Impact of varicocelectomy on urine dopamine value in patients with premature ejaculation and varicocele.

Dopamine is an important regulator of male sexual function and behaviour. Decreased levels of this substance have been observed in blood and seminal plasma of infertile men. Hence, this study was carried out to determine the impact of varicocelectomy on 24-hr urine dopamine values in patients with both premature ejaculation (PE) and varicocele. In this prospective study, 55 consecutive patients with premature ejaculation and grade 2 or 3 varicocele were enrolled. The urine dopamine level was measured in a 24-hr sample by HPLC method in a single laboratory centre. Two samples were gathered from each patient, one before and the other 1 month after varicocelectomy. The mean initial and final 24-hr urine dopamine levels were 259.6 ± 86.3 and 602.9 ± 88.4 micrograms, respectively, showing statistically significant increase (p = .0001), while there was no statistically significant difference between urine volume and creatinine. However, the change in intravaginal ejaculation latency time value was not statistically significant at this short time visit. According to our findings, varicocelectomy results in a significant increase in 24-hr urine dopamine levels in patients with premature ejaculation and varicocele. However, the effect of this change on premature ejaculation in the long term has yet to be determined.

Effect of Irrigation Solution Temperature on Complication of Percutaneous Nephrolithotomy: A Randomized Clinical Trial.

PURPOSE: Many factors affecthypothermia and shivering during percutaneous nephrolithotomy and in recovery.Hence this study was carried out to determine the effect of irrigation solution temperature on complications ofpercutaneous nephrolithotomy. MATERIALS AND METHODS: In this randomized clinical trial, 60 patients undergoing PCNL in Sina University Hospitalwere enrolled. The patients were randomly assigned in three groups according to simple random manner. Thegroups included three groups of room temperature fluid (24 degree), warm solution (37 degree), and cold fluid (20degree) during nephroscopy. RESULTS: Although the initial core temperature was alike across the groups (P > .05); the hypothermia rate occuredin all 20 patients in the cold fluid group (P = .012). There was significant difference between the groups interms of final temperature and alteration amount (P = .001). The mean VAS scores were significantly lower in thewarm fluid group compared with the others groups at recovery, and 8hrs post-operatively (P = .03). Assessmentof shivering rates revealed that 3(15%) patients in warm solution group shivered compared to8 (40%) patients incold fluid group (P = .018). CONCLUSION: Warm irrigation solution during PCNL results in significantly decreased hypothermia, mean postoperativepain score and shivering. Hence use of warm irrigation fluid for this matter is recommended.

Totally tubeless percutaneous nephrolithotomy is feasible in morbidly obese patients.

OBJECTIVE: Regarding technical difficulties that obese body habitus might impose to percutaneous nephrolithotomy (PNL) success and higher risk of peri-operative complications in this group of patients, we decided to retrospectively gather data from our patients during past 8 years to determine the stone free and complication rates. MATERIAL AND METHODS: Between January 2007-December 2015, seventy-eight obese patients with body mass index over 35 who had indication for PNL including stones larger than 2 cm in pelvi-calyceal system or smaller extracorporeal shock wave lithotripsy (ESWL) resistant stones or who were not a fit candidate for ESWL due to increased skin to target distance, with no contraindication of PNL (including bleeding diathesis, inability to be positioned in prone) were enrolled. They were randomly assigned to group 1 (standard PNL with nephrostomy and ureteral stent) or group 2 (totally tubeless PNL with no ureteral stent and no nephrostomy). The outcomes were compared. RESULTS: The transfusion rate, operation time, and the hemoglobin drop were same across the groups (p>0.05). Total analgesic use was equivalent of 33.8 vs. 14.7 mgs of morphine sulfate (18-77 mg) and was significantly lower in total tubeless group (p=0.001). Return to normal activity was described as total number of in-patient and outpatient days from time of admission to the point which the patients returns to normal life activity such as going to job or school and was 19.4 vs. 9.3 days (6-30 days, p=0.001). CONCLUSION: Totally tubeless PNL in obese subjects would have lower analgesic use and return to normal activity versus standard PNL. Totally tubeless PNL is recommended for obese patients.

Effect of tubeless percutaneous nephrolithotomy on early renal function: Does it deteriorate?

