The examination of the nephroprotective effect of montelukast sodium and N-acetylcysteine in renal ischemia with dimercaptosuccinic acid imaging in a placebo-controlled rat model.

PURPOSE: To determine the nephroprotective effect of NAC and Montelukast Sodium administration against the development of renal damage associated with long warm renal ischemia. METHODS: Twenty-seven rats were randomly divided into 3 study groups, which received NAC, montelukast and placebo, and 3 rats were included in the sham-treated control group. Medications were given 3 days before the procedure. DMSA renal scintigraphy was performed before and after surgery. The right renal pedicle was occluded for 45 min to induce ischemia and then subjected to reperfusion for 6 h (I/R groups). RESULTS: On pathological examination, the mean pathological scores of the montelukast and NAC groups were significantly lower than those of the placebo group. (p <0.05). In biochemical examination, significant differences were found in all parameter levels between the placebo group and the montelukast and NAC groups. (p <0.05) When postoperative DMSA renal scintigraphy measurements and renal function levels were compared, significant differences were found between the montelukast and NAC groups and the placebo and sham groups. CONCLUSION: The administration of NAC and montelukast sodium was seen to have a nephroprotective effect against the development of renal damage associated with warm renal ischemia.

The examination of the nephroprotective effect of montelukast sodium and N-acetylcysteine in renal ischemia with dimercaptosuccinic acid imaging in a placebo-controlled rat model

Abstract Purpose To determine the nephroprotective effect of NAC and Montelukast Sodium administration against the development of renal damage associated with long warm renal ischemia. Methods Twenty-seven rats were randomly divided into 3 study groups, which received NAC, montelukast and placebo, and 3 rats were included in the sham-treated control group. Medications were given 3 days before the procedure. DMSA renal scintigraphy was performed before and after surgery. The right renal pedicle was occluded for 45 min to induce ischemia and then subjected to reperfusion for 6 h (I/R groups). Results On pathological examination, the mean pathological scores of the montelukast and NAC groups were significantly lower than those of the placebo group. (p <0.05). In biochemical examination, significant differences were found in all parameter levels between the placebo group and the montelukast and NAC groups. (p <0.05) When postoperative DMSA renal scintigraphy measurements and renal function levels were compared, significant differences were found between the montelukast and NAC groups and the placebo and sham groups. Conclusion The administration of NAC and montelukast sodium was seen to have a nephroprotective effect against the development of renal damage associated with warm renal ischemia.

A new checklist method enhances treatment compliance and response of behavioural therapy for primary monosymptomatic nocturnal enuresis: a prospective randomised controlled trial.

PURPOSE: The aim of the study was to demonstrate the benefits of a newly-established written checklist of behavioural instructions for monosymptomatic nocturnal enuresis. METHODS: From a total of 96 parents with children who complain of bedwetting three or more nights per week for at least 14 days, 79 were randomly divided into three groups. Group I (n = 27) were instructed to apply only behavioural therapy as a written guideline, Group II (n = 26) were instructed to apply behavioural therapy with a written checklist for parents to fully complete and Group III (n = 26) received desmopressin treatment plus verbal behavioural therapy. All participants were analysed in respect of compliance and the response rate to treatment over a time period of 8 weeks. RESULTS: A total of 63 participants completed the study period. The participants in all three groups were similar in terms of the age of the child and the parents, number of siblings, and the educational and economic status of the parents (p > 0.05). High rates of treatment compliance were determined for the participants with the checklist compared to those with written guideline. No statistically significant difference was determined between Group II and III in respect of compliance rates (p = 0.12). The treatment response rates of the participants in Group I were significantly lower compared to those of Group II and III (p = 0.001) with no statistical difference determined between Groups II and III (p = 0.15). CONCLUSION: The success rate of behavioural therapy for MNE can be increased with the newly-designed method of a written checklist form of behavioural instructions.

Comparision of Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery For The Treatment of Multicalyceal and Multiple Renal Stones.

