A Different and Novel Alternative (ADANA) Renal Access Technique when CT or USG Guidance Is Inadequate in Case of Retro-Renal Colon.

INTRODUCTION: Computed tomography (CT) or ultrasonography (USG)-guided renal access for percutaneous nephrolithotomy (PNL) is not suitable in all cases with retro-renal colon (RRC) due to anatomical and technical restrictions. We would like to describe our novel technique that permits standard subcostal renal access with a small incision for these patients. METHODS: This method was performed on adult patients with severe RRC and complex renal stones who were not suitable for renal access with CT or USG guidance. Time from skin incision to puncture needle insertion, incision length, stone-free rate (SFR), and complications were evaluated. SURGICAL TECHNIQUE: The appropriate renal calyx for renal access was identified with retrograde pyelography. The skin closest to the identified calyx was incised and retroperitoneum visualized. The RRC was swept laterally by blunt dissection to obtain a safe puncture line. The retractors were placed to keep the colon away from the incision. Then, the puncture needle was placed over Gerota's fascia. After this, the puncture needle was inserted into the targeted calyx under fluoroscopic guidance. The insertion of guidewire and the rest of the procedure such as dilatation and insertion of Amplatz sheath were performed under same maneuver. RESULTS: A total of 1,348 patients were treated with PNL between January 2016 and November 2019. Our group consisted of 16 adult patients with a median age of 44.8 years (7 females and 9 males) who underwent PNL with our new access technique. SFR and clinically insignificant residual fragment (CIRF) rate were 72.5 and 14.2%, respectively. The median access time was 22.2 min (range: 15-30 min). The median skin incision length was 3.7 (range: 3.0-4.5) cm. The average skin incision length was 3.7 cm. The SFR and CIRF rate were 72.5 and 14.2%, respectively. We did not observe any complication related to our access technique. CONCLUSION: Our novel access technique created a safe anatomical route for standard subcostal renal access with acceptable incision length and very low complication rate.

Predictive Factors Affecting the Success of Nephrectomy for the Treatment of Nephrogenic Hypertension: Multicenter Study.

INTRODUCTION: The aim of our study is to evaluate the predictive factors affecting the success of treatment with nephrectomy in patients with poorly functioning kidney and nephrogenic hypertension. METHODS: Data for patients who underwent nephrectomy with a diagnosis of nephrogenic hypertension in 3 centers between May 2010 and January 2020 were analyzed. In the postoperative period, if the blood pressure (BP) was below 140/90 mm Hg without medical treatment, it was accepted as complete response; if the arterial BP was below 140/90 mm Hg with medical treatment or less medication, it was accepted as partial response; and if BP did not decrease to normal values, it was accepted as unresponsive. Demographic characteristics, duration of hypertension, preoperative and postoperative BP values, and presence of metabolic syndrome were statistically evaluated. RESULTS: Our study consisted of 91 patients with a mean preoperative hypertension duration of 23.3 ± 12.1 months. Among patients, 42 (46.2%) had complete response, 18 (19.8%) had partial response, and 31 (34.0%) had no response. Preoperative systolic and diastolic BP values were not effective on treatment success (p = 0.071, p = 0.973, respectively), but the increase in age and hypertension duration (p = 0.030 and p < 0.001, respectively) and the presence of metabolic syndrome (p = 0.002) significantly decreased the complete response rates. CONCLUSIONS: Preoperative hypertension duration, advanced age, and presence of metabolic syndrome are predictive factors affecting the response to treatment in patients who undergo nephrectomy due to nephrogenic hypertension.

Atrial electromechanical duration prolongs in patients with erectile dysfunction.

