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Introduction Recent investigations showed that anticholinergic drugs could use for the management of storage symptoms after transurethral resection of the prostate (TURP). The use of intravesical botulinum toxin-A (BTX-A) for the management of overactive bladder is rapidly increasing. In this research, we assess the efficacy of BTX-A vs solifenacin in men suffering from bladder outlet obstruction-over active bladder (BOO-OAB) managed with TURP. Methods In this case-control study, 50 men with BOO-OAB randomized into two groups. The control group (A) underwent TURP and subsequently managed by solifenacin 5 mg daily, and the case group (B) underwent TURP and BTX-A injection in the bladder wall in the same session. Treatment success was the primary outcome and defined as post-injection improvement in the storage score of the International Prostate Symptom Score (IPSS) from baseline. Results The IPSS, post-void residual volume, frequency, incomplete emptying, nocturia and urgency subscores considerably ameliorated after 12 weeks and 36 weeks for both groups, but it was more significant in the case arm. The quality of life (QoL) scores significantly improved after the treatments in both groups. Intervention group showed significant reductions regarding urgency incontinence compared with the solifenacin group at 12th and 36th weeks. Conclusion BTX-A is an effective and well-tolerated treatment in patients with benign prostatic hyperplasia (BPH) who are candidates of TURP and simultaneously suffer from OAB symptoms.

5-14% of patients underwent surgery for benign prostate hyperplasia harboring prostate cancer (PCa) focus. The best management of incidental prostate cancer (iPCa) has been debated. The decision "treatment or no treatment" should be determined by predictors which accurately foretell PCa progression after transurethral resection of the prostate (TURP). The purpose of this study is to review the available data that can be useful in daily clinical judgment. Transrectal ultrasound prostate biopsy (TRUSBx) did not provide further Gleason score (GS) data in most patients diagnosed with iPCa. TRUSBX may be useful before active surveillance, but not in all following radical prostatectomy. The decision "treatment or no treatment" should be dependent on the expected chance of having residual cancer and clinical progression. Prostate-specific antigen (PSA) levels before and after TURP are good predictors of residual cancer after TURP. Pathological report of T0 is most likely seen in patients with low PSA density after TURP and indistinguishable lesion on multiparametric magnetic resonance imaging. The decision "treatment vs no treatment" is judged by life expectancy, tumor characteristic in the pathology report of TURP sample and PSA level following TURP. Active surveillance should be contemplated in patients with iPCa who have both prostate-specific antigen density ≤0.08 after TURP and indistinguishable cancer lesion on multiparametric magnetic resonance imaging. Patients who do not meet the criteria for active surveillance are candidates for radical prostatectomy or radiotherapy (RT). Radical prostatectomy could be peacefully done after TURP with somewhat greater morbidity. RT in patients who had a history of TURP could be safely done and is associated with acceptable quality of life.

Chronic pelvic pain syndrome (CPPS) can be triggered by a various types of gynecological, gastrointestinal, urological, and musculoskeletal disorders. Recently, the role of the central nervous system has proven to be an integral part on the development of any chronic pain syndrome, including CPPS. However, owing to the complex and heterogeneous etiology and pathophysiology of CPPS, the establishment of effective therapeutic interventions remains challenging for both physicians and patients. Nonetheless, recent studies have pointed that medicinal plants and their secondary metabolites can be effectively used in CPPS therapy, besides contributing to restore the patients' quality of life and potentiate the conventional CPPS management. In this sense, this review aims to provide a careful overview on the biomedical data for the use of medicinal plants use and their secondary metabolites on CPPS management.

Introduction: The retrograde approach is a modification that makes the percutaneous cystolitholapaxy (PCCL) a more trendy method, especially in operating rooms with limited facilities. The transurethral approach for bladder calculi lithotripsy by a laser has become popular among urologists. In this study, we investigate the feasibility and safety of retrograde assisted access for PCCL in comparison with transurethral cystolithotripsy by the holmium-YAG laser (Ho: YAG). Methods: According to the type of intervention, the patients were stratified to two matched groups. In the retrograde-assisted percutaneous cystolitholapaxy (RPCCL) group, a Benique was conducted through the urethra into the bladder; palpating the suprapubic region, an about 1.5 cm incision was done over the tip, then an Amplatz sheath was placed over it, treading into the bladder; further cystolitholapaxy was done by a routine order. In transurethral Ho: YAG laser lithotripsy (TULL) via 200 µm fiber vaporize the stone. Results: A total of 124 male patients with the mean age of 50.33±9.64 years and the average stone burden of 3.35±1.07 cm were included in the study. The most common cause of vesical calculi was spinal cord injury. Statistically significant differences were found in terms of the mean operation time in favor of the RPCCL group (P≤0.05) and the mean hospital stay in favor of the TULL group (P≤0.05). The stone-free rate (SFR) was 100% in both methods after a onemonth follow-up. None of the interventions changed to open surgery. There were not any major complications in both methods. Conclusion: RPCCL is a safe and effective method in bladder stone treatment and is applicable in medical centres without Ho: YAG equipment.

