Protective effect of Alpha-Linolenic acid on Lipopolysaccharide-Induced Orchitis in mice.

Previous studies have demonstrated that polyunsaturated fatty acids (PUFAs) have anti-inflammatory effects. One specific PUFA, alpha-linolenic acid (ALA), shows both anti-inflammatory and antioxidant properties. In the testes, inflammatory mediators are known to increase when orchitis is induced by bacterial lipopolysaccharide (LPS). This study aimed to determine whether the anti-inflammatory properties of ALA could have a protective effect against LPS-induced orchitis in mice. The mice were divided into untreated control, orchitis and ALA-treated orchitis groups. Orchitis was induced by intraperitoneal injection of LPS. The ALA-treated group was administered ALA by gavage three days before intraperitoneal LPS injection. Cyclooxygenase-2 (COX-2), cytosolic phospholipase A2 (cPLA2), inducible nitric oxide synthase (iNOS) enzymes and nuclear factor kappa-B (NF-κB) in the testes, as well as serum interleukin 6 (IL-6) and tumour necrosis factor-alpha (TNF-α), were analysed using enzyme-linked immunosorbent assay (ELISA) tests. LPS administration increased the expression of several inflammatory mediators, including IL-6, TNF-α and NF-κB, as well as the COX-2, cPLA2 and iNOS enzymes. ALA administration significantly prevented the LPS-induced increases in these inflammatory mediators and enzymes (p < .05). The anti-inflammatory and antioxidant effects of ALA may make it a useful candidate for the treatment of orchitis caused by bacterial LPS.

Alpha-linolenic acid confers protection on mice renal cells against cisplatin-induced nephrotoxicity.

Cisplatin is an antineoplastic agent used in the treatment of various types of solid tumors. Despite the dose-dependency of its antineoplastic effect, the high risk for nephrotoxicity frequently precludes the use of higher doses. α-Linolenic acid (ALA), a carboxylic acid having three cis double bonds, is an essential fatty acid required for health and can be acquired via foods that contain ALA or supplementation of foods high in ALA. Previous studies have shown that ALA demonstrates anti-cancer, anti-inflammatory, and anti-oxidative effects. In this study, we show the protective effect of ALA on cisplatin-induced renal toxicity associated with oxidative stress in mice using biochemical parameters. The mice were randomly assigned into four experimental groups. Group 1 (control group) were administered physiological saline solution for 9 days; group 2 (ALA group) received 200 mg/kg alpha-linolenic acid via gavage for 9 days; group 3 (CIS group) received 100 mg/kg intraperitoneal (i.p.) CIS for 9 days; and group 4 (ALA + CIS group) received 100 mg/kg i.p. CIS and followed by ALA 200 mg/kg via gavage for 9 days. Alpha-linolenic acid significantly reduced the expression of myeloperoxidase (MPO), phospholipase A2 (PLA2), cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) in the ALA + CIS group compared to the CIS group. Furthermore, catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx) quantities were significantly elevated in the ALA + CIS group when compared to the CIS group. ALA significantly decreased the levels of Bax and cleaved caspase-3, while significantly increasing the level of bcl-2, an anti-apoptotic protein, in the ALA + CIS group than in the CIS group. Finally, histopathological examination in renal tissue showed that the significant edematous damage induced by CIS administration alone was reduced in ALA + CIS group. In conclusion, our findings show that ALA is beneficial to CIS-induced nephrotoxicity in mice via its anti-inflammatory and anti-oxidative effects.

Is the Homocysteine Level a Good Predictive Marker for Evaluating Kidney Function in Patients After Percutaneous Nephrolithotomy.

PURPOSE: The purpose of this study is to evaluate the preoperative, early and late postoperative homocysteine levels and its relationship with kidney function in patients after undergoing percutaneous nephrolithotomy (PNL). MATERIALS AND METHODS: Twenty-three patients with kidney stones underwent PNL and blood samples were taken preoperatively as well as at 48 hours and three months after the operation. The homocysteine level was determined by high pressure liquid chromatography and the fluorometric method in blood samples with ethylenediaminetetraaceticacid. The Cockcroft - Gault formula was used to calculate the glomerular filtration rate (GFR). Non-contrast computed tomography was performed for all patients before surgery. Stone burden was calculated asthe sum of the area of each stone in mm2. RESULTS: Fourteen male (60.9%) and nine female (39.1%) patients were recruited for this study, and the median age was 44.3 ± 15.17 (20 - 71) years. There were no statistically significant differences between the preoperative homocysteine level and the level at 48 hours post-operation (P = .460). However, the homocysteine level three months after the operation was significantly lower than the preoperative and 48 hour levels (P = .001 and P = .003, respectively). CONCLUSION: Renal function, which deteriorated after the PNL procedure, was preserved or improved over time. Homocysteine may be a sensitive indicator to assess the change in renal function pre-and post-PNL.

