Introduction: Female urethral stricture disease (FUSD) is a rare and often disregarded cause of blockage of the female bladder outlet. Diagnostic delays are typical because lower urinary tract symptoms (LUTS) might be confused with other, more prevalent urological disorders in women. Urethral dilatation (UD) has a significant risk of recurrence even though it is a first-line therapeutic. A dorsal onlay buccal mucosal graft (BMG) urethroplasty has emerged as a feasible alternative for surgical reconstruction due to its anatomical and functional advantages.Methods: This retrospective study was done at Kanti Devi Medical College and Research Centre, Mathura, Uttar Pradesh, India, from February 2017 to February 2024. 30 female patients with urethral stricture underwent dorsal onlay BMG urethroplasty. Clinical symptoms, micturating cystourethrogram (MCUG), post-void residual (PVR) urine measures, uroflowmetry, and cystoscopy were used to make the diagnosis. Patients who had at least two unsuccessful attempts at urethral dilatation were eligible to participate. The same surgical team operated on each patient, performing dorsal onlay BMG urethroplasty. Evaluations of postoperative follow-up were carried out at 3, 6, and 12 months, and subsequently once a year for a maximum of five years. Stricture recurrence, PVR urine volume decrease, and Qmax improvement were important endpoint indicators.Results: The mean age of this research population was 50.77±6.14 years. The mean Qmax was 7.05±1.81 mL/s according to preoperative uroflowmetry, but it significantly improved to 19.5±2.83 mL/s after surgery (P-value < 0.0001). The average PVR urine volume before surgery was 116.07±21.99mL, and after surgery, it dropped to 29.13±13.09mL (P-value<0.0001). Following female BMG urethroplasty, success was achieved in 27 (90%) cases, with recurrence observed in 3 (10%) cases. Self-urethral dilatation was used to successfully manage every recurrence case.Conclusions: A safe, efficient, and technically possible surgical option for treating female urethral stricture disease is dorsal onlay BMG urethroplasty. It offers minimal complications, a high success rate, and excellent functional outcomes. For women with recurrent or resilient urethral strictures, this method is a beneficial choice.
Introduction: The Banff classification is widely used for diagnosing kidney transplant rejection, but challenges persist in accurately identifying certain histological features. This study aimed to evaluate the efficacy of PAS/CD3 mixed staining in improving the diagnosis and grading of T-cell mediated rejection (TCMR) compared to conventional staining methods.Methods: Paraffin-embedded tissue samples from 106 kidney transplant recipients were examined using H&E, PAS, and PAS/CD3 mixed staining. Two pathologists independently evaluated Tubulitis, interstitial inflammation, and intimal arteritis according to Banff classification criteria. Concordance between staining methods were assessed using weighted Kappa statistics.Results: High agreement was observed between conventional and mixed staining methods for Tubulitis (85%, P-value<0.001), interstitial inflammation (87%, P-value<0.001), and intimal arteritis (100%, P-value<0.001). Notably, 31% of cases initially scored as t0 in routine staining were upgraded to t1, and about 25% of t1 cases were upgraded to t2 when using CD3/PAS slides.Conclusions: While PAS/CD3 mixed staining showed high concordance with conventional methods, it demonstrated potential benefits in detecting mild Tubulitis and interstitial inflammation. The upgraded scores in a significant portion of t0 and t1 cases suggest that mixed staining could enhance the detection of subtle histological changes. However, the clinical significance of these findings remains to be determined, and further research is warranted to fully elucidate the role of mixed staining in kidney transplant biopsy evaluation.