Introduction: Transurethral lithotripsy (TUL) is an appropriate treatment for ureteral stones and is usually used for stones in the middle and lower part of the ureter. Different devices such as the Holmium laser, the stone basket, and the stone cone exist to prevent any fragments from retropulsion during TUL. The present study aims to compare the advantages and disadvantages of the Holmium laser, the stone basket, and the stone cone. Methods: A retrospective study was conducted from September 2016 to January 2018 comparing various TUL methods in 88 subjects with proximal ureteral calculi. The study participants were divided into 4 matched groups. The first one included 20 patients undergoing TUL with no device (group 1), the second group included 22 patients undergoing TUL while using the stone retrieval basket, the third group included 18 patients undergoing TUL while utilizing the stone cone and the fourth group included 28 patients undergoing TUL while using the Hol-YAG laser. Results: A residual stone ≥3 mm was recorded in 15.9% of the patients. The stone free rate was seen in 100%, 90.9, 83.3%, and 55% of the Holmium laser group, the retrieval basket group, the stone cone group and the no device group respectively (P=0.001). The lowest rate of surgery complications including ureteral perforation, post-operative fever, and mucosal damage between the 4 groups (P=0.003) and the highest time of surgery (P=0.001) belonged to the laser group. If we want to ignore the laser group, the success rate for lithotripsy was better in both groups with a stone retrieval device compared to the no device group, but no advantage existed between the stone basket and the stone cone. Conclusion: We can safely conclude that lasers significantly help to prevent stone migration during TUL. If we want to ignore the laser group, the success rate for lithotripsy was significantly better in both groups with a stone retrieval device compared to the no device group, but no advantage existed between the stone basket and the stone cone.

Introduction: Many valid option modalities are available for the management of urethral stricture disease (USD), such as internal urethrotomy which has the success rates of 33%–60%. The aim of this study was to assess the outcome of holmium: YAG (Ho: YAG) laser urethrotomy (HLU). Methods: One hundred thirty-eight patients with urethral stricture with the mean age of 48±3.03 years old treated by HLU from March 2011 to August 2017. The main purpose of this investigation was to evaluate mean operation time, stricture recurrence rate and post-operation Qmax and complications of transurethral HLU. Results: The most common cause of USD was trauma in 82 (59.4%) patients. Mean laser operation time, mean hospital stay and mean postoperative duration of catheterization were 23.08 ± 9.1 minutes, 19.02 ± 10.7 hours and 10.3 ± 1.05 days respectively. The mean Qmax was 8.3 ± 2.07 mL/s before surgery and 16 ±3.1 mL/s afterward. At the end of 12 months follow-up, a total of 37 (26.8%) patients developed recurrence of the stricture. Patients with posterior, longer urethral strictures and previous history of interventions have more recurrence rate of the stricture. Conclusion: HLU is minimally invasive and seems to be an effective and safe management option for primary, short, urethral strictures. The hospital stay is remarkably short and complications are negligible.

Background: The association between chronic nephrolithiasis and several systemic conditions has been established in previous studies. Patients with recurrent urinary stones generally experience more urinary calcium loss, resulting in a lower bone mineral density (BMD). Dual-energy X-ray absorptiometry (DEXA) is the standard imaging method for diagnosing a low BMD. However, imaging imposes significant cost and radiation burden on patients. Objectives: We aimed to assess the relationship between 24-hour urinalysis biometrics and bone mineral content, retrieved from non-contrast computed tomography (CT) imaging, which is routinely preformed for urinary stone patients as a primary evaluation. Patients and Methods: The sample population for this retrospective study included urinary stone patients, undergoing percutaneous nephrolithotomy (PCNL) during 2015-2019, with available 24-hour urinalysis and CT imaging records. Stone size was defined as the maximum stone diameter on the CT image. BMD for each subject was also calculated at the vertebral L1 level, with CT attenuation measured in Hounsfield units (HU). According to the literature, a cutoff value of 160 HU was selected to distinguish normal BMD from low BMD. Results: The present results showed a significant association between the stone size and BMD (P < 0.05). Moreover, patients with a low BMD had a higher urinary calcium excretion in the 24-hour urinalysis (P < 0.05). Evaluation of urine chemical composition and stone size demonstrated a significant association between hypercalciuria and urinary stone volume (P < 0.05). Conclusion: A low BMD detected by CT imaging in patients with urinary stones is associated with abnormal 24-hour urinalysis biometrics and larger stones; therefore, it should be properly assessed.

