Publications by authors named "Mohammad Hossein Izadpanahi"

22 Publications

  • Page 1 of 1

Serum levels of total and urine level of PCA3 in patients with benign prostatic hyperplasia and prostate cancer.

Am J Clin Exp Urol 2020 25;8(1):43-47. Epub 2020 Feb 25.

Department of Orology, School of Medicine, Isfahan University of Medical Sciences Isfahan, Iran.

Background: Urine test with the PSA result will provide a good prognosis of the prostate cancer. Therefore, considering the importance of PCA3 in this study, we aimed to compare the serum total and urinary PCA3 levels in patients with benign hyperplasia and prostate cancer.

Methods: This cross-sectional study was performed on 90 patients referring to Noor and Hazrat-e-Ali Asghar Hospital in Isfahan from October 2017 to October 2018 for prostate biopsy. Patients were divided into two groups including benign prostate hyperplasia (BPH) and prostate cancer. Serum total and urinary PCA3 levels were measured and compared in both groups.

Results: 38 patients with prostate cancer and 52 patients with BPH participated in this study. Mean age in prostate cancer group was significantly higher than BPH group (P=0.01). Also mean PCA3, and total PSA, in patients with prostate cancer was significantly higher than patients with BPH (P<0.05).

Conclusion: PCA3 was an important marker in patients with prostate cancer and BPH.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7076296PMC
February 2020

Electrocoagulation Accounts for a Significant Portion of Discrepancy Between Preoperative Ultrasonography Prostate Size Estimation and Resected Tissue Weight.

J Endourol 2020 06 22;34(6):671-675. Epub 2020 Apr 22.

Department of Neuroscience, University of Toronto, Toronto, Canada.

Transurethral resection of the prostate (TURP) is considered to be the gold standard surgical procedure for medium-sized prostates. However, there is a drastic difference between the weight of resected tissue reported by the pathologist and the sonographic estimate of prostate weight before the operation. The present study investigates the role of electrocoagulation in tissue loss during monopolar (M-) and bipolar (B-) TURP. In this experimental study, 33 prostate glands removed from patients by open suprapubic prostatectomy were roughly divided in half and the weight of each half was recorded precisely. One half of the specimen was resected using a monopolar resectoscope and the other half was resected by bipolar resectoscope in an out-of-body simulated condition. The weight of obtained chips was measured and the amount of lost tissue was calculated. Data from prostates with final pathologic diagnosis of benign prostatic hyperplasia were included in the analysis. The mean difference of prostate weight before and after out-of-body resection and also the proportion of tissue loss between M-TURP and B-TURP were compared using -test. Data from 62 prostate halves were included in the final analysis. The mean weight of samples after M-TURP was considerably lower than before resection (38.0 ± 6.9 and 48.7 ± 9.0, respectively,  < 0.001). Similarly, the mean weight of prostate samples after B-TURP was lower than the weight before resection (36.2 ± 7.3 and 48.4 ± 9.1, respectively,  < 0.001). However, the ratio of tissue loss in B-TURP (25.3% ± 2.5%) was significantly higher than in M-TURP (21.3% ± 3.7%) ( < 0.001). Prostate resection using electrocoagulation leads to a significant prostate tissue loss due to heat effect. Furthermore, tissue loss in B-TURP is slightly more than M-TURP.
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http://dx.doi.org/10.1089/end.2020.0037DOI Listing
June 2020

The effect of selenium supplementation on cystine crystal volume in patients with cystinuria.

Biomedicine (Taipei) 2018 Dec 26;8(4):26. Epub 2018 Nov 26.

Isfahan Kidney Transplantation Research Center, Department of Urology, Alzahra Research Centers, Isfahan University of Medical Science, Isfahan, Iran.

Background: Cystinuria as an autosomal recessive sickness is a relatively rare disease. Formation of cystine stones indicates cystinuria. Few studies are considered the cysteine crystal volume in management of cystinuria. Selenium may inhibit organization of crystal stone, growth and stone aggregation. Since the role of selenium on inhibition of cystine crystal formation is not known, the aim of this study was to evaluate the effect of selenium supplementation on cystine crystals volume in patients with cystinuria.

Materials And Methods: This double-blind clinical trial study was conducted on 48 patients in Al-Zahra hospital, Isfahan, Iran from 2015 to 2017. These patients received selenium (200 mg/ daily) for 6 weeks. The urine crystal volume was evaluated before and after treatment. Data were entered SPSS and analyzed by Paired sample T test, Spearman and Pearson coefficient correlation. P- value < 0.05 was considered significant.

