Mean Platelet Volume-A Predictive Factor for the Diagnosis of Nonsymptomatic Prostatitis: Results of Univariate and Multivariate Models.

Mean platelet volume (MPV) has been reported to be related to inflammation. Prostate-specific antigen (PSA) is a protein produced by the prostate, and this protein may be elevated for several reasons, including prostatitis, benign prostatic hyperplasia, and/or cancer. The aim of the current study was to investigate the predictive effect of MPV values on nonsymptomatic prostatitis diagnosis and the relation between MPV and PSA. A total of 275 patients, 89 affected by benign prostate hyperplasia, 94 by prostate adenocancer, and 92 by prostatitis were included in the current study. PSA, total blood count parameters, and urine analysis were investigated. Findings were compared with the groups. The correlation between MPV and the other parameters were analyzed. Univariate and multivariate logistic regression analysis was performed to determine independent predictors of nonsymptomatic prostatitis diagnosis. MPV was significantly higher in patients with nonsymptomatic prostatitis than the other groups. There were negative correlations between MPV and age, total PSA or free PSA ( r = -.123; p = .042, r = -.235; p < .001, r = -.184; p = .006, respectively). According to multivariate regression model, only MPV was identified as the predictive factor for nonsymptomatic prostatitis (odds ratio: 1.451, 95% confidence interval [1.116, 1.887], p = .005). MPV, in the absence of other reasons that increased the MPV level, was significantly increased in cases with nonsymptomatic prostatitis; this increase is significantly higher than elevated PSA level in nonsymptomatic prostatitis patients. MPV could have a predictive value for the diagnosis of nonsymptomatic prostatitis.

Protective effects of caffeic acid phenethyl ester on the dose-dependent acute nephrotoxicity with paraquat in a rat model.

Paraquat (PQ), which is used extensively as a potent herbicide throughout the world, is highly toxic in humans. We aimed to determine PQ-induced biochemical and histologic changes in the kidneys, and to evaluate the ability of the protective effects of caffeic acid phenethyl ester (CAPE) against PQ-induced injury in rats. Forty-eight rats were divided into eight groups of six: Group 1: Control; Group 2: 10 µmol/kg CAPE; Group 3: 15 mg/kg PQ; Group 4: 30 mg/kg PQ; Group 5: 45 mg/kg PQ; Group 6: 15 mg/kg PQ+CAPE; Group 7: 30 mg/kg PQ+CAPE; Group 8: 45 mg/kg PQ+CAPE. PQ and CAPE were injected intraperitoneally. The levels of the total oxidant status (TOS) and total antioxidant status (TAS) were determined in the supernatants of the excised left kidney. Right kidney tissue of each rat was removed to obtain a histologic score. When PQ-administrated (15, 30, 45) groups compared with other groups, TOS values were found to be significantly higher (p < 0.01). PQ (15, 30, 45) groups had significantly diminished values of TAS than the other groups (p < 0.001). Of histologic score evaluation, only the PQ45 group had a significantly higher value than the sham, and CAPE groups (p < 0.05). Moreover, in CAPE+PQ45 group, the level of histologic score was decreased compared to PQ45 group (p < 0.001). In conclusion, the evaluation of the data suggests that CAPE can be used to prevent the acute effects of PQ nephrotoxicity.

Tubeless percutaneous nephrolithotomy: yes but when? A multicentre retrospective cohort study.

