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The Allium turcicum L. (Zuzubak) plant as a cultivated vegetable have various health benefits and consumed as a food. Due to the shortcoming evidence in literature and the importance of this plant in folk medicine, in the present study, for the first time, we evaluated the bioactive profile of components (using LC-MS/MS), cytotoxicity, anticancer, antioxidant, and antibacterial prospectives of Zuzubak methanol extract. Reported results show that the extract is rich in bioactive compounds and has anticancer activity with breast cancer cells (MCF-7), human prostate cancer cells (DU-145), and Human osteosarcoma cancer Cell lines of (IC50) in dose dependent manner in the concentration range of 31.25 µg/mL and 2000 µg/mL for 24 and 48 h. Western blotting results determined that the extract significantly suppressed the growth of U2OS, MCF-7, and DU-145 cancer cells by down expression of Ang-1 (angiogenic protein) and Beclin-1 (autophagy protein) and overexpression of Bax (a proapoptotic protein). The oxidative stress indices showed a reduction in RPE-1 and MCF-7 cells and an upsurge in U2OS and DU-145 cells. Additionally, the antimicrobial assay showed suppression of the growth of various pathogenic microorganisms in 4.00-8.00 µg/concentrations of Zuzubak extract using the microdilution method. The phytochemicals identified showed promising anticancer, antioxidant effects, and antimicrobial properties, representing a valuable herbal source for drug development studies.
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BACKGROUND: Prostate cancer is among the most common cancers in men with an increasing incidence rate. Radiation therapy (RT) is a therapeutic strategy for the management of prostate cancer after surgery; nonetheless, it has different side effects on neighboring healthy cells/tissues. Moreover, radioresistance has been an increasing phenomenon in the recent years. Therefore, there is an urgent need for the introduction of a safe and effective radiosensitizing agent. Accordingly, the recent trend in the development of novel drugs is accompanied by a push toward natural compounds. Our study evaluated the effects of betanin combined with RT as a potential radiosensitizing agent in the PC-3 cell line. METHODS AND RESULTS: MTT assay was utilized to determine the growth inhibitory impact of betanin. The possible synergistic effect was evaluated with CompuSyn software upon Trypan blue exclusion test. Apoptosis-related gene expression was evaluated via Real-time PCR and the protein expression of P21 was determined using western blotting. A synergistic anticancer effect with an optimal combination index of 0.61 was achieved by treating PC-3 cells with betanin and RT. The results pointed out that betanin synergistically triggered RT-mediated apoptosis and cell cycle arrest through modulating gene and protein expression in comparison with each of the monotherapies. CONCLUSION: These findings shed light on the synergistic antitumor effect of betanin and RT in prostate cancer, indicating the potential use of betanin as a radiosensitizer agent.
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Neoplasias da Próstata , Radiossensibilizantes , Masculino , Humanos , Betacianinas/farmacologia , Betacianinas/uso terapêutico , Linhagem Celular Tumoral , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/metabolismo , Apoptose , Radiossensibilizantes/farmacologiaRESUMO
Urinary diversion with suprapubic cystostomy and delayed urethroplasty is recommended for the treatment of penetrating posterior urethral traumas. A devastating urethral trauma caused by a blast injury due to an improvised explosive device is an extremely rare clinical condition and treatment options are limited due to accompanying massive tissue and muscle loss. Staged urethral reconstruction using a pedicled gracilis muscle flap with a skin or buccal mucosa graft is the preferred treatment option for complex urethral traumas. In case of a devastated urethra due to an intensive explosive device injury, treatment options are limited, especially if the gracilis muscle cannot be used. We report the case of a 30-year-old male patient with a devastated bulbopenile urethra and massive local tissue and adjacent muscle loss including the gracilis muscle. The patient was successfully treated by buccal mucosa graft tube urethroplasty. Urethral stricture recurred but was successfully treated by means of endoscopy. At 24 months' follow-up, the patient was continent and urinated normally.
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Procedimentos de Cirurgia Plástica , Estreitamento Uretral , Ferimentos Penetrantes , Masculino , Humanos , Adulto , Uretra/cirurgia , Mucosa Bucal/transplante , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Retalhos Cirúrgicos/cirurgiaRESUMO
BACKGROUND: Fournier's gangrene (FG) is rapidly progressing and life-threatening necrotizing fasciitis of genital and perineal regions. The aim of the study was to share our experience with FG and to analyze the relationship of clinical data with whole blood count parameters, inflammation cells, and systemic inflammation markers. METHODS: The digital medical records of the adult patients followed-up and treated with diagnosis of FG between January 2016 to December 2020 were retrospectively analyzed. Data were as age, gender, total length of hospital stay, predisposing factors, etiological factors, total number of debridement's, surgical procedures, and antibiotherapy were collected. Serum glucose levels, complete blood count parameter levels, serum inflammation indicators and C-reactive protein (CRP) levels measured at the initial day of hospital admission, post-debridement 1st and 7th days were measured. RESULTS: Thirty-six male patients were included, with a mean age of 56.42 (22-86) years. The most common predisposing factor was diabetes mellitus (n=13; 36.1%). The most frequently seen etiological cause was scrotal abscess (n=19; 52.8%). A statistically significant decrease was found in White blood cell count, neutrophil level, neutrophil-to-lymphocyte ratio (NLR) value and CRP level measured before debridement, post-debridement 1st and 7th days (p<0.05). There was a positive correlation between the number of debridement's and age, NLR, platelet-to-lymphocyte ratio, and CRP values at the initial admission time (p<0.05). CONCLUSION: The infections of urogenital region are the essential etiological origin of FG. As a rare urological emergency, significant changes were observed in clinical data and blood count parameters during the course of FG.
