Pediatric extracorporeal shock wave lithotripsy: multi-institutional results.

AIM: To evaluate the efficacy, auxiliary procedures and complications of pediatric extracorporeal shock wave lithotripsy (ESWL) performed with electrohydraulic lithotripters. METHODS: Children with urolithiasis, aged between 0 and 15, were retrospectively evaluated. ESWL was performed by using two different electrohydraulic lithotripters, Elmed Multimed Classic (Elmed Medical Systems, Ankara, Turkey) and E-1000 (EMD Medical Systems, Ankara, Turkey), between January 2008 and December 2012 in four different referral centers in Turkey. RESULTS: 85.5% of patients were stone-free at 3 months. Further ESWL treatment was needed in 33.7% of the cases (one session, n = 55; two sessions, n = 15; three sessions, n = 13). Steinstrasse occurred in 10 patients but 8 of them cleared completely during the follow-up period. Urinary tract infection was detected in 3 (3.9%), fever in 3 (3.9%) and a small subcapsular hematoma in one (1.3%) patient, respectively. When the stones were divided into two groups as those with diameters <10 mm and ≥10 mm, it was found that the stone-free rate was associated with stone diameter, and that the smaller diameters had higher but statistically insignificant stone-free rates (P = 0.196). CONCLUSION: ESWL yields favorable results with low rates of complication and auxiliary procedures in selected pediatric patients.

Core Length: An Alternative Method for Increasing Cancer Detection Rate in Patients with Prostate Cancer.

PURPOSE: We determine whether the lengths of benign and malignant cores affect cancer detection rates in patients with prostate cancer (PCa). MATERIALS AND METHODS: We evaluated retrospectively 512 patients in our clinic who had undergone 12 core transrectal ultrasound (TRUS)-guided prostate biopsies. The cores were divided into two groups: one with cancer (group 1) and one without cancer (group 2). We also classified Gleason scores as poorly differentiated (scores of 7-10) and moderately differentiated (scores of 5-6); these scores were compared with each other in terms of the core length. The core lengths of the groups were compared using a Student's t-test. A P value of less than .05 was considered to be statistically significant. RESULTS: Of the 512 patients, 76 (15%) had PCa. In total, we evaluated 912 cores of prostate biopsy samples from the 76 patients. Since 92 cores included insufficient tissue and rectal mucosa, we were not able to evaluate them. The remaining 820 cores were divided into two groups. Cancer was detected in 302 cores; 518 cores were benign in nature. The average core length in group 1 was 11.9 ± 4.4 mm, and the average core length in group 2 was 11.1 ± 5.1 mm (P = .015). The core lengths of poorly differentiated and moderately differentiated cancers were similar: 12.3 ± 4.2 mm and 11.7 ± 4.5 mm, respectively (P = .25). CONCLUSION: Increasing cancer detection rates in cores may be related to core length in TRUS-guided prostate biopsies in PCa patients.

The Effect of Testicular Cryoablation on Testosterone Level in Rats: An Experimental Model of Histopathological Orchiectomy.

PURPOSE: To determine whether testicular cryoablation caused histopathological orchiectomy, and to show its effects on serum total testosterone (t-testosterone) levels in rats. MATERIALS AND METHODS: A total of 12 Wistar albino male rats were used in this study. The animals were divided into two groups, as cryoablation (9 rats) and control (3 rats) groups. Bilateral cryoablation was performed in the cryoablation group. T-testosterone levels were measured in both groups before scrotal exploration. Bilateral or­chiectomy was performed in both groups 10 days after the cryoablation procedure. T-testosterone was measured immediately before orchiectomy. Mann-Whitney U test was used for intergroup comparisons. RESULTS: Baseline t-testosterone levels were 1.31 (0.78-2.45) ng/mL and 0.98 (0.91-2.05) ng/mL in the cryoab­lation and the control groups, respectively (P = .92). T-testosterone levels were 0.23 (0.07-1.12) ng/mL and 2.87 (0.63-3.06) ng/mL in the cryoablation and the control groups, respectively, in the blood samples obtained at the time of orchiectomy (P = .03). Histopathological examination of rat testes revealed varying degrees of paratestic­ular inflammation and necrosis in 13 of 18 testes in the cryoablation group. None of 6 testes showed necrosis in the control group. CONCLUSION: Our study showed that histopathological orchiectomy could be obtained by cryoablation in rat testes.

