Effect of carbon dioxide pneumoretroperitoneum on bacterial translocation in an experimental retroperitoneoscopy model.

PURPOSE: To evaluate the effect of artificial CO2 pneumoretroperitoneum on bacterial translocation in an experimental retroperitoneoscopy model. MATERIALS AND METHODS: Eighteen adult male New Zealand White rabbits weighing 2.5 to 3 kg were divided into two groups. Group 1 (control group) consisted of 6 rabbits, while the remaining 12 served as the pneumoretroperitoneum group (group 2). In group 1, the left retroperitoneal space was dissected with a 50-mL balloon without CO2 insufflation, and the animals were kept under anesthesia for 3 hours with the balloons inflated. In group 2, after balloon dissection as in group 1, CO2 insufflation was applied at 1 L/min to achieve a pressure of 10 to 12 mm Hg for 3 hours. Afterward, all animals were sacrificed, and samples were taken from the blood, retroperitoneal area, lungs, liver, mesentery, heart, kidneys, ureters, bladder, colon, small intestine, and spleen and carried to the microbiology laboratory in Carry-Blair medium. Bacterial growth was evaluated using standard techniques. RESULTS: All animals survived the experimental procedures. None of the rabbits in the control group demonstrated any bacterial translocation in the sampled tissues. In the pneumoretroperitoneum group, one rabbit was found to have 10(2) colony-forming units of E. coli in the kidney, but this was considered to be the result of contamination, not translocation. CONCLUSION: Carbon dioxide pneumoretroperitoneum does not seem to cause bacteremia or bacterial translocation in this experimental model. Retroperitoneoscopy probably does not create any additional risk of septic complications.

The effect of carbon dioxide pneumoretroperitoneum on free oxygen radicals in rabbit retroperitoneoscopy model.

The aim of this study was to investigate the possible effects of carbon dioxide (CO2) pneumoretroperitoneum on free oxygen radicals in the kidney. Twelve male New Zealand rabbits were divided into 2 equal groups; group 1; control operation group (retroperitoneal space preparation without CO2 insufflation) and group 2; study group (10-12 mm Hg pneumoretroperitoneum for 3 hours with CO2). At the end of the procedure, laparotomy was performed to harvest ipsilateral and contralateral kidney in both groups after three hours. Kidney tissues were homogenized and were assayed for malondialdehyde (MDA), protein carbonyls (for protein oxidation), and reduced glutathione (GSH). Ipsilateral and contralateral kidney tissue levels of the MDA, protein carbonyls and GSH were not different in both the study and the control group (P > 0.05 for all comparisions). Corresponding ipsilateral and contralateral tissue levels of the markers, MDA and protein carbonyls were found to be significantly different in the study group as compared with the control group (P < 0.05 for the four comparisons mentioned). However, neither the ipsilateral nor the contralateral tissue levels of the marker GSH showed statistically relevant difference when the study group was compared with the control group. Oxidative stress was identified as a component of CO2 pneumoretroperitoneum-induced kidney injury using an animal model of retroperitoneoscopy. Oxidative stress is likely to contribute to the impairment of renal function after retroperitoneoscopy using a 10 mm-12 mm Hg CO2 pneumoretroperitoneum.

Terazosin and doxazosin in the treatment of BPH: results of a randomized study with crossover in non-responders.

OBJECTIVE: To compare the effects of the doxazosin and terazosin on total International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax) in treating patients with lower urinary tract symptoms (LUTS) and compare this effectivity by switching the drugs in the patients who did not benefit from either the first or the second drug. METHODS: This is a prospective randomized study of the patients with LUTS suggestive of benign prostatic hyperplasia (BPH). Fifty male patients (mean age 59.4 +/- 7.6 years) received either doxazosin (n = 25) or terazosin (n = 25) once daily every night. The patients were evaluated in the 1st, 2nd and 3rd months of treatment. Minimum 20% improvement in IPSS and Qmax in the 3rd month was considered as improvement. The patients with no improvement in any of the parameters switched the drugs, and they were followed up in the next 3 months. The patients whose only one parameter improved were excluded from the study. RESULTS: Eleven (44%) out of 25 patients using doxazosin and 10 (40%) out of 25 patients using terazosin showed improvement in both IPSS and Qmax at the end of the 3rd month and continued using the drug. After 3 months of treatment, increase in Qmax (p < 0.001) and decrease in IPSS (p < 0.01) was significant for both doxazosin and terazosin. Nineteen patients, who did not show improvement in any of the parameters, switched the drug. Of the patients who switched the drug, 2 (4%) showed improvement both in IPSS and in Qmax, while 2 (4%) showed improvement only in IPSS but not in Qmax. The remaining 15 (30%) patients did not show improvement in any of the parameters. CONCLUSION: The results of the study suggest that alpha-blockade with either doxazosin or terazosin is effective in males with LUTS. The two alpha-blocking drugs showed equal effectiveness in the treatment of LUTS. If one of the drugs is ineffective in the treatment of LUTS, then the other drug will probably be ineffective.

