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Papers by mahmoud tavakkoli

World Journal of Urology, 2012

Benign prostatic hyperplasia (BPH) is the main cause of lower urinary tract symptoms (LUTS) in el... more Benign prostatic hyperplasia (BPH) is the main cause of lower urinary tract symptoms (LUTS) in elderly men. Some patients respond poorly to routine medical therapy and are not well suited for surgery, too. This study was planned to evaluate the effect of Botulinum-A on BPH refractory to current medical therapy in poor surgical candidates. In this clinical trial, 10 patients with LUTS suggestive of BPH who had responded poorly to medical therapy for at least 6 months and were poor surgical candidates, were received different doses of transurethral Botulinum-A injection based on their prostate volume. The prostate volume, PSA, Qmax, IPSS, PVR and frequency of nocturia were evaluated and compared before and after treatment. The mean IPSS was 24.50 ± 3.8 and 13.40 ± 2.67 before and after the treatment, respectively (P < 0.001). The mean prostate volume was decreased from 41.50 ± 10.85 mL to 30.40 ± 8.05 mL (P < 0.001). The Qmax was increased from 7.87 ± 2.01 mL/s to 16.19 ± 1.76 mL/s (P < 0.001). The mean PSA was 3.12 ± 0.49 ng/mL and 1.71 ± 0.39 ng/mL before and after treatment, respectively (P < 0.001). The mean PVR was 75.6 ± 51.63 mL and 63.50 ± 36.59 mL before and after treatment, respectively (P = 0.096). The mean number of nocturia was decreased from 4.1 ± 0.87 to 2.4 ± 0.84 (P < 0.001). The mean IPSS, Prostate volume, PSA and frequency of nocturia were decreased significantly. Although mean PVR was decreased but it wasn't statistically significant. The mean Qmax was increased significantly. Intraprostatic injection of Botulinum-A may be an effective and safe treatment for symptomatic BPH in selected patients whose medical treatment has faced failure and are poor surgical candidates. Transurethral method could be selected as a preferable technique of injection.

Saudi Journal of Kidney Diseases and Transplantation, 2014

The aim of this study was to determine the effect of kidney transplantation on serum prostate-spe... more The aim of this study was to determine the effect of kidney transplantation on serum prostate-specific antigen (PSA) levels. Forty patients who were on peritoneal dialysis or hemodialysis underwent kidney transplantation at our department. The immunosuppressive protocol was uniform during the study period. The creatinine and prostate specific antigen (PSA) levels, both free and total, were measured by immunofluorometric assays immediately before transplantation and on post-transplant Days 1, 7, 90 and 180. The mean age of the patients was 49.97 ± 4.4 years. After transplantation, there was a significant decrease in free PSA, but there was no correlation between total PSA and serum creatinine. Free PSA levels were significantly decreased after kidney transplantation but total PSA remained unchanged. This was observed in post-transplant patients irrespective of whether they had delayed graft function, slow graft function or immediate graft function during the observed period. Therefor...

Experimental and Clinical Transplantation, 2014

To assess the safety and efficacy of minimally invasive procedures for urolithiasis in transplant... more To assess the safety and efficacy of minimally invasive procedures for urolithiasis in transplanted kidneys. A retrospective study was done on kidney transplant patients who had urolithiasis treated with minimally invasive procedures between January 1989 and September 2011. We evaluated patient characteristics, predisposing factors, clinical presentation, minimally invasive procedures used, frequency of success, and complications. In 1800 kidney transplants, 21 recipients developed urolithiasis (mean age, 31 y; 13 men and 8 women) and were treated with minimally invasive procedures. Predisposing factors included hyperparathyroidism (6 patients), hyperuricemia (5 patients), recurrent urinary tract infection (4 patients), ureteral stricture or obstruction (2 patients), and unknown factors (4 patients). Clinical presentation included hematuria (5 patients), azotemia (4 patients), anuria (3 patients), urinary tract infection (3 patients), and hydronephrosis (2 patients). The stones were...

Objective: This study sought to evaluate platelet volume indices (mean platelet volume [MPV], pla... more Objective: This study sought to evaluate platelet volume indices (mean platelet volume [MPV], platelet distribution width [PDW], and platelet large cell ratio [P-LCR]) in varicocele patients, and compare it with platelet volume parameters in healthy controls. Methods: This cross-sectional study involved 2 groups: group 1 included 51 varicocele subjects and group 2 consisted of 50 healthy control subjects of similar ages. Peripheral venous blood samples were collected with ethylenediaminetetraacetic acid-K2 anticoagulant between 8:30 AM and 10 AM following an overnight fast. Platelet volume parameters (MPV, PDW, and P-LCR) were measured in both groups within 2 hours of sampling. Results: The mean PDW, MPV, and P-LCR were 13.9±2.5%, 10.1±1.3 fL, and 27.3±7.8 % in varicocele patients, respectively, and were 12.6±2.4%, 9.3 ± 1.1 fL, and 21.9 ± 6.4 % in the control group, respectively. The mean PDW, MPV, and P-LCR were significantly higher in the varicocele group than the control group. ...

