Is Peyronie's an IgG4-related disease?

OBJECTIVE: We believe that IgG4 may have a role in the pathogenesis of Peyronie's disease (PD), and this role could be particularly beneficial for developing new strategies; therefore, we aimed to investigate the role of IgG4 in PD. METHODS: This study included 3 groups with a total of 139 subjects: (I) PD group (n=61), (II) control group (n=48), and (III) benign prostatic hyperplasia (BPH) group (n=30). IgG4 measurement was performed using the enzyme-linked immunosorbent assay. Plaque size, penile curvature, and the presence of concomitant impotence were evaluated in the PD group. Impotence was assessed based on the International Index of Erectile Function (IIEF). RESULTS: A significant difference was observed between the PD and control groups and between the PD and BPH groups with regard to IgG4 levels, while no significant difference was found between the BPH and control groups (p=0.0001, p=0.002, and p=0.07, respectively). The IgG4 levels were significantly higher in the PD than in the other groups. The cutoff value determined between the groups was 87.5, 82, and 31.5, respectively. Mean plaque size was 2.0±1.01 cm, and a significant relationship was found between plaque size and IgG4 concentration (p=0.02). Mean penile curvature was 35.6±25.1°, and a significant relationship was found between penile curvature of >60° and IgG4 concentration (p=0.001). Mean IIEF score was 19 (range, 7-25). Moreover, no significant relationship was found between erectile dysfunction and IgG4 concentration. Penile pain was present in 24 (39.3%) patients with PD. CONCLUSION: The IgG4 levels were significantly increased in patients with PD, which implies that IgG4 may have a role in the pathogenesis of PD. This finding could be particularly beneficial for developing new strategies. Future studies with larger patient series are needed to substantiate our findings.

Comparison of dorsal intercostal perforator artery flap and primary closure in myelomeningocele repair.

PURPOSE: Of the many suggested techniques, we used dorsal intercostal perforator artery flap (DIPAF) for the closure of myelomeningocele defects. This study compared the outcomes of primary closure and DIPAF in the closure of myelomeningoceles. METHODS: Data of 24 patients that underwent myelomeningocele surgery at a single institution between November 2015 and September 2019 were retrospectively reviewed. RESULTS: The primary closure group had 13 patients (54.17%) and the DIPAF group had 11 (45.83%). The mean age was 7.91 ± 13.27 days (1-60 days). Twelve patients were female and 12 were male. In 22 patients, the myelomeningocele sacs were in the lumbosacral region, while in 2, they were in the thoracolumbar region. The mean defect sizes were 14.20 ± 4.62 cm2 and 18.44 ± 3.49 cm2 in the primary closure and DIPAF groups, respectively. In each group, four patients had a kyphotic deformity. In the primary closure group, three patients had wound necrosis, two had wound dehiscence, and four had cerebrospinal fluid (CSF) leakage. In the DIPAF group, one patient had wound necrosis and one had CSF leakage. Significantly fewer complications related to the operation area were observed in the DIPAF group (p < 0.05). Increased defect size, kyphotic deformity, and presence of hydrocephalus were found to be risk factors for complications related to the operation area. CONCLUSION: This surgical treatment protects neural tissue, prevent CSF leakage, and reduce central nervous system infection rates in myelomeningocele patients. Closure technique with the fasciocutaneous skin flap has more satisfying results than primary closure.

Course of Urological Problems in Children with Spinal Dysraphism: Long-Term Follow-Up Results.

BACKGROUND/AIMS: We aimed to evaluate the course of urinary problems in children with spinal dysraphism. METHODS: This multicenter study evaluated data on pediatric patients diagnosed with spinal dysraphism between 2010 and 2019. The neurological and urological conditions of the patients were examined retrospectively. This study focused on the course of urological problems. Urodynamic examinations including urodynamic bladder capacity, bladder pressure in maximal capacity, compliance, detrusor hyperactivity, uroflowmetry, and residual urine amount were evaluated. All patients underwent urinary system ultrasonography, urinalysis, hemogram and biochemical tests, and urodynamics at admission and follow-ups. RESULTS: A total 62 patients (35 males, 27 females) with a mean age of 7.50 ± 4.01 years and age range of 1-16 years were included in the study. Ultrasonographic evaluation revealed normal results in 32 patients and abnormal findings, including moderate-to-severe calyceal dilatation, parenchymal thinning, and residual urine, in 30 patients. At the time of diagnosis, culture-positive urinary tract infection was detected in 22 patients, and leukocyte and/or bacterial positivity was detected in 18 patients. The differences between bladder capacity, bladder pressure at maximal capacity, compliance, and detrusor hyperactivity at first admission and post-treatment were statistically significant (p < 0.05). Vesicoureteral reflux was also detected in 25 patients. Thirty patients underwent oral anticholinergic and antibiotic prophylaxis, while 17 additionally underwent clean intermittent catheterization. Five patients underwent intravesical Botox injection, clean intermittent catheterization, and medical treatment, and 10 patients underwent augmentation cystoplasty. CONCLUSION: The prevalence of urinary tract problems is high in patients with spinal dysraphism for whom early diagnosis is very important for both urologic and neurosurgical considerations. Early follow-up of urodynamics should be performed, and treatment should be carried out if necessary. Regular follow-up and appropriate treatment have positive effects on the quality of life of these patients and may also prevent the occurrence of severe renal dysfunction.

