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Abstract Background Prostate cancer (PCa) causes a substantial health and financial burden worldwide, underscoring the need for efficient mass screening approaches. This study attempts to evaluate the Net Cost-Benefit Index (NCBI) of PCa screening in Iran to offer insights for informed decision-making and resource allocation. Method The Net Cost-Benefit Index (NCBI) was calculated for four age groups (40 years and above) using a decision-analysis model. Two screening strategies, prostate-specific antigen (PSA) solely and PSA with Digital Rectal Examination (DRE), were evaluated from the health system perspective. A retrospective assessment of 1402 prostate cancer (PCa) patients’ profiles were conducted, and direct medical and non-medical costs were calculated based on the 2021 official tariff rates, patient records, and interviews. The monetary value of mass screening was determined through Willingness to Pay (WTP) assessments, which served as a measure for the benefit aspect. Result The combined PSA and DRE strategy of screening is cost-effective, yields up to $3 saving in costs per case and emerges as the dominant strategy over PSA alone. Screening for men aged 70 and above does not meet economic justification, indicated by a negative Net Cost-Benefit Index (NCBI). The 40–49 age group exhibits the highest net benefit, $13.81 based on basic information and $13.54 based on comprehensive information. Sensitivity analysis strongly supports the cost-effectiveness of the combined screening approach. Conclusion This study advocates prostate cancer screening with PSA and DRE, is economically justified for men aged 40–69. The results of the study recommend that policymakers prioritize resource allocation for PCa screening programs based on age and budget constraints. Men’s willingness to pay, especially for the 40–49 age group which had the highest net benefit, leverages their financial participation in screening services. Additionally, screening services for other age groups, such as 50–54 or 55–59, can be provided either for free or at a reduced cost.

Abstract Introduction This study investigates Iranian men’s willingness to pay (WTP) for prostate cancer (PCa) screening and influencing factor, along with the impact of information. Method We assessed preferences for prostate cancer screening in 771 Iranian men aged 40 and above using an internet-based questionnaire survey. Participants received basic and complementary information, and their willingness to pay was determined through a payment card approach. A Wilcoxon test assessed the impact of information. We also analyzed prostate cancer screening demand and employed Heckman's two-step model to evaluate factors influencing the willingness to pay. Additionally, reasons for unwillingness to pay were explored. Results Willingness to pay significantly decreased with complementary information relative to basic information (16.3$ vs 17.8$). Heckman model, using WTP based on basic information shows age, education, and monthly household expenditure positively influenced the decision to pay. In contrast, health status, expectations of remaining life and prostate problems history positively affect amount of WTP for PCa screening, and insurance coverage has a negative impact on it. Majority of respondents (91%) supported PCa screening, with 82% expressing a willingness to pay. Common reasons for not paying include seeing screening as a public good (43%), financial constraints (35%), and having insurance (20%). The screening demand is price-sensitive. Conclusion The basic mindset of Iranian men exaggerates the risk of prostate cancer. Reduced willingness to pay after receiving information reassures the reliability of their financial expectation. Taking into account the factors that influence PCa screening is essential for accurate planning and the successful implementation of this program.

Abstract Objective To assess the routine serum and 24-hour urine tests proficiency in diagnosing the baseline metabolic abnormality of kidney stone formers. Methods This study analyzes the routine serum and 24-hour urine tests proficiency in diagnosing the baseline metabolic abnormality of kidney stone formers. The sensitivity and specificity, false positive, and negative results of the tests are extracted from diagnostic kits used in the laboratories of the target community. To accurately infer the results, a simulation based on 1000 people was used through 22 standard laboratory tests (Additional File 2), including calcium, oxalate, phosphate, uric acid, sulfate, potassium, sodium, citrate, and magnesium in 24-hour urine; and calcium, creatinine, Vit D, uric acid, and intact parathyroid hormone (PTH) in serum. The incremental cost-effectiveness ratio (ICER) was calculated and compared for each diagnostic test versus other diagnostic tests according to the incremental cost required for correct diagnoses of stone causes. Results Urinary uric acid, citrate, and serum potassium constitute the cost-effectiveness boundary curve in this study. This means that other diagnostic tests are not cost-effective compared to these three tests in terms of indexing at least one item of cost and effectiveness. The ICER index for each correct diagnosis with the urinary uric acid test was $ 1.25 per diagnosis, the most cost-effective test compared to serum potassium and urinary citrate. Conclusion The simplified blood and 24-hour urine metabolic evaluation, including urinary uric acid, citrate, and serum potassium, constitute the cost-effectiveness boundary curve. The most cost-effective test was urinary uric acid measurement.