Plasma kinetic vaporization of the prostate: clinical evaluation of a new technique.

PURPOSE: We evaluated our results with bipolar plasma kinetic electrovaporization in the treatment of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Twenty-one patients with infravesical obstruction by BPH have been treated with bipolar plasma kinetic electrovaporization. International Prostate Symptom Score (IPSS) with a quality of life (QOL) scoring questionnaire, uroflowmetry (maximum flow rate; Qmax), transrectal ultrasonography (TRUS), and residual urine volume and prostate specific antigen (PSA) measurements had been performed before surgery. The IPSS scores, prostate volumes, and residual urine volumes were reevaluated during the third postoperative month. Uroflowmetry was repeated on postoperative days 7, 15, 30, and 90. Total PSA and free PSA measurements were repeated on postoperative days 3, 5, 7, 15, 30, and 90. RESULTS: The results of 20 patients could be evaluated. The median age of these patients was 61 years. The median volume of the prostates was 42 cc (95% CI 56-53). The median operation time and postoperative hospitalization were 55 minutes (95% CI 40-65) and 3 days (95% CI 3-5), respectively. The mean period of time needed for vaporizing 1 g of tissue was calculated as 2.8 +/- 1.3 minutes. Postoperative day 90 values of IPSS, QOL, prostate volume, residual urine volume, and Qmax showed significant improvement compared with preoperative values (p < 0.05). The median preoperative PSA value was 1.64 mg/mL (95% CI 1-3.6). The value showed a statistically significant increase 24 hours after the intervention (p < 0.0001), but the PSA values on the 30th (p = 0.041) and 90th (p = 0.025) days were below preoperative values. CONCLUSION: The IPSS with QOL scores, prostate volumes, and residual urine volumes showed significant decreases and Qmax values showed a significant increase after bipolar plasma kinetic electrovaporization. This treatment modality causes a temporary increase in the PSA concentration, as do other interventional treatment methods, but the measurements on the 30th and 90th days were below preoperative values.

Induction of spermatogenesis in idiopathic hypogonadotropic hypogonadism with gonadotropins in older men.

We investigated the treatment results in 6 azoospermic idiopathic hypogonadotropic hypogonadism (IHH) cases that remained untreated 41-47 years of age. Medical history, physical examination, hormone profile measurements, peripheral blood karyotype, skull X-ray and/or magnetic resonance imaging were performed. Patients received 1,000 to 5,000 IU hCG, 2-3 times per week, and 75 to 150 IU hMG, 2-3 times per week for 24 months. Serum testosterone levels were assessed every month for maximum 6 months to evaluate optimal dose of treatment and then every 3 months thereafter. Sperm counts were assessed every 3 months. Testosterone level increased from 2.7 +/- 0.9 mIU/L to 22 +/- 7.04 mIU/L with treatment; testicular volume increased by 4.6 ml during the treatment. Sperm were detected in the ejaculate in 3 out of 6 patients on the 22nd, 18th, and 15th month of treatment. 3 patients underwent testicular biopsy; histopathology revealed tubular hyalinization. Spermatogenesis in older men with IHH was restored by exogenous gonadotropins.

Early effects of extracorporeal shock-wave lithotripsy exposure on testicular sperm morphology.

