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Introduction The aim of this article was to compare oncological outcomes after partial nephrectomy between patients with positive (PSM) and negative (NSM) surgical margins. Material and methods In this retrospective study, the data of 733 patients who underwent partial nephrectomy with diagnosis of renal cell carcinoma (RCC) were analyzed. A total of 80 patients from the NSM group were matched to 42 PSM patients. The Kaplan-Meier method was used to estimate freedom from local disease recurrence and metastatic progression and overall survival. Cox proportional hazards models were used to assess the predictors for recurrence/metastasis. Results The mean age was 58.4 ±11.4 years (range: 29 to 82). Median follow-up was 24 months (IQ25-75: 15-36.2). A total of 5 patients from the PSM group (6.2%) developed local recurrence and metastasis was detected in 2 (2.5%) of them while no metastasis or recurrence was observed in the NSM group. In the multivariate analysis, positive surgical margin was the only independent predictor for recurrence/metastasis (HR[CI] = 0.19[0.04-0.75], p = 0.019). Recurrence-free survival was higher in the NSM group (100% for the NSM group vs 88.1%, p = 0.002) and recurrence/metastasis-free survival was also higher in the NSM group (100% for the NSM group vs 85.7%, p = 0.001), but there were no differences in overall survival between the two groups (96.3% for the NSM group vs 97.6% for the PSM group, p = 0.68). Conclusions Although tumor recurrence was more prevalent in positive surgical margin patients who underwent partial nephrectomy, there were no differences in overall survival between the two groups. Therefore, active surveillance against further surgery would be a proper option after finding the tumorinvolved margins. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the safety and efficacy of transperitoneal laparoscopic pyelolithotomy in renal stone cases with previous renal surgeries. Patients and methods: In this prospective study, 190 consecutive patients with renal stones, who were candidates for transperitoneal laparoscopic pyelolithotomy, were enrolled. The patients were divided into two groups. In group A, 163 patients without a history of renal surgery underwent standard laparoscopic pyelolithotomy, whereas in group B laparoscopic pyelolithotomy was performed in 27 patients with a history of kidney stone surgery including percutaneous nephrolithotomy or open stone surgery. All intraoperative data including the operating time and complications such as bleeding requiring transfusion were recorded. Postoperative data such as length of hospitalization, hemoglobin level alteration, and other complications were also recorded. Results: There was no significant difference in the preoperative data such as stone size, stone site, age, sex, and stone side between the two groups. There was no significant difference in the stone-free rate between the two groups (p = 0.4). There was no significant difference between the two study groups regarding the operating time, hospital stay, stone-free rate, complications, and transfusion rate. Conclusion: Laparoscopic pyelolithotomy can be used as a safe and feasible treatment modality in the setting of previous renal surgery. The complications and stone-free rate of laparoscopic pyelolithotomy in patients with history of renal surgery are acceptable. [ABSTRACT FROM AUTHOR]

Purpose: The role of laparoscopic pyelolithotomy (LPL) in the management of renal stones is evolving. One of the challenges in LPL for renal stones is patients with intrarenal pelvis. Here we present our experience with laparoscopic pyelolithotomy for the management of renal stones with intrarenal pelvis anatomy.Materials and Methods: Patients candidate for laparoscopic pyelolithotomy from February 2014 to March 2015 were included. Intrarenal pelvis was defined as > 50% of the renal pelvis area contained inside renal parenchyma. Laparoscopic pyelolithotomy was done by transperitoneal approach. Residual stones were checked by computed tomography and/or intravenous pyelography and ultrasonography 6 weeks after the operation.Results: 28 patients were included in this study. The mean±SD of patients' age was 45.8±12.5 years. 19 patients (68%) were male. Stone locations were pelvis, multiple, and staghorn in 22, 3, and 3 patients respectively. The mean±SD of operation duration was 160±48 minutes. Residual stones were observed in 3 patients with multiple (n=2) or staghorn (n=1) stones. Urinary leak was observed in 3 patients and was managed conservatively in 2 patients. In one patient ureteral stent was inserted by cystoscopy. No conversion to open surgery or re-operation occurred.Conclusion: Laparoscopic pyelolithotomy is a feasible operation for patients with renal stones and intrarenal pelvis in centers with adequate experience in laparoscopy. However, the success of LPL decreases in patients with multiple stones and intrarenal pelvis. [ABSTRACT FROM AUTHOR]

