Comparision of Ureteral Stent Colonization Between Deceased and Live Donor Renal Transplant Recipients.

BACKGROUND: The use of a ureteral stent can cause a urinary tract infection (UTI), although it reduces urologic complications. UTIs are associated with a higher rate of ureteral stent colonization (USC). The aim of this study was to compare USC in living and deceased donor renal transplant recipients. MATERIAL AND METHODS: We conducted a prospective study of 48 patients who underwent renal transplantation between January and December 2016. The stents were removed aseptically, the inner surface of proximal and distal ends of stents were irrigated with liquid culture medium, and then they were vortexed for bacteriological investigation. Urine cultures were taken at the same time. RESULTS: A total of 45 renal transplantation patients (21 from cadavers, 24 from live donors) were evaluated in the study. The duration time of stent retention in patients with live donors was 25.04 ± 4.55 and in patients with deceased donors was 26.19 ± 4.08 days (P = .376). USC was observed in 12 (57.1%) and 6 (25%) patients while positive urine culture (PUC) was detected in 5 (23.8%) and 2 (8.3%) patients in deceased and live donor transplant recipients, respectively. Although the USC rate was significantly higher in the deceased donor renal transplant group (P = .022), there was no significant different in the rates of PUC (P = .137). Enterecoccus species was the common pathogen isolated from ureteral stent and urine. The micro-organisms isolated from ureteral stent in deceased and live donors, respectively, were distributed as follows: Enterococcus 5/3, Candida 3/1, Escherichia coli 2/1, Klebsiella pneumonia 1/1, and staphylococci in 1/0 patients. All E coli and K pneumoniae are extended spectrum beta-lactamase (ESBL)-positive isolates and resistant to sulfamethoxazole-trimethoprim (SMX/TMP). CONCLUSIONS: We report a high incidence of USC in deceased renal transplants. Enterecoccus instead of E coli is the most common pathogen during the first month after transplantation. Transplantation centers should be aware that deceased donor renal transplant recipients are more prone to stent-related infection and the antibacterial resistance rapidly increases in uropathogens.

Increased bladder apoptosis with alpha-1 adrenoceptor antagonists in benign prostatic hyperplasia.

OBJECTIVE: To determine whether preoperative usage of alpha-1 adrenoceptor antagonists (alpha-1ARA) prevents the alterations in bladder wall components due to obstruction via changing apoptotic and/or proliferative activity and provides an advantage for improvement of irritative symptoms following removal of bladder outlet obstruction. MATERIAL AND METHODS: A total of 39 patients were enrolled to the present study. According to preoperative medical treatment, patients were divided into 2 groups as preoperative untreated (n = 15) and medically treated patients with alpha-1ARA (n = 24). Apoptotic and proliferative indices of bladder wall were determined with TUNEL assay and proliferating cell nuclear antigen immunoreactivity, respectively. RESULTS: While the mean apoptotic indexes (AI) of lamina propria were 0.293 +/- 0.163 vs 0.978 +/- 0.194 in untreated and treated patients, the mean AI of myofibroblast cells were 0.10 +/- 0.06 and 0.90 +/- 0.23 in untreated and treated patients, respectively. There were statistically significant differences between lamina propria (p = 0.0067) and myofibroblast cells (p = 0.0280) AI in the two groups. However, there were no significant differences between postoperative symptom indices in preoperatively treated and untreated groups. CONCLUSIONS: alpha 1-ARA treatment might have an effect on hypertrophy and supersensitivity of bladder wall due to increased outlet obstruction via prevention of the imbalance between cell proliferation and apoptosis, providing normal homeostatic control mechanisms, through the interval between the onset of the lower urinary tract symptoms and time surgical intervention. However, further studies should be organized to demonstrate the impact of long-term alpha 1-ARA medication for post-operative significant improvement on irritative symptom index.

Urinary fibronectin levels in patients treated with intravesical bacillus Calmette-Guérin for superficial bladder cancer.

