Mahdi Hemmati Ghavshough

Background: Non–muscle-invasive bladder cancer (NMIBC) accounts for the majority of newly diagnosed bladder cancer cases and is characterized by high rates of recurrence and progression. Intravesical Bacillus Calmette–Guérin (BCG) remains the standard of care for high-risk disease; however, treatment intolerance, failure, and global supply shortages have prompted investigation of alternative intravesical therapies. Objective: To summarize and critically appraise the existing clinical evidence evaluating sequential intravesical gemcitabine and docetaxel (Gem/Doce) in NMIBC, across different clinical contexts. Methods: We performed a narrative review of published clinical studies assessing sequential intravesical Gem/Doce in patients with BCG-unresponsive, BCG-exposed, and selected treatment-naïve NMIBC. Reported oncologic outcomes, including recurrence-free survival, progression, cystectomy rates, and treatment-related adverse events, were reviewed. Emerging exploratory approaches, including biomarker-based risk stratification, were also described. Results: Across multiple retrospective and prospective studies, Gem/Doce has demonstrates favorable recurrence-free survival, and acceptable safety profiles, particularly in patients with BCG-unresponsive or previously treated high-risk NMIBC. Reported rates of progression and cystectomy are generally low, and treatment discontinuation due to toxicity is uncommon. Exploratory studies have evaluated AI-assisted histologic biomarkers as potential tools for risk stratification and hypothesis-generating treatment selection; however, these approaches remain investigational and require prospective validation. Conclusion: Current evidence suggests that sequential intravesical Gem/Doce is a well-tolerated bladder-sparing option with encouraging oncologic outcomes, particularly in patients with recurrent or BCG-unresponsive NMIBC. While early data have explored its use in treatment-naïve settings, definitive conclusions regarding its role as first-line therapy require validation in prospective randomized trials.

Introduction and Hypothesis We aimed to translate and validate the International Consultation on Incontinence Questionnaire Nocturia (ICIQ-N) and Nocturia Quality of Life (ICIQ-Nqol) into Persian by assessing the validity and reliability of the translated versions. Methods The English versions of the ICIQ-N and ICIQ-Nqol were translated into Persian using a forward–backward translation method. Content validity was assessed quantitatively using the Content Validity Index (CVI) and Content Validity Ratio (CVR) by ten urologists. Construct validity was evaluated using exploratory factor analysis (EFA) on data from 208 female patients with at least one lower urinary tract symptom. Internal consistency was determined using Cronbach’s alpha, and test–retest reliability was assessed over a 14-day interval using the intraclass correlation coefficient (ICC). Result The Persian translations demonstrated high content validity, with all items achieving acceptable CVI and CVR values. Exploratory factor analysis revealed a single dominant component for both questionnaires. Cronbach’s alpha for the ICIQ-N was 0.888 and for the ICIQ-Nqol was 0.986, indicating excellent internal consistency. Test–retest reliability was also high, with ICC values of 0.869 (95% CI 0.817–0.905) for the ICIQ-N and 0.974 (95% CI 0.968–0.979) for the ICIQ-Nqol. Conclusion The Persian ICIQ Nocturia and Nocturia Quality of Life were valid and efficiently adapted for use in various settings.

