Publications by authors named "Nasser Simforoosh"

109 Publications

Oncologic Outcomes Following Positive Surgical Margins in Patients who Underwent Open Versus Laparoscopic Partial Nephrectomy

Urol J 2021 11 28. Epub 2021 Nov 28.

Urology resident, Urology and Nephrology Research Center, Shahid Beheshti University of Medical sciences, Tehran, Iran.

Objectives: To evaluate oncological outcomes in patient with positive surgical margin (PSM) following partial nephrectomy (PN).

Material And Methods: In this retrospective study, we enrolled the data of patients who underwent PN between 2008 and 2017. The inclusion criteria were a definite diagnosis of kidney tumor who underwent PN with at least one year follow up.

Results: From the 450 patients who underwent PN, The PSM was found in 35 (22 male/13 female) patients. 18/237 (7.6%) and 17/213 (7.9%) of them were in open and laparoscopic group, respectively. Clear cell RCC was the most prevalent pathology (18 patients) in the PSM patients. The mean time of follow up was 46±2.02 months. Recurrence was developed in 5 (14.2%) patients. There was no correlation between recurrence and sex (p=1.00), surgery type (p=0.658), age (p=0.869), tumor size (p= 0.069), pathology (p=0.258) and stage (p=0.744) in PSM patients. Recurrence free survival was similar between the open and laparoscopy groups in PSM patients (p=0.619).

Conclusion: Beside numerous advantages of minimally invasive techniques, laparoscopic approach would be comparable to conventional open partial nephrectomy in terms of oncologic outcomes. The rate of recurrence following partial nephrectomy in PSM patients is considerable and closely monitoring is mandatory.
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http://dx.doi.org/10.22037/uj.v18i.6858DOI Listing
November 2021

Off Clamping Laparoscopic Resection of An Extreme Rare Renal Mesenchymal Tumor: An Angiomyolipoma of Renal Capsule.

Urol J 2021 Jul 11;18(6):703-705. Epub 2021 Jul 11.

Assistant professor of pathology department of Shiraz University of medical science.

Renal mesenchymal tumors are described as neoplasms with vascular, fibrous, and adipose tissues. The renal lipoma is an extremely rare renal mesenchymal tumor, typically originating from renal capsule and it is usually presented as well circumscribed homogenous fat containing mass. Angiomyolipoma (AML) is the most common benign mesenchymal renal tumor which is composed of mature epithelioid cells. The renal AML usually presented as exophytic, non-infiltrative, and fat contain tumor. The well differentiated renal retroperitoneal liposarcoma and lipoma seem to be misdiagnosed by exophytic renal angiomyolipoma but the renal AML usually arises from renal parenchyma with characteristic images. A 37-year-old woman came to our clinic with rapid growth renal mass and pain. The spiral abdominopelvic computed tomography scan (CT-scan) showed well-circumscribed hypoheterodense fat-containing mass near to middle pole of the right kidney with minimal fat stranding without neovascularity and cortical defect. The Patient underwent off-clamping laparoscopic resection of renal mass with pre-operative impression: liposarcoma versus lipoma of the kidney. The cross-section of the surgical specimen revealed irregular lobulated fatty tissue with hemorrhagic streaks. Definite diagnosis was made by immunohistochemistry study. Spindle cells and epithelioid cells are diffusely and strongly positive for α-smooth muscle actin. The perivascular cells and epithelioid cells are positive for HMB-45 and Melanin. The immunostaining pattern was compatible with angiomyolipoma that originated from renal capsule. In our experience, a rapid growing mass that is accompanied by pain draws the attention to malignant process. The renal AML rarely arises from renal capsule without characteristic images so having high doubt may lead to proper pre-operative diagnosis.
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http://dx.doi.org/10.22037/uj.v18i.6512DOI Listing
July 2021

A Proposal for Data Registry system for Urologic Cancers in Iran.

Urol J 2021 Jun 30. Epub 2021 Jun 30.

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

Purpose: Data registries are organized systems that facilitate collection, storage, and analysis of data related to a specific disease in a defined population. Here we introduce a data registry system which was designed to cover the four most common urologic cancers (prostate, bladder, renal and testis).

Materials And Methods: All contributing centers can enter data into the system after logging in with their unique usernames and passwords. In this system, the information of each individual patient will be entered in several structured forms covering various steps of management of the patients.

Results: Our proposed registry is an interactive, web-based database designed to collect complete data of patients with common urological cancers. We devised a council that functions as the central committee that will initiate, supervise, and monitor all steps of the projects including data collection, data audit, as well as data analysis and publication. To facilitate manuscript publication, the system will provide assistance and support throughout all the steps of statistical analysis and manuscript preparation.

Conclusion: This proposed registry can have a national target and is designed to provide evidence-based information that could support strategic planning and national multi-centric studies.
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http://dx.doi.org/10.22037/uj.v18i.6790DOI Listing
June 2021

Living Donor Kidney Transplantation: Global and Regional Trend.

Urol J 2021 May 9;18(3):359-361. Epub 2021 May 9.

Resident of General Surgery, Zahedan University of Medical Sciences, Zahedan, Iran.

Request for kidney transplantation (K.T.) is increasing rapidly because of the worldwide pandemic of end-stage renal disease, and the most critical issue is organ shortage. The available deceased donors will not resolve the continuing scarcity of organs. It is now professionally and ethically acknowledged and is vital to pay money to the donors for excluding disincentives of living organ donation. Living organ donation should be a vital part of the K.T. Program of any country.
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http://dx.doi.org/10.22037/uj.v18i.6820DOI Listing
May 2021

Preference for Patient -Urologist Gender Similarity and Its Implications for Urology Departments: A Systematic Narrative Review and Thematic Analysis.

Urol J 2020 May 28;17(6):568-577. Epub 2020 May 28.

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

Purpose: To evaluate the evidence that could help health system policy makers to approach the preference for same-gender urologists.

