Accuracy of unenhanced computerized tomography interpretation by urologists in patients with acute flank pain.

PURPOSE: The aim was to compare the findings of non-contrast computerized tomography (NCCT) evaluated by urology specialists with the findings of experienced radiologists, who are accepted as a standard reference for patients who present with acute flank pain. MATERIALS AND METHODS: Five hundred patients evaluated with NCCT were included in the study. The NCCT images of these patients were evaluated by both radiologists and urology specialists in terms of the presence of calculus, size of calculus, the location of calculus, the presence of hydronephrosis, and pathologies other than calculus, and the results were compared. RESULTS: The evaluations of urology specialists and standard reference radiology specialists are consistent with each other in terms of the presence of calculus (kappa [κ]: 0.904), categorical stone size (κ: 0.81), the location of calculus (κ: 0.88), and hydronephrosis (κ: 0.94). However, the evaluations of urology specialists in detecting pathologies other than calculus, which may cause acute flank pain or accompany renal colic, were found to be inadequate (κ: 0.37). The false-negative rate of detecting pathologies outside of the urinary system by the urology specialists is calculated as 0.86. CONCLUSION: Although the urology specialists can evaluate the findings related to calculus sufficiently with NCCT, they may not discover pathologies outside of the urinary system.

The effect of sildenafil and udenafil on testicular damage following ischemia-reperfusion injury in rats.

PURPOSE: Ischemia-reperfusion injury can cause testicular damage and phosphodiesterase inhibitors are reported to regulate antioxidant activity. We investigated the prevention of ipsilateral and contralateral testicular damage using 2 phosphodiesterase inhibitors after testicular detorsion in rats. MATERIALS AND METHODS: A total of 28 adult male rats were randomly divided into 4 groups of 7 each, including group 1-sham operation, group 2-testicular torsion and detorsion, group 3- testicular torsion and detorsion with sildenafil administration before detorsion and group 4- testicular torsion and detorsion with udenafil administration before detorsion. Tissue levels of malondialdehyde, total sulfhydryl and nitrite were evaluated, and histopathological changes in the groups were examined. RESULTS: Compared to group 1 significantly increased tissue malondialdehyde (p = 0.001), significantly decreased total sulfhydryl (p = 0.038) and insignificantly increased nitrite were found in group 2. Compared to group 2 malondialdehyde decreased significantly and total sulfhydryl increased significantly in groups 3 and 4. The decrease in nitrite was insignificant in the latter 2 groups. Histopathology revealed increased hemorrhage, congestion and edema in group 2 rats. The testicular injury score was lower in groups 3 and 4. In group 2 grades II to IV injury was detected while most specimens in treated groups showed grade II injury. CONCLUSIONS: This study indicates that intraperitoneal administration of sildenafil and udenafil efficiently suppresses radical production while decreasing histological changes after testicular ischemia-reperfusion injury.

How many times should the uroflowmetry be repeated before making a treatment decision in the elderly males?

OBJECTIVE: To investigate the effect of repeating uroflowmetry test on results of patients with or without lower urinary tract symptoms. METHODS: The prospective study was conducted at the Department of Urology, Ankara Training and Research Hospital, Turkey, from August to December 2012, and comprised 79 consecutive male patients with or without infravesical obstruction symptoms. All patients underwent uroflowmetry testing thrice on different occasions. The urinary maximum flow rate, average flow rate, voided volume (> or = 150 ml), voiding time, flow time and time to void values were evaluated. SPSS 16 was used for statistical analysis. RESULTS: The overall mean of maximum flow rate was 11.4 +/- 1.69, 12.4 +/- 1.47 and 13.7 +/- 1.44 ml/sec at the first, second and third repetition respectively (p > 0.05). The mean percentage difference in maximum flow was +8% higher between the first and second attempt, and +4% higher between the second and third attempt. The mean average flow rate, the mean voiding time and the mean flow time values were also found to have insignificantly improved. The mean voided volumes of the patients were 201 +/- 48, 209 +/- 57 and 248 +/- 61 ml, respectively (p > 0.05). The time to void decreased significantly in the second and third attempts (p < 0.01). CONCLUSION: Repeating uroflowmetry exhibits a minor improvement in maximum and average flow rates, and voided values in men, while a significant decrease was noted in time to void.

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.

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.

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.

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.

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.

The association of 5alpha-reductase II (SRD5A2) and 17 hydroxylase (CYP17) gene polymorphisms with prostate cancer patients in the Turkish population.

