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Benign prostatic hyperplasia (BPH) is one of the most common problems in elderly men. Transurethral resection of the prostate (TURP) can be performed for most patients who need re-do prostate surgery, but open prostatectomy should be considered in patients with prostate size larger than 70 grams. This study assessed the feasibility of open prostatectomy (OP) after previous TURP in patients whose prostate size was larger than 70 grams.We subdivided patients into two groups: group 1 included patients who had a history of prostate surgery presented with severe voiding symptoms and a large prostate (70 gram). Patients who were candidate for open simple prostatectomy without a history of prostate surgery were allocated to group 2.Between June 2007 and April 2018, 2700 patients underwent TURP or open prostatectomy in our department. 152 of 2700 patients came to us because of severe voiding symptoms after previous prostate surgery, but only 30 patients met the criteria to be enrolled in this study. Perioperative complication (capsular perforation) occurred in 4 (13.3%) patients in group 1 whereas none of the patients in the group 2 had capsular perforation. Hemoglobin drop in group 1 was not significantly different from patients in group 2. The rate of blood transfusion did not differ between the groups (2 [6.6%] patients in group 1 and 41 (5.6%) patients in group 2). After 6-12 months, re-operation rate because of urethral/bladder neck stricture was done in 10 (30%) patients in group 1 and 15 (2%) patients in group 2 (p0.05). Four (13.3%) patients in group 1 complained of urinary leakage (more than one pad per day) 6 months after the operation whereas 5 patients in group 2 used more than one pad per day (0.7%) (p0.05). Hospital stay was slightly longer in patients in group 1. Six months after the operation, the patients' quality of life was better in group 2 compared with group 1 (p0.05).Open simple prostatectomy was a feasible procedure in patients with large prostate after previous TURP, but it was associated with more complications in the long term.

To assess the prognostic effect of blood urea nitrogen to serum albumin ratio in patients with Fournier's gangrene (FG) in a referral center in order to reduce the mortality of FG patients.Patients with FG were admitted and enrolled consecutively in this study from March 2008 to April 2020. Statistical analysis was done to evaluate the differences between the two groups and to identify the best cutoff value to predict mortality and the need for intensive care.Of all 114 patients, 46 patients (40.35%) died in the course of hospitalization and 40 entered the study. No variable manifested a notable difference except for the BUN to albumin ratio, which was significantly different (P-value = 0.045). The ratio of BUN to albumin was not associated with any other variables and was independently a predictor of death in FG patients.The ratio of BUN to albumin was significantly different among deceased and survived patients with FG. Therefore, more studies with a larger sample size are still needed to access this parameter properly.

The purpose of Current Procedural Terminology (CPT) is to offer a universal language to describe medical services. The elaborate systems designed by high-income countries are not fully applicable in ones with limited resources. Therefore, in the current study we aimed to ask urologists' opinion about deploying relative value units in valuation of medical services in Islamic republic of Iran.A group of appointed urologists first selected 15 urological surgeries as exemplar urological procedures. Next, urologists around the country were asked to fill out an online questionnaire comparing these procedures with standard one (varicocelectomy). Then, mean scores of four categories (Difficulty, duration, adverse events and legal issues) were determined separately for each of the 15 procedures. Subsequently, mean score for each surgery was measured using the calculated mean scores of the four aforementioned categories.273 urologists completed an online questionnaire. All of the calculated codes were higher compared to the current codes. Urethroplasty showed the least increment with 25.22 equivalent to 51.69% while extracorporeal shock wave lithotripsy showed the most increment of 63.59 equivalent to 114.37%. Although CPT is an important tool in valuation of medical services, making modifications to it, especially in low-to-middle-income countries seems necessary. In this survey, we aimed to evaluate current surgical codes for urological procedures based on urologists' opinion. All of the calculated codes were higher compared with current codes. This, indicated the necessity of making changes in relative value units of urological procedures.

To compose a comprehensible and fluent Persian translation of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and to determine its linguistic validity in a Persian sample population.The standard double-back translation method, provided by the previous studies were utilized by three professional linguists to translate the English version of the NIH-CPSI to Persian, and a group of 10 urologists further reviewed and translated questionnaire. The questionnaire was then presented to the sample study, comprised of 60 men with CP/CPPS and 60 controls with adverse urological history, and the collected data was analyzed through IBM-SPSS software to test its validity, evaluative, and discriminatory power, psychometric qualities and internal consistency.A total of 80 subjects (42 CP/CPPS patients and 38 healthy controls) were considered eligible for this study. The total Persian NIH-CPSI scores and each subdomain showed significant difference (P0.001) between the two study groups, indicating a satisfactory discriminant validity for the index. Psychometric analysis established the index to benefit from a high internal consistency. The translation was also considered by both the subjects and the physicians to be easily comprehensible.The Persian NIH-CPSI is a reliable and valid instrument for evaluating CP/CPPS symptoms in general population, while also benefitting from high discriminatory power, and can be utilized with ease in both clinical practice and laboratory studies.

Chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS) is a nonspecific pelvic pain in the absence of signs of infection or other obvious local pathology for at least three of the last 6 months. Evidence for treatment approach is limited. So the aim of this study is to investigate the effect of extracorporeal shock wave therapy (ESWT) combined with pharmacotherapy in the treatment of CP/CPPS.In this randomized clinical trial, 31 patients with CP/CPPS were investigated in two groups: the intervention group (n=16) was treated with a combination of an alpha-blocker, an anti-inflammatory agent, a muscle relaxant and a short course of antibiotic in combination with 4 sessions of focused ESWT (a protocol of 3000 impulses, 0.25 mJ/mm2 and 3 Hz of frequency). The control group (n=15) received the aforementioned pharmacotherapy with 4 sessions of sham-ESWT . Follow-up was performed 4 and 12 weeks following ESWT by using the Visual Analogue Scale (VAS), International index of Erectile function (IIEF) 5, National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) and International Prostate Symptom Score (IPSS) questionnaires. Post void residual (PVR) urine and maximum flow rate (Qmax) were also assessed in both groups.The patients mean age was 43.7 ±12.6 years. In both groups, the mean scores of NIH-CPSI (total and sub-domains) and VAS showed statistically significant improvements after 4 and 12 weeks compared to the baseline (P.001). In the intervention group, IPSS (mean difference: 4.25) and Qmax (mean difference: 2.22) were also significantly improved (P.001). There was a significant improvement in NIH-CPSI (mean difference: 1.1) and VAS scores (mean difference: 1.1) in the intervention group as compared to the control group (P.01). Qmax, PVR and IIEF score were not statistically different in the two groups.ESWT in combination with pharmacotherapy could improve the treatment outcome in patients with CP/CPPS.