Comparison of the Effect of Hydroalcholic Extract of Alhagi maurorum and Hydrochlorothiazide on Excretion of 4-10 mm Kidney and Ureteral Stones in Adults: A Randomized Prospective Study.

Objective: The prevalence of kidney stones and their complications is high. The review of the literature showed the therapeutic effects of Alhagi maurorum extract on urinary tract stones. This study reviewed the Alhagi plant's hydroalcholic extract's effect on eliminating kidney and ureteral stones compared to hydrochlorothiazide. Materials and Methods: In this randomized prospective study, from March 2019 to September 2021, 80 patients over 18 years of age with kidney stones in the upper ureter with a size of 4-10 mm were divided into two groups based on the block random allocation method. The first group received hydrochlorothiazide tablets (50 mg), and the second group received 1 gram/day of the hydroalcholic areal extract of Alhagi maurorum in a two-divided capsule. The mean size and number of stones, renal function tests, and side effects were checked and compared in both groups before and after the study. Results: Mean age, sex, serum urea level (P=0.351), serum creatinine (P=0.393), stone size (P=0178), and the number of stones (P=0.052) before intervention were similar. After intervention, the size and number of stones diminished, up to 70% in both groups. However, there was not a statistically significant difference between the two groups. Conclusion: The study showed that Alhagi maurorum is as effective as hydrochlorothiazide in treatment of kidney and ureteral stones with no significant complications and is promising.

Evaluation of the Effect of Pentoxifylline on Cisplatin-Induced Testicular Toxicity in Rats.

Chemotherapy is associated with male infertility. Cisplatin (cis-diamminedichloro-platinum (II) (CDDP) as a chemotherapy medication used to treat a number of cancers has been reported to most likely induce testicular toxicity. Administration of antioxidants, such as pentoxifylline (PTX) may reduce some Adverse Drug Reactions (ADRs) of CDDP. Therefore, this study investigated the potentially protective effects of PTX on CDDP-induced testicular toxicity in adult male rats. For this purpose, 42 male rats were randomly divided into 7 groups. The rats were orally pretreated with PTX at the 3 doses of 75, 150, and 300 mg/kg once a day for 14 successive days. On the 14th day of the study, they were intraperitoneally (IP) administered with a single dose of CDDP (7 mg/kg). Finally, the sperm/testis parameters, serum levels of reproductive hormones, including testosterone, Luteinizing Hormone (LH), and Follicle Stimulating Hormone (FSH) as the pivotal endocrine factors controlling testicular functions, and histopathological changes of testis tissue were examined. Pretreatment with the two doses of 75 and 150 mg/kg PTX indicated significant increases in the sperm count and motility induced by CDDP administration. The right and significantly left testis weights were decreased following the treatment with 300 mg/kg of PTX plus CDDP. However, 75 mg/kg of PTX plus CDDP showed the best near-to-normal histopathological features. The results demonstrated that PTX alone enhanced some parameters, such as the sperm count, while reducing other parameters, including sperm fast motility and germ layer thickness. Furthermore, despite testosterone or LH levels, the mean serum FSH level was significantly augmented by the doses of 75 and 150 mg/kg. It was concluded that PTX administration cannot reduce CDDP-induced testicular toxicity even at high doses (e.g., 300 mg/kg), while it seemed to partially intensify CDDP toxicity effects at a dose of 75 mg/kg. Thus, further research is required in this regard.

Effects of hydrophilic extract of Nasturtium officinale on prevention of ethylene glycol induced renal stone in male Wistar rats.

