The effect of tadalafil therapy on kidney damage caused by sepsis in a polymicrobial septic model induced in rats: a biochemical and histopathological study.

INTRODUCTION: Sepsis is an inflammatory reaction to bacteria involving the whole body and is a significant cause of mortality and economic costs. The purpose of this research was to determine whether tadalafil exhibits a preventive effect on sepsis in a septic model induced in rats with cecal ligation and puncture (CLP). MATERIALS AND METHODS: Rats were randomly separated into groups, 10 rats in each: (i) a sham (control) group, (ii) an untreated sepsis group, (iii) a sepsis group treated with 5mg/kg tadalafil and (iv) a sepsis group treated with 10mg/kg tadalafil. A polymicrobial sepsis model was induced in rats using CLP. Rats were sacrificed after 16h, and blood and kidney tissues were collected for biochemical and histopathological study. RESULTS: Levels of the inflammatory parameter IL-6 decreased significantly in the sepsis groups receiving tadalafil in comparison with the untreated sepsis group (p < 0.05). In terms of histopathology, inflammation scores investigated in kidney tissues decreased significantly in the sepsis groups receiving tadalafil compared to the untreated sepsis group (p < 0.05). In addition, levels of creatinine and cystatin C measured in septic rats receiving tadalafil were lower by a clear degree than in septic rats (p < 0.05). CONCLUSION: In this study, tadalafil exhibited a preventive effect for sepsis-related damage by suppressing inflammation in serum and kidney tissue of septic rats in a polymicrobial sepsis model induced with CLP.

Evaluation of Tl-201 SPECT imaging findings in prostate cancer.

OBJECTIVES: To compare with histopathological findings the findings of prostate cancer imaging by SPECT method using Tl-201 as a tumor seeking agent. METHODS: The study comprised 59 patients (age range 51-79 years, mean age 65.3 ± 6.8 years) who were planned to have transrectal ultrasonography (TRUS)-guided biopsies due to suspicion of prostate cancer between April 2011 and September 2011. Early planar, late planar and SPECT images were obtained for all patients. Scintigraphic evaluation was made in relation to uptake presence and patterns in the visual assessment and to Tumor/Background (T/Bg) ratios for both planar and SPECT images in the quantitative assessment. Histopathological findings were compatible with benign etiology in 36 (61%) patients and malign etiology in 23 (39%) patients. Additionally, comparisons were made to evaluate the relationships between uptake patterns,total PSA values and Gleason scores. RESULTS: A statistically significant difference was found between the benign and malignant groups in terms of uptake in planar and SPECT images and T/Bg ratios and PSA values. No statistically significant difference was found between uptake patterns of planar and SPECT images and Gleason scores in the malignant group. CONCLUSIONS: SPECT images were superior to planar images in the comparative assessment. Tl-201 SPECT imaging can provide an additional contribution to clinical practice in the diagnosis of prostate cancer and it can be used in selected patients.

Intraperitoneal stone migration during percutaneos nephrolithotomy.

Percutaneos nephrolithotomy (PNL) is the standard care for renal stones larger than 2 cm. The procedure has some major and minor complications. Renal pelvis laceration and stone migration to the retroperitoneum is one of the rare condition. We report the first case of intraperitoneal stone migration during PNL.

Preventive effects of propofol and ketamine on renal injury in unilateral ureteral obstruction.

PURPOSE: The aim of the present study was to investigate the preventive effects of propofol and ketamine as anesthetics on renal injury in unilateral ureteral obstruction (UO). METHODS: Twenty-four male New Zealand white rabbits were randomly assigned to four groups of six rabbits each. Anesthesia was induced and maintained with propofol in groups 1 and 2 and with ketamine in groups 3 and 4. Groups 2 and 4 received complete left ureteral ligation. Groups 1 and 3 (control groups) underwent an identical surgical procedure without ureteral ligation. At 14 days of obstruction, animals were sacrificed and ipsilateral kidneys were removed for determination of tissue nitric oxide (NO) levels and immunohistochemical evaluation of endothelial nitric oxide synthase (eNOS), inducible NOS (iNOS), and apoptosis protease-activating factor 1 (APAF-1). RESULTS: Between groups 1 and 3, there were no differences in tissue NO levels and eNOS, iNOS, and APAF-1 expressions. iNOS and APAF-1 expressions were at the mild to moderate levels in group 2, but these parameters were markedly increased in group 4 at 14 days of obstruction. Also, elevated expression of iNOS was accompanied by a high NO production in group 4 compared with group 2. Although eNOS expressions were increased in both groups 2 and 4, there were no significant differences between these groups. CONCLUSIONS: Propofol as an anesthetic agent may attenuate NO-induced renal tubular cell apoptosis by downregulating the expression of iNOS in an animal model of unilateral UO.

