Comparison of intraoperative and postoperative complications based on ASA risks in patients who underwent percutaneous nephrolithotomy.

OBJECTIVE: In this study we aimed to evaluate intraoperative and postoperative complications which developed according to pre-operative American Society of Anesthesiologists (ASA) risk criteria in patients who had undergone percutaneous nephrolithotomy (PNL). MATERIAL AND METHODS: Five hundred and sixty patients who had undergone PNL between 2002 and 2014 were included in the study. Patients operated on the ipsilateral kidney, those with solitary kidney or the cases who had previously undergone more than one access were excluded from this study. Preoperative anesthesia risks were determined according to preoperative classification developed by ASA. Postoperative complications were evaluated using Clavien Complication Grading Scale. RESULTS: The mean age of the cases was 47±14 years. The 57% (n=319) of the cases were male, 241 (43%) of them were female. The average indwell time of nephrostomy catheter was 2.88±1.00 (1-8), and length of hospital stay was 4.91±1.54 (2-17) days. When the cases were assessed according to ASA risk groups, intraoperative complications were observed in 9 (5.5%) ASA I, 27 (8.6%) ASA II, and 18 (22%) ASA III patients and and distribution of the patients was statistically significant (p<0.001). When intraoperative complications were evaluated one by one, intraoperative hypotension developed in ASA I (n=3; 1.8%), ASA II (n=20; 6.4%) and ASA III (n=11; 13.4%) risk groups and this distribution (p=0.002) of patients was statistically significant. When assessed according to Clavien Postoperative Scale, postoperative complications developed (p=0.053) in ASAI (n=24; 14.7%), ASA II (n=27, 8.6%) and ASA III (n=13; 15.9%) risk groups, and this distribution of the patients was not statistically significant. In postoperative complications, Grade 3a complications developed in ASA I (n=12; 7.4%), ASA II (n=19; 6%) and ASA III (n=8; 9.8%) risk groups and this distribution was not seen to be statistically significant (p=0.485). CONCLUSION: A statistically significant difference observed regarding intraoperative complications in the groups formed according to ASA risk criteria, on Clavien Grading scale no statistically significant difference was observed as for postoperative complications. In this context, we considered that ASA risks are major risk factors for PNL operations in terms of intraoperative complications.

Are the urology operating room personnel aware about the ionizing radiation?

PURPOSE: We assessed and evaluated attitudes and knowledge regarding ionizing radiation of urology surgery room staff. MATERIALS AND METHODS: A questionnaire was sent by e-mail to urology surgery room personnel in Turkey, between June and August 2013. The questionnaire included demographic questions and questions regarding radiation exposure and protection. RESULTS: In total, 127 questionnaires were answered. Of them, 62 (48.8%) were nurses, 51 (40.2%) were other personnel, and 14 (11%) were radiological technicians. In total, 113 (89%) participants had some knowledge of radiation, but only 56 (44.1%) had received specific education or training regarding the harmful effects of radiation. In total, 92 (72.4%) participants indicated that they used a lead apron and a thyroid shield. In the subgroup that had received education about the harmful effects of radiation, the use ratio for all protective procedures was 21.4% (n=12); this ratio was only 2.8% (n=2) for those with no specific training; the difference was statistically significant (p=0.004). Regarding dosimeters, the use rates were 100% for radiology technicians, 46.8% for nurses, and 31.4% for other hospital personnel; these differences were statistically significant (p<0.001). No significant relationship between working period in the surgery room, number of daily fluoroscopy procedures, education, task, and use of radiation protection measures was found. CONCLUSIONS: It is clear that operating room-allied health personnel exposed to radiation do not have sufficient knowledge of ionizing radiation and they do not take sufficient protective measures.

Are the urology operating room personnel aware about the ionizing radiation?

ABSTRACT Purpose: We assessed and evaluated attitudes and knowledge regarding ionizing radiation of urology surgery room staff. Materials and Methods: A questionnaire was sent by e-mail to urology surgery room personnel in Turkey, between June and August 2013. The questionnaire included demographic questions and questions regarding radiation exposure and protection. Results: In total, 127 questionnaires were answered. Of them, 62 (48.8%) were nurses, 51 (40.2%) were other personnel, and 14 (11%) were radiological technicians. In total, 113 (89%) participants had some knowledge of radiation, but only 56 (44.1%) had received specific education or training regarding the harmful effects of radiation. In total, 92 (72.4%) participants indicated that they used a lead apron and a thyroid shield. In the subgroup that had received education about the harmful effects of radiation, the use ratio for all protective procedures was 21.4% (n=12); this ratio was only 2.8% (n=2) for those with no specific training; the difference was statistically significant (p=0.004). Regarding dosimeters, the use rates were 100% for radiology technicians, 46.8% for nurses, and 31.4% for other hospital personnel; these differences were statistically significant (p<0.001). No significant relationship between working period in the surgery room, number of daily fluoroscopy procedures, education, task, and use of radiation protection measures was found. Conclusions: It is clear that operating room-allied health personnel exposed to radiation do not have sufficient knowledge of ionizing radiation and they do not take sufficient protective measures.

