Distribution of Aquaporin-4 channels in hippocampus and prefrontal cortex in mk-801-treated balb/c mice.

Functional disorders of the glymphatic system and Aquaporin-4 (AQP-4) channels take part in the pathophysiology of neurodegenerative disease. The aim of this study was to describe the distribution of AQP-4 channels in the prefrontal cortex and hippocampus in a mouse model of NMDA receptor blocking agent-induced schizophrenia-like behavior model. NMDA receptor antagonist MK-801 was used to produce the experimental schizophrenia model. MK-801 injections were administered for eleven days to Balb/c mice intraperitoneally. Beginning from the sixth day of injection, the spatial learning and memory of the mice were tested by the Morris water maze (MWM) task. A group of mice was injected with MK-801 for ten days without the MWM task. Hippocampus and prefrontal specimens were collected from this group. Tissue samples were stained immunohistochemically and AQP-4 channels were examined by electron microscope. Time to find the platform was significantly longer at MK-801 injected group than the control group at the MWM task. Also, time spent at the target quadrant by the MK-801 group was shorter compared to the control group. AQP-4 expression increased significantly at MK-801 group glial cells, neuronal perikaryon, perineuronal and pericapillary spaces. In the MK-801 group, there was remarkable damage in neurons and glial cells. Increased AQP-4 channel expression and neurodegeneration at the MK-801 group induced with schizophrenia-like behavior model. MK-801 induced NMDA receptor blockade causes a decline in cognitive and memory functions. Increased AQP-4 expression at the prefrontal cortex and hippocampus to elicit and transport products of synaptic neurotransmitters and end metabolites is suggested.

Encrusted cystitis caused by corynebacterium urealyticum: a case report with novel treatment strategy of intravesical dimethyl sulfoxide

ABSTRACT Encrusted cystitis (EC) was first described as chronic cystitis with mucosal calcification in 1914 (1). It is a very rare chronic inflammatory disease presenting with dysuria, pelvic pain and gross hematuria. Voided urine contains mucus or calcified mucopurulent stone like particles. Urinalysis always reveals alkaline pH. It may be present in healthy individuals with no predisposing etiological factors (2-4). Etiologically, previous urological diseases, immunosuppression, urinary infection with urea splitting bacteria, or urological interventions resulting in bladder mucosa trauma may also be present (5, 6). In the present case report, we describe a novel treatment for EC with intravesical dimethyl sulfoxide.

Encrusted cystitis caused by corynebacterium urealyticum: a case report with novel treatment strategy of intravesical dimethyl sulfoxide.

Encrusted cystitis (EC) was first described as chronic cystitis with mucosal calcification in 1914 (1). It is a very rare chronic inflammatory disease presenting with dysuria, pelvic pain and gross hematuria. Voided urine contains mucus or calcified mucopurulent stone like particles. Urinalysis always reveals alkaline pH. It may be present in healthy individuals with no predisposing etiological factors (2-4). Etiologically, previous urological diseases, immunosuppression, urinary infection with urea splitting bacteria, or urological interventions resulting in bladder mucosa trauma may also be present (5, 6). In the present case report, we describe a novel treatment for EC with intravesical dimethyl sulfoxide.

Prognostic influence of 5 alpha reductase inhibitors in patients with localized prostate cancer under active surveillance.

