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PurposeThis study is a systematic analysis of the evidence regarding oncological, perioperative and postoperative outcomes and the cost of open retropubic radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP) and robotic-assisted laparoscopic radical prostatectomy (RALP).MethodsSummary data was abstracted from 104 original research articles representing 227,400 patients. PubMed/Medline, Scopus, Google Scholar, EMBASE and the Cochrane Library were reviewed in December 2016. A total of 104 publications were selected for inclusion. The primary outcomes were positive surgical margin (PSM) and major complication rate according to Clavien classifications. Secondary outcomes were operative time, length of hospital stay, estimated blood loss, transfusions, conversions, rate of post-operative erectile dysfunction and incontinence and total cost of procedure.ResultsORP had a significantly higher rate than RALP for PSM (OR: 1.18; 95% CI 1.05–1.32; p = 0.004), but the rate of PSM was not significantly different between ORP versus LRP (OR: 1.37; 95% CI 0.88–2.14; p = 0.17) and RALP versus LRP (OR: 0.83; 95% CI 0.40–1.72; p = 0.62). The major Clavien complication rate was significantly different between ORP and RALP (OR: 2.14; 95% CI 1.24–3.68; p = 0.006). Estimated blood loss, transfusions and length of hospital stay were low for RALP, moderate for LRP and high for ORP. The rate of erectile dysfunction (OR: 2.58; 95% CI 1.77–3.75; p < 0.001) and incontinence (OR: 3.57; 95% CI 2.28–5.58; p < 0.001) were significantly lower after RALP than LRP and equivalent for other comparisons. Total cost was highest for RALP, followed by LRP and ORP.ConclusionsFor PSM and peri- and post-operative complications, RALP showed better results than ORP and LRP. In the context of the biases between the studies, one should interpret the results with caution.

PurposeThe percutaneous nephrolithotomy (PCNL) has become the gold-standard for treating patients with the larger renal stones and staghorn calculi. This study was designed to evaluate the outcomes of flank versus prone position in patients underwent ultrasonic-guided PCNL for treatment of large kidney stones.MethodsThis prospective randomized clinical trial was conducted from September 2017 to September 2019 in the department of Urology, Labbafinejad University hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Two hundred patients with kidney stones larger than 2 cm underwent PCNLs in prone (n = 100) or flank position (n = 100). Success rate, operative time, access time, hemoglobin and creatinine changes, hospital stay, auxiliary procedure and surgical complications were compared between the two groups.ResultsThe two groups were similar in their baseline characteristics. The success rates in prone (87%) versus flank position (85%) were not significantly different at the first post-operative follow-up (p = 0.91). At the three-month follow-up, the overall stone free rates for the prone position PCNLs and flank position PCNLs were 94/100 (94%) and 90/100 (90%) (p = 0.96). There were no significant difference between the groups in operative time (p = 0.42), access time (p = 0.66), hemoglobin (p = 0.46) and creatinine (p = 0.22) changes, hospital stay (p = 0.05), auxiliary procedures (p = 0.75) and surgical complications.ConclusionOverall, there is no significant difference between prone and flank positions in success rate and complications. More prospective studies must be carried out to identify patient populations who are most apt to benefit from one position over the other.Trial registration numberIRCT20200902048597N1Date of registration2020-11-21, retrospectively registered

Purpose This study was designed to compare clinical, radiological, and general health results of two prostheses (mobile vs. fixed weight-bearing devices) that are used in total knee arthroplasty with a 5-year follow-up. Methods This randomized controlled study was conducted from 2004 to 2010 in the Department of Orthopedic Surgery at two university hospitals in Isfahan, Iran. Three hundred patients with expected primary total knee arthroplasty (TKA) without severe deformity (a fixed varus or valgus deformity greater than 20°) received fixed weight-bearing ( n  = 150) or mobile weight-bearing ( n  = 150) devices. Clinical, radiological, and quality of life outcomes were compared between the two groups at six-month intervals for the first year, after which the comparisons were made annually for the next 4 years. Results Both groups had similar baseline characteristics. Although there was significant improvement in both groups, there was no significant difference between the groups with regard to the means of the Knee Society Scores, which were 92 (SD: 12.1) for the fixed weight-bearing device and 93 (SD: 14.2) for the mobile weight-bearing device (n.s.) at the final follow-up point. Radiographs showed that there was no significant difference in prosthetic alignment and no evidence of loosening. After TKA, the SF-36 score increased in both groups, but there was no statistical difference between the groups in quality of life at the final follow-up (62 (12.2) vs. 64 (14.3), n.s.). There was no revision after 5 years. Conclusions In terms of clinical, radiological or general health outcomes for people who underwent TKA, the results of this study showed no clear advantage of mobile weight-bearing over the fixed weight-bearing prosthesis at the five-year follow-up. Level of evidence I.