PURPOSE: Comparison of efficiency and reliability of percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) in treatment of multicalyceal and multiple renal stones in the same renal unit. MATERIALS AND METHODS: Between 2011 and 2015, records of patients who underwent surgery for renal stone were retrospectively reviewed. Patients who had multiple stones located in different calices in the same renal unit were included. The patients that underwent PNL and RIRS were defined as Group I and Group II, respectively. Patient criteria (age,sex); the stone characteristics; time of procedure, fluoroscopy and hospitalization; stone-free and complication rates of groups were evaluated between the treatment groups. RESULT: There were no significant differences in terms of age, gender, BMI, laterality, number of stones, number of stone localization, hounsfield units and surface area characteristics of the stone between the PNL (n = 47) and RIRS (n = 35) groups (P = .558, P = .278, P = .375, P = 0.051, P = .053, P = .064, P = .642, P = .080, respectively). Stone free rate was 59.6% (n=28) in PNL, and 88.6% (n=31) in RIRS (P=.004). 1st or 2nd degree complications according to Modified Clavien Classification developed in 10 patients (21.3%) in Group I and 1 patient (2.9%) in Group II (P = .015). The 3A or 3B complications were similar in groups (P = .077). Time of procedure, fluoroscopy and hospitalization were significantly lower in Group II (P < .001, P < .001 and P < .001, respectively). CONCLUSION: RIRS is more effective and more reliable procedure than PNL with higher stone-free and lower complication rates in treatment of multicalyceal and multiple stone in the same renal unit.

Comparison of tubularized incised plate urethroplasty and onlay island flap urethroplasty techniques in the repair of primarily proximal hypospadias.

OBJECTIVES: To compare the success of the 'tubularized incised plate urethroplasty' (TIPU) and 'Onlay island flap urethroplasty' (OIFU) techniques for the repair of primary proximal hypospadias. MATERIAL AND METHODS: A retrospective evaluation was made of the medical records of 68 patients with primary, non-complicated hypospadias, who were operated on in the Department of Urology, Ministry of Health Ankara Education and Research Hospital, between January 1997 and December 2012. Patients who underwent hypospadias surgery with TIPU were labelled as Group 1 and the OIFU technique as Group 2. Patient age, native meatus localization, operation time, diversion type, surgical success and complication rates were all assessed. Surgical success was evaluated with direct vision of voiding and uroflowmetry at the time of catheter removal, then at 2 weeks, 6 weeks, 6 months and 1 year. RESULTS: Group 1 consisted of 43 patients and Group 2 of 25 patients. The mean age of patients was 6.4±3.1 years in Group 1 and 8.0±4.6 years in Group 2 (p=0.09). The mean operating time was significantly lower in Group 1. (Group 1- 104.8±16.8 min, Group 2-125.4±24.7min; p<0.001) The distribution of meatus localization was similar in both groups. At 1 year postoperatively, urethrocutaneous fistula was the only complication and the definitive success rates were 81.6% in Group 1 and 72% in Group 2. CONCLUSION: Despite less frequent usage since the description and popularization of TIPU for proximal hypospadias repair, OIFU remains a valuable technique as a single-stage procedure in cases where the urethral plate is insufficient. Currently, both TIPU and OIFU are used successfully in the treatment of patients with proximal hypospadias.

What happens to asymptomatic lower pole kidney stones smaller than 10 mm in children during watchful waiting?

BACKGROUND: The optimal management of lower pole kidney (LPK) stones in children is controversial. The aim of this study was to determine the outcomes of children with asymptomatic isolated LPK stones smaller than 10 mm during follow-up. METHODS: A total of 242 patients with 284 stones presenting at our institution between June 2004 and December 2014 with an asymptomatic, single LPK stone with a diameter of <10 mm were enrolled in the study. All children were assigned to receive first-line therapy and then categorized according to the need for medical intervention. Age, gender, stone laterality, stone size and type, associated urinary tract problems, and uncontrolled metabolic status were assessed as predictive factors of medical treatment for small (<10 mm) asymptomatic LPK stones. Stone-free rates were compared between interventions. RESULTS: The mean age and mean stone size were 9.4 ± 1.9 years and 7.4 ± 0.6 mm at admission, respectively. Stone progression rate was 61.2%, and the mean time for intervention was 19.2 ± 4.6 months. Flexible ureterorenoscopy (n = 68) or micro-percutaneous nephrolithotomy (n = 4) were performed for 72 stones (25.4%; group 1), and extracorporeal shock wave lithotripsy was performed for 102 stones (35.9%; group 2). The stone-free rates were 81.8 and 79.3% in group 1 and 2, respectively (p > 0.05). The remaining asymptomatic stones (110, 38.8%; group 3) were managed by continued observation, and at the end of the observation time (mean 40.8 ± 20.8 months) the spontaneous passage rate was 9.1% in this group. In the multivariate analysis, stone size of >7 mm, concurrent renal anomalies, and stones composed of magnesium ammonium phosphate (struvite) and cystine were statistically significant predictors of the need for intervention. CONCLUSIONS: Children with stones larger than 7 mm, renal anomalies, or stones composed of metabolically active cystine or struvite are more likely to require intervention, and those with asymptomatic LPK stones smaller than 10 mm can be managed by continued observation.

