Erectile function after anastomotic urethroplasty for pelvic fracture urethral injuries.

There is an established association between ED and pelvic fracture urethral injuries (PFUIs). However, ED can occur after the injury and/or the urethral repair. To our knowledge, only one study of erectile function (EF) after urethroplasty for PFUIs used a validated questionnaire. This study was carried out to determine the impact of anastomotic posterior urethroplasty for PFUIs on EF. We retrospectively reviewed the computerized surgical records to identify patients who underwent anastomotic urethroplasty for PFUIs from 1998 to 2014. Those patients were contacted by phone or mail and were re-evaluated in the outpatient clinic by International Index of Erectile Function questionnaire; in unmarried men, the single-question self-report of ED was used for evaluation of EF, clinical examination and penile color Doppler ultrasonography (CDU) for men with ED. Overall, 58 patients were included in the study among whom 36 (62%) men were sexually active and the remaining 22 (38%) were single. The incidence of ED among our group is 72%. All patients developed ED after initial pelvic trauma and none of our patients had impaired EF after urethroplasty. The incidence of ED increased proportionally with severity of pelvic trauma. All patients with type-C pelvic fracture, associated symphysis pubis diastasis, sacroiliac joints diastasis and bilateral pubic ramus fractures had ED. Men with PFUIs had worse EF than men in other series with pelvic fractures without urethral injury. The majority (88%) of men with ED showed veno-occlusive dysfunction on penile CDU. So we concluded that men with PFUIs had a high incidence of ED up to 72%. Anastomotic posterior urethroplasty had no negative impact on EF and the development of ED after PFUIs was related to the severity of the original pelvic trauma. Veno-occlusive dysfunction is the commonest etiology of ED on penile CDU.

Activation of Nrf2 by ischemic preconditioning and sulforaphane in renal ischemia/reperfusion injury: a comparative experimental study.

Objectives of the study were to investigate impact of ischemic preconditioning (Ipre) and sulforaphane (SFN) and combination of them on nuclear factor 2 erythroid related factor 2 (Nrf2) gene and its dependent genes, heme oxygenase-1 (HO1) and NADPH-quinone oxidoreductase1 (NQO-1) and inflammatory cytokines TNF-alpha, IL1beta, and intercellular adhesion molecule-1 (ICAM1) and caspase-3 in renal ischemia/reperfusion (I/R) injury. Ninety male Sprague Dawely rats were classified into 5 groups (each consists of 18 rats): sham, control, Ipre, sulforaphane and Sulfo+Ipre. Each group was subdivided into 3 subgroups each containing 6 rats according to time of harvesting kidney and taking blood samples; 24 h, 48 h, and 7 days subgroups. Renal functions including serum creatinine, BUN were measured at basal conditions and by the end of experiment. Expression of Nrf2, HO-1, NQO-1, TNF-alpha, IL-1beta, and ICAM-1 was measured by real time PCR in kidney tissues by the end of experiment. Also, immunohistochemical localization of caspase-3 and chemical assay of malondialdehyde (MDA), GSH and SOD activity were measured in kidney tissues. Both Ipre and SFN improved kidney functions, enhanced the expression of Nrf2, HO-1, and NQO-1, attenuated the expression of inflammatory (TNF-alpha, IL-1, and ICAM-1) and apoptotic (caspase-3) markers. However, the effect of sulforaphane was more powerful than Ipre. Also, a combination of them caused more improvement in antioxidant genes expression and more attenuation in inflammatory genes but not caspase-3 than each one did separately. Sulforaphane showed more powerful effect in renoprotection against I/R injury than Ipre as well as there might be a synergism between them at the molecular but not at the function level.

Fate of accessory renal arteries in grafts with multiple renal arteries during live-donor renal allo-transplantation.

INTRODUCTION: To determine risk factors for and the effects of impaired perfusion (IP)-"reduced or non-perfusion"-of graft areas supplied by an accessory artery on allograft function. OBJECTIVES: One hundred five consecutive grafts with multiple renal arteries were prospectively evaluated using Doppler ultrasound (US) to detect the perfusion of allograft segments supplied by the accessory artery. We studied factors predicting and the effects of IP on graft function. RESULTS: Doppler US diagnosed IP of allograft accessory arteries in 11 (10.5%) allografts. Mean values ± standard deviations and median (range) of renographic clearance of grafts with IP were 50.5 ± 26 and 40 (range, 21-92) mL/min, while those of grafts with patent accessory arteries were 68.6 ± 18.9 and 67.2 (range 21-117; P < .01). The percentage change in renographic clearance before versus after transplantation increased among grafts with patent arteries and decreased for those with IP (P = .03). On multivariate analysis, factors predicting IP of the accessory artery were delayed graft function (odds ratio [OR] = 9.9; 95% confidence interval [CI] = 1.6-58.6; P = .01) and upper polar arteries (OR = 8.9; 95% CI = 1.8-43.4; P < .01). CONCLUSION: When considering transplants with accessory arteries, greatest attention and efforts should be exerted on upper polar arteries to avoid delayed graft function.