Evaluation of the efficacy of oxidized cellulose (surgicel) in reducing blood loss in suprapubic simple open prostatectomy: A randomized clinical trial.

Background: Simple open prostatectomy is still the treatment of choice for removing large prostates; however, peri-surgical bleeding accompanied by this technique has always been a challenge for urologist surgeons. Therefore, the present study aimed to investigate the effect of surgicel on reducing bleeding in trans-vesical prostatectomy. Materials and Methods: The present double-blinded clinical trial included 54 patients with Benign Prostatic Hyperplasia (BPH), divided into two groups of 27, and underwent trans-vesical prostatectomy. After removing the prostate, the prostate adenoma was weighed in the first group. Then, two surgicel were inserted into the prostate loge for prostate adenomas weighing 75 g or less. For larger prostates, another surgicel was inserted for each 25 g weight higher than the limit of 75 g. However, no Surgicel was inserted in the control group. Other steps of the procedure were the same in both groups. Moreover, hemoglobin and hematocrit levels were assessed in both groups; preoperation, intra-operative, 24 h, and 48 h postoperative. In addition, all the fluid used for bladder irrigation was collected, and its hemoglobin level was assessed. Results: According to our results, no intergroup difference in hemoglobin level changes, hematocrit changes, International Prostate Symptom Score (IPSS), postoperative hospital stay, and number of packed cells received. However, the postoperative blood loss in bladder lavage fluid was significantly higher in the control group (120.83 ± 46.66 g) as compared to the surgicel group (72.56 ± 32.53 g) (P < 0.001). Conclusion: The present study concluded that using surgicel in trans-vesical prostatectomy could reduce postoperative bleeding without increasing the chance of postoperative complications.

Ureterocele mimicking uterine polyp in a young woman presenting with a vulvar mass: A case report.

Ureterocele is a distal ureteral segment cystic dilatation. Its prevalence in women ranges from 1/5000 to 1/12000. A 22-year-old adult female presented with a vulvar tumor with left-side pain. She was a candidate for an interlabial lump biopsy. A vulvar growth mimicking a uterine polyp was identified during her further evaluation. On ultrasonography of the abdomen and pelvis, a left-sided hydronephrisis (grade 1), proximal ureteral dilatation, and a ureterocele related to the distal portion of the left ureter that protruded into the urethra were detected. Under anesthesia examination, the ureterocele was removed.

The effect of distance learning via SMS on academic achievement and satisfaction of medical students.

INTRODUCTION: Recently, medical education has made significant progress, and medical teachers are trying to find methods that have most impressive effects on learning. One of the useful learning methods is student active participation. One of the helpful teaching aids in this method is mobile technology. The present study aimed to determine the effect of sending educational questions through short message service (SMS) on academic achievement and satisfaction of medical students and compare that with lecture teaching. SUBJECTS AND METHODS: In an semi-experimental, two chapters of urology reference book, Smiths General Urology 17th edition, were taught to 47 medical students of Isfahan University of Medical Sciences in urology course in 2013 academic year. Kidney tumors chapter was educated by sending questions through SMS, and bladder tumors part was taught in a lecture session. For each method, pretest and posttest were held, each consisting of thirty multiple choice questions. To examine the knowledge retention, a test session was held on the same terms for each chapter, 1 month later. At the end, survey forms were distributed to assess student's satisfaction with SMS learning method. Data were analyzed through using SPSS 20. RESULTS: The findings demonstrated a statistically significant difference between the two learning methods in the medication test scores. Evaluation of the satisfaction showed 78.72% of participants were not satisfied. CONCLUSIONS: The results of the study showed that distance learning through SMS in medical students could lead to increase knowledge, however, it was not effective on their satisfaction.

Is it Necessary to Perform Nephrostography before Tube Removal after Percutaneous Nephrolithotomy.

BACKGROUND: The aim of this study is the caparison of the complications rate among the patients which underwent nephrostomy removal with and without performing nephrostography. MATERIALS AND METHODS: Between October 2010 and November 2011, 200 patients who underwent standard percutaneous nephrolithotomy (PCNL) procedures were included in this study. The patients were randomly assigned into two groups, Group A (n = 100) did not undergo the antegrade nephrostography on postoperative day 2 and the patients were discharged keeping the nephrostomy until postoperative day 3, while in Group B (n = 100) the nephrostomy tube was removed on postoperative day 3 after antegrade nephrostography demonstrating ureteral drainage down to the bladder. Postoperative complications in both groups were recorded and compared between two groups. RESULTS: A total of 200 patients were treated with standard PCNL. The persistent leakage of urine after removal of the nephrostomy tube was encountered in 5 (5.0%) and 3 (3%) of patients in Groups 1 and 2, respectively. Urinary leakage was resolved with conservative management in 3 and 2 patients of Groups 1 and 2, respectively, but a double-J stent was inserted in 2 and 1 patients in each group because of persistent leakage of urine more than 1-week. The two groups show comparable complications such as prolonged urinary leakage which managed in a similar manner, however, postoperative hospital stay was lesser in Group 1. CONCLUSION: Our results revealed postoperative performing nephrostogramy before tube removal changed the planning of complications such as prolonged urinary leakage and could be omitted in cases.

