Management of ureteropelvic junction obstruction in horseshoe kidneys by an assortment of laparoscopic options

Introduction: We report our experience with laparoscopic management of ureteropelvic junction obstruction in horseshoe kidneys. Methods: Between February 2004 and March 2014, 15 patients with horseshoe kidneys and symptomatic ureteropelvic junction obstruction underwent laparoscopic management at our national referral centre. Depending on the anatomy and presence of obtrusive vessels or isthmus, we performed either dismembered, Scardino or Foley YV pyeloplasty, or Hellstrom vessel transposition. Patients were initially evaluated by ultrasonography, then diuretic scintiscan at 4 to 6 months, and followed by yearly clinical and sonographic exams. Results: This study included 11 male and 4 female patients between the ages of 4 to 51 year (average 17.7). The left kidney was involved in 12 patients (80). Operation time was 129 minutes (range: 90-186), and patients were discharged within 2.8 days (range: 1-6). Although 8 (53.3) patients had crossing vessels, of which 6 required transposing, the Hellstrom technique was solely used in 3 cases, of which notably 1 case failed to resolve and required laparoscopic Hynes within the next year. Eight cases underwent dismembered pyeloplasty, 2 Foley YV, 1 Scardino flap and 1 required isthmectomy and vessel suspension. At the mean follow-up of 60 (range: 18-120) months, the overall success rate was 93.3. Conclusions: To our knowledge, this represents the largest report on laparoscopic pyeloplasty for horseshoe kidneys, providing the longest follow-up. Our findings confirm prior reports supporting laparoscopy and furthermore show that despite the prevalence of crossing vessels, transposition alone is seldom sufficient. © 2015 Canadian Urological Association

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

Totally laparoscopic combined freehand ileocystoplasty and malone procedures

Background and Purpose: Cecostomy performed together with open enterocystoplasty can allow continent bowel evacuation in children with neurogenic dysfunction. We present the first report on a combined approach to fecal and urinary incontinence in children with myelomeningocele that was performed exclusively by freehand laparoscopy. Patients and Method: We treated six dysrhaphic patients for total urinary and fecal incontinence by laparoscopy. Through five ports, a selected segment of ileum was isolated with cautery. A single-layer intestinal anastomosis, fashioning of the U-shaped patch, and anastomosis to the opened bladder dome were all done by endocorporeal freehand suturing. The tip of the appendix was simply brought to the skin via a trocar site. Results: The procedures took 5 to 8.5 hours. Patients remained hospitalized for 5 to 16 days (median 5 days). At 13 to 16 months' follow-up, all patients remain continent of urine, and nearly perfect fecal continence has resulted on antegrade enema. Leak from the ileal anastomosis in one patient resolved rapidly with conservative management. One short retrocecal appendix later developed stenosis and was replaced by a tubed cecal flap. Conclusion: Apart from its cosmetic advantage, this procedure is notable for addressing all evacuation problems at one session. Our suturing time seems reasonable compared with open sutured precedents. Use of a gastrointestinal stapling device for anastomosis would have significantly increased the cost while not necessarily guaranteeing against complications. We present this laparoscopic combination as an effective alternative to its open counterpart. © Mary Ann Liebert, Inc

The relationship between the findings of transvaginal dynamic sonography with patient�s signs and symptoms after mid-urethral sling surgery using TVT tape

