Evaluation of postoperative bleeding control employing Surgicel: a clinical trial.

INTRODUCTION: Various techniques have been developed for the rapid control of bleeding as a potential surgical complication. Research shows that the Surgicel has a significant effect on reducing bleeding in most surgeries; however, in our experimental observations on patients undergoing open prostatectomy, not only no significant reduction was seen in the amount of bleeding, but in some cases, Surgicel led to infection. Therefore, in this study, the effect of the Surgicel on infection and bleeding in open prostatectomy was investigated. MATERIALS AND METHODS: Thirty patients undergoing open prostatectomy were randomly divided into two groups. To control bleeding after suturing the bladder neck, the Surgicel was installed in the first group, while it was not in the second group. Hemoglobin, hematocrit, PT, PTT, INR, bleeding rate, and postoperative complications were evaluated in all patients. RESULTS: In the studied groups, hemoglobin level and hematocrit percentage before surgery and on the first and second days after surgery, along with coagulation status, were compared in terms of PT, PTT, and INR. There were no significant differences between the studied variables and baseline variables. CONCLUSION: The present study revealed that the Surgicel in open prostatectomy was ineffective in controlling bleeding and can lead to infection.

One-layer macroscopic verus two-layer microscopic vasovasostomy: Our experience in two referral hospitals.

OBJECTIVE: Vasovasostomy is the most common surgery to restore the fertility of vasectomized men. This study aimed to compare the outcomes of one-layer macroscopic VV (MOLVV) or two-layer microscopic VV (TLMVV). METHODS: This study was performed on the medical records of 100 patients who underwent VV surgery in two tertiary hospitals from 2014 to 2017. All patient information, including demographic and sperm analysis, was collected. The chi-square test, independent t-test, and survival analysis using Kaplan-Meyer test and Cox regression were performed to analyze the data using SPSS software version 25, and the significance level was considered 0.05. RESULTS: The fertility rate in patients of both groups was 15%. The findings showed a statistically significant difference between the mean percentage of normal sperm morphology according to the type of surgery (p = 0.045). There was no statistically significant difference between the mean sperm count, sperm motility percentage, and mean hospital costs according to the type of surgical procedure (p > 0.05). The incidence of spouse pregnancy in the TLMVV method after 15 and 24 months was 87.5% and 58.3%, respectively. In patients with unilateral anastomosis, the incidence of pregnancy at 13 and 15 months after surgery was 98.7% and 95.8%, respectively. The mean and median time of pregnancy in the spouses of patients with each surgical shower were 24 and 25 months. Other variables had no significant effect on spouse pregnancy. CONCLUSION: Vasovasostomy with the one and two-layer methods had equal results. The number, movement, and normal morphology of sperm after surgery were low. Therefore, these people will need assisted reproductive techniques.

Percutaneous Drainage with Injection of Ethanol as the Sclerosing Agent for Treatment of Simple Kidney Cysts: A New Modification.

Introduction: The simple kidney cyst is the most common type of benign kidney tumor in adults and it is usually asymptomatic. Symptomatic cysts are treated with percutaneous aspiration with or without sclerosing agent injection, laparoscopic decortication, or open surgery in rare cases. Considering the probable complications of anesthesia in open surgery and laparoscopic methods, we used an innovative method of percutaneous aspiration, insertion of a single J draining catheter for 24 hours, and injection of sclerosing agents, leaving the agent inside the cyst, while the catheter was removed immediately. Long-term results of this method were evaluated using sonography. Materials and Methods: Twenty-eight patients with symptomatic kidney cysts underwent the process of insertion of the percutaneous catheter and aspiration of its contents in two steps and a one-time injection of 95% ethanol. After the first aspiration, patients stayed admitted for 24 hours. Then, the second aspiration was performed and the total fluid volume was measured. Patients were then followed for a mean follow-up period of 14 months. The procedure was considered effective with no signs of relapse (consistent with reduced size of cysts) in a sonographic evaluation of long-term results. Results: Among all the patients, 23 (82.14%) showed positive results in the sonographic evaluation after 14 months. Death occurred in one patient (3.6%), not attributable to the procedure, and recurrence was observed in five patients (17.9%). Conclusions: Our study showed that this method is safe, effective, and minimally invasive in treating simple kidney cysts and can be a proper substitute for the other current methods.

Penile Rehabilitation Strategy after Nerve Sparing Radical Prostatectomy: A Systematic Review and Network Meta-Analysis of Randomized Trials.