Ureaplasma urealyticum: Presence among Sexually Transmitted Diseases.

The aim of this study was to detect the presence of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis, Trichomonas vaginalis, and Ureaplasma urealyticum in genital specimens of symptomatic patients. This study also examined the role of U. urealyticum in infections of the lower genital tract. Cervical and urethral samples from 96 patients (46 males, 50 females) were tested using the Seeplex(®) STD6 ACE kit. Consent forms were received and a questionnaire was applied. All statistical analyses were performed using the SPSS statistical software program (version 17.0). Among the samples tested, at least 1 pathogen was detected in 49% of the samples; specifically, the rate of detection of U. urealyticum, M. hominis, C. trachomatis, N. gonorrhoeae, M. genitalium, and T. vaginalis was 29.1%, 10.4%, 8.3%, 7.3%, 6.3%, and 4.2%, respectively. U. urealyticum was detected as the sole pathogen in samples from 10% of female patients and 28.3% of male patients (p = 0.035). U. urealyticum was present in 54.5% (18/33) of samples in which a single pathogen was detected and 71.4% (10/14) of samples in which multiple pathogens were detected. Among men, significant differences in discharge, dysuria, and pruritus were not noted among those with negative results (84.6%, 69.2%, and 38.5%, respectively), among those positive for only U. urealyticum (100%, 66.7%, and 26.7%, respectively), and those positive for N. gonorrhoeae, C. trachomatis, M. genitalium, and T. vaginalis (100%, 93.3%, and 26.7%, respectively). Detection of U. urealyticum, either alone or together with other pathogens, in a symptomatic group of patients is an important finding, particularly in men.

Outcomes of Laparoscopic Treatment Modalities for Unilateral Non-palpable Testes.

PURPOSE: To date, laparoscopy has gradually become the gold standard for treatment of non-palpable testicles (NPT) with different success and complication rates. In this study, we aimed to evaluate outcomes of laparoscopic approaches for NPT. MATERIALS AND METHODS: We reviewed data of 82 consecutive patients who underwent laparoscopic treatment for unilateral NPT at two institutions by two high volume surgeons from 2004 January to 2014 December. Laparoscopic-assisted orchidopexy (LAO) and two-stage Fowler-Stephens technique (FST) was performed for 45 and 37 patients, respectively. Age (at surgery), follow-up time, laterality of testes, and postoperative complications were analyzed. Modified Clavien classification system (MCCS) was used for evaluating complications. RESULTS: The median age (at surgery) and median follow-up time were 18 (range: 6-56) and 60 (range: 9-130) months, respectively. Overall success rate for two laparoscopy techniques was 87.8% during the maximal follow-up time. We observed wound infection in two, hematoma in one, testicular atrophy in five, testicular re-ascending in two patients at follow-up period. There was no statistical difference between two laparoscopic techniques for grade I (five vs. two patients, p = 0.14) and grade IIIb MCCS complications (five vs. two patients, p = 0.44). CONCLUSION: Our results have shown that two laparoscopic approaches have low complication rates.

Evaluating Ureteral Wall Injuries with Endoscopic Grading System and Analysis of the Predisposing Factors.