The repair of complex penile defect with composite anterolateral thigh and vascularized fascia lata flap.

One-stage reconstruction of complex penile defects with functional and cosmetic results is a challenging procedure. The selection of proper technique and materials for reconstruction depends on the type of the deficient tissue components, the size of the wound surface, and the donor site. This article presented a case of a partial penile and urethral defect due to an infection in the previous surgical site. The patient was treated with a perforator based pedicled composite anterolateral thigh flap combined with vascularized fascia lata. The urethral defect was reconstructed with the vascularized fascia lata. The remaining part of the flap was used for the resurfacing of the right cavernous body and penile skin defect. There was no fistula and the urinary caliber was accepted as good. The pedicled composite anterolateral thigh flap contains various tissue components suitable for a functional and cosmetic reconstruction of complex penile defects using the one-stage technique.

Does metabolic syndrome or its components associate with prostate cancer when diagnosed on biopsy?

PURPOSE: To investigate the association between metabolic syndrome and prostate cancer risk in Turkish men. METHODS: We examined data from 220 patients with prostate cancer and 234 men in a control group with benign biopsy results, who had a serum prostate-specific antigen (PSA) level ⩾ 4 ng/ml, or an abnormal digital rectal examination finding and who underwent transrectal ultrasound-guided prostate biopsy at two main training and research hospitals between February 2009 and April 2013. Metabolic syndrome was diagnosed according to The Society of Endocrinology and Metabolism of Turkey metabolic-syndrome criteria. Age, total PSA, waist circumference, body mass index, lipid profiles, fasting blood sugar level, blood pressure level and metabolic syndrome were considered for analysis. RESULTS: A total of 454 patients were enrolled: 85 cases in group 1 (38.6% of 220 prostate cancer cases) and 104 control subjects in group 2 (40.4% of 234 controls) were diagnosed with metabolic syndrome. Higher ages and lower high-density lipoprotein-cholesterol were two parameters that were significant only in the prostate cancer group with metabolic syndrome. There was no significant predictor factor for prostate cancer alone; however, higher triglycerides (odds ratio [OR], 1.286; 95% confidence interval [CI] 1.09-1.82 and 1.142; 95% CI 1.06-1.62) and fasting glucose levels (OR, 1.222; 95% CI 1.08-1.61 and 1.024; 95% CI 1.07-1.82) were significant predictors in both the prostate cancer group and control group. CONCLUSIONS: We found little evidence to support the hypothesis that increased incidence of metabolic syndrome (or its components) contributes to increased incidence of prostate cancer. A larger, prospective, multicentre investigation is mandatory to confirm if there is any relationship between metabolic syndrome and prostate cancer.

The effect of intraurethral dexpanthenol on healing and fibrosis in rats with experimentally induced urethral trauma.

OBJECTIVE: To determine the efficacy of dexpanthenol applied early after urethral trauma for preventing inflammation and spongiofibrosis. MATERIALS AND METHODS: Twenty-seven rats were randomized and divided into 3 groups, with 9 rats in each group. The urethras of all rats were traumatized with a pediatric urethrotome knife at 6-o' clock. For 14 days, group I was given 0.9% saline twice a day (control group), group II was given dexpanthenol 500 mg/kg ampules once a day and 0.9% saline once a day, and group III was given dexpanthenol 500 mg/kg ampules twice a day intraurethrally using a 22 ga catheter sheath. On day 15, the penises of the rats were degloved to perform penectomy. RESULTS: The mean fibrosis scores were 2.4, 2.2, and 1.4, and mean inflammation scar scores were 2, 1.4, and 1.3 in groups I, II, and III, respectively. There was a significant difference between groups I and II for inflammation (P = .011); however, the difference for fibrosis was not significant (P = .331). The differences between groups I and III were statistically significantly different both for inflammation and fibrosis (P = .004 and P = .003, respectively). Groups II and III were not different significantly for inflammation (P = .638); however, there was less fibrosis in group III, in which high-dose dexpanthenol was administered. CONCLUSION: We showed that dexpanthenol applied early after urethral trauma significantly decreased inflammation and spongiofibrosis. We hope that our study will help to decrease strictures after urethral trauma and contribute to pharmaceutical investigations aiming to improve the success of the surgery for urethral strictures.

