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Background: The present study was conducted to report the incidence rate of ureteral avulsion and its management in two referral medical centers. Methods: We retrospectively reviewed a total of 36683 transurethral lithotripsy procedures performed during 17 years. All ureteral avulsions were also included in the current study as an intraoperative complication of Transurethral Lithotripsy (TUL). Data including stone location, avulsion site and management details were recorded. Results: Fourteen cases of complete ureteral avulsion had occurred in the study period (0.038%), consisting of 8 healthy males and 6 healthy females aged 26 to 73 years (mean age: 50 yrs). Out of these 14 cases, 7 cases had distal ureteral avulsion and seven others had proximal ureteral avulsion. Six cases of distal ureteral avulsion had been promptly treated by the reimplant method whereas immediate nephrectomy had been performed in the remaining case due to a history of poor condition of the renal unit. Proximal ureteral avulsions had been treated by combined Boari flap-psoas hitch procedures with renal mobilization in 3 cases, the autotransplant method in another 3 and by ileal interposition in one case. Conclusion: Although the present study is a case series which is normally classified as low level of evidence, it seems that both autotransplant and combined Boari flap-psoas hitch procedures with renal mobilization are safe and feasible techniques for the management of full-length complete ureteral injury. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the influence of bimanual compression of abdomen-flank to control bleeding after completion of percutaneous nephrolithotomy (PCNL) including tubeless PCNL. Materials and methods: This study is a parallel-group randomized clinical trial with 1:1:1 randomization. Ninety patients who were candidates for PCNL during July to October 2019 were enrolled. After completion of PCNL operation, patients were randomized into three groups to receive bimanual abdomen-flank compression for 0, 3, and 7 min by the operating surgeon with the opening of sealed envelopes (groups 0, 3, and 7 min afterwards). Preoperative, 24, and 48 h postoperative hemoglobin (Hb) and electrolytes were collected. The primary endpoint of interest was the comparison of 48-h blood loss across study groups. Secondary endpoints included the percent drop in 24- and 48-h Hb, transfusion rates, and operation complications. This trial is registered at www.irct.ir with the following number: IRCT20190618043925N1 on 18 July 2019. Results: There was no statistically significant difference in study groups regarding stone mass, stone location, access location, and patients' age (all p > 0.05). The medians (IQR) of 48-h blood loss were 490 mL (105–916), 338 mL (160–933), and 413 mL (71–650) in groups of 0, 3, and 7 min. The percent drop in 24-h postoperative Hb relative to preoperative Hb were 11.5 ± 8.6% versus 9.2 ± 7.3% versus 9.3 ± 6.8% (p = 0.44) and relative values for the percent drop in 48-h Hb relative to preoperative Hb were 8.6 ± 8.7% versus 9.5 ± 9.9% versus 7.2 ± 9.6% (p = 0.63) in groups of 0, 3, and 7 min respectively. Transfusion was needed in four patients in group 0 min, five patients in group 3 min, and three patients in group 7 min. Conclusions: The results of this study reveal that postoperative bimanual compression of abdomen-flank has no statistically significant influence on the control of bleeding after PCNL operations. [ABSTRACT FROM AUTHOR]

