Predictive value of pre-operative inflammation-based prognostic scores (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-eosinophil ratio) in testicular sperm extraction: a pilot study.

To investigate the ability of some hematologic prognostic scores demonstrating inflammation in predicting sperm presence in testicular sperm extraction (TESE). We retrospectively investigated the medical data of 430 patients with the diagnosis of non-obstruc tive azoospermia (NOA) who had undergone TESE operation consecutively in our institution between the dates of January 2009 and February 2017. In all, 352 patients with the diagnosis of NOA, with bilaterally palpable vas deferens, who had undergone TESE for the first time, were included in the study. Patients with genetic anomalies, genital infection, history of surgery or vasectomy, chronic diseases, history of inflammatory, metabolic, rheumatologic, or malignant diseases, morbid obesity, with the diagnosis of clinical varicocele, or patients who had undergone TESE for the second time were excluded from the study. According to the results of TESE, the patients were divided into two groups as those with sperm retrieval and those without sperm retrieval. These groups were compared in terms of age, infertility duration, body mass index, hormone profile, hematologic parameters, neutrophil-to-lymphocyte ratio (NRL), monocyte-to-eosinophil ratio (MER), and platelet-to-lymphocyte ratio (PLR). The NLR and PLR levels were found to be significantly higher in patients without sperm retrieval at TESE compared to those with sperm retrieval. The logistic regression analysis showed NLR as an independent factor that showed the presence of spermatozoa at TESE (odds ratio: 4.786, %95 confidence interval: 2.667-8.589, p < 0.001). The area under the ROC curve (AUC) for the PLR was determined to be 0.574. As the calculated AUC value of the PLR was below 0.6, there was insufficient evidence determined at TESE to say that it was a reliable marker to indicate the presence of spermatozoa. The area of the MER value under the ROC curve was not statistically significant. It has been demonstrated that systemic inflammation negatively affects the probability of extracting spermatozoa in TESE and NLR is an independent factor indicating the presence of spermatozoa in TESE.

Comparing the short-term outcomes and complications of monopolar and bipolar transurethral resection of non-muscle invasive bladder cancers: a prospective, randomized, controlled study / Comparación de los resultados a corto plazo y complicaciones de la resección transuretral monopolar y bipolar de tumores vesicales no músculo-infiltrantes: estudio prospectivo, randomizado, controlado

OBJECTIVES: To compare perioperative outcomes and complications of plasmakinetic bipolar and monopolar transurethral resection of bladder tumors (TURBT) in patients with non-muscle invasive bladder cancer (NMIBC). METHODS: Between March and December 2015, a total of 130 consecutive patients underwent TURBT for NMIBC. Patients were equally randomized into monopolar TURBT (M-TURBT) and bipolar TURBT (B-TURBT) groups. Primary outcome of this study was safety of the procedures including obturator jerk, bladder perforation, clot retention, febrile urinary tract infection and TUR syndrome. The secondary outcome was efficacy of both TURBT procedures, including complete tumor resection, sampling of the deep muscle tissue and sampling of the qualified tissues that without any thermal damage. RESULTS: Complete tumor resection rate was higher in B-TURBT than M-TURBT (89.2% vs 78.5%, respectively), but the difference was not significant (p = 0.152). No significant differences were found between the muscle tissue sampling rates (64.6% vs 72.3%, p = 0.345) and the numbers of patients with thermal tissue damage (7 patients vs 3 patients, p = 0.194). Obturator jerk was detected in 21.5% of the patients in M-TURBT group and 4.6% of the patients in B-TURBT group, and this difference was statistically significant (p = 0.013). Bladder perforation was significantly higher in M-TURBT group than B-TURBT (21.5 % vs 6.1%, p = 0.039). CONCLUSIONS: Bipolar TURBT had significantly lower obturator jerk and bladder perforation than monopolar. B- TURBT is a reasonable treatment modality in patients with NMIBC

