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S14 CONTINUOUS RENAL REPLACEMENT THERAPIES IN THE TREATMENT OF ACUTE RENAL FAILURE
was achieved in 6 of 9 in ESWL group (75%), in 7 of 10 in TULP group (70%), in 6 of 6 in PCNL group (100%). In patients who were not stone-free we used combination therapy and at last all of our patients were stone-free (100%). No intraoperative complications occurred, including major bleeding. Mean initial and post operative creatinine levels were (3 and 1.5) mg/100. Conclusions: Endourological procedures for urolithiasis in transplanted kidneys are safe and effective methods with a high overall stone-free rate and should be considered in experienced hands and centers.
S13
Extensive ureteral stricture after kidney transplantation: The assessment of risk factors and their effects on patient and graft survival
Mahdavi Zafarghandi R., Taghavi R., Tavakoli M., Sheikhi Z., Mahdavi Zafarghandi M. Mashhad University of Medical Sciences, Dept. of Urology, Mashhad, Iran Introduction & Objectives: Extensive ureteral stricture (EUS) after renal transplantation (RTx) is an important urological complication that adversely affects the long term function of the allograft and therefore the morbidity and mortality of the recipients. The aim of this study was to evaluate the prevalence of the EUS in RTx recipients and its impact on patient and graft survival. Material & Methods: By a retrospective analysis, we assessed 1450 patients who underwent renal transplantation by a fixed surgical team between December 1991 to 2009 at Emam Reza Hospital, Mashhad University of Medical Science, Mashhad, Iran. Results: EUS was diagnosed in 13 cases (1.11%) including 8 (61.5%) male. The mean age of patients at the time of surgery was 33.6 ± 13.7 (10.0 to 60.0) years old. The length of follow up was 77.9 ± 63.5 (12.0 to 228.0) months and the ischemic time was 126.5 ± 114.1 (25.0 to 300.0) minutes. Mostly, EUS was noticed in the graft recipients with more than one artery (P < 0.05) and cadaveric donors with more than 4 hour ischemic time (P < 0.001). After ureteropyelostomy (7 cases), ipsilateral pyelopyloplasty (4 cases) and contralateral pyelopyeloplasty (2 cases), no evidence of ureteral stricture recurrence, graft loss or death was found during the follow-up Conclusions: The incidence of extensive ureteral stricture as a urologic complication after renal transplantation is very low. The advanced techniques of RTx that preserve the ureteric blood supply and the better procedures for ureteral reconstruction have improved the survival rate of patient and graft.
S14
Continuous renal replacement therapies in the treatment of acute renal failure
Penkov R.D., Nikolov S.D., Angelov P.V. Military Medical Academy, Clinic of Urology, Sofia, Bulgaria Introduction & Objectives: Acute renal failure (ARF) is a part of multi-organ failure with complications such as shock, cardial and non-cardial pulmonary edema, hemodynamic instability, bleeding, hypercatabolismis. If ARF is treated via conventional intermittent hemodialysis, the kidney function is considerably damaged, during the therapy, and after it. Continuous Renal Replacement Therapies (CRRT), which have been developed and implemented in the end of last century, protect the kidney function, due to the fact that hemodynamic stability is improved in patients during these procedures. Material & Methods: For a period of eight years we have performed 27 /twentyseven/ CRRPT in 11 /eleven/ patients with ARF, which has resulted from: heavy traumas (3 patients), complications after an operative interventions (5 patients), and severe septic conditions (3 patients). We have performed the procedures with a system for CRRT, high-flux capillary filters and sterile solutions with an option for correction of electrolyte composition. The average time for procedure performance is 8 hours. Results: In 9 /nine/ patients, we have successfully restored the electrolyte balance, by handling the pulmonary stasis and the disequilibrium syndrome. We have managed the damaged kidney depuration in 7 patients, and two patients continued a definitive chronic dialysis treatment. Two patients deceased. Conclusions: The interest towards the CRRT in the recent 15-16 years results from its better flexibility and better tolerance by patients with ARF. The system does not require water reversible osmosis and could be installed besides the patient’s bed. Its purifying capacity equals the capacity of intermittent dialysis.
