Unilateral J-cut division versus partial and subtotal removal techniques in female patients with mesh-related urethral obstruction: Multicentric comparative study.

Objective: To compare the functional (obstruction relieving) outcomes and complications of unilateral J-cut division, partial and subtotal vaginal removal techniques were performed for mesh-related urethral obstruction (MRUO) in females. Methods: Patient review included demographics, a medical history and proforma with details of lower urinary tract symptoms (LUTS), physical and urodynamic findings, detailed surgical reports and follow-up data. Variables were compared between the three groups. Results: Out of 130 patients with sling revision surgery (SRS), 54 women underwent SRS for MRUO with a median follow-up of 48 (17-96) months. Unilateral J-cut division, partial and subtotal vaginal removal techniques were performed in 12, 31 and 11 patients with a median duration of surgery of 30 (25-34), 40 (35-56) and 60 (60-70) minutes, respectively (p = 0.001). Statistically significant increase in median maximum free urine flow rate and decrease in median post-void residual urine volume were found after SRS in the three groups, while de novo stress urinary incontinence (SUI) developed in 10%, 44% and 60% of the patients in the unilateral J-cut division, partial and subtotal removal groups, respectively (p = 0.007). Conclusions: The unilateral J-cut division technique was as effective as the partial and subtotal vaginal removal techniques in relieving MRUO with a shorter duration of surgery time (p = 0.001) and lower risk of de novo SUI (p = 0.007). Comparative studies with a larger number of patients are needed.

Effects of hyperbaric oxygen therapy on hydrochloric acid-induced interstitial cystitis in rats: a histological and ultrastructural study.

INTRODUCTION: Currently no definitive cure exists for interstitial cystitis (IC). We investigated the therapeutic effects of hyperbaric oxygen (HBO2) therapy in this syndrome in an experimental IC model through biochemical analyses and histopathological assessments. METHODS: 24 Sprague Dawley rats were divided into three treatment groups sham (transurethral intravesical injection with sterile distilled water), rats with IC (induced by transurethral intravesical injection with hydrochloric acid), and rats with IC + HBO2. After completion of experiments the animals were sacrificed and their urinary bladders were removed surgically. Tissues were evaluated by light and electron microscopy. Lesion index scoring system for IC was used to evaluate vesical injury. TNF-α levels were measured by ELISA test kit. RESULTS: Lesion index scores and TNF-α levels of the sham and IC + HBO2 treatment groups were quite similar (p < 0.01). Although HBO2 treatment did not show any effect in reducing the number of mast cells (p > 0.05), it reduced the mast cell activity (p < 0.05). All parameters except mitochondrial damage (p > 0.05) were improved in the IC + HBO2 treatment group compared to the IC without HBO2 treatment group. CONCLUSION: HBO2 treatment may alleviate the inflammation, may lead to a certain degree of reversal of adverse histopathological changes, and is effective in enhancing the healing process in interstitial cystitis. We believe that HBO2 treatment may be included as a weapon in our armamentarium against IC.

Effect of Work-Related Factors on Lower Urinary Tract Symptoms in Nurses and Secretaries.

OBJECTIVE: The objective of the present study was to examine the relationship between work-related factors and lower urinary tract symptoms (LUTS) and to emphasize the vicious circle between symptoms and work conditions. METHODS: The Turkish version of the Nurse Bladder Survey was used to estimate the prevalence of LUTS and to assess the relationship between individual characteristics, personal habits and work-related factors in nurses and secretaries who were working in Eskisehir Osmangazi University Hospital. The Turkish version of the Short Form 36 Health Survey was used to assess the nurses' and secretaries' health-related quality of life (HRQL). RESULTS: Of the 281 women who participated in the study, 218 (77.5%) and 63 (22.5%) were nurses and secretaries, respectively. There were no significant differences in personal habits and work-related factors between the nurses and secretaries. Of the study participants, 121 (43.1%) experienced at least one type of LUTS. There were no significant differences in the prevalence of any type of LUTS between the two groups. Only the mean scores of social functioning were significantly different for nurses and secretaries on the other aspects of HRQL in the SF-36. When the nurses with LUTS and the secretaries with LUTS were compared, the secretaries had a greater score on the general health domain than nurses. CONCLUSION: There is a vicious circle between symptoms and work conditions. To prevent the working women from harmful effects of this circle, the employers should be aware of this health problem; working conditions should be improved; educational programs for LUTS should be organized and the working women should be encouraged to go to the health providers to seek treatment when the symptoms occurred.

