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Recent studies have demonstrated that quick sequential organ failure assessment criteria may be more accurate than systemic inflammatory response syndrome criteria to predict postoperative sepsis. In this study we evaluated the ability of these 2 criteria to predict septic shock after percutaneous nephrolithotomy.We performed a retrospective multicenter study in 320 patients who underwent percutaneous nephrolithotomy at a total of 8 institutions. The criteria for quick sequential organ failure assessment and systemic inflammatory response syndrome were collected 24 hours postoperatively. The study primary outcome was postoperative septic shock. Secondary outcomes included 30 and 90-day emergency department visits, and the hospital readmission rate.Three of the 320 patients (0.9%) met the criteria for postoperative septic shock. These 3 patients had positive criteria for quick sequential organ failure assessment and systemic inflammatory response syndrome. Of the entire cohort 23 patients (7%) met quick sequential organ failure assessment criteria and 103 (32%) met systemic inflammatory response syndrome criteria. Specificity for postoperative sepsis was significantly higher for quick sequential organ failure assessment than for systemic inflammatory response syndrome (93.3% vs 68.4%, McNemar test p0.001). The positive predictive value was 13% for quick sequential organ failure assessment criteria and 2.9% for systemic inflammatory response syndrome criteria. On multivariate logistic regression systemic inflammatory response syndrome criteria significantly predicted an increased probability of the patient receiving a transfusion (β = 1.234, p0.001). Positive quick sequential organ failure assessment criteria significantly predicted an increased probability of an emergency department visit within 30 days (β = 1.495, p0.05), operative complications (β = 1.811, p0.001) and transfusions (p0.001). The main limitation of the study is that it was retrospective.Quick sequential organ failure assessment criteria were superior to systemic inflammatory response syndrome criteria to predict infectious complications after percutaneous nephrolithotomy.

Wolfram syndrome (WS) is a rare genetic disorder described by a pattern of clinical manifestations such as diabetes mellitus, diabetes insipidus, optic nerve atrophy, sensorineural hearing loss, urinary tract abnormalities, and psychiatric disorders. WFS1 and WFS2 loci are the main genetic loci associated with this disorder. In the current study, we investigated associations between these loci and WS via STR markers and homozygosity mapping in 13 Iranian families with WS. All families were linked to WFS1 locus. Mutation analysis revealed four novel mutations (Q215X, E89X, S168Del, and E391Sfs*51) in the assessed families. Bioinformatics tools confirmed the pathogenicity of the novel mutations. Other identified mutations were previously reported in other populations for their pathogenicity. The current study adds to the mutation repository of WS and shows a panel of mutations in Iranian population. Such panel would facilitate genetic counseling and prenatal diagnosis in families with WS cases.

Urethral diverticula are rare but clinically significant entities among female patients. Ventrally located, mid-to distal, simple or horseshoe diverticula are most commonly observed and are usually repaired via a transvaginal approach with varying levels of difficulty but high success rates. Dorsally (anteriorly) located urethral diverticula are more challenging to repair secondary to the need to access the side of the urethra opposite the vaginal lumen, abutting the external urethral sphincter. Unique proximal anatomy in the case presented led to careful consideration of the surgical options. We present a review of techniques reported in the literature and a video demonstrating our technique for transabdominal robot-assisted laparoscopic excision of a large, dorsal, very proximally located, crescenteric urethral diverticulum in a patient who initially presented with urosepsis. Robotic-assisted excision of the urethral diverticulum was accomplished in 3:27 h with an estimated blood loss of 50 cc. Vaginal counter-incision was not necessary. The patient’s postoperative course was uneventful. Postoperative voiding cystourethrogram prior to suprapubic catheter removal revealed a well-healed repair without extravasation. At 6-month follow-up, she denied any de novo lower urinary tract symptoms such as urinary incontinence, post-void dribbling, urinary tract infection or urinary hesitancy. Dorsal urethral diverticulum in women, particularly when very proximal, can present a diagnostic and surgical challenge for reconstructive pelvic surgeons. The robotic approach to urethral diverticulectomy is feasible for a proximal dorsal urethral diverticulum which lies cephalad to the pubic symphysis. This or other laparoscopic applications may also be considered as an adjunct to the standard vaginal approach for complex urethral diverticuli with a proximal dorsal component.