Introduction: The role of omentectomy and omentopexy is crucial in reducing complications of catheter placement in peritoneal dialysis. This meta-analysis aimed to analyze the outcomes of omentectomy/omentopexy for patients undergoing peritoneal dialysis.Methods: Literature searching was done using PubMed, Cochrane Library, and Scopus, following the PRISMA guidelines. We used the keywords “continuous ambulatory peritoneal dialysis”, “omentectomy”, and “omentopexy” up to 1st November 2024. Effect sizes for outcomes with continuous and binary data are mean difference (MD) and odds ratio (OR), respectively, with 95% confidence interval. Outcomes include complications and surgical time. Results: Total of 10 studies from 381 articles were identified, consisting of retrospective and randomized controlled trial studies. From pooled analysis, omentectomy/omentopexy could reduce complications that lead to catheter removal (OR 0.31; 95% CI: 0.22−0.44), catheter dysfunction (OR 0.16; 95% CI: 0.03−0.84), and peritonitis (OR 0.28; 95% CI: 0.14−0.56), but not significant for catheter leakage (OR 0.6; 95% CI: 0.32−1.10) and bleeding (OR 0.44; 95% CI: 0.09−2.14). We found no significant result for surgical time (MD 12.72 minutes; 95% CI: -3.46−28.90). Conclusion: This meta-analysis showed that omentectomy/omentopexy can reduce complications that lead to catheter removal, peritonitis, and catheter dysfunction. Further multicentre randomized controlled trials are essential to perform a thorough comparison between the omentectomy and omentopexy for both the pediatric and adult populations.
Introduction: Bladder cancer (BC) is a major malignancy, and prostate involvement is a critical clinical concern influencing prognosis and treatment. Current BC management includes neoadjuvant chemotherapy followed by radical cystectomy, with emerging immunotherapies offering promising new avenues. Prostate involvement, reported in 15–48% of radical cystectomy cases, may occur via direct invasion or urethral spread, with stromal invasion indicating a worse prognosis. Risk factors include bladder carcinoma in situ (CIS), multifocal tumors, bladder neck involvement in prostate involvement, higher tumor grade/stage, and prior pelvic radiotherapy.Methods: This retrospective study investigated the prevalence and risk factors for prostate involvement in 281 patients with BC who underwent radical cystoprostatectomy at Alzahra and Khorshid Hospitals, Isfahan, Iran, between 2017 and 2022. Data were collected from medical records on demographics, pathological findings (tumor stage, lymph node involvement, prostate involvement, tumor size, and distance from the bladder neck), and PSA levels. Statistical analysis was performed using SPSS v26, employing the Chi-square test, independent t-test, and Mann–Whitney U test.Results: Prostate involvement was observed in 13.9% (39/281) of patients. Significant correlations were found between prostate involvement and higher tumor stage (P-value<0.001), lymph node involvement (P-value<0.001), larger tumor size (P-value=0.009), shorter distance to the bladder neck (P-value<0.001), and higher PSA levels (P-value<0.001). No significant relationship was found with age, smoking, or hospital type.Conclusion: Prostate involvement in BC is relatively common. Higher tumor stage, lymph node involvement, larger tumor size, and proximity to the bladder neck are key predictors. These findings highlight the need for a comprehensive evaluation of high-risk BC patients to improve treatment planning and oncological outcomes.
Introduction: Sexually transmitted infections rank among the primary contributors to health, social, and economic challenges in numerous nations. Circumcision is believed to change the microbial flora of the penis. In Indonesia, decisions regarding circumcision are predominantly driven by religious beliefs.Methods: This pilot study aimed to examine and compare the penile microbiome profiles of men with condyloma acuminata (CA) who had undergone either medical circumcision (MCCA) or traditional circumcision (TCCA), alongside healthy controls who had undergone medical circumcision (NMC) or traditional circumcision (NTC). The study involved two participants per group (MCCA, TCCA, NMC, NTC). Microbiome analyses were conducted using species annotation, as well as assessments of alpha and beta diversity.Results: Findings from this exploratory study revealed that the predominant bacterial genera across groups were Staphylococcus, Corynebacterium, Ralstonia, and Finegoldia. In the MCCA, TCCA, and NTC groups, Corynebacterium was the dominant genus, whereas the NMC group was predominantly colonized by Ralstonia. These preliminary results suggest that circumcision type may influence the penile microbiota composition; notably, the microbiomes of traditionally circumcised individuals (NTC) showed similarities to those of patients with condyloma acuminata who underwent either medical or traditional circumcision.Conclusion: These findings tentatively support the view that medical circumcision may offer greater microbiome stability compared to traditional circumcision; however, it may does not appear to reduce the risk of HPV infection or the development of condyloma acuminata. Larger-scale studies are warranted to validate these preliminary observations and elucidate their clinical significance.