The aim of our study is to determine the predictive factors for placement of percutaneous nephrostomy tube (PNT) in percutaneous nephrolithotomy (PCNL) procedure and to evaluate the optimal cutoff points of the predictive factors. 229 patients, who had undergone percutaneous nephrolithotomy operation between February 2009 and February 2013 were reviewed retrospectively. Five patients were excluded from the study because of solitary kidney. All characteristics of 224 patients, stones and operative data were investigated. Patient and stone-related factors, such as age, BMI, history of previous surgery or SWL, characteristics of the stone, renal parenchymal thickness (RPT), as well as procedural factors, such as percutaneous access number and location were analyzed by univariate and multivariate tests. The continuous variables were analyzed using Receiver operating characteristic curve analysis. There were no differences in sex, age, BMI and hemoglobin decrease between the groups. Previous operation status, RPT, stone size, multiplicity of the stone, stone localization, blood transfusion presence, access points, access number and operation time were found statistically different according to univariate analysis. Multivariate analysis showed that RPT, operation time and stone size were the independent factors that affected the PNT insertion. For RPT, operation time and stone size, the optimal cutoff points for insertion PNT were 13.75 mm, 75.5 min and 890 mm(2), respectively. Tubeless PCNL should be chosen in patients with stone area less than 890 mm(2), and parenchymal thickness thicker than 13.75 mm and procedure with operation period <75.5 min.

Association Between Prostate Volume and Red Cell Distribution Width.

OBJECTIVES: To evaluate relation between red cell distribution width (RDW) and benign prostatic hyperplasia (BPH). METHODS: The overall study population consisted of 942 men with lower urinary tract symptoms (LUTS), ranging in age from 60 to 85 years old. Patients with disorder or medication that can influence lower urinary tract or erythrocytes were excluded from the study. The relationship between RDW, white blood cell (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and prostate volume, International Prostate Symptom Score (IPSS) were assessed with multivariate linear regression model. Patients were analyzed in four groups stratified according to the quartiles of prostate volume. The one-way analysis of variance (anova) was used to compare RDW, WBC CRP, and ESR between different quartiles of prostate volume. RESULTS: A graded and independent association of RDW with the prostate volume was identified (P = 0.001). RDW was significantly associated with prostate volume in multivariate linear regression model that was adjusted for age and hemoglobin. IPSS was significantly correlated with RDW, CRP and ESR. However significance was lost after adjustment for age and prostate volume. The RDW was significantly associated with the surgical treatment in the multivariate linear regression model that was adjusted for age and prostate volume. CONCLUSIONS: A correlation between an increased RDW and prostate volume was suggested by the new data from this study. This relation may be a consequence of inflammatory stress arising from BPH. The significant association between the easy, inexpensive RDW may provide a rational basis to include the RDW in algorithms for surgery risk prediction.

Caffeic acid phenethyl ester (CAPE) protects against acute urogenital injury following pneumoperitoneum in the rat.

PURPOSE: Our aim is to determine the biochemical and histologic changes induced in the kidneys, testis and prostate on possible ischemia and reperfusion (I/R) injury caused by pneumoperitoneum (PNP) in a rat model and to evaluate the ability of protective effects of caffeic acid phenethyl ester (CAPE). METHODS: Twenty-eight adult male Wistar albino rats were randomly divided to one of three treatment groups, with seven animals in each group. Sham, laparoscopy (L), and laparoscopy plus CAPE (L + C) group were subjected to 60 min of PNP with 15 mmHg one hour before the desufflation period. Total oxidant status (TOS) and total antioxidant status (TAS) levels were determined in kidney, testis, and prostate. Kidney and testis tissues were removed to obtain a histologic score. Also, Johnsen scoring system was used for testicular tissue analysis. RESULTS: L group had significantly higher TOS and lower TAS levels on kidney and testis compared to the other groups. In prostate biochemical analysis, there was not any difference between groups. No difference was found between groups according to kidney and testis tissues' histologic evaluation. In evaluation of Johnsen scoring, L group showed significant lower score compared to the other two groups. CONCLUSIONS: Increased intraabdominal pressure (IAP) had an oxidative effect on kidney and testis but not on prostate in rats. Moreover, it could affect the testicular Johnsen score. All these adverse effects of IAP on both kidney and testis could be prevented by CAPE administration.

Direct pelvic access percutaneous nephrolithotomy in management of ectopic kidney stone: a case report and literature review.