Results: In current study, mean cystine crystal volume before and after treatment was 6787.4 ± 11902.6 and 3110.9 ± 7225.4, respectively. Significant difference was observed before and after treatment in terms of cystine crystal volume (p < 0.001). No relation was observed between the mean cystine crystal volume with sex, age and type of medical procedures (p > 0.05).

Conclusion: In this study, selenium treatment affected cystine crystal volume. It seems that selenium had the potential value to alleviate the volume of cystine crystal. Therefore, since reducing of cystine crystal volume decreases crystal formation, selenium may be effective to cure patients with cystinuria. However, age, sex and type of medical procedures did not affect cysteine crystal volume.
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http://dx.doi.org/10.1051/bmdcn/2018080426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6254100PMC
December 2018

Discrepancies Between Biopsy Gleason Score and Radical Prostatectomy Specimen Gleason Score: An Iranian Experience.

Urol J 2019 02 21;16(1):56-61. Epub 2019 Feb 21.

Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Purpose: Considering the importance of treatment decisions for prostate cancer (PCa) and the utility of Gleason scoring system (GS) in this field, we aimed to assess the percent of agreement and disagreement between needle biopsy (NB) Gleason score and radical prostatectomy (RP) specimen Gleason score.

Materials And Methods: In this retrospective study, consecutive patients with PCa, who underwent NB and subsequently RP were enrolled. GS of both NB and RP specimens were recorded for each patient. Patients were classified according to the GS as low-grade (? 3+3), intermediate-grade (3+4 and 4+3), and high-grade (GS?8-10). The levels of agreement and discrepancy of NB GS was compared to its corresponding RP GS using Kappa coefficient of agreement. Over-grading and under-grading of NB GS were also determined.

Result: A total of 100 embedded RP and corresponding NB were analyzed. The rate of discrepancy for group and individual scoring of GS was 41% and 56%, respectively. The rate of under and over-grading was 34% and 7%, respectively. Kappa value for group and individual scoring was .443 (95%CI: .313 - .573) and .411 (95%CI: .291 - .531), respectively.

Conclusion: The findings of our study indicate that though the agreement between NB GS and RP GS are fair to moderate, but the feature of discrepancy, i.e. under-grading in low and intermediate grades and over-grading in high grades of NB GS, could help us in making more appropriate clinical decision especially considering other biochemical and pathological factors such as the level of PSA or peri-neural invasion.
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http://dx.doi.org/10.22037/uj.v0i0.4174DOI Listing
February 2019

Evaluation of the Results and Complications of Transabdominal Preperitoneal Laparoscopic Inguinal Hernia Repair in Patients with a History of Radical Prostatectomy.

Urol J 2020 01 26;17(1):24-29. Epub 2020 Jan 26.

Isfahan University of Medical Sciences, Isfahan, Iran.

Purpose: Radical prostatectomy is one of the most common urological surgeries. Inguinal hernia is a well-known complication of radical prostatectomy. There are many controversies about selection of surgical techniques for repair of inguinal hernia. Traditionally laparoscopic approach was contraindicated for patients with history of lower abdominal surgery, but recent studies showed that it could be safe and successful and even has some advantages over open repair. In this prospective study we evaluated outcomes of laparoscopic hernia repair in patients who previously underwent radical prostatectomy.

Materials And Methods: In this prospective study, 34 consecutive patients diagnosed with inguinal hernia after radical retropubic prostatectomy underwent laparoscopic transabdominal inguinal repair and followed up for outcomes and complications.

Results: The surgery duration was 167.44 ± 52.85 min (75-230 min). No intraoperative complications occurred. Patients were discharged within 20.79 ± 4.76 hours (12-34 hours). 69.8% of cases (30 patients) needed analgesic administration. No conversion to open surgery occurred. There were 9.3% (4 hernias) hernia recurrences. We followed patients for 9.9 ± 5.33 months (2-19 months).

Conclusion: It is concluded that TAPP for inguinal hernia repair after radical prostatectomy has good results and is effective. But according to rate of recurrence, its safeness is conflicting. We notice no major complication in our patients during the time of follow up. This may be due to safety of the operation in the proposed patients.
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http://dx.doi.org/10.22037/uj.v0i0.4751DOI Listing
January 2020

A comparison between dextranomer/ hyaluronic acid and polyacrylate polyalcohol copolymer as bulking agents for treating primary vesicoureteral reflux.