BACKGROUND: The impact of standard percutaneous nephrolithotomy (PCNL) on short or long-term renal function has been evaluated in many studies. We evaluated the effect of tubeless PCNL on early renal function. MATERIALS AND METHODS: A total of 117 patients referring to our university center for PCNL were enrolled in the study if they were matched with the inclusion criteria. Serum creatinine and hemoglobin (Hb) levels were measured before PCNL and 6, 24, 48, and 72 h after the operation. Glomerular filtration rate (GFR) was calculated using Cockroft-Gault formula. RESULTS: There were 79 (67.5%) men and 38 women (32.5%) with the mean age of 49.94 years ranging from 18 to 80 years in the study group. The mean creatinine level elevated in the first 48 h after PCNL but it started to reduce on the 3(rd) day (mean preoperative creatinine level: 1.32 ± 0.18 mg/dL, mean creatinine level after 48 h: 1.59 ± 0.24 mg/dL, creatinine level after 72 h: 1.42 ± 0.21245 mg/dL) (P < 0.0001). GFR values had the same rise and fall pattern as serum creatinine level (mean preoperative GFR: 74.89 mL/min, mean GFR after 48 h: 64.04 mL/min, GFR after 72 h: 69.54 mL/min, P < 0.0001). PCNL also affected blood Hb level. The mean preoperative Hb level was 15.06 ± 0.87 g/dL and it significantly decreased to 13.09 ± 1.06 g/dL after the operation (P < 0.0005). CONCLUSIONS: Tubeless PCNL like standard PCNL decreases GFR in the very early postoperative days. It is recommended that factors that might have a negative impact on renal function during first few days after PCNL be avoided.

One shot tract dilation for percutaneous nephrolithotomy: is it safe and effective in preschool children?

OBJECTIVE: To evaluate the safety and feasibility of percutaneous tract dilation by the one-stage method in preschool children. METHODS: Between April 2009 and February 2013, all preschool (<6 years) children who were candidates for percutaneous nephrolithotomy were enrolled in this prospective study. Patients were randomly assigned to dilation by serial metallic dilators (group I, 31 patients) or dilation by one-stage Amplatz according to Frattini et al. [J Endourol 2001;15:919-923] (group II, 31 patients). The primary endpoint of interest was fluoroscopy time. Secondary endpoints included tract creation and dilation time, success rate and complications. Stone-free status was defined as residuals ≤3 mm. RESULTS: Age, stone size, operation success and operation time were not significantly different between the studied groups. The most common stone composition was calcium oxalate in both groups. The mean ± standard deviation of access and fluoroscopy times in groups I and II were 7.3 ± 1.2 min vs. 5.9 ± 1.5 min (p > 0.05) and 70.0 ± 8.9 s vs. 22.0 ± 5.6 s (p < 0.001), respectively. Postoperative complications included one case of postoperative fever lasting less than 48 h in group I. CONCLUSIONS: Percutaneous tract dilation by the one-stage method is safe and effective. Also, it is associated with considerably less radiation exposure in preschool children.

Ureterocele associated with renal agenesia presented as a pelvic mass in an adult.

Adult ureteroceles are generally known as simple ureteroceles with minimal obstructive effects 1 that can usually be managed endoscopically. Such pathology presented with acute abdominal pain and fever in a 32-year-old man with left renal agenesia, a cranial blind left ureter and left obstructed ureterocele. The retained secretions were suppurative.

Role of frenular web preservation on ejaculation latency time.

Premature ejaculation (PE) is one of prevalent male sexual dysfunctions worldwide. Despite many psychiatric backgrounds, yet there are speculations about organic etiologies considering both anatomic and physiologic points of view. This survey assesses effect of frenular web preservation on premature ejaculation. One thousand and forty otherwise healthy men being visited for urolithiasis (asymptomatic patients) were asked for PE according to the International Society of Sexual Medicine definition criteria as intravaginal ejaculation latency time (IELT) less than a minute according to stop watch checked by patients' partner and were examined for presence of frenular web. Frenular web defined as a residual of frenulum after a circumcision. Overall prevalence of PE was 18.2% (n=102). We found the presence of frenulum at physical examination in 255 out of 560 (45.5%). Prevalence of PE was 20.7% (n=53) and 16% (n=49) in patients with frenular web preserved and without it, respectively. PE was higher among the men with frenulum preserved; but no statistically significant differences were seen (P=0.70). We did not find any relationship between frenular web and PE, and concerns about this, during circumcision, may not be justified. PE is a not only a problem of local anatomical condition but many psychological and neurological factors could interact with it.

A 75-year old man complaining of flank pain and obstructive urinary symptoms: a case report.

Benign renal cystic adenoma with out malignant features is a very rare entity. A 75 year old male with obstructive Lower tract symptoms and vague flank pain was admitted and planned for nephrectomy of non functional kidney -due to long term nephrolithiasis- intra operative finding was a cystic hydronephrotic kidney filled by thick mucous secretions which turned out to be a cyst adenoma of kidney with no malignant features.

Role of sexual intercourse in hematuria and proteinuria in males and females.