Urothelial cancer of bladder in young versus older adults: clinical and pathological characteristics and outcomes.

Bladder urothelial carcinoma is rare in young adults and occurs more commonly in older individuals. The aim of this study was to compare the clinical behavior, pathologic characteristics, and prognosis of urothelial carcinoma of urinary bladder in young versus older adults. A retrospective review of our records between 2007 and 2013 identified 56 patients (42 males and 14 females) with transitional cell carcinoma of the bladder who were less than 40 years old. Clinical and pathological parameters of patients who were less than 40 years of age were compared with those of a series of patients older than 40 years of age (the control group) during the same period. A survival analysis was performed using the Kaplan-Meier method and log-rank test, and Cox regression was performed to identify clinical parameters that affected the clinical outcomes. The mean age was 29.21 years (range, 5-40 years) for patients less than 40 years old and 61.66 years (range, 41-75) for those older than 40 years. The mean follow-up was 40.26 months (range, 12-65 months) for young patients and 42.57 months (range, 12-72 months) for the older patients. Young bladder cancer patients had smaller-sized tumors (less than 3 cm), less high-grade cancers, higher papillary urothelial neoplasms of low malignant potential, and low-grade tumors than patients older than 40 years. Multivariate logistic regression analysis predicted tumor recurrence in young patients with high-grade tumors [odds ratio (OR), 1.959; 95% confidence interval (CI), 1.235-2.965; p = 0.046] and tumors larger than 3 cm (OR, 1.772; 95% CI, 1.416-1.942; p = 0.032). The 5-year overall survival rate was 100% for young patients and 88.1% for older patients. No difference was observed in the recurrence-free (p = 0.321) and progression-free (p = 0.422) survival rates between the two groups. We concluded that although the clinical stage distribution, natural history, and outcomes of bladder urothelial cancer in young adults are similar to those in their older counterparts, clinicians must be aware that patients under 40 years of age presented with higher-grade and larger (>3 cm) tumors and are more likely to experience tumor recurrence.

Deficiency of vitamin D and elevated aldosterone in prostate hyperplasia.

BACKGROUND: Epidemiological studies have confirmed the association between vitamin D deficiency and benign prostate hyperplasia (BPH). Lately, serum calcium and parathyroid hormones were shown to stimulate prostate growth, assuming an interplay between elements of the calcium metabolism rather than a sole role of any. Finally, aldosterone actions were found to be affected by vitamin D. OBJECTIVES: We have sufficient reason to believe that human disease, BPH in this case, is a dysfunction of a fine network rather than a failure of a particular substance. Unfortunately, previous studies include results of studies that fall short in combining the overall structure. This study aimed to investigate these four parameters in BPH patients. MATERIAL AND METHODS: Twenty five patients with BPH (median age 62 years) and 30 volunteer healthy controls (median age 63.5 years) were enrolled. Serum total prostate specific antigen (PSA), intact parathormone (PTH), calcium, 25-hydroxy vitamin D (25-(OH) 2D), aldosterone and lipids were measured. RESULTS: We found serum aldosterone levels significantly higher in BPH patients (p = 0.04). BPH patients had significantly higher serum PSA levels (p < 0.0001). 25-(OH) 2D levels were lower in the BPH group (p = 0.05). Median serum 25-(OH) 2D levels in both groups were lower than the threshold reference limit (20 ng/mL). CONCLUSIONS: The co-existence of vitamin D deficiency and elevated levels of aldosterone in BPH, presented for the first time in literature, strongly favors a link between the renin-angiotensin system (RAS), vitamin D and BPH pathogenesis. Our findings may influence studies with larger groups of subjects.

Predictors of Gleason score upgrading in patients with prostate biopsy Gleason score ≤6.