Background: Quinine (QU) as an anti-malarial drug induces alterations in testicular tissue. Toxic effects of monosodium glutamate (MSG) on the male reproductive system have been recognized. Objective: To investigate the impact of MSG administration on the intensity of gonadotoxicity of QU. Materials and Methods: Sixty eight-wk old Wistar rats weighing 180-200 gr were divided into six groups (n = 10/each): the first group as a control; the second and third groups received low and high doses of MSG (2 & 4 gr/kg i.p.), respectively, for 28 days; the fourth group received QU for seven days (25 mg/kg); and in the fifth and sixth groups, QU was gavaged following the MSG administration (MSG + QU) from day 22 to day 28. Serum testosterone and malondialdehyde (MDA) levels were measured. Testes samples were prepared for tissue MDA levels, histomorphometry, and immunohistochemistry of p53. Sperm analysis was performed on cauda epididymis. Results: Serum and tissue MDA levels were increased in treated groups compared to the control group. This increment was higher in the MSG + QU groups. The testosterone levels were reduced significantly (p < 0.0001) in all treated groups. In addition, histomorphometric indices and tubular epithelium population were reduced significantly (p < 0.0001) in QU, MSG + QU, and consequently in high-dose MSG, QU, MSG + QU groups. All spermatogenic indices were reduced in the treated groups, particularly in the MSG + QU groups. Sperm motility and viability indices were reduced significantly (p = 0.003) in the MSG + QU groups. Finally, the overexpression of p53 was observed in the MSG + QU groups. Conclusion: The administration of MSG before and during QU therapy may intensify testicular tissue alterations. Key words: Male reproductive system, Monosodium glutamate, Quinine hydrochloride, Rat.

Background: Sarcomas of the genitourinary tract are rare clinical entities with relatively few studies conducted on their prevalence and characteristics globally. Previous literature has established the effects of ethnicity and race on soft tissue sarcomas’ clinical attributes and prognosis. Objectives: To provide researchers and clinicians with a better understanding of the matter, this study aims at providing descriptive data regarding urologic sarcoma among the Iranian population. Methods: All patients diagnosed with genitourinary sarcoma registered in the Cancer Research Center (CRC) between 2009 and 2014 were enrolled in this national population-based study. Basic patient data including their gender, age, city, and province of origin, as well as each patient’s tumor characteristics were retrieved from CRC’s database. Chi-square test was utilized in determining a possible relationship between patient data and the tumor characteristics. Results: A total of 337 patients with primary genitourinary sarcoma were selected for this study. More than half of the patients were classified in the 15 to 65-year-old group. The most common primary site of involvement was the kidneys with the most prevalent histological subtype being liposarcoma. Conclusions: This study found sarcomas of the genitourinary tract to be more prevalent among the adult Iranian population, with liposarcoma, leiomyosarcoma, and rhabdomyosarcoma being the most commonly observed subtype, and factors such as age, gender, and tumor grading all related to the anatomical distribution of the tumors.

Background: At present, there is a lack of evidence concerning urinary complications caused by intensity-modulated radiation therapy (IMRT) used for the management of prostate cancer (PCa). Objectives: This study aimed at identifying the nature and severity of post-IMRT urinary symptoms in patients with PCa. Methods: This prospective study was performed with consecutive patients, who had clinically localized PCa (cT1c-cT2c) and had undergone IMRT treatment from 2016 to 2019. At 1, 6, and 12 months of follow-up, medical history, physical information, prostate-specific antigen values, International Prostate Symptom Score (IPSS), medication use, Radiation Therapy Oncology Group (RTOG), acute and late toxicity, and Q max were collected. Results: A total of 127 patients with a mean age of 71.04 ± 7.1 years received IMRT and underwent 12 months of follow-up. The mean IPSSs at baseline versus those at 1, 6, and 12 months after IMRT was 14.5 ± 6.8 versus 13.3 ± 6.1, 12.3 ± 5.3, and 10.4 ± 4.2, respectively (P < 0.000). The mean prostate volume was 38.2 ± 12.1 cc. At the last follow-up, 31 patients (24.4%) took genitourinary (GU) medications. Conclusions: This study showed that the majority of GU side effects caused by primary IMRT for PCa treatment are transient. Treatment triggered an acute increase in obstructive urinary symptoms, which peaked during the first month after IMRT. In most patients, in the course of 6 months, symptoms returned to baseline.

Introduction: Bladder stone is more common in developing countries and it is one of the rare diseases affecting children. In recent years, there is an increasing tendency in urologists to have minimal invasive approaches. The aim of this study was to compare the results of surgical bladder stone management in our single tertiary center. Methods: From 159 children younger than 18 years with vesical stones treated during January 2000 to January 2015 in Shohada-e-Tajrish hospital, Tehran, Iran, 146 subjects entered to the study. According to type of intervention, patients stratified to three groups. First group included 80 patients that open cystolithotomy (OCL) was done for them, second group was 39 patients who underwent percutaneous cystolithotomy (PCCL) and third group was 27 patients who treated by transurethral cystolithotripsy with holmium-YAG laser (TULL). Demographic data, hospital stay, operation time, and post operation complications were recorded and comparison were drawn between the three groups. Results: Mean age was 8.3±5.1 years (8.6±5.1, 6±4.2 years for boys and girls, respectively). Mean stone size (MSS) was 2.76±1.07 cm and no significant differences were found between the three groups but it was larger in OCL group. Mean operative time (MOT) was 29.15±7.12 minutes in separate; MOT in TULL was significantly higher than PCCL and OCL respectively (36.3±5.97, 30.54±5.27 and 26.06±6.32 minutes/P =0.000). Mean hospital stay (MHS) in OCL group was 3.55±1 days that was higher than PCCL and TULL groups significantly (P =0.000). Conclusion: Based on our study, holmium:YAG lithotripsy has a high success rate, and is a minimally invasive management, therefore it is a safe method for children bladder calculi treatment if proper equipment was available and done by expert hands.

