Publications by authors named "Mohammad Hossein Soltani"

49 Publications

Transperitoneal Laparoscopic Pyelolithotomy versus Percutaneous Nephrolithotomy for Treating the Patients with Staghorn Kidney Stones: A Randomized Clinical Trial.

Urol J 2021 Dec 20. Epub 2021 Dec 20.

Student Research Committee, Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

Purpose: To compare the performance and outcomes of laparoscopic pyelolithotomy (LPL) versus percutaneous nephrolithotomy (PCNL) in the management of staghorn kidney stones.

Materials And Methods: This study was a parallel-group randomized clinical trial study carried out on 68 patients with staghorn stones (one single piece or maximally two-piece stones with large extra renal part) over 18 years referred to Labbafinejhad Hospital. Patients were randomly divided on a ratio of 1:1 into two groups of LPL and PCNL using random allocation software. The primary outcome was the stone free rate, which was evaluated with KUB, and ultrasonography. Secondary outcomes were duration of surgery, bleeding, fever, post-operative pain, length of hospital stay, and postoperative complications.

Results: The mean±SD age of patients in PCNL and LPL groups were 48.50 ± 13.33 years and 52.17 ± 15.74 years, respectively (P=.303). LPL was associated with a higher duration of surgery (196.55 ± 26.58 minutes versus 110.88 ± 34.82; P=.001). Hemoglobin drop in the PCNL group was higher than the LPL group (2.67 ± 2.61 g/dL versus -0.7912 ± 1.06 g/dL; P=.001). Stone free status was observed in 29 (85.3%) patients in the LPL group, which was significantly higher than the PCNL group (22 patients, 64.7%; P =.050).

Conclusion: The results of this study indicate that LPL offers a higher stone free rate with less bleeding in patients with single particle or limited particles staghorn stones with extrarenal pelvis but is associated with a higher duration of operation. The application of LPL in patients with multiple stones carries a lower achievement and is not encouraged.
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http://dx.doi.org/10.22037/uj.v18i.6831DOI Listing
December 2021

Potential protective effects of Aloe vera gel on cardiovascular diseases: A mini-review.

Phytother Res 2021 Nov 5;35(11):6101-6113. Epub 2021 Aug 5.

School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran.

Cardiovascular diseases (CVDs) comprise the most prevalent causes of morbidity and mortality in both men and women worldwide. CVDs are associated with several risk factors such as hyperlipidemia, diabetes mellitus, hypertension, obesity, tobacco smoking and an unhealthy diet. Currently, in addition to the use of related pharmacological treatments in the management of CVDs, the investigation of other suitable healthcare approaches for these disorders such as the identification of herbal medicines has been considered in the scientific communities. Aloe vera (L.) Burm.f. is a perennial medicinal plant. The innermost leaf layer of this plant contains transparent gel, which is used as food. Pre-clinical studies have shown several biological activities of A. vera gel (AVG), including antidiabetic, lipid-lowering, antioxidant, antiinflammatory, hepatoprotective, and immunomodulatory effects. Other pharmacological activities of AVG such as anti-fibrotic, anti-hypertensive, and anti-atherosclerotic effects have been reported. Moreover, several clinical studies have demonstrated the ameliorating effects of AVG on some markers of CVDs risk factors. Thus, this study was conducted to review clinical trials besides in vitro and in vivo studies on the cardiac beneficial effects of AVG. However, further high-quality studies are needed to firmly establish the clinical efficacy of the plant.
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http://dx.doi.org/10.1002/ptr.7219DOI Listing
November 2021

Single Umbilical Stoma for Bilateral Ureterostomy after Radical Cystectomy.

Urol J 2021 Jul 6;18(6):646-651. Epub 2021 Jul 6.

Urology and Nephrology Research, Center, Shahid Labbafinejad, Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: Cutaneous ureterostomy after radical cystectomy is less preferred compared with other permanent urinary diversions due to bilateral stomas. Single umbilical stoma for bilateral ureterostomy (SUSBU) may be a choice, in this study we reviewed the outcomes of SUSBU in seventeen patients who underwent radical cystectomy.

Methods And Materials: This was a case-series study conducted from April 2016 to Dec 2017. Seventeen male patients with confirmed PT2 bladder urothelial carcinoma who were not suitable for performing conduit or orthotopic urinary diversion, including those with high-risk patients underwent single umbilical stoma for bilateral ureterostomy after radical cystectomy. All patients were prospectively followed up for 24 months ± 2 months, this study was done in a teaching center mainly by senior residents.

Results: The mean age of patients was 68.6 ± 6.41 years. The mean length of operation time was 176.7 ± 15.1 minutes (from intubation to extubation from anesthesia). Sixteen patients were diagnosed with PT2 and one patient had a PT4 diagnosis. The decrease in hemoglobin level after surgery was 1.72 mg/dl ± 0.35 and creatinine increased by 0.15 ± 0.05 mg/dl. None of our patients had oliguria. One case developed constipation and no gas passing, with the suspicion of obstruction, underwent abdominal exploration, however, no obstruction or urine leakage was found and the patient was treated conservatively. One patient developed a fever during admission, in which atelectasis was identified as the cause. One patient underwent a second operation because of fascia dehiscence.

Conclusion: It seems that this technique is suitable for high-risk patients with acceptable operating time, surgical complications, and fast recovery after the operation and one ureterostomy bag instead of two one's comparing to bilateral cutaneous ureterostomy.
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http://dx.doi.org/10.22037/uj.v18i.5857DOI Listing
July 2021

Incentives to Reduce Salt Intake Resulting From Women's Experiences: A Qualitative Study.

Int Q Community Health Educ 2021 Feb 20:272684X21991375. Epub 2021 Feb 20.