INTRODUCTION: The discrepancy between prostate biopsy and prostatectomy Gleason scores is common. We investigate the predictive value of prostate biopsy features for predicting Gleason score (GS) upgrading in patients with biopsy Gleason scores ≤6 who underwent radical retropubic prostatectomy (RRP). Our aim was to determine predictors of GS upgrading and to offer guidance to clinicians in determining the therapeutic option. METHODS: We performed a retrospective study of patients who underwent RRP for clinically localized prostate cancer at 2 major centres between January 2007 and March 2013. All patients with either abnormal digital examination or elevated prostate-specific antigen at screening underwent transrectal ultrasound-guided prostate biopsy. Variables were evaluated among the patients with and without GS upgrading. Our study limitations include its retrospective design, the fact that all subjects were Turkish and the fact that we had a small sample size. RESULTS: In total, 321 men had GS ≤6 on prostate biopsy. Of these, 190 (59.2%) had GS≤6 concordance and 131 (40.8%) had GS upgrading from ≤6 on biopsy to 7 or higher at the time of the prostatectomy. Independent predictors of pathological upgrading were prostate volume <40 cc (p < 0.001), maximum percent of cancer in any core (p = 0.011), and >1 core positive for cancer (p < 0.001). CONCLUSIONS: When obtaining an extended-core biopsy scheme, patients with small prostates (≤40 cc), greater than 1 core positive for cancer, and an increased burden of cancer are associated with increased risk of GS upgrading. Patients with GS ≤6 on biopsy with these pathological parameters should be carefully counselled on treatment decisions.

Does the time from biopsy to radical prostatectomy affect Gleason score upgrading in patients with clinical t1c prostate cancer?

PURPOSE: It is debated whether treatment delay worsens oncologic results in localized prostate cancer (PCa). Few studies have focused on the role of a delay between the time of biopsy and the time of surgery. Thus, we aimed to investigate the effect of the time period between biopsy and surgery on Gleason score upgrading (GSU). MATERIALS AND METHODS: A total of 290 patients who underwent radical retropubic prostatectomy in Ankara Training and Research Hospital were included in the study. The biopsy Gleason score, age, total prostate-specific antigen (PSA) value, prostate volumes, and PSA density (PSAD) were analyzed in all patients. The patients were divided into two groups: patients with GSU (group 1) and patients without GSU (group 2). Variables having a p-value of ≤0.05 in the univariate analysis were selected and then evaluated by use of multivariate logistic regression models. Results were considered significant at p<0.05. RESULTS: GSU occurred in 121 of 290 patients (41.7%). The mean age of the patients was 66.0±7.2 years in group 1 and 65.05±5.60 years in group 2 (p=0.18). The mean PSA values of groups 1 and 2 were 8.6±4.1 and 8.8±4.3 ng/dL, respectively. The mean prostate volumes of groups 1 and 2 were 43.8±14.1 and 59.5±29.8 mL, respectively. The PSAD of group 1 was significantly higher than that of group 2 (0.20 vs. 0.17, p=0.003). The mean time to surgery was shorter in group 2 (group 1, 52.2±22.6 days; group 2, 45.3±15.5 days; p=0.004). According to the logistic regression, time from biopsy to surgery is important in the prediction of GSU. CONCLUSIONS: We suggest that the time period between biopsy and surgery is a significant factor that affects GSU in patients with clinically localized PCa.

Synchronous bladder and prostate cancers in the specimens of radical cystoprostatectomy: a multicenter retrospective analysis.

The purpose of this study was to evaluate the features of prostate cancer that have been incidentally detected in radical cystoprostatectomy specimens of bladder cancer patients. The researchers of the current study retrospectively evaluated the data from 119 men who underwent radical cystoprostatectomy at four referral institutions in Ankara, Turkey. Of the 21 prostate cancer patients, 17 (81%) were aged ≥ 60 years; 10 (47.6%) had clinically significant diseases; three had a Gleason score of 6, three had a Gleason score of 7, three had a Gleason score of 8, one had a positive surgical margin along with extracapsular invasion of the tumor and a high Gleason score, and three patients had a tumor volume of ≥ 0.5 cm(3), of which two also had a high Gleason score. Patients were followed-up for a mean of 29 ± 10.2 months; the overall survival was 96.6% (n = 115) during that period. Preoperative digital rectal examination and prostate-specific antigen values did not differ between the benign and prostate cancer groups. There was no survival advantage in the insignificant prostate cancer and benign prostate groups. No additional benefit for predicting prostate cancer was found with digital rectal examination and prostate-specific antigen tests, although some clinicians advised such. In patients aged < 60 years, organ-sparing cystectomy seems reasonable. In prostate-sparing surgery, candidates who are aged >60 years, the preoperative work-up may routinely include prostate biopsy, especially the apex. Preoperative findings of multifocality of bladder cancers and the presence of carcinoma in situ have the risk of prostatic involvement.