Penile fracture (PF) is considered an emergency in urology. In the literature there are some case series reporting considerable incidence of PF in some parts of Iran. There are no accurate data about the incidence of PF all around Iran. Although it may be uncommon in other parts of the country and in the other countries, it can also be underreported. There are some challenges in diagnosis, management, and also reporting of these cases. In this review of Iranian medical literature, we searched for penile fracture and penile injury keywords in Medline, Scopus, SID, Google and Persian medical journals. We reviewed the status of epidemiology, etiology, diagnosis, management and complications of PF in different parts of Iran in the published literature. To collect more accurate data, we also performed a questionnaire-based study with sending questionnaires by emails to 700 urologists throughout the country with 14% response rate. Incidence of PF varies significantly in different parts of Iran. Western province of Kermanshah has a significantly higher rate of PF. Adding data from different regions of Iran, we calculated that incidence of PF in Iran can be estimated between 1.14 to 10.48 per 100,000 of male populations, most probably closer to lower end. Although the incidence of PF varies significantly in different geographical areas, urologists practicing in Iran on average may encounter a PF patient every 3.5 months. To diagnose PF, majority of reviewed studies relied on history and clinical examination and did not recommend imaging except in patients with possible urethral injuries. Immediate surgical intervention can make good functional results with low morbidity and short hospital stay. Delayed surgical intervention and observational management approaches need large population studies with long term follow up.

Background: Prostate cancer (PCa) is the second most common cancer in men worldwide. The accuracy of Gleason score (GS), as a useful system for histopathological assessment, is important because any fault in the assessment and calculation leads to inappropriate approaches and complications. Multifocality is common in PCa and it is expected that different grading of cancer would be seen in different areas. This is one of the sources of diversity in pathologic reports of transrectal ultrasound guided biopsy (TRUS BX) and radical prostatectomy, which is obtained in 41% to 43% of samples with exact accordance; so, when choosing the treatment plan is based on of the needle biopsy sample, the accuracy of TRUS BX GS is bolded. Objectives: In this study, we compared the pathology reports of initial biopsy and final pathology of the prostate after radical prostatectomy to determine the discrepancy among the Iranian population. Methods: In this retrospective study, 105 of 127 patients that underwent both TRUS Bx and radical prostatectomy in Shohada-e-Tajrish Hospital from August 2009 to October 2017 enrolled in the study. Results: In the current study, 55% of the patients were without change and 36% were upgraded. The rate of abnormal digital rectal examination and the increase of prostate-specific antigene levels have a statistically significant correlation with the upgrading of GS, respectively (P = 0.001 and 0.02). Conclusions: It is generally concluded that the initial biopsy with the final pathology of radical prostatectomy is similar in our investigation.

ObjectivesTo review the current literature on the presence of COVID-19 virus in the urine of infected patients and to explore the clinical features that can predict the presence of COVID-19 in urine.Materials and MethodsA systematic review of published literature between 30th December 2019 and 21st June 2020 was conducted on Pubmed, Google Scholar, Ovid, Scopus, and ISI web of science. Studies investigating urinary viral shedding of COVID-19 in infected patients were included. Two reviewers selected relative studies and performed quality assessment of individual studies. Meta-analysis was performed on the pooled case reports and cohort with a sample size of 9.ResultsThirty-nine studies were finally included in the systematic review; 12 case reports, 26 case series, and one cohort study. Urinary samples from 533 patients were investigated. Fourteen studies reported the presence of COVID-19 in the urinary samples from 24 patients. The crude overall rate of COVID-19 detection in urinary samples was 4.5%. Considering case series and cohorts with a sample size of ≥ 9, the estimated viral shedding frequency was 1.18 % (CI 95%: 0.14 – 2.87) in the meta-analysis. In adult patients, urinary shedding of COVID-19 was commonly detected in patients with moderate to severe disease (16 adult patients with moderate or severe disease versus two adult patients with mild disease). In children, urinary viral shedding of COVID-19 was reported in 4 children who all suffered from mild disease. Urinary viral shedding of COVID-19 was detected from day 1 to day 52 after disease onset. The pathogenicity of virus isolated from urine has been demonstrated in cell culture media in one study while another study failed to reveal replication of isolated viral RNA in cell cultures. Urinary symptoms were not attributed to urinary viral shedding.ConclusionsWhile COVID-19 is rarely detected in urine of infected individuals, infection transmission through urine still remains possible. In adult patients, infected urine is more likely in the presence of moderate or severe disease. Therefore, caution should be exerted when dealing with COVID-19 infected patients during medical interventions like endoscopy and urethral catheterization.

