The effect of tadalafil therapy on kidney damage caused by sepsis in a polymicrobial septic model induced in rats: a biochemical and histopathological study

ABSTRACT Introduction Sepsis is an inflammatory reaction to bacteria involving the whole body and is a significant cause of mortality and economic costs. The purpose of this research was to determine whether tadalafil exhibits a preventive effect on sepsis in a septic model induced in rats with cecal ligation and puncture (CLP). Materials and Methods Rats were randomly separated into groups, 10 rats in each: (i) a sham (control) group, (ii) an untreated sepsis group, (iii) a sepsis group treated with 5mg/kg tadalafil and (iv) a sepsis group treated with 10mg/kg tadalafil. A polymicrobial sepsis model was induced in rats using CLP. Rats were sacrificed after 16h, and blood and kidney tissues were collected for biochemical and histopathological study. Results Levels of the inflammatory parameter IL-6 decreased significantly in the sepsis groups receiving tadalafil in comparison with the untreated sepsis group (p<0.05). In terms of histopathology, inflammation scores investigated in kidney tissues decreased significantly in the sepsis groups receiving tadalafil compared to the untreated sepsis group (p<0.05). In addition, levels of creatinine and cystatin C measured in septic rats receiving tadalafil were lower by a clear degree than in septic rats (p<0.05). Conclusion In this study, tadalafil exhibited a preventive effect for sepsis-related damage by suppressing inflammation in serum and kidney tissue of septic rats in a polymicrobial sepsis model induced with CLP.

The effect of tadalafil therapy on kidney damage caused by sepsis in a polymicrobial septic model induced in rats: a biochemical and histopathological study.

INTRODUCTION: Sepsis is an inflammatory reaction to bacteria involving the whole body and is a significant cause of mortality and economic costs. The purpose of this research was to determine whether tadalafil exhibits a preventive effect on sepsis in a septic model induced in rats with cecal ligation and puncture (CLP). MATERIALS AND METHODS: Rats were randomly separated into groups, 10 rats in each: (i) a sham (control) group, (ii) an untreated sepsis group, (iii) a sepsis group treated with 5mg/kg tadalafil and (iv) a sepsis group treated with 10mg/kg tadalafil. A polymicrobial sepsis model was induced in rats using CLP. Rats were sacrificed after 16h, and blood and kidney tissues were collected for biochemical and histopathological study. RESULTS: Levels of the inflammatory parameter IL-6 decreased significantly in the sepsis groups receiving tadalafil in comparison with the untreated sepsis group (p < 0.05). In terms of histopathology, inflammation scores investigated in kidney tissues decreased significantly in the sepsis groups receiving tadalafil compared to the untreated sepsis group (p < 0.05). In addition, levels of creatinine and cystatin C measured in septic rats receiving tadalafil were lower by a clear degree than in septic rats (p < 0.05). CONCLUSION: In this study, tadalafil exhibited a preventive effect for sepsis-related damage by suppressing inflammation in serum and kidney tissue of septic rats in a polymicrobial sepsis model induced with CLP.

Management of lower pole renal stones: the devil is in the details.

Shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and minimally invasive percutaneous nephrolithotomy (MIP) are highly effective treatment options for lower pole stones up to 2 cm. Selecting the best treatment modality represents a controversial area in urology, because each treatment methods have their own advantages and disadvantages. Donaldson and co-workers have recently published a very comprehensive review and meta-analysis to compare the benefits and harms of SWL, RIRS and PNL techniques.

Rigid Ureteroscope Aided Insertion of Ureteral Access Sheath in Retrograde Intrarenal Surgery.