To date, research has led to the invention of multiple genes and their single nucleotide polymorphisms (SNPs) and environmental factors that influence the prostate cancer (PCa) pathogenesis. Therefore, the genes involved in these pathways are candidates for PCa predisposition. It is thought that polymorphisms of 5alpha-reductase II (SRD5A2) and 17 hydroxylase (CYP17) genes are likely to increase susceptibility. The aim of this study was to investigate the risk association of SRD5A2 and CYP17 gene polymorphisms in the development and progression of PCa in the Turkish population. In this study, 100 PCa patients and 105 healthy controls were studied. SRD5A2 and CYP17 gene polymorphisms were determined by real-time PCR and polymerase chain reaction-restriction length polymorphisms (PCR-RFLP) techniques. First, the AT and TT genotypes of SRD5A2 gene at codon 49 were not observed. Second, there was no significant association between the polymorphisms at codon 89 and the risk of PCa. Third, in the CYP17 gene, the A1A1 genotype is more common (46%) in cases than controls (32.4%). The odds ratios (ORs) of the A1A1 genotype was found at 1.69 (95% confidence interval [CI], 0.77-3.74) compare with the A2A2 genotype. Genotyping results of the SRD5A2 and CYP17 genes were also analyzed in relation to prostate-specific antigen (PSA) levels, Gleason score (GS), and tumor stage, but no statistically significant difference was observed (P > 0.05). Finally, we conclude that there was no evidence of an association between CYP17 (P = 0.134) and SRD5A2 (P = 0.784) polymorphism and PCa risk in the Turkish population.

Isolated renal hydatic cyst; from an unusual course to diagnosis.

An isolated renal cyst hydatic in a 65 year old man with unusual symptomatology, course and complications were presented.

Contractile responses of rabbit bladder neck to adrenaline, acetylcholine and papaverine after doxazosin treatment.

It has been demonstrated that long-term administration of doxazosin, an alpha 1 adrenoceptor antagonist, causes an up-regulation in the expression of alpha 1 adrenoceptor subtype mRNAs in the rat genitourinary tract. The aim of this study is to determine whether this up-regulation does have any effect on contractile response of rabbit bladder neck to adrenaline, acethylcholine and papaverin after long-term doxazosin treatment. Fourteen rabbits, treated with doxazosin 3 mg/kg/day p.o for 6 months, and were fed with a diet of standard laboratory rabbit chow (100 g/kg/day). Ten rabbits received the same amount of regular chow but no drug. Contractile responses of rabbit bladder neck to adrenaline acethylcholine and papaverine were measured.

Rapid communication: renal apoptosis after shockwave application in rabbit model.

PURPOSE: To identify any apoptotic effect of shockwave lithotripsy (SWL) on renal tubular and glomerular cells. MATERIALS AND METHODS: Thirty-five male New Zealand White rabbits were divided into five groups of seven rabbits each: I (control), II (sham), and III, IV, and GV (treated and sacrificed 1, 7, and 28 days after SWL, respectively). Intramuscular anesthetic agent (ketamine HCl; 20 mg/kg) and intravenous contrast medium (iohexol 300 mg of I/mL) were administered to animals in group II. The left kidneys of animals in groups III, IV, and V were exposed to 2000 shockwaves at 18 kV after administration of anesthesia and contrast medium. The animals were sacrificed on day 1, 7, or 28 after SWL, and the kidneys were removed. Apoptotic and proliferative indices of renal tubular and glomerular cells were determined by terminal deoxynucleotidyl transferase dUTP nick and label (TUNEL) and Ki-67 labeling methods, respectively, counting 1000 cells in each preparation. RESULTS: No apoptosis was detected in glomerular cells in any group. The mean apoptotic indices of the tubular cells in animals in groups I and II were 483.0 +/- 85 and 484.4 +/- 105, respectively with no significant difference between the groups. In groups III and IV, the mean apoptotic indices were 343.4 +/- 89 and 358.4 +/- 61, respectively. There were no statistically significant differences between groups III and IV and the control group. Similarly, there were no significant differences in the apoptotic indices in groups III and IV. However, the apoptotic index in group V was 821.4 +/- 57, significantly higher than in the control group. The proliferative indices of all SWL groups were lower than that of the control group. CONCLUSION: Shockwave lithotripsy has an apoptotic effect on renal tubular cells that can be detected 4 weeks after the procedures, but no apoptotic effect on glomerular cells. Treatment with SWL also attenuates the proliferation of both tubular and glomerular cells.

The prevalence of overactive bladder syndrome and urinary incontinence in a Turkish women population; associated risk factors and effect on Quality of life.