Hemostatic role of a folkloric medicinal plant extract in a rat partial nephrectomy model: controlled experimental trial.

PURPOSE: Ankaferd BloodStopper is a mixture of 5 plants used in traditional Turkish medicine as hemostatic agent for external traumatic, postoperative and dental bleeding. We investigated the hemostatic efficacy of Ankaferd BloodStopper for partial nephrectomy. MATERIALS AND METHODS: A total of 24 Wistar rats were divided into 4 groups of 6 each. Group 1 underwent partial nephrectomy with hilar control as the conventional technique. Group 2 underwent the conventional technique with hemostatic agent application. Group 3 underwent hemostatic agent application to the renal parenchyma. In Group 4 partial nephrectomy was performed and the hemostatic agent was used without hilar control. Warm ischemia and partial nephrectomy times, and the number of hemostatic agent applications were recorded. Histopathological evaluations were completed. The Fisher, Kruskal-Wallis and Mann-Whitney U tests were used for statistical analysis. RESULTS: Mean kidney size was 2 x 2.5 x 0.05 cm. Mean partial nephrectomy time was 3.7, 2.7, 1.8 and 3.2 minutes in groups 1 to 4, respectively, which was significantly different between groups 1 and 3 (p = 0.007). Warm ischemia time in group 3 was less than in group 1 (p = 0.011). The number of hemostatic agent applications was higher in groups 3 and 4 compared to those in group 2 (p = 0.003). Glomerular necrosis was detected at a higher rate in group 1 compared to that in groups 3 and 4 (p = 0.015). Calcification formed significantly more in group 1 than in groups 2 to 4 (p <0.05). Erythrocyte aggregation was greater in groups 2 to 4 than in group 1 (p = 0.015). Giant cell reaction, fibrosis, inflammation and microvascular proliferation were not statistically different among the groups (p >0.05). CONCLUSIONS: Ankaferd BloodStopper decreases partial nephrectomy and warm ischemia times, and provides hemostasis. Erythrocyte aggregation confirmed the hemostatic action of the agent, while the absence of glomerular necrosis and calcification may have positive relevance.

Influence of high bladder pressure on vesicoureteral reflux and its resolution.

OBJECTIVES: Voiding dysfunction may result in lower urinary tract symptoms in children and is associated with urinary tract infection, renal damage and vesicoureteral reflux (VUR). The aim of this study was to assess the relationship between detrusor pressure, VUR and abnormal renal scintigraphy findings in children with dysfunctional voiding. PATIENTS AND METHODS: Between 2004 and 2007, 30 children with VUR and voiding dysfunction, 22 girls and 8 boys, median age 8.2 years, were evaluated. Urodynamic study, renal scan and voiding cystourethrography were performed in all patients. RESULTS: The degree of the renal scarring was found to be associated with the detrusor pressures (p = 0.018). The highest detrusor pressure was shown in the group of urge syndrome. The degree of the VUR was found to be correlated with the detrusor pressures (p = 0.038). In our study group, VUR had resolved in 11 (37%) patients, had improved in grade in 10 (33%) patients and remained unchanged in 9 (30%) patients after anticholinergic therapy. No significant relationship was found between the duration of therapy and the voiding patterns (p = 0.389). CONCLUSION: Every child with VUR should undergo a careful evaluation of its bladder function. The patients who have high detrusor pressures should be evaluated carefully for the presence of VUR and renal damage.

An in vitro study comparing the coagulation and cautery effects of bipolar and unipolar cutting modalities on prostatic tissue.

