Comparing the outcomes of papillary and non-papillary access in percutaneous nephrolithotomy.

BACKGROUND: Some publications have recently been released on the safety of non-papillary access (NPA) in percutaneous nephrolithotomy (PCNL) by a Greek group. The purpose of this study was to prospectively examine the outcome of NPA during two years in a referral center. METHODS: This prospective cohort study was conducted on PCNL operations performed from January 2020 to April 2022 in Labbafinejad Hospital. In cases in which obtaining papillary access (PA) was not obtainable after several attempts and NPA was obtained, or in cases in whom after entry to the pyelocalyceal system, a NPA was observed, the cases were categorized in the NPA group (n = 67). The control group (PA) was composed of patients who had undergone PCNL with papillary access with similar stone bulk (n = 67). The primary endpoints of interest were hemoglobin drop and transfusion frequency. The secondary endpoint included: stone free rate (SFR), operation duration, and complications. RESULTS: A total of 134 patients were enrolled during the study period which included 33 female patients (25%). The mean ± SD age of patients was 49.6 ± 13.2 years. The frequency of transfusion and residual stones was not different between NPA and PA groups: 6 (9%) versus 8 (11%), P = 0.29; and 16 (24%) versus 12 (18%), P = 0.26. Likewise, the operation time (87.6 ± 25.8 versus 90.2 ± 22.6 min, P = 0.45), and the frequency of intraoperative and postoperative complications were not different between the NPA and PA groups. CONCLUSION: The results of this prospective study did not reveal a higher frequency of residual stones, transfusion, or complications in the NPA group. Nevertheless, our study is not powered enough to reveal complications of low frequency including delayed bleeding.

Ultrasound-guided percutaneous nephrolithotomy in patients with retrorenal colon: a single-center experience.

BACKGROUND: Retrorenal colon is a risk factor for colonic injury during percutaneous nephrolithotomy (PCNL). Our aim in this study is to report the feasibility and outcomes of ultrasound-guided percutaneous nephrolithotomy in patients with preoperatively known retrorenal colon by cross-sectional imaging. METHODS: In this prospective study, all patients with large renal stones and retrorenal colon in preoperative cross-sectional imaging from September 2020 to January 2022 who were candidates for PCNL were enrolled. Percutaneous access was established by ultrasonography guidance by the freehand method with dilation of the tract by a combination of fluoroscopy and ultrasonography. RESULTS: Of the 1123 patients (Male = 760 and Female = 363) who underwent PCNL, 13 patients (Male = 6 and Female = 7) had retrorenal colon in the preoperative computed tomography. The series included two patients with malrotated kidneys. Complete stone clearance was achieved in 11 patients. Patients were followed up for at least 3 months. No serious postoperative complications were observed during follow-up. CONCLUSION: In selected patients and experienced hands, ultrasound-guided PCNL can be an alternative option for the treatment of patients with large renal stones who have retrorenal colon in cross-sectional imaging.

Our Experience with Totally Ultrasonography-Guided Percutaneous Nephrolithotomy in Children.

Purpose: To present the safety and efficacy of totally ultrasonography-guided percutaneous nephrolithotomy (PCNL) for managing urinary stones in pediatric patients. Patients and Methods: Ten children with a mean age of 5.4 (3-11) years underwent totally ultrasonography-guided PCNL from March 2013 to November 2013. The pyelocaliceal system was punctured with the patient in the prone position by using ultrasonographic guidance, and the tract was dilated using a single-shot dilation technique. All steps of renal access were performed by using ultrasonography; no fluoroscopy was used. PCNL in all cases was performed by using adult instruments. Results: The mean stone size was 28.9±6.7 mm (range 17-35 mm). The mean access time to stone was 4.45±2.25 minutes (range 3-10 min). The mean nephroscopic time was 45.9±17 minutes (range 20-80 min). The stone-free rate was 83%. Mean hospital stay of patients was 3 days (range 2-5 days). No major complications were happened. Only one patient needed ureteral stent insertion because of urinary leakage from the nephrostomy tract. Conclusion: Our experience with totally ultrasonography-guided PCNL using adult size instruments in children revealed proper results and acceptable complications compared with the standard technique of PCNL. Likewise, this alternative method has the advantage of preventing radiation hazard.

The Association Between Gelsolin-like Actin-capping Protein (CapG) Overexpression and Bladder Cancer Prognosis.

