Mahtab Zargham

Isfahan University of Medical Sciences, Isfahan, Ostān-e Eşfahān, Iran

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Publications (15)11.53 Total impact

  • Urology journal 01/2014; 11(1):1343-6. · 0.56 Impact Factor
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    ABSTRACT: The aim of this study is to evaluate the outcome of an innovative, minimally invasive sling technique with autologous tissue in women with concomitant incontinence and anterior vaginal wall prolapse (AVWP). Fifty-six women with stress urinary incontinence (SUI) or mixed urinary incontinence and AVWP were randomly assigned into two groups: In Group A (26 patients), anterior colporrhaphy (Kelly placation) and sling placement using a strip of anterior vaginal wall were performed, and in Group B (30 patients), transvaginal mesh correction of AVWP and tension-free vaginal tape (TVT) insertion (retropubic - craniocaudal route) using polypropylene mesh were carried out. The patients were followed-up for over 18 months and were assessed objectively using a 48 h frequency-volume chart, a 48 h pad test and a standardized stress test. Related surgical complications and outcomes were recorded and compared. Surgical cure rates for Group A and Group B at the first (3 days) and last (18 months) post-operative visits were 62% and 84%; and 54%, and 72%, respectively (P = 0.09 and 0.31). Complications occurred in 9 patients (44%) of Group B, but only 3 patients (12%) in Group A. Vaginal sling surgery using an anterior vaginal wall strip can improve SUI and in comparison with propylene mesh is associated with lower complication rates. Although, the surgical success rate of this technique is lower than T-Sling, larger studies with selected patients will help assess the suitable patients for this pelvic reconstructive surgery.
    Journal of research in medical sciences 07/2013; 18(7):588-93. · 0.68 Impact Factor
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    ABSTRACT: Background: To investigate the effect of polyacrylate polyalcohol copolymer (Vantris) injection for the correction of VUR in children according to ureteral orifice shape and VUR grade. Materials and Methods: Forty children (29 girls and 11 boys) with 61 renal refluxing units (RRU) and primary VUR underwent endoscopic correction of their reflux, using Vantris. Under general anesthesia, routine cystoscopy was performed and ureteral orifice configuration and dynamic hydro distention grade were determined. The injection technique was STING, HIT or a combination of them. Ultrasound scan was performed one and 3 months after injection and radionuclide cystography (RNC) was performed 3 months after the operation. Results: The mean volume of injected Vantris was 0.62 cc. Reflux was corrected in 52 (85.2%) of the 61 RRU after single injection and this equates reflux correction in 37 of the 40 patients. No significant correlation was observed between ureteral orifice shape and VUR correction rate. Conclusions: Our results showed that there was no correlation between the ureteral orifice configuration and the success rate of endoscopic surgery for VUR in short term. Abstract Original Article tract infection (UTI). [1,2] The association of reflux, UTI and renal scaring is well recognized and reflux nephropathy is a major cause of childhood hypertension and chronic renal failure. [2,3] The goal of vesicoureteric reflux (VUR) treatment is to prevent pyelonephritis and to preserve renal function. The method of treatment has traditionally been surgical intervention or medical treatment. The endoscopic use of tissue bulking agents has been gaining popularity as an alternative to medical treatment and surgical intervention. The long‑term requirement of prophylactic antibiotic therapy and the complications of open surgical treatment led to the development of endoscopic treatment of VUR in early 1980s. [4,5] This treatment was popularized
  • Journal of research in medical sciences 02/2013; 18(2):167. · 0.68 Impact Factor
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    ABSTRACT: To investigate the effect of polyacrylate polyalcohol copolymer (Vantris) injection for the correction of VUR in children according to ureteral orifice shape and VUR grade. Forty children (29 girls and 11 boys) with 61 renal refluxing units (RRU) and primary VUR underwent endoscopic correction of their reflux, using Vantris. Under general anesthesia, routine cystoscopy was performed and ureteral orifice configuration and dynamic hydro distention grade were determined. The injection technique was STING, HIT or a combination of them. Ultrasound scan was performed one and 3 months after injection and radionuclide cystography (RNC) was performed 3 months after the operation. The mean volume of injected Vantris was 0.62 cc. Reflux was corrected in 52 (85.2%) of the 61 RRU after single injection and this equates reflux correction in 37 of the 40 patients. No significant correlation was observed between ureteral orifice shape and VUR correction rate. Our results showed that there was no correlation between the ureteral orifice configuration and the success rate of endoscopic surgery for VUR in short term.