Percutaneous nephrolithotomy (PNL) is an effective procedure for the treatment of patients with large or complex stones. PNL is challenging in anomalous kidneys, certain patients, such as those with renal ectopia. It is unable to undergo PNL in conventional technique safely in these cases. We presented a case report of laparoscopic-assisted PNL via direct pelvic puncture in a pelvic kidney stone and discussed previous published literature. A 49-year-old man presented with right lower quadrant pain and hematuria. Intravenous pyelography and three-dimensional computerized tomography revealed an opaque 2.7 × 1.7 cm pelvis renalis stone in a right side ectopic pelvic kidney with grade III hydronephrosis. Laparoscopic-assisted tubeless PNL was performed to remove the calculus. Laparoscopic-assisted PNL as a minimally invasive therapy in ectopic kidney has many advantages. Our case showed that, in pelvic ectopic kidney with pelvic stones greater than 1.5 cm in size, laparoscopic-assisted PNL via direct pelvis puncture is a safe and effective technique.

Antioxidative and anti-inflammatory effect of thymoquinone in an acute Pseudomonas prostatitis rat model.

INTRODUCTION: The aim of this study is to investigate the potential antioxidant and anti-inflammatory effects of thymoquinone (TQ) to improve acute bacterial prostatitis (ABP) induced by Pseudomonas aeruginosa. MATERIAL AND METHODS: A total of 42 male Wistar albino rats were divided into 7 groups as follows: control, ABP (24, 48, and 72 h), and TQ-ABP (24, 48, and 72 h). The prostate tissue samples were assayed for prostate tissue malondialdehyde (MDA) and nitric oxide (NO) levels, and catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPX) activities. Sections were examined for characteristic histological changes, and a histological scoring system was used. RESULTS: When the ABP groups given TQ (24, 48, and 72 h) were compared to the ABP groups not given TQ, the levels of MDA and NO and the GPX activity were found to be significantly lower in the groups given TQ. Concerning SOD values, the TQ-ABP-72 group was lower in comparison with the ABP-72 and control groups, but statistically higher than the TQ-ABP-48 group (p < 0.05). Concerning CAT activity, only the TQ-ABP-72 and ABP-72 groups had a significant difference with the control group. TQ improved prostate histology significantly only in the TQ-ABP-24 group compared to the ABP-24 group (p < 0.001). CONCLUSION: Our study demonstrated for the first time that ABP induced by P. aeruginosa had an oxidative effect on prostate tissue and could regress following TQ administration as shown with the biochemical and histological findings.

Histopathologic evaluation of neurovascular bundles and periprostatic tissue in interfascial and intrafascial nerve-sparing radical prostatectomy technique: a cadaveric anatomic study.

OBJECTIVE: To compare interfascial (IEF) or intrafascial (IAF) periprostatic nerve dissection technique in prostate tissue using immunohistochemical methods in fresh cadavers. MATERIALS AND METHODS: Prostate tissues of 25 fresh cadavers were removed from rectum and other surrounding structures. IEF nerve dissection (n = 25) was performed on the right and IAF nerve (n = 25) dissection on the left side of each prostate under direct visualization. The base, center, and apex of each prostate lobes and fascia dissected were sampled for blind histopathologic evaluation. Total counts of nerve, artery, and vein were performed on hematoxylin and eosin stained sections, whereas sympathetic and parasympathetic nerve counts were performed on immunohistochemical stained sections. Iatrogenic surgical margin injury at base, center, and apex detected were compared between groups. RESULTS: Thickness of neurovascular bundle dissected in IAF was found significantly higher than IEF technique. The number of residual sympathetic fibers after dissection of neurovascular bundle was found significantly higher in IAF group. There were significant decreases in total nerve, parasympathetic, and sympathetic nerve counts only at the central region of prostate in IAF group. A significant decrease was found in the number of residual vein left in the fascia only at the apex by IAF dissection. Of surgical margin injury results, no significant difference was detected between IAF and IEF groups at any location. CONCLUSION: IAF provides better preservation of sympathetic but not parasympathetic fibers without increasing surgical injury of prostate capsule.

The investigation of total PSA, free PSA, and free/total PSA ratio in patients with liver cirrhosis patients according to Child-Pugh score.