PURPOSE: Muscle-invasive bladder cancer (MIBC) is associated with disease progression and metastasis leading to poor prognosis. Current chemotherapy approaches have not adequately increased patient survival. Therefore, in this study, tissue proteome of patients with MIBC was performed to introduce possible protein candidates for bladder cancer prognosis as well as targeted therapy. MATERIALS AND METHODS: After obtaining tumoral and non-tumoral tissues of MIBC patients, and normal bladder tissue of non-bladder cancer patients, two-dimensional gel electrophoresis (2-DE) and liquid chromatography-mass spectrometry (LC-MS/MS) were used to analyze tissue proteome. Gelsolin-like Actin-capping (CAPG) protein was further examined using Real-time PCR and western blot analysis. RESULTS: The 2-DE analysis and LC-MS/MS identified CAPG protein as differentially expressed protein in tumor and non-tumor tissues of bladder cancer compared with normal tissues. Western blot analysis showed the CAPG overexpression in tumor tissues compared with normal tissues in a stage-dependent manner. Correspondingly, Real- time PCR showed a higher mRNA expression in tumoral bladder tissues than normal ones. CAPG mRNA overexpression had significantly a positive relation with tumor size (P = 0.019), the TNM staging (P = 0.001), and tumor differentiation (grade) (P = 0.006). Patients with lower levels of CAPG had higher recurrence-free survival in comparison with patients with higher levels (P = .027). CONCLUSION: CAPG overexpression was correlated with size, stage, grade, and shorter time to recurrence of bladder cancer. Therefore, CAPG overexpression could be related to poor prognosis of bladder cancer. These results suggest that CAPG may be considered as a prognostic factor and also for targeted therapy in bladder cancer. Moreover, it could be concluded that cancerous and noncancerous tissues of MIBC have the same protein expression because 2-DE results showed the CAPG expression in cancer and adjacent cancer tissues of bladder while CAPG was not detectable in normal tissues of bladder.

Genetic Polymorphism of Mismatch Repair Genes and Susceptibility to Prostate Cancer.

PURPOSE: Mismatch repair (MMR) is one of the DNA repair systems that correct mispaired bases during DNA replication errors. Polymorphisms in genes can increase susceptibility to the development of prostate cancer (PCa). In this study, we investigated mutL homolog 1 (MLH1) -93G>A (rs1800734) and mutS homolog 3 (MSH3) (rs26279) polymorphisms with the risk of PCa. MATERIALS AND METHODS: In this study of Iranian population, 175 histopathologically confirmed (PCa) patients and 230 benign prostate hyperplasia (BPH) as the controls were recruited. The genotypes of MLH1 and MSH3 were determined by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) method. RESULTS: There was no significant difference of MLH1 (P = 0.4) and MSH3 (P?=?0.5) genotype distributions among PCa cases and controls. And also patients with PCa were not significant differences compared to those without in stage of cancer, grade of tumor, perineural invasion, and vascular invasion. CONCLUSION: Our results did not show adequate evidence for any significant association of MLH1 and MSH3 polymorphisms and PCa .

Role of the gonadal vessels on the stone lodgment in the proximal ureter: Direct observation during laparoscopic ureterolithotomy.

INTRODUCTION: Previous radiological studies revealed that stones lodge more frequently in the ureterovesical junction (UVJ) as well as the proximal ureter. Factors that prevent stone passage from the proximal ureter are not well studied. AIM: To explore the site of the lodged stones in the proximal ureter with direct observation during laparoscopic ureterolithotomy. MATERIALS AND METHODS: Between November 2014 and February 2015, we included 26 patients including 18 men and 8 women with stones larger than 10 millimeters in the proximal ureter who were candidate for laparoscopic ureterolithotomy. We prospectively recorded the site of the lodged stones in the ureter during laparoscopic ureterolithotomy in relation with the sites of ureteral stenosis as well as the gonadal vessels. RESULTS: Among 26 patients with ureteral stone, in 19 cases stone was found close to the gonadal vein compared with seven cases that stone was in other locations of the ureter (p = 0.02). The characteristics of patients and stones were not different in cases that the stone was close to gonadal vessels compared with other locations. CONCLUSIONS: This study showed that most of the stones lodged in the proximal ureter were in close proximity with gonadal vessels. Gonadal vessels may be an extrinsic cause of ureteral narrowing.