Introduction and objective: Understanding the various eHealth strategies used in the Covid-19 pandemic and its consequences can help to better and more effectively benefit in the future and identify its potential challenges, and more effective and efficient solutions to deal with future epidemics. In this study, we aimed to review the types of eHealth strategies used in the COVID-19 pandemic, the consequences and weaknesses and related challenges. Methods: In this scoping review we use PRISMA statement to guide or study. Quantitative and qualitative studies that have empirically examined the application of eHealth strategies in Covid-19 pandemic management were included in the review. Inclusion criteria were outlined based on the three characteristics of Population, Concept, and Context (PCC); the population was population of countries affected by the Covid-19 pandemic. The concept was the use of eHealth strategies to control the Covid-19 pandemic and reduce its negative consequences for individuals and community. And the context was Covid-19 pandemic. Results: Search strategies yielded 3,683 results, and 21 studies were included in the review. Main challenges of adopting eHealth strategies in the COVID-19 era included privacy and data security concerns, resource limitation, need for wireless/internet base systems, need for accuracy and efficiency approval, high cost, and need for linked health information systems. eHealth strategies have been successful in controlling nosocomial infections, reducing the relationship between treatment staff and patients, more accurate and faster diagnosis, providing services to a wide range of patients, and providing quality services. Conclusion: Evidence suggests that different countries, depending on their infrastructure and available resources, have been able to effectively and efficiently benefit from eHealth strategies in identifying, diagnosing, treating and caring for patients. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the influence of stone opacity in plain radiography on stone free rate and complications of percutaneous nephrolithotomy (PCNL). Materials and Methods: A number of 101 patients who underwent PCNL between July-September 2015 were prospectively included. Stone opacity was judged on preoperative plain Kidney-Ureter-Bladder X-ray. Stone free rate was evaluated two weeks after the operation by ultrasonography and KUB. Results: There were 61 patients with opaque stones and 40 patients with non-opaque stones. The age, body mass index, preoperative creatinine, history of stone surgery, and stone size was not statistically different between patients with opaque and non-opaque stones. Neither operation duration nor access numbers were statistically significant between opaque and non-opaque stones. The frequency of stone free patients in opaque stones and non-opaque stones were 55/61 (90%) and 30/40 (75%) respectively (P = .04) The magnitude of hemoglobin drop in opaque stones and non-opaque stones were 1.9 ± 1.2 mg/dL versus 2.9 ± 1.7 mg/dL (P = .005). Conclusion: The stone free rate is lower and the magnitude of bleeding is higher in PCNL of non-opaque stones when compared to opaque stones if rigid instruments are used for nephroscopy. [ABSTRACT FROM AUTHOR]

Background: The optimal treatment is not possible yet for chronic prostatitis due to the unknown etiology of the diseases. We aimed to investigate the association of Helicobacter pylori infection with chronic prostatitis. Methods: In this prospective case-control study that conducted in Imam Hospital Complex affiliated to Tehran University of Medical Sciences in Tehran, Iran from 2014 to 2015, patients with diagnosis of chronic prostatitis according to the criteria of National Institute of Health (NIH) were enrolled. Control group constituted of consecutive healthy patients. Blood samples were obtained for each patient and control and evaluated for serum levels of anti H. pylori IgG, A. Data analysis was carried out using SPSS, version 18. Values of P<0.05 were considered statistically significant. Results: Mean ± SD age of patients was 59.5 ± 3.08 yr in the case group and 56.88 ± 3.20 yr in the control group with no significant difference (P>0.05). Mean ± SD levels of anti H. pylori IgG and IgA in the control group were 9.36 ± 7.45 U/ml and 6.25 ± 7.29 U/ml, respectively compared with 20.94 ± 16.98 U/ml and 18.63 ± 15.65 U/ml in the case group, respectively both of which revealed statistically significant (P<0.05). Conclusion: Chronic prostatitis is associated with H. pylori infection. Both anti H. pylori IgG and IgA are increased in patients with chronic prostatitis. Therefore, treatment of HP infection could be effective in the prostatitis cure. [ABSTRACT FROM AUTHOR]

