Sexual Function in Renal Transplant Recipients with Internal versus External Iliac Artery Anastomosis: A Randomized Clinical Trial.

PURPOSE: The choice between using the internal or external iliac arteries to supply a transplanted kidney poses a dilemma during renal transplantation. As the internal iliac artery branches to the genital tract, cutting it could potentially result in sexual dysfunction. The purpose of this study was to compare the effects of these two surgical methods on sexual function. MATERIALS AND METHODS: 122 sexually active male patients under the age of sixty were randomly divided into two groups: the internal iliac anastomosis group and the external iliac artery anastomosis group. Before surgery and one year after the procedure, patients completed the International Index of Erectile Function-15 questionnaire (IIEF- 15), and the difference in scores of each domain was measured. RESULTS: Statistically, kidney transplantation improved all domains of IIEF in both groups, except for erectile function in patients who underwent internal iliac artery anastomosis group. Additionally, there were significant differences between the two groups in the domains of erectile function (p-value=0.04) and overall satisfaction (p-value = 0.002), while other domains such as orgasmic function, sexual desire, and intercourse satisfaction did not show any statistically significant differences. CONCLUSION: In conclusion, the choice between using the internal or external iliac artery for arterial anastomosis during kidney transplantation does not significantly impact graft function. However, it may negatively affect erectile function in patients who undergo internal iliac artery anastomosis.

Female Urethral Cavernous Hemangioma: Introducing Treatment and Follow-Up Course of Three Cases.

Cavernous hemangioma is a benign vascular tumor occurring in all parts of the urinary system, including the kidney, bladder, prostate, ureter, and rarely urethra. Urethral cavernous hemangiomas are mostly seen in male patients, and only a few cases of female urethral hemangiomas are reported. Herein, we present the management and follow-up course of 3 cases of female urethral cavernous hemangioma. All 3 cases were menopause women complaining of lower urinary tract symptoms. Definitive diagnosis is made by histopathologic evaluation. In case of large or pedunculated masses, initial surgical resection is highly recommended. Regular follow-up of patients in order to prevent any recurrence is suggested.

Diagnostic value of total serum/free prostate specific antigen and prostate cancer antigen-3 levels in prostate cancer.

BACKGROUND: The purpose of this study was to compare serum total and free prostate specific antigen (PSA) levels and serum prostate cancer antigen-3 (PCA3) levels in patients with prostate cancer in 2018 and 2019. METHODS: This research was a prospective case-control study. The case group included all patients with suspected prostate cancer, and the control group included individuals without prostate disease who were referred to Ali Asghar and Nour Hospital in Isfahan, Iran, from October 2018 to October 2020. The serum total PSA, free PSA, and PCA3 levels in both groups were measured using the ELISA method with standard kits and compared between the groups. RESULTS: The two groups were matched in terms of age and body mass index (BMI). The results showed that the mean free PSA level in the control group was significantly higher than that in the case group (P<0.05). Conversely, the mean total PSA level in the case group was significantly higher than that in the control group (P<0.05). However, no significant difference was observed in the mean PCA3 levels between the case and control groups. In addition, the total PSA variable with a cutoff of ≤3.14 exhibited 93% sensitivity and 82% specificity, demonstrating the highest diagnostic accuracy in distinguishing between prostate cancer and healthy individuals. Similarly, the PCA3 value with a cutoff of ≤3.5 had a sensitivity and specificity of 70% and 72%, respectively. CONCLUSION: Overall, the study results indicated that total PSA and PCA3 levels have higher diagnostic accuracy in distinguishing patients with suspected prostate cancer from healthy individuals.

Mechanical Ablation of the Posterior Urethral Valve Omitting Thermal Energy: A Brief Report.

Management of the posterior urethral valve (PUV) is a clinical challenge in pediatric urology. We report the results of a modified valve ablation method without using a pediatric resectoscope and thermal energy. Patients were selected from children with PUV who were referred to the pediatric urology clinic of Shahid Labbafinejad Hospital, Tehran, Iran, and have undergone endoscopic valve ablation surgery between May 2019 to May 2021. Ten male patients with PUV underwent mechanical valve ablation without the use of the conventional pediatric resectoscope, and thermal energy was replaced by a 6F semi-rigid urethroscope and 3Fr ureteral catheter. Patients were assessed both pre-and postoperatively using serum creatinine, urinary tract ultrasound imaging, and voiding cystourethrography. The mean age was 23.88±30.13 months (range= 25 days to 8 years). Four out of 10 patients (40%) had elevated serum creatinine, and seven had unilateral or bilateral hydroureteronephrosis (70%). No major complications were reported according to Clavien-Dindo Classification System. The level of serum creatinine, the grade of hydroureteronephrosis, and the ratio of the prostatic urethra to anterior urethra diameter in postoperative voiding cystourethrography were decreased. A decrease in serum creatinine level occurred in patients after valve ablation, but this decrease was not statistically significant (P=0.059). The decrease in hydroureteronephrosis grade on the right (P=0.006) and left (P=0.022) was statistically significant. There was no evidence of urethral stenosis or need for repeating resection. It can be concluded that our mechanical valve ablation method might be a safe and effective technique for PUV ablation.

