The effect of Cornus mas extract on nicotine-induced oxidative stress and intratesticular damage in male rats.

The role of oxidative stress in disease pathogenesis has been extensively investigated. Researchers have gathered sufficient evidence related to oxidative stress-mediated intratesticular damage. The aim of this was study to evaluate the effects of Cornus Mas (CM) extract on intratesticular changes in rats exposed to nicotine. Thirty Wistar albino rats were divided into four groups. The groups and the administrated agents for 35 days were as follows; Control group (n=6): 0.9% saline, intraperitoneally; Nicotine group (n=7): 4 mg/kg nicotine, subcutaneous; CM group (n=7): 1000 mg/kg CM extract in 0.5 ml saline, via gavage; Nicotine + CM Group (n=8): 4 mg/kg Nicotine, subcutaneous + 1000 mg/kg CM extract via gavage. One rat each from the groups Nicotine and CM died.  In spermatogenetic and histopathological examination, significant positive changes were detected in nicotine + CM group regarding seminal parameters, apoptotic cells, Factor VIII and Johnsen score as compared to nicotine group. Oxidative stress markers were higher in nicotine group as compared to the control group. OSI and MDA levels were found to be reduced in nicotine + CM group than nicotine group. Nicotine induced a significant increase in TNF-α and IL-6 levels compared to the control group; however, CM effectively counteracted this increase. We have shown that nicotine increases testicular damage, causes apoptosis of testicular cells and adversely affects spermatogenesis by increasing inflammation. We concluded that CM extract exerted beneficial effects on spermatogenesis and minimized testicular parenchymal damage, apoptosis and angiogenesis. Rapidly increasing understanding of the complexity of oxidative stress in intratesticular is the key to unlocking the potential of ROS-targeting therapies.

Effect of the COVID-19 Pandemic on Radical Prostatectomy: A Turkish Multicenter Study.

OBJECTIVE: The present study examines the effects of the coronavirus disease 2019 pandemic on radical prostatectomy performed as part of localized prostate cancer treatment in Turkey. MATERIAL AND METHODS: A retrospective analysis was made of the data of 176 patients from 8 centers in Turkey who underwent radical prostatectomy due to localized prostate cancer over the 2 years spanning March 1, 2019, to February 28, 2021. Within this timeframe, March 1, 2019, to February 28, 2020, was denoted the 1-year pre-coronavirus disease 2019 period, while March 1, 2020, to February 28, 2021, was denoted the 1-year coronavirus disease 2019 period. An analysis was made of whether there was a difference in the number of radical prostatectomies performed for prostate cancer, the time from biopsy to operation, and the biopsy and radical prostatectomy pathology between the 2 periods. RESULTS: It was found that the number of radical prostatectomies performed for localized prostate cancer during the coronavirus disease 2019 pandemic was statistically and highly significantly fewer than in the pre-coronavirus disease 2019 period (P <.001). The patients diagnosed with Gleason 3+3 (low risk) prostate cancer were statistically significantly fewer in number in the coronavirus disease 2019 period (P <.001). The pathological Gleason score was upgrading than the biopsy Gleason score in all patients who underwent in both periods (P <.001). When the periods were compared, the pathological involvement determined by lymph node dissection performed during radical prostatectomy was found to be decreased in the coronavirus disease 2019 period, although the difference was not statistically significant (P =.051). CONCLUSION: As with many diseases, the diagnosis and treatment of prostate cancer have been adversely affected by the coronavirus disease 2019 pandemic.

Prediction of The Energy Required for Ho:YAG Laser Lithotripsy of Urinary Stones.

PURPOSE: In this study, we aimed to find a more accurate predicting constant value of energy per mm3xHounsfield Unit (HU) to ablate urinary stones by endoscopic stone treatment. MATERIAL AND METHODS: The files of 142 patients who underwent rigid or flexible ureteroscopic laser lithotripsy in our clinic between December 2018 and March 2020 were evaluated retrospectively. Total energy administered for the ablation of the stone was obtained from the registry of the Ho:YAG laser and recorded to the follow-up forms. The constant value was calculated for each stone, and the final mean value was figured out by calculation of the mean of all constant values. RESULTS: The study was conducted with 142 patients; 102 males and 40 females. The mean age of the population was 46.61 ± 14.58 years. The number of stones was 1.27 ± 0.67. The mean constant value of energy needed per mm3xHU for urinary stones was 22.87 milliwatt. CONCLUSION: This study was conducted to report a predictive constant value and is the very first study evaluating the energy prediction per mm3xHU. The data of the study showed that the constant value is 22.87 mW/mm3xHU. Urologists may estimate the required energy and plan the surgery according to the outcomes of the study. As a future aspect of our study, the constant value may represent predictive information about the time and accuracy of the operation.