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Gangrena de Fournier , Adulto , Desbridamento , Gangrena de Fournier/diagnóstico , Gangrena de Fournier/etiologia , Gangrena de Fournier/cirurgia , Humanos , Inflamação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Centros de Atenção TerciáriaRESUMO
Benign prostatic hyperplasia (BPH) is one of the most prevalent conditions among aged men. The use of 5α-reductase inhibitors (5-ARIs) to treat BPH was linked to erectile dysfunction (ED). Many medicinal plants and secondary metabolites are used in the management of ED. Onion (Allium cepa L.) is an economically affordable vegetable with vital phytochemicals and biological functions. The study aimed to identify the beneficial effects of onion juice on dutasteride (a 5-ARI)-induced ED. Rats were divided into two groups (n = 5 per group): control and dutasteride-treated rats (0.5 mg/kg/day). Dutasteride was administered in drinking water for 12 weeks. Experiments were performed at the end of the 12th week. In vivo erectile responses were measured before and after intracavernosal injection of onion. Relaxant responses to onion juice were examined in the corpus cavernosum (CC). Acetylcholine (ACh)-, electrical field stimulation (EFS)-, sodium nitroprusside (SNP)-induced relaxation responses in CC tissues were evaluated in the absence and presence of onion juice. Total intracavernosal pressure (ICP) and ICP/ mean arterial pressure were significantly reduced in dutasteride-treated rats (1881.14 ± 249.72 mmHg, P < 0.001;0.26 ± 0.03, P < 0.01) as compared to control rats (4542.60 ± 429.19 mmHg, 0.51 ± 0.05), which was normalized after the intracavernous administration of onion (3288.60 ± 185.45 mmHg, 0.58 ± 0.04). Onion markedly induced relaxant responses in control (72.5 ± 4.7) and dutasteride-treated (66.5 ± 2.7) groups after precontraction with phenylephrine. Relaxation responses to onion were partially inhibited after precontraction with KCl (32.5 ± 3.1, P < 0.001). The relaxant responses to ACh (14.9 ± 4.2, P < 0.01) were diminished in dutasteride-treated CC) compared to control CC (59.8 ± 3.4), which was enhanced after the incubation with onion (36.6 ± 4.8). There were no differences in relaxation response to SNP among all groups. However, relaxation response to SNP was reduced in dutasteride-treated CC at 1 µM (P < 0.05) and 10 µM dosages (P < 0.001), which was partially increased after the incubation with onion at 10 µM dosage (P < 0.01). The presence of onion did not change the reduction in EFS-caused relaxation in the dutasteride-treated group. The current data suggest that red onion juice has a restorative effect on erectile function and endothelium-dependent relaxation response following the treatment of dutasteride.
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Disfunção Erétil , Hiperplasia Prostática , Inibidores de 5-alfa Redutase/farmacologia , Inibidores de 5-alfa Redutase/uso terapêutico , Assistência ao Convalescente , Idoso , Animais , Dutasterida/farmacologia , Dutasterida/uso terapêutico , Disfunção Erétil/tratamento farmacológico , Disfunção Erétil/etiologia , Humanos , Masculino , Cebolas , Oxirredutases/farmacologia , Pênis , Hiperplasia Prostática/complicações , Ratos , Ratos Sprague-DawleyRESUMO
INTRODUCTION/BACKGROUND: Although a full bilateral template RPLND is thought to be the standard of care for the management of postchemotherapy retroperitoneal residual masses for nonseminomatous germ cell tumors (NSGCT), in the past decade modified templates have become increasingly popular. In this study, we aimed to present our oncological and perioperative outcomes of consecutive seventeen NSGCT patients who underwent a modified template unilateral PC-RPLND for retroperitoneal residual disease. MATERIALS AND METHODS: We retrospectively evaluated the medical records of 17 consecutive NSGCT patients who underwent modified template unilateral PC-RPLND in our university hospital between 2017 and 2020. All patients had normal serum tumour markers with residual disease in the retroperitoneum. Surgical characteristics including the size of the retroperitoneal residual mass, residual tumor pathology, removed lymph nodes, positive percentage of removed lymph nodes, accompanying operations, complications, mean operation time and hospital stay, and long-term results including survival and antegrade ejaculation were evaluated. RESULTS: Eleven patients underwent left and six right-sided surgery. Median residual lymph node diameter was 41mm. Median hospitalisation time was 3.5 days. Median follow-up time was 10.5 months. Necrosis/fibrosis was seen in 6 patients, and teratoma in 11 patients. No viable tumour was seen. No patients died in the follow-up period. None of the patients relapsed during follow-up. Ten/seventeen patients had antegrade ejaculation. CONCLUSIONS: Modified template unilateral PC-RPLND leads to very good oncological outcomes with decreased perioperative morbidity as well as better antegrade ejaculation rates. Low volume retroperitoneal disease seems to fit this procedure best.
