Noninvasive treatment of intraperitoneal urinary system perforations with percutaneous placement of a peritoneal drainage catheter

Background/aim: Intraperitoneal urinary system perforation is a rare but serious complication of endoscopic urologic surgery. Percutaneous placement of a peritoneal drainage catheter is already mainly used for diagnostic purposes. We present our experience with percutaneous drainage catheters for conservative management of intraperitoneal urinary system perforations occurring during endoscopic urologic surgery with close monitorization in selected cases. Materials and methods: Urinary system perforations had developed in 21 (0.8%) of 2603 patients undergoing endoscopic urologic surgery at our department in 2014­2016. The perforation was intraperitoneal in only 5 (0.19) of all the patients. A percutaneous peritoneal drainage catheter with the guidance of ultrasonography was placed in four of the patients. Results: Conservative management by draining excess fluid with a drainage catheter percutaneously placed under close monitorization was successful in four out of five patients with urinary system perforation occurring during endoscopic urologic surgery. The remaining patient was treated successfully with open laparotomy because of fulminant evidence of peritonitis. Conclusion: Our findings and experience may suggest that conservative management of intraperitoneal urinary system perforations occurring during endoscopic urologic surgery by percutaneous drainage catheter under close monitorization is feasible in carefully selected patients.

Comparison of transurethral incision of the prostate and silodosin in patients having benign prostatic obstruction in terms of retrograde ejaculation.

BACKGROUND: To compare the functional outcomes and retrograde ejaculation (RE) after transurethral incision of the prostate (TUIP) or silodosin in bladder outlet obstruction (BOO) secondary to a small prostate. METHODS: Prospectively collected data from December 2011 through December 2014 of 192 LUTS patients having fertility concerns with prostate volume smaller than 40 ml receiving either TUIP or silodosin treatment were prospectively reviewed. The treatment outcomes were evaluated and compared. RESULTS: TUIP was performed in 96 cases and silodosin 8 mg was prescribed in 96 cases. At 12th months after TUIP or continuous silodosin treatment, the decrease in mean International Prostate Symptom Score (IPSS) and postvoiding residual urine (PVR) and the improvement of mean maximal flow rate (Qmax) were significant (p = 0.000). The improvement in IPPS and Qmax was significantly higher in TUIP group compared to silodosin group (p = 0.005, p = 0.000) with a lower rate of retrograde ejaculation (RE) in TUIP group. (11/96 vs 33/96) (p = 0.000) Conclusions: Both TUIP and silodosin ensures comparable improvement in PVR, IPSS and Qmax with a lower rate of RE on the TUIP group in prostates weighing less than 40 grams suggesting that TUIP is a better choice in younger patiens seeking preservation of ejaculation with fertility concerns.

Metabolic assessment of recurrent and first renal calcium oxalate stone formers.

OBJECTIVES: This study aimed to demonstrate the dominant role of metabolic disorders in the formation of calcium oxalate stones in patients with recurrent urolithiasis, as well as in patients experiencing their first episode of urolithiasis. PATIENTS AND METHODS: The records of the patients who attended our kidney stone outpatient clinics between 2008 and 2012 were reviewed, and the data of 318 calcium oxalate stone patients who had undergone a metabolic assessment were retrospectively analysed. The patients were divided in two groups. The first group included the patients who presented with their first episode of urolithiasis (Group 1, n = 170), and the second group included patients with recurrent urolithiasis (Group 2, n = 148); intergroup comparisons of metabolic disorders were performed. RESULTS: A significant difference was found between the two groups in mean urine calcium levels (Group 1, 0.25; Group 2, 0.31; p = 0.001); the mean serum calcium level was found to be significantly higher although at less extent in Group 2 (Group 1, 9.4; Group 2, 9.6); p = 0.04). Significant differences were also found in mean urine citrate (Group 1, 481.9; Group 2, 397.2, p < 0.0001) and oxalate levels (Group 1, 22.1; Group 2, 28.5; p < 0.0001) . CONCLUSIONS: This study revealed a metabolic tendency to hypercalciuria in calcium oxalate stone patients, predominantly in those with recurrent calcium oxalate urolithiasis. Urinary oxalate excretion was found to be higher in recurrent urolithiasis in comparison to the first episode of calcium oxalate urolithiasis and urinary citrate excretion lower in recurrent urolithiasis.

