The impact of hypomagnesemia on erectile dysfunction in elderly, non-diabetic, stage 3 and 4 chronic kidney disease patients: a prospective cross-sectional study.

BACKGROUND: Erectile dysfunction (ED) is common in older men with chronic kidney disease. Magnesium is essential for metabolism of nitric oxide which helps in penile erection. There is little information available about the influence of serum magnesium on ED. The aim of the study was to assess the influence of hypomagnesemia on ED in elderly chronic kidney disease patients. SUBJECTS AND METHODS: A total of 372 patients aged 65-85 years, with an estimated glomerular filtration rate of 60-15 mL/min/1.73 m2, were divided into two groups according to serum magnesium levels: hypomagnesemia, n=180; and normomagnesemia, n=192. ED was assessed through the International Index of Erectile Function-5. Hypomagnesemia is defined as serum magnesium <1.8 mg/dL. RESULTS: The prevalence of ED was higher among hypomagnesemic subjects compared to that among normomagnesemics (93.3% vs 70.8%, P<0.001). Severe ED (62.8% vs 43.8%, P=0.037), mild-to-moderate ED (12.2% vs 5.2%, P=0.016), abdominal obesity (37.2% vs 22.9%, P=0.003), metabolic syndrome (38.4% vs 19.2%, P=0.026), proteinuria (0.83±0.68 vs 0.69±0.48 mg/dL, P=0.023), and C-reactive protein (6.1±4.9 vs 4.1±3.6 mg/L, P<0.001) were high; high-density lipoprotein cholesterol (48.8±14.0 vs 52.6±13.5 mg/dL, P=0.009), and albumin (4.02±0.53 vs 4.18±0.38 g/dL, P=0.001) were low in the hypomagnesemia group. Serum magnesium ≤1.85 mg/dL was the best cutoff point for prediction of ED. Hypomagnesemia (relative risk [RR] 2.27), age ≥70 (RR 1.74), proteinuria (RR 1.80), smoking (RR 21.12), C-reactive protein (RR 1.34), abdominal obesity (RR 3.92), and hypertension (RR 2.14) were predictors of ED. CONCLUSION: Our data support that ED is related to hypomagnesemia in elderly patients with moderately to severely reduced kidney function.

Ameliorative effect of selenium in cisplatin-induced testicular damage in rats.

In this study, we investigated the protective effect of selenium (Se) on cisplatin (Cis) induced testicular damage using histopathological, immunohistochemical and biochemical approaches. Twenty-one male Wistar rats were equally divided into three groups of seven rats each: control (C), Cis, and Cis+Se. Cis and Cis+Se group rats received Cis at a dose of 12mg/kg b.w./day, intraperitoneally for 3 consecutive days. Cis+Se group rats received selenium via oral gavage 3mg/kg/day (twice-a day as 1.5mg/kg) until 11th consecutive days starting at 5 days before cisplatin injection. C group received only 0.9% NaCl intraperitoneally and orally at same time and at equal volume. After the treatment, the histopathological, immunohistochemical and biochemical examinations were performed. In seminiferous tubules of Cis treated rats were observed the most consistent findings characterized with vacuolization, desquamation, disorganization, and also was a considerable reduction in elongated spermatids, however the Cis+Se group exhibited improved histopathologic changes. In the immunohistochemical examinations, caspase-3 immunopositive cells displayed higher in the Cis group according to C and Cis+Se groups. Bcl-2 and NF-κB staining revealed a moderate number in the C group and significantly fewer in the Cis group compared to the Cis+Se groups. Additionally, MDA levels were also significantly increased in the Cis group in comparison to Control group, but pretreatment with selenium prevented elevation of MDA levels significantly in Cis+Se group rats. This study indicates that Cis-treatment induced testicular apoptosis and lipid peroxidation, and combined treatment with selenium prevented severity of the toxicity in rats.

Nephrotoxic effects of varenicline as the most effective drug used for smoking cessation: a preliminary experimental study.