Introduction: In this study, we aimed to evaluate the safety and efficacy of the percutaneous nephrolithotomy procedure performed with adult-sized instruments in pediatric cases with staghorn kidney stone. Methods: We retrospectively evaluated the efficacy and safety of 94 percutaneous nephrolithotomy procedures performed during 15 years in a single center for 82 pediatric patients with staghorn calculi using adult-sized instruments (24-Fr nephroscope). Stone free status was defined as complete clearance of the stones or the presence of insignificant residual stones of <3 mm in diameter. Results: The mean age was 108 ± 53 months (range, 14–180 months). There were 39 patients (48%) with complete staghorn stones and 43 cases (52%) with partial staghorn. We fulfilled 91.4% of operations through a single access. The stone free rate was 86.6% after one percutaneous nephrolithotomy session. In total, seven patients referred for shock wave lithotripsy and four cases were scheduled for the second percutaneous nephrolithotomy session. Fever occurred in 18 patients (21%) and bleeding requiring transfusion in four children (5%). Prolonged leakage from nephrostomy site requiring anesthesia for double J stent placement occurred in one patient. No grade IV or V Clavien complication occurred. Conclusion: The success rate and complications of percutaneous nephrolithotomy with adult-size instruments in pediatric patients are acceptable. [ABSTRACT FROM AUTHOR]

Background: The most difficult, time-consuming, and critical steps of laparoscopic pyeloplasty (LPP) are ureteral spatulation, apical ureteral stitch placement, and ureteropelvic anastomosis. To simplify these critical steps, avoid the risk of ureteral shortening, and also minimize ureteral manipulation, we present a modified dismembered technique for suturing with the outcome of patients who underwent LPP using this technique.Materials and Methods: This study included 23 patients who were candidates for transperitoneal dismembered Anderson-Hynes LPP. The ureter was partially cut just below the ureteropelvic junction. The ureter was spatulated at its lateral aspect to cross the obstruction site and reach the normal ureter. The renal pelvis was obliquely cut equal to the size of ureteral spatulation. The ureter and pelvis were still connected partially. At this point, the first stitch was placed between the lower point of the spatulated ureter and the lowest corner of the renal pelvis. Anastomosis was performed by running sutures.Results: No cases of internal organ injury and no cases of open surgery conversion were encountered. The radiologic success rate was 96%. After operation, in 1 patient, obstruction still existed and the patient underwent nephrectomy due to a nonfunctional obstructive kidney.Conclusions: This modification preserves total ureteral length and facilitates spatulation and suturing in transperitoneal laparoscopic dismembered pyeloplasty. The results showed that it is a useful method, especially for less-experienced surgeons. [ABSTRACT FROM AUTHOR]

Laparoscopic pyelolithotomy has recently been introduced for renal stones. However, the use of this technique is limited in patients with history of extensive abdominal surgeries. We present a case of right side staghorn renal stone with history of abdominal open cystectomy who underwent laparoscopic pyelolithotomy with uneventful outcome. [ABSTRACT FROM AUTHOR]

MicroRNAs (miRNAs) participate in diverse biological pathways and may act as oncogenes or tumor suppressors. The single nucleotide polymorphisms (SNPs) in miRNAs potentially can alter miRNA-binding sites on target genes as well as affecting miRNAs expression. The present study aimed to evaluate the impact of miR-608 rs4919510 C>G variant on bladder cancer risk. This case-control study conducted on 233 bladder cancer patients and 252 healthy subjects. Genotyping of miR-608 rs4919510 was done using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Our findings showed that CG as well as CG+GG genotypes significantly increased the risk of bladder cancer (OR = 1.94, 95% CI = 1.28-2.94, p = 0.002, and OR = 1.90, 95% CI = 1.26-2.86, p = 0.002, respectively) compared to CC genotype. The G allele significantly increased the risk of bladder cancer compared to C allele (OR = 1.69, 95% CI = 1.17-2.45, p = 0.005). Our findings proposed that miR-608 polymorphism might be associated with increased risk of bladder cancer in a sample of Iranian population. Further large-scale studies with different ethnicities are needed to verify our findings. [ABSTRACT FROM AUTHOR]

Aim. Sonography has been brought in percutaneous nephrolithotripsy (PCNL) as an adjunct to or substitute for X-ray to restrict radiation exposure. This study was designed to investigate the possible predictors for the success of the solo sonographically guided PCNL. Methods. 148 consecutive cases were prospectively enrolled. All steps of PCNL were performed solely with sonography guidance under spinal anesthesia. Residual stones were evaluated the day after surgery using sonography and plain radiography. Results. The mean age was 46±15 years; 40% of kidneys had hydronephrosis. The mean stone burden was 504±350 mm2. The mean duration of surgery was 43±21 minutes. The early stone-free rate was 92% in inferior or middle calyceal stones, 89.5% in single pelvic stones, 81.5% in partial staghorn stones, and 61.9% in staghorn stones. The mean residual stone size was 13±8 mm. Logistic regression showed that a lower age and a larger stone burden significantly predicted positive residual stones. Fifteen percent of patients presented with grade I or II and six percent showed grade III complication based on Clavien classification. There was no cases of organ injury or death. Conclusion. Solo ultrasonographically guided PCNL under spinal anesthesia is feasible with an acceptable stone-free rate and complication rate. [ABSTRACT FROM AUTHOR]