Purpose: To review our 5-year experience in percutaneous nephrolithotomy (PCNL) for horseshoe kidney with large stone burden or failed shockwave lithotripsy (SWL). Materials and Methods: During 5 years (2006 to 2011), PCNL was performed on 21 patients with horseshoe kidney stone. We evaluated patients (age and gender), stones characteristics (size, number, side, and site), surgical technique, and outcomes. Results: Sixteen (76.16%) subjects were men and 5 (23.80%) were women, with the mean age of 35 ± 12 years. Mean stone size was 37.2 ± 16.6 mm. Percutaneous nephrolithotomy was performed because of the stone size (over 20 mm) in 18 (85.68%) and failed SWL in 3 (14.28%) subjects. Stone numbers were more than one in 18 (85.68%) subjects, and were in the pelvis and at least one calyx. The most common access site was superior posterior calyx (66.64%). Stone-free rate with single session and rigid nephroscope was 71.40%. No major complication occurred during the surgery or in post surgical period. Postoperative minor complications occurred in 3 (14.28%) patients, including transfusion in one (4.76%), fever in one (4.76%), and ileus in one (4.76%) subject. Conclusion: Percutaneous nephrolithotomy has acceptable results in horseshoe kidney stone and is feasible with rigid nephroscope. Safety and efficacy of PCNL resembled the normal anatomy kidney in our study. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the safety and efficacy of pediatric percutaneous nephrolithotomy (PCNL) using adult sized instruments in the management of pediatric urolithiasis. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 38 children younger than 15 years who had undergone 45 PCNLs with adult sized instruments in our center between August 2007 and February 2010. RESULTS: There were 26 boys and 12 girls, with a mean age of 8.4 ± 4.24 years (range, 12 months to 13 years). Twelve patients had complete staghorn stone. Mean stone burden was 2.93 ± 0.89 cm. The tract was dilated between 26 and 30F. Standard PCNL was performed in 8 patients and tubeless PCNL in the next 37 subjects. Simultaneous transurethral lithotripsy was done in 9 patients. Stone clearance rate was 67%. Mean pre and postoperative hemoglobin levels were 12.67 ± 1.7 and 11.39 ± 1.6 g/dL, respectively. Mean hospitalization was 3.5 ± 1.1 days. Eight subjects had postoperative fever beyond day 1. Blood transfusion was required in only one patient. In one patient (3 years old) with a staghorn stone, hyponatremia and seizure occurred, which were treated conservatively without any adverse sequela. There was a significant difference in hospital stay between tubeless and standard PCNL groups (P < .02). CONCLUSION: We concluded that PCNL using adult sized instruments was relatively safe in children, with a clearance rate of 67%. We suggest prospective randomized studies to compare mini-perc and adult sized instruments use in pediatric PCNL. [ABSTRACT FROM AUTHOR]

Purpose: To compare outcomes in two groups of patients with kept and discarded nephrostomy tube after percutaneous nephrolithotomy (PCNL) complicated with bleeding. Materials and Methods: Two hundred patients who had undergone PCNL complicated with hemorrhage were recruited in this study. Patients were randomly allocated to two groups: group A, who underwent tubeless PCNL and tract port was packed for 3 to 4 minutes after removing Amplatz sheath, and group B, for whom a 24-F nephrostomy tube was left in place at the end of the procedure. Patients were followed up for 3 months to check if bleeding occurred. Results: The mean operation time was 68 ± 4.3 minutes in group A and 74 ± 5.6 minutes in group B (P = .098). The mean stone size was similar in groups A and B (36.26 ± 5.3 mm versus 35.35 ± 5.85 mm; P = .613). The mean hemoglobin drop was 3.65 ± 1.20 g/dL in group A and 3.13 ± 1.06 g/dL in group B. There was no significant difference between the mean of stone free rate in groups A and B (92.58% ± 5.97 versus 89.60% ± 8.3; P = .210). Patients in group A experienced a significantly less duration of hospitalization than group B (2.42 ± 0.84 days versus 3.70 ± 0.80 days; P < .001). Conclusion: In the absence of clear indication, nephrostomy tube insertion after PCNL does not seem to be beneficial, and its removal does not pose patients at any additional risk. [ABSTRACT FROM AUTHOR]

