Analgesic effects and safety of desmopressin, tramadol and indomethacin in patients with acute renal colic; a randomized clinical trial

Objective: To compare the efficacy of desmopressin [DDAVP], tramadol and indomethacin on pain intensity of patients with acute renal colic caused by urolithiasis

Methods: This prospective, randomized clinical trial was conducted between July 2005 and July 2006 including 120 patients [70 men and 50 women, mean age 38.2 +/- 5.8 years] referring to emergency room of Shahid Faghihi hospital with renal colic caused by urolithiasis without any previous treatment. The patients were randomly assigned to three groups: groupAreceived tramadol 50mg intramuscularly [n=40], groupBreceived desmopressin 40 [micro]g intranasally [n=40] and group C received indomethacin 100mg rectally [n=40]. The pain was assessed both on admission and 30 minutes after the intervention. The pain intensity and the side effects were compared between two study groups

Results: There was no significant difference between two study groups regarding the baseline characteristics. The intensity of pain of presentation was almost similar in all groups. In group A, 30 patients [75%], in group B, 15 patients [37.5%] and in group C, 19 patients [47.5%] had complete pain relief. The pain intensity decreased significantly after the intervention within all three groups [p<0.001]

Conclusion: According to the results of the current study, rectal indomethacin, intramuscular tramadol and intranasal desmopressin are effective and safe routs of controlling pain in acute renal colic secondary to urolithiasis. Tramadol was the most effective agent in controlling the pain

Sympathetic Skin Response in Patients with Vascular Erectile Dysfunction

PURPOSE: We aimed to investigate the utility of sympathetic skin response (SSR) test for evaluating vasculogenic erectile dysfunction (ED) which is the most common type of impotence. MATERIALS AND METHODS: Men in the age group of 28 to 60 years and suffering from vasculogenic ED, as confirmed by a papaverin test and color Doppler sonography, at least for 6 months referred from our university urology department were included. We used the International Index of Erectile Function (IIEF-5) for grading severity of dysfunction and recorded the SSR of every patient from the median, tibial, and dorsal nerves of the penis. One-way analysis of variance (ANOVA), independent t-test and Pearson's correlation coefficient were used for comparing quantitative variables, and Fisher's Exact test was used for comparing qualitative variables. The Mann-Whitney U Test and the Kruskal-Wallis test were performed for analysis of data that were not normally distributed. A p value of less than 0.05 was considered significant. RESULTS: Forty-two patients were recruited for the study. We found a strong statistical relationship between the IIEF score and the pathologic SSR registered from every mentioned nerve. Patients with abnormal SSR had more severe ED according to IIEF score (p<0.001). In addition, the IIEF score had a significantcorrelation with diabetes mellitus and cardiovascular disease (t-test; p<0.05). CONCLUSIONS: Our results confirmed the presence of autonomic dysfunction in patients with vasculogenic impotence via an SSR test. We suggest evaluating the efficacy of the SSR test in patients with vascular impotence for treatment response monitoring in future studies.

Neurologic Complications in Percutaneous Nephrolithotomy

PURPOSE: Percutaneous nephrolithotomy (PCNL) has been the preferred procedure for the removal of large renal stones in Iran since 1990. Recently, we encountered a series of devastating neurologic complications during PCNL, including paraplegia and hemiplegia. There are several reports of neurologic complications following PCNL owing to paradoxical air emboli, but there are no reports of paraplegia following PCNL. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who had undergone PCNL in 13 different endourologic centers and retrieved data related to neurologic complications after PCNL, including coma, paraplegia, hemiplegia, and quadriplegia. RESULTS: The total number of PCNL procedures in these 13 centers was 30,666. Among these procedures, 11 cases were complicated by neurologic events, and four of these cases experienced paraplegia. All events happened with the patient in the prone position with the use of general anesthesia and in the presence of air injection. There were no reports of neurologic complications in PCNL procedures performed with the patient under general anesthesia and in the prone position and with contrast injection. CONCLUSIONS: It can be assumed that using room air to opacify the collecting system played a major role in the occurrence of these complications. Likewise, the prone position and general anesthesia may predispose to these events in the presence of air injection.

CTLA-4 Exon one +49 A/G gene variants in patients with superficial and invasive bladder cancer: a study in southern Iran

Cytotoxic T-cell lymphocyte antigen 4 [CTLA-4] is a member of the superfamily of immunoglobulins that are mainly expressed by activated T cells. It is established that blockade of CTLA-4 receptors leads to the enhancement of an immune response. Different polymorphisms of the CTLA-4 gene have been described which cause increased susceptibility to various malignancies such as lymphoma or multiple myeloma. Considering that bladder cancer is one of the most prevalent cancers worldwide, we have evaluated the role of CTLA-4 gene polymorphism at position +49 A/G in the formation or progression of bladder cancer in southern Iran. A total of 226 individuals between February 2005 and June 2006 were included and placed into two subgroups: patients diagnosed with bladder cancer and a control group. Demographic data and risk factors were collected from both groups. The DNA of all subjects was extracted from their blood samples. Different genotypes of the CTLA-4 gene were determined using the restriction fragment length polymorphism [RFLP] technique and data were compared in both groups by using Pearson's chi-square test. The prevalence of AA, AG and GG genotypes at position 49, according to the PCR-RFLP method, were 57.5%, 37.2% and 5.3% in the control group, respectively. In the patient group, the prevalence of these genotypes was: AA in 57.5%, AG in 32.7% and GG in 9.8%. Statistical analysis of data showed no significant difference in both groups [P value=0.40]. Also there was no correlation between different genotypes of the CTLA-4 gene and invasiveness of the disease in our cases. Although polymorphism of the CTLA-4 gene at position 49 of exon-1 increases susceptibility to several malignancies, our study showed no relationship between polymorphism at this position and genetic susceptibility to the development of bladder cancer, nor was there any association with disease progression

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

Laparoscopic adrenalectomy ten-year experience, 67 procedures

The purpose of this study was to evaluate the short-term and long-term results of laparoscopic adrenalectomies carried out in our center. A total of 67 laparoscopic adrenalectomies were performed during the 10 years between 1995 and 2005 at Shahid Labbafinejad Medical Center. A transperitoneal lateral approach was used in 65 [97.0%] of the patients, and retroperitoneal approach was used in 2 [3.0%]. The clinical characteristics and the outcomes were reviewed in a retrospective study. Indications for laparoscopic adrenalectomy in our patients were as follows: pheochromocytoma in 28 patients [41.8%], aldosterone-producing adenoma in 15 [22.4%], pseudocyst in 6 [9.0%], Cushing syndrome [macronodular adrenocortical hyperplasia] in 5 [7.5%], nonfunctioning adenoma [incidentaloma] in 5 [7.5%], myelolipoma in 2 [3.0%], almost normal adrenal tissue in 2 [3.0%], adrenal cyst in 2 [3.0%], adenocarcinoma in 1 [1.4%], and schwannoma in 1 [1.4%]. The mean operative time for unilateral cases was 149.0 A +/- 36.1 minutes. The mean intraoperative blood loss was 126 A +/- 36 mL. Conversion rate to open surgery was 7.5%. Reoperation due to hemorrhage was performed in 1 patient. Laparoscopic adrenalectomy is a safe procedure in some adrenal tumors and a reasonable option for selected large adrenal tumors when complete resection is technically feasible and there is no evidence of local invasion