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"nBackground: Asthma is a life-threatening disease that can cause death due to bronchospasm. In addition to clinical symptoms such as wheezing, acute paroxysmal dyspnea, chronic cough after exposure to cold air or cough after exercise, spirometry is also necessary for the diagnosis of asthma. The association between respiratory symptoms and a positive methacholine challenge test (MCT) is still controversial. The aim of this study was to determine the association between methacholine test results and respiratory symptoms and allergy."n "nMethods: One hundred and forty-six patients with respiratory symptoms and normal baseline pulmonary function tests were enrolled in this cross-sectional study. The participants were divided into two groups according to their positive or negative response to MCT. The association between MCT and the clinical symptoms and allergy was later evaluated statistically."n "nResults: Out of 146 participants of the study 59 (40.4%) were female and 87 (59.6%) were male. The mean age of the participants was 33.8±13.8 years. Sixty-one patients (41.8%) had positive results for the test. There was an association between a history of allergy, wheezing and age with positive MCT results. The other clinical signs had no association with the test."n "nConclusion: Methacholine challenge test is the best diagnostic test for ruling out asthma in patients with normal pulmonary function tests in whom we cannot definitely rule out asthma based solely on clinical symptoms. Nevertheless, in adults with a history of allergy, wheezing and also in patients below 30, the probability for a positive MCT is high.

Purpose: The management of complicated and irreparable urethral strictures can be challenging, and continent urinary diversion has emerged as a viable option. This study aims to investigate the complications associated with continent urinary diversion using the Mitrofanoff principle in patients with complex urethral strictures that cannot be corrected through urethroplasty surgery., Materials and Methods: A total of 22 patients were included in this study, who underwent continent urinary diversion surgery using the Mitrofanoff technique. The patients were monitored for post-surgical complications over an average follow-up period of 28.36±14.26 months. Surgical failure was defined as the inability to completely and regularly empty urine from the new urinary tract., Results: Half of the patients experienced surgical complications, with only one case resulting in surgery failure. The most common complication observed was stoma stenosis. Two patients reported slight urinary leakage from the stoma site. Notably, all patients except one, regained control over their urine after the procedure. Early therapeutic interventions were classified according to the Clavien-Dindo grading system, showed that none of the patients experienced severe complications (grade 4 or 5)., Conclusion: The study examines the outcomes of continent urinary diversion using the Mitrofanoff technique in adults with complex urethral strictures, providing realistic expectations of complications. Overall, the study shows that this approach is a viable option with a high success rate and manageable complication for individuals with complex urethral strictures that cannot be corrected through urethroplasty surgery.

Purpose: Evaluating pseudomotor performance can be a valuable tool for investigating the peripheral autonomic nervous system in diabetic patients. Sudoscan, a simple and non-invasive method for assessing pseudomotor performance, has been developed in recent years. This study aimed to investigate autonomic neuropathy using Sudoscan in diabetic patients with lower urinary tract symptoms (LUTS) of unknown cause., Materials and Methods: In this cross-sectional study conducted from April 2022 to April 2023, we included 195 patients with type 2 diabetes who were referred to the urology clinic. We extracted demographic, clinical, and laboratory data from the patient files and evaluated urinary symptoms using the International Prostate Symptom Score (IPSS) questionnaire. Patients underwent Sudoscan testing to evaluate autonomic neuropathy in the physical medicine and rehabilitation clinic. To further assess urinary irritative symptoms, patients underwent urodynamic studies (UDS) and ultrasonography., Results: The Sudoscan test results showed that autonomic neuropathy was present in 77 patients (40%), with 43 (22.1%) having moderate and 44 (22.6%) having severe neuropathy. Patients with autonomic neuropathy were found to be older, had longer diabetes durations, higher average blood glucose levels, and higher creatinine levels. Additionally, we found a significant correlation between autonomic neuropathy and signs of high post-void residue on ultrasound and detrusor contraction disorders on UDS (p-value < 0.05)., Conclusion: Our study found a higher prevalence of autonomic neuropathy in diabetic patients with LUTS using Sudoscan (40%). Longer diabetes duration and poor glycemic control were associated with an increased risk of autonomic neuropathy linked with LUTS, such as urge incontinence.

