Pub Date : 2023-07-04DOI: 10.5812/numonthly-132192
A. Hamidi Madani, Mahmoud Shabanipour, Mohammad Hamidi Madani, Gh R Mokhtari, E. Kazemnezhad, A. Karimi Rouzbahani, Mahshid Abhari Khoshdel
Background: Non-invasive treatments, such as low-intensity extracorporeal shock waves treatment (Li-ESWT), can be a safe and effective alternative for patients with erectile dysfunction (ED) who are resistant to phosphodiesterase type 5 inhibitors (PDE5Is). Objectives: This clinical trial study aimed to evaluate the effect of Li-ESWT on ED in non-responders to PDE5Is, its durability, and factors predicting its success. Methods: This study was conducted on 128 patients with ED who were resistant to PDE5Is. Before any intervention, written informed consent was obtained, demographic characteristics were collected, and the severity of the ED score was determined using the international index of erectile function (IIEF). Patients were treated with Li-ESWT, and ED severity was remeasured by the IIEF scale at the end of the intervention, three months, and six months after the intervention. The data were analyzed by chi-square, repeated measure ANOVA, Bonferroni post hoc, and binary logistic regression tests. Results: A total of 128 patients with ED who had not responded to PDE5Is, with a mean age of 58.35 ± 8.28 and an average ED of 3.41 ± 1.78 years, were included. At the end of the intervention, the IIEF score significantly increased. Moreover, this score was significantly higher three months and six months after the intervention. Three and six months later, the IIEF score decreased significantly. However, the score was significantly higher all three times than before the intervention. Being younger than 60 years, having an ED duration of fewer than three years, being non-smoking, being non-diabetic, and having no lower urinary tract symptoms (LUTS) were the most prominent predictors of a successful ED treatment. Conclusions: Low-intensity extracorporeal shock waves treatment is a safe and effective method for short and long-term treatment of ED patients. Identifying predicting factors can be beneficial for urologists in selecting suitable patients and avoiding the overtreatment of those who are not suitable candidates.
背景：低强度体外冲击波治疗（Li-ESWT）等非侵入性治疗方法，对于对磷酸二酯酶 5 型抑制剂（PDE5Is）耐药的勃起功能障碍（ED）患者来说，是一种安全有效的替代疗法。研究目的这项临床试验研究旨在评估 Li-ESWT 对 PDE5Is 无应答者的 ED 效果、其持久性以及预测其成功的因素。研究方法研究对象为 128 名对 PDE5Is 耐药的 ED 患者。在采取任何干预措施之前，均已获得患者的书面知情同意，收集了患者的人口统计学特征，并使用国际勃起功能指数（IIEF）确定了患者的 ED 严重程度。患者接受了Li-ESWT治疗，并在干预结束、三个月和六个月后使用IIEF量表重新测量了ED严重程度。数据采用卡方检验、重复测量方差分析、Bonferroni post hoc 和二元逻辑回归检验进行分析。结果共纳入128名对PDE5Is无效的ED患者，平均年龄（58.35±8.28）岁，平均ED时间（3.41±1.78）年。干预结束后，IIEF评分明显提高。此外，干预三个月和六个月后，IIEF 分数也明显提高。三个月和六个月后，IIEF 分数明显下降。然而，这三次的得分都明显高于干预前。年龄小于 60 岁、ED 持续时间少于三年、不吸烟、无糖尿病、无下尿路症状（LUTS）是预测 ED 治疗成功的最主要因素。结论是低强度体外冲击波治疗是一种安全有效的短期和长期治疗 ED 患者的方法。找出预测因素有助于泌尿科医生选择合适的患者，避免对不合适的患者进行过度治疗。
{"title":"Low-intensity Extracorporeal Shock Waves for Treatment of Erectile Dysfunction in Patients Not Responding to Phosphodiesterase Type 5 Inhibitors, Its Durability, and Factors That May Influence the Outcome: A Clinical Trial","authors":"A. Hamidi Madani, Mahmoud Shabanipour, Mohammad Hamidi Madani, Gh R Mokhtari, E. Kazemnezhad, A. Karimi Rouzbahani, Mahshid Abhari Khoshdel","doi":"10.5812/numonthly-132192","DOIUrl":"https://doi.org/10.5812/numonthly-132192","url":null,"abstract":"Background: Non-invasive treatments, such as low-intensity extracorporeal shock waves treatment (Li-ESWT), can be a safe and effective alternative for patients with erectile dysfunction (ED) who are resistant to phosphodiesterase type 5 inhibitors (PDE5Is). Objectives: This clinical trial study aimed to evaluate the effect of Li-ESWT on ED in non-responders to PDE5Is, its durability, and factors predicting its success. Methods: This study was conducted on 128 patients with ED who were resistant to PDE5Is. Before any intervention, written informed consent was obtained, demographic characteristics were collected, and the severity of the ED score was determined using the international index of erectile function (IIEF). Patients were treated with Li-ESWT, and ED severity was remeasured by the IIEF scale at the end of the intervention, three months, and six months after the intervention. The data were analyzed by chi-square, repeated measure ANOVA, Bonferroni post hoc, and binary logistic regression tests. Results: A total of 128 patients with ED who had not responded to PDE5Is, with a mean age of 58.35 ± 8.28 and an average ED of 3.41 ± 1.78 years, were included. At the end of the intervention, the IIEF score significantly increased. Moreover, this score was significantly higher three months and six months after the intervention. Three and six months later, the IIEF score decreased significantly. However, the score was significantly higher all three times than before the intervention. Being younger than 60 years, having an ED duration of fewer than three years, being non-smoking, being non-diabetic, and having no lower urinary tract symptoms (LUTS) were the most prominent predictors of a successful ED treatment. Conclusions: Low-intensity extracorporeal shock waves treatment is a safe and effective method for short and long-term treatment of ED patients. Identifying predicting factors can be beneficial for urologists in selecting suitable patients and avoiding the overtreatment of those who are not suitable candidates.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139363263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-27DOI: 10.5812/numonthly-129099