Radiotherapy is a valuable treatment option for a variety of cancers, including prostate cancer. As indications for radiotherapy for diseases continue to change, it is important to consider the risks and how they affect the benefits of treatment. The advent of genomics has revolutionized our understanding of the genetic structure of the tumor and its response to radiation therapy in prostate cancer Germline single nucleotide polymorphisms, somatic mutations, gene expression phenotypes, and immune microenvironment in tumor and normal tissues can predict tumor response and toxicity after prostate cancer radiotherapy. Differences in response to treatment and side effects after treatment cannot be fully explained by treatment dose alone. This study examines the role of genetic differences in how patients respond to radiotherapy.
Introduction: Inadvertent placement of a nephrostomy tube in the inferior vena cava (IVC) is a very rare complication that can occur in patients with hydronephrosis who are candidates for nephrostomy placement.Case presentation: In this study, we present a 73-year-old male patient with a history of left renal agenesis and a history of pyelolithotomy and PCNL of the right kidney for moderate hydronephrosis and fever, who was a candidate for right renal nephrostomy due to increased creatinine. In this report, we show that without open surgery, by correcting the nephrostomy site and pulling it out by 6 cm under the control of a C-arm device, a new nephrostomy site was observed.Conclusion: Our recommendation in this study: Accurate measurement of the depth of penetration of the Sheba needle into the dilator and nephrostomy should be performed at the nephrostomy coil position. Also, nephrostomy placement should be performed by experienced urologists and the nephrostomy site should be checked by C-arm at the end of the procedure, and the advancement of the nephrostomy metal pin without accurate measurement should be prevented.
Introduction: Nephrolithiasis is a condition that is very common around the world. The gold standard for treating big renal calculi is Percutaneous nephrolithotomy (PCNL), which is often carried out in the prone position. Recently, there has been an increase in interest in supine PCNL in the global endourology arena.Method: This is a prospective comparative study. 53 patients with renal stones underwent PCNL, done by a single expert surgeon, the patients were divided randomly into 2 groups, 26 of them operated with supine percutaneous nephrolithotomy and 27 with prone percutaneous nephrolithotomy. Patient’s demographics, access time, operative duration, stone-free rate, post-operative hemoglobin drop and complications were compared.Results: The demographics and characteristics of the stones were similar in both groups. The supine position for PCNL demonstrated a notably shorter operative time compared to the prone position for PCNL., 60.3±3.7 min vs 79.7±2.5min (P-value<0.001). The stone-free rate at 1-month duration was slightly better for prone, 24 patients (88.9%) for prone and 22 patients (84.6%) for supine, but statistically not significant (P-value 0.645). Hospital stays were 50.3±6.7 hr for supine and 52.65±6.4 hr for prone respectively (P-value 0.198). Hb drops were comparable, 1.22±0.09 in supine and 1.26±0.096 in prone (P-value 0.124). Post-operative Complications were found to be 4 patients (15.4%) of which (2 with fever and hematuria, and 2 with hematuria only) occurred in supine while 5 patients (18.5%) had occurred in prone group (1 with fever only, 2 with fever and hematuria, and 2 with hematuria only) (P-value 0.761). Patients had no complications Clavien grade III or higher in both groups.Conclusion: Supine PCNL is as safe and effective procedure as prone, with comparable stone-free rate and complications, with added advantage of a significantly lower operative time.