Departments of Biostatistics and Epidemiology, Center For Healthcare Data Modeling, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Introduction: Over consumption of salt adversely affects health and is associated with some diseases. Salt over consumption has been reported to be higher in Asian countries including Iran. This research aimed to identify the facilitative factors of reduced salt consumption among 20-65 year-old women to develop effective educational interventions. This research used qualitative content analysis. We included 42 (31 women aged 20-65 years residing in Hamidia, Yazd and 11 healthcare providers) using Purposeful sampling method. Data were collected through focal group discussions (three groups of 6) and in-depth semi-structured individual interviews with 24 Participants. Data analysis was done using Graneheim and Lundman's approach. Motivators and facilitators were extracted. The former consisted of sub-categories: physical fitness and healthcare, obtaining others' approval, family cooperation and support, internal motivators, contextual motivators and healthcare staff support. Sub-categories of the latter were gaining more information from different instructions, willingness to acquire self-protection skills and nutritional advice. These factors affected to reduce the salt intake among women. In the light of the qualitative results of motivating and facilitating factors, it is essential to enhance internal motivators and increase access to information via different communicative channels in community including schools, medical care providers and public associations. It is also necessary to pave the way for more family and medical staff support, provide appropriate educational and advertising programs, raise women's awareness and change their attitude and behavior with this concern.
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http://dx.doi.org/10.1177/0272684X21991375DOI Listing
February 2021

Symptom Resolution and Recurrence Outcomes after Partial Versus Total Laparoscopic Adrenalectomy: 13 years of Experience with Medium-Long Term Follow up.

Urol J 2020 Oct 20;18(2):165-170. Epub 2020 Oct 20.

Urology Nephrology Research Centre (UNRC) , Shahid Labbafinejad Hospital, Shahid BEheshti University of Medical Sciences, Tehran, Iran.

Purpose: Partial adrenalectomy (PA) is an emerging modality typically performed for the treatment of hereditary and sporadic bilateral tumors, to reduce the risk of adrenal failure. In this study, we evaluated the recurrence and functional outcomes after partial and total adrenalectomy (TA).

Materials And Methods: From March 2005 to July 2018, 284 patients with functional tumor or > 5 cm adrenal mass underwent clipless and sutureless laparoscopic partial or total adrenalectomy (PLA and TLA). Patients with a pathological diagnosis of pheochromocytoma, Cushing or Conn's disease and more than two year follow up were included in this study. Pre-operative and operative variables were collected retrospectively and functional outcomes and recurrence were gathered prospectively.

Results: One hundred forty patients (mean age: 43±5.1years) were included in the study. PLA and TLA were performed for pheochromocytoma (total n=78; PLA=12 (15%), TLA=66 (85%)), Cushing syndrome (toal n=17; PLA = 4 (24%), TLA = 13 (76%)), and Conn's disease (total n=45; PLA=7 (16%), TLA=38 (84%)). In pheochromocytoma patients, improvement of hypertension, palpitation, and headache was not different between patients who underwent PLA versus TLA (all P > 0.05). Two recurrences were observed in patients with pheochromocytoma who had undergone TLA. In patients with Cushing disease, central obesity, fascial plethora, and hypertension were improved in all patients six months after treatment, muscle weakness was improved one year after surgery, and acne and hyperpigmentation only improved two years after surgery. The length of time for resolution of symptoms was not different in patients who underwent PLA versus TLA. In Conn's disease hypertension was resolved in all patients and no patient required potassium supplements post-operatively. In follow up no recurrence was observed in patients with a pathological diagnosis of Cushing or Conn's disease.

Conclusion: In our experience, PLA can provide excellent control of the symptoms parallel with TLA and with no statistically significant difference in recurrence making PLA an attractive option in patients with an adrenal mass.
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http://dx.doi.org/10.22037/uj.v16i7.6338DOI Listing
October 2020

The association between a dietary habits score and the risk of metabolic syndrome: A cohort study.

Clin Nutr 2020 01 20;39(1):282-290. Epub 2019 Feb 20.

Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Electronic address:

Background: Dietary habits are proposed to affect the risk of metabolic syndrome (MetS). The present study aimed to investigate the association between a dietary habits score (DHS) and the risk of MetS and its components among Iranian adults.

Materials And Methods: In this cohort study 1092 participants without MetS were followed up to 10 years. The baseline data on general characteristics as well as dietary habits were assessed through interview. The modified National Cholesterol Education Program, adult treatment panel III guideline was used to define MetS. The hazard ratio for the association between each dietary habit and MetS was used to calculate the DHS for each participant and the participants were categorized into quartiles based on their final calculated score.

Results: In total, 809 (74.1%) with mean age of 43 ± 14.4 years were followed. The risk of abdominal obesity (HR = 3.43, 95%CI: 1.97-5.94), low HDL cholesterol (HR = 3.01, 95%CI: 1.62-5.62), hyperglycemia (HR = 3.06, 95%CI: 1.58-5.94), and hypertension (HR = 3.44, 95%CI: 1.85-6.37) and MetS (HR = 2.94, 95%CI: 1.6-5.39) were significantly higher in those with the highest DHS compared with subjects categorized in the lowest quintile of DHS after adjustment for all possible confounders. There was a linear trend between the dietary habit score and the risk of developing MetS and its components (P < 0.05).

Conclusion: The DHS was significantly associated with an increased risk of MetS and some of its components. Future studies are needed to confirm the approach used to calculate the DHS and its association with the risk of MetS and its components in other populations.
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http://dx.doi.org/10.1016/j.clnu.2019.02.005DOI Listing
January 2020

Echocardiographic predictors of worsening renal function in acute heart failure: observations from the RASHF registry.

ESC Heart Fail 2018 12 18;5(6):1060-1068. Epub 2018 Oct 18.

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Aims: Echocardiography is known as the most useful diagnostic test in the assessment of patients with heart failure (HF), and the prognostic significance of echocardiographic findings in HF is well known. In this report, we aim to present the prognostic significance of a limited set of echocardiographic parameters obtained within 24 h of admission of patients enrolled in the Rajaie Acute Systolic Heart Failure registry.