Methods: We performed this systematic narrative review according to the PRISMA guidelines. We searched MEDLINE, Web of science, EMBASE, CINAHL and Google Scholar for articles focused on the preference for patient-urologist gender similarity in the male-dominated department from 1999-2019. Finally, a narrative synthesis of studies meeting the inclusion and quality criteria was conducted in accordance with the nature of the evidences. We applied a thematic analysis using inductive approach for synthesizing studies employing heterogeneous research methods and designs.

Results: Of 208 titles and abstracts screened, 23 were included and three major themes including reasons, impacts, and implications were identified. Overall, patients with urologic problems prefer same gender urologists and females were more likely to prefer the same gender urologist than males. Many women delays care due to a perceived lack of female urologists. The major identified reasons for the same-gender preference are religious believes, cultural background, emotional relationship, past experiences, and sensitive examinations. The results indicate that the urologists-patients gender similarity improves the quality of primary care. Our review reveled that urologists prefer to perform more same gender-specific procedures. Besides, female urologist and residents perceived to underestimate from their male counterparts.

Conclusion: This study could help health system to honor the patient's preference for same gender urologist. The findings may help medical education and health policy makers to move the male-dominated urology departments towards a culture supportive of female urologists.
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http://dx.doi.org/10.22037/uj.v0i0.5779DOI Listing
May 2020

Fundamental Values of the Healthcare and Medical Education System: Evolution of the Iranian-Religious Progress Model.

J Relig Health 2021 Jun 4;60(3):2138-2153. Epub 2021 Jan 4.

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

Iranian culture and religious teachings lead to a unique value-laden model in health and medical education systems. This research aimed to determine these fundamental values. To identify the health system values in the religious context of Iran, a mixed critical analysis-synthesis method was conducted. Furthermore, a focus group discussion with experts was conducted. Finally, we determined the fundamental values for the Iranian-religious progress model of health care and medical education. God centeredness, spirituality, divine and religious belief, ethical virtues, health centeredness and promoting all dimensions of human health, justice, protecting the human dignity, protecting health-related rights, social accountability, community centeredness, and scientific authority (excellence) are the values that should be considered to complete the value statement of the Iranian-religious progress model of health care and medical education.
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http://dx.doi.org/10.1007/s10943-020-01118-0DOI Listing
June 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

Clinical Features Deserve Consideration for a Urologist in COVID-19.

Urol J 2020 Jul 14;17(5):528-529. Epub 2020 Jul 14.

Resident of General Surgery, Zahedan University of Medical Sciences, Zahedan, Iran.

We have studied up-to-date knowledge about the clinical feature of the Novel coronavirus pandemic worth consideration by the urologist. PubMed database, the United States centers for disease control and prevention (CDC), and the World Health Organization (WHO) websites were also accessed. A staging system introduced by Siddiqi et al. for the COVID-19 is acknowledged. Hemodialysis centers are high-risk zones in the outbreak of a COVID-19 epidemic. Symptoms and signs, clinical features, and laboratory findings of the renal transplant patients are almost similar to non-transplanted patients.
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http://dx.doi.org/10.22037/uj.v16i7.6080DOI Listing
July 2020

Health Care and Medical Education to Promote Women's Health in Iran; Four Decades Efforts, Challenges and Recommendations.

Arch Iran Med 2020 07 1;23(7):469-479. Epub 2020 Jul 1.

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

Background: The aim of this paper is to present a synthesis of solutions for post-graduate medical education (PGME) and the health-care system in addressing challenges in relation to women's health.

Methods: A critical review was conducted within three themes: women's health status, women's preferences for female physicians, and women in surgery. The study was conducted in two phases that consisted of an analysis of the trends of Iranian women's health and women's participation in PGME since 1979 followed by a thematic analysis to assess the current challenges and their implications on medical education.

Results: Our analysis revealed important trends and challenges. Since 1979, life expectancy has increased by 29% in Iranian women, while female adult mortality rate has decreased by 78%, and maternal mortality rate has decreased by 80%. The number of female medical specialists has increased by 933% , while the number of female subspecialists has increased by 1700%. According to our review, ten major challenges regarding women's health were identified: 1) Increase in chronic disease; 2) Increase in cancer cases; 3) Preference for same-gender physicians in sensitive procedures; 4) Delayed care-seeking due to lack of female surgeons; 5) Lack of gender-concordance in clinical settings; 6) Underestimating female surgeons' capabilities; 7) Female physicians' work-family conflicts; 8) Male-dominancy in surgical departments; 9) Women's under-representation in higher rank positions; and 10) Lack of women in academic leadership.

Conclusion: We identified different solutions to bridge these gaps. Community-based education, Gender- concordant considerations, and empowering women in surgical departments could help medical education policy makers to address the challenges.
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http://dx.doi.org/10.34172/aim.2020.44DOI Listing
July 2020

Improving early urinary continence recovery after radical prostatectomy by applying a sutureless technique for maximal preservation of the intrapelvic urethra: A 17-year single-surgeon experience.

Urologia 2020 Nov 3;87(4):178-184. Epub 2020 Jun 3.

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

Background: There is a growing concern about postsurgical outcomes of radical prostatectomy, especially in the younger population and patients with earlier tumor stages. Here, we present our 17 years' experience of sutureless vesico-urethral alignment after radical prostatectomy with a focus on postoperative functional urinary outcomes.

Methods: Data of 784 patients who underwent radical prostatectomy during 2001-2017 were evaluated retrospectively. Before surgery, patients' demographic information, pathologic stage, margin of surgery, prostate-specific antigen, and Gleason score were obtained. Then, serum prostate-specific antigen level, urinary continence, potency, and other functional outcomes of surgery were recorded after each postoperative visit.