Background: Nephrolithiasis is a common condition that has been linked to various systemic diseases. Recent studies have suggested that young patients with nephrolithiasis are at increased risk of developing premature atherosclerosis. This study aims to investigate the relationship between nephrolithiasis and systemic disease by examining the association between aortic calcification and the severity of kidney stone disease., Methods: This study employed a matched case-control design involving 144 patients with kidney stones and 144 non-stone formers. All participants underwent non-contrast abdominal and pelvic CT scans. The Agatston score was used to quantify the severity of aortic calcification. The data were analyzed and compared between the two groups. Quantitative data were analyzed using Pearson's chi-square test. Non-parametric data were analyzed using the Mann-Whitney test., Results: The Agatston score was measured in both case and control groups, with mean values of 316±734 and 231±706, respectively. However, the difference between the two groups was not statistically significant ( P = 0.122). Notably, a significant correlation was observed between Agatston score and stone size ( P = 0.014). The value of the correlation coefficient is 0.23, which shows the increase in severity of aortic calcification with increasing stone size. A comparison of the Agatston score between male kidney stone formers patients aged 45 years or younger and controls revealed a statistically significant difference, with a p-value of 0.049, indicating more pronounced aortic calcification in the patient group., Conclusion: These results suggest that there may be a shared pathophysiological mechanism underlying both nephrolithiasis and atherosclerosis., Competing Interests: The authors declare that they have no competing interests., (© 2024 Iran University of Medical Sciences.)

Introduction: Fournier's gangrene (FG) is a type of necrotizing fasciitis affecting the external genitalia or perineum. The Geriatric Nutritional Risk Index (GNRI) has been reported as a prognostic factor to evaluate the outcomes of various diseases. This study aimed to investigate the utility of GNRI in predicting the mortality of FG patients., Methods: This retrospective cross-sectional study evaluated the patients admitted to a referral hospital, during 14 years, with diagnosis of FG. The role of GNRI in predicting the mortality of these patients was studied. To further investigate the relationship of the GNRI score with patients' prognosis, we controlled for the scores of Fournier's Gangrene Severity Index (FGSI) and Charlson Comorbidity Index (CCI)., Result: 78 patients with the mean age of 60.79 ± 13.76 (range: 24 -85) years were included in the study (89.74% male). The mortality rate in this series was 23 (29.5%) cases. The survived cases had significantly higher GNRI score (p < 0.001), higher Albumin level (p < 0.001), higher weight (p = 0.04), and lower mortality risk based on FGSI score (p < 0.001). In patients with low mortality risk according to FGSI score (p = 0.036) and mild comorbidities based on CCI score (p = 0.030), the association between GNRI and final prognosis was significant. In contrast, in patients with high mortality risk according to FGSI score (p =0.074) and moderate (p = 0.118) and severe (p = 0.215) comorbidities by CCI score this association was not significant.The independent predictors of mortality in FG patients were GNRI score (OR: 1.242, 95%CI: 1.08, 1.41; p =0.001) and FGSI score (OR: 54.614, 95%CI: 6.89, 432.31; p < 0.001). The area under the receiver operating characteristic (ROC) curve of GNRI score in predicting the mortality of FG patients was 0.84 (95%CI: 0.75 - 0.93). The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of GNRI score at the optimal cut-off point (78.5) were, 80%, 77.9%, 60.6%, 90.4%, 3.69, and 0.255 respectively., Conclusions: Our findings indicate that among patients with mild FG, as assessed by FGSI score, and those with low comorbidities based on CCI score, the GNRI score in survivors was significantly higher than that in non-survived. Additionally, multivariate regression analysis demonstrated that the GNRI score serves as an independent predictor of patient outcomes., Competing Interests: The authors declare no conflict of interest.