Samaneh Salehipour Bavarsad1, M. Jalali, H. Shahbazian, S. M. Saadati, Saeed Hesam, Narges Mohammadtaghvaie
Background: Numerous equations are applied in order to estimate the glomerular filtration rate (GFR). Objectives: This study aimed to spot the optimal equation that accurately estimates GFR and, therefore, the chronic kidney disease (CKD) stage in renal transplant patients. Methods: This cross-sectional study was conducted on 58 renal transplant patients. Their venous blood samples were obtained for serum creatinine and cystatin C determination used to calculate estimated GFR (eGFR). The average contrast of GFR in each equation was calculated using the Bland-Altman method. The correlation, bias, imprecision, and 10% and 30% accuracy were compared between the eGFR cystatin C and creatinine. Concordance between both equations for CKD staging was assessed. The classification of patients was also investigated. Results: Bland-Altman plots and bias demonstrated that eGFR by the abbreviated modification of diet in renal disease (Ab-MDRD) was the most accurate compared with chronic kidney disease epidemiology collaboration (CKD-EPI) cystatin C, followed by CKD-EPI eGFR creatinine. With reference to CKD-EPI cystatin C, the imprecision of the equations was approximately similar to Ab-MDRD, and CKD-EPI creatinine is still better than the Cockcroft-gault (CG) formula. They also showed good 30% accuracy. Finally, our finding suggested that Ab-MDRD and CKD-EPI eGFR creatinine might be the best-performing equation in the classification of the CKD stages in a cutoff of 60 mL/min/1.73 m2. Conclusions: Due to the high cost and potential delay in measuring cystatin C, it would be much more appropriate to measure Ab-MDRD; after that, CKD-EPI eGFR creatinine as an alternative approach in order to facilitate rapid clinical decision in renal transplant patients.
{"title":"Performance of Creatinine and Cystatin C-Based Equations to to Estimate Kidney Function in Renal Transplant Recipients","authors":"Samaneh Salehipour Bavarsad1, M. Jalali, H. Shahbazian, S. M. Saadati, Saeed Hesam, Narges Mohammadtaghvaie","doi":"10.5812/numonthly-129099","DOIUrl":"https://doi.org/10.5812/numonthly-129099","url":null,"abstract":"Background: Numerous equations are applied in order to estimate the glomerular filtration rate (GFR). Objectives: This study aimed to spot the optimal equation that accurately estimates GFR and, therefore, the chronic kidney disease (CKD) stage in renal transplant patients. Methods: This cross-sectional study was conducted on 58 renal transplant patients. Their venous blood samples were obtained for serum creatinine and cystatin C determination used to calculate estimated GFR (eGFR). The average contrast of GFR in each equation was calculated using the Bland-Altman method. The correlation, bias, imprecision, and 10% and 30% accuracy were compared between the eGFR cystatin C and creatinine. Concordance between both equations for CKD staging was assessed. The classification of patients was also investigated. Results: Bland-Altman plots and bias demonstrated that eGFR by the abbreviated modification of diet in renal disease (Ab-MDRD) was the most accurate compared with chronic kidney disease epidemiology collaboration (CKD-EPI) cystatin C, followed by CKD-EPI eGFR creatinine. With reference to CKD-EPI cystatin C, the imprecision of the equations was approximately similar to Ab-MDRD, and CKD-EPI creatinine is still better than the Cockcroft-gault (CG) formula. They also showed good 30% accuracy. Finally, our finding suggested that Ab-MDRD and CKD-EPI eGFR creatinine might be the best-performing equation in the classification of the CKD stages in a cutoff of 60 mL/min/1.73 m2. Conclusions: Due to the high cost and potential delay in measuring cystatin C, it would be much more appropriate to measure Ab-MDRD; after that, CKD-EPI eGFR creatinine as an alternative approach in order to facilitate rapid clinical decision in renal transplant patients.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44590985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-21DOI: 10.5812/numonthly-133605