We evaluated whether cessation of renal colic is consistent with an expelled ureteral stone or whether imaging may be indicated even in the absence of symptoms.We performed a retrospective study of patients who presented to our institution with acute renal colic and ureteral stone, and were subsequently evaluated at a followup visit where they reported complete cessation of pain for at least 72 hours.Study inclusion criteria were met by 52 patients, who reported no pain for at least 72 hours at the time of the followup visit. A persistent ureteral stone was demonstrated in 14 of the 52 patients (26%) although they denied any associated symptoms. Multivariate logistic regression did not show an association between stone size or location and the likelihood of passage in this cohort.Cessation of pain was associated with ureteral stone passage in almost 75% of this study cohort but 26% of patients still had persistent ureteral stones. We recommend routine followup imaging in all patients with ureteral stones to document stone passage and avoid the risks of silent ureteral obstruction.

To evaluate the quality and readability of online information on ureteral stents.Google.com was queried using the search terms "ureteric stent", "ureteral stent", "double J stent" and, "Kidney stent" derived from Google AdWords. Website popularity was determined using Google Rank and the Alexa tool. Website quality assessment was performed using the following criteria: Journal of the American Medical Association (JAMA) benchmarks, Health on the Net (HON) criteria, and a customized DISCERN questionnaire. The customized DISCERN questionnaire was developed by combining the short validated DISCERN questionnaire with additional stent-specific items including definition, placement, complications, limitations, removal and "when to seek help". Scores related to stent items were considered as the "stent score" (SS). Readability was evaluated using five readability tests.Thirty-two websites were included. The mean customized DISCERN score and "stent score" were 27.1 ± 7.1 (maximum possible score = 59) and 14.6 ± 3.8 (maximum possible score = 24), respectively. A minority of websites adequately addressed "stent removal" and "when to seek medical attention". Only two websites (6.3%) had HON certification (drugs.com, radiologyinfo.org) and only one website (3.3%) met all JAMA criteria (bradyurology.blogspot.com). Readability level was higher than the American Medical Association recommendation of sixth-grade level for more than 75% of the websites. There was no correlation between Google rank, Alexa rank, and the quality scores (P 0.05).Among the 32 most popular websites on the topic of ureteral stents, online information was highly variable. The readability of many of the websites was far higher than standard recommendations and the online information was questionable in many cases. These findings suggest a need for improved online resources in order to better educate patients about ureteral stents and also should inform physicians that popular websites may have incomplete information.

Objectives Ureterocele is a sac-like dilatation of terminal ureter. Precise anatomic delineation is of utmost importance to proceed with the surgical plan, particularly in the ectopic subtype. However, the level of ureterocele extension is not always elucidated by the existing imaging modalities and even by conventional cystoscopy, which is considered as the gold standard for evaluation of ureterocele. This study aims to evaluate the accuracy of three-dimensional virtual sonographic cystoscopy (VSC) in the characterization of ureterocele in duplex collecting systems. Methods Sixteen children with a mean age of 5.1 (standard deviation 1.96) years with transabdominal ultrasonography–proven duplex system and ureterocele were included. They underwent VSC by a single pediatric radiologist. All of them subsequently had conventional cystoscopy, and the results were compared in terms of ureterocele features including anatomy, number, size, location, and extension. Results Three-dimensional VSC was well tolerated in all cases without any complication. Image quality was suboptimal in 2 of 16 patients. Out of the remaining 14 cases, VSC had a high accuracy in characterization of the ureterocele features (93%). Only the extension of one ureterocele was not precisely detected by VSC. Conclusions The results of this study suggest three-dimensional sonography as a promising noninvasive diagnostic modality in the evaluation of ectopic ureterocele in children.