The comparative evaluation of apoptosis produced by leuprolide or orchiectomy on rat prostate tissue.

INTRODUCTION: Organisms are constantly in a balance meaning that while new cells are produced, some of the older ones die which takes place in 2 ways: necrosis or apoptosis. Apoptosis is the programmed cellular death triggered by intrinsic or extrinsic stimuli. In this study we have evaluated the apoptosis of prostate tissue generated by surgical or medical orchiectomy. MATERIAL AND METHOD: In this experimental study, we used 36 adult male rats that were evaluated in 3 groups. The first group (Group 1) consisted of 12 rats that had bilateral orchiectomy; the second group (Group 2) included 12 rats that were given leuprolide acetate and the third group (Group 3) consisted of 12 control rats. Immunohistochemical staining of the prostate of all rats was performed and the presence of glandular atrophy and apoptosis were evaluated in the three groups. The statistical differences between the two groups were evaluated by the Fisher exact test. RESULTS: Glandular atrophy was not determined in any rat of the control group, and the apoptotic staining was in the normal limits in all the control rats. In Leuprolide group, glandular atrophy was mild in 7 cases, and moderate in 3 rats. In 2 rats of the Leuprolide group, atrophy was not demonstrated. In surgical orchiectomy group, glandular atrophy was present in all cases. Atrophy was observed as cystic atrophy. Statistical analysis with the Fisher exact test revealed that glandular atrophy was statistically significantly more common in surgical orchiectomy group compared with Leuprolide group (p = 0,012). CONCLUSION: If the aim of treatment in androgen dependent prostatic adenocarcinoma or benign prostate hypertrophy is the construction of a robust apoptosis, bilateral orchiectomy generates a more powerful apoptosis compared with Leuprolide.

The histology and the proapoptotic control in the ipsilateral and the contralateral testes following unilateral vasectomy.

OBJECTIVE: The aim of this study was to enlighten both the testicular histology and the genetic aspects of the apoptotic process. Thus an experimental study was designed with a model of unilateral vasectomy. METHODS: Twenty-two adult male rats were used and 4 main groups were formed. The first (A), the second (B), the third (C), and the fourth group (D) consisted of 4, 4, 4 and 10 rats respectively. Rats in group A had sham operation while rats in other groups (B, C, D) underwent left vasectomy operation including binding of ductus deferens with a 3/0 silk and cutting a minimum of 1 cm part while preserving the vascular structure under 9x magnification. Rats undergoing unilateral vasectomy were sacrificed at the 1(st), 2(nd) and 8(th) weeks and their testicular structure and proapoptotic gene proteins were compared with that of the control group undergoing sham operation. RESULTS: We found that vasectomy gradually caused destruction and both ipsilateral and contralateral testicles were affected showing initial apoptosis. CONCLUSION: The procedure causes destruction in the testicular structure by causing bilateral intratubular germ cell necrosis, unilateral obstruction, increase in the tubular pressure and processes that are aggravated by some probable autoimmune reactions.

The adverse influence of spina bifida occulta on the medical treatment outcome of primary monosymptomatic nocturnal enuresis.

