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Purpose: To evaluate the safety and efficacy of holmium LASER resection of the bladder tumor (HoLRBT) vs. transurethral resection of bladder tumor (TURBT) as the first treatment modality for non-muscle-invasive bladder cancer (NMIBC)., Materials and Methods: Eighty-eight patients with primary non-muscle invasive bladder cancer were allocated randomly in two groups who were treated with HoLRBT or TURBT. The intraoperative and postoperative characteristics and complications of the HoLRBT and TURBT groups were compared. The data of operation time, obturator nerve reflex rate, bladder perforation, bladder irrigation, catheterization time, hospital stay, and 1, 3, 6, 12, 18 months recurrence free survivals were considered in two groups., Results: There was not significant difference in operative duration among the two groups. Compared with the TURBT group, HoLRBT group had less intraoperative and postoperative complications, including obturator nerve reflex, transient hematuria and postoperative bladder irritation. There were no significant differences among the two groups in the transfusion rate and occurrence of urethral strictures. Patients in the HoLRBT group had less catheterization and hospitalization time in comparison to those in the TURBT group. There were no significant differences in the overall recurrence rate among the TURBT and HoLRBT groups., Conclusion: HoLRBT can be regarded as a safe and efficient method with several advantages over TURBT. HoLRBT can be used as an alternative procedure for TURBT in patients with non-muscle invasive bladder cancer.

Purpose: There are some previous reports on the relationship between pathological grades and HPV detection. To determine the Human Papilloma Virus(HPV)  DNA in Tumor Tissue and Urine in Different Stage of Bladder Cancer conducted this study.Materials and Methods: Polymerase chain reaction (PCR) was used to detect general HPV and HPV16 and 18 subtypes in 110 bladder tumor tissue and urine specimens of patients with TCC of bladder between January 2014 to May 2016 that underwent transurethral resection of bladder tumor. Exclusion criteria were genital wart and cases with immunosupression., Results: Mean age of 110 patients was 61.6±10 years and fourteen (12.7%) of patients were female. PCR for general HPV primer in bladder tumor tissue was positive in 3 (9.4%), 22 (38.6%) and 15 (71.4%) of Ta, T1 and T2 bladder tumors, respectively (p<0.001). PCR for HPV16 in bladder tumor tissue was positive in 2(6.3%), 10 (17.5%) and 13 (61.9%) and PCR for HPV18 in bladder tumor tissue was positive in 1 (3.1%), 14 (24.6%) and 12 (57.1%) of Ta, T1 and T2 bladder tumors, respectively (p<0.001, p<0.001). Thirty seven (33.6%) of urine specimens were positive for general HPV using PCR and HPV16 and 18 subtypes were positive in 17 (15.5%) and 14 (12.7%) of urine specimens, respectively., Conclusion: HPV infection may be associated with higher stages and grades of bladder carcinomas. Urine sampling for HPV detection is is as reliable as tumor tissue sample which could be considered for prognostic and follow up implications.

Purpose: Chronic inflammation is an important factor in the etiology of prostate cancer. Macrophage migration inhibitory factor (MIF) plays an important regulatory role in inflammatory responses. The aim of this study was to investigate the potential association between MIF-173 G/C polymorphism, and both biological behavior and incidence of prostate cancer., Materials and Methods: Analysis of polymorphic variants for MIF was performed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method in 128 subjects with prostate cancer and 135 controls., Results: The frequency of MIF-173 *C allele was significantly (OR = 2.18, 95% CI = 1.32-3.61) higher in patients with prostate cancer (19.5%) than in healthy individuals (10%). Prostate cancer patients with Gleason scores ? 7 had higher frequency of MIF-173 *C allele than Gleason scores < 7 (86.1% vs. 27.1%, P = 0.003, OR = 3.18, 95%CI = 1.46-6.95). The frequency of MIF-173 *C allele was significantly different in patients with T1, T2 and ?T3 clinical stages of prostate cancer (15.2% vs. 42.6% and 47.8%, P = 0.003)., Conclusion: Our data suggest that MIF-173 polymorphisms may be associated with a higher incidence of prostate cancer compared to controls. We believe that MIF-173 GC+CC genotype can be used as a predictive factor for aggressive behavior of prostate cancer including pathological stage and Gleason scores as well as metastatic potential.