Introduction: The efficacy of arteriovenous fistula (AVF) for hemodialysis (HD) in the elderly population is still a matter of concern. Our study aimed to assess the results of arteriovenous fistula performed at our institution in patients aged 65 years and older.Methods: All chronic kidney disease (CKD) patients, aged 65 years or older, who underwent the creation of an AVF between December, 2021 and January, 2023, were included in this retrospective study. Essential demographic data, such as age, gender, and any other existing medical conditions were documented. Details regarding the method of access and the specific location were documented. The study's objective was to determine the primary and Cumulative (secondary) patency rates as the endpoint. The study had a minimum follow-up time of 1 year.Results: Within the study period, 116 AVF surgeries were done. The mean age was 69.4 years. We created brachiocephalic AVF in 68% of cases (n=79), radiocephalic AVF in 21% (n=24), brachiobasilic Transposition in 5% (n=6), using brachiocephalic transposition in 2.58% (n=3), and with a PTFE graft in 1.7% (n=2). Additionally, two patients underwent a brachiobasilic (side-to-side) approach. The overall survival rate of the AVF was 74% at one year following formation. By the 18th month, the primary and secondary potencies were 58.6% and 69%. BC AVF has better survival rate compared to RC AVF and BBT. In terms of the reasons for access failure, thrombosis accounted for 50%, Non thrombotic complications in 16% and severe cannulation injury in 10%Conclusion: In elderly population our aim should be to create the initial access point that has the highest likelihood of maintaining dialysis over an extended period of time. We have found that Complications are the primary driver of AVF failure (coefficient 1.19, P-value<0.001), while AVF type alone does not significantly predict failure.
Introduction: Double-J (DJ) ureteral stents are essential to modern urological therapy because they allow internal urine drainage in a variety of clinical contexts, such as obstructive uropathy, postoperative support, and short-term ureteral blockage alleviation. Despite advancements in design, material, and surface coatings since their initial description in 1967 and further refining in 1978, patient-reported discomfort is still a major problem with DJ stents.Methods: This review summarizes the most recent data about the causes, symptoms, complications, and pharmaceutical treatment of adverse effects associated with stents. A complex combination of ureteral smooth muscle spasm, vesicoureteral reflux, and mechanical irritation of the bladder caused by the distal coil contribute to the pathophysiology of ureteral stent-related symptoms (USRS).Results: Prevalence estimates vary from 50% to 80% across a range of patient demographics, and often reported symptoms include flank discomfort, hematuria, sexual dysfunction, and lower urinary tract symptoms (frequency, urgency, and dysuria). Especially when indwelling for longer than three months, complications include encrustation, biofilm formation, stent migration, fragmentation, and retained ("forgotten") stents increase morbidity. Pharmacological strategies aim to mitigate USRS by addressing the underlying mechanisms: neuropathic pain modulators (duloxetine, pregabalin) address central pain pathways; alpha-adrenergic antagonists (tamsulosin) decrease ureteral smooth muscle tone and reduce flank pain and urinary urgency; anticholinergics (solifenacin) attenuate detrusor overactivity and improve bladder storage symptoms; and β₃-adrenergic agonists (mirabegron) enhance detrusor relaxation with favorable tolerability; and neuropathic pain modulators (pregabalin) address central pain pathways. Randomized trials show that combination regimens (alpha-blocker plus anticholinergic) provide superior relief of irritative and voiding symptoms compared to monotherapy, with notable improvements in validated symptom scores and quality-of-life indices.Conclusion: For patients who need ureteral stenting, a multidisciplinary, patient-centered strategy that includes prompt stent removal, optimal medication, and careful monitoring is crucial to improving tolerability, lowering adverse events, and improving overall results.