Serum omentin level in patients with prostate cancer.

Prostate cancer (PCa) is the second leading cause of cancer-related death in males. Hypertriglyceridemia and obesity are known risk factors for disease development. Omentin is a plasma adipokine that is synthesized in visceral adipose tissue; its plasma concentration changes in colorectal cancer and conditions associated with insulin resistance. To our knowledge, the relationship between omentin and PCa has not been investigated previously. Therefore, we evaluated omentin levels in PCa patients in this matched case-control study. Fifty consecutive patients newly diagnosed with PCa and 30 consecutive patients newly diagnosed with benign prostatic hyperplasia (BPH) were assessed. Patients with PCa were divided into three subgroups according to the Gleason score. The omentin concentrations were determined using enzyme-linked immunosorbent assays. Blood urea nitrogen (p < 0.001), creatinine (Cr; p < 0.001), total cholesterol (p < 0.001), low-density lipoprotein (p < 0.001), and prostate-specific antigen (PSA; p = 0.03) levels were significantly higher in the PCa group than the BPH group. The median omentin level in BPH patients was 373 (207-792) versus 546.8 (297.1-945.7) ng/mL in the PCa group (p < 0.001). There was a negative weak/moderate correlation between omentin and body mass index in the BPH group (r = -0.364, p = 0.048). Circulating omentin levels were elevated in patients with PCa. Further studies would be useful to establish the mechanism underlying this increase and to assess the interaction between PCa and adipose tissue.

Comparison of ultrasonic and pneumatic intracorporeal lithotripsy techniques during percutaneous nephrolithotomy.

OBJECTIVES: To compare the effectiveness and safety of ultrasonic and pneumatic lithotripters in the treatment of renal stone disease. MATERIALS AND METHODS: A total of 227 consecutive percutaneous nephrolithotomy procedures for renal calculi were performed. In 107 patients ultrasonic lithotriptors were used (group I) and in 83 patients pneumatic lithotriptors were used (group II). In the remaining 37 patients, stones were managed with both pneumatic and ultrasonic lithotripters. Follow-up studies included intravenous urography (IVU) and/or computed tomography (CT). RESULTS: The mean operative time and duration of hospitalization were similar between the groups. In the ultrasonic treatment group, 100 (96.9%) patients were stone-free on postoperative day 1 and 5 (4.6%) went on to undergo an additional treatment modality, resulting in a total stone-free rate of 97.2%. In the pneumatic lithotripsy group, 68 (81.9%) patients were stone-free after the primary procedure on the first day and 15 (18.1%) went on to undergo an additional treatment modality, resulting in a stone-free rate of 91.5%. The final stone-free rates at 3 months postoperatively in groups I, II, and III were 97.2%, 91.5%, and 87.9%, respectively (P = 0.826). CONCLUSIONS: We conclude that both ultrasonic and pneumatic lithotripters are effective and safe for intracorporeal lithotripsy. However, the ultrasonic lithotripter provides higher stone-free rates with similar morbidity compared with pneumatic devices.

Enhanced HDL-cholesterol-associated anti-oxidant PON-1 activity in prostate cancer patients.

Increases in the generation of reactive oxygen species and decreases in antioxidant enzyme activities with aging have been reported in the prostate, and are also observed in age-related disorders such as atherosclerosis, Alzheimer's disease, and cataracts. Several studies have demonstrated that proteins are targets for reactive oxidants in cells, and that oxidized proteins accumulate during aging, oxidative stress and in some pathological conditions. However, only a limited number of studies have actually evaluated oxidative damage in relation to HDL-cholesterol-associated antioxidant enzyme activities or have assessed its relationship with prostate cancer. In this study, we examined the effect of HDL-cholesterol-associated antioxidant enzyme activities, paraoxonase1, arylesterase and new oxidative stress parameters (total oxidant status, total antioxidant status [and oxidative stress index]) in newly-diagnosed prostate cancer patients and healthy controls. There were no significant differences in oxidative stress parameters and lipid parameters between prostate cancer patients and controls, however, paraoxonase1 enzyme activity, and non-HDL-cholesterol levels were higher in prostate cancer patients than controls. The results of this study were derived from a small number of subjects, but might represent an important working hypothesis for further research in a larger number of cases to clarify the role of paraoxonase1 overproduction on the prostate and its clinical relevance.