OBJECTIVE: The incidence of prostate adenocarcinoma (PCa) is increased with the use of prostate-specific antigen (PSA). In the current study, we aimed to investigate the impact of 5- alpha- reductase inhibitors (5-ARI) on pathological progression in patients followed by active surveillance (AS). MATERIAL AND METHODS: Records of 69 patients with localized prostate cancer under AS (PSA ≤15 ng/mL, PSAD ≤0.20, ≤cT2c, Gleason sum ≤3+3, the number of cancer positive cores ≤3) were evaluated retrospectively. Patients were followed-up with quarterly PSA testing and semiannual digital rectal examination during the first 2 years, and semiannual PSA testing thereafter. Repeat biopsies were done annually and whenever indicated by clinical findings. Pathological progression was defined as increasing Gleason grade, number of cancer-positive cores, and/or increasing percentage of cancer in any core. RESULTS: Patients using (29/69: 42%) and not using (40/69: 58%) 5-ARI were followed for a median of 39 (IQR: 23-45) and 23.5 (IQR: 17-37.5) months, respectively. Pathological progression was observed in 32% (22/69) of the patients at a median of 25 (IQR: 18-39) months. Pathological progression was observed in 34.5% (10/29) and 30% (12/40) of the patients using and not using 5-ARI, respectively (Log-rank p=0.4151). Definitive treatment was done in 31% (9/29) and 47.5% (19/40) of the patients using and not using 5-ARI, respectively. Patients who did not use 5-ARI received definitive treatment earlier than 5-ARI users (Log-rank p=0.0342). On multivariate analysis, more than 2 cancer-positive cores (HR: 11.62) and age (HR: 0.94) were independently associated with pathological progression (p<0.05), rather than 5-ARI use (p=0.148). CONCLUSION: More than 2 cancer- positive cores at the initial biopsy was the strongest covariate associated with pathological progression; these patients should not be offered AS. There was no impact of 5-ARI use on pathological progression in AS.

Does using alprazolam during outpatient flexible cystoscopy decrease anxiety and pain?

OBJECTIVES: To evaluate the effect of pre-operative alprazolam medication on anxiety and pain in flexible cystoscopy for bladder cancer follow-up. METHODS: A total of 86 male patients who had flexible cystoscopy for bladder cancer follow-up at 6th and 9th months were included in the study. A visual analog scale (VAS) pain score and the State-Trait Anxiety Inventory (STAI) were used. The 6th (VAS-1)and 9th (VAS-2) month pain scores and 6th month STAI score (STAI-1) and, 9th month STAI score before (STAI-2a) and after alprazolam (0.5 mg) intake (STAI-2b) were compared. RESULTS: The mean age was 66.49±12.45 years. Patients were grouped by age≤65 (Group-1) and age≥66 (Group-2). Mean VAS score for VAS-1 and VAS-2 were 2.66±0.96 and 2.44±1.05, respectively (p=0.007). The mean VAS-1 and VAS-2 scores in Group 1 were 3.0±1.05 and 2.73±1.18, respectively (p=0.009). The mean VAS-1 and VAS-2 scores in Group 2 were 2.36±0.77 and 2.17±0.86 respectively (p=0.031). The differences between mean anxiety scores were all statistically significant. All STAI (1, 2a, and 2b) and VAS (1 and 2) scores in Group-1 were statistically significantly higher than Group-2. Increasing STAI score is associated with a statistically significant increase in the VAS scores in the 0.50 and 0.75 quantiles (p=0.021 and p=0.039, respectively). CONCLUSIONS: Using alprazolam before flexible cystoscopy reduces both anxiety (STAI-1 vs STAI-2b) and pain (VAS-1 vs VAS-2). Previous cystoscopy experience reduces anxiety (STAI-2a vs. STAI-2b). Elderly patients have less anxiety and pain scores than younger patients in flexible cystoscopy.

Does using alprazolam during outpatient flexible cystoscopy decrease anxiety and pain? / ¿Disminuye el Alprazolam la ansiedad y el dolor durante la cistoscopia flexible ambulatoria?

OBJECTIVES: To evaluate the effect of pre-operative alprazolam medication on anxiety and pain in flexible cystoscopy for bladder cancer follow-up. METHODS: A total of 86 male patients who had flexible cystoscopy for bladder cancer follow-up at 6th and 9th months were included in the study. A visual analog scale (VAS) pain score and the State-Trait Anxiety Inventory (STAI) were used. The 6th (VAS-1) and 9th (VAS-2) month pain scores and 6th month STAI score (STAI-1) and, 9th month STAI score before (STAI-2a) and after alprazolam (0.5 mg) intake (STAI-2b) were compared. RESULTS: The mean age was 66.49±12.45 years. Patients were grouped by age≤65 (Group-1) and age≥66 (Group-2). Mean VAS score for VAS-1 and VAS-2 were 2.66±0.96 and 2.44±1.05, respectively (p = 0.007). The mean VAS-1 and VAS-2 scores in Group 1 were 3.0±1.05 and 2.73±1.18, respectively (p = 0.009). The mean VAS-1 and VAS-2 scores in Group 2 were 2.36±0.77 and 2.17±0.86 respectively (p = 0.031). The differences between mean anxiety scores were all statistically significant. All STAI (1, 2a, and 2b) and VAS (1 and 2) scores in Group-1 were statistically significantly higher than Group-2. Increasing STAI score is associated with a statistically significant increase in the VAS scores in the 0.50 and 0.75 quantiles (p = 0.021 and p = 0.039, respectively). CONCLUSIONS: Using alprazolam before flexible cystoscopy reduces both anxiety (STAI-1 vs STAI-2b) and pain (VAS-1 vs VAS-2). Previous cystoscopy experience reduces anxiety (STAI-2a vs. STAI-2b). Elderly patients have less anxiety and pain scores than younger patients in flexible cystoscopy