S15
Reduction of sperm DNA fragmentation by oral ginger extract treatment
Daliri Hampa A., Hosseini S.J., Hoseinifar H., Sabbaghian M., Modarresi T., Nakhjavani R., Sadighi Gilani M.A., Salman Yazdi R., Farrahi F., Dadkhah F. Royan Institute, Dept. of Andrology, Tehran, Iran Introduction & Objectives: Sperm DNA fragmentation is known to affect male fertility. Previous findings have suggested the implication of oxidative stress in the etiology of this pathological condition. The present study was designed to find out
Eur Urol Suppl 2012;11(4):136
DNA fragmentation in ejaculated spermatozoa can be reduced by oral treatment with Ginger extract. Material & Methods: 71 men with Idiopathic infertility were randomized between a Ginger treatment (500 milligram daily for 3months) group and a placebo group. Sperm DNA fragmentation was evaluated by Terminal deoxyribonucleotidyl transferase– mediated dUTP nick-end labeling assay (TUNEL) before and after treatment. Results: No differences in basic sperm parameters were found between the Ginger treatment and the placebo group before or after treatment. However, the percentage of DNA-fragmented spermatozoa was markedly reduced (P<0.05) in the Ginger treatment group after the treatment as compared with the pretreatment values). No difference in the pretreatment and post treatment incidence of sperm DNA fragmentation was observed in the placebo group. Conclusions: These data show that sperm DNA damage can be efficiently treated with oral Ginger extract administered during a relatively short time period.
S16
External genital anomaly ratios in male school children’s in Sakarya region
Budak S.1, Sağlam H.S.1, Sonbahar A.E.2, Acar B.3, Gökırmak G.3, Sarı U.4, Köse O.1, Kumsar S.1, Adsan O.1 1 Ministry of Health, Sakarya University,educational Hospital, Dept. of Urology, Sakarya, Turkey, 2Geyve State Hospital, Urology Clinic, Sakarya, Turkey, 3Karasu State Hospital, Urology Clinic, Sakarya, Turkey, 4Hendek State Hospital, Urology Clinic, Sakarya, Turkey Introduction & Objectives: The goal of the study was to determine external genital anomaly types in children attending primary school (6-15 years old) in Sakarya. Material & Methods: 1573, 5-16 years old student randomly selected from 8 schools inside the province. The students were examined in an appropriate room in school, and external genital anomalies were identified and noted. Results: In this study, a total of 106 (%6,7) anomalies were identified in 1573 students. The most common anomalies were phimosis 3,6 % (56) and undescended testis 2,6% (41). Pathology Phimosis undescended testes Hypospadias İnguinal hernia Hydrocele Meatal stenosis Totally
Number 56 41 6 4 4 5 106
Percentage (%) % 3.6 % 2.6 % 0.4 % 0.3 % 0.3 % 0.3 1573
Conclusions: This study shows that the ratio of the external genital anomaly that needs to be cured before primary school is high. Socioeconomic differences and environmental factors can affect anomaly prevalence. Health care workers all over the country should be trained. In addition to these, to identify genital anomalies before children start primary school, specific communication programs should be prepared for parents.
S17
Initial experience with suprainguinal microscopic lymphatic sparing varicocelectomy
Zougkas K.1, Varouxakis E.1, Papadopoulos V.1, Vasilas M.1, Sotrillis T.1, Mosiello G.2, Ferro F.2 1 General Hospital of Rhodes, Dept. of Urology, Rhodes, Greece, 2“Bambino Gesù” Children's Hospital, Dept. of Urology, Rome, Italy Introduction & Objectives: We present our initial experience in suprainguinal microscopic lymphatic sparing varicocelectomy (SMLV) to our patients. Material & Methods: 16 patients with varicocele underwent SMLV between March-May 2012. All patients evaluated with medical history, physical examination, hormonal status, 2 sperm counts and Color Doppler Ultrasound of the scrotum (CDS) which is determined by the size of each testicle and confirmed the reflux of blood flow during Valsalva maneuver. Results: The mean patient age is 24.3 years (18-29 years). 3/16 had oligospermia, 5 patients had asthenospermia, 8 patients had oligoasthenospermia while 5/16 patients presented with mild pain in the ipsilateral testicle. 5.3 vessels (range 3-8) were indentified and ligated while more than two (2-5) lymphatic channels remained intact in each patient. Mean surgical time was 23.6 (range 16-35) minutes. No patient appeared hydrocele, recurrence, atrophy, orcheodynia or wound infection while the results of the semen parameters (volume, concentration, motility and morphology) and the change in testicular size will be analyzed at 6 or 12 months after surgery. Conclusions: The SMLV is simple, safe and effective method, has less discomfort for the patient and is accompanied by almost minimal long-term postoperative complications (recurrence or hydrocele). It can be applied in cases of failure of previous surgery technique with high ligation and the presence of varicocele relapse.
