Gastric and Pancreatic Ectopic Mucosa in the Gallbladder: A Unique Mimicker of Polypoid Lesions.

A 46-year-old woman with upper quadrant pain and nausea, diagnosed with cholelithiasis, underwent cholecystectomy. A 0.7 cm polypoid lesion in the gallbladder showed mostly heterotopic gastric mucosa with antral and oxyntic glands and foveolar epithelium. A focal area of the heterotopic pancreas, comprising acini and ducts with positive trypsin staining but no islet cells, was found. Additional findings included minimal inflammation, an adenomyoma on the opposite wall, and black gallstones, leading to a diagnosis of a heterotopic polyp. This case underscores the importance of thorough histopathological examination in diagnosing rare heterotopic tissues in the gallbladder, preventing misdiagnosis with malignant entities.

Correlation of Postoperative Outcomes According to the Amount of Prostatic Tissue Removed in Patients Undergoing Transurethral Resection of the Prostate.

OBJECTIVE: The present study assesses the effect of the proportion of tissue resected during transurethral resections of the prostate (TUR-P) on lower urinary tract symptoms (LUTS) and other parameters in patients with a benign prostatic obstruction (BPO). MATERIALS AND METHODS: Forty-three patients who underwent TUR-P between 2018 and 2021 were assessed prospectively. The patients were divided into two groups according to the percentage of tissue removed (group 1 <30%, group 2 >30% resection). Age, prostate volume, amount of resected tissue, operative time, length of hospital stay, duration of catheterization, International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum urinary flow rate (Qmax), and serum prostate-specific antigen (PSA) (ng/dl) at preoperative and postoperative three months were recorded. RESULTS: The percentage of tissue removed was 22.2% vs. 48.4% (p = 0.001), IPSS reduction was 77.7% vs. 83.3% (p = 0.048), QoL improvement was 77.2% vs. 84.8% (p = 0.133), Qmax increase was 171.3% vs. 193.5% (p = 0.032), and serum PSA decrease was 56.4% vs. 69.2% (p = 0.049) in groups 1 and 2, respectively. In addition, the operative time was 38.5 vs. 53.6 min (p = 0.001), the length of hospital stay was 2.0 vs. 2.4 days (p = 0.001), and the duration of catheterization average was 4.1 vs. 4.9 days (p = 0.002). CONCLUSION: Resections of at least 30% of prostatic tissue can provide a significant improvement in the symptoms and parameters related to benign prostatic obstruction, while resections of less than 30% of prostatic tissue can effectively reduce urinary symptoms and improve the quality of life in older adult patients with comorbidities who require shorter operating times.

Clinical Outcomes of Prostatic Artery Embolization in Patients with Benign Prostatic Hyperplasia: A Prospective Clinical Study.

OBJECTIVE: To determine the clinical outcomes of prostatic artery embolization applied to patients with Material and methods: The study includes 30 patients diagnosed with benign prostatic hyperplasia in the urology clinic between 2012 and 2016, for whom anesthesia was contraindicated due to advanced age and comorbidities and who underwent prostatic artery embolization. These patients were evaluated before the procedure and in the 1st, 3rd, 6th, and 12th months after the procedure. RESULTS: The mean prostate volume of the patients was 68 cm3 before the procedure and 45 cm3 12 monthsafter the procedure. A statistically significant decrease was observed (P = .001). The mean prostate-specific antigen value was 4.9 ng/dL before the procedure and 2.8 ng/dL 12 months after the procedure (P = .008). The mean Qmax value was 0 mL/s before the procedure and 12 mL/s 12 months after the procedure (P = .001). The mean international prostatic symptom scores value was 35 before and 16 twelve months after the proce-dure (P = .001). While the international index of erectile function value was 8.25 before the procedure, it was8.46 12 months after the procedure (P = .32). The quality of life index value was measured as 3.02 before theprocedure and 3.09 twelve months after the procedure; a statistically significant difference was determined (P = .027). CONCLUSION: Prostatic artery embolization, which is a minimally invasive procedure, can be applied as a safe and effective method to patients with benign prostatic hyperplasia who cannot tolerate anesthesia due to advanced age and comorbidities.