BACKGROUND: Nasturtium officinale is a traditional herb that is used for diuresis. OBJECTIVES: The aim of this study is to determine the effects of hydrophilic extract of Nasturtium officinale on ethylene glycol-induced renal stone in male Wistar rats. MATERIALS AND METHODS: In this study 32 male Wistar rats were randomly divided in six groups and studied during 30 days. Two groups of negative and healthy control received 1% ethylene glycol in water respectively. Low and high dose preventive groups, in addition to 1% ethylene glycol, daily gavaged with 750 mg/kg and 1.5 g/kg of extract respectively. All rats were hold in metabolic cages individually in days 0, 15 and 30 and 24-hour urine samples were collected and checked for urinary parameters of stone formation. In 30th day, rats were anesthetized with ether, and after taking serum sample from them, were sacrificed and their kidneys were sent for pathological evaluation and for presence and volume of calcium oxalate crystals. RESULTS: Percentage of calcium oxalate crystals in negative control groups (75%), preventive groups with low dose (28.6%) and high dose (57.1%) in comparison to healthy control group (12.5%) increased (P < 0.05). In 30th day urinary oxalate concentration in preventive and negative control groups were more than healthy control group (P < 0.05). CONCLUSIONS: This research showed that the Nasturtium officinale extract has no significant effects in urinary and chemical parameters efficient in calcium oxalate stone crystals in rat but its extract in low dose has some preventive effect on renal stone formation.

General versus spinal anesthesia in percutaneous nephrolithotomy.

PURPOSE: To compare efficacy and complications of spinal anesthesia versus general anesthesia in percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: In a prospective randomized study, 110 patients were randomly assigned into two groups for PCNL; group 1 (n = 52) underwent general anesthesia and group 2 (n = 58) received spinal anesthesia. In group 1, PCNL was performed using standard technique under general anesthesia. In group 2, spinal anesthesia was done by injecting bupivacaine and fentanyl in spinal space L4 in sitting position. Thereafter, a urethral catheter was placed in lithotomy position, head of the bed was tilted down for 5 to 10 minutes, and the level of anesthesia was checked. Then, PCNL was done by standard technique. Complications were recorded and analyzed by SPSS software using Chi-Square and Student's t tests. RESULTS: Mean stone size in groups 1 and 2 was 34.2 ± 9.8 mm and 31.3 ± 7.9 mm, respectively. Intra-operative hypotension and postoperative headache and low back pain were more in spinal group than the general group with a significant difference (P < .05). No neurologic complication was observed in both groups. Need to narcotic medications on the day of operation in groups 1 and 2 was 12.4 ± 3.1 mg and 7.8 ± 2.3 mg of morphine sulphate, respectively (P = .03). The cost of anesthetic drugs was 23 ± 3.7 US $ and 4.5 ± 1.3 US $ in groups 1 and 2, respectively (P = .001). CONCLUSION: Spinal anesthesia with combined bupivacaine and fentanyl is a safe, effective, and cost-effective method for performing PCNL in adult patients.

Results and complications of spinal anesthesia in percutaneous nephrolithotomy.

INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for large kidney calculi, staghorn calculi, and calculi that are multiple or resistant to shock wave lithotripsy. In many centers, PCNL is performed under general anesthesia. However, complications under spinal anesthesia can be less frequent. We evaluated the impact of spinal anesthesia on intra-operative and postoperative outcome in patients undergoing PCNL. MATERIALS AND METHODS: The intra-operative and postoperative anesthetic and surgical outcomes were evaluated in 160 consecutive patients who underwent PCNL under spinal anesthesia in the prone position. RESULTS: The mean age of the patients was 40.0 +/-14.3 years, and the mean operative time was 95.0 +/- 37.8 minutes. The mean calculus size was 34.2 +/- 9.8 mm. Ten patients had staghorn calculi (mean size, 4.2 +/- 1.1 cm; mean operative time, 140 +/- 40 minutes). Return of sensory and motor activity took 140.0 +/- 19.7 minutes and 121.0 +/- 23.8 minutes, respectively. During the first part of anesthesia, 18 patients developed hypotension, which was controlled by ephedrine, 10 mg, intravenously. Ten patients (6.3%) needed blood transfusion and 6 complained of mild to moderate headache, dizziness, and mild low back pain for 2 to 4 days after the operation, which improved with analgesics and bed rest. Seventy percent of the patients had complete clearance of calculus or no significant residual calculi larger than 5 mm on follow-up ultrasonography. CONCLUSION: Spinal anesthesia is safe and effective for performing PCNL and is a good alternative for general anesthesia in adult patients.