OBJECTIVE: Previous reports have suggested that the incidence of spina bifida occulta (SBO) in patients with primary monosymptomatic nocturnal enuresis (PMNE) is higher than the general population. The purpose of this study was to investigate the effect of spina bifida occulta on the medical treatment outcome of PMNE. MATERIAL AND METHODS: Between January 2008 and December 2011, a total of 223 children (151 boys and 72 girls, aged 6-16 years; mean age: 10.1 ± 3.04 years) with PMNE were reviewed retrospectively. All of the children underwent physical examination, urine analysis, urinary tract ultrasonography and kidney ureter bladder (KUB) scout film. All patients were initially treated with a timed voiding program and were given desmopressin acetate when necessary. RESULTS: Spina bifida occulta was detected in 75 children (33.6%). Spina bifida occulta affected L4 in 2 children, L5 in 6 children, L4-L5 in 3 children, S1 in 52 children, S2 in 7 children and S1-S2 in 2 children. Treatment was successful in 79% of the children without SBO, and in only 48% of the children with SBO. Medical treatment success rates differed significantly between the study groups. CONCLUSION: The presence of spina bifida occulta significantly affects the response to medical treatment in patients with PMNE. Thus, verifying spina bifida occulta status in PMNE can facilitate prognostic predictions about the response to medical treatment.

Intravesical Prostatic Protrusion: A Potential Marker of Alpha-blocker Treatment Success in Patients With Benign Prostatic Enlargement.

OBJECTIVE: To investigate the value of anatomic and blood-flow measurements of the prostate via ultrasound in identifying medical treatment response of patients with lower urinary tract symptoms due to benign prostatic enlargement. A secondary objective of the study was to compare transabdominal-transrectal measurements. MATERIALS AND METHODS: Male patients (age range 50-80) with lower urinary tract symptoms who applied to our outpatient clinic to be diagnosed with benign prostatic enlargement that were eligible for medical management were included in the prospective study. Patients (n = 49) were administered with tamsulosin for management. At baseline evaluation, all patients underwent International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), transabdominal and transrectal ultrasound [prostate volume (PV), post-void rezidu and intravesical prostatic protrusion (IPP)], and prostate subcapsular resistive index value measurement. Follow-ups were carried out 1 and 3 months after treatment. At these time-points, patients were assessed with IPSS and uroflowmetry. RESULTS: IPP were identified to be negatively correlated with baseline Qmax values (P = .001, R = -0.485) and positively correlated with PSA (P = .013, R = 0.353) and PV (P = .003, R = 0.420). PV was related with resistive index (P = .026, R = 0.318) and PSA (P = .001, R = 0.619). Subsequent to medical treatment on the follow-ups, an overall improvement in the IPSS and Qmax was identified (P = .001). However, a negative correlation was identified in the change that occurred between IPSS and IPP (P = .004, R = -0.410). Other parameters were not correlated (P > .05) with the change in IPSS and Qmax. Transabdominal and transrectal measures were similar (P = .001). CONCLUSION: This study has shown that increased IPP values are associated with lower response to alpha-receptor specific management. Transabdominal measurements are sufficient for the evaluation compared with transrectal measurement.

Monosymptomatic nocturnal enuresis caused by seasonal temperature changes.

BACKGROUND: Primary nocturnal enuresis is the most frequent urologic complaint among pediatric patients. Enuresis is believed to have a complex etiology involving genetic, somatic, and behavioral factors. We study the relationship between seasonal temperature changes effect and monosymptomatic nocturnal enuresis (MNE). METHODS: Between 2011 and 2012, a total of 75 children with primary MNE selected from urology and pediatry clinics were included in this study. All of the children underwent physical examinations, urine analyses, urinary ultrasounds, and direct urinary graphs. We evaluated the enuresis ratio for the summer (the hot season from June to September) and winter (the cold season from December to March) months in nightly, weekly, and monthly intervals via prepared questionnaires. RESULTS: Of the 75 study participants, 45 were boys (60%) and 30 were girls (40%). The age range was 6-16 years (mean 10.3±2.0 years). We observed a difference in the ratio of enuresis data between the summer and winter months in 29 males and 19 females, which totals 48 of the 75 MNE patients evaluated in this study. There was a statistically significant difference noted in monthly enuresis ratio in the summer and winter (p<0.0001). We observed a significant difference in quality of life, and this difference caused considerable emotional discomfort for the patients. CONCLUSION: In the winter months, the nightly, weekly, and monthly ratios are higher in children with MNE. This increase causes a decrease in the quality of life of these children.