Methods And Results: A total of 230 patients with the diagnosis of acute systolic HF (left ventricular ejection fraction ≤ 35%) were enrolled into the study. Transthoracic echocardiography was performed for all study population within 24 h of admission. The primary endpoint of the study was the occurrence of worsening renal function (WRF) during the hospitalization course.Acquiring data of transthoracic echocardiography within 24 h of admission was feasible in all study participants. The median (inter-quartile range) of left ventricular ejection fraction was 20% (15-23%). Severe right ventricular dysfunction was observed in 21.5% of patients. The grade of inferior vena cava collapse and right ventricular systolic dysfunction were associated with WRF. In multivariable analysis, right ventricular systolic dysfunction was among the independent predictors of WRF [β = 0.8, P = 0.01, odds ratio (OR) = 2.4 (1.2-4.9)] and in-hospital mortality [β = 0.6, P = 0.04, OR = 1.5 (0.5-4.6)].

Conclusions: Echocardiographic parameters are useful for baseline assessment and provide additional information besides other clinical variables for prognostication. Right ventricular dysfunction is the most important risk factor in developing WRF and in-hospital mortality in patients with acute HF.
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http://dx.doi.org/10.1002/ehf2.12358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6300822PMC
December 2018

Laparoscopic Pyelolithotomy for Management of Complete Staghorn Stone of An Ectopic Pelvic Kidney.

Urol J 2018 07 10;15(4):214-216. Epub 2018 Jul 10.

Endourology department of Shahid Labbafinejad Hospital, Urology and nephrology research center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran.

A 40-year-old man was referred to our urology clinic due to vague abdominal pain and hematuria. Computed tomography (CT) without contrast material visualized an ectopic kidney in the left iliac fossa with a complete staghorn stone. Under general anesthesia, operation was done in supine position with a gentle lateral elevation on the right side. The surgeon stands on the right side of the patient. First, a 12 mm port was inserted at the umbilicus using the Hasson technique. After creation of pneumoperitoneum, operation was done by three 5 mm trocars were arranges as paraumbilical, the point between umbilicus and inguinal canal at left and right side.A vertical pyelotomy incision was made over the anterior pelvic wall and then extended to a cross figure. The stone extracted intact with a laparoscopic stone grasper and placed in endobag. A short double J stent was placed via the pyelotomy incision and renal pelvis was closed using continuous 4.0 vicryl sutures. He was discharged from hospital after 3 days without any complication.
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http://dx.doi.org/10.22037/uj.v0i0.4121DOI Listing
July 2018

Fluoroscopy-free ultrasonography-guided percutaneous nephrolithotomy in pediatric patients: a single-center experience.

World J Urol 2018 Apr 18;36(4):667-671. Epub 2018 Jan 18.

Department of Urology, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objectives: To present the safety and efficacy of fluoroscopy-free ultrasound-guided PCNL for the treatment of renal calculi in pediatric patients of all ages.

Methods: 30 children with mean age of 5 years (6 months-12 years) underwent totally ultrasound-guided PCNL from March 2013 to August 2016. The pyelocalyceal system was punctured in prone position using only ultrasonography guidance, and the tract was dilated using a single shot dilation technique. No fluoroscopy was used during any of the stages of renal access. The procedure was performed using adult-sized instruments.

Results: The mean stone size was 27.1 ± 8.7 mm. Mean access time was 4.3 ± 2 min. Mean nephroscopic time was 34.6 ± 15.2 min. Mean hospital stay of patients was 3 days (range 2-5). 21 patients were stone-free after the procedure (70% success rate). Only four patients out of 30 experienced postoperative complications.

Conclusions: The results of this study showed that fluoroscopic-free ultrasound-guided PCNL in pediatric patients of all ages is safe, highly efficient, and minimizes potential radiation exposure risks associated with the procedure.
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http://dx.doi.org/10.1007/s00345-018-2184-zDOI Listing
April 2018

Effect of dietary habits on the risk of metabolic syndrome: Yazd Healthy Heart Project.

Public Health Nutr 2018 04 13;21(6):1139-1146. Epub 2017 Dec 13.

3Nutrition and Food Security Research Center,Shahid Sadoughi University of Medical Sciences,Yazd,Islamic Republic of Iran.

Objective: Metabolic syndrome (MetS) refers to a group of risk factors that increase the risk of cardiovascular mortality and morbidity. Dietary habits are among the most important risk factors for MetS. The current study aimed at assessing the effect of dietary habits on the risk of MetS in a 10-year follow-up study in central Iran.

Design: Cohort study.

Setting: Yazd, Iran.

Subjects: Participants aged 20-74 years without any history of MetS, who were originally recruited for Yazd Healthy Heart Project (YHHP) during 2005-2006, were revisited during 2015-2016. At phase I of YHHP, demographic data, anthropometric measurements, five components of MetS, biochemical tests and dietary habits were evaluated; and the same data were collected in phase II.

Results: A total of 1092 participants were eligible to be included in the present study. After follow-up, the 10-year cumulative incidence of MetS was 56·1 %. After adjustment for potential confounders, increased risk of MetS (hazard ratio; 95 % CI) was found in those who did not try to control their body weight (1·57; 1·06, 2·35), did not usually eat salad (1·91; 1·22, 3·00) and added salt to their food (1·57, 1·06, 2·33). These associations were stronger in men than in the total population after subgroup analysis, but were not present in women.

Conclusions: Dietary habits affect the risk of MetS in the Iranian population. Lifestyle interventions are needed to improve dietary habits to reduce the risk of MetS. Future studies are highly recommended to confirm our results in other populations.
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http://dx.doi.org/10.1017/S1368980017003627DOI Listing
April 2018

Stented Versus Stentless Laparoscopic Ureterolithotomy: A Systematic Review and Meta-Analysis.

J Laparoendosc Adv Surg Tech A 2017 Dec 20;27(12):1269-1274. Epub 2017 Jun 20.

2 Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences , Tehran, Iran .

Introduction: This systematic review and meta-analysis were designed to evaluated the efficacy and safety of stented versus stentless laparoscopic ureterolithotomy (LU).