Background: It is well known that erectile dysfunction (ED) is associated with increased risk of atrial fibrillation (AF) development. On the other hand, prolongation of the duration of atrial electromechanical delay (AEMD) is known to be a precursor for AF development. We aimed to evaluate AEMD in patients with ED patients without documented AF.Methods: Total of 68 outpatients with previously documented vascular ED and 44 participants without ED were enrolled to the current study. Sixty-eight patients with ED called as ED group and 44 participants without ED served as control group. We performed International Index of Erectile Function (IIEF-5) questionnaire for all participants to determine the disease severity of ED groups and to diagnose ED in control groups. Patients with a IIEF-5 score ≥22 were defined as having normal erectile functions. Both intra- and inter-AEMD were measured with tissue Doppler imaging. P-wave dispersion (PWD) was measured on a 12-lead electrocardiogram.Results: Basal characteristics were similar between the two groups. PWD, inter- and right intra-AEMD were significantly prolonged in patients with ED, compared to the control group (p = .02, p < .001 and p < .001, respectively). In the correlation analysis, IIEF-5 score was significantly negative correlated with systolic blood pressure, right intra- and inter-AEMD (r = -0.37, p = .02; r= -0.27, p = .02; r = -0.39, p = .001, respectively).Conclusions: According to current study results, AEMD is significantly correlated with ED severity and may be useful to stratify ED patients to the high-risk group for future development of AF as a cheap and easy method.

Long-term follow-up results and complications in cancer patients with persistent nephrostomy due to malignant ureteral obstruction.

PURPOSE: We aimed to evaluate the long-term complications and predisposing factors for these complications in patients with malignant ureteral obstruction (MUO) treated with percutaneous nephrostomy (PN). METHODS: The records of patients with MUO treated with PN between January 2015 and 2018 were retrospectively reviewed for PN dislodgement, PN obstruction, PN replacement, pyelonephritis, hospitalizations due to PN complications, and other complications due to PN such as macroscopic hematuria, skin infections, or renal/perirenal abscess. RESULTS: Data for a total of 147 patients (229 renal units [RU], 107 males, 40 females) were evaluated. In 174 (76%) RU, PN was replaced due to PN dislodgement. The predisposing factors for PN dislodgement were follow-up time, body mass index (BMI), chemotherapy, diabetes mellitus (DM), low educational level (LEL), pyelonephritis, and catheter-related skin infections (CSRI). The PN was replaced in 40 RU due to obstruction. The predisposing factors for obstruction were follow-up time and BMI. Pyelonephritis developed at least once in 61 (41.5%) patients. Follow-up time, BMI, previous surgery, DM, and LEL were the predisposing factors for pyelonephritis. CSRI developed in 16 RU. Follow-up time, BMI, DM, and LEL were the predisposing factors for CSRI. Macroscopic hematuria developed in 11 patients. Follow-up time, previous surgery, DM, chemotherapy, and LEL were predisposing factors for macroscopic hematuria. CONCLUSION: The most common complication in patients with MUO treated with PN was PN dislodgement. However, life-threatening complications such as macroscopic hematuria and severe infections can also occur. Patients with DM, LEL, and chemotherapy are at high risk of PN-related complications.

Muslim mothers mainly saw circumcision in terms of religion or tradition but wanted it to be carried out medical professionals.

AIM: This study assessed the relationship between the education level of Muslim Turkish mothers whose sons had been circumcised and their views on circumcision. METHODS: Interviews based on 20 close-ended questions were carried out in the Çukurova region of southern Turkey between June 2015 and September 2016. The participants were 1497 Muslim Turkish mothers whose sons had been circumcised and who were recruited using convenience sampling in schools, hospitals and public spaces. RESULTS: Most (82%) of the mothers saw circumcision as a religious and traditional requirement, 64% mentioned the health benefits and 48% mentioned cosmetic appearance. The majority (80%) were performed by health organisations, with two-thirds (66%) expressing this preference. Most circumcisions were at school age (38%), which was about 6 years of age plus at the time of the study, and there were no complications in 79% of cases. Higher education levels were associated with views that circumcision was an important surgical procedure, it decreased the risk of urinary tract infections, it should be performed in hospitals and the foreskin did not prevent sexual intercourse. CONCLUSION: Circumcision was mainly seen as a religious and traditional ritual, and more highly educated Turkish Muslim mothers were better informed about the health aspects.

Safety and Efficacy of Flexible Ureterorenoscopy Surgery: Results of Our Large Patient Series.

