Success rate and complications of performing elective ureteroscopy in <1 week versus over 1 week from renal colic initiation in ureteral stones larger than 6 mm.

Background: The aim of this study was to compare the outcomes, success rate, and complications of performing elective ureteroscopy at different times: <1 week from renal colic initiation (early) and more than 1 week from renal colic initiation (late) in patients with ureteral stone larger than 6 mm. Materials and Methods: This comparative observational study was conducted on 338 consecutive patients. Patients were evaluated in two groups: patients who underwent ureteroscopy in <1 week (A) and patients who underwent ureteroscopy in more than 1 week (B) from renal colic initiation. Helical unenhanced computed tomography was used to assess the size, location, and hardness of stone for all patients. Operation success was defined as complete clearance of stone with no stone residue (stone free) at 2-week postoperative ultrasonography with no need to further interventions. Operation data were collected using medical records, and postoperative complications were investigated at 2 weeks postoperative follow-up visits. Results: Group A included 165 patients and Group B included 173 patients. The overall mean stone size was 8.60 ± 1.12 mm: for Group A 9.13 ± 0.94 mm and for Group B 8.10 ± 1.04 mm (P < 0.001). Stone residues were found in 11 patients: 9 in Group A (5.4%) and 2 in Group B (1.1%) (P = 0.026). Nine patients needed repeated ureteroscopy: 8 (4.8%) in Group A and 1 (0.6%) in Group B (P = 0.015). A double-J stent was used for 85 (51.5%) patients in Group A and 66 (38.2%) patients in Group B (P = 0.016). Major intraoperative complications did not happen in any patients. Fifty-three (32.1%) patients in Group A and 28 (16.2%) patients in Group B suffered from postoperative complications (P = 0.001). Conclusion: Our study revealed that performing elective ureteroscopy with an interval of more than 1 week from the onset of renal colic in combination with medical treatments was associated with less need for double-J stent placement, less need for repeated ureteroscopy, and fewer postoperative complications compared to performing elective ureteroscopy in <1 week from the renal colic onset in nonemergent patients with ureteral stone larger than 6 mm. Although the rate of ureteroscopy failure was higher among the patients who underwent ureteroscopy in <1 week from their renal colic initiation, there was no statistically significant relationship between performing ureteroscopy in <1 week and an increased risk for ureteroscopy failure.

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.

Evaluating the effectiveness of tranexamic acid administration in reducing bleeding in benign prostate hyperplasia patients underwent open prostatectomy: A double-blind randomized clinical trial.

Background: Blood loss of postoperative after prostate surgery could be related with an increase in urinary fibrinolytic activity. Tranexamic acid (TXA) is both a potent inhibitor of plasminogen and urokinase activators and a low molecular weight substance that is excreted unchanged in the urinary tract and can be administered both orally and intravenously. This study aimed to evaluate the effectiveness TXA administration in reducing bleeding in benign prostatic hyperplasia (BPH) patients who underwent open prostatectomy. Materials and Methods: This double-blind randomized clinical trial was conducted on patients with BPH who underwent open prostatectomy. The first group received TXA (1 gr IV from during surgery to 48 h after surgery, 3 times/day). Twenty-four hours after surgery, the two groups were compared in terms of bleeding rate. Hemoglobin (Hb), hematocrit (HCT), and platelet (Plt) counts were also assessed before and after the intervention. Results: Intervention and control groups were comparable in terms of basic and baseline values of variables at the beginning of the study (P > 0.05). The mean bleeding volume in TXA group was significantly lower than the control group 112.11 ± 53.5 and 190.00 ± 97.5 CC; P ≤ 0.001). Mean hospitalization (3.28±0.46 vs. 4.38 ± 0.95 days P < 0.001) and surgery duration (98.11 ± 37.11 vs. 128.00 ± 39.12 h; P = 0.001) were significantly lower in TXA group compared to control intervention. Conclusion: According to the findings of the current study, the administration of TXA led to reduce bleeding in BPH patients who underwent open prostatectomy. Furthermore, the mean Hb, HCT, levels were significantly affected by TXA. TXA treatment approach also can reduce the surgery and hospitalization time effectively. TXA approach is recommended as effective procedure in BPH patients who underwent open prostatectomy.

Modeling land use/cover change based on LCM model for a semi-arid area in the Latian Dam Watershed (Iran).

