Glandular amputation by strangulating tied suture: A case report of late-onset complication in the Plastibell circumcision technique

Background: Circumcision is considered to be a procedure with minimal morbidity but may be associated with catastrophic complications in inexpert hands. Case presentation: We presented a 9-year-old boy with a past medical history of circumcision at the age of one year with Plastibell clamp who was referred with severe chronic penile injury due to neglected plastibell string. After string removal under a loupe magnification (4�), we saw a deep circular injury at distal penile shaft which led to painless glandular autoamputation 45 days later. The patient was managed conservatively with daily urethral self-dilation until future reconstructive surgery. Conclusion: This complication emphasized the importance of the follow-up visit by a physician for any probable string remnant. © 2019 The Author(s)

A comparison of the progression and recurrence risk index in non-muscle-invasive bladder tumors detected by narrow-band imaging versus white light cystoscopy, based on the eortc scoring system

Background: Transitional cell carcinoma of the bladder, the second most common urologic malignancy, is amenable to early diagnosis. This study presents the potential prognostic benefit for a less invasive modification to the standard endoscopic approach. Objectives: To evaluate the risk index for the progression and recurrence of additional tumors detected with narrow-band imaging (NBI) cystoscopy compared to standard white light imaging (WLI) cystoscopy in non-muscle-invasive bladder cancer (NMIBC), based on the European organization for research and treatment of cancer (EORTC) scoring system. Patients and Methods: Patients with NMIBC, who were scheduled for resection between May 2012 and May 2013, were studied and mapped under NBI and WLI cystoscopy by independent surgeons prior to resection. Detection rates and tumor characteristics, including EORTC progression and the recurrence risk index, were compared. Results: Fifty patients, aged 63.86 ± 10.05 years, were enrolled. The overall detection rate was 98.9 for NBI vs. 89.4 for WLI (P = 0.001), and the false-positive rates were 9.6 and 5.8, respectively (P = 0.051). Ten tumors were detected by NBI alone, including four grade I tumors, four grade III tumors, and two carcinomas in situ. The tumor progression index was not significantly reduced with NBI compared to WLI (P > 0.05); however, the recurrence index was significantly lower in the NBI group (P < 0.05). Conclusions: NBI cystoscopy improved the detection rate. Although false positives were more common with NBI, this was not statistically significant. NBI found additional aggressive tumors, which underscores the impact of detection in EORTC recurrence risk scoring. © 2016, Nephrology and Urology Research Center

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

Purpose: In recent years, endoscopic subureteral injection has gained popularity as a therapeutic alternative to open surgery because of its high success rates and low morbidity. We compared the success and complication rates of Polyacrylate polyalcohol copolymer (PPC) and Dextranomer/Hyaluronic acid (Dx/HA) in the endoscopic treatment of VUR. Materials & Methods: We retrospectively reviewed the patients who underwent endoscopic correction of their VUR by subureteric injection of PPC or Dx/HA from Jan 2010 to April 2016. The injection technique was STING (subureteric), distal HIT (intraureteric), and double HIT according the hydrodistention (HD) grade. The success rate, injection technique, injection volume, VUR grade, and obstruction rate were evaluated and compared between two groups. Results: 107 renal refluxing units (RRU) with a mean age 55.23 ± 36.58 months and 64 RRU with a mean age 52.13 ± 31.66 months were treated in Dx/HA and PPC groups, respectively. The PPC group showed a more successful outcome in comparison to the Dx/HA group (92.2 versus 75.7 of the RRU with P < .001) at 3 months follow up. The injection technique was not significantly different between two groups. In PPC group the success rate was decreased significantly with increasing reflux grade but this reduction was not statistically significant in Dx/HA group. The injected volume was significantly more in PPC group; in addition, there was statistically significant correlation between injected volume of the bulking agent and obstruction rate. However, the obstruction rate did not establish significant difference between the two groups (P = .83), however it was earlier in Vantris (4 months versus 22 months). Conclusion: Our investigation approved PPC as a more effective material, regardless of other confounding variables such as reflux grade, learning cure, and technique of injection, in endoscopic treatment of VUR. In addition, the other remarkable point is this effectiveness is not accompanied by more post-operation obstruction. © 2019, Urology and Nephrology Research Centre

