Morteza Fallah Karkan

Introduction: Over the past decade, energy-based therapies have been introduced as non-invasive and restorative treatment modalities for erectile dysfunction. Furthermore, previous studies have shown the efficacy of penile vibratory stimulation and photobiomodulation in treating erectile dysfunction. Integrating these therapeutic approaches, which are employed simultaneously in the Vibradiofotology technology, may lead to achieving better outcomes in the treatment of erectile dysfunction. This study aims to evaluate the efficacy of Vibradiofotology technology delivered via the Erectofix device in patients with erectile dysfunction. Methods: In this randomized clinical trial, fifty-five patients diagnosed with erectile dysfunction were included. The patients were assigned to either the control group or the intervention group. In the intervention group, the patients received treatment with the Erectofix device for five sessions. Each session lasted 45 minutes and was administered once a week. Meanwhile, the control group received oral medication along with sham laser treatment. Results: Among the fifty-five patients included in the study, 27 were assigned to the intervention group and 28 to the control group. The intervention group showed a significant improvement in each domain of the IIEF score compared to the control group. The erectile function showed a significantly greater increase in IIEF scores in the intervention group (19.59±5.57) compared to the control group (7.39±2.23; P<0.001). Furthermore, significant improvements were observed in orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction in the intervention group. Conclusion: Vibradiofotology technology, which integrates different therapeutic approaches, may be a safe treatment option for erectile dysfunction. Improvements in IIEF scores, patients’ overall satisfaction, and erectile function can be promising in the efficacy of this modality. Nevertheless, due to the limitations of the present study, further research is required to investigate the potential benefits of this novel modality in improving patients’ quality of life.

Background: Overactive bladder (OAB) syndrome correlates with mental disorders, especially depressive disorders and anxiety disorders, and less frequently obsessive-compulsive symptoms, and occurs mostly in older people. Obsessive-compulsive disorder (OCD) is more frequent in OAB patients. Most OCD people are diagnosed at the age of about 19, typically with an earlier age of onset in boys than in girls, but the onset after age 35 does occur less frequently. Objectives: This study aimed to evaluate the relationship between OCD and OAB. Methods: In this case-control study, 1,160 cases who were over 18 years old who were referred to the urodynamic clinic of Shohada-e-Tajrish center from June 2013 to February 2018 in Tehran, Iran, enrolled of whom 580 were considered the control group who were non-OAB patients, and 580 subjects were considered the case group who were OAB patients. The diagnosis of OAB was confirmed by a single urologist. All cases had detrusor overactivity (DO) in urodynamic study (UDS). The OAB-validated 8-questionnaire screen test (OAB-V8) was conducted, and the diagnosis of OCD was confirmed by a single psychiatrist according to DSM-5 criteria. Moreover, the Yale-Brown questionnaire was completed for each patient to rate the severity of OCD symptoms. Results: About the Yale-Brown Obsessive-compulsive Scale (Y-BOCS) total score, there is a significant difference between patients with obsessive traits and the control group (P < 0.001). OCD scores were significantly higher in the OAB group compared to the control group (P < 0.001). Logistic regression analysis showed that the population of the studied patients with OAB was more probable to have OCD than non-OAB control subjects in aged classified groups (OR: 6.23; P < 0.001). Conclusions: The findings of this study showed that OAB patients reported higher obsessive-compulsive scores (Y-BOCS) compared to the controls. There is an independent correlation between OCD and OAB. However, the linkage between OCD and OAB justifies the need for more research.

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

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

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

Objective: Prostate cancer is one of the common malignant tumors in men worldwide. Nowadays it seems that Gleason Score 3+3 may not need definite treatment and some of the experts even ignore it as a cancer but we should be aware that in some patients with Gleason Score 3+3 there is a higher risk for harboring higher-grade cancer. We had done this study to evaluate patients with prostate cancer with Gleason Score 3+3 to determine the value of tumor volume in these cases. Material and methods: From September 2010 to October 2017, radical prostatectomy was done for 123 sequential patients with localized prostate cancer in two referral centers of Shahid Beheshti Medical University, Tehran, Iran, and 42 cases with Gleason Scores 3+3 which who were candidates for active surveillance were included in the study. Results: Thirty of 42 (71.4%) patients had significant tumor volumes (≥0/5 cm3). When tumor volume was less than 0.5 cm3, none of the patients had extra prostatic tumor extension. In patients with tumor volume greater than 0.5 cm3, two cases (6.6%) had extra prostatic extension, 4 cases (13.3%) had positive margins, four cases (13.3%) reactive lymph nodes and 16 cases (53.3%) perineural invasion. Conclusion: We suggest that some patients with Gleason Score 3+3 have tumor volume >0.5 cm3 who are considered having significant cancer pathology and active surveillance may not be appropriate approach to manage all cases with Gleason Score 3+3. Cite this article as: Ghiasy S, Abedi AR, Moradi A, Hosseini SY, Karkan MF, Sadri G, et al. Is active surveillance an appropriate approach to manage prostate cancer patients with Gleason Score 3+3 who met the criteria for active surveillance? Turk J Urol 2019; 45(4): 261-4.

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

Exchange transfusion is the standard method for treatment of severe hyperbilirubinemia. Our goal was to determine the indications for exchange transfusion (ECT) and the rates of ECT-related adverse events. A retrospective descriptive investigation was performed in newborns that underwent ECT at 17 Shahrivar Pediatric Hospital, Rasht, Guilan province during the period April 2008 to April 2011. Of the 69 patients, 2 (2.9%) required more than one ECT. The mean total serum bilirubin before ECT was 21.55 ± 5.12 mg/dl. The most common cause of ECT was ABO incompatibility (26.1%). ECT complications occurred in 9 neonates (13.0%), the most common being sepsis (7.4%). No case of ECT related mortality was observed. All the adverse events resolved completely before discharge. ABO isoimmunization was the most common cause of ECT in this study. The majority of adverse events associated with ECT are asymptomatic and reversible.