Influence of COVID-19 pandemic on sexuality: a cross-sectional study among couples in Turkey.

Coronavirus disease 2019 (COVID-19) pandemic has been continuing to affect the lives of all people globally. It has been shown that restrictions due to changes in lifestyles lead to mental health problems. This study aims to investigate the effect of COVID-19 pandemic on couples' sexuality. A total of 245 volunteers (148 men and 97 women) were enrolled in the study. Generalized Anxiety Disorder-7, Patient Health Questionnaire, Perceived Stress Scale were administered to screen anxiety and depression symptoms. International Index of Erectile Function (IIEF-15) and Female Sexual Function Index (FSFI) along with self-constructed sexual behavior questionnaire were administered to participants, in order to evaluate sexual functions and behavioral changes during the pandemic. Sexual function scores (IIEF erectile function domain and total FSFI) during pandemic (24.55 ± 5.79 and 24.87 ± 7.88, respectively) were lower compared to the prepandemic period (26.59 ± 4.51 and 26.02 ± 6.22, respectively) (p = 0.001 and p = 0.027, respectively). During pandemic compared to prepandemic period, the frequency of sexual intercourse decreased in men (p = 0.001) and women (p = 0.001) while sexual avoidance and solitary sexual approach behaviors (masturbation or watching sexual content videos, etc.) increased in men (p = 0.001) and women (p = 0.022). However, the couples that spent more time together during the pandemic reported better sexual function scores (men; p = 0.001, women; p = 0.006). Although this is the first study evaluating couples from Turkey with a convenience sample, further studies with a greater number may better elucidate the effects of this pandemic on sexuality.

Comparison of the patient's satisfaction underwent penile prosthesis; Malleable versus Ambicor: Single center experience.

OBJECTIVE: To compare the surgical results, complications, and satisfaction levels of patients who underwent malleable penile prosthesis implantation (M-PPI) and Ambicor penile prosthesis implantation (A-PPI). MATERIAL AND METHODS: One hundred forty two patients who underwent penile prosthesis implantation [M-PPI (Promedon- Tube®, Cordoba, Argentina): 81, and A-PPI (American Medical Systems, Minnesota, USA): 61] between 2013-2018 were evaluated retrospectively. Patients' age, body mass index, smoking history, etiological factors, modified "Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) Questionnaire" scores, shortening of the penis, and complications were recorded. RESULTS: The patients who performed A-PPI implantation were younger (56.27 ± 10.81 vs. 51.47 ± 11.79, p = 0.009). The EDITS scores of 31(38.2%) patients who underwent M-PPI and 44 (72.4%) patients who underwent A-PPI were available. It was observed that the scores on the following questions were statistical significantly higher in the A-PPI group: "Overall, are you satisfied with your penile prosthesis?, How much of your expectations did penile prosthesis meet?, How often do you use your penile prosthesis?" (p = 0.05, p = 0.048, p = 0.038). No difference was observed between the groups in terms of the scores on the other three questions (p = 0.447, p = 0.326, p = 0.365). A 61.3% of patients in MPPI (19/31) group, and 56.8% of patients in A-PPI (25/44) group stated penile shortening (p = 0.417). Mean shortening was reported as 2.1 ± 0.45 cm, and 2.12 ± 0.52 cm, in M-PPI and A-PPI groups, respectively (p = 0.90). CONCLUSION: It is remarkable that the patients who underwent A-PPI experienced higher satisfaction with their prosthesis. Even though it has not been evidenced in the current literature data, patients who have had either M-PPI or A-PPI should be informed about the risk of penile shortening.

Thermochemotherapy in adjuvant treatment of primary high risk non muscle invasive bladder cancers: Single center results.