OBJETIVOS: Evaluar el efecto del alprazolam preoperatorio sobre la ansiedad y el dolor durante la cistoscopia flexible en el seguimiento del cáncer vesical. Métodos Se incluyeron 86 pacientes varones en seguimiento con cistoscopia flexible por cáncer vesical a los 6 y 9 meses. Se utilizaron una escala visual analógica (EVA) para el dolor y el Formulario STAI (State-trait anxiety Inventory) de ansiedad. Se compararon los resultados de dolor al 6º (EVA1) y 9º mes (EVA2) y los resultados del formulario STAI al 6º (STAI 1) y 9º mes, antes (STAI 2a) y después de la toma de alprazolam (STAI 2b). RESULTADOS: La edad media fue de 66,49±12,45 años. Los pacientes se agruparon por edad ≤ 65 años (Grupo 1) y ≥ 66 (Grupo 2). Las puntuaciones de la EVA 1 y EVA 2 fueron 2,66±0,96 y 2,44±1,05, respectivamente (p = 0,007). La media de las puntuaciones EVA 1 y EVA 2 en el grupo 1 fueron 3,0±1,05 y 2,73±1,18, respectivamente (p = 0,009). La media de las puntuaciones EVA 1 y EVA 2 en el grupo 2 fueron 2,36±0,77 y 2,17±0,86, respectivamente (p = 0,031). Las diferencias entre las puntuaciones medias de ansiedad fueron todas significativas. Todas las STAI (1, 2a y 2b) y EVA (1 y 2) en el grupo 1 fueron superiores a las del grupo 2, con diferencias estadísticamente significativas.Una puntuación del STAI creciente se asocia con un aumento significativo de las puntuaciones de la EVA en los cuartiles 0,50 y 0,75 (p = 0,021 y p = 0,039, respectivamente). CONCLUSIONES: La utilización de alprazolam antes de la cistoscopia flexible reduce tanto la ansiedad (STAI-1 vs STAI-2b) como el dolor (EVA-1 vs EVA-2). La experiencia de cistoscopia previa reduce la ansiedad (STAI-2a vs. STAI-2b). Los pacientes ancianos tienen valores más bajos de ansiedad y dolor en la cistoscopia flexible que los pacientes jóvenes

Validity of modified early warning, Glasgow Blatchford, and pre-endoscopic Rockall scores in predicting prognosis of patients presenting to emergency department with upper gastrointestinal bleeding.

BACKGROUND: GBS, MEWS, and PER scoring systems are not commonly used for patients presenting to emergency department with GIS bleeding. This study aimed to determine the value of MEWS, GBS, and PER scores in predicting bleeding at follow-up, endoscopic therapy and blood transfusion need, mortality, and rebleeding within a 1-month period. METHODS: A total of 202 consecutive patients with upper GIS bleeding between July 2013 and November 2014 were prospectively enrolled in the study. The relationship between MEWS, GBS, and PER scores and hospital outcome, bleeding at follow-up, endoscopic therapy, transfusion need, rebleeding, and death were examined. RESULTS: The study included a total of 202 subjects, with 84 (41.6 %) females and 118 (58.4 %) males. There was a significant correlation between GBS, MEWS, and PER scores and hospital outcomes (p <0.004, p <0.001, p <0.001, respectively). A GBS score greater than 11 succesfully predicted bleeding at follow-up (p = 0.0237). GBS score's sensitivity for predicting endoscopic therapy was greater than those of other scoring systems. The discriminatory power of each scoring system was significant for predicting transfusion (p <0.0001, p = 0.0470, and p = 0.0014, respectively). A GBS score greater than 13, a MEWS score greater than 2, and a PER score greater than 3 predicted death. A PER score greater than 3 predicted rebleeding (p <0.0001). CONCLUSION: The scoring systems in question can be easily calculated in patients presenting to ED with upper GIS bleeding and may be beneficial for risk stratification, determination of transfusion need, prediction of rebleeding, and decisions of hospitalization or discharge.