Relationship between Twinkle Artefacts and in vivo Biochemical Composition of Kidney Stones.

INTRODUCTION: Our aim was to predict the chemical composition of kidney stones according to their twinkle artefact (TA) features obtained by in vivo color Doppler ultrasonography and to determine the potential factors affecting the formation and intensity of TAs. MATERIALS AND METHODS: A total of 101 patients who met the inclusion criteria were included in the study. All patients were evaluated for TAs using color Doppler ultrasonography. All stones were subjected to chemical analysis. The relationships between the TA and the size and chemical composition of the stone, presence of hydronephrosis and body mass index (BMI) were evaluated statistically. RESULTS: According to the results of the chemical analysis, 66 (65.3%) were calcium oxalate stones. It was found that the in vivo TA intensity did not predict cystine and calcium oxalate monohydrate stones (p > 0.05) and the intensity of TAs increases with increasing BMI (p = 0.002). CONCLUSION: The present study is the first to show that TAs may not be reliable in overweight patients. The TAs could not predict the chemical composition of stones; so future comprehensive in vivo studies will clarify the role of TAs in the prediction of the stone type preoperatively.

Effect of αlipoic acid and silymarin on bladder outlet obstruction.

The aim of the present study was to determine whether the treatment of obstructed rat bladders with αlipoic acid (ALA) and silymarin reverses the biochemical and physiological responses to bladder outlet obstruction (BOO). A total of 32 adult Sprague Dawley rats were divided into four groups (n=8 per group): sham (placebo surgery) animals with no treatment (group 1); control animals with surgically induced BOO (group 2); obstructed rats treated with ALA (group 3); and obstructed rats treated with silymarin (group 4). Histological evaluation, bladder weights, collagen structure, TdT-mediated biotin nick end-labeling (TUNEL), inducible nitric oxide sentase (iNOS) mRNA levels, malondialdehyde (MDA) levels and tumor necrosis factor (TNF) levels were investigated. The ALA-treated group had similar bladder weights, collagen levels and TUNEL positivity and decreased iNOS levels compared with the control group, while the silymarin group exhibited further differences. Serum MDA and TNF-α levels were both decreased in the ALA and silymarin groups. ALA treatment reduced the increased oxidative stress and bladder inflammation caused by BOO and may contribute to the protection of bladder function.

Effects of rotenone on inducible nitric oxide synthase and cyclooxygenase-2 mRNA levels detected by real-time PCR in a rat bladder ischemia/reperfusion model.

We aimed to determine whether rotenone treatment prevents induced ischemia/reperfusion (I/R) damage in rat bladders by detecting inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) levels by real-time PCR (RT-PCR). A total of 18 Sprague-Dawley albino rats were used in this experiment. The experimental groups each consisted of 6 rats and were treated as follows: group I, control; group II, I/R; group III, rotenone + I/R. In the control group, the rat bladders were removed by lower abdominal incision without any procedure. In the I/R group, 1 h prior to the ischemia 1 cc physiological serum was administered and the abdominal aortas were clamped for 1 h to achieve bladder ischemia. Following the ischemia, reperfusion was induced for 1 h and the bladders were removed. In the rotenone + I/R group, the rats were treated with 25 mg/kg rotenone intraperitoneally. The iNOS and COX-2 mRNA levels in each group were detected using RT-PCR. In the I/R group, the COX-2 levels in the bladder tissue were higher compared with the control group (P<0.05). The COX-2 levels in the rotenone-treated group were statistically lower compared with the I/R group (P<0.01). Vascularization and edema were markedly increased in the I/R group. Following rotenone treatment these were abrogated inversely to inflammation. Although iNOS levels were slightly higher in the I/R group compared with the control group, iNOS levels did not decrease and no significant difference was observed between the groups with regard to rotenone treatment (P>0.05). We suggest that rotenone may be used clinically to treat I/R damage due to its diminishing effect on COX-2 levels.

Verrucous carcinoma of the renal pelvis with a focus of conventional squamous cell carcinoma.