OBJECTIVE: To evaluate the results of Thermochemotherapy in adjuvant treatment of primary high risk non-muscle invasive bladder cancer in our center. METHODS: The study included 26 patients with an age of 51-78 years (mean: 62.4 years). All patients had transurethral tumor resection (TURB) after being diagnosed with a primary bladder tumor and were pathologically diagnosed with non-muscle invasive urothelial carcinoma. Thermochemotherapy (TCT) applications were performed via the Synergo® system SB-TS 101. RESULTS: Of the study participants, 13 patients had T1 Grade III, six patients had T1Grade III CIS (+), four patients had Ta Grade III, and three patients Ta Grade II multiple > 5 cm tumor. In all patients, six weeks plus six months protocol were completed. All patients completed the follow-up protocol. With a median follow-up time of 16.4 months (range: 6 - 48 months), recurrent urothelial carcinoma was identified in three patients. With a median follow-up time of 16.4 months, the recurrence-free survival was 88.4% in 26 patients included in the study. CONCLUSIONS: The obtained data suggest that the TCT method can be used effectively and safely in non-muscle invasive bladder cancers of primary high-risk. Prospective randomized studies will shed light on this subject which are BCG vs TCT in primary high risk patients and second course BCG vs TCT in the BCG insufficient patients.

When routine D-J implantation necessary during PNL? / ¿Cuándo es necesaria la colocación rutinaria de catéter doble J durante la efrolitectomía percutánea?

OBJECTIVE: We investigated the characteristics of patients who underwent Double-J catheter (D-J) implantation, the risk factors for prolonged urine leakage (PUL), and prediction of patients who require medical treatment. METHODS: The data of 535 adult patients who underwent PNL due to kidney stone disease between January 2005 and December 2011 in our clinic were analyzed retrospectively. Patients were divided into 2 groups: Group 1 (n=77) (14.39%) included patients with Double-J catheter due to prolonged (> 24 h) urinary leakage and Group 2 (n=458) (85.61%) patients without urinary leakage. RESULTS: The mean stone burden was 951.94 ± 539.09 mm2 in Group 1, and 676.35 ± 296.65 mm2 in Group 2 (p < 0.05). DJ catheter was implanted in 11.33% of the patients with stone burden below 1000 mm2 versus in 51.21% of the patients with stone burden above 1000 mm2. In Group 1, the number of patients with two or more accesses performed was 18.18%, whereas in Group 2 it was 8.5% (p <0.05). Among all patients, DJ implantation was performed in 13.07 % of patients with a single access versus 26.41% of patients with two or more accesses. Also, DJ catheter was implanted in 41.46% of patients with residual stones versus 12.14% of stone-free patients. Three patients with stone burden above 1000 mm2, two or more accesses, and residual stone, all of them required DJ implantation. CONCLUSION: DJ implantation due to PUL had approximately 5-fold increase stone burden above 1000 mm2, 2-fold increase in patients undergoing two or more access and 3-fold increase in patients with residual stones. Therefore, we think that the D-J implantation is highly advisable in case of a stone load above 1000 mm2, two or more accesses, and in patients with residual stones