INTRODUCTION: We aimed to compare plasmakinetic prostate resection (PKRP), plasmakinetic prostate vaporization (PKVP) and transurethral prostate resection (TURP) procedures according to cautery artifacts in tissue specimens and to compare the coagulation depths of these procedures. MATERIALS AND METHODS: The prostate specimens of 10 patients that underwent open transvesical prostatectomy were used. TURP, PKVP and PKRP procedures were performed immediately. Artifactual pathological patterns that were identified in the specimens included: abnormal cellular orientation and spindling, artifactual cellular detachment from the underlying basement membrane, atypical cytological changes and stromal coagulative artifacts. The severity of cautery artifact was graded as absent, mild, moderate or severe according to the sum of points in each specimen. RESULTS: When the groups were compared according to moderate and severe artifacts, it was observed that PKRP caused more moderate artifacts and TURP caused more severe artifacts than the other two groups (p < 0.05). The depth of the tissue affected by coagulation was 1.52 +/- 1.29 mm with the TURP procedure. There were significant differences between TURP and the other two methods (p < 0.05). CONCLUSIONS: Three transurethral procedures cause cautery artifacts of varying grades. The application of TURP seems to cause more severe artifacts and PKRP and PKVP procedures seem to result in a deeper coagulation zone in the residual prostatic tissue.

Effect of tadalafil on renal resistivity and pulsatility index in partial ureteral obstruction.

INTRODUCTION: To investigate the effect of tadalafil on Resistivity Index (RI) and Pulsatility Index (PI) in partial unilateral ureteral obstruction (PUUO). METHODS: Twelve New Zealand rabbits were assigned into two groups. Baseline renal Doppler ultrasonography (USG) was performed in all rabbits. The rabbits in group 1 received tadalafil for a month (10 mg/72 h) and group 2 was defined as sham. After 1 month, in both groups left PUUO was created. Renal Doppler USG was performed to measure RI and PI parameters of both kidneys on the 4th hour and 1st and 3rd days postoperatively. RESULTS: Baseline renal Doppler USG revealed that there was no difference between two kidneys in both groups. The differences in mean RI and PI values of the kidneys between the sham and tadalafil groups were not statistically significant. Compared with the preoperative values, postoperative RI and PI values for the left kidneys were significantly increased in the period from 4 h to 3 days postoperatively in the sham group (p < 0.05). However, mean RI and PI values were not increased in the tadalafil group when compared with the sham group and this difference between the two groups was significant (p < 0.05). CONCLUSIONS: Tadalafil has a lowering affect on RI and PI in experimentally created PUUO.

Effect of cyanoacrylic glue on penile fracture: an experimental study.

PURPOSE: We investigated the effect of Glubran(R)2 cyanoacrylic glue on rat cavernous tissue after forming penile fractures experimentally as well as the histopathological effect. We also investigated its clinical use. MATERIALS AND METHODS: Experimental penile fracture was formed by incising from the proximal dorsal side of the penis in 32 Wistar Albino rats. The rats were randomly assigned to 4 main groups of 8 each. In the control group the incision was not repaired and it was left to secondary healing. In the glue group cyanoacrylic glue was only applied to the incision region. In the primary repair group the incision was primarily repaired and in the final group cyanoacrylic glue was applied to the incision region following primary repair. Three weeks later penectomy materials were examined histopathologically. RESULTS: When the control group was compared with the other groups, the differences in cavernous tissue healing with fibrosis and hyperemia-bleeding were statistically significant (p = 0.043 and 0.003, respectively). In the glue group fibrosis was observed in 2 rats. This group was the best according to cavernous healing. Although there was no significant difference between the control group and the other groups according to inflammation (p = 0.057), the glue group was better than the primary repair group (p = 0.026). No significant inflammation or hyperemia-bleeding was observed in the glue group. When the experimental groups were evaluated for histopathological parameters, it was observed that the best results were obtained in the glue group. CONCLUSIONS: Cyanoacrylic glue can be used in cavernous surgery due to its hemostatic, adhesive and anti-inflammatory properties.

Ginkgo biloba (EGb 761) usage attenuates testicular injury induced by testicular ischemia/reperfusion in rats.

INTRODUCTION: We investigated the effect of ginkgo biloba on testicular ischemia-reperfusion (IR) injury. MATERIALS AND METHODS: Thirty-two Wistar Albino rats were randomly assigned into four groups. Torsion/detorsion (T/D) performed to the rats in group 1, group 2 received ginkgo biloba (50 mg/day) for a month before T/D, group 3 received only gingko biloba (50 mg/day) for a month and group 4 was defined as sham group. After 1 month the testes were removed. RESULTS: Mean testicular malondialdehyde, nitrate and nitrite levels were significantly increased in group 1 compared to groups 2, 3 and 4 (P<0.05). The rats in group 3 provided basal histological appearance. In group 1, edema, congestion and hemorrhage between seminiferous tubules were predominant. In group 2, histopathologic features were markedly less than group 1. CONCLUSIONS: Malondialdehyde, nitrate and nitrite levels were increased after unilateral testicular torsion. EGb 761 has a protective effect on testicular injury induced by IR.