    Advanced biomedical research. 01/2013; 2:1.
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    ABSTRACT: Urinary incontinence is relatively common in women and is usually associated with pelvic organs prolapse. Our aim was to determine the relationship between type and intensity of urinary incontinence and different grades and types of pelvic organ prolapse among women. One-hundred female patients with the chief complaint of incontinence, who were diagnosed with pelvic organ prolapse participated in this study. Intensity of prolapse, stress and urge incontinence were evaluated using POP-Q (Pelvic Organ Prolapse Questionnaire), SEAPI (Stress related, Emptying ability, Anatomy, Protection, Inhibition) and Freeman criteria, respectively. Patients' mean age was 51.95 ± 12.82 years. The most common type of incontinence was stress incontinence (53%) and the most common prolapse type was cystocele (76%). Cystocele and rectocele had a significant relationship with stress (P value = 0.012) and urge incontinence (P value = 0.035), respectively; however, no relationship was observed between different grades of cystocele, rectocele and enterocele with different types of urinary incontinence (P value > 0.05). In patients with urge and mixed incontinence, prolapse grade significantly increased with age, but no such relationship was found in patients with stress incontinence. The number of vaginal deliveries had a significant relationship only with cystocele and rectocele grade; however, the relationship between other variables such as intensity of different types of urinary incontinence and enterocele grade with the number of deliveries was not significant. Pelvic organ prolapse had a significant relationship with urinary incontinence regardless of intensity and POP should be examined in all of these patients.
    Advanced biomedical research. 01/2013; 2:22.
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    ABSTRACT: Abstract Purpose: To compare blind and nerve stimulation guided transurethral obturator nerve block (ONB) in transurethral resection of bladder tumor (TURBT) to prevent obturator reflex. Patients and Methods: One hundred and twelve patients with lateral bladder wall tumors and at high risk for general anesthesia were categorized randomly in three groups. In the first group (34 patients), after spinal analgesia was administered, the exact site of the obturator nerve was determined by nerve stimulation and 15 mL of lidocaine HCl 2% was injected around the nerve. In the second group (31 patients), we determined the obturator nerve using nerve stimulation (like the first group), then 20 mL of saline was injected. In the third group (47 patients), the obturator nerve was determined based on anatomic landmarks and blocked subsequently. Leg jerking was reported and compared in the three groups. Results: The median ages in the three groups were 55.4, 59.4, 57.8 years in the first, second, and third groups, respectively. Male/female ratios were 79.5% in the first, 80.7% in the second, and 80.9% in the third group (P=0.986). Leg jerking was reported in 5.8%, 34%, and 6.3% of patients in the first, second, and third groups, respectively (P=0.0001). ONB took 6.7 minutes in the first, 6.1 minutes in the second, and 5.2 minutes in the third group, on average. There was no report of adverse effects of lidocaine HCl in this study. Conclusion: Transvesical ONB is a safe and effective method of ONB before TURBT. This method is feasible by urologists and promising even without nerve stimulation and only by anatomic landmarks.