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BACKGROUND: Bench and virtual reality nonbiological simulator models for anatomic endoscopic enucleation of the prostate (AEEP) surgery have been reported in the literature. These models are acceptable but have limited practical applications. OBJECTIVE: To validate a fresh-frozen human cadaver model for holmium AEEP training and assess its content validity. DESIGN SETTING AND PARTICIPANTS: Holmium AEEP operations on fresh-frozen cadavers performed by an experienced surgeon were recorded, and a video, including the main steps of the operation, was produced. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The video and an accompanying questionnaire were subsequently distributed electronically to ESUT AEEP study group experts and associates (N = 32) for assessment of the AEEP training model. A ten-point Likert global rating scale was used to measure the content validity. RESULTS AND LIMITATIONS: A total of 26 answers were returned (81%). The experts agreed on the model's suitability for AEEP training (mean Likert score: 8). According to the responses, "identifying anatomic structures and landmarks" was the most valuable aspect of the model in terms of AEEP training (median Likert score: 9). Conversely, the experts found the model's ability, in terms of demonstrating laser and tissue reactions, to be weak (median Likert score: 6). CONCLUSIONS: Based on the content validity assessment, the fresh-frozen cadaver-training model for laser AEEP seems to be a promising model for demonstrating and learning the correct prostate enucleation technique. PATIENT SUMMARY: An increasing number of researchers have proposed that anatomic endoscopic enucleation of the prostate (AEEP) should replace transurethral resection of the prostate surgery and become the gold standard for treatment of bladder outlet obstruction due to benign prostatic hyperplasia. AEEP requires anatomic familiarity for enucleation, technical knowledge, and a solid training program before starting with the first cases. This is the first cadaver study to assess the content validity of a fresh-frozen human cadaver model for AEEP training.
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OBJECTIVE: Testicular tumor constitutes 1% of male neoplasms. Infertility can be determined in patients with testicular tumors before orchiectomy due to the deterioration of spermatogenesis. The aim of this study was to show the clinical, radiological, and pathological characteristics and spermiogram results of patients with testicular tumor and their relationship with each other. METHODS: The data of patients who underwent orchiectomy due to testicular tumor between 2016 and 2019 were reviewed retrospectively. These data included sociodemographic data of the patients, pretreatment spermiogram characteristics, level of serum tumor markers, characteristics of the ultrasonography, type of orchiectomy, and histopathological examination. RESULTS: This study included 53 male patients, with a mean age of 33.51±12.86 years. The mean levels of all tumor markers were above the reference levels. The mean tumor size was 34.68±23.32 mm. Multiple localizations and microlithiasis were detected in 11.3 and 13.2% of the tumors, respectively. The most common masses were hypoechoic (n=37; 69.8%) and hypervascular (n=47; 81%). Spermiogram and cryopreservation were performed in 29 (54.7%) of 53 patients preoperatively. The mean sperm concentration before orchiectomy was 24.21×106 /mL and group A sperm motility 0.79%, group B sperm motility 39.10%, group C sperm motility 9.83%, and group D sperm motility 22.69% in testicular tumors. CONCLUSION: Spermatogenesis adversely affected before the treatment due to local and systemic effects of testicular cancer. Fertility expectations can be increased in the subsequent years by semen analysis and referral to cryopreservation.
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Neoplasias Testiculares , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Orquiectomia , Estudos Retrospectivos , Análise do Sêmen , Contagem de Espermatozoides , Motilidade dos Espermatozoides , Neoplasias Testiculares/cirurgia , Adulto JovemRESUMO
SUMMARY OBJECTIVE: Testicular tumor constitutes 1% of male neoplasms. Infertility can be determined in patients with testicular tumors before orchiectomy due to the deterioration of spermatogenesis. The aim of this study was to show the clinical, radiological, and pathological characteristics and spermiogram results of patients with testicular tumor and their relationship with each other. METHODS: The data of patients who underwent orchiectomy due to testicular tumor between 2016 and 2019 were reviewed retrospectively. These data included sociodemographic data of the patients, pretreatment spermiogram characteristics, level of serum tumor markers, characteristics of the ultrasonography, type of orchiectomy, and histopathological examination. RESULTS: This study included 53 male patients, with a mean age of 33.51±12.86 years. The mean levels of all tumor markers were above the reference levels. The mean tumor size was 34.68±23.32 mm. Multiple localizations and microlithiasis were detected in 11.3 and 13.2% of the tumors, respectively. The most common masses were hypoechoic (n=37; 69.8%) and hypervascular (n=47; 81%). Spermiogram and cryopreservation were performed in 29 (54.7%) of 53 patients preoperatively. The mean sperm concentration before orchiectomy was 24.21×106 /mL and group A sperm motility 0.79%, group B sperm motility 39.10%, group C sperm motility 9.83%, and group D sperm motility 22.69% in testicular tumors. CONCLUSION: Spermatogenesis adversely affected before the treatment due to local and systemic effects of testicular cancer. Fertility expectations can be increased in the subsequent years by semen analysis and referral to cryopreservation.