Remaining Surgicel in the body can be mistaken for complications such as hematoma, abscess, or tumor recurrence in paraclinical examinations after surgery. We have presented the case of kidney cancer who underwent radical nephrectomy. In radiological follow-ups, hematoma was reported in the surgery site. The typical appearance of Surgicel on a postoperative CT scan is characterized by air trapped bubbles. Surgicel exhibits a short relaxation time on T2-weighted images. It is important to differentiate the remaining Surgicel from cases such as hematoma, abscess and tumor recurrence. T2MRI images will be most accurate in the correct diagnosis of Surgicel., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Mixed epithelial and stromal tumor of the kidney (MESTK) is a rare benign kidney tumor. In rare cases, malignant transformation, such as sarcomatoid features indicates poor clinical outcomes. In this study, we will describe a 45 years old man with a diagnosis of MESTK with malignant transformation of the sarcomatoid component, after right radical nephrectomy. The patient underwent chemotherapy with adriamycin, ifosfamide, and granulocyte-colony stimulating factor (G-CSF). The radiological characteristics of MESTK can pose diagnostic challenges due to its non-unique radiological appearance. The presence of sarcomatoid transformation is a hallmark feature of malignant MESTK which can be very aggressive., Competing Interests: The authors declare no conflicts of interest in this work., (© 2024 The Authors.)

Cancer treatment has the potential to cause cardiovascular issues and can encourage the appearance of all aspects of cardiac disease, including coronary heart disease, myocardial disease, heart failure, structural heart disease, and rhythm problems. Imaging is required for both diagnostic workup and therapy monitoring for all possible cardiovascular side effects of cancer therapy. Echocardiography is the cardiac imaging gold standard in cardio-oncology. Despite advancements in its use, this method is often not sensitive to early-stage or subclinical impairment. The use of molecular imaging technologies for diagnosing, assessing, and tracking cardiovascular illness as well as for treating, it is fast growing. Molecular imaging techniques using biologically targeted markers are gradually replacing the traditional anatomical or physiological approaches. They offer unique insight into patho-biological processes at the molecular and cellular levels and enable the evaluation and treatment of cardiovascular disease. This review paper will describe molecularbased single-photon emission computed tomography (SPECT) and positron emission tomography (PET) imaging techniques that are now available and in development to assess post-infarction cardiac remodeling. These methods could be used to evaluate important biological processes such as inflammation, angiogenesis, and scar formation., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Purpose: The most common adjuvant therapy known for non-invasive muscle bladder cancer (NMIBC) is intravesical Bacillus Calmette-Guerin (BCG). Intravesical chemotherapy drugs like gemcitabine can also be used post-TURBT, which is considered as a good alternative for BCG, or can be used as a second-line treatment. Due to the common side effects of BCG, the use of chemotherapy drugs as intravesical treatments is currently increasing., Materials and Methods: 117 intermediate-risk NMIBC cases were included in this study. All the patients underwent TURBT surgery and received 1 gr intravesical gemcitabine immediately after performing the surgery. The patients were then divided into two groups, either receiving intravesical gemcitabine or intravesical BCG weekly for 6 weeks. The patients were followed up with cystoscopy., Results: Most patients were men who had smoking risk factors. The youngest patient was 36 years old and the oldest one was 88 years old. The rate of side effects in the group receiving gemcitabine (13.6%) was much lower than the group receiving BCG (44.8%). (P-value = 0.016). The recurrence rate during a one year period was lower in the group consisting of patients receiving gemcitabine compared to the group receiving BCG (19 patients vs. 23 patients) (p-value = 0.401) Conclusion: The efficacy of intravesical gemcitabine and intravesical BCG was almost equal in the treatment of intermediate-risk NMIBCs. The adverse effects of gemcitabine were found to be significantly lower than BCG. Due to causing fewer complications, gemcitabine can be known as a good alternative, especially among elderly patients with comorbidities.

Sertoli cell tumor is a rare type of testicular tumor. In this study, a 70-year-old man was presented with a Sertoli cell tumor with non-classical findings. The patient noticed progressive swelling on the left hemiscrotum. Preoperative ultrasound findings were not consistent with the classic findings of the Sertoli cell tumor. Patients underwent radical left orchiectomy. The testis was multicystic and no clear parenchyma was seen. The pathology report confirmed the diagnosis of a Sertoli cell tumor., Competing Interests: The authors report no conflicts of interest in this work., (© 2022 The Authors. Published by Elsevier Inc.)