Introduction: Secondary diverticula initially serve as a pop-off mechanism in high-pressure voiding. Large diverticula, however, have been implicated in bladder-neck and ureteral obstruction and frequently demand definitive treatment, which, so far, has usually meant excision. We present this first report on using the diverticulum for laparoscopic urothelialized bladder augmentation as a novel procedure. Patients and Methods: We performed laparoscopic freehand sutured diverticulocystoplasty in 3 adult male patients suffering from low-capacity, low-compliance bladders accompanied by hydroureteronephrosis. All 3 patients had a dominant large diverticulum with very poor drainage by voiding and catheterization. The technique is described in detail. Patients were followed for upper tract changes and bladder anatomy by cystogram, sonography antegrade pyelography (per case), and laboratory studies. Results: The procedures lasted 114–152 minutes. Patients were discharged uneventfully on postoperative day 3. At the 9-month follow-up, mean functional bladder capacity had increased by 266% (range, 195–351), and mean maximum detrusor pressure had dropped by 190% (range, 167–234). At 15–32 months, upper tract dilation has improved in all 3 patients. All patients remain on intermittent catheterization, though with far less frequency than before surgery. Conclusion: When there is a dominant bladder diverticulum with poor evacuation, and the bladder is noncompliant, laparoscopic bladder augmentation by the diverticulum (instead of standard diverticulectomy) can afford functional improvement with minimal morbidity. [ABSTRACT FROM AUTHOR]

We evaluated the outcomes of percutaneous nephrolithotomy in patients with chronic renal insufficiency. A total of 60 patients with a creatinine level greater than 1.5 mg/dL who underwent PCNL were included. Serum creatinine level, as a kidney function index, was assessed before and after the operation. The mean calculus size was 31.13 ± 9.38 mm. The mean pre-operative and 2-week postoperative serum creatinine levels were 2.43 ± 0.75 mg/dL and 2.08 ± 0.78 mg/dL, respectively. There was a significant difference between the pre-operative and postoperative creatinine levels in all postoperative days (days 1, 2, and 14). Fifty of the 60 patients (83.3%) were stone free. Ten patients (16.6%) developed postoperative fever. We can conclude that percutaneous nephrolithotomy seems to be a safe and effective therapeutic option for kidney calculi in patients with chronic kidney disease. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the efficacy of laparoscopically assisted percutaneous nephrolithotomy (PCNL) in treating patients with pelvic kidyney stones. The study finds that no patient received blood transfusion during or after PCNL and suggests that PCNL should be used as treatment for kidney calculi. It reveals that no patient experienced postoperative leakage after PCNL. The article also discusses the procedure of the study.

Purpose: Percutaneous-nephrolithotomy (PCNL), is the current modality of choice for large renal stones. Delayed post-op bleeding may herald pseudo aneurysm (PA) or arteriovenous fistula (AVF) necessitating costly and inconsistently available angioembolization, or prolonged hospitalization. The goal of this study is to identify criteria that may predict response to conservative therapy, for delayed bleeding from post PCNL intrarenal vascular lesions.Materials and Methods: We reviewed all data on patients re-admitted for post PCNL gross hematuria at our high volume center between 2011 and 2016. Perioperative findings, factors related to the stone and management details, were subjected to multifactorial analysis. Logistic regression for multivariable analysis and ROC curves to find thresholds predicting mandatory angioembolization.Results: Of 4403 PCNLs, 83 (1.9%) with delayed bleeding were diagnosed with intrarenal vascular lesions: Arteriovenous fistulas in 54 (AVF, 65%) and pseudoaneurysm in 29 (PA, 35%). Overall 49 (59%) responded to conservative management but 34 (41%) eventually required angioembolization. On multivariable analysis, predictive factors for poor response to conservative treatment were requiring transfusion beyond initial stabilization, pseudoaneurysm, history of open renal surgery, longer interval-to-second-admission, and size of vascular lesion. The proposed POPVESL score (short for Post PNL Vascular Embolization selection) when below 11, correctly predicts success of conservative management with 81.6% sensitivity and 100% specificity.Conclusions: Our findings including the proposed POPVESL score have the potential for clinical application and enhancing practical guidelines on the management of post-PCNL bleeding. [ABSTRACT FROM AUTHOR]