OBJECTIVE: A probable association has been proposed between sexual intercourse and hematuria and proteinuria in either sex. The present study was to assess the role of sexual intercourse in hematuria and proteinuria in immediate dipstick urine test and morning urine sample analysis and whether sexual intercourse might be a cause of microscopic hematuria and proteinuria. MATERIAL AND METHODS: Forty-two healthy married adult volunteers (27 male and 15 female; age range 20-48) were enrolled in a prospective clinical trial. Immediately after sexual intercourse urine samples were analyzed regarding hematuria and proteinuria with a dipstick, and the next morning samples for standard urinalysis. For categorical data analysis Fisher's exact test was utilized. p < 0.05 was considered significant. RESULTS: Proteinuria immediately after intercourse was significantly higher in males (88.9 vs. 13.3%, p < 0.001) but females showed significant higher hematuria (73.3 vs. 22.2%). None of the women developed hematuria and/or proteinuria in morning after urinalysis samples but males indicated significant proteinuria (33.3 vs. 0%, p = 0.02). CONCLUSIONS: Proteinuria and hematuria following sexual intercourse are gender-dependent, and temporally related to the timing of the testing and sexual activity. Testing the urine in the morning following intercourse may give false-positive protein results in men, but there is no evidence of false-positive hematuria in women unless the activity immediately precedes the testing.

Impact of fasting on shockwave lithotripsy in renal stones: a randomized controlled trial.

PURPOSE: We evaluated the impact of fasting on the effectiveness of shockwave lithotripsy (SWL) in patients with renal calculi. PATIENTS AND METHODS: The study was a randomized controlled trial for patients with renal stones. Between May 2005 and November 2006, patients (n = 97) with a single radio-opaque renal stone (7-21 mm) who were candidates for SWL were enrolled. Patients were randomized to fasting (F, n = 49) and nonfasting (NF, n = 48) groups. F group patients were asked to fast for 12 hours before SWL. Urine specific gravity (SG) was measured after fasting. All patients were monitored every 2 weeks until complete stone clearance. Treatment effectiveness was defined as complete clearance up to 3 months. RESULTS: There were 32 men in the F group and 28 men in the NF group. The mean age was 37.9 +/- 8.5 years in the F group and 39.1 +/- 7.7 years in the NF group. The mean body mass index was 22.8 +/- 2.5 and 23.1 +/- 2.6 in F and NF patients, respectively. The urine SG in the F group (1.036 +/- 0.004) was significantly higher than in the NF group (1.013 +/- 0.004; P < 0.001). At 3-month follow-up, the overall stone-free rate using SWL was 86.1% in the F group, which was higher than the rate of 72.9% in the NF group; however, the difference was not statistically significant (P = 0.16). CONCLUSION: Fasting significantly changes the urine SG but does not have a significant impact on the effectiveness of SWL for isolated renal stones.

Changes in intrarenal resistive index following electromagnetic extracorporeal shock wave lithotripsy.

INTRODUCTION: Our aim was to study the changes in resistive index (RI) of the ipsilateral and contralateral kidneys following electromagnetic extracorporeal shock wave lithotripsy (SWL) of the kidney calculi. MATERIALS AND METHODS: Using color Doppler ultrasonography, the RI was determined in 21 patients with unilateral caliceal and pelvic kidney calculi. The RI of the interlobar renal arteries were measured for the regions near and far from the calculi (distance, less and more than 2 cm), before, 30 minutes after, and 1 week after SWL. The same measurements were carried out for the contralateral kidney. Changes in the RI values and their relation with age were evaluated. RESULTS: The RI near the calculi increased 30 minutes after SWL from 0.594 +/- 0.062 to 0.620 +/- 0.048 (P = .003; 95% confidence interval, 0.020 to 0.073), but returned to the pre-SWL values 1 week later. The RI values of the region remote from the calculus and in the contralateral kidney did not change significantly. There was a weak correlation between age and the RI far from the calculus before and 1 week after SWL. There were no relationships between the RI and age, sex, weight, blood pressure, and smoking. CONCLUSION: The results suggest that SWL of the kidney calculi changes the RI only near the calculus which is immediate, transient, and not age-related.

Treatment of ureteral calculi with ballistic lithotripsy.

BACKGROUND AND PURPOSE: Ballistic lithotripsy is one of the new intracorporeal lithotripsy methods. In this study, the efficacy and complications of this method in the management of ureteral calculi were evaluated. PATIENTS AND METHODS: From November 1999 to December 2001, 340 patients (mean age 39.8 years; range 1.5-82 years) with a total of 362 ureteral calculi (bilateral in 22 cases) were treated with an 8.5F rigid ureteroscope and the Swiss Lithoclast. Of the calculi, 115 (32%) were located in the upper ureter, 63 (17%) in the middle ureter, and 184 (51%) in the lower ureter. The mean stone size was 10.4 mm (range 5-22 mm). RESULTS: Nearly all (344; 95%) of the calculi were accessible with the ureteroscope, and 321 calculi (88.7%) were fragmented completely, either with no residual fragments or with residual fragments <3 mm. In 3 cases (0.8%), there were residual fragments of about 4 mm after the procedure that passed spontaneously. Twenty calculi (5.5%) migrated to the kidney during the procedure and were subsequently treated with adjuvant SWL. Major complications occurred in 2 cases (0.54%): ureteral perforation and stenosis in 1 patient each. The 2-week stone-free rate was 89.5% (324/362). CONCLUSION: Lithoclast ballistic lithotripsy is a safe and effective approach for the treatment of ureteral calculi regardless of composition.