Ishwar Ram Dhayal, Shivani Shah
Introduction: Malignant peripheral nerve sheath tumor (MPNST) of the kidney is an uncommon neoplasm. We present a rare case of MPNST successfully managed by surgical intervention. Case Presentation: A 23-year-old male patient presented with dull aching pain in the right flank associated with hematuria. On examination, an abdominal mass with firm consistency occupied the right lumbar quadrant with the fullness of the right renal angle. Contrast-enhanced computed tomography (CECT) showed heterogeneously hypoenhancing lobulated mass (9.2 × 6.4 × 7.6 cm) arising exophytically from the anterior cortex of the middle and lower poles of the right kidney with necrosis. It was compressing the pelvicalyceal system causing mild hydronephrosis. Kidney function tests revealed normal results. Urine cytology for malignant cells was negative. The patient underwent an open radical nephrectomy. Renal mass was adhered to ascending colon and duodenum and was abutting the liver. The histopathological report suggested malignant peripheral nerve sheath tumors with margins microscopically clear of tumor cells. S-100 and Vimentin were stained positively. The patient has been under regular follow-up (every three months) for the last year. Conclusions: If feasible, wide local excision is considered the preferred approach, as prognosis mainly depends on the completeness of surgical resection.
{"title":"A Case of Malignant Peripheral Nerve Sheath Tumour of the Kidney","authors":"Ishwar Ram Dhayal, Shivani Shah","doi":"10.5812/numonthly-133605","DOIUrl":"https://doi.org/10.5812/numonthly-133605","url":null,"abstract":"Introduction: Malignant peripheral nerve sheath tumor (MPNST) of the kidney is an uncommon neoplasm. We present a rare case of MPNST successfully managed by surgical intervention. Case Presentation: A 23-year-old male patient presented with dull aching pain in the right flank associated with hematuria. On examination, an abdominal mass with firm consistency occupied the right lumbar quadrant with the fullness of the right renal angle. Contrast-enhanced computed tomography (CECT) showed heterogeneously hypoenhancing lobulated mass (9.2 × 6.4 × 7.6 cm) arising exophytically from the anterior cortex of the middle and lower poles of the right kidney with necrosis. It was compressing the pelvicalyceal system causing mild hydronephrosis. Kidney function tests revealed normal results. Urine cytology for malignant cells was negative. The patient underwent an open radical nephrectomy. Renal mass was adhered to ascending colon and duodenum and was abutting the liver. The histopathological report suggested malignant peripheral nerve sheath tumors with margins microscopically clear of tumor cells. S-100 and Vimentin were stained positively. The patient has been under regular follow-up (every three months) for the last year. Conclusions: If feasible, wide local excision is considered the preferred approach, as prognosis mainly depends on the completeness of surgical resection.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44617330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-17DOI: 10.5812/numonthly-134095
F. Allameh, S. Hosseininia, Abas Khoshnamak, F. Sodeifian, Houman Teymourian
Background: Evidence shows that spinal anesthesia can alter the penile length and penile engorgement and the fact that patients undergoing spinal anesthesia may experience erectile dysfunction. We hypothesized that spinal anesthesia would not result in altered penile length; however, it can lead to temporary erectile dysfunction. Methods: A total of 73 patients referred to our hospital for endoscopic urological surgeries underwent either spinal anesthesia (SA, n = 37) or general anesthesia (GA, n = 36). We measured patients’ penile length in both stretched and flaccid states during surgery and compared changes in penile length between the SA and GA groups. We assessed erectile function in patients through a standard questionnaire one month and three months after the surgery. Results: No significant difference was observed in penile length during and two weeks after surgery between the SA and GA groups (P > 0.05). Regarding erectile function, we observed a significant difference in the international index of erectile function (IIEF)-5 score between the two study groups one-month after surgery (P < 0.05). However, there was no significant difference between the SA and GA groups three months after the surgery. Spinal anesthesia had no significant effect on penile length during and two weeks after surgery compared to general anesthesia. Conclusions: Patients undergoing SA may experience transient erectile dysfunction one month after surgery; however, they may develop transient erectile dysfunction, which is recovered three months after surgery.
