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Background: The prevalence of negative act behaviors among medical residents has not yet been assessed in our country. Present study aimed at evaluating the prevalence and impact of negative act behaviors among residents of four academic hospitals in Iran. Methods: This cross-sectional survey was conducted on medical residents in two educational hospitals affiliated to Iran University of Medical Sciences. An online electronic questionnaire was distributed to all clinical residents in these hospitals via WhatsApp. We used an online electronic four-part questionnaire including demographic data, Negative Act Questionnaire-Revised (NAQ-R), some questions on negative behaviors causes and effects, and General Health Questionnaire 12 (GHQ-12). Results: In total, 254 completed questionnaires were received, with an overall response rate of 71%. Ninety five percent of participants had experienced negative act behaviors once or more during the last six months, whereas 91% of responders had witnessed negative act behaviors during this time. The most common source of these behaviors were senior residents (73.8% of those bullied, n=178). There was a significant positive correlation between the GHQ score and the NAQ-R score assays. Conclusion: This study, as the first study on the prevalence of bullying and negative acts in Iranian medical residents, showed that the medical education atmosphere in residency is not optimal. Therefore, there is a need for certain interventions in the medical education environment. We recommend better education of residents and faculty members, strong policy making, situation assessment and feedback regulations as essential steps towards diminishing bullying and negative behaviors in resident training centers.

The Article Abstract is not available.

Background: The purpose of the current study was to investigate Lower Urinary Tract Symptoms (LUTS) in patients infected by SARS-CoV-2. Methods: In this cross-sectional study, 203 patients diagnosed with COVID-19 based on the positive results of Reverse Transcription Polymerase Chain Reaction (RT-PCR) tests of oropharyngeal and nasopharyngeal swabs were enrolled. None of the patients were on diuretic drugs, anticholinergic agents, and alpha blockers. Patients with a history of LUTS, urethral stenosis, neurogenic bladder, urinary tract infection, and Benign Prostatic Hyperplasia (BPH) were excluded from the study. Questions about basic characteristics and de novo LUTS were asked from each patient and the answers were recorded. Results: De novo lower urinary tract symptoms were identified in 30 (14.7%) patients, 23 males and 7 females indicating a significant difference in terms of sex (p=0.005). The most frequent urinary tract symptom was frequency which was reported in 21 patients. Conclusion: There is no clear explanation on the relationship between LUTS and SARS-CoV-2. However, the potential ability of the virus for causing viral cystitis may be a reasonable hypothesis. Therefore, still further studies are required to determine the role of COVID-19 virus in urinary tract symptoms.

Bullying and harassment, as widespread problems, negatively affect the medical training atmosphere. Accordingly, we read with great interest the paper by Alamri about the bullying of medical students in research projects.1 Herein, we would like to add a comment on this study. ‘Workplace bullying’, defined as a group of persistent, offensive and abusive behaviours which cause a negative effect on recipients, was described in the 1990s.2 Subsequently, many studies were conducted on the workplace bullying definition, prevalence, effects and prevention. Nevertheless, bullying in research is a relatively novel multifaceted topic. There is …

Vaginal metastases from renal cell carcinoma has been recorded as extremely rare. We present a patient with vaginal bleeding as primary manifestation of renal cell carcinoma. A 40-year-old woman presented to a local private clinic with intermittent vaginal bleeding for approximately one month. Gynecological examination revealed a mass on the vaginal wall at approximately 8 o’clock. She underwent dilation and curettage (D&C) and mass excision. Microscopic histopathology and immunohistochemical stains showed vaginal metastases of clear cell RCC. The patient was referred to our urology clinic. Magnetic Resonance Imaging (MRI) of abdomen and pelvic showed a well-defined solid mass lesion measuring 16 × 12 × 11 cm in left kidney. Patient underwent left side radical nephrectomy through a left subcostal intraperitoneal incision. Histopathological results and metastasis workup confirmed the diagnosis of RCC with solitary metastatic vaginal lesion. After radical nephrectomy, she was treated with Sunitinib. No local relapse or distant metastasis was recognized 5 months after radical nephrectomy. In conclusion, the incidence of RCC metastasis to the vagina is extremely rare; but, in cases of vaginal bleeding or lesions we have to keep in mind the possibility of metastatic RCC.