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Humanos , Masculino , Adulto , Adulto Jovem , Neoplasias Testiculares/cirurgia , Contagem de Espermatozoides , Motilidade dos Espermatozoides , Orquiectomia , Estudos Retrospectivos , Análise do Sêmen , Pessoa de Meia-IdadeRESUMO
AIM: The aim of this study was to present our experiences for anesthesia management in patients undergoing robot-assisted radical prostatectomy (RARP) in light of current literature data. MATERIAL AND METHODS: This clinical retrospective study included 103 patients who underwent robot-assisted radical prostatectomy. All patient data were obtained from the patient files and anesthesia follow-up forms. Demographic datas, intraoperative fluids, blood products requirement and blood gas parameters were recorded. RESULTS: A total 15 of 103 patients data were lack, the remaining 88 patients were evaluated. Combination of crystalloid and colloid was used for intravenous fluid management. About 11% of patients required transfusion during surgery. The mean pH and pO2 values of the patients were observed to decrease whereas pCO2 and lactate values increased. DISCUSSION: Radical Prostatectomy can be performed either using open technique as a traditional approach or laparoscopic or robot-assisted technique as a minimally invasive approach. Today, minimally invasive approaches have replaced traditional open prostatectomy. Anaesthesia management of these minimally invasive techniques is very different and challenging from open technique in many aspects. CONCLUSION: Although minimally invasive techniques have good surgical outcomes such as less blood loss, smaller surgical incision, and shorter hospitalization, these techniques bring new problems that anesthesiologists have to deal with. Increased RARP operations has led to the anesthesiologists more likely to encounter perioperative problems. KEY WORDS: Anesthesia, Minimally invasive techniques, Radical prostatectomy.
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Anestesia , Laparoscopia , Prostatectomia , Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Humanos , Masculino , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Diabetic men are at a higher risk of erectile dysfunction (ED). A tropical plant, clove (Syn. Eugenia caryophyllata, Caryophyllus aromaticus L., Syzygium aromaticum (L.) Merr. & L.M. Perry) from the Myrtaceae family has displayed aphrodisiac activity. The present research aimed to investigate the impacts of clove essential oil (CEO) and the ingredient of CEO, eugenol (E) on ED in diabetic rats. We divided Sprague-Dawley rats into control and diabetic groups. Erectile function was evaluated before and after CEO and E intracavernosal injection. CEO- and E-induced relaxation responses were investigated in isolated corpus cavernosum (CC) using various inhibitors. The intracavernous administration of CEO and E restored erectile responses in diabetic rats. CEO and E induced remarkable relaxation in all groups. CEO- and E-induced relaxation responses were partially inhibited after pre-contraction with KCl. Tetraethylammonium and glibenclamide inhibited the relaxation response to CEO. Glibenclamide inhibited maximum relaxation to E. The inhibitors of nitric oxide synthase (NOS), soluble guanylyl cyclase and nifedipine did not change CEO- and E-induced relaxation responses. The current results suggest that CEO and the major compound of the essential oil, E improved diabetes-induced ED in rats, and CEO caused CC relaxation via K+ channels independently NO signalling pathway.
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Óleo de Cravo/farmacologia , Diabetes Mellitus Experimental/fisiopatologia , Disfunção Erétil/fisiopatologia , Eugenol/farmacologia , Ereção Peniana/efeitos dos fármacos , Animais , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Experimental/metabolismo , Disfunção Erétil/etiologia , Disfunção Erétil/metabolismo , Glibureto/farmacologia , Técnicas In Vitro , Injeções , Masculino , Nifedipino/farmacologia , Óxido Nítrico Sintase/antagonistas & inibidores , Óleos Voláteis/farmacologia , Pênis/efeitos dos fármacos , Bloqueadores dos Canais de Potássio/farmacologia , Ratos , Ratos Sprague-Dawley , Guanilil Ciclase Solúvel/antagonistas & inibidores , Tetraetilamônio/farmacologiaRESUMO
OBJECTIVES: Cyclophosphamide (CP) is an alkylating agent widely used as an antineoplastic and immunosuppressive agent. The genotoxicity of CP has been studied in a variety of in vivo and in vitro systems and is routinely used as a positive control in genotoxicity tests. Traditional medicine Nigella sativa L., (N. sativa), Ranunculaceae family, especially in the Eastern Mediterranean countries, especially in many countries, and is widely used in many countries as a spice and folk medicine since the time of Dioscorides used as a plant. In this study, it was aimed to show the protective effects of N. sativa oil at different concentrations against the genotoxic effects of CP by micronucleus test. MATERIALS AND METHODS: For this purpose, healthy cells were treated in vitro with N. sativa oil at concentrations of 1, 5, 10 µg/mL and CP as positive control for 68 hours. The micronuclei were then counted. RESULTS: No significant increase in micronucleus frequency was observed when the application of N. sativa oil at concentrations of 1, 5, 10 µg/mL compared with the negative control. There was a decrease in the number of micronucleus in all three concentrations (1, 5, 10 µg/mL) compared to the CP group in the groups treated with N. sativa oil and CP. CONCLUSION: It has been shown that N. sativa oil may have protective effects against genotoxicity agents in vitro. But more work is needed to understand the mechanism of the genotoxicity effects of N. sativa oil.