Results: The mean age (±standard deviation) of patients was 61.3 (±6.30) years. The median (IQ) duration of follow-up was 30 (12-72) months. Full continence was achieved in 90% and 95.9% of patients at 3 and 6 months post surgery and 96.4% of the patients were continent at the last follow-up visit. Bladder neck stricture occurred in 167 patients (21.3%). During the follow-up period, none of the patients complained of total incontinence and at the last visit, 36.6% of patients reported potency. The frequency of grade 2 continence was significantly higher in patients with high-stage tumors (T3/T4), high Gleason score (⩾8), high preoperative serum prostate-specific antigen (>20 ng/dL), and positive margin of surgery. Potency had a significant relationship with age, stage of the disease, and preoperative prostate-specific antigen.

Conclusion: Maximal sparing of intrapelvic urethral length through sutureless vesico-urethral alignment technique results in excellent early urinary continence recovery after radical prostatectomy. A more advanced tumor stage (T1/T2), a higher Gleason score, high preoperative prostate-specific antigen, as well as positive surgical margin are risk factors of postoperative incontinence in patients who undergo radical prostatectomy.
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http://dx.doi.org/10.1177/0391560320925570DOI Listing
November 2020

Laparoscopic Donor Nephrectomy Is a Safe Surgical Approach in Healthy Obese Kidney Donors: A 10-Year Single-Center Retrospective Study.

Exp Clin Transplant 2021 01 2;19(1):20-24. Epub 2020 Jun 2.

From the Department of Urology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, and the Urology and Nephrology Research Center (UNRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objectives: A lack of donors continues to be a significant problem. Kidney donors with a body mass index ≥ 30 kg/m² are not suitable for laparoscopic donor nephrectomy; however, some studies have suggested that an obese donor could be an appropriate donor with similar surgical outcomes. Here, we report the results of our 10-year experience of laparoscopic donor nephrectomy, examining the effects of body mass index on the surgical results of laparoscopic donor nephrectomy.

Materials And Methods: We retrospectively reviewed medical records of patients who underwent laparoscopic donor nephrectomy at the Shahid Beheshti University Medical Science, Urology Center (Tehran, Iran) from 2005 to 2015. The collected information included pretransplant and posttransplant serum levels of hemoglobin and creatinine. We also collected data on surgical outcomes (operation time, cold and warm ischemia, need for blood transfusion, and conversion to open surgery, length of hospital stay, and complication rates) with respect to body mass index categories (≤ 24.9, 25-29.9, and ≥ 30 kg/m²).

Results: Of 1083 kidney donors, 732 donors had body mass index of ≤ 24.9 kg/m², 256 had body mass index between 25 and 29.9 kg/m², and 95 had body mass index of ≥ 30 kg/m². Differences among groups were not significant in terms of operation time (P = .558), warm or cold ischemic time (P = .829 and .951, respectively), blood transfusion (P = .873), and length of hospital stay (P = .850).

Conclusions: The laparoscopic approach for donor nephrectomy is a safe and effective method in obese donors without significant postoperative complications.
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http://dx.doi.org/10.6002/ect.2019.0381DOI Listing
January 2021

Living or deceased-donor kidney transplant: the role of psycho-socioeconomic factors and outcomes associated with each type of transplant.

Int J Equity Health 2020 06 1;19(1):79. Epub 2020 Jun 1.

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

Background: Kidney transplant improves patients' survival and quality of life. Worldwide, concern about the equality of access to the renal transplant wait-list is increasing. In Iran, patients have the choice to be placed on either the living or deceased-donor transplant wait-list.

Methods: This was a prospective study performed on 416 kidney transplant recipients (n = 217 (52.2%) from living donors and n = 199 (47.8%) from deceased donors). Subjects were recruited from four referral kidney transplant centers across Tehran, Iran, during 2016-2017. The primary outcome was to identify the psycho-socioeconomic factors influencing the selection of type of donor (living versus deceased). Secondary objective was to compare the outcomes associated with each type of transplant. The impact of psycho-socioeconomic variables on selecting type of donor was evaluated by using multiple logistic regression and the effect of surgical and non-surgical variables on the early post-transplant creatinine trend was assessed by univariate repeated measure ANOVA.

Results: Based on standardized coefficients, the main predictors for selecting living donor were academic educational level (adjusted OR = 3.25, 95% CI: 1.176-9.005, p = 0.023), psychological status based on general health questionnaire (GHQ) (adjusted OR = 2.46, 95% CI: 1.105-5.489, p = 0.028), and lower monthly income (adjusted OR = 2.20, 95% CI: 1.242-3.916, p = 0.007). The waiting time was substantially shorter in patients who received kidneys from living donors (p < 0.001). The early post-transplant creatinine trend was more desirable in recipients of living donors (β = 0.80, 95% CI: 0.16-1.44, p-value = 0.014), patients with an ICU stay of fewer than five days (β = - 0.583, 95% CI: - 0.643- -0.522, p-value = < 0.001), and those with less dialysis duration time (β = 0.016, 95% CI: 0.004-0.028, p-value = 0.012). Post-operative surgical outcomes were not different across the two groups of recipients (p = 0.08), however, medical complications occurred considerably less in the living-donor group (p = 0.04).

Conclusion: Kidney transplant from living donors was associated with shorter transplant wait-list period and better early outcome, however, inequality of access to living donors was observed. Patients with higher socioeconomic status and higher level of education and those suffering from anxiety and sleep disorders were significantly more likely to select living donors.
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http://dx.doi.org/10.1186/s12939-020-01200-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7268666PMC
June 2020

Preference for Patient -Urologist Gender Similarity and Its Implications for Urology Departments: A Systematic Narrative Review and Thematic Analysis

Urol J 2020 05 28;17(6):5779. Epub 2020 May 28.

Department of Urology, Shahid Labbafi Nejad Hospital, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Corresponding Author: Professor Nasser Simforoosh, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To evaluate the evidence that could help health system policy makers to approach the preference for same-gender urologists.