Purpose. To evaluate the effects of the surgical ligation of the ureter in different locations on the kidney over time in the rat model. Methods. A total of 155 rats were enrolled and randomly divided into the case (n = 150) and control (n = 5) groups. The case group included three separate groups (fifty rats in each group) that underwent surgical ureteral ligation at the proximal, middle, and distal ureter. The laboratory tests, and tumor necrosis factor α (TNF-α), were measured in groups. The pathological evaluation for glomerular changes, tubular dilation, interstitial fibrosis, and interstitial infiltration of the inflammatory cells following the obstruction was performed (severity of tubular atrophy categorized too mild (+), moderate (++), and severe (+++)). To compare the continuous variables between the groups and between the measurement times, the analysis of variance (ANOVA) was used. Results. Our results revealed that the creatinine four weeks after the obstruction was significantly higher in the proximal group obstruction (p value: 0.046). The three groups had no significant differences regarding urine creatinine, serum sodium, and serum TNF (p value: 0.261). Obstruction did not change the glomerular morphology in three intervention groups after six weeks. The commencing of severe tubular atrophy in proximal, middle, and distal ureteral obstruction was at weeks three, four, and six, respectively. Conclusion. The location of ureteral obstruction is also crucial in deciding to intervene to relieve the complete ureteral obstruction. Severe tubular damage occurs in weeks three, four, and six in proximal, middle, and distal ureteral obstruction, respectively.

Retroperitoneal masses are a rare condition that may be discovered incidentally in routine abdominal imaging. These lesions are commonly asymptomatic but may be associated with intestinal obstruction and rarely presented with acute abdomen. They may originate from the retroperitoneal organs, including the genitourinary or gastrointestinal tract, or originate primarily from retroperitoneal space, such as retroperitoneal fat, muscle, nervous system, and lymphatic system. The malignant masses are more common than benign masses, and sarcoma is the most malignant tumor in this space. We present a case with the hilar lesion of the left kidney that was managed with laparoscopic resection. The laparoscopy revealed that the mass completely enclosed the left renal hilum, but the mass was excised without any complication. The final pathologic report revealed a benign mesenteric cyst. Although most of the retroperitoneal mass had a malignant etiology, in cystic lesions in the renal hilar area, the benign mesenteric cyst may keep in mind the differential diagnosis of a mass in this anatomic region.

Introduction: The main purpose of this study was to investigate the relationship between Covid-2019 and sexual dysfunction. Methods: A cross-sectional study included the affected coronavirus disease 2019 patients in outpatient and inpatient settings between July 2020 and December 2020. This study was used the International Index of Erectile Function (IIEF-5) and Female Sexual Function Index (FSFI) questionnaires to evaluate sexual function. Two different questionnaires were used for men(15 questions) and women (19 questions). Two similar forms were given to the affected patients; the first questionnaire related the sexual function status before the pandemic, and the second related to the sexual function changes after the Covid-2019 infection (at least one month after covid infection recovery). Results: The sexual desire significantly decreased in males (change from 12.58±2.15 to 10.75 ±2.81; P-value