Methods: We conducted a systematic review and meta-analysis that included six trials that investigated the outcomes, including the rate of prolonged urine leakage, operative time, time to drain removal, and estimated blood loss, between stented versus stentless LU.

Results: Four studies with 289 participants were included in the study. There was no significant difference between two groups in rate of prolonged urine leakage (odds ratios [OR] 0.35, 95% confidence intervals [CI] 0.09-1.46, p = 0.15). Significant longer operative time was detected in patients who underwent stented LU compared with stentless group (mean difference 11.36, 95% CI 7.53-15.20, P < .00001). There was no significant difference between two groups in day of drain removal (mean difference -1.09, 95% CI -2.33-0.15, P = .08). No significant difference in blood loss in patients who underwent stented LU compared with stentless group was detected (mean difference 7.67, 95% CI -0.29-15.64, P = .06).

Conclusion: Our study demonstrated that the rate of prolonged urine leakage, time to drain removal, and estimated blood loss were not significantly different between stented and stentless LU.
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http://dx.doi.org/10.1089/lap.2017.0183DOI Listing
December 2017

Impact of Kidney Graft Weight-to-Recipient Body Weight Ratio on Long-Term Graft Function in Living Donor Kidney Transplant.

Exp Clin Transplant 2017 Oct 18;15(5):532-535. Epub 2016 Nov 18.

From the Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objectives: Our objective was to evaluate the effect of kidney graft weight-to-recipient body weight ratio as a nonimmune factor that may affect long-term graft function.

Materials And Methods: We retrospectively collected data from 2531 living donor kidney transplant procedures performed between 1994 and 2010 at Shahid Labbafinejad Medical Center; 635 patients were included in this study. Each kidney was weighed after cold wash. The kidney weight-to-recipient body weight ratio was calculated. As an indicator of graft function, we used the Modification of Diet in Renal Disease Study Group equation to estimate glomerular filtration rate. For statistical analyses, we used simple linear regression analysis and the mixed model test using SPSS version 17.0 software (SPSS, Chicago, IL, USA).

Results: Mean age of recipients and median follow-up duration were 37.5 years (range, 6-77 y) and 36 months (range, 25-84 mo). Long-term graft function showed a positive correlation with kidney graft-to-recipient body weight ratio but not with the graft weight alone. The magnitude of this correlation was higher early after surgery (day 7) and decreased with long-term follow-up but was still statistically significant (P < .001).

Conclusions: From our results, we conclude that kidney graft-to-recipient body weight ratio is correlated with the kidney graft function; graft size matching may be considered for kidney donor selection.
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http://dx.doi.org/10.6002/ect.2016.0045DOI Listing
October 2017

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

Urol J 2016 Oct 10;13(5):2837-2840. Epub 2016 Oct 10.

Endourology Department of Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran.

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. .
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October 2016

Stent Removal in 200 Kidney Transplant Recipients: Nonoperative Versus Endoscopic Removal.

Exp Clin Transplant 2016 Aug;14(4):385-8

From the Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objectives: Inserting a double J stent during kidney transplant has reduced the rate of urologic complications. Traditionally, a double J stent is removed via endoscopic intervention. Here, we assessed the safety and efficacy of a nonoperative method for double J stent removal.

Materials And Methods: Our study group included 200 consecutive patients who underwent kidney transplant from January 2013 to April 2014. Group A consisted of 100 recipients who had a double J stent that was tied to a Foley catheter with 2-0 silk suture. The stent was simply removed by taking out the Foley catheter after 3 weeks. Patients in group A were compared with a second group of 100 kidney transplant patients whose stents were removed endoscopically 3 weeks later (group B).

Results: Patients were matched between the 2 groups regarding age distribution, male-to-female patient ratio, deceased versus living donor graft, prevalence of type 2 diabetes mellitus, and body mass index. The incidence of urinary fistula (3% in group A and 4% in group B; P = .7), ureteral stenosis (1% in group A and 2% in group B; P = .56), wound infection (1% in group A and 2% in group B; P = .56), and positive urine culture (20% in group A and 29% in group B; P = .14) after stent removal were not significantly different between the 2 groups.

Conclusions: This study shows that nonoperative removal of a double J stent is a safe and effective method. This approach is simple, and there is no need for a surgical procedure or any outpatient surgical intervention.
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August 2016

Solo Sonographically Guided PCNL under Spinal Anesthesia: Defining Predictors of Success.

Scientifica (Cairo) 2016 3;2016:5938514. Epub 2016 May 3.

Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran.

Aim. Sonography has been brought in percutaneous nephrolithotripsy (PCNL) as an adjunct to or substitute for X-ray to restrict radiation exposure. This study was designed to investigate the possible predictors for the success of the solo sonographically guided PCNL. Methods. 148 consecutive cases were prospectively enrolled. All steps of PCNL were performed solely with sonography guidance under spinal anesthesia. Residual stones were evaluated the day after surgery using sonography and plain radiography. Results. The mean age was 46 ± 15 years; 40% of kidneys had hydronephrosis. The mean stone burden was 504 ± 350 mm(2). The mean duration of surgery was 43 ± 21 minutes. The early stone-free rate was 92% in inferior or middle calyceal stones, 89.5% in single pelvic stones, 81.5% in partial staghorn stones, and 61.9% in staghorn stones. The mean residual stone size was 13 ± 8 mm. Logistic regression showed that a lower age and a larger stone burden significantly predicted positive residual stones. Fifteen percent of patients presented with grade I or II and six percent showed grade III complication based on Clavien classification. There was no cases of organ injury or death. Conclusion. Solo ultrasonographically guided PCNL under spinal anesthesia is feasible with an acceptable stone-free rate and complication rate.
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http://dx.doi.org/10.1155/2016/5938514DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868899PMC
May 2016

Living Unrelated Versus Related Kidney Transplantation: A 25-Year Experience with 3716 Cases.

Urol J 2016 Mar 5;13(1):2546-51. Epub 2016 Mar 5.

Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To evaluate the results of transplantation from living unrelated donors (LURD) versus living related donors (LRD) with a long term follow-up of 25-30 years.

Materials And Methods: From 1984 to 2015, a total of3716 kidney transplantations (411 LRDs and 3305 LURDs) were enrolled to the study. Long-term survival of grafts and patients as well as the association between relation state and patients or grafts surveillance were the outcomes.

Results: A total of 3716 live donor kidney transplants (LRD, n = 411; LURD, n = 3305) were carried out over this period. The mean age of donors was 28 ± 54 years in the LURD group and 34.4 ± 11.7 years in LRD (P < . 001), while the mean age of the recipients was 35.6 ± 15.6 years and 27.6 ± 10.1 years for the two groups, respectively. Donor age was the only statistically significant predictor of graft survival rate (hazard ratio = 1.021, 95% confidence interval: 1.012-1.031). Between 1984 and 2015, patient survival and graft survival improved significantly also patient survival and graft survival was similar in LURDs compared with LRDs.

Conclusion: It seems that the outcome of LURD and LRD is comparable in terms of patient and graft survival. Therefore, transplants from LURDs may be proposed as an acceptable management for patients with end stage renal disease.
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March 2016

Long-Term Follow-up After Right Laparoscopic Donor Nephrectomy and Inverted Kidney Transplant.

Exp Clin Transplant 2016 Feb;14(1):27-31

From the Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objectives: The objective of this study was to investigate the long-term outcomes of inverted kidney transplant, an alternative easy and safe technique to overcome difficulties associated with short right renal vein anastomosis after laparoscopic donor nephrectomy.

Materials And Methods: Seventy-nine laparoscopic donor nephrectomies and intentionally inverted renal transplants were performed between 2004 and 2009. For these transplants, the renal artery was ligated by Hem-o-lok (Weck Surgical Instruments, Teleflex Medical, Durham, NC, USA) and titanium clips, and the vein was closed with 2 Hem-o-lok clips, resulting in a short renal vein. By inverting the recovered kidney to the ipsilateral pelvic side of he recipient, the short renal vein is placed posterior and adjacent to the external iliac vein; this made an easy and safe short renal vein anastomosis possible.

Results: All donor nephrectomies were completed laparoscopically, and no conversion to open surgery was required. The mean warm and cold ischemic times were 7.3 minutes (range, 3.2-17.5 min) and 37.5 minutes (range, 14.2-88 min). Only 6 patients (7.6%) had delayed graft function. At 5 years after transplant, patients showed excellent graft function, with mean serum creatinine level of 1.46 mg/dL and graft survival of 93.7%. There were no occurrences of vascular thrombosis or acute rejection. However, 5 years after transplant, 4 patients had died, with 3 patients still having functional transplanted kidneys and 1 patient experiencing graft rejection 1 month before death.

Conclusions: Inverted kidney transplant is an easy and safe method to overcome the complications associated with short right renal vein anastomosis after laparoscopic donor nephrectomy. This simple modification might obviate the need to elongate a short renal vein.
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February 2016

Minilaparoscopy vs. standard laparoscopic donor nephrectomy: comparison of safety, efficacy and cosmetic outcomes in a randomized clinical trial.

Urol J 2015 Sep 4;12(4):2223-7. Epub 2015 Sep 4.

Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran..

Purpose: This study was conducted to compare safety, efficacy and cosmetic outcome between standard laparoscopic live donor nephrectomy (sLDN) and mini-laparoscopic donor nephrectomy (mLDN) in a randomized clinical trial.

Materials And Methods: From March 2012 to June 2013, 100 consecutive kidney donors were randomly assigned to two equal groups for laparoscopic donor nephrectomy. mLDN: Six to eight centimeters Pfannenstiel incision was made slightly above pubis symphysis and 11 millimeters trocar was fixed through exposed fascia using open technique. Five mm port was placed under direct vision at the umbilicus for camera insertion and two 3.5 mm ports were placed in subxiphoid and paraumbilical area. sLDN: Ten mm port was placed at umbilicus using open access technique for camera insertion. Five mm trocar for grasping and 11 mm trocar for vascular clipping were placed at subxiphoid and paraumbilical areas under direct vision, respectively. The second 5 mm trocar was placed in suprapubic area. Cosmetic appearance was assessed three months after surgery by using the Patient Scar Assessment Questionnaire (PSAQ).

Results: Demographic data of the patients was not significantly different between two groups. Total operative time and ischemic time was nearly similar in both groups (104 ± 21 vs. 114 ± 24 min; P = .327 and 4.03 vs. 4.07 min; P = .592). There were no cases of conversion to open surgery. Mean hospital stay was similar between the two groups [2.1 (2-5) vs. 2.4 (2-5) days; P = .346]. Kidney graft function assessed by serum creatinine val­ues (mg/dL) of recipients, was equivalent in both groups (1.58 vs. 1.86: P = .206). Mean appearance score (34 vs. 29) and consciousness score (22 vs. 18) in PSAQ showed significantly better results in the mLDN group.

Conclusion: Our experience in this study revealed that peri- and post-operative findings were comparable between sLDN and mLDN, but mLDN has significant better cosmetic appearance than standard laparoscopic approach.
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September 2015

THE IMPACT OF ANESTHETIC TECHNIQUES ON COGNITIVE FUNCTIONS AFTER UROLOGICAL SURGERY.

Middle East J Anaesthesiol 2015 Feb;23(1):35-42

Background: Postoperative cognitive dysfunction (POCD) is a well-recognized complication of cardiac and noncardiac surgery. However, contradictory results concerning postoperative mental function have been reported. The aim is to determine the effect of anesthetic techniques (general or spinal) on cognitive functions using more sensitive neuropsychological tests in patients undergoing urological surgery.

Material And Methods: A total of thirty patients were enrolled in the study and assigned to receive either general (n = 15) or spinal (n = 15) anesthesia. A battery of neuropsychological tests including Wisconsin Card Sorting Test, Iowa Gambling Task, Stroop Color-Word Test, N-back Task and Continuous Performance Test was performed preoperatively and three days later.