Percutaneous nephrolithotomy: Effect of unilateral procedure on contralateral kidney function.

BACKGROUND: Although long-term effects of percutaneous nephrolithotomy (PCNL) on renal function and structure have been evaluated, knowledge regarding the immediate effects of surgery on renal function is limited. We conducted this study to evaluate the impact of unilateral PCNL on bilateral renal function during immediate post-operative period. MATERIALS AND METHODS: From April to September 2012, 40 eligible patients were enrolled in this study and underwent unilateral PCNL. During the post-operative period, creatinine clearances (CrCl) of treated and untreated sides were estimated separately and pattern of changes in bilateral renal function following this procedure was evaluated. RESULTS: Following the operation, CrCl of both kidneys showed a similar pattern of changes, of course more dramatic on treated side. We observed progressive decline in CrCl of both sides followed by bilateral improvement in renal function toward pre-operative values. CONCLUSIONS: During the early post-operative period following unilateral PCNL, both kidneys experienced a temporary drop in function warranting more intensive post-operative care.

Percutaneous nephrolithotomy success rate and complications in patients with previous open stone surgery.

PURPOSE: To determine the effect of previous single or multiple open stone surgeries on percutaneous nephrolithotomy (PCNL) results and complications. MATERIALS AND METHODS: We reviewed medical records of 1422 patients who had been undergone PCNL in our institute between 1998 and 2011 by the same surgeon. Patients were divided into 3 groups. The first group included patients with no history of previous ipsilateral open stone surgery (n = 711). Patients in second group had been undergone only one open stone surgery before PCNL (n = 405) and patients with more than one previous open stone surgery were placed in third group (n = 306). We compared operation duration, stone free rate (SFR), number of attempts to access the collecting system and intraoperative and postoperative complications between 3 groups. RESULTS: There were no differences in sex, body mass index, stone burden and laterality between 3 groups. Operation time was significantly shorter in the first group (P = .000) while there was no statistically significant differences in operation duration between second and third groups (P > .973). The number of attempts to enter the collecting system was significantly lower in the first group in comparison to other two groups (P = .00). We didn’t find significant differences between 3 groups in hospital stay, SFR, intraoperative and postoperative complications. CONCLUSION: Our findings demonstrated that PCNL can be performed in patients with one or more open stone surgery history successfully without further complications.

A comparison of bladder neck preservation and bladder neck reconstruction for urinary incontinence after radical retro pubic prostatectomy.

BACKGROUND: Prostate cancer is the sixth most common cancer worldwide and will include about 30% of all malignancies in men. Since the initial report of the anatomic radical prostatectomy, refinements in the surgical technique have been made. Several studies show that bladder neck preservation (BNP) during radical prostatectomy makes improve early return of urinary continence, erectile function or both. However, some clinical trials have suggested little difference between the return of continence while using modifications. In this study, we compared outcomes of BNP and bladder neck reconstruction (BNR) during radical retropubic prostatectomy (RRP). MATERIALS AND METHODS: This prospective study was performed on 60 patients at a referral university hospital from March 2010 to March 2012. Study population was all patients candidate for RRP (RRP in this period. All patients divided into two groups, A and B (30 patients in each group). Group A (n = 30) who preserved bladder neck (BNP) and Group B (n = 30) who had BNR. Prostate specific antigen (PSA) before and at 2, 6, 9, 12 and18 months after surgery, anastomotic stricture symptoms, positive bladder neck margin, Gleason score and urine incontinence were compared between two groups. Also, we compared bladder neck contracture, urinary continence and positive surgical margin rates after BNP and BNR while retropubic prostatectomy in 24 months period follow-up. RESULTS: The mean age of the patients was 61.81 ± 7.15 years (range, 50-74 years). After a follow-up period of 24 months, the PSA rising was not different between the two groups. After 2 months, 19 (63.33%) of patients in A group and the same number in B group were continent (P = 0.78). Stricture of the bladder neck at the anastomosis site requiring transurethral dilation occurred in 7 (23.33%) and 3 (10.0%) patients in groups A and B, respectively (P = 0.04). CONCLUSION: Although there was no difference in prevalence and duration of return of urinary continence after the operation between two groups, but results of our study showed that stenosis of the bladder neck was lower in BNP. Hence in the group of BNP, need for further operation and overflow incontinency due to the obstruction of urinary tract will be less likely than BNR and patients have better long time (24 months) urinary continence.