Comparison between spousal donor transplantation treated with anti-thymocyte globulin induction therapy and, living related donor transplantation treated with standard immunosuppression.

The worldwide shortage of organs available for transplantation has led to the use of living-unrelated kidney donors. In this context, spouses represent an important source of organ donors. We compared the allograft outcomes of spousal donor transplantation (SDT) with anti-thymocyte globulin (ATG) induction therapy and living related donor transplantation (LRDT) with triple immonosuppression and basiliximab, in addition. Among the 335 living and deceased donor kidney transplantations performed between April 2001 and June 2010, there were 274 living donor kidney transplantations including 34 SDT and 240 LRDT. The minimum follow-up period was 36 months. All recipients of SDT received ATG (1.5 mg/kg) induction therapy, which was stopped five to seven days after surgery. Maintenance immunosuppression included tacrolimus (TAC), mycophenolate mofetil (MMF) and prednisolone. LRDT recipients received triple immunosuppressive protocol consisting of cyclosporine or TAC, MMF and prednisolone, in addition to basiliximab. There was a significant difference between the two groups in recipient age, while pre-operative duration on dialysis, recipient sex and donor age and sex were not significantly different. There was also a significant difference between the two groups in the number of human leukocyte antigen (HLA) mismatches. The 1-, 3- and 5-year graft survival rates of SDT were 94.1%, 88.2% and 79.4%, respectively, and the frequency of acute rejection episodes was 5.8% (two cases). The 1-, 3- and 5-year graft survival rates of LRDT were 95.8%, 91.6% and 83.3%, respectively, with the frequency of acute rejection being 16.2%. The graft survival rates of SDT were as good as LRDT, while the acute rejection rates in SDT were lower than in LRDT, although the difference was not statistically different (P = 0.13).

Immediate and long-term high levels of plasma homocysteine after extracorporeal shock wave lithotripsy in patients with renal stone disease.

BACKGROUND: Plasma homocysteine levels increase in patients with chronic renal failure. Numerous studies have demonstrated that kidney function is one of the most important determinants of plasma total homocysteine (tHcy) concentration. In this study we aimed to evaluate the relationship between tHcy levels and extracorporeal shock wave lithotripsy (ESWL) for patients with renal stones and to see if the change in homocysteine levels continued if renal dysfunction improved. MATERIALS AND METHODS: The study consisted of 20 patients who underwent first-time ESWL for renal stones. Every patient gave 3 blood samples at 24 h before surgery and at 2 days and at 3 months after ESWL for measurement of plasma levels of tHcy, creatinine, vitamin B6, and vitamin B12. RESULTS: The 20 patients (12 male, 8 female) had a mean age of 42.8 ± 11.7 years. tHcy levels showed a statistically significant increase from 9.4 ± 1.4 to 18 ± 4.8 and 11.2 ± 2.1 at 2 days and at 3 months, respectively. Serum creatinine also showed a statistically significant increase compared to baseline at 2 days and at 3 months after ESWL. CONCLUSION: After first-time ESWL, the increase in serum levels of creatinine and tHcy due to renal injury, such as ischemia/reperfusion injury, may be severe and continue for a long period, such as 3 months. According to baseline levels, the increase in homocysteine levels as an indicator of oxidant stress was more severe than the creatinine levels after ESWL for renal stones. Our patients were first-time ESWL patients; however, in patients who undergo EWSL more than once long-term high tHcy levels should also be considered as renal.

The effect of rectal Foley catheterization on rectal bleeding rates after transrectal ultrasound-guided prostate biopsy.

