Management of Zinner’s Syndrome Associated with Contralateral Seminal Vesicle Hypoplasia: A Case Report

A 27-year-old man presented with chronic hematospermia, painful ejaculation, and primary infertility. Physical examination, transrectal ultrasonography, and pelvic magnetic resonance imaging (MRI) demonstrated left seminal vesicle cyst, left renal agenesia, and contralateral seminal vesicle hypoplasia. Hormone workup (LH, FSH, prolactin, and testosterone) was normal. Sperm analysis showed oligoasthenozoospermia and low ejaculate volume. We performed transurethral resection of the ejaculatory duct (TUR-ED) using methylene blue vasography guidance without surgical-related complications. Hematospermia and painful ejaculation completely improved at 2-month followup, and the patient’s wife experienced a missed abortion thereafter. This patient was considered as a rare variant of Zinner’s syndrome and was managed effectively with a less invasive treatment modality (TUR-ED)

Donor Nephrectomy With and Without Preservation of Gonadal Vein While Dissecting the Ureter

<p class="MsoNormal" style="margin: 0cm 0cm 0pt; direction: ltr; unicode-bidi: embed; text-align: left;"><span style="font-size: small;"><span style="font-family: Times New Roman;"><strong>Introduction: </strong>Preservation of the gonadal vein while dissecting the ureter for donor nephrectomy may decrease the distal ureteral ischemia and urological complications in kidney transplant recipients. In this study, we compared the outcome of kidney allografts harvested with preservation of the gonadal vein while dissecting the ureter with allografts harvested without preserving the gonadal vein.<strong></strong></span></span></p><p class="MsoNormal" style="margin: 0cm 0cm 0pt; direction: ltr; unicode-bidi: embed; text-align: left;"><span style="font-size: small;"><span style="font-family: Times New Roman;"><strong>Materials and Methods: </strong>We reviewed 167 consecutive kidney transplantations between April 2003 and April 2004. During donor nephrectomy, we preserved the gonadal vein in 106 harvested kidneys (group 1), while we did not preserve this vein in 61 allografts (group 2). The recipients in each group were followed up for a 2-year follow-up on average, and the outcomes including ureteral complications, graft loss, and patient and graft survival were compared between the two groups.<strong></strong></span></span></p><p class="MsoNormal" style="margin: 0cm 0cm 0pt; direction: ltr; unicode-bidi: embed; text-align: left;"><span style="font-size: small;"><span style="font-family: Times New Roman;"><strong>Results: </strong>Urine leakage was noted in few patients (2 in group 1 and 3 in group 2) and its frequency was not significantly different between the two groups (<em>P</em> = .26). Ureteral stricture was not seen in any of the kidney allograft recipients. No differences were found in the frequencies of acute rejection episodes, graft loss, and death between the two groups. <strong></strong></span></span></p><p class="MsoNormal" style="margin: 0cm 0cm 0pt; direction: ltr; unicode-bidi: embed; text-align: left;"><span style="font-size: small;"><span style="font-family: Times New Roman;"><strong>Conclusion: </strong>Preservation of the gonadal veins did not significantly decrease the frequency of ureteral complications in the kidney transplant recipients. We recommend meticulous handling of the ureter in donor nephrectomies to prevent further remote complications regardless of the approach to the gonadal veins while nephrectomy.<strong></strong></span></span></p&gt

A systematic review and meta-analysis of complications of artificial urinary sphincters in female patients with urinary incontinence due to internal sphincter insufficiency

Abstract Background Urinary incontinence (UI) is a common worldwide rising health issue among women with a prevalence of 5 to 70%. Stress urinary incontinence (SUI) is the most common subtype of UI. There are different treatments for UI, including AUS (artificial urinary sphincter) implantation, as one of the surgical options for treating SUI. The aim of this study was to determine the complication rate of AUS, exclusively in female patients with SUI, which resulted from ISD (intrinsic sphincter deficiency). We also compared the complication rate between minimally invasive (laparoscopic or robotic surgery) and open approaches. Methods Scopus, PubMed, Web of Science, Embase, and Google Scholar were searched for studies regarding complications in AUS implantation surgery, from the beginning of the project to March 2022. After screening and reviewing of full text, the general characteristics of the study and study population including follow-up time, type of surgery, and the number of complications that occurred such as necrosis, atrophy, erosion, infection, mechanical failure, revision, and leak, were extracted. Results We found that atrophy occurred in 1 of 188 (0.53%) patients treated with minimally invasive surgery and in 1 of 669 (0.15%) patients treated with open surgery. None of the 17 included studies reported the occurrence of necrosis in the patients under study. Erosion occurred in 9 of 188 (4.78%) patients treated with minimally invasive surgery and in 41 of 669 (6.12%) patients treated with open surgery. Infection occurred in 12 of 188 (6.38%) patients treated with minimally invasive surgery and in 22 of 669 (3.2%) patients treated with open surgery. The mechanical failure occurred in 1 of 188 (0.53%) patients treated with minimally invasive surgery and in 55 of 669 (8.22%) patients treated with open surgery. Reconstructive surgery occurred in 7 of 188 (3.72%) patients treated with minimally invasive surgery and in 95 of 669 (14.2%) patients treated with open surgery. Leaks occurred in 4 of 188 (2.12%) patients treated with minimally invasive surgery and in 6 of 669 (0.89%) patients treated with open surgery. The type of surgery was associated with a statistically significant increase in mechanical failure (p-value = 0.067) and infection (p-value = 0.021), and reconstructive surgery (p-value = 0.049). Out of the 857 participats in the study,469 were studied for less than five years and 388 were studied for more than five years.21 of 469 (4.4%) (p-value = 0.08) patients and 81 of 388 (20.8%) (p-value = 0.001) patients required reconstructive surgery. Erosion occurred in 23 of 469 (4.9%) (p-value = 0.01)patients with following time less than five years and in 27 of 388 (6.9%) (p-value = 0.001) patients with following time more than five years. Conclusion The use of artificial urinary sphincters in the treatment of UI causes complications such as atrophy, erosion, and infection; the amount of which is influenced by the surgical method and the duration of using the artificial urinary sphincter. It seems that the use of new surgical methods, such as laparoscopic surgery, is useful in reducing the incidence of complications

