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Objectives: To compare health-related quality of life (HRQOL), cost-effectiveness, and survival among different types of urinary diversion (UD) utilized after radical cystectomy (RC) for bladder cancer with consideration of the unique economic and cultural context in Iran. Patients and methods: In this retrospective study, we examined all patients who underwent RC from May 2017 to December 2021 at two specialized centers by the same surgical team. Patients were grouped based on their UD. Post-surgical HRQOL (obtained from EORTC QLQ-C30 and QLQBLM-30), financial burden, surgical complications, and survival were compared. Kruskal-Wallis H test, One-way ANOVA, and Kaplan-Meier analyses were utilized; accordingly. Results and limitations: In total 187 patients were identified—orthotopic neobladder (ONB) (N = 75), ileal conduit (IC) (N = 57), and cutaneous ureterostomy (CU) (N = 55)—and were followed for a median 17.5 (Interquartile range: 7.0, 47.0) months. ONB was associated with better HRQOL, especially in the domains addressing physical, role and social functioning (p = 0.003, 0.011, 0.045) as well as better body image (p < 0.001), lower short- and long-term financial burden (p = 0.034 and <0.001, respectively), marginally lower complication rate (p = 0.049), and better 5-year overall survival (p < 0.001), in comparison with other UDs. Patients who underwent CU had the lowest HRQOL and worst survival. Limitations were retrospective design and possibility of selection bias. Conclusions: In this first study that assesses a Middle Eastern collective; ONB seems to be the UD of choice with regard to HRQOL and economic burden when there is no contraindication. [ABSTRACT FROM AUTHOR]

Urinary tract infection (UTI) is a common type of infectious disease globally. The aim of this study was to detect the frequency of fosA3 and fosC2 genes in extended-spectrum β-lactamases (ESBL) and blaDHA, blaCMY-2, and blaCMY-42 genes in AmpC β-lactamases-producing isolates of Escherichia coli. In total, 120 isolates of E. coli were collected from three teaching hospitals between March 2014 and February 2015. Antibiotic susceptibility tests were carried out by disk diffusion method. The presence of blaCMY-2, blaCMY-42, blaDHA, fosA3, and fosC2 genes was detected by polymerase chain reaction (PCR) and sequencing. Of the 120 strains, 92 (76.6%) were identified as ESBL producers, 30 (25%) were determined as AmpC β-lactamase producers, and 24 (20%) had both ESBL and AmpC β-lactamase enzymes. Imipenem, fosfomycin, and nitrofurantoin had the best effect against isolates of E. coli. PCR assay demonstrated that the frequency of blaCMY-2, blaCMY-42, and blaDHA genes among AmpC β-lactamases-producing strains were 39%, 1%, and 17.5%, respectively. This study reports the first detection of fosfomycin resistance in Iran. This study indicated the increasing prevalence of UTI isolates of E. coli-harboring ESBL and AmpC β-lactamases genes in Iran. Therefore, due to the high rate of blaDHA and blaCMY genes and emergence of fosfomycin-resistant E. coli isolates, we recommend continuous monitoring of antibiotic resistance as well as attention to guidelines of infection controls. [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: A randomized clinical trial was designed to compare the efficacy, success rate and surgical complications of percutaneous nephrolithotomy (PCNL) and laparoscopic pyelolithotomy (LP). Materials and Methods: Sixty patients with renal pelvic stones larger than 2 cm were randomly divided into two groups of LP and PCNL. All patients were followed up to three months after surgery using renal diethylenetriaminepentaaceticacid (DTPA) scan and determining the glomerular filtration rate (GFR). Results: Mean operation time (149 ± 31 vs. 107 ± 26 min) and mean hospital stay (3.4 vs. 2.16 days) were significantly higher in LP, but mean hemoglobin drop (0.85 vs. 1.88 g/dL) and the rate of blood transfusion were significantly lower. Stone free rate was 90% and 86.6% for LP and PCNL, respectively (P =.59), while the changes in GFR were not statistically significant 3 days after surgery between two groups. Those in LP group showed better improvement in GFR at three months postoperatively. Improvement of the affected split kidney function was significantly higher in LP group (P =.04). No major complications were observed in both groups according to Clavien grading system. Conclusion: PCNL remains the gold standard treatment for most large kidney stones, nevertheless, laparoscopic pyelolithotomy can be considered for selected cases especially in whom maximal preservation of renal function is necessary. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to assess the prevalence, potential risk factors and management of delayed post-percutaneous nephrolithotomy (PCNL) bleeding. Material and methods. Records of 2512 patients who had undergone PCNL from April 2008 to April 2011 were reviewed retrospectively. The prevalence of delayed post-PCNL hemorrhage and correlation of different variables such as age, body mass index, stone location and burden, surgical approach, type and number of access ports, type of drainage, comorbidities and previous history of stone surgery with postoperative bleeding were assessed. The efficacy of conservative management and need for angioembolization were analyzed. Results. In total, 2304 patients [1562 men (67.8%) and 742 women (32.2%)], with a mean age of 46.4 ± 13.6 years (range 17--86 years), were enrolled in the study. The prevalence of delayed hemorrhage was 2.6% (61 patients) and the mean time to the onset of hemorrhage after PCNL was 5.8 days (range 3--11 days). Of 61 patients presenting with delayed hemorrhage, only 16 patients received a blood transfusion. Eight patients underwent angiography because of uncontrolled bleeding and only three underwent embolization. No significant association was found between other variables and post-PCNL hemorrhage, except for type of drainage, in that tubeless surgery increased the rate of postoperative bleeding. Conclusion. Delayed hemorrhage is an uncommon complication following PCNL that can be successfully managed with conservative management; only a few patients will require angiography and then embolization. Tubeless PCNL significantly predicted the occurrence of severe postoperative bleeding. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the predictive factors for prostatic involvement according to the bladder transitional cell carcinoma (TCC) characteristics in a prospective study. Materials and Methods: Hundred patients with the bladder TCC who had undergone standard radical cystoprostatectomy were enrolled in this study. A number of factors, including vascular and perineural invasion, number of tumors, maximum diameter of the tumor, presence of carcinoma in situ, distance between the tumor and the bladder neck, grade, and local stage of the tumor were recorded, and their relationships with prostatic involvement were studied. In addition, hydronephrosis and age of the patients were included in the analysis. Results: The mean age of the patients was 62.6 ± 10.8 years. Of a total of 100 patients, 21 (75%) were found to have prostatic involvement with TCC. Univariate statistical analysis showed that vascular invasion and the distance between the tumor and the bladder neck were significantly related to the prostatic involvement (P = .001 and P < .001) and tumor stage had relatively low P value (P = .08). In the logistic regression, only the distance between the tumor and the bladder neck was found to be significantly related to the prostatic involvement (P = .004). Conclusion: This study demonstrated that distance between the tumor and the bladder neck is a predictive factor for prostatic involvement; hence, prostate-sparing or capsule-sparing cystectomy in patients with tumors in short distances from prostatovesical junction is not rationale and should be avoided. [ABSTRACT FROM AUTHOR]