OBJETIVO: Investigamos las características de los pacientes sometidos a colocación de catéter doble J (DJ), los factores de riesgo de fuga urinaria prolongada y la predicción de qué pacientes requieren tratamiento medico. MÉTODOS: Analizamos retrospectivamente los datos de 535 pacientes adultos sometidos a nefrolitectomía percutanea (NLPC) entre Enero del 2005 y Diciembre del 2011 en nuestra clínica. Los pacientes fueron divididos en dos grupos: El Grupo 1(n=77) (14,39%) incluía pacientes con catéter doble J debido a fuga de orina prolongada (>24h) y el Grupo 2 (n=458) (85.61%) pacientes sin fuga urinaria. RESULTADOS: La carga litiásica media fue de 951.94 ± 539.09 mm2 en el Grupo 1, y 676.35 ±296.65 mm2 en el Grupo 2 p < 0.05). Se colocó catéter doble J en el 11,33% de los pacientes con una carga litiásica menor de 1000 mm2 frente al 51,21% de los pacientes con una carga superior a 1000 mm2. En el Grupo 1, el número de pacientes con dos o más accesos realizados fue de 18,18%, mientras que en el grupo 2 el 8,5% (p <0.05). De todos los pacientes, se colocó DJ en el 13,07% con un único acceso en comparación con el 26,41 de los pacientes con dos o más accesos. También se colocó DJ en el 41,46% de los pacientes con litiasis residual frente al 12,14% de los pacientes sin cálculos residuales. Tres pacientes con los tres factores, una carga residual mayor de 1000 mm2, dos o más accesos y cálculos residuales requirieron colocación de DJ. CONCLUSIONES: La colocación de un catéter doble J debido a la fuga urinaria prolongada es unas 5 veces más frecuente en pacientes con una carga litiásica superior a 1000 mm2, 2 veces en pacientes sometidos a dos ó más accesos y 3 veces en pacientes con cálculos residuales. Por lo tanto, pensamos que la colocación del DJ es altamente aconsejable en caso de carga litiásica superior a 1000 mm2, dos o más accesos y en el paciente con cálculos residuales

Chemical cystitis developed in experimental animals model: Topical effect of intravesical ozone application to bladder.

AIMS: To demonstrate the effects of intravesical ozone treatment on inflammation and epithelial cell damage in chemical cystitis animal model. MATERIALS AND METHODS: A total of 30 New Zealand rabbits were divided into six groups. Cystitis was conducted with transurethral intravesical hydrochloric acid instillation on the subjects in Groups IA, IB, IIA, and IIB. Then, Group IA-IB subjects were transurethrally administered intravesical ozone therapy twice a week, while Group IIA-IIB subjects were only given intravesical isotonic NaCl instillation. Group IIIA-IIIB subjects were administered intravesical isotonic NaCl instillation without conducting chemical cystitis in order to create the same stress. Treatment schemes of all groups were arranged in the same manner. Following a 3-week (early period) and 6-week (late period) therapy, the rabbits were sacrificed and histopathologic investigations were carried out in order to demonstrate changes in the urinary bladder. RESULTS: In our study, we observed that the basal membrane and mucosal integrity were maintained, inflammatory cells were suppressed in Group IA-IB (Early and late period), which received ozone therapy. However, it was also observed that mucosal integrity was spoiled, numerous inflammatory cells were accumulated in Group IIA-IIB, which was administered isotonic NaCl. CONCLUSION: Due to its low cost and minimal side effects; ozone therapy could be a new therapeutic approach in the treatment of interstitial cystitis.

Comparison of the complications and the cost of open and laparoscopic radical nephrectomy in renal tumors larger than 7 centimeters.

PURPOSE: To compare the complications and the cost analysis of open radical nephrectomy (ORN) versus laparoscopic radical nephrectomy (LRN) in patients with renal tumors larger than 7 centimeters (cm). MATERIALS AND METHODS: A retrospective analysis was performed in 173 patients (ORN group, n = 140; LRN group, n = 33) who underwent surgery for kidney tumors between 2008 and 2011. Patients' age, tumor size, pre-operative surgical risk score (American Society of Anesthesiologists score), duration of hospitalization, complications and the costs of hospitalization were recorded. The complications in ORN group and LRN group were specified with Modified Clavien System in five grades. RESULTS: The mean age was found 58.52 ± 13.74 years in ORN group, and 58.15 ± 12.81 years in LRN group (P = .847). Post-operative pain necessitating analgesics was observed in all patients (100%) after early post-operative period in both groups (Grade 1 complications). Blood transfusions were required in 51 patients (36.42%) in the ORN group, and 7 (21.21%) patients in the LRN group (Grade 2 complications) (P = .185). Grade 3 complication was not observed in each groups. Grade 4 complications were occurred in 6 (4.28%) patients [aortic injury, acute tubular necrosis, the need for dialysis, respiratory arrest (2), atrial fibrillation] in the ORN group, and in 1 (3.03%) patient (pulmonary embolism) in the LRN group. Grade 5 complication was occurred in 1 (0.71%) patient (death) in the ORN group. By the cost analysis, the average cost of ORN group was €1328, whereas €1508 in LRN group (P < .05). CONCLUSION: Laparoscopy is used in many clinics with an increasing frequency because of the improved patient comfort, better cosmetic results, less post-operative pain, lower transfusion rates, and early return to the daily activities. Besides these advantages, the negligible difference in the costs compared to the open surgery (mean difference = €180 per case) makes it even more attractive.

