The course of alterations in ureteral jet dynamics following kidney transplantation: a prospective observational cohort study.

OBJECTIVES: To prospectively investigate the alterations and normal ranges of ureteral jet dynamics after double-J-stent (DJS) removal in patients who underwent renal transplantation (RTx). METHODS: Patients who underwent RTx were prospectively evaluated between November 2017 and June 2018. After RTx, Doppler ultrasonography (D-US) was performed on all patients after DJS removal. Renal artery resistive index (RA-Ri), renal pelvis anterior-posterior diameter (RP-APD), pelvicalyceal system dilation (PCSD), and ureteral jet flow dynamics (maximum and average velocity; JETmax and JETave) were measured by D-US. Also, patients' demographics, estimated glomerular filtration rate (eGFR) levels, and acute rejection were investigated in the study. Patients were assessed two different times by D-US, about 6 and 12 weeks after DJS removal, and the two different measurements were compared with the Wilcoxon test and Chi-square test. RESULTS: A total of 25 patients were evaluated in the study. Nonobstructive PCSD rate (12% vs 8%), JETave (18.8 vs 12.9 cm/sec), and JETmax (29.2 vs 20 cm/sec) levels were significantly decreased (p values are 0.01, 0.010 and 0.014, respectively). In addition, monophasic and square pattern rates were significantly observed to increase over time (p=0.035); however, ureteral jet patterns were correlated between the two different D-US measurements (R=0.225, p=0.032). CONCLUSION: After RTx, dilation rate and ureteral jet flow velocities were significantly decreased, and monophasic and square JETpattern rates were significantly increased over time. Ureteral jet dynamics can provide useful information about the follow-up of peristaltic activity in the pelvic-ureteric system.

The course of alterations in ureteral jet dynamics following kidney transplantation: a prospective observational cohort study

SUMMARY OBJECTIVES To prospectively investigate the alterations and normal ranges of ureteral jet dynamics after double-J-stent (DJS) removal in patients who underwent renal transplantation (RTx). METHODS Patients who underwent RTx were prospectively evaluated between November 2017 and June 2018. After RTx, Doppler ultrasonography (D-US) was performed on all patients after DJS removal. Renal artery resistive index (RA-Ri), renal pelvis anterior-posterior diameter (RP-APD), pelvicalyceal system dilation (PCSD), and ureteral jet flow dynamics (maximum and average velocity; JETmax and JETave) were measured by D-US. Also, patients' demographics, estimated glomerular filtration rate (eGFR) levels, and acute rejection were investigated in the study. Patients were assessed two different times by D-US, about 6 and 12 weeks after DJS removal, and the two different measurements were compared with the Wilcoxon test and Chi-square test. RESULTS A total of 25 patients were evaluated in the study. Nonobstructive PCSD rate (12% vs 8%), JETave (18.8 vs 12.9 cm/sec), and JETmax (29.2 vs 20 cm/sec) levels were significantly decreased (p values are 0.01, 0.010 and 0.014, respectively). In addition, monophasic and square pattern rates were significantly observed to increase over time (p=0.035); however, ureteral jet patterns were correlated between the two different D-US measurements (R=0.225, p=0.032). CONCLUSION After RTx, dilation rate and ureteral jet flow velocities were significantly decreased, and monophasic and square JETpattern rates were significantly increased over time. Ureteral jet dynamics can provide useful information about the follow-up of peristaltic activity in the pelvic-ureteric system.

