The role of gel-infused translabial ultrasound as a new modality in evaluation of female urethral stricture.

Introduction: To investigate the role of trans-labial ultrasound study in detection of female urethral stenosis (FUS) compared to former cysto-urethroscopy as the currently available definitive diagnostic modality. Material and methods: In this cross-sectional study, 60 consecutive patients with bladder outlet obstruction diagnosed by clinical symptoms and urodynamic study, were included from 2019 to 2022. For additional assessment, all these patients underwent gel-Infused trans-labial ultrasound (GITLUS) and cystourethroscopy. Trans-labial real-time ultrasonography was performed following the insertion of 20 ml steady stream viscous jelly into the urethral meatus to assess the length of the urethra and exact location and length of the probable narrowing, as well as the presence of peri-urethral fibrosis (PUF). Results: In GITLUS evaluation, urethral stricture was found in 27 patients. Mean urethral length and stricture length were 35.63 ±4.78 and 17.04 ±10.59, respectively. All these stenosis were confirmed via cysto-urethroscopy. PUF was found in 20 of 27 patients. In cysto-urethroscopy, urethral stricture was confirmed in 40 patients: 13 in urethral meatus and 27 in other parts or pan-urethra. GITLUS could not reveal urethral stricture in 13 patients with meatal stenosis, confirmed with cystoscopy. GITLUS detected FUS less accurately when it involves pure distal urethra compared to other parts of urethra or pan-urethral stenosis (p value = 0.002). Conclusions: GITLUS is a safe, non-invasive, and valuable technique for detecting FUS. The location and the length of the stricture and probable peri-urethral fibrosis can be identified by this method. However, in meatal or pure short-length distal urethral strictures, this method should be used with caution.

Genitourinary Fistula: 5 Years' Experience of Five Referral Centers in Iran.

INTRODUCTION AND HYPOTHESIS: Genitourinary fistula is a devastating ailment that has an impact on women's physical health, mental health, emotional health, and financial security. The management of genitourinary fistula depends on the type, size, and duration of fistula formation. The purpose of this study is to report the features of genitourinary fistula in Iranian women and our experience in the management of fistula. METHODS: Retrospective chart reviews of 283 patients were performed to determine the cause of the fistula, prior repairs, tissue interposition, and the success rate. The operation was considered successful if the patient did not have any urine leakage during the observation time. RESULTS: The mean (SD) age of women was 49.51 (19.39; range: 21-70) years, Of these, 137 (52.9%) had a history of previous genitourinary fistula surgery. The average fistula was 1.53 (0.041) cm in size. The median (interquartile range) operation lasted 70 (15) min. The success rate after fistula repair was 91.5%. The typical follow-up period lasted 13.26 (range: 1-88) months. Forty-three (15.2%) patients had a big fistula (>2.5 cm) and 4 patients (1.4%) had a history of pelvic radiation therapy, among other reasons for failure. After a second repair, all patients' initial failures were resolved. There were no significant complications, as classified by Clavien-Dindo class 2 or greater. Additionally, there were no bowel, ureteral, or nerve injuries. CONCLUSIONS: Our patients with genitourinary fistula had a successful outcome following repair techniques, without any significant morbidity or mortality.

Pediatric Pyeloplasty in the Poor Function Kidneys: Does Surgical Success Guarantee Improvement in Renal Function? Single-Center Experience and Review of Literature.

PURPOSE: To investigate the effect of pyeloplasty in pediatric patients with poor function kidneys, focusing on the split renal function (SRF) and anteroposterior diameter (APD) of the renal pelvis. MATERIALS AND METHODS: A retrospective study included 47 pediatric patients with ureteropelvic junction obstruction (UPJO) who underwent open pyeloplasty with SRF< 20%. All patients were recruited from the Labbafinejad University Hospital center from April 2014 to October 2020. The results of preoperative ultrasonography and Diethylenetriamine pentaacetate (DTPA) scan compared with the results of the ultrasonography and DTPA scan 6 months and one year after surgery. Finally, Wilcoxon signed-rank test was used to test differences the SPSS (version 25) software statistical computer package. RESULTS: The mean age of participants was 1.5 years. There were 34 cases with SRF between 10% and 20%, and 13 cases with SRF < 10%. The findings showed that pyeloplasty for UPJO leads to a significant improvement in renal function in poorly functioning renal units with 10% ≤ SRF < 20%. Although improvement in renal function occurred in the group with SRF of less than 10%, it was not statistically significant. The APD in both groups was statistically significantly improved. No correlation between genders and outcomes was found. CONCLUSION: Poorly functioning renal unit (SRF < 20%) can show functional improvement after the pyeloplasty.

