Mohammad Mehdi Hosseini

Purpose: To assess and compare the safety and efficacy of supracostal and subcostal access percutaneous nephrolithotomy (PCNL) for isolated upper pole stones, we designed a prospective randomized clinical trial. Materials and methods: A prospective randomized study of 76 patients (18–65 years old) was conducted from January 2024 to September 2024 on isolated upper calyceal renal stones at a medical teaching hospital. The eligible participants were divided into subcostal and supracostal access for PCNL groups (38 patients per group). The measured variables included age, sex, body mass index, stone size, comorbidities, procedure time, stone-free rate, hospital stay, and complications (modified Clavien Dindo grading). Results: Of 76 patients, 47 were male and 29 female, with a mean age of 47 and 53 years for the subcostal and supracostal groups, respectively. The mean stone size was 27.38 and 28.89 mm in the two studied groups, respectively. The mean operation and fluoroscopy time, hospital stay, laboratory data, and complications had no significant difference between the two investigated groups. Conclusion: Unlike the traditional view, supracostal access during PCNL is safe and effective and is not associated with a higher incidence of postoperative complications. However, both procedures were performed by skilled surgeons, so surgeons should have sufficient training and choose the proper method for each patient individually to minimize complications and obtain the best results. Further studies with a large number of cases are recommended.

Stuttering is a common problem at all ages that is required to be treated since childhood. Atomoxetine is currently used for the treatment of attention deficit hyperactivity disorder (ADHD). It can be effective for the treatment of stuttering due to its selective inhibition of norepinephrine reuptake and dopaminergic properties. Therefore, this randomized controlled trial aimed to evaluate the effect of atomoxetine on children's stuttering. The children aged 4-12 years and diagnosed with stuttering, referred to Pediatric Neurology and Psychology clinics , were randomly divided into experimental (n=50) and control (n=50) groups. One group received atomoxetine plus speech therapy, and the other group received only speech therapy. Both groups completed the Stuttering Severity Instrument-Fourth Edition at the baseline (on the first visit) and 3 months after the intervention. The results were compared between the two groups using SPSS software (version 21). Most of the children (67%) were male. Moreover, 24%, 46%, and 30% of the subjects were within the age ranges of < 60, 60-95, and > 95 months, respectively. Nearly half of the patients (52%) had a positive family history of stuttering. Stuttering severity was the highest within the age range of 60-95 months, in left-handed children, in those who used formula, and in those who felt insecure in the family; however, there was no difference in stuttering severity based on child's gender, concomitant ADHD, multilingualism, facial or movement tics, sleeping hours, and using teats. The mean stuttering severity reduced in both groups (P<0.001), with a greater decrease in the experimental group, compared to that of the control group (P=0.011). Atomoxetine plus speech therapy is effective for the treatment of children's stuttering and can be used as a complementary treatment strategy in such patients.

Objective: The objective of the study was to assess the outcome and feasibility of ultrasonography (US)-guided minimally invasive percutaneous nephrolithotomy (mini-PCNL) in children. Materials and Methods: Twenty-five children with upper urinary tract stones who had undergone US-guided mini-PCNL from June 2017 to June 2020 were enrolled in this study. Patients’ demographic information and post-treatment results were retrospectively gathered and analysed. Pyelocaliceal system was punctured in prone position using US guidance, and the tract was dilated using single-shot dilation technique. All steps of renal access were done using only US. Mini-PCNL in all cases was done by using 15 Fr rigid nephroscope. Stones were fragmented with a pneumatic lithotripter and evacuated. Results: The patients’ mean age was 6.30 ± 3.25 years (range: 1.5–15). The mean stone size was 16.04 ± 3.93 mm (range: 10–30). The mean access time to the stone was 1.50 ± 0.62 min (range: 1–4). The mean operation time was 94.66 ± 3.05 min (range: 90–100 min). The final stone-free rate was 96%. Post-operation fever occurred in 4 (16%) patients who were treated successfully with an antibiotic. No major complications occurred. Conclusions: We recommend US-guided mini-PCNL as a harmless alternative treatment option, in children with renal calculi due to its excellent outcomes and little complications.

Background and aim: Although urolithiasis is not common in pregnancy, but is the most common nonobstetric complication in pregnant women. It can associate with significant potential risks for both mother and fetus and needs multi-disciplinary and perfect team work. Diagnosis and management are challenging because of physiological changes and limitation ...