[Misdiagnosis of pulmonary embolism and causes]. / Pulmoner embolide yanlis tani ve sebepleri.

INTRODUCTION: Pulmonary thromboembolism (PTE) is not only one of the prevelant diseases with a high mortality risk but also has a high ratio of delayed diagnosis and misdiagnosis. In this study, it was aimed to determine the demographical characteristics, risk factors, clinical and laboratory findings of the patients that were diagnosed as PTE at their first hospital visit and of the PE patients who were misdiagnosed at their first admission. We aimed to investigate the factors which can leads to misdiagnosis of PE, and to determine the ways to avoid misdiagnosis. MATERIALS AND METHODS: One hundred PTE patients who were admitted to University Hospital between the dates January 2007-December 2011 were included in the study. Clinical and laboratory findings of these patients were evaluated. Among these patients, 26 were misdiagnosed at their first admission but diagnosed accurately (as PTE) in our hospital and 74 were diagnosed accurately. Two groups were compared with respect to various data of the patients clinical and demographical characteristics. RESULTS: Between the two groups, there was no difference in terms of physical examination and laboratory findings. The patients with the symptoms onset was over a week ago had a higher misdiagnosis rate (p= 0.002). The patients with no risk of PTE had a higher misdiagnosis rate (p= 0.017). Misdiagnosis rate of the patients with cardiac diseases was lower (p= 0.033) According to Geneva risk score, we observed that the misdiagnosis risk was reduced in the patients with higher clinical probability (p= 0.011). CONCLUSION: In conclusion, misdiagnosis rate was found to be statistically significant in the patients with low score according to the Geneva risk classification, and whose pre-diagnosis period lasted for more than a week and with no risk factors of PTE or cardiac diseases. We are in the opinion that considering these parameters will help to reduce in misdiagnosis of pulmonary embolism cases.

Retrospective analysis of poisoning cases admitted to the emergency medicine.

BACKGROUND: We aimed herein to assess demographic, etiological, and clinical characteristics of patients presenting to our hospital's emergency department with acute poisoning. METHOD: This study included a total of 509 (0.27%) patients diagnosed with poisoning at our emergency department within a 3-year period. This was a retrospective study.  RESULTS: Seventy-one point three (n = 363) percent of the patients were female. The majority of the victims were in the 18-25 years age group (P < 0.001). The poisoning incident was for suicidal purposes in 83.7% of patients. Among the patients presenting with prescription drug poisoning, 92.9% were poisoned in a suicide attempt while 73.2% of patients presenting with poisoning with non-medical substances were poisoned accidentally. Suicidal poisonings were more common in young age group and females (P < 0.001). The most common poisoning agent was antidepressants (17.6%) followed by analgesics (12.8%), and other psychotropic drugs (6.1%). Antidepressant drugs were the most common prescription drugs taken for suicidal purposes (P < 0.001). Poisonings occurred with a single agent in 72.5% of cases and with two or more agents in 27.5% of cases.  Analysis of duration of hospital stay revealed that 52.6% (n = 60) of patients stayed in hospital for 2 days. The mortality rate was 0.4%. CONCLUSION: The majority of poisonings were with prescription drugs, for suicidal purposes, in young age group, and in females. In our study, the three most common agents causing poisoning were antidepressants, analgesics, and other psychotropic substances.

The role of the bipolar plasmakinetic TURP over 100 g prostate in the elderly patients.