    Journal of endourology / Endourological Society 06/2012; 26(10):1319-22. · 1.75 Impact Factor
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    ABSTRACT: Background: The aim of the study was to determine the relative frequency of abnormal urodynamic findings in new multiple sclerosis (MS) cases without micturition complaints and to find its correlation with the number of MS plaques on magnetic resonance imaging (MRI), urinary tract involvement and the number of disease episodes. Methods: In this prospective study, 50 new female case of multiple sclerosis were enrolled. Age, urodynamic findings, micturition complaints and number of plaques on MRI were recorded on admission. Occurrence of urinary symptoms and number of episodes of the disease were recorded every three months during one-year follow-up. Results: The mean patients' age was 32.4 ± 7.2 years and all patients were female. Of the 50 patients, 19 (38%) had a normal urodynamic test and 31 (62%) had abnormal urodynamic findings at the beginning of the study. The occurrence of micturition complaints during follow-up in patients with abnormal urodynamic findings (94%) was significantly higher (p < 0.0001) than patients with normal urodynamic findings (37%). In addition, the number of plaques on MRI at the beginning of the study in patients with abnormal urodynamic finding was significantly higher (p < 0.004) compared to patients with a normal urodynamic study. The number of episodes during follow-up was not statistically different between patients with normal and abnormal urodynamic findings (p = 0.46). Conclusions: According to this study, 62% of all new MS patients had an abnormal urodynamic test. This is a considerable proportion of patients and it seems urodynamic studies can be used when MS is first diagnosed.
    Journal of research in medical sciences 04/2012; · 0.68 Impact Factor
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    ABSTRACT: The aim of the study was to determine the relative frequency of abnormal urodynamic findings in new multiple sclerosis (MS) cases without micturition complaints and to find its correlation with the number of MS plaques on magnetic resonance imaging (MRI), urinary tract involvement and the number of disease episodes. In this prospective study, 50 new female case of multiple sclerosis were enrolled. Age, urodynamic findings, micturition complaints and number of plaques on MRI were recorded on admission. Occurrence of urinary symptoms and number of episodes of the disease were recorded every three months during one-year follow-up. The mean patients' age was 32.4 ± 7.2 years and all patients were female. Of the 50 patients, 19 (38%) had a normal urodynamic test and 31 (62%) had abnormal urodynamic findings at the beginning of the study. The occurrence of micturition complaints during follow-up in patients with abnormal urodynamic findings (94%) was significantly higher (p < 0.0001) than patients with normal urodynamic findings (37%). In addition, the number of plaques on MRI at the beginning of the study in patients with abnormal urodynamic finding was significantly higher (p < 0.004) compared to patients with a normal urodynamic study. The number of episodes during follow-up was not statistically different between patients with normal and abnormal urodynamic findings (p = 0.46). According to this study, 62% of all new MS patients had an abnormal urodynamic test. This is a considerable proportion of patients and it seems urodynamic studies can be used when MS is first diagnosed.
    Journal of research in medical sciences 04/2012; 17(4):382-5. · 0.68 Impact Factor
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    ABSTRACT: To analyze the role of negative versus positive immunoexpression of E-cadherin in recurrence rate of low-grade bladder tumors. A total of 180 patients with unifocal, superficial, low-grade, papillary transitional cell carcinoma of the bladder were included in this study. The E-cadherin expression was evaluated using E-cadherin antibody. The patients were followed up for 36 months. Thereafter, recurrence rate of the tumor was compared between E-cadherin positive and negative groups. Of 180 low-grade carcinomas, E-cadherin immunoexpression was negative in 101 (56%) and positive in 79 (44%) patients. The recurrence rate in negative and positive groups was 65.6% and 37.9%, respectively. Negative in comparison with positive E-cadherin expression was associated with more disease recurrence (P = .045). There is an association between decreased E-Cadherin immunoexpression and tumor recurrence in low-grade and non-muscle invasive transitional cell carcinoma of the bladder.
