Female anterior wall onlay urethroplasty with lower lip buccal mucosal graft: Importance of the laterally extended incision.

Objective: To describe the outcome of female anterior wall (pubic side) onlay urethroplasty with buccal mucosal graft using laterally extended surgical dissection in patients with previously failed minimally invasive techniques. Methods: From January 2016 to April 2018, 17 symptomatic patients with previously failed minimally invasive procedures were enrolled in the study. The diagnosis of urethral stricture was confirmed based on a combination of patients' symptoms, post-void residual urine, video-urodynamics, and cystoscopy. Urethroplasty with lower lip mucosal graft was performed using the modified laterally extended dissection. Patients were evaluated pre-operatively and 12-month post-operatively with the American Urological Association symptom score, post-void residual urine, and maximum flow rate. Results: Despite the previously failed minimally invasive procedures, urethroplasty with lower lip buccal graft and laterally extended dissection resulted in favorable outcomes (success rate=94%). The mean±standard deviation of American urological association symptom score improved from pre-operative levels at the 12-month post-operative follow-up (25.82±3.97 to 10.88±5.57); so did postvoid residual urine (71.12±74.98 mL to 15.00±28.30 mL), and maximum flow rate (7.88±1.72 mL/s to 25.82±5.59 mL/s) with all statistically significant (p<0.05). Conclusion: The current study showed that female urethroplasty with buccal graft could be highly successful in experienced hands. An anterior approach could be superior to the posterior one due to higher mechanical support and lower sacculation rate. A laterally extended incision may improve visualization and better graft placement by providing wider working space. The results should be evaluated in the future studies with larger sample size.

Differential gene expression of BCL-2, ZEB2-AS1 and BALR-2 in prostate cancer and benign prostatic hyperplasia.

Prostate cancer (PCa) and benign prostate hyperplasia (BPH) are highly prevalent heterogeneous disorders among men. Whereas PCa and BPH underline common pathological features, apoptotic-related genes might be differentially expressed in these diseases. This study was aimed at testing BCL-2 as well as BALR-2 and ZEB2-AS1 apoptosis-related long non-coding RNA (lncRNA) in patients with PCa and BPH. The expression levels of the BCL-2 gene and ZEB2-AS1 lncRNA were upregulated in tumoural tissues in comparison to adjacent non-cancerous tissues (ANCTs) and BPH tissues. In contrast, the expression level of BALR-2 lncRNA was significantly higher in BPH compared with tumoural tissues. Furthermore, while no association was noticed between the relative expression of ZEB2-AS1 and the tumour grade, the relative expression of BCL-2 and BALR-2 is strongly associated with a higher grade of the tumour in PCa samples compared with the ANCTs. The receiver operating characteristic (ROC) curve analysis indicated the highest specificity and diagnostic value in distinguishing PCa and ANCTs as well as PCa and BPH, respectively. In conclusion, altered expression of BCL-2 and BALR-2 was observed to be associated with tumoural progression and could be used as potential candidates for distinguishing PCa tissues from ANCTs or BPH samples.

Comparison of the Efficacy of Oxybutynin, Phenazopyridine, Celecoxib, and Placebo in the Treatment of Urinary Tract Symptoms after BCG Therapy in Patients with Bladder Tumors.

PURPOSE: Intravesical BCG (Bacillus Calmette-Guérin) therapy is indicated as an effective treatment for patients with non-muscle-invasive bladder cancer, despite associate with the side effects. In this study, the incidence of BCG therapy adverse effects was compared among three groups of patients who received celecoxib, phenazopyridine, and oxybutynin with placebo. MATERIALS AND METHODS: The randomized controlled clinical trial was conducted on four groups using the parallel group method. A checklist is used for weekly assessment of urinary symptoms, systemic symptoms of BCG therapy, and adverse drug reactions. RESULTS: The study included 120 patients, 10 female and 110 male. The mean age 59.65 ± 6.2 years. The results of multivariate analysis show that there is a significant decrease in urinary frequency for patients who received phenazopyridine (95% CI: 0.09, 0.31, OR = 0.17, P <.001) and also celecoxib group (95% CI: 0.10, 0.43, OR = 0.21, P <.001) compared to those in placebo group. Patients in celecoxib group (95% CI: 0.02, 0.07 ,OR = 0.04, P <.001), phenazopyridine (95% CI : 0.07, 0.37,OR=0.16, P <.001) and oxybutynin (95% CI: 0.02, 0.12,OR = 0.05, P <.001) were less likely to have urgency than those in placebo. Moreover, significant decrease was found for dysuria in the three treatment groups in comparison with placebo group. CONCLUSION: According to the results, celecoxib, phenazopyridine and oxybutynin can effectively decrease the side effects of BCG immunotherapy compared to placebo. Among these three treatments, the most effective and safest treatment option is celecoxib.