Urol J 2019 05 5;16(2):174-179. Epub 2019 May 5.

Department of Urology, Isfahan University of Medical Sciences (IUMS), Isfahan, Iran.

Purpose: In recent years, endoscopic subureteral injection has gained popularity as a therapeutic alternative to open surgery because of its high success rates and low morbidity. We compared the success and complication rates of Polyacrylate polyalcohol copolymer (PPC) and Dextranomer/Hyaluronic acid (Dx/HA) in the endoscopic treatment of VUR.

Materials & Methods: We retrospectively reviewed the patients who underwent endoscopic correction of their VUR by subureteric injection of PPC or Dx/HA from Jan 2010 to April 2016. The injection technique was STING (subureteric), distal HIT (intraureteric), and double HIT according the hydrodistention (HD) grade. The success rate, injection technique, injection volume, VUR grade, and obstruction rate were evaluated and compared between two groups.

Results: 107 renal refluxing units (RRU) with a mean age 55.23±36.58 months and 64 RRU with a mean age 52.13±31.66 months were treated in Dx/HA and PPC groups, respectively. The PPC group showed a more successful outcome in comparison to the Dx/HA group (92.2% versus 75.7% of the RRU with P value<0.001) at 3 months follow up. The injection technique was not significantly different between two groups. In PPC group the success rate was decreased significantly with increasing reflux grade but this reduction was not statistically significant in Dx/HA group. The injected volume was significantly more in PPC group; in addition, there was statistically significant correlation between injected volume of the bulking agent and obstruction rate. However, the obstruction rate did not establish significant difference between the two groups (P value=0.83), however it was earlier in Vantris (4 months versus 22 months).

Conclusions: Our investigation approved PPC as a more effective material, regardless of other confounding variables such as reflux grade, learning cure, and technique of injection, in endoscopic treatment of VUR. In addition, the other remarkable point is this effectiveness is not accompanied by more post-operation obstruction.
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http://dx.doi.org/10.22037/uj.v0i0.4156DOI Listing
May 2019

A comparison of pain control and complications using three different ways of anesthesia in patients undergoing transrectal ultrasound-guided prostate biopsy.

J Res Med Sci 2018 20;23:17. Epub 2018 Feb 20.

Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: We aim to compare the degree of pain control and complications in three types of anesthesia using periprostatic nerve block (PPNB) plus intrarectal local anesthesia (IRLA), low-dose spinal anesthesia, and intravenous (IV) sedation in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy.

Materials And Methods: In this clinical trial study, 106 patients were participated from December 2015 to December 2016 at Alzahra Hospital, Isfahan, Iran. Patients were randomly allocated into three groups to receive PPNB plus IRLA ( = 36), low-dose spinal anesthesia ( = 35) and IV sedation ( = 35) before TRUS-guided prostate biopsy. Pain scores were recorded using a 10 point visual analog scale right after the biopsy was done. Early and late complications were assessed using a questionnaire after the procedure and in follow-up of patients.

Results: Overall, the pain score in the low-dose spinal anesthesia group was significantly lower than PPNB plus IRLA and IV sedation groups ( < 0.001). The differences in pain scores between PPNB plus IRLA group and IV sedation group were not significant ( = 0.30). Urinary retraction and fever were significantly more frequent in low-dose spinal anesthesia and IV sedation, retrospectively ( = 0.04, = 0.03). No significant difference in late complications was found among the groups.

Conclusion: This study demonstrates that low-dose spinal anesthesia is superior to PPNB plus IRLA and IV sedation in terms of pain controlling and was associated with higher tolerance of the examination and patient comfort.
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http://dx.doi.org/10.4103/jrms.JRMS_639_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842442PMC
February 2018

Comparison of Two Treatment Methods "One Shot" and "Sequential" on Reduction the Level of Hemoglobin in Patients with Percutaneous Nephrolithotripsy in Al Zahra Hospital in 2012-2013.

Adv Biomed Res 2017 14;6:84. Epub 2017 Jul 14.

Isfahan Kidney Transplantation Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Access dilation is the most important part of percutaneous nephrolithotripsy (PCNL) that is done by different methods, especially metal telescoping and one shot. In this study, two different methods of access dilation one shot and telescoping were compared.

Materials And Methods: In observational cross-sectional study, 240 patients who were a candidate for PCNL were selected and randomly divided into two groups. The first group was undergone one-shot method and the second group was undergone telescoping method. The decrease in hemoglobin (Hb), duration of hospitalization and the time of radiation exposure during access dilation was compared in two groups by SPSS software version 21, (SPSS Inc., Chicago, IL, USA).

