Familial relations and recurrence pattern in nephrolithiasis. New words about old subjects

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. Using a multistage stratified sampling in 4 seasonal phases, 6127 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. Of 6127 patients with the mean 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% Confidence Interval [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 90[th] 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]. 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

Early continence after open and laparoscopic radical prostatectomy with sutureless vesicourethral alignment an alternative technique, 8 years experience

We reviewed urinary outcomes after sutureless vesicourethral alignment in open radical prostatectomy [ORP] and laparoscopic radical prostatectomy [LRP]. Charts of 324 patients who underwent sutureless ORP [n = 188] and LRP [n = 136] were reviewed. After prostatectomy, a 22-to 24-F silicon Foley catheter was passed into the bladder via the preserved bladder neck. The Foley balloon was filled, and mild traction was applied to appose the bladder neck to the urethral stump. The Foley catheter was fixed to the patient's leg. No cystostomy was placed. The follow-up period ranged from 12 to 60 months. The mean operative time was 65 minutes in ORP and 260 minutes in LRP. Blood transfusion was significantly less frequent with LRP [9.6% versus l9.7%, P = .02]. The mean postoperative catheterization durations were 12 days in ORP and 13 days in LRP. Complete continence was achieve in 293 patients [90.4%] after 3 months of follow-up [88.9% in LRP and 91.5% in ORP, P = .78]. The continence rate improved to 96.3% in LRP and 95.2% in ORP at 1 year [P = .52]. Bladder neck stricture rate was 13.6% [12.8% in ORP versus 14.7% in LRP, P = .87]. Sutureless vesicourethral alignment during ORP and LRP is a promising approach with minimum urinary extravasation, a high rate of continence, and an acceptable rate of stricture. This technique could be considered as an alternative in anatomically demanding situations

Varicocele in brothers of patients with varicocele

The aim of this study was to evaluate varicocele patients' brothers to determine whether they are at a higher risk of varicocele than the general population of men. A total of 56 patients with varicocele and their 131 brothers [> 16 years old] were evaluated. The brothers had no complaints of infertility, pain, or cosmetic problems. They were all examined for varicocele. One hundred and fifty men who referred for employment medical examinations were considered as the control group. Of the subjects, 39 [69.6%] had grade III varicocele. Sixty [45.8%] of the brothers had varicocele. The grade of varicocele was III in 16 [26.7%] brothers. In the control group, varicocele was present in 15 [10%] which was grade III in 5 [33.3%]. The frequency of varicocele was 4.5-fold greater in the brothers of the patients than the controls [P < .001]. Also, the frequency of grade III varicocele was significantly more than grades I and II in the patients in comparison with their brothers and controls with varicocele [P < .001]. There was no significant difference in the grades between the controls and the patients' brothers [P = .31]. The frequency of bilateral varicocele was not statistically different between the three groups [P = .14]. Our findings showed that a significant increase is seen in the prevalence of varicocele in the patients' brothers compared to men in the general population, warranting evaluation of the first-degree relatives of men who present with varicocele

Blind puncture in comparison with fluoroscopic guidance in percutaneous nephrolithotomy: a randomized controlled trial

Our aim was to evaluate blind puncture in percutaneous nephrolithotomy [PCNL] for decreasing the risk of radiation. One hundred candidates for PCNL were randomly assigned into 2 groups. Blind access was performed for the patients in group 1 and the standard access using fluoroscopy for those in group 2. In group 1, displacement of the targeted calyx in the prone position was estimated by fluoroscopy comparing to the image on intravenous urography. Puncture of the calyx was attempted 3 cm to 4 cm below the marked site of the targeted calyx with a 30 degree sign angle. If the access to the collecting system was felt and urine came out, the site of puncture would be controlled by fluoroscopy. If the access failed, we would repeat puncturing up to 5 times. The mean time to access was 6.6 +/- 2.1 minutes and 5.5 +/- 1.7 minutes in groups 1 and 2, respectively [P=.008]. The mean time of radiation exposure was 0.95 +/- 0.44 minutes in group 2. A successful puncture of the targeted calyx was achieved in 50% and 90% of the patients in groups 1 and 2, respectively [P<.001] and a successful calculus removal in 62% and 100% of the patients in groups 1 and 2 [P<.001]. Although about half of the patients benefited from blind access in our study, this technique can not be solely relied on, and fluoroscopy or ultrasonography should be available for prevention of complications