Neurologic complications in percutaneous nephrolithotomy.

PURPOSE: Percutaneous nephrolithotomy (PCNL) has been the preferred procedure for the removal of large renal stones in Iran since 1990. Recently, we encountered a series of devastating neurologic complications during PCNL, including paraplegia and hemiplegia. There are several reports of neurologic complications following PCNL owing to paradoxical air emboli, but there are no reports of paraplegia following PCNL. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who had undergone PCNL in 13 different endourologic centers and retrieved data related to neurologic complications after PCNL, including coma, paraplegia, hemiplegia, and quadriplegia. RESULTS: The total number of PCNL procedures in these 13 centers was 30,666. Among these procedures, 11 cases were complicated by neurologic events, and four of these cases experienced paraplegia. All events happened with the patient in the prone position with the use of general anesthesia and in the presence of air injection. There were no reports of neurologic complications in PCNL procedures performed with the patient under general anesthesia and in the prone position and with contrast injection. CONCLUSIONS: It can be assumed that using room air to opacify the collecting system played a major role in the occurrence of these complications. Likewise, the prone position and general anesthesia may predispose to these events in the presence of air injection.

Impacts of percutaneous nephrolithotomy on the estimated glomerular filtration rate during the first few days after surgery.

Long-term effects of percutaneous nephrolithotomy (PCNL) on renal function have been evaluated in many studies but there are little data on the renal effects of PCNL immediately after surgery in human patients. The aim of this study was to evaluate estimated glomerular filtration rate (GFR) during the first few days after PCNL. From July to September 2008, we gathered preoperative and postoperative serum creatinine data of all the patients who underwent PCNL at our center. Children and patients who received transfusion during surgery were excluded. Creatinine clearance was estimated by Cockcroft-Gault equation and was used to estimate GFR. 94 patients met the inclusion criteria. The mean ± SD of creatinine clearance by Cockcroft-Gault equation was 87.5 ± 32.2 cc/min before operation. It decreased to 85.5 ± 29.4 cc/min, 77.0 ± 26.8 cc/min and 75.9 ± 25.0 cc/min at 6, 24 and 48 h after operation and then increased slightly to 81.9 ± 26.4 cc/min 72 h after operation. Renal GFR decreases immediately after PCNL reaches a nadir 48 h after operation, and then, increases slowly. It seems advisable to avoid factors that can bear a negative influence on renal function during the early postoperative period such as nephrotoxic drugs, contrast agents, shock wave lithotripsy and Re-PCNL.

Evaluation of the learning curve for percutaneous nephrolithotomy.

PURPOSE: To determine the number of percutaneous nephrolithotomy (PCNL) operations which are required to achieve competence or excellence. MATERIALS AND METHODS: One hundred and five consecutive PCNL operations performed by a fellow in endourology, with no previous experience in performing solo PCNL, were studied. Operation duration, stone extraction percent, stone-free rate, number of access, tubeless cases, and complications were studied in sequential groups of 15 patients as the surgeon gained experience. RESULTS: Operation duration decreased from the mean of 95.4 minutes in the first to 15th patients to 78.3 minutes in the 31st to 45th patients, and then remained unchanged. Minor complications were only observed in the first to 45th patients. Stone extraction percent increased from the mean of 88.3% in the first to 15th patients to 99.3% in 91st to 105th patients. Percentage of patients with no residual fragments decreased from 53% in the first to 15th patients to 6.7% in the 91st to 105th patients. No statistically significant differences were observed in estimated blood loss or transfusion rate between sequential groups of subjects. CONCLUSION: An improvement in operation duration was observed, and absence of complications was achieved after 45 cases. The improvement in stone clearance was observed up to the last subjects. Competence and excellence were achieved after 45 and 105 operations, respectively.

An assessment of serum sodium within 48 h after percutaneous nephrolithotomy with half-strength saline solution.