Nephro-Urology Monthly

Context: Nowadays, the demand for a kidney allograft is increasing in Iran as well as the rest of... more Context: Nowadays, the demand for a kidney allograft is increasing in Iran as well as the rest of the world, which is growing the wait list. The Iranian model of a kidney transplant was initiated for solving organ shortage and has been extremely controversial both inside and outside of Iran. Evidence Acquisition: This narrative review was done by using Iranian and international databases to retrieve literature dealing with the Iranian model of kidney transplantation. All publications up until January 2018 were included. It has drawn out the weaknesses and strengths as well as the advantages and disadvantages, then, it provides some suggestion for better functioning of the Iranian model. Results: Overall, 61 publications were retrieved and selected. After exclusion of unsuitable and duplicate articles, 17 were included. The main strengths of the Iranian model were having a lawful structure, supporting health centers and patients financially by government and charity funds, as well as reducing the waiting list. The main weaknesses include inadequate public awareness regarding the concept of brain death, the absence of a well-defined kidney registry system, need for renewing existing laws, regulations, and guidelines, the absence of permanent health insurance and follow-up for donors, as well as absence of a comprehensive network organ bank. Conclusions: The transplant authorities in Iran should work on reinforcement of the model by solving and overcoming some challenges. Preventing organ failure, as well as its risk factors, public education and encouraging organ donation from individuals who are brain dead, improving the outcomes of circulatory death donation, and investment in tissue engineering could significantly reduce organ shortage. The final solution is living unrelated renal donation (LURD).

Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2014

We read the interesting article by Dr. Sidebottom and associates published in your journal.1 Ther... more We read the interesting article by Dr. Sidebottom and associates published in your journal.1 There is controversy in the literature about the necessity and duration of drains after transplant. Drains can act as a gateway for entry of organisms. In contrast, drains can give early warning of bleeding, urine leakage, or lymphatic leakage.2-4 Drains can decrease the incidence of deep vein thrombosis and lymphocele formation and treatment.5 The study attempted to determine the association between drains and wound complications. There were some important limitations of this report. The most important limitation was the presence of selection bias. In this study, Patients at greater risk of wound complications had drains, and low-risk patients did not have drains. This important bias is a serious limitation in interpreting the results. We believe that in the high-risk group, early recognition of wound complications can minimize the morbidity of patients and decrease the incidence of complic...

Nuclear medicine review. Central & Eastern Europe, 2021

BACKGROUND The feasibility of the sentinel node mapping in upper tract urothelial cancers (UTUC) ... more BACKGROUND The feasibility of the sentinel node mapping in upper tract urothelial cancers (UTUC) was evaluated, using a radiotracer as the mapping material. MATERIAL AND METHODS To identify the sentinel lymph nodes, 37 MBq of [99mTc] phytate was injected in five patients with the renal pelvis or ureter cancer, who were candidates for ureterectomy and lymphadenectomy. The radiotracer was injected in a peritumoral fashion following the surgical exposure of the tumour. The sentinel lymph nodes were detected using a handheld gamma probe. RESULTS By intraoperatively injecting the radiotracer immediately after surgical exposure of the tumour, at least one sentinel lymph node could be detected in each patient, and the detection rate was 100%. The location of sentinel nodes was in the paracaval, renal hill, retro-aortic, para-aortic, common iliac, and external iliac areas, which was dependent on the tumour location. No false-negative case was identified. CONCLUSIONS Sentinel node mapping is...

1. Assistant Professor, Kidney Transplantation Complications Research Center, Mashhad University ... more 1. Assistant Professor, Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 2. Instructor, Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 3. Assistant Professor, Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 4. Assistant Professor, Clinical Research Units, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 5. Medicine Student, Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 6. Assistant Professor, Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Journal of patient safety and quality improvement, 2019

Introduction: Prostate carcinoma is the most common type of cancer and the second lethal cancer i... more Introduction: Prostate carcinoma is the most common type of cancer and the second lethal cancer in men. Overexpression of Her2-neu gene affects the growth and prognosis of some tumors. HER2 gene amplification is seen in about one-third of prostatic adenocarcinoma cases.it also seems to correlate with androgen independence of the prostate tumors. We evaluated the HER2-neu expression in prostate cancer and its relation with known prognostic factors, in this study. Material and Methods: Immunohistochemical staining was used to evaluate the expression of Her2-neu in 60 cases of prostate carcinoma. The relation between HER2-neu expression and prognostic factors of prostatic carcinoma was evaluated,which included serum PSA values , number of core involvement, high percentage of core involvement,Gleason score,Gleason grade,extra prostatic extension of the tumoral cells and tumor volume.Results: Among 60 patients included in our study ,Her2-neu was negative in 49 (81.7%) cases (zero score i...

Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2017

OBJECTIVES Vascular complications, especially immediate events during kidney transplant, are the ... more OBJECTIVES Vascular complications, especially immediate events during kidney transplant, are the major cause of graft loss, and prompt surgical intervention is important for salvage of the graft and recipient. In this study, our aim was to show our experiences with vascular interventions and their effects on graft outcomes in transplant patients with suspected immediate vascular events. MATERIALS AND METHODS Over 24 years (from 1990 to 2014), 2100 renal transplant procedures (1562 living and 538 deceased donors) were performed by one fixed team. We reviewed the recipients to find cases with immediate vascular complications, including artery or vein kinking or torsion, renal artery thrombosis, and renal vein thrombosis. Diagnosis of a vascular event was suspected when urinary output suddenly stopped and was confirmed by color Doppler ultrasonography or immediate exploration. Characteristics of the patients and events, surgical interventions for saving grafts, and graft outcomes were ...

Background The patients undergoing kidney transplantation are at risk of increasing Intra-Abdomin... more Background The patients undergoing kidney transplantation are at risk of increasing Intra-Abdominal Pressure (IAP) due to the abdominal surgery. Methods This diagnostic accuracy study was conducted on 135 patients, who had undergone kidney transplantation from alive and brain death patients in two hospitals of Iran and Afghanistan, in 2019. The patients' intra-abdominal pressure was measured every 6 hours up to 24 hours after surgery by nurses. The indices of renal dysfunction were utilized, including creatinine level, urine volume, need dialysis and thymoglobulin after transplantation and nephrectomy in 6 months. The sensitivity as well as positive and negative predictive value of the IAP test was counted based on these indices. Doppler ultrasound of the transplanted kidney was used as a gold standard diagnostic test. Data analysis was done by using STATA 14. Results According to the results 10 (7.4%) people of 135 patients were observed with IAP > 10mmhg. Nobody revealed IA...

Case Reports in Urology

Circumcision is the most prevalent surgery among men. Like any other surgical intervention, it is... more Circumcision is the most prevalent surgery among men. Like any other surgical intervention, it is associated with several complications. A rare shocking complication is glans amputation which is a urologic emergency. Herein, we present a 4-year-old boy with penile glans amputation following circumcision. The reimplantation was performed in less than two hours. We approximated the ends over a size 4 : 0 catheter. The urethral anastomosis was performed via 6 : 0 Vicryl sutures. Then, we sutured amputated glans in place via Vicryl 4 : 0. We immobilized the penis for a week via bandages used in penile reconstruction surgeries. We also used pentoxifylline to treat glans ischemia after surgery. The patient and his parents did not mention any difficulties or abnormalities while voiding, and the cosmetic result was favorable after three months of follow-up.

Annals of Nuclear Medicine

Objective In this study, the validity of sentinel node biopsy procedure as our index test was ass... more Objective In this study, the validity of sentinel node biopsy procedure as our index test was assessed and compared with bilateral pelvic lymphadenectomy for staging and detecting the regional lymph nodes metastasis in patients with muscleinvasive bladder cancer (MIBC). Methods Consecutive series of cases with T1-T4 urothelial MIBC were included. Following the injection of radiotracer, sentinel nodes were sought using a handheld gamma probe and all hot nodes were harvested. Bilateral pelvic lymphadenectomy was done for all patients following sentinel node biopsy. The tumor specimen, sentinel nodes, and excised lymph nodes were evaluated histopathologically. Same as the other midline tumors, detection rate and false negative rates were calculated using patient basis and side basis methods. Results By evaluating each patient as a unit of analysis, sentinel nodes were detected in 35 of 41 patients (85%), 13/16 (81%) of the neoadjuvant chemotherapy (NAC) and 22/25 (88%) of the no-neoadjuvant chemotherapy (No-NAC) participants. The false negative rate was 3/7 (42%): 1/3 (33%) for NAC, and 2/4 (50%) for No-NAC patients. By evaluating each hemipelvis as a unit of analysis, sentinel nodes were detected in 53 of 82 hemipelves (65%), 19/32 (66%) of the NAC, and 34/50 (68%) of the No-NAC hemipelves. No false-negative result was found by assessing each hemipelvis as a unit of analysis. Conclusions Sentinel node biopsy is a feasible method for lymph node staging in MIBC, including patients with a history of NAC. To optimize the sensitivity, the decision regarding the lymphadenectomy is best to be based on the pathological status of sentinel node harvested from each hemipelvis separately as the unilateral finding of a sentinel node, does not rule out the possibility of metastatic involvement of contralateral pelvic lymph nodes.