PURPOSE: Varenicline is a new most effective drug for smoking cessation. Its effect on kidney functions remains unclear. This study purposed to investigate whether varenicline causes nephrotoxicity in rats. METHODS: Fifteen rats were randomly assigned to three groups: control, 0.0125 mg kg(-1) varenicline and 0.025 mg kg(-1) varenicline (single dose for 3 days, i.p.). Before and after experimental period, serum neutrophil gelatinase-associated lipocalin, creatinine and urea levels were measured. Total oxidant and antioxidant status were measured in kidney homogenates. Histological examination was performed in kidney. RESULTS: The nephrotoxic effects of varenicline were detected by histopathological and biochemical examinations in the varenicline treatment groups. No change was observed in the control group. CONCLUSIONS: These findings firstly indicate that a 3-day varenicline treatment causes nephrotoxic effects in rats.

The Effect of Systemic Tamsulosin Hydrochloride on Choroidal Thickness Measured by Enhanced Depth Imaging Spectral Domain Optical Coherence Tomography.

BACKGROUND: To evaluate the effects of selective α1A-adrenoceptor antagonist tamsulosin hydrochloride on choroidal thickness using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT). METHODS: This is a prospective observational study including 29 eyes of 29 patients with newly diagnosed benign prostatic hyperplasia. Choroidal thickness and retrobulbar ocular blood flow measurements were performed at baseline and after 3 months of treatment. Results were analyzed by the masked observer. RESULTS: The mean subfoveal choroidal thickness (275.8-291.9 µm) and thicknesses 750 µm nasal (257.9-270.4 µm) and 750 µm temporal (262.4-277.0 µm) to the fovea were significantly increased after 3 months of treatment (p < 0.001). No statistically significant change was found in retrobulbar ocular blood flow. CONCLUSIONS: Tamsulosin causes a significant increase in EDI-OCT-based choroidal thickness measurements. This increase might be associated with choroidal vasodilation in consequence of blockade of sympathetic α1A-adrenoceptors, which is critical for the maintenance of vascular tone and resistance in the choroidal vascular architecture. This should be kept in mind when choroidal disease and its response to treatment are followed by EDI-OCT imaging.

Effect of the body mass index on outcomes of flexible ureterorenoscopy.

The aim of the study to compare outcomes of flexible ureterorenoscopy in patients with different body mass index (BMI) scores and to explore whether the BMI has an effect on outcomes of RIRS. Five hundred and two patients who underwent flexible URS in 3 centers between 2008 and 2012 for the management of single upper urinary tract calculi were retrospectively reviewed. Patients were categorized as normal weight BMI 18.5 to 24.99 kg/m(2), overweight 25 to 29.99 kg/m(2), obese 30 to 39.99 kg/m(2) and morbid obese >40 kg/m(2).The groups were assessed in terms of demographic parameters including age, gender, stone size, intraoperative and postoperative variables. The mean patient age was 41.3 ± 15.51 (18-81) years and with an average BMI 26.68 ± 5.2 kg/m(2) (16.64-55.15 kg/m²). Of the patients, 43.2 % had normal weight (NW), 32.2 % were overweight (OW), 21.9 % were obese (O) and 2.5 % were morbidly obese (MO). Stone-free rates after single procedure in NW, OW, O, MO groups were 60.8, 61.7, 73.6, 61.5 %, respectively (p = 0.079). Overall targeted stone-free rates were also similar in four groups (88.9, 90.1, 93.6, 90.4 %, p = 0.586). There were no statistically significant differences in the frequency of complications and mean hospitalization time among the groups (p > 0.05). In conclusion, this study demonstrated that flexible URS is a valuable option for the treatment of kidney stone in both obese and non-obese patients. BMI did not influence the postoperative outcomes.

Tubeless procedure is most important factor in reducing length of hospitalization after percutaneous nephrolithotomy: results of univariable and multivariable models.