Results: The decrease of Hb level after intervention in one-shot group was 1.08 ± 1.23 g/dl and in telescoping, group was 1.51 ± 1.08 g/dl with no difference statistically ( = 0.37). The mean duration of hospitalization in one shot and telescoping group were 2.36 ± 0.67 and 2.28 ± 0.61 days, respectively. According to -test, there was no significant difference between the two groups ( = 0.37). Average radiation exposure in one shot group was 7.13 s and in telescoping, group was 35.75 s, and there was a significant difference between the two groups ( < 0.001).

Conclusion: One-shot method is superior to telescoping method due to less time for radiation exposure and no more blood loss and other complications during PCNL.
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http://dx.doi.org/10.4103/2277-9175.210661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5539665PMC
July 2017

The effect of urethral catheterization on the level of prostate-specific antigen.

J Res Med Sci 2017 15;22:38. Epub 2017 Mar 15.

Department of Urology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The normal prostate-specific antigen (PSA) level in patients with urethral catheterization is a controversy. We designed this study to investigate the effect of nontraumatic urethral catheterization without urinary retention on serum PSA.

Materials And Methods: Seventy patients scheduled for urethral catheterization before elective surgeries were randomly selected and included in the study. They were categorized into two age groups: 40-60 years (Group A) and over 60 years (Group B). Total PSA, PSA density, and free/total PSA were assessed before and after catheterization.

Results: The PSA levels showed no statistically significant rise after urethral catheterization. The average of PSA level was 1.01 and 1.6 in A and B Groups, respectively, and changed to 1.38 and 1.80 in A and B Groups 1 day after catheterization ( > 0.05). Free/total PSA was 28.75 and 26 in A and B Groups before catheterization and changed to 28.35 and 27.5 in A and B Groups after catheterization ( > 0.05).

Conclusion: Nontraumatic urethral catheterization has very little effect on PSA level and in patients with urethral catheter routine evaluation of PSA rising should be considered.
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http://dx.doi.org/10.4103/1735-1995.202145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393098PMC
March 2017

Factors influencing sperm retrieval following testicular sperm extraction in nonobstructive azoospermia patients.

Clin Exp Reprod Med 2017 Mar 31;44(1):22-27. Epub 2017 Mar 31.

Medical Genetics Laboratory, Al-Zahra University Hospital, Isfahan, Iran.

Objective: Azoospermia owing to testicular disorders is the most severe manifestation of male infertility. The main concern for patients with nonobstructive azoospermia (NOA) is the probability of successful sperm retrieval following testicular sperm extraction (TESE). Therefore, the goal of this study was to determine predictive factors correlated with sperm retrieval.

Methods: We assessed the testicular histopathological patterns, the choice of TESE surgical procedure, hormone levels, and chromosomal abnormalities in patients with NOA (n=170). The histopathology specimens were analyzed based on the histopathological patterns of hypospermatogenesis, maturation arrest, and Sertoli cell-only syndrome.

Results: The mean rate of sperm retrieval was 48.8%. The rate of sperm retrieval was significantly higher in the hypospermatogenesis group than in the other groups (<0.001). There was a positive correlation between micro-TESE (vs. conventional TESE) and the sperm retrieval rate (odds ratio, 8.077; <0.01). A logistic regression model demonstrated that high levels of follicle-stimulating hormone (FSH) and small testicular volume were significantly associated with lower chances of successful sperm retrieval.

Conclusion: Some parameters, including testicular histopathology patterns, FSH levels, testicular volume, and method of TESE surgery, may be able to predict the chances of obtaining spermatozoa in patients with NOA. However, despite the efficiency of some predictive models, the hope of retrieving any functioning spermatozoa may be sufficient to disregard predictive factors of the success of intracytoplasmic sperm injection in these patients.
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http://dx.doi.org/10.5653/cerm.2017.44.1.22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5395548PMC
March 2017

Addition of Ceftriaxone and Amikacin to a Ciprofloxacin plus Metronidazole Regimen for Preventing Infectious Complications of Transrectal Ultrasound-Guided Prostate Biopsy: A Randomized Controlled Trial.

Adv Urol 2017 10;2017:4635386. Epub 2017 Jan 10.

Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran.

