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Castleman disease is a benign complex lymphoproliferative disease. The most common site is the mediastinum. In this paper, we present a case of Castleman disease in the adrenal gland, as a very rare region. A 29-year-old woman was referred to our clinic due to a well-defined right adrenal mass. She underwent laparoscopic adrenalectomy with the transperitoneal approach. Microscopic histopathology confirmed the hyaline vascular type of Castleman disease. In conclusion, Castleman's disease, as a rare disorder, must be considered in the differential diagnosis of an adrenal mass especially in cases with an enhancing well-defined, nonfunctional solid adrenal mass with lymphadenopathy.

Xanthogranulomatous inflammation, as a type of chronic granulomatous inflammation, typically occurs in the gall bladder and kidneys. In this paper, we present a 56-year-old man with Xanthogranulomatous cystitis mimicking bladder malignancy. He was referred to our clinic with the chief complaint of a one-year history of urgency and frequency. CT scan showed a solid lesion in the bladder. The patient underwent complete transurethral resection of the bladder tumor. Microscopic histopathology revealed xanthogranulomatous cystitis. The patient received a course of antibiotic therapy. Follow-up Cystourethroscopy showed normal bladder.

The overall complication rate of Transurethral resection of prostate (TURP) is about 11.1%. Amongst all complications, ocular complications are one of the rarest. In this paper, we present a case of vision loss due to paradoxical embolism as a rare complication following TURP. Ocular complications are very rare in urological surgeries but can happen due to paradoxical embolism following patent foramen ovale. Therefore, we recommend the early diagnosis and treatment of PFO prior to this type of surgery.

The possibility of bilateral adrenal gland metastasis from renal cell carcinoma (RCC) has been extremely rarely reported. Surgery may be the preferred treatment strategy for adrenal metastasis from RCC. In this article, we present a patient with bilateral large adrenal metastases from the left RCC, which was managed with simultaneous bilateral laparoscopic excision. A 64-year-old woman had undergone left adrenal sparing radical nephrectomy for a left RCC 7 years ago. Her abdominal CT scan revealed bilateral large adrenal metastasis. She underwent bilateral laparoscopic adrenalectomy. The operation was uneventful and the patient was discharged after 4 days with no complications. Bilateral laparoscopic adrenalectomy for adrenal metastasis seems to be a feasible and safe procedure in such cases, but this needs to be confirmed by further studies with a larger sample size.

We read with great interest the paper by York and colleagues [1] entitled "Randomized controlled trial comparing three different modalities of lithotrites for intracorporeal lithotripsy in PCNL". This study showed that the safety and efficacy of Cyberwand, Lithoclast Select, and the StoneBreaker lithotripters are similar and comparable. They stated that "the clearance rate of “hard” stones (defined as brushite, cystine, and uric acid stones) was comparable across the 3 groups). We would like to point out that this statement is one side of the coin. It is possible that the clearance rate of "soft” stones was different. This paper did not perform analysis between "soft" stone compositions. Previous studies with higher sample size showed that stone composition is an important factor that affect stone clearance rate of different types of lithotripters [2]. Furthermore, we want to make a minor criticism of this study: the low sample size of this study may be responsible for this non-significant finding.

Ongoing lifelong learning in health-related professions is recognized as one of the most important essential competencies for optimal clinical practice [1]. Continuing medical education (CME) in lifelong learning for physicians focuses on maintaining or upgrading the knowledge and skills of medical graduates to ensure competent practice [2]. The goal of current CME systems for urologists is to improve knowledge and practical skills via formats such as conferences, formal courses, and workshops [3]. In recent years, technological improvements that have shifted education from classrooms to online platforms have significantly changed medical education [4]. Social media have become a valuable tool for e-learning, particularly when incorporated in medical education and clinical practice [5]. To facilitate lifelong learning for urologists, we established two Telegram ‘‘Urologist’’ groups in September 2014. Telegram is a communication application similar to Viber andWhatsapp that allows users to send texts, images, and videos to a contact list. To achieve the goals mentioned above, we used different medical education strategies, including case-based learning, clinical experience, discussion groups, lectures, evidence-based journal clubs, and problem-based learning. Besides the main priority of continuing education, this approach aims to establish an effective consultation system, especially for young urologists, for discussing complex or unusual cases with expert colleagues. Between November 2014 and November 2015, the Telegram urologist groups involved 256 case-based learning discussions, 20 clinical experiences, 12 lectures, and 24 evidence-based journal clubs. Approximately 1180 cases were discussed in this period of time and membership increased from 35 to 408. Telegram groups are an exceptionally easy tool that urologists can use to connect to invaluable resources for which access might otherwise be limited by geographic distance or time barriers [5]. This e-learning tool may be useful in improving clinical knowledge and narrowing the gap between high-quality evidence and clinical practice in developing countries such as Iran. Despite these opportunities, medical education via social media has certain limitations that must be acknowledged. First, the effect of this educational system on clinical skills is unclear, especially for surgical skills in urology. Second, there are still some concerns regarding medical ethics and patient privacy and confidentiality in such programs.