A novel diagnostic tool for the detection of bladder cancer: Measurement of urinary high mobility group box-1.

OBJECTIVE: We aimed to investigate the diagnostic value of urinary High Mobility Group Box-1 (HMGB1) level as a noninvasive tool that can be potentially used for diagnosis and during follow-up in patients with bladder cancer patients. METHOD: The study was conducted in a total of 121 participants including 61 patients diagnosed with primary bladder cancer, 30 patients with an acute urinary tract infection and 30 healthy controls. Age, gender and urinary HMGB1 levels of the study groups were evaluated. The association of clinical features (tumor diameter, number of foci, pathological grade, muscle invasion) with urinary HMGB1 levels was investigated in patients with bladder cancer. RESULTS: All 3 groups showed a normal age and gender distribution with no significant difference among them (P = 0.775 and P = 0.967, respectively). A significant difference was detected in urinary HMGB1 levels among the 3 groups (P < 0.001). When urinary HMGB1 levels were compared between patients with high grade vs. low grade tumors, the mean HMGB1 level was 44.39 pg/ml (12.1-505.2) in patients with low grade tumors and 280 pg/ml (18.7-2685.3) in patients with high grade tumors (P < 0.001). Patients with a greater number of tumor foci had higher HMGB1 levels in comparison to patients with a single tumor focus (P = 0.008). Urinary HMGB1 levels were higher in patients with a tumor diameter of ≥3 cm than in patients with a tumor diameter less than 3 cm (P = 0.001). Patients with muscle-invasive bladder cancer exhibited higher urinary HMGB1 levels compared to patients with non-muscle-invasive bladder cancer (P = 0.033). The cut-off values derived from the ROC analysis were 63.30 pg/ml for distinguishing bladder cancer from urinary tract infection, 30.94 pg/ml for urinary tract infection versus control group and 38.70 pg/ml for bladder cancer vs. control group, respectively. Sensitivity was 59% and specificity was found 77%. CONCLUSION: In future controlled studies involving larger patient groups, urinary HMGB1 levels can be used for diagnostic and screening purposes in bladder cancer patients.

A neural network-based algorithm for predicting the spontaneous passage of ureteral stones.

In this study, a prototype artificial neural network model (ANN) was used to estimate the stone passage rate and to determine the effectivity of predictive factors on this rate in patients with ureteral stones. The retrospective study included a total of 192 patients with ureteral stones, comprising 128 (66.7%) men and 64 (33.3%) women. Patients were divided into two groups. Group 1 (n: 125) consisted of people who spontaneously passed their stones, Group 2 (n: 67) consisted of people who could not pass stones spontaneously. The groups were compared with regard to the relationship between input data and stone passage rate by using both ANN and standard statistical tests. To implement the ANN, the patients were randomly divided into three groups: (a) training group (n = 132), (b) validation group (n = 30), and (c) test group (n = 30). The accuracy rate of ANN in the estimation of the stone passage ratio was 99.1% in the group a, 89.9% in the group b, and 87.3% in the group c. It was revealed that certain criteria (stone size, body weight, pain score, ESR, and CRP) were relatively more significant for saving treatment cost and time and for avoiding unnecessary treatment. ANN can be highly useful for the avoidance of unnecessary interventions in patients with ureteral stones as it showed remarkably high performance in the estimation of stone passage rate (99.16%).