Evaluation of the results of urodynamic studies in patients with vesicoureteral reflux.

BACKGROUND: To investigate urodynamic abnormalities associated with vesicoureteral reflux (VUR) in toilet-trained children. METHODS: The data of 157 children who were diagnosed with vesicoureteral reflux and referred to our hospital between 2013 and 2022 were retrospectively examined. The urodynamic parameters were analyzed and correlated with age, gender, lower urinary tract symptoms (LUTS), reflux severity, and laterality. RESULTS: Overall, 131 (83.4%) patients had abnormal urodynamic findings with a male-to-female ratio of 1:1.4. The most common pathological finding was detrusor overactivity (DO), identified in 101 (64.3%) patients, followed by dysfunctional voiding (DV) in 74 (50.3%) patients. Children with VUR grades II and III exhibited a greater percentage of abnormal urodynamic findings than children with grades IV and V. The prevalence of DO was higher in children younger than 10 years old with unilateral and lower-grade VURs. DV was more frequent in children older than 10 years, with bilateral VUR, and higher grade VUR. The prevalence of LUTS, bowel and bladder dysfunction (BBD), and urinary tract infection (UTI) was higher among children with abnormal urodynamic findings. CONCLUSIONS: Children with VUR have a high incidence of urodynamic disorders. Urodynamic dysfunction may contribute to the pathogenesis of VUR, especially in mild cases.

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.

Urodynamic findings in children with primary refractory nocturnal enuresis: 10 years' experience of a tertiary center.

Background/Aim: To identify correlations between urodynamic study (UDS) findings and urinary symptoms in children with refractory monosymptomatic and nonmonosymptomatic primary nocturnal enuresis. Materials and Methods: A total of 96 neurologically normal children were enrolled, 44 consecutive boys and 51 consecutive girls, aged 5-18 years, of whom 41 (38.8%) had refractory monosymptomatic nocturnal enuresis (MNE) and 55 (61.2%) had refractory non-MNE (NMNE). We assessed the urodynamics of all children to detect any underlying bladder overactivity. A comparative analysis was carried out between the two groups of patients. Results: Detrusor overactivity (DO), low bladder capacity, low compliance, and increased postvoid residual (PVR) were identified in 70 (72.9%), 35 (36.5%), 43, and 76 (79.2%) patients, respectively. The mean bladder compliance was 21.66 ± 14.52 mL/cmH2O (2-75 cmH2O). Of the NMNE patients, 50 (90.9%) had abnormal urodynamic findings, while 40 (97.5%) had abnormal urodynamic findings in the MNE group. There was a statistically significant relationship between NMNE and both increased PVR and abnormal voiding patterns. Both high PVR and DO were significantly associated with obstructive urinary symptoms. Constipation and history of urinary tract infection (UTI) did not significantly correlate with UDS abnormality (p = 1.0 and p = 0.49, respectively). Conclusion: There was a high prevalence of bladder function disorders in both refractory MNE and NMNE patients in our study. This included small functional capacity, low bladder compliance, and marked DO. A nocturnal enuresis may be the only presenting symptom, however, it may be associated with bladder overactivity, UTI, and constipation; the UDS findings may aid in guiding the assessment and treatment of children suffering from primary refractory nocturnal enuresis and its association with bladder and bowel symptoms.

Evaluating the Effectiveness of Intravesical Instillation of BCG by Modified Maintenance Method in Patients With High-Risk Ta and T1 Bladder Cancer: A Randomized Clinical Trial.