BACKGROUND AND PURPOSE: Bipolar plasma kinetic (BP) transurethral resection of prostate (TURP) has been proved to be a safe and effective treatment for benign prostatic enlargement (BPE). However, the role of bipolar TURP on large prostates over 100 g compared with open suprapubic prostatectomy (SP) in elderly patients (>65 years) has not ever been studied before. PATIENTS AND METHODS: A retrospective analysis of patients' medical records between 2007 and 2012 was performed. A total of 102 patients who underwent SP (n = 44) or BP-TURP [Gyrus Plasma Kinetic™ (Gyrus ACMI, USA)] (n = 58) for obstructive lower urinary tract symptoms due to BPE were included in this retrospective study. Inclusion criteria were age ≥65 years, prostate volume ≥100 g, International Prostate Symptom Score (IPSS) ≥18, and peak urinary flow rate (PFR) ≤15 ml/s. Exclusion criteria were urethral stricture, known history of neurogenic bladder due to neural disorders, previous prostate and/or urethral surgery, bladder stone, bladder cancer, and known prostate cancer. Operation time, hospitalization, and catheter removal times were noted. Patients were re-evaluated at postoperative 3rd and 12th months. Evaluated parameters were IPSS, quality of life (QoL), simplified International Index of Erectile Function-5 (IIEF-5), PFR, post-voiding residual urinary volume (PVR). Statistical significance was set at 0.05 and all tests were two-tailed. RESULTS: Preoperative IPSS, PVR, IIEF-5, QoL, and prostate volume were not statistically significantly different between two groups except for PFR. Mean follow-up for BP-TURP and SP groups were 15.0 ± 5.8 (R: 11-38), 22.1 ± 11.2 (R: 11-59) months, respectively (p < 0.001). When compared with SP, mean catheter removal time (p < 0.001) and median hospitalization time (p < 0.001) were significantly shorter in BP-TURP group. However, mean operative time was significantly (p < 0.001) longer than SP group and also median resected material weight was significantly lower in the BP-TURP group (p < 0.001). IPSS, QoL, PFR, PVR, and IIEF-5 scores at postoperative 3rd and 12th month were not significantly different between the two groups (p > 0.05). Thirty-three patients had perioperative complications according to the modified Clavien-Dindo system. Thirteen patients (22.4 %) in BP-TURP group and 20 patients (45.4 %) in SP group had complications. In 12th month follow-up visit, four patients presented with urethral stricture, three patients (5.1 %) were in BP-TURP group, and one patient (2.3 %) in SP group (p = 0.455). All strictures were treated with internal urethrotomy. CONCLUSIONS: BP-TURP is a safe and highly effective treatment modality for BPE in the elderly patients with prostate glands over 100 g. Clinical efficacy and postoperative 12th month's results were similar to SP. Larger studies with longer follow-up are needed in order to confirm our findings.

Impact of the quadrivalent HPV vaccine on disease recurrence in men exposed to HPV Infection: a randomized study.

INTRODUCTION: Human papillomavirus (HPV) is one of the most common sexually transmitted infections and is the cause of several different diseases in men and women. Although little is known about HPV infection in men, they are also in the risk group of HPV infection and play an important role in transmitting the virus to women. AIM: To define the efficacy of the HPV vaccine through cross-immunization and its role in clearance of HPV infection, and to assess infection-associated factors in men. METHODS: This prospective randomized clinical study enrolled 171 evaluable men with genital warts between June 2009 and October 2013. After the initial treatment intervention, 91 patients were randomly assigned to receive HPV vaccine in three doses. Eighty patients were in the control (unvaccinated) group. One hundred-eleven men were single and 60 men were married. Patients who had previous treatment for pre-existing warts and medical disorders that needed chronic treatment or immunosuppression were not included in the randomization. Also 29 men with follow-up less than 12 months and incomplete vaccination were not included. MAIN OUTCOME MEASURES: The patients were assessed regarding age, condom use, marital status, number of visible genital warts, and smoking status. Post-treatment follow-up was monthly up to 12th month. RESULTS: Mean age was 34 ± 7.6. One hundred fifteen patients were smokers. For the recurrence of warts, age, smoking, vaccination status were insignificant and marital status was significant in the univariable analysis; only marital status preserved significance (HR: 2.0 CI:1.29-3.12 P = 0.002) in the multivariable analysis including vaccination status, marital status, and smoking. CONCLUSION: Among the investigated factors vaccination status was not but marital status significantly influenced wart recurrence. Married men had more recurrences in our population. Larger multicenter randomized clinical trials are lacking and seriously required to investigate the therapeutic effect of current quadrivalent HPV vaccine in genital warts.