In this study, a novel technique of irreversible sphincter deficiency by pudendal nerve transection (PNT) using 40 female rats for studying the pathophysiology of stress urinary incontinence associated with childbirth was developed. Of the 40 rats, 10 served as controls and the remaining underwent bilateral PNT at the anastomotic lumbosacral trunk level. Urethral morphological changes following bilateral PNT were assessed with serial hematoxylin and eosin (H&E) and immunohistochemistry (IHC) staining methods at 50, 90, and 130 days post-intervention. Leak point pressure (LPP) measurement was used to determine the effect of pudendal injury on urethral outlet resistance after the transection. H&E and IHC staining showed irreversible loss of striated muscle mass of the sphincter region and increase in collagen deposition compatible with muscle atrophy. LPP measurements also significantly decreased following bilateral PNT. In conclusion, a novel method of irreversible sphincter insufficiency was developed. This model effectively decreased urethral outlet resistance and caused irreversible striated muscle atrophy. It was suggested that this technique can be used to develop a permanent sphincter deficiency model for the preclinical testing of treatment modalities exclusively triggering the pudendal nerve.

Objectives To assess the efficacy of transcutaneous interferential electrical stimulation (IFES) and urotherapy in the management of non-neuropathic underactive bladder (UAB) in children with voiding dysfunction. Patients and Methods In all, 36 children with UAB without neuropathic disease [15 boys, 21 girls; mean (sd) age 8.9 (2.6) years] were enrolled and then randomly allocated to two equal treatment groups comprising IFES and control groups. The control group underwent only standard urotherapy comprising diet, hydration, scheduled voiding, toilet training, and pelvic floor and abdominal muscles relaxation. Children in the IFES group likewise underwent standard urotherapy and also received IFES. Children in both groups underwent a 15-session treatment programme twice a week. A complete voiding and bowel habit diary was completed by parents before, after treatment, and 1 year later. Bladder ultrasound and uroflowmetry/electromyography were performed before, at the end of treatment course, and at the 1-year follow-up. Results The mean (sd) number of voiding episodes before treatment was 2.6 (1) and 2.7 (0.76) times/day in the IFES and control groups, respectively, which significantly increased after IFES therapy in IFES group, compared with only standard urotherapy in the control group [6.3 (1.4) vs 4.7 (1.3) times/day, P < 0.002). The mean (sd) bladder capacity before treatment was 424 (123) and 463 (121) mL in the control and IFES groups, respectively, which decreased significantly at 1 year after treatment in the IFES group compared with the controls, at 227 (86) vs 344 (127) mL (P < 0.01). Maximum urine flow increased and voiding time decreased significantly in the IFES group compared with controls at the end of treatment sessions and 1 year later (P < 0.05). All the children had abnormal flow curves at the beginning of the study. The flow curve became normal in 14/18 (77%) of the children in the IFES group and six of 18 (33%) in the control group by the end of follow-up (P < 0.007). At the end of the treatment course, night-time wetting was improved in all children who had this symptom before the treatment in the IFES group (P < 0.01). Conclusion Combining IFES and urotherapy is a safe and effective therapy in the management of children with UAB.

Purpose To present the long-term outcomes of appendicovesicostomy using the Mitrofanoff principle for end-stage Wolfram bladder dysfunction as an alternative to clean intermittent self-catheterization (CIC) per urethra mainly following blindness. Methods Twelve Wolfram patients presenting with bilateral hydroureteronephrosis and advanced bladder dysfunction were included in this study. All patients were managed initially by CIC per urethra. All of these patients became blind during follow-up and were unable to perform urethral CIC independently. Out of these patients, six patients agreed to proceed to appendicovesicostomy. Appendicovesicostomy urinary diversion using the Mitrofanoff principle was performed in these six blind patients. The rest of the patients stopped CIC or performed CIC irregularly. Results Severe hydroureteronephrosis and large bladders were found in all patients prior to intervention. All patients were able to conduct CIC independently through the stoma and maintained overnight bladder free drainage. In all patients with urinary diversion and CIC, the hydroureteronephrosis was reduced and renal function returned to normal. However, the non-intervention group ended with different degrees of progressive renal failure with three mortalities during the follow-up. Conclusions We suggest appendicovesicostomy as a safe and lifesaving procedure for long-term management of bladder dysfunction in Wolfram syndrome particularly after progression to blindness