PURPOSE: To assess whether Foley catheterization of the rectum after transrectal ultrasound (TRUS)-guided prostate biopsy decreases complication rates. MATERIALS AND METHODS: Between June 2000 and September 2006, 275 consecutive patients were evaluated after undergoing TRUS-guided prostate biopsy. All procedures were performed on an outpatient basis. Patients were divided into two groups. In the first group (n = 134), a Foley catheter was inserted into the rectum and inflated to 50 cm(3) after TRUS-guided biopsy. In the second group (n = 141), catheterization was performed without balloon placement. Rectal bleeding, hematuria, hematospermia, infection, and acute urinary retention rates were compared between groups. RESULTS: The mean ages of the patients were 63.3 years +/- 5.6 and 62.1 years +/- 7.2 years in the Foley catheter group and control group, respectively (P = .112). Hematuria, hematospermia, infection, and rectal bleeding occurred in 31 (23.1%), 30 (22.4), nine (6.7%), and two patients (1.5%), respectively, in the Foley catheter group; and in 36 (25.5%), 36 (25.5%), 11 (7.8%), and 25 patients (17.7%), respectively, in the control group. The incidences of infection, hematuria, and hematospermia were not significantly different between groups (P > .05). In contrast, the rectal bleeding rate was significantly lower in the Foley catheter group (1.5%) than in the control group (17.7%; P = .001). CONCLUSIONS: Although it has no effect on other complications, TRUS-guided prostate biopsy with rectal Foley catheterization is a useful, practical method to decrease or prevent rectal bleeding.

Patient tolerance during cystoscopy: a randomized study comparing lidocaine hydrochloride gel and dimethyl sulfoxide with lidocaine.

PURPOSE: Cystoscopy is one of the most common examinations in urologic outpatient clinics. Various anesthetic approaches have been used to make cystoscopy more tolerable for patients. The aim of the present prospective randomized study was to evaluate the efficacy of lidocaine hydrochloride gel compared to dimethyl sulfoxide (DMSO) with lidocaine in rigid cystoscopy. MATERIALS AND METHODS: Male patients requiring 17F rigid cystoscopy were eligible for inclusion in this study. A total of 140 patients were divided into two groups: group 1 (n=70) received approximately 11 mL of 2% lidocaine gel intraurethrally, while in group 2 (n=70) approximately 10 mL of 40% DMSO with an amount of lidocaine equal to that in the lidocaine gel was smeared around the scope and external urethral meatus. A penile clamp was placed for 15 minutes and 5 minutes in group 1 and group 2, respectively. Immediately after cystoscopic examination pain was scored on a 10-cm visual analog scale. RESULTS: The mean pain scores after the procedure for group 1 and group 2 were 3.9+/-1.1 and 2.1+/-1.0, respectively. The pain scores were significantly lower for group 2 than for group 1 (P=0.015). No patients needed additional anesthetic agents or sedatives due to insufficient analgesia, and there were no serious side effects in either group. CONCLUSIONS: Our study has shown that DMSO with lidocaine gel causes significantly less delivery discomfort in the male urethra than lidocaine hydrochloride gel. The advantages of DMSO with lidocaine are the mixture takes less time to act and had lower pain scores.

Pain scores and local anesthesia for transrectal ultrasound-guided prostate biopsy in patients with anorectal pathologies.

PURPOSE: The aim of the present randomized study was to evaluate the efficacy of lidocaine gel compared with dimethylsulfoxide (DMSO) with lidocaine for transrectal ultrasonography (TRUS)-guided prostate biopsy in patients with anorectal pathologies. PATIENTS AND METHODS: Sixty-two patients were randomly divided into two equal groups. Group 1 was given 10 mL of 2% lidocaine gel intrarectally 10 minutes before the biopsy. Group 2 was given 10 mL of intrarectal 40% DMSO with an amount of lidocaine equal to that in the lidocaine gel 10 minutes before the procedure. The degree of pain was rated by patients using a 10-point visual analog scale. RESULTS: The pain scores for probe insertion were significantly lower for group 2 (3.15 +/- 1.41) than for group 1 (4.58 +/- 160) (P = 0.01). No significant differences were found between the pain scores of the two groups for biopsy-needle insertion (P = 0.62). CONCLUSIONS: Dimethylsulfoxide with lidocaine instilled into the rectum is a simple, safe, rapid-acting, and effective method of anesthesia delivery before TRUS-guided prostate biopsy in patients with anorectal pathologies.