Bilateral testicular germ cell tumors.

Testicular cancer represents 1% to 1.5% of neoplasias in males and 5% of urologic tumors in general. The incidence of bilateral testicular tumors is 1-5%. Approximately one third of the cases are diagnosed as synchronous, while the other two thirds are diagnosed as metachronous tumors. Additionally, 5% of all patients diagnosed with testicular cancer may have contralateral intratubular germ cell neoplasia and may develop a contralateral germ cell tumor. However, few data are available regarding bilateral testicular germ cell tumors (BTGCTs). In this review, we aim to provide an overview of the incidence, pathological features and clinical outcomes.of BTGCTs.

Diminished arylesterase enzyme activity and total thiol levels in bladder cancer patients.

BACKGROUND: It is difficult to think of a disease in the etiology of which free radicals would not be involved. The human body has a number of endogenous free-radical scavenging systems to avoid harm that can lead to any disease including cancer. This study aims to measure the total anti-oxidative status (TAS), in particular the activities of HDL-associated anti-oxidative enzymes paraoxonase (PON1), arylesterase (ARE), and total thiol levels (Ttl) in bladder cancer (BC) patients for the first time in literature. METHODS: Forty two male patients (mean age, 66.6 +/- 12.7 years) with BC who had presented at the Urology Outpatient Clinic were prospectively included in the study. Forty age- and gender-matched healthy control subjects (mean age 65 +/- 7.4 years) were also enrolled for comparison. Analysis of PON1, ARE activities, measurement of TAS, and Ttl of serum were carried out using colorimetric measurement methods. Statistical analyses were performed using the MedCalc statistical software program. RESULTS: ARE enzyme activity and Ttl levels were significantly lower in patients with BC compared to controls (p = 0.03; p = 0.02, respectively), whereas PON1 enzyme activity and TAS did not show significant differences. Ttl levels were lower in patients with a high grade cancer compared to those with a low grade cancer (p = 0.03). CONCLUSIONS: Anti-oxidant measurements might be essential in routine clinical use, not only as cancer disease markers but also as major actors in the management of anti-oxidant remedies in the very near future. Our findings showed that determination of ARE enzyme activity and Ttl levels were more precise than PON1 enzyme activity or TAS measurements, particularly in BC patients. When composing a marker panel, it should be kept in mind that determination of anti-oxidant levels based merely on TAS or PON1 activity may be deceptive and must include ARE enzyme activity and/or Ttl measurements. However, long-term clinical studies are needed to clarify the pathophysiological role of serum anti-oxidative levels and HDL-associated PON1 activity in BC patients.

Nephron-sparing surgery: the effect of surface cooling and temporary renal artery occlusion on renal function.

AIMS: To evaluate whether transient renal artery clamping and external renal hypothermia cause any detrimental effect on the remaining renal parenchyma after nephron-sparing surgery with the use of (99m)Tc-DMSA-SPECT. METHODS: Twenty-eight patients with a unilateral renal mass but a normal contralateral kidney underwent nephron-sparing surgery. Serum biochemistry, 24-hour urinary creatinine clearance and absolute uptakes of the injected dose (%ID) of both kidneys as measured by renal (99m)Tc-DMSA-SPECT were compared preoperatively and in the 3rd postoperative month. (99m)Tc-DMSA uptakes in the contralateral kidney were used as controls. RESULTS: The average tumor size and mean renal artery clamping time were 37.4 +/- 11.3 (range 25-68) mm and 53.7 +/- 13 (range 38-90) min, respectively. Pre- and postoperative mean absolute uptakes of %ID in the remaining parenchyma of the operated kidneys were 15.13 +/- 3.30 and 14.74 +/- 3.38%, respectively (p = 0.052). In the contralateral kidneys, there was also no significant difference between the two studies (18.82 +/- 6.26 vs. 19.14 +/- 7.19%, respectively; p = 0.546). Likewise, there was no statistically significant difference between pre- and postoperative serum creatinine (p = 0.179) and creatinine clearance values (p = 0.108). CONCLUSION: Renal artery clamping and external cooling during nephron-sparing surgery have no demonstrable harmful effects on the renal parenchyma as measured by (99m)Tc-DMSA-SPECT analysis.