The objective of this study was to evaluate the efficacy of adding single doses of ceftriaxone and amikacin to a ciprofloxacin plus metronidazole regimen on the reduction of infectious complications following transrectal ultrasound-guided prostate biopsy (TRUS Bx). Four hundred and fifty patients who were candidates for TRUS Bx were divided into two groups of 225 each. The control group received ciprofloxacin 500 mg orally every 12 hours together with metronidazole 500 mg orally every 8 hours from the day prior to the procedure until the fifth postoperative day. In the second group, single doses of ceftriaxone 1 g by intravenous infusion and amikacin 5 mg/kg intramuscularly were administered 30-60 minutes before TRUS Bx in addition to the oral antimicrobials described for group 1. The incidence of infection was compared between the groups. The incidence of infectious complications in the intervention group was significantly lower than that in the control group (4.6% versus 0.9%, = 0.017). The addition of single doses of intramuscular amikacin and intravenously infused ceftriaxone to our prophylactic regimen of ciprofloxacin plus metronidazole resulted in a statistically significant reduction of infectious complications following TRUS Bx.
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http://dx.doi.org/10.1155/2017/4635386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5259611PMC
January 2017

Efficacy of Long-Acting Octreotide on Reducing Mucus Production in Patients With Ileal Neobladder.

Clin Genitourin Cancer 2017 02 4;15(1):e9-e13. Epub 2016 Nov 4.

Isfahan University of Medical Sciences, Isfahan, Iran.

Purpose: To evaluate the efficacy of long-acting-release octreotide (trade name Sandostatin) on decreasing mucus secretion, thus reducing catheter obstruction after radical cystectomy and orthotopic reconstruction.

Patients And Methods: In this double-blind, placebo-controlled study, we treated 73 cases of radical cystectomy between the years 2008 and 2014; 65 were deemed eligible for the study. Cases were randomly divided into 2 groups. Group A (n = 32) received 2 doses of 20 mg intramuscular long-acting-release octreotide 4 weeks before and on the day of surgery, while group B (n = 33) received placebo. Catheter irrigation was only performed when there was an obstruction due to a mucus plug. The need for catheter irrigation and the volume of mucus produced by the neobladder were evaluated and compared between the 2 groups.

Results: The average number of neobladder irrigations required to treat mucus plugs was 2.3 ± 1.5 in group A and 9.5 ± 4.3 in group B (P < .001) before hospital discharge. This number changed to 2.5 ± 1.5 versus 11.4 ± 2.7 in groups A and B, respectively (P < .001), after discharge from the hospital. The 24-hour mucus production at the end of the first week was 5.4 ± 2.7 mL versus 21.5 ± 5.6 mL in groups A and B, respectively (P < .001). At the end of the third week, this amount changed to 5.5 ± 2.3 mL versus 21.8 ± 5.6 mL in groups A and B, respectively (P < .001).

Conclusion: Two injections of long-acting-release octreotide can dramatically reduce mucus production and hence catheter obstruction due to mucus plugs after radical cystectomy and orthotopic reconstruction.
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http://dx.doi.org/10.1016/j.clgc.2016.10.012DOI Listing
February 2017

Role of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Staging of Bladder Cancer.

J Clin Diagn Res 2016 Apr 1;10(4):TC01-5. Epub 2016 Apr 1.

Assistant Professor, Department of Radiology, Shahrekord University of Medical Sciences , Shahrekord, Iran .

Introduction: Dynamic Contrast Enhanced (DCE)-Magnetic Resonance Imaging (MRI) is a useful technique in which rapid enhancement of tumour by uptake of the contrast agent compared to bladder wall.

Aim: To evaluate the accuracy of dynamic gadolinium-enhanced MRI in staging of bladder cancer through differentiating superficial tumours from invasive tumours and organ-confined tumours from non-organ-confined tumours. In addition, the benefits of DCE-MRI in diagnosis of tumour progression steps were investigated.

Materials And Methods: This was a quasi-experimental study in which 45 patients (95.55% men and 4.45% women) were enrolled. Patients with confirmed transitional cell carcinoma by histopathology findings were imaged using 1.5 Tesla MRI systems. Pathology results were considered as the standard reference. Tumour stage was determined by imaging findings and compared with pathologic findings after radical cystectomy. Data were analysed by SPSS version 16 and the level of significance in all tests was considered p<0.001.