Methods: We performed this systematic narrative review according to the PRISMA guidelines. We searched MEDLINE, Web of science, EMBASE, CINAHL and Google Scholar for articles focused on the  preference for patient-urologist gender similarity in the male-dominated department from 1999-2019. Finally, a narrative synthesis of studies meeting the inclusion and quality criteria was conducted in accordance with the nature of the evidences. We applied a thematic analysis using inductive approach for synthesizing studies employing heterogeneous research methods and designs. Results: Of 208 titles and abstracts screened, 23 were included and three major themes including Reasons, Impacts, and Implications were identified. Overall, patients with urologic problems prefer same gender urologists and females were more likely to prefer the same gender urologist than males. Many women delays care due to a perceived lack of female urologists. The major identified reasons for the same-gender preference are religious believe, cultural background, emotional relationship, past experiences, and sensitive examinations. The results indicate that the urologists-patients gender similarity improves the quality of primary care. Our review reveled that Urologists prefer to perform more same gender-specific procedures. Beside, Female urologist and residents perceived to underestimate from their male counterparts. Conclusion: This study could help health system to honor the patient's preference for same gender urologist. The findings may help medical education and health policy makers to move the male-dominated urology departments towards a culture supportive of female urologists.
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http://dx.doi.org/10.22037/uj.v0i0.5779DOI Listing
May 2020

Randomized, Double-blind Pilot Study of Nanocurcumin in Bladder Cancer Patients Receiving Induction Chemotherapy.

Urol J 2020 Apr 30;18(3):295-300. Epub 2020 Apr 30.

Department of Radiation Oncology, Shohada-e-Tajrish Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To evaluate the feasibility and potential efficacy of nanocurcumin supplementation in patients with localized muscle-invasive bladder cancer (MIBC) undergoing induction chemotherapy.

Materials And Methods: In this double-blind, placebo-controlled trial, 26 MIBC patients were randomized to receive either nanocurcumin (180 mg/day) or placebo during the course of chemotherapy. All patients were followed up to four weeks after the end of treatment to assess the complete clinical response to the chemotherapy as primary endpoint. Secondary endpoints were the comparisons of chemotherapy-induced nephrotoxicity, hematologic nadirs, and toxicities between the two groups. Hematologic nadirs and toxicities were assessed during the treatment.

Results: Nanocurcumin was well tolerated. The complete clinical response rates were 30.8 and 50% in the placebo and nanocurcumin groups, respectively. Although nanocurcumin was shown to be superior to placebo with respect to complete clinical response rates as the primary endpoint, there was no significant difference between the groups (p = 0.417). No significant difference was also found between the two groups with regard to grade 3/4 renal and hematologic toxicities as well as hematologic nadirs.

Conclusion: These preliminary data indicate the feasibility of nanocurcumin supplementation as a complementary therapy in MIBC patients and support further larger studies. Moreover, a substantial translational insight to fill the gap between the experiment and clinical practice in the field is provided.
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http://dx.doi.org/10.22037/uj.v0i0.5719DOI Listing
April 2020

Laparoscopic Pyelolithotomy for the Management of Large Renal Stones with Intrarenal Pelvis Anatomy.

Urol J 2020 Apr 13;18(1):40-44. Epub 2020 Apr 13.

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

Purpose: The role of laparoscopic pyelolithotomy (LPL) in the management of renal stones is evolving. One of the challenges in LPL for renal stones is patients with intrarenal pelvis. Here we present our experience with laparoscopic pyelolithotomy for the management of renal stones with intrarenal pelvis anatomy.

Materials And Methods: Patients candidate for laparoscopic pyelolithotomy from February 2014 to March 2015 were included. Intrarenal pelvis was defined as > 50% of the renal pelvis area contained inside renal parenchyma. Laparoscopic pyelolithotomy was done by transperitoneal approach. Residual stones were checked by computed tomography and/or intravenous pyelography and ultrasonography 6 weeks after the operation.

Results: 28 patients were included in this study. The mean±SD of patients' age was 45.8±12.5 years. 19 patients (68%) were male. Stone locations were pelvis, multiple, and staghorn in 22, 3, and 3 patients respectively. The mean±SD of operation duration was 160±48 minutes. Residual stones were observed in 3 patients with multiple (n=2) or staghorn (n=1) stones. Urinary leak was observed in 3 patients and was managed conservatively in 2 patients. In one patient ureteral stent was inserted by cystoscopy. No conversion to open surgery or re-operation occurred.

Conclusion: Laparoscopic pyelolithotomy is a feasible operation for patients with renal stones and intrarenal pelvis in centers with adequate experience in laparoscopy. However, the success of LPL decreases in patients with multiple stones and intrarenal pelvis.
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http://dx.doi.org/10.22037/uj.v0i0.5576DOI Listing
April 2020

Five compelling UTI questions after kidney transplant.

World J Urol 2020 Nov 7;38(11):2733-2742. Epub 2020 Apr 7.

Department of Urology, Shahid Labbafinejad Medical Center, Tehran, Iran.

Purpose: Urinary tract infection (UTI) is the most common bacterial infection among infectious complications in kidney transplant recipients (KTR). After transplantation, infections can result from surgical complications, donor-derived infections, pre-existing recipient infections, and nosocomial infections. Post-transplant infection is still a major cause of morbidity, mortality, graft dysfunction and rejection. In this paper, we aimed to review a few compelling questions in kidney transplantation (KTX).

Methods: To identify relevant clinical questions regarding KTX and UTI a meeting was conducted among physicians involved in the KT program in our hospital. After discussion, several clinically relevant questions related to UTI after KTX. The 5 first rated in importance were judged generalizable to other clinical settings and selected for the purposes of this review.

Results: Nearly half of the patients present in the first three months of transplant with UTI. The most common uropathogens in post-transplant UTIs are Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis. Risk factors for UTI include female sex, advanced age, recurrent UTI before transplant, prolonged urethral catheterization, delayed graft function, and cadaveric kidney transplant.

