Challenges of Assisted Reproductive Technology during COVID19 Pandemic; a Letter to Editor

The coronavirus has spread rapidly all over the world and has become a worldwide crisis. On 11th March, 2020, the World Health Organization (WHO) described the coronavirus disease as a global pandemic. Following the mortality due to COVID-19 infection, many healthcare systems have been affected in many countries. On July 11th, 2020, 12322395 confirmed cases of coronavirus were reported, of which 556335 led to death (1)

Post-syncope trauma should be considered in COVID-19 patients

In December  2019, a new form of respiratory infection associated with coronavirus appeared in Wuhan, China. As of today, COVID-19 has spread all around the world. There have been 9.24 million confirmed cases and 477,000 deaths globally. Fever, cough, and coexistence chest or back pain are some of the most reported symptoms of COVID-19. Although syncope is not a primary symptoms, we see patients passing out in the street after coronavirus pandemic. Up to now, syncope due to COVID-19 has only been reported by CHANTAL and coauthor in a 79 year-old patient. (1) There is no available data on syncope in COVID-19 patients. This is while some patients have been referred to us purely for their symptoms of fainting. Etiology of fainting in COVID-19 may be the product of orthostatic hypotension and vasovagal syncope due to dehydration. Increasing pressure in thoracic cavity during sequential cough may induce “cough syncope

Different Aspect of Transperitoneal Laparoscopic Pyelolithotomy for Management of Pelvic Stones Larger than 20 mm: a Cuasi-Experimental Study in Male Patients

Background: We study different aspect of laparoscopic pyelolithotomy (LP) in patients with large renal pelvis stone regarding success rate, complications as well as the recurrence free status. Material and methods: From July 2015 to January 2019, 32 patients underwent LP for single large renal pelvis stone ($\ge$2 cm). Patient characteristics, preoperative and postoperative hemoglobin, creatinine as well as possible complications based on Clavien classification were recorded. Stone free status was evaluated using computed tomography scan one month after the surgery. Any particle bigger than 4 mm was considered as significant residual stone. During the next one years after the operation, renal ultrasonography was performed for all patients every six month to find any stone recurrence. Results: Mean operation time was 134.55$\pm$31.41 minutes. Patients were hospitalized 3.36$\pm$1.13 days in the LP group. Patients showed hemoglobin decrease of 1.50$\pm$1.05 (P=0.2). Stone free rate was 93.75\% and Mean overall stone free status estimated to be 32 months. Conclusion: PCNL has been the treatment of choice for large renal pelvis stones; however, in expert hands, LP is an appropriate substitute with superior stone free rate, less bleeding and remarkably less stone recurrence

Treatment of Kidney Stones Using Extracorporeal Shock Wave Lithotripsy (ESWL) and Double-J Stent in Infants

Background. Extracorporeal shock wave lithotripsy (ESWL) has progressively acquired popularity as being the gold standard treatment for upper urinary tract lithiasis in infants since 1980. Our aim was to evaluate the outcome of ESWL for kidney stones and the use of double-J stent in infants. Material and Methods. A prospective clinical trial study performed on 50 infants with renal calculi at pelvic admitted in the Urology ward of Shafa Hospital, Sari, Iran, between 2001 and 2010. Main outcome measure of our study was clearing stones after one or more consecutive sessions of ESWL. Results. The study included 50 patients with renal calculi at pelvic. Among them, there were 35 (70%) boys and 15 (30%) girls with the age ranging from 1 to 13 months (mean of 7 month ± 3 days). All of them were treated by standard ESWL using Simons Lithostor plus machine. The stone sizes ranged from 6 mm to 22 mm. Double-J stents were placed in 11 infants (22%) with stones larger than 13 mm. Most of the patients required only one ESWL session. Conclusion. Since there were no complications following ESWL treatment, we can conclude that, in short term, ESWL is an effective and safe treatment modality for renal lithiasis in infants. In addition, we recommend double-J stent in infants with stones larger than 13 mm

Different Aspects of Penile Amputation; Surgery, Forensics, and Psychiatry (Case Report and Short Review)

Penile amputation (PA) is a rare genitourinary injury. Three main etiologies of PA consist of iatrogenic, accidental, and self-mutilation. Eighty-seven percent of the self-mutilated patients suffer from psychiatric disorders. Nowadays, microsurgical techniques with neurovascular anastomosis are the best approach for PA. This paper insists on psychiatric and legal consequences, which may involve health-care team. A 25-year-old male patient presented to our emergency department with self-inflicted PA. As he had a history of some psychiatric problems, psychiatric consultation was requested. The patient did not accept any surgical interventions. We informed his relatives completely; however, they did not agree with surgical intervention because they predicted that he might repeat amputation again. According to the forensic medicine specialist consultation, we took the coroner's warrant for emergency surgical intervention and transferred the patient to the operating room without any consent. Microsurgical penile replantation was performed. There was no leakage in retrograde pericatheter urethrography on the 3rd postoperative week, and the urethral catheter was removed. The patient was able to void normally, and cystostomy tube was removed at the same time. Consent for all medical procedures is an important part of national and international human right law and medical ethics. Physicians should inform patients about their problem and take a reliable consent. If the patient was unreliable for informed consent, relatives could do it. However, in an emergency, there is an exception in the law that let surgeons do the operation without consent for these cases

Satisfaction of Patients after Urethral Reconstruction

Introduction: Urethroplasty is one of the most common and important reconstructive procedures in the field of urology. In order to improve patient’s condition, medical man needs to be acquainted with this technique.  We aimed to evaluate quality of life and satisfaction of patients with Urethroplasty in the reconstructive urology department of Shohada-e-Tajrish Hospital, during 1995-2016. Materials and Methods: This study was a retrospective cohort. Sampling was done by census method. The patients' demographic information, cause and duration of urethral stricture, type and frequency of procedures, daily fluid intake, urinary obstruction symptoms, the quality of marital relations, and the quality of life of patients before and after the surgery, were evaluated.  Results: The mean age of the patients was 36.6 years. 46.4% of the patients had moderate and more than moderate marital satisfaction after surgery, while this preoperative satisfaction was 48.2% (P>0.05). Patients' quality of work life and job satisfaction was significantly higher than before surgery (P=0.05). In 90.3% of the patients, urination status had no or little negative impact on their daily life after surgery. Also, 86.9% of the patients did not have weak urinary flow during follow-up. 88% of the patients were satisfied with the outcome of their surgery. Patients' satisfaction with their physical health after surgery was 82.1%. Conclusion: In general, it is inferred that Urethroplasty is associated with a high success rate and patient satisfaction, and also improves their quality of life

Cavernous sinus thrombosis syndrome and brainstem involvement in patient with leptospirosis: Two rare complications of leptospirosis

Leptospirosis is a bacterial disease that is caused by pathogenic spirochetes of the genus Leptospira. It can affect humans and animals. In humans, it can lead to a wide spectrum of symptoms. It is known as the most common zoonosis in the world. The typical presentation of the disease is an acute biphasic febrile illness with or without jaundice. Less common clinical manifestations may result from involvement of different human body systems. In many places, this disease may be under-diagnosed, especially when associated with neurological complications. Moreover, without treatment, leptospirosis can lead to organ damages, and even death. Neurological complications are uncommon and are reported in a few cases. Cavernous sinus thrombosis syndrome and brainstem involvement are rare complications of leptospirosis and are associated with a high mortality risk. To our knowledge, no such cases have been reported in the literature