Evaluation of the role of reflux pattern in Color Doppler Ultrasound on spermogram improvement after varicocelectomy.

PURPOSE: Many attempts are being made to find an association between varicocele characteristics and sperm parameters. In this study, we investigated the association between a newly introduced varicocele reflux grading pattern and sperm parameters, as well as its effect on spermogram improvement after varicocelectomy. METHODS: In a prospective study, 73 patients with a clinical single-sided varicocele who underwent corrective varicocelectomy were included. Reflux pattern was determined on Color Doppler Ultrasound (CDUS) and categorized into four grades: grade 1 (retrograde), grade 2 (augmentation), grade 3 (enhancement), and grade 4 (stasis). The association of pre- and postoperative spermogram with the patients' reflux pattern was evaluated. RESULTS: A significant positive association was found between the venous diameter and reflux pattern. Higher grades of the reflux pattern were associated with the more severe hemodynamic pattern of the reflux (shunt type). A significant association was found between the reflux pattern and preoperative semen characteristics, and this association was more prominent in constant venous diameter. In this respect, the enhancing reflux type was associated with the most impaired preoperative sperm count, motility, and morphology. The enhancing type also revealed the most improvement in spermogram after varicocelectomy. CONCLUSION: Patients with a higher reflex grade, particularly enhancing pattern, will most benefit from the surgical correction of varicocele. These findings suggest reflux pattern as a promising prognostic factor for a favorable outcome after varicocelectomy.

Impact of prostate needle biopsy on erectile function: A prospective study.

BACKGROUND: Needle biopsy of the prostate is a diagnostic method for prostate cancer which is a relatively safe method with low risk of serious complications. The evidences regarding the occurrence of erectile dysfunction following prostate biopsy are controversial. Herein, we aimed at determining the rate of erectile dysfunction in those undergoing transrectal ultrasound-guided prostate biopsy. METHOD: All candidates for prostate biopsy were enrolled. The International Index of Erectile Function-5 was completed 1 m before and 1, 3, and 6 months after ultrasound-guided prostate biopsy by each patient for erectile dysfunction. Patients with a previous history of erectile dysfunction which due to a positive pathology had received any type of treatment were excluded from the study. RESULTS: Eighty patients with the mean age of 64.8 years, the mean prostate-specific antigen level of 11.64 ng/dL, and the mean prostate volume of 62.43 cc were included. The prostate biopsy result was positive in 38.8% of the cases. No significant relationship was found between erectile dysfunction and prostate-specific antigen level, prostate volume, and the pathology result (P = 0.320, 0.509, and 0.131). The mean questionnaire score 1 month before and after the biopsy was 23 and 18, respectively; it demonstrated a significant difference (P < 0.001). The same score was 17 and 14.5 three and six months after biopsy. The mean score 1 m before and 3 m after biopsy also revealed a significant difference (P < 0.001). CONCLUSION: Transrectal ultrasound-guided needle biopsy of the prostate causes progressive erectile dysfunction in these patients. This relationship is not affected by the biopsy result, prostate volume, or the prostate-specific antigen level.

The role of blood neutrophil count and the neutrophil-to-lymphocyte ratio as a predictive factor for prostate biopsy results.

BACKGROUND:: It is apparent that prostate cancer has harmful effects on the erythrocytes, leucocytes, and platelets. In addition, it has been suggested that the toxic granules in neutrophils lead to inflammation in the cancerous tissues besides the activation of monocytes, so in this study we aimed to evaluate the blood neutrophil count besides the neutrophil-to-lymphocyte ratio as a predictive factor for prostate biopsy results and their relationship with prostate cancer grade in patients undergoing biopsy of the prostate. METHODS:: For all men with irritative lower urinary tract symptoms visiting Hasheminezhad Hospital from January to July 2015, in case of having a suspicious digital rectal examination or aged above 40 years, prostate-specific antigen was requested and in case of abnormal results, they underwent prostate biopsy. In order to examine the study hypothesis, the blood neutrophil count and the neutrophil-to-lymphocyte ratio were measured and compared with the abnormal prostate-specific antigen results and suspicious digital rectal examination. RESULTS:: Among the 500 referred samples for biopsy, 352 (70.4%) had a negative biopsy result, while it was positive in the other 148 (29.6). The mean neutrophil count showed no statistical difference regarding the biopsy results (p = 0.381). When measuring the neutrophil-to-lymphocyte ratio again with biopsy results, no statistically significant difference was obtained based on the biopsy results (p = 0.112). CONCLUSION:: Neutrophil count and neutrophil-to-lymphocyte ratio cannot be predictive factors for positive prostate cancer biopsy.