PURPOSE: Despite the advances in nerve sparing and minimally invasive radical prostatectomy, erectile dysfunction remains an important adverse event after radical prostatectomy. Penile rehabilitation strategies have been developed to expedite and improve erectile function recovery. However, the differential efficacy and the best penile rehabilitation strategy are unclear as yet. We conducted a systematic review and network meta-analysis to investigate and compare the efficacy of different penile rehabilitation strategies. MATERIALS AND METHODS: A systematic search was performed in May 2020 using PubMed® and Web of Science™ databases according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) extension statement for network meta-analysis. Studies that compared the erectile function recovery rate and adverse events between penile rehabilitation treatment groups (eg medications, devices and actions) and control group were included. We used the Bayesian approach in the network meta-analysis. RESULTS: A total of 22 studies (2,711 patients) met our eligibility criteria. Out of 16 different penile rehabilitation strategies and schedules vs placebo, only pelvic floor muscle training (OR 5.21, 95% CrI 1.24-29.8) and 100 mg sildenafil regular doses, ie once daily or nightly (OR 4.00, 95% CrI 1.40-13.4) were associated with a significantly higher likelihood of erectile function recovery. The certainty of results for 100 mg sildenafil regular dose was moderate, while pelvic floor muscle training had low certainty. The sensitivity analysis confirmed that the regular high dose of phosphodiesterase-5 inhibitors regardless of type vs placebo (OR 2.09, 95% CrI 1.06-4.17) was associated with a significantly higher likelihood of erectile function recovery with a moderate certainty. The on-demand doses of phosphodiesterase-5 inhibitors were not proven to be more beneficial than placebo. Secondary outcomes such as adverse events were not analyzed due to incomplete data in the literature. However, no serious adverse events were reported in any of the studies. CONCLUSIONS: Sildenafil 100 mg regular dose is the best penile rehabilitation strategy to improve erectile function recovery rates after radical prostatectomy. Although pelvic floor muscle training has been shown to be effective in increasing the erectile function recovery rate, well designed randomized controlled trials with larger sample sizes are needed to confirm the presented early results. The on-demand dose of phosphodiesterase-5 inhibitors should not be considered as a penile rehabilitation strategy.

Ramadan Fasting and Kidney Stones: A Systematic Review.

PURPOSE: Ramadan fasting in Muslims may contain several hours of abstaining from food and drinking in any kind. This can potentially increase the risk of urinary stone disease. Current literature on possible effects of Ramadan fasting on urolithiasis is rather limited. Having the gap in scientific background, we decided to evaluate the available comparative information in this systematic review. MATERIALS AND METHODS: We included all studies comparing fasting and non-fasting conditions, studies evaluating stone formation and clinical manifestations of kidney stone disease. All the English studies published from January 1980 to the end of 2019 were included. The exclusion criteria were as followed: fasting out of Ramadan, non-comparative studies, animal studies, patients with bladder stones, and studies evaluating conditions that are only indirectly related to the stone formation or clinical manifestations of it. Applying the Joanna Briggs Institute (JBI) methodology for systematic review showed the quality of included studies was not high. RESULTS: Only five studies remained after exclusion. Meta-analysis was not applicable due to the diversity in methods and evaluated population. CONCLUSION: Main trend of the included studies is toward showing no difference between fasting and non-fasting conditions in terms of renal stone formation. However, generalization of the findings to greater populations should be applied carefully considering the heterogeneity of results and quality of studies.

Effect of tranexamic acid on gross hematuria: A pilot randomized clinical trial study.

OBJECTIVE: Local forms of the tranexamic acid have been effective in treating many haemorrhagic cases. So that the aim of the current study is to assess the effectiveness of local tranexamic acid in controlling painless hematuria in patients referred to the emergency department. METHODS: This is a randomized, double-blind clinical trial study, which was conducted on 50 patients with complaints of painless lower urinary tract bleeding during June 2014 and August 2015. The patients were randomly divided into two groups of 25 people each, one group receiving tranexamic acid and the other given a placebo. During bladder irrigation, local tranexamic acid and the placebo were injected into the bladder via Foley catheter. Patients were examined over 24h in terms of the amount of normal saline serum used for irrigation, level of hemoglobin, and blood in urine. RESULTS: In this study it was observed that consumption of tranexamic acid significantly decreased the volume of used serum for bladder irrigation (P=0.041) and the microscopic status of urine decreased significantly in terms of the hematuria after 24h (P=0.026). However, the rate of packed cell transfusion and drop in hemoglobin levels showed no significant difference in both groups of patients (P˃0.05). CONCLUSION: The results of this study showed that tranexamic acid could significantly reduce the volume of required serum for bladder irrigation to clear urine, but it had no significant effect on the drop in serum hemoglobin levels.

Prevalence of diabetes mellitus after extra corporeal shock wave lithotripsy in 15 years follow-up.