Nephro-Urology Monthly, Mar 25, 2020

Nephro-Urology Monthly, Feb 5, 2019

Context: Nowadays, the demand for a kidney allograft is increasing in Iran as well as the rest of... more Context: Nowadays, the demand for a kidney allograft is increasing in Iran as well as the rest of the world, which is growing the wait list. The Iranian model of a kidney transplant was initiated for solving organ shortage and has been extremely controversial both inside and outside of Iran. Evidence Acquisition: This narrative review was done by using Iranian and international databases to retrieve literature dealing with the Iranian model of kidney transplantation. All publications up until January 2018 were included. It has drawn out the weaknesses and strengths as well as the advantages and disadvantages, then, it provides some suggestion for better functioning of the Iranian model. Results: Overall, 61 publications were retrieved and selected. After exclusion of unsuitable and duplicate articles, 17 were included. The main strengths of the Iranian model were having a lawful structure, supporting health centers and patients financially by government and charity funds, as well as reducing the waiting list. The main weaknesses include inadequate public awareness regarding the concept of brain death, the absence of a well-defined kidney registry system, need for renewing existing laws, regulations, and guidelines, the absence of permanent health insurance and follow-up for donors, as well as absence of a comprehensive network organ bank. Conclusions: The transplant authorities in Iran should work on reinforcement of the model by solving and overcoming some challenges. Preventing organ failure, as well as its risk factors, public education and encouraging organ donation from individuals who are brain dead, improving the outcomes of circulatory death donation, and investment in tissue engineering could significantly reduce organ shortage. The final solution is living unrelated renal donation (LURD).

Research and Reports in Urology

Introduction: There are several investigations about preimplantation biopsy results in alive dono... more Introduction: There are several investigations about preimplantation biopsy results in alive donors. However, assessment of the biopsies in deceased donors' kidney and its correlation with patient survival is limited. In this study, we evaluated the correlation between zero-time pretransplant kidney biopsy and survival of kidney in deceased donors. Patients and methods: This was a cohort study conducted at Montaserieh Hospital, Mashhad, between January 2016 and December 2017. We included all brain dead patients who were referred to Montaserieh transplantation center. After vascular anastomosis of kidneys in recipient patients, in the operation room, and de-clumping of vessels, biopsies were taken from upper pole of donated kidney. Blocks of biopsies were evaluated by expert pathologists and then reported. We followed patients for 1 year and compared the pathologic findings and renal survival in them. Results: The mean age of deceased donors was 32.32±1.49 years and that of the recipient patients was 36.33±1.27 years. Thirty-eight recipient patients (45.2%) were female and 46 were male (54.8%). The most pathologic pattern in our study was grade I separation, followed by blebs, dilatation, and loss of attenuation. We showed that most of the transplantations were safe after 1-year follow-up (85.7%) without any complications. We observed thrombosis in two cases (2.4%) and rejection of transplantation in ten patients (11.9%). Cox regression analysis showed that end-stage renal disease grade (HR =3.84, 95% CI =2.315-6.348; P<0.0001) and gender of the deceased donors (HR =0.34, 95% CI =0.145-0.797; P=0.013) were related to graft survival rate. Conclusion: Only cast feature in pathologic exam was related to graft survival, which is a marker of tissue ischemia. There was no significant correlation between other histological findings and graft survival.

Clinical Epidemiology and Global Health

Abstract Background End-stage Renal Disease is considered a health problem due to the high preval... more Abstract Background End-stage Renal Disease is considered a health problem due to the high prevalence and economic burden on society and the health system. This study utilizes a cost-utility analysis to evaluate the costs and outcomes of the Iranian End Stage Renal Disease patients. Methods A Markov model-based economic evaluation with a societal perspective, and a lifetime horizon performed to quantify the costs and health-related outcomes in terms of QALY. Direct medical costs obtained from hospital billing and medical records and direct non-medical costs, and indirect costs derived from interviews with patients. Three policy options, the hemodialysis, peritoneal dialysis and kidney transplantation were compared. Most of the Transplants from deceased and rest were from Live Related Donors. One-way and probabilistic sensitivity analyses were performed to study uncertainty. Results Annual average cost of hemodialysis is 13477costofperitonealdialysisis13477 cost of peritoneal dialysis is 13477costofperitonealdialysisis12865, and cost of Transplantation is 16450.TheTransplantationarmgained9.43QALYcomparedwithperitonealdialysisandhemodialysiswith6.95and6.04QALYrespectively.WhenTransplantationwascomparedwithperitonealdialysis,IncrementalCost−EffectivenessRatiowas16450.The Transplantation arm gained 9.43 QALY compared with peritoneal dialysis and hemodialysis with 6.95 and 6.04 QALY respectively. When Transplantation was compared with peritoneal dialysis, Incremental Cost-Effectiveness Ratio was 16450.TheTransplantationarmgained9.43QALYcomparedwithperitonealdialysisandhemodialysiswith6.95and6.04QALYrespectively.WhenTransplantationwascomparedwithperitonealdialysis,IncrementalCost−EffectivenessRatiowas1744 per QALY. ICER value suggests that Transplantation is cost-effective compared with peritoneal dialysis at a willingness-to-pay threshold of $12,400, and hemodialysis was dominated. Conclusion This study suggests that kidney transplantation is a better option over hemodialysis and peritoneal dialysis. We conclude that serious efforts ought to be made to foster potential brain-dead donors and altruistic kidney donation and promote peritoneal dialysis as a superior alternative to hemodialysis for eligible patients.