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OBJECTIVES: In this study, we aimed to define the clinico-radiological data and treatment options for intratesticular epidermoid cysts (IEC). MATERIALS AND METHODS: We retrospectively reviewed the medical records of the patients that under went surgery for testicular mass between 1995 and 2017. Data of the patients whose histopathological evaluation revealed IEC were recorded. RESULTS: A total of 20 patients with IEC were identified.While three of 20 patients were excluded due to incomplete data, the remaining 17 patients with pathologically proven IEC were reviewed and analyzed in the study. The mean patient age was 22.2 years (range, 17-29 years). All patients were presented with painless testicular swelling and/or mass. Serum tumor markers of all patients were within the ranges. Four patients treated with radical orchiectomy (23.5%), while 13 patients under went partial orchiectomy (76.5%). The mean size ofthe IEC was 17.7x15.1 mm (range, 26x10 mm). IEC swere mostly located in the middle pole of the testes (10of 17 patients, 58.8%). CONCLUSIONS: This study is designed in retrospective nature, but the patient population is one the largest reported in the literature. According to our study, we can easily state that partial orchiectomy can be performed safely after FSA in patients that have IECs.
OBJETIVOS: En este estudio, nuestro objetivofue definir los datos clínico-radiológicos y las opciones de tratamiento de los quistes epidermoides intratesticulares (CEI). MATERIALES Y MÉTODOS: Revisamos retrospectivamente los registros médicos de los pacientes que se sometieron a cirugía para la masa testicular entre 1995 y 2017. Entre ellos se registraron los datos de los pacientes cuya evaluación histopatológica reveló IEC. RESULTADOS: Se identificaron un total de 20 pacientes con IEC. Mientras que tres de los 20 pacientes fueron excluidos debido a los datos incompletos, los 17pacientes restantes con IEC patológicamente probada se revisaron y analizaron en el estudio. La edad media de los pacientes fue de 22,2 años (rango, 17-29años). A todos los pacientes se les presentó hinchazón y/o masa testicular indolora. Los marcadores tumorales séricos de todos los pacientes estaban dentro de los rangos. Cuatro pacientes tratados con orquiectomía radical (23,5%), mientras que 13 pacientes se sometieron a orquiectomía parcial (76,5%). El tamaño medio de la IEC fue de 17,7x15,1 mm (rango, 26x10 mm). Los IEC se encontraban principalmente en el polo medio de los testículos (10 de 17 pacientes, 58,8%). CONCLUSIONES: Este estudio está diseñado de forma retrospectiva, pero la población de pacientes es una de las más numerosas que se han publicado en la literatura. Según nuestro estudio, podemos afirmar fácilmente que la orquiectomía parcial se puede realizar de manera segura después de la FSA en pacientes que tienen CEI.
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Cisto Epidérmico , Orquiectomia , Doenças Testiculares , Cisto Epidérmico/diagnóstico , Cisto Epidérmico/terapia , Humanos , Masculino , Estudos Retrospectivos , Doenças Testiculares/diagnóstico , Doenças Testiculares/terapiaRESUMO
OBJECTIVES: To evaluate the effect of silodosin on stages of the flexible ureterorenoscopy (F-URS) procedures. METHODS: Between November 2015 and August 2017, a total of 76 patients suffering from 10-30 mm kidney stone were enrolled in this randomized prospective study. Patients were randomly divided into 2 groups for treatment: Group 1 had F-URS with preoperative daily uptake of 8 mg silodosin for 10 days, and group 2 had F-URS without silodosin uptake. None of the patients had preoperative JJ stenting. Stages of the F-URS was defined as entrance to bladder time (ETBT) with a semirigid ureterorenoscope (R-URS), entrance to ureteric orifice time (ETUOT) with R-URS using a guide wire and proceeding 2 cm inside the ureter, application of access sheath time (AAST) using the guide wire advanced through R-URS, F-URS time (FURST) + lithotripsy with laser time (LT), and total operation time (OT). We compared the time of each stage between two groups. RESULTS: There were 38 patients group1 and 2, respectively. There was one ureteral access sheath (UAS) application failure in group 1, and 3 failures in group 2 (p=0.307). The ETBT, ETUOT, and AAST were significantly short in group 1 than group 2 (p=0.001,0.007,0.002). CONCLUSIONS: Although preoperative use of silodosin facilitated only an insignificant positive effect on UAS placement failure, it eased the F-URS procedure by reducing the ETBT, ETUOT, and AAST in seconds. More studies are needed to make an exact conclusion.
OBJETIVOS: Evaluar el efecto de la silodosina en las etapas de los procedimientos de ureterorrenoscopia flexible (F-URS).MÉTODOS: Entre noviembre de 2015 y agosto de 2017, un total de 76 pacientes con cálculos renales de 10-30 mm se inscribieron en este estudio prospectivo aleatorizado. Los pacientes se dividieron aleatoriamente en 2 grupos para el tratamiento: el grupo 1 tenía F-URS con captación diaria preoperatoria de 8 mg de silodosina durante 10 días, y el grupo 2 tenía F-URS sin captación de silodosina. Ninguno de los pacientes tenía stent JJ preoperatorio. Las etapas del F-URS se definieron como entrada al tiempo de la vejiga (ETBT) con un ureterorrenoscopio semirrígido (R-URS), entrada al tiempo del orificio ureteral (ETUOT) con R-URS usando una guía y 2 cm dentro del uréter. Aplicación del tiempo de vaina de acceso (AAST) utilizando el cable de guía avanzado a través de R-URS, tiempo de F-URS (FURST) + litotricia con tiempo de láser (LT) y tiempo total de operación (OT). Comparamos el tiempo de cada etapa entre dos grupos. RESULTADOS: Hubo 38 pacientes grupo 1 y 2, respectivamente. Hubo una falla en la aplicación de la cubierta de acceso ureteral (UAS) en el grupo 1 y 3 fallas en el grupo 2 (p=0,307). ETBT, ETUOT y AAST fueron significativamente cortos en el grupo 1 que en el grupo 2 (p=0,001, 0,007, 0,002). CONCLUSIONES: Aunque el uso preoperatorio de silodosina facilitó solo un efecto positivo insignificante en la falla de colocación de UAS, alivió el procedimiento de F-URS al reducir el ETBT, ETUOT y AAST en segundos. Se necesitan más estudios para llegar a una conclusión exacta.