Background: It is estimated that 75% of urothelial bladder cancers are non-muscle-invasive cancers (NMIBCs). The development of more effective methods for optimizing the management of this subset of patients is of paramount importance. This study aimed to evaluate the effectiveness and side effects of modified maintenance Bacillus Calmette-Guérin (BCG) therapy in patients with high-risk NMIBC. Methods: A total of 84 patients with NMIBC who met the inclusion criteria were randomly divided into 2 groups of 42 patients after receiving intravesical BCG weekly, 1 month after transurethral resection of the bladder tumor (TURT) for 6 weeks as the induction. In group I, patients continued monthly intravesical instillation of BCG for 6 months as maintenance, whereas group II patients did not. All patients were followed up for recurrence and progression for 2 years. Results: Although the recurrence rate was lower in group I (16.7% vs 31%), there was no significant difference among groups (P = .124). Pathology progression was also lower in group I (7.1% vs 11.9%) with no significant difference among groups (P = .713). Complications were not statistically different among groups (P = .651). A statistically significant difference was not observed between the groups in the acceptance rate of patients (97.6% in group I vs 100% in group II). Conclusions: The recurrence rate and progression rate in NMIBC patients with maintenance-free induction therapy after TURT were almost twice as high as those with 6-month maintenance therapy; however, it was not statistically significant. Modified BCG maintenance protocol made favorable compliance for patients. Trial registration: This study was retrospectively registered at Iranian Registery of Clinical Trials with the code IRCT20220302054165N1.

Multiple sclerosis and lower urinary tract symptoms: A survey of prevalence, characteristic and urological evaluations.

Objective: Most multiple sclerosis patients have urological complications such as lower urinary tract symptoms. This study was conducted to evaluate the prevalence of these symptoms and whether they result in a urological evaluation. Methods: A cross-sectional study of 517 multiple sclerosis patients at Tehran's referral multiple sclerosis center and neurology clinics between 2018 and 2022 was performed. Data were collected through interviews after patients completed informed consent forms. Urological examinations, including urine analysis and ultrasonography, were evaluated as final assessments. The data were analyzed using descriptive and inferential statistical tests in Statistical Package for Social Science. Results: Among all participants, the prevalence of lower urinary tract symptoms was 73% (n = 384), with urgency (44.8% n = 232) being the most common symptom. The prevalence of intermittency was significantly higher among women (p = 0.004). There was no gender-significant difference in terms of the prevalence of other symptoms (p > 0.050). Lower urinary tract symptoms were significantly correlated with age, clinical course, disease duration, and disability (p < 0.001). Additionally, 37.3% and 18.7% of patients with lower urinary tract symptoms, as well as 17.9% and 37.5% of patients with multiple sclerosis attacks, respectively, had undergone urine analysis and ultrasonography. Conclusion: Multiple sclerosis patients rarely undergo urological evaluations during the course of their disease. Proper assessment is essential as these symptoms are among the most detrimental manifestations of this disease.

A case report of unusual presentation of a rare renal tumor.

There are very few cases of primary renal Ewing sarcomas, which are characterized by a high rate of metastasis. These tumors are often mistaken for other more common kidney tumors due to their rarity and lack of pathognomonic symptoms in the early stages. A 28-year-old male patient presented to our clinic with a 2-month history of nonproductive progressive cough and left flank pain. The chest was scanned with contrast-enhanced computed tomography, which showed a heterogeneously enhancing mass with central vascularity on the left retroperitoneal. An abdominal dynamic multiphasic magnetic resonance imaging with contrast revealed a large mass that was highly suggestive of neoplastic pathology and multiple metastatic nodules. The pathology report indicated a renal Ewing sarcoma as the result of a core needle biopsy. In order to initiate chemotherapy promptly, early detection is crucial, and radiology plays an important role in diagnosing.

Antegrade Percutaneous Retrieval of Upward Migrated Double-J Stent in Very Small Size Pediatric Patients Under Ultrasonic Guide.

