Role of Contrast Enhancement and Corrected Attenuation Values of Renal Tumors in Predicting Renal Cell Carcinoma (RCC) Subtypes: Protocol for a Triphasic Multi-Slice Computed Tomography (CT) Procedure.

BACKGROUND: To distinguish RCC subtypes based on contrast enhancement features of CT images. MATERIAL/METHODS: In total, 59 lesions from 57 patients were included. All patients underwent multi-slice CT imaging with a triphasic protocol, which included non-contrast, corticomedullary, nephrographic and urographic phases. Contrast enhancement features of renal masses were evaluated in terms of CT attenuation values (AV) and differences in contrast density; the aorta or renal parenchyma were evaluated based on corrected or relative values. RESULTS: Clear cell RCC (ccRCC) showed more intense contrast enhancement than other RCC subtypes. When differentiating ccRCC from other RCC subtypes, a cut-off AV of 86-89 HU, aorta-based corrected AV of 89-95 HU and renal parenchyma-based corrected AV of 87-95 HU showed a diagnostic accuracy of 81-86%, 86-88% and 74-78%, respectively, in the corticomedullary phase. Furthermore, a cutoff of 2.42-2.72 for the relative contrast enhancement ratio, a cutoff of 2.59-2.74 for the aorta-based corrected relative contrast enhancement ratio and a cutoff of 2.63-2.76 for the renal parenchyma-based attenuation ratio showed a diagnostic accuracy of 83-88%, 88-90% and 81%, respectively. CONCLUSIONS: The most reliable parameters for differentiating ccRCC from other RCC subtypes are aorta-based corrected AV and aorta-based corrected relative contrast enhancement values in the corticomedullary phase.

Protective effect of 2-APB on testicular ischemia-reperfusion injury in rats.

PURPOSE: We performed biochemical and histopathological evaluations to assess the effects of 2-APB on ischemia-reperfusion induced testicular damage. MATERIALS AND METHODS: A total of 28 rats were randomly divided into 4 groups, including sham treated, ischemia-reperfusion, ischemia-reperfusion plus 2 mg/kg 2-APB and ischemia-reperfusion plus 4 mg/kg 2-APB. Testicular tissue superoxide dismutase, glutathione, malondialdehyde, total antioxidant capacity and DNA fragmentation levels were determined. Testicular tissue samples were examined by histopathology and TUNEL staining. RESULTS: Mean superoxide dismutase, total antioxidant capacity and glutathione were significantly higher in the sham treated group than in the ischemia-perfusion group (p <0.05). Mean malondialdehyde and DNA fragmentation levels were significantly lower in the sham treated group than in the ischemia-reperfusion group (p <0.05). After 2-APB treatment superoxide dismutase, total antioxidant capacity and glutathione were significantly increased but malondialdehyde and DNA fragmentation levels were significantly decreased compared to the ischemia-reperfusion group (p <0.05). The number of TUNEL positive cells was significantly lower in the 2-APB treatment groups than in the ischemia-reperfusion group (p <0.05). CONCLUSIONS: In rats 2-APB reduced the oxidative stress and apoptosis caused by testicular ischemia-reperfusion injury. The testicular protective effect of 2-APB appears to be mediated through its antiapoptotic and antioxidative effects.

Nitric oxide synthase (eNOS4a/b) gene polymorphism is associated with tumor recurrence and progression in superficial bladder cancer cases.