Introduction: Prostatic ductal adenocarcinoma (DAC) is a rare and aggressive variant of prostate cancer that can present clinical features mimicking other malignancies, such as transitional cell carcinoma (TCC). This case highlights the diagnostic challenges and the importance of distinguishing DAC from TCC due to differing treatment approaches and prognoses.Case Presentation: An 80-year-old man presented with hematuria and mild lower urinary tract symptoms. A digital rectal examination revealed a mildly enlarged, rubbery prostate, and his prostate-specific antigen (PSA) level was 2 ng/ml (normal range: 0–4 ng/ml). Cystoscopy identified a lesion at the verumontanum suggestive of TCC. However, histopathological analysis of biopsy specimens revealed high-grade DAC of the prostate with cribriform and papillary architecture. Immunohistochemical staining was positive for prostate-specific acid phosphatase (PSAP) and PSA, confirming the diagnosis. Imaging studies, including a bone scan, pelvic MRI, and CT of the thorax, abdomen, and pelvis, showed no evidence of localized or metastatic disease. The patient underwent transurethral resection (TUR) of the transitional zone and verumontanum, with histopathology reporting no carcinoma infiltration.Conclusions: This case emphasizes the need for thorough diagnostic evaluation in patients presenting with lesions suggestive of TCC, as DAC may present similarly but requires distinct management. Early and accurate diagnosis can significantly impact treatment strategies and clinical outcomes.
Introduction: To assess the effect of omega-3 supplementation on the semen profile of men experiencing infertility.Methods: This study included men diagnosed with spermogram disorders who sought treatment at Ghaem Hospital, Mashhad, Iran, from October 2022 to October 2023. After eligibility criteria evaluation, the participants were randomly assigned to two groups. The control group received standard treatments (zinc supplements, 15mg/d) along with a placebo, whereas the intervention group was administered oral omega-3 supplements (1000mg/d) in addition to the standard treatments for a duration of three months. A second spermogram was performed for both groups, and the outcomes were compared and analyzed.Results: The research involved 58 participants, with an average age of 33.52 ± 6.32 years, who were evenly distributed into two groups of 29 each. No significant differences were observed between the two groups in the field of changes in seminal fluid volume (P-value=0.450), sperm count (P-value=0.217), or the percentage of sperm with normal morphology (P-value=0.665). However, a significant increase of 13.09±13.51% in the number of motile sperm was noted in the intervention group, whereas a decrease of 19.70±4.28% was observed in the control group (P-value<0.001).Conclusions: The findings of this article recommend that omega-3 supplements may increase certain sperm parameters in men with infertility. However, further investigations are needed to ascertain the efficacy of omega-3 fatty acids in enhancing fertility.
Introduction: The purpose of this retrospective cohort study was to clarify the effect of high-flux hemodialysis on hemoglobin and phosphorus level in hemodialysis patients.Methods: A retrospective cohort study was performed at the hemodialysis center of 22 Bahman Hospital of Mashhad, in which 30 end-stage renal disease (ESRD) participants were allocated randomly to receive high-flux or low-flux hemodialysis. Hemodialysis was applied three times a week for four hours each session. Biochemical parameters such as hemoglobin and phosphorus serum levels were assessed before and after three months of hemodialysis.Results: The average age of 30 ESRD patients who met the inclusion criteria was 56.7 years. After three-month hemodialysis course, serum phosphorus level showed significant reduction in high-flux group (P-value=0.0001), while there was no significant difference for low-flux group (P-value=0.740). Hemoglobin levels in the pre-and post-dialysis stage did not differ significantly in the high-flux or low-flux group (P-value>0.05). High-flux dialysis resulted in significantly more reduction in phosphorus level than low-flux dialysis (P-value=0.003); however, regarding changes in hemoglobin levels, no considerable difference was reported among both groups (P-value=0.834).Conclusion: We found that the use of high-flux hemodialysis has a positive effect on reducing the level of phosphorus, but it may require a longer duration of treatment to be effective on the other parameters such as hemoglobin, hematocrit, PTH and ferritin.