OBJECTIVE: To investigate the hypothesis that extracorporeal shock wave lithotripsy (ESWL) increases the risk of new onset diabetes mellitus (DM) or significant changes in fasting blood sugar (FBS). MATERIALS AND METHODS: A total number of 307 patients enrolled in this study. All of them had undergone ESWL for kidney stone from 1991 to 1994. In 2009, after 15-19 years, we invited patients to check their blood sugar. RESULTS: There were 307 patients, 19.8% females, and 80.1% males. The mean age of the patients was 44 for females and 42 years for males. 47.5% had kidney stone in the left side, 42.9% in the right side and 9.4% bilateral. The mean FBS increasing was 11.86 g/dl. It was 14.54 g/dl for the right side, 8.57 g/dl for left and 16.24 g/dl for bilateral ESWL. DISCUSSIONS: The increasing of FBS is more significant in shock wave intensities higher than 15.5 KV. And there wasn't any significant relationship between age, sex, body mass index (BMI) and total number of shock waves with increasing of FBS. ESWL treatment might associate with increasing FBS without any relation to age, sex and BMI.

The Comparison of Apotel plus Low Dose of Morphine and Full Dose of Morphine in Pain Relief in Patients with Acute Renal Colic.

BACKGROUND: Renal colic is an acute flank pain which may radiate to the groin, lower abdomen, or external genitalia due to the passage of a urinary stones. Pain management is the most important task in emergency wards when a patient with renal colic attends. This study aims to compare intravenous acetaminophen plus a low dose of morphine with a full dose of morphine in renal colic. METHODS: In present randomized clinical trial, 100 patients with confirmed renal colic were recruited from the Emergency Ward of Imam Reza Teaching Hospital affiliated to Tabriz University of Medical Sciences, Iran, during a one-year period. These patients randomly received either intravenous acetaminophen (Apotel, 1 g) plus a low dose of morphine (n = 50), or a high dose of morphine (5 mg) (n = 50). Visual analogue scale (VAS) was used for reporting pain during 35 minutes. Side effects and rescue analgesic demand were recorded after 30 minutes. FINDINGS: The two groups were matched for the patients' age and gender. Intra-group analysis showed significant gradual decreases in pain intensity after 35 minutes for both groups. Inter-group analysis, however, did not show a significant difference between the two groups in this regard. There was no significant difference between the two groups in terms of side effects. The rate of rescue analgesic demand was 36% in the first and 40% in the second group (P = 0.68). CONCLUSION: According to the results study, Apotel plus a low dose of morphine is at least as effective and safe as a full dose of morphine in patients with renal colic.

Opioid-sparing effect of intravenous paracetamol after percutaneous nephrolithotomy: a double-blind randomized controlled trial.

PURPOSE: To evaluate meperidine-sparing effect of intravenous (IV) paracetamol in patients undergoing percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: One hundred patients who underwent PCNL were randomized to paracetamol (n=50) and placebo (n=50) groups. Patients received 100 mL of physiologic saline with or without 1 g IV paracetamol every 8 hours after PCNL up to 24 hours in the paracetamol and placebo groups, respectively. Patients in both groups received intramuscular meperidine in case of unrelieved pain. The visual analog scale (VAS) was used to evaluate pain intensity scores in the postoperative period. Total meperidine consumption, mean VAS score in the first 6 and 24 hours, demographic variables, operative variables, and side effects were recorded. RESULTS: The mean VAS pain intensity scores at 6 and 24 hours were 50.22 and 41.32 mm in the paracetamol and 75.29 or 65.5 mm in the placebo group (P<0.001). The mean consumed meperidine dose was 54.40 mg and 77.60 mg in the paracetamol and placebo groups, respectively (P<0.001). CONCLUSION: In this study, IV paracetamol significantly reduced total meperidine consumption and pain intensity scores compared with placebo. IV paracetamol can be an effective and safe part of multimodal analgesia regimes for postoperative pain management after PCNL.

Percutaneous nephrolithotomy in horseshoe kidney: our 5-year experience.

PURPOSE: To review our 5-year experience in percutaneous nephrolithotomy (PCNL) for horseshoe kidney with large stone burden or failed shockwave lithotripsy (SWL). MATERIALS AND METHODS: During 5 years (2006 to 2011), PCNL was performed on 21 patients with horseshoe kidney stone. We evaluated patients (age and gender), stones characteristics (size, number, side, and site), surgical technique, and outcomes. RESULTS: Sixteen (76.16%) subjects were men and 5 (23.80%) were women, with the mean age of 35 ± 12 years. Mean stone size was 37.2 ± 16.6 mm. Percutaneous nephrolithotomy was performed because of the stone size (over 20 mm) in 18 (85.68%) and failed SWL in 3 (14.28%) subjects. Stone numbers were more than one in 18 (85.68%) subjects, and were in the pelvis and at least one calyx. The most common access site was superior posterior calyx (66.64%). Stone-free rate with single session and rigid nephroscope was 71.40%. No major complication occurred during the surgery or in post surgical period. Postoperative minor complications occurred in 3 (14.28%) patients, including transfusion in one (4.76%), fever in one (4.76%), and ileus in one (4.76%) subject. CONCLUSION: Percutaneous nephrolithotomy has acceptable results in horseshoe kidney stone and is feasible with rigid nephroscope. Safety and efficacy of PCNL resembled the normal anatomy kidney in our study.