INTRODUCTION: The aim of our study is to evaluate the success rates of our retrograde intrarenal surgery operations and the complications we encountered and to determine in which kidney segment the operations were more successful with flexible ureterorenoscopy. METHODS: The records of retrograde intrarenal surgery operations performed between March 2013 and January 2021 in Health Sciences University, Adana City Training and Research Hospital, urology clinic were analyzed retrospectively. Patients' age, body mass index, operation side, stone size, stone density, duration of operation, first-day and first-month operation success status, presence of preoperative and postoperative ureteral stent, preoperative and postoperative first-day and first-month creatinine levels, and preoperative and postoperative first-day and first-month hematocrit levels were recorded. RESULTS: Our study consisted of a total of 1128 patients, 618 males (54.7%) and 510 (45.2%) females, with an average age of 42.3±14.4. Kidney stones were most commonly found in the renal pelvis (54.2%). The postoperative first-day success rate was highest in the pelvis stone group (P=0.009). The first month's success rates were highest in those with pelvic stones (93.1%), and the lowest in patients with multiple stones (85.7%). Patients' operation time, postoperative hematocrit and creatinine levels, and complications did not differ statistically between the groups (P>0.05). CONCLUSION: Retrograde intrarenal surgery is an acceptable minimally invasive and effective surgery with low complication rates. There is a high success rate, especially in pelvis stones.

Erectile dysfunction and testosterone levels prior to COVID-19 disease: What is the relationship?

OBJECTIVE: We aimed to investigate the relationship between COVID-19 and Erectile Dysfunction (ED) and the effect of serum testosterone level on the disease prognosis. METHODS: Between April-December 2020, 70 patients who were admitted with a complaint of ED after having COVID-19 and whose serum testosterone level was checked for varicocele, premature ejaculation, and infertility reasons before COVID-19. The patients filled the International Index of Erectile Function (IIEF-5) and their testosterone level was checked. The questionnaire was arranged to assess the first month before COVID-19 and after COVID-19. Testosterone levels of the patients before and after COVID-19 were compared. The relationship between testosterone levels and hospitalization in the intensive care was evaluated. RESULTS: It was revealed that testosterone levels and IIEF-5 scores after COVID-19 in all patients were statisticaly and significantly different compared to the period before COVID-19 (p < 0.05). Testosterone levels of patients in need of intensive care were significantly higher than those without any need of intensive care (p < 0.05). CONCLUSIONS: Our study has presented that COVID-19 may cause ED and high testosterone levels increase the rate of hospitalization in the intensive care by intensifying the disease.

Ultrasonographic Detection of Retrorenal Colon in Prone Position: An Alternative to Computed Tomography.

OBJECTIVE: To evaluate the correlation between ultrasonography (US) and computed tomography (CT) in prone position to detect retrorenal colon (RRC). MATERIALS AND METHODS: In this prospective study, we included 310 patients who presented to our clinic between April 2017 and June 2019. All patients were evaluated for RRC with US and CT in prone position. Kappa compliance coefficient (κ) was used to express the compliance between CT and US outcomes. RESULTS: This study included 119 (38%) female and 191 (62%) male patients with a mean age of 44.5 ± 16.1 years. With both CT and US, RRC was detected in a total of 42 (13.5%) patients. RRC was found in 9 patients (8%) on the right side, in 32 patients (18%) on the left side and in 1 patient on both sides with CT (P = .036). However, with US, it was detected in 10 patients (8%) on the right, in 31 patients on left side and in 1 patient on both sides (P = .083). The RRC detection compliance coefficients were excellent between US and CT (κ: 0.945). CONCLUSION: US used in prone position is a suitable and practical imaging alternative to CT for detection of RRC.

Comparison of Two Different Retrograde Intrarenal Surgical Techniques: Is It Mandatory to Use Fluoroscopy During Retrograde Intrarenal Surgery?