Purpose: To compare outcomes of retrograde intrarenal surgery (RIRS) with extracorporeal shock wave lithotripsy (SWL) for stones &le; 2 cm., Materials and Methods: Patients who were diagnosed with kidney stones of &le; 2 cm underwent RIRS or SWL in a parallel group randomized clinical trial with balanced randomization [1:1] from 2011 to 2014. The primary outcome of interest was stone free rate after a single session intervention. Patients were evaluated by ultrasonography and KUB at 1 and 3 months after the intervention for the presence of residual stone by a radiologist who was blinded to the study., Results: The stone free rate one month after a single session intervention in the RIRS group was higher than the SWL group (90% versus 75%, P = .03). The success rates after two sessions of RIRS versus SWL were 96.7% versus 88.3% respectively. (P = .08) Patients in the RIRS group had significantly lower postoperative visual analogue pain score compared to the SWL group (5.2 &plusmn; 2.8 versus 3.1 &plusmn; 2.7, P &lt; .001). Steinstrasse formation and renal hematoma were observed in 4 and one patient in the SWL group versus no patient in the RIRS group. Postoperative hospital stay was significantly shorter in the SWL group (6.7 &plusmn; 1.3 versus18.9 &plusmn; 4.3 hours, P &lt; .001)., Conclusion: The RIRS procedure is a safe treatment option for renal stones of &le;2cm with less pain and higher success rate at first session compared to SWL.&nbsp.

Purpose: Due to the negative impact of radiation on the patient and the surgical team during percutaneous nephrolithotomy (PCNL), we aimed to evaluate success rate and complications of blind access for PCNL using lumbar notch landmark and compare with conventional fluoroscopy-guided access., Materials and Methods: In a clinical trial, 100 patients who were candidate for PCNL, were randomly assigned into blind group (1) and fluoroscopy-guided group (2). In group 1 the lumbar notch was used to guide percutaneous access and in group 2 fluoroscopy performed after needle insertion, Amplatz placement and at the end of surgery. If the access failed, we would repeat puncturing up to 5 times. In group 2, access was achieved using full fluoroscopy guidance. All patients underwent postoperative assessment including kidney-ureter-bladder X-ray and ultrasonography., Results: Both mean access time and mean operation time were statically similar in group 1 and group 2 (3.3 ± 0.5 vs. 3.6 ± 0.7 min and 35.2 ± 4.6 vs. 38.9 ± 4.1 min, respectively). A successful puncture was achieved in 86% and 94% of the patients in groups 1 and 2, respectively (P = .18). Total success rate of procedure was 80% and 88% of the patients in groups 1 and 2, respectively (P = .27)., Conclusion: According to this study, it seems that blind access is a safe and effective PCNL method, and we recommend employment of this technique by skilled endourologist in urology centers especially for patient with large hydronephrotic kidney.

Purpose: To compare efficacy and safety of holmium:YAG laser and pneumatic lithotripter in the management of ureteral stones., Materials and Methods: One hundred and twelve patients with 1 to 2 cm ureteral calculi were selected for pneumatic or holmium:YAG laser transurethral ureterolithotripsy (56 patients in each group). Ultrasonography and plain abdominal x-ray were performed for all the patients before the operation. The pneumatic lithoclast was Swiss LithoClast, while in laser lithotripsy, holmium:YAG laser frequency was used, which was usually set between 5 and 10 Hz at a power of 10 to 15 Watt. Intravenous urography was performed for all the patients at 3 months to assess functional status and to delineate the ureteral anatomy., Results: The mean patients' age and stones' size were the same in both groups, and there were no statistical differences. Mean duration of lithotripsy was 13.7 ± 12.6 minutes in laser group and 7.9 ± 4.2 minutes in pneumatic lithotripsy group. Immediate stone-free rate was 100% and 82.1% in the laser and pneumatic groups, respectively (P = .001). Stone pushing back occurred only in 10 (17.9%) patients in pneumatic group. In terms of complications, such as perforation, mucosal injury, and bleeding, there were no differences between the two groups. No intravenous pyelography related complication was seen at 3-month follow-up., Conclusion: Laser lithotripsy is a superior approach for the management of upper ureteral stones of 1 to 2 cm in size due to its higher rate of stone clearance.

Purpose: To assess the accuracy of voided urine cytology versus urinary nuclear matrix protein 22 (NMP22) qualitative assay in the diagnosis of various grades and stages of recurrent bladder transitional cell carcinoma (TCC)., Materials and Methods: From July 2007 to February 2009, all patients with history of superficial bladder TCC were included in this multi-center study. Each patient provided three serial voided urine samples for cytologic examination and one sample for the NMP22 qualitative assay prior to urethrocystoscopy. The sensitivity and specificity of urine cytology and the NMP22 test were determined., Results: The sensitivities of the NMP22 test and cytology for detection of recurrence were 78.8% and 44.2%, respectively (P = .001), while the specificities were 69.6% and 83.7%, respectively (P = .019). The NMP22 test showed significantly higher sensitivity than cytology in detecting recurrences in low-risk and intermediate-risk groups., Conclusion: The NMP22 assay could be used for detection of superficial bladder cancer, especially in low- and intermediate-risk groups; however, the value of the test is limited by its low specificity.