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Cálculos Renais , Litotripsia , Cálculos Ureterais , Ureteroscopia , Humanos , Indóis , Cálculos Renais/terapia , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Cálculos Ureterais/terapiaRESUMO
OBJECTIVES: In this research, we designed a cognitive fusion(CF) prostate biopsy(PB) (CFPB) technique by examining the multiparametric MRI of prostate (MP_MRI-P) images in a smart-phone near the trans-rectal ultrasound (TRUS) device, and examined the results. METHODS: Between January 2011 and January 2017, a total of 344 men who had PB enrolled in this study. Group 1 had a minimum of a 12-core standard TRUS PB (TRUSPB). Group 2 had CFPB while examining the MP_ MRI-P images in a smartphone near the TRUS device. A minimum 12 cores + cognitive targeted 1-3 biopsy were taken. The detection of Pca and significant Pca in group 1 and 2 were evaluated and compared. Then, the effect of MP_MRI-P findings on the detection of prostate cancer (Pca) and significant Pca were evaluated. RESULTS: Group 1 and 2 included 138 and 206 patients. After the PB, 45(32.8%) and 33(23%) patients ingroup 1, and 74(35.9%) and 60(29%) patients in-group 2 were detected to have Pca and significant Pca, respectively (p=0.001 for both). Higher PIRADS caused significant detection of Pca and significant Pca (p=0.004 and 0.002). Nodule in MP_MRI-P caused significant detection of Pca and significant Pca (p=0.001 and 0.001). Especially, when PSA was <10ng/ml, higher PIRADS and nodule in MP_MRI-P caused significant detection of Pca and significant Pca (p=0.02 and 0.019 for PIRADS, and p=0.01 and 0.042 for nodules). CONCLUSIONS: In the advanced hands with our new technique, the CFPB using prebiopsy MP_MRI-P seems to be an effective method to detect Pca and significant Pca.
OBJETIVOS: En este estudio de investigación diseñamos una técnica de biopsia de próstata (BxP) con fusión cognitiva (FC) (BxPFC) mediante el examen de la RMN multiparamétrica (RMNmp) de la próstata en un dispositivo móvil cerca del aparato de ecografía transrectal (ETR) y examinamos los resultados.MÉTODOS: Entre enero de 2011 y enero del 2017 se incluyeron en el estudio un total de 344 varones sometidos a BxP. El Grupo 1 hizo una BxP guiada por ecografía transrectal estándar que tenía un mínimo de 12 muestras. El Grupo 2 fue sometido a BxPFC utilizando un dispositivo móvil para evaluar las imágenes de la RMNmp de próstata cerca del aparato de ecografía transrectal. Se tomaron un mínimo de 12 muestras + 1-3 dirigidas de forma cognitiva. Se evaluaron y compararon la detección de CaP y de CaP significativo entre los grupos. También se evaluó el efecto de los hallazgos de la RMNmp de próstata sobre la detección de cáncer de próstata y CaP significativo. RESULTADOS: Los grupos 1 y 2 incluyeron 138 y 206 pacientes respectivamente. Después de la BxP, se detectaron 45(32,8%) pacientes con CaP y 33(23%) con CaP significativo en el grupo 1, y 74(35,9%) y 60(29%) pacientes en el Grupo 2, respectivamente (p=0,001 para ambos). Los valores más altos de PIRADS se asociaron con una detección significativa de CaP y CaP significativo (p=0,004 y 0,002). La presencia de un nódulo en la RMNmp se asocia con una detección significativa de CaP y CaP significativo (p=0,001 y 0,001). Especialmente, cuando el valor del PSA era <10 ng/ml, el PIRADS más alto y existía un nódulo en la RMN mp el diagnóstico de CaP y CaP significativo era significativamente mayor (p=0,02 y 0,019 para PIRADS, y p=0,01 y 0,042 para nódulos). CONCLUSIONES: Con nuestra nueva técnica en manos expertas, la BxP con fusión cognitiva utilizando las imágenes de RMNmp previa parece ser un método efectivo para detectar CaP y CaP significativo.