PURPOSE: To evaluate the efficacy and reliability of fluoroscopy-free retrograde intrarenal surgery. MATERIALS AND METHODS: A retrospective evaluation was made of the data of 226 patients who underwent RIRS as kidney stone treatment between May 2015 and May 2017. When evaluation was made acccording to the exclusion criteria, the study continued with a total of 190 patients including 103 in whom fluoroscopy was used (Group 1) and 87 who underwent a fluoroscopy-free procedure (Group 2). RESULT: Group 1 patients comprised of 56 males and 47 females with a mean age of 41.5 ± 13.9 years. Group 2 patients comprised of 48 males and 39 females with a mean age of 42.6 ± 15.2 years. The mean stone size was 14.3 ± 2.7 mm in Group 1 and 14.1 ± 2.8 mm in Group 2. The mean operating time was calculated as 63.6 ± 8.2 minutes in Group 1 and 65.7 ± 9.7 minutes in Group 2. In Group 1, the success rate was determined as 83.5% on postoperative day 1 and as 92.2% in the postoperative first month. In Group 2, these rates were 81.6% and 90.8% respectively. No statistically significant difference was determined between the groups in respect of stone size (P= .752), operating time (P = .108) and postoperative first day (P = .732) and first month success rates (P = .724). CONCLUSION: Fluoroscopy-free RIRS is a surgical technique with a high rate of success that can be applied safely to be able to protect patients at high risk of radiation and the surgical team, particularly in centers with high patient circulation..

The role of RENAL, PADUA and C-index scoring systems in predicting the results of partial nephrectomy without ischemia.

OBJECTIVE: To evaluate the feasibility and renoprotective effect of off-clamp partial nephrectomy (PN) by renal scoring systems. METHODS: After approval of the local ethics committee, the radiological and clinical data of patients with renal masses who underwent PN between January 2012 and January 2017 were evaluated in two university hospitals. Total 132 patients who underwent open surgery and off-clamp technique were included. All patients underwent contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) preoperatively. Preoperative demographic data, estimated glomerular filtration rate (e-GFR) and hematocrit changes, operation time, tumor volume and hospitalization time from patients were evaluated separately and statistically for each of the three scoring systems. RESULTS: Our study consisted of 132 patients with a mean age of 53.9 ± 13.9 with 69 male and 63 female. Statistically significant difference between the risk groups in RENAL and PADUA scoring were found according to tumor T stage and tumor volüme (p <0.005). Statistically significant difference was only found between risk groups of RENAL scoring system in e-GFR reduction (p<0.05). There was no statistically significant difference between the groups in the complications of all three classification systems (p > 0.005). CONCLUSIONS: In our study, all three scoring sytem successfully predicted the surgical complexity ve surgical outcomes and our results indicate that off-clamp PN has similar success and complications rates when compared to the literature. The off-clamp PN must be kept in mind to maintain postoperative renal functions eligible patients.

Recurrent Pilonidal Sinus Cyst on Penis.

Pilonidal sinus, including one or more sinus canals and hairs, is a disease with a chronic course showing acute attacks which is often encountered in the general population, usually affecting young adults, at a rate in males twice that of females. Pilonidal sinus on the penis is so rare that very few cases have been reported in literature. A 20-year-old male presented to the urology outpatient clinic with the complaint of a suppurative lesion with discharge on the skin of the penis which had been ongoing for approximately three months. Clinical examination revealed an indurated, erythematous, ulcerative lesion, 3 cm x 2 cm in size, in the middle of the ventral aspect of the penile shaft. We present the first case in literature of recurrent pilonidal sinus related to Actinomyces israelii, located on the penis.

Photoselective Vaporization of the Prostate Using 120 W High Performance System: A Prospective Evaluation of Results Over 2 Years.