Introduction: This study investigates the potential antiurolithiatic properties of two nutraceutical herbs, Amaranthus viridis and Capsicum annuum. Both herbs, known for their medicinal and nutritional benefits, has been explored for their role in preventing or treating kidney stone formation. Methods: Ethanolic extracts of Amaranthus viridis leaves and Capsicum annuum fruits were selected for evaluating anti-urolithiatic activity in Wistar rats due to presence of flavanoids, phenols, saponins and tannins. In-vitro assays was performed using aggregation and nucleation assay and in-vivo antiurolithiatic activity was performed by ethylene glycol induced urolithiasis model.Results: In-vitro results showed that both plant extracts and Cystone effectively inhibited nucleation and aggregation steps in kidney stone formation. The plant extracts demonstrated stronger inhibition during the aggregation phase, suggesting they may serve as a potent alternative or complement to cystone in preventing kidney stones. In-vivo evaluations using a glycol-induced urolithiasis model indicated that treatment with the extracts inhibited the increment in calcium and uric acid levels, thereby promoting a less acidic urinary environment. Serum analysis revealed reductions in creatinine and urea levels, indicating improved renal function. Kidney weight assessments and histopathological examinations of kidneys showed protective effects against hypertrophy and tissue damage. Conclusion: Findings suggested that Amaranthus viridis and Capsicum annuum possess significant antiurolithiatic property, supporting their potential as natural remedies for kidney stone prevention. Further research is recommended to isolate the active compounds and explore their mechanisms of action.
Introduction: Voiding dysfunction is a prevalent health issue in women. Treatment options for women are limited, with alpha-blockers being the first-line therapy for obstructive lower urinary tract symptoms (LUTS). The aim of this research was to compare the efficacy and safety of Tamsulosin and Terazosin in the treatment of obstructive symptoms in females with functional bladder outlet obstruction.Methods:The study included women aged 18-65 with at least 3 months of obstructive lower urinary tract symptoms, high PVR (post void residual), obstructive appearance in uroflowmetry study and high-pressure, low-flow appearance in urodynamic study. The patients were randomly divided into two groups: one group received a 0.4 mg tamsulosin capsule at night, and the other received 1 mg of terazosin daily for the first week and then 2 mg daily. The patients were evaluated for clinical symptoms and urodynamic parameters after three months. The primary outcome was the change in IPSS score at 12 weeks and secondary outcomes included PVR, Qmax, Qavg, MUCP and pdetQmax as well as safety and tolerability.Results: After 12 weeks of treatment, both groups experienced significant reductions in International Prostate Symptom Score (4.32±0.61 and 4.72±0.74 points, P-value< 0.001 for each), with no meaningful difference between them (Δ=0.40, P-value=0.214). Post-void residual volume fell slightly more with tamsulosin ,with no significant between-group difference (P-value=0.36). Terazosin produced a slightly greater increase in average flow and Qmax compared with Tamsulosin; however, these between-group differences did not reach statistical significance (P-value=0.73). Maximum urethral closure pressure (MUCP) and detrusor pressure at Qmax (PdetQmax) decreased markedly with both treatments (P-value<0.001 for both), with no significant between-group difference.Conclusion: Over 12 weeks, both tamsulosin and terazosin yielded small-to-moderate improvements in IPSS and urodynamic parameters in women with functional BOO without a clear difference in efficacy. Agent selection may therefore be guided by patient tolerance, comorbidities, and individual preference.
Despite the transformative success of immunotherapy in various cancers, its efficacy in prostate cancer remains limited due to the tumor’s immunosuppressive microenvironment and poor T-cell infiltration. This editorial examines the multifaceted roles of PIM kinases, specifically PIM1, PIM2, and PIM3, in driving prostate cancer progression, immune evasion, and therapeutic resistance. PIM kinases promote oncogenic signaling, suppress apoptosis, and upregulate immunosuppressive molecules such as PD-L1 and PD-L2, thereby attenuating anti-tumor immune responses. Their influence extends to the tumor microenvironment, where they modulate tumor-associated macrophages and inflammatory pathways, contributing to resistance and disease recurrence. Although PIM inhibitors have demonstrated promise in preclinical studies, their clinical translation has been limited by toxicity and resistance mechanisms. Emerging evidence suggests that combining PIM inhibition with immune checkpoint blockade may synergistically enhance anti-tumor efficacy. These editorial highlights the promising therapeutic strategy of inhibiting PIM kinases to reshape the immune microenvironment in prostate cancer, thereby improving the efficacy of immunotherapy.