Conclusion: The incidence of post-transplant UTI is similar in both developed and developing countries. E.coli is the most common pathogen in most of studies. Cadaveric donor and post-dialysis transplantation are defined as independent risk factors for post-transplant UTI. Further studies are still required to identify risk factors after kidney transplantation and UTI's importance for graft function and patient outcome.
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http://dx.doi.org/10.1007/s00345-020-03173-4DOI Listing
November 2020

Technical Challenges and Innovations in Kidney Transplantation: Experience With Over 5000 Cases.

Exp Clin Transplant 2020 01;18(Suppl 1):10-15

From the Department of Urology and Renal Transplantation, Shahid Labbafinejad Hospital, Urology Nephrology Research Center, Shahid Beheshti University of Medical Science, Tehran, IR Iran.

Kidney transplant has been the standard-of-care treatment for patients with end-stage renal disease for many years. To expand the acceptance and care of complicated situations in patients with end-stage renal disease, transplant teams should be ready to find innovative solutions to prevent and manage pretransplant, intraoperative, and posttransplant problems. In this report, we present our approach for the following scenarios: transplant in patients with urinary diversion and augmentation, polycystic disease in recipients, tumors in transplanted kidney and native kidneys, and the roles of laparoscopy and mini-laparoscopy in kidney transplant.
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http://dx.doi.org/10.6002/ect.TOND-TDTD2019.L19DOI Listing
January 2020

Comparison of Removing Double-J Stent With and Without Cystoscopy in Kidney Transplant Patients: A Randomized Clinical Trial.

Urol J 2020 03 16;17(2):173-179. Epub 2020 Mar 16.

Resident in General Surgery, Shiraz, Iran.

Purpose: The ureteric stent can be attached to the Foley catheter in kidney transplantation to exclude cystoscopy for its removal. It is rarely practiced in renal transplantation. There has been no randomized trial to evaluate the outcome of this procedure on major urologic complications.

Materials And Methods: One hundred sixty-three kidney transplant patients were randomized into an intervention group in which the stent was attached to the Foley catheter and removed together and a control group in which stent was removed by cystoscopy. In both groups, stents were removed around the 8th post-operative day.

Results: From March 2016 to June 2017, out of 234 kidney transplants performed in our center, one hundred Sixty-three (69.6%) patients met the study inclusion criteria.  91patients (55.8%) were allocated to the intervention group. Mean days before JJ removal for intervention and control groups ("per-protocol" group) were 8.08 ± 1.52 and 8.57 ± 1.58, respectively (P = .09). There was no difference between groups regarding major urologic complications (P = .679). Visual analog scale pain scores were significantly higher in the control group (p = .001). The procedure reduced 63-120 USD from the cost of operation in the intervention group.

Conclusion: In selected kidney transplant patients, attaching stent to the Foley catheter and removing both of them early may be a safe maneuver regarding major urological complications, reduces pain, and eliminates the cost of cystoscopy.
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http://dx.doi.org/10.22037/uj.v0i0.5448DOI Listing
March 2020

Factors Predicting Prostate Specific Antigen Failure Following Radical Prostatectomy: Experience with 961 Patients.

Urol J 2020 01 4;17(5):486-491. Epub 2020 Jan 4.

Department of Urology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objective: To determine disease-related predictors for the occurrence of prostate specific antigen (PSA) failure in Iranian prostate cancer patients who underwent radical prostatectomy.

Methods: In this cohort study, we enrolled eligible patients with prostate cancer who underwent radical prostatectomy at our center between 2001 and 2018. The primary endpoint was the incidence of postoperative biochemical failure, defined as two consecutive PSA levels >= 0.2 ng/dl. Patients with TNM stage >= III, Gleason score >=8, or baseline PSA above our calculated cut-off level were considered as high risk. Kaplan-Meier survival method and Cox proportional hazards regression analysis were used for determining the biochemical relapse-free survival and its predictors.

Results: Data of 959 patients (age=61.2 ± 6.4 years) were analyzed with a median follow up of 36 months (range 6 months to 18 years). A total of 97 patients (10.1%) developed biochemical failure at the time of analysis who had a significantly older age and longer follow-up duration (P=0.024 and P<0.001, respectively). Preoperative PSA level of 8.85 mg/dl could predict the occurrence biochemical failure with a sensitivity of 83.2% and specificity of 39.2% (Area under the curve=0.601, 95% CI: 0.541-0.662; P=0.001). In the multivariate analysis, higher preoperative PSA, Gleason score?8, and high-risk TNM stage were independent predictors for biochemical relapse (P=0.029, P=0.001, and P=0.008, respectively).

Conclusion: Preoperative PSA, Gleason score, and TNM stage were independent predictors for biochemical failure following radical prostatectomy in prostate cancer patients. We also determined a lower cut-point for PSA that could predict biochemical failure.
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http://dx.doi.org/10.22037/uj.v0i0.5670DOI Listing
January 2020

Laparoscopic pyelolithotomy in patients with previous ipsilateral renal stone surgery.

Urologia 2021 Feb 23;88(1):41-45. Epub 2019 Dec 23.

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

Objectives: To evaluate the safety and efficacy of transperitoneal laparoscopic pyelolithotomy in renal stone cases with previous renal surgeries.

Patients And Methods: In this prospective study, 190 consecutive patients with renal stones, who were candidates for transperitoneal laparoscopic pyelolithotomy, were enrolled. The patients were divided into two groups. In group A, 163 patients without a history of renal surgery underwent standard laparoscopic pyelolithotomy, whereas in group B laparoscopic pyelolithotomy was performed in 27 patients with a history of kidney stone surgery including percutaneous nephrolithotomy or open stone surgery. All intraoperative data including the operating time and complications such as bleeding requiring transfusion were recorded. Postoperative data such as length of hospitalization, hemoglobin level alteration, and other complications were also recorded.