The Correlation between CD44 and ABCG2 Expression and Pathological Grades of Bladder Carcinoma

Background: The human bladder cancer progression is accompanied by the growth of side-populations of cancer stem cells (CSCs). The expression of ABCG2 and CD44, as the CSC markers, may be associated with different pathological grades of bladder cancer. This study was designed to identify the changes occurring in ABCG2 and CD44 in different types of bladder tumors at various grades.Methods: The sample included 67 patients with bladder cancer (63 males; 4 females) with a diagnosis of transitional cell carcinoma (urothelial cancer) using cystoscopy. Based on the tumor pathological grade, we divided the tumor biopsies into two low-grade (N=20) and high-grade (N=21) groups. The tumor samples along with 26 normal-looking bladder tissues were analyzed by techniques like immunohistochemistry (IHC) and total RNA extraction for qPCR.Results: Based on the results obtained by IHC analysis of ABCG2 and CD44 protein in bladder low- and high-grade tumors, these CSC markers showed significant elevation in malignant tissues in comparison to the normal bladder tissues. The scoring of ABCG2 expression in normal, low-grade and high-grade tissues was 28, 120, and 140 respectively. The CD44 scores in the normal bladder, low-grade and high-grade tissues were found to be 0.6, 11.5, and 29.0, respectively. The IHC data showed inconsistency with the qPCR data, suggesting an overexpression of ABCG2 (4-6.5 folds) and CD44 (15-22 folds) in the low and high-grade tumors in comparison to the normal bladder tissue.Conclusions: Finding a good relationship between ABCG2 and CD44 markers and different grades of bladder cancer demonstrated that these markers can be seen as potential and predictive indicators of bladder malignancy

The Correlation between CD44 and ABCG2 Expression and Pathological Grades of Bladder Carcinoma

Background: The human bladder cancer progression is accompanied by the growth of side-populations of cancer stem cells (CSCs). The expression of ABCG2 and CD44, as the CSC markers, may be associated with different pathological grades of bladder cancer. This study was designed to identify the changes occurring in ABCG2 and CD44 in different types of bladder tumors at various grades.Methods: The sample included 67 patients with bladder cancer (63 males; 4 females) with a diagnosis of transitional cell carcinoma (urothelial cancer) using cystoscopy. Based on the tumor pathological grade, we divided the tumor biopsies into two low-grade (N=20) and high-grade (N=21) groups. The tumor samples along with 26 normal-looking bladder tissues were analyzed by techniques like immunohistochemistry (IHC) and total RNA extraction for qPCR.Results: Based on the results obtained by IHC analysis of ABCG2 and CD44 protein in bladder low- and high-grade tumors, these CSC markers showed significant elevation in malignant tissues in comparison to the normal bladder tissues. The scoring of ABCG2 expression in normal, low-grade and high-grade tissues was 28, 120, and 140 respectively. The CD44 scores in the normal bladder, low-grade and high-grade tissues were found to be 0.6, 11.5, and 29.0, respectively. The IHC data showed inconsistency with the qPCR data, suggesting an overexpression of ABCG2 (4-6.5 folds) and CD44 (15-22 folds) in the low and high-grade tumors in comparison to the normal bladder tissue.Conclusions: Finding a good relationship between ABCG2 and CD44 markers and different grades of bladder cancer demonstrated that these markers can be seen as potential and predictive indicators of bladder malignancy

Familial Relations and Recurrence Pattern in Nephrolithiasis: New Words About Old Subjects