Effect of Endoscopic Ureteral Stone Treatment on Kidney Function.

INTRODUCTION: Ureteral stones may have an influence on kidney functions due to postrenal obstruction or urinary infections. Urgent decompression or stone removal is necessary and recommended to prevent further complications in case of severe conditions such as anuria and urosepsis. Although it is believed that ureteral stone removal would result in renal function improvement, there are still unclear points on whether ureteroscopy (URS) can provide benefit as expected and has some adverse effects. In this study, we aimed to evaluate the alteration of kidney functions of patients who undergo rigid or flexible URS for ureteral stones and find if there are any influencing factors on kidney function alteration. MATERIALS AND METHOD: We analyzed 126 patients who underwent retrograde intrarenal surgery (RIRS) for renal stones between May 2018 and February 2020 prospectively. The estimated glomerular filtration rate (eGFR) was calculated on the day before the surgery, by modification of diet in renal disease (MDRD) formula. The calculation was repeated and saved three times during follow-up for the same patient; on the day after the operation, on the postoperative 30th day, and the postoperative 90th day. Then, we evaluated the renal function by comparing eGFR and assessed the predicting factors affecting the kidney function. RESULTS: Preoperative mean eGFR was 82.28 ± 25.20 mL/min/1.73 m2 for the study group. Mean eGFR was calculated 90.92 ± 22.97 mL/min/1.73 m2 on the first postoperative day, and 94.54 ± 21.95 mL/min/1.73 m2 on the third-month follow-up. The mean change in eGFR was 8.63 ± 16.68 mL/min/1.73 m2 in the early period and 12.26 ± 21.09 mL/min/1.73 m2 in the long-term follow-up period. Fifty-one patients improved on chronic kidney disease (CKD) stage, and 13 deteriorated in three months follow-up. CONCLUSION: Removing the stone and relieving the obstruction by ureteroscopic treatment have an alteration on eGFR. Although eGFR improves in the short-term follow-up, amelioration is evident in long-term follow-up, especially in female patients. The other predictive factors for eGFR improvement after URS are the presence of ureteral obstruction and high preoperative serum creatinine levels.

External Validation and Comparison of Nephrolithometric Scoring Systems Predicting Outcomes of Retrograde Intrarenal Surgery.

Introduction: Preoperative assessment of renal stones is essential to selecting treatment options and achieving high success rates; thus, some nephrolithometric scoring systems have been developed by using preoperative clinical data and stone characteristics. Initially, nomograms predicting stone-free rates (SFRs) were designed for percutaneous nephrolithotomy. After this, some were modified, and new scoring systems were developed for retrograde intrarenal surgery (RIRS). In this study, we aimed at validating and comparing the accuracy of four scoring systems predicting the SFR of RIRS. Materials and Methods: We conducted a prospective study. The data of 110 consecutive patients who required RIRS for renal stones between May 2018 and February 2020 were evaluated. The patients were divided into four groups regarding total score: 0, 1, 2, ≥3 according to the Resorlu-Unsal Stone Score (RUSS). The scores were calculated between 5 and 15 for the size of the stone, topography or location, degree of obstruction of the urinary system, number of stones, and evaluation of Hounsfield units (S.T.O.N.E.) scoring system. Modified Seoul National University Renal Stone Complexity (S-ReSC) scores of the patients were between 1 and 12. Finally, the patients were classified between 4 and 10 points with the R.I.R.S. scoring system. Results: The mean RUSS, S.T.O.N.E., R.I.R.S., and modified S-ReSC scores were 1.14 (±0.818), 10.78 (±1.499), 6.50 (±1.305), and 2.29 (±1.710), respectively. The area under curve values of RUSS, S.T.O.N.E., R.I.R.S., and S-ReSC were 0.735 (95% confidence interval [CI] 0.623-0.826), 0.725 (95% CI 0.626-0.823), 0.752 (95% CI 0.646-0.857), and 0.755 (95% CI 0.660-0.849), respectively. Logistic regression analysis revealed that the RUSS was an independent predictive factor for SFR (p = 0.028). Conclusion: The results showed that all four scoring systems predict the SFRs for RIRS accurately. However, surgeons should prefer RUSS when all four nomograms are available, except when assessing single renal stones. In that case, S-ReSC should be used for assessment. Three other nomograms except the S.T.O.N.E. scoring system can be suitable for the assessment of lower caliceal stones.