Postchemotherapy retroperitoneal lymph node dissection in patients with nonseminomatous testicular cancer: A single center experiences

Background: Testicular cancer accounts for about 1 - 1.5 of all malignancies in men. Radical orchiectomy is curative in 75 of patients with stage I disease, but advance stage with retroperitoneal lymph node involvement needs chemotherapy. All patients who have residual masses � 1 cm after chemotherapy should undergo postchemotherapy retroperitoneal lymph node dissection (PC-RPLND). Objectives: Treatment of advanced nonseminomatous testicular cancer is usually a combination of chemotherapy and surgery. We described our experience about postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) in our center. Patients and Methods: In a retrospective cross-sectional study between 2006 and 2011, patients with a history of postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) in Imam Khomeini hospital were evaluated. All patients had normal postchemotherapy serum tumor markers and primary nonseminomatous cancer. We reviewed retrospectively clinical, pathological, and surgical parameters associated with PC-RPLND in our center. Results: Twenty-one patients underwent bilateral PC-RPLND. Mean age was 26.3 years (ranged 16 - 47). Mean size of retroperitoneal mass after chemotherapy was 7.6 cm. Mean operative time was 198 minutes (120 - 246 minutes). Mean follow-up time was 38.6 months. Pathologic review showed presence of fibrosis/necrosis, viable germ cell tumor and teratoma in 8 (38.1), 10 (47.6) and 3 (14.28) patients, respectively. One patient in postoperative period of surgery and three patients in two first years after surgery were expired. Of 17 alive patients, only two (11.8) had not retrograde ejaculation. Conclusions: PC-RPLND is one the major operations in the field of urology, which is associated with significant adjunctive surgeries. In appropriate cases, PC-RPLND was associated with good cancer specific survival in tertiary oncology center. © 2015, Nephrology and Urology Research Center

Urinary carbohydrate antigen 19-9/creatinine ratio: A non-invasive marker for follow-up of unilateral ureteropelvic junction obstruction in children

Introduction: Ureteropelvic junction obstruction (UPJO) is the most common cause of hydronephrosis in children. One major challenge in the management of UPJO is to select the patients that must be subjected to early obstruction relief. Currently, there is no gold standard for this assessment. Therefore, the aim of the present study was to evaluate the urinary levels of carbohydrate antigen (CA) 19-9 and normalized CA 19-9 (Ca 19-9/Cr ratio) in UPJO patients before and after surgery and compare them with a control group to assess their potential clinical application as an assisting tool in diagnosis of UPJO patients. Material and methods: From Jan 2013 to Jun 2016, 30 children with history of inguinal hernia, circumcision, hydrocele, and undescended testis as the control group (group 1) and 30 children with unilateral congenital UPJO (group 2) were enrolled in the study. Random CA 19-9 and random creatinine were measured in the voided urine samples of control group and proven congenital UPJO group preoperatively (group 2A) and at 6 months after dismembered pyeloplasty (group 2B). In addition, the random urinary CA 19-9/CR ratio was evaluated as a marker to normalized urinary CA 19-9. Discussion: The urinary CA 19-9/Cr ratio was significantly greater in the UPJO group than in the control group. The urinary CA 19-9 also was more in group 2A than in group 1; however, it was not statistically significant. The urinary CA 19-9/Cr ratio and renal pelvis anteroposterior diameter decreased significantly in the group 2B 6 month after complete relief of obstruction in comparison with group 2A preoperatively. Urinary CA 19-9 also decreased in 2B group though it was not significant. Conclusion: Urinary CA 19-9/Cr ratio is suggested as a non-invasive marker that can assist in diagnosis and long-term follow-up of UPJO patients. This ratio is superior to urinary CA 19-9 as it is more strongly correlated with UPJ obstruction.Figure presented © 2017 Journal of Pediatric Urology Compan

Urinary carbohydrate antigen 19-9/creatinine ratio: A non-invasive marker for follow-up of unilateral ureteropelvic junction obstruction in children