The aim of this study was to evaluate the postoperative serum sodium changes after percutaneous nephrolithotomy (PCNL) with half-strength saline irrigation. PCNL operations from June to August 2008 were included. PCNL was performed according to the standard prone position with fluoroscopic guidance. Patients received 0.3% saline-3.3% dextrose by intravenous infusion in the first 24 h after operation. Serum sodium was measured before the operation and at 6, 24 and 48 h after the operation. 96 patients were included. Serum sodium slightly decreased from preoperative 140.3 ± 2.8 mEq/l to 140.1 ± 3.6, 139.1 ± 3.4 (p < 0.01) and 139.3 ± 2.7 (p < 0.05) at 6, 24 and 48 h after the operation, respectively. Half-strength saline irrigation does not result in considerable change in the postoperative serum sodium in simple PCNL operations. The use of intravenous solutions with hypotonic sodium is discouraged in PCNL patients with the possibility of high volume absorption of hypotonic irrigation fluid.

Laparoscopic bilateral retroperitoneal lymph node dissection in stage II testis cancer.

PURPOSE: We report our experience with laparoscopic bilateral retroperitoneal lymph node dissection (RPLND) in 4 patients with stage II testis cancer. MATERIALS AND METHODS: Between January 2002 and January 2009, 4 patients with stage II testis cancer underwent laparoscopic bilateral RPLND. In 2 patients, laparoscopic bilateral RPLND was performed for residual mass post-chemotherapy. We performed classic bilateral RPLND without patient repositioning. RESULTS: The procedure was done uneventfully without any major perioperative complication. The demanding part was contralateral, depending side dissection, which was accomplished with the help of a bowel retractor. Patient repositioning was not necessary. CONCLUSION: Laparoscopic bilateral RPLND can be performed efficiently and safely in stage II testis cancer, without need to repositioning and placement of trocar in contralateral side.

Ureteroscopic management of symptomatic, simple parapelvic renal cyst.

PURPOSE: Laparoscopic treatment of parapelvic renal cysts, as a gold standard, is quick and effective. Ureteroscopic unroofing, however, could be used as an alternative technique in selected patients. PATIENTS AND METHODS: Two men (aged 56 and 53 years) presented with parapelvic cyst. In the first patient, intravenous urography and CT scan revealed multiple renal cysts with a 6 x 5 cm parapelvic cyst, and the other patient showed a 6.5 x 7.5 cm parapelvic cyst, both with hydronephrosis. There were no solid tissues in the cysts. Semirigid ureteroscopy was performed and the parapelvic cyst was unroofed and marsupialized to the adjacent collecting system. Retrograde pyelography was performed within 5 hours of the procedure, and the ureteral catheter was removed. We evaluated our patients at 2 weeks and 3 months postoperatively. RESULTS: We had no intraoperative or postoperative complications. Operative times were 35 and 30 minutes in patients 1 and 2, respectively. Retrograde pyelography showed contrast media filling the parapelvic cyst and the collecting system without extravasation. The first patient's flank pain was partly relieved. In the other patient, hypertension decreased noticeably (preoperational: 160/95 mm Hg, and postoperational 3 months: 135/85 mm Hg) and right flank pain totally disappeared. Intravenous pyelography and CT images showed objective improvement in hydronephrotic changes, with no evidence of symptomatic and radiographic recurrences. CONCLUSIONS: Ureteroscopic treatment is feasible and safe in selected patients with simple parapelvic renal cysts; however, further studies with longer follow-up periods are essential to document its durability.

Prognostic value of insulin- like growth factor-I receptor expression in renal cell carcinoma.

The insulin-like growth factor-I receptor (IGF-IR), a tyrosine kinase receptor over expressed in many tumor cell lines and in some human tumors, plays a critical role in transformation, tumorigenicity and metastasis. The aim of the present study is to investigate the role of IGF-IR expression as a prognostic factor in RCC. This study was conducted in a historical cohort of 82 patients who had RCC treated with radical nephrectomy from 1994 to 2005. Specimens were reevaluated with regard to histological subtype, nuclear grade, stage and IGF-IR expression. The IGF-IR stain was semi-quantitatively evaluated using the Allred score system. Kaplan-Meier analysis demonstrated a significant positive correlation between Fuhrman nuclear grade and IGF-IR Allred score (P< 0.0001). Survival in patients with score IGF-I < or = 4 was 90.21 month and in patients with score IGF-1R> 4 was 33.39 month (P Value < 0.0001). Cox regression analysis indicated that expression of IGF-IR is a prognostic factor in patients with RCC (P Value < 0.0001, odds Ratio = 2.38). In conclusion, a statistically significant correlation was demonstrated between IGF-IR expression and Fuhrman nuclear grading and survival in patients with RCC. In stage-by-stage and grade-by-grade analysis; however, it seems that we cannot consider IGF-IR as an independent prognostic factor.