Urolithiasis during pregnancy poses risks for mother and the fetus with specific challenges in diagnosis and management. We report our experience with urgent percutaneous nephrolithotomy (PCNL) in seven pregnant patients with symptomatic renal stone in early pregnancy. Seven pregnant patients with symptomatic renal stones were reviewed. The technique comprised PCNL with complete access under guide of ultrasonography in prone position under general anesthesiausing pneumatic lithoclast for stone fragmentation. There was no significant residual fragment of stone in the operated kidneys. The patients discharged without complications and delivered their babies healthy. PCNL should not be considered as the first therapeutic method in the first trimester of pregnancy, unless in urgent situations such as symptomatic renal pelvic stone with moderate to severe hydronephrosis in patients who do not tolerate or are complicated by nephrostomy or internal stent. However, this procedure could be technically demanding and should be done in centers with enough experience and equipment in percutaneousnephrolithotomy.

Background Transurethral resection of prostate (TURP) is the most common treatment for benign prostatic hyperplasia (BPH). Urinary tract catheter is inserted post-operatively which results in catheter-related bladder discomfort (CRBD) in many patients. The purpose of this study was to assess the preventive effect of hyoscine N-butyl bromide on CRBD caused by a urinary tract catheter after TURP surgery in patients with BPH. Methods Twenty-four and twenty-six patients in the treatment and control groups were enrolled, respectively. At the end of the surgery, slow intravenous injection of 20 mg hyoscine N-butyl bromide was administered to the patients of treatment group. The severity of CRBD was followed up at five different time periods and up to 2 h after surgery. Results On arrival to PACU and after 30 min of injection, statistically significant less CRBD was seen in the treatment group comparing to the control group (P ≤ 0.05 and P ≤ 0.007). The total utilized meperidine dose during PACU stay and the time to discharge for the intervention group were significantly lower than those for the control group (P ≤ 0.0001) with no significant difference in adverse effects (P > 0.05). Conclusions Hyoscine N-butyl bromide could reduce the severity of CRBD related to TURP in patients with BPH and their need for analgesic consumption either. It shortened the length of stay in the recovery room. Regarding its availability and low cost, it can be an effective pain relief drug for CRBD discomfort related to TURP in BPH patients.

Objectives: The study aimed to compare tubeless, totally tubeless, and standard percutaneous nephrolithotomy (PNL) in a tertiary center with selected patient population. Methods: Between September 2013 and March 2015, percutaneous nephrolithotomy was performed on 216 patients in our center. Patients without massive bleeding, calyceal perforation, and residual fragments smaller than 4 mm were enrolled in this study. The patients were divided into 3 groups. In the first group (n = 68), we placed nephrostomy and kept ureteral catheter for 24 hours (the standard group). In second the group (n = 69), no nephrostomy was inserted and ureteral catheter was removed in the operation room (the totally tubeless group) and in the third group (n = 79), no nephrostomy catheter was placed but antegrade DJ stent was inserted intraoperatively (the tubeless group). Three groups were compared with respect to age, analgesic requirement, BMI, length of stay, pain, and stone size. Results: No significant differences were found in the mean stone size, operation time, transfusion rates, and hemoglobin level change between the groups. However, hospitalization time, the amount of narcotic usage, and pain were significantly lower in the second group compared to the other groups (P < 0.05). Conclusions: In patients with no major intraoperative bleeding and calyceal perforation, the totally tubeless approach is safe with decreased pain, analgesia requirement, and hospital stay. Keywords: Nephrolithiasis; Percutaneous; Tubeless; Outcome

Aim: To compare open suprapubic transvesical prostatectomy (OSP) without insertion of suprapubic cystostomy, OSP with insertion of cystostomy, and transurethral resection of the prostate (TURP). Patients and Methods: A total of 104 patients with an indication for prostatectomy were retrospectively assigned to TURP (group 1), OSP with cystostomy (group 2), and OSP without cystostomy (group 3). They were evaluated for length of the operation, length of hospital stay, post-operative complications, hemoglobin drop, changes of blood pressure, and intraoperative blood loss. Results: Mean age was 67.2 ± 8.7 in group 1, 73.3 ± 8.4 in group 2, and 74.0 ± 5.7 in group 3. Prostatic volume was 35.9 ± 13.8, 74.1 ± 33.8, and 74.3 ± 31.8 in groups 1, 2, and 3, respectively. There was no significant difference in prostatic volume between groups 2 and 3 (P = 0.99), but in group 1 it was lesser than groups 2 and 3 (P = 0.00). Length of the operation was 1.2 ± 0.2 in group 3 and 1.1 ± 0.2 in group 2, without a significant difference (P = 0.45). Length of hospital stay in group 3 (2.3 ± 0.4 days) was lesser than that in group 2 (2.6 ± 0.7) (P = 0.01). The amount of hemoglobin drop was 1.1 ± 0.9 in group 1, 1.1 ± 0.7 in group 2, and 1.4 ± 0.91 in group 3 without a significant difference between all groups. The amount of bleeding during operation was 173 ± 103 in group 2 and 161 ± 78 in group 3 (P = 0.98). Conclusion: OSP without insertion of cystostomy tube is a relatively safe method; however, larger studies are needed. It is also comparable to TURP in terms of postoperative efficacy and complications.