Verrucous carcinoma (VC) is a rare variant of squamous cell carcinoma (SCC) with an extremely well-differentiated microscopic appearance. It is able to show extensive local invasion, but practically never metastasizes. VCs mostly occur in the oral cavity, larynx, nasal cavity, esophagus, vulva, vagina, anorectal region, penis and skin. VCs sometimes coexist with conventional SCCs, and in these instances they are associated with a higher recurrence rate than pure VCs. The occurrence of VC in the renal pelvis is very rare and to date only 4 cases have been reported. We report here a case of VC with a focus of conventional SCC in the renal pelvis. The patient showed fistula formation by residual tumor in the follow-up period.

Is ureteral stenting really necessary after ureteroscopic lithotripsy with balloon dilatation of ureteral orifice? A multi-institutional randomized controlled study.

PURPOSE: Our aim was to evaluate the role of balloon dilatation of the ureteral orifice on the decision to stent after ureteroscopy. MATERIALS AND METHODS: We prospectively enrolled 505 patients from two clinics, undergoing ureteroscopy (URS) for urolithiasis. Patients having balloon dilatation of the ureteral orifice and uncomplicated ureteroscopy were randomized to be either stented (n = 144) or nonstented (n = 142). Ureteroscopy was done with a 9.8 rigid ureteroscope. For dilatation of ureteral orifice, 18Fr-4 cm balloons were used (Uromax™, Boston Scientific, USA). Holmium laser or pneumatic devices were used for lithotripsy. In the second postoperative week, patients were asked to assess: pain, dysuria, and urgency using a 10-cm visual analog score (VAS) and unplanned visits. In each visit, urinalysis, urine culture, plain X-ray, and ultrasound examinations were performed. Six months after URS, follow-up IVU was performed to evaluate ureteral narrowing. Results for the separate clinics were not revealed until the end of study. RESULTS: There were no significant differences between the two groups regarding gender, age, preoperative serum creatinine levels, stone size, stone side and location, lithotripsy type, pain, infectious complications, unplanned visits, and ureteral narrowing. However, irritative symptoms were more common in the stented group. Success rates of 97.8 and 97.2% were similar in the unstented and stented groups. CONCLUSION: In uncomplicated URS, balloon dilatation of the ureteral orifice should not significantly affect the decision for or against stent placement. Avoiding stents lowers costs and gives fewer irritative symptoms.

Protective effects of leptin on ischemia/reperfusion injury in rat bladder.

The aim of the study was to evaluate protective effects of exogenous leptin on ischemia/reperfusion (I/R)-induced injuries to the urinary bladder tissue and to investigate the effect on tumor necrosis factor alpha (TNF-alpha) levels and apoptotic cells during I/R injury. Bladder I/R injury was induced by abdominal aorta occlusion by ischemia for 45 min, followed by 60 min of reperfusion in rats. The rats were divided into three groups: control (n = 8 + 8), I/R (n = 8 + 8) and I/R+leptin group (n = 8 + 8). The rats in the I/R+leptin group were treated intraperitoneally with leptin (10 microg/kg) 60 min prior to ischemia induction. At the end of the reperfusion period, urinary bladders of the first eight rats from each group were removed for TUNEL staining processing while the others were removed for biochemical analyses for MDA and TNF-alpha levels. In the I/R group, the ratios of TUNEL-positive nuclei were higher than the control and the I/R+leptin groups. The MDA and TNF-alpha levels of the bladder tissue in the I/R group were higher than the control and leptin-treated groups. TUNEL-staining and biochemical studies revealed that leptin has a protective effect on urinary bladder I/R injury.

Antioxidant effects of melatonin and coenzyme Q10 on oxidative damage caused by single-dose ochratoxin A in rat kidney.

In the study, the effects of relatively high single-dose of Ochratoxin A (OTA) and the antioxidant effects of Melatonin (Mel) and Coenzyme Q10 (CoQ10) on OTA-induced oxidative damages in rats were investigated. A total of 28 male Sprague-Dawley rats were divided into four groups of 7 rats each: Control, OTA, Mel+OTA and CoQ10+OTA groups. Malondialdehyde (MDA) levels in the plasma and glutathione (GSH) levels in whole blood were measured; kidneys (for histological inspection and for apoptosis detection by TUNEL method) and bone marrow samples (for chromosome aberration and mitotic index) were taken. The rats in the OTA group showed limited degeneration of tubular cells. In some tubules karyomegaly, desquamated cells and vacuolization were observed by light microscopy. Mel and CoQ10 treatment significantly reduced the severity of the lesions. MDA levels of the OTA group were significantly higher than the control, OTA+Mel and OTA+CoQ10 groups, while GSH levels were significantly lower than the control, OTA+Mel and OTA+CoQ10 groups. Higher incidences of apoptotic bodies were observed in the kidneys of the OTA group although OTA administration did not significantly change the incidence of apoptotic bodies when compared to the control and antioxidant administrated groups. Although the percentage of the mitotic index was lowest in the OTA group, no statistical difference was found among the groups. Additionally, OTA had no numerical and structural significant effects on chromosomes. It was observed that single-dose OTA administration caused oxidative damages in rat kidney and Mel or CoQ10 treatment appeared to ameliorate the OTA-induced tissue injuries.