Headache is one of the most common complaints during medical curriculum and it occurs due to numerous psychological and physical stressors, which are more common in medical students than general population. The purpose of this study was to evaluate the frequency of different types of headache and associated factors. This cross-sectional study was conducted in Isfahan University of Medical Sciences, from September 2011 to January 2012. First- to seven-year medical students who have experienced some forms of headache in their life and had headache attacks during the past 6 months were included in this study. All medical students completed a structured check list, which consisted of demographics data, associated factors, and headache characteristics. A total of 480 (258 [53.8%] males and 222 [46.2%] females) students (93.7%) were evaluated. The prevalence of headache was 58.7%, the prevalence of migraine, and tension-type headache was 14.2% (10.5% in male vs. 18.5% in female, P = 0.08) and 44.2% (49.2% in male vs. 39.2% in female, P = 0.006), respectively. A family positive history was found in 9.5% of students with headache. The lower socio-economic status, year of study (3(rd) and 5(th) year students), was seemed to had higher prevalence in students with headache. There was no significant difference between headache and concomitant disease. The results demonstrate that prevalence of headache is high among medical student. Socio-economic and the year of study might be significant factors in the prevalence of headache. Further multicenter studies would be necessary to evaluate headache epidemiology among medical students in the whole country.

Compressive neuropathy of median nerve is relatively common but development of an hourglass like constriction is a rare phenomenon. The purpose of this study is to show morphologic changes of median nerve in advances carpal tunnel syndrome. Eighty patients with thenar atrophy, anesthesia and paresthesia of first, second and third finger and severe changes of EMG-NCV were chosen for surgery. All the cases were operated by classic approach. At ten cases, nerve was constricted in point and in six patients' area constriction was seen. Internal and external neurolysis was performed in all the cases. In two of them because of the wide and severe constriction, resection and end-to-end repair was performed. All the patients have been examined periodically. Mean follow-up was 12 month (8-40). According to grading, pain degree (from 8-9 pre operation to 3-4 post operation) and two point discrimination (from the mean of 14 mm (13-20 mm) to 8 mm (6-10 mm)) decreased. Grip power was increased from the mean of 10 kg to 21 kg. In 15 cases return of sensation, and in 13 cases improvement of opposition power was seen. We recommend epineurolysis for mild to moderate constriction and also end-to-end repair may be needed if extensive and severe constriction was found. It means that if we manage mild to moderate constriction sooner, it can prevent the need for further surgical procedure because of sever constriction.

Aims: Determining the source of low back pain (LBP) is still controversial. This study was designed to determine the source of LBP and its relations with age and gender. Settings and Design: A retrospective chart review at Isfahan University of Medical Sciences, Isfahan, Iran. Materials and Methods: A total of 1,125 patients were evaluated to determine the sources of their LBP with physical examinations, imaging, injections, and other laboratory examinations, if needed. The patients were divided into five groups based on their ages. Frequencies of the sources of pain were assessed in the five age groups, and the assessments were done separately by gender. Statistical Analysis Used: Independent t-test, analysis of variance (ANOVA), chi-square test. Results: The patients enrolled in this study consisted of 527 males (46.8%) and 598 females (53.2%). The frequencies of the sources of pain were, in descending order, spine (689, 61.2%), no cause found (163, 14.5%), spine with sacroiliac joint (SIJ) (72, 6.4%), spine with hip (65, 5.8%), SIJ (60, 5.3%), hip (44, 3.9%), spine along with hip and SIJ (20, 1.8%), hip with SIJ (8, 0.7%), and other diseases (4, 0.4%). There were significant statistical differences between the genders and mean ages for different sources (P = 0.03 and 0.000, respectively). Conclusions: This study showed that the spine was the main source of LBP in all age groups. Physicians should always be alert for other sources in middle-aged and older patients. Future studies with long-term follow-up for determining the benefits of treatments are warranted.