Results: The two experimental groups were similar at baseline assessment of cognitive function. Although there were no statistically significant differences between general and spinal anesthetic groups with respect to Wisconsin Card Sorting Test and Iowa Gambling Task, a significant intergroup difference between pre-and postoperative N-back scores was detected in the general anesthesia group (p = 0.001 & p = 0.004). In addition, patients within this group had significantly higher error rates on the Stroop Color-Word (p = 0.019) and Continuous Performance Tests (p = 0.045). In contrast, patients receiving spinal anesthesia exhibited little change or marginal improvement on all subscales of the battery.

Conclusions: Our findings indicate significant decline in specific aspects of mental function among patients who were administered general anesthesia compared with the other technique. It seems that spinal anesthesia contributes to lower disturbance after surgery.
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February 2015

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

J Endourol 2021 05 7;35(5):749-752. Epub 2015 Aug 7.

Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran.

To present the safety and efficacy of totally ultrasonography-guided percutaneous nephrolithotomy (PCNL) for managing urinary stones in pediatric patients. 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. 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. 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.
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http://dx.doi.org/10.1089/end.2014.0660DOI Listing
May 2021

Concomitant anterior and posterior urethral valves in pediatrics: A single center experience over 12 years and long-term follow up after endoscopic treatment.

Int J Urol 2015 May 16;22(5):514-9. Epub 2015 Feb 16.

Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.

Objective: To report our 12-year experience with endoscopic management of patients with concomitant anterior and posterior urethral valves.

Methods: We retrospectively reviewed the charts of patients referred to us for management of urethral valves from 2000 to 2012 to find cases with concomitant anterior and posterior valves. The diagnosis of valves was first suspected on voiding cystourethrography and confirmed by urethrocystoscopy. We collected available data on patients' age at diagnosis, clinical presentations, ultrasound and urodynamic findings, and surgical treatments. The final outcome at last follow up was also recorded.

Results: From 38 cases with anterior urethral valve, six (15.8%) presented concomitant anterior and posterior valves. The age at diagnosis in these patients ranged from antenatal diagnosis to 13 years. Initial presenting symptoms were recurrent urinary tract infection, incontinence, urosepsis and poor urinary stream. All valves were ablated by transurethral fulguration/resection using small-sized urethrocystoscopes. Among those with concomitant anterior and posterior valves, four patients had vesicoureteral reflux at presentation that resolved in two patients after valve ablation. One patient progressed to renal failure and required dialysis. Bladder hypercontractility and detrusor overactivity were the main urodynamic patterns in these patients.

Conclusions: Concomitant anterior and posterior valves seem to be more prevalent than previously assumed, and might be missed on initial assessment. Oblique view voiding cystourethrography with full-length delineation of the urethra is of paramount diagnostic importance when obstruction is suspected. A meticulous urethrocystoscopy should follow for confirming the diagnosis and endoscopic ablation/resection of the valves.
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http://dx.doi.org/10.1111/iju.12712DOI Listing
May 2015

Comparison of safety and efficacy of laparoscopic pyelolithotomy versus percutaneous nephrolithotomy in patients with renal pelvic stones: a randomized clinical trial.

Urol J 2014 Nov 30;11(6):1932-7. Epub 2014 Nov 30.

Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran.

Purpose: A randomized clinical trial was designed to compare the efficacy, success rate and surgical complications of percutaneous nephrolithotomy (PCNL) and laparoscopic pyelolithotomy (LP).

Materials And Methods: Sixty patients with renal pelvic stones larger than 2 cm were randomly divided into two groups of LP and PCNL. All patients were followed up to three months after surgery using renal diethylenetriamine­pentaaceticacid (DTPA) scan and determining the glomerular filtration rate (GFR).

Results: Mean operation time (149 ± 31 vs. 107 ± 26 min) and mean hospital stay (3.4 vs. 2.16 days) were significantly higher in LP, but mean hemoglobin drop (0.85 vs. 1.88 g/dL) and the rate of blood transfusion were significantly lower. Stone free rate was 90% and 86.6% for LP and PCNL, respectively (P =.59), while the changes in GFR were not statistically significant 3 days after surgery between two groups. Those in LP group showed better improvement in GFR at three months postoperatively. Improvement of the affected split kidney function was significantly higher in LP group (P =.04). No major complications were observed in both groups according to Clavien grading system.

Conclusion: PCNL remains the gold standard treatment for most large kidney stones, nevertheless, laparoscopic pyelolithotomy can be considered for selected cases especially in whom maximal preservation of renal function is  necessary. 
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November 2014

Pediatric kidney transplant with laparoscopic donor nephrectomy.

Exp Clin Transplant 2014 Oct;12(5):391-5

From the Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Shahid Labbafinejad Medical Center, Tehran, Iran.

Objectives: To evaluate outcomes and complications with pediatric living-donor kidney transplant, mostly performed with laparoscopic donor nephrectomy.

Materials And Methods: In the 25 years between February 1987 and December 2012, there were 493 children aged ≤ 17 years who received a kidney transplant. Demographic characteristics, graft and patient survival, rejection episodes, and complications were recorded. Analysis was performed for 3 sequential periods (1987-1994, 1995-2002, and 2003-2012).

Results: The mean patient age was 13 ± 4 years (age range, 2.5-17 y). There were 290 males (59%). Glomerulonephritis was the most common cause of end-stage renal disease. Preemptive kidney transplant was performed in 412 patients (84%). Donor nephrectomy was performed laparoscopically in 445 patients (90%). The 5-year graft and patient survival were improved from 1987-1994 to 2003-2012. The overall death-censored graft survival was 96% at 1 year, 78% at 5 years, and 66% at 10 years after transplant. The overall patient survival was 96% at 1 year, 83% at 5 years, and 75% at 10 years after transplant.