{"title":"The Effect of Spinal Anesthesia on Penile Length and Erectile Function in Patients Underwent Endoscopic Urological Surgeries: A Double-Blinded Randomized Clinical Trial","authors":"F. Allameh, S. Hosseininia, Abas Khoshnamak, F. Sodeifian, Houman Teymourian","doi":"10.5812/numonthly-134095","DOIUrl":"https://doi.org/10.5812/numonthly-134095","url":null,"abstract":"Background: Evidence shows that spinal anesthesia can alter the penile length and penile engorgement and the fact that patients undergoing spinal anesthesia may experience erectile dysfunction. We hypothesized that spinal anesthesia would not result in altered penile length; however, it can lead to temporary erectile dysfunction. Methods: A total of 73 patients referred to our hospital for endoscopic urological surgeries underwent either spinal anesthesia (SA, n = 37) or general anesthesia (GA, n = 36). We measured patients’ penile length in both stretched and flaccid states during surgery and compared changes in penile length between the SA and GA groups. We assessed erectile function in patients through a standard questionnaire one month and three months after the surgery. Results: No significant difference was observed in penile length during and two weeks after surgery between the SA and GA groups (P > 0.05). Regarding erectile function, we observed a significant difference in the international index of erectile function (IIEF)-5 score between the two study groups one-month after surgery (P < 0.05). However, there was no significant difference between the SA and GA groups three months after the surgery. Spinal anesthesia had no significant effect on penile length during and two weeks after surgery compared to general anesthesia. Conclusions: Patients undergoing SA may experience transient erectile dysfunction one month after surgery; however, they may develop transient erectile dysfunction, which is recovered three months after surgery.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48814306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-11DOI: 10.5812/numonthly-129810
A. Farazi, M. Keshvari, M. Tavakkoli, M. Najaf Najafi, A. Ebrahimi, Anahita Ghazaghi, Maryam Noorbakhsh, Hamidreza Rahimi
Background: Interstitial cystitis (IC) is a chronic, debilitating bladder disease that primarily affects middle-aged women and significantly affects their quality of life. Bladder hydrodistention is the usual therapeutic and diagnostic procedure, but symptoms tend to relapse. Adding hyaluronic acid to hydrodistention has been shown to improve the outcomes. Objectives: To compare the therapeutic effects of bladder hydrodistention alone or with intravesical cystistat (40 mg of sodium hyaluronate in a 50 mL vial) in treating IC/bladder pain syndrome (IC/BPS). Methods: This randomized controlled clinical trial was conducted in Imam Reza Hospital of Mashhad in 2017. Twenty-four female IC/BPS patients were selected using clinical examinations and the O`Leary-Sant IC questionnaire to evaluate treatment effects. Patients with a history of other diseases related to the urogenital system and urination frequency less than eight times a day were excluded. The control group (n = 12) underwent hydrodistention under general anesthesia, and the intervention group (n = 12) received intravesical cystistat in addition to hydrodistention weekly for four weeks, followed by monthly for two months. Results: In the control group, the mean baseline score of the questionnaire was 33.2 ± 1.9 and reached 33.9 ± 2.6 after three months, showing no significant change. In the intervention group, the mean baseline score of the questionnaire was 32.6 ± 3.6 and reached 6.4 ± 12.4 at the end of the third month, which indicates a significantly better improvement (P < 0.001). In this study, the disease symptoms resolved in 83.3% of the intervention group after three months of treatment, while the controls did not improve. Conclusions: Based on our study, intravesical instillation of cystistat is effective in treating patients with IC/BPS and has significantly better effects than hydrodistention alone.