S13
Extensive ureteral stricture after kidney transplantation: The assessment of risk factors and their effects on patient and graft survival
Mahdavi Zafarghandi R., Taghavi R., Tavakoli M., Sheikhi Z., Mahdavi Zafarghandi M. Mashhad University of Medical Sciences, Dept. of Urology, Mashhad, Iran Introduction & Objectives: Extensive ureteral stricture (EUS) after renal transplantation (RTx) is an important urological complication that adversely affects the long term function of the allograft and therefore the morbidity and mortality of the recipients. The aim of this study was to evaluate the prevalence of the EUS in RTx recipients and its impact on patient and graft survival. Material & Methods: By a retrospective analysis, we assessed 1450 patients who underwent renal transplantation by a fixed surgical team between December 1991 to 2009 at Emam Reza Hospital, Mashhad University of Medical Science, Mashhad, Iran. Results: EUS was diagnosed in 13 cases (1.11%) including 8 (61.5%) male. The mean age of patients at the time of surgery was 33.6 ± 13.7 (10.0 to 60.0) years old. The length of follow up was 77.9 ± 63.5 (12.0 to 228.0) months and the ischemic time was 126.5 ± 114.1 (25.0 to 300.0) minutes. Mostly, EUS was noticed in the graft recipients with more than one artery (P < 0.05) and cadaveric donors with more than 4 hour ischemic time (P < 0.001). After ureteropyelostomy (7 cases), ipsilateral pyelopyloplasty (4 cases) and contralateral pyelopyeloplasty (2 cases), no evidence of ureteral stricture recurrence, graft loss or death was found during the follow-up Conclusions: The incidence of extensive ureteral stricture as a urologic complication after renal transplantation is very low. The advanced techniques of RTx that preserve the ureteric blood supply and the better procedures for ureteral reconstruction have improved the survival rate of patient and graft.
S14
Continuous renal replacement therapies in the treatment of acute renal failure
Penkov R.D., Nikolov S.D., Angelov P.V. Military Medical Academy, Clinic of Urology, Sofia, Bulgaria Introduction & Objectives: Acute renal failure (ARF) is a part of multi-organ failure with complications such as shock, cardial and non-cardial pulmonary edema, hemodynamic instability, bleeding, hypercatabolismis. If ARF is treated via conventional intermittent hemodialysis, the kidney function is considerably damaged, during the therapy, and after it. Continuous Renal Replacement Therapies (CRRT), which have been developed and implemented in the end of last century, protect the kidney function, due to the fact that hemodynamic stability is improved in patients during these procedures. Material & Methods: For a period of eight years we have performed 27 /twentyseven/ CRRPT in 11 /eleven/ patients with ARF, which has resulted from: heavy traumas (3 patients), complications after an operative interventions (5 patients), and severe septic conditions (3 patients). We have performed the procedures with a system for CRRT, high-flux capillary filters and sterile solutions with an option for correction of electrolyte composition. The average time for procedure performance is 8 hours. Results: In 9 /nine/ patients, we have successfully restored the electrolyte balance, by handling the pulmonary stasis and the disequilibrium syndrome. We have managed the damaged kidney depuration in 7 patients, and two patients continued a definitive chronic dialysis treatment. Two patients deceased. Conclusions: The interest towards the CRRT in the recent 15-16 years results from its better flexibility and better tolerance by patients with ARF. The system does not require water reversible osmosis and could be installed besides the patient’s bed. Its purifying capacity equals the capacity of intermittent dialysis.