Time-dependent changes in biomechanical properties of four different synthetic materials in a rabbit model and the importance in respect to sling surgery.

AIM: To examine the time-dependent biomechanical properties of four different implanted synthetic materials. MATERIALS AND METHODS: 18 New Zealand rabbits were randomly categorized into three groups: group 1 to be evaluated at the 2nd week, group 2 at the 8th week, and group 3 at the 12th week. Before the implantation, baseline values were obtained. Each of the 2 x 5 cm sized materials of mersilene, prolene, ultrapro and vypro mesh were placed in the anterior abdominal fascia. The mesh materials were removed, tensile strength (N/mm(2)) and ultimate strain (%) were measured by tensinometry and surface area losses (cm(2)) were calculated. RESULTS: Tensile strength values (mean +/- SD) were 9.2 +/- 1.5, 8.5 +/- 1.2 for mersilene, 25.2 +/- 7.3, 14.0 +/- 2.9 for prolene, 2.2 +/- 0.6, 12.5 +/- 1.4 for ultrapro and 8.1 +/- 1.6, 7.0 +/- 1.8 for vypro at baseline and the 12th week. Ultimate strain values (mean +/- SD) were 131.2 +/- 46.1, 110.4 +/- 98.6 for mersilene, 181.0 +/- 26.4, 78.5 +/- 14.4 for prolene, 91.5 +/- 8.2, 89.6 +/- 20.5 for ultrapro and 84.3 +/- 8.9, 55.0 +/- 13.2 for vypro at baseline and the 12th week. Surface areas (mean +/- SD) were 8.87 +/- 0.14, 9.38 +/- 0.17, 8.4 +/- 0.32 and 8.76 +/- 0.16 for mersilene, prolene, ultrapro and vypro at the 12th week respectively. CONCLUSIONS: Although prolene mesh demonstrated a decrease in its tensile strength it still remains the highest at the 12th week. Considering the significant time-dependent increase in its tensile strength, ultrapro mesh should be studied in humans. A final decision on the preference of ultrapro mesh in sling surgery could be reached after such studies.

Association of genetic polymorphisms in vitamin D receptor gene and susceptibility to sporadic prostate cancer.

Genetic and environmental factors are involved in prostate cancer (PCa) etiology. Single nucleotide polymorphisms (SNPs) may contribute to the PCa pathogenesis. The goal of this study is to determine the role of vitamin D receptor (VDR) gene polymorphisms and haplotypes in the development and progression of sporadic PCa. One hundred and thirty-three PCa patients and 157 age-matched healthy controls were genotyped for the Apa I (rs7975232), Bsm I (rs1544410) and Taq I (rs731236) polymorphisms in VDR gene by using polymerase chain reaction-restriction fragment length polymorphism. An association was observed between the Apa I polymorphism and PCa predisposition (P = 0.03). When compared with AA genotype, there was a highly notable difference in the frequencies of the Aa (P = 0.02), aa (P = 0.026) and Apa I ''a'' allele carriers (Aa + aa) (P = 0.009) genotypes. Furthermore, we found a statistical difference in the allele frequencies of the Apa I polymorphism between the sporadic PCa patients and control subjects (P = 0.013). The genotype distribution for the Bsm I and Taq I polymorphisms were similar between cases and controls (P > 0.05). No clinically significant relationship was found between the three-locus haplotypes and development of sporadic PCa. The genotype frequencies for the three polymorphisms of the VDR gene within subgroups of PCa (defined by tumor stage, Gleason score, PSA levels) were also analyzed, but no statistically noteworthy difference was observed (P > 0.05). As far as we know, this is the first study which investigates the relationship between VDR genotypes and sporadic PCa in the Turkish population. Our findings suggest that the VDR ApaI (rs7975232) polymorphism may play a role in the development of sporadic PCa.