Guidewires are a mainstay of endourologic procedures, as they provide safe access to the urinary tract and allow the passage of catheters and stents [1]. The development of guidewires in urology began with the application of angiographic tools in urologic endoscopy. Fritzche et al. reported the use of angiographic guidewires in 7 patients with ureteral obstruction in 1981 [2]. The authors noted in this study that their methods allow the “placement of angiographic guide wires and catheters past ureteral obstacles when standard urological retrograde procedures are not feasible technically.” The transvesical approach was described as where a 6Fr open-ended polyethylene catheter was placed at the ureterovesical junction and followed by advancing a 0.035 in. diameter guide wire [2]. The authors noted several advantages of the angiographic catheters and wires that allowed their urological application. The smaller diameter floppy tip reduced the risk of ureteral injury. A curve could be applied to the wire to facilitate manipulation and a wide range of shapes and sizes available for angiography allowed the urologist to attach a stone basket to the catheter for multiple passages through the level of obstruction [2]. Advances over subsequent years created specialized categories of guidewires which allowed the urologist to select the most appropriate tool for a given circumstance. These wires include hydrophilic straight and angled guidewires (used for bypassing more difficult obstructions or for the tortuous ureter), the hybrid wires (wires with a hydrophilic distal tip for bypassing obstructing stones and a nitinol core which is kink resistant to be used as a working wire) and stiffer wires such as Amplatz extra stiff (used to straighten ureter or for stabilization when passing dilating catheters and access sheaths) [1, 3]. More recent studies have evaluated the mechanical characteristics and performance elements of guidewires, including tip bending, resistance, pull force, shaft bending resistance, tip puncture force, shaft stiffness, and lubricity [1, 4]. The authors corroborated that hybrid wires offer the combination of the hydrophilic tip and stiffer shaft than standard wires, while the extra stiff wires may be best-suited for placement of ureteral access sheaths or larger stents. Interestingly they also noted that “brand name” guidewires designed for the same purposes may differ from one manufacturer to the next.

Ureterocele is a sac-like dilatation of terminal ureter. Precise anatomic delineation is of utmost importance to proceed with the surgical plan, particularly in the ectopic subtype. However, the level of ureterocele extension is not always elucidated by the existing imaging modalities and even by conventional cystoscopy, which is considered as the gold standard for evaluation of ureterocele. This study aims to evaluate the accuracy of three-dimensional virtual sonographic cystoscopy (VSC) in the characterization of ureterocele in duplex collecting systems.Sixteen children with a mean age of 5.1 (standard deviation 1.96) years with transabdominal ultrasonography-proven duplex system and ureterocele were included. They underwent VSC by a single pediatric radiologist. All of them subsequently had conventional cystoscopy, and the results were compared in terms of ureterocele features including anatomy, number, size, location, and extension.Three-dimensional VSC was well tolerated in all cases without any complication. Image quality was suboptimal in 2 of 16 patients. Out of the remaining 14 cases, VSC had a high accuracy in characterization of the ureterocele features (93%). Only the extension of one ureterocele was not precisely detected by VSC.The results of this study suggest three-dimensional sonography as a promising noninvasive diagnostic modality in the evaluation of ectopic ureterocele in children.

Acute scrotum is a critical clinical entity in children. This report presents a 12-year-old boy presented with recurrent epididymo-orchitis (EO) with a history of pelvic trauma and urethral disruption 10 years ago. Antegrade and retrograde studies confirmed urethrovasal reflux. The patient did not respond to prophylactic antibiotics, clean intermittent catheterization and endoscopic injection of bulking agent at the junction of the ejaculatory duct and posterior urethra. As the last option, neurovascular sparing vas clipping was performed and the patient made a full recovery. This is the first report of this technique in the treatment for recurrent EO caused by traumatic injury.