Transurethral lithotripsy (TUL) surgery, which is used to crush ureteral stones, can have complications, including bleeding, infection, ureteral stenosis, ureteral rupture, and ureteral avulsion. In this study, we present a 45-year-old woman who was referred, due to a right ureteral rupture during transurethral lithotripsy surgery. At first, the patient underwent ureteroneocystostomy surgery by a combination of boari flap and psoas hitch techniques. Due to the obstruction and necrosis at the anastomosis site, the patient underwent calicovesicostomy surgery., Competing Interests: The authors declare no conflicts of interest in this work., (© 2022 The Authors. Published by Elsevier Inc.)

Introduction: Medical and surgical priorities were dramatically changed during the COVID-19 pandemic. This study aimed to evaluate the impact of this pandemic on presentation to emergency department (ED) with urologic complaint., Method: This cross-sectional study was conducted at a tertiary urology referral center in Tehran, Iran. The data of all ED admissions were collected and the frequency of admissions with urologic complain and their outcomes were compared between two 90-day periods (before and during COVID-19 era)., Results: 480 ED admissions were studied. The number of patients visiting the ED with urologic complaint during COVID-19 era was significantly lower than the same period in the pre-COVID-19 period (125 vs. 355 admissions; p = 0.01). The mean hospitalization days for patients in the pre-COVID-19 period were significantly higher (5.6 ± 4.4 vs. 3.2 ± 4.2 days; p <0.001). The most common patient complaints before and during COVID-19 period were flank pain (32.7%) and gross hematuria (32.8%), respectively. The number of patients discharged against medical advice in the COVID-19 period was significantly higher than before (22 (17.6%) vs. 10(2.8%); p < 0.001). The number of patients who developed severe complications was significantly higher in the COVID-19 period than in the pre-COVID-19 period (p = 0.001)., Conclusion: During the COVID-19 pandemic we were faced with decreasing frequency of admission with urologic complaint, change in the pattern of referrals, decrease in the duration of hospitalization, increase in the number of patients discharged against medical advice, and increase in the number of cases with irreversible urologic complications or complications requiring surgery due to deferred treatment., Competing Interests: The authors have no conflicts of interest relevant to this article.

Percutaneous Nephrolithotomy (PCNL) is the gold standard treatment of large kidney stones that has rare but serious complications such as gallbladder injury. In this article, a 62-year-old woman with a right lower kidney who was scheduled for PCNL was presented. The patient had acute abdomen on the first day after PCNL, so explorative laparotomy and cholecystectomy were done. The patient was discharged five days after surgery in good condition., Section Headings: Endourology/Stone Disease., Competing Interests: The authors report no conflicts of interest in this work., (© 2022 The Authors.)

Synovial Sarcoma (SS) is a rare soft-tissue malignancy. Only about 15% of SS originates from the retroperitoneum. Retroperitoneal SS (RSS) is usually diagnosed incidentally due to the anatomy of the retroperitoneum. The most common complaints of patients are abdominal and low back pain. Other common symptoms of RSS are palpable abdominal mass, weight loss, and anemia. In this study, we will describe a 29-year-old white Asian man with a diagnosis of RSS after radical nephrectomy. He was admitted to the Urology Department of Shohada-e Tajrish hospital, Tehran, Iran in March 2019. The distinguishing feature of this case is the size of the mass, which has never been reported so much for retroperitoneal synovial sarcoma. Radiologic imaging showed a huge retroperitoneal mass originating from the kidney. Based on the pathologic features and immunohistochemistry (IHC) study, the diagnosis was consistent with synovial sarcoma. Accurate diagnosis of RSS is usually based on the pathological findings. Therefore, in case of doubt, a biopsy can be employed. Surgical resection of the tumor and lymph nodes dissection is the main and most important part of the treatment. Aggressive resection with free margin is recommended. The role of adjuvant and neoadjuvant chemotherapy in RSS is not certain to date, but it is recommended according to the patient's condition., (Copyright: © Iranian Journal of Medical Sciences.)