Evaluation of the influence of subinguinal varicocelectomy procedure on seminal parameters, reproductive hormones and testosterone/estradiol ratio.

OBJECTIVE: Varicocele is the most commonly surgically curable cause of male infertility. However, the mechanisms related to the effect of reducing fertility potential have not been clearly identified. The aim of this study was to investigate the effects of varicocelectomy on semen parameters, reproductive hormones and testosterone / estradiol ratio. Matherial and methods: Fifty seven patients outcomes were evaluated before and 6 months after subinguinal microsurgical varicocelectomy. Semen parameters, reproductice hormones and testosteron/estradiol ratio results of patients were compared retrospectively. RESULTS: The mean age was 26.8 years. Fifty four (94.7%) patients had grade 3 and 3 (5.3%) patients had grade 2 varicocele. There was a significant increase in semen parameters except semen volume. There was a statistically significant increase in serum testosterone levels, but not on testosterone/ estradiol ratio. CONCLUSIONS: According to our results, microsurgical subinguinal varicocelectomy can be recommended for both improving semen parameters and hormonal recovery.

Factors Affecting Retrograde Intrarenal Surgery Success: 6 Years Experience of a Clinic in Central Anatolia.

Background: Urinary system stone disease is an important health problem. It has been reported to have a prevalence of 14.8% in Turkey. The aim of the renal stone removal surgery is to clear the stones with minimal complications. Retrograde intrarenal surgery (RIRS) is a safe method due to the fewer and minor complications. As a clinic in central Anatolia, we aimed at researching the factors affecting RIRS success in our area. Methods: After local ethics committee's approval, the data of the patients who had undergone RIRS between 2014 and 2019 were reviewed. Patients who were <18 years old, had kidney anomalies, and had both ureter and kidney stones were excluded from the study. The patients who were defined as successful were named as Group 1 and the others were named as Group 2. The demographic, intraoperative, and postoperative data of the two groups were compared. Results: There were a total of 416 patients in our study. Group 1 consisted of 332 patients, whereas Group 2 had 84 patients. Opacity was significantly different between the groups (P = .004). Stone size, stone volume, and operation time were significantly higher in Group 2. After logistic regression analysis, we found that stone size, opacity, and operation time affected the success of RIRS significantly (P < .05). There was a reverse relationship with stone size, operation time, and opacity. Conclusions: We believe that in patients who have large lower calix stones and who want effective treatment, percutaneous nephrolithotomy should still be an option for treatment.

Carob attenuates nicotine-induced oxidative stress and intratesticular damage in male rats.

In this study, we aimed to evaluate the effect of carob extract against intratesticular histological, apoptotic, biochemical and spermatogenic changes in rats exposed to nicotine. Twenty-eight rats were divided into four groups and were administered saline, nicotine, carob, or nicotine + carob once a day for 35 days. Superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-PX), GSH, total anti-oxidative status (TAS), total oxidative status (TOS), oxidative stress index (OSI), IL-6, TNF-α and seminal parameters were evaluated. Johnsen's testicular histopathological examination, factor VIII protein (angiogenesis marker) and the number of apoptotic cells were determined in the testicular tissues. The spermatogenic and histopathological examination revealed that nicotine + carob group had significant positive changes in seminal parameters, Johnsen score, apoptotic cell count and factor VIII protein compared to nicotine group. Biochemical test results indicated that the nicotine + carob group had significantly lower TAS levels compared to the control group; however, those levels were higher than those of the nicotine group. Nicotine caused a significant increase in IL-6 and TNF-α levels compared to the control group, but carob seems to significantly counteract that increase. In conclusion, carob extract had positive effects on spermatogenesis and reduced testicular parenchymal damage, apoptosis and angiogenesis.