Over the past 2 decades, ureteroscopy has changed from a procedure considered second-line to shockwave lithotripsy to a commonly performed procedure for renal and ureteral stones. The increase in the use of ureteroscopy is due largely to improvements in technique and technology during this time period. Herein we review outcomes of ureteroscopy in terms of success rates, complications, and unique patient populations. This work will synthesize the data as it pertains to the practice of ureteroscopy for all endourological indications, including stone disease and management of upper tract urothelial carcinoma, as well as review state-of-the-art techniques.

Summary Objective The aim of this study was to present a novel laparoscopic technique for persistent urinary incontinence in pediatrics due to ectopic ureter associated with poor functioning upper renal moiety. Methods This technique consisted of laparoscopic clipping of the upper moiety artery and vein. The ectopic ureter was also clipped afterwards without upper pole partial nephrectomy. Results The patient was a seven-year-old girl with persistent urinary incontinence and confirmation of duplex kidney with poor functioning upper moiety in pre-operative investigations. The upper moiety ureter was ectopically drained to the vaginal cavity. She was immediately dry after surgery and discharged on the second postoperative day. During the follow-up period of 14 months, she was continent and symptom-free. Hydronephrosis was not visualized in follow-up ultrasonography. Conclusions This laparoscopic upper renal moiety vascular and ureteral clipping without partial nephrectomy could serve as a promising, safe and simple alternative in the treatment of patients with ectopic ureter associated with poor functioning renal moiety. Also, ipsilateral normal functioning moiety would not be associated with potential morbidity in this technique.

Introduction and Objective Hypospadias is a common congenital malformation of the male genital tract. The most frequent complication after hypospadias repair is urethrocutaneous fistula. 1 Its incidence has been reported up to 35% worldwide. 2 The diagnosis of these fistulas is sometimes challenging particularly with tiny and multiple fistulas. Usually, parents complain of urinary spraying, sprinkling, or passing a single stream of urine from the undersurface of the penis after the surgery. Urethrocutaneous fistulas are not always visible on physical examination. Locating the fistula and status of the surrounding skin is very important in order to choose the surgical repair technique. 3 The patency and anatomy of the distal urethra should also be determined before the repair surgery. 4 That is why urologists usually use retrograde urethrography or cystoscopy to find the location of fistula. However, these modalities have their own risk for children and are not always helpful. Sometimes the contrast media inserted can clog some fistulas especially near the glans and preclude the diagnosis. We present an easy technique to screen for urethrocutaneous fistulas after hypospadias surgery. Technique In this technique ( Video 1 ), an antibiotic ointment is inserted through the meatus while the base of the penis is held; the ointment is then gently pushed through the meatus. As shown in the video, the ointment will protrude through the fistulas anywhere along the shaft. This technique can also be performed reversely as the ointment inserted from the fistulas will protrude from the meatus. For younger children under the age of 3, we exclusively perform this technique under anesthesia on the repair surgery day, whereas in toddlers we perform this technique in the office and once again under anesthesia right before the repair surgery. Result This technique shows even tiny and multiple fistulas not detectable on physical examinations. We have used this technique in our clinic and have not missed any fistulas. The diameter of the protruded ointment in reverse fistulography is an indicator of the distal urethral diameter. Therefore, in case of narrow ointment diameter, distal urethral strictures should be suspected as correction of distal obstruction is an important determinant in the success rate of fistula repair surgery. 5 Conclusion We suggest this diagnostic technique as a safe, inexpensive, easy, office-based, feasible, and reproducible method. Negative urine culture is not required for this examination. Also, there is no need to insert contrast media as in retrograde urethrography or induce anesthesia as in cystoscopy. We believe this simple technique help urologists around the world to diagnose this common complication of hypospadias surgery without the need for special equipment.