Purpose: 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., Materials and Methods: 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., Results: 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 (p < 0.05). 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%) (p > 0.05). 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 (p < 0.05)., Conclusion: 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.

A 35-year-old diabetic woman was referred to the emergency department with fever, left flank pain, pneumaturia, and impaired vision of the left eye from 4 days ago. Fever, tachycardia, tachypnea, low blood pressure, metabolic acidosis, and azotemia were the first findings. The diagnosis was a coincidence of emphysematous pyelonephritis and emphysematous endophthalmitis due to computerized tomography of the patient. Immediate fluid and electrolytes resuscitation, intravenous antibiotic administration, and nephrectomy save the patient. Urine, blood, and vitreous cultures revealed mixed germ infection., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Published by Elsevier Inc.)

Priapism is a condition in which a person has an erection without sexual arousal and lasts for at least 4 hours. High flow priapism (HFP) usually follows blunt trauma to the penis or perineum, causing arterial-lacunar fistula. HFPs are rare after sexual intercourse, and early treatment by embolization can prevent erectile dysfunction (ED). The use of gel foam has good results and has shown the least side effects., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 The Authors.)

Simultaneous herniation of the bladder and ureter into the scrotum is a rare condition. In this study, we present a 60-year-old man who has been suffering from pain and swelling in the right hemi-scrotum. The patient needed to squeeze his scrotum for urination and he had difficulty in emptying his bladder. Ultrasound and Computed Tomography(CT) was performed for the patient, which confirmed the diagnosis. The patient underwent herniorrhaphy and partial cystectomy. His urinary problems were completely eliminated with surgery., Competing Interests: The authors report no conflicts of interest in this work., (© 2021 Published by Elsevier Inc.)

Purpose: 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., Materials and Methods: 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., Results: 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., Conclusion: 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.

Introduction: Fournier's gangrene (FG) is a life-threatening disease, even with early diagnosis and administration of vigorous treatment, its mortality rate is high. This study aimed to evaluate the factors relate to mortality in patients with FG or necrotising fasciitis managed in a referral center., Methods: This retrospective cross-sectional study was conducted on patients managed in a tertiary referral center, Tehran, Iran, from March 2009 to March 2019, with diagnosis of FG or necrotising fasciitis. The correlation between different demographic and clinical parameters with mortality was analysed and reported., Results: 73 cases with the mean age of 59.1 ± 15.8 (range: 25 - 88) years were studied (87.7% male). 21 (28.8%) patients died. Escherichia coli (26 cases, 35.6%) was the most frequent microorganism in cultures. Non-survived cases had higher mean age (p = 0.01), higher frequency of hyperlipidaemia (p = 0.02), immunosuppression (p < 0.001), longer hospital stay (p=0.02), lower blood pressure (p=0.01), and lower platelet count (p=<0.001). Based on multivariate analysis, age (p = 0.015; Odds: 0.88 (0.79-0.97)), haematocrit level (p = 0.01; Odds: 1.27 (1.04-1.55)), platelet count (p = 0.03; Odds: 10.11 (1.14-89.35)), and immunosuppression (p = 0.01; Odds: 0.01 (0.0-0.54)) were independent related factors of mortality., Conclusions: The rate of mortality due to FG and necrotizing fasciitis was 28.8%. Based on multivariate analysis, the independent related factors of mortality were older age, lower haematocrit level and platelet count, and presence of immunosuppression.