AIMS: To investigate the prevalence and risk factors of overactive bladder syndrome and urinary incontinence in Turkish women; furthermore, to assess the impact on the quality of life. MATERIALS AND METHODS: A cross-sectional, epidemiological study was carried out in women of reproductive age to define overactive bladder syndrome, urinary incontinence, ICIQ-SF score and medical care seeking. RESULTS: The women's average age was 34.4 ± 5.26 years. The prevalence of UI was 26.9%. Stress UI was the predominant form. The prevalence of UI increased with age, BMI, number of pregnancies and children delivered. The prevalence of OAB was 20.7%. Women with OAB were older and had greater number of pregnancies than women without OAB. History of nocturnal enuresis was a significant risk factor for OAB and UUI. Women with MUI had more frequent and more abundant leakage of urine. 10.7% of women sought medical care for their condition. CONCLUSIONS: Although prevalence estimates differ across studies, the available evidence indicates that UI and OAB are highly prevalent conditions among women. UI had negative effect on QoL, but only severely-affected women sought medical care. Public health and clinical management programs are needed to determine diagnosis and management of these social problems.

Overview of different scoring systems in Fournier's Gangrene and assessment of prognostic factors.

OBJECTIVE: In this study we aimed to evaluate prognostic factors for the survival of patients with Fournier's gangrene (FG), and overview different validated scoring systems for outcome prediction. MATERIAL AND METHODS: We retrospectively analyzed the data of 39 patients treated for FG in our clinic. Data were collected on medical history, symptoms, physical examination findings, vital signs, laboratory parameters at admission and at the end of treatment, timing and extent of surgical debridement, and the antibiotic treatment used. The Fournier's Gangrene Severity Index (FGSI) and Charlson Comorbidity Index (CCI) were used to predict outcome. The data were analyzed in relation with the survival of the patients. Mann-Whitney U test, chi -square test, Wilcoxon signed rank test, and Cox regression analysis were used for the statistical analysis. RESULTS: Of 39 patients analyzed, 8 (20.5%) died and 31 (79.5%) survived. The median FGSI score on admission was 2 (0-9) for the survivors and 6 (2-14) for the non-survivors (p=0.004). The median CCI scores of the survivors and non-survivors were 2 (0-10) and 6.5 (5-11), respectively (p=0.001). Except for urea, albumin and hematocrit levels, no significant differences were found between survivors and non-survivors for other laboratory parameters on admission. Lower albumin levels and advanced age were found to be associated with mortality. CONCLUSION: High blood urea, low albumin, and low hematocrit levels were associated with poor prognosis. High CCI and FGSI scores could be associated with a poor prognosis in patients with FG.

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.

Subureteral dextranomer/hyaluronic acid copolymer injection for vesicoureteral reflux in transplant candidates.

BACKGROUND AND PURPOSE: Endoscopic subureteral injection of tissue-augmenting substances has become an alternative to antibiotic prophylaxis and open surgery for the management of vesicoureteral reflux (VUR). Several injectable materials have been tried for this purpose. In this study, we tried to determine the efficacy of dextranomer/hyaluronic acid copolymer (Dx/HA) injection for the treatment of VUR in renal-transplant candidates. PATIENTS AND METHODS: A total of 21 transplant candidates (29 ureteral units; 13 females, 8 males) with a mean age of 20.2 years (range 14-26 years) underwent endoscopic correction of VUR with Dx/HA. Diagnosis of VUR was made by voiding cystourethrography. The efficacy of the treatment was assessed with voiding cystourethrography at 3 months and 1 year postoperatively. Renal transplantation with living related donor organs was performed in 11 of the 21 patients. RESULTS: Endoscopic treatment was performed without complication in all cases. Higher success rates were obtained in patients with low-grade reflux, the overall success rate in the series being 82.7%. The mean follow- up after renal transplantation was 21.8 months (range 5-45 months). In one patient, reflux recurred after renal transplantation and was treated successfully by a repeat Dx/HA injection. The urine cultures of all patients remained sterile. CONCLUSION: Transplant candidates with VUR can be treated with Dx/HA, which cured the majority of our patients after one or two treatments with few low side effects. Endoscopic subureteral injection of Dx/HA has become an alternative treatment for VUR in transplant candidates. Long-term results are needed before making a final statement about its value.

Rib resection for live-donor nephrectomy.