Introduction: Stress urinary incontinence is a major problem affecting economic - social aspects and private lives of many women. Different surgical techniques such as TVT are used to treat the problem. This study was performed with aim to investigate the relationship between the findings of transvaginal dynamic sonography with patient�s signs and symptoms after Mid-urethral sling surgery using TVT tape. Methods: In this study, all women aged between 17 to 88 years who underwent TVT surgery for treatment of urinary incontinence at Tehran Hasheminejad Hospital during the past 2 years (2011-2013) and at least three months had passed of their surgery were entered to the study. A questionnaire for evaluation of age, body mass index, parity, irritative and obstructive symptoms was completed by the urologist. Then, a radiologists performed transvaginal ultrasound for the patients to determine the distance of tape from the urethra and bladder neck. Data was analyzed using SPSS statistical software (version 16) and non-parametric tests. PResults: Among 190 patients, 22 cases (10) had irritative symptoms, 14 (?) obstructive symptoms, and 17 (8.9) with symptoms of incontinence urgency. The sonography showed that mean distance of tape (c shape) from urethra was 3 ± 0.3 mm and mean distance of tape (c shape) from bladder neck was 11.3 ± 0.3 mm; there was no significant relationship between the prevalence of irritative symptoms and variables (P=0.14). Conclusion: There is no significant relationship between the findings of dynamic trans-vaginal ultrasound with patient�s signs and symptoms after Mid-urethral sling surgery using TVT tape to treat urinary incontinence in women. © 2015, Mashhad University of Medical Sciences. All rights reserved

Roundabout accident prediction model: random-parameter negative binomial approach

Roundabouts have been used widely on all road classes in the United Kingdom because they are considered safer than other types of intersections in general. The objective of this study was to examine geometric and traffic characteristics and their influences on the number of accidents. Data from each of 70 roundabouts (with 284 approaches) included all recorded vehicle accidents as well as geometric and traffic characteristics for the entire roundabout, within circulatory lanes, and at roundabout approaches. Resulting estimates were compared with those from random-parameter and fixed-parameter negative binomial count data models. The random-parameter results provided better goodness of fit than the fixed-parameter results, and more variables were found to be significant. Significant variables that influenced the number of accidents were total approach traffic, truck percentage, entry width, inscribed circle diameter, number of lanes, and presence of traffic signals

Comparing the Efficacy of Tolterodine and Gabapentin Versus Placebo in Catheter Related Bladder Discomfort after Percutaneous Nephrolithotomy: A Randomized Clinical Trial

Purpose: The purpose of this study was to compare the efficacy of tolterodine and gabapentin vs placebo in catheter related bladder discomfort (CRBD) following percutaneous nephrolithotomy (PCNL). Materials and Methods: This study was a double-blind parallel group randomized clinical trial. Patients who were candidates of PCNL were enrolled. Patients were randomized to treatment groups of tolterodine 2 mg orally (PO) (group T, n = 50), gabapentin 600 mg PO (group G, n = 50), and placebo (group P, n = 70) 1 hour before operation using balanced block randomization. The primary endpoint of interest was visual analog pain scale in 1, 3, 12, and 24 hours after the operation. Secondary endpoints included rescue analgesic use (opioid and nonopioid). Results: The frequency of severe CRBD in 1,12, and 24 hours after the operation was 4, 4, and 6 in group T vs 4, 0, and 2 in group G vs 47, 14, and 6 in the P group (p < 0.001). The number of paracetamol injections for CRBD in the T and G groups was significantly lower than the placebo group (1.8 ± 0.8 vs 1.8 ± 0.7 vs 3.6 ± 0.7, p < 0.001). Likewise the number of pethidine injections in the T and G groups was significantly lower than the placebo group (0.42 ± 0.54 vs 0.68 ± 0.62 vs 2.4 ± 0.64, p < 0.001). In patients with history of Double-J insertion, the severity of CRBD was lower in all treatment groups. Conclusions: Preoperative administration of oral tolterodine or gabapentin reduces postoperative CRBD and the need for rescue analgesics as much as 24 hours after surgery. Patients with history of Double-J insertion experience less CRBD. © Copyright 2018, Mary Ann Liebert, Inc

Comparing the Efficacy of Tolterodine and Gabapentin Versus Placebo in Catheter Related Bladder Discomfort after Percutaneous Nephrolithotomy: A Randomized Clinical Trial

