Modified unilateral periureteral injection technique in the treatment of patients with high-grade vesicoureteral reflux: A study of primary findings.

Objective: Although endoscopic treatment has been used by many pediatric urologists for the treatment of vesicoureteral reflux (VUR), it has no considerable success in high-grade VUR. We aimed to describe the primary outcomes of unilateral periureteral injection technique (PIT), as well as bilateral PIT in high-grade VUR. Methods: In this prospective study, we examined 92 ureters in 45 boys and 40 girls from February 2010 to May 2018. Bilateral PIT and unilateral PIT were applied in 67 and 25 refluxing units, respectively. In the unilateral PIT, the subureteral injection site was only at the 5- or 7-o'clock position. However, in the bilateral PIT, the subureteral injection sites were at 5- and 7-o'clock position. Pre- and post-operative reflux grades were evaluated by voiding cystourethrography 6 months after surgery. Results: Seven patients had bilateral reflux. Overall, 75 (81.5%) ureters showed Grade IV VUR, while 17 (18.5%) had primary Grade V VUR. The mean age of the subjects was 39.2 months. In unilateral PIT ureters, VUR was resolved in 23 (92.0%) refluxing units. It was downgraded to Grade III in one ureter (4.0%) and to Grade II in another ureter (4.0%). In addition, in bilateral PIT cases, VUR was resolved in 60 (89.6%) ureters; it downgraded to Grades II and III in 3 (4.5%) and 4 (6.0%) refluxing units, respectively. Conclusion: Unilateral PIT can be highly effective in the treatment of selected ureters of high-grade VUR. However, further studies are needed to confirm our results.

Effectiveness of spinal anesthesia combined with obturator nerve blockade in preventing adductor muscle contraction during transurethral resection of bladder tumor.

OBJECTIVE: To determine whether spinal anesthesia combined with obturator nerve blockade (SOB) is effective in preventing obturator nerve stimulation, jerking and bladder perforation during transurethral resection of bladder tumor (TURBT). MATERIAL AND METHODS: In this clinical trial, 30 patients were randomly divided into two groups: spinal anesthesia (SA) and SOB. In SA group, 2.5 cc of 0.5% bupivacaine was injected intrathecally using a 25-gauge spinal needle and in SOB after spinal anesthesia, a classic obturator nerve blockade was performed by using nerve stimulation technique. RESULTS: There was a statistically significant difference between jerking in both groups (p=0.006). During the TURBT, surgeon satisfaction was significantly higher in SOB group compared to SA group (p=0.006). There was no significant correlation between sex, patient age and location of bladder tumor between the groups (p>0.05). CONCLUSION: Obturator nerve blockade by using 15 cc lidocaine 1% is effective in preventing adductor muscle spasms during TURBT.

A unique case of kidney's collecting system MALT lymphoma.

Low-grade B cell lymphomas of mucosa-associated lymphoid tissue (MALT lymphomas) are mostly seen in the gastrointestinal tract. MALT lymphomas involving kidney are extremely rare. We report on a case of MALT lymphomas of the kidney. A 74-year-old woman presented with an episode of gross hematuria and right flank pain. In renal sonography, we found a hypoecho lesion measuring 61 × 58 × 44 mm in the lower pole of right kidney. A computed tomography scan revealed an enlarged hypodense soft tissue measuring 62 × 42 × 37 mm within the pelvic brim of the right kidney, with extension to the proximal portion of the ipsilateral ureter and engulfed it. The patient underwent a right radical nephrectomy. The pathology specimen indicated a lymphoprolifrative disorder involving the kidney and ureter. To obtain a definitive diagnosis, we used an immunohistochemistry, which confirmed the diagnosis of a MALT lymphoma.

Treatment of loin pain suspected to be renal colic with papaverine hydrochloride: a prospective double-blind randomised study.