{"title":"Short-term Outcomes of Hydrodistention with Intravesical Hyaluronic Acid (Cystistat®) Versus Hydrodistention Alone for Treating Interstitial Cystitis: A Randomized Controlled Trial","authors":"A. Farazi, M. Keshvari, M. Tavakkoli, M. Najaf Najafi, A. Ebrahimi, Anahita Ghazaghi, Maryam Noorbakhsh, Hamidreza Rahimi","doi":"10.5812/numonthly-129810","DOIUrl":"https://doi.org/10.5812/numonthly-129810","url":null,"abstract":"Background: Interstitial cystitis (IC) is a chronic, debilitating bladder disease that primarily affects middle-aged women and significantly affects their quality of life. Bladder hydrodistention is the usual therapeutic and diagnostic procedure, but symptoms tend to relapse. Adding hyaluronic acid to hydrodistention has been shown to improve the outcomes. Objectives: To compare the therapeutic effects of bladder hydrodistention alone or with intravesical cystistat (40 mg of sodium hyaluronate in a 50 mL vial) in treating IC/bladder pain syndrome (IC/BPS). Methods: This randomized controlled clinical trial was conducted in Imam Reza Hospital of Mashhad in 2017. Twenty-four female IC/BPS patients were selected using clinical examinations and the O`Leary-Sant IC questionnaire to evaluate treatment effects. Patients with a history of other diseases related to the urogenital system and urination frequency less than eight times a day were excluded. The control group (n = 12) underwent hydrodistention under general anesthesia, and the intervention group (n = 12) received intravesical cystistat in addition to hydrodistention weekly for four weeks, followed by monthly for two months. Results: In the control group, the mean baseline score of the questionnaire was 33.2 ± 1.9 and reached 33.9 ± 2.6 after three months, showing no significant change. In the intervention group, the mean baseline score of the questionnaire was 32.6 ± 3.6 and reached 6.4 ± 12.4 at the end of the third month, which indicates a significantly better improvement (P < 0.001). In this study, the disease symptoms resolved in 83.3% of the intervention group after three months of treatment, while the controls did not improve. Conclusions: Based on our study, intravesical instillation of cystistat is effective in treating patients with IC/BPS and has significantly better effects than hydrodistention alone.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43316865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-08DOI: 10.5812/numonthly-120643
T. Gawlik-Jakubczak
: Urethral cancer is one of the rarest cancers. This study reported four cases treated in our department during the last two years. The patients’ medical histories differed and showed various symptoms and courses of illness. Each patient was treated surgically and received additional treatment. Two patients had pelvic injuries recorded in their medical history. One patient had progressive cancer on the basis of condyloma. The late diagnosis was a significant problem. None of the patients presented distal metastasis at the time of diagnosis, but the local advancement was significant. The courses of disease were aggressive in all patients. This study also reviewed the literature concerning primary male urethral cancer regarding the course of the disease and possible treatment methods.
{"title":"Cancer of Male Urethra: Case Series and Review of Literature","authors":"T. Gawlik-Jakubczak","doi":"10.5812/numonthly-120643","DOIUrl":"https://doi.org/10.5812/numonthly-120643","url":null,"abstract":": Urethral cancer is one of the rarest cancers. This study reported four cases treated in our department during the last two years. The patients’ medical histories differed and showed various symptoms and courses of illness. Each patient was treated surgically and received additional treatment. Two patients had pelvic injuries recorded in their medical history. One patient had progressive cancer on the basis of condyloma. The late diagnosis was a significant problem. None of the patients presented distal metastasis at the time of diagnosis, but the local advancement was significant. The courses of disease were aggressive in all patients. This study also reviewed the literature concerning primary male urethral cancer regarding the course of the disease and possible treatment methods.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":"197 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71291450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-03DOI: 10.5812/numonthly-128168
Ishwar Ram Dhayal, Rakesh K. Gupta, Alok Srivastava, P. Rai
Background: Percutaneous nephrolithotomy (PCNL), established in the 1970s, has replaced open surgery for large stones. Extracorporeal shock wave lithotripsy (ESWL), once the preferred first-line treatment for small-to-medium-sized renal stones, has a questionable charm owing to patient reluctance for repeated treatments and hospitalizations since ESWL has a reduced stone-free rate (SFR). Flexible ureterorenoscopy, also referred to as RIRS, originally applied in the management of lower pole stones resistant to ESWL, is increasingly being used as a primary modality to manage lower pole stones, and it may potentially achieve higher SFR than ESWL and lower morbidity than PCNL for patients with low-volume stone diseases. Objectives: Observations were made to compare ESWL, mini PCNL, and RIRS in managing lower pole renal calculi of < 1.5 cm. Methods: This observational study encompassed all patients with lower pole renal stones with < 1.5 cm diameter and < 1000 HU density who underwent mini PCNL, RIRS, or ESWL from January 2020 to July 2021. There were 40, 60, and 60 patients in the RIRS, mini PCNL, and ESWL groups, respectively, for all of whom preoperative CT urogram was performed. The patients were informed of the procedures, and their informed consent was obtained. The stone-free rates of the three modalities were compared, and the outcomes were statistically analyzed. Results: The mean stone sizes in the present study were 12.99 × 3.56 mm in mini PCNL, 10.62 × 2.51 mm in RIRS, and 10.93 × 3.13 mm in ESWL. The mini PCNL group's SFR was significantly higher than those of other groups: 59 (98.3%) in mini PCNL, 34 (85%) in RIRS, and 46 (76.7%) in ESWL (P = 0.002). Out of the 60 patients in the mini PCNL group, only one (1.7%) required an ancillary procedure, while only six (10%) out of 40 patients in the RIRS group and 11 (18.33%) out of 60 patients in the ESWL group required the ancillary procedure (P = 0.031). Conclusions: For lower pole renal calculi < 1.5 cm, mini PCNL has the highest SFR, followed by RIRS and ESWL, in sequence. The ancillary procedure rate was 18.33% in the ESWL group, which was higher than those of mini PCNL (1.7%) and RIRS (10%).