OBJECTIVE To evaluate the use of human amniotic membrane allograft to prevent urethrocutaneous fistula after tubularized incised plate repair for redo-hypospadias and anterior urethral defects. METHODS This pilot study included 28 patients (mean age 25.3 ± 11 years) with a history of previous failed hypospadia repair, who underwent tubularized incised plate urethroplasty in one session by the same surgical team from April 2016 to April 2019. After the reconstruction of a neourethra and proper hemostasis, a human amniotic membrane allograft - Grafting Scaffold - was used to cover the suture lines. RESULTS The mean follow-up time was 13.3 ± 4.5 months. Two urethrocutaneous fistulas occurred within the first 2 weeks after the surgery, one of which was caused by the infection of the surgical site. No penile torsion, urethral diverticula, meatal stenosis or glans dehiscence was reported. CONCLUSIONS Amniotic membrane graft provides an applicable, low-cost, feasible, biodegradable and safe second cover in redo-hypospadias repairs by tubularized incised plate technique. Its use is technically easy; it has satisfactory cosmetic outcomes and might decrease urethrocutaneous fistula formation.

Background: No consensus management is available for the bladder neck contracture (BNC) secondary to radical retropubic prostatectomy (RRP). We present our experience of a technique in which holmium: YAG surgical laser was utilized transurethrally to incise the stenotic area. Methods: Incisions with holmium: YAG surgical laser were made in 34 subjects with BNC between January 2012 and May 2018. Medical charts were reviewed to evaluate related data including medical history, international prostate symptoms score, uroflowmetry, and recurrence of the stricture. Results: The mean length of operation was 34 ± 4.06 minutes. No significant postoperative or perioperative complications were noted. The median length of hospital stay after surgery was two days. Five subjects (13.8%) required endoscopic holmium: YAG laser retreatment. After the first treatment with holmium: YAG surgical laser, the mean duration for recurrence was 4.3 months. In addition, significant improvements were observed in Qmax, residual urine volume, and the total IPSS score. Conclusions: BNC after RRP is relatively frequent but it can be safely and effectively managed by transurethral holmium: YAG laser incision

Introduction: Primitive neuroectodermal tumor (PNET) is a very rare type of prostate sarcoma that mostly occurs in young adults, and it is associated with a poor prognosis. Case Presentation: A 37-year-old male was admitted with intermittent painless gross hematuria from 1 month prior to admission. Cystosocopy, abdominopelvic computed tomography scan (ACTS), and magnetic resonance imaging (MRI) revealed huge prostate. All tumor markers were negative and pathology findings of trans-rectal ultrasonographic biopsy (TRUS Bx) and trans-urethral resection of prostate (TURP) were consistent with severely inflamed prostatic urethra with no evidence of malignancy. The patient underwent radical prostatectomy. Histopathology of the specimens showed malignant neoplasm of small round and oval cells suggestive of PNET. Immunohistochemistry (IHC) study results on CD99 were positive. Conclusions: We report a rare uncommon case of prostate PNET presented by intermittent painless gross hematuria. As the prognosis is very poor, medical staff should pay enough attention to the differential diagnosis, choosing the best treatment and subjects close follow-up.

Introduction: The management of Peyronie’s disease (PD) has remained a therapeutic dilemma for physicians and there is no gold standard treatment. In this paper, we decided to investigate the beneficial effect of the intralesional administration of verapamil compared with the intralesional administration of verapamil plus a low-intensity laser (LIL). Methods: Research was activated from May 2016 to May 2018 and a total of 38 men aged 18 years and older completed the investigation. The subjects were randomly divided into 2 groups. Group 1 was composed of 22 patients that were treated only by verapamil (5 mg) plus a sham laser weekly for 6 weeks, and group 2 consisted of 22 patients that received a laser, using the BTL–6000 HIGH-INTENSITY LASER 12 W machine and the same protocol of intralesional verapamil injection. The visual analogue scale (VAS) was used to evaluate pain during an erection, penile ultrasonography was used to measure plaque size, the penile curvature angle degree was measured using the photographs taken during an erection, and the International Index of Erectile Function questionnaire was used to assess erectile function. The follow-up treatment lasted for nine months, with visits performed in the 3rd and 9th months. Results: All study parameters decreased significantly after treatment in both arms, but the reduction in pain and penile curvature improvements in combination therapy revealed more significant changes in 3 months (p = .035, p=.032). Nevertheless, these improvements were not seen in the follow-up session after 9 months. Conclusion: A laser appears to be safe treatment modality in carefully-selected patients with PD. It has moderate efficacy in the short term.

