Vitamin D levels in non-pregnant women with a history of recurrent pregnancy loss with and without autoantibodies.

Background: The objective of this study was to compare the levels of vitamin D in non-pregnant women with a history of recurrent pregnancy loss (RPL) who were seropositive or seronegative for autoantibodies (autoAbs). Methods: The study examined 58 RPL patients with autoAbs (ANA, anti-TPO, or APAs), 34 RPL patients without autoAbs, and 58 healthy women with prior successful pregnancies and without autoantibodies. The levels of 25 (OH) D were measured using the sandwich ELISA technique. Results: Our results showed insufficient serum 25(OH) D levels in study groups, with significantly lower levels observed in RPL patients with or without autoAbs compared to healthy women (P=0.0006). In addition, RPL patients with autoAbs had significantly lower 25(OH) D levels compared to RPL patients without autoAbs. We also found that serum levels of 25(OH) D in RPL patients with autoAbs were significantly lower than in RPL patients without autoAbs (20.51 ± 1.15 ng/ml Vs. 23.69 ± 0.74 ng/ml, P=0.0356). Further analysis indicated that RPL patients who were positive for ANA, and APAs, except anti-TPO, had significantly lower than 25(OH)D serum levels than RPL patients without autoAbs. Conclusion: These findings suggest that RPL patients, especially those with APAs or ANA, have lower vitamin D levels compared to healthy women. This may indicate a link between maternal immune dysregulation due to vitamin D deficiency and the presence of autoantibodies in RPL.

Safety and efficacy of pneumatic lithotripters versus holmium laser in management of ureteral calculi: a randomized clinical trial.

PURPOSE: To compare efficacy and safety of holmium:YAG laser and pneumatic lithotripter in the management of ureteral stones. MATERIALS AND METHODS: One hundred and twelve patients with 1 to 2 cm ureteral calculi were selected for pneumatic or holmium:YAG laser transurethral ureterolithotripsy (56 patients in each group). Ultrasonography and plain abdominal x-ray were performed for all the patients before the operation. The pneumatic lithoclast was Swiss LithoClast, while in laser lithotripsy, holmium:YAG laser frequency was used, which was usually set between 5 and 10 Hz at a power of 10 to 15 Watt. Intravenous urography was performed for all the patients at 3 months to assess functional status and to delineate the ureteral anatomy. RESULTS: The mean patients' age and stones' size were the same in both groups, and there were no statistical differences. Mean duration of lithotripsy was 13.7 ± 12.6 minutes in laser group and 7.9 ± 4.2 minutes in pneumatic lithotripsy group. Immediate stone-free rate was 100% and 82.1% in the laser and pneumatic groups, respectively (P = .001). Stone pushing back occurred only in 10 (17.9%) patients in pneumatic group. In terms of complications, such as perforation, mucosal injury, and bleeding, there were no differences between the two groups. No intravenous pyelography related complication was seen at 3-month follow-up. CONCLUSION: Laser lithotripsy is a superior approach for the management of upper ureteral stones of 1 to 2 cm in size due to its higher rate of stone clearance.

Epitheliod leiomyoma of the bladder: an unusual case of irritative and obstructive voiding symptoms.

Epitheloid leiomyoma is a very rare subtype of benign mesothelial tumors of the bladder. A 46-year-old female patient presented to our hospital with prolonged dysuria, frequency, and recurrent urinary tract infections. Bimanual examination revealed a mobile, round mass in bladder. There was a round hyperdense intravesical mass near bladder neck in computed tomography (CT) scan that was compatible with her magnetic resonance imaging (MRI). A well defined 3 × 4 centimeter mass was seen in superolateral part of bladder neck during cystoscopy. The patient underwent partial cystectomy and histopathologic findings confirmed the diagnosis of epithelioid leiomyoma. The patient's followup was uneventful in a period of 2 years. Size and anatomic location of this tumor were major factors that affect on treatment.