Introduction: Previous radiological studies revealed that stones lodge more frequently in the ureterovesical junction (UVJ) as well as the proximal ureter. Factors that prevent stone passage from the proximal ureter are not well studied. Aim: To explore the site of the lodged stones in the proximal ureter with direct observation during laparoscopic ureterolithotomy. Materials and methods: Between November 2014 and February 2015, we included 26 patients including 18 men and 8 women with stones larger than 10 millimeters in the proximal ureter who were candidate for laparoscopic ureterolithotomy. We prospectively recorded the site of the lodged stones in the ureter during laparoscopic ureterolithotomy in relation with the sites of ureteral stenosis as well as the gonadal vessels. Results: Among 26 patients with ureteral stone, in 19 cases stone was found close to the gonadal vein compared with seven cases that stone was in other locations of the ureter (p = 0.02). The characteristics of patients and stones were not different in cases that the stone was close to gonadal vessels compared with other locations. Conclusions: This study showed that most of the stones lodged in the proximal ureter were in close proximity with gonadal vessels. Gonadal vessels may be an extrinsic cause of ureteral narrowing. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate meperidine-sparing effect of intravenous (IV) paracetamol in patients undergoing percutaneous nephrolithotomy (PCNL). Patients and Methods: One hundred patients who underwent PCNL were randomized to paracetamol ( n=50) and placebo ( n=50) groups. Patients received 100 mL of physiologic saline with or without 1 g IV paracetamol every 8 hours after PCNL up to 24 hours in the paracetamol and placebo groups, respectively. Patients in both groups received intramuscular meperidine in case of unrelieved pain. The visual analog scale (VAS) was used to evaluate pain intensity scores in the postoperative period. Total meperidine consumption, mean VAS score in the first 6 and 24 hours, demographic variables, operative variables, and side effects were recorded. Results: The mean VAS pain intensity scores at 6 and 24 hours were 50.22 and 41.32 mm in the paracetamol and 75.29 or 65.5 mm in the placebo group ( P<0.001). The mean consumed meperidine dose was 54.40 mg and 77.60 mg in the paracetamol and placebo groups, respectively ( P<0.001). Conclusion: In this study, IV paracetamol significantly reduced total meperidine consumption and pain intensity scores compared with placebo. IV paracetamol can be an effective and safe part of multimodal analgesia regimes for postoperative pain management after PCNL. [ABSTRACT FROM AUTHOR]

Background: Management of staghorn renal stones is still challenging. We present our experience with laparoscopic anatrophic nephrolithotomy as an alternative option for management of staghorn renal calculi. Patients and Methods: Twenty-four patients with staghorn renal calculi underwent 25 laparoscopic anatrophic nephrolithtomy procedures. Characteristics of patients and stones along with perioperative features such as operation time, transfusion, ischemic time, hospitalization, stone-free rate, and biochemical data were recorded prospectively. We applied the one-layer knotless technique for renorrhaphy repair. Results: The mean age of the patients was 55.1±10.9 years (range, 28-74 years). Eleven (44%) operations were done on the right side, and 14 (56%) were done on the left side. Complete and partial staghorn stones existed in 17 (68%) and 8 (32%) renal units, respectively. The mean stone size was 61.5±11.5 mm. Ischemic time was 30.4±7.55 minutes. The stone-free rate was 88% on discharge and 92% after one session of extracorporeal shockwave lithotripsy. Conclusions: Although percutaneous nephrolithotomy is the standard of care for treatment of staghorn stone, laparoscopic anatrophic nephrolithotomy seems to be a safe and feasible option in select patients. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous nephrolithotomy (PCNL) is the recommended first-line treatment for staghorn stones. To achieve complete stone clearance, PCNL may require using multiple tracts. Objective: To evaluate outcome of PCNL in patients with staghorn calculi and its correlation with the number of tracts and stone features. Materials and Methods: One hundred consecutive patients with staghorn renal stone who underwent PCNL were included in the study. Perioperative and postoperative features were recorded. Correlation of the variables with number of tracts and stone size was assessed. Results: Mean age (±SD) was 49.6 ± 14.7 years. Our patients were ASA class I. The mean cumulative stone burden was 365.9 ± 156.5 mm2. The mean number of tracts was 2.4 (range: 1-7), and stone-free rate was 83%. The stone-free rate (p = 0.026) and hospital stay (p = 0.005) correlated with stone size, but not with number of tracts. Postoperative fever correlated with stone size (p = 0.017) and number of tracts (p = 0.037). Conclusion: PCNL using multiple tracts seem to be effective and safe in treatment of staghorn calculi. Most outcome measures correlated with stone size rather than number of tracts. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article presents a case study of a 37-year-old man presented with a hard large mass in the right testis. The patient's pathologic examination result reveals that he has teratoma along with choriocarcinoma and was followed up with laboratory tests and computed tomography (CT). It notes that the patient has underwent retroperitoneal lymph node dissection and was administered with postoperative chemotherapy using four courses of of bleomycin, etoposide, and cisplatin regimen.