Comparing of different methods for prevention stone migration during ureteroscopic lithotripsy.

AIM: To compare the effectiveness of Stone Cone™, PercSys and lidocaine jelly instillation to prevent stone migration during ureterorenoscopy (URS). MATERIALS AND METHODS: One hundred patients who underwent URS for proximal ureteral stones between 2007 and 2012 were evaluated prospectively. The patients were divided into four groups consecutively. The control group (Group I) consisted of the 25 consecutive patients, in whom no device or method was used to prevent stone migration. Group II consisted of 25 patients treated with the Stone Cone, group III consisted of 25 patients treated with PercSys, and group IV consisted of 25 patients treated with lidocaine jelly instillation. RESULTS: The migration rates were 4.5% in group II, 8.7% in group III, 21.7% in group IV, and 31.8% in group I. The migration rate was found to be statistically significantly lower in the groups treated with the Stone Cone and PercSys compared to the control group (p = 0.014, p = 0.048). However, there was no statistically significant difference between the lidocaine jelly group and the control group in terms of migration rates (p = 0.444). CONCLUSIONS: Our results suggested that the Stone Cone and PercSys were the most successful methods with significantly low migration rates (4.5 and 8.7%, respectively).

Comparison of demographic data in patients undergoing Percutaneous Nephrolithotomy in Southeastern Anatolia and the Black Sea region: A multicenter study.

OBJECTIVE: The aim of this study was to compare demographic data in adult patients undergoing percutaneous nephrolithotomy (PNL) for kidney stone disease in university hospitals from Southeastern Anatolia and the Black Sea regions. MATERIAL AND METHODS: The demographic data of 535 (53.3%) patients undergoing PNL from Gaziantep University, Department of Urology (GAUN group), and 468 (46.6%) patients undergoing PNL from Ondokuz Mayis University, Department of Urology (OMU group) were evaluated retrospectively. Patients' gender, mean age, stone laterality, and size and results of the stone analyses were compared. RESULTS: The mean patient ages were 40.94±13.33 (17-81) and 48.03±13.95 (17-81) years in the GAUN and OMU Groups, respectively, (p=0.0001). The mean stone size was 716.01±449.60 (100-3000) mm(2) and 612.7±445.87 (65-3220) mm(2) in the GAUN and OMU Groups, respectively (p= 0.0001). There were no statistically significant differences between the groups with respect to stone laterality (p=0.196), and gender of the patients (p=0.65). Stone analysis revealed that the distribution of stone composition was as follows in the GAUN group: Ca oxalate (90.19%), cystine (7.84%), uric acid (5.88%), and struvite (1.96%). In the OMU group, the stone composition was as follows: Ca oxalate (86.84%), cystine (1.34%), uric acid (13.15%), and struvite (9.21%). CONCLUSION: The incidence of kidney stone disease varies throughout Turkey based on etiological factors, and a higher incidence of kidney stone disease is observed in the Southeastern Anatolia region endemically. Lower mean ages and higher stone sizes in patients undergoing PNL in southeastern Anatolia suggest that geographic factors can affect stone disease.

Reliability of percutaneous nephrolithotomy in pediatric patients: comparison of complications with those in adults.