World Journal of Urology, 2012

Benign prostatic hyperplasia (BPH) is the main cause of lower urinary tract symptoms (LUTS) in el... more Benign prostatic hyperplasia (BPH) is the main cause of lower urinary tract symptoms (LUTS) in elderly men. Some patients respond poorly to routine medical therapy and are not well suited for surgery, too. This study was planned to evaluate the effect of Botulinum-A on BPH refractory to current medical therapy in poor surgical candidates. In this clinical trial, 10 patients with LUTS suggestive of BPH who had responded poorly to medical therapy for at least 6 months and were poor surgical candidates, were received different doses of transurethral Botulinum-A injection based on their prostate volume. The prostate volume, PSA, Qmax, IPSS, PVR and frequency of nocturia were evaluated and compared before and after treatment. The mean IPSS was 24.50 ± 3.8 and 13.40 ± 2.67 before and after the treatment, respectively (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The mean prostate volume was decreased from 41.50 ± 10.85 mL to 30.40 ± 8.05 mL (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The Qmax was increased from 7.87 ± 2.01 mL/s to 16.19 ± 1.76 mL/s (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The mean PSA was 3.12 ± 0.49 ng/mL and 1.71 ± 0.39 ng/mL before and after treatment, respectively (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The mean PVR was 75.6 ± 51.63 mL and 63.50 ± 36.59 mL before and after treatment, respectively (P = 0.096). The mean number of nocturia was decreased from 4.1 ± 0.87 to 2.4 ± 0.84 (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The mean IPSS, Prostate volume, PSA and frequency of nocturia were decreased significantly. Although mean PVR was decreased but it wasn&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;t statistically significant. The mean Qmax was increased significantly. Intraprostatic injection of Botulinum-A may be an effective and safe treatment for symptomatic BPH in selected patients whose medical treatment has faced failure and are poor surgical candidates. Transurethral method could be selected as a preferable technique of injection.

Saudi Journal of Kidney Diseases and Transplantation, 2014

The aim of this study was to determine the effect of kidney transplantation on serum prostate-spe... more The aim of this study was to determine the effect of kidney transplantation on serum prostate-specific antigen (PSA) levels. Forty patients who were on peritoneal dialysis or hemodialysis underwent kidney transplantation at our department. The immunosuppressive protocol was uniform during the study period. The creatinine and prostate specific antigen (PSA) levels, both free and total, were measured by immunofluorometric assays immediately before transplantation and on post-transplant Days 1, 7, 90 and 180. The mean age of the patients was 49.97 ± 4.4 years. After transplantation, there was a significant decrease in free PSA, but there was no correlation between total PSA and serum creatinine. Free PSA levels were significantly decreased after kidney transplantation but total PSA remained unchanged. This was observed in post-transplant patients irrespective of whether they had delayed graft function, slow graft function or immediate graft function during the observed period. Therefor...

Experimental and Clinical Transplantation, 2014

To assess the safety and efficacy of minimally invasive procedures for urolithiasis in transplant... more To assess the safety and efficacy of minimally invasive procedures for urolithiasis in transplanted kidneys. A retrospective study was done on kidney transplant patients who had urolithiasis treated with minimally invasive procedures between January 1989 and September 2011. We evaluated patient characteristics, predisposing factors, clinical presentation, minimally invasive procedures used, frequency of success, and complications. In 1800 kidney transplants, 21 recipients developed urolithiasis (mean age, 31 y; 13 men and 8 women) and were treated with minimally invasive procedures. Predisposing factors included hyperparathyroidism (6 patients), hyperuricemia (5 patients), recurrent urinary tract infection (4 patients), ureteral stricture or obstruction (2 patients), and unknown factors (4 patients). Clinical presentation included hematuria (5 patients), azotemia (4 patients), anuria (3 patients), urinary tract infection (3 patients), and hydronephrosis (2 patients). The stones were...

Objective: This study sought to evaluate platelet volume indices (mean platelet volume [MPV], pla... more Objective: This study sought to evaluate platelet volume indices (mean platelet volume [MPV], platelet distribution width [PDW], and platelet large cell ratio [P-LCR]) in varicocele patients, and compare it with platelet volume parameters in healthy controls. Methods: This cross-sectional study involved 2 groups: group 1 included 51 varicocele subjects and group 2 consisted of 50 healthy control subjects of similar ages. Peripheral venous blood samples were collected with ethylenediaminetetraacetic acid-K2 anticoagulant between 8:30 AM and 10 AM following an overnight fast. Platelet volume parameters (MPV, PDW, and P-LCR) were measured in both groups within 2 hours of sampling. Results: The mean PDW, MPV, and P-LCR were 13.9±2.5%, 10.1±1.3 fL, and 27.3±7.8 % in varicocele patients, respectively, and were 12.6±2.4%, 9.3 ± 1.1 fL, and 21.9 ± 6.4 % in the control group, respectively. The mean PDW, MPV, and P-LCR were significantly higher in the varicocele group than the control group. ...