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 role of ultrasound (US) and magnetic resonance imaging (MRI) in penile fracture mapping for modified surgical repair.

PURPOSE: To determine the accuracy of ultrasound (US) and magnetic resonance imaging (MRI) in the diagnosis of penile fracture and preoperative mapping for modified surgical repair. METHODS: Twenty-five consecutive patients were included in the study prospectively over 29 months (from February 2014 to June 2016). US examination and MRI were performed on all patients and interpreted by two expert radiologists independently. The location of the defect in tunica albuginea was mapped onto a designed scheme preoperatively using each imaging modality. The detection rate, as well as agreement between preoperative radiologic mapping and surgical outcomes, was determined for each modality. RESULTS: The mean age of the patients was 28 ± 7.5 years. The most common etiology was intercourse (88%). The most common location of tunica albuginea rupture was mid-shaft of the penis (60%), and the mean length of tunica defects in their greatest dimension was 13.5 ± 3.95 mm. All patients had associated hematoma, but no urethral injury was detected. The detection rate of US and MRI was 88 and 100%, respectively. US mapped the tear location correctly in 18 patients [61 out of 75 items (81%); κ = 0.66], while MRI mapped it precisely in 23 patients [73 out of 75 items (97%); κ = 0.95]. CONCLUSION: Both modalities are extremely helpful for the diagnosis of penile fracture. Considering the cost-efficiency and accessibility of ultrasonography, US is recommended as the first-line tool for both diagnosis and preoperative mapping. MRI may be used as a complementary study in the patients for whom US fails to visualize or precisely define the tunica defect.

Obesity and urologic complications after renal transplantation.

Although obesity has been associated with improved survival on dialysis, its short-and long-term effects on renal transplantation outcomes remain unclear. Herein, we evaluate the short-term and intermediate long-term effects of obesity on first-time renal transplant patients. A retrospective analysis was performed on 180 consecutive renal transplant recipients from living unrelated donors during 2006-2008 in a major transplantation center in Tehran, Iran. Among these, 34 (18%) patients were found to be obese (body mass index ≥30 kg/m 2 ). Obese patients were more likely to develop post-transplant renal artery stenosis (RAS) (17.6% vs. 2.8%, P <0.001), hematoma (47.9% vs. 17.6, P = 0.009), surgical wound complications (64.7% vs. 9.6%, P <0.001) and renal vein thrombosis (2% vs. 0%, P <0.001). However, the incidence of delayed graft function, lymphocele, urologic complications of ureterovesical junction stenosis or urinary leakage, surgical complications of excessive bleeding or renal artery thrombosis and duration of hospitalization were similar between the two groups. The two-year patient and graft survival were also statistically not different. Renal transplantation in obese recipients is associated with a higher incidence of post-transplant RAS, hematoma, surgical wound complications and renal vein thrombosis, but similar two-year patient and graft survival.

Renal transplantation in allografts with multiple versus single renal arteries.

Allograft with multiple renal arteries (MRA) is considered to have an increased post-transplantation risk due to vascular and urologic complications. The aim of this study is to investigate the outcome of living donor kidney transplantation using allograft with a single artery and recipients of allografts with multiple arteries. Seven hundred and eighteen consecutive adult kidney transplants done between 1998 and 2007, with living unrelated kidney donors, were enrolled in this retrospective analysis. Data from the group with MRA (n = 60) were compared with those from the group with single renal artery (SRA) (n = 658). Delayed graft function (DGF) was more frequent in recipients' allografts with more than 2 arteries when compared with SRA recipients (Odds Ratio: 1.2; 95% CI:1.08-1.9, P = 0.02), but there was no difference between SRA and allograft with two arteries. The incidence of acute rejection (AR) was not statistically greater in recipients with MRA. Renal artery stenosis (RAS) occurred more frequently in patients with MRA (8.3% vs. 5.9% and P = 0.02), but other vascular complications such as renal artery thrombosis and hematoma revealed no differences (P > 0.05). Urologic complications such as UVJ obstruction, urinary leakage and ureteropelvic obstruction were not statistically different between the groups. The actuarial 1-year allograft survival rate was comparable in both groups (93.6% vs 96.8%, P = 0.22). Allografts with more than two arteries were associated with increased DGF and RAS, but no surgical or urological complications were detected in our series. Our findings demonstrate that renal allograft transplantation with multiple arteries could be performed with reasonable complications and acceptable outcomes.

