Purpose: To investigate the literature on the presence of COVID-19 virus in urine of infected patients and evaluate the attributes and clinical significance of COVID-19 in urine including probability of infection transmission through urine. Data sources: A systematic review of literature from December 2019 to 6 th May 2020 was conducted on Pubmed, google scholar, ovid, scopus and ISI web of science. Study eligibility criteria: Studies which investigated urinary viral shedding of COVID-19 in infected patients were included. Study appraisal and synthesis methods: Two reviewers selected relative studies and performed quality assessment of individual studies. Meta-analysis was performed the pooled case reports and case series. Fixed-effects model was used for analysis as no significant heterogeneity was observed between studies. Results: Thirty three studies were finally included in the systematic review including 12 case reports, 20 case series, and one cohort. Urinary samples from 430 patients were investigated. Ten studies reported the presence of COVID-19 in urinary samples from 16 patients. The rate of COVID-19 presence in urinary samples was 3.7%. Urinary viral load was low in most reports. The presence of virus in urine was not related to the disease course of the illness. Urinary COVID-19 was mostly detected from patients with moderate to severe disease (13 pts) but was also isolated from two children (one neonate and one 7 year-old girl) and one adult with mild disease. The pathogenicity of virus isolated from urine has been demonstrated in cell culture media in one study. Conclusions: This review highlights the low frequency of COVID-19 presence in urine of infected individuals and the potential of isolated virus for cytopathic effects. Therefore the probability of infection transmission through urine can be suggested. Caution must be exerted when dealing with urine of patients infected with COVID-19 including medical interventions like endoscopy and urethral catheterization. : medRxiv preprint ABSTRACT Purpose: To investigate the literature on the presence of COVID-19 virus in urine of infected patients and evaluate the attributes and clinical significance of COVID-19 in urine including probability of infection transmission through urine. Data sources: A systematic review of literature from December 2019 to 6 th May 2020 was conducted on Pubmed, google scholar, ovid, scopus and ISI web of science. Study eligibility criteria: Studies which investigated urinary viral shedding of COVID-19 in infected patients were included. Study appraisal and synthesis methods: Two reviewers selected relative studies and performed quality assessment of individual studies. Meta-analysis was performed the pooled case reports and case series. Fixed-effects model was used for analysis as no significant heterogeneity was observed between studies.Results: Thirty three studies were finally included in the systematic review including 12 case reports, 20 case series, and one cohort. Urinary samples from 430 patients were investigated...

Penile fracture (PF) is considered an emergency in urology. In the literature there are some case series reporting considerable incidence of PF in some parts of Iran. There are no accurate data about the incidence of PF all around Iran. Although it may be uncommon in other parts of the country and in the other countries, it can also be underreported. There are some challenges in diagnosis, management, and also reporting of these cases. In this review of Iranian medical literature, we searched for penile fracture and penile injury keywords in Medline, Scopus, SID, Google and Persian medical journals. We reviewed the status of epidemiology, etiology, diagnosis, management and complications of PF in different parts of Iran in the published literature. To collect more accurate data, we also performed a questionnaire-based study with sending questionnaires by emails to 700 urologists throughout the country with 14% response rate. Incidence of PF varies significantly in different parts of Iran. Western province of Kermanshah has a significantly higher rate of PF. Adding data from different regions of Iran, we calculated that incidence of PF in Iran can be estimated between 1.14 to 10.48 per 100,000 of male populations, most probably closer to lower end. Although the incidence of PF varies significantly in different geographical areas, urologists practicing in Iran on average may encounter a PF patient every 3.5 months. To diagnose PF, majority of reviewed studies relied on history and clinical examination and did not recommend imaging except in patients with possible urethral injuries. Immediate surgical intervention can make good functional results with low morbidity and short hospital stay. Delayed surgical intervention and observational management approaches need large population studies with long term follow up.