Purpose: Percutaneous-nephrolithotomy (PCNL), is the current modality of choice for large renal stones. Delayed post-op bleeding may herald pseudo aneurysm (PA) or arteriovenous fistula (AVF) necessitating costly and inconsistently available angioembolization, or prolonged hospitalization. The goal of this study is to identify criteria that may predict response to conservative therapy, for delayed bleeding from post PCNL intrarenal vascular lesions., Materials and Methods: We reviewed all data on patients re-admitted for post PCNL gross hematuria at our high volume center between 2011 and 2016. Perioperative findings, factors related to the stone and management details, were subjected to multifactorial analysis. Logistic regression for multivariable analysis and ROC curves to find thresholds predicting mandatory angioembolization., Results: Of 4403 PCNLs, 83 (1.9%) with delayed bleeding were diagnosed with intrarenal vascular lesions: Arteriovenous fistulas in 54 (AVF, 65%) and pseudoaneurysm in 29 (PA, 35%). Overall 49 (59%) responded to conservative management but 34 (41%) eventually required angioembolization. On multivariable analysis, predictive factors for poor response to conservative treatment were requiring transfusion beyond initial stabilization, pseudoaneurysm, history of open renal surgery, longer interval-to-second-admission, and size of vascular lesion. The proposed POPVESL score (short for Post PNL Vascular Embolization selection) when below 11, correctly predicts success of conservative management with 81.6% sensitivity and 100% specificity., Conclusions: Our findings including the proposed POPVESL score have the potential for clinical application and enhancing practical guidelines on the management of post-PCNL bleeding.

Objective: To review the experiences of selected countries in the use of public-private partnership in the provision of hospital services., Methods: This comparative study was conducted in 2015 in Iran. To collect data, valid databases as well as articles, theses, reports and related books in the field of private-sector partnership in hospital services were employed. Using purposive sampling, countries such as the United Kingdom, Spain, Canada, Turkey, Australia and Lesotho, which had successful experiences in the field of application of the public-private partnership in hospital services, were included. Likewise, the only experience in Iran in this field was also reviewed. Studies done between 1980 and 2015 were examined. The results obtained from each country were compared., Results: Implementing public-private partnership had great and valuable outcomes and achievements for governmental hospitals. Moreover, clinical and nonclinical service delivery, hospital utilisation and management along with building, repairing and supportive operations through public-private partnership contracts can be differently divided among the partners. Furthermore, duration of the projects ranged from 12 to 40 years in different countries, depending on the type of the model used., Conclusions: A successful experience in the use of the public-private partnership in the provision of hospital services was observed.

Introduction: We present our experience in continuing percutaneous nephrolithotomy (PCNL) versus delayed PCNL when purulent fluid is aspirated during access to the pyelocaliceal system., Materials and Methods: This randomized controlled study was carried out on patients who had purulent urine in the pyelocaliceal system at the initial puncturing during PCNL. Patients with recent untreated urinary tract infection, thick or foul pus in aspirated urine, fever, and immunocompromised condition were excluded. Thirty-one patients were randomly divided into 2 groups. In group 1, PCNL was continued, but in group 2, nephrostomy tube was placed and PCNL was performed 10 days later after documented sterile nephrostomy urine. The preoperative and postoperative findings were compared., Results: There were 16 and 15 patients in groups 1 and 2, respectively. All patients had negative urine cultures for microorganisms, preoperatively. The purulent aspirated fluid was infected in 43.8% and 40.0% of the patients in groups 1 and 2, respectively. Postoperative fever was seen in 25.0% and 26.7% of the patients, respectively. No statistical differences were observed between the two groups in terms of bacteriuria, bacteremia, positive calculus cultures, or stone-free rates, and duration of hospitalization between groups 1 and 2, respectively. More analysis with linear regression model showed that postoperative positive blood culture (P < .001), fever (P = .001), and postoperative positive urine culture (P = .02) correlated with duration of hospitalization., Conclusion: In the absence of untreated recent UTI and aspiration of thick or foul pus, continuing PCNL can be safe while purulent urine is encountered.