OBJECTIVE: To compare the outcomes of the ureteral access sheath (UAS) placement techniques in patients undergoing retrograde intrarenal surgery. MATERIALS AND METHODS: The patients were divided into two groups with respect to placement method of UAS. UAS was placed with the classical method, through the guidewire, in the first group of the patients (group I). The outer sheath of UAS was worn on the semirigid endoscope and placed into the ureter under direct vision in the second group (group II). The number of patients was the same in two groups (n = 42). RESULTS: Overall, 70 of 84 (83.3%) patients were stone free after the initial treatment. The success rates were comparable between the two groups (80.9% vs 85.7%, P = .859) 1 month after surgery. Fluoroscopy screening time (11.7 ± 5.7 seconds vs 0 second), UAS placement time (245 ± 138.4 seconds vs 40 ± 17.9 seconds; P < .001), and operation time (58.7 ± 17.1 minutes vs 51.2 ± 16.7 minutes; P = .046) were significantly longer in group I when compared to group II. The complication rate was higher in group I when compared to group II (23.8% vs 9.5%), but the difference was not statistically significant (P = .079). CONCLUSION: Introducing UAS into ureter under direct vision while it was precisely worn on ureteroscope makes this step safer, and protects the surgeon and patient from radiation exposure by shortening fluoroscopy and operation times.

Comparison of the efficacy and histopathological effects of three hemostatic agents in a partial nephrectomy rat model.

PURPOSE: The major complications of partial nephrectomy are bleeding and urine leakage. While various hemostatic agents are used to control bleeding, the histopathological characteristics of these hemostatic agents have not been investigated adequately. We aimed to investigate and compare the histopathological and hemostatic effects of local hemostatic agents in a partial nephrectomy rat model. METHODS: Thirty-two rats were divided into four equal groups, and partial nephrectomy was done to all rats. Conventional suture repair, Glubran2®, FloSeal®, and Celox™ were applied to every single group. The period of warm ischemia and hemostasis during surgical process was timed. Rats were killed later 3 weeks, and their partial nephrectomy applied kidneys were evaluated histopathologically. RESULTS: The fastest hemostasis was provided with Glubran2® (32.87 s). FloSeal® was the second (40.85 s), and Celox™ was the third (55.75 s). Glomerular necrosis and calcification were seen more in the suture group than other groups (p < 0.001). Fibrosis was found significantly less in Celox™ group. Fibroblast activation was found significantly less comparing to other groups (p < 0.01). The erythrocyte aggregation was significantly greater in the Glubran2® and FloSeal® groups than suture group (p < 0.01 and p < 0.001). CONCLUSION: The negative effects of hemostatic agents to the renal histopathology were less than conventional suture repair. Celox™ was the best biocompatible agent. In comparison with three agents, it was observed that Glubran2® provided hemostasis faster than other agents.

Seasonal preponderance in testicular torsión: is it a myth / Preponderancia estacional de la torsión testicular: ¿Es un mito?

OBJECTIVE: In this study, we aimed to investigate the relation of testicular torsion and weather conditions, and to report results from Turkey, a country located between temperate and sub-tropical climate zones. METHODS: A total of 56 patients that had surgery with the diagnosis of testicular torsion in Ankara Education and Research Hospital Urology Clinic between 2005 and 2014 were included in the study. Age of the patient, side of torsion, date and time at onset of pain, scrotal exploration time, ischemia duration, degree Arch. Esp. Urol. 2015; 68 (10): 750-754 of cord torsion, the surgical procedure performed, and scrotal Doppler ultrasound (USG) findings at the time of diagnosis and 1 month after surgery were retrospectively analyzed. The web archives of Turkish Republic Meteorology General Directorate was used to determine the seasonal and mean temperatures at the time of diagnosis. The data were analyzed with SPSS V. 16 statistical package program using Chi-square, Mann-Whitney U and Wilcoxon tests. RESULTS: The mean age of 56 males included in the study was 18.88 ± 0.73 years. Right testicular torsion was seen in 23, and left testicular torsion was seen in 33 patients. Testicular arterial flow was absent in 37, arterial flow was moderately decreased in 12, and significantly decreased in 7 patients on Doppler USG. Detorsion procedure was performed in 46 patients while 10 patients had orchiectomy. Nine patients were admitted in summer, 14 in fall, 15 in winter, and 18 in spring. The mean air temperature at the time of admittance was 9.31 ± 1.05ºC. The prevalence of testicular torsion was not found different among the seasons (p = 0.39). The analysis of air temperature at the time of admittance of the patients revealed that it was below 15ºC in 40 patients while it was above 15ºC in 16 patients, with a significant difference in between (p = 0.002). CONCLUSIONS: The prevalence of testicular torsion did not change in relation with the seasons. However, it was determined that its prevalence was directly proportional to the air temperature, and increased particularly below 15ºC