OBJECTIVE: To analyze the predictive factors for intraoperative ureteral wall injury due to semirigid ureteroscopy (URS) used in the treatment of ureteral calculi. METHODS: The data of 437 patients who had URS due to ureteral stones were prospectively analyzed. The ureteral wall injuries that occurred during URS were reviewed endoscopically at the end of surgery and divided into two groups as low grade (grades 0 and 1) and high grade (grades 2, 3, and 4) according to classification of ureteral wall injuries. Those two groups were compared for patient and stone characteristics and perioperative findings. RESULTS: Ureteral wall injury was seen in 133 (30.4%) patients after surgery. According to the endoscopic classification of the lesions after URS, grades 0, 1, 2, and 3 injury were seen in 69.5%, 16.4%, 11.2%, and 2.7% of the patients, respectively. There were no grade 4 injuries in our series. Two groups showed statistically significant differences for the location (prox- vs distal and mid-ureter) and size of the stone (9.9 mm vs 14.03 mm), presence of preoperatively urinary tract infection (UTI) (12% vs 50.8%), needed balloon dilatation (9.8% vs 36.1%), duration of surgery (33.6 min vs 43.3 min), and surgical success rate (90% vs 76%) (p = 0.01, for all). Stone size, location, duration of surgery, and presence of preoperative infection were determined as independent prognostic factors for mucosal injury. CONCLUSION: The ureteral wall injury grading system may be used for standardized reporting of ureteral lesions after ureteroscopy. Big, proximal ureteral stone, longer operation time, and presence of UTI are the risk factors for ureteral wall injury during URS.

Pediatric extracorporeal shock wave lithotripsy: multi-institutional results.

AIM: To evaluate the efficacy, auxiliary procedures and complications of pediatric extracorporeal shock wave lithotripsy (ESWL) performed with electrohydraulic lithotripters. METHODS: Children with urolithiasis, aged between 0 and 15, were retrospectively evaluated. ESWL was performed by using two different electrohydraulic lithotripters, Elmed Multimed Classic (Elmed Medical Systems, Ankara, Turkey) and E-1000 (EMD Medical Systems, Ankara, Turkey), between January 2008 and December 2012 in four different referral centers in Turkey. RESULTS: 85.5% of patients were stone-free at 3 months. Further ESWL treatment was needed in 33.7% of the cases (one session, n = 55; two sessions, n = 15; three sessions, n = 13). Steinstrasse occurred in 10 patients but 8 of them cleared completely during the follow-up period. Urinary tract infection was detected in 3 (3.9%), fever in 3 (3.9%) and a small subcapsular hematoma in one (1.3%) patient, respectively. When the stones were divided into two groups as those with diameters <10 mm and ≥10 mm, it was found that the stone-free rate was associated with stone diameter, and that the smaller diameters had higher but statistically insignificant stone-free rates (P = 0.196). CONCLUSION: ESWL yields favorable results with low rates of complication and auxiliary procedures in selected pediatric patients.

Can urinary nerve growth factor and bladder wall thickness correlation in children have a potential role to predict the outcome of non-monosymptomatic nocturnal enuresis?