PURPOSE: This study evaluated the safety and efficacy of photoselective vaporization of prostate using the 120 W High Performance System for management of symptomatic benign prostatic hyperplasia (BPH). METHODS: We prospectively obtained data from 229 patients between January 2009 and December 2012. We evaluated the serum prostate specific antigen level, International Prostate Symptom Score (IPSS), prostate volume; maximum urine flow rate (Qmax); and postvoid residual urine volume (PVR) in the patients at presentation and on follow-up at 1, 6, 12, and 24 months. The mean duration of the surgery, energy used, hospital stay, and intra- and postoperative complications were assessed. RESULTS: The mean age of the patients was 71.2 ± 9.6 years, and the mean preoperative size of the prostate was 59.41 ± 28.1 mL. The mean duration of the surgery was 47.35 ± 16.14 min, and the mean energy use was 184.39 ± 101.3 kJ. The mean time to removal of the urinary catheter was 21.45 ± 11.06 h, while the mean duration of hospital stay was 24.82 ± 11.5 h. The IPSS declined and mean Qmax increased by over twofold within the first month. The PVR also declined significantly in all groups up to 6 months after the surgery and increased slightly thereafter. Urinary urgency and incontinence occurred in two patients, while four patients developed urinary strictures. Between 12 and 24 months after the surgery, four patients underwent repeat surgery. CONCLUSIONS: Our findings show that photoselective vaporization is safe and effective for the management of BPH and resulted in few complications. It yielded improvements in all parameters that were sustained even up to 2 years after the surgery.

Conservative/surgical treatment predictors of maternal hydronephrosis: results of a single-center retrospective non-randomized non-controlled observational study.

PURPOSE: To determine the parameters that may help the clinicians decide the best suitable treatment method for the pregnant women with symptomatic hydronephrosis which will be based on the easily accessible laboratory tests, monitoring methods and clinical symptoms. METHODS: Digital data and documents of 246 pregnant women with symptomatic hydronephrosis who were hospitalized in our clinic between the dates of January 2011 and January 2016 were retrospectively evaluated. All patients were statistically evaluated in terms of age, symptomatic maximal anterior-posterior diameter of the renal pelvis (MADP), parity, C-reactive protein (CRP) level, white blood cell count (WBC), presence of pyuria, growth of urine culture, fever, serum urine and creatinine levels, visual analog scale (VAS) score of pre- and post-therapy and threatened preterm labor. RESULTS: The study includes a total of 211 pregnant women with symptomatic hydronephrosis. In the second and third trimester groups, the surgical treatment group statistically provided higher levels of CRP, WBC and VAS. Mean MADP in the second trimester of the conservative and surgical groups where symptomatic hydronephrosis was on the right side was 16.67 ± 4.67 and 28.68 ± 7.70 mm, respectively. Mean MADP in the third trimester group of the conservative and surgical groups where symptomatic hydronephrosis was on the right side was 16.96 ± 5.96 and 28.85 ± 7.64 mm, respectively. CONCLUSIONS: In patients with symptomatic pregnancy hydronephrosis, the likelihood of surgical treatment for CRP levels, WBC counts and VAS is high.

Safety and Efficacy of Pneumatic Lithotripters Versus Holmium Laser on Multiple Ureteral Calculi.

BACKGROUND: Different energy sources can be used for ureteroscopic stone fragmentation, such as pneumatic, ultrasonic, laser or electrohydraulic. The aim of this study was to compare the efficacy and safety of pneumatic lithotripters versus Ho: YAG laser in the treatment of multiple stones in the distal ureter. METHODS: A retrospective evaluation was done using the data of patients to whom ureteroscopic lithotripsy (URL) was applied for ureter stones in our clinic. From these patients, those with multiple unilateral distal ureter stones were identified, then these patients were separated into 2 groups according to the type of lithotriptor used in stone fragmentation as laser lithotripsy (Group 1) and pneumatic lithotripsy (Group 2). RESULTS: Statistically, the two groups were similar in respect of the number of stones, stone burden and the number of double J stents applied intra-operatively. The mean operating time was similar in the 2 groups as 53.47 (±17.3) minutes in Group 1 and 50.59 (±15.3) minutes in Group 2. On postoperative day 1 after the URL, the stone free rate (SFR) of Group 1 (78.7%) was found to be significantly high compared to the SFR of Group 2 (63.6%), while at postoperative month 1, the SFR of both groups was found to be similar. Binary logistic regression was applied to determine the effect of related independent variables on the 1st month SFR. In this model, age and stone burden were affecting variables. CONCLUSION: Compared to the pneumatic lithotripter, the Ho: YAG laser seems to have advantages of a higher SFR in the early postoperative period, eventhough there are statistically similar success rates and complication rates.