PURPOSE: We investigated the relationship between the distribution of the eNOS4a/b polymorphism and the clinical features of superficial bladder cancer. MATERIALS AND METHODS: This study included 201 healthy controls with a mean ± SD age of 62.35 ± 7.96 years and 123 patients with a mean age of 64.03 ± 11.00 years diagnosed with histopathologically confirmed superficial bladder cancer. The eNOS4a/b polymorphism genotype (aa, bb or ab) was identified by polymerase chain reaction. Blood glutathione and plasma malondialdehyde levels were measured by spectrophotometry as an indicator of oxidative stress. We estimated total plasma levels of nitric oxide metabolites using a colorimetric assay kit. RESULTS: There were no significant differences in age or body mass index between patients and controls. Malondialdehyde and nitric oxide metabolite levels were statistically significantly increased (p = 0.000 and 0.024, respectively) and glutathione levels were decreased (p = 0.000) in patients with superficial bladder cancer. The bb genotype of the eNOS4a/b polymorphism is the most frequent one in the Turkish population and the aa genotype was significantly more common in patients with superficial bladder cancer (p = 0.000). Also, the aa plus ab genotype was significantly more common in patients with high grade tumors (p = 0.013) and in those with more progression to muscle invasive disease (p = 0.000). This genotype was also a significant independent risk factor for recurrence after adjusting for smoking status, stage, grade and the presence of carcinoma in situ on logistic regression analyses (OR 3.095, 95% CI 1.21-7.86, p = 0.018). CONCLUSIONS: The current study suggests that a genotype containing the a allele of the eNOS4a/b polymorphism may be a risk factor for bladder cancer. Additionally, patients harboring the aa plus ab genotype are more likely to experience tumor recurrence and progression.

A rare complication of inguinal hernia repair: Total testicular ischemia and necrosis.

Testicular ischemia and necrosis are quite rare complications following inguinal hernia repair. There is still no consensus on the mechanism of infarction and necrosis in the literature. We present a case with total testicular ischemia and necrosis in the early period following the inguinal hernia repair with prolene mesh, ending up with orchiectomy.

Ureteroscopy With Holmium:Yag Laser Lithotripsy for Ureteral Stones in Preschool Children: Analysis of the Factors Affecting the Complications and Success.

OBJECTIVE: To evaluate the factors that may affect the efficacy and safety of ureteroscopy with holmium:YAG laser lithotripsy in the management of ureteral stones in preschool children. MATERIALS AND METHODS: Medical records of 70 children, 32 boys and 38 girls, who were treated for ureteral stones at our clinic between 2014 and 2016 were retrospectively reviewed. Patients were grouped according to size of the instrument used as group 1 (n = 40, ultrathin 4.5 Fr) and group 2 (n = 30, 7.5 Fr). Patient age, stone characteristics, and operative and postoperative outcomes were compared. The effect of age, stone size and location, type of the instrument, and operative times on success and complication rates were also investigated. In addition, factors related with postoperative hydronephrosis were evaluated. RESULTS: Patients in group 1 were significantly younger than group 2 (32.22 ± 22.72 vs 63.53 ± 16.98 months, P = .000). Groups were similar in terms of gender, stone laterality, size and location, and operative times. However, access failure rate was significantly higher in group 2 (0 vs 20%, P = .022). Stone-free rate was 87.5% in group 1 and 76.6% in group 2 (P = .237), complication rates were not significantly different among groups. Stone size and location were found to be associated with success rates. Stone location and operative times were the factors affecting the complication rates. Presence of preoperative hydronephrosis and prolonged operative time were determined as the predictors of postoperative hydronephrosis. CONCLUSION: Ultrathin ureteroscopy with laser lithotripsy can be used safely and effectively for ureteral calculi including proximal ones in significantly younger children without any access failure.

Transrectal ultrasound-guided prostate rebiopsy: How many core sampling should be applied to which patient?

BACKGROUND: We investigated the correlation between the sampled number of cores in rebiopsy and the cancer detection rate (CDR). MATERIALS AND METHODS: Two hundred and twelve patients with normal rectal examination who had undergone rebiopsy in the past 5 years were examined retrospectively. Moreover, 68% of them had undergone 12 cores (Group 1) while 32% had undergone 20 cores (Group 2). Both groups were compared with respect to the CDR. RESULTS: There was no difference between groups in terms of age, total prostate-specific antigen, and prostate volume (P > 0.05). Forty-one (19%) of 212 patients were diagnosed with cancer, and the CDR was significantly higher in Group 2 (30.9% vs. 13.9%, P = 0.004). This rate increased from 6.5% to 20% (P = 0.025) and from 0% to 33.3% (P = 0.023), respectively, with 12-core and 20-core rebiopsies in patients whose initial pathology indicated benign and high-grade prostatic intraepithelial neoplasia (HGPIN). Furthermore, cancer was detected in 24 (40%) of 60 patients who were diagnosed with atypical small acinar proliferation (ASAP) in the initial biopsy. However, despite being higher in 20-core biopsy group (47.6% vs. 35.9%), this was not statistically significant (P = 0.377). CONCLUSIONS: At least 20 cores should be sampled in rebiopsy, especially in the patients diagnosed with benign and HGPIN. However, we believe that standard systematic sampling will be sufficient for the patients diagnosed with ASAP.