OBJECTIVES: To evaluate the effects of kidney stones and patient-related parameters on the length of hospitalization (LOH), which is one important factor affecting the cost effectiveness of percutaneous nephrolithotomy (PCNL). Recently, increases in healthcare costs have highlighted the importance of evaluating the cost effectiveness of a treatment as much as its efficacy. MATERIAL AND METHOD: During an 8-year period, the records of 1669 patients with renal calculi who underwent PCNL were reviewed retrospectively. Eleven patients with urosepsis were excluded from the present study. A total of 1658 patients were categorized into 2 groups (group 1 = ≤2 days; group 2 = >2 days) according to the median LOH (median = 2 days). Multivariate binary logistic regression analysis was used to detect the effects of independent variables, including the patient age, gender, body mass index, history of extracorporeal shock wave lithotripsy or open surgery, stone size and opacity, presence of hydronephrosis, and localization and number of accesses, on the LOH after PNL. RESULTS: Overall success was achieved in 86.2% of cases after one session of PCNL. The mean length of hospitalization was 2.89 ± 1.66 days (range, 1-21). According to the outcome of the multivariate analysis, diabetes (P = .0001, OR = 1.67), impaired kidney function (P = .03, OR = 1.64), stone size (P = .031, OR = 1.31), number of accesses (P = .001, OR = 1.59), intercostal access (P = .001, OR = 1.79), and tubeless procedure (P = .0001, OR = 0.23) were variables influencing LOH. CONCLUSIONS: The presence of diabetes, a large stone burden, intercostals access, multiple accesses, and impaired kidney function prolong the LOH after PCNL. The use of the tubeless procedure was able to diminish the LOH.

Factors affecting the fluoroscopic screening time during percutaneous nephrolithotomy.

PURPOSE: Percutaneous nephrolithotomy (PNL) is established in urology practice with routine use of fluoroscopic guidance. Herein, we retrospectively evaluated the potential factors affecting the fluoroscopic screening time (FST) during PNL. MATERIALS AND METHODS: A total of 282 patients with documented FST in detail during PNL performed by one surgeon were enrolled in this study. In all cases, PNL was performed on patients in prone position under C-armed fluoroscopy unit. The correlation between the FST and patient and also stone factors, including body mass index (BMI), previous open renal surgery, characteristics and size of the stone, and presence of hydronephrosis, as well as procedural factors such as percutaneous access number and location and operation time were analyzed. RESULTS: The mean age of the patients was 43 +/- 14.7 (range: 18-67) years. The mean operation time was 78.9 +/- 22.0 (range: 45-150) minutes, and the mean FST was 10.19 +/- 6.3 (range: 3-50) minutes. The mean stone size was 8.46 +/- 5.11 cm(2) (range: 2-30). The FST was significantly prolonged in patients with increased stone burden (p = 0.001) and necessitating multiple accesses procedures (p = 0.007). However, BMI of the patient, stone configuration, degree of hydronephrosis, history of open renal surgery, and access location did not have an impact on FST (p > 0.05). CONCLUSION: In patients with large stones necessitating multiple accesses, FST is significantly prolonged; therefore, they have to be managed by experienced surgeons to diminish the radiation exposure. However, BMI, stone configuration, presence of hydronephrosis, history of open renal surgery, and access location did not have effect on FST in our study.

Does previous extracorporeal shock wave lithotripsy affect the performance and outcome of percutaneous nephrolithotomy?

PURPOSE: ESWL and percutaneous nephrolithotomy are the primary treatment modalities for kidney stones. Furthermore, percutaneous nephrolithotomy is first line treatment when ESWL fails. We assessed how previous ESWL affects the performance and outcome of percutaneous nephrolithotomy. MATERIALS AND METHODS: A total of 1,008 patients underwent percutaneous nephrolithotomy between 2002 and 2007, of whom 230 (22.8%) had a recent history of failed ESWL. Patient characteristics, operative findings, success and complication rates in patients with and without a history of ESWL were analyzed and compared. RESULTS: In the post-ESWL group mean stone size was significantly lower and the mean +/- SD interval between the last ESWL session and percutaneous nephrolithotomy was 3.4 +/- 2.1 months (range 1 to 12). Mean operative time and fluoroscopic screening time were similar in the 2 groups (p >0.05). However, mean operative time per cm(2) stone and fluoroscopic screening time per cm(2) stone were significantly prolonged in the post-ESWL group (p <0.05). At a mean followup of 5.6 +/- 1.2 months (range 3 to 6) an overall success rate of 89% was achieved. Success and complication rates were comparable in the 2 groups. CONCLUSIONS: Although similar success and complication rates were achieved with percutaneous nephrolithotomy after failed ESWL, percutaneous nephrolithotomy is usually more difficult with prolonged operative time and fluoroscopic screening time per cm(2) stone due to the tissue effects of ESWL and scattered stone fragments in the pelvicaliceal system.