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.

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.

Effect of intravenous acetaminophen versus fentanyl on postoperative pain after transurethral lithotripsy / Efeito do acetaminofeno versus fentanil intravenosos na dor pós litotripsia transuretral

Abstract Background: Postoperative pain is the most common postoperative complication. This study was conducted to assess the effect of acetaminophen versus fentanyl on postoperative pain relief in patients who underwent urologic surgeries. Methods: This clinical trial was conducted on patients aged 18-65 years. Patients were randomly assigned to receive either 2000 mg acetaminophen (propacetamol) or 2 mcg.kg-1 fentanyl intravenously, 15 min before the end of surgery. The postoperative pain was evaluated every 6 h for 24 h using the Visual Analog Scale. Total morphine dose taken in 24 h and hemodynamic status were evaluated. Results: Eighty patients were enrolled into the trial. The mean score of pain in 6, 12, 18, and 24 h after surgery was lower in the acetaminophen group than in the fentanyl group but the difference was not statistically significant except in 12 and 18 h after surgery (p < 0.05). The amount of administered morphine was higher in the fentanyl group than in the acetaminophen group, but the difference was not statistically significant. The hemodynamic status including systolic and diastolic blood pressure and heart rates were nearly the same in the two groups but the SpO2 mean was significantly higher in the acetaminophen group than the fentanyl group. Conclusions: This trial indicated that intravenous acetaminophen is as effective as intravenous fentanyl in pain relief after urologic surgeries (transurethral lithotripsy).

Resumo Justificativa: A dor pós-operatória é a complicação mais comum no período pós-operatório. Este estudo foi realizado para avaliar o efeito de acetaminofeno versus fentanil no alívio da dor pós-operatória em pacientes submetidos a cirurgias urológicas. Métodos: Este ensaio clínico foi realizado com pacientes cujas idades variou entre 18 e 65 anos. Os pacientes foram randomicamente designados para receber 2.000 mg de acetaminofeno (propacetamol) ou 2 mcg.kg-1 de fentanil por via intravenosa 15 min antes do final da cirurgia. A dor pós-operatória foi avaliada a cada 6 horas por 24 horas, utilizando a escala visual analógica. A dose total de morfina administrada em 24 horas e o estado hemodinâmico foram avaliados. Resultados: Oitenta pacientes foram incluídos no estudo. O escore médio de dor em 6, 12, 18 e 24 horas após a cirurgia foi menor no grupo acetaminofeno que no grupo fentanil, mas a diferença não foi estatisticamente significativa, exceto em 12 e 18 horas após a cirurgia (p < 0,05). A quantidade de morfina administrada foi maior no grupo fentanil que no grupo acetaminofeno, mas a diferença não foi estatisticamente significativa. O estado hemodinâmico, incluindo pressão arterial sistólica e diastólica e frequência cardíaca, foi quase o mesmo nos dois grupos, mas a média de SpO2 foi significativamente maior no grupo acetaminofeno que no grupo fentanil. Conclusões: Este estudo indicou que acetaminofeno intravenoso é tão eficaz quanto fentanil intravenoso no alívio da dor após cirurgias urológicas (litotripsia transuretral).

[Effect of intravenous acetaminophen versus fentanyl on postoperative pain after transurethral lithotripsy]. / Efeito do acetaminofeno versus fentanil intravenosos na dor pós litotripsia transuretral.