Nephro-Urology Monthly

Context: Nowadays, the demand for a kidney allograft is increasing in Iran as well as the rest of... more Context: Nowadays, the demand for a kidney allograft is increasing in Iran as well as the rest of the world, which is growing the wait list. The Iranian model of a kidney transplant was initiated for solving organ shortage and has been extremely controversial both inside and outside of Iran. Evidence Acquisition: This narrative review was done by using Iranian and international databases to retrieve literature dealing with the Iranian model of kidney transplantation. All publications up until January 2018 were included. It has drawn out the weaknesses and strengths as well as the advantages and disadvantages, then, it provides some suggestion for better functioning of the Iranian model. Results: Overall, 61 publications were retrieved and selected. After exclusion of unsuitable and duplicate articles, 17 were included. The main strengths of the Iranian model were having a lawful structure, supporting health centers and patients financially by government and charity funds, as well as reducing the waiting list. The main weaknesses include inadequate public awareness regarding the concept of brain death, the absence of a well-defined kidney registry system, need for renewing existing laws, regulations, and guidelines, the absence of permanent health insurance and follow-up for donors, as well as absence of a comprehensive network organ bank. Conclusions: The transplant authorities in Iran should work on reinforcement of the model by solving and overcoming some challenges. Preventing organ failure, as well as its risk factors, public education and encouraging organ donation from individuals who are brain dead, improving the outcomes of circulatory death donation, and investment in tissue engineering could significantly reduce organ shortage. The final solution is living unrelated renal donation (LURD).

Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2014

We read the interesting article by Dr. Sidebottom and associates published in your journal.1 Ther... more We read the interesting article by Dr. Sidebottom and associates published in your journal.1 There is controversy in the literature about the necessity and duration of drains after transplant. Drains can act as a gateway for entry of organisms. In contrast, drains can give early warning of bleeding, urine leakage, or lymphatic leakage.2-4 Drains can decrease the incidence of deep vein thrombosis and lymphocele formation and treatment.5 The study attempted to determine the association between drains and wound complications. There were some important limitations of this report. The most important limitation was the presence of selection bias. In this study, Patients at greater risk of wound complications had drains, and low-risk patients did not have drains. This important bias is a serious limitation in interpreting the results. We believe that in the high-risk group, early recognition of wound complications can minimize the morbidity of patients and decrease the incidence of complic...

Nuclear medicine review. Central & Eastern Europe, 2021

BACKGROUND The feasibility of the sentinel node mapping in upper tract urothelial cancers (UTUC) ... more BACKGROUND The feasibility of the sentinel node mapping in upper tract urothelial cancers (UTUC) was evaluated, using a radiotracer as the mapping material. MATERIAL AND METHODS To identify the sentinel lymph nodes, 37 MBq of [99mTc] phytate was injected in five patients with the renal pelvis or ureter cancer, who were candidates for ureterectomy and lymphadenectomy. The radiotracer was injected in a peritumoral fashion following the surgical exposure of the tumour. The sentinel lymph nodes were detected using a handheld gamma probe. RESULTS By intraoperatively injecting the radiotracer immediately after surgical exposure of the tumour, at least one sentinel lymph node could be detected in each patient, and the detection rate was 100%. The location of sentinel nodes was in the paracaval, renal hill, retro-aortic, para-aortic, common iliac, and external iliac areas, which was dependent on the tumour location. No false-negative case was identified. CONCLUSIONS Sentinel node mapping is...

1. Assistant Professor, Kidney Transplantation Complications Research Center, Mashhad University ... more 1. Assistant Professor, Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 2. Instructor, Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 3. Assistant Professor, Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 4. Assistant Professor, Clinical Research Units, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran 5. Medicine Student, Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 6. Assistant Professor, Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

Journal of patient safety and quality improvement, 2019

Introduction: Prostate carcinoma is the most common type of cancer and the second lethal cancer i... more Introduction: Prostate carcinoma is the most common type of cancer and the second lethal cancer in men. Overexpression of Her2-neu gene affects the growth and prognosis of some tumors. HER2 gene amplification is seen in about one-third of prostatic adenocarcinoma cases.it also seems to correlate with androgen independence of the prostate tumors. We evaluated the HER2-neu expression in prostate cancer and its relation with known prognostic factors, in this study. Material and Methods: Immunohistochemical staining was used to evaluate the expression of Her2-neu in 60 cases of prostate carcinoma. The relation between HER2-neu expression and prognostic factors of prostatic carcinoma was evaluated,which included serum PSA values , number of core involvement, high percentage of core involvement,Gleason score,Gleason grade,extra prostatic extension of the tumoral cells and tumor volume.Results: Among 60 patients included in our study ,Her2-neu was negative in 49 (81.7%) cases (zero score i...

Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 2017

OBJECTIVES Vascular complications, especially immediate events during kidney transplant, are the ... more OBJECTIVES Vascular complications, especially immediate events during kidney transplant, are the major cause of graft loss, and prompt surgical intervention is important for salvage of the graft and recipient. In this study, our aim was to show our experiences with vascular interventions and their effects on graft outcomes in transplant patients with suspected immediate vascular events. MATERIALS AND METHODS Over 24 years (from 1990 to 2014), 2100 renal transplant procedures (1562 living and 538 deceased donors) were performed by one fixed team. We reviewed the recipients to find cases with immediate vascular complications, including artery or vein kinking or torsion, renal artery thrombosis, and renal vein thrombosis. Diagnosis of a vascular event was suspected when urinary output suddenly stopped and was confirmed by color Doppler ultrasonography or immediate exploration. Characteristics of the patients and events, surgical interventions for saving grafts, and graft outcomes were ...

Background The patients undergoing kidney transplantation are at risk of increasing Intra-Abdomin... more Background The patients undergoing kidney transplantation are at risk of increasing Intra-Abdominal Pressure (IAP) due to the abdominal surgery. Methods This diagnostic accuracy study was conducted on 135 patients, who had undergone kidney transplantation from alive and brain death patients in two hospitals of Iran and Afghanistan, in 2019. The patients' intra-abdominal pressure was measured every 6 hours up to 24 hours after surgery by nurses. The indices of renal dysfunction were utilized, including creatinine level, urine volume, need dialysis and thymoglobulin after transplantation and nephrectomy in 6 months. The sensitivity as well as positive and negative predictive value of the IAP test was counted based on these indices. Doppler ultrasound of the transplanted kidney was used as a gold standard diagnostic test. Data analysis was done by using STATA 14. Results According to the results 10 (7.4%) people of 135 patients were observed with IAP > 10mmhg. Nobody revealed IA...

Case Reports in Urology

Circumcision is the most prevalent surgery among men. Like any other surgical intervention, it is... more Circumcision is the most prevalent surgery among men. Like any other surgical intervention, it is associated with several complications. A rare shocking complication is glans amputation which is a urologic emergency. Herein, we present a 4-year-old boy with penile glans amputation following circumcision. The reimplantation was performed in less than two hours. We approximated the ends over a size 4 : 0 catheter. The urethral anastomosis was performed via 6 : 0 Vicryl sutures. Then, we sutured amputated glans in place via Vicryl 4 : 0. We immobilized the penis for a week via bandages used in penile reconstruction surgeries. We also used pentoxifylline to treat glans ischemia after surgery. The patient and his parents did not mention any difficulties or abnormalities while voiding, and the cosmetic result was favorable after three months of follow-up.

Annals of Nuclear Medicine

Objective In this study, the validity of sentinel node biopsy procedure as our index test was ass... more Objective In this study, the validity of sentinel node biopsy procedure as our index test was assessed and compared with bilateral pelvic lymphadenectomy for staging and detecting the regional lymph nodes metastasis in patients with muscleinvasive bladder cancer (MIBC). Methods Consecutive series of cases with T1-T4 urothelial MIBC were included. Following the injection of radiotracer, sentinel nodes were sought using a handheld gamma probe and all hot nodes were harvested. Bilateral pelvic lymphadenectomy was done for all patients following sentinel node biopsy. The tumor specimen, sentinel nodes, and excised lymph nodes were evaluated histopathologically. Same as the other midline tumors, detection rate and false negative rates were calculated using patient basis and side basis methods. Results By evaluating each patient as a unit of analysis, sentinel nodes were detected in 35 of 41 patients (85%), 13/16 (81%) of the neoadjuvant chemotherapy (NAC) and 22/25 (88%) of the no-neoadjuvant chemotherapy (No-NAC) participants. The false negative rate was 3/7 (42%): 1/3 (33%) for NAC, and 2/4 (50%) for No-NAC patients. By evaluating each hemipelvis as a unit of analysis, sentinel nodes were detected in 53 of 82 hemipelves (65%), 19/32 (66%) of the NAC, and 34/50 (68%) of the No-NAC hemipelves. No false-negative result was found by assessing each hemipelvis as a unit of analysis. Conclusions Sentinel node biopsy is a feasible method for lymph node staging in MIBC, including patients with a history of NAC. To optimize the sensitivity, the decision regarding the lymphadenectomy is best to be based on the pathological status of sentinel node harvested from each hemipelvis separately as the unilateral finding of a sentinel node, does not rule out the possibility of metastatic involvement of contralateral pelvic lymph nodes.