The article presents a case study of a 53-year-old man who presented with a history of pain and a palpable mass in the left side of the abdomen. Computed tomography and magnetic resonance imaging (MRI) was performed on the patient, which revealed a complex cyst in the left side of the abdominal cavity. It notes that the patient suffered from cystic pheochromocytoma, and that the cyst was surgically removed through a thoracoabdominal incision.

Sleep disturbances have been shown to be associated with diabetes control, but the relation between planned wakings or napping with glycemic indices has not been evaluated yet. This study evaluated the relation between sleep quality, duration, and pattern, including daytime napping of people with diabetes and their glycemic control. Across-sectional correlation research design was used for this study. We enrolled 118 people with type 2 diabetes receiving oral agents without major complications at the Shahid Bahonar Center, Kerman. The age, weight, height, serum HbA1c, as well as other glycemic indices and lipid profile were measured. BMI was also calculated. All participants were requested to fill in the Pittsburgh Sleep Quality Index (PSQI) questionnaire to evaluate their sleep quality. In addition, they were inquired about their sleep schedule during day and night. Pearson correlation and multiple regression analyses were conducted to examine the correlation between HbA1c and sleep pattern variables. The variables were also compared between participants with or without napping using t-test. All analyses were performed with the SPSS version 19 (SPSS, Chicago, IL, USA). The mean age was 58±11 years and mean HbA1c (%) was 7.8±11 (62±13 mmol/mol). Sleep duration and the number of sleep segments significantly predicted HbA1c (F (2,114)=5.232, P=0.007, R2=0.084). A one-hour increment in sleep duration was associated with a 0.174% (1.4 mmol/mol) decrement in HbA1c. PSQI score did not contribute to the regression model. Moreover, participants who napped (66%) had a lower HbA1c (7.6±1) compared to others (8.1±1.3) (P=0.04). We concluded that napping and segmented sleep are associated with a better glycemic control in type 2 diabetes and there is a linear correlation between sleep duration and better glycemic control. [ABSTRACT FROM AUTHOR]

Purpose: To compare the outcome of percutaneous nephrolithotomy (PCNL) using split or intact Amplatz sheath. Materials and Methods: Seventy two patients who underwent PCNL were randomly divided into two groups; PCNL using intact (group 1) and split (group 2) Amplatz sheath. Preoperative data, operative time, largest extracted stone size, fluoroscopy and lithotripsy time, and serum biochemistry tests before and after PCNL were evaluated. Results: Preoperative features and stone size were not significantly different between the groups. There were no significant differences in complications and postoperative changes in hemoglobin and serum electrolytes. Stone free rate in group 2 (88.1%) was insignificantly higher than group 1 (83.3%) (p = .05), but in staghorn stones and stones larger than 1000 mm2, stone free rate in group 2 was significantly higher than group 1 (82% vs. 72%). The mean extracted stone size in group 2 (150 ± 49mm2) was significantly larger than group 1 (40 ± 16 mm2) (p < .005). The mean operative, lithotripsy and fluoroscopy times were significantly longer in group 1. Conclusion: Using split Amplatz sheath in PCNL facilitates extraction of larger stone fragments which could contribute to shorter fluoroscopy, lithotripsy and operative times. [ABSTRACT FROM AUTHOR]

Purpose: Data registries are organized systems that facilitate collection, storage, and analysis of data related to a specific disease in a defined population. Here we introduce a data registry system which was designed to cover the four most common urologic cancers (prostate, bladder, renal and testis).Materials and Methods: All contributing centers can enter data into the system after logging in with their unique usernames and passwords. In this system, the information of each individual patient will be entered in several structured forms covering various steps of management of the patients.Results: Our proposed registry is an interactive, web-based database designed to collect complete data of patients with common urological cancers. We devised a council that functions as the central committee that will initiate, supervise, and monitor all steps of the projects including data collection, data audit, as well as data analysis and publication. To facilitate manuscript publication, the system will provide assistance and support throughout all the steps of statistical analysis and manuscript preparation.Conclusion: This proposed registry can have a national target and is designed to provide evidence-based information that could support strategic planning and national multi-centric studies. [ABSTRACT FROM AUTHOR]