{"title":"A Comparative Study on Outcomes of Retrograde Intrarenal Surgery (RIRS), Mini Percutaneous Nephrolithotomy (PCNL), and Extracorporeal Shock Wave Lithotripsy (ESWL) for Lower Pole Renal Calculi of < 1.5 cm","authors":"Ishwar Ram Dhayal, Rakesh K. Gupta, Alok Srivastava, P. Rai","doi":"10.5812/numonthly-128168","DOIUrl":"https://doi.org/10.5812/numonthly-128168","url":null,"abstract":"Background: Percutaneous nephrolithotomy (PCNL), established in the 1970s, has replaced open surgery for large stones. Extracorporeal shock wave lithotripsy (ESWL), once the preferred first-line treatment for small-to-medium-sized renal stones, has a questionable charm owing to patient reluctance for repeated treatments and hospitalizations since ESWL has a reduced stone-free rate (SFR). Flexible ureterorenoscopy, also referred to as RIRS, originally applied in the management of lower pole stones resistant to ESWL, is increasingly being used as a primary modality to manage lower pole stones, and it may potentially achieve higher SFR than ESWL and lower morbidity than PCNL for patients with low-volume stone diseases. Objectives: Observations were made to compare ESWL, mini PCNL, and RIRS in managing lower pole renal calculi of < 1.5 cm. Methods: This observational study encompassed all patients with lower pole renal stones with < 1.5 cm diameter and < 1000 HU density who underwent mini PCNL, RIRS, or ESWL from January 2020 to July 2021. There were 40, 60, and 60 patients in the RIRS, mini PCNL, and ESWL groups, respectively, for all of whom preoperative CT urogram was performed. The patients were informed of the procedures, and their informed consent was obtained. The stone-free rates of the three modalities were compared, and the outcomes were statistically analyzed. Results: The mean stone sizes in the present study were 12.99 × 3.56 mm in mini PCNL, 10.62 × 2.51 mm in RIRS, and 10.93 × 3.13 mm in ESWL. The mini PCNL group's SFR was significantly higher than those of other groups: 59 (98.3%) in mini PCNL, 34 (85%) in RIRS, and 46 (76.7%) in ESWL (P = 0.002). Out of the 60 patients in the mini PCNL group, only one (1.7%) required an ancillary procedure, while only six (10%) out of 40 patients in the RIRS group and 11 (18.33%) out of 60 patients in the ESWL group required the ancillary procedure (P = 0.031). Conclusions: For lower pole renal calculi < 1.5 cm, mini PCNL has the highest SFR, followed by RIRS and ESWL, in sequence. The ancillary procedure rate was 18.33% in the ESWL group, which was higher than those of mini PCNL (1.7%) and RIRS (10%).","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41342709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-04DOI: 10.5812/numonthly-130299
S. Taheri, M. Mortazavi, S. Shahidi, A. Atapour, Maryam Kazemi Naeini, Zahra Zamani, G. Ghasemi
Background: The efficacy and quality of hemodialysis (HD) are closely related to the dialyzer characteristics. Objectives: This study aimed to determine the efficacy and complications of modified polyethersulfone (m-PES) -1.5 hollow fiber filters in comparison to conventional filters during HD. Methods: This non-inferiority crossover randomized clinical trial was performed in adult dialysis units at three HD centers within May 2019 to March 2020. The patients were randomly enrolled in two groups. Group A was first put on HD for six sessions with a low or high flux smart flux filter (m-PES-1.5 hollow fiber), which was made in Italy by Medica S.P.A. Group. Group B was hemodialyzed with a corresponding low or high flux filter made in Iran by Meditechsys Company. After a two-week clearance phase, the patients were dialyzed for six sessions with the opposite filter of the first six sessions. Laboratory variables, such as blood urea nitrogen and creatinine, were measured. Kt/V (i.e., a measurement of HD efficacy) and urea reduction ratio (URR) were calculated. Additionally, blood pressure was monitored. Results: A total of 40 patients were entered into the final analysis. No matter which filter was used, no statistically significant differences were observed in URR, creatinine, Kt/V, and blood pressure at different times during dialysis between the two types of filters. Packaging problems (P < 0.001) and blood clotting (P = 0.009) were two more frequent complications in the m-PES group. Conclusions: This study showed that smart flux m-PES-1.5 hollow fiber filters are similar to Meditechsys Company filters.