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.

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 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.

Background: Nowadays, diverse approaches have been existed for laparoscopic procedures. The most common laparoscopic entry methods included close and direct entry laparoscopy and open (Hasson) laparoscopy. There is no evidence regarding the superiority in safety and initial speed for the use of open and optical laparoscopic entry. Therefore, the sight of current study was to evaluate comparative survey of two methods of laparoscopic trocar insertion (Hasson and VisiportTM) in terms of speed and complications in urologic surgery. Methods: This expertized base clinical trial study was conducted on 100 patients who underwent urological laparoscopy in Alzahra Hospital, Isfahan, Iran. These patients were randomly divided to two groups (n = 50). One group underwent open laparoscopy and another group Visiport optical trocar. Speed and Complications of urologic surgery was extracted from medical records. Independent T test was used for doing of analysis. Results: The mean age of patients in Hasson and Visiport laparoscopic group was 41.4 ± 11.2 and 41.6 ± 15 years old, respectively (p = 0.91). The mean time for initial trocar placement in patients who underwent Visiport trocar system and Hasson laparoscopic technique was 37.7 ± 15.59 and 95.4 ± 31.75 seconds. There was gratifying difference between two techniques of laparoscopic trocar insertion (Hasson and Visiport) in terms of speed (p = 0.000). In addition, complications were observed in 8% of patients who underwent Visiport trocar system. However, no complications were observed in Hasson laparoscopy group. Conclusion: Visiport optical trocar technique is faster for initial trocar placement than open laparoscopy. However it is associated with complications compared to open laparoscopy. Therefore, there is evidence of benefit in terms of speed for initial trocar placement and harm based on complications in Visiport trocar system.

Introduction: Achieving suitable percutaneous access to the kidney is the most important step in percutaneous nephrolithotomy. The triangulation biplanar access technique under fluoroscopy is the standard method to achieve percutaneous renal access, but it is not successful in all cases. We used the new biplanar oblique access technique as a rescue method for the failed standard biplanar technique. The aim of this study was to evaluate the effects of this oblique access technique on access outcome. Methods: In total, 782 percutaneous nephrolithotomy procedures were performed under the standard triangulation biplanar technique. The biplanar access failed in 35 cases. Access failure was defined as no urine dropping from the needle or inability to insert the guide wire into the renal pelvis or selected calyx. In 28 failed access cases, the lower calyx was the targeted calyx. We used the oblique access technique for these cases. Initially, the arm of fluoroscopy was in the vertical position. Then the fluoroscopy device was rotated to 30° near the surgeon and 30° caudal to the patient and the needle was inserted into the appropriate calyx. Results: Percutaneous nephrolithotomy procedures were performed by the oblique access technique in 28 patients. Successful access was achieved in eight patients by the oblique technique (success access rate = 28.6%). No major or minor complication occurred in these patients. Conclusion: The oblique technique is an auxiliary method for accessing the lower calyx in cases which the standard triangular biplanar method has failed. As the failure rate of the biplanar technique is low, the oblique technique can be considered as a useful method for percutaneous access.

Hepatic fibrosis is a common feature in different types of chronic liver injury. The demonstration of the pro-fibrogenesis role of angiotensin II in chronic liver diseases brought up the idea that anti-angiotensin II agents may be effective on improvement of hepatic fibrosis by either blocking the angiotensin II receptor or inhibition of angiotensin converting enzyme (ACE). This study is aimed at comparing the anti-fibrogenesis effects of two ACE inhibitors, captopril and enalapril, in the livers of rats with bile duct ligation through biochemical and histopathological parameters. Male Albino Wistar rats were divided into four groups (n=4-5 each), including sham operated, bile duct ligated, captopril and enalapril treated. After 28 days of treatment, the liver was removed and the levels of hepatic hydroxyproline, glutathione and lipid peroxidation were determined. The degree of the development of fibrosis was evaluated through histopathological numerical scores. The results demonstrated that angiotensin converting enzyme inhibitors increased GSH, decreased lipid peroxidation and improved hepatic fibrosis as shown by histopathology as well as decreased hepatic content of hydroxyproline. Enalapril was significantly more effective than captopril (p