Introduction: Emphysematous pyelonephritis is a necrotizing infection characterized by the presence of gas in the renal parenchyma, collecting system, and peri-renal tissues. It is a life-threatening disease with a nonspecific presentation and is extremely rare in transplant recipients. Associated factors include diabetes mellitus, female sex, immunosuppression, urinary tract obstruction, and impaired vascular supply.Case Presentation: We present a case of a non-diabetic male who underwent a kidney transplant earlier and later exhibited fever, nausea, and flank discomfort. The presence of gas was confirmed through computed tomography, and the patient was therapeutically managed with percutaneous drainage, broad-spectrum antibiotics, and intense hydration. A graft biopsy performed 40 days post-transplant showed no findings suggestive of rejection. Enhanced outcomes were observed due to early diagnosis and a multidisciplinary care approach, ultimately allowing the patient to continue with successful kidney transplantation.Conclusions: This case emphasizes the contemporary tomographic criteria used in diagnosing and treating emphysematous pyelonephritis. It also underscores the importance of considering the patient's clinical status when determining the necessity of nephrectomy in cases of emphysematous pyelonephritis.
Introduction: Prostatic abscess (PA) is a rare condition that can complicate diagnostic evaluation due to nonspecific symptoms and overlap with malignancy.Case presentation: This report describes a 63-year-old male with poorly controlled hyperthyroidism presenting with markedly elevated total PSA (239.00ng/mL). Imaging and biopsy confirmed benign prostatic hyperplasia with PA, while thyroid dysfunction appeared to contributed to an altered PSA dynamic. Treatment with antibiotics and thyroid management normalized the PSA levels. Conclusion: Our findings highlight the need for integrative clinical assessments in atypical PSA elevations, underscoring the importance of considering PA and endocrine influences to avoid misdiagnosis.
Introduction: Diagnosing ureteral injuries during pelvic laparoscopic surgeries is challenging and requires high suspicion, surgical proficiency, and understanding of ureteric anatomy. These injuries can cause serious consequences. The present study presents a case of iatrogenic ureterovaginal fistula that developed shortly after a laparoscopic hysterectomy conducted for the purpose of gender reassignment surgery.Case presentation: A 23-year-old female with gender dysphoria underwent laparoscopic hysterectomy and oophorectomy for gender reassignment. After a clear discharge from the vagina, a CT scan revealed damage to the left ureter and contrast leakage. Double-J stent implantation was planned, but unsuccessful due to left ureter obstruction. A double dye test confirmed a urinary tract fistula. A ureteroscopy session was performed, but Double-J stent implantation was unsuccessful. The patient underwent ureteroneocystostomy using the Modified Lich-Gregoir technique. After 6 weeks, the Double-J stent was discharged without any specific complaints or abnormalities.Conclusion: The case study emphasizes the importance of early detection and diagnosis of uretrovaginal fistulas, using spiral CT scans and retrograde cystography. Despite initial complications, the Modified Lich-Gregoir technique successfully addressed thermal injury and ureteral interruption, leading to a smooth recovery and a multidisciplinary approach.
Introduction: Prostate cancer is one of the most common cancers in men, and genetic mutations in various genes play a significant role in its progression. The BRCA2 gene, a tumor suppressor gene, is associated with an increased risk of prostate cancer. The aim of this study is to investigate the role of BRCA2 mutations in predicting prostate cancer progression in Iranian patients. Methods: This study included 250 prostate cancer patients treated in Tehran hospitals between 2020 and 2023. We used polymerase chain reaction (PCR) to detect BRCA2 mutations and DNA sequencing to confirm them. Results: The results showed that 18% of patients had a BRCA2 mutation associated with an older mean age at diagnosis, higher metastasis rate on MRI imaging, and shorter survival. Also, mutations in the aforementioned gene are associated with specific clinical features and more aggressive progression of prostate cancer.Conclusion: The integration of genetic testing and imaging provides valuable tools for the prediction and management of prostate cancer, especially in Iranian patients.