Introduction: Genital warts in young adults aged 18-28 years are very common. Several approaches are routinely used in the treatment of warts, viz., medical treatment (podophyllin and trichloroacetic acid), conventional surgery (excision or electrocautery), cryotherapy, and laser treatment. Because of high recurrence rates after treatment, complications and long duration of treatment, newer modalities have been developed. One of these newer methods is laser, which has been used in several urologic diseases. However, there are only a few studies about use of Holmium laser for treatment of genital warts. This retrospective study compared the success rate of Holmium laser with other available treatments for genital warts. Methods: Between October 2011 and May 2016, 142 patients with genital warts attended the urology clinics at Shohada-e-Tajrish hospital in Tehran, Iran. Out of these, a total of 101 patients were included in this study consisting of 42, 39, 11 and 9 patients treated with cryotherapy, laser, conventional surgery and podophyllin respectively. Results: The most successfully cleared lesions were seen in the holmium laser treatment group (P=0.001). The lowest recurrence rate was observed in the holmium laser treatment group (P=0.001). 17 patients had one of these following problems: dysuria, initial hematuria or a change in the force and caliber of their urinary stream that after physical examination showed them to have a meatal wart. These patients then underwent cystoscopy up to urinary sphincter. All of them in addition to the meatus wart had a penile shaft lesion(s). Thirteen patients had meatal lesions, 9 of whom received holmium laser therapy and 4 patients were treated with electrocautery. Based on routine follow up after treatment, none of the patients treated with holmium laser had urinary stricture, but one case treated with electrocautery returned with a penile urethral stricture. Conclusion: This study showed that treatment with Holmium laser has the highest clearance rate (92.2%) and lowest recurrence rate (14.3%) compared to other available treatments in this study. It may be concluded that holmium laser is a safe and effective treatment for genital warts with a low rate of recurrence.

OBJECTIVE: Prostate cancer is one of the common malignant tumors in men worldwide. Nowadays it seems that Gleason Score 3+3 may not need definite treatment and some of the experts even ignore it as a cancer but we should be aware that in some patients with Gleason Score 3+3 there is a higher risk for harboring higher-grade cancer. We had done this study to evaluate patients with prostate cancer with Gleason Score 3+3 to determine the value of tumor volume in these cases. MATERIAL AND METHODS: From September 2010 to October 2017, radical prostatectomy was done for 123 sequential patients with localized prostate cancer in two referral centers of Shahid Beheshti Medical University, Tehran, Iran, and 42 cases with Gleason Scores 3+3 which who were candidates for active surveillance were included in the study. RESULTS: Thirty of 42 (71.4%) patients had significant tumor volumes (≥0/5 cm(3)). When tumor volume was less than 0.5 cm(3), none of the patients had extra prostatic tumor extension. In patients with tumor volume greater than 0.5 cm(3), two cases (6.6%) had extra prostatic extension, 4 cases (13.3%) had positive margins, four cases (13.3%) reactive lymph nodes and 16 cases (53.3%) perineural invasion. CONCLUSION: We suggest that some patients with Gleason Score 3+3 have tumor volume >0.5 cm(3) who are considered having significant cancer pathology and active surveillance may not be appropriate approach to manage all cases with Gleason Score 3+3.

Introduction: Endometriosis is a condition in which endometrial tissue exists outside the uterine cavity. Urinary tract lesions are present in 1 % of women with this condition. Case Presentation: A 34-year-old woman was presented to our clinic with a 3-year history of dysuria and frequency. Her past medical history was significant for cesarean sections, performed 3 years earlier. In our center, the patient underwent cystoscopy and transurethral resection of a lesion found in the bladder wall, which on histopathology examination appeared to be endometriosis. A course of six-month hormonal therapy with luteinizing hormone-releasing hormone (LHRH)-agonist (Dipherelin™ 3.75 IM per 28 day) was planned for her. One month later, trans-vaginal ultrasound revealed a nodule posterior to the bladder, which had grown 1 cm in the preceding month. Therefore, Hysterectomy, bilateral oophorectomy, and partial cystectomy were performed. The pathology report was Mullerianosis. During two years of follow up, the patient remained asymptomatic. Conclusions: Endometriosis and endocervicosis should be regarded as important differential diagnoses in patients with gross hematuria and those suspected to have urothelial carcinomas.