Purpose: While medical and surgical approaches to urolithiasis are different for single and recurrent stone former (RSF), the RSF definition itself is commonly overlooked. Moreover, despite consensus on association between family history (FH) and urolithiasis, more epidemiologic evidence is requiredto clarify the nature of this relationship. Our purpose was to propose a more precise definition of RSF, and also to investigate how family history may affect urolithiasis.Materials and Methods: Using a multistage stratified sampling in 4 seasonal phases, 6127 subjects with imaging-proven urolithiasis were detected in 12 Iranian regions. The FH of urolithiasis and the average interval between episodes (cycles) were determined by an informed interview. Results: Of 6127 patients with the mean age of 41.8 ± 15.1 years, 42% had FH, and 22.2% were RSF of whom 61% were men. The patients with FH had a greater chance of recurrence (OR = 1.2, 95% Confidence Interval (CI), 1.1 to 1.4). Furthermore, patients with positive FH had more episodes (P = .0001), comparable cycles and younger ages at the onset (P = .02) than those patients without a FH. In the RSF group, the 90th percentiles of the cycle were 60 months and the estimated mean stone cycle for the population was 25.34 months (99% CI, 23.0 to 27.7).Conclusion: Family history seems very common in Iranian population and is a risk factor for recurrence. Moreover, RSF could be identified by the estimated average cycle in the population (25.3 months) or by the percentiles

Urinary lithogenic risk profile in recurrent stone formers with hyperoxaluria: a randomized controlled trial comparing DASH (Dietary Approaches to Stop Hypertension)-style and low-oxalate diets.

BackgroundPatients with nephrolithiasis and hyperoxaluria generally are advised to follow a low-oxalate diet. However, most people do not eat isolated nutrients, but meals consisting of a variety of foods with complex combinations of nutrients. A more rational approach to nephrolithiasis prevention would be to base dietary advice on the cumulative effects of foods and different dietary patterns rather than single nutrients.Study designRandomized controlled trial.Setting & participantsRecurrent stone formers with hyperoxaluria (urine oxalate > 40 mg/d).InterventionThe intervention group was asked to follow a calorie-controlled Dietary Approaches to Stop Hypertension (DASH)-style diet (a diet high in fruit, vegetables, whole grains, and low-fat dairy products and low in saturated fat, total fat, cholesterol, refined grains, sweets, and meat), whereas the control group was prescribed a low-oxalate diet. Study length was 8 weeks.OutcomesPrimary: change in urinary calcium oxalate supersaturation.SecondaryChanges in 24-hour urinary composition.Results57 participants were randomly assigned (DASH group, 29; low-oxalate group, 28). 41 participants completed the trial (DASH group, 21; low-oxalate group, 20). As-treated analysis showed a trend for urinary oxalate excretion to increase in the DASH versus the low-oxalate group (point estimate of difference, 9.0mg/d; 95% CI, -1.1 to 19.1mg/d; P=0.08). However, there was a trend for calcium oxalate supersaturation to decrease in the DASH versus the low-oxalate group (point estimate of difference, -1.24; 95% CI, -2.80 to 0.32; P=0.08) in association with an increase in magnesium and citrate excretion and urine pH in the DASH versus low-oxalate group.LimitationsLimited sample size, as-treated analysis, nonsignificant results.ConclusionsThe DASH diet might be an effective alternative to the low-oxalate diet in reducing calcium oxalate supersaturation and should be studied more

Urinary lithogenic risk profile in recurrent stone formers with hyperoxaluria: a randomized controlled trial comparing DASH (Dietary Approaches to Stop Hypertension)-style and low-oxalate diets.

BackgroundPatients with nephrolithiasis and hyperoxaluria generally are advised to follow a low-oxalate diet. However, most people do not eat isolated nutrients, but meals consisting of a variety of foods with complex combinations of nutrients. A more rational approach to nephrolithiasis prevention would be to base dietary advice on the cumulative effects of foods and different dietary patterns rather than single nutrients.Study designRandomized controlled trial.Setting & participantsRecurrent stone formers with hyperoxaluria (urine oxalate > 40 mg/d).InterventionThe intervention group was asked to follow a calorie-controlled Dietary Approaches to Stop Hypertension (DASH)-style diet (a diet high in fruit, vegetables, whole grains, and low-fat dairy products and low in saturated fat, total fat, cholesterol, refined grains, sweets, and meat), whereas the control group was prescribed a low-oxalate diet. Study length was 8 weeks.OutcomesPrimary: change in urinary calcium oxalate supersaturation.SecondaryChanges in 24-hour urinary composition.Results57 participants were randomly assigned (DASH group, 29; low-oxalate group, 28). 41 participants completed the trial (DASH group, 21; low-oxalate group, 20). As-treated analysis showed a trend for urinary oxalate excretion to increase in the DASH versus the low-oxalate group (point estimate of difference, 9.0mg/d; 95% CI, -1.1 to 19.1mg/d; P=0.08). However, there was a trend for calcium oxalate supersaturation to decrease in the DASH versus the low-oxalate group (point estimate of difference, -1.24; 95% CI, -2.80 to 0.32; P=0.08) in association with an increase in magnesium and citrate excretion and urine pH in the DASH versus low-oxalate group.LimitationsLimited sample size, as-treated analysis, nonsignificant results.ConclusionsThe DASH diet might be an effective alternative to the low-oxalate diet in reducing calcium oxalate supersaturation and should be studied more