RESUMO OBJETIVOS Investigar prospectivamente as alterações e as variações normais da dinâmica do jato ureteral após a remoção do J-stent duplo (DJS) em pacientes submetidos a transplante renal (RTx). MÉTODOS Pacientes submetidos a RTx foram avaliados prospectivamente entre novembro de 2017 e junho de 2018. Após o RTx, o D-US foi realizado em todos os pacientes após a remoção do DJS. Índice de resistência da artéria renal (RA-Ri), diâmetro ântero-posterior da pelve renal (AP-DPR), dilatação do sistema pelvicaliceal (PCSD) e dinâmica do jato ureteral (velocidade máxima e média; JETmax e JETave) foram medidos por D-US. Além disso, a demografia dos pacientes, os níveis estimados de taxa de filtração glomerular (eGFR) e a rejeição aguda foram investigados no estudo. Os pacientes foram avaliados em dois momentos diferentes pelo D-US, cerca de 6 e 12 semanas após a remoção do DJS, e as duas medidas diferentes foram comparadas com o teste de Wilcoxon e o teste do qui-quadrado. RESULTADOS Um total de 25 pacientes foi avaliado no estudo. Taxa de PCSD não obstrutiva (12% vs. 8%), JETave (18,8 vs. 12,9 cm/seg) e JETmax (29,2 vs. 20 cm/seg), os níveis foram significativamente diminuídos (valores de p são 0,01, 0,010 e 0,014, respectivamente). Além disso, as taxas de padrão monofásico e quadrado foram significativamente observadas para aumentar ao longo do tempo (p=0,035); no entanto, padrões de jato ureteral foram correlacionados entre as duas diferentes medidas D-US (R=0,225, p=0,032). CONCLUSÃO Após o RTx, a velocidade de dilatação e as velocidades de fluxo do jato ureteral foram significativamente diminuídas e as taxas de JET padrão monofásico e quadrado foram significativamente aumentadas ao longo do tempo. A dinâmica do jato ureteral pode fornecer informações úteis sobre o acompanhamento da atividade peristáltica no sistema pélvico-ureteral.

Predictive role of neutrophil-to-lymphocyte ratio on upstaging of organ-confined invasive urothelial bladder cancer to non-organ-confined disease.

OBJECTIVE: The aim of this study is to examine the usefulness of preoperative neutrophile-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratios to predict pathological upstaging of invasive bladder cancer who underwent radical cystectomy. MATERIAL AND METHODS: A total of 126 patients who underwent radical cystectomy at our clinic between January 2006 and March 2015 were retrospectively analysed. One hundred and twelve patients with organ-confined invasive bladder tumors (T2) detected at histopathological examination of transuretral resection material were included in the study. Upstaging was seen at histopathological examination of radical cystectomy specimens of 42 patients. We compared preoperative neutrophile-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio between upstaged and not-upstaged groups. RESULTS: There were no statistically significant correlation between age, time to radical cystectomy, gender, lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio ratios and carcinoma in situ in upstaged and non-upstaged groups. Statistical analyses showed that preoperative neutrophile-to-lymphocyte ratio was higher in upstaged patients (p=0.009). In multivariate analysis preoperative neutrophile-to-lymphocyte ratio and positive surgical margin were significantly higher in upstaged group. CONCLUSION: In organ-confined muscle invasive bladder cancer neutrophile-to-lymphocyte ratio seems to be an acceptable parameter to predict locally advanced disease.

External validation and comparison of the scoring systems (S.T.O.N.E, GUY, CROES, S-ReSC) for predicting percutaneous nephrolithotomy outcomes for staghorn stones: A single center experience with 160 cases.

The aim of this study was validation and comparison of stone scoring systems (S.T.O.N.E, GUY, CROES, S-ReSC) used to predict postoperative stone-free status and complications after percutaneous nephrolithotomy (PCNL) for staghorn stones. A total of 160 patients who had staghorn renal stones and underwent PCNL between January 2012 and August 2015 were included in the current retrospective study. Guy, S.T.O.N.E., S-ReSC (Seoul National University Renal Stone Complexity) and CROES (Clinical Research Office of the Endourological Society) nephrolithometry scores were calculated for each patient, and their potential association with stone-free status, operative and fluoroscopy time, and length of hospital stay (LOS) were evaluated. Postoperative complications were graded according to the modified Clavien classification, and the correlation of scoring systems with postoperative complications was also investigated. The mean CROES, S.T.O.N.E, Guy and S-ReSC scores were 143.5 ± 33.6, 9.7 ± 1.6, 3.5 ± 0.5 and 6.2 ± 2.0 respectively. The overall stone-free rate was 59%. All scoring systems were significantly correlated with stone-free status in univariate analysis. However, Guy and S-ReSC scores were the only significant independent predictor in multivariate analysis. And all four nomograms failed to predict complication rates. Current study demonstrated that Guy and S-ReSC scoring systems could effectively predict postoperative stone-free status for staghorn stones. However all four scoring systems failed to predict complication rates.