Pain scores and early complications of transrectal ultrasonography-guided prostate biopsy: effect of patient position.

BACKGROUND: The aim of the study was to evaluate the pain scores and complications of transrectal ultrasonography (TRUS)-guided prostate biopsy and to compare lithotomy position (LP) versus left lateral decubitis position (LLDP). METHODS: A total of 340 patients were referred for TRUS-guided biopsy. In group 1 (n = 170), biopsies were performed in LP (n = 170), and in group 2 (n = 170) biopsies were performed in LLDP (n = 170). In 68 patients, biopsies were repeated. We constituted two additional groups: in group 3 (n = 33) patients underwent biopsies in LP and LLDP, respectively, and in group 4 (n = 35) patients underwent biopsies in LLDP and LP, respectively. Pain score, infection rates, hematospermia, hematuria, rectal bleeding, and serious complications were compared between group 1 and group 2. Pain scores were compared between the four groups. RESULTS: There were no differences between group 1 and group 2 for age, prostate volume, prostate-specific antigen level, biopsy time, hematuria, infection, hematospermia, and rectal bleeding. Pain scores were lower in group 2 than in group 1. Also, for LLDP, pain scores were lower in group 3 and group 4. CONCLUSION: The effect of position on pain scores in TRUS biopsy patients has not been previously described. Our study indicates that pain scale values are lower in LLDP than in LP.

Effect of biofeedback treatment on spinning top urethra in children with voiding dysfunction.

OBJECTIVES: Spinning top urethra (STU) deformity arises secondary to detrusor instability, leading to an increase in the intravesical pressure against a closed sphincter. We retrospectively analyzed the effect of biofeedback treatment on STU in children with dysfunctional voiding. METHODS: A total of 121 patients with STU and voiding dysfunction were enrolled in this study. The patients divided into two groups. Group 1 (n = 49) were treated with simple bladder retraining with timed voiding, and group 2 (n = 72) were treated with biofeedback therapy. Voiding cystourethrography was performed 6 and 12 month later to determine the status of the STU after both therapies. RESULTS: The patient age range was 5 to 13 years (mean 8.1 +/- 1.9) in group 1 and 5 to 13 years (mean 8.2 +/- 1.7) in group 2. Group 1 consisted of 41 girls and 8 boys; group 2 consisted of 63 girls and 9 boys. Voiding cystourethrography revealed vesicoureteral reflux in 39 and 59 children in groups 1 and 2, respectively. The improvement rates of the biofeedback therapy in children with STU and vesicoureteral reflux were significantly greater than the children treated with timed voiding at 6 months and 1-year of follow-up. CONCLUSIONS: For children admitted to urology clinics with urinary infection or complaints thought to be an unstable urinary bladder, proximal urethral dilation called STU is detected at a high frequency. It should be remembered that this situation can be related to vesicoureteral reflux and urinary bladder instability. Biofeedback training is a simple, effective, and well-tolerated treatment modality for these children.

Long-term outcome of scrotal incision orchiopexy for undescended testis.

OBJECTIVES: To perform a prospective study to evaluate the success of scrotal incision orchiopexy in children with a palpable undescended testis within the inguinal canal or beyond the external inguinal ring with or without inguinal hernia. METHODS: A total 204 scrotal orchiopexies were performed in 166 patients with a primary undescended testis. These children were followed up for an average of 29.4 months to document the testicular position and size. RESULTS: The scrotal orchiopexy technique was successful in 192 testes; the remaining 12 testes required conversion to traditional inguinal orchiopexy because of inadequate mobilization. Of 108 children (128 testes) in whom the testis was distal to the external inguinal ring, this technique was successful in 104 (124 testes). The success rate was 96.9% (124 testes of 128), and only 4 patients (four testes) required conversion to a traditional inguinal incision. The average operative time was 15 minutes in this group. In the other group with 58 children (76 testes) with a testicular location within the inguinal canal, conversion to the traditional inguinal orchiopexy was performed in 8 patients (eight testes). The success rate in this group was 89.5% (68 of 76 testes). The average operative time was 21 minutes in these patients, and follow-up ranged from 16 to 68 months (average 29.4). All testes were satisfactorily positioned in the scrotum, and no testicular atrophy developed. CONCLUSIONS: The results of our study have shown that scrotal orchiopexy is simple, safe, and effective in selected cases compared with the standard two-incision approach in the treatment of the palpable undescended testis.