    Urology journal 01/2012; 9(3):581-5. · 0.56 Impact Factor
  • Urology 01/2011; 78(3). · 2.42 Impact Factor
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    ABSTRACT: Background: Renal transplant ureteral stricture or obstruction is a rare but devastating complication after renal transplantation.Objective: To determine the efficacy and complications of subcutaneous prosthetic ureters as a salvage procedurein transplanted kidneys with recurrent ureteral obstruction.Methods: 5 subcutaneous prosthetic ureters were inserted in 5 kidney recipients who had recurrent ureteral stenosis and failed endoscopic and open reconstructive surgeries. The prosthetic ureter consisted of an internal silicone tube covered by a coiled PTFE tube. The proximal end of the tube was introduced in the transplanted kidney percutaneously, the tube was passed through a subcutaneous tunnel, and the distal end was inserted in the bladder through a small suprapubic incision.Results: The mean follow-up of patients was 11.3 months. One of the patients re-operated two days after the procedure because of urinary leakage from the distal end of the prosthetic ureter. No infection or tube encrustation was encountered.Conclusion: Subcutaneous prosthetic ureter is a safe alternative for permanent percutaneous nephrostomy in transplanted kidneys with obstructed ureter and failed endoscopic and open procedures.
    International Journal of Organ Transplantation Medicine. 01/2010;
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    ABSTRACT: In clinical practice, internal urethrotomy is an easy procedure and is offered as a first modality for treatment of short urethral strictures. Internal urethrotomy refers to any procedure that opens the stricture by incising or ablating it transurethrally. The most common complication of internal urethrotomy is stricture recurrence. The curative success rate of internal urethrotomy is approximately 20%. Triamcinolone has antifibroblast and anticollagen properties. This study evaluated the efficacy of triamcinolone in the prevention of anterior urethral stricture recurrence after internal urethrotomy. Fifty male patients with anterior urethral stricture were randomized to undergo internal urethrotomy with or without urethral submucosal injection of triamcinolone. Using general anesthesia urethrotomy was performed. Triamcinolone (40 mg) was injected submucosally at the urethrotomy site in 25 patients. The patients were followed for at least 12 months and the stricture recurrence rate was compared between the two groups. 23 patients in the triamcinolone group and 22 in the control group completed the study. There were no significant differences in the baseline characteristics of the patients or the etiology of the stricture between the two groups. Mean follow-up time was 13.7 ± 5.5 months (range: 1-25 months). Urethral stricture recurred in five patients (21.7%) in the triamcinolone group and in 11 patients (50%) in the control group (P = 0.04). Injection of triamcinolone significantly reduced stricture recurrence after internal urethrotomy. Further investigations are warranted to confirm its efficacy and safety.
    International Urology and Nephrology 12/2009; 42(3):565-8. · 1.33 Impact Factor
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    ABSTRACT: Introduction and hypothesisTransabdominal (TA) ultrasound and perineometry have been currently used to assess lifting aspect and squeezing action of pelvic floor muscles (PFM) function, respectively, in women with stress urinary incontinence (SUI). However, no study has directly compared these measurements. The purpose of this study was to investigate the reliability and correlation between perineometry and TA ultrasound as measurements of different aspect of PFM function. MethodsA total of 28 women with SUI participated in the study. Vaginal squeeze pressure using a perineometer and bladder base movement on TA ultrasound was measured. Scattergram was depicted to determine the correlation between variables. Intraclass correlation coefficient and Bland–Altman plot were used to assess reliability. ResultsScatter diagram depicted significant correlation of TA ultrasound with vaginal squeeze pressure (r = 0.72, R 2 = 0.52, p < 0.0001). High reliability was found for measurements. ConclusionTA ultrasound measurement may be an alternative measurement to perineometry when assessing PFM function. KeywordsPelvic floor muscles-Perineometry-Transabdominal ultrasound-Stress urinary incontinence-Vaginal squeeze pressure-Reliability
    International Urogynecology Journal 12/2009; 20(12):1491-1496. · 2.17 Impact Factor
  • Fertility and Sterility - FERT STERIL. 01/2008; 90.