Men suffering from category III chronic prostatitis may benefit from N-acetylcysteine as an adjunct to alpha-blockers.

OBJECTIVE: We designed this study to investigate the potential use of N-acetylcysteine (NAC) as an adjunct to alpha-blockers in the treatment of category III chronic prostatitis (CP). METHODS: Sixty-three men with category III CP with a National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score of 15 or more were randomized to either the NAC treatment group or the placebo treatment group. Besides tamsulosin at a dose of 0.4 mg once daily, participants based on their allocation group received NAC or placebo at a dose of 600 mg twice daily for 12 weeks. The efficacy of the medications was assessed by measuring changes in the NIH-CPSI total score and its subscales, including pain, urinary symptoms, and quality of life. RESULTS: Based on the general linear model analysis of the data, over the 12-week treatment, NAC+tamsulosin was statistically superior to placebo+tamsulosin in reducing the total NIH-CPSI score, pain subscore, and quality-of-life subscore (P value <.001). Further, after 12 weeks, more patients in the NAC+tamsulosin group than in the placebo+tamsulosin group met the responder criterion, defined as a decrease of at least 6 points in the NIH-CPSI total score (65.6% vs 29.0%). A more favorable outcome was also noted in the NAC+tamsulosin group regarding the number of patients reporting moderate or marked improvement in symptoms (62.5% vs 25.80%). No significant difference was seen between the groups concerning changes in urinary symptoms. CONCLUSIONS: Our study provided clinical evidence that men with category III CP might benefit from NAC treatment. Further studies are needed for the validation of these findings.

Proximal ureteral reconstruction using renal capsule flap: a canine experimental model.

INTRODUCTION: The aim of this article was to evaluate the effectiveness of using the renal capsule in ureteral reconstruction in a canine model. MATERIAL AND METHODS: Ten clinically healthy male adult dogs were used in this study. Dogs underwent ureteral reconstruction using a tube-shaped flap of the renal capsule. RESULTS: All but one animal (90%) survived till nephrectomy and thereafter. At 30 days after operation, the double-J stent was removed from the ureter, and at the 60th day, intravenous pyelography confirmed openness of the duct. The internal surface of the tunneled flap was coated with thick, folded urothelium. Maturing granulation tissue and angiogenesis as well as fiber producing fibroblasts were observed in the lamina propria. The presence of smooth muscle cells beneath the lamina propria indicated complete reconstitution of the damaged ureter. CONCLUSIONS: The results showed that the autologous renal capsular flap provided a practical option for treating ureteral defects in dogs with an acceptable outcome. So, using the selfsame renal capsular tissue is a feasible method for restoration of the injured proximal ureter.

Percutaneous Nephrolithotomy Versus Laparoscopy in the Management of Large Proximal Ureteral Stones: The Experience of Two Different Settings.

PURPOSE: This study was conducted to compare the success rate and complications of percutaneous nephrolithoto-my (PCNL) and laparoscopic ureterolithotomy for the treatment of large proximal ureteral stones. MATERIALS AND METHODS: In this prospective cohort study, the success rate and complications in 52 patients under-going PCNL in Hamadan's Shahid Beheshti Hospital and 55 patients undergoing laparoscopic ureterolithotomy in Tehran's Shahid Labbafinejad Hospital were compared. All patients had large proximal ureteral stones. RESULTS: In the PCNL group, the mean age was 47.78 ±16.72 years, 75% were male, and 50% of calculi were on the upper right side and the rest on upper left side. The mean duration of surgery was 32 ± 9.4 minutes and success rate 100%. The mean stone size was 18.33 ± 2.63 mm in PCNL group and 21.29 ± 2.18 mm in laparoscopy group which was significantly different (P <.001). In the laparoscopy group, the mean age of patients was 42.92 ± 16.10 years and 83.6% were male. In this group, 46.6% of calculi were on the right side and the rest were on the left side. The mean duration of surgery was 107.43 ± 22.86 minutes and success rate was 100%. There was not a statistically significant association between surgical technique and age, gender, stone location, mean hospital stay length after surgery, degree of hydronephrosis and success rate (P >.05). However, surgery duration was significantly shorter in the PCNL group compared to the laparoscopy group (P <.001) and the decrease in hemoglobin, hematocrit and serum urea level was more pronounced in the PCNL group than in the laparoscopy group. CONCLUSION: PCNL and laparoscopic ureterolithotomy met with the same success rate in the treatment of upper large ureteral stones. However, the two methods should be utilized depending on the hospital facilities and equip-ment, surgical team qualifications, and patient conditions.

Does intraperitoneal injection of propofol prior to detorsion improve testes weight and histopathological findings in a rat model?