Results: There was no significant difference in the preoperative data such as stone size, stone site, age, sex, and stone side between the two groups. There was no significant difference in the stone-free rate between the two groups (p = 0.4). There was no significant difference between the two study groups regarding the operating time, hospital stay, stone-free rate, complications, and transfusion rate.

Conclusion: Laparoscopic pyelolithotomy can be used as a safe and feasible treatment modality in the setting of previous renal surgery. The complications and stone-free rate of laparoscopic pyelolithotomy in patients with history of renal surgery are acceptable.
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http://dx.doi.org/10.1177/0391560319890993DOI Listing
February 2021

Feasibility and Safety of Clipless and Sutureless Laparoscopic Adrenalectomy: A 7-Year Single Center Experience.

Urol J 2020 03 16;17(2):143-145. Epub 2020 Mar 16.

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

Purpose: Laparoscopic adrenalectomy (LAD) is considered the gold standard surgical method for resecting adrenal tumors. To date, only few small studies have investigated the safety of clipless laparoscopic adrenalectomy in which the adrenal vessels were controlled by the LigaSure system or bipolar coagulation. The aim of the present study was to evaluate the safety and feasibility of sutureless and clipless laparoscopic adrenalectomy operations performed in our center.

Materials And Methods: All patients with functional adrenal tumors, nonfunctional adrenal tumors larger than 5 cm and secondary adrenal metastases from the kidneys, lungs or breasts who had underwent an LAD procedure between 2012 to 2019 were included in our study. In all of the cases, complete coagulation of adrenal veins was achieved through bipolar cautery and no vascular staplers, clips or other energy sources were used for controlling the adrenal vessels whatsoever. Outcomes of interest included operation time, length of hospital stay, changes of serum hemoglobin level, and occurrence of major complications.

Results: Of a total 251 patients, unilateral right and left-side adrenalectomy was performed in 168 and 67 cases, respectively, and 16 cases had underwent bilateral adrenal resection. The mean age (SD) of patients was 40.7 (13.6) years old at the time of operation and the mean size (SD) of the adrenal lesions was 5.2 (3.1) cm as measured by the greatest diameter. Histological examination showed that the most common pathology of the resected adrenal glands was pheochromocytoma (n=78). None of the laparoscopic operations required a conversion to open surgery. Also, major bleeding or other serious complications did not occur in any of the cases either intraoperatively or postoperatively.

Conclusion: Clipless and sutureless laparoscopic adrenalectomy seems to be feasible and safe for removing adrenal tumors. Moreover, bipolar cautery is associated with an acceptable outcome for vessel closure.
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http://dx.doi.org/10.22037/uj.v0i0.5493DOI Listing
March 2020

Living Unrelated Kidney Transplantation: Does It Prevent Deceased-Donor Kidney Transplantation Growth?

Exp Clin Transplant 2019 01;17(Suppl 1):250-253

From the Department of Urology and Kidney Transplantation, Shahid Labbafinejad Hospital, Urology Nephrology Research Center, Shahid Beheshti Medical University, Tehran, Iran.

Objectives: It is usually assumed that an active livingdonor transplant program inhibits the growth of a deceased-donor kidney transplant program. In our 33-year experience, we found the contrary to be true.

Materials And Methods: From 1984 until 2017, we performed a total of 4966 kidney transplant procedures. All cases were registered through the Collaborating Transplant Study (Heidelberg, Germany).

Results: During the first 16 years, only living-donor kidney transplant procedures were done. Our first unrelated living-donor kidney transplant procedure was in 1986 and involved a wife to husband donation. This breakthrough in our country was the first in our unrelated living-donor kidney transplant program. In 2000, the Iranian Parliament passed the deceased-donor transplant act, and we have started deceased-donor kidney transplants since then. Despite a jam-packed living-donor kidney transplant program, our deceased-donor kidney transplant program has grown steadily since then and now comprises more than 50% of our kidney transplant procedures. When we compared the outcome of these programs, the 5-year survival from Collaborating Transplant Study report of 3527 cases of 114 living-related donor procedures was 90%. The 5-year survival rates for living unrelated-donor (n = 2689) and deceased-donor (n = 724) transplant procedures were 88% and 83%, respectively (P = .001).

Conclusions: Our data showed that deceased-donor kidney transplant procedures have steadily increased despite an active unrelated living-donor kidney transplant program. Wait lists for kidney transplant can be significantly reduced by following our model, both in developed and in developing countries.
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http://dx.doi.org/10.6002/ect.MESOT2018.P110DOI Listing
January 2019

Long-Term Outcome of Zero-Ischemia Partial Nephrectomy for the Treatment of Multifocal Renal Cell Carcinoma in Renal Transplant Allograft: A Case Report.

Exp Clin Transplant 2019 01;17(Suppl 1):145-147

From the Department of Urology and Kidney Transplantation, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Multifocal synchronous renal cell carcinoma in the functioning allograft is a rare disease; there is no consensus regarding its treatment, and few cases have been reported. In isolated masses, some authorities advocate graft nephrectomy, and some recommend partial nephrectomy. To our knowledge, we describe the first experience of nephron-sparing surgery in multifocal synchronous renal cell carcinoma in an allograft with its long-term outcome. A 42-year-old male patient with a history of living related-donor kidney transplant from his brother (18 years previously) presented with a history of gross hematuria over the past few months. Imaging studies revealed a 5.5-cm exophytic cystic mass lesion in lower pole and an 11-mm solid mass in the upper pole of the renal allograft. Both graft nephrectomy and nephronsparing surgery were offered to him. After the patient provided written informed consent, zero-ischemia partial nephrectomy of lower pole and enucleation of upper pole mass were performed. Pathology reports for both lesions indicated clear cell carcinoma, and margins were free of tumor. Twelve months after surgery, the patient was free of tumor, and his creatinine level was 1.6 mg/dL. At 29 months after surgery, his creatinine level was 2.4 mg/dL, and imaging revealed a tumor-free allograft. Nephronsparing surgery in multifocal renal cell carcinoma in the functioning renal allograft was feasible in our patient, and the long-term outcome was satisfactory. This surgical option provided dialysis-free and longterm tumor-free survival to the patient.
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http://dx.doi.org/10.6002/ect.MESOT2018.P13DOI Listing
January 2019

Mini-Laparoscopic Management of Ureteropelvic Junction Obstruction in Adults and Children: A High-Volume Case Series.