Nephro-Urology Monthly, Mar 25, 2020

Nephro-Urology Monthly, Feb 5, 2019

Context: Nowadays, the demand for a kidney allograft is increasing in Iran as well as the rest of... more Context: Nowadays, the demand for a kidney allograft is increasing in Iran as well as the rest of the world, which is growing the wait list. The Iranian model of a kidney transplant was initiated for solving organ shortage and has been extremely controversial both inside and outside of Iran. Evidence Acquisition: This narrative review was done by using Iranian and international databases to retrieve literature dealing with the Iranian model of kidney transplantation. All publications up until January 2018 were included. It has drawn out the weaknesses and strengths as well as the advantages and disadvantages, then, it provides some suggestion for better functioning of the Iranian model. Results: Overall, 61 publications were retrieved and selected. After exclusion of unsuitable and duplicate articles, 17 were included. The main strengths of the Iranian model were having a lawful structure, supporting health centers and patients financially by government and charity funds, as well as reducing the waiting list. The main weaknesses include inadequate public awareness regarding the concept of brain death, the absence of a well-defined kidney registry system, need for renewing existing laws, regulations, and guidelines, the absence of permanent health insurance and follow-up for donors, as well as absence of a comprehensive network organ bank. Conclusions: The transplant authorities in Iran should work on reinforcement of the model by solving and overcoming some challenges. Preventing organ failure, as well as its risk factors, public education and encouraging organ donation from individuals who are brain dead, improving the outcomes of circulatory death donation, and investment in tissue engineering could significantly reduce organ shortage. The final solution is living unrelated renal donation (LURD).

Research and Reports in Urology

Introduction: There are several investigations about preimplantation biopsy results in alive dono... more Introduction: There are several investigations about preimplantation biopsy results in alive donors. However, assessment of the biopsies in deceased donors' kidney and its correlation with patient survival is limited. In this study, we evaluated the correlation between zero-time pretransplant kidney biopsy and survival of kidney in deceased donors. Patients and methods: This was a cohort study conducted at Montaserieh Hospital, Mashhad, between January 2016 and December 2017. We included all brain dead patients who were referred to Montaserieh transplantation center. After vascular anastomosis of kidneys in recipient patients, in the operation room, and de-clumping of vessels, biopsies were taken from upper pole of donated kidney. Blocks of biopsies were evaluated by expert pathologists and then reported. We followed patients for 1 year and compared the pathologic findings and renal survival in them. Results: The mean age of deceased donors was 32.32±1.49 years and that of the recipient patients was 36.33±1.27 years. Thirty-eight recipient patients (45.2%) were female and 46 were male (54.8%). The most pathologic pattern in our study was grade I separation, followed by blebs, dilatation, and loss of attenuation. We showed that most of the transplantations were safe after 1-year follow-up (85.7%) without any complications. We observed thrombosis in two cases (2.4%) and rejection of transplantation in ten patients (11.9%). Cox regression analysis showed that end-stage renal disease grade (HR =3.84, 95% CI =2.315-6.348; P<0.0001) and gender of the deceased donors (HR =0.34, 95% CI =0.145-0.797; P=0.013) were related to graft survival rate. Conclusion: Only cast feature in pathologic exam was related to graft survival, which is a marker of tissue ischemia. There was no significant correlation between other histological findings and graft survival.

Clinical Epidemiology and Global Health

Abstract Background End-stage Renal Disease is considered a health problem due to the high preval... more Abstract Background End-stage Renal Disease is considered a health problem due to the high prevalence and economic burden on society and the health system. This study utilizes a cost-utility analysis to evaluate the costs and outcomes of the Iranian End Stage Renal Disease patients. Methods A Markov model-based economic evaluation with a societal perspective, and a lifetime horizon performed to quantify the costs and health-related outcomes in terms of QALY. Direct medical costs obtained from hospital billing and medical records and direct non-medical costs, and indirect costs derived from interviews with patients. Three policy options, the hemodialysis, peritoneal dialysis and kidney transplantation were compared. Most of the Transplants from deceased and rest were from Live Related Donors. One-way and probabilistic sensitivity analyses were performed to study uncertainty. Results Annual average cost of hemodialysis is 13477costofperitonealdialysisis13477 cost of peritoneal dialysis is 13477costofperitonealdialysisis12865, and cost of Transplantation is 16450.TheTransplantationarmgained9.43QALYcomparedwithperitonealdialysisandhemodialysiswith6.95and6.04QALYrespectively.WhenTransplantationwascomparedwithperitonealdialysis,IncrementalCost−EffectivenessRatiowas16450.The Transplantation arm gained 9.43 QALY compared with peritoneal dialysis and hemodialysis with 6.95 and 6.04 QALY respectively. When Transplantation was compared with peritoneal dialysis, Incremental Cost-Effectiveness Ratio was 16450.TheTransplantationarmgained9.43QALYcomparedwithperitonealdialysisandhemodialysiswith6.95and6.04QALYrespectively.WhenTransplantationwascomparedwithperitonealdialysis,IncrementalCost−EffectivenessRatiowas1744 per QALY. ICER value suggests that Transplantation is cost-effective compared with peritoneal dialysis at a willingness-to-pay threshold of $12,400, and hemodialysis was dominated. Conclusion This study suggests that kidney transplantation is a better option over hemodialysis and peritoneal dialysis. We conclude that serious efforts ought to be made to foster potential brain-dead donors and altruistic kidney donation and promote peritoneal dialysis as a superior alternative to hemodialysis for eligible patients.