Rationale, aims and objectives Attitude towards and knowledge of various groups of health care providers regarding evidence-based medicine (EBM) have been assessed worldwide. Also, barriers to practising EBM have been found to be different in different countries. However, there is little evidence on the place of EBM among some developing countries, like Iran. The aim of this study was to explore the current status of EBM among different medical specialists in Iran. Methods This cross-sectional study was conducted from August 2007 until March 2009 on a sample of 181 doctors in different medical specialties practising in Isfahan, Iran, not including faculty members. Attitude towards EBM and the barriers in practice and awareness of technical terms were investigated through a self-administered questionnaire. Results Less than half (41%) of the doctors reported they use EBM in their practice. They believed EBM improves the quality of health care services (70%); however, their understanding of the technical terms used in EBM was poor. The barrier to practising EBM identified by most respondents (74.3%) was the lack of EBM training courses in their academic curriculum. Conclusion Despite the general welcoming attitude of all groups of specialists, they had insufficient knowledge and inadequate use of EBM in their practice. Designing and conducting EBM training courses and its integration into the general practitioners' training curriculum should be considered.

To report the feasibility, efficacy and safety of decellularized dermal strip as a sling material in the pudendal denervated stress urinary incontinence (SUI) in an animal model. Thirty female Sprague–Dawley rats were randomly allocated into three equal groups (n = 10). In group 1, rats underwent bilateral pudendal nerve transection (BPNT) with no vaginal sling placement. Group 2 underwent BPNT with homologous decellularized dermal strip placement as vaginal sling 12 weeks later. Group 3 was considered as controls to evaluate baseline leak point pressure (LPP). Leak point pressure was measured 18 weeks after BPNT in group 1 and 6 weeks after sling implantation in group 2. Sling and sphincter samples were prepared for histological and immunohistochemistry (IHC) staining. H&E staining of external urethral sphincter showed decrease in striated muscle layer in group 1 (BPNT) compared to control confirmed by desmin staining (45 % decrease in desmin staining). Sling implantation caused significant increase in mean LPP from 11.6 ± 2.8 cm H2O in group 1 (BPNT) to 27.2 ± 5.4 cm H2O in group 2 (BPNT/sling). There was no significant difference between LPP after the sling placement in group 2 and LPP in group 3 (27.2 ± 5.4 cm H2O vs. 27.6 ± 5.9, P = 0.832). IHC staining was positive for α-SMA and CD34. Based on present results, this dermal strip could be considered as a potential sling material for treatment of SUI in this animal model. This study provides the basis for further investigation of the efficacy of biological decellularized scaffold as suburethral sling material.

In this study, a novel technique of irreversible sphincter deficiency by pudendal nerve transection (PNT) using 40 female rats for studying the pathophysiology of stress urinary incontinence associated with childbirth was developed. Of the 40 rats, 10 served as controls and the remaining underwent bilateral PNT at the anastomotic lumbosacral trunk level. Urethral morphological changes following bilateral PNT were assessed with serial hematoxylin and eosin (HE) and immunohistochemistry (IHC) staining methods at 50, 90, and 130 days post-intervention. Leak point pressure (LPP) measurement was used to determine the effect of pudendal injury on urethral outlet resistance after the transection. HE and IHC staining showed irreversible loss of striated muscle mass of the sphincter region and increase in collagen deposition compatible with muscle atrophy. LPP measurements also significantly decreased following bilateral PNT. In conclusion, a novel method of irreversible sphincter insufficiency was developed. This model effectively decreased urethral outlet resistance and caused irreversible striated muscle atrophy. It was suggested that this technique can be used to develop a permanent sphincter deficiency model for the preclinical testing of treatment modalities exclusively triggering the pudendal nerve.

Electrical stimulation has been used as an alternative therapy for adult urinary syndromes and for children with constipation. We have evaluated the safety and efficacy of interferential (IF) electrical stimulation in children with nocturnal enuresis (NE). This was a randomized clinical trial in which 54 children (23 girls, 31 boys) aged 6–14 years with primary NE were recruited and randomly divided into two groups. Children in the control group underwent standard urotherapy only (hydration, scheduled voiding, toilet training, diet), whereas children in the IF group (cases) were treated with standard urotherapy + 15 sessions of IF electrical stimulation for 20 min twice per week. An improvement score was calculated to identify relative decrease in wet nights after the treatment for each child. All children were followed for 1 year. Overall, 15/27 (55.5 %) and 6/27 (22 %) of children in the IF and control groups responded to treatment at the 1-year follow-up (P = 0.01). The mean number of wet nights per week in the control and IF groups decreased from 5.4 ± 2 and 5.7 ± 2 to 3.3 ± 3 and 1.1 ± 2, respectively, at first evaluation (P = 0.003). The mean improvement score in the IF group was significantly higher than that of the control group after 1 year (78 vs. 46 %, respectively; P = 0.004). Interferential therapy can be applied as a safe, effective and well-tolerable alternative therapy in the treatment of children with NE.