Purpose: To evaluate the safety of antegrade percutaneous retrieval migrated ureteral stent in very small size pediatric patients with ultramini instruments under ultrasonography guide. Materials and Methods: A total number of 10 out of 115 patients who were referred to our center with upward migrated Double-J (DJ) were candidates for antegrade approach from 2017 to 2020. The pyelocalyceal system was punctured in a prone position by using an 18-gauge disposable needle with Chiba tip and visualization of the upper tract by 3.5 MHz ultrasonic guidance. Then 0.038-inch J tipped guide wire was passed through the needle and the tract was dilated up to 6F under ultrasonographic guide. The 8F access sheath was positioned over the 6F dilator. The semirigid 6F ureteroscope was introduced through the sheath and DJ was removed with a grasper. Results: The mean age was 11.4 ± 5.48 months. The mean time from the previous surgery to DJ removal procedure was 6.4 ± 0.84 weeks. The mean operation time was 11.7 ± 1.76 minutes. All the patients were discharged from the hospital within the 1st day. There were no serious complications (grade 3, 4, or 5) according to Clavien-Dindo classification. Conclusion: The antegrade retrieval of upward migrated DJ with ultramini instrument under ultrasonographic guidance in failed cases of retrograde approach is a safe and effective approach in very small size pediatric patients.

Correlation between trans-perineal ultra-sonography, urodynamic study and physical examination findings in female patients with stress urinary incontinence: Single center experience.

BACKGROUND: To evaluate the efficacy of Trans-perineal ultrasonography (TPUS) in assessment of stress urinary incontinence (SUI) and its correlation with urodynamic study (UDS) and physical examination in women with SUI. METHODS: The study enrolled a total of 91 females including 66 women with SUI and 25 women with no history of urinary incontinence as control group. The α and ß angles (anterior urethral and posterior urethro-vesical angle respectively) were recorded both at rest and at straining, using TPUS. The differences between these angles at rest and during the straining were considered as the rotational angles (Rα and Rß). Urethral length and caliber, bladder neck funneling, and pubo-urethral distance were measured as well. RESULTS: The mean (SD) α angle at rest of the SUI group was 49.0 (±14.3)°, which was higher than the same parameter in the control group: 47.6 (±9.7)°. Similarly, the α angle at straining was significantly higher in the SUI group versus the control group, 61.0 (±15.4)° versus 55.8 (±15.8)°. The mean (SD) ß angle in the SUI group at rest was 124.6 (±28.5)°, which was significantly higher than that of the control group at 114.0 (±22.5)°. The mean (SD) ß angle at straining was also higher in the SUI group versus the control group: 151.8 (±90.6) versus 136.0 (±27)°. Moreover, higher Rα and Rß angels were documented in the SUI group. CONCLUSION: Our data suggest that TPUS can be considered as a non-invasive, easily conducted, and accurate modality in early diagnosis of female SUI. It may reduce the need for performing relatively invasive UDS. However, the role of TPUS in assessment of SUI severity remains to be studied probably with a larger sample size.

A case report of sacral neuromodulation tined lead migration into the rectum.

This report describes a 26-year-old woman who underwent sacral neuromodulation explant following lead migration and rectal wall penetration. Her device was implanted due to persistent urinary retention. The tined lead wire was dissected to the fascia and cut. The rectal part of the lead was removed with gentle traction.

Accreditation of an old surgical technique for stress urinary incontinence: long-term outcomes of modified autologous fascial pubovaginal sling.

PURPOSE: To evaluate long-term outcomes of modified autologous fascial pubovaginal sling (AFPVS) in women with stress urinary incontinence (SUI). METHODS: To evaluate long-term outcomes of modified AFPVS, we retrospectively reviewed the medical records of our patients from 2004 to 2015. From 2 decades ago, we have made modifications to classic surgical technique to make it simpler and faster. RESULTS: 199 patients were contacted with mean age of 52 years. The mean follow-up period was 107 months. According to Revised Urinary Incontinence Scale (RUIS) questionnaire, overall success rate was 83.9%. In patients with positive history for SUI surgery, success rate was 73% compared to 87% in those without it. Body mass index was negatively associated with cure rate. We did not encounter any major complications and most of the issues were managed conservatively. Recurrence of SUI occurred in 6 patients (3.5%) after initial improvement. CONCLUSION: Modified AFPVS is an effective surgical technique for treatment of SUI with high and durable success rate. At the present time with concerns regarding the use of transvaginal synthetic mesh, there is increasing interest and request for modified traditional procedures. It is likely that AFPVS may become more popular in upcoming years.