Prevention of bradycardia by atropine sulfate during urological laparoscopic surgery: a randomized controlled trial.

INTRODUCTION: Cardiac arrhythmias are a well-recognized complication of anesthesia for laparoscopy. The aim of this study was to evaluate the efficacy of atropine sulfate for prevention of bradyarrhythmia during laparoscopic surgery. MATERIALS AND METHODS: Sixty-four candidates for urological laparoscopic surgery were randomly assigned into 2 groups to receive either atropine sulfate or hypertonic saline solution (as placebo), intravenously 3 minutes before induction of anesthesia for the laparoscopic procedure. Then, all of the patients underwent anesthesia intravenous sodium thiopental and atracurium, followed by isoflurane or halothane inhalation. Heart rate and blood pressure were recorded preoperatively in the recovery room, preoperatively in the operation room, after induction of anesthesia, after induction of pneumoperitoneum, and postoperatively. RESULTS: A significant decreasing trend was seen in the heart rates during the operation in patients without atropine sulfate. Nine of 32 patients (28.1%) in this group developed bradycardia, while none of the patients with atropine sulfate prophylaxis had bradycardia perioperatively (P < .001). The mean decreases in systolic blood pressure between induction of anesthesia and pneumoperitoneum were 15.7 +/- 10.2 mm Hg in group 1 and 23.5 +/- 9.8 mm Hg in group 2 (P < .001). The mean decreases in diastolic blood pressure between these two measurements were 8.7 +/- 5.2 mm Hg in group 1 compared to 12.1 +/- 6.2 mm Hg in group 2 (P = .001). CONCLUSION: This study suggests that routine prophylaxis with an anticholinergic agent might be helpful in prevention of sinus bradycardia during urological laparoscopic surgery.

Blind puncture in comparison with fluoroscopic guidance in percutaneous nephrolithotomy: a randomized controlled trial.

INTRODUCTION: Our aim was to evaluate blind puncture in percutaneous nephrolithotomy (PCNL) for decreasing the risk of radiation. MATERIALS AND METHODS: One hundred candidates for PCNL were randomly assigned into 2 groups. Blind access was performed for the patients in group 1 and the standard access using fluoroscopy for those in group 2. In group 1, displacement of the targeted calyx in the prone position was estimated by fluoroscopy comparing to the image on intravenous urography. Puncture of the calyx was attempted 3 cm to 4 cm below the marked site of the targeted calyx with a 30 angle. If the access to the collecting system was felt and urine came out, the site of puncture would be controlled by fluoroscopy. If the access failed, we would repeat puncturing up to 5 times. RESULTS: The mean time to access was 6.6 +/- 2.1 minutes and 5.5 +/- 1.7 minutes in groups 1 and 2, respectively (P = .008). The mean time of radiation exposure was 0.95 +/- 0.44 minutes in group 2. A successful puncture to the targeted calyx was achieved in 50% and 90% of the patients in groups 1 and 2, respectively (P < .001) and a successful calculus removal in 62% and 100% of the patients in groups 1 and 2 (P < .001). CONCLUSION: Although about half of the patients benefited from blind access in our study, this technique can not be solely relied on, and fluoroscopy or ultrasonography should be available for prevention of complications.

Varicocele in brothers of patients with varicocele.