Results of biofeedback treatment on reflux resolution rates in children with dysfunctional voiding and vesicoureteral reflux.

OBJECTIVES: It is well known that a relationship exists between vesicoureteral reflux (VUR) and dysfunctional voiding, and the spontaneous resolution rate in older children is lower than the rate in younger children. In this study, we analyzed our experience with biofeedback treatment in older children with confirmed voiding dysfunction and VUR and investigated the effect of this treatment on the reflux resolution rates in these children. METHODS: A total of 78 children, 5 to 14 years old (mean age 9), with voiding dysfunction and VUR detected by voiding cystourethrography were treated with biofeedback therapy. Voiding cystourethrography was performed 6 months after completion of the biofeedback program to determine the reflux status. The treatment results were also documented as subjective and objective improvements. RESULTS: The reflux in 98 units (20 bilateral) was grade 1 in 26, grade 2 in 32, grade 3 in 28, and grade 4 in 12. At 6 months of follow-up, VUR had resolved on voiding cystourethrography in 62 units (63%), the grade had improved in 28 units (29%), and the reflux had remained unchanged in 8 units (8%). Among the older children treated with biofeedback, we also observed improvements in nocturnal enuresis (82%), daytime wetting (70%), constipation (78%), frequency (76%), infrequency (64%), urgency (71%), staccato voiding (81%), flattened voiding (81%), bladder overactivity (82%), detrusor sphincter dyssynergia (77%), spinning top urethra (67%), and urinary tract infection (80%). CONCLUSIONS: Biofeedback therapy is applicable in older children with dysfunctional voiding and VUR and yields greater resolution rates than the historical resolution rates.

Comparison of ethanol and sodium tetradecyl sulfate in the sclerotherapy of renal cyst.

BACKGROUND AND PURPOSE: Renal cysts are common in the adult population. Symptomatic cysts traditionally have been treated by percutaneous aspiration with injection of sclerosant agents. Our aim was to compare the efficacy and side effects of ethanol and sodium tetradecyl sulfate (STDS) as sclerosants for symptomatic simple renal cyst. PATIENTS AND METHODS: Sixty-five patients with 68 symptomatic simple renal cysts were included in this study. An 8F pigtail catheter was inserted into the cyst under ultrasound guidance followed by aspiration of the cyst fluid. Either 95% ethanol (N = 34) or 3% STDS (N = 34), assigned randomly, was then instilled into the empty sac. Patients recorded any flank pain on a visual analog scale and were followed up by ultrasonography for 6 to 18 months. RESULTS: There was complete ablation of 28 (82%) and 26 (76%) cysts, partial regression of 3 (9%) and 6 (18%) cysts, and failure of treatment in 3 (9%) and 2 (6%) cysts in the ethanol and STDS groups, respectively. There was no major complication in either group. The pain caused by the injection was significantly less for the group receiving STDS (pain score 2.1 +/- 1.1 v 3.8 +/- 1.2 for ethanol; P = 0.019). CONCLUSIONS: Ethanol and STDS are simple, noninvasive, cost-effective, and well-tolerated sclerosants for the treatment of simple renal cysts. We prefer STDS as a first choice because it causes less pain.

Risk of developing fibroadenoma with the use of cyclosporine A in renal transplant recipients.

To investigate the effect of cyclosporine A (Cyc A) on the development of fibroadenomas, 30 renal transplant patients and 20 chronic renal failure patients on dialysis were breast examined with ultrasonography and/or mammography. Of the renal transplant patients, 17 were receiving Cyc A-based combination therapy for immunosuppression. All patients were female with the age range of 29.7+/-9.2 years in the transplant group and 33.95+/-9.91 in the dialysis group. Eight of the 17 patients receiving Cyc A had fibroadenomas, 5 of them having bilateral lesions. None of the other patients, those on dialysis and on non-Cyc A combination therapy had fibroadenomas. A significant difference for fibroadenoma incidence in patients receiving Cyc A combination immunosuppression was found.