The Effect of Botulinum Toxin (Masport) Injection Following Internal Urethrotomy of Bulbar Urethral Stricture: A Pilot Study.

The application of Botulinum toxin (Masport) in urology has a long history. We aimed to assess the effect of local Masport on improvement in patients with urethral stricture by reducing the recurrence of urethral stricture. This pilot study conducted was a double-blind randomized clinical trial with code IRCT20191222045852N1 on patients suffering from urethral stricture. Finally, 28 patients were allocated to intervention and control groups. Twelve patients received intralesional injection with Masport in addition to internal urethrotomy, while 16 patients underwent internal urethrotomy with normal saline. The Cox regression hazard model was used to evaluate the effect of treatment status on recurrence time adjusted for the age, length, and location of the stenosis, cause of the stenosis, and history of previous operations. The effect of treatment type was significant at the .05 level. The past medical history and cause of urethral stricture had a significant impact on relapse-free survival. Also, the improvement in the mean score of the EuroQol Visual Analogue Scale (EQ-VAS), International Prostate Symptom Score (IPSS), and Q-max in the group with Masport was significantly different from the group with normal saline. The internal urethrotomy with intralesional injection of Masport has a better survival prognosis than internal urethrotomy with normal saline group. Therefore, the authors suggest that, given this successful initial clinical trial, consideration be given to future studies involving the use of botox in the management of urethral strictures in conjunction with internal urethrotomy.

Tele-Urology in the Era of COVID-19: an Experience of the Reconstructive Urology Department in Iran.

INTRODUCTION: The outbreak of coronavirus has put additional pressure on the health care systems of many countries; but telemedicine can be an important way to deal with it, especially for people whose health has been affected by the virus. The present study aims to investigate the Implementation of a Tele-urology Program for Reconstructive Urologic Referrals: Initial Results and Patient Satisfaction. MATERIAL AND METHODS: All patients with a history of a urethral reconstructive surgery during last year was entered to our study and two nurses collected data of demographic and past medical history of patients by existed. Telephone visits:Fellowship of reconstructive urology was connected to patients during a phone call and filled the USS-PROM and COVID-19 questionnaires. Face to face visits: All patients were asked to answer the questionnaire about recent exposure and infection by corona virus, recent travel and other risk factors of COVID-19. RESULTS: Mean of USSPROM scale was calculated as 1.65 (+2.91) with a range of 0-15. Based on categorization for USSPROM scale, 74 patients (94.8%) had mild symptoms while 4 patients (5.1%) had moderate symptoms and needed further medical attention. Four patients with moderate USSPROM score were required to cystoscopic evaluation, which one patient with moderate USSPROM score had severe stricture and candidate for redo urethroplasty. Two other patients need for urethral stricture dilatation. Cost was calculated based on taxi-service fee. Accordingly, the average (+SD) cost for in-person visits to the physician was estimated as 4.80 + 4.32 million Rials. In terms of distance, the average distance for receiving medical services according to the patient`s residence area was 373.2 +348.79 kilometres.In terms of the patient`s opinion regarding virtual examination, inappropriateness of virtual visits for physical examination, and patient`s inability to explain the problem correctly, patient`s condition at the time of the virtual visit were the main challenges reported by the respondent. CONCLUSION: Considering that the present COVID-19 emergency will likely last for months, telehealth could be the safest way to deliver urological care for a large percentage of the patients, such as those who are more at risk of unfavorable outcomes of COVID-19.

Medium-Term Stone Recurrence after zero-fragment transperitoneal Laparoscopic Pyelolithotomy Compared with Percutaneous Nephrolithotomy for Large Single Renal Pelvis Stones.

PURPOSE: To compare medium-term stone recurrence between laparoscopic pyelolithotomy (LP) and percutaneous nephrolithotomy (PCNL). MATERIAL AND METHODS: 98 patients who underwent PCNL or LP (2015-2019) for large single renal pelvis or staghorn stones (≥ 2 cm) were selected. The stone-free rate was evaluated using a computed tomography scan at one month and then, ultrasonography at six months intervals during the first year and annually thereafter for up to three years. Time-to-stone recurrence was compared using the Kaplan-Meier estimate. Hazard ratio was estimated by Cox regression. RESULTS: The one month stone-free rate was 93.88% in the LP group vs. 79% in the PCNL group (P = .03). The mean overall time-to-stone recurrence was 31 (CI:24-34) months in the LP vs. 28 (CI: 23-32) in the PCNL groups (P = .02). Cox regression analysis showed that PCNL increased the risk of stone recurrence with a hazard ratio of 2.3 (CI: 1.1 - 5.3) compared to the laparoscopy. (p = .03) In subgroup analysis, time-to-stone recurrence in those without previous history of intervention was estimated at 31 (CI: 27 to 35) months in the LP vs. 25 (CI:16 to 34) in PCNL groups (= 0.04). Subanalysis with a BMI cutoff of 25 kg/m2 showed an overall time-to-stone recurrence of 34 (CI:30 to 37) months in the LP group and 28 (CI:22 to 33) months in the PCNL group (= 0.04) in those with BMI higher than 25 kg/m2. CONCLUSION: Medium-term time to stone recurrence was in favor of LP compared with PCNL for large single renal pelvis or staghorn stones.

