[Efficacy and safety of herbal drug, Hypericum perforatum in the treatment of premature ejaculation]

Premature ejaculation is the most prevalent form of male sexual dysfunction. Efforts to develop novel drugs safer than existing therapies are continued. Assessment of efficacy of Hypericum Perforatum in the treatment of premature ejaculation. This is the double blind, randomized placebo- controlled study. In this study were selected 50 married men [18-50 years old] who were referred to urology department of Razi hospital in Rasht from 2007 to 2008 with premature ejaculation were selected. These patients were divided to control and cases groups. Hypericum [160mg tablets] were prescribed for case group and placebo for control group. All participants completed IIEF-15 questionnaire before and after treatment. Intra vaginal latency time [IVLT] was measured before and after treatment. The results were analyzed using chi-square and paired t-test. After 4 weeks, there was difference in IVLT between 2 groups. This difference was statically significant [P<0.001]. There was an increase in two variables of the IIEF-15 [Intercourse satisfaction and overall satisfaction] in hypericum perforatum group [p<0.001]. In 3 participants drug was discontinued because of adverse reactions. It seems that hypericum perforatum may be regarded as a safe and effective alternative in the treatment of premature ejaculation

[Survey and comparison of the urinary calcium level in normal and calcium stone forming groups]

Urinary stones are the third common disease in the urinary system. Because there is not any study about Hypercalciuria in normal people and patients with stone in our province [Guilan], we decided to evaluate and compare the level of urinary calcium in normal people and patients with urinary stones. Survey of the urinary calcium level in normal and calcium stone forming groups. This is a descriptive, retrospective study. Our cases were the people who had attended to Razi Hospital outpatient ward during 2004-6 and included 502 people without history of urinary tract stone [group 1], 391 patients with history of an episode of urinary tract stone [group 2] and 109 patients with history of more than one episode of urinary stone [group 3]. We extracted requested information such as age, sex, Urine Ca 24h level, serum Ca level and stone analysis from the files and data analyzed by t-test. The most common stone was Calcium Oxalate [95%]. The mean level of urinary calcium was 156 +/- 7 mg/dl in group 1, 163 +/- 7 mg/dl in group 2 and 183 +/- 5 mg/dl in group 3. There was a significant statistical difference between these 3 groups [p<0.05]. Hypercalciuria is a risk factor for stone formation, so we can use as a protective method to inhibit stone formation

[Survey the addition of sildenafil to alpha- blockers in the management of acute urinary retention related to benign prostatic hyperplasia]

Introduction: acute Urinary Retention [AUR] related to benign prostatic hyperplasia [BPH] is an increasingly prevalent condition in men, and the presenting feature in about 25% of men undergoing prostatectomy

Objective: evaluate the efficacy of sildenafil for treating patients with AUR due lo BPH

Materials and Methods: this is a clinical trial, randomized, double blind study. Eighty patients with AUR related lo BPH randomly assigned to receive either 0.4mg tamsulosine hydrochloride and 25mg sildenafil citrate or 0.4mg tamsulosine hydrochloride and placebo. After 48hours, the catheter was removed and ability to void in each group was assessed. Data were analyzed by SPSS 10 and K 2, T test, P<0.05 was considered significant

Results: differences in age, prostate size and residue was not significant between two groups [p=0.791, p=0.587, p=0.364 respectively]. After catheter removal 22 patients [55%] in placebo group and 32 patients [80%] in sildenafil group voided successfully [p=0.017]. After week 19 men [47.5% ] taking placebo and 28men [70%] taking sildenafil could void yet [p=0.041].The difference 1 between two groups was statically significant [p=0.041]

Conclusion: addition of sildenafil citrate to alpha-blockers is effective in successful voiding after catheter removal for AUR related to BPH. Sildenafil may be recommended for reducing the re-catheterization rate

[Comparison of the complication of PNL with open surgery in patients with renal staghorn stones]