OBJETIVO: En este estudio buscamos investigar la relación entre la torsión testicular y las condiciones meteorológicas, y comunicar los resultados de Turquía, un país localizado entre las zonas climáticas templada y subtropical. Metodos: Se incluyeron en el estudio 56 pacientes que fueron intervenidos con el diagnostico de torsión testicular en la consulta de Urología del Hospital Ankara Education and Research Hospital entre 2005 y 2014. La edad del paciente, el lado de la torsión, la fecha y hora del inicio del dolor, la hora de la exploración escrotal, el tiempo de isquemia, el grado de torsión del cordón, la intervención quirúrgica realizada y los hallazgos de la ecografía Doppler en el momento del diagnostico y al mes de la cirugía fueron analizados retrospectivamente. Se utilizaron los archivos web de la Dirección General de Meteorología de la República Turca para determinar las temperaturas estacionales y medias en el momento del diagnóstico. Los datos se analizaron con el programa SPSS V. 16 statistical package utilizando las pruebas de Chi-cuadrado, U de Mann-Whitney y Wilcoxon. RESULTADOS: La edad media de los 56 varones incluidos en el estudio fue de 18,88 ± 0.73 años. La torsión fue derecha en 23 pacientes e izquierda en 33. No había flujo arterial testicular en la ecografía Doppler en 37 pacientes, estaba moderadamente disminuido en 12 y significativamente disminuido en 7. Se realizó detorsión en 46 pacientes y orquiectomía en 10. Nueve pacientes ingresaron en verano, 14 en otoño, 15 en invierno y 18 en primavera. La temperatura media del aire en el momento del ingreso era de 9,31 ± 1,05ºC. No se encontró una prevalencia diferente de torsión testicular entre las estaciones (p = 0,39). El análisis de la temperatura del aire en el momento del ingreso reveló que era menor de 15ºC en 40 pacientes y mayor de 15ºC en 16 pacientes, con una diferencia significativa (p = 0,002). CONCLUSION: La prevalencia de torsión testicular no cambia en relación con las estaciones. Sin embargo, se determinó que su prevalencia era directamente proporcional a la temperatura del aire, y aumentaba particularmente por debajo de 15ºC

Evaluation of Tl-201 SPECT imaging findings in prostate cancer.

OBJECTIVES: To compare with histopathological findings the findings of prostate cancer imaging by SPECT method using Tl-201 as a tumor seeking agent. METHODS: The study comprised 59 patients (age range 51-79 years, mean age 65.3 ± 6.8 years) who were planned to have transrectal ultrasonography (TRUS)-guided biopsies due to suspicion of prostate cancer between April 2011 and September 2011. Early planar, late planar and SPECT images were obtained for all patients. Scintigraphic evaluation was made in relation to uptake presence and patterns in the visual assessment and to Tumor/Background (T/Bg) ratios for both planar and SPECT images in the quantitative assessment. Histopathological findings were compatible with benign etiology in 36 (61%) patients and malign etiology in 23 (39%) patients. Additionally, comparisons were made to evaluate the relationships between uptake patterns,total PSA values and Gleason scores. RESULTS: A statistically significant difference was found between the benign and malignant groups in terms of uptake in planar and SPECT images and T/Bg ratios and PSA values. No statistically significant difference was found between uptake patterns of planar and SPECT images and Gleason scores in the malignant group. CONCLUSIONS: SPECT images were superior to planar images in the comparative assessment. Tl-201 SPECT imaging can provide an additional contribution to clinical practice in the diagnosis of prostate cancer and it can be used in selected patients.

Effect of positive surgical margins on biochemical failure, biochemical recurrence-free survival, and overall survival after radical prostatectomy: median long-term results.