Introduction: Presently, different holmium: yttrium aluminum garnet (Ho:YAG) laser calibers are used for endoscopic stone treatment, which include 200, 365, 500 and 1000 Mm fibers. Currently, there are not enough studies to compare the performance of these fibers. In this retrospective investigation, we compared the outcome of 200, 365 and 500 Mm fibers of Ho:YAG laser in transurethral lithotripsy of ureteral stone. Methods: From January 2016 to June 2017, 74 subjects with mean age of 35.3 ± 5.6 were randomly allocated to 3 groups according to the caliber of laser, 200, 365 and 500 Mm for transurethral lithotripsy. The main purpose of this investigation was to evaluate mean operation time (MOT), stone free rate (SFR) and complications. Results: MOT and SFR were significantly different in 500 Mm laser caliber (P=0.046, P=0.029, respectively). There was no remarkable difference between the 3 groups in this regard. Conclusion: Based upon our data, the clinical potency of the Ho: YAG laser was great in all 3 fiber calibers. The most important results of this comparison were the significantly higher SFR with increased laser caliber.

Amir-reza Abedi,1 Morteza Fallah-Karkan,2 Farzad Allameh,1 Arash Ranjbar,1 Afshin Shadmehr3 1Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2Urology Department, Shohada-e-Tajrish Hospital, Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3Urology Department, Isfahan University of Medical Sciences, Isfahan, Iran Objective: Incidental prostate cancer (IPCa) is defined as a symptom-free cancer unexpectedly discovered upon microscopic examination of resected tissue. The aim of this study was to report the correlation between some specific clinical criteria in patients incidentally diagnosed with prostate cancer (PCa) during transurethral resection of the prostate (TURP) or open prostatectomy (OP) after clinically suspected benign prostatic hyperplasia.Patients and methods: This was a cross-sectional, retrospective study. Data were collected from Shohada-e-Tajrish Hospital database during November 2006 to October 2016. Four hundred and twenty three men suffering from symptomatic benign prostatic hyperplasia who underwent either TURP or OP that provided a prostate specimen were evaluated. The data analysis was performed using Pearson correlation test and independent t-test using SPSS version 20 software.Results: The mean age of subjects was 68.74±9.87 years old (45–93 years). The mean prostate specific antigen (PSA) level was 21.47±13.44 ng/mL (0.6–47.1 ng/mL). Results showed that 84 patients (19.9%) had PCa (40 patients who underwent TURP [12.6%] and 44 patients who underwent OP [40.7%] groups). Cut-off point of PSA for detecting IPCa was 3.8 ng/mL in our study, and this showed sensitivity, specificity, negative predictive value, and positive predictive value of 26.08%, 100%, 100%, and 29.79%, respectively. Twenty two patients with cancer had a positive family history for PCa; thus, a significant relationship between familial history of PCa and its occurrence was shown (p=0.0001).Conclusion: According to the results of this study, the cut-off point for PSA levels in detecting PCa was 3.8 ng/mL, which is similar to that reported by other studies. Familial history of PCa and PSA levels were two predictors in determining the PCa. Keywords: incidental prostate cancer, transurethral resection of the prostate, open prostatectomy, prostate cancer, Iran

Introduction: Several different modalities are available for ureteral stone fragmentation. From them pneumatic and holmium: yttrium-aluminum-garnet (Ho: YAG) lithotripsy have supportive outcomes. In this study we studied 250 subjects who had ureteroscopic pneumatic lithotripsy (PL) or laser lithotripsy (LL). Methods: Two-hundred fifty patients with ureteral stones underwent ureteroscopic lithotripsy (115 subjects in the PL group, 135 subjects in the LL group) from August 2010 to April 2016. The purpose of this investigation was to evaluate stone-free rate (SFR), mean operation time (MOT), mean hospital stay (MHS), stone migration and complications. Results: Two groups were similar in age, gender, mean size of stones, side of stone, and complications. There was a statistical difference in terms of SFR, stone migration and MHS in favor of the LL group (P ≤ 0.05, P ≤ 0.05 respectively), and MOT in favor of the PL group (P ≤ 0.05). Conclusion: Both the PL and LL techniques were effective and safe for ureteral stones, however a slightly higher SFR was found in the LL group.

Introduction: Chromophobe renal cell carcinoma (RCC) like other types of RCCs maybe asymptomatic but few of them existing with rare presentations. Case Presentation: A male patient attended the emergency department of our center with sudden right flank pain. According to investigations performed, he had a tumor mass measuring 75 mm with extracapsular extension and heterogeneous enhancement in lower pole of the right kidney and a perinephric hematoma secondary to rupture of capsular vessels. Conclusions: Wunderlich syndrome can be the first presentation of chromophobe RCC.