Introduction: open surgery is the gold standard of treating the saghorn calculus which all other forms of treatment are compared with it. New endourological techniques leads to treating staghorn calculus with more effective and less invasive methods

Objective: compare the complication of PNL [percutaneous nephrolithotomy] versus open surgery in staghorn stones

Materials and Methods: in this study 120 patients with staghorn stones who admitted in Razi hospital during September 2005 to September 2007 were considered. The requested information was extracted such as age, sex, treatment method, intraoperative and postoperative complications [including Obstructive uropathy, Massive hematuria, and Wound infection] and hospital stay. The results and complications were compared in patients who underwent PCNL with open surgery and were compared and data were analyzed by T-test and chi- square

Results: we studied 72 patients [60%] underwent PNL and 48 patients [40%] underwent open surgery. We recorded intraoperative complication in 18.8% and 13.9% in PNL and open surgery respectively. The most common intraoperative complication was bleeding requiring blood transfusion. We recorded postoperative complication in 12.5% and 4.2% of patients in PNL and open surgery repectively. Mean hospital stay was 3.93 +/- 1.76 and 5.08 +/- 2.42 day in PNL and open surgery respectively. Stone free rate was 81.9% and 91.6% of patients who underwent PNL of patients and open surgery respectively

Conclusion: PNL is a valuable treatment option for staghorn stones with complication and stone free rate approaching that of open surgery. Moreover, it has advantages such as shorter hospital stay that because it is the first stage in treatment of most patients with staghorn stones

[ case report of adrenal neurofibroma surgical by laparoscopy in Middle East]

Introduction: Now a days, the increased use of abdominal ultrasound and CT scanning has led to the frequent finding of unexpected adrenal masses, which named incideltaloma. Unsuspected adrenal masses have been detected in 0.6-1.3% of upper abdominal CT scan

Case report: The case was a 24 years old woman who had vauge pain in her right flank. In sonography one mass, 5 cm diameter, in retroperitoneoum and right kidney was observed which had shifted renal vein to anterior. In CT scan, one mass, sized 4.6chi 39 mm, in anatomic size of right adrenal with significant enhancement and central hypodensity was observed which had moved renal vein to anterior. The patient underwent transperitoneal laparoscopic adrenalectomy and in pathology, neurofibroma was reported

[ effect of semen analysis factors regarding IUI with male factor infertility]

There is evidence in literature that IUI is the first line treatment and the most cost-effective procedure for mild to moderate male factor sub-fertility, however, the relative influence of various semen characteristics with the likelihood of a successful outcome is controversial. This study is designed to show the correlation between semen parameters and the pregnancy rate in patients, with mild to moderate male factor sub-fertility and whose wives were normal and underwent hyper-stimulation, including IUI. From January 2005 to January of 2006, 95 couples with male factor infertility underwent 140 IUI cycles with husbands washed semen were included in this study .They were divided into two groups based on semen parameters, mild and moderate. Post- wash sperm parameters, type of infertility [primary and secondary], male/ female age and duration of infertility were evaluated and correlated with clinical pregnancy outcome. The clinical pregnancy rate per cycle was 26 [18.5%]; 15 [21.4%] in mild group, while 11[15.7%] in moderate group. The clinical pregnancy rate per couple was 27.3%. There were significant correlation between female age, duration of infertility, sperm concentration and progressive motility, and clinical pregnancy. Our findings suggest that post- wash sperm concentration and progressive motility, female age and duration of infertility are the most important factors for prediction of successful pregnancy

[ study of testis agenesia in patients with undescended testis]

Introduction: Cryptorchidism is one of the most common disorders of childhood. This anomaly occurs when the descent of testis inhibited anywhere along it's normal pathway between kidney and scrotum. There isn't any study about testis agenesia in our region and the picture of the disease may be different in this region. The aim of this study, is to determine more clear picture of this disease in our region and to consider that whether not to use diagnostic laparoscopy in this area can be lead to increased false diagnosis of testis agenesia or not