Outcomes of HUD Versus CIC in Patients With Urethral Strictures.

Treatment of urethral stricture is a complex reconstructive urology treatment. Previous surgery in the treatment of urethral stricture increases the risk of urinary incontinence. Therefore, this study aimed to assess the outcome of comparing two preservative or nonsurgical methods, clean intermittent catheterization (CIC) or hydraulic urethral dilatation (HUD). Forty-eight patients diagnosed with symptomatic urethral stricture were enrolled in the study. Patients were randomly divided into two groups: Nelaton-based dilatation and HUD treatment. Patients were assessed using patient-reported outcome measure for urethral stricture surgery (USS-PROM) through direct clinical interview and were followed up for 12 months. The rate of urinary infection, the need for surgical intervention, and the patient's quality of life were considered as outcomes of the interventions. SPSS software, version 20.0, was used for statistical analysis. Overall, 23 (47.9%) patients underwent HUD of stricture and Nelaton-based dilatation of stricture was done in 25 (52.1%) patients. We found that surgical intervention was required in four patients in the HUD group, but 15 patients in the CIC group required surgical intervention. Also, the need for surgical intervention and urinary tract infection (UTI) was significantly greater in the CIC group compared with the HUD group. With respect to the patient-reported outcomes, the mean Peeling's voiding picture (Q8) and EQ-VAS score (Q16) in the HUD group (p = .02) were significantly greater than those in the CIC group (p = .02). We obtained excellent results by using an HUD catheter. This safe, simple, well-tolerated, home-based procedure reduced the need for hospital admission to operate for repeat.

Genital Ulcer as a Complication of COVID-19 Infection: A Case Report.

Coronavirus disease 2019 (COVID-19), as a pandemic disease and a global concern, is a respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Besides its common symptoms, some other less common symptoms, including genital ulcers, have been reported. Other complications such as autoimmune disease can present with genital ulcers. Differential diagnosis includes Reiter syndrome, Behcet's disease, and psoriasis. We report a 32-year-old married man with genital ulcers due to COVID-19 infection and as a complication of his disease.

Pan-urethral stricture with epidermolysis bullosa (EB): A case report.

EB is an inherited skin disease that presents with the symptom of skin blisters following trauma, Involvement of the Urogenital system in these people is in the form of meatal stenosis, urinary tract infection and ureteral stricture. We introduce patient with EB and urethral involvement. A 32-year-old man without prenatal problems whose EB skin symptoms started at 6 months of age and urinary symptoms started at 12 years of age. Skin changes on prenatal ultrasound at 18 and 21 weeks of gestation will help in the diagnosis. Follow-up of EB patients with ultrasound will help to identify urogenital complications earlier.

Prevention of COVID-19: Preventive Strategies for General Population, Healthcare Setting, and Various Professions.

The disease 2019 (COVID-19) made a public health emergency in early 2020. Despite attempts for the development of therapeutic modalities, there is no effective treatment yet. Therefore, preventive measures in various settings could help reduce the burden of disease. In this chapter, the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing COVID-19, non-pharmaceutical approaches at individual and population level, chemoprevention, immunoprevention, preventive measures in different healthcare settings and other professions, special considerations in high-risk groups, and the role of organizations to hamper the psychosocial effects will be discussed.

Cavernous sinus thrombosis syndrome and brainstem involvement in patient with leptospirosis: Two rare complications of leptospirosis.

Leptospirosis is a bacterial disease that is caused by pathogenic spirochetes of the genus Leptospira. It can affect humans and animals. In humans, it can lead to a wide spectrum of symptoms. It is known as the most common zoonosis in the world. The typical presentation of the disease is an acute biphasic febrile illness with or without jaundice. Less common clinical manifestations may result from involvement of different human body systems. In many places, this disease may be under-diagnosed, especially when associated with neurological complications. Moreover, without treatment, leptospirosis can lead to organ damages, and even death. Neurological complications are uncommon and are reported in a few cases. Cavernous sinus thrombosis syndrome and brainstem involvement are rare complications of leptospirosis and are associated with a high mortality risk. To our knowledge, no such cases have been reported in the literature.