Management of urinary tract infection with intravesical amikacin may increase the risk of bladder oxidative stress in children with neurogenic bladder.

INTRODUCTION: We evaluated the bladder oxidative stress in neurogenic bladder children treated with intravesical amikacin for recurrent UTI and whether urinary isoprostane f2 alpha (F2-IsoP) is a good biomarker in this particular condition. METHODS: This prospectively designed controlled study was approved by the Adnan Menderes University institutional ethics committee (Adnan Menderes University, 2015/649). Between January 2016 and January 2017, twenty-six children with meningomyelocele who had been doing CIC were recruited. Serum and urine samples were collected during urinary tract infection (UTI) (group 1) and after management of UTI with intravesical amikacin (group 2) besides standard oral antibiotic treatment. While oxidative stress parameters SOD, GSH, GPX, MDA, F2-IsoP and NO were analyzed in the serum samples, only F2-IsoP was analyzed in the urine. All data were compared with 23 normal healthy control children (group 3). RESULTS: Median age, CIC duration and number of CIC per day of patients' group were 84 (60-147) months, 60 (30-90) months and 4 (4-6), respectively. Male-to-female ratio was 1:16. There was no statistical difference between groups in terms of serum oxidative stress parameters (p > 0.05). However, statistically significant urine F2-IsoP changes exist between groups (p = 0.011) (Fig. 1). But there were no correlations between urine F2-IsoP and disease clinical data such as CIC duration or number of CIC per day. Serum glutathione levels in group 2 were higher than group 1 and 3, as well (p = 0.023, Kruskal-Wallis test). Fig. 1 Comparison of median urinary isoprostane f2 alpha levels CONCLUSION: Higher urine F2-IsoP levels after management of UTI with intravesical amikacin may reflect increased lipid peroxidation and oxidative stress in children with NB. This detrimental effect on bladder should be considered in the long-term treatment period.

Laparoscopic Dismembered Pyeloplasty in a Solitary Kidney with Intrarenal Pelvis: Two Challenges in One Case.

Laparoscopic pyeloplasty (LP) for ureteropelvic junction obstruction (UPJO) is one of the most appropriate surgical techniques to achieve the optimal goal of minimally invasive surgery. However, urologists hesitate to use the laparoscopic approach in UPJO with solitary kidney or intrarenal pelvis. There are a few published studies on laparoscopic pyeloplasty cases in intrarenal pelvis. However, to the best of our knowledge, the present case is the first in the literature in terms of intrarenal pelvis in a solitary kidney. Generally, YV plasty is the accepted technique instead of dismembered pyeloplasty in UPJO with small or intrarenal pelvis. However, in this report, we showed that dismembered LP can be performed with good results in intrarenal pelvis UPJO, even if it is in the solitary kidney.

Prevalence and correlates of female sexual dysfunction among Turkish pregnant women.

OBJECTIVE: The aim of the present study was to determine the prevalence and associated factors of female sexual dysfunction together with the concerns of women about sexuality during pregnancy. MATERIAL AND METHODS: A total of 207 healthy, sexually active pregnant women were enrolled in the study. Demographic data of all participants were noted and sexual functions were evaluated by Female Sexual Function Index (FSFI). Each FSFI domain score was calculated and mean scores were noted. Concerns of women about sexuality were also investigated. RESULTS: Mean age of participant women was 27.0±5.9 (range 15-44) years. Prevalence of sexual dysfunction was found to be 87% in study population. Mean FSFI score was 18.6±1.21. The rate of sexual dysfunction was higher in the first (87%) and third (92.6%) trimesters when compared to the second (80.6%) trimester (p=0.243). Among demographic variables, education levels of partners and preconceptional sexual dysfunction were found to be significantly related to FSD. The most common concerns of women about sexual relationship have been reported as the fear of having pain (35%), risk of abortion (21.3%) and religious factors (10%). CONCLUSION: Prevalence of sexual dysfunction is relatively high among pregnant women. Educational levels and preconceptional sexual functions were found to have an impact on this high rate. Accurate counseling of partners about sexuality during pregnancy may help to reduce misbeliefs, concerns and, thereby, decrease this high rate of female sexual dysfunction.