Purpose: To report laparoscopic retroperitoneal lymph node dissection (RPLND) as an approach for management of low-stage nonseminomatous germ cell testis tumors (NSGCT). Materials and Methods: Between August 2002 and December 2008, 19 patients with stage I NSGCT underwent RPLND in our center. Results: Mean operation time was 340 minutes (range, 250 to 360 minutes). Procedure in 2 (10.5%) patients was converted to open. Four (21%) patients had tumors with pure histopathology while other 15 (79%) had mixed histopathology. The mean number of removed lymph nodes was 11 (range, 6 to 14). Pathology revealed lymph node involvement in 8 (42%) patients, including 6 (75%) viable tumors and 2 (25%) teratoma. After on average 47-month follow-up (range, 3 to 70 months), recurrence occurred in 2 (10.5%) patients, who underwent open retroperitoneal lymph node dissection after chemotherapy, and surgical pathology revealed teratoma in one and fibrotic tissue in another. No patient developed systematic metastasis during followup period. Conclusion: Our results show that compared with open surgery, RPLND has same oncologic outcome, but lower, and can be recommended for management of patients with low stage NSGCT. [ABSTRACT FROM AUTHOR]

Purpose: To compare erectile function following low flow priapism in patients undergoing distal and proximal shunts. Materials and Methods: From January 1995 to December 2005, we retrospectively studied 16 patients who presented to our medical center with refractory priapism. Of 16 patients, 5 underwent Winter shunt, while El-Ghorab procedure was performed for 7 patients and the remaining 4 underwent Grayhack shunt. Erectile function was assessed in a minimum follow-up of 2 years (range, 2 to 10 years) using erectile dysfunction (ED) intensity scale [Total score: 5 to 10 (severe ED); 11 to 15 (moderate ED); 16 to 20 (mild ED); and 21 to 25 (no ED)]. Results: The mean patients' age was 40.62 ± 15.27 years. Mean duration of priapism was 51.12 ± 37.99 hours. Of 4 patients (25%) who underwent proximal shunt (Grayhack procedure), 2 (50%) were impotent, 1 had potency, and the other one achieved some penile erection with administration of oral sildenafil. Of 5 patients (31.25%) who underwent Winter procedure, 1 died because of metastatic bladder cancer and of 4 remainders, 2 (50%) had normal erectile function, but 1 patient suffered from recurrent priapism. Of 7 patients (43.75%) who underwent El-Ghorab procedure, 1 was lost for follow-up and of remaining 6 patients, 2 (33.3%) had normal erectile function and 4 (66.6%) were impotent. No surgical complication was seen. Median lag time from priapism till surgery for patients with and without ED was 48 and 26 hours, respectively (P = .22). Conclusion: Grayhack shunt is a safe surgical procedure without any major complications and with lower ED rate. Grayhack shunt might be considered as treatment of choice for refractory low flow priapism. [ABSTRACT FROM AUTHOR]