In the cystoscopic follow-up of non-muscle-invasive transitional cell carcinoma, NMP-22 works for high grades, but unreliable in low grades and upper urinary tract tumors.

INTRODUCTION AND OBJECTIVES: Two percent of the bladder non-muscle-invasive (NMI) transitional cell carcinomas (TCC) are associated with upper urinary tract (UUT) TCC. We evaluated the role of nuclear matrix protein-22 (NMP-22) (BladderChek) test in the diagnosis of lower urinary tract and UUT-TCC. METHODS: From March 2009 to June 2011, 122 patients with bladder NMI-TCC underwent 205 control cystoscopy. A total of 95 (78 men and 17 women, mean age 60.7 years, range, 27-88) patients who were followed regularly with NMP-22 test and with follow-up cystoscopies (145 episodes; min. 1-max. 5) were included in this study. For routine monitoring of the UUT, IVU or CT urography was used once a year for high grades (HG), and once in every other year for low grades (LG). The sensitivity and specificity of NMP-22 were evaluated by ROC curves, and sensitivity, specificity, and positive and negative predictive values were calculated. Chi-square test was used for the differences between the subgroups. RESULTS: Cystoscopy and NMP-22 results of the patients included in the study revealed the sensitivity (44.4%) of the test was very low and the specificity (98.4%) was quite high (p < 0.001). Among the 10 cystoscopies where NMP-22 was negative, but cystoscopy was positive for tumor, 8 had LG and 2 had HG TCC. NMP-22 was never positive in low-grade tumors, in other words, all of the NMP-22-positive 8 tumors were high grade. On the other hand, in 20% (2/10) of the cases, NMP-22 can be negative although the tumor was high grade. Two (2.1%) HG UUT-TCC were detected in 95 patients. These 2 patients were within the 125 cystoscopies (75 patients) where both NMP-22 and cystoscopy were negative for tumor. CONCLUSIONS: Nuclear matrix protein-22 cannot detect LG TCC. However, it detects overwhelming majority of HG TCC. For this reason, positive NMP-22 test largely indicates HG TCC. NMP-22 is also not reliable in UUT-TCC, even in HG tumors.

Size of the transrectal ultrasound probe makes no difference in pain perception during TRUS-Bx under adequate local anesthesia.

INTRODUCTION AND OBJECTIVES: In the great majority of the cases, transrectal ultrasound guided prostate biopsy (TRUS-Bx) is the definitive step in the diagnosis of prostate cancer (CaP). Although this procedure is well tolerated by most patients, it can result in considerable discomfort that can effectively be overcome with local injection anesthesia. In this study, we evaluated the effect of the size (i.e., circumference) of the transrectal probe on pain during TRUS-Bx. MATERIAL AND METHODS: One hundred and seventy eligible patients who had elevated total prostate specific antigen (tPSA) and/or abnormal digital rectal examination (DRE) were included in this study. Patients (pts.) were divided into three TRUS-Bx groups; Group I: 60 pts. underwent TRUS-Bx with newer B-K Type 8808 probe (circumference 58 mm) under injectable periprostatic anesthesia, Group II: 60 pts. underwent TRUS-Bx with B-K Type 8551 probe (circumference 74 mm) under injectable periprostatic anesthesia, and Group III: 50 pts. underwent TRUS-Bx with B-K Type 8551 probe (circumference 74 mm) without local anesthesia. Periprostatic injection anesthesia was performed with 10 cc, 1% lidocaine (5 cc on each side) 10 min before TRUS-Bx. Pain was assessed using a 10-point modified visual analog scale (VAS) 15 min after the biopsy procedure. RESULTS: Three groups were homogeneous with respect to age and tPSA, and no statistically significant difference was observed in terms of mean biopsy duration between the 3 groups. Most of the patients experienced no pain to slight pain in Groups I and II, but 66% of the patients had more than moderate pain (VAS ≥ 5) in Group III with mean VAS score statistically higher than the other two groups (Group I vs. III, P = 0.0001; Group II vs. III, P = 0.0001). Mean VAS score was not statistically different between Group I and II (P = 0.126). No statistically significant difference in VAS pain perception was observed between different age categories within the Group I, II, and III. CONCLUSION: In the absence of injectable local anesthesia, larger probe (74 mm) results in much higher VAS pain perception than same size and smaller (58 mm) probe used under injectable local anesthesia. However, under injectable local anesthesia, the size (circumference) of the transrectal probe (58 mm vs. 74 mm) does not result in any different pain perception during TRUS-Bx.