Penile crural injury due to perineal penetrating trauma: a case report.

Perineal traumas are rarely seen in males, and can affect the anterior urethra and corpus cavernosum of the penis. In this paper, we report the case of a 14-year-old boy admitted to the emergency room with a pencil entering the perineum. We performed perineal exploration and observed that the urethra was totally intact, and that the pencil had entered into the right penile cavernosal structure.

Spontaneous rupture and emergency repairment of the renal pelvis.

A case of spontaneous rupture of the renal pelvis is very rare and unusual occurrence. Our case was a young woman who did not present with any disease that was a factor for pelvic rupture. The diagnosis was confirmed by abdominopelvic CT, and emergency repair of the renal pelvis was performed and a ureteral stent was inserted. Appropriate antibiotherapy was ordered, and the recovery was rapid. The differential diagnosis of this ease is discussed and the literature is reviewed:

Do hydronephrosis and extracorporeal shock wave lithotripsy affect carbohydrate antigens?

OBJECTIVES: To investigate carbohydrate antigen (CA 19-9, CA 15-3, and CA 125) levels in the patients who had hydronephrosis with renal stones and in whom Extracorporeal shock wave lithotripsy (ESWL) was performed. MATERIALS AND METHODS: This prospective study included 20 people with no known disease for control group and 30 patients who had hydronephrosis with renal stones and in whom ESWL was performed between January 2005 and January 2006. None of patients had urinary infection and malignancy. The blood for carbohydrate antigens was taken pre-ESWL and 30 min after ESWL in both groups. CA 19-9, CA 15-3, and CA 125 in the serum were tested with the electro-immunoassay method on the Roche E-170 apparatus with the original Roche kit. RESULTS: The CA 19-9 and CA 125 values in the patients group were found to be statistically significant when compared with the control group but the CA 15-3 was not found to be significant. However, CA 19-9, CA 15-3, and CA 125 values of post-ESWL were not statistically significant when compared with pre-ESWL group (P > 0.05). CONCLUSIONS: The average serum values of CA 125 and CA 19-9 in patients were found to be significantly high. However, serum values of CA 19-9, CA 15-3, and CA 125 were not affected by ESWL.

Lower urinary tract symptoms, prostate volume, uroflowmetry, residual urine volume and bladder wall thickness in Turkish men: a comparative analysis.

AIM: To evaluate the association between lower urinary tract symptoms (LUTS) severity and bladder wall thickness (BWT). MATERIALS AND METHODS: The study included 155 patients referred to outpatient clinics for LUTS. Patients were divided into three groups due to their IPSS. Group A included the patients with mild symptoms, group B included patients with moderate symptoms and group C included patients with severe symptoms. The patients were again divided into two groups due to their uroflowmetry results. Group 1 included the patients whose Q (max) 10 ml/s. RESULTS: The mean BWT was 4.14 + 1.03 mm (from 3 to 9 mm). Although there was no difference between the IPSS groups in BWT (P = 0.325), it was statistically significant between uroflowmetry study groups (P < 0.01). CONCLUSIONS: BWT seems to be significantly increased in men who have Q (max) values smaller than 10 ml/s.

Intraurethral honey application for urethral injury: an experimental study.

OBJECTIVES: To evaluate the effect of honey applied intraurethrally after urethral injury on histopathological healing. MATERIALS AND METHODS: A total of Wistar male rats were used. The rats were divided into four groups: control (Group 1), sham (Group 2), 1 week honey applied group (Group 3) and 3 weeks honey applied group (Group 4). The urethral damage was caused with a 29 G needle. In sham group, only intraurethral saline solution was given, and 10% of honey was applied to rats in Groups 3 and 4 intraurethrally. After killing, penile tissues were investigated under a light microscopy. RESULTS: The irregularities of urethral epithelium and connective tissue were observed in Group 1. Also narrowing of lumen was present in control group rats except one rat in which no inflammation and total healing were observed. Hyperemia-bleeding was found in whole rats. In Group 2, there were irregularities in urethral epithelium and connective tissue. Total healing was observed in one rat. In Group 3, while regularity in urethral epithelium was present in six rats, inflammation and fibrosis was absent in rats. In Group 4, inflammation and fibrous tissue accumulation were not observed in rats. CONCLUSIONS: Intraurethral honey, applied after urethral injury, prevents inflammation, accelerates urethral healing and provides perfect healing.