Background and Objective: Benign prostatic hyperplasia (BPH) often necessitates surgical treatment, with open prostatectomy remaining a standard approach. However, this procedure carries a significant risk of intraoperative and postoperative bleeding, often requiring blood transfusions. Tranexamic acid (TXA), an antifibrinolytic agent, has shown potential in reducing surgical blood loss. This study aims to evaluate the effect of intraoperative local administration of TXA on perioperative blood loss in patients undergoing open prostatectomy for BPH. Methods: In this double‐blind randomized controlled trial, 140 patients with BPH were assigned to either a TXA group or control group. In the intervention group, 1 g of TXA was diluted in 100 mL of normal saline and injected into the prostatic fossa during surgery, followed by three additional postoperative doses. The primary outcome was total perioperative blood loss. Secondary outcomes included changes in hemoglobin, hematocrit, platelet count, transfusion requirement, and length of hospital stay. Baseline differences, including a significant age gap between the groups (mean age: TXA group 60.70 ± 7.44 years vs. control group 70.50 ± 6.68 years), were statistically adjusted during analysis. Results: Perioperative blood loss was significantly lower in the TXA group (116.65 ± 43.23 mL) compared to the control group (210.27 ± 87.94 mL, p value = 0.001). The mean hemoglobin drop was also significantly reduced in the TXA group at both 24 and 48 h postoperatively. Fewer patients in the TXA group required blood transfusion (2.85%) compared to the control group (10%, p value = 0.03). No major adverse events directly attributed to TXA were identified, although one patient in the TXA group developed a pulmonary embolism. Conclusion: Intraoperative local administration of TXA significantly reduces perioperative blood loss and the need for blood transfusion in patients undergoing open prostatectomy. TXA appears to be a safe and effective strategy for minimizing surgical bleeding in this setting. Trial Registration: Iranian Registry of Clinical Trials: IRCT20180625040232N8

Introduction: Schwannomas are typically benign tumors with a low likelihood of becoming malignant. Approximately 4% of schwannomas occur in the nasal passages, leading to gradual enlargement, cosmetic issues, and sensory disturbances. Common symptoms include nasal congestion and headaches. Nasal tip schwannomas are particularly rare, with only a few cases documented. This report presents a case of nasal tip schwannoma, detailing the symptoms, diagnostic process, and treatment provided. Case Presentation: A 14-year-old girl was referred for evaluation of a nasal lump that altered the appearance of her nose. She reported mild pain and numbness in the nasal area. Upon examination, a mobile lump was identified beneath the skin and inside the nasal cavity, with no other abnormalities noted. Preoperative imaging revealed a well-defined soft tissue mass without infiltration into surrounding structures. During an open rhinoplasty procedure, 17 nodules were excised to correct nasal deviation. Pathology confirmed a benign schwannoma. The surgery was successful, and after nine months, the patient maintained a stable nasal appearance and reported symptom relief. No complications or recurrences were observed, preserving the aesthetic outcome. Conclusions: Nasal tip schwannoma is an uncommon condition that is diagnosed through imaging studies and confirmed by histopathology. Accurate diagnosis requires careful review of the patient’s medical history, a thorough physical examination, and relevant diagnostic tests. This comprehensive approach is essential for timely and precise diagnosis of rare nasal conditions, including differential diagnoses such as hemangioma.

Background: Varicocele is a leading cause of male infertility. Left-sided nephrectomy has been associated with an increased risk of varicocele. Objectives: This study aimed to report the frequency and investigate the association between physical examination, Doppler ultrasonography, histological findings, and varicocele diagnosis in kidney donors who underwent left-sided nephrectomy. Methods: This cross-sectional study included adult males who underwent nephrectomy. The study compared the results of physical examination, ultrasound, and histological findings of the diameter of the left spermatic vein and pampiniform venous plexus. The chi-square test was used to assess differences in the diagnosis and grading of varicocele between the different methods. Results: Fifty males with a mean age of 36.6 years were included. Through physical examination, 42% were diagnosed with varicocele, with most cases classified as grade II. Ultrasound examination revealed that 46% had varicocele, with the majority also being grade II. Histological findings showed that most cases had intact valves (54%), followed by lax and incompetent valves (32%), and no valves (4%). There was a significant difference between the physical examination diagnosis of varicocele and the histological findings (P = 0.04), whereas the difference was not significant for Doppler ultrasound (P = 0.07). Conclusions: In kidney donors, there was a notable discrepancy in varicocele diagnosis between physical examination and histological findings, unlike ultrasound. Larger observational studies are recommended to further assess this association and explore alternative methods for varicocele diagnosis.