The aim of this study was to investigate the median long-term effects of positive surgical margin (PSM) and other prognostic factors on biochemical recurrence-free survival, overall survival, and biochemical failure in patients who underwent radical prostatectomy. Our study included 121 patients with pT2-3N0 disease treated between March 2006 and August 2012. The patients were divided into two groups: those with PSM and those with negative surgical margin (NSM). We analyzed the age, clinical and pathological stages, preoperative and postoperative Gleason scores, duration of the follow-up, adjuvant chemo-/radiotherapy, biochemical failure, biochemical recurrence-free survival, and overall survival in these patients. PSM was found in 25 (20%) patients, whereas 96 patients had NSM. The median follow-up time was 46.6 months (range 12-72 months) for the PSM group and 48.3 months (range 7-149 months) for the NSM group. The biochemical failure rate was 24% in the PSM group and 8.3% in the NSM group (p = 0.029). The biochemical recurrence-free survival was found as 76% in the PSM group and 91.7% in the NSM group. The difference between the groups was not statistically significant (p = 0.06). The overall survival was 100% in both groups. The surgical margins of the radical prostatectomy material is an important pathological indicator for biochemical failure at mid long-term follow-up. We did not find any effect of PSM on overall survival or biochemical recurrence-free survival.

Intraperitoneal stone migration during percutaneos nephrolithotomy.

Percutaneos nephrolithotomy (PNL) is the standard care for renal stones larger than 2 cm. The procedure has some major and minor complications. Renal pelvis laceration and stone migration to the retroperitoneum is one of the rare condition. We report the first case of intraperitoneal stone migration during PNL.

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.

Evaluation of urinary stones ex vivo with micro-computed tomography: preliminary results of an investigational technique.

PURPOSE: To evaluate the ultrastructural features of the urinary stones removed with endoscopic stone surgery, using micro computed tomography (micro-CT). MATERIALS AND METHODS: Patients who had endoscopic surgery for renal or ureteral stones removal were included in this study. After surgery, the stones were classified into three groups and investigated with Skyscan 1174 micro-CT. Group I underwent percutaneous nephrolithotomy (PNL) with ultrasonic lithotripsy; group II had ureteroscopic stone surgery (USS) with pneumatic lithotripsy; and group III (the control group) had stone removal with USS or PNL without lithotripsy. Stone homogeneity, voids, and the internal structure of the stones were evaluated. Chi-square test was used to evaluate the difference statistically. P values less than .05 were considered statistically significant. RESULTS: A total of 24 "calcium oxalate monohydrate" stones from 24 patients were scanned with micro-CT. Stones treated with ultrasonic lithotripsy (group I) were more fragile, fragmented, and cracked than those treated with the pneumatic lithotripsy (group II; P = .01). Stones in group II were more homogeneous and smooth than those in group I and resembled those of the control group (P = .02). Homogeneous, non-fragile stones and heterogeneous, fragile calculi were seen in all groups. CONCLUSION: The stone fragility could be confirmed by micro-CT investigation. Ultrasonic lithotripters increase the stone fragility, which is demonstrated with increased heterogeneity by micro-CT.

A very unusual anatomical variation and complication of common iliac artery and ureter in retroperitonoscopic ureterolithotomy.

Anatomical localization of theureter comes along psoas major muscle and crosses over common iliac artery bifurcation. Common iliac artery aneurysm and impacted atherosclerosis are a rare condition that should be differed from the impacted ureter stone to avoid from undesirable complication. In this case, we present a very unusual anatomical variation and complication of common iliac artery and ureter in retroperitonoscopic ureterolithotomy.

Phosphodiesterase 5 inhibitors attenuate renal tubular apoptosis after partial unilateral ureteral obstruction: an experimental study.