Intravesical Botulinum toxin-A injection in pediatric overactive neurogenic bladder with Detrusor overactivity: Radiologic and clinical outcomes.

OBJECTIVE: The neurogenic bladder is one of the most serious and painful disorders seen in pediatric urology clinics. The upper urinary tract can be impaired by increased bladder pressure. Botulinum toxin-A (BTX-A) is one of the new therapeutic interventions for this disease. Thus, this research was designed to determine the clinical as well as radiological outcomes intravesical BTX-A injections in patients with overactive neurogenic bladder with Detrusor over activity. PATIENTS AND METHODS: From March 2012 to March 2019, this cohort study was conducted at Shahid Labbafinejad hospital in Tehran, Iran. Thirty-five pediatric patients with a neurogenic bladder and Detrusor overactivity who fulfilled the eligibility criteria received BTX-A injections. Demographic data, including spinal cord lesions or congenital malformations, upper and lower urinary tract nuclear scans, evidence of vesicoureteral reflux (VUR) and its severity, and hydronephrosis and 72 h voiding diary before and after intervention were all recorded. RESULTS: The mean ± standard deviation age of participants was 9.47 ± 4.61 years. After injection, nocturia and urination frequency as general symptoms of the overactive neurogenic bladder improved (p < 0.05). Also, the severity of hydronephrosis was decreased in 33% of patients following injection. In our study, 32 out of 35 patients had vesicoureteral reflux. Of those, there was complete resolution and downgrading of VUR in 17 (53.12%) and 13 (40.62%) respectively. CONCLUSION: In the evaluation of voiding cystourethrography (VCUG) before and after the injection, downgrading of VUR was seen in 53% of the cases. In the 99mTc-DMSA nuclear scan before and after the injection, the appearance of a new parenchymal scar and uptake reduction was not observed, which indicates the cessation of scar formation in all patients. Although Enuresis, Urgency, Frequency, Nocturia, and UUI significantly improved after injection.

Comparison of polyacrylate polyalcohol copolymer (PPC) and dextranomer/hyaluronic acid (Dx/HA) for treatment of vesicoureteral reflux. A systematic review and meta-analysis.

PURPOSE: Our study aimed to compare the efficacy of polyacrylate polyalcohol copolymer and Dextranomer-Hyaluronic Acid for endoscopic treatment of vesicoureteral reflux. MATERIAL AND METHODS: MEDLINE, EMBASE, Scopus, Web of science, Ovid, Cochrane databases, Google scholar have been searched for studies published until January 2022 in any language. Studies that compared the success rate for endoscopic treatment of vesicoureteral reflux in children with two bulking agents, namely, "polyacrylate polyalcohol copolymer." and "Dextranomer-Hyaluronic Acid" were included for this analysis. RESULTS: Nine studies were included in data synthesis for this meta-analysis. Pooled data with a total of 763 ureters in PPC group and 718 ureters in Dx/HA group indicated that ureters in PPC group were more likely to undergo complete reflux resolution than Dx/HA (OR 3.80, 95% CI: 2.71; 5.31). Among subgroup of patients with high grade reflux, PPC injection had more resolution rate compared to Dx/HA patients (OR: 2.92, 95% CI: 1.19-7.16). In total, 95.81% of the PPC group and 86.52% of the Dx/HA group experienced success after the third injection. However a concerning complication of endoscopic treatment which is ureterovesical junction obstruction (UVJO) was more prevalent in PPC group. So the possible benefits arising from endoscopic treatment with PPC could be offset by the costs of re-implantation surgery or stenting in the case of UVJO. CONCLUSION: These data indicate that PPC injection for vesicoureteral reflux treatment was associated with a higher success rate, but concerningly, UVJO incidence was higher in the PPC group which might negate the possible benefits of PPC injection However, due to the lack of studies with long-term follow-up, we couldn't reach a definitive conclusion about the superiority of one of the bulking agents over the other.