Recurrent labial adhesion and vaginal destruction treatment with ileal vaginoplasty and labia major flap: A rare case report.

Labial adhesion (LA) and vaginal destruction are very rare conditions in women. We report a 40-year-old woman with severe LA and distal vaginal stenosis after a radical hysterectomy at the age of 35. Completely destruction of vaginal epithelium, severe recurrent LA, voiding symptoms, and chronic pelvic pain occurs for her due to the repeated vaginal dilatation and low estrogen level. A combination of ileal vaginoplasty (IV) and labia majora flap was used in two surgical stages for treatment. After surgery, the patient's urinary symptoms and pelvic pain were relieved and she was able to have sex with her partner.

Effect of Rectal Midazolam on Pain, Stress, and Cooperation of Patient during Urodynamic Test in Women: A Randomized Clinical Trial.

PURPOSE:  The urodynamic study is an invasive test, and causes pain and stress in the patient. We have investigated the effect of rectal midazolam sedation on the pain, stress, and cooperation of women performing urodynamic study.  Materials and Methods: At the present randomized clinical trial (RCT) from January to July of 2021 a total of 84 women were prospectively randomized to undergo urodynamic study with or without sedation. The primary outcome of interest was experienced pain during urodynamic study. In the intervention group, after monitoring baseline vital signs (heart rate, blood pressure, O2 saturation), sedation was done with rectal midazolam at a dose of 0.3 mg/kg (maximum 15 mg). Completing the procedure, after recovery from sedation patients were asked to fill a self-assessed visual analog pain scale (VAS, 0-10), 5-point visual stress scale (1-5) and, patient collaboration level during urodynamic study was evaluated by nurse with a researcher-made tool (0-3). In the control group test was performed in routine practice with no sedation. Baseline vital signs measured pre and intra-procedural time, as well as their experienced pain, stress, and cooperation levels were recorded.  Results: 84 female cases were evaluated. In terms of comparison of changes in pre and intra-test physiologic parameters, results showed that there were no significant differences between the two groups for all physiologic parameters: SBP, DBP, PR, SpO2. Analysis of the pain score showed that it was lower in the intervention group, and there was a significant difference in pain score between the two groups (P =.024). While the stress and corporation scores were not reported statistically significant (P=.388 and P=.955, respectively). CONCLUSION:   Sedation with rectal midazolam in adult women before UDS is safe and effective in reducing pain but is not effective in reducing stress and increasing cooperation. The amount of pain based on the visual analog pain scale is mild and although this method is safe, its use routinely is not recommended.

Labial Cellulitis and Suprapubic Urine Leakage after Midurethral Sling: A Rare Presentation of Unrecognized Bladder Neck Perforation.

Retropubic midurethral sling (MUS) is safe and effective surgery used for the treatment of stress urinary incontinence in women. Bladder neck perforation is a rare intraoperative complication. If this complication missed in intraoperative cystoscopy may have serious morbidity. A 52-year-old woman underwent a retropubic MUS. She presented with early and unusual symptoms such as suprapubic and labial cellulitis and urine leakage through the suprapubic incision 1 week after surgery which was due to a missed bladder neck perforation during surgery. In cystoscopy after MUS revealed mesh traversing the bladder neck and it was removed. The missed bladder perforation may have early and unusual symptoms and cystoscopy must be done more carefully and obsessively in patients with risk factors.

Evaluation of Therapeutic Effect of Intratrigonal Injection of AbobotulinumtoxinA(Dysport) and Hydrodistention in Refractory Interstitial Cystitis /Bladder Pain Syndrome.

PURPOSE: There are two brands of BotulinumtoxinA(BTXA) that commonly used in treatment of Lower Urinary Tract Disease: OnabotolinumtoxinA(Ona-BTXA) and AbobotulinumtoxinA (Abo-BTXA). The present study was conducted to assess the potential therapeutic and adverse effect of Abo-BTXA or Dysport   for IC/BPS. MATERIALS AND METHODS: Twenty-two out of 52 women diagnosed with IC/BPS who were refractory or had a low response to oral treatments of IC/BPS after 6 months, were included in the study. The end-point was O'Leary-Sant Score (OSS) including "symptoms" and "problem" indexes (ICSI and ICPI respectively) assessment after 1,3and 6 months after Abo-BTXA injection. Each patient underwent cystoscopy and immediately after hydrodistention received intratrigonal injections of 300 IU of Abo-BTXA (Dysport®) in30sites. The effect and side effects of this treatment over time have been investigated. Complications including high post void residual urine (PVR), bladder rupture, and urinary tract infections (UTI) were also assessed. RESULTS: The mean age of patients was 46.2±13.7 years and median OSS was 27.8±5.8.: After single injection ICSI, ICPI and total OSS significantly reduced in 1, 3, and 6 months follow up; rate of decrease   total OSS was 39.5%, 36%, 18%, respectively. Its effect lasted up to six months and started to decrease after 1 months (p-value<0.05). Complications included urinary retention (PVR>200ml), bladder rupture, and UTI in 13.5%, 4.3%, and 18% of the patients, respectively. CONCLUSION: intravesical injection of 300IU Abo-BTX(Dysport) could be a useful approach for the treatment of patients with refractory IC/BPS in a period of six months.