Treatment of Moderate Sized Renal Pelvis Calculi: Stone Clearance Time Comparison of Extracorporeal Shock Wave Lithotripsy and Retrograde Intrarenal Surgery.

PURPOSE: To compare the stone clearance times in patients undergoing extracorporeal shock wave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) for single radiopaque renal pelvis stones 10-20 mm in size. The results of this study may guide urologists and patients and aid in selecting the optimal preoperative treatment. MATERIALS AND METHODS: Between January 2013 and February 2015, we conducted a retrospective study and collected data from 333 patients treated with SWL (n = 172) or RIRS (n = 161). We included successfully treated patients with a single radiopaque renal pelvis stone 10-20 mm in size to calculate stone clearance times. RESULTS: The average stone size for the SWL group was 14.62 ± 2.58 mm and 14.91 ± 2.92 mm for the RIRS group. The mean Hounsfield unit (HU) of the patients was 585.40 ± 158.39 HU in the SWL group and 567.74 ± 186.85 HU in the RIRS group. Following full fragmentation, the mean stone clearance time was 26.55 ± 9.71 days in the SWL group and 11.59 ± 7.01 days in the RIRS group (P < .001). CONCLUSION: One of the most overlooked parameters in urinary stone treatments is stone clearance. We believe this study will shed light for those who aim to conduct larger randomized prospective studies. .

Comparison of Ho:Yag laser and pneumatic lithotripsy combined with transurethral prostatectomy in high burden bladder stones with benign prostatic hyperplasia.

OBJECTIVES: To compare the efficacy and reliability of Ho:YAG laser lithotripsy (HLL) and pneumatic lithotripsy (PL) in the treatment of bladder stones in patients with benign prostatic hyperplasia and stones ≥ 20 mm who were transurethrally treated in the same surgical session. METHODS: We studied the data of patients with benign prostatic hyperplasia and ≥20 mm bladder stones who were treated with transurethral resection of the prostate and cystolithotripsy in the same session, obtained between January 2010 and February 2014 from three urology clinics. All patients underwent bipolar plasmakinetic (PK) transurethral resection of the prostate. For treatment of the bladder stone, either HLL or PL was applied. A total of 62 patients were divided into two groups: PK-PL (Group 1, n = 29) and PK-HLL (Group 2, n = 33). The data of both groups were analyzed for stone dimensions, stone fragmentation time, total operating time, hospitalization duration, prostate dimensions, success rates, and complications. RESULTS: Group 1 included 29 patients with a mean age of 70 ± 7.6 (range, 57-85) years, whereas Group 2 included 33 patients with a mean age of 67.5 ± 10.5 (range, 45-84) years. In Group 1, five patients had mucosa injury, one patient had residual stone, and one patient had bladder perforation. In Group 2, three patients had mucosa injury, three patients had postoperative fever, and one patient had residual stone. Total operation time and stone fragmentation time were significantly lower in Group 2 (p < 0.05). The remaining analyzed data were similar (p > 0.05). CONCLUSION: PK-HLL using a single shaft without the need for repeated access has the advantages of shorter fragmentation and operation time.

Effect of obesity on International Prostate Symptom Score and prostate volume.

AIM: The aim of this study was to investigate the relationship between obesity and lower urinary tract symptoms and prostate volume in patients who underwent prostate biopsies. MATERIALS AND METHODS: Between December 2008 and November 2009, transrectal ultrasound-guided prostate biopsy was performed on patients who had elevated prostate-specific antigen levels or abnormal digital rectal examination findings. A total of 211 patients were included in this study. Prostate volumes, International Prostate Symptom Score (IPSS) values, and the patient's height and weight were all recorded during the biopsy. Body mass index (BMI) <18.5 was determined as underweight, 18.5-23.0 normal, 23.0-27.5 overweight, and >27.5 obese. RESULTS: The mean age of the patients was 68.0 ± 6.3 years, and the mean BMI was 28.0 ± 4.9 kg/m(2). The mean prostate volume of the normal, overweight, and obese groups was 30, 50, and 70 ml, respectively. The positive and statistically significant correlation between BMI and prostate volume was determined (P < 0.001). According to BMI, the mean IPSS was 8.0, 16.5, and 20.0 in the groups, respectively. Similarly, a statistically positive correlation between BMI and IPSS was demonstrated (P < 0.001). CONCLUSIONS: As the result of a rise in BMI, prostate volumes and IPSS increase in patients. Prostate volume and IPSS decrease due to weight loss, and hence that fewer urinary symptoms occur, and the quality-of-life of patients may increase.

