopic management of patients with concomitant anterior and posterior urethral valves. METHODS: We retrospectively reviewed the charts of patients referred to us for management of urethral valves from 2000 to 2012 to find cases with concomitant anterior and posterior valves. The diagnosis of valves was first suspected on voiding cystourethrography and confirmed by urethrocystoscopy. We collected available data on patients' age at diagnosis, clinical presentations, ultrasound and urodynamic findings, and surgical treatments. The final outcome at last follow up was also recorded. RESULTS: From 38 cases with anterior urethral valve, six (15.8%) presented concomitant anterior and posterior valves. The age at diagnosis in these patients ranged from antenatal diagnosis to 13 years. Initial presenting symptoms were recurrent urinary tract infection, incontinence, urosepsis and poor urinary stream. All valves were ablated by transurethral fulguration/resection using small-sized urethrocystoscopes. Among those with concomitant anterior and posterior valves, four patients had vesicoureteral reflux at presentation that resolved in two patients after valve ablation. One patient progressed to renal failure and required dialysis. Bladder hypercontractility and detrusor overactivity were the main urodynamic patterns in these patients. CONCLUSIONS: Concomitant anterior and posterior valves seem to be more prevalent than previously assumed, and might be missed on initial assessment. Oblique view voiding cystourethrography with full-length delineation of the urethra is of paramount diagnostic importance when obstruction is suspected. A meticulous urethrocystoscopy should follow for confirming the diagnosis and endoscopic ablation/resection of the valves.

Does bone marrow-derived mesenchymal stem cell transfusion prevent antisperm antibody production after traumatic testis rupture?

OBJECTIVE: To determine whether transfusion of mesenchymal stem cells (MSCs) could prevent humoral immune response and autoimmunization against sperms after traumatic testis rupture. METHODS: Immunomodulatory properties of MSCs have been evaluated by a prospective cohort on 50 adult BALB/c mice. In each interventional arms of study, controlled testis rupture and surgical repair were exerted. In addition to tissue repair, single dose of 5×10(5) MSCs labeled by green fluorescent protein was delivered intravenously to 20 cases (cell therapy group). After euthanizing, seroconversion of antisperm antibody (ASA) was compared between 2 interventional groups as response of humoral immune system. Lung and testis tissues were examined for green fluorescent protein-positive cells to assess whether presence of stem cells is correlated with seroconversion rates. RESULTS: Six cases had been lost during the study. Fourteen of 16 mice in cell therapy control group formed ASA (87.5%) but 6 of 18 mice (33.3%) in cell therapy group were immunized and formed ASA (P=.002). Transplanted cells were traced in lungs of 55% (n=10) of cell therapy group and none were found in trauma site. Small volume of mice blood was our main limitation to trace seroconversion or quantitative measurement of ASA in each case. CONCLUSION: In this in vivo model of autoimmune infertility, bone marrow-derived MSC transfusion showed immunosuppressive effects on antibody production. Considering immunomodulatory properties of MSCs even in allogeneic settings, novel clinical application should be investigated further.

Surgically treated bladder hemangiopericytoma/solitary fibrous tumor: report of a 12-year asymptomatic follow-up.

Hemangiopericytoma (HPC)/solitary fibrous tumor (SFT) is an uncommon vascular tumor suggested to be originating from pericytes. There are few reports on bladder HPC/SFT. We present a case of huge bladder HPC/SFT measuring 13.9 × 12.2 × 11.1 cm with invasion to right iliac vein in a 54-year-old man. The patient underwent radical surgical tumor excision without chemotherapy or radiotherapy. The patient is symptom-free without recurrence or metastasis during the 12-year follow-up period. This case is the longest follow-up reported to date for bladder HPC/SFT.

Is intravenous urography required when ultrasonography and KUB evidence a ureteroscopy plan?