Conclusions: Kidney transplant is available for most pediatric patients and has acceptable graft and patient survivals. Laparoscopic donor nephrectomy improves donor satisfaction and morbidity, and may provide excellent graft outcomes in children.
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October 2014

Does sildenafil enhance the effect of tamsulosin in relieving acute urinary retention?

Int Braz J Urol 2014 May-Jun;40(3):373-8

Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, I.R. Iran.

Objective: To compare the safety and efficacy of combined therapy using sildenafil and tamsulosin for management of acute urinary retention (AUR) with tamsulosin alone in patients with benign prostate hyperplasia (BPH).

Materials And Methods: 101 patients were enrolled in a randomized placebo-controlled study from June 2009 to April 2012. Patients presenting with an initial episode of spontaneous AUR underwent urethral catheterization and then prospectively randomized to receive tamsulosin 0.4 mg plus sildenafil 50mg in group A and tamsulosin 0.4 mg plus placebo in group B for three days. Urethral catheter was removed three days after medical treatment and patient's ability to void assessed at the day after catheter removal and seven days later. Patients who voided successfully were followed at least for three months.

Results: Mean age of patients was 59.64 ± 3.84 years in group A and 60.56 ± 4.12 years in group B (p value = 0.92). Mean prostate volume and mean residual urine were comparable between both groups (p value = 0.74 and 0.42, respectively). Fifteen patients in group A (success rate: 70%) and nineteen patients in group B (success rate: 62.7%) had failed trial without catheter (TWOC) at 7th day following AUR (p value = 0.3). No significant difference was noted between both groups regarding the rate of repeated AUR at one month and three month follow-up period (p = 0.07 and p = 0.45, respectively).

Conclusion: It seems that combination therapy by using 5-phosphodiesterase inhibitor and tamsulosin has no significant advantages to improve urinary retention versus tamsulosin alone.
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http://dx.doi.org/10.1590/S1677-5538.IBJU.2014.03.11DOI Listing
February 2015

Intermittent perirenal instillation of bupivacaine after tubeless percutaneous nephrolithotomy under spinal anesthesia: a double-blind, placebo-controlled clinical trial.

J Endourol 2014 Nov 21;28(11):1299-303. Epub 2014 Aug 21.

Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU) , Tehran, I.R. Iran .

Background And Purpose: Pain at the surgery site is a common complaint in patients who experience percutaneous nephrolithotomy (PCNL). The aim of this double-blind, randomized clinical trial is evaluation of the effect of scheduled infusion of bupivacaine on postsurgical pain and narcotic consumption after tubeless PCNL under spinal anesthesia.

Patients And Methods: Forty patients were randomly divided into two groups. A small caliber fenestrated feeding tube was placed into the nephrostomy tract under direct vision in a manner in which its tip lied close to the renal capsule. The study group received infusion of diluted bupivacaine while physiologic saline was injected in the control group. Each patient was given the same dose every 6 hours until 24 hours after the surgical procedure.

Results: Mean pethidine injection was significantly lower in the group who underwent bupivacaine instillation (20.5±14.5 vs 3.97±2.4 mg: P=0.009). There was no significant difference between mean visual analogue scale (VAS) score in these two groups after 6 and 12 hours while it was significantly lower after 18 and 24 hours in the patients who had received bupivacaine. Mean time to the first analgesic request was significantly longer in the study group (11.35 vs 6.44 hours: P=0.001).

Conclusion: Intermittent perirenal instillation of bupivacaine via the nephrostomy tract after PCNL decreases the need for more systemic narcotics and provides acceptable analgesia in the postoperative period.
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http://dx.doi.org/10.1089/end.2014.0408DOI Listing
November 2014

Clipless laparoscopic adrenalectomy in children and young patients: a single center experience with 12 cases.

Urol J 2014 Mar 3;11(1):1228-31. Epub 2014 Mar 3.

Shahid Labbafinejad Medical Center , Urology and Nephrology Research Center , Shahid Beheshti University of Medical Sciences, Tehran, Iran..

Purpose: Laparoscopy is the gold standard approach for management of some adrenal masses in adult cases. Still there have not been many findings in case of children. We present our experience with clipless laparoscopic adrenalectomy in pediatric cases for the first time.

Materials And Methods: From January 2007 to January 2011, thirteen laparoscopic adrenalectomy were performed in patients 5-18 years old. The first port (10 mm) was inserted using open approach above the umbilicus and three 5 mm trocars were inserted under direct vision. On the left side, the colon was mobilized medially, then the renal vein exposed. Adrenal vein was coagulated using bipolar cautery after separating from renal vein. No endoscopic clips were used.

Results: Eight girls and five boys with the mean age of 14.4 years old (ranging from 5 to 18 years old) underwent laparoscopic adrenalectomy. The mean operative time was 151 ± 47 (80- 240) minutes. The mean size of adrenal lesions in greatest diameter was 6.9 ± 2.4 cm (3.5 to 10). The mean hospital stay was 3.7 days (2-5) and average follow-up time was 21 months (6-27).

Conclusion: Laparoscopic adrenalectomy in children and young adults is effective and safe if the cases are selected appropriately. Clipless laparoscopic approach by an expert surgeon has acceptable outcomes.
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March 2014

Mini-laparoscopic live donor nephrectomy: initial series.

Urol J 2014 Jan 4;10(4):1054-8. Epub 2014 Jan 4.

Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences.

Purpose: To present the safety and surgical outcomes of the initial series of mini-laparoscopic live donor nephrectomy and graft outcomes in related recipients.

Materials And Methods: From January 2012 through July 2012, fifty patients underwent minilaparoscopic live donor nephrectomy. Two 3.5 mm trocars were inserted above and lateral to the umbilicus for grasping and scissoring. One 5 mm trocar with a camera was inserted in the umbilicus and an 11 mm trocar was inserted through fascia from a 6-8 cm Pfannenstiel incision for bipolar coagulation, kidney extraction, and vascular clip applier.