The aim of the present study was to evaluate the effects of phosphodiesterase 5 inhibitors on renal tubular apoptosis and also on expressions of endothelial and inducible nitric oxide synthases (eNOS and iNOS) in the ipsilateral kidney after partial unilateral ureteral obstruction (PUUO) in a rat model. Forty Wistar albino rats were divided into five groups. In Groups 1-4, left experimental PUUO was created. Sildenafil, vardenafil, and tadalafil were administrated to the rats of Groups 2-4, respectively. The pills were orally given to the rats for 30 days. Group 5 was defined as sham. After 30 days, all rats were sacrificed, and nephrectomy was performed. The renal specimens were examined histopathologically. Left hydroureteronephrosis was observed in Groups 1-4. Mean apoptotic cell count and eNOS and iNOS levels were significantly increased in Group 1 when compared with the other groups. The rats in Groups 2-4 showed significantly decreased apoptotic cell count and eNOS and iNOS values in the renal tubular tissue in accordance with Group 1 (p<0.05). There were significant differences in apoptotic cell counts between sildenafil group and the other two study groups. The sildenafil group demonstrated lesser apoptotic cell count than the vardenafil (p=0.021) and tadalafil (p=0.009) groups. PUUO increases the renal tubular apoptosis and elevates NOS concentrations in renal tubular tissue after PUUO. Phosphodiesterase 5 inhibitors have a protective effect against the tubular apoptosis.

First clinical experience of Ankaferd BloodStopper as a hemostatic agent in partial nephrectomy.

Open partial nephrectomy is an effective and safe alternative treatment modality to radical nephrectomy for small renal tumors. Many techniques that use hemostatic agents have been described to provide hemostasis during this procedure. Ankaferd BloodStopper® (ABS) is a unique folkloric medicinal plant extract that has been used historically in Turkish traditional medicine as a hemostatic agent. ABS has therapeutic potential to manage hemorrhage and this agent should be investigated in clinical trials. In the present case, we evaluated the effectiveness of ABS in partial nephrectomy and reviewed the literature.

Preventive effects of propofol and ketamine on renal injury in unilateral ureteral obstruction.

PURPOSE: The aim of the present study was to investigate the preventive effects of propofol and ketamine as anesthetics on renal injury in unilateral ureteral obstruction (UO). METHODS: Twenty-four male New Zealand white rabbits were randomly assigned to four groups of six rabbits each. Anesthesia was induced and maintained with propofol in groups 1 and 2 and with ketamine in groups 3 and 4. Groups 2 and 4 received complete left ureteral ligation. Groups 1 and 3 (control groups) underwent an identical surgical procedure without ureteral ligation. At 14 days of obstruction, animals were sacrificed and ipsilateral kidneys were removed for determination of tissue nitric oxide (NO) levels and immunohistochemical evaluation of endothelial nitric oxide synthase (eNOS), inducible NOS (iNOS), and apoptosis protease-activating factor 1 (APAF-1). RESULTS: Between groups 1 and 3, there were no differences in tissue NO levels and eNOS, iNOS, and APAF-1 expressions. iNOS and APAF-1 expressions were at the mild to moderate levels in group 2, but these parameters were markedly increased in group 4 at 14 days of obstruction. Also, elevated expression of iNOS was accompanied by a high NO production in group 4 compared with group 2. Although eNOS expressions were increased in both groups 2 and 4, there were no significant differences between these groups. CONCLUSIONS: Propofol as an anesthetic agent may attenuate NO-induced renal tubular cell apoptosis by downregulating the expression of iNOS in an animal model of unilateral UO.

An in vitro study comparing the coagulation and cautery effects of bipolar and unipolar cutting modalities on prostatic tissue.

INTRODUCTION: We aimed to compare plasmakinetic prostate resection (PKRP), plasmakinetic prostate vaporization (PKVP) and transurethral prostate resection (TURP) procedures according to cautery artifacts in tissue specimens and to compare the coagulation depths of these procedures. MATERIALS AND METHODS: The prostate specimens of 10 patients that underwent open transvesical prostatectomy were used. TURP, PKVP and PKRP procedures were performed immediately. Artifactual pathological patterns that were identified in the specimens included: abnormal cellular orientation and spindling, artifactual cellular detachment from the underlying basement membrane, atypical cytological changes and stromal coagulative artifacts. The severity of cautery artifact was graded as absent, mild, moderate or severe according to the sum of points in each specimen. RESULTS: When the groups were compared according to moderate and severe artifacts, it was observed that PKRP caused more moderate artifacts and TURP caused more severe artifacts than the other two groups (p < 0.05). The depth of the tissue affected by coagulation was 1.52 +/- 1.29 mm with the TURP procedure. There were significant differences between TURP and the other two methods (p < 0.05). CONCLUSIONS: Three transurethral procedures cause cautery artifacts of varying grades. The application of TURP seems to cause more severe artifacts and PKRP and PKVP procedures seem to result in a deeper coagulation zone in the residual prostatic tissue.