ObjectiveIncidental prostate cancer (IPCa) is defined as a symptom-free cancer unexpectedly discovered upon microscopic examination of resected tissue. The aim of this study was to report the correlation between some specific clinical criteria in patients incidentally diagnosed with prostate cancer (PCa) during transurethral resection of the prostate (TURP) or open prostatectomy (OP) after clinically suspected benign prostatic hyperplasia.Patients and methodsThis was a cross-sectional, retrospective study. Data were collected from Shohada-e-Tajrish Hospital database during November 2006 to October 2016. Four hundred and twenty three men suffering from symptomatic benign prostatic hyperplasia who underwent either TURP or OP that provided a prostate specimen were evaluated. The data analysis was performed using Pearson correlation test and independent t-test using SPSS version 20 software.ResultsThe mean age of subjects was 68.74±9.87 years old (45–93 years). The mean prostate specific antigen (PSA) level was 21.47±13.44 ng/mL (0.6–47.1 ng/mL). Results showed that 84 patients (19.9%) had PCa (40 patients who underwent TURP [12.6%] and 44 patients who underwent OP [40.7%] groups). Cut-off point of PSA for detecting IPCa was 3.8 ng/mL in our study, and this showed sensitivity, specificity, negative predictive value, and positive predictive value of 26.08%, 100%, 100%, and 29.79%, respectively. Twenty two patients with cancer had a positive family history for PCa; thus, a significant relationship between familial history of PCa and its occurrence was shown (p=0.0001).ConclusionAccording to the results of this study, the cut-off point for PSA levels in detecting PCa was 3.8 ng/mL, which is similar to that reported by other studies. Familial history of PCa and PSA levels were two predictors in determining the PCa.

5-14% of patients underwent surgery for benign prostate hyperplasia harboring prostate cancer (PCa) focus. The best management of incidental prostate cancer (iPCa) has been debated. The decision "treatment or no treatment" should be determined by predictors which accurately foretell PCa progression after transurethral resection of the prostate (TURP). The purpose of this study is to review the available data that can be useful in daily clinical judgment. Transrectal ultrasound prostate biopsy (TRUSBx) did not provide further Gleason score (GS) data in most patients diagnosed with iPCa. TRUSBX may be useful before active surveillance, but not in all following radical prostatectomy. The decision "treatment or no treatment" should be dependent on the expected chance of having residual cancer and clinical progression. Prostate-specific antigen (PSA) levels before and after TURP are good predictors of residual cancer after TURP. Pathological report of T0 is most likely seen in patients with low PSA density after TURP and indistinguishable lesion on multiparametric magnetic resonance imaging. The decision "treatment vs no treatment" is judged by life expectancy, tumor characteristic in the pathology report of TURP sample and PSA level following TURP. Active surveillance should be contemplated in patients with iPCa who have both prostate-specific antigen density ≤0.08 after TURP and indistinguishable cancer lesion on multiparametric magnetic resonance imaging. Patients who do not meet the criteria for active surveillance are candidates for radical prostatectomy or radiotherapy (RT). Radical prostatectomy could be peacefully done after TURP with somewhat greater morbidity. RT in patients who had a history of TURP could be safely done and is associated with acceptable quality of life.

Introduction: The retrograde approach is a modification that makes the percutaneous cystolitholapaxy (PCCL) a more trendy method, especially in operating rooms with limited facilities. The transurethral approach for bladder calculi lithotripsy by a laser has become popular among urologists. In this study, we investigate the feasibility and safety of retrograde assisted access for PCCL in comparison with transurethral cystolithotripsy by the holmium-YAG laser (Ho: YAG). Methods: According to the type of intervention, the patients were stratified to two matched groups. In the retrograde-assisted percutaneous cystolitholapaxy (RPCCL) group, a Benique was conducted through the urethra into the bladder; palpating the suprapubic region, an about 1.5 cm incision was done over the tip, then an Amplatz sheath was placed over it, treading into the bladder; further cystolitholapaxy was done by a routine order. In transurethral Ho: YAG laser lithotripsy (TULL) via 200 µm fiber vaporize the stone. Results: A total of 124 male patients with the mean age of 50.33±9.64 years and the average stone burden of 3.35±1.07 cm were included in the study. The most common cause of vesical calculi was spinal cord injury. Statistically significant differences were found in terms of the mean operation time in favor of the RPCCL group (P≤0.05) and the mean hospital stay in favor of the TULL group (P≤0.05). The stone-free rate (SFR) was 100% in both methods after a onemonth follow-up. None of the interventions changed to open surgery. There were not any major complications in both methods. Conclusion: RPCCL is a safe and effective method in bladder stone treatment and is applicable in medical centres without Ho: YAG equipment.