Autologous rectus fascia graft in the treatment of high-stage apical vaginal prolapse: preliminary results of a new surgical approach with native tissue.

PURPOSE: Since vaginal meshes in pelvic organ prolapse have been associated with more complications in the last decades, native tissue vaginal repair is still the mainstay of prolapse surgery. This study introduces a new transvaginal approach with bilateral sacrospinous ligament fixation augmented by autologous rectus fascia graft to repair high-stage apical vaginal wall prolapse. METHODS: Between December 2018 and June 2020, 13 patients with high-stage apical vaginal wall prolapse (point C ≥ + 1) accompanied by high-stage anterior vaginal wall prolapse (paint Ba ≥ + 1) were included. In this procedure, the central part of the anterior rectus fascia graft (6-8 cm in length and 1-1.5 cm in width) is sutured to the underlying tissue of the vaginal apex or cervix and the arms of the rectus graft augmented to the sacrospinous ligament with a Capio suture capturing device (Boston Scientific). The patients are evaluated by history taking, physical examination, Pelvic Floor Impact Questionnaire (PFIQ-7), and Pelvic Floor Distress Inventory (PFDI-20) Questionnaire. RESULTS: The patient's mean age was 61.2 ± 2.7 years and they were followed up to 12 months. The anatomical success rate was 92.3%. The PFDI-20 and PFIQ-7 were significantly improved (P < 0.001). There were no significant perioperative complications. Three patients complained of unilateral groin or buttock pain which resolved gradually at the first post-operative month. CONCLUSION: The transvaginal bilateral sacrospinous ligament fixation augmented by autologous rectus fascia graft is an effective and safe surgical approach in treating high-stage apical vaginal prolapse with short-term follow-up.

Benign prostatic hyperplasia: Who will benefit from surgical intervention? A single center experience.

BACKGROUND: To evaluate the pre-operative factors affecting clinical response to prostate surgery in men with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: In this prospective cohort study, 172 patients who underwent surgical intervention for BPH (either as open prostatectomy (n = 78) or monopolar-trans-urethral resection of prostate (n = 94) from February 2017 to October 2019 were consecutively enrolled. Pre-operative conventional three-lumen urodynamic study and transabdominal sonography were performed for all patients to determine peak flow rate (Qmax), detrusor pressure at the peak flow rate (PdetQmax), post-void residual volume (PVR), presence of detrusor overactivity (DO), prostate volume and median lobe size, and bladder wall thickness with empty and full bladder. Uroflowmetry and cystoscopy were performed during follow-up, whenever indicated. Successful surgical outcome was defined as subjective satisfaction of the patient and a Qmax of more than 15 ml/s on post-operative uroflowmetry. RESULTS: At 1-year follow-up, complete resolution of lower urinary tract syndrome (LUTS) was detected in 138 (80.2%) patients; however, 21 (12.2%) still had pure obstructive LUTS, 9 (5.2%) had pure storage LUTS, and 4 (2.3%) were still suffering from both storage and obstructive LUTS. After performing multivariable analysis, shorter duration of pre-operative medical treatment and higher pre-operative bladder contractility index (BCI) were found to be independent predictors of successful surgery (p = 0.012 and p < 0.001, respectively). Results of the ROC curve analysis showed that a preoperative BCI level more than 90.95 and pre-surgical medical treatment duration less than 14.45 months have the most specificity and sensitivity to predict the success of surgical outcome. We also observed that the probability of recovery decreased considerably over time following surgery. CONCLUSION: Shorter duration of pre-operative medical treatment and increased pre-operative BCI can independently predict favorable outcome of BPH surgery. These factors could be used for better patient management and appropriate planning and consultation before BPH surgery.

Evaluation of the Clinical Effects of Abobotolinum Toxin A (Dysport) Injection in the Treatment of Neurogenic Lower Urinary Tract Dysfunction.