Tubeless versus standard percutaneous nephrolithotomy in pediatric patients: a systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis was designed to evaluate the post-operative outcomes between tubeless and standard percutaneous nephrolithotomy (PCNL) among children. METHODS: Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and meta-analysis that included three trials investigating the outcomes including the length of hospital stay, operation time, hemoglobin decrease, blood transfusion rate, perirenal fluid presence, post-operative fever, stone clearance rate, and the need for a second operation. RESULTS: The patients who underwent tubeless PCNL had shorter length of hospitalization compared to standard PCNLs (mean difference -1.57, 95% confidence interval -3.2 to 0.07, p = 0.06). No significant decrease was detected in hemoglobin after tubeless PCNL compared to standard PCNL (mean difference 0.05, 95% confidence interval -0.03 to 0.13, p = 0.21). There were no significant differences in operation time (p = 0.7), perirenal fluid presence (p = 0.15), post-operative fever (p = 0.72), stone clearance (p = 0.68), and the need for a second operation (p = 0.90). CONCLUSIONS: This study showed no significant difference between tubeless and standard PCNLs in children. However, due to the lack of data, the results should be mentioned prudently. Future randomized trials with more sample sizes and longer follow-ups are warranted.

Association of homeobox B13 (HOXB13) gene variants with prostate cancer risk in an Iranian population.

Background: Prostate cancer is a complex condition in which both genetic and environmental factors concomitantly contribute to the tumor initiation and progression. Recently, HOXB13 has been proposed as a susceptibility gene for prostate cancer. Objective: The present study was conducted to determine the existence of potential variations in HOXB13 gene in Iranian men with prostate cancer (PCa) compared to benign prostatic hyperplasia (BPH) cases. Methods: HOXB13 genetic status was screened in 51 samples, including 21 blood and tissue of PCa cases, and compared to 30 cases affected by BPH using PCR/sequencing. Then, the existence of potential association was investigated between genomic DNA alterations in blood and tissue PCa specimens. Results: Analysis of BPH tissues showed single nucleotide variations c.366C > T (rs) or c.513T > C (rs9900627) in exon 1, but not in exon 2. Evaluation of PCa tissues revealed 2 cases with both synonymous c.366C > T and c.513T > C variants and 2 cases with the synonymous c.366C > T variant in exon 1. The variants c.366C > T and c.513T > C, simultaneously or separately, were found in blood samples of PCa patients. The novel variant c.127A > G in exon 2 was detected in 1 PCa blood sample. Our analysis indicated a significant reciprocal correlation between HOXB13 mutation in the tissue and blood samples of PCa cases (p= 0.02). Conclusion: The variants in exon 2 of HOXB13 may influence the risk of prostate cancer. Also, evaluation of HOXB13 mutation may be considered as a novel marker for screening PCa. Further investigations are warranted to evaluate the clinical significance of HOXB13 in Iranian population.

Comparing the Efficacy and Safety of Ultrasonic Versus Pneumatic Lithotripsy in Percutaneous Nephrolithotomy: A Randomized Clinical Trial.

BACKGROUND: Percutaneous nephrolitotomy (PCNL) is the preferred treatment for large renal stones. There is a need for more comparative data for different lithotripters used in PCNL. OBJECTIVE: To evaluate the comparative safety and efficacy of ultrasonic and pneumatic lithotripsy in patients undergoing PCNL. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted at Labbafinejad University Hospital, Tehran, Iran. A total of 180 patients were selected and divided randomly into two groups: 88 patients to pneumatic and 92 to ultrasonic lithotripsy. INTERVENTION: Standard fluoroscopy-guided PCNL was performed using pneumatic or ultrasonic lithotripsy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary outcome was the procedure success rate. We also evaluated other outcome measures including operation time, stone fragmentation and removal time (SFRT), length of hospital stay, and postoperative complications. We used SPSS software version 18.0 for data analysis. RESULTS AND LIMITATIONS: The two groups were similar in baseline characteristics. There were no significant differences between the groups in stone fragmentation and removal time (p=0.63), stone free rate (p=0.44), and hospital stay (p=0.66). SFRT for hard stones was shorter using pneumatic lithotripsy (p<0.001). By contrast, ultrasonic lithotripsy was associated with a shorter SFRT for soft stones (p<0.001). Postoperative complications were similar in the two groups. A limitation of this study might be the 3-mo follow-up period. CONCLUSIONS: In general, there were no significant differences in the success rate and complications between pneumatic and ultrasonic lithotripsy. SFRT was significantly shorter using pneumatic lithotripsy for hard stones, and ultrasonic lithotripsy for soft stones. PATIENT SUMMARY: We found no significant differences in the success rate and complications of percutaneous nephrolitotomy using pneumatic and ultrasonic lithotripsy. Ultrasonic and pneumatic lithotripsy differed in the time for stone fragmentation and removal for hard and soft stones.

Living related and living unrelated kidney transplantations: A systematic review and meta-analysis.