Comparison of Safety and Efficiency of General, Spinal and Epidural Anesthesia Methods Used for the Endoscopic Surgical Treatment of Ureteral Stones: Which One is Better To Access The Ureter and Reach The Stone?

PURPOSE: The aim of this study is to evaluate the effects of anesthesia methods on the success of urethral access and stone access achievement in endoscopic treatment of urolithiasis. MATERIALS AND METHODS: In this prospective randomized study, 105 patients who underwent primary ureterorenoscopy (URS) procedure for ureteral stones were evaluated. The patients were randomized into three groups by permuted block randomization according to the applied anesthesia method: General anesthesia (GA): 33 patients, Spinal anesthesia (SA): 31 patients, and Epidural anesthesia (EA): 31 patients. Ten patients, whose ureteral access was not successful, were dropped out. The success of the three anesthesia methods on the success of the ureter access and its effects on surgical outcomes were compared. RESULTS: There was no statistically significant difference among the three groups in terms of the demographic values and preoperative features except the American Society of Anesthesiologists (ASA) status. Dilatation and the access time to stone were statistically significantly longer in SA and EA group compared to the GA group. There was no statistically significant difference among the groups in terms of operation, lithotripsy time, stone-free rate (SFR), and complication rates. The Visual Analog Scale (VAS) scores in the 8th and 24th hours were statistically significantly higher in the GA group. CONCLUSION: In patients who decided to undergo primary ureterorenoscopy procedure, it can be suggested to treat with GA to provide a better relaxation of the ureter if there are no contraindications.

Relationship between visceral adiposity index and male infertility.

The visceral adiposity index (VAI), which is calculated by using parameters such as body mass index (BMI), waist circumference, triglyceride, and high-density lipoprotein cholesterol, has been reported to be associated with visceral fat distribution and increased cardiometabolic risk. We aimed to investigate the relationship between the VAI and hormone profiles as well as semen analysis in male infertility. This retrospective study included 278 adult men that were admitted to the urology and endocrine outpatient clinics. Patient data were reviewed, and outcomes were recorded. BMI and VAI were calculated and noted separately. BMI was negatively correlated with serum testosterone and testosterone/ estradiol ratio (T/E2) (p < .05 for all). There was no significant relationship between BMI and semen parameters (p > .05 for all). However, there was a significant negative correlation between VAI and semen parameters, total serum testosterone and T/E2 (p < .05 for all). Furthermore, VAI was independently associated with the total motility score. The increase in visceral adiposity that can be demonstrated by VAI may adversely affect male fertility due to its metabolic and hormonal effects. Since infertility occurs as a result of different metabolic conditions, the underlying mechanisms can be better understood from a multidisciplinary perspective.

Do Anesthesia Methods in Retrograde Intrarenal Surgery Make Difference Regarding the Success of Ureteral Access and Surgical Outcomes?

Background: Retrograde intrarenal surgery (RIRS) is a safe and minimally invasive method for the endoscopic treatment of upper urinary system stones especially sized <2 cm. Ureteral entrance is an important stage of RIRS. General anesthesia (GA) is usually used for RIRS. There is not enough data about the effect of anesthesia methods on the success of ureteral entrance and RIRS. We aimed to evaluate the effects of anesthesia methods (spinal anesthesia [SA], epidural anesthesia [EA], and GA) on the ureteral access and RIRS outcomes in primary surgery. Methods: After local ethical approval, 105 patients were prospectively randomized into three groups according to the anesthesia methods. GA, SA, and EA were defined as Group 1, 2, and 3, respectively. Results: Stone density was statistically significantly different between three groups (P = .008). Lithotripsy and operation time were significantly lower in Group 3 (P = .001). Dilatation and stone access time were significantly lower in Group 1. There was no statistically significant difference for scopy time, success, Visual Analog Scale score at 8th and 24th hours, and intraoperative and postoperative complications. Conclusions: GA may be recommended to decrease manipulations for the success of first ureteral access and time to reach the stone if there is not any contraindication.