PURPOSE: Neurogenic lower urinary tract dysfunction (NLUTD) is one of the most challenging problems in urology. In recent years, Onabotulinum toxin A (Botox) is considered a second-line treatment in these patients. This study aimed to evaluate the clinical effects of Abobotolinum toxin A (Dysport) into the bladder and urethra. MATERIALS AND METHODS: We classified our patients with NLUTD into three groups: neurogenic detrusor overactivity (group 1), detrusor sphincter dyssynergia (group 2), and patients with both symptoms (group 3). The severity of the patient's symptoms was assessed using the Urinary Distress Inventory- Short form (UDI-6), urodynamic study, and post-void residual urine (PVR) at baseline. After injection of Dysport, the patients were evaluated by the change in UDI-6 score, PVR, and the patient's general satisfaction. In group 1, 500-900 U diluted Dysport injected intra-vesical. If associated with detrusor sphincter dyssynergia (group 3), 100 U diluted Dysport injected peri-urethral. In group 2, only 100 U diluted Dysport injected peri-urethral. RESULTS: Data from 52 women with NLUTD were analyzed. The mean age was 51.3 ± 21.6 years. The prevalence of detrusor overactivity and the value of Q max was more in group 1. However, the amount of PVR was more in groups 2 and 3. The overall success rate was acceptable in all three groups. In addition, there were significant improvements in UDI-6 parameters. CONCLUSION: Peri-urethral injection of Abobotolinum toxin A is effective and safe. However, the selection of the patients and the dose of toxin needs more studies.

Translation and linguistic validation of the Persian version of the International consultation on Incontinence Questionnaire Vaginal Symptoms.

BACKGROUND: There is no validated measurement tool to assess vaginal symptoms (VS), sexual matter (SS), and quality of life (QOL) among Persian-speaking women. This study aimed at translating and assessing the validity and reliability of the Persian version of the International Consultation on Incontinence Questionnaire for Vaginal Symptoms (PICIQ-VS). MATERIALS AND METHODS: In this cross-sectional study, after obtaining permission from the International Consultation on Incontinence Questionnaire (ICIQ) Advisory Board, the English version of ICIQ-VS was translated into Persian per a standard translate and back translate process, and the validity and reliability were studied. Two hundred women with and without pelvic organ prolapse were asked to complete the PICIQ-VS (mean age: 52.1, range: 22-84 years). A panel of 10 experts evaluated the content and face validity of the questionnaire. Cronbach's alpha examined the internal consistency reliability of the measure. To evaluate the test-retest reliability, we redistributed the questionnaire among 30 patients 2 weeks after their initial visit using intra-class correlation coefficient (ICC). RESULTS: Content and face validity of the questionnaire was confirmed after some light modification (content validity ratio ranged from 0.69 to 1.00, and content validity index ranged from 0.79 to 1.00). PICIQ-VS showed an acceptable internal consistency and stability reliability (VS: α = 0.64, ICC = 0.84; SM: α = 0.69, ICC = 0.88; and total scale: α = 0.72, ICC = 0.91, respectively). Significant differences were observed between the asymptomatic and symptomatic groups for VS and the total score (P < 0.05). CONCLUSION: In the light of the results, interestingly, PICIQ-VS could be utilized as a valid and reliable tool to assess the VS among Persian-speaking women, both in research and clinical practice.

Huge vaginal wall Mullerian cyst mimicking high stage pelvic organ prolapse.

Vaginal Mullerian cysts are usually small and asymptomatic. Occasionally, they are enlarged and mimic other anatomical disorders, such as anterior vaginal wall prolapse, middle compartment defects (enterocele, apical vaginal wall prolapse) or urethral diverticulum.  Herein we report a female case with a huge vaginal wall Mullerian cyst which was initially misdiagnosed as stage 4 cystocele. Pelvic MRI and cysto uerthroscopy revealed no communication between the cyst and adjacent structures. The cyst was completely excised through a vaginal approach. The pathologic evaluation revealed a benign Mullerian cyst lined with mucinous epithelium. Diagnostic approach to space occupying lesions in the vaginal cavity needs assessment by history, physical examination and appropriate imaging which are essential to prevent misdiagnosis and mistreatment.