The effect of garlic powder on human urinary cytokine excretion.

PURPOSE: To evaluate the effects of orally administered dehydrated garlic powder on cytokine excretion in the urinary tract. MATERIALS AND METHODS: A total of 60 healthy volunteers, randomized into 3 groups, were given a single oral dose of 1 g or 3 g of dehydrated garlic powder or placebo. Urine samples were obtained 6.0 and 24.0 h after garlic intake and assayed for interleukin-8 (IL-8), interleukin- 12 (IL-12), tumor necrosis factor-alpha (TNF-α), diallyl disulfide (DADS) and diallyl sulfide (DAS). RESULTS: Significant increases in IL-12 levels over baseline were noted in urine samples obtained after oral intake of 1 g and 3 g of garlic powder (P < .001). In the 1 g and 3 g garlic powder treatment groups, time-dependent variations in IL-12 levels over the study period were significantly different from the placebo group (P < .001). In both garlic treatment groups, urinary levels of IL-8 and TNF-α were not significantly different from baseline and placebo levels (P > .017). DADS and DAS were not detected in the urine samples at any time after garlic powder intake. CONCLUSION: Oral intake of doses of garlic traditionally used for daily supplementation increases urinary levels of IL-12, which is a potent stimulator of T helper cell 1 (Th-1) immune responses. This observation encourages further studies investigating the immunostimulatory role of garlic in the urinary tract.

Papillary ureteral neoplasm of low malignant potential in the upper urinary tract: endoscopic treatment.

INTRODUCTION: Papillary ureteral neoplasm of low malignant potential (PUNLMP) is a rare diagnosis, and to our knowledge, has not yet been reported in the upper urinary tract. In this study, we aimed to present our experience in managing a very rare diagnosis, PUNLMP, in the upper urinary tract, with endoscopic treatment. MATERIALS AND METHODS: Files of patients who received surgery between January 2007 and January 2013 for upper urinary tract tumors were reviewed and patients treated for PUNLMP in the upper urinary tract in 4 urology clinics were reviewed. Patients included in the study had at most 2 tumors in the ureter and had a pathology of PUNLMP. RESULTS: The study included 11 patients with a mean age of 58.5 years. There were 9 men, and 2 women with a smoking rate of 81.8%. Nine patients (8 in the distal and 1 in the mid ureter) were managed using a semirigid ureteroscope. Two patients (1 with mid ureteral and 1 proximal) were treated using flexible ureteroscopy. The mean hospital stay was 1.56 days. Mean surgical time was 37.18 ± 7.14 minutes. The mean follow-up was 31.5 (range, 7-72) months. In the follow-ups, 3 patients had recurrences of 3, 2, and 4 mm in 9, 15, and 17 months, respectively. CONCLUSION: For tumors with a low risk of progression and relatively low risk of recurrence, organ-sparing treatments should be the choice of preference. To support our initial findings, randomized controlled studies on larger cohorts should be designed.

Emphysematous cystitis: The role of CT imaging and appropriate treatment.

Emphysematous cystitis is a relatively rare disease characterized by the presence of gas in the bladder wall and/or lumen. The primary risk factor is diabetes mellitus. Emphysematous cystitis should be considered in cases of urinary tract infections in diabetic patients with unusual presentations. Imaging studies are necessary to detect emphysematous cystitis. Accurate diagnosis of the disease and appropriate treatment typically results in a favourable prognosis and can improve the outcome. We present a case of emphysematous cystitis diagnosed by a computed tomography scan in a diabetic woman with poor glycemic control.