Purpose: Our goal was to present our experience with ultrasound guided supine or prone percutaneous nephrolithotomy in three pregnant women under spinal anesthesia.Materials and Methods: Three pregnant women in the 16th, 20th and 28th weeks of pregnancy presented with symptomatic large renal stone in the first patient and multiple renal stones in the second and third patients which were unresponsive to conventional medical therapy. They requested a definitive stone treatment. The operations were done in November 2012, June 2014 and February 2015. Data was gathered prospectively. All steps of gaining access to the pyelocalyceal system including needle insertion, tract dilation, and Amplatz sheath placement were performed under ultrasonography guidance. Tract was dilated with a single shot technique. The first two procedures were performed in supine position and the third procedure was performed in lateral flank position.Results: Two patients were stone-free postoperatively and one patient had only an asymptomatic 4 mm residual stone. They were discharged on the 2nd postoperative day and had an uneventful postoperative course. No fever, bleeding or renal colic was noticed during postoperative hospitalization. All patients delivered their fetuses at term without any abnormality reported by the examining pediatric specialist after their birth.Conclusion: Ultrasonography can be used as an imaging modality guiding all steps of obtaining percutaneous access in pregnant women. Supine or flank ultrasound guided percutaneous nephrolithotomy can be offered to pregnant women in whom conservative measures fail to the patients' wellbeing. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of autologous single-donor fibrin glue after tubeless percutaneous nephrolithotomy (PCNL).Materials and Methods: Forty-three patients were planned for tubeless PCNL in a prospective cohort study and randomized in two groups with or without using fibrin glue. Randomization method was based on the computer-generated random numbers.Results: Transfusion, urinary leakage, or major complications were found in neither of the groups. There was no difference between two groups in stone free rate (P = .53), and changes in hemoglobin (P = .61) and serum creatinine (P = .63) level.Conclusion: Although autologous fibrin glue did not play any significant role in improving results or decreasing complications after tubeless PCNL in our study, its use was safe and did not increase complications. [ABSTRACT FROM AUTHOR]

PURPOSE: To compare two matched groups of men with bladder transitional cell carcinoma (TCC) who underwent prostate-sparing cystectomy (PSC) or conventional radical cystoprostatectomy (CRC). MATERIALS AND METHODS: Twenty-three men who have undergone PSC with the diagnosis of bladder TCC (Ta-T2) from 2003 to 2008 in Tehran, Iran were included in the study as the experimental group. The control group composed of 27 men with comparable tumor characteristics and age range, who had non-nerve-sparing radical cystoprostatectomy and orthotopic ileal W pouch reconstruction in the same center. All the procedures were performed by the same surgical group under the supervision of different attending staff. RESULTS: Mean follow-up period was 39 months in PSC and 35 months in CRC group. The 5-year overall survival was 47% and 30% in PSC and CRC groups, respectively. Median survival was 48 months in PSC and 36 months in CRC group, using Kaplan-Meier survival analysis (P > .05). Impotence was observed in 16.6% in PSC and in 83.3% in CRC group (P = .002). Mean International Index of Erectile Function-5 score of the PSC group was 19.8 compared with 5.7 in the CRC group (P = .003). Only one patient in each group was completely incontinent. Urethral anastomosis stricture occurred in 2 patients in CRC group. CONCLUSION: Patients who underwent PSC did not show decreased overall survival compared to CRC, which provided better functional results. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the efficacy of laparoscopic nephroureterectomy and open bladder cuff excision for management of upper urinary tract urothelial carcinoma. MATERIALS AND METHODS: Twenty-two patients with upper urinary tract urothelial carcinoma, who had undergone laparoscopic nephroureterectomy and open bladder cuff excision between September 2004 and October 2010, were studied retrospectively. Operation time, blood loss, analgesic dose, and complications were recorded. Local and port site recurrence, distant metastasis, and survival rate were also evaluated. RESULTS: Patients consisted of 18 men and 4 women, with the mean age of 64.1 years (range, 52 to 83 years). Right upper urinary tract was the involved site in 12 patients and left in 10 patients. Mean operation time was 216 minutes (range, 145 to 395 minutes) and mean hospital stay was 4.3 days. Mean follow-up period was 36.57 months (range, 6 to 65 months). No trocar site recurrence occurred. Three-year overall survival and metastasis-free survival were 95% and 90%, respectively. CONCLUSION: Laparoscopic nephroureterectomy along with open bladder cuff excision harbors an advantage of laparoscopy concomitant with simplicity and safety of open excision of distal ureter and bladder cuff through the same inevitable incision that is needed for specimen retrieval, without adding any more morbidity to the patient, a win-win radical surgery. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of laparoscopic nephroureterectomy and open bladder cuff excision for management of upper urinary tract urothelial carcinoma. Materials and Methods: Twenty-two patients with upper urinary tract urothelial carcinoma, who had undergone laparoscopic nephroureterectomy and open bladder cuff excision between September 2004 and October 2010, were studied retrospectively. Operation time, blood loss, analgesic dose, and complications were recorded. Local and port site recurrence, distant metastasis, and survival rate were also evaluated. Results: Patients consisted of 18 men and 4 women, with the mean age of 64.1 years (range, 52 to 83 years). Right upper urinary tract was the involved site in 12 patients and left in 10 patients. Mean operation time was 216 minutes (range, 145 to 395 minutes) and mean hospital stay was 4.3 days. Mean follow-up period was 36.57 months (range, 6 to 65 months). No trocar site recurrence occurred. Three-year overall survival and metastasis-free survival were 95% and 90%, respectively. Conclusion: Laparoscopic nephroureterectomy along with open bladder cuff excision harbors an advantage of laparoscopy concomitant with simplicity and safety of open excision of distal ureter and bladder cuff through the same inevitable incision that is needed for specimen retrieval, without adding any more morbidity to the patient, a win-win radical surgery. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the outcome of laparoscopic retroperitoneal lymph node dissection (LRPLND) using bipolar electrocoagulation instead of clipping the lym-phatic vessels. Materials and Methods: Between August 2002 and April 2008, a total of 13 pa-tients underwent transperitoneal LPRLND for nonseminomatous germ cell tumor of the testis. In this experience, in contrast to other techniques, we did not use clips for ligation of the lymphatic vessels; instead, we used bipolar cautery for coagulation of the lymphatic vessels. We followed up the patients for lymphocele formation or lymphatic leakage using abdominal computed tomography scan. Results: Mean age of the patients was 24.2 years (range, 19 to 39 years). Six tumors were on the left side and 7 on the right. Pathological stage was I in 12 pa-tients and IIA in one. The mean follow-up period was 29.9 months (range, 3 to 70 months). No re-operation was required. There was no prolonged lymphatic leak-age or lymphocele formation during the follow-up period. Conclusion: Our study demonstrates that using bipolar electrocoagulation instead of clips, for sealing of the lymphatic vessels during LRPLND, does not hamper the outcome of the procedure. This should be further evaluated in randomized clinical trials with more subjects. [ABSTRACT FROM AUTHOR]