J Laparoendosc Adv Surg Tech A 2019 Jun 4;29(6):747-751. Epub 2019 Jan 4.

Urology and Nephrology Research Center (UNRC), ShahidBeheshti University of Medical Sciences, Tehran, Iran.

We retrospectively reviewed the perioperative outcomes of mini-laparoscopic procedure in the treatment of ureteropelvic junction obstruction (UPJO) in children and adults. From August 2009 to March 2017, 229 patients referred to our center to repair UPJO by mini-laparoscopic operation. In 203 cases, dismembered pyeloplasty was accomplished, while in other 26 cases, crossing aberrant vein division and crossing artery upward transposition were performed. A follow-up renal ultrasound was done on the cases 3 and 6 months after surgery. During the follow up period, if the patients had persistent hydronephrosis or sustained clinical complaints, diethylenetriamine pentaacetic acid (DPTA) scan was done to rule out the stenosis. Among 229 patients, 140 patients were younger than 18 years (Range: 2 months-18 years old, mean: 3.01 ± 1.2 year) and others were scheduled as Adult (Range: 18-57 years old, mean: 35.12 ± 7.54 year). Total clinical and radiological success rates were 99.5% (228/229) and 86.5% (198/229) respectively. Mean operative times were 127.4 ± 20.3 minutes in dismembered pyeloplasty and 110.6 ± 12.7 minutes in crossing vessel transposition surgery. Mean of hemoglobin decreasing in children and adults was 0.3 ± 0.1 mg/dL;  = .26, and 0.5 ± 1.5 mg/dL;  = .13, respectively. Length of hospital stay was 3.41 ± 0.6 days in dismembered pyeloplasty and 2.1 ± 0.6 days in patients with crossing vessel transposition surgery. We did not suture the skin incision in the entrance site of 3 mm ports and the surgical scar was hardly visible after 6 months. The results of our study suggest that mini-laparoscopic pyeloplasty in adults and particularly in children is feasible, and it seems to be safe and effective in the treatment of UPJO. Furthermore, the patients tolerated the surgery well and they appreciated its outstanding cosmetic outcomes.
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http://dx.doi.org/10.1089/lap.2018.0470DOI Listing
June 2019

Randomized, double-blind, placebo-controlled phase II trial of nanocurcumin in prostate cancer patients undergoing radiotherapy.

Phytother Res 2019 Feb 14;33(2):370-378. Epub 2018 Nov 14.

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

Clinical potential of curcumin in radiotherapy (RT) setting is outstanding and of high interest. The main purpose of this randomized controlled trial (RCT) was to assess the beneficial role of nanocurcumin to prevent and/or mitigate radiation-induced proctitis in prostate cancer patients undergoing RT. In this parallel-group study, 64 eligible patients with prostate cancer were randomized to receive either oral nanocurcumin (120 mg/day) or placebo 3 days before and during the RT course. Acute toxicities including proctitis and cystitis were assessed weekly during the treatment and once thereafter using CTCAE v.4.03 grading criteria. Baseline-adjusted hematologic nadirs were also analyzed and compared between the two groups. The patients undergoing definitive RT were followed to evaluate the tumor response. Nanocurcumin was well tolerated. Radiation-induced proctitis was noted in 18/31 (58.1%) of the placebo-treated patients versus 15/33 (45.5%) of nanocurcumin-treated patients (p = 0.313). No significant difference was also found between the two groups with regard to radiation-induced cystitis, duration of radiation toxicities, hematologic nadirs, and tumor response. In conclusion, this RCT was underpowered to indicate the efficacy of nanocurcumin in this clinical setting but could provide a considerable new translational insight to bridge the gap between the laboratory and clinical practice.
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http://dx.doi.org/10.1002/ptr.6230DOI Listing
February 2019

Cytoreductive and Palliative Radical Prostatectomy, Extended Lymphadenectomy and Bilateral Orchiectomy in Advanced Prostate Cancer with Oligo and Widespread Bone Metastases: Result of a Feasibility, Our Initial Experience.

Urol J 2019 05 5;16(2):162-167. Epub 2019 May 5.

Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, 9th Boostan, Pasdaran avenue, Tehran, Iran.

Purpose: to evaluate the feasibility of cytoreductive radical prostatectomy (RP), lymphadenectomy, and bilateral orchiectomy in patients with advanced prostate cancer (PCa) with oligo- and poly-metastases. Furthermore, the functional and oncological outcomes of these patients in comparison with the control group that underwent treatment only with systemic therapy (ST group) is investigated in a well-selected, prospective cohort study.   Material and methods: A total of 26 patients were enrolled in CRP (cytoreductive radical prostatectomy) group and 23 patients in ST group. The patients have been followed (9 to 43 months(median:19.5)) with PSA (prostate specific antigen), whole body bone scan and other necessary imaging and laboratory tests. Functional and oncological outcomes were compared between two groups.

Results: Biochemical relapse was occurred in 9 patients (34.6%) in CRP group and in 17 patients (73.9%) in ST group (p=0.01). Whole-body bone scans showed reduced metastasis volume occurred more in CRP group (p=0.003). There was no voiding dysfunction in 22 patients in CRP group post-operatively (84.6%), while in ST group trans-urethral resection of prostate or permanent Foley catheter was needed in 8 patients (34.7%) and bilateral percutaneous nephrostomy was done in one. six patients in CRP group (23%) and eight patients in ST group (34.7%) were expired because of prostate cancer and there was no difference between cancer specific survival between two groups (p=0.975).