Material and Methods: This study is descriptive and basis of our study is to refer to hospital archive files, from all patients that admitted during 1996-2003, we found those who had UDT, then all of required data including patient's age, unilateral or bilateral UDT, associated disease, site of UDT, diagnostic procedures, and first symptoms were extracted and then we analyzed this data

Results: Out of 7200 patients that admitted during 1996-2003 yrs, 235 patients had UDT, according to this data the relative frequency of UDT is 3.26%. Regarding to age of patients most patients were in 5-14 y/o [41.3%]. According to associated disease 14% had contralateral UDT, 8.1%had inguinal hernia, 1.7% had hypospadiasis, 6% had hydrocele, 0.9% had torsion of testis and 3% had infertility. Regarding to anatomic site of descent cessation, intracanalicular in 61.4% pts. Superficial inguinal pouch in 16.1% pts, intraabdominal in 14% pts, suprapubic region in 0.9% pts and agenesis of testis in 7.6% pts was found

Conclusion: According to this survey, the relative frequency of UDT was relative common and the most of operated patients are in higher range of age group [5-14yo]. Which shows necessity of public education and also high incidence of testis agenesia [7.6%] suggests using of preoperative diagnostic laparoscopy in patients with nonpalpable testis

[Prevalence of hidden prostate carcinoma]

Introduction: Benign prostate hyperplasia [BPH] is the most common benign tumor in males and a major cause of urinary symptoms in most males over 50. Prostate cancer is the second lethal cancer, after lung cancer, in the males

Objective: In attention to the possibility of occurring incidental carcinoma in BPH patients, in this study we decided to estimate its prevalence in urology centers of Rasht hospitals: Razi, Aria and Golsar

Materials and Methods: In this descriptive cross sectional study, from April 2000 through July 2002, we interviewed all patients who later underwent surgery for BPH and filled out the questionnaire form. The reports of the patients were collected from patients and Rasht pathology centers. Data were analyzed by SPSS.9.0 using chi square test, t- test and fisher exact test. P value less than 0.05 was considered significant

Results: From 1437 patients, 39 patients were excluded from study because their pathology reports were not found, and 1398 patients were enrolled. The mean age of patients was 67.8± 7.8 years [43-91]. Prostate carcinoma was detected in 75 patients [5.4%], and all had adenocarcinoma. Mean age of prostate cancer group was 69.4±8.3 years. Fifty patients [66.7%] were smokers. Familial history of prostatic cancer was negative in all patients in cancer group. In patients with diagnosis of cancer, the major symptoms at admission were irritate symptoms [5.3%], irritate obstructive [94.7%] and none of them had only obstructive signs. The grade of tumor in 62.3% was well differentiated and in 37.7% was moderate differentiated. The mean of PSA in cancer and BPH groups were 8.2±12.7 and 2.6±4.1 mg/ml respectively [P= 0.0001] The kind of operation in 53.1% was TURP and in 46.9% was open prostatectomy. In prostate cancer group, 76% of operations were TURP and in 24% were open prostatectomy

Conclusion: In this study, prevalence of prostate cancer in operated patients with a BPH diagnosis was 5.4% that is similar to other studies

Correlation between HLA system and primary vesicoureteral reflux

The polygenic mode for inheritance of Vesicoureteral Reflux [VUR] is a debutable issue. Our study is aimed to investigate the correlation between HLA system and VUR. Materials: The study included thirty patients with VUR and sixty patients from kidney donors as control group. Initially the HLA formulas of each patient were detected according to racial-geographical distribution as well as common and specific antigens. Then, the Relative Risk [RR] for the class I antigens of the HLA system was calculated and the X2 statistical test was performed for the antigens with RR>1 to establish a significant association between HLA system and VUR. Result: Increased frequency of the genes HLA-A9, HLA-B44 were characterized by statistical analysis [RR>1, X2>3.84]. Therefore, the significant correlation was found between VUR and HLA system [P<0.05]. There are significant correlation between VUR and HLA-A9 and HLA-B44. However, more study is necessary so that these genes may become markers for VUR