Background: The present study aims at evaluating the safety and efficacy of ureteral reimplantation and its influence on quality of life in the complete ureteral obstruction due to prostate cancer. Methods: In a prospective randomized study, 86 patients with complete ureteral obstruction were randomized into 2 groups: group 1 (ureteral reimplantation) and group 2 (nephrostomy). Biochemical values, complications, and survival of patients were recorded. Results: The mean age of patients were 72.20 ± 7.77 and 74.26 ± 7.56 years in group 1 and group 2, respectively (P ₌ 0.21). The mean decrease in Creatinine values were not significant between 2 groups (P = 0.639). The mean survival of patients after intervention were 22.42 ± 0.87 months in group1 and 20.48 ± 0.65 in group 2 (P = 0.0001). No major complications were happened in group 1. Main delayed complications in group 1 were ureteral stricture at the anastomosis point 20% (n = 8), UTI 27.5% (n = 11), and permanent pain at the operation site 15% (n = 6). In group 2, 100% of patients had experienced complications, including: febrile UTI 65.2% (n = 30), perirenal abscess 10.8% (n = 5), dislodgement of nephrostomy tube 30.4% (n = 14), local inflammation and dermatitis of nephrostomy tract 54.3% (n = 25), and hemorrhage during nephrostomy placement 4.3 (n = 2). Likewise, all of them (100%) had social inconvenience, local pain and discomfort in tract and sutures of tube, urine leakage and odor, and need to regular replacement of tube. Conclusions: Reimplantation is a safe and effective option in the management of complete ureteral obstruction due to advanced prostate cancer with significant benefits in overall survival and patient satisfaction.

Introduction: Renal rhabdomyosarcoma is a rare malignant mesenchymal tumor, representing 1% - 3% of all renal malignant tumors. Case Presentation: In the present study, we discussed about a 33-year-old woman with a botryoid type embryonal rhabdomyosarcoma of the left kidney presented with gross hematuria. Conclusions: This very rare tumor in adults should be considered in differential diagnosis among undifferentiated malignant tumors.

Primary signet-ring cell adenocarcinoma of bladder is a rare neoplasm, usually seen in middle age adults. We report the case of an 18-year-old man who presented with intermittent gross hematuria. Computed tomography imaging showed multifilling defects in the bladder. The patient underwent a transurethral resection of the bladder tumor. Histological findings were consistent with poorly differentiated mixed mucinous and signet-ring cell adenocarcinoma. We ruled out other possible origins of tumor by gastrointestinal endoscopy and colonoscopy. The patient was treated with radical cystectomy with prostate and seminal vesicle sparing technique and orthotopic diversion using “W” ileum pouch with pelvic lymphadenectomy to the bifurcation of the aorta was done. Six-month follow-up of patient showed normal conditions without metastatic spread or any recurrence.

Subcutaneous emphysema (SE) is a condition often causing minimal symptoms, but sometimes it can be severe and even life-threatening. This study is the first great survey about SE. The aim of this study is to classify and evaluate the etiology, signs, symptoms, and management of SE. This retrospective study was performed by reviewing patients who had been diagnosed as having SE in Rasht, between January 2001 and January 2011. We classified the severity of SE in five grades including the (1) base of the neck, (2) all of the neck area, (3) subpectoralis major area, (4) chest wall and all of the neck area, and (5) chest wall, neck, orbit, scalp, abdominal wall, upper limbs, and scrotum. We excluded all patients in grades 1 and 2, because the symptoms and signs were not significant. Statistical analysis was carried out with SPSS 18. We collected 35 cases of SE with the mean age of 53 ± 14.83 (71 % men). The most common cause of SE was pneumothorax with background of COPD and surgery in grade 5, trauma due to rib fracture in grade 4, and iatrogenicity in grade 3. We performed two bilateral 2-cm infraclavicular incisions. In our patients with infraclavicular incisions, expansion of the lung was better, and the patients’ appearance improved. Infraclavicular incisions as a simple method for the management of SE can decrease the severity of SE with no cosmetic problem.

This figure shows the hexadactyly of feet and severe inflammation of the lower limbs of a 32-year-old Iranian female patient with Bardet–Biedl syndrome (BBS) who was referred to us with uraemic symptoms and metabolic acidosis. She had suffered from insulin-resistant type 2 diabetes mellitus for 2 years and moderate hypertension for 6 months. Her parents had noticed progressive decline in her vision and hearing since the age of 7 years. She had mild mental retardation. She had irregular menstrual periods but her secondary sex characteristics were normal. Her parents were not consanguineous. On physical examination, the patient was markedly obese with a body mass index of 31.4 Kg/cm2. She was dyspnoeic and often unwell. The blood pressure was 190/100 mmHg, axillary temperature 39°C, respiratory rate 22 beats/min, and heart rate 78 beats/min. Fundus examination revealed pigmentary retinopathy. Both lungs had coarse crackle in the basal field. Cardiac, abdominal and genital examinations were normal. On admission, her blood glucose level was 482 mg/dL, blood urea nitrogen 190 mg/dL and serum creatinine 12.6 mg/dL. Blood revealed metabolic acidosis. Ultrasonography also showed bilateral small-sized high echogenic kidneys without cyst and hydronephrosis. BBS is a rare autosomal recessive disease characterized by the abdominal obesity, mental retardation, pigmentary retinopathy, polydactyly and hypogenitalism. The degree of polydactyly, a prominent feature of this syndrome, varies from patient to patient, ranging from a wide fifth metatarsal or metacarpal to a complete sixth digit.