Purpose: Gleason score (GS), as well as other prognostic and diagnostic modalities, can predict the possibility of tumor growth and metastasis during the life of patients with prostate cancer. Based on the prostate biopsy GS, clinicians choose the most appropriate therapy for managing patients. The objective of this cross-sectional study was to determine the discrepancy between needle biopsy and radical prostatectomy GS and to identify its predictive factors among the Iranian population., Materials and Methods: A total of 1147 patients who underwent radical prostatectomy from 2009 to 2019 were initially enrolled in this study. After consideration of the inclusion and exclusion criteria, 439 patients were finally included. The demographic variables and clinical data including age, PSA level, prostate volume, PSA density, GS derived from ultrasonography-guided core needle biopsy specimen, and GS derived from radical prostatectomy specimen were collected from the medical records of patients with prostate adenocarcinoma and were reviewed by a urology resident. Statistical analysis was done by using the Social Sciences Software version 21., Results: The average age of patients was 64.5 years (range 48-84 years), and the average preoperative PSA level was 14.8 ng/mL. On histopathological examination, no changes in GS were observed in 237 (53.9%) patients, whereas GS was upgraded in 144 (32.8%) patients and downgraded in 58 (13.2%) patients at radical prostatectomy. The number of patients who had extracapsular extension, seminal vesicle invasion and positive lymph nodes was significantly higher in the upgraded group compared with the non-upgraded group.  Conclusion: In this study, there was a steady decrease in GS upgrading with the prostate size extending up to 49.7 g. There was also an association between downgrading and extending prostate size. Due to the greater risk of high-grade disease in men with small prostates, smaller prostate bulks are most probably upgraded after radical prostatectomy. A higher maximum percentage of involvement per core was an independent predictive factor of upgrading from biopsy grade 1 to grade ≥ 2. Our study showed that patients' age was not predictive of upgrading, which is consistent with other studies. Also, we demonstrated a non-significant relationship between PSA level and upgraded GS. Findings in this study did not demonstrate a significant relationship between PSA level and upgrading.

Purpose: Surgical repair of post-traumatic complex urethral stricture poses a major challenge to urologists. Here, we report six patients with irreparable urethral strictures who were successfully treated by using the appendix as conduit for urinary diversion., Materials and Methods: Six patients who had underwent urinary diversion using an appendix during 2015 to 2019 were included in our study. All patients had a history of one or more failed attempts of urethral reconstruction in the past. Mean follow-up for patients was 29 months. Continency was defined as being completely dry for at least 3 hours., Results: Mean age of patients was 40.1 years old (range: 20-70 years). Intermittent catheterization through the conduit was easily performed for every patient without any stomal stenosis. Mild stomal incontinence only occurred in one case which was resolved after a few months. All patients were continent during day and night., Conclusion: Based on the results of our study, Mitrofanoff's technique is a valuable procedure for managing patients with serious complicated urethral strictures who cannot be treated with common standard approaches.

Purpose: Prevention and treatment of urethroplastic postoperative pain is a major challenge in post-surgery care. gabapentin can treat postoperative pain by preventing excessive sensitivity to the central nervous system. we have tried to compare the effect of gabapentin with the placebo on reducing the pain associated with posterior urethroplasty in patients., Material and Method: This prospective, randomized, double-blind study was scheduled in Shohad e Tajrish hospital where a single dose of Gabapentin was compared with placebo given to patients preoperatively. In this study,100 patients with posterior urethral stricture were included for surgery with 50 patients in each arms .All patients underwent posterior urethroplasty. After surgery, the pain level is assessed and evaluated by the visual analog scale in two hours,four hours, six hours,eight hours, twelve hours, and 24 hours after the operation., Result: In this study, there was a significant difference in the pain level that was evaluated by the visual analog scale in two hours, four hours, six hours, eight hours, twelve hours, and 24 hours after the surgery (p.value <0.001). We also found a significant decrease in morphine consumption in the gabapentin group vs the placebo group. (p.value <0.001) The post-surgery assessments showed significant lower adverse effects such as vomiting, nausea, drowsiness, and pruritus in the gabapentin group vs. placebo group., Conclusion: The consequences of this study revealed that gabapentin effective in controlling posterior urethroplasty postoperative pain, consumption of opioid, nausea, vomiting, drowsiness, and pruritus compared with the placebo group.