Incidence and risk factors of transplant renal artery stenosis in living unrelated donor renal transplantation.

BACKGROUND: This study was designed to evaluate the incidence and risk factors of transplant renal artery stenosis (TRAS) among living donor unrelated kidney recipients. PATIENTS AND METHODS: Three hundred and sixty kidney consecutive transplant recipients were included in this retrospective cohort study. Informed written consent was obtained, only TRAS occurring three months after transplantation were considered. After five-year follow up, TRAS was established in 6.6% (24 patients) of patients. RESULTS: Mean +/- SD age of recipients was 39.8 +/- 14.9 years old (range 16-77). Upon multivariate analysis recipient age >50 (RR = 2.9, CI 95%: 1.33-2.93, p = 0.008), recipient BMI >30 (kg/m(2)) (RR: 7.97, CI 95%: 3.44-18.46, p < 0.001), retransplantation (RR = 4.88, CI 95%: 2.21-10.77, p < 0.001), cytomegalovirus (CMV) infection and delayed graft function (DGF) (RR: 4.29, CI 95%: 3.12-13.79, p = 0.01) appeared to be independently associated with TRAS. Positive CMV-antibody was more frequent in recipients with TRAS (95.83% vs. 70.8%, p = 0.04) but all of them were HCV-antibody negative. Other variables as discussed were similar between two groups. CONCLUSION: High recipient age, BMI > 30, hyper trigelyceridaemia, previous transplantation, CMV infection and DGF are shown to be risk factors for TRAS.

Impact of obesity on urologic complications among unrelated living donor kidney transplants.

PURPOSE: Although obesity has been associated with improved survival on dialysis, its effects on renal transplantation outcomes remain unclear. Herein we aimed to evaluate the effect of obesity on posttransplantation complications. PATIENTS AND METHODS: A retrospective analysis of consecutive renal transplant recpients from un related living donors was undertaken from 2006 to 2008. RESULTS: We included 180 patients, 34 (18%) were obese (body mass index >30 kg/m(2)) and 146 were lean. Obese patients were more likely to develope renal artery stenosis (17.6% vs 2.8%, p < 0.001), hematoma (47.9% vs 17.6, p = 0.009), wound complications (64.7% vs 9.6%, P < 0.001) and renal vein thrombosis(2% vs 0%, p < 0.001). Urologic complications consisting ureteral, ureteropelvic and ureterovesicular junction stenosis, wound bleeding, urinary leakage and renal artery thrombosis and also hospitalization time were found similar between the two groups. 2 year patiets and graft survival were not statististically different. CONCLUSIONS: Renal transplantation could be performed with reasonable urologic complications in obese patients.

Posttransplant soluble CD30 as a predictor of acute renal allograft rejection.

BACKGROUND: Recent results have indicated that high prerenal and postrenal transplant soluble CD30 levels may be associated with an increased acute rejection and graft loss. The aim of this study was to evaluate the feasibility of using serum sCD30 as a marker for predicting acute graft rejection. MATERIALS AND METHODS: In this prospective study,we analyzed clinical data of 80 patients, whose pretransplant and posttransplant serum levels of sCD30 were detected by enzyme-linked immunoassay. Eight patients developed acute rejection, 7 patients showed delayed graft function, and 65 recipients experienced an uncomplicated course group. The patients were followed for 12 months, and there were no deaths. RESULTS: Preoperative sCD30 levels of 3 groups were 96.2 -/+ 32.5, 80.2 -/+ 28.3, and 76.8 -/+ 29.8 U/mL (P = .28). After transplant, a significant decrease in the sCD30 level was detected in 3 groups on day 14 posttransplant (P < .001), while sCD30 levels of acute rejection group remained significantly higher than delayed graft function and nonrejecting patients (28.3 -/+ 5.2, 22.1 -/+ 3.2, and 19.8 -/+ 4.7 U/mL) (P = .02). Positive panel reactive antibody was not statistically different among groups (P = .05). Also, hemodialysis did not affect sCD30 levels (P = .05). Receiver operating characteristic curve demonstrated that the sCD30 level on day 14 posttransplant could discriminate patients who subsequently suffered acute allograft rejection (area under receiver operating characteristic curve, 0.95). According to receiver operating characteristic curve, 20 U/mL may be the optimal operational cutoff level to predict impending graft rejection (specificity 93.8%, sensitivity 83.3%). CONCLUSIONS: Measurement of the soluble CD30 level on day 14 after transplant might offer a noninvasive means for recognizing patients at risk of acute graft rejection during the early posttransplant period.