Intrathoracic Kidney after Blunt Abdominal Trauma: A Case Report and Review of the Literature.

Abdominal trauma is responsible for most genitourinary injuries. The incidence of renal artery injury and intrathoracic kidney is quite low in patients who present with blunt trauma experiencing damage. There are four defined etiologies for intrathoracic kidney, which include real intrathoracic ectopic kidney, eventration of the diaphragm, congenital diaphragmatic herniation, and traumatic diaphragmatic rupture. The traumatic intrathoracic kidney is an extremely rare case. We presented intrathoracic kidney case after traumatic posterior diaphragmatic rupture.

The protective effect of tadalafil on IMA (ischemia modified albumin) levels in experimental renal ischemia-reperfusion injury.

INTRODUCTION: To investigate the effect of the tadalafil in experimental renal I/R injury and to evaluate these changes with IMA (nonspesific early biomarker of ischemia), NO and MDA levels. MATERIALS AND METHODS: Twenty four female Wistar rats were randomly divided into 3 groups (n=8): Group I, sham; Group II, 60 min I/R; Group III, 60 min I/R plus tadalafil. Tadalafil was administered via an orogastric tube (10 mg/kg) 24 h prior to the procedure. After ischemia of the left kidney and 1 h of reperfusion, blood samples were obtained, and the kidney was removed. RESULTS: Statistically significant histopathologic changes were exist between groups, with the most severe injury was determined in group II in comparison to the others (X(2)=21,803, P=0.000). Also mean serum IMA levels were higher in group II, but not statistically significant (19.83±7.81 U/ml, 22.26±7.14 U/ml and 19.82±7.77 U/ml, P=0.613). In addition, NO values were lower in I/R groups (P=0.049). There were no differences among the groups in terms of MDA. CONCLUSIONS: IMA may be used as a nonselective biomarker for IR injury before the occurrence of necrosis. Decreased IMA levels may indicate the nephroprotective effect of tadalafil in renal IR injury.

Low magnesium levels an important new prognostic parameter can be overlooked in patients with Fournier's gangrene: a multicentric study.

INTRODUCTION: We evaluated low magnesium levels and three different scoring systems including the Fournier's Gangrene Severity Index (FGSI), the Uludag Fournier's Gangrene Severity Index (UFGSI), and the Charlson Comorbidity Index (CCI) for predicting mortality in a multicentric, large patient population with FG. METHODS: The medical records of 99 FG patients who were treated and followed up in different clinics were reviewed. The biochemical, hematological, and bacteriological results from the admission evaluation were recorded. The CCI, FGSI, and UFGSI were evaluated and stratified by survival. RESULTS: The results were evaluated for the following patients: the survivors (n = 82) and the nonsurvivors (n = 17). The magnesium level for the survivors and nonsurvivors was 2.09 ± 0.28 and 1.68 ± 0.23, respectively (p 0.004). The admission FGSI, UFGSI, and CCI scores were significantly higher in nonsurvivors (p 0.001, p 0.001, p < 0.001, respectively). The receiver operating characteristics analysis revealed that the UFGSI was more powerful than the FGSI. The hypomagnesemia, low hemoglobin and hematocrit, low albumin and HCO3 levels; high alkaline phosphatase; and the high heart and respiratory rates, an FGSI >9, rectal involvement, and a high CCI were associated with a worse prognosis. CONCLUSION: Low magnesium levels might be an important parameter for a worse FG prognosis. Monitoring the serum magnesium levels might have prognostic and therapeutic implications in patients with FG. High CCI, FGSI, and UFGSI scores might be associated with a worse prognosis in patients with FG. The UFGSI might be more powerful scoring system than the FGSI.

A rare cause of testicular metastasis: upper tract urothelial carcinoma.