Intravesical bacillus Calmette-Guérin (BCG) has been shown to be an effective treatment for superficial transitional cell carcinoma (TCC) of the bladder, but the precise mechanism of action of BCG remains poorly understood. Fibronectin (FN), an important component of the extracellular matrix, has been found to play a role in BCG therapy. Some studies have shown that the soluble form of FN can compete efficiently with the matrix form of binding to the specific receptors on the bacteria and could consequently diminish the effect of BCG treatment. To evaluate a possible correlation between the urinary levels of FN and the efficacy of BCG therapy, we determined prospectively the urinary FN levels in 38 patients with TCC of the bladder and in 25 control subjects without malignancy matched for age and sex. All TCC patients were treated with transurethral tumor resection plus 6 weekly intravesical BCG instillations. After an average follow-up of 30 months, 8 patients (21.1%) had recurrent tumors, while 30 (78.9%) were free of tumor after intravesical BCG therapy. Urinary levels of FN in cancer patients have been shown to be significantly higher than controls (p < 0.001). These elevated levels were not decreased significantly after the operation (p > 0. 05). It was also found that the mean urinary FN levels were not statistically significant between patients with recurrence and complete remission. The data suggest that BCG-bladder tumor cell binding is not influenced by soluble fibronectin and urinary FN may not be a ideal marker for selecting patients to BCG therapy.

Do renal failure and hemodialysis have any effect on the elimination of free and total prostate-specific antigen?

OBJECTIVES: The aim of this study was first to determine the serum levels of free prostate-specific antigen (f-PSA), total prostate-specific antigen (t-PSA) and f-PSA/t-PSA ratios in patients with renal failure, and secondary, to investigate whether a significant difference between serum f-PSA and t-PSA levels consists in patients with end-stage renal disease before and after hemodialysis. METHODS: Serum concentrations of f-PSA and t-PSA were measured in 36 men with end-stage renal disease before and after hemodialysis and in 95 healthy controls. A chemiluminescent enzyme assay was used to determine the levels of f-PSA and t-PSA. RESULTS: The mean concentrations of serum t-PSA were 1.36+/-0.43 ng/ml in patients on hemodialysis and 1.08+/-0.60 ng/ml in controls. There was no significant difference in f-PSA and t-PSA levels between patients with renal failure and controls. F-PSA and t-PSA levels in patients with renal failure also showed no statistical differences before and after hemodialysis. CONCLUSIONS: The limited kidney reserve in patients with end-stage renal disease is sufficient to maintain the levels of t-PSA and f-PSA within normal ranges and hemodialysis does not alter the serum levels of different PSA forms.

Serum free and total prostate-specific antigen levels in patients with liver disease.

OBJECTIVES: To determine the effect of liver diseases on serum free prostate-specific antigen (fPSA) levels, total prostate-specific antigen (tPSA) levels, and fPSA/tPSA ratios. METHODS: Serum concentrations of tPSA and fPSA were measured in 18 men with histologically confirmed liver cirrhosis, 20 men with histologically proved chronic hepatitis, and 20 healthy men. All patients underwent a standard urologic evaluation, including history, physical examination, urine analysis, serum fPSA and tPSA determinations, and liver function tests (serum bilirubin, serum glutamic oxaloacetic transaminase, and serum glutamic pyruvic transaminase). RESULTS: Patients with liver cirrhosis had slightly lower fPSA levels than did control subjects or patients with chronic hepatitis, but these differences did not reach statistical significance. tPSA levels also were not significantly different among the three groups. CONCLUSIONS: In the presence of liver disease, despite the limited liver reserve, tPSA and fPSA are specific and reliable markers in the clinical management of prostatic diseases in this population. This result should be taken into account when serum concentrations of fPSA, tPSA, and the fPSA/tPSA ratio are evaluated in patients with liver disease.

Ratio of free to total prostate-specific antigen in patients with prostatic intraepithelial neoplasia.