Assuntos
Neoplasias da Próstata , Smartphone , Humanos , Biópsia Guiada por Imagem , Imageamento por Ressonância Magnética , Masculino , Neoplasias da Próstata/diagnósticoRESUMO
OBJECTIVES: We conducted this study to evaluate the analgesic efficacy of ultrasound guided unilateral transversus abdominis plane (TAP) block when used in combination with oral diclofenac administration during extracorporeal shock wave lithotripsy (SWL). DESIGN AND SETTING: The study is a retrospective clinical experimental study conducted in a university hospital between January 2017 and January 2018. METHODS: 42 SWL eligible patients were divided into three groups. Group 1 (n: 15) received no medication due to patient's preference. Group 2 (n: 15) received 50 mg oral diclofenac 30 minutes prior to the procedure, and Group 3 (n: 12) received both oral diclofenac and unilateral ultrasound (US) guided TAP block 30 minutes before the procedure. Patient`s characteristics, SWL data and "visual analogue pain scale" (VAS) scores were collected and compared between groups. RESULTS: A total of 44 eligible patients were included in the study. When compared between groups, patient's characteristics including age, body mass index, and SWL data including stone size, SWL number, total energy transmitted and duration of the procedure, were similar and there was no statistical significance. Between groups statistical significance was achieved in only VAS scores. Mean VAS scores in groups 1,2, and 3 were 6.3 ± 1.8, 4.3 ± 2.3, and 1.3 ± 1.0, respectively. No complication was seen in any of the groups. CONCLUSION: Pain relief during SWL operations is still a challenging issue for many clinicians. Our study demonstrates that, among many other anesthetic/analgesic agents and techniques described, unilateral US guided TAP block and diclofenac combination is a feasible option for pain relief during SWL procedures.
OBJECTIVO: Llevamos a cabo un estudio para evaluar la eficacia analgésica del bloqueo unilateral del plano del musculo transverso abdominal (TAP) guiado por ecografía utilizado en combinación con la administración oral de diclofenaco durante la litotricia extracorporea por ondas de choque (LEOC).MATERIAL Y MÉTODOS: Estudio clínico experimental retrospectivo llevado a cabo en un hospital universitario entre Enero de 2017 y Enero del 2018. 42 pacientes sometidos a LEOC fueron incluidos. Se dividieron en tres grupos. Grupo 1 (n=15): No recibió medicación debido a las preferencias del paciente. Grupo 2 (n=15): Recibieron 50 mg de diclofenaco oral 30 minutos antes del procedimiento; y Grupo 3 (n=12): recibieron ambos diclofenaco oral y bloqueo unilateral del plano del musculo transverso abdominal guiado por ecografía 30 minutos antes del procedimiento. Se recogieron y compararon entre los grupos las características de los pacientes, los datos de la LEOC y las puntuaciones de la escala visual analógica (EVA). RESULTADOS: Se incluyeron 44 pacientes en el estudio. En la comparación entre grupos, las características del paciente, incluyendo edad e índice de masa corporal, y los datos de la LEOC, incluyendo tamaño de la litiasis, número de ondas de choque, energía total transmitida y duración del procedimiento, fueron similares y no hubo diferencias estadísticamente significativas. En la comparación entre grupos, solo la puntuación de la EVA alcanzó significación estadística. Las puntuaciones medias de la EVA fueron 6,3 ± 1,8, 4,3 ± 2,3 y 1,3 ± 1,0, en los grupos 1, 2 y 3 respectivamente. No hubo complicaciones en ninguno de los grupos. CONCLUSIONES: El alivio del dolor durante las intervenciones de LEOC es todavía un desafío para muchos clínicos. Nuestro estudio demuestra que entre otros agentes anestésicos/analgésicos y técnicas descritas, la combinación de bloqueo unilateral del plano del musculo transverso abdominal (TAP) guiado por ecografía y diclofenaco oral es una opción factible para el alivio del dolor durante la LEOC.
Assuntos
Litotripsia , Manejo da Dor , Músculos Abdominais , Analgésicos , Humanos , Bloqueio Nervoso , Dor Pós-Operatória , Estudos RetrospectivosRESUMO
OBJECTIVES: To introduce a new technique for the placement of ureteral access sheaths (UAS) when there is failure in standard UAS placement. MATERIALS AND METHODS: Between March 2014 and June 2016, a total of 25 patients had difficulty while UAS placement during F-URS procedures. The placement of UAS in these patients was accomplished by utilizing the technique outlined in this study. The causes of difficulty in UAS placement, kinds of UAS deformation, ureteric injuries, and operation time were recorded for all procedures conducted in this study. RESULTS: The pre-operative and post-operative mean stone sizes, Hgb, urea, and creatinine levels were 10.64 (5-19)mm and 1.8 (2-4)mm (p<0.000); 13.9 (10.50-16.73)g/dL and 12.81 (9.4-16.6)g/dL (p = 0.0001); 30.73 (15-48)mg/dL and 28.83 (16- 41)mg/dL (p = 0.067); 1.07 (0.74-1.79)mg/dL and 1.10 (0.77-1.75)mg/dL (p = 0.242), respectively. The causes of difficulty in UAS placement were mainly the failure of insertion at ureteric orifice due to orifice shape and angle (not stenosis) in 18 (72%), narrow ureter in 3 (12%), twisted ureter in 3 (12%) and duplex ureter in 1 (4%) of patients. Angulation deformity with kinking was observed in 10 (40%) of operations. No buckling or kinking due to external force was noted. Providing a smooth insertion force of the F-URS accomplished insertion in patients with angulation deformities without difficulties. Mild mucosal heamorragia was observed in 16 (64%) patients. Mean operation time was 57 minutes and each operation ended with success. CONCLUSIONS: Application of UAS under direct visualization provides a safer UAS placement, makes the F-URS more applicable, and we think this technique decreases the operation time when there is difficulty in UAS placement.