OBJETIVO: Comparar los resultados perioperatorios y las complicaciones de la resección transuretral bipolar plasmaquinética y monopolar de tumores vesicales en pacientes con carcinoma vesical no musculo-infiltrante (CVNMI). MÉTODOS: Entre marzo y diciembre del 2015, un total de 130 pacientes consecutivos fueron sometidos a RTU de tumor vesical por CVNMI. Los pacientes fueron randomizados por igual en los grupos de RTU monopolar (RTU-M) y RTU bipolar (RTU-B). El objetivo primario del estudio era evaluar la seguridad de la operación incluyendo la contractura del obturador, perforación vesical, retención por coágulos, infección urinaria febril y síndrome post RTU. El objetivo secundario era evaluar la eficacia de ambos procedimientos de RTU, incluyendo la resección completa del tumor, obtención de tejido muscular profundo y de los tejidos cualificados sin lesión térmica. RESULTADOS: La tasa de resección completa del tumor fue superior en el grupo de RTU-B frente al de RTU-M (89,2% vs 78,5%, respectivamente), pero la diferencia no fue significativa (p = 0,152). No se encontraron diferencias significativas entre las tasas de obtención de la capa muscular en las muestras (64,6% vs 72,3%, p = 0,345) ni en el número de pacientes con lesión térmica tisular (7 pacientes frente a 3 pacientes, p = 0,194). Se detectó contractura del obturador en el 21,5% de los pacientes en el grupo de RTU-M y 4,6% de los pacientes del grupo de RTU-B, y esta diferencia era estadísticamente significativa (p = 0,013). La perforación vesical fue significativamente mayor en el grupo de RTU-M frente al de RTU-B (21,5% vs 6,1%, p = 0,039). CONCLUSIONES: La RTU bipolar de tumor vesical tiene una incidencia de contractura del obturador y perforación significativamente menores que la de la monopolar. La RTU-B del tumor vesical es una modalidad de tratamiento razonable en pacientes con CVNMI

[The efficacy and toxicity of gemcitabine and cisplatin chemotherapy in advanced/metastatic bladder urothelial carcinoma]. / La eficacia y toxicidad de la quimioterapia con gemcitabina y cisplatino en el carcinoma urotelial de vejiga avanzado/metastásico.

OBJECTIVE: Many new agents have been introduced as an alternative to standard MVAC therapy with improved efficacy and lower toxicity profile in advanced bladder carcinoma. The aim of this study is to evaluate the response rate and toxic side effects of gemcitabine-cisplatin (GC) in patients with advanced/metastatic bladder carcinoma. METHODS: Between January 2001 and April 2006, 58 patients with histologically confirmed advanced/metastatic transitional cell carcinoma (TCC) were enrolled in the study. All patients received 1,000 mg/m(2) gemcitabine administered via intravenous infusion of 30-60 minutes on days 1, 8 and 15, and 70 mg/m(2) cisplatin as an infusion of 60-min on day 2. All toxicities were graded using the WHO scale and the National Cancer Institute scale. RESULTS: The average number of cycles was 4.1. Neutropenia and thrombocytopenia were clinically significant treatment-related side-effects. Hematologic toxicity included mainly grade 3-4 neutropenia in 56%, grade 3-4 thrombocytopenia in 59%, and grade 3- 4 anemia in 33% of patients. There was only one death from neutropenic sepsis. Complete response and partial response were obtained in 13 (22.4%) and 17 (29.3%) of patients, respectively, 17 (29.3%) of patients were found to have stable disease, and progression was observed in 11 patients (18.9%). Median survival for the whole group was 14.7 months (2-67). CONCLUSIONS: GC therapy is an effective regimen owing to its high tumor response and long survival with a low incidence of toxicity in advanced or metastatic patients.

Metastatic testicular germ cell tumor presenting with abdominal pain: CT and MRI findings.

Testicular tumors are the most common solid tumors in young adult males. Patients with testicular tumor often present with painless scrotal mass. Rarely, symptoms are related to metastases. We describe the case of a patient presenting with abdominal pain due to retroperitoneal lymphadenopathy. We describe the magnetic resonance imaging findings of lumbar spine osseous metastasis.