Resolution of Posterior Nutcracker Syndrome through Left Renal Vein Ligation: A Case Report

This case report presents the clinical course of a 54-year-old male patient diagnosed with posterior Nutcracker Syndrome (NCS). The patient experienced recurrent episodes of macroscopic hematuria and severe left flank pain. He was diagnosed with retro-aortic left renal vein (RLRV), an unusual congenital abnormality, which can result in the compression of the left renal vein between the aorta and the vertebra. Initial attempts at conservative management and endovascular interventions were unsuccessful. An open surgical intervention was ultimately performed. The surgery involved ligation of the left renal vein. Postoperatively, the patient experienced marked improvement in symptoms, with complete resolution of hematuria and pain. Furthermore, renal function remained stable, and no kidney-related complications were reported. This case suggests that, in certain situations where endovascular intervention and transposition of LRV or re-implantation of the left gonadal vein are not feasible, ligation of the LRV may provide a safe and practical treatment option for patients with posterior NCS. Future research is needed to validate these findings

Laser Therapy in Lumbar Disc Surgery : A Narrative Review

Introduction: Low back pain is one of the most chronic debilitating conditions involving considerable loss of cash, work, and quality time. Lasers are utilized in different fields of drugs, providing unique advantages. They are useful and advantageous in treating lumbar disc disease. In this research, an attempt is made to examine the role and importance of different lasers in lumbar disc surgeries.Methods: We conducted studies about laser therapy in lumbar disc surgery. Our primary search began with reviewing English-language citations from PubMed and Scopus between 1990 and 2019 using the keywords: (laser therapy) OR (lumbar disc AND disc surgery). The initial search yielded 97 articles. However, about 49 articles were selected and used in the present study.Results: Based on the present study, it can be found that there are several methods of using lasers to treat lumbar disc surgery. These methods all have their strengths and weaknesses.Conclusion: The development of laser lumbar disc surgery can be very helpful due to the reduction of surgical risks and the length of the patients’ hospital stay. However, the choice of method used for this type of surgery should be made according to the patient’s condition and based on the opinion of the treating physician

Prevalence of Different Subtypes of Renal Cell Carcinoma among Patients who have Undergone Nephrectomy; Statistics of a Referral Medical Center in Iran

Renal cell carcinoma (RCC) is the third most common genitourinary cancer in the world, and has the highest mortality rates among these types of cancers. In the present cross-sectional assessment, the prevalence of RCC subtypes in a sample of Iranian patients diagnosed with RCC which have undergone nephrectomy surgery between years 2014 to 2019 in a referral medical center has been investigated. We have studied 68 patients, including 47 male and 21 female individuals with an average age of 55. The patients have been studied for demographic and pathologic information such as age, sex, tumor size, tumor subtype, TNM staging, Fuhrman nuclear grading, and other pathological information. The statistical analysis was done via SPSS software version 21. Quantitative data were examined by T test and qualitative data were assessed by Chi square test. As we observed in the results, the most common RCC subtype among these patients was clear cell 53%, followed by papillary 22% and chromophobe 19%, emphasizing the higher rates of chromophobe RCC compared to the statistics worldwide

The Trends of Urolithiasis Therapeutic Interventions over the Last 20 Years: A Bibliographic Study