OBJECTIVE: To investigate the total prostate-specific antigen (tPSA), free PSA (fPSA), and free/total PSA (fPSA/tPSA) ratio in patients with liver cirrhosis (LC) according to the severity of hepatic insufficiency. METHODS: Eighty-two male patients with LC were studied. The severity of liver disease was categorized by Child-Pugh score (Child-Pugh A, B, and C). Forty-two age-matched healthy subjects were used as a control group. The tPSA, fPSA, fPSA/tPSA ratio, total prostate volume (TPV), total testosterone (TT), and total protein (TP) were measured. The LC group was compared with the control group in terms of these parameters. In addition, intra-comparison and inter-comparison was made between all the Child-Pugh groups and normal subjects, in terms of these parameters. RESULTS: The tPSA and fPSA levels in LC cases, Child-Pugh A, Child-Pugh B, and Child-Pugh C groups were significantly decreased compared with the control group. The ratio of fPSA/tPSA in the LC subjects and Child-Pugh A groups significantly increased compared with the control group. TT, TP levels, and TPV in patients with LC were significantly lower compared with the control group and the results were significantly correlated with the Child-Pugh score. CONCLUSION: The present study reveals that tPSA and fPSA were decreased in patients with LC in comparison to healthy subjects in terms of 3 mechanisms. First, it might be due to shrunken prostatic volume. Second, it also resulted in decreased levels of testosterone because of the abnormality of hypothalamic-pituitary-testicular axis. Third, it might be the diminished serum protein level in the composition of the PSA.

Relationship between endothelial dysfunction and nocturia with benign prostatic hyperplasia.

OBJECTIVE: There are limited data on whether there is an association between nocturia, benign prostatic hyperplasia (BPH) and endothelial dysfunction. The aim of the present study was to evaluate whether there is an association between nocturia and endothelial dysfunction in patients with BPH. MATERIAL AND METHODS: Forty-two men with a diagnosis of BPH and 42 age-matched controls were enrolled. All patients were assessed for frequency and duration of nocturia, and prostate volume, completed the International Prostate Symptom Score (IPSS) questionnaire, and underwent brachial flow-mediated dilatation (FMD) evaluation. RESULTS: There was a negative correlation between FMD and frequency of nocturia (r = -0.879, p < 0.0001). Moreover, there was a negative correlation between duration of nocturia and FMD (r = -0.890, p < 0.0001). In addition, FMD was significantly decreased in the BPH group compared with the control group (6.0 ± 0.09 to 7.8 ± 0.10%) (p = 0.0001). CONCLUSION: In patients with BPH, nocturia is associated with endothelial dysfunction and may be an insidious risk factor for cardiovascular disease.

Effects of sildenafil citrate, isoniazid, and streptomycin on testicular tissue and epididymal semen quality in rats.

OBJECTIVE: To evaluate the effects of isoniazid (INH) and streptomycin (STR) on epididymal semen quality and testicular tissue, and to evaluate the protective effect of sildenafil citrate (SC) on possible testicular toxicity induced by STR and INH in rats. METHODS: Eighty adult male Sprague-Dawley rats were divided randomly into 8 groups including control, SC, INH, STR, STR+INH, SC+INH, SC+STR, and SC+INH+STR. After 45 days of treatment, the reproductive organ weights, epididymal semen quality, testicular histopathological findings, levels of serum nitric oxide, testosterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were investigated. RESULTS: SC significantly increased the epididymal sperm motility and concentration, and the levels of FSH, LH, and testosterone. The STR group had a significantly higher percentage of sperm head defect than the control group (P < .05). The INH group had lower Johnsen Testicular Biopsy Score than the control group (P < .001). Although SC and INH treatment alone did not affect the epididymal semen quality negatively, the SC+INH group had significantly higher spermatozoon tail and total morphologic defect ratios than the control group (P < .05). CONCLUSION: It has been concluded from this study that (1) SC has positive effects on spermatogenesis, sperm production, and semen quality; (2) STR affected the testicular biopsy score and spermatozoon head morphology negatively, but positively affected the other spermatologic traits; (3) INH did not effect the epididymal semen quality negatively, but decreased testicular biopsy score; and (4) SC can prevent the spermatozoon head defects induced by STR and can decrease the testicular toxicity induced by INH.