PURPOSE: To determine whether pre-ureteroscopic stone extraction (USE) evaluation by intravenous urography (IVU) can change the clinical decision made on the basis of a plain X-ray of the kidneys, ureters, and bladder (KUB) plus an ultrasonography in the case of ureteral calculi. MATERIALS AND METHODS: From October 2005 to November 2007, 139 USE candidates were selected based on ultrasonography and KUB, and were randomly divided into two groups. Each group was assessed by an expert urologist to decide about the treatment plans. Thereafter, all the patients underwent an IVU pre-operatively and were evaluated for the second time by the other urologist considering IVU. Presence of a hydronephrotic kidney on the ultrasonography, existence of a density in the probable tract of the ureter on KUB, and previous episodes of renal colic were considered as inclusion criteria. Exclusion criteria were non-opaque stones on KUB, hypersensitivity to contrast media, and serum creatinine > 1.5 mg/dL. RESULTS: On the basis of ultrasonography and KUB assessment, all of the patients were identified candidate for USE. According to secondary IVU-based planning, of 139 patients, 127 (91.3%) required USE, 10 (7.1%) ureteroscopy, and 2 (1.4%) non-operative treatment. About 8.7% of treatment plans was changed by IVU, which was not statistically significant (P = .35). Positive predictive value of ultrasonography plus KUB to diagnose a ureteral stone which needed USE was 92.8% while IVU is the gold standard (95% confidence interval: 92.38 to 93.22). CONCLUSION: Intravenous urography is not useful enough to be performed routinely before entire USEs.

Feasibility of totally tubeless percutaneous nephrolithotomy under the age of 14 years: a randomized clinical trial.

OBJECTIVE: To assess the outcome and safety of the totally tubeless percutaneous nephrolithotomy (PCNL) in comparison with standard PCNL in the children under the age of 14 years. PATIENTS AND METHODS: Twenty-three patients under the age of 14 with renal stones were enrolled in a prospective randomized clinical trial during March 2010 to June 2011. The inclusion criteria were existence of renal stone larger than 2.5 cm in diameter or extracorporeal shockwave lithotripsy-resistant kidney stone; furthermore, exclusion criteria were kidney anomalies, renal failure on admission, and serious bleeding or perforation in the collecting system during the operation. The patients were divided into two groups according to block randomization. Group A comprised of 13 children with mean age 10.31 (4-14) years, were rendered totally tubeless at the end of surgery, while 10 patients in group B with mean age 11.1 (9-14) years underwent standard PCNL. The incidence of complications, transfusion rate, analgesic use, hemoglobin drop, operation time, and hospital stay were compared between the two groups during a one-month study period. RESULTS: The mean stone burden was 29.23 mm (SD=4.85) in group A versus 31.4 mm (SD=5.19) in group B. Hospitalization averaged 39.54 (SD=11.39) hours versus 58.7 (SD=10.37) (p<0.001) and the average analgesics use was 0.07 (SD=0.03) mg/kg of morphine versus 0.15 (SD=0.04) (p<0.001), respectively. Operation time, transfusion rate, complications, retreatment, and hemoglobin drop were not different, significantly. CONCLUSION: Totally tubeless PCNL for pediatric population yields decreased hospital stay and analgesic use with no more complications. So, it can be considered as a standard and cost-beneficial procedure in appropriately selected group of patients.

A 75-year old man complaining of flank pain and obstructive urinary symptoms: a case report.

Benign renal cystic adenoma with out malignant features is a very rare entity. A 75 year old male with obstructive Lower tract symptoms and vague flank pain was admitted and planned for nephrectomy of non functional kidney -due to long term nephrolithiasis- intra operative finding was a cystic hydronephrotic kidney filled by thick mucous secretions which turned out to be a cyst adenoma of kidney with no malignant features.

Prevalence of selected sexually and blood-borne infections in Injecting drug abuser inmates of bandar abbas and roodan correction facilities, Iran, 2002

Human Immunodeficiency Virus (HIV) and other blood borne viral infections like hepatitis B virus (HBV) and hepatitis C virus (HCV) are major health issues especially in young and growing population of developing countries. All around the globe correctional facilities are known as potential source of spreading such disease. During summer 2002, HIV, HCV antibodies, hepatitis B surface (HBs) antigen and rapid plasma reagin (RPR) test were checked in venous blood samples of 252 injecting drug abuser prisoners from correctional facilities in southern Iran. Overall HIV, HCV and HBV infection rate was 15.1 percent (38/249), 64.8 percent (163/249), and 4.7 percent (12/249), respectively. HCV infection rate of HIV positive cases was 94 percent (35/38). All RPR results were negative. Duration of previous drug abuse and imprisonment were correlated with HIV and HCV infection (p value = 0.0003 and 0.015 & p value =0.02 and 0.02). Considering the higher prevalence of HIV and HCV infection in correctional facilities compared to general population of Iran, warrants immediate multidisciplinary approaches targeted at controlling further spread of these infections primarily among prisoners and secondarily preventing them to act as carrier to general population.