BACKGROUND: Postoperative pain is the most common postoperative complication. This study was conducted to assess the effect of acetaminophen versus fentanyl on postoperative pain relief in patients who underwent urologic surgeries. METHODS: This clinical trial was conducted on patients aged 18-65 years. Patients were randomly assigned to receive either 2000mg acetaminophen (propacetamol) or 2mcg.kg-1 fentanyl intravenously, 15min before the end of surgery. The postoperative pain was evaluated every 6h for 24h using the Visual Analog Scale. Total morphine dose taken in 24h and hemodynamic status were evaluated. RESULTS: Eighty patients were enrolled into the trial. The mean score of pain in 6, 12, 18, and 24h after surgery was lower in the acetaminophen group than in the fentanyl group but the difference was not statistically significant except in 12 and 18h after surgery (p<0.05). The amount of administered morphine was higher in the fentanyl group than in the acetaminophen group, but the difference was not statistically significant. The hemodynamic status including systolic and diastolic blood pressure and heart rates were nearly the same in the two groups but the SpO2 mean was significantly higher in the acetaminophen group than the fentanyl group. CONCLUSIONS: This trial indicated that intravenous acetaminophen is as effective as intravenous fentanyl in pain relief after urologic surgeries (transurethral lithotripsy).

Chronic kidney disease: a review of proteomic and metabolomic approaches to membranous glomerulonephritis, focal segmental glomerulosclerosis, and IgA nephropathy biomarkers.

Chronic Kidney Disease (CKD) is a global health problem annually affecting millions of people around the world. It is a comprehensive syndrome, and various factors may contribute to its occurrence. In this study, it was attempted to provide an accurate definition of chronic kidney disease; followed by focusing and discussing on molecular pathogenesis, novel diagnosis approaches based on biomarkers, recent effective antigens and new therapeutic procedures related to high-risk chronic kidney disease such as membranous glomerulonephritis, focal segmental glomerulosclerosis, and IgA nephropathy, which may lead to end-stage renal diseases. Additionally, a considerable number of metabolites and proteins that have previously been discovered and recommended as potential biomarkers of various CKDs using '-omics-' technologies, proteomics, and metabolomics were reviewed.

Safety and Efficacy of Percutaneous Nephrolithotomy in Patients with Severe Skeletal Deformities.

PURPOSE: Treatment of renal calculi in patients with severe skeletal deformities can be challenging. We present our experience in order to provide an assessment of technical difficulties, associated complications, and outcomes of percutaneous nephrolithotomy (PCNL) as a treatment option in this special patient group. MATERIALS AND METHODS: Our study included eight patients treated with PCNL for renal stones. All had severe skeletal deformities including six with severe kyphoscoliosis, one with osteogenesis imperfecta, and another withrickets. After pre-operative evaluation the procedure was performed under fluoroscopic and/or ultrasonic guidance. In all but one case, PCNL was performed with the patient in the prone position. Silicone rolls and soft padded bolsters were used to obtain the best positioning for the procedure. Clearance rates and complications were assessed. RESULTS: Complete stone-free rate was achieved in six patients (75%) after first-PCNL. The two patients with residual stones underwent a second-look PCNL, after which one was completely cleared. The overall completestone-free rate after second PCNL was 87%. Only minor complications were seen in two patients (25%). CONCLUSION: We found PCNL to be safe and effective for managing kidney stones in patients with severe skeletal deformities.

Mesh fixation compared with nonfixation in transabdominal preperitoneal laparoscopic inguinal hernia repair.

This study was conducted to compare laparoscopic inguinal hernia repair with or without mesh fixation regarding recurrence rate and duration of operation time. A sample of 73 patients who underwent laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair from January 2002 to January 2010 were derived from the medical records of university hospitals including Ekbatan, Beasat, and Shaheed Beheshti, as well as private hospitals. MERSILENE™ Mesh (Johnson & Johnson Medical GmbH, Norderstedt, Germany) fixation was performed for 23 cases and polypropylene mesh without fixation for the rest. The recurrence rate was followed in both groups for two years. The patients ages were from 7 to 64 years, 70 patients (95%) were male. Operation time for mesh fixation and nonfixation was 68.09 and 21.10 minutes, respectively (P < 0.001). Two recurrences occurred in the mesh fixation group versus no recurrence in the nonfixation group (P = 0.096). The results of this study revealed that laparoscopic TAPP inguinal hernia repair without mesh fixation is safe and feasible with no increase in recurrence rate. In addition, it offers a significantly shorter operation time than TAPP mesh fixation. However, we need more evidence based on randomized clinical trials to compare the benefits and harm of the two methods.