Hemostasis in retropubic radical prostatectomy with Ankaferd BloodStopper: a case report.

Ankaferd BloodStopper (ABS) is a licensed medicinal plant product that provides active hemostasis in external, postsurgical and dental bleeding, and is approved in Turkey by the Ministry of Health. The use of ABS for internal organ hemorrhage is under investigation. Our clinic is one of the certified centers conducting a phase II trial investigating the effects and reliability of ABS in urogenital surgery. We have used ABS to stop bleeding during radical retropubic prostatectomy in one patient, presented here as a case report.

Effect of tadalafil on renal resistivity and pulsatility index in partial ureteral obstruction.

INTRODUCTION: To investigate the effect of tadalafil on Resistivity Index (RI) and Pulsatility Index (PI) in partial unilateral ureteral obstruction (PUUO). METHODS: Twelve New Zealand rabbits were assigned into two groups. Baseline renal Doppler ultrasonography (USG) was performed in all rabbits. The rabbits in group 1 received tadalafil for a month (10 mg/72 h) and group 2 was defined as sham. After 1 month, in both groups left PUUO was created. Renal Doppler USG was performed to measure RI and PI parameters of both kidneys on the 4th hour and 1st and 3rd days postoperatively. RESULTS: Baseline renal Doppler USG revealed that there was no difference between two kidneys in both groups. The differences in mean RI and PI values of the kidneys between the sham and tadalafil groups were not statistically significant. Compared with the preoperative values, postoperative RI and PI values for the left kidneys were significantly increased in the period from 4 h to 3 days postoperatively in the sham group (p < 0.05). However, mean RI and PI values were not increased in the tadalafil group when compared with the sham group and this difference between the two groups was significant (p < 0.05). CONCLUSIONS: Tadalafil has a lowering affect on RI and PI in experimentally created PUUO.

Hemostatic role of a folkloric medicinal plant extract in a rat partial nephrectomy model: controlled experimental trial.

PURPOSE: Ankaferd BloodStopper is a mixture of 5 plants used in traditional Turkish medicine as hemostatic agent for external traumatic, postoperative and dental bleeding. We investigated the hemostatic efficacy of Ankaferd BloodStopper for partial nephrectomy. MATERIALS AND METHODS: A total of 24 Wistar rats were divided into 4 groups of 6 each. Group 1 underwent partial nephrectomy with hilar control as the conventional technique. Group 2 underwent the conventional technique with hemostatic agent application. Group 3 underwent hemostatic agent application to the renal parenchyma. In Group 4 partial nephrectomy was performed and the hemostatic agent was used without hilar control. Warm ischemia and partial nephrectomy times, and the number of hemostatic agent applications were recorded. Histopathological evaluations were completed. The Fisher, Kruskal-Wallis and Mann-Whitney U tests were used for statistical analysis. RESULTS: Mean kidney size was 2 x 2.5 x 0.05 cm. Mean partial nephrectomy time was 3.7, 2.7, 1.8 and 3.2 minutes in groups 1 to 4, respectively, which was significantly different between groups 1 and 3 (p = 0.007). Warm ischemia time in group 3 was less than in group 1 (p = 0.011). The number of hemostatic agent applications was higher in groups 3 and 4 compared to those in group 2 (p = 0.003). Glomerular necrosis was detected at a higher rate in group 1 compared to that in groups 3 and 4 (p = 0.015). Calcification formed significantly more in group 1 than in groups 2 to 4 (p <0.05). Erythrocyte aggregation was greater in groups 2 to 4 than in group 1 (p = 0.015). Giant cell reaction, fibrosis, inflammation and microvascular proliferation were not statistically different among the groups (p >0.05). CONCLUSIONS: Ankaferd BloodStopper decreases partial nephrectomy and warm ischemia times, and provides hemostasis. Erythrocyte aggregation confirmed the hemostatic action of the agent, while the absence of glomerular necrosis and calcification may have positive relevance.