This study was designed to compare two methods of surgery, anterior subcutaneous transposition (ASCT) and anterior submuscular transposition (ASMT) of the ulnar nerve in treatment of cubital tunnel syndrome. This randomized trial study was conducted from October 2008 to March 2009 in the Department of Orthopedic Surgery at University Hospital. Forty-eight patients with confirmed cubital tunnel syndrome were randomized in two groups, and each patient received one of two different surgical treatment methods, either ASCT (n = 24) or ASMT (n = 24). In the ASCT technique, the ulnar nerve was transposed and retained in the subcutaneous bed, whereas in the ASMT, the nerve was retained deep in the transected muscular complex, near the median nerve. Patient outcomes, including pain, sensation, muscle strength, and muscle atrophy were compared between groups. The two groups were similar in baseline characteristics. However, those treated with ASMT had a statistically significant reduction in their pain levels compared with ASCT (21 (87.5%) vs 8 (33.3%), P < 0.05). There were no statistically significant differences between the two groups relative to sensation (11 (45.8%) vs 12 (50%)), muscle strength (17 (70.8%) vs 15 (62.5%)), or muscle atrophy (15 (62.5%) vs 17 (70.8%)) (P > 0.05). Our results indicate that ASMT are more efficient than ASCT for managing cubital tunnel syndrome. In patients who had ASMT, there were significant reductions of pain compared with ASCT.

Unicameral bone cysts are benign, fluid-filled lesions that occur mostly in long bones (proximal humerus, 50–60%; femur, 30%) of male children aged 5 to 15 years. Occurrence in the scaphoid of an adult is rare. We report 2 such patients who presented with wrist pain, with and without a history of trauma. Both underwent curettage and bone grafting (harvested from the distal radius) and achieved good functional recovery.

Hydatid disease is still endemic in several regions of the world and is caused by two species of tapeworms, Echinococcus granulosus and Echinococcus alveolaris. It primary involves liver and lung, and bone involvement is relatively rare (0.2-4%), where it is most commonly seen in the spine. The skeletal involvement is usually due to secondary extension such as hematogenous spread. The disease has usually a silent manifestation until a complication exists; so, many cases are diagnosed intraoperatively. Treatment of hydatid disease because of its bone involvement and spillage of fluid with subsequent contamination seeding is difficult, so it has a high mortality rate and many cases will recur. Therefore, we can prevent these occurrences if we treat hydatid disease completely and in the primary stage. Adjuvant medical treatment, if the diagnosis is known, prevents systemic spread and recurrence. Here, we present a primary recurrent hydatosis at the site of non-union humerus fracture. We have pointed out osseous hydatosis as one of the important differential diagnoses in destructive bone lesions and the necessity of its radical resection.

In recent years, outcome assessment related to orthopedic surgeries has increasingly focused on patient-reported questionnaires. The Oxford Hip Score (OHS), self-administered questionnaire, is a reliable, valid, and responsive instrument for assessing hip in patients undergoing Arthroplasty. The study involved 105 adult Persian-speaking patients admitted for primary Total Hip Arthroplasty in two hospitals in Isfahan in Iran from September 2009 until April 2011. All of them filled out their scales (Persian OHS, WOMAC, and SF12) in preoperative examination. Mean scores of OHS in first administrations was 42.7 ± 12.7. The Persian OHS overall score demonstrated high reproducibility (ICC,0.93, P < 0.001) and internal consistency (CA, 0.94). PersianOHS had high correlations with WOMAC total score (r = 0.86), function score (r = 0.86), and pain score (r = 0.79), the relationship between the Persian OHS and the WOMAC stiffness subscale was somewhat lower (r = 0.69). The correlation coefficient between the Persian OHS and the PCS of the SF-12 in our study was moderate (r = 0.58). Persian OHS had low correlation with MCS of the SF-12 (r = 0.40). Persian OHS had high correlations with WOMAC total score, function score, and pain score. It had moderate correlation with PCS of the SF-12 and low correlation with MCS of the SF-12. Our study demonstrated the trans-cultural adaptation and validation of the Persian OHS is a reliable and practicable instrument for assessment of function and pain in Iranian patients with hip osteoarthritis.