{"title":"Efficacy and Safety of Modified Polyethersulfone Hemodialysis Filters in Comparison to Conventional Filters: A Non-inferiority Clinical Trial","authors":"S. Taheri, M. Mortazavi, S. Shahidi, A. Atapour, Maryam Kazemi Naeini, Zahra Zamani, G. Ghasemi","doi":"10.5812/numonthly-130299","DOIUrl":"https://doi.org/10.5812/numonthly-130299","url":null,"abstract":"Background: The efficacy and quality of hemodialysis (HD) are closely related to the dialyzer characteristics. Objectives: This study aimed to determine the efficacy and complications of modified polyethersulfone (m-PES) -1.5 hollow fiber filters in comparison to conventional filters during HD. Methods: This non-inferiority crossover randomized clinical trial was performed in adult dialysis units at three HD centers within May 2019 to March 2020. The patients were randomly enrolled in two groups. Group A was first put on HD for six sessions with a low or high flux smart flux filter (m-PES-1.5 hollow fiber), which was made in Italy by Medica S.P.A. Group. Group B was hemodialyzed with a corresponding low or high flux filter made in Iran by Meditechsys Company. After a two-week clearance phase, the patients were dialyzed for six sessions with the opposite filter of the first six sessions. Laboratory variables, such as blood urea nitrogen and creatinine, were measured. Kt/V (i.e., a measurement of HD efficacy) and urea reduction ratio (URR) were calculated. Additionally, blood pressure was monitored. Results: A total of 40 patients were entered into the final analysis. No matter which filter was used, no statistically significant differences were observed in URR, creatinine, Kt/V, and blood pressure at different times during dialysis between the two types of filters. Packaging problems (P < 0.001) and blood clotting (P = 0.009) were two more frequent complications in the m-PES group. Conclusions: This study showed that smart flux m-PES-1.5 hollow fiber filters are similar to Meditechsys Company filters.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45479102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-07DOI: 10.5812/numonthly-127442
Fereshte Aliakbari, S. Nematollahi, Seyed Khalil Pestehei, N. Mogharabian, Neda Taghizabet, Fatemeh Rezaei-Tazangi, J. Hosseini, M. Emadeddin
Background: Men’s sexual health is one of the main aspects of their lives. Male sexual dysfunction (SD) includes a wide range of sexual impairments and is not limited to premature ejaculation (PE) and erectile dysfunction (ED). ED can be a life-changing issue that might be mixed up with male sexual impotence characterized by PE and ED. Objectives: The objectives of this study were to estimate the prevalence of sexual dysfunction and its associated factors among the Iranian male population. Methods: This is a cross-sectional study for which data was collected from a nationwide reproductive morbidities project among males in Iran. To do so, 2296 men aged 25 - 60 years were selected from four provinces by cluster sampling. Statistical analysis was done in SPSS (18.0.0) Results: The prevalence of severe/medium SD and severe SD were 66.9% and 18.1%, respectively. The prevalence of low sexual satisfaction, low sexual desire, and dissatisfaction with the length of intercourse before orgasm were 9.5%, 9%, and 12%. Conclusions: Sexual dysfunction is highly likely prevalent among less educated, unemployed men with a history of chronic diseases. Various educational programs to raise awareness are thoroughly recommended.
{"title":"The Prevalence of Erectile Dysfunction Among Adult Men: The Results of a National Survey on Male Morbidities","authors":"Fereshte Aliakbari, S. Nematollahi, Seyed Khalil Pestehei, N. Mogharabian, Neda Taghizabet, Fatemeh Rezaei-Tazangi, J. Hosseini, M. Emadeddin","doi":"10.5812/numonthly-127442","DOIUrl":"https://doi.org/10.5812/numonthly-127442","url":null,"abstract":"Background: Men’s sexual health is one of the main aspects of their lives. Male sexual dysfunction (SD) includes a wide range of sexual impairments and is not limited to premature ejaculation (PE) and erectile dysfunction (ED). ED can be a life-changing issue that might be mixed up with male sexual impotence characterized by PE and ED. Objectives: The objectives of this study were to estimate the prevalence of sexual dysfunction and its associated factors among the Iranian male population. Methods: This is a cross-sectional study for which data was collected from a nationwide reproductive morbidities project among males in Iran. To do so, 2296 men aged 25 - 60 years were selected from four provinces by cluster sampling. Statistical analysis was done in SPSS (18.0.0) Results: The prevalence of severe/medium SD and severe SD were 66.9% and 18.1%, respectively. The prevalence of low sexual satisfaction, low sexual desire, and dissatisfaction with the length of intercourse before orgasm were 9.5%, 9%, and 12%. Conclusions: Sexual dysfunction is highly likely prevalent among less educated, unemployed men with a history of chronic diseases. Various educational programs to raise awareness are thoroughly recommended.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42811488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-29DOI: 10.5812/numonthly-131333