A new technique--"lipocorticoplasty"--for the closure of partial nephrectomy defects and its comparison with the standard technique.

OBJECTIVE: We describe a new technique that can easily be used as a tension-free practical alternative in closing the renal defects resulting after open partial nephrectomy (PN). METHODS: A new technique (called "lipocorticoplasty") where "wrapped fatty tissue" was placed in the tumor crater to close the renal defects that occur following PN is reported in 10 consecutive patients who underwent PN between May 2006 and January 2009 (Group I). Patients were compared with equal number of consecutive patients who underwent standard open PN before January 2009 (Group II) in terms of operative time, bleeding, tumor size, drain removal time, postoperative length of stay (PLOS), complications, and functional and oncological follow-up. Postoperative follow-up included physical examination, laboratory tests, and radiological screening at 3-month intervals for the first year, at 6-month intervals for the second year, and annually thereafter. RESULTS: Mean tumor size (35.2 vs. 33.8 mm), operative time (156 vs. 165 min), bleeding (650 vs. 765 cc), drain removal time (2.8 vs. 2.5 POD), and PLOS (4.4 vs. 4.2 POD) were not statistically different between Group I and Group II, respectively. No intraoperative complications occurred. Postoperatively, transient complications without any permanent sequela were observed in 3 (1 in Group I and 2 in Group II) patients. Mean follow-up time was 16.1 months (7-26) in Group I and 19.1 months (8-36) in Group II. None of the patients had local or systemic recurrence at follow-up. CONCLUSION: Our new technique provides obvious benefits in local hemostasis, simplifies parenchymal suturing, obviates the need for coaptation of the edges of the tumor bed defect under tension, and minimizes nephron loss due to kinking and tearing of renal parenchyma in the closure of the renal defects following open renal tumor excision.

Is stent placement necessary after uncomplicated ureteroscopy for removal of impacted ureteral stones?

BACKGROUND AND PURPOSE: Ureteral stent placement after ureteroscopic lithotripsy has some advantages and disadvantages. In this randomized study, the necessity of ureteral stent placement after uncomplicated ureteroscopy for impacted ureteral stones was assessed. MATERIALS AND METHODS: Between 2005 and 2007, 60 evaluable patients were equally randomized to groups with and without stents. Patients underwent ureteroscopic pneumatic lithotripsy for ureteral stones. The operation was completed with or without stent placement according to the randomization order. Excretory urography was performed 3 months after the procedure. All stents were cystoscopically removed at the third postoperative week. Sociodemographic and clinical variables (age, sex, stone location, stone size, operative time, hospital stay, narcotic and nonnarcotic analgesic use), and postoperative complications (fever, pain delaying discharge, emergency department visit, urinary retention, stent-related irritative symptoms) were evaluated. RESULTS: Mean stone size was not significantly different in both groups. Mean operative time was significantly longer in the stent group: 30.5 +/- 9.6 vs 43.7 +/- 11.6 minutes. On the operation day and until postoperative day (POD) 5, narcotic (P = 0.004) and nonnarcotic analgesic (P = not significant) use was more frequent in the no-stent group. At POD 5 and later, although narcotic and nonnarcotic analgesic use were frequently necessary in the stent group, both were almost unnecessary in the no-stent patients. Stent-related irritative symptoms were overwhelmingly higher (10% vs 93%) in the stent group. Discharge was delayed (23% vs 10%) and unplanned emergency department visits (20% vs 10%) were exercised almost two times more commonly in the no-stent group. Stone-free rates were identical (n = 29/30; 97%) in both groups. CONCLUSION: Routine placement of a ureteral stent is not mandatory in patients without complications after ureteroscopic lithotripsy for impacted ureteral stones. Stent placement can be argued and agreed with the patients preoperatively in the light of the data presented above.

Asymptomatic retained surgical gauze towel diagnosed 32 years after nephrectomy.