Urolithiasis is rare in renal transplant patients (

Introduction: The present study aimed to evaluate the association between the pre-transplant psychosocial profile and kidney transplant candidates' clinical outcomes. Methods: The present study population included all patients assessed for kidney transplant candidacy in Sina Hospital, Tehran University of Medical Sciences. The 42 patients who were candidates for kidney transplantation were enrolled in the present study. The mental health was measured by psychosocial assessment of candidates for transplantation (PACT) questionnaire. A global score of equal or lower than 2 was categorized as a low PACT score and equal and higher than 3 was defined as a high score. PACT questionnaire was completed before the kidney transplantation for each patient. The outcomes of our study were post-transplant dialysis, time of dialysis, hospital stay after transplant, rejection after transplant, time of rejection after transplant, delayed graft function, re-hospitalization after transplant, and time of re-hospitalization that were followed after transplantation. Results: A total of 42 patients underwent kidney transplantation; 15 ( 35.7%) patients had a poor PACT score while 27 (64.3%) patients had a high PACT score. There were no significant differences in age, sex, marital status, literacy, insurance, supplementary insurance, smoking, being head of household between the two groups. There were no significant differences between the two groups in clinical characteristics after kidney transplantation (P-value > 0.05). Conclusions: In our study, there was no significant association between psychosocial status and clinical outcomes and it has been suggested that more studies are needed in this field

Introduction: The steinstrasse or stone street is a rare complication after Shock wave lithotripsy (SWL). The true incidence is unknown but is mentioned between 1-4 % in stone size less than 2 cm to 13% in large stone. Case presentation: we present a 37-year-old man with a proximal ureter steinstrasse. He was managed with laparoscopic ureterolithotomy as the SWL failed, and also, ureteroscopic access to the upper ureter failed due to the ureteral stenosis. Conclusion: The laparoscopic removal of ureteral stone is a viable option in steinstrasse that the conservative and endourologic management is failed and could be chosen as an alternative to open surgery.

Objective: This study explores associations between recurrent kidney stones and genetic polymorphisms.Methods: Meta-analysis of polymorphisms in renal stone cases versus control groups. Four electronic databases (PubMed, SCOPUS, EMBASE, and Web of Science) were searched up to 30 May 2021, using the keywords: “kidney stone” or “kidney calculi,” or “urolithiasis” or “nephrolithiasis” or “urinary calculi” and “genome” or “genetic” or “mutation” or “single nucleotide polymorphism.” Forrest plots, ORs, 95% CI, Chi-square (χ2)-test, and index of heterogeneity (I2) were calculated. Only studies with Newcastle–Ottawa scale (NOS) ≥ 6 were included for quality control, and Funnel, Begg’s, and Eager’s plots assessed publication bias. PROSPERO: CRD42022250427.Results: Among 7,671 searched articles, 72 were included. Polymorphisms in VDR (OR: 1.20; 95% CI: 1.06–1.36), CASR (OR = 1.24; 95% CI: 1.01–1.52), Osteopontin (OR = 1.38; 95% CI: 1.09–1.74), and Urokinase genes (OR = 1.52; 95% CI: 1.02–2.28) showed a significant association with risk of urinary stone formation, while Klotho gene showed a protective effect (OR = 0.75; 95% CI: 0.57–0.99). The VDR gene polymorphism was frequent in Asians, whereas CASR polymorphism was frequent in European and North American populations.Conclusion: Multifactorial nature of the stone formation, emphasizing the role of environmental factors, might explain contradictory results in the literature. While polymorphisms in VDR, CASR, Osteopontin, and Urokinase genes were associated with urinary stone formation, the Klotho gene showed a protective effect.

Introduction: Fournier gangrene is a surgical emergency that presents as necrotizing fasciitis. It mainly involved the genital and perineal regions. The predisposing factors are immunosuppression, diabetes mellitus, alcoholism, and surgical procedures. The underlying source of infection is usually recognizable in the anorectal and genitourinary systems. The physical exam may be misleading as findings in early evaluation is minimal compared to the exact spreading of infection. A high index of suspicion is needed for early diagnosis of this condition and management with broad-spectrum antibiotic therapy and prompt surgical debridement. Case presentation: In this case report, a case of Fournier gangrene that occurred after colostomy closure in a patient with a previous history of colostomy due to bowel obstruction was presented. Conclusions: The patient had extensive gas formation from chest to mid-thigh proximally and distally respectively but managed with surgical debridement and planned for future reconstructive surgery.