Introduction: Ureteropelvic junction obstruction (UPJO) is the most common cause of hydronephrosis in children. One major challenge in the management of UPJO is to select the patients that must be subjected to early obstruction relief. Currently, there is no gold standard for this assessment. Therefore, the aim of the present study was to evaluate the urinary levels of carbohydrate antigen (CA) 19-9 and normalized CA 19-9 (Ca 19-9/Cr ratio) in UPJO patients before and after surgery and compare them with a control group to assess their potential clinical application as an assisting tool in diagnosis of UPJO patients. Material and methods: From Jan 2013 to Jun 2016, 30 children with history of inguinal hernia, circumcision, hydrocele, and undescended testis as the control group (group 1) and 30 children with unilateral congenital UPJO (group 2) were enrolled in the study. Random CA 19-9 and random creatinine were measured in the voided urine samples of control group and proven congenital UPJO group preoperatively (group 2A) and at 6 months after dismembered pyeloplasty (group 2B). In addition, the random urinary CA 19-9/CR ratio was evaluated as a marker to normalized urinary CA 19-9. Discussion: The urinary CA 19-9/Cr ratio was significantly greater in the UPJO group than in the control group. The urinary CA 19-9 also was more in group 2A than in group 1; however, it was not statistically significant. The urinary CA 19-9/Cr ratio and renal pelvis anteroposterior diameter decreased significantly in the group 2B 6 month after complete relief of obstruction in comparison with group 2A preoperatively. Urinary CA 19-9 also decreased in 2B group though it was not significant. Conclusion: Urinary CA 19-9/Cr ratio is suggested as a non-invasive marker that can assist in diagnosis and long-term follow-up of UPJO patients. This ratio is superior to urinary CA 19-9 as it is more strongly correlated with UPJ obstruction.Figure presented © 2017 Journal of Pediatric Urology Compan

A comparison between tourniquet application and epinephrine injection for hemostasis during hypospadias surgery: The effect on bleeding and postoperative outcome

Objective To compare tourniquet application and epinephrine injection for hemostasis during hypospadias surgery in terms of bleeding and complications. Methods Between April 2013 and September 2014, patients who were admitted for hypospadias repair were divided by random allocation into either a diluted epinephrine injection (DE) group or tourniquet application (T) group for hemostasis during the procedure. In the T group, a rubber band was applied at the base of the penis after skin dissection, and in the DE group, epinephrine 1/100,000 was injected along the incision lines. The patients' ages, urethral defect lengths, pre-operative, intraoperative and postoperative variables were compared between the two groups. Results A total of 70 patients (35 in each group) were enrolled into the study. The mean ages and preoperative variables were not significantly different. Average blood loss was 23.51 ± 15.36 cc in the tourniquet group and 15.99 ± 10.00 cc in the epinephrine group, and was significantly higher in tourniquet group (P = 0.022); however, the mean operative time was not significantly different. Postoperative complications, described as Clavian classification, were reported in eight patients (23) in the T group and 10 patients (30) in the DE group, which was not significantly different. Conclusion Epinephrine injections minimize operative bleeding without significant harmful effects on postoperative outcomes; therefore, it could be considered to be a safe and effective method for preparation of a bloodless field during hypospadias surgery. © 2016 Journal of Pediatric Urology Compan

Optical Rotation from Coupled Cluster and Density Functional Theory: The Role of Basis Set Convergence

We have calculated the electronic optical rotation of seven molecules using coupled cluster singles-doubles (CCSD) and the second-order approximation (CC2) employing the aug-cc-pVXZ (X = D, T, or Q) basis sets. We have also compared to time-dependent density functional theory (TDDFT) by utilizing two functionals B3LYP and CAM-B3LYP and the same basis sets. Using relative and absolute error schemes, our calculations demonstrate that the CAM-B3LYP functional predicts optical rotation with the minimum deviations compared to CCSD at \uce\ubb = 355 and 589.3 nm. Furthermore, our results illustrate that the aug-cc-pVDZ basis set provides the optical rotation in good agreement with the larger basis sets for molecules not possessing small-angle optical rotation at \uce\ubb = 589.3 nm. We have also performed several two-point inverse power extrapolations for the basis set convergence, i.e., OR\ue2\u88\u9e+ AX-n, using the CC2 model at \uce\ubb = 355 and 589.3 nm. Our results reveal that a two-point inverse power extrapolation with the aug-cc-pVTZ and aug-cc-pVQZ basis sets at n = 5 provides optical rotation deviations similar to those of aug-cc-pV5Z with respect to the basis limit