Results: The most common stage that was seen in pathology and MRI findings was T3b. Kappa agreement coefficient between MRI and pathology was 0.7 (p<0.001). The accuracy of MRI in differentiating superficial tumours (≤T1) from invasive tumours (≥ T2a), and organ-confined tumours (≤T2b) from non-organ-confined tumours (≥T3b) was 0.97 and 0.84, respectively. The overall accuracy of MRI was 0.77 (p<0.001). Totally, 10 cases of disagreement between MRI and pathological staging were found, eight (80%) of which were overestimated and two cases (20%) underestimated. MRI detection rate was 0% in stage Ta, 100% in stage T1, 66.7% in stage T2, 86.7% in stage T3, and 100% in stage T4. The sensitivity and specificity of MRI in differentiating superficial tumours from invasive tumours were 0.97 and 1, respectively, and in differentiating organ-confined tumours from non-organ-confined tumours were 0.94 and 0.77, respectively. The Spearman's correlation coefficient between the signal enhancement slope of time-intensity curves and tumour stages was 0.88 (p<0.001).

Conclusion: Gadolinium-enhanced MRI is an appropriate and useful modality with a high accuracy in determining the stage of the bladder cancer. In addition, this method shows extension and progression of tumour and tumour invasion depth.
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http://dx.doi.org/10.7860/JCDR/2016/17596.7690DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866211PMC
April 2016

A comparison of bladder neck preservation and bladder neck reconstruction for urinary incontinence after radical retro pubic prostatectomy.

J Res Med Sci 2014 Dec;19(12):1140-4

Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Prostate cancer is the sixth most common cancer worldwide and will include about 30% of all malignancies in men. Since the initial report of the anatomic radical prostatectomy, refinements in the surgical technique have been made. Several studies show that bladder neck preservation (BNP) during radical prostatectomy makes improve early return of urinary continence, erectile function or both. However, some clinical trials have suggested little difference between the return of continence while using modifications. In this study, we compared outcomes of BNP and bladder neck reconstruction (BNR) during radical retropubic prostatectomy (RRP).

Materials And Methods: This prospective study was performed on 60 patients at a referral university hospital from March 2010 to March 2012. Study population was all patients candidate for RRP (RRP in this period. All patients divided into two groups, A and B (30 patients in each group). Group A (n = 30) who preserved bladder neck (BNP) and Group B (n = 30) who had BNR. Prostate specific antigen (PSA) before and at 2, 6, 9, 12 and18 months after surgery, anastomotic stricture symptoms, positive bladder neck margin, Gleason score and urine incontinence were compared between two groups. Also, we compared bladder neck contracture, urinary continence and positive surgical margin rates after BNP and BNR while retropubic prostatectomy in 24 months period follow-up.

Results: The mean age of the patients was 61.81 ± 7.15 years (range, 50-74 years). After a follow-up period of 24 months, the PSA rising was not different between the two groups. After 2 months, 19 (63.33%) of patients in A group and the same number in B group were continent (P = 0.78). Stricture of the bladder neck at the anastomosis site requiring transurethral dilation occurred in 7 (23.33%) and 3 (10.0%) patients in groups A and B, respectively (P = 0.04).

Conclusion: Although there was no difference in prevalence and duration of return of urinary continence after the operation between two groups, but results of our study showed that stenosis of the bladder neck was lower in BNP. Hence in the group of BNP, need for further operation and overflow incontinency due to the obstruction of urinary tract will be less likely than BNR and patients have better long time (24 months) urinary continence.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4333521PMC
December 2014

Expression of adenosine receptor subclasses in malignant and adjacent normal human prostate tissues.

Prostate 2015 May 20;75(7):735-47. Epub 2015 Feb 20.

Department of Biochemistry, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Adenosine, a purine nucleoside plays important roles in the pathogenesis of cancer initiation and promotion via interaction with four adenosine receptors. In the present study we examined the differential expression pattern of adenosine receptors in the malignant and adjacent normal human prostate tissues.

Methods: Prostate cancer tissue samples and adjacent normal tissues were obtained from 20 patients undergoing radical prostatectomy and histopathological diagnosis was confirmed for each sample. Total RNA was extracted and reverse transcribed into cDNA and the mRNA expression levels of adenosine receptors were investigated by Taq-man real-time RT-PCR experiment. Quantitative protein analysis was done by Western blotting experiment. Moreover, the mRNA and protein expression levels of adenosine receptors were measured after androgen treatment.