OBJECTIVE: To investigate the effects of extracorporeal shock-wave lithotripsy (ESWL) applied to the pelvic region on testicular histology and spermatogenesis. MATERIAL AND METHODS: ESWL (2000 shock waves over a 20-min period at 18 kV) was applied to 12 adult New Zealand male rabbits. The rabbits were divided into three equal groups: those in Group 1 were sacrificed 1 h after the intervention, those in Group 2 were sacrificed on the 3rd day and those in Group 3 were sacrificed on the 7th day. Both testicles were removed for histopathological examination to investigate the effects of ESWL. Transmission electron microscopy (TEM) was used to detect ultrastructural changes. Epididymal and testicular touch-print preparations were stained with SperMac stain in order to evaluate the morphology of the spermatozoa. RESULTS: There were no significant differences between the groups in terms of sperm morphology (p = 0.386). TEM revealed only huge vacuolation of Sertoli cells and diffuse edema in the mitochondria of Sertoli cells. CONCLUSION: No detrimental effect of ESWL on sperm morphology was detected in this study. We conclude that shock waves do not cause severe permanent effects but only transient disorders in testes.

An artificial neural network for predicting the presence of spermatozoa in the testes of men with nonobstructive azoospermia.

PURPOSE: We developed an artificial neural network (ANN) for predicting spermatozoa prior to testicular biopsy in men with nonobstructive azoospermia. The performance of this ANN was compared to that of the standard logistic regression (LR) model. MATERIALS AND METHODS: Data were retrospectively collected from the physical examination and laboratory records of 303 patients who presented with infertility due to nonobstructive azoospermia. Input factors were patient age, duration of infertility, serum follicle-stimulating hormone, luteinizing hormone, total testosterone and prolactin, and left and right testicular volume. The ANN and LR models were constructed based on data on cases in which spermatozoa were and were not detected on testicular sperm extraction. The ANN was trained and validated with the data in the training (200 cases) and validation (30 cases) sets, and the model was then used to predict findings in the test set (73 cases). The LR model was constructed using the same data on the 230 training and validation cases. The same 73 patients served as the test set. RESULTS: The sensitivity of the ANN model was significantly higher than that of the LR model (68% vs 28%, p < 0.0001). The neural network correctly predicted the outcome in 59 of the 73 test set patients (80.8%), whereas LR correctly predicted the outcome in 48 (65.7%, p = 0.07). CONCLUSIONS: This ANN model, which is based on age, duration of infertility, serum hormone levels and testicular volumes, has clinically acceptable sensitivity. It may be of value for predicting spermatozoa in men with nonobstructive azoospermia.

Early tissue reactions in the rat bladder wall after contact with three different synthetic mesh materials.

OBJECTIVES: To investigate bladder tissue reactions to three types of implanted mesh material, i.e. polypropylene, polyglactin and polypropylene-polyglactin combined. MATERIALS AND METHODS: Forty-eight adult female Wistar albino rats were randomized to four equal groups, i.e. group 1 (sham-operated controls), group 2 (polypropylene mesh), group 3 (polyglactin mesh) and group 4 (polypropylene-polyglactin mesh). A laparotomy incision was made to access the bladder and fix a 0.5 x 1 cm piece of mesh directly on the bladder wall. Each group was randomly divided into two subgroups of six animals, killed at 7 and 14 days after mesh implantation, respectively, to study mesh and tissue features with time. Bladders were harvested for histological and immunohistochemical investigation. Microvessels that developed around the mesh were detected with the avidin-biotin peroxidase system, using antibody to Factor VIII-related antigen as an endothelial marker. Vessels were counted in the most intensely stained area of one section from each animal's bladder. RESULTS: Compared with the other groups, group 4 had more inflammatory reaction at 7 days but the tissue reactions to all mesh materials were similar at 14 days; the mesh penetrated the bladder muscularis propria at 14 days in all six rats in group 2, in one in group 3, and two in group 4. Group 4 tended to have a greater microvessel density at 14 than at 7 days. In contrast, groups 2 and 3 had lower microvessel densities at 14 than at 7 days. CONCLUSION: The rat bladder wall had a similar early response to all three types of mesh materials. Penetration was more marked with polypropylene mesh than with the other materials. This nonabsorbable material persists in tissue and is currently widely used for clinical applications. These results for penetration suggest that the use of polypropylene mesh risks serious postoperative complications, e.g. urethral tissue erosion.