AIM: To compare the outcomes between related and unrelated kidney transplantations. METHODS: Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and a meta-analysis, which included 12 trials that investigated outcomes including the long-term (ten years), mid-term (one to five years), and short-term (one year) graft survival rate as well as the acute rejection rate. Meta-analyses were performed using fixed and random-effects models, which included tests for publication bias and heterogeneity. RESULTS: No difference in graft survival rate was detected in patients who underwent living related kidney transplantations compared to unrelated (P = 0.44) transplantations after ten years. There were no significant differences between the graft survival rate in living related and unrelated kidney transplantations after a short- and mid-term follow-up (P = 0.35, P = 0.46). There were no significant differences between the acute rejection rate in living related and unrelated kidney transplantations (P = 0.06). CONCLUSION: The long, mid and short term follow-up of living related and unrelated kidney transplantation showed no significant difference in graft survival rate. Also, acute rejection rate was not significantly different between groups.

Association between polymorphisms in TP53 and MDM2 genes and susceptibility to prostate cancer.

Tumor protein 53 (TP53), a tumor suppressor gene, is a vital cellular cancer suppressor in multicellular organisms. Murine double minute-2 (MDM2) is an oncoprotein that inhibits TP53 activity. A number of studies have examined the association of TP53 and MDM2 polymorphisms with the risk of common forms of cancer, but the findings remain inconclusive. The present study aimed to evaluate the impact of the 40-bp insertion/deletion (I/D) polymorphism (rs3730485) in the MDM2 promoter region and the 16-bp I/D polymorphism (rs17878362) in TP53 on the susceptibility of prostate cancer (PCa) in a sample of the Iranian population. This case-control study included 103 patients with pathologically confirmed PCa and 142 patients with benign prostatic hyperplasia. The MDM2 40-bp I/D and TP53 16-bp I/D polymorphism was determined using polymerase chain reaction analysis. The results demonstrated that the MDM2 40-bp I/D polymorphism increased the risk of PCa in a co-dominant inheritance model [odds ratio (OR)=1.88; 95% confidence interval (CI)=1.11-3.19; P=0.023, D/D vs. I/I], while this variant marginally increased the risk of PCa in a dominant model (OR=1.69; 95% CI=1.00-2.83; P=0.051, I/D+D/D vs. I/I). No significant association was observed between the TP53 16-bp I/D polymorphism and PCa. In conclusion, the present study demonstrated that the 40-bp I/D polymorphism in the MDM2 promoter increased the risk of PCa in an Iranian population. Further investigations with diverse ethnicities and larger sample sizes are required to verify these results.

Pri-miR-34b/c rs4938723 polymorphism increased the risk of prostate cancer.

The association studies between miR-34b/c rs4938723 polymorphism and cancer risk showed conflicting results. This study aimed to assess the impact of rs4938723 polymorphism on prostate cancer risk. This case-control study was done on 151 prostate cancer (PCa) patients and 152 benign prostate hyperplasia to examine whether rs4938723 polymorphism in the promoter of pri-miR-34b/c was linked to the carcinogenesis of PCa in a sample of Iranian population. Genotyping of Pri-miR-34 b/c rs4938723 polymorphism was performed by using polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) method. The results showed that rs4938723 variant significantly increased the risk of PCa in codominant (OR = 1.92, 95% CI = 1.15 - 3.18, p= 0.012, TC vs TT), dominant (OR = 1.99, 95% CI = 1.23 - 3.24, p= 0.005, TC + CC vs TT), and allelic (OR = 1.79, 95% CI = 1.20 - 2.68, p= 0.005, C vs T) inheritance model. Our findings propose that Pri-miR-34 b/c rs4938723 variant may be a risk factor for the development of PCa in a sample of Iranian population. Larger sample sizes with different ethnicities are required to validate our findings.

What is the impact of extracorporeal shock wave lithotripsy on semen parameters? A systematic review and meta-analysis.

BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) is an important tool for the management of urolithiasis. The effects of shockwaves on tissues are established. The aim of this meta-analysis is to evaluate the microscopic semen characteristics of young men before and after ESWL treatment for lower ureteral calculi. METHODS: Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and meta-analysis that included six trials that investigated the effects of ESWL on semen parameters, including sperm concentration, motility, and hematospermia. Meta-analyses were performed using fixed and random-effects models with tests for publication bias and heterogeneity. RESULTS: Significant worsening was detected in sperm concentration and motility after ESWL between case and control groups (mean difference -17.23, 95% confidence interval -22.53 to -11.93, p<0.00001, mean difference -10.82, 95% confidence interval -18.56 to -3.07, p = 0.006). Rate of microscopic and macroscopic hematospermia was significantly higher after ESWL between case and control groups [risk ratio (RR) 40.00, 95% confidence interval 10.11-158.30, p<0.00001, RR 14.33, 95% confidence interval 2.82-72.90, p = 0.001]. All parameters recovered after 3 months. CONCLUSIONS: This study showed sperm concentration, motility, and rate of hematospermia (microscopic and macroscopic) were affected by ESWL that was used for the treatment of lower ureteral stone. Long-term studies with a focus on male fertility (i.e., pregnancy rates) after ESWL are warranted.