INTRODUCTION: The aim of this study was to evaluate varicocele patients' brothers to determine whether they are at a higher risk of varicocele than the general population of men. MATERIALS AND METHODS: A total of 56 patients with varicocele and their 131 brothers (> 16 years old) were evaluated. The brothers had no complaints of infertility, pain, or cosmetic problems. They were all examined for varicocele. One hundred and fifty men who referred for employment medical examinations were considered as the control group. RESULTS: Of the subjects, 39 (69.6%) had grade III varicocele. Sixty (45.8%) of the brothers had varicocele. The grade of varicocele was III in 16 (26.7%) brothers. In the control group, varicocele was present in 15 (10%) which was grade III in 5 (33.3%). The frequency of varicocele was 4.5-fold greater in the brothers of the patients than the controls (P<.001). Also, the frequency of grade III varicocele was significantly more than grades I and II in the patients in comparison with their brothers and controls with varicocele (P<.001). There was no significant difference in the grades between the controls and the patients' brothers (P=.31). The frequency of bilateral varicocele was not statistically different between the three groups (P=.14). CONCLUSION: Our findings showed that a significant increase is seen in the prevalence of varicocele in the patients' brothers compared to men in the general population, warranting evaluation of the first-degree relatives of men who present with varicocele.

One-stage tract dilation for percutaneous nephrolithotomy: is it justified?

PURPOSE: To assess the feasibility of one-stage acute dilation of the nephrostomy tract with a 30F Amplatz dilator in patients who are candidate for percutaneous nephrolithotomy (PCNL) regardless of whether there is a previous renal scar to make the procedure less time consuming and more cost effective. PATIENTS AND METHODS: The outcomes of one-stage tract dilation for PCNL in 100 consecutive patients with and without a history of ipsilateral open stone surgery (OSS), treated by one surgeon, were examined prospectively. Forty-six patients (group 1) had a history of ipsilateral OSS, and 54 patients (group 2) did not have this history. Demographic data as well as intraoperative information, such as access time and radiation exposure time during access, were recorded. The success of the access technique and its bleeding complications were analyzed between the two groups. RESULTS: By applying a "one-stage" technique, the targeted calix could be entered with a success rate of 93%. There was no difference in the procedural success rate between groups 1 and 2 (93.5% v 92.6%, respectively). All seven failed attempts (7%; three with previous OSS) were managed successfully using an Alken dilator to gain access to the proposed calix in the same session. Previous OSS did not impact access time, radiation exposure time during access, postoperative hemoglobin drop, and bleeding complications. There were no visceral and vascular injuries. CONCLUSIONS: One-stage tract dilation for PCNL is a safe and effective method in almost every adult patient.

Analysis of serum prostate-specific antigen levels in men aged 40 years and older in Yasuj, Iran.

INTRODUCTION: Serum prostate-specific antigen (PSA) is still the simplest marker for early diagnosis and follow-up of prostate cancer. Because racial differences in PSA levels have been found, we performed this study to determine the reference level of serum PSA for men in Yasuj, in southwest Iran. MATERIALS AND METHODS: Men aged 40 years and older who had been referred to any of the Yasuj hospitals for a blood cell count for any reason were randomly selected. Those with a history of prostate cancer, prostatitis, urinary tract infection, bladder outlet obstruction, or transurethral procedures were excluded. Blood samples were taken, and PSA levels were measured. RESULTS: Prostate-specific antigen levels in the 95th percentile were 1.35 ng/mL, 1.85 ng/mL, 3.2 ng/mL, and 4.4 ng/mL for men aged 40 to 49, 50 to 59, 60 to 69, and older than 69 years, respectively. Mean serum PSA levels were 0.7 ng/mL, 0.9 ng/mL, 1.6 ng/mL, and 2.2 ng/mL, respectively. CONCLUSION: A comparison of our results with those from studies in the United States and Japan shows that the reference PSA level in our society is significantly lower than that for white and black Western men, and slightly lower than that for Japanese men. Although we examined men with no history of prostate cancer, cancer was not ruled out by diagnostic test; hence, our results may be overestimated. Further investigations in Iran are warranted.