Comparison of tumor grade and stage with nuclear factor kappa b and p38 mitogene activated protein kinase expressions in renal cell cancer.

OBJECTIVES: Renal cancer is common among urinary system cancers. Most common one is clear cell carcinoma and it makes up 60-70% of renal cell carcinomas. Invasion pathophysiology and molecular mechanisms that take part are crucial for the diagnosis, treatment and prognosis of this disease. In this study, nuclear factor kappa B (NFKB/p65) and p38 mitogene activated protein kinase, which play an important role in signal transduction system of clear cell renal carcinoma, are assessed. MATERIALS AND METHODS: We considered 40 patients who had radical nephrectomy or partial nephrectomy for renal tumor in Okmeydani Training and Research Hospital 1st Urology Clinic. Normal tissue samples of these patients were used as control group. Paraffin embedded samples of renal cancer were studied with immunohistochemistry using spesific monoclonal and polyclonal antibodies of NFKB and MAPKC Expression density was compared with tumor grade and diameter, semiquantitively. Results were assessed with Spearman correlation and Pearson chi-square tests. RESULTS: There were 28 (70%) males and 12 (30%) females in our study. Age range of patients was between 19 and 80 years, and mean age was 59.3 +/- 13.4. NFKB and p38MAPK expressions were higher in cancer specimens compared with control group (p < 0.05). Tumor diameter and grade increase were directly correlated with p65(NFKB) and p38MAPK expression (p < 0.05). CONCLUSIONS: MAPK and NFKB expression is related to tumor grade and stage. Also more studies are needed to define the relationship with lymph node metastasis, organ metastasis and survival rates.

Stem cell markers aldehyde dehydrogenase type 1 and nestin expressions in renal cell cancer.

OBJECTIVES: To identify stem cell markers aldehyde dehydrogenase type 1 (ALDH-1) and nestin expression in renal cell carcinoma (RCC). MATERIALS AND METHODS: 95 RCC patients who had radical or partial nephrectomy were included in this study. Normal renal tissue samples of the same patients were designated as the control group. Paraffin blocks of RCC patients were studied immunohistochemically. Expressions were analyzed semiquantitively. Relation of tumor grade and stage with these expressions was determined. Results were calculated with Mann Whitney U and Kruskal Wallis tests. RESULTS: There were 55 male (57.8%) and 40 (42.2%) female patients in the study. Age and sex of the patients were not correlated with their antibody expressions (p > 0.05). ALDH-1 and nestin expression was higher in cancer tissues than normal tissues (p < 0.05). Nestin expression in renal cencer tissue was inversely related with tumor stage (p < 0.05) but there was no relation with Fuhrman grade. ALDH-1 expression was correlated with tumor grade (p < 0.05) but not with tumor stage (p > 0.05). CONCLUSIONS: ALDH-land nestin expression have a role in RCC pathophysiology. There is a need to perform more studies about stem cell markers in RCC with more patients and in these future studies lymph node metastasis, distant organ metastasis and survival rates should be included.

Comparison of p38MAPK (mitogene activated protein kinase), p65 NFkappaB (nuclear factor kappa b) and EMMPRIN (extracellular matrix metalloproteinase inducer) expressions with tumor grade and stage of superficial and invasive bladder tumors.

To identify the molecular mechanisms of bladder cancer invasion pathophysiology. To assess EMMPRIN, p65NFkappaB and p38MAPK expressions which play a role in signal transmission system of muscle and non muscle invasive bladder tumors. Fifty-seven patients with non muscle invasive tumors (mean age 65.2 +/- 16.1) and 34 patients with muscle invasive tumors (mean age 62.2 +/- 20.7) were included in this study. Normal tissue from the same patients' bladders were used as control group. Patients had either TUR or radical cystectomy and paraffin sections were prepared for immunohistochemistry. Expression density was evaluated semiquantitively according to tumor grade and invasion depth. Results were compared with Mann Whitney U, Wilcoxon W, Chi Square and variation analysis tests. MAPK and EMMPRIN expression was increased according to tumor grade (p < 0.05). These expressions were also significantly higher in muscle invasive tumors than in non muscle invasive ones (p < 0.05). In normal tissue samples of both TUR and radical cystectomy materials, EMMPRIN, NFkappaB and MAPK expressions were lower than in tumor samples (p < 0.05). NFkappaB wasn't related to tumor grade/stage (p > 0.05). It can be stated that MAPK and EMMPRIN expression is related to the grade of bladder tumor and that NFkappaB positivity is not related to the grade/stage of the disease. In future positivity of lymph nodes and visceral metastasis and survival must be assessed to define the relationship with the expressions in long term follow up studies involving a larger number of patients.