nutcracker syndrome: an underdiagnosed cause for high grade varicocele

The nutcracker syndrome represents a clinical condition caused by compression of the left renal vein [LRV] between the superior mesenteric artery [SMA] and the aorta. One of its manifestations is left-sided varicocele. The aim of this study is to determine the prevalence of nutcracker syndrome in patients with primary and recurrent high grade left-sided varicocele. Fifty patients with primary and recurrent high grade left-sided varicocele were enrolled in this study. Color Doppler ultra-sonography [US] of renal vessels was done and diameter of LRV and peak systolic velocity [PSV] were measured in renal hilum and in site of compression of LRV be-tween SMA and the aorta and then magnetic resonance angiography [MRA] of renal vessels was done. Thirty six patients [72%] had primary high grade varicocele and 14 patients [28%] had recurrent high grade varicocele. Twelve patients [33%] with primary high grade varicocele and seven patients [50%] with recurrent varicocele had evidences of NCS in color Doppler US and MRA. The differences of LRV diameter in NCS group and in patients without NCS were statistically significant [P<0.001]. The differences of PSV in the LRV at the hilar portion in the NCS group and in the patients without NCS were not statistically significant. The differences of PSV in the LRV at the aortomesenteric portion in the NCS group and in the patients without NCS were statistically significant [P< 0.001]. In all patients with NCS, MRA showed dilatation and compression of LRV at site of passage between aorta and SMA. NCS should be suspected in patients with high grade primary and recurrent varicocele

efficacy and safety of intravesical bacillus-calmette- guerin in the treatment of female patients with interstitial cystitis: a double-blinded prospective placebo controlled study

To evaluate the efficacy and safety of intravesical Bacillus Calmette-Gurein injection in the treatment of female patients with interstitial cystitis. Thirty women meeting the National Institute of Arthritis, Diabetes, digestive and kidney diseases criteria for interstitial cystitis, were randomized in a double-blinded fashion in two groups each consisted of 15 patients to receive six, weekly instillation of 120 mg BCG vaccine of Iranian Institute of pastor or placebo. Periodic questionnaires on symptoms of interstitial cystitis, voiding diaries, bladder capacity at first desire to void, and maximum bladder capacity were obtained. Adverse events were closely monitored during the treatment and follow-up phases of the study. Subjective and objective baseline values were compared with the follow-up data. With a mean follow-up of 24 [range 6 to 33] months11 out of 15 [73%] in BCG group, and 3 out of 15 [20%] in placebo group responded to the treatment [p<0.002]. Responders were defined the patients with more than 40% improvement in the symptoms of interstitial cystitis. The global improvement in symptoms and signs of interstitial cystitis was 62%. Adverse events were similar in both groups, mostly irritative in nature and no significant systemic event was noted. BCG did not worsen interstitial cystitis symptoms. We concluded that intravesical BCG is safe, effective, available, and inexpensive with relatively durable results in the treatment of interstitial cystitis

Results of Dermal Patch Graft in the Treatment of Peyronie's Disease

To investigate the efficacy of "dermal patch graft" in surgical management of Peyronie's. Eighteen of Peyronie's disease cases, with a mean age of 49 and a history of penile curvature and painful erection were enrolled in this study. Diagnosis was made clinically by plaque palpation. All of them were in the chronic stage of disease with symptom duration of at least 6 months. We also evaluate their potency through Brief Sexual Function Inventory [BSFI] questionnaire before and after the operation, meanwhile the degree of penile curvature was measured with goniometry while artificial erection status was induced. Mean penile curvature, before and after the operation [58 and 5 degrees respectively], showed significant improvement [p<0.001]. The improvement of curvature was irrespective of the plaque size. All of our patients suffered from inability to intercourse due to significant penile curvature but after the procedure 11 of them [66.1%] could do so. Also the BSFI score improved significantly in this subgroup [p<0.05]. The remaining 7 cases [39%] already suffered from erectile dysfunction despite of operation; however, the penile curvature improved significantly in them. Six of this latter group had a plaque size greater than 4 cm2 and BSFI score was not significantly improved. Dermal patch graft as a cost effective method in the management of Peyronie's disease significantly corrects the curvature irrespective of plaque size and curvature severity. We found that if the fibrous plaque is less than 4 cm2 and the patient has no severe erectile dysfunction, this procedure will significantly improve his potency; however, if the patient suffers from a plaque sized greater than 4 cm2 and/or severe erectile dysfunction, to reach satisfactory erection, implantation of penile prosthesis or applying other methods of artificial erection in addition to dermal patch graft is suggested

Expression of HLA-class I and II, ICAM-1 and CD44 antigens in transitional csll carcinoma of bladder

The expression of monomorphic determinants of the histocompatibility leucocyte antigens [HLA] class I and class II, ICAM-1 and CD44 were studied using immunochemical staining of bladder tissue specimens from 30 cases of transitional cell carcinoma [TCC] of bladder. The results indicated that HLA-class I antigens were relatively well preserved in low grade cases but high grade tumors, either lacked or had markedly reduced HLA-class I antigens. Statistical analysis showed a significant difference between tumor grade in the expression of these molecules [p<0.05]. Aberrant expression of HLA-DR was detected in 30% of cases and moderate to strong expression of ICAM-1 and CD44 molecules were observed in 43% and 50% of cases, respectively. No significant difference in ICAM-1 and CD44 expression was found in relation to differentiation of tumor cells

New modified surgical approach in lymphedema of the penis and scrotum

A 14 year old boy suffering from marked penoscrotal lymphedema is reported. Reduction scrotoplasty was done and the neoscrotum was made by combining the anterior suprapubic and posterior scrotal U-shaped flaps. A split thickness skin graft from the thigh was placed over the denuded penis. No complication was encountered and the cosmetic result was satisfactory

Endourethral urethroplasty: a simple method for treatment of urethral stricture

Following meatotomy, internal urethrotomy and dilatation of the bulbous and bulbo-membranous urethra, six patients had primary split-thickness skin grafts inlaid over the urethrotomy site. Follow-up of these patients revealed good results in five and satisfactory in one case

Direct vision urethrotomy [experiences with 38 cases of urethral stricture]

Transurethral urethrotomy under direct vision is a simple procedure which can be done under local or general anesthesia as a day case for the majority of the patients suffering from urethral strictures. Of 38 patients who underwent this procedure with a maximum of 2.5 years follow-up, 20 had excellent results, 8 were satisfactory, and 4 showed poor results. Six patients were lost to follow up. The highest success rates were among patients with short strictures [about 1 cm length]. This simple, inexpensive, and least disabling technique, with its low risk of complications and least amount of discomforture, makes it the procedure of choice for most urethral strictures