Background and Objective: Kidney Transplantation (KT) is one of the preferred treatments for patients with end-stage renal disease (ESRD) and chronic kidney disease (CKD). However, KT is associated with undesired outcomes. This study aims to explore the reasons and prevalence of urological complications among organ recipients after the KT procedure in Eastern Asia. Materials and Methods: We studied 94 patients who received cadaver transplants at Imam Reza Hospital in Tabriz from 2018 to 2022. Demographic information, including body mass index, age, and gender, were gathered and analyzed. Results: Urological complications were documented in 19 out of 94 patients (20.21%). Patients aged over 55, male gender, high American Society of Anesthesiologists score, high blood pressure, and diabetes mellitus were associated with an increased risk of complications by 2.29, 1.96, 14.37, 5.24, and 8.14 times, respectively. Conclusion: Our results demonstrated the high prevalence of urological complications after KT. These findings underscore the importance of implementing preventive approaches and monitoring urological complications among KT recipients. By implementing appropriate strategies, healthcare providers can improve the outcomes and success of KT.

Background Varicocele, which is defined as varicose veins in the scrotum, is associated with different complications, in particular infertility. However, the definite etiologies have not determined yet. Our objective was to investigate the association between left lumbar, renal, and gonadal veins diameters and varicocele occurrence and grading in kidney donors underwent left-sided nephrectomy. Also, the frequency of varicocele were evaluated three months after the surgery. Methods In this observational study, male kidney donors aged 18 to 65, who underwent open nephrectomy were included between 2022 and 2023. Baseline data on age, body mass index (BMI), and the presence or grade of varicocele were collected through medical records and physical examinations. During the procedure, the diameter of the left lumbar, renal, and gonadal veins were measured using a graded ruler on the back table. Three months after the nephrectomy, the patients were re-evaluated for varicocele recurrence. Results We included 30 kidney donor with a mean age of 38.2 years and BMI of 23.5 kg/m2. The renal vein diameter decreased with higher grading (p = 0.05) and the gonadal vein diameter increased with higher grading (p = 0.04). However, there was no significant association between varicocele grading and left lumbar vein diameter. Following three months of nephrectomy, the frequency of varicocele increased from 33.4–50.0%. Conclusions The diameter of the left lumbar vein was almost unchanged in varicocele, while the size of the left renal vein decreased, and the size of the left gonadal vein increased. Furthermore, occurrence of varicocele increased after three months of left-sided nephrectomy. Therefore, people undergoing nephrectomy are at a higher risk of developing varicocele which should be considered in follow-up visits.

Background: Early graft loss (EGL) is one of the rare complications of kidney transplantation. Several factors play a role in the occurrence of EGL in kidney transplant recipients, which must be identified and limited. Objectives: This ten-year retrospective study was conducted in a single center on 32 kidney transplant recipients with EGL to determine the reasons for and risk factors of kidney transplant rejection in Iran. Methods: This descriptive-analytical study’s population included 605 kidney transplant recipients receiving kidneys during the last ten years in our center. The diagnosis of EGL was based on renal allograft biopsy examination and primary clinical complications, including a rapid increase in serum creatinine. The age, gender, blood group, and rhesus (Rh) of both donors and recipients, as well as the kinship between the donor and recipient (relative and non-relative), right/left-sided living donor/recipient kidneys, primary kidney disease, the presence of underlying disease in the recipient, dialysis duration, the year of kidney transplantation, transplant survival time, patient survival time, and complications (surgery and others) were gathered. The data were analyzed using SPSS version 18. Results: In this study, 32 out of 605 kidney transplant recipients (5.28%) experienced EGL (53.1% male and 46.9% female, average age of 41.12 years). The duration of kidney function after transplantation was 5.56 ± 0.13 days. The transplanted kidneys were functional between 72 hours and one week after transplantation in 34.4% of the patients. The causes of EGL were found to be tissue rejection in 31.3% of the patients and vascular thrombosis and hyperacute rejection in 21.8%. Nephrectomy occurred in 41% of the patients, and 43.75% died because of a heart attack. Conclusions: Our findings supported previous studies' results, suggesting that EGL is associated with receiving an incompatible kidney transplant and surgery-related complications, including bleeding and thrombosis.