Laparoscopic Pyelolithotomy in Children Less Than Two Years Old with Large Renal Stones: Initial Series.

PURPOSE: Treatment of pediatric urolithiasis is still on debate. This study was designed to evaluate the safety and efficacy of laparoscopic pyelolithotomy in five children less than two years old. MATERIALS AND METHODS: Five children (less than two years old) with large kidney stones underwent laparoscopic pyelolithotomy. All patients underwent laparoscopic pyelolithotomy via a transperitoneal approach. After medial mobilization of colon and once renal pelvis and ureteropelvic junction were exposed, a longitudinal or circular incision was made on the renal pelvis, depending on the location and shape of the stone. Stones were extracted using an Endobag. Demographic data, size of stones, operation time, duration of hospital stay and stone free rate were assessed. RESULTS: Four boys and a one girl were included in this study. The mean age of patients was 17.6 (range: 13-22) months and the mean duration of operation was 130 (range: 115-145) minutes. The mean size of stone was 24.6 (range: 22-27) mm and the mean duration of hospital stay was 4.4 (range: 4-5) days. Stone free rate was 100%. There was no major complication. CONCLUSION: Even with a small number of patients, our results seem to show that laparoscopic pyelolithotomy could be a treatment option for selected cases of young pediatric cases with large renal stones. We believe that transperitoneal laparoscopic pyelolithotomy is feasible and it introduces a novel approach for managing kidney stones in pediatric population. .

Efficacy and safety of percutaneous nephrolithotomy with adult standard size instruments in children under 3 years of age: a 10 years single-center experience.

BACKGROUND: Using percutaneous nephrolitotomy (PCNL) with large adult instruments in treatment of pediatricurolithiasis is still in debate. This study was conducted to evaluate the efficacy and safety of PCNL with adult's instrument in treatment of patients less than 3 years old. METHODS: Data on patient characteristics and outcomes for 261 consecutive children undergoing PCNL at a Labbafinejad University Hospital were collected prospectively from September 2006 to February 2016. Thirty-two children, with 34 renal units, who were treated with PCNL were enrolled in the study. All PCNL procedures were performed via subcostal approach with one access tract in all of them. Postoperative complications were evaluated according to the modified Clavien grading system. RESULTS: The mean age of patients was 19.4 ± 6.2 months. Two patients had bilateral stones; thus, PCNL was performed on 34 kidney units. The mean size of the largest stone diameter was 17.5 ± 7.8 mm. The mean duration of procedures was 121.52 ± 29.05 minutes, ranging from 60 to 180 minutes. The most common complication was fever (n = 9, 26.4%), and hemorrhage that needs transfusion was the second one (n = 4, 11.7%). Seventeen patients with complications were in the first degree of Clavien complication system and five of them were in the second degree. CONCLUSIONS: Due to our experience, utilizing PCNL with adult-sized instruments in management of urolithiasis in less than 3 years old children appeared to be effective and relatively safe.

Association of XPC Gene Polymorphisms with Prostate Cancer Risk.

BACKGROUND: Defective DNA repair capacity caused by inherited polymorphisms could be associated with cancer susceptibility. One of the major repair pathways is Nucleotide Excision Repair (NER). We investigated Xeroderma Pigmentosum complementation group C (XPC) polymorphisms (Lys939Gln, PAT) with the risk of prostate cancer. METHODS: 154 confirmed prostate cancer patients and 205 Benign Prostate Hyperplasia (BPH) controls were recruited in this survey. The genotypes were determined by PCR-Restriction Fragment Length Polymorphism (RFLP) method. RESULTS: Our results indicated that there were no significant differences between the BPH group and patient group for the XPC Lys939Gln in this pathway. However, deletion/insertion (D/I) and insertion/insertion (I/I) of XPC PAT polymorphism in this pathway could decrease the risk of prostate cancer and act as a protective factor. CONCLUSIONS: In this study, XPC Lys939Gln gene polymorphism was not associated with the risk of developing prostate cancer in Iranian patients. There are no association between different alleles of this polymorphism and grades and stages of tumors, but our results indicated the significant association between XPC PAT and reduction of prostate cancer risk in this group of patients. For more significant results, further samples are required.