PURPOSE: To assess the reliability of percutaneous nephrolithotomy (PNL) in pediatric patients by comparing complications between pediatric patients and adults by use of the modified Clavien grading system. MATERIALS AND METHODS: The data of 74 pediatric (0 to 16 years) and 535 adult (17 years and older) patients who underwent PNL owing to kidney stone disease between January 2005 and December 2011 were analyzed retrospectively. The complications in the pediatric and adult patients were classified in five grades according to the modified Clavien system. RESULTS: The most frequent cause of grade I complications was fever requiring antipyretics, which was seen in 4 pediatric patients (5.4%) and 30 adult patients (5.6%). Grade II complications (blood transfusions, <12 hours urinary leakage) were observed in 11 pediatric patients (14.8%) and 80 adult patients (14.9%). Grade III complications were also seen in 6 pediatric patients (8.1%) (grade IIIb; D-J catheter implantation under general anesthesia) and 78 adult patients (14.5%) (grade IIIa; D-J catheter implantation and angio-embolization under local anesthesia). There was no statistically significant difference between the two groups in terms of grade I, II, or III complications (p>0.05). Colonic injury occured in one patient (1.3%) in the pediatric group (grade IVa). In the adult group, one patient (0.2%) died as the result of myocardial infarction (grade V). CONCLUSIONS: Thanks to technological developments and minimalization of the equipment used, when indicated, pediatric patients can be safely treated with PNL with low complication rates similar to those in adult patients.

Comparative outcomes of plasmakinetic versus monopolar transurethral resection of benign prostatic hyperplasia: 7 years' results.

OBJECTIVE: We compared results from the standard monopolar or the bipolar plasmakinetic method for the transurethral resection of the prostate (TURP) due to benign prostatic hyperplasia (BPH) at 4 and 7 years after surgery (medium to long term). MATERIAL AND METHODS: A retrospective analysis was performed on the complete data from 124 patients who were alive and had 7 years of regular follow-up. Of those 124 patients with BPH, 65 (52%) underwent monopolar TURP (M-TURP) and 59 (48%) underwent plasmakinetic TURP (P-TURP). During the follow-up period, the International Prostate Symptom Score (IPSS), the maximal flow rate (Qmax) measured using uroflowmetry and the prostate specific antigen (PSA) values were recorded. Patients in whom alpha blockers were administered due to the growth of postoperative adenoma and who had been operated on due to urethral stricture, bladder neck contracture or a growing adenoma were also noted and recorded. RESULTS: There was no statistically significant difference between M-TURP and P-TURP groups in any pre-operative or post-operative follow-up parameter at 4 or 7 years post-surgery. Specifically, PSA, IPSS and Qmax values; urethrotomies performed; alpha-blocker use; and the frequency of re-operations were statistically insignificant (p>0.05). CONCLUSION: Our study demonstrated that when medium-to long-term results are compared, P-TURP and M-TURP appear to result in similar IPSS scores, Qmax values, complication rates and retreatment rates. Larger prospective studies are required to corroborate these results.

Transvaginal repair of unrecognized bladder injury after transobturator tape surgery.

Currently, minimally invasive surgeries, which are often characterized by reliable and successful results, are preferred for the treatment of stress urinary incontinence. Although all of the currently used surgeries are minimally invasive, morbidities, including hemorrhage, voiding dysfunction, infection, pain, skin infection and erosion, and bladder injuries, are observed. We detected bladder injury in a 42-year-old female patient with complaints of burning and pain during urination who had previously undergone transobturator tape (TOT) surgery. Complete abdominal hysterectomy for a secondary myoma and a TOT procedure had been simultaneously performed 3 months prior to her presentation. Cystoscopy demonstrated a foreign body compatible with sling material in the bladder which was extracted transvaginally.

Analysis of changes in the glomerular filtration rate as measured by the cockroft-gault formula in the early period after percutaneous nephrolithotomy.