Metastatic testicular cancers are rare. Primary tumor sources are prostate, lung, and gastrointestinal tract for metastatic testicular cancers. Metastasis of urothelial carcinoma (UC) to the testis is extremely rare. Two-thirds of upper tract urothelial carcinoma (UTUC) is of invasive stage at diagnosis and metastatic sites are the pelvic lymph nodes, liver, lung, and bone. We report a rare case of metastatic UTUC to the testis which has not been reported before, except one case in the literature. Testicular metastasis of UC should be considered in patients with hematuria and testicular swelling.

Increased preoperative levels of plasma fibrinogen and D dimer in patients with renal cell carcinoma is associated with poor survival and adverse tumor characteristics.

BACKGROUND AND OBJECTIVE: The relationship between renal cell carcinoma (RCC) and coagulation/fibrinolysis system has been described in several studies. The aim of this study was to investigate the role of 4 different coagulation/fibrinolysis factors on the prediction of histopathologic and survival prognosis in patients with RCC. PATIENTS AND METHODS: Data from 128 patients who underwent surgical intervention between March 2006 and January 2011 for RCC were evaluated in this prospective study. Blood samples were collected from all patients on the morning of the operation to measure the plasma fibrinogen, D-dimer, coagulation factor VII, and antithrombin 3 levels. The relationships of these factors in the demographic, clinical, and histopathologic outcomes were analyzed using the Student t, Mann-Whitney U, Kruskal-Wallis, and one-way analysis of variance tests. Receiver operating curve analyses were performed to determine the optimal cutoff level for fibrinogen and d dimer, both of which had a strong relation with the clinical and histopathologic parameters. Disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) were assessed using the Kaplan-Meier method. Multivariate Cox regression analyses (forward stepwise logistic regression) were performed to examine the independent prognostic values on survival outcomes. RESULTS: Increased plasma fibrinogen and d-dimer levels were associated with tumor size (P = 0.004 and 0.106), nuclear grade (P<0.001 and<0.001), TNM category (P<0.001 and 0.029), and metastasis (P<0.001 and 0.032). Both increased plasma fibrinogen and d-dimer levels predicted decreased DFS (P = 0.027 and 0.04), CSS (P = 0.007 and 0.043), and OS (P = 0.014 and 0.001) rates based on Kaplan-Meier analyses. Furthermore, multivariate analyses demonstrated that fibrinogen independently predicted poor DFS (hazard ratio [HR] = 2.52; 95% CI: 1.04-6.31; P = 0.029) and CSS (HR = 3.89; 95% CI: 1.13-13.40; P = 0.032), whereas d dimer had negative independent prognostic value on OS (HR = 4.01; 95% CI: 1.54-10.50; P = 0.005). CONCLUSIONS: Increased plasma fibrinogen levels accurately predict poor histopathologic and survival outcomes and may be an effective independent prognostic factor in patients with RCC. Moreover, d dimer may serve as a copredictive factor in conjunction with fibrinogen.

Clinical and radiological characteristics of patients operated in the first year of life due to ureteropelvic junction obstruction: significance of renal pelvis diameter.

OBJECTIVES: To analyze the data of our series of patients either operated in the first year of life or managed conservatively because of prenatally detected ureteropelvic junction obstruction, with particular consideration for the significance of renal pelvis diameter. METHODS: A total of 56 patients with prenatal ultrasonographic findings suggestive of ureteropelvic junction obstruction were enrolled in this study. Operated group and control group consisted of 35 and 21 patients, respectively. We compared postnatal imaging findings of patients managed either conservatively or operatively. The diagnostic accuracy of imaging studies in confirming the diagnosis of obstruction and determining the need for surgery was analyzed. RESULTS: If relative function of the involved side being <40% was accepted as the gold standard, renal pelvis diameter was found to be a statistically significant predictor of surgical intervention based on the results of receiver operating characteristic curve analysis. The critical diameter was found to be 22 mm, at which sensitivity and specificity of identifying surgical candidates were calculated to be 78.9% and 50%, respectively. In addition, if we consider that having undergone a pyeloplasty procedure is the most accurate definition of ureteropelvic junction obstruction, the critical pelvis diameter was found to be 19 mm. Renal pelvic dilation >19 mm defines obstruction that may necessitate surgical treatment with a sensitivity of 93.9% and specificity of 71.4%. CONCLUSIONS: Renal pelvis diameter may indicate the need for surgical intervention or further assessment to define clinical significance more accurately.