OBJECTIVE: There are many reports about the effects of prostatic intraepithelial neoplasia (PIN) on serum prostate-specific antigen (PSA) level. The aim of this study was to determine the relationship between PIN and serum free PSA/total PSA (fPSA/tPSA) ratios. METHODS: We evaluated 46 patients with PIN, 15 patients with benign prostatic hyperplasia (BPH), and 16 patients with localized prostatic carcinoma (CaP) for the amount of fPSA and tPSA with the chemiluminescent enzyme assay. RESULTS: fPSA values from BPH to high-grade PIN (PIN2 and PIN3) was increased, and then a decrease was observed from high-grade PIN to CaP. fPSA was significantly different between BPH and low-grade PIN and high-grade PIN. There was no significant difference observed between BPH and CaP. tPSA values increased from BPH to CaP. tPSA was significantly different between BPH and high-grade PIN and CaP. fPSA/tPSA ratios decreased from BPH to CaP. This ratio was significantly different between CaP and BPH and low-grade PIN. There was no significant difference between CaP and high-grade PIN. CONCLUSIONS: Our results confirm that fPSA/tPSA ratio is better at discriminating between patients with CaP and those with BPH, but not between patients with CaP and those with high-grade PIN. Due to similarities between CaP and high-grade PIN, we think that decreased fPSA/tPSA ratio obtained at the time of intial diagnosis of PIN without concurrent carcinoma could be used as predictive factors to distinguish patients in whom carcinoma will be found on subsequent biopsies from those with PIN not associated with cancer on repeat biopsy.

Determination of the site of metabolism of total, free, and complexed prostate-specific antigen.

OBJECTIVES: To determine the site of metabolism of total prostate-specific antigen (tPSA), free PSA (fPSA), and complexed PSA (cPSA). METHODS: A total of 20 male patients, 50 years old or older, having a clinical indication for left and right heart catheterization were enrolled in this study. Selective blood samples were obtained from the infrarenal, infrahepatic, and suprahepatic inferior vena cava, renal vein, hepatic vein, superior vena cava, pulmonary artery, and femoral artery. cPSA concentration was accepted as the difference between tPSA and fPSA concentrations. RESULTS: We found that tPSA and fPSA concentrations in the infrarenal inferior vena cava were significantly higher than in the systemic artery. There was no significant difference between the systemic artery and the infrarenal inferior vena cava for cPSA concentration. Although fPSA concentration decreased significantly across the renal circulation, the decreases in cPSA and tPSA concentrations were statistically insignificant. In the hepatic circulation, we found that tPSA, fPSA, and cPSA concentrations were significantly decreased. No decrease in tPSA, fPSA, and cPSA concentrations were noted across the pulmonary circulation. CONCLUSIONS: Our results indicate that fPSA and tPSA are released into serum from the prostate but the prostate may not have a significant role in complex formation of PSA. In addition, the liver has a significant role in the elimination of tPSA, fPSA, and cPSA. By contrast, the kidneys have a significant role only in the elimination of fPSA. We also found that the lungs did not have a significant role in the elimination of tPSA, fPSA, or cPSA.

Morbidity associated with patient positioning in extracorporeal shock wave lithotripsy of distal ureteral calculi.

In 115 patients with 123 distal ureteral stones located below the lower border of the sacroiliac joint, in situ extracorporeal shock wave lithotripsy (ESWL) was performed with a Siemens Lithostar Lithotriptor. Our initial experience with the prone position in 8 out of 49 cases did not reveal stone fragmentation and on the final treatment sessions shock waves were allowed to enter via the obturator or sciatic foramen whilst the patients were in the supine position, in order to compare the results of treatments performed in both positions. The mean number of treatment sessions per patient, mean number of shock waves per treatment sessions, mean shock voltage per session and mean fluoroscopy time per session were significantly lower in the supine group than in the prone group (p < 0.05 for all variables). ESWL of the distal ureteral stones in the prone position seems to have an associated patient morbidity when we compare the results of treatments performed in both positions.