Villous adenoma of the urinary bladder: rare location.

Villous adenomas are common lesions of the gastrointestinal tract but they are rarely located in the urinary tract including the urinary bladder. There are a few case reports and series in the literature. Here we report a 43-year-old male patient who had a polypoid lesion located on the left lateral wall of the urinary bladder. Transurethral resection was performed. The diagnosis was 'villous adenoma of urinary bladder' with clinical and histopathological findings. Villous adenomas are mostly seen in elderly males. The coexistence of villous adenoma with adenocarcinoma, squamous cell carcinoma, and urothelial carcinoma was observed but there is not clear evidence about progression to carcinoma, in spite of its colonic counterpart. Generally complete surgical resection is accepted as curative but there are no exact data about follow-up and recurrence. By presenting this case, we aim to emphasize that it is a rare but important lesion because of coexistence with malignancies and uncertain malignant potential.

Assessment of female sexual function and quality of life in predialysis, peritoneal dialysis, hemodialysis, and renal transplant patients.

INTRODUCTION: Chronic renal failure (CRF) and renal replacement treatments have a negative effect on sexual function and quality of life (QoL). The literature on female sexual dysfunction (FSD) in patients with CRF is limited. The aim of this study is to compare the sexual function and QoL in predialysis (PreD), dialysis, and transplant patients. MATERIALS AND METHODS: A total of 106 women including 21 PreD, 45 dialysis, 20 renal transplantation (Tx), and 20 control patients were enrolled in the study. The Female Sexual Function Index (FSFI) and SF-36 scales were used to assess all patients, and demographic and clinical variables were documented. The FSFI and QoL scale scores were compared among the groups. RESULTS: The rates of FSD were 50, 81, 66.7, 75, and 50% in the control, PreD, peritoneal dialysis (PD), hemodialysis (HD) and Tx patients respectively. Total FSFI scores for desire, arousal and orgasm scores in the PreD group were significantly lower than those in Tx and control patients (P < 0.05). Physical components of QoL in CRF patients were significantly worse than in the control group (P < 0.0001). On logistic regression analysis, age, glucose and creatinine were significantly associated with FSD. CONCLUSION: This preliminary study documented that Tx is the most effective way to retain good sexual function in women, and a diagnosis of FSD should be made routinely in CRF patients.

Percutaneous management of stones in transplanted kidneys.

OBJECTIVES: Stone disease is a rare complication after renal transplantation, and the management of these stones can be difficult. In many cases, the best modality to treat stones in transplanted kidneys/ureters is with a percutaneous approach. The goal of this study was to review our series of percutaneous nephrolithotomy (PNL) to evaluate the success rates and present the key technical points to achieve a successful outcome. METHODS: We retrospectively reviewed our series of PNL from January 1997 to December 2007 and identified 15 patients who had had PNL performed in a transplanted kidney. We evaluated multiple perioperative variables and how the patients' urolithiasis presented. We also collected intraoperative data. RESULTS: A total of 15 patients underwent successful PNL in a transplanted kidney. In all patients, but 3, access into an anterior, upper pole calix was achieved, and access was obtained with ultrasound guidance alone or a combination of ultrasound guidance and fluoroscopy. Ten patients had a pre-existing nephrostomy tube, and this was used in all but 1 patient. Of the 15 patients, 8 (53%) were treated with percutaneous flexible nephroscopy/ureteroscopy, and 7 had tracts dilated to 30F to perform rigid PNL. All patients were rendered stone free at the end of the procedure, no complications developed, and no patient required a blood transfusion. CONCLUSIONS: Nephrolithiasis in a transplanted kidney can be challenging to diagnose and to treat. PNL is most often the best modality to render patients stone free.