The monitoring and modeling of changes, based on a time-series LULC approach, is fundamental for planning and managing regional environments. The current study analyzed the LULC changes as well as estimated future scenarios for 2027 and 2037. To achieve accuracy in predicting LULC changes, the Land Change Modeler (LCM) was used for the Latian Dam Watershed, which is located approximately in the northeast of Tehran. The LULC time-series technique was specified utilizing four atmospherically endorsed surface reflectance Landsat images for the years t1 (1987), t2 (1998), t3 (2007), and t4 (2017) to authenticate the LULC predictions, so to obtain estimates for t5 (2027) and t6 (2037). The LULC classes identified in the watershed were water bodies, build-up areas, vegetated areas, and bare lands. The dynamic modeling of the LULC was based on a multi-layer perceptron (MLP), the neural network in LCM, which presented good results with an average accuracy rate equivalent to 84.89 percent. The results of the LULC change analysis showed an increase in the build-up area and a decrease in bare lands and vegetated areas within the duration of the study period. The results of this research could help in the formulation of public policies designed to conserve environmental resources in the Latian Dam Watershed and, consequently, minimize the risks of the fragmentation of orchards and vegetated areas. Also, careful regional planning ensuring the preservation of natural landscapes and open spaces is critical to creating a resilient regional environment and sustainable development.

Factors affecting the COVID-19 risk in the US counties: an innovative approach by combining unsupervised and supervised learning.

The COVID-19 disease spreads swiftly, and nearly three months after the first positive case was confirmed in China, Coronavirus started to spread all over the United States. Some states and counties reported high number of positive cases and deaths, while some reported lower COVID-19 related cases and death. In this paper, the factors that could affect the risk of COVID-19 infection and death were analyzed in county level. An innovative method by using K-means clustering and several classification models is utilized to determine the most critical factors. Results showed that longitudinal coordinate and population density, latitudinal coordinate, percentage of non-white people, percentage of uninsured people, percent of people below poverty, percentage of Elderly people, number of ICU beds per 10,000 people, percentage of smokers were the most significant attributes.

An evaluation of the marine environmental resilience to the north of Qeshm Island.

There is always an adamant need to comprehend and draw the complex challenges of sustainability in order to help organize studies, due to the increasing human-related pressures on coastal zones. Hence, by formulating such a comprehensive framework, it could be possible to anticipate changes and support managerial decisions, as well as the degree of resilience of the region's environment. One of the approaches utilized in littoral or coastal zones is the conceptual framework of drivers, pressure, status, impact, and responses (DPSIR)..Qeshm Island, the largest island in the Persian Gulf, is accounted for being the most vital and strategic areas of the mentioned region. In recent decades, Qeshm has become one of the major cultural, natural, geological, and tourism hubs of the country due to its unique regional characteristics, along with its biodiversity and environmental sensitivity. Thereby, in the present research, a combined approach shall be followed to explore the resilience of the marine environment on the northern coast of Qeshm Island by taking advantage of the socioeconomic criterion. In this respect, the conceptual framework of the DPSIR model is utilized in combination with the structural equation model (SEM-PLS) (or partial least squares), which is one of the nonexperimental techniques, to quantify the results in the best manner possible. On the basis of the fuzzy cognitive map (FCM), the regional economic index bearing the weights of 0.62, 0.62, and 0.5, along with an institutional-managerial and biological index, respectively, denotes a two-way positive correlation, whereas this factor has a two-way, but adverse correlation, relationship with a weight of 0.65 in terms of the sociocultural index. Similarly, there is also a one-way and negative relationship, as to the economic index, with a weight of 0.69 which is in relevance with the physio-chemical index.

Catastrophic retroperitoneal hemorrhage in COVID-19 patients under anticoagulant prophylaxis.

COVID-19 patients are at high risk for both capillary micro thrombi and large vessel thrombosis. Anticoagulant administration in COVID-19 patients, especially in ICU setting, is recommended by some researchers. However, clinical guidelines don't yet recommend anticoagulation therapies in therapeutic doses in these patients. In this article, we try to introduce a less known complication of heparin application in COVID-19 patients. Retroperitoneal hemorrhage when involves the psoas muscle might be deadly because of the large volume of bleeding before causing any significant alarm. It is very important to be careful in diagnosing and managing this complication.

Prognostic Value of Hemoglobin Concentration and Graft Vein Blood Oxygenation on Renal Transplant Outcomes.

OBJECTIVE: Our objective was to investigate vein blood gas levels in the transplanted kidney during surgery as a predictive factor for delayed graft function after renal transplant. MATERIALS AND METHODS: Sixty patients with renal transplant were enrolled in our study from January 2015 to January 2016. After vessels were declamped posttransplant, blood samples from the transplanted kidney veins were taken and acidosis and oxygenation in these samples were measured. Patients were classified based on acidosis and oxygenation of grafted vein and also hemoglobin concentration. We compared delayed graft function in recipients with acidosis versus normal pH, hypoxia versus normal oxygenation, and hemoglobin less than 10 g/dL versus more than 10 g/dL. RESULTS: Of 60 patients, 6 (10%) experienced delayed graft function and needed hemodialysis. All patients needing hemodialysis were in the acidotic and hypoxic patient groups. Five of six recipients with delayed graft function had hemoglobin concentration < 10 g/dL. Hospital stay was significantly longer in patients with hypoxia, acidosis, and anemia. CONCLUSIONS: Vein blood gas measurements of the grafted renal vein during surgery can be easily obtained and applied as a prognostic factor for delayed graft function.