OBJECTIVES: To determine the long-term preventive effects of intraperitoneal propofol on testicular ischemia-reperfusion injury in a rat model. MATERIALS AND METHODS: Forty adult male albino Wistar rats were divided randomly into the following four groups according to the planned treatment (n=10 per group): group I, control; group II, sham-operated; group III, torsion/detorsion (T/D); and group IV, T/D plus propofol. Testicular ischemia was achieved by twisting the left testis 720° clockwise (ie, applying torsion) for 1 h. In the T/D plus propofol group (group IV), 50 mg/kg propofol was administered intraperitoneally 30 minutes before detorsion. Ipsilateral orchiectomy was performed under general anesthesia to determine the mean testicular weight and to enable histopathological examination of the testes using Johnsen's mean testicular biopsy score 30 days after the surgical procedure in all groups. RESULTS: The testicular weights in groups I, II, III, and IV were 1.65±0.32, 1.59±0.33, 1.11±0.56, and 1.08±0.50 g (mean ± SD), respectively. Testicular weight was significantly lower in the T/D groups (III and IV) than in both the control and sham-operated groups (I and II), but there was no improvement in testicular weight as a result of propofol administration. Similarly, Johnsen's mean testicular biopsy score was lower in groups III and IV than in groups I and II, but no positive effect was conferred by the administration of propofol in group IV. CONCLUSION: The use of propofol in the treatment of testicular ischemia-reperfusion injury caused by testis torsion has no significant long-term therapeutic potential.

Comparison of the safety and efficacy of one-shot and telescopic metal dilatation in percutaneous nephrolithotomy: a randomized controlled trial.

Minimizing X-ray exposure during percutaneous nephrolithotomy (PCNL) is challenging. Using the single semirigid dilator, also called "one-shot" or "one-stage" is a good alternative to routine telescopic metal dilators to reduce X-ray exposure. Our aim was to compare the single semirigid one-shot dilator with a telescopic metal dilator in PCNL. The intraoperative status was evaluated in 100 consecutive patients randomly assigned to two equal groups undergoing PCNL either with the one-shot (group A) or telescopic technique (group B). No significant difference in stone burden and location existed between the groups (P > 0.05). The mean age of group A and group B was 44.8 ± 15 and 45.6 ± 14 years, respectively (P = 0.78). The mean operation time was 51.14 ± 40.85 min in group A and 57.00 ± 38.85 min in group B (P = 0.46). The mean X-ray exposure time was 41.2 ± 17 and 48.4 ± 15 s in group A and group B, respectively (P = 0.03). The stone-free rate was 94 % (n = 47) in group A and 84 % (n = 42) in group B (P = 0.10). The mean hemoglobin drop was 1.26 ± 0.09 and 1.44 ± 0.11 g/dl in group A and group B, respectively (P = 0.09). The one-shot technique is feasible, safe, and well tolerated in patients undergoing PCNL. In addition to lack of complications, the method also provides less radiation exposure for urologists and nursing teams.

The effect of adenotonsillectomy on pediatric nocturnal enuresis: a prospective cohort study.

INTRODUCTION: Sleep disorder caused by adenotonsillar hypertrophy has been implicated as a cause of primary and secondary nocturnal enuresis in children. This study was conducted to investigate the effect of adenotonsillectomy on enuresis in children with adenotonsillar hypertrophy. MATERIALS AND METHODS: This prospective cohort study was conducted in Hamadan City in Western Iran, from April 2010 to December 2011. Ninety-seven children aged 3 to 12 years with adenotonsillar hypertrophy who were admitted to Besat Hospital for adenotonsillectomy were evaluated. The primary outcome was the number of incidents of bedwetting (nocturnal enuresis) post-operation compared with pre-operation. Patients were followed-up for 3 months. Data were collected using a questionnaire regarding number of bedwetting incidents, type of enuresis (primary or secondary), and family history of enuresis, as well as results of urine analysis. RESULTS: Of 420 children admitted for adenotonsillectomy, 97 had a positive history of preoperative enuresis, including 42 girls and 55 boys, with mean age of 48 months. The parents of 84 (86.6%) children agreed to participate in the study. Three months after adenotonsillectomy, enuresis had resolved completely in 51 (60.7%) children and had shown relative improvement in 22 (26.2%) children. Enuresis had not improved in the remaining 11 (13.1%) children (P<0.001). CONCLUSION: The results of this study indicate that adenotonsillectomy can improve enuresis in the majority of children with adenotonsillar hypertrophy. However, further evidence based on large multi-center randomized clinical trials is required to confirm these results.