Extramedullary hematopoiesis presenting as a right adrenal mass in a patient with Beta thalassemia.

INTRODUCTION: Extramedullary hematopoiesis in the kidney and adrenal are rarely reported in medical literature and are usually found as incidentaloma. It usually occurs in patients with hematologic disorder such as thalassemia. CASE PRESENTATION: The patient was a 23-year-old Iranian man with beta thalassemia who was admitted with a suprarenal mass. Adrenal mass was detected by ultrasonography and computed tomography. Results of biochemical evaluations were insignificant. The patient underwent right adrenalectomy. Gross and microscopic histopathologic examination demonstrated extramedullary hematopoiesis without any adrenal tissue. CONCLUSIONS: To the best of our knowledge, we document the first reported case of adrenal extramedullary hematopoiesis in Iran, which seems to be rare and remarkable.

Treatment of Kidney Stones Using Extracorporeal Shock Wave Lithotripsy (ESWL) and Double-J Stent in Infants.

Background. Extracorporeal shock wave lithotripsy (ESWL) has progressively acquired popularity as being the gold standard treatment for upper urinary tract lithiasis in infants since 1980. Our aim was to evaluate the outcome of ESWL for kidney stones and the use of double-J stent in infants. Material and Methods. A prospective clinical trial study performed on 50 infants with renal calculi at pelvic admitted in the Urology ward of Shafa Hospital, Sari, Iran, between 2001 and 2010. Main outcome measure of our study was clearing stones after one or more consecutive sessions of ESWL. Results. The study included 50 patients with renal calculi at pelvic. Among them, there were 35 (70%) boys and 15 (30%) girls with the age ranging from 1 to 13 months (mean of 7 month ± 3 days). All of them were treated by standard ESWL using Simons Lithostor plus machine. The stone sizes ranged from 6 mm to 22 mm. Double-J stents were placed in 11 infants (22%) with stones larger than 13 mm. Most of the patients required only one ESWL session. Conclusion. Since there were no complications following ESWL treatment, we can conclude that, in short term, ESWL is an effective and safe treatment modality for renal lithiasis in infants. In addition, we recommend double-J stent in infants with stones larger than 13 mm.

A rapid and reliable genotyping method for hepatitis B virus genotypes (A-H) using type-specific primers.

Eight genotypes of HBV (A-H) are recognized. A simple, rapid, and more specific genotyping system for HBV involving PCR using type-specific primers is described. The complete genomes of 234 human HBV strains for all the genotypes submitted to GenBank were aligned. The type-specific primers were designed based on the differences in the sizes of bands for eight genotypes in two sets. This genotyping system was tested with 24 positive HBV DNA controls. PCR was performed using two sets of type-specific primers for each sample in two tube. All 24 samples were PCR positive and possessed type-specific bands. PCR mix containing set 1 primers revealed specific bands of genotypes B, C, F and G, whereas PCR mix containing set 2 primers revealed specific bands of genotypes A, D, E and H. Type-specific PCR products were identified accurately by their sizes in agarose gels. The simplicity and rapidity of this PCR assay may reduce the cost and complexity of recognizing these genotypes. This method may be useful for HBV genotyping in large-scale clinical and epidemiologic studies.

Complete spontaneous improvement of non-displaced femoral neck fracture without any surgery modality.

BACKGROUND: Fracture of the femoral neck is still a medical dilemma due to high rates of complications and the choice of treatment. Although rigid internal fixation with cannulated screws through open or percutaneous approaches is the traditional treatment for undisplaced fractures (Garden type I and II) to avoid secondary displacement, considerable controversy still exists regarding the rate of this problem, thus it seems that a new trend in conservative management of this types of femoral neck fracture is emerging. CASE REPORT: Our case is a 46-year-old woman with Garden type II femoral neck fracture, who refused all surgical options and willingly ignored her problem. Six months later she returned to our center with uneventful recovery of her fracture. CONCLUSIONS: The previous belief about the absolute poor prognosis of Garden type II with 100% rate of secondary displacement with non-operative management must have been an overestimation or the success histories in the literature about non-operative treatment of these fractures originates from inherited weakness of the Garden classification in differentiating type I from type II. The patient gave the informed consent prior being included into the study.