INTRODUCTION: Living-related kidney transplants yield more favorable results than cadaveric kidney transplant. Although multiple techniques have been described for living-related donor nephrectomy, operation is generally performed subcostally in lateral decubitis position or by an 11th or 12th rib resection. Recently laparoscopic donor nephrectomy is getting popular. The aim of this study is to determine the rib resection increase the morbidity or not. MATERIALS AND METHODS: Between 1997 and 2004 in our center 118 living donor nephrectomies were performed. 15 of these patients did not come to follow-up controls. This study consists of 103 patients: 11th rib resection (30 patients) determined as group I, 12th rib resection (52 patients) determined as group II, subcostal incision (21 patients) determined as group III. All these three groups were compared with each other according to operation time, pleural or peritoneal defect, pneumothorax, blood transfusion, wound infection, length of hospital stay, postoperative analgesic requirement, return to threshold activities and incisional hernia. RESULTS: Patients whose 11th rib was removed had the shortest operation time. But pain due to surgery continued more than others in this group of patients. The risk of developing incisional hernia was seen most in patients who had subcostal incision. In this group of patients incidence of incisional hernia was 4 (19%). None of the patients had wound infection. We also did not experience any pneumothorax and blood transfusion requirement. Peritoneal or pleural opening occurred in 4 out of 103 patients accidentally and there was no difference between groups. There was also no difference between groups in terms of returning back to daily activation. CONCLUSION: Morbidity of nephrectomy done with removal of 12th rib was less compared with other groups. Resection of 11th should be reserved for patients with high residing kidneys and also for those with a polar artery of the upper pole.

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.

Can urinary nerve growth factor and bladder wall thickness correlation in children have a potential role to predict the outcome of non-monosymptomatic nocturnal enuresis?

INTRODUCTION: Measurement of bladder wall thickness (BWTh) by ultrasound has been introduced as a new and promising technique to assess bladder dysfunction, and increased levels of nerve growth factor have also been reported in the bladder tissue and urine of patients with sensory urgency and detrusor overactivity (DO). OBJECTIVE: In this study we aimed to generate a clinically useful tool with urinary nerve growth factor levels and ultrasonographic BWTh to find possible pathogenetic clues and prognostic indicators as guides for the choice of therapy of non-monosymptomatic nocturnal enuresis. METHODS: A total of 110 children, aged 6-16 years old, were involved in this prospective study. Group 1 consisted of children with non-monosymptomatic nocturnal enuresis (n = 40), Group 2 of children with monosymptomatic nocturnal enuresis (n = 40) and Group 3 of children with healthy normal controls (n = 30). Children were evaluated with detailed history and physical examination, including neurologic examination; they were asked to complete a self-reported questionnaire and a 3-day bladder diary with the aid of their parents. The number of wet nights, the number of voids per night, the presence of daytime voiding symptoms (urgency, urge incontinence, incontinence, holding maneuvers, frequency), fluid intake, and any history of urinary tract infections (UTIs) were recorded. Monosymptomatic nocturnal enuresis and non-monosymptomatic nocturnal enuresis diagnosis was made using the International Children's Continence Society definition. Urinary nerve growth factor levels were measured by enzyme-linked immunosorbent assay and BWTh was measured transabdominally by a uroradiologist who specialized in pediatric ultrasonography. Urinary nerve growth factor levels were normalized by urinary creatinine levels and compared in all subgroups. RESULTS: The mean age of the study group was 9.6 (range 6-16) years. The mean BWTh was significantly increased in Group 1 compared with Group 2 (4.33 ± 1.12 mm, 2.33 ± 1.03 mm; p < 0.001) and healthy controls (4.33 ± 1.12 mm, 1.86 ± 0.57 mm; p < 0.001, respectively). Urinary levels of nerve growth factor corrected to urine creatinine (NGF/Cr) significantly increased in Group 1 with to Group 2 (2.75 ± 1.15 vs. 0.58 ± 0.15; p < 0.001) and controls (2.75 ± 1.15 vs.0.28 ± 0.10; p < 0.001, respectively). In receiver operating characteristic analysis, BWTh was found to have sensitivity of 95% and specificity of 85.7% (3.00 area under the curve [AUC] 0.937; 95%) and NGF/Cr had sensitivity of 97.5% and specificity of 98.6% (0.885; AUC, 999; 95%) in predicting lower urinary tract symptoms (LUTS) for non-monosymptomatic nocturnal enuresis (NMNE) (Figure). DISCUSSION: In our study we have investigated that BWTh together with urinary NGF levels normalized to the concentration of urinary creatinine (NGF/Cr) may predict daytime voiding problems in children with primary nocturnal enuresis (PNE). The main basis of this study is previous findings which demonstrated that ultrasonography (US)-based measurement of BWTh is a useful diagnostic parameter for LUTS in children, and that increased levels of NGF in bladder tissue and urine such as sensory urgency, DO, and overactive bladder (OAB) was indicated by clinical and experimental studies. The present study demonstrated that urinary NGF/Cr levels and BWTh measurements were significantly increased in patients with NMNE with daytime urinary symptoms (urgency, urge-incontinence, incontinence, frequency) showing symptoms of an OAB than controls and MNE. CONCLUSION: BWTh measurements and NGF/Cr values, as non-invasive tools, may guide therapy and improve outcomes in the treatment of children with NMNE. Further studies including a larger number of patients would be of great interest.