Introduction: The clinical and economic burden of kidney stones is a challenge for the healthcare system. There is a limited bibliometric project exploring the literature trends on ‘urolithiasis’ and its related management.Methods: A review was conducted to discover the related abstracts regarding each specific issue, investigated year by year from May 2000 to May 2020. To make an effective comparison, the statistics resulting from every single study were allocated to two 10-year periods: period 1 (2000 to 2010) and period 2 (2010 to 2020). We included all English language articles, all non-English articles with English abstracts, and studies in which interventions were used for stone removal, including laser technology.Results: These articles are about ureteroscopy (URS) (n=10360, 33.45%), percutaneous nephrolithotomy (PCN) (n =10790, 34.84%) and extracorporeal shockwave lithotripsy (ESWL) (n=9846, 31.76%). When evaluating the two time periods, there were 9912 studies available in period one, which increased by ×2.12 times (112.71% rise) to 21 084 studies in period two (P=0.001). The increase was 133%, 103.51%, and 70.4% for URS, PCN, and SWL respectively. A total of 855 studies on Laser application via URS were published on PubMed over a 20-year period. There was an increasing trend toward using laser applications via URS over the study period. Also, there were 230 articles published in period one, which increased by nearly 2.71 times to 625 papers in period two (P< 0.001). There was an increasing trend toward using laser application via PCN; 126 papers were published in period one, which increased by nearly 3.05 times (rise of 205.5%) to 385 papers in period two (P = 0.002).Conclusion: The minimal invasive interventions for stone removal, including URS and PCN, increased dramatically in the last decade, and the use of lasers in stone treatment increased significantly in the last decade. DOI:10.34172/jlms.2021.1

Evaluating the results of Nocturnal Penile Tumescence test utilizing Iranian erection analyzer - a case control study

Background:  Erectile dysfunction (ED) is a male sexual condition that affects 10% to 25% of men globally. Identifying the underlying cause of ED in males is a critical aspect of diagnosis. For many years, the Rigiscan® devices have been utilized to distinguish between psychological and physiological erectile dysfunction. The purpose of this study was to look at the validity of an Iranian erection analyzer equipment for evaluating nocturnal penile tumescence (NPT) in ED patients referred to Shahada-e-Tajrish Hospital in 2021. Materials and Methods: Patients who were diagnosed with vascular erectile dysfunction by doppler ultrasound evaluation and intra-cavernosal injection (ICI) test were included in this study. Also, a group of sexually healthy volunteers were included in the study as a control group. After receiving written informed consent, both groups were evaluated for two nights with the NPT test with the Iranian Erection Analyzer device. The results of the two groups were collected and analyzed. Results: A total of 45 patients with erectile dysfunction and 29 sexually healthy individuals were included in the study. Both groups were hospitalized for two nights in the isolation room of the urology ward and the NPT test was performed for them. Our results showed that the NPT test performed by the Iranian Erection Analyzer device with 62% sensitivity and 100% specificity is capable of distinguishing patients with erectile dysfunction from sexually healthy men. Conclusions: Based on our results, the Iranian Erection Analyzer device is accurate enough to diagnose patients with erectile dysfunction and can be used in clinics

Men's Health Week in Iran; the Discrepancy between Experts and the General Population for Educational Priorities

Introduction: With the obsoletion of the paternalistic model of the doctor-patient relationship, considering public opinion regarding healthcare policymaking seems to be of great necessity. The present study was conducted to determine the educational priorities of male urology specialists and the general male population concerning urological diseases. Materials and methods: In this cross-sectional survey study, 400 male urologists and 400 men from the general population were assessed. Our investigation was carried out using a seven-item questionnaire covering the most important urological conditions. Respondents gathered from all over Iran through the 22nd Congress of Iranian Urological Association (IUA) and street surveys. Results: The mean age of the participants was 40.69 ± 13.23. The mean age for the general population and urologists was 35.8 ± 13.7 and 45.6 ± 10.6 years, respectively (P=0.0001). 56.8% of the respondents from the general population had a university degree. Overall, erectile dysfunction and sexually transmitted diseases (STDs) were the most mentioned diseases as an educational priority (40.1%). Chronic prostatitis was also the least mentioned condition as an educational priority in both groups and overall among all the participants ‎ (20.9%). A significant difference was observed between the general population and urologists in all the examined conditions (P<0.05).  Conclusion: This study indicated the differences among the educational priorities of the general male population and male urologists, and the necessity to make these two points of view closer and to involve the opinion of general population in decision making for men’s health week educational topics. &nbsp