Extensive Labial Adhesion Causing Voiding Urinary Symptoms in a Postmenopausal Woman: A Case Report.

Labial adhesion (LA) is a rare clinical entity in postmenopausal women. Estrogen deficiency and lack of sexual activity are probable contributing causes. Voiding dysfunction due to LA is even rarer in postmenopausal women, and only a few studies have previously reported such occurrence. A 62-year-old virgin postmenopausal woman presented to the Al-Zahra Hospital (Isfahan, Iran) with a 5-year history of voiding dysfunction and recurrent urinary tract infection. Despite multiple medical visits, no genital examination was ever performed by a medical practitioner, mainly due to the patient's refusal to be examined by a male physician. On physical examination, we observed extensive LA with only a small opening. Surgical separation of the labia was performed and subsequently, the urinary tract symptoms were completely resolved. Herein, we present a case of LA causing urinary problems in a virgin postmenopausal woman. The case underlines the importance of the genital examination of female patients with urinary tract symptoms.

The Therapeutic Effect of Intravesical Instillation of Platelet Rich Plasma on Recurrent Bacterial Cystitis in Women: A Randomized Clinical Trial.

PURPOSE: Recurrent bacterial cystitis is a common infection in women and there are concerns about its antibiotic therapy. Platelet rich plasma has antimicrobial and tissue repairing effects. We investigated the effect of platelet rich plasma as an intravesical therapy to prevent recurrence of bacterial cystitis. MATERIALS AND METHODS: Thirty women with a history of recurrent bacterial cystitis were randomly assigned into two groups: 1) platelet rich plasma and 2) control groups. The first group received 10 mL of platelet rich plasma with intravesical instillation plus 40 mL of normal saline. The control group only received 50 mL of normal saline. We did the instillation once a week for four weeks in both groups. We followed up the participants two and 12 months after the last instillation with a questionnaire (the international consultation on incontinence questionnaire in overactive bladder) and result of their urine culture. RESULTS: A significant decrease was observed in the number of bacterial cystitis recurrences in the platelet rich plasma group compared to the control group 12 months after the instillation (4 vs. 1, P = 0.004). Also, there was a significant improvement in the questionnaire's score two (3.6 ± 2.58 vs. 0.66 ± 1.63, P = 0.002) and 12 months (3.4 ± 2.77 vs. 0.006 ± 1.83, P < 0.001) after instillation in the platelet rich plasma group compared to control group. There was no adverse effect 12 months after instillation. CONCLUSION: Platelet rich plasma can significantly decrease the recurrence of bacterial cystitis up to a year after instillation without any side effect.

Stress Urinary Incontinence and Pelvic Organ Prolapse Correction by Single Incision and Using Monoprosthesis: Three-year Follow-up.

BACKGROUND: The aim was to study the effectiveness and safety of a modified technique that employs a four-arm polypropylene (PP) mesh (NAZCA-TC) to treat pelvic organ prolapse (POP) and concurrent stress urinary incontinence (SUI) simultaneously. MATERIALS AND METHODS: This prospective follow-up study was conducted on fifty SUI women with concurrent high-grade (greater than Stage 2) anterior vaginal wall and/or uterine prolapse who were referred to Al-Zahra and Noor Hospitals in Isfahan and underwent surgery using the NAZCA-TC, Promedon, Argantina kit. The POP-Quantification system was employed for staging POP before and after surgery. To evaluate lower urinary tract symptoms (LUTS) and patients' quality of life, a stress test and the short form of International Consultation on Incontinence Questionnaire of Female Lower Urinary Tract Symptom were used. Patients were followed up and assessed at 6 weeks, 6 months, and 1, 2, and 3 years after surgery. RESULTS: The mean age of patients was 58.2 ± 10.2 years. There was a great reduction (88.6%) in POP staging after surgery. The success rate of SUI treatment was significantly high (83.5%). During 3 years of postoperative follow-up, mesh erosion occurred in 18%, 5 patients (10%) presented with mesh erosion in the first years after operation, 16% reported significant groin or pelvic pain, and 10% required sling release. CONCLUSION: A single vaginal incision and using two less percutaneous access sites with the PP meshes were effective for treating patients with concurrent POP and SUI but have a high rate of postsurgery erosion rate.