Neutrophil to Lymphocyte Ratio as a predictor of early penile prosthesis implant infection.

PURPOSE: To investigate the predictive value of preoperative serum neutrophil-to-lymphocyte ratio (NLR) on the development of postoperative infections in patients undergoing penile prosthesis implantation (PPI). METHODS: We retrospectively analyzed the data of 361 patients who underwent PPI over a 4-year period with at least 1-year follow-up. Demographics, blood results, and postoperative 1-year complications were recorded. Recommended cutoff values of NLR for early postoperative infectious complications were determined using receiver operating characteristic analysis. RESULTS: A total of 153 patients with the mean age of 56.4 ± 8 years were included in the study. Mean follow-up time was 56.7 ± 30.4 months (12-108 months). Early postoperative infectious complications were occured in 18 patients (11.8%). These infections were prosthesis infection in 8 patients (5.2%), wound infection in 6 patients (3.9%), and urinary tract infection in 4 patients (2.6%). All these complications were occured within the first year of the surgery. Mean NLR was statistically higher in patients with postoperative complications when compared with uncomplicated cases (7.2 ± 3.9 vs. 2.2 ± 1.4, p < 0.001, respectively) Using a cut point of 6.2, preoperative NLR predicted postoperative complications with a sensitivity of 67% and specificity of 99%. CONCLUSIONS: This study is the first to investigate the relationship between NLR and early postoperative infection as a complication of PPI. The results demonstrated that the NLR value could be a potential laboratory parameter for predicting early postoperative infectious complications in patients undergoing PPI.

Neutrophil-to-lymphocyte and neutrophil-to-monocyte rates in the decision for a prostate re-biopsy in patients with a previous benign pathology and consistently 2,5-10 ng/ml PSA value.

OBJECTIVES: In this study we compared neutrophil-to-lymphocyte ratio (NLR) and neutrophilto- monocyte ratio(NMR) between patients with prostate cancer after first transrectal ultrasound (TRUS)- guided biopsy and patients with benign prostate hyperplasia(BPH) after second TRUS-guided biyopsy. METHODS: A total of 224 patients who underwent multi (≥12)-core TRUS -guided biopsy at our clinic for elevated PSA or abnormal digital rectal examination in between January 2008 and March 2015 were retrospectively analyzed. There were 2 groups. Group 1 consisted of 146 patients with a diagnosis of prostate cancer after the first TRUSguided biyopsy and group 2 consisted of 78 patients with a diagnosis of benign prostate hyperplasia after second TRUS-guided biyopsy. Age, PSA, NLR and NMR values were compared between the two groups. RESULTS: There were no statistically significant correlation between PSA and NLR(p=0.46). The mean of age, PSA, NLR, NMR values in the group 1 and 2 were respectively 64.6±7.7 and 61.6±6.9, 6.5±1.9 and 5.3±1.2, 2.8±1.5 and 2.3±1.1, 9.2±3.9, 8.1±2.9 (p=0.03, p=0.001, p=0.012 and p=0.30). The mean PSA, NLR ,NMR values of the group 1 were significantly higher than those in group 2 (p=0.002). Gleason grade and pathological stage were significantly increases as NLR increases. CONCLUSION: NLR and NMR in patients with BPH after second TRUS-guided biopsy were lower than that of those with a diagnosis of prostate cancer after the first TRUS-guided biopsy.White blood test subtypes can be considered for the decision to perform a second TRUSguided biopsy in patients with previous negative biopsy with persistently elevated PSA.

Pararectal Migration of a Malleable Rod: An Unusual Late Complication.

A 75-year-old male had failed to respond conservative therapy for erectile dysfunction and had undergone insertion of a malleable penile prosthesis in 1995. Twenty years after the initial implant he presented with right-sided prosthesis localized in the buttock. There was no infection. The prosthesis was extracted through an incision in the right hip. As in the recent case, mechanical failures in malleable penile prosthesis models, can occur. Penile implant migration back to the buttock without a curve deformity is an extremely rare complication. Clinicians should be alert about possible late complications of penile prosthesis.