PURPOSE: To compare the outcome of corporeal plication using absorbable versus nonabsorbable sutures for the treatment of congenital penile curvature. MATERIALS AND METHODS: Thirty-eight men older than 15 years old with congenital penile curvature were enrolled in the study. Patients were randomly divided into two equal groups based on the suture material (Nylon versus Vicryl) used in corporeal plication. Patients were followed up for a mean period of 8.1 ± 1.4 months (range, 6 to 9.1 months). A standardized questionnaire was used to evaluate long-term outcome and patient's satisfaction. RESULTS: Thirty-five patients (17 in Vicryl group and 18 in Nylon group) completed the study. Mean age of the patients and degree of penile curvature were not significantly different between the two groups (P = .74). Postoperatively, 15 (88.2%) and 16 (88.9%) patients in Vicryl and Nylon groups had 75% or greater correction in penile curvature, respectively (P = .61). Patient's satisfaction rate differed between two groups (82% in Vicryl group versus 66% in Nylon group), which did not reach statistical significance (P = .44). Palpable sutures were reported by 7 (39%) patients in Nylon group and only 1 (6%) in Vicryl group (P = .04). Shortening of penile length was reported by 3 (16.7%) patients in Nylon group and 4 (23.5%) in Vicryl group (P = .69). CONCLUSION: Corporeal plication technique using absorbable suture provides reasonable success rate with less frequent palpable suture knots. [ABSTRACT FROM AUTHOR]

Introduction. We searched for a pathophysiologically based feature of major water electrolytes, which may define water quality better than the water hardness, respecting urinary calculus formation. Materials and Methods. Utilizing a multistage stratified sampling, 2310 patients were diagnosed in the imaging centers of the provincial capitals in Iran between 2007 and 2008. These were composed of 1755 patients who were settled residents of 24 provincial capitals. Data on the regional drinking water composition, obtained from an accredited registry, and their relationships with the region's incidence of urinary calculi were evaluated by metaregression models. The stone risk index (defined as the ratio of calcium to magnesium-bicarbonate product in drinking water) was used to assess the risk of calculus formation. Results. No correlation was found between the urinary calculus incidence and the amount of calcium, bicarbonate, or the total hardness of the drinking water. In contrast, water magnesium had a marginally significant nonlinear inverse relationship with the incidence of the disease in the capitals (R² = 26%, P = .05 for a power model). The stone risk index was associated nonlinearly with the calculus incidence (R² = 28.4%, P = .04). Conclusions. Urinary calculus incidence was inversely related with drinking water magnesium content. We introduced a new index constructed on the foundation of a pathophysiologically based formula; the stone risk index had a strong positive association with calculus incidence. This index can have therapeutic and preventive applications, yet to be confirmed by clinical trials. [ABSTRACT FROM AUTHOR]