Comparison of transurethral prostate resection and plasmakinetic prostate resection according to cautery artefacts in tissue specimens.

OBJECTIVES: The objectives were to evaluate cautery artifacts histopathologically in tissue specimens after plasmakinetic prostate resection (PKRP) and transurethral prostatectomy (TURP), and compare the results of the two procedures. MATERIALS AND METHODS: The histopathological specimens of 65 patients who underwent PKRP and TURP were examined retrospectively. Tissue chips for examination were selected randomly. Artifactual pathological patterns that were identified in the specimens included: abnormal cellular orientation and spindling, artifactual cellular detachment from the underlying basement membrane, atypical cytological changes and stromal coagulative necrosis. Each pattern identified was awarded 1 point. The severity of the cautery artefact was graded as absent, mild, moderate or severe according to the sum of points in each specimen. RESULTS: In TURP, the artefacts were graded absent (9%), mild (6%), moderate (18.7%), and severe (65.6%) changes. In PKRP, the artefacts were graded absent (6%), mild (18.1%), moderate (36.3%), and severe (39.4%) changes. While the number of mild and moderate artefacts observed was higher in PKRP (P = 0.023), severe artefacts were observed in higher numbers with TURP (P = 0.034). No prostate cancer was detected during the follow-up period. CONCLUSIONS: It has been observed that the application of TURP causes fewer mild to moderate artefacts and PKRP causes fewer severe artefacts in the histopathological evaluation of specimens in comparison to each other.

Acute urinary retention due to retrovesical hematoma: a case report.

Acute urinary retention is a urologic emergency, which has a meaningful impact on patients' quality of life. The compression of retrovesical hematoma is a rare cause of urinary retention. We report the presentation and discuss the differential diagnosis of acute urinary retention due to retrovesical hematoma in a 57-year-old male patient.

Unexpected complication after cystometry in the hypocompliant urinary bladder: formation of a knot in the double lumen urethral catheter--a case report.

Urodynamic evaluation is frequently used in the follow-up of the treatment and diagnosis of incontinence, which develops in connection with a neurogenic or non-neurogenic reason. There is no identified serious complication during or after urodynamic evaluation, present in the literature up to date. Hematuria, due to the urethral catheter, the development of oedema in the urinary bladder wall and the development of urinary bladder spasm as a result of catheter irritation, are some of the complications, which may occur. In this paper, twist and knot formation in the double lumen urethral catheter after cystometry of a patient with a hypocompliant urinary bladder, has been presented.

Surgical treatment options in proximal hypospadias: retrospective analysis of 171 cases at a single institution.

AIM: So far, various techniques have been used in the surgical treatment of proximal hypospadias. The aim of all techniques is to form a near to normal penis functionally and cosmetically. In the present study, proximal hypospadias cases operated in our clinic were evaluated. MATERIAL METHOD: Overall 171 cases with proximal penile, penoscrotal and scrotal meatus, aged between 3 and 28 were included in the study. Early and late postoperative complication rates and factors affecting success were investigated retrospectively. RESULTS: Sixteen cases underwent Duckett, 20 Onlay, 28 free tube, 56 Belt-Fuqua and 51 Thiersch operations. Success rate at early postoperative period was 60.8%, while it became 81.2% following secondary interventions. CONCLUSION: No effect of operation technique and meatus levels were observed on complication rates whilst previous operation increased complication rates significantly.

Squamous cell carcinoma of the male bulbomembranous (proximal) urethra--how should the treatment be done? A case report and review of the literature.

The probability of the squamous cell carcinoma of the male bulbomembranous urethra is rare. The patients generally diagnosed as urethral stenosis. It has a high stage because of the late symptoms and diagnosis. Monotherapy and multimodal treatments have been considered. Currently, the standard therapy has not been decided yet.