INTRODUCTION: Measurement of bladder wall thickness (BWTh) by ultrasound has been introduced as a new and promising technique to assess bladder dysfunction, and increased levels of nerve growth factor have also been reported in the bladder tissue and urine of patients with sensory urgency and detrusor overactivity (DO). OBJECTIVE: In this study we aimed to generate a clinically useful tool with urinary nerve growth factor levels and ultrasonographic BWTh to find possible pathogenetic clues and prognostic indicators as guides for the choice of therapy of non-monosymptomatic nocturnal enuresis. METHODS: A total of 110 children, aged 6-16 years old, were involved in this prospective study. Group 1 consisted of children with non-monosymptomatic nocturnal enuresis (n = 40), Group 2 of children with monosymptomatic nocturnal enuresis (n = 40) and Group 3 of children with healthy normal controls (n = 30). Children were evaluated with detailed history and physical examination, including neurologic examination; they were asked to complete a self-reported questionnaire and a 3-day bladder diary with the aid of their parents. The number of wet nights, the number of voids per night, the presence of daytime voiding symptoms (urgency, urge incontinence, incontinence, holding maneuvers, frequency), fluid intake, and any history of urinary tract infections (UTIs) were recorded. Monosymptomatic nocturnal enuresis and non-monosymptomatic nocturnal enuresis diagnosis was made using the International Children's Continence Society definition. Urinary nerve growth factor levels were measured by enzyme-linked immunosorbent assay and BWTh was measured transabdominally by a uroradiologist who specialized in pediatric ultrasonography. Urinary nerve growth factor levels were normalized by urinary creatinine levels and compared in all subgroups. RESULTS: The mean age of the study group was 9.6 (range 6-16) years. The mean BWTh was significantly increased in Group 1 compared with Group 2 (4.33 ± 1.12 mm, 2.33 ± 1.03 mm; p < 0.001) and healthy controls (4.33 ± 1.12 mm, 1.86 ± 0.57 mm; p < 0.001, respectively). Urinary levels of nerve growth factor corrected to urine creatinine (NGF/Cr) significantly increased in Group 1 with to Group 2 (2.75 ± 1.15 vs. 0.58 ± 0.15; p < 0.001) and controls (2.75 ± 1.15 vs.0.28 ± 0.10; p < 0.001, respectively). In receiver operating characteristic analysis, BWTh was found to have sensitivity of 95% and specificity of 85.7% (3.00 area under the curve [AUC] 0.937; 95%) and NGF/Cr had sensitivity of 97.5% and specificity of 98.6% (0.885; AUC, 999; 95%) in predicting lower urinary tract symptoms (LUTS) for non-monosymptomatic nocturnal enuresis (NMNE) (Figure). DISCUSSION: In our study we have investigated that BWTh together with urinary NGF levels normalized to the concentration of urinary creatinine (NGF/Cr) may predict daytime voiding problems in children with primary nocturnal enuresis (PNE). The main basis of this study is previous findings which demonstrated that ultrasonography (US)-based measurement of BWTh is a useful diagnostic parameter for LUTS in children, and that increased levels of NGF in bladder tissue and urine such as sensory urgency, DO, and overactive bladder (OAB) was indicated by clinical and experimental studies. The present study demonstrated that urinary NGF/Cr levels and BWTh measurements were significantly increased in patients with NMNE with daytime urinary symptoms (urgency, urge-incontinence, incontinence, frequency) showing symptoms of an OAB than controls and MNE. CONCLUSION: BWTh measurements and NGF/Cr values, as non-invasive tools, may guide therapy and improve outcomes in the treatment of children with NMNE. Further studies including a larger number of patients would be of great interest.

Comparison of ultrasonic and pneumatic intracorporeal lithotripsy techniques during percutaneous nephrolithotomy.

OBJECTIVES: To compare the effectiveness and safety of ultrasonic and pneumatic lithotripters in the treatment of renal stone disease. MATERIALS AND METHODS: A total of 227 consecutive percutaneous nephrolithotomy procedures for renal calculi were performed. In 107 patients ultrasonic lithotriptors were used (group I) and in 83 patients pneumatic lithotriptors were used (group II). In the remaining 37 patients, stones were managed with both pneumatic and ultrasonic lithotripters. Follow-up studies included intravenous urography (IVU) and/or computed tomography (CT). RESULTS: The mean operative time and duration of hospitalization were similar between the groups. In the ultrasonic treatment group, 100 (96.9%) patients were stone-free on postoperative day 1 and 5 (4.6%) went on to undergo an additional treatment modality, resulting in a total stone-free rate of 97.2%. In the pneumatic lithotripsy group, 68 (81.9%) patients were stone-free after the primary procedure on the first day and 15 (18.1%) went on to undergo an additional treatment modality, resulting in a stone-free rate of 91.5%. The final stone-free rates at 3 months postoperatively in groups I, II, and III were 97.2%, 91.5%, and 87.9%, respectively (P = 0.826). CONCLUSIONS: We conclude that both ultrasonic and pneumatic lithotripters are effective and safe for intracorporeal lithotripsy. However, the ultrasonic lithotripter provides higher stone-free rates with similar morbidity compared with pneumatic devices.

Ureteral Stricture after Laparoscopic Tubal Ligation due to Suturing of the Serosa.

Strictures secondary to traumas of the ureter are some of the complications of urogynecologic surgery. We present a 43-year-old female who had a history of laparoscopic tubal ligation a year ago and was admitted to our department with recurrent flank and inguinal pain. It was soon understood that a suture has pulled the ureter from the lateral serosa of the upper part to the lateral serosa of the lower part causing dilatation of the proximal and midureter because of the previous surgery while there was no damage on the ureteral lumen. Consequently successful reconstruction was performed with open ureteroureterostomy.