PURPOSE: We aimed to analyze the changes in kidney function during the postoperative early period caused by the application of percutaneous nephrolithotomy (PNL), which is commonly used in kidney stone surgery. MATERIALS AND METHODS: PNL was performed in 80 patients (48 men, 32 women) with kidney stones. The mean age of the patients was 43.71 years (range, 18 to 71 years). Preoperative and postoperative values for stone size, glomerular filtration rate (GFR), serum creatinine, urea, electrolytes (Na, K, Cl), and Hb were compared in 80 patients in whom PNL surgery was performed. The formula of Cockroft-Gault was used to calculate the GFR during the early postoperative period (72 to 96 hours). RESULTS: Statistically significant decreases after PNL were observed in average stone size (preoperative, 627.75±375.10 mm(2); postoperative, 81.70±16.15 mm(2)), serum urea (preoperative, 38.40±17.26 mg/dl; postoperative, 33.28±16.98 mg/dl), and creatinine (preoperative, 1.03±0.53 mg/dl; postoperative, 0.97±0.55 mg/dl) and an increase was observed in GFR (preoperative, 104.30±37.30 ml/min; postoperative, 112.38±40.1 ml/min). No changes were detected in the serum electrolyte values (Na, K, Cl). Multiple access, operation time, and type of lithotripter did not have any significant effects on the change in the GFR. CONCLUSIONS: In light of our results, PNL for kidney stone operations appears to be a reliable and efficient method that provides recovery of kidney functions in the early post-operative period by increasing the GFR and with high stone-free rates.

The use of artificial neural networks in decision support in vesicoureteral reflux treatment.

AIM: To develop a prediction model based on artificial neural networks (ANN) for the treatment selection in vesicoureteral reflux (VUR). METHODS: A total of 96 children with VUR (145 ureteric units (UU)) were treated at our institution during 2004-2006. An ANN based on quick propagation architecture was created with the commercially available software package. The patients' age and sex, the cause and grade of VUR, the affected ureter, the type of treatment (conservative, subureteric injection, or open surgery), existence of renal scar on DMSA, follow-up times and the number of injections were used as variables. These data were also transferred to a statistical software package and regression analysis was done. RESULTS: In all, 105 UU showed no reflux, 5 UU showed improvements in reflux grade (considered only in the conservative management group), and the remaining 35 UU showed persistence. In the training group (n = 99), ANN showed 98.5% sensitivity, 92.5% specificity, 97% positive predictive value, and 96% negative predictive value in predicting treatment outcome. CONCLUSIONS: We have demonstrated that ANN can accurately predict the resolution of VUR, and thus could be useful in daily clinical practice. This approach would allow urologists to aid in the decision-making process of VUR treatment.

Primary synovial sarcoma of the kidney: use of PET/CT in diagnosis and follow-up.

Primary renal synovial sarcoma is a rarely seen renal neoplasm. An experienced uropathologist is needed to make the pathological diagnosis. A patient, operated on with a prediagnosis of renal cell carcinoma, the pathology of which was reported as synovial sarcoma, is presented in this article. 18F-fluoro-deoxyglucose positron emission tomography and computed tomography were performed preoperatively and in the postoperative follow-up to detect the primary tumor and lymph node metastases.

Verapamil prevents the apoptotic and hemodynamic changes in response to unilateral ureteral obstruction.