Introduction: While medical and surgical approaches to urolithiasis are different for single and recurrent stone former (RSF), the RSF definition itself is commonly overlooked. Moreover, despite consensus on association between family history (FH) and urolithiasis, more epidemiologic evidence is required to clarify the nature of this relationship. Our purpose was to propose a more precise definition of RSF, and also to investigate how family history may affect urolithiasis. Materials and Methods: Using a multistage stratified sampling in 4 seasonal phases, 6 127 subjects with imaging-proven urolithiasis were detected in 12 Iranian regions. The FH of urolithiasis and the average interval between episodes (cycles) were determined by an informed interview. Results: Of 6 127 patients with the mean (± SD) age of 41.8 ± 15.1 years, 42% had FH, and 22.2% were RSF of whom 61% were men. The patients with FH had a greater chance of recurrence (OR = 1.2, 95% CI: 1.1 to 1.4). Furthermore, patients with positive FH had more episodes (P = .0001), comparable cycles and younger ages at the onset (P = .02) than those patients without a FH. In the RSF group, the 90th percentiles of the cycle were 60 months and the estimated mean stone cycle for the population was 25.34 months (99% CI: 23.0 to 27.7). Conclusion: Family history seems very common in Iranian population and is a risk factor for recurrence. Moreover, RSF could be identified by the estimated average cycle in the population (25.3 months) or by the percentiles. [ABSTRACT FROM AUTHOR]

Purpose: Data registries are organized systems that facilitate collection, storage, and analysis of data related to a specific disease in a defined population. Here we introduce a data registry system which was designed to cover the four most common urologic cancers (prostate, bladder, renal and testis)., Materials and Methods: All contributing centers can enter data into the system after logging in with their unique usernames and passwords. In this system, the information of each individual patient will be entered in several structured forms covering various steps of management of the patients., Results: Our proposed registry is an interactive, web-based database designed to collect complete data of patients with common urological cancers. We devised a council that functions as the central committee that will initiate, supervise, and monitor all steps of the projects including data collection, data audit, as well as data analysis and publication. To facilitate manuscript publication, the system will provide assistance and support throughout all the steps of statistical analysis and manuscript preparation., Conclusion: This proposed registry can have a national target and is designed to provide evidence-based information that could support strategic planning and national multi-centric studies.

Purpose: The role of laparoscopic pyelolithotomy (LPL) in the management of renal stones is evolving. One of the challenges in LPL for renal stones is patients with intrarenal pelvis. Here we present our experience with laparoscopic pyelolithotomy for the management of renal stones with intrarenal pelvis anatomy., Materials and Methods: Patients candidate for laparoscopic pyelolithotomy from February 2014 to March 2015 were included. Intrarenal pelvis was defined as > 50% of the renal pelvis area contained inside renal parenchyma. Laparoscopic pyelolithotomy was done by transperitoneal approach. Residual stones were checked by computed tomography and/or intravenous pyelography and ultrasonography 6 weeks after the operation., Results: 28 patients were included in this study. The mean±SD of patients' age was 45.8±12.5 years. 19 patients (68%) were male. Stone locations were pelvis, multiple, and staghorn in 22, 3, and 3 patients respectively. The mean±SD of operation duration was 160±48 minutes. Residual stones were observed in 3 patients with multiple (n=2) or staghorn (n=1) stones. Urinary leak was observed in 3 patients and was managed conservatively in 2 patients. In one patient ureteral stent was inserted by cystoscopy. No conversion to open surgery or re-operation occurred., Conclusion: Laparoscopic pyelolithotomy is a feasible operation for patients with renal stones and intrarenal pelvis in centers with adequate experience in laparoscopy. However, the success of LPL decreases in patients with multiple stones and intrarenal pelvis.

Background and Objectives: Major vascular injury is the most devastating complication of laparoscopy, occurring most commonly during the laparoscopic entry phase. Our goal is to report our experience with major vascular injury during laparoscopic entry with closed- and open-access techniques in urologic procedures., Methods: All 5347 patients who underwent laparoscopic urologic procedures from 1996 to 2011 at our hospital were included in the study. Laparoscopic entry was carried out by either the closed Veress needle technique or the modified open Hasson technique. Patients' charts were reviewed retrospectively to investigate for access-related major vascular injuries., Results: The closed technique was used in the first 474 operations and the open technique in the remaining 4873 cases. Three cases of major vascular injury were identified among our patients. They were 3 men scheduled for nephrectomy without any history of surgery. All injuries occurred in the closed-access group during the setup phase with insertion of the first trocar. The injury location was the abdominal aorta in 2 patients and the external iliac vein in 1 patient. Management was performed after conversion to open surgery, control of bleeding, and repair of the injured vessel., Conclusions: Given the high morbidity and mortality rates associated with major vascular injury, its clinically higher incidence in laparoscopic urologic procedures with the closed-access technique leads us to suggest using the open technique for the entry phase of laparoscopy. Using the open-access technique may decrease laparophobia and encourage a higher number of urologists to enter the laparoscopy field.