Y. Shabani, H. Sadeghi, P. Yousefichaijan, Davoud Shabani, F. Rafiee
Background: Urinary tract infection (UTI) is one of the most common childhood infections. Urinary tract infections are divided into simple and complex types. If the bladder infection is not treated, it can cause secondary kidney infections, such as acute pyelonephritis, which can lead to kidney scar or permanent kidney damage. A significant percentage of patients of any age are re-infected after antimicrobial treatments during the first six months after the first period of UTI. Objectives: This research aimed to investigate the risk factors affecting UTI in infants and children hospitalized in Arak Amir Kabir Hospital in 2017-2018 to prevent UTI and its secondary complications. Methods: In this cross-sectional study, the data collection tool was a validated questionnaire to gather the child's demographic characteristics, including age, sex, type of nutrition, circumcision, age of circumcision, as well as information about fetal birth weight, chronic maternal diseases such as diabetes and stress, and residence place. The content validation method was used to determine the validity of the checklist, and the test-retest was used for reliability. Data were analyzed by SPSS version 22 software. Results: Sixty four percent of children had the normal ultrasound, while 22% had hydronephrosis and nephrolithiasis on ultrasound. The average thickness and size of the right kidney were 71.75 and 9.11, and those of the left kidney were 9.11 and 9.50, respectively. The most common microorganism was Escherichia coli. Conclusions: Given the importance of prevention and timely diagnosis and treatment of UTI to prevent kidney injuries, it is necessary to find UTI risk factors as the first step to preventing children from secondary kidney injuries.
背景:尿路感染(UTI)是儿童最常见的感染之一。尿路感染分为简单型和复杂型。如果不治疗膀胱感染，可能会引起继发性肾脏感染，如急性肾盂肾炎，这可能导致肾疤痕或永久性肾损伤。在首次尿路感染后的头6个月内，任何年龄的患者在接受抗菌药物治疗后再次感染的比例都很高。目的:本研究旨在探讨2017-2018年在Arak Amir Kabir医院住院的婴幼儿尿路感染的危险因素，以预防尿路感染及其继发并发症。方法:在本横断面研究中，数据收集工具是一份经过验证的问卷，收集儿童的人口统计学特征，包括年龄、性别、营养类型、包皮环切术、包皮环切术年龄，以及胎儿出生体重、母体慢性疾病(如糖尿病和压力)、居住地等信息。效度采用内容验证法，信度采用重测法。数据采用SPSS 22软件进行分析。结果:64%的儿童超声检查正常，22%的儿童超声检查有肾积水和肾结石。右肾平均厚度为71.75，大小为9.11，左肾平均厚度为9.11，大小为9.50。最常见的微生物是大肠杆菌。结论:鉴于尿路感染的预防和及时诊治对预防肾脏损伤的重要性，有必要将发现尿路感染危险因素作为预防儿童继发性肾脏损伤的第一步。
{"title":"Prevalence of Risk Factors of Urinary Tract Infections in Infants and Children in Arak, Iran: A Cross-sectional Study","authors":"Y. Shabani, H. Sadeghi, P. Yousefichaijan, Davoud Shabani, F. Rafiee","doi":"10.5812/numonthly-131333","DOIUrl":"https://doi.org/10.5812/numonthly-131333","url":null,"abstract":"Background: Urinary tract infection (UTI) is one of the most common childhood infections. Urinary tract infections are divided into simple and complex types. If the bladder infection is not treated, it can cause secondary kidney infections, such as acute pyelonephritis, which can lead to kidney scar or permanent kidney damage. A significant percentage of patients of any age are re-infected after antimicrobial treatments during the first six months after the first period of UTI. Objectives: This research aimed to investigate the risk factors affecting UTI in infants and children hospitalized in Arak Amir Kabir Hospital in 2017-2018 to prevent UTI and its secondary complications. Methods: In this cross-sectional study, the data collection tool was a validated questionnaire to gather the child's demographic characteristics, including age, sex, type of nutrition, circumcision, age of circumcision, as well as information about fetal birth weight, chronic maternal diseases such as diabetes and stress, and residence place. The content validation method was used to determine the validity of the checklist, and the test-retest was used for reliability. Data were analyzed by SPSS version 22 software. Results: Sixty four percent of children had the normal ultrasound, while 22% had hydronephrosis and nephrolithiasis on ultrasound. The average thickness and size of the right kidney were 71.75 and 9.11, and those of the left kidney were 9.11 and 9.50, respectively. The most common microorganism was Escherichia coli. Conclusions: Given the importance of prevention and timely diagnosis and treatment of UTI to prevent kidney injuries, it is necessary to find UTI risk factors as the first step to preventing children from secondary kidney injuries.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46529127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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