Coronavirus disease 2019 (COVID-2019) is a viral infection that mainly causes pulmonary infection but mortality usually occurred in patients have comorbidities, such as chronic kidney disease (CKD) that accounts for over 20% of mortalities, morbid obesity, immunosuppression, diabetes mellitus, hypertension, and cancer. Also, the incidence of acute kidney failure reported 5-10% in outpatient series and up to 50% in patients that need to be admitted to the intensive care unit. It is important to know that acute kidney injury (AKI) is associated with increased mortality, so this essay is going to review possible mechanisms that result in AKI. Based on the multifactorial mechanism of AKI, we should have considered probable causes of AKI and act in a stepwise manner to tackle these mechanisms and improve the ultimate prognosis of patients. Although most of the measures are supportive, in some patients such as severely ill cases cytokine storm may be attributed to the severity of symptoms, so immunomodulatory treatments could be considered to decrease AKI and consequently mortality. Among hypotheses that propose AKI; pre-renal and direct renal involvement by a virus are discussed in detail.

IntroductionThere is a challenge on the medical efficacy of intravesical Bacillus Calmette-Guérin (BCG) therapy and the power of the immune system boosting, which can be influenced by the age of the non-muscle-invasive bladder cancer (NMIBC) patients. This meta-analysis evaluates the efficacy of BCG therapy among aged (>70) and younger patients with non-muscle-invasive bladder cancer (NMIBC).MethodsThe central database of PubMed, Scopus, and Web of Science were queried until August 4, 2021, by using "BCG," "Bladder Cancer," "AGE," and "efficacy" keywords. After excluding duplicated results, titles and abstracts were evaluated by two independent reviewers. The exclusion criteria included non-English studies, conference abstracts, reviews, editorials, letters, and comments. Three main outcomes, disease-free survival (DFS), progression-free survival (PFS), and cancer-specific survival (CSS), were considered. The statistical analysis was performed using STATA (version 14; Stata Corp, College Station, Texas, USA).ResultsFrom 1115 found documents, the 24 research articles were recruited in the systematic review, and 10 were the candidate for meta-analysis. The overall estimate of H.R. revealed that BCG therapy in those over age 70 is significantly associated with an improved risk of progression and cancer-specific death in studied patients. However, this association was not statistically significant for DFS (1.04 (95% CI: 0.85,1.26)).ConclusionThe BCG maintenance therapy improved CSS and PFS oncological outcomes in elderly patients with NMIBC. BCG therapy did not significantly change the DSF.

Renal artery aneurysm is a rare condition. Most patients are asymptomatic. This case presented to the emergency with colicky pain and underwent left transurethral lithotripsy for left ureteral stone, due to simultaneous renal stone candidates for percutaneous nephrolithotomy. In the review of the imaging, we found a large renal artery aneurysm, so vascular surgery consult was done and the patient managed with coil embolization Misdiagnosis of this condition could be led to life-threatening bleeding if percutaneous nephrolithotomy was done. It is recommended that renal artery aneurysm should be considered in the differential diagnosis of renal rim-like opaque lesions.

Introduction Laparoscopic ureterolithotomy (LU) is a viable option for large ureteral stones (1, 2). The lost stone during laparoscopy is a rare event and most reports are in gallstone surgeries. Most experts recommended that the lost gallstone should be extracted from the abdominal cavity to prevent abscess formation but in laparoscopic ureterolithotomy with lost stone the optimal management is controversial (3-5). We report our experience with a lost ureteral stone during laparoscopy and the technique that was successful to find it. Case presentation The patient was a 28-year-old man, presented with a 22 millimetres stone in the proximal part of the left ureter. The spiral computed tomography scan revealed severe hydronephrosis. The patient was positioned in the left flank and camera port inserted in the lateral border of rectus muscle then two 5 mm working ports inserted in the left upper quadrant and left lower quadrant, respectively. The ureterolithotomy process was performed uneventfully with Double-J stent insertion, but during the extraction of stone from 10 mm port, the stone was lost in abdominal space due to rupture of our endobag (which was a finger of a surgical glove). We extract the lost stone with stepwise searching of the dependent part of the abdominal cavity and found the stone in the dependent part of the right lower quadrant. The operative time was 165 minutes. The patient had no complication in the Post-operative course, the Foley catheter was removed on post-operative day 2 and the drain was removed on post-operative day 3. The patient was discharged home at post-operation day 4 and stent removed four weeks later. Conclusions We believe that any effort should be performed to extract lost stone in laparoscopic ureterolithotomy cases due to the potential risk of abscess formation and the probability of misleading imaging in the future follow-up of patients.