OBJECTIVE: • To assess the efficacy of papaverine hydrochloride combined with a diclofenac sodium suppository to relieve renal colic compared with diclofenac suppository monotherapy, as the effect of phosphodiesterase inhibitors on ureteric muscles might reduce the pain of renal colic. PATIENTS AND METHODS: • A prospective, double-blind clinical study was performed. • In all, 550 patients aged 17-55 years with acute renal colic were randomised to two groups. Patients in one group (group A) received a diclofenac suppository (100 mg) plus saline 0.9% (placebo) and the other group (group B) received a diclofenac suppository (100 mg) plus intravenous (i.v.) papaverine hydrochloride (1.5 mg/kg up to 120 mg). • Pain intensity was assessed using a visual analogue scale (VAS) at 0, 20 and 40 min after treatment. Further analgesia was provided at the patients' request (25 mg pethidine intramuscularly). RESULTS: • Baseline characteristics (sex, age, past history of similar pains) were similar in the two groups. • There were significant differences in VAS pain scores between 0 and 20 min and 0 and 40 min in both groups (P < 0.001). • At the end of study, 71.1% of patients in group A and 90.9% of patients in group B reported pain relief and did not require pethidine, respectively. • Significantly more patients in group A required further analgesia. CONCLUSIONS: • According to our results, i.v. papaverine hydrochloride plus a diclofenac suppository were more effective than the diclofenac suppository alone for treating acute renal colic. • Therefore, i.v. papaverine hydrochloride is a beneficial supplemental therapy to relieve renal colic pain, particularly combined with non-steroidal anti-inflammatory drugs.

The role of intraprostatic inflammation in the acute urinary retention.

OBJECTIVES: Almost 20% of patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) might also have symptoms of prostatitis. But, the interrelationship between BPH and prostatic inflammation, and how one can influence the other, is under controversy. The aim of our study was to determine the incidence of prostatic inflammation in BPH patients presented with acute urinary retention (AUR). METHODS: This crosssectional study was conducted in a hospital at Guilan, the northern province of Iran. A total of 280 patients undergoing transurethral resection of the prostate (TURP) or open prostatectomy from 1999 to 2002 were enrolled. Histopathologic samples of prostate were examined for existence of acute and/or chronic intraprostatic inflammation (ACI). RESULTS: Overall, 150 (536%) of patients undertook surgery for AUR and 130 (464%) for LUTS. Among them, 130 patients (46.4%) showed ACI in the pathologic examinations whereas 150 patients (53.6%) did not. The patients with AUR were significantly older than those with LUTS. ACI was significantly associated with AUR. The mean prostate weight was significantly higher in AUR group compared the LUTS group. Those patients who showed ACI according to pathologic examinations had heavier prostates than those who did not. The association of ACI and AUR should be considered in secondary prevention for BPH patients. CONCLUSIONS: ACI may increase the degrees of urinary obstruction and AUR.

Celecoxib for treatment of nocturia caused by benign prostatic hyperplasia: a prospective, randomized, double-blind, placebo-controlled study.

OBJECTIVES: Nocturia is a well-recognized symptom of benign prostatic hyperplasia (BPH), which is commonly treated by alpha(1)-blockers and/or 5alpha-reductase inhibitors. However, the effectiveness of these drugs for nocturia has been reported to be only 25%-39%. The aim of this study was to investigate the efficacy of celecoxib, a cyclooxygenase-2 inhibitor, in the treatment of patients with BPH complaining of nocturia. METHODS: This was a prospective, randomized, double-blind, placebo-controlled study. A total of 80 men with lower urinary tract symptoms and BPH were entered into the study and were randomized to receive celecoxib, 100 mg at 9 pm vs placebo for 1 month. The inclusion criteria also included a total International Prostate Symptom Score >8 and complaints of >or=2 voids nightly. The efficacy and safety of the treatment were assessed by changes in the urinary flow and symptoms between baseline and 1 month of follow-up. RESULTS: In the celecoxib group (n = 40), the mean nocturnal frequency (+/-SD) decreased from 5.17 +/- 2.1 to 2.5 +/- 1.9 (P < .0001), and the mean International Prostate Symptom Score (+/-SD) decreased from 18.2 +/- 3.4 to 15.5 +/- 4.2 (P < .0001). In the control group (n = 40), the mean nocturnal frequency (+/-SD) decreased from 5.30 +/- 2.4 to 5.12 +/- 1.9 (P > .05), and the mean International Prostate Symptom Score (+/-SD) decreased from 18.4 +/- 3.1 to 18 +/- 3.9 (P > .05). A statistically significant difference was found between the 2 groups (P < .0001). No statistically significant differences were found in the changes in the peak flow rate between the celecoxib and control groups or in celecoxib group between baseline and 1 month (P > .05). No significant side effects were reported. CONCLUSIONS: Celecoxib is effective in the treatment of patients with BPH complaining of refractory nocturia. Our results suggest a novel treatment option for this common condition.