Morbidity after urodynamic study in diabetic patients.

The aim of this prospective study was to evaluate the morbidity of invasive urodynamic study (UDS) in type 2 diabetic patients. Study was conducted on 94 diabetic (59.4 +/- 0.8 years) and 110 non-diabetic (58.1 +/- 0.9 years) patients who had lower urinary tract symptoms. All patients underwent pressure-flow study. The major complication rate after UDS, including urinary tract infection, fever, urinary retention and gross hematuria, was 11.8% for non-diabetics and 22.3% for diabetics (p = 0.044). No significant differences were found between diabetics and non-diabetics according to gender with respect to dysuria, hematuria and pain (p > 0.05). Existence of pyuria before UDS was significantly higher in diabetic women with major complication than without major complication (p = 0.011). On the other hand, residual urine volume (p = 0.004) and diabetic cystopathy (0.005) were found significantly higher in diabetic men with major complication than without major complication. Our study demonstrated that UDS has an important role on the occurrence of high objective and subjective morbidity in diabetic and non-diabetic patients. Therefore, UDS indication should be carefully evaluated, especially in diabetic men who have high residual urine volume and diabetic women who have pyuria before UDS.

Perforation of the upper ureter: a rare complication of extracorporeal shock wave lithotripsy.

Perforation of the upper ureter is a rare but serious complication of extracorporeal shock wave lithotripsy (SWL). Ureteral perforation can cause a series of problems including the retroperitoneal urinoma, urosepsis, abscess formation, infection, and subsequent renal function impairment. We reported here a rare case of SWL-induced upper ureteral rupture resulting in an expanding retroperitoneal urinoma that required percutaneous drainage. Ureteral perforation was treated successfully without major surgical intervention by employing temporary percutaneous drainage and antibiotics. The present case indicates that potential ureter rupture may form in rare cases; especially in patients having infected stones and exposed to a high number of shock waves. This complication further emphasizes the importance of adequate pre-and post-operative evaluation and the precise identification of the cause of the persistent pain after SWL.

Bladder dysfunction in type 2 diabetic patients.

AIMS: To reevaluate urodynamic findings of bladder dysfunction (BD) in type 2 diabetic patients with patient characteristics and concommittant chronic complications. METHODS: Patients (M/F:27/27) with lower urinary tract symptoms (LUTS) underwent a detailed urodynamic investigation. Urodynamic findings were classified as diabetic cystopathy [DC, characterized by impaired bladder sensation, increased post-void residual urine (PVR) and increased bladder capacity and decreased bladder contractility], detrusor overactivity, bladder outlet obstruction (BOO), urge and stress urinary incontinence or BD in which one of the alterations was included. Glycated hemoglobin (HbA1C), diabetic retinopathy, nephropathy, sensorimotor, and autonomic neuropathies were evaluated. RESULTS: BD was present in 74.07% of men (DC, 50%; BOO, 25%; detrusor overactivity, 25%) and in 59.26% of diabetic women (DC, 43.75%; detrusor overactivity, 31%; urge incontinence, 12.5%; stress urinary incontinence 12.5%). In men, age, duration of diabetes and HbA1C threshold values predicting BD were >64 years, >9 year, >7.9%, while in women, they were >56 years, >8 years, >7%, respectively. Prolongation of QTc, abnormal esophageal transit and gastric emptying times, diabetic retinopathy, and microalbuminuria were associated with an increased risk of PVR >or= 100 ml. CONCLUSIONS: DC was the most frequent finding in patients. Ageing, duration of diabetes, worse metabolic control, PVR 100 ml, cardiac, esophageal and gastric parasympathetic autonomic neuropathies, retinopathy, and microalbuminuria provided a means to predict BD in patients in order to investigate by urodynamics. The establishment of DC in at least 8-9 years after the diagnosis of type 2 DM was an important parameter to inform our diabetic patients.