A Randomized Control Trial Comparing Combined Glandular Lidocaine Injection and Intraurethral Lidocaine Gel with Intraurethral Lidocaine Gel Alone in Cystoscopy and Urethral Dilatation.

PURPOSE: Cystoscopy is one of the most common urologic procedures. The aim of this study is to investigate the combined effect of intraurethral lidocaine gel and intraglandular injection of lidocaine 2% on pain during and after cystoscopy. Materials & Methods: In this double-blind, parallel group randomized clinical trial, 156 patients referred for double J removal, urethral dilatation, or cystoscopy were enrolled. The patients were divided into two groups, A and B. All patients received 20 cc of intraurethral lidocaine gel 2%. In group A (N = 75), lidocaine 2% was also injected into the glans penis. The patients in group B (N = 81) only received the intraurethral lidocaine gel. Cystoscopy was performed 10 minutes later. The primary outcome of interest was measured in terms of pain score (visual analogue scale) during and 5 minutes after cystoscopy. RESULTS: Immediate pain score after the procedure was 3.4 ± 3 and 4.6 ± 3 in groups A and B, respectively (P = .011). CONCLUSION: Based on the findings of the present study, lidocaine injection into the glans penis significantly reducedpain perception.

The effect of urethral catheterization on the level of prostate-specific antigen.

BACKGROUND: The normal prostate-specific antigen (PSA) level in patients with urethral catheterization is a controversy. We designed this study to investigate the effect of nontraumatic urethral catheterization without urinary retention on serum PSA. MATERIALS AND METHODS: Seventy patients scheduled for urethral catheterization before elective surgeries were randomly selected and included in the study. They were categorized into two age groups: 40-60 years (Group A) and over 60 years (Group B). Total PSA, PSA density, and free/total PSA were assessed before and after catheterization. RESULTS: The PSA levels showed no statistically significant rise after urethral catheterization. The average of PSA level was 1.01 and 1.6 in A and B Groups, respectively, and changed to 1.38 and 1.80 in A and B Groups 1 day after catheterization (P > 0.05). Free/total PSA was 28.75 and 26 in A and B Groups before catheterization and changed to 28.35 and 27.5 in A and B Groups after catheterization (P > 0.05). CONCLUSION: Nontraumatic urethral catheterization has very little effect on PSA level and in patients with urethral catheter routine evaluation of PSA rising should be considered.

Artificial Ureter in Patients with Extensive Ureteral Damage.

PURPOSE: loss of significant lengths of ureter when substitution with bowel or bladder fails is a disaster in urology. This study is conducted to evaluate the results of subcutaneous nephron-vesical bypass (SNVB) in ureteral damage of different etiologies. MATERIALS AND METHODS: Seventeen SNVB were employed in patients with ureteral injuries. We employed a device consisted of an internal silicone tube covered by a coiled PTFE tube to replace the ureter. This is called artificial ureter (AU). Proximal end of the AU was introduced in the kidney percutaneously, the tube was passed through a subcutaneous tunnel, while the distal end was inserted in the bladder through a small suprapubic incision. RESULTS: Follow-up ranged from six months to ten years. We removed the prosthetic ureter in one patient due to gross hematuria two months after insertion. One of the patients was reoperated two days after the procedure because of urinary leakage. In all other patients, the procedure was safe and effective. CONCLUSION: Subcutaneous nephron-vesical bypass is a safe and appealing alternative to a nephrostomy tube. This is a permanent device with no need for exchange. The technique can be applied in ureteral injuries due to various causes.

Efficacy of Long-Acting Octreotide on Reducing Mucus Production in Patients With Ileal Neobladder.

PURPOSE: To evaluate the efficacy of long-acting-release octreotide (trade name Sandostatin) on decreasing mucus secretion, thus reducing catheter obstruction after radical cystectomy and orthotopic reconstruction. PATIENTS AND METHODS: In this double-blind, placebo-controlled study, we treated 73 cases of radical cystectomy between the years 2008 and 2014; 65 were deemed eligible for the study. Cases were randomly divided into 2 groups. Group A (n = 32) received 2 doses of 20 mg intramuscular long-acting-release octreotide 4 weeks before and on the day of surgery, while group B (n = 33) received placebo. Catheter irrigation was only performed when there was an obstruction due to a mucus plug. The need for catheter irrigation and the volume of mucus produced by the neobladder were evaluated and compared between the 2 groups. RESULTS: The average number of neobladder irrigations required to treat mucus plugs was 2.3 ± 1.5 in group A and 9.5 ± 4.3 in group B (P < .001) before hospital discharge. This number changed to 2.5 ± 1.5 versus 11.4 ± 2.7 in groups A and B, respectively (P < .001), after discharge from the hospital. The 24-hour mucus production at the end of the first week was 5.4 ± 2.7 mL versus 21.5 ± 5.6 mL in groups A and B, respectively (P < .001). At the end of the third week, this amount changed to 5.5 ± 2.3 mL versus 21.8 ± 5.6 mL in groups A and B, respectively (P < .001). CONCLUSION: Two injections of long-acting-release octreotide can dramatically reduce mucus production and hence catheter obstruction due to mucus plugs after radical cystectomy and orthotopic reconstruction.