Percutaneous nephrolithotomy in patients with previous open nephrolithotomy: one-shot versus telescopic technique for tract dilatation.

BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy (PCNL) can be done in patients who have previously had open nephrolithotomy. Currently, dilatation of the nephrostomy tract is achieved using an Amplatz renal dilator or telescopic metal dilators in these patients. The aim of this study was to compare the safety and efficacy of the "one-shot" procedure in patients with previous open nephrolithotomy with those of the current telescopic technique. PATIENTS AND METHODS: Thirty-one patients with past history of open surgery for kidney stone disease underwent PCNL at our institution from February 2006 to March 2007. Patients were randomly divided into two groups according to dilation technique used: group A (telescopic procedure) and group B (one-shot procedure). X-ray exposure, blood loss, and complications were evaluated. RESULTS: No significant difference in hemoglobin decrease was seen in the two groups. The stone-free and complication rates were the same in the two groups. Fluoroscopy time during the one-shot procedure was significantly shorter than that of the telescopic procedure (P < 0.000). CONCLUSION: Our experience indicated that the one-shot procedure is feasible in patients with previous open nephrolithotomy. It is as safe and effective as the telescopic procedure, with significant reduction in x-ray exposure.

Treatment of ureteral stones: A prospective randomized controlled trial on comparison of Ho:YAG laser and pneumatic lithotripsy.

OBJECTIVES: To study the treatment of ureteric stones by HO:YAG laser lithotripsy and pneumatic lithotripsy and to evaluate the results of the two treatment modalities to assess effectiveness and complications. MATERIALS AND METHODS: Over 1-year period, a total of 79 patients with 82 ureteral stones were randomized into two groups. In group 1 (39 cases with 41 ureteral stones) ureteroscopic HO:YAG laser lithotripsy was performed using a rigid 8 Fr-ureteroscope (LL group). In group 2 (40 cases with 41 ureteral stones) pneumatic lithotripsy was performed in like manner. Efficacy safety and complications in both groups were analyzed. RESULTS: A total of 79 patients with 82 calculi were treated. Two cases in LL group and one in PL group had bilateral ureteral stones. Mean stone size was 12.07 mm in LL group and 10.2 mm in PL group. Stones located in lower ureter in 30 cases on LL group and 29 cases in PL group. Proximal migration of stone occurred in 1 case on LL group and in 3 cases on PL group. Successful fragmentation occurred in 37 cases on LL group and in 30 cases on PL group. Stone-free rate after 1 month in the base of Kidney Ureter Bladder (KUB) and sonography was 95% in LL group and 80.5% in PL group. Ureteral perforation, urinoma, and urosepsis were not seen in both groups. CONCLUSION: HO:YAG laser has advantages over PL in high efficacy of stone fragmentation and a low-retrograde migration of ureteral stone treatment. Other complication of ureteral stone treatment with LL and PL are the same and very rare.

Uroflowmetry findings in patients with bladder outlet obstruction symptoms in standing and crouching positions.

INTRODUCTION: Bladder emptying in crouching position is a conventional way in many eastern countries. Our aim was to evaluate uroflowmetry parameters as an index of obstruction severity in standing and crouching positions and comparison of them in patients with bladder outlet obstruction symptoms. MATERIALS AND METHODS: Uroflowmetry in standing and crouching positions was done in 83 patients with bladder outlet obstruction symptoms due to benign prostatic hyperplasia (BPH). The patients were 50 years old or older and their maximum flow rate in standing position was less than 15 mL/s. The maximum flow rate, average flow rate, maximum flow time, and postvoid residual urine volume were measured and recorded. The results in standing and crouching positions were compared. RESULTS: The mean maximum flow rate and mean average flow rate in crouching position increased 86% and 51%, respectively (P < .001; P = .012), while mean maximum flow time and postvoid residual volume decreased 40% and 46%, respectively (P < .001; P < .001). These changes were also significant in patients with maximum flow rates of less than 10 mL/s and 10 mL/s to 15 mL/s in standing position, except for the maximum flow time in the latter group. CONCLUSION: A more complete emptying of bladder in crouching position in patients with BPH can be attributed to the increased bladder pressure due to a good transmission of intra-abdominal pressure and a complete and coordinated relaxation of pelvic floor muscles. This position can help improve patients' symptoms.