Preventive effects of Ginkgo biloba extract on ischemia-reperfusion injury in rat bladder.

AIMS: The aim of this experimental study was to evaluate the effects of Ginkgo biloba (EGb 761) on ischemia-reperfusion (I-R) injury in the rat bladder. METHODS: A bladder I-R injury was induced by abdominal aorta occlusion by ischemia for 30 min, followed by 45 min reperfusion in rats. The rats were divided into four groups of 7 rats each; the control, I-R, and I-R groups were pretreated intraperitoneally with 50 or 100 mg/kg G. biloba 60 min before ischemia induction. Contractile responses to carbachol through isolated organ bath studies were recorded, histological sections were evaluated by light microscopy, and TUNEL staining was performed for the evaluation of apoptosis. RESULTS: In the I-R group, the contractile responses of the bladder strips were lower than those of the control group (p < 0.01-0.001) and were restored by pretreatment with 100 mg/kg G. biloba (p < 0.05-0.001). Decreased polymorphonuclear leukocyte infiltration was detected in the G. biloba pretreatment groups when compared to the I-R group during histological evaluation. The ratio of TUNEL-positive nuclei was 1.84% in the I-R group, whereas it was decreased in both of the G. biloba pretreatment groups (p < 0.01, p < 0.01). CONCLUSION: Our data indicated that G. biloba has a preventive effect on I-R injury in rat urinary bladder.

Adenonocarcinoma of the urinary bladder mimicking simple ureterocele: a case report.

We report a case of adenocarcinoma of the urinary bladder, mimicking simple ureterocele in a 55-year-old man, presenting irritative bladder symptoms. The literature review highlights the rarity of such tumor. Intravenous urography showed a dilated terminal portion of the left ureter resembling a cobra-head appearance. Cystoscopy revealed suspicious hyperemic lesion on the mucosa of the dilated terminal portion of the left ureter. Transurethral biopsy of the lesion was performed and pathological examination revealed a muscle-invasive adenocarcinoma. There were no metastatic lesions on computed tomography. The patient underwent radical cystectomy and urinary diversion.

Effectiveness of ciprofloxacin prophylaxis in preventing bacteriuria caused by urodynamic study: a blind, randomized study of 192 patients.

OBJECTIVES: To determine the efficacy of prophylactic ciprofloxacin in preventing urinary tract infections caused by urodynamic study (UDS). METHODS: A total of 210 patients presenting for UDS during a 16-month period were offered enrollment in the study. A clean-catch midstream urine sample was taken 24 hours before and 48 to 72 hours after the procedure and after microscopic examination and culture were done. All patients underwent a standard UDS. The 192 patients who had sterile urine before intervention were included in the study. Randomly, 98 of the 192 patients were orally given 500 mg of ciprofloxacin 1 hour before the urodynamic intervention and 94 were not given anything. The patients who were found to have significant bacteriuria after UDS were followed up and treated properly. RESULTS: Eighteen patients (8.6%) who had significant bacteriuria in the urine culture before UDS were excluded from the study. The rate of significant bacteriuria in the urine culture after UDS was 7.3% overall, 1% in the prophylaxis group, and 14% in the controls, a significant difference (P = 0.002). The most common uropathogen was Escherichia coli (57%). Three independent risk factors were identified: not giving antibiotic prophylaxis before UDS; antibiotic use in the preceding month; and the presence of pyuria before UDS. CONCLUSIONS: Urinary tract infections after UDS decreased from 14% to 1% with a single dose of ciprofloxacin 500 mg orally before UDS. We recommend antibiotic prophylaxis for patients undergoing a UDS.

Fibroepithelial polyp of glans penis.

A case of fibroepithelial polyp of the penis in a 59-year-old man is presented. The physical examination showed that the lesion affected the ventral surface of the glans, near the urethral meatus. No communication was found with the urethra. The patient had a history of long-term condom catheter use. He was successfully treated by wide local excision. The histopathologic diagnosis was a fibroepithelial polyp. Postoperatively, the follow-up examinations at 3, 6, 12, and 24 months showed normal findings and no recurrence.