Is there any role for urodynamic study in children with high-grade vesicoureteral reflux?

OBJECTIVE: To determine the clinical symptoms and urodynamic characteristics among children with primary high-grade vesicoureteral reflux (VUR). MATERIALS AND METHODS: We prospectively studied clinical symptoms and urodynamic parameters in 147 consecutive patients ≤ 12 years old with idiopathic high-grade VUR referred to our hospital. RESULTS: Of 147 patients with high-grade VUR, 139 cases with mean age of 5.3 years met our inclusion criteria (88.5% females, 11.5% males). The most common symptom was recurrent urinary tract infection (57%) and urgency (59%) followed by enuresis (31.6%) and frequency (26.6%). Normal urodynamic findings were observed in 23% of patients. Overactive bladder (74%), high-end filling pressure (72.7%), low-compliance bladder (56%), and low bladder capacity (51%) were the most common urodynamic reports in this study. Other urodynamic findings were underactive bladder (1.5%), hypersensitive bladder (1.5%), hyposensitive bladder (3%), and high capacity bladder (2.2%). CONCLUSION: Proper management of VUR is very important because of its harmful potential effects on kidney function in children. With regard to the issue that most children with grade III and higher VUR had overactive bladder, high-end filling pressure, and other urodynamic disorders in their urodynamic study, it seems that these urodynamic disorders could be the basic cause of reflux.

Dorsal versus ventral oral mucosal graft urethroplasty.

PURPOSE: To evaluate success rate of dorsal versus ventral oral mucosal graft for anterior urethroplasty. MATERIALS AND METHODS: In a retrospective study, the results of the ventral and dorsal oral mucosal graft (OMG) anterior urethroplasty were assessed in 24 and 29 patients, respectively. Demographic and clinical characteristics of subjects were gathered from the medical records. RESULTS: Patients were followed up for a mean duration of 32 months (range, 25 to 51 months). The success rates of dorsal and ventral anterior OMG urethroplasty were 83.3% and 75.8%, respectively (P = .5). At penile site, dorsal and ventral OMG were done for 9 and 10 patients with stricture lengths of 3.7 ± 1.1 cm and 3.9 ± 1.2 cm, respectively (P = .7). Success rates of dorsal and ventral penile OMG were 88.9% and 70%, respectively (P = .3). At the bulbar site, dorsal and ventral OMG were performed on 15 and 19 patients with stricture lengths of 4.1 ± 1.1cm and 4.2 ± 1.5 cm, respectively (P = .7). The success rates of dorsal and ventral bulbar OMG were 80% and 79%, respectively (P = .94). CONCLUSION: Oral mucosal graft is a versatile and an effective procedure for management of strictures throughout the anterior urethra, and in experienced hands, the outcomes are similarly favorable whether a dorsal or ventral approach is taken.

Delayed retropubic urethroplasty of completely transected urethra associated with pelvic fracture in girls.

INTRODUCTION: The objective of the present study was to evaluate the results and the complications of delayed retropubic urethroplasty of completely transected urethra associated with pelvic fracture in girls. MATERIALS AND METHODS: From 2002 to 2008, a total of 7 girls with complete urethral disruption after pelvic fracture were referred to our center and all of them underwent delayed retropubic urethroplasty with end-to-end anastomosis of the urethra. RESULTS: Seven female patients with a median age of 6 years old underwent delayed end-to-end anastomosis. The median time to surgery was 6 months from the trauma. Voiding was normal after catheter removal in all of the patients. The median follow-up was 36 months. Three patients had mild stress urinary incontinence after catheter removal. CONCLUSION: There are some different strategies for management of complete urethral avulsion in females who have sustained pelvic fracture, including early realignment, bladder flaps, and end-to-end anastomosis. The strategy of delayed end-to-end anastomosis urethroplasty with retropubic approach is sound and produces acceptable results. The use of flexible cystoscope and omental flap is effective in achieving continence after urethroplasty in such cases.