We present 3 patients with testicular epidermoid cysts who experienced testis-sparing surgery. These patients had a palpable painless testicular mass and underwent inguinal testicular exploration. Intraoperative frozen section revealed no evidence of malignancy and therefore enucleation of the tumour was performed. We demonstrate that careful intraoperative frozen-section examination helps to avoid unnecessary orchidectomy in testicular epidermoid cysts.

Introduction: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large, extracorporeal lithotripsy failure stones and those in the inferior calyx. Despite the development of new techniques and the increasing experience in recent decades, complications may still occur. Colonic perforation is one of the most dangerous and rare complications of PCNL, which may lead to peritonitis and sepsis. We present our 18-year experience on the diagnosis and management of colonic perforation during PCNL.Methods: We retrospectively reviewed the data of 5260 PCNL procedures performed between May 1995 and August 2013. Preoperative and operative factors, such as age, sex, history of previous ipsilateral stone intervention, stone side, stone location, site of skin puncture and punctured calyx, were reviewed in patients with colonic injury.Results: Colonic perforation was found in 11 patients (5 males and 6 females) and the mean age was 40.4 ± 22.2 years (range: 4 to 71). All injuries were retroperitoneal. The left side was affected in 5 patients and the right side was injured in 6 cases. Conservative management was the treatment planned for all patients. It included withdrawal of the nephrostomy tube outside the kidney to the colon as a percutaneous colostomy, insertion of a double-J ureteral stent, intravenous broad-spectrum antibiotics, bowel rest and total parenteral nutrition. Under this conservative management, complete healing of the colon was achieved in all patients.Conclusion: Early diagnosis and conservative management of colonic perforation can minimize patient morbidity and mortality and result in excellent healing of the fistulous tract without any serious complications.

Objective: This study sought to evaluate platelet volume indices (mean platelet volume [MPV], platelet distribution width [PDW], and platelet large cell ratio [P-LCR]) in varicocele patients, and compare it with platelet volume parameters in healthy controls. Methods: This cross-sectional study involved 2 groups: group 1 included 51 varicocele subjects and group 2 consisted of 50 healthy control subjects of similar ages. Peripheral venous blood samples were collected with ethylenediaminetetraacetic acid-K2 anticoagulant between 8:30 AM and 10 AM following an overnight fast. Platelet volume parameters (MPV, PDW, and P-LCR) were measured in both groups within 2 hours of sampling. Results: The mean PDW, MPV, and P-LCR were 13.9 ± 2.5%, 10.1 ± 1.3 fL, and 27.3 ± 7.8% in varicocele patients, respectively, and were 12.6 ± 2.4%, 9.3 ± 1.1 fL, and 21.9 ± 6.4% in the control group, respectively. The mean PDW, MPV, and P-LCR were significantly higher in the varicocele group than the control group. Conclusion: The results of the present study suggest that vascular components may play an important role in the pathophysiology of varicocele; therefore, there is a great need for prospective studies to confirm this relationship.

I read with interest the paper by Aldemir et al.1 They conducted a before and after study evaluating the pistachio diet on erectile function parameters and serum lipid profiles in patients with erectile dysfunction (ED). They concluded that pistachio diet improved erectile function parameters without any side effects in patients with ED. I think this study design is not appropriate for the evaluation of this relationship, because its main limitation is the lack of a control group, which makes it difficult to establish a causal relationship. The effect of pistachio on ED may be a placebo effect because de Araujo et al.2 showed that treatment of ED with oral placebo agents demonstrates clinical effects, improving erectile function and quality of erection. In addition, in recent years patients have more positive attitudes to complementary medicine.3 We see in our daily practice a large number of patients who think herbal medicine has more effect and lower adverse effect than conventional treatments. This positive attitude can increase the placebo effect of herbal medicine.

A healthy 37 - year - old woman referred to our clinic with one - year history of recurrent urinary tract infection, dysuria and frequency. Her past medical history informed us that an IUD (Copper TCu380A) had been inserted 11 years ago. Eleven months after the IUD insertion she had become pregnant, unexpectedly. At that time, she had undergone gynecological examination and abdominal ultrasound study. However, the IUD had not been found, and the gynecologist had made the diagnosis of spontaneous fall out of the IUD. She had experienced normal pregnancy and caesarian section with no complications. On physical examination, pelvic examination was normal and no other abnormalities were noted. Urinalysis revealed microhematuria and pyuria. Urine culture was positive for Escherichia coli. Ultrasound study revealed a calculus of about 10 mm in the bladder with a hyperdense lesion. A plain abdominal radiograph was requested which showed a metallic foreign body in the pelvis. We failed to remove the IUD by cystoscopic forceps because it had strongly invaded into the uterine and bladder wall. Despite previous papers suggesting open or laparoscopic surgeries in this situation (1, 2), we performed a modified cystoscopic extraction technique. We made a superficial cut in the bladder mucosa and muscle with J - hook monopolar electrocautery and extracted it completely with gentle traction. This technique can decrease the indication of open or laparoscopic surgery for extraction of intravesical IUDs. In the other side of the coin, this technique may increase the risk of uterovesical fistula. Therefore, the depth of incision is important and the surgeon should cut the bladder wall superficially with caution. Although present study is a case report which is normally classified as with low level of evidence, it seems that our modified cystoscopic extraction technique is a safe and useful method for extraction of partially intravesical IUDs.