Purpose: The purpose of this study was to compare the efficacy of tolterodine and gabapentin vs placebo in catheter related bladder discomfort (CRBD) following percutaneous nephrolithotomy (PCNL). Materials and Methods: This study was a double-blind parallel group randomized clinical trial. Patients who were candidates of PCNL were enrolled. Patients were randomized to treatment groups of tolterodine 2 mg orally (PO) (group T, n = 50), gabapentin 600 mg PO (group G, n = 50), and placebo (group P, n = 70) 1 hour before operation using balanced block randomization. The primary endpoint of interest was visual analog pain scale in 1, 3, 12, and 24 hours after the operation. Secondary endpoints included rescue analgesic use (opioid and nonopioid). Results: The frequency of severe CRBD in 1,12, and 24 hours after the operation was 4, 4, and 6 in group T vs 4, 0, and 2 in group G vs 47, 14, and 6 in the P group (p < 0.001). The number of paracetamol injections for CRBD in the T and G groups was significantly lower than the placebo group (1.8 ± 0.8 vs 1.8 ± 0.7 vs 3.6 ± 0.7, p < 0.001). Likewise the number of pethidine injections in the T and G groups was significantly lower than the placebo group (0.42 ± 0.54 vs 0.68 ± 0.62 vs 2.4 ± 0.64, p < 0.001). In patients with history of Double-J insertion, the severity of CRBD was lower in all treatment groups. Conclusions: Preoperative administration of oral tolterodine or gabapentin reduces postoperative CRBD and the need for rescue analgesics as much as 24 hours after surgery. Patients with history of Double-J insertion experience less CRBD. © Copyright 2018, Mary Ann Liebert, Inc

Large area magnetic micropallet arrays for cell colony sorting

A new micropallet array platform for adherent cell colony sorting has been developed. The platform consisted of thousands of square plastic pallets, 270 μm by 270 μm on each side, large enough to hold a single colony of cells. Each pallet included a magnetic core, allowing them to be collected with a magnet after being released using a microscope mounted laser system. The micropallets were patterned from 1002F epoxy resist and were fabricated on translucent, gold coated microscope slides. The gold layer was used as seed for electroplating the ferromagnetic cores within every individual pallet. The gold layer also facilitated the release of each micropallet during laser release. This array allows for individual observation, sorting and collection of isolated cell colonies for biological cell colony research. In addition to consistent release and recovery of individual colonies, we demonstrated stable biocompatibility and minimal loss in imaging quality compared to previously developed micropallet arrays

Differential mortality in Iran

Background: Among the available data provided by health information systems, data on mortality are commonly used not only as health indicators but also as socioeconomic development indices. Recognizing that in Iran accurate data on causes of death were not available, the Deputy of Health in the Ministry of Health and Medical Education (MOH&ME) established a new comprehensive system for death registration which started in one province (Bushehr) as a pilot in 1997, and was subsequently expanded to include all other provinces, except Tehran province. These data can be used to investigate the nature and extent of differences in mortality in Iran. The objective of this paper is to estimate provincial differences in the level of mortality using this death registration system. Methods: Data from the death registration system for 2004 for each province were evaluated for data completeness, and life tables were created for provinces after correction for under-enumeration of death registration. For those provinces where it was not possible to adjust the data on adult deaths by using the Brass Growth Balance method, adult mortality was predicted based on adult literacy using information from provinces with reliable data. Results: Child mortality (risk of a newborn dying before age 5, or q) in 2004 varied between 47 per 1000 live births for both sexes in Sistan and Baluchistan province, and 25 per 1000 live births in Tehran and Gilan provinces. For adults, provincial differences in mortality were much greater for males than females. Adult mortality (risk of dying between ages 15 and 60, or 45q15) for females varied between 0.133 in Kerman province and 0.117 in Tehran province; for males the range was from 0.218 in Kerman to 0.149 in Tehran province. Life expectancy for females was highest in Tehran province (73.8 years) and lowest in Sistan and Baluchistan (70.9 years). For males, life expectancy ranged from 65.7 years in Sistan and Baluchistan province to 70.9 years in Tehran. Conclusion: Substantial differences in survival exist among the provinces of Iran. While the completeness of the death registration system operated by the Iranian MOH&ME appears to be acceptable in the majority of provinces, further efforts are needed to improve the quality of data on mortality in Iran, and to expand death registration to Tehran province