Introduction: Urinary stone disease is the third most common affliction of the urinary tract that has been associated with an increasing incidence. Over decades, great advances have been made in the minimally invasive treatment of urinary stones. Recently, transurethral lithotripsy (TUL) by holmium laser was introduced as a possible therapeutic option. This study evaluated the effect of propofol on the success rate of TUL by holmium laser. Methods: A double-blind randomized controlled trial was conducted on 180 patients to investigate the effect of propofol on the success and complication rate of TUL by holmium laser. The enrolled patients were divided into two groups: the first group received sodium thiopental (n=89) while the second group received propofol (n=91). The two groups were compared in terms of the fluctuations of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), operation time, future stone-free rate (SFR), stone migration, post-operative fever, and ureteral complications such as perforation and mucosal damage. Other developed complications were also recorded. After data gathering, statistical analysis was performed with SPSS version 21. Results: the patients' data such as age, sex, stone diameter, stone laterality, duration of stone impaction, primary SBP, DBP and HR were not significantly different between the two groups (P>0.05). TUL and anesthesia duration, first-minute and fifth-minute SBP and DBP, and also changes of HR were significantly lower in the propofol group compared with the sodium thiopental group ( P <0.001). Moreover, SFR of TUL was more evident in the propofol group. Ureteral mucosal damage was significantly less in the propofol group. Conclusion: Propofol was associated with a higher reduction in SBP and DBP, decreased duration of TUL, fewer fluctuations in HR, and an increased success rate of stone removal by TUL with holmium laser., (Copyright © 2020 J Lasers Med Sci.)

Background: Multiple sclerosis (MS) is an inflammatory and demyelinating disease of central nervous system (CNS). The aim of the present study was to determine the type and the frequency of initial presenting symptoms in patients with MS and their relation with demographic characteristics in Babol, northern Iran., Methods: All patients of this study were recruited over a ten year period from 2002 to 2012 from single neurologic clinic. Diagnosis of MS was confirmed according to the McDonald criteria, demographic and clinical features Then, all the clinical findings and demographic variables including: age, sex, marital status, age at onset, education, place of residence, disease duration, initiation pattern of disease have been collected. Expanded Disability Status Scale (EDSS) was used for the evaluation of disability at the onset of disease. Data analysis was performed by chi-square test., Results: A total of 263 consecutive MS patients with the age range of 17 to 61 yr were examined. Optic neuritis was the most prevalent initial presenting symptom in 123 (46.8%) patients followed by sensory disturbances as the second common presenting symptom of MS. Significant difference was found between patients with or without optic neuritis and the onset age of the disease and EDSS (p<0.001). The mean EDSS score at the time of initial presentation was 1.67±0.77., Conclusion: The findings of this study indicated that optic neuritis is the most prevalent initial presentation of MS in the geographic region of northern Iran. In patients less than 30 years, development of visual disturbances justifies neurologic examination.

Background: Polysymptomatic or monosymptomatic patients of multiple sclerosis (MS) at the onset of the disease may influence the natural course of the disease. The purpose of this study was to determine the prognostic effect of the expanded disability status scale (EDSS) of patients with MS with polysymptomatic or monosymptomatic onset of the disease., Methods: From 2001 to 2011, 263 patients with definitive diagnosis of MS were investigated in Shahid Beheshti Teaching Hospital in Babol, Iran. These patients were assessed regarding mono-or poly symptoms at the beginning of their disease. MRI of brain and spinal cord was done for all cases. These cases were evaluated every three months interval. EDSS of each patient at the beginning of their disease and then yearly were evaluated and registered., Results: One hundred sixty-one subjects (61.2%) were monosymptomatic and 102 (38.8%) were polysymptomatic at the onset of their disease. The mean age of patients with monosymptomatic onset was 26.81+84 while in polysymptomatic was 26.35+7.7 years (P=0.656). Sex, place of residence and marriage statusbetween these two groups were equal. The mean EDSS in monosymptomatic and polysymptomatic patients were 1.37±0.64 and 2.16±0.714, respectively (P=0.0001). After the initiation of treatment, reduction of EDSS was seen in both groups but after the reduction in the first year, an increase of EDSS was seen in both groups. But there was no significant difference in the increase of EDSS in both groups., Conclusion: The results showed that the mean EDSS in monosymptomatic was lower than the polysymptomatic patients before treatment, but after treatment, this value does not differ in the increase of EDSS.