OBJETIVOS: Introducir una nueva técnica de inserción de las vainas de acceso ureteral (VAU) cuando fracasa la inserción estándar. MATERIAL Y MÉTODOS: Entre marzo 2014 y junio 2016 hubo dificultades durante la inserción de la VAU para la ureterorrenoscopia flexible (URS-F) en un total de 25 pacientes. La inserción de la VAU se consiguió utilizando la técnica descrita en este estudio. En todos los casos incluidos en el estudio se registraron las causas de dificultad de inserción de la VAU, tipo de deformación de la vaina, lesiones ureterales y tiempo de operación. RESULTADOS: Los valores pre y postoperatorios de tamaño medio de las litiasis, hemoglobina, urea, y creatinina fueron 10,64 mm (5-19 mm) y 1,8 mm (2-4) (p<0,000); 13,9 g/dL(10,50-16,73) y 12,81 g/dL(9,4-16,6) (p = 0,0001); 30,73 mg/dL(15-48) y 28,83 mg/dL(16- 41) (p = 0,067); 1,07(0,74-1,79) mg/dL y 1,10(0,77- 1,75) mg/dL(p = 0,242), respectivamente. Las causas de dificultad de inserción de la VAU fueron principalmente el fallo de inserción en el orificio ureteral debido a la forma y ángulo del orificio (no estenosis) en 18 pacientes (72%), uréter estrecho en 3 (12%) y duplicación ureteral en uno (4%). Se observó deformidad por angulación y el catéter retorcido en 10 operaciones (40%). No se observó deformidad o retorcimiento por fuerzas externas. Se consiguió una inserción sin dificultad en los pacientes con deformidades por angulación siempre que la fuerza de inserción del ureteroscopio flexible fuera suave. Se apreció una hemorragia mucosa leve en 16 pacientes (64%). El tiempo medio de operación fue de 57 minutos y en todos los casos la operación se terminó con éxito. CONCLUSIONES: La inserción de una VAU bajo visión directa ofrece una colocación más segura, hace la URS-F más aplicable, y nosotros pensamos que esta técnica disminuye el tiempo de operación cuando hay dificultades para la colocación de la VAU.
Assuntos
Ureter , Doenças Urológicas , Prepúcio do Pênis , Humanos , Pelve Renal , Masculino , Ureteroscopia , Doenças Urológicas/cirurgiaRESUMO
A 49-year-old male patient was diagnosed with ADPKD while the evaluation of urinary tract infection in 2010. He was suffering from nutritional problems due to gastro-intestinal disturbances and vomiting secondary to the pressure of the kidneys. He was also a candidate for kidney transplantation, but there was no adequate and enough space in the abdomen for the transplant kidney. Therefore, we performed open unilateral nephrectomy to the bigger kidney. As we now there is not too many cases regarding giant polycystic kidney nephrectomy, we presented our case to make additional contribution to the current literature
Se diagnosticó poliquistosis renal autosómica dominante a un paciente masculino de 49 años durante la evaluación de un cuadro de infección urinaria en 2010. El paciente padecía problemas nutricionales debido a trastornos gastrointestinales y vómitos causados por la presión de los riñones. Asimismo, era candidato a trasplante renal, pero el espacio del abdomen no era adecuado ni suficiente para realizar este procedimiento. Por lo tanto se realizó una nefrectomía unilateral, en el riñón de mayor tamaño. Debido a que no se conocen muchos casos de nefrectomía en pacientes con poliquistosis renal con quistes gigantes, presentamos este para realizar un aporte a la bibliografía existente
Assuntos
Humanos , Cistos/terapia , Doenças Renais Policísticas/terapia , Nefrectomia , Transplante de RimRESUMO
OBJECTIVE: To determine the success rate of percutaneous nephrolithotomy (PNL) in kidney stones over 50 milimeters. MATERIAL AND METHODS: Twenty-four patients with a renal stone size of >50 mm between January 2007 and December 2016 were enrolled. Stone-free and complication rates were investigated. RESULTS: Twenty-one (87.5%) patients were male and 3 (12.5%) were female. Fifteen (62.5%) stones were located in the right, and 9 (37.5%) in the left kidney. Twenty-one (87.5%) patients were operated using single-access, and three (12.5%) patients were double-access. Thirteen (54%) patients were found to have no stone after operation and 11 (46%) patients had residual stones. Extracorporal shock wave lithotripsy was applied to 5 of 11 patients with residual stones, while flexible ureteroscopy was applied to 6 of them. After additional treatments, 8 (33.5%) patients were observed to be stone free. The stone-free rate was 87.5%. The mean operation time was 135.43 (85-240) minutes. Hemoglobin levels before and after operation were 14.8 (12-16.7) and 12.6 (9.3-15.5), respectively (p=0.001). The hospital stay was 6.04 (4-8) days. Complications were observed in four patients (16.6%). CONCLUSION: PNL has high stone-free rate on staghorn type large stones compared with multiple calyceal scattered large stones.