Result: Taq-man real-time RT-PCR measurements show different expression levels of adenosine receptor transcripts. A2B adenosine receptor was predominantly expressed in tumor tissues (2.4-fold) followed by significantly expression of A3 (1.6-fold) and A2A adenosine receptors (1.5-fold) compared to adjacent normal tissues. The presence of adenosine receptors at protein levels in prostate cancer tissues compared with normal tissues was shown the following rank order: A2B  > A3  > A2A  > A1 . Androgen receptor regulates adenosine receptors mRNA and protein expression in AR-positive LNCaP cells, which was not seen in AR-negative PC-3 cells.

Conclusion: These results indicated for the first time, the differential mRNA expression profile and protein levels of adenosine receptors in the human prostate cancer. Interestingly, the A2B adenosine receptor followed by A3 is highly expressed in prostate tumor samples in comparison with the adjacent normal tissues. The findings support the possible key role of A2B adenosine receptor in promoting cancer cell growth and suggest that A2B may be a novel target for prostate cancer treatment.
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http://dx.doi.org/10.1002/pros.22955DOI Listing
May 2015

Percutaneous nephrolithotomy: Effect of unilateral procedure on contralateral kidney function.

Adv Biomed Res 2014 29;3:227. Epub 2014 Nov 29.

Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Although long-term effects of percutaneous nephrolithotomy (PCNL) on renal function and structure have been evaluated, knowledge regarding the immediate effects of surgery on renal function is limited. We conducted this study to evaluate the impact of unilateral PCNL on bilateral renal function during immediate post-operative period.

Materials And Methods: From April to September 2012, 40 eligible patients were enrolled in this study and underwent unilateral PCNL. During the post-operative period, creatinine clearances (CrCl) of treated and untreated sides were estimated separately and pattern of changes in bilateral renal function following this procedure was evaluated.

Results: Following the operation, CrCl of both kidneys showed a similar pattern of changes, of course more dramatic on treated side. We observed progressive decline in CrCl of both sides followed by bilateral improvement in renal function toward pre-operative values.

Conclusions: During the early post-operative period following unilateral PCNL, both kidneys experienced a temporary drop in function warranting more intensive post-operative care.
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http://dx.doi.org/10.4103/2277-9175.145710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260279PMC
December 2014

Concomitant surgical correction of severe stress urinary incontinence and anterior vaginal wall prolapse by anterior vaginal wall wrap: 18 months outcomes.

J Res Med Sci 2013 Jul;18(7):588-93

Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The aim of this study is to evaluate the outcome of an innovative, minimally invasive sling technique with autologous tissue in women with concomitant incontinence and anterior vaginal wall prolapse (AVWP).

Materials And Methods: Fifty-six women with stress urinary incontinence (SUI) or mixed urinary incontinence and AVWP were randomly assigned into two groups: In Group A (26 patients), anterior colporrhaphy (Kelly placation) and sling placement using a strip of anterior vaginal wall were performed, and in Group B (30 patients), transvaginal mesh correction of AVWP and tension-free vaginal tape (TVT) insertion (retropubic - craniocaudal route) using polypropylene mesh were carried out. The patients were followed-up for over 18 months and were assessed objectively using a 48 h frequency-volume chart, a 48 h pad test and a standardized stress test. Related surgical complications and outcomes were recorded and compared.

Results: Surgical cure rates for Group A and Group B at the first (3 days) and last (18 months) post-operative visits were 62% and 84%; and 54%, and 72%, respectively (P = 0.09 and 0.31). Complications occurred in 9 patients (44%) of Group B, but only 3 patients (12%) in Group A.

Conclusion: Vaginal sling surgery using an anterior vaginal wall strip can improve SUI and in comparison with propylene mesh is associated with lower complication rates. Although, the surgical success rate of this technique is lower than T-Sling, larger studies with selected patients will help assess the suitable patients for this pelvic reconstructive surgery.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897027PMC
July 2013

Ureteropelvic junction obstruction presenting after antireflux surgery.

Adv Biomed Res 2012 6;1:20. Epub 2012 Jul 6.

Department of Urology, Isfahan Urology and Renal Transplantation Research Center, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

Ureteropelvic junction obstruction (UPJO) and vesicoureteral reflux (VUR) are two of the most common urologic problems in children that sometimes coexist simultaneously in a patient. However, presentation of UPJO after VUR treatment is rare. We will present two cases and discuss diagnostic and therapeutic aspects of the condition.
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http://dx.doi.org/10.4103/2277-9175.98121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507019PMC
December 2012

E-cadherin expression as a prognostic factor in transitional cell carcinoma of the bladder after transurethral resection.