E-cadherin expression as a prognostic factor in transitional cell carcinoma of the bladder after transurethral resection.

PURPOSE: To analyze the role of negative versus positive immunoexpression of E-cadherin in recurrence rate of low-grade bladder tumors. MATERIALS AND METHODS: A total of 180 patients with unifocal, superficial, low-grade, papillary transitional cell carcinoma of the bladder were included in this study. The E-cadherin expression was evaluated using E-cadherin antibody. The patients were followed up for 36 months. Thereafter, recurrence rate of the tumor was compared between E-cadherin positive and negative groups. RESULTS: Of 180 low-grade carcinomas, E-cadherin immunoexpression was negative in 101 (56%) and positive in 79 (44%) patients. The recurrence rate in negative and positive groups was 65.6% and 37.9%, respectively. Negative in comparison with positive E-cadherin expression was associated with more disease recurrence (P = .045). CONCLUSION: There is an association between decreased E-Cadherin immunoexpression and tumor recurrence in low-grade and non-muscle invasive transitional cell carcinoma of the bladder.

A comparison between blind and nerve stimulation guided obturator nerve block in transurethral resection of bladder tumor.

PURPOSE: To compare blind and nerve stimulation guided transurethral obturator nerve block (ONB) in transurethral resection of bladder tumor (TURBT) to prevent obturator reflex. PATIENTS AND METHODS: One hundred and twelve patients with lateral bladder wall tumors and at high risk for general anesthesia were categorized randomly in three groups. In the first group (34 patients), after spinal analgesia was administered, the exact site of the obturator nerve was determined by nerve stimulation and 15 mL of lidocaine HCl 2% was injected around the nerve. In the second group (31 patients), we determined the obturator nerve using nerve stimulation (like the first group), then 20 mL of saline was injected. In the third group (47 patients), the obturator nerve was determined based on anatomic landmarks and blocked subsequently. Leg jerking was reported and compared in the three groups. RESULTS: The median ages in the three groups were 55.4, 59.4, 57.8 years in the first, second, and third groups, respectively. Male/female ratios were 79.5% in the first, 80.7% in the second, and 80.9% in the third group (P=0.986). Leg jerking was reported in 5.8%, 34%, and 6.3% of patients in the first, second, and third groups, respectively (P=0.0001). ONB took 6.7 minutes in the first, 6.1 minutes in the second, and 5.2 minutes in the third group, on average. There was no report of adverse effects of lidocaine HCl in this study. CONCLUSION: Transvesical ONB is a safe and effective method of ONB before TURBT. This method is feasible by urologists and promising even without nerve stimulation and only by anatomic landmarks.

Transvesical blockade of the obturator nerve to prevent adductor contraction in transurethral bladder surgery.

PURPOSE: To evaluate the efficacy of transvesical obturator nerve block (ONB) in the prevention of obturator nerve reflex and leg jerking during transurethral resection of bladder tumors (TURBT). PATIENTS AND METHODS: A total of 60 patients were studied, in whom the transurethral resection of tumors on the posterolateral bladder wall were performed under spinal anesthesia (SA). The patients were randomly divided into two groups. In the first group, we performed transvesical ONB and SA together, while the second group received only SA. The patients underwent TURBT using monopolar cautery. Incidence of leg jerking was registered and compared in these two groups. We used a nerve stimulator to detect the obturator nerve next to the lateral bladder wall. The obturator nerve was identified by its response to nerve stimulation. Then, 10 mL of 1% lidocaine was slowly injected through the working channel of a cystoscope. RESULTS: In the intervention group, 34 ONBs (4 bilateral and 26 unilateral) were tried. We could not detect the obturator nerve by nerve stimulation in six patients, and lidocaine injection was carried out blindly in these cases. One patient in the intervention group experienced adductor contraction. Among 30 patients in the control group, 5 patients had leg jerking, and in 2 patients, the procedure ended incompletely because of muscle spasm. Comparing these two groups, transvesical ONB effectively decreased leg jerking during TURBT (16.5% vs 3%; P < 0.05). CONCLUSION: Local blockade of the obturator nerve during cystoscopy is an effective method to avoid its stimulation in TURBT. It can be performed easily, and we did not experience any serious complication.