Purpose: The standard treatment for a duplex kidney with poorly functioning upper pole moiety is ipsilateral upper pole heminephrectomy. This procedure is usually performed by open surgery, but with recent developments in techniques of uro-laparoscopy, it can be done with it, safely. In this study we evaluated the results and safety of laparoscopic heminephrectomy in our consecutive cases., Materials and Methods: From February 2001 to May 2007 fourteen unilateral laparoscopic heminephrectomy were performed in our center. Patients' characteristics, presenting symptoms, operative time, and blood loss, early and late complications were all collected retrospectively. Using pre-operative ultrasonography, intravenous pyelography (IVP) and CT scanning, unilateral upper pole hydronephrosis was detected in all cases. By DMSA isotope scan hypofunctioning of ipsilateral moieties was detected in all cases., Results: Mean operative time was 203±80 minutes. No major intra-operative or early complications were identified. Mean hospital stay was 4.1 days. On mean follow-up of 32 months no disturbing symptoms or episodes of urinary tract infections (UTIs) were detected. Atrophic kidney was detected in one case in post-operative IVP., Conclusion: Laparoscopic heminephrectomy is a valuable minimal invasive procedure that can be performed safely in experienced hands without any important complication. Perfect renal pedicles vascular system manipulation is important for the preservation of renal function post-operatively.

Objectives: The objective of this study was to describe our experience with laparoscopic simultaneous bilateral dismembered pyeloplasty in two pediatric cases by using three midline ports., Methods: A 5-year-old boy and a 5-month-old male infant with bilateral ureteropelvic junction obstruction underwent bilateral laparoscopic transperitoneal dismembered pyeloplasty. A 10-mm trocar was placed through the umbilicus, and two 5-mm trocars were also placed in the midline superior and inferior to the umbilicus. On the left side, dismembered pyeloplasty was performed through a transmesocolic approach. Double-J ureteral stent was inserted through one of the trocars on both sides., Results: The postoperative period was uneventful. Patients were discharged on postoperative days 4 and 5. Oral feeding was tolerated on the first postoperative day. In a 6-month follow-up period, excretory urography and renal scan showed resolution of obstruction., Conclusions: Laparoscopic dismembered pyeloplasty can be performed in a single session for pediatric patients with bilateral ureteropelvic junction obstruction. This can obviate the need for two sessions of anesthesia induction and intubation. However, more studies with large number of patients are needed to confirm this result.

Background and Purpose: Laparoscopic partial nephrectomy is a demanding procedure. To popularize the procedure, simplifying the technique is of great concern for most laparoscopic urologists. Our objective was to evaluate the results of laparoscopic partial nephrectomy (LPN) when eliminating bolster in repair of the tumor bed., Patients and Methods: Thirty-three patients with single sporadic renal masses who underwent LPN are included in this study. After tumor excision, both parenchymal tissue and collecting system (if violated) were closed with a single row of polyglactin 2/0 stitches in running fashion. No bolster was applied in the renal defect, even in broad tumor beds. To avoid time-consuming knot tying, the sutures were buttressed by the use of Hem-o-Lok clips. No ureteral stenting was performed after repair. Data on perioperative and early postoperative outcomes were collected prospectively., Results: Mean tumor size was 4.06 +/- 1.13 cm (range 1.80-6 cm), with 15 tumors larger than 4 cm in greatest diameter. Blood loss was minimal. Mean ischemia time was 25.8 +/- 6.9 minutes (range 14-39 min). Urine leakage occurred in one (3.0%) patient and was managed conservatively. Three (9.0%) patients received blood transfusion. All of the procedures were completed laparoscopically without the need for open conversion or postoperative surgical intervention., Conclusion: LPN could be accomplished safely without the use of bolster. Such an approach could help simplify the procedure and consequently popularize it among urologists.

The Bam Earthquake caused one of the most destructive disasters from naturally occurring hazards in recent years. Children are one of the most vulnerable age groups during disasters, in terms of both physical and psychological injuries. The assessment of pedatric injuries in the aftermath of the Bam Earthquake is discussed is this article. Within one week of the Earthquake, 119 patients < 16 years of age were admitted to three tertiary-level referral hospitals in Tehran, Iran. Extremity, chest, and abdomen, and head and spinal column injuries were present in 83, 17, and 36 patients, respectively. Lower extremity injuries were more common than upper extremity injuries. A total of 65 operations were performed: 52 (80%) orthopedic, eight (12.3%) general, and five (7.7%) neurosurgical.

An earthquake measuring 6.5 on the Richter scale devastated Bam, Iran on the morning of 26 December 2003. Due to the great health demands and collapse of health facilities, international aid could have been a great resource in the area. Despite sufficient amounts and types of resources provided by international teams, the efficacy of international assistance was not supported in Bam, as has been experienced in similar events in other countries. Based on the observations in the region and collecting and analyzing documents about the disaster, this manuscript provides an overview of the medical needs during the disaster and describes the international medical response. The lessons learned include: (1) necessity of developing a national search and rescue strategy; (2) designing an alarm system; (3) establishing an international incident command system; (4) increasing the efficacy of the arrival and implementation of a foreign field hospital; and (5) developing a flowchart for deploying international assistance.