Urol J 2012 ;9(3):581-5

Department of Urology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

Purpose: To analyze the role of negative versus positive immunoexpression of E-cadherin in recurrence rate of low-grade bladder tumors.

Materials And Methods: A total of 180 patients with unifocal, superficial, low-grade, papillary transitional cell carcinoma of the bladder were included in this study. The E-cadherin expression was evaluated using E-cadherin antibody. The patients were followed up for 36 months. Thereafter, recurrence rate of the tumor was compared between E-cadherin positive and negative groups.

Results: Of 180 low-grade carcinomas, E-cadherin immunoexpression was negative in 101 (56%) and positive in 79 (44%) patients. The recurrence rate in negative and positive groups was 65.6% and 37.9%, respectively. Negative in comparison with positive E-cadherin expression was associated with more disease recurrence (P = .045).

Conclusion: There is an association between decreased E-Cadherin immunoexpression and tumor recurrence in low-grade and non-muscle invasive transitional cell carcinoma of the bladder.
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June 2013

Bladder involvement in Behcet's disease.

Urol J 2012 ;9(1):347-50

Isfahan Urology and Renal Transplantation Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

Purpose: To review different aspects of the bladder involvement in Behcet's disease as a rare complication.

Materials And Methods: We searched PubMed, Ovid, and Google Scholar for Behcet's and neuro-Behcet's disease and neurogenic and neuropathic bladder, bladder involvement, voiding dysfunction, and urologic manifestations. Fourteen full-texts and one abstract were retrieved.

Results: Most involved patients are young to middle-aged men. Both bladder filling and emptying problems can be seen, with the storage symptoms being the most common finding. Sphincter function could be normal, dyssynergic, or deficient. The most common urodynamic finding is detrusor overactivity. In cystoscopic examination, ulcers or nodules due to vasculitis can be seen, which along with neurologic causes give rise to the voiding symptoms. The rate of cancers does not increase in Behcet's disease. Surgery and chemotherapy are tolerated well. However, radiotherapy may be associated with increased complication rates.

Conclusion: Treatment plan should be tailored according to the specific type of the bladder involvement. Periodic re-evaluation is required because of the changing nature of the bladder behavior.
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August 2012

Internal urethrotomy and intraurethral submucosal injection of triamcinolone in short bulbar urethral strictures.

Int Urol Nephrol 2010 Sep 1;42(3):565-8. Epub 2009 Dec 1.

Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

Objectives: In clinical practice, internal urethrotomy is an easy procedure and is offered as a first modality for treatment of short urethral strictures. Internal urethrotomy refers to any procedure that opens the stricture by incising or ablating it transurethrally. The most common complication of internal urethrotomy is stricture recurrence. The curative success rate of internal urethrotomy is approximately 20%. Triamcinolone has antifibroblast and anticollagen properties. This study evaluated the efficacy of triamcinolone in the prevention of anterior urethral stricture recurrence after internal urethrotomy.

Methods: Fifty male patients with anterior urethral stricture were randomized to undergo internal urethrotomy with or without urethral submucosal injection of triamcinolone. Using general anesthesia urethrotomy was performed. Triamcinolone (40 mg) was injected submucosally at the urethrotomy site in 25 patients. The patients were followed for at least 12 months and the stricture recurrence rate was compared between the two groups.

Results: 23 patients in the triamcinolone group and 22 in the control group completed the study. There were no significant differences in the baseline characteristics of the patients or the etiology of the stricture between the two groups. Mean follow-up time was 13.7 ± 5.5 months (range: 1-25 months). Urethral stricture recurred in five patients (21.7%) in the triamcinolone group and in 11 patients (50%) in the control group (P = 0.04).

Conclusions: Injection of triamcinolone significantly reduced stricture recurrence after internal urethrotomy. Further investigations are warranted to confirm its efficacy and safety.
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http://dx.doi.org/10.1007/s11255-009-9663-5DOI Listing
September 2010

Laparoscopic heminephrectomy in horseshoe kidney using bipolar energy: report of three cases.

J Endourol 2008 Apr;22(4):667-70

Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran.

Variability in blood supply, the renal isthmus, and abnormal kidney location are unique features that contribute to making a laparoscopic approach for heminephrectomy in a horseshoe kidney technically challenging. We report three cases of laparoscopic heminephrectomy for benign disease in horseshoe kidneys using bipolar energy for transection of the isthmus.
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http://dx.doi.org/10.1089/end.2007.0109DOI Listing
April 2008