INTRODUCTION: Obstruction of the urinary tract has marked effects on renal blood flow, glomerular filtration rate (GFR), and tubular function. Moreover, ureteral obstruction results in an injury response that can progress to irreversible renal fibrosis and tubular atrophy by apoptosis. METHODS: We examined the effect of a calcium channel blocker (verapamil) on renal functions and the abundance of apoptotic (p53, Fas, proliferating cell nuclear antigen [PCNA]) markers 1 week after Unilateral Ureteral Obstruction (UUO). RESULTS: Immunohistochemistry studies revealed that UUO was markedly associated with up-regulation in the expression of p53 (1550 +/- 82 vs 100 +/- 23%), Fas (657 +/- 48 vs 100 +/- 31%), and proliferating cell nuclear antigen (945 +/- 70 vs 100 +/- 17% of sham levels). Administration of verapamil normalized the up-regulation of apoptotic markers p53 (724 +/- 116 vs 1550 +/- 82%); Fas (162 +/- 38 vs 657 +/- 48%) and PCNA (353 +/- 54 vs 945 +/- 70%). Furthermore, tubular diameter, as an important marker for detecting tubular atrophy was significantly decreased compared to those in UUO rabbits. The percent area of interstitial fibrosis in UUO kidneys was significantly greater than that in Verapamil-treated kidneys. Importantly, Verapamil reduced the development of interstitial fibrosis in UUO rabbits. We measured the GFR and renal blood flow in UUO. Short-term Verapamil challenge partially prevented the decrease in GFR (non-treated UUO: 62 +/- 14; Verapamil + UUO: 119 +/- 7; Sham: 127 +/- 23 microL x min(-1) x kg body wt(-1), P < 0.05) and renal blood flow (non-treated UUO: 1.1 +/- 0.4; Verapamil + UUO: 5.0 +/- 0.2; sham: 6.3 +/- 0.2 mL x min(-1) x kg body wt(-1), P < 0.05). CONCLUSION: Verapamil significantly prevents impairment in renal function and also prevents the up-regulation of p53, Fas, and PCNA during UUO, demonstrating a marked renoprotective effect of Verapamil treatment in conditions with urinary tract obstruction.

Verapamil attenuates renal tubular apoptosis in response to partial unilateral ureteral obstruction.

INTRODUCTION: Partial unilateral ureteral obstruction (PUUO) is the type of obstruction that is most often encountered in pediatric clinical practice. The majority of our knowledge on PUUO has been derived from experimental studies and the effects of PUUO on the kidney have still been a source of continual investigation. MATERIAL AND METHODS: In the present study, renal expression of p53, Fas and PCNA were examined in rabbits with long-term (4 weeks) partial obstruction. Additionally, the effect of calcium channel blocker on pronounced apoptotic changes were evaluated. RESULTS: Immunohistochemistry results revealed that PUUO for 4 weeks caused an upregulation of p53 to 55.2 +/- 2% and Fas to 30.1 +/- 1.1%, whereas verapamil challenge attenuated the expression of these two apoptotic markers (p53: 15.9 +/- 1.8%; Fas: 18.2 +/- 1.4%, p < 0.05). Importantly, PCNA activity was also increased in response to PUUO. However, verapamil treatment after onset of obstruction caused a markedly decrease in the expression of PCNA (42.9 +/- 10.8% vs. 9.6 +/- 2.1%, PUUO, PUUO + verapamil; respectively, p < 0.05). CONCLUSION: The expression of p53, Fas and PCNA molecules is associated with long-term partial ureteral obstruction, whereas verapamil seems to be a protective agent against apoptotic changes.

Comparative evaluation of efficacy of use of tamsulosin and/or tolterodine for medical treatment of distal ureteral stones.

OBJECTIVES: To evaluate the activity of the therapeutic agents (tamsulosin and/or tolterodine) used to accelerate the expulsion of stones and to reduce the probable complications during observation of the medical treatment of distal ureteral stones to allow spontaneous passage. METHODS: A total of 120 patients with distal ureteral stones were included in the study. Patients with stones less than 10 mm and allowing urinary flow were included in the study. The patients were studied in four randomly divided groups. Group 1 patients received tamsulosin 0.4 mg/day, group 2 patients received tamsulosin 0.4 mg/day plus tolterodine 2 mg (twice a day), group 3 patients received tolterodine 2 mg (twice a day), and group 4 patients did not receive any medical treatment (control group). RESULTS: Differences among the four groups in patient age and stone dimension were not statistically significant (P >0.05). The stone expulsion rates were greater (P <0.05) in groups 1 and 2 than in groups 3 and 4. A significant variation (P <0.05) regarding the time to stone expulsion was observed in groups 1 and 2. CONCLUSIONS: In our study, the use of tamsulosin for the expulsion of distal ureteral stones was effective; however, the use of tolterodine provided no additional advantages.