Role of native thiol, total thiol and dynamic Disulphide in diagnosis of patient with prostate cancer and prostatitis

ABSTRACT Background: Our study investigates whether Native Thiol, Total Thiol and disulphide levels measured in serum of patients with prostate cancer and prostatitis and of healthy subjects, have any role in differential diagnosis. Materials and Methods: Patients followed up for histopathologically verified diagnosis of prostate cancer and prostatitis in 2016-2017 at the Medicalpark Gaziantep Hospital Urology Clinic were included in the study. Native Thiol (NT), Total Thiol (TT), Dynamic Disulphide (DD) levels in serum were measured by a novel automated method. Results: NT, TT, DD, NT / TT ratios, DD / TT ratio and DD / NT ratio were measured as 118.4 ± 36.8μmoL / L, 150.3 ± 45.3μmoL / L, 15.9 ± 7μmoL / L, 78.8 ± 7μmoL / L, 10.5 ± 3.5μmoL / L, 13.8 ± 5.8μmoL / L respectively in patients with prostate cancer; as 116.4 ± 40.5μmoL / L, 147.5 ± 50.1μmoL / L, 15.5 ± 8.7μmoL / L, 79.7 ± 9μmoL / L, 10.1 ± 4.5μmoL / L, 13.5 ± 7.2μmoL / L in patients with prostatitis and as 144.1 ± 21.2μmoL / L, 191 ± 32.3μmoL / L, 23.4 ± 10.1μmoL / L, 76.1 ± 98.3μmoL / L, 11.9 ± 4.1μmoL / L, 16.4 ± 6.9μmoL / L in healthy subjects. Significant difference was detected between groups of NT, TT and DD levels (p = 0.008, p = 0.001, p = 0.002). No significant difference was detected in terms of the NT / TT, DD / TT and DD / NT rates (p = 0.222, p = 0.222, p = 0.222). Conclusions: Serum NT, TT, DD levels in patients with prostatitis and prostate cancer were found significantly lower compared to the control group. This indicates that just as inflammation, prostate cancer also increases oxidative stress on tissues.

Role of native Thiol, total Thiol and dynamic Disulphide in diagnosis of patient with prostate cancer and prostatitis.

BACKGROUND: Our study investigates whether Native Thiol, Total Thiol and disulphide levels measured in serum of patients with prostate cancer and prostatitis and of healthy subjects, have any role in differential diagnosis. MATERIALS AND METHODS: Patients followed up for histopathologically verified diagnosis of prostate cancer and prostatitis in 2016-2017 at the Medicalpark Gaziantep Hospital Urology Clinic were included in the study. Native Thiol (NT), Total Thiol (TT), Dynamic Disulphide (DD) levels in serum were measured by a novel automated method. RESULTS: NT, TT, DD, NT / TT ratios, DD / TT ratio and DD / NT ratio were measured as 118.4 ± 36.8µmoL / L, 150.3 ± 45.3µmoL / L, 15.9 ± 7µmoL / L, 78.8 ± 7µmoL / L, 10.5 ± 3.5µmoL / L, 13.8 ± 5.8µmoL / L respectively in patients with prostate cancer; as 116.4 ± 40.5µmoL / L, 147.5 ± 50.1µmoL / L, 15.5 ± 8.7µmoL / L, 79.7 ± 9µmoL / L, 10.1 ± 4.5µmoL / L, 13.5 ± 7.2µmoL / L in patients with prostatitis and as 144.1 ± 21.2µmoL / L, 191 ± 32.3µmoL / L, 23.4 ± 10.1µmoL / L, 76.1 ± 98.3µmoL / L, 11.9 ± 4.1µmoL / L, 16.4 ± 6.9µmoL / L in healthy subjects. Significant difference was detected between groups of NT, TT and DD levels (p = 0.008, p = 0.001, p = 0.002). No significant difference was detected in terms of the NT / TT, DD / TT and DD / NT rates (p = 0.222, p = 0.222, p = 0.222). CONCLUSIONS: Serum NT, TT, DD levels in patients with prostatitis and prostate cancer were found significantly lower compared to the control group. This indicates that just as inflammation, prostate cancer also increases oxidative stress on tissues.

Aggressive course in a patient with mucin-producing urothelial-type adenocarcinoma of the prostate: A case report and review of the literature.

Prostate cancer is one of the frequently seen types of cancers in men. The most frequent histological type of prostate cancer is the acinar adenocarcinoma. Mucin-producing urothelial-type adenocarcinoma of the prostate is a very rare subtype. The mucin-producing urothelial-type adenocarcinoma of the prostate has microscopic similarities with colon and bladder adenocarcinoma. It has a more aggressive clinical course and does not respond to androgen deprivation therapy. A 77-year-