Preventing unnecessary invasive cancer-diagnostic tests: changing the cut-off points

To determine a cut-off point of tPSA and PSAD to prevent unnecessary invasive cancer-diagnosing tests in the community. This study was performed on 688 consecutive patients referred to our center due to prostatism, suspicious lesions on digital rectal examination and/or elevated serum PSA levels. All patients underwent transrectal ultrasound guided biopsies and obtained PSAD. Serum levels of tPSA and fPSA were measured by chemiluminescence. Comparisons were done using tests of accuracy [AUC-ROC]. Prostate cancer was detected in 334 patients, whereas the other 354 patients were suffering from benign prostate diseases. The mean tPSA in case and control groups were 28.32 +/- 63.62 ng/ml and 7.14 +/- 10.04 ng/ml; the mean f/tPSA ratios were 0.13 +/- 0.21 and 0.26 +/- 0.24 in PCa and benign prostate disease groups; the mean PSAD rates were 0.69 +/- 2.24, 0.12 +/- 0.11, respectively. Statistically significant differences were found [P<0.05]. Using ROC curve analysis, it was revealed that AUC was 0.78 for tPSA and 0.80 for f/tPSA. Sensitivity was 71% for the cut-off value of 7.85ng/ml. For f/tPSA ratio, the optimal cut-off value was 0.13 which produced the sensitivity of 81.4% and for PSAD, it was15%. As this trial is different from the European and American values, we should be more cautious in dealing with the prostate cancer upon the obtained sensitivity and specificity for PCa diagnosis [7.85ng/mL fortPSA, 15% for PSAD and 0.13 for f/tPSA ratio]

role of ureteroscopy in the treatment of renal transplantation complications

To determine the feasibility, safety, and efficacy of diagnostic and therapeutic ureteroscopy in renal allograft ureters. We reviewed 1560 consecutive renal allografts have been preformed between June 1989 and February 2002. Twenty-eight patients [1.8%] had indication for endoscopic procedure on allograft ureter. Six patients had obstructive ureteral calculi with a history of failed ESWL, 3 had suspected ureteral stricture, 9 had upward migrated ureteral stents and 10 had ureteral stricture at ureteroneocystostomy site. Ureters were anastomosed to bladder using Leadbetter- Politano and Lich-GreGoire methods in 6 and 22 cases, respectively. Ureteroscopies were performed with semi rigid 9.8F wolf ureteroscope. Identifying and introducing the ureteral orifice was successful in 19 [68%] cases. If we exclude 10 patients with ureteral stricture, ureteroscopy was successful in 13 out of 18 [72%]. Four ureteral calculi [67%] were removed with ureteroscope.Seven out of nine migrated stents [78%] were retrieved. Four patients with ureteral stricture at ureteroneocystostomy site [40%] had successful ureteral dilatation and double J ureteral catheters were also inserted. Diagnostic ureteroscopy was successful in all cases. Two complications including one urinary leakage and one symptomatic urinary tract infection occurred that were managed conservatively. Ureteral endoscopy was safe and effective method for management of urological complications after RT [renal transplantation]. This procedure can be considered as the first choice compared with percutaneous and antegrade modalities

Management of Peyronie's Disease by Dermal Grafting

To evaluate the results of plaque excision and dermal grafting in Peyronie's disease. Twenty seven patients were scheduled to undergo plaque excision and dermal grafting for Peyronie's disease. Potency, bending of erected penis, and having painful erection were evaluated in patients before and after operation. To evaluate erectile dysfunction, we used International Index of Erectile Function [IIEF] by interviewing the patients and filling questionnaires by their partners. Doppler ultrasonography was used to determine the vascular competence of penis before and after operation in 15 patients. The disease was more prevalent between the ages of 40 and 60 years. Plaques were located as follows: dorsal in 18, right lateral in 6 and left lateral in 3. Mean plaque size was 11 [range 5 to 18] mm. After plaque excision and dermal grafting, penile deformity, erectile dysfunction, and painful erection had remained yet in 4 [15%] out of 27, 3 [16%] out of 19, and 3 [14%] out of 22, respectively. Doppler ultrasonographic study in 15 patients revealed improvement in peak systolic velocity [p<0.01]. In addition, a decrease in end diastolic velocity was noted also that was not significant statistically [p=0.26]. Resistive index did not improve after operation. This procedure showed significant improvement in penile deformity [85% of cases], erectile dysfunction [84% of cases] and painful erection [86% of cases]. We recommend plaque excision and dermal grafting as an effective procedure in treating Peyronie's disease

Epidemiologic study of 284 patients with urogenital trauma in three trauma center in Tehran

To perform an epidemiologic study of urogenital injuries in traumatic patients who were referred to three traumatic centers in Tehran during one year. This study included a part of data of National Trauma Registries, which was performed within one year. Questionnaires were completed by trained staff in three different geographical regions of Tehran: Shohada-e-Tajrish hospital [north of Tehran], Sina hospital [south of Tehran], and Shaheed Faiazbakhsh [west of Tehran]. Two hundred and eighty four [5%] out of 57367 patients who were referred to the above mentioned centers had genitourinary trauma, of whom, 145 [42%] were hospitalized. Males with a frequency of 92% [258 patients] were the most injured group. Patients mean age was 25 +/- 14 years, mostly between 20 and 29 years [33.6%] followed by 10-19 years age group with a frequency of 25.6%. Non-penetrating trauma with a frequency of 96% was the most common type and accident was the most mechanism of trauma. One hundred and one patients out of the studied population had associated injuries. The most frequent injuries were occurred in extremities [40%] and the less in head and neck [7%]. There were 22 [21.7%] intra-abdominal organ injuries. Sixty nine percent of patients developed mild injury [ISS<7], 20% developed severe injury and [ISS>12], and 4.2% of patients died. The most common injured organ was kidney [3.3%] and the least one was ureter, as no ureteral injury was reported. Although a low percentage of traumatic patients develop urogenital injuries, disregarding these injuries may lead to serious complications and it is recommended to consider these injuries while dealing with such patients. Considering the fact that these complications which could be preventable, are mostly developed in the youth, making solution for such problem is recommended