Voiding dysfunction is a common entity in pediatric urology. It is believed to have a multifactorial etiology. The aim of this study was to investigate whether there is an increased prevalence of generalized joint hypermobility (GJH) in children with voiding dysfunction compared to normal children. Moreover, the prevalence of voiding complaints in patients with and without GJH was assessed. A total of 226 children—aged 5 to 14 years—including 113 patients diagnosed with voiding dysfunction and 113 sex/age/body mass index-matched normal children were recruited. GJH was evaluated in both groups using the Beighton score (4 or more = hypermobile). In the patient’s group, GJH was significantly more frequent than in controls: 51/113 (45 %) versus 19/113 (17 %) (P = 0.001). In addition, in both groups, GJH was more prominent in girls than boys (P

Hemangiopericytoma (HPC)/solitary fibrous tumor (SFT) is an uncommon vascular tumor suggested to be originating from pericytes. There are few reports on bladder HPC/SFT. We present a case of huge bladder HPC/SFT measuring 13.9 × 12.2 × 11.1 cm with invasion to right iliac vein in a 54-year-old man. The patient underwent radical surgical tumor excision without chemotherapy or radiotherapy. The patient is symptom-free without recurrence or metastasis during the 12-year follow-up period. This case is the longest follow-up reported to date for bladder HPC/SFT.

Several studies have evaluated cytoskeletal proteins as prognostic factors for some types of nephrotic syndrome. However, studies concerning children with FSGS are scarce. This study was done to evaluate the glomerular, tubular, and interstitial expression of vimentin, desmin, and alpha smooth muscle actin (α-SMA) in kidney specimens of children with FSGS. Clinical and histologic data of 31 children with FSGS were reviewed. Thirty one formalin-fixed, paraffin-embedded kidney biopsy sections (3 μm) were selected for immunohistochemical staining. Double immunohistochemistry using a microwave-based two-color staining was applied. The mean age at onset in male and female was 56.3 ± 41.4 and 78.0 ± 60.4 months, respectively. The duration of follow-up was 46.3 ± 56.5 months. Interstitial fibrosis and tubular atrophy were reported in 42% and 54% of the patients, respectively. The latest evaluated mean blood pressure was significantly correlated with the expression of both vimentin and α-SMA in the interstitium (P < 0.05). However, we were not able to demonstrate any cytoskeletal protein expression as an independent predictor for renal survival. Further studies with larger sample size and longer follow-up periods are warranted to investigate the prognostic values of other histopathologic features in pediatrics with FSGS.

Attitude towards and knowledge of various groups of health care providers regarding evidence-based medicine (EBM) have been assessed worldwide. Also, barriers to practising EBM have been found to be different in different countries. However, there is little evidence on the place of EBM among some developing countries, like Iran. The aim of this study was to explore the current status of EBM among different medical specialists in Iran.This cross-sectional study was conducted from August 2007 until March 2009 on a sample of 181 doctors in different medical specialties practising in Isfahan, Iran, not including faculty members. Attitude towards EBM and the barriers in practice and awareness of technical terms were investigated through a self-administered questionnaire.Less than half (41%) of the doctors reported they use EBM in their practice. They believed EBM improves the quality of health care services (70%); however, their understanding of the technical terms used in EBM was poor. The barrier to practising EBM identified by most respondents (74.3%) was the lack of EBM training courses in their academic curriculum.Despite the general welcoming attitude of all groups of specialists, they had insufficient knowledge and inadequate use of EBM in their practice. Designing and conducting EBM training courses and its integration into the general practitioners' training curriculum should be considered.