Pneumatic Lithotripsy Versus Laser Lithotripsy for Ureteral Stones

Introduction: Several different modalities are available for ureteral stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet (Ho: YAG) lithotripsy have supportive outcomes. In this study we studied 250 subjects who had ureteroscopic pneumatic lithotripsy (PL) or laser lithotripsy (LL).Methods: Two-hundred fifty patients with ureteral stones underwent ureteroscopic lithotripsy (115 subjects in the PL group, 135 subjects in the LL group) from August 2010 to April 2016. The purpose of this investigation was to evaluate stone-free rate (SFR), mean operation time (MOT), mean hospital stay (MHS), stone migration and complications.Results: Two groups were similar in age, gender, mean size of stones, side of stone, and complications. There was a statistical difference in terms of SFR, stone migration and MHS in favor of the LL group (P ≤ 0.05, P ≤ 0.05 respectively), and MOT in favor of the PL group (P ≤ 0.05).Conclusion: Both the PL and LL techniques were effective and safe for ureteral stones, however a slightly higher SFR was found in the LL group

Effect of Nettle Extract and Pumpkin Seed on Prostate Specific Antigen and Urinary Symptoms in Patients Taking Alfa-blocker for Benign Prostatic Hyperplasia

Introduction: We aimed to compare the effect of nettle extract and pumpkin seed on Prostate Specific Antigen (PSA) and international prostate symptoms score (IPSS) in patients taking alfa-blocker for benign prostatic hyperplasia (BPH). Materials and Methods: For this purpose, 90 outpatients were studied in three groups, including men over 40 years of age with benign prostatic enlargement. The first group (Urtidin) contained consumers of nettle extract from Barijessence Company called Urtidin tablets with tamsulosin; the second group took tablets containing pumpkin seed extract called Prosta Barij and tamsulosin; the third group (Control) received only tamsulosin for three months. Patients were not randomly assigned to the groups PSA, IPSS, and related factors were evaluated and analyzed using SPSS software. Results: 89 patients completed the study (30/89 in Urtidin group with a mean age of 62.4±7.39 years, 29/89 in Prosta Barij group with a mean age of 65.9±7.32 years, and 30/89 in the control group with a mean age of 64.7±8.64 years). The results showed that nettle and pumpkin seed extracts affect PSA in patients taking tamsulosin for BPH. Also, after the intervention, IPSS had a significant decrease compared with baseline in both drug treatment groups. There was no significant difference in these three types of treatment. Conclusion: It seems that the desired herbal products did not have a synergistic effect with alpha blockers in the control and treatment of BPH but they can affect the serum PSA level

The Impact of the First Covid 19 Pandemic on Urology Residency Training in Iran

Background: During the pandemic, Iranian healthcare system had faced many challenges including the continuation of medical education. In this time, almost all elective surgeries have been suspended, outpatient visits have been limited to seriously ill patients, and academic meeting have been cancelled. This process has caused a significant decrease in clinical and surgical practice in the field of urology. In this article, we assess as to what extent and how this pandemic has impacted the urology residency training in Iran. Material and Methods: a 15-item-long questionnaire was designed and sent to all Iranian urology residents via social network and/or email from the 10th of MAY to the 10th of Jun 2020. This questionnaire assessed different training activities, including on-call duty, outpatient visits, diagnostic procedures such as cystoscopy, endoscopic procedures, and open major surgeries, prior and during the pandemic. The results were evaluated using t-test and ANOVA. Results: the percentage of urology resident’s involvement in each training activity, including on-call duty, outpatient visits, diagnostic procedures such as cystoscopy, endoscopic procedures, and open major surgeries, demonstrated a significant decline (p<0.001) during this time compared to the pre-COVID-19 period. Conclusion: urology residency training significantly decreased during the COVID-19 period. In order to address the second and third waves of COVID-19 outbreak, long-term action plans, such as telemedicine and stimulation, can help prepare training programs and residents during these unprecedented times