Retained surgical gauze is a rare but known problem in patients who have medical history of surgery. Suspicion and evaluation of this rare condition is sometimes very difficult for the clinician because retained surgical sponges can be totally asymptomatic or can hide themselves perfectly in the plain abdominal films. For this reason clinican should excersize high rate of suspicion, should not solely depend upon plain films and should consider more sophisticated examinations like ultrasonography (US) or computerized tomography for the appropriate management of these retained sponges. We present here a very unusual and late presentation of surgically retained gauze which gave a false appearance of a kidney with decreased functional activitity in the excretory urography (EU) 32 years after nephrectomy.

Combined "periprostatic and periapical" local anesthesia is not superior to "periprostatic" anesthesia alone in reducing pain during Tru-Cut prostate biopsy.

OBJECTIVES: To evaluate, in a prospective study, the benefit of adding local periapical prostatic anesthesia to routine periprostatic infiltration to the prostate-seminal vesicle junction in a randomized fashion. Transrectal ultrasound-guided biopsy is the reference standard in the diagnosis of prostate cancer. Although well tolerated by most patients, it can be associated with discomfort. METHODS: A total of 120 consecutive evaluable patients with an elevated total prostate-specific antigen (tPSA) level, increased tPSA velocity, and/or abnormal digital rectal examination findings were enrolled. The patients were randomized into two groups. Group 1 received periprostatic infiltration of 6 mL 1% lidocaine. Group 2 received periprostatic and apical infiltration: 4 mL 1% lidocaine at the prostate-seminal vesicle junction and 2-mL infiltration at the prostatic apex 15 minutes before transrectal ultrasound-guided biopsy. Pain was assessed using a 10-point modified visual analog scale. RESULTS: The mean patient age was 63.7 +/- 1.2 years and 64.2 +/- 1.1 years, the mean tPSA level was 12.1 +/- 1.5 ng/mL and 13.6 +/- 2.7 ng/mL, the mean biopsy duration was 6.2 +/- 2.5 minutes and 6.1 +/- 2.2 minutes, and the mean visual analog scale pain score was 1.26 +/- 0.1 and 1.23 +/- 0.1 for groups 1 and 2, respectively. No statistically significant difference was observed with respect to age, tPSA level, mean biopsy duration, or pain score between the two groups. CONCLUSIONS: Periprostatic lidocaine infiltration provides local anesthesia that results in improved visual analog scale pain scores. Additional apical infiltration did not improve patient discomfort further. However, comparative evidence has indicated that increasing the time elapsed between the anesthetic infiltration and the biopsy procedure may further improve pain control.

Lack of effect of intrarectal lidocaine for pain control during transrectal prostate biopsy: a randomized prospective study.

INTRODUCTION AND OBJECTIVES: Transrectal ultrasound guided biopsy is an essential part in the diagnosis of prostate cancer. Although this procedure is well tolerated by most patients, sometimes it can result in some uneasiness. In this randomised double-blind placebo controlled study, we evaluated the effectiveness of intrarectal lidocaine during TRUS guided biopsy. MATERIALS AND METHODS: 100 consecutive eligible patients who had elevated total prostate specific antigen (tPSA) and/or abnormal digital rectal examination (DRE) were included into this study. Patients were randomised into two groups. Group I received 20 cc of 2% intrarectal lidocaine 20 minutes before transrectal ultrasound guided biopsy and Group II received same amount of serum physiologic. Pain was assessed using a 10 point modified visual analog scale. RESULTS: Mean patient age was 65.5+/-2.5 and 64.5+/-11.5 years, mean tPSA was 12.3+/-3.6 and 11.3+/-1.7 ng/ml, mean biopsy duration was 6.8+/-2.5 and 6.6+/-2.2 minutes, mean pain score during transrectal ultrasound guided biopsy was 4.8+/-2.2 and 4.4+/-2.1 in Groups I and II, respectively. No statistically significant difference was observed with respect to age, tPSA, mean biopsy duration and pain score between these groups. There was only one patient who could not tolerate the procedure at all, and he was paradoxically in the lidocaine group. CONCLUSION: The use of intrarectal lidocaine is not superior to placebo during transrectal prostate biopsy for pain control.