Purpose: To compare arterial blood gas analysis of patients who underwent percutaneous nephrolithotomy (PCNL) in flank position under ultrasonography guidance with PCNL in prone and supine positions under fluoroscopic guidance., Materials and Methods: In a clinical trial, a total of 90 patients with no upper urinary tract abnormalities were candidate for the PCNL. They were assigned into three groups using pseudorandomization method (30 patients in each group). Patients in group 1 underwent ultrasonography-guided PCNL in flank position. Patients in groups 2 and 3 underwent fluoroscopic-guided PCNL in prone and supine positions, respectively. Arterial blood gas was taken just before and 20 minutes after repositioning., Results: The patients' mean age was 40.8 ± 6.9, 39.4 ± 10.6, and 37.2 ± 11.1 years in flank, prone, and supine positions, respectively (P = .69). The mean body mass index was 27.8 ± 3.4, 26.7 ± 4.7, and 28.1 ± 5.1 kg/m² in flank, prone, and supine positions, respectively (P = .21). Arterial oxygen pressure (PaO₂) increased significantly in flank (111.7 ± 43.8 to 132.8 ± 58.1 mmHg; P = .01) and prone (118.6 ± 50.2 to 134.6 ± 58.5 mmHg; P < .001) positions and decreased nonsignificantly in supine group (121.7 ± 64.5 to 119.7 ± 60.9 mmHg; P = .23). With surgical positioning, there were no significant changes demonstrated in PaCO₂ and serum concentration of HCO₃ in the flank, prone, and supine groups., Conclusion: We could suggest that flank and prone positions could improve patients' oxygenation during PCNL procedure.

Purpose: To evaluate success rate of dorsal versus ventral oral mucosal graft for anterior urethroplasty., Materials and Methods: In a retrospective study, the results of the ventral and dorsal oral mucosal graft (OMG) anterior urethroplasty were assessed in 24 and 29 patients, respectively. Demographic and clinical characteristics of subjects were gathered from the medical records., Results: Patients were followed up for a mean duration of 32 months (range, 25 to 51 months). The success rates of dorsal and ventral anterior OMG urethroplasty were 83.3% and 75.8%, respectively (P = .5). At penile site, dorsal and ventral OMG were done for 9 and 10 patients with stricture lengths of 3.7 ± 1.1 cm and 3.9 ± 1.2 cm, respectively (P = .7). Success rates of dorsal and ventral penile OMG were 88.9% and 70%, respectively (P = .3). At the bulbar site, dorsal and ventral OMG were performed on 15 and 19 patients with stricture lengths of 4.1 ± 1.1cm and 4.2 ± 1.5 cm, respectively (P = .7). The success rates of dorsal and ventral bulbar OMG were 80% and 79%, respectively (P = .94)., Conclusion: Oral mucosal graft is a versatile and an effective procedure for management of strictures throughout the anterior urethra, and in experienced hands, the outcomes are similarly favorable whether a dorsal or ventral approach is taken.

Introduction: The present study aimed to assess the efficacy and safety of percutaneous nephrolithotomy (PCNL) in elderly patients., Materials and Methods: We retrospectively reviewed 50 PCNLs performed in the elderly patients (age > 65 years) carried out in our clinic from 2001 through 2007 and compared those with 248 PCNLs performed in younger patients (age < 40 years) during the same period., Results: No significant difference was seen in calculus burden between the two groups. The success rates (stone-free patients and patients with residual calculi < 4 mm) were 85% for the elderly patients and 90% for the younger patients (P = .45). The major composition of calculi was calcium oxalate in 58% and 66.5% of the elderly and younger groups, respectively. No significant complication was observed in the elderly group. Fever without sign and symptoms of bacteremia was seen in 3 patients of each group (8.0% versus 1.2%, P = .004). The operative time was 75.0 +/- 6.4 minutes and 76.0 +/- 5.1 minutes (P = .25), and the mean hospital stay was 3.7 +/- 0.3 days and 3.8 +/- 0.9 days (P = .80) in the elderly and younger patients, respectively., Conclusion: We found that PCNL in patients over 65 years was a safe and reliable technique with a stone-free rate of 85% for all types of calculi. Well-controlled comorbidities do not increase the risk of operation. It seems that despite the higher medical risk in the elderly patients, PCNL could be safe and yields a high stone-free rate.

Purpose: To compare dorsal versus ventral anterior urethral spatulation in posterior urethroplasty., Materials and Methods: In a retrospective study, we evaluated the records of 320 posterior urethroplasties which have been done in our center over a 7-year period from January 2000 to December 2006. The results of dorsal and ventral anterior urethral spatulations were compared., Results: The studied subjects consisted of 264 men and 54 prepubescent boys (≤ 15 years) with the mean age of 23 years (range, 5 to 84 years). The mean follow-up was 52 months (range, 27 to 107 months). Six o'clock (group A) and 12 o'clock (group B) anterior urethral spatulations were performed in 101 (32%) and 219 (68%) of the patients, respectively. The success rates were 96% and 87.6% in groups A and B, respectively (P = .025). There were no urethro-rectal fistula and perineal wound infection during the follow-up period., Conclusion: Our data suggest that the dorsal anterior urethral spatulation in urethroplasty is more efficient than ventral anterior urethral spatulation in terms of treatment success outcome.