Results: Mean age of donors was 28 ± 4.2 (range, 21-39) years. Mean operative time from trocar insertion was 145.8 (range, 85-210) minutes. No major perioperative or postoperative complications occurred. The average decrease in hemoglobin level was 1.14 (range, 0.32-1.8) mg/dL and no one required blood transfusion. Mean warm ischemia time was 4.41 (range, 2.35- 9) minutes. Mean hospital stay was 2.2 (range, 2-5) days. Mean follow-up time of the recipients was 215 (range, 130-270) days. The mean serum creatinine level of the recipients at discharge time and the last follow-up visit was 1.38 mg/dL and 1.22 mg/dL, respectively.

Conclusions: While the primary purpose of this technique is to make donor nephrectomy less invasive and more cosmetic, it is also comfortable for the laparoscopist surgeons because it is nearly similar to standard laparoscopy. A randomized controlled trial with a large sample size, long-term follow-up, and comparison with standard laparoscopy are necessary to present more definitive data about this technique.
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January 2014

Delayed postpercutaneous nephrolithotomy hemorrhage: prevalence, predictive factors and management.

Scand J Urol 2014 Feb 21;48(1):110-5. Epub 2013 Nov 21.

Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU) , Tehran, IR , Iran.

Objective: The aim of this study was to assess the prevalence, potential risk factors and management of delayed post-percutaneous nephrolithotomy (PCNL) bleeding.

Material And Methods: Records of 2512 patients who had undergone PCNL from April 2008 to April 2011 were reviewed retrospectively. The prevalence of delayed post-PCNL hemorrhage and correlation of different variables such as age, body mass index, stone location and burden, surgical approach, type and number of access ports, type of drainage, comorbidities and previous history of stone surgery with postoperative bleeding were assessed. The efficacy of conservative management and need for angioembolization were analyzed.

Results: In total, 2304 patients [1562 men (67.8%) and 742 women (32.2%)], with a mean age of 46.4 ± 13.6 years (range 17-86 years), were enrolled in the study. The prevalence of delayed hemorrhage was 2.6% (61 patients) and the mean time to the onset of hemorrhage after PCNL was 5.8 days (range 3-11 days). Of 61 patients presenting with delayed hemorrhage, only 16 patients received a blood transfusion. Eight patients underwent angiography because of uncontrolled bleeding and only three underwent embolization. No significant association was found between other variables and post-PCNL hemorrhage, except for type of drainage, in that tubeless surgery increased the rate of postoperative bleeding.

Conclusion: Delayed hemorrhage is an uncommon complication following PCNL that can be successfully managed with conservative management; only a few patients will require angiography and then embolization. Tubeless PCNL significantly predicted the occurrence of severe postoperative bleeding.
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http://dx.doi.org/10.3109/21681805.2013.806586DOI Listing
February 2014

Evolution of laparoscopic live donor nephrectomy: a single-center experience with 1510 cases over 14 years.

J Endourol 2014 Jan 19;28(1):34-9. Epub 2013 Nov 19.

Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences (SBMU) , Tehran, Islamic Republic of Iran .

Objective: This study evaluated the outcomes of laparoscopic donor nephrectomy (LDN) and proposed modifications for kidney donation surgery. From February 1997 to February 2011, 1510 LDNs were performed.

Patients And Methods: Surgical modifications included a modified open access technique for entry into the abdominal cavity, using vascular clips for safe and cost-effective control of the renal pedicle, control of the lumbar veins, and adrenal vein using bipolar cautery instead of clips, and leaving the gonadal vein intact with the ureter. Kidneys were extracted by hand through a Pfannenstiel incision. Heparin was not used after the first 300 cases to prevent potential hemorrhagic complications.

Results: Although three major vascular injuries occurred using the closed access method that were managed successfully, no access-related complications occurred using the modified open access technique. Clip failure did not happen in any cases. Patient and graft survival at 1 year post-transplantation were 96.5% and 95.5%, respectively, and at 5 years post-transplantation were 95.3% and 89.5%, respectively.

Conclusion: The proposed surgical modifications are based on 14 years of experience and 1510 cases, and make LDN simple, safe, and cost-effective. The excellent recipient and graft outcomes with minimal morbidity obtained further confirm that LDN can be considered as the gold standard for kidney donation surgery.
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http://dx.doi.org/10.1089/end.2013.0460DOI Listing
January 2014

Comparison of percutaneous nephrolithotomy under spinal versus general anesthesia: a randomized clinical trial.

J Endourol 2013 Aug 13;27(8):974-8. Epub 2013 Jul 13.

Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, IR Iran.

Purpose: To evaluate the safety and efficacy of spinal anesthesia compared with general anesthesia in patients who underwent percutaneous nephrolithotomy (PCNL).

Patients And Methods: One hundred patients with American Society of Anesthesiologists (ASA) score <3 were randomly divided into two groups according to the type of anesthesia. Spinal anesthesia was performed using an injection of 0.25 mg/kg bupivacaine 0.5% in the intrathecal space; no opium (fentanyl) agent was used. All procedures were performed with the patient in the prone position. Stone access was made by using fluoroscopic guidance, and the tract was dilated using a single-stage technique. All patients received a solution including 1 mg/kg morphine in every 100 mL physiologic saline through the volumetric pump during the 3-hour post-PCNL period in the recovery room. Afterward, morphine (0.05 mg/kg) was injected only according to the verbal rating scale greater than 3 after discharge from the recovery room until 24 hours after surgery.

Results: The two groups were matched by mean age, distribution of stone location, and stone burden. Mean operative time, hospital stay, stone-free rate and mean hemoglobin drop were comparable between the two groups. The rate of complications according to the Clavien grading system was nearly similar in both groups. Mean analgesic requirement during 24 hours after PCNL was 6.8 mg in the spinal group and 13.2 mg in the general group (P<0.001).

Conclusion: It seems that using spinal anesthesia by intrathecal injection of local anesthetic solutions vs general anesthesia has comparable surgical outcomes and reduces the requirement for analgesia after PCNL in the early postoperative period.
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http://dx.doi.org/10.1089/end.2013.0145DOI Listing
August 2013
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