Transurethral Ureterolithotripsy (TUL) is a frequently used procedure in urology departments. Many urologists perform TUL without antibiotic prophylaxis; however the use of chemoprophylaxis before TUL remains a controversial issue in urology. Thisstudy was carried out to assess the safety of omitting antibiotic prophylaxis prior to TUL. In a prospective randomized clinical trial from January 2005 to December 2007, 114 patients with ureteral stones were enrolled; Fifty seven had preoperative antibiotic prophylaxis administered before TUL and fifty seven patients underwent TUL without antibiotic prophylaxis. The rate of postoperative infectious complications (fever, positive blood culture, significant bactriuria), the length of hospital stay and overall stone free rate were compared between the two groups. There was no statistically significant difference between two groups in the operation time, length of hospital stay, postoperative bacteriuria, positive urine culture, postoperative fever and overall success rate of TUL. It appears that the incidence of infectious complications does not increase in patients undergoing TUL without antibiotic prophylaxis if they have negative pre-operative urine culture and antiseptic technique have been performed thorough the procedure.

Transurethral Ureterolithotripsy (TUL) is a frequently used procedure in urology departments. Many urologists perform TUL without antibiotic prophylaxis; however the use of chemoprophylaxis before TUL remains a controversial issue in urology. Thisstudy was carried out to assess the safety of omitting antibiotic prophylaxis prior to TUL. In a prospective randomized clinical trial from January 2005 to December 2007, 114 patients with ureteral stones were enrolled; Fifty seven had preoperative antibiotic prophylaxis administered before TUL and fifty seven patients underwent TUL without antibiotic prophylaxis. The rate of postoperative infectious complications (fever, positive blood culture, significant bactriuria), the length of hospital stay and overall stone free rate were compared between the two groups. There was no statistically significant difference between two groups in the operation time, length of hospital stay, postoperative bacteriuria, positive urine culture, postoperative fever and overall success rate of TUL. It appears that the incidence of infectious complications does not increase in patients undergoing TUL without antibiotic prophylaxis if they have negative pre-operative urine culture and antiseptic technique have been performed thorough the procedure.

Background: Contact lenses play a substantial role in the management of childhood aphakia. However, the use and care of the lenses can be challenging. Despite its prevalence, the phenomenon of living with children with aphakia is not explained in Iran yet. The aim of this study was to illuminate the lived experience of the parents of children with aphakia. Materials and Methods: This hermeneutic phenomenological study was conducted on the parents who have been referred to Farabi Eye Hospital of Tehran, Iran in 2019, whose children were diagnosed with aphakia, and the condition was corrected with contact lenses. Qualitative semi-structured interviews were conducted with 20 parents of children with congenital cataract. Analysis was based on the framework of Diekelmann enabled data interpretation and elaboration of shared themes. Results: The 20 parents involved in the study consisted of 12 women and 8 men. The participant's experiences were classified in 4 categories: Self-Ignorance, Troubled mind, Self-Regulation, and Coping with the problem while hoping for the future. Conclusions: "Self-Ignorance" and "Troubled Mind" indicates that because of the risk of burnout in the long-term process of treatment, the psychological support of parents is necessary. Psychological support will continue until the parents acquire the ability of self-regulation. Giving a realistic hope to families is a core element in psychological support. [ABSTRACT FROM AUTHOR]