S15
Reduction of sperm DNA fragmentation by oral ginger extract treatment
Daliri Hampa A., Hosseini S.J., Hoseinifar H., Sabbaghian M., Modarresi T., Nakhjavani R., Sadighi Gilani M.A., Salman Yazdi R., Farrahi F., Dadkhah F. Royan Institute, Dept. of Andrology, Tehran, Iran Introduction & Objectives: Sperm DNA fragmentation is known to affect male fertility. Previous findings have suggested the implication of oxidative stress in the etiology of this pathological condition. The present study was designed to find out
Eur Urol Suppl 2012;11(4):136
DNA fragmentation in ejaculated spermatozoa can be reduced by oral treatment with Ginger extract. Material & Methods: 71 men with Idiopathic infertility were randomized between a Ginger treatment (500 milligram daily for 3months) group and a placebo group. Sperm DNA fragmentation was evaluated by Terminal deoxyribonucleotidyl transferase– mediated dUTP nick-end labeling assay (TUNEL) before and after treatment. Results: No differences in basic sperm parameters were found between the Ginger treatment and the placebo group before or after treatment. However, the percentage of DNA-fragmented spermatozoa was markedly reduced (P<0.05) in the Ginger treatment group after the treatment as compared with the pretreatment values). No difference in the pretreatment and post treatment incidence of sperm DNA fragmentation was observed in the placebo group. Conclusions: These data show that sperm DNA damage can be efficiently treated with oral Ginger extract administered during a relatively short time period.
S16
External genital anomaly ratios in male school children’s in Sakarya region
Budak S.1, Sağlam H.S.1, Sonbahar A.E.2, Acar B.3, Gökırmak G.3, Sarı U.4, Köse O.1, Kumsar S.1, Adsan O.1 1 Ministry of Health, Sakarya University,educational Hospital, Dept. of Urology, Sakarya, Turkey, 2Geyve State Hospital, Urology Clinic, Sakarya, Turkey, 3Karasu State Hospital, Urology Clinic, Sakarya, Turkey, 4Hendek State Hospital, Urology Clinic, Sakarya, Turkey Introduction & Objectives: The goal of the study was to determine external genital anomaly types in children attending primary school (6-15 years old) in Sakarya. Material & Methods: 1573, 5-16 years old student randomly selected from 8 schools inside the province. The students were examined in an appropriate room in school, and external genital anomalies were identified and noted. Results: In this study, a total of 106 (%6,7) anomalies were identified in 1573 students. The most common anomalies were phimosis 3,6 % (56) and undescended testis 2,6% (41). Pathology Phimosis undescended testes Hypospadias İnguinal hernia Hydrocele Meatal stenosis Totally
Number 56 41 6 4 4 5 106
Percentage (%) % 3.6 % 2.6 % 0.4 % 0.3 % 0.3 % 0.3 1573
Conclusions: This study shows that the ratio of the external genital anomaly that needs to be cured before primary school is high. Socioeconomic differences and environmental factors can affect anomaly prevalence. Health care workers all over the country should be trained. In addition to these, to identify genital anomalies before children start primary school, specific communication programs should be prepared for parents.
S17
Initial experience with suprainguinal microscopic lymphatic sparing varicocelectomy
Zougkas K.1, Varouxakis E.1, Papadopoulos V.1, Vasilas M.1, Sotrillis T.1, Mosiello G.2, Ferro F.2 1 General Hospital of Rhodes, Dept. of Urology, Rhodes, Greece, 2“Bambino Gesù” Children's Hospital, Dept. of Urology, Rome, Italy Introduction & Objectives: We present our initial experience in suprainguinal microscopic lymphatic sparing varicocelectomy (SMLV) to our patients. Material & Methods: 16 patients with varicocele underwent SMLV between March-May 2012. All patients evaluated with medical history, physical examination, hormonal status, 2 sperm counts and Color Doppler Ultrasound of the scrotum (CDS) which is determined by the size of each testicle and confirmed the reflux of blood flow during Valsalva maneuver. Results: The mean patient age is 24.3 years (18-29 years). 3/16 had oligospermia, 5 patients had asthenospermia, 8 patients had oligoasthenospermia while 5/16 patients presented with mild pain in the ipsilateral testicle. 5.3 vessels (range 3-8) were indentified and ligated while more than two (2-5) lymphatic channels remained intact in each patient. Mean surgical time was 23.6 (range 16-35) minutes. No patient appeared hydrocele, recurrence, atrophy, orcheodynia or wound infection while the results of the semen parameters (volume, concentration, motility and morphology) and the change in testicular size will be analyzed at 6 or 12 months after surgery. Conclusions: The SMLV is simple, safe and effective method, has less discomfort for the patient and is accompanied by almost minimal long-term postoperative complications (recurrence or hydrocele). It can be applied in cases of failure of previous surgery technique with high ligation and the presence of varicocele relapse.