Conclusion: Although surgery doesn't improve cancer specific survival in patients with skeletal metastatic prostate cancer in the short term, but offers better local control, improves biochemical relapse-free survival, might prevent excessive interventions, reduce bone pain and metastasis.
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http://dx.doi.org/10.22037/uj.v0i0.4783DOI Listing
May 2019

Comparison Between Bipolar Lymphatic Vessels Cautery and Suture Ligature in Prevention of Postrenal Transplant Lymphocele Formation: A Randomized Controlled Trial.

Exp Clin Transplant 2019 02 26;17(1):26-30. Epub 2018 Apr 26.

From the Department of Urology, Shahid Beheshti Medical University, Tehran, Iran.

Objectives: In this randomized controlled trial, our aim was to compare bipolar cautery of lymphatic vessels with standard silk-tie ligation in renal transplant procedures for prevention of lymphocele formation.

Materials And Methods: Sixty end-stage renal disease patients were enrolled in a prospective randomized controlled trial. The mean age of recipients in the suture ligature group was 41.6 years (range, 6-65 years) and 40.9 years in the bipolar cautery group. Patients were assessed by symptoms; however, ultrasonography was also used as the primary diagnostic procedure in all patients to find lymphocele collection within 5 months.

Results: Of 60 patients, 25 received living-donor kidney transplant and 35 received deceased-donor kidney transplant. Fifty-threeprocedures were first-time kidney transplants, 6 were retransplants, and 1 was for a third-time transplant. No lymphocele collection (symptomatic or asymptomatic) was diagnosed by ultrasonography at the 5-month follow-up. Postoperative pain was not significantly different between the 2 groups (P = .245). The time for ligation or cauterization of lymphatic vessels was similar between the 2 groups. Mean duration of operative field drainage was 5.6 days in the suture ligature group and 6.07 days in the bipolar cautery group (not significantly different; P = .547).

Conclusions: Bipolar cautery of lymphatic vessels to prevent lymphocele formation in kidney transplant seems to be an effective, easy, and safe method.
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http://dx.doi.org/10.6002/ect.2017.0207DOI Listing
February 2019

Comparison of Open Versus Laparoscopic Versus Hand-Assisted Laparoscopic Nephroureterectomy: A Systematic Review and Meta-Analysis.

J Laparoendosc Adv Surg Tech A 2018 Jun 20;28(6):656-681. Epub 2018 Feb 20.

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

Background: A systematic analysis of the evidence regarding oncological, perioperative and postoperative outcomes of open nephroureterectomy (ONU), laparoscopic nephroureterectomy (LNU), and hand-assisted laparoscopic nephroureterectomy (HALNU) was designed.

Methods: The summarized data were abstracted from 52 original research articles representing 19,195 patients. PubMed/Medline, Scopus, Google Scholar, EMBASE, and the Cochrane Library were reviewed in March 2017, following PRISMA framework. A total of 52 publications were selected for inclusion. The primary outcomes were 2- and 5-year cancer-specific survival (CSS) rate, overall survival (OS) rate, and recurrence-free survival (RFS) rate. The secondary outcomes were operative time, lengths of hospitalization period, estimated blood loss, transfusions, major Clavien complication rate, metastasis rate, bladder recurrence rate, and positive surgical margin.

Results: On comparing LNU versus ONU and HALNU versus ONU, no significant differences between the 5-year CSS rate (P = .25, P = .39), OS rate (P = .06, P = .46), and RFS rate (P = .85, P = .73) were found. On comparing LNU versus ONU and HALNU versus ONU during a 2-year follow-up period, the following were found: CSS rate (P = .61, P = .04) and OS rate (P = .33, P = .19). There were no significant differences between the LNU versus ONU and HALNU versus ONU rates, regarding bladder recurrence (P = .12, P = .85) and metastasis rate (P = .07, P = .27). Significant higher operative time (P = .01, P = .0004), lower length of hospitalization period (P < .001, P < .001), and estimated blood loss (P = .0004, P < .001) were found in comparison to that of LNU versus ONU and HALNU versus ONU.

Conclusion: Both LNU and HALNU had comparable oncological and better perioperative and postoperative outcomes, when compared with ONU.
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http://dx.doi.org/10.1089/lap.2017.0662DOI Listing
June 2018

Editorial Comment on: Anatomic and Radiologic Study of Renal Avascular Plane (Brödel's Line) and Its Potential Relevance on Percutaneous and Surgical Approaches to the Kidney by Macchi et al.

J Endourol 2018 02 26;32(2):160. Epub 2018 Jan 26.

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

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http://dx.doi.org/10.1089/end.2017.0909DOI Listing
February 2018

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

Urologia 2018 Feb;85(1):3-9

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

Background: This systematic review and meta-analysis was designed to evaluate the post-operative outcomes between tubeless and standard percutaneous nephrolithotomy (PCNL) among children.

Methods: Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and meta-analysis that included three trials investigating the outcomes including the length of hospital stay, operation time, hemoglobin decrease, blood transfusion rate, perirenal fluid presence, post-operative fever, stone clearance rate, and the need for a second operation.

Results: The patients who underwent tubeless PCNL had shorter length of hospitalization compared to standard PCNLs (mean difference -1.57, 95% confidence interval -3.2 to 0.07, p = 0.06). No significant decrease was detected in hemoglobin after tubeless PCNL compared to standard PCNL (mean difference 0.05, 95% confidence interval -0.03 to 0.13, p = 0.21). There were no significant differences in operation time (p = 0.7), perirenal fluid presence (p = 0.15), post-operative fever (p = 0.72), stone clearance (p = 0.68), and the need for a second operation (p = 0.90).

Conclusions: This study showed no significant difference between tubeless and standard PCNLs in children. However, due to the lack of data, the results should be mentioned prudently. Future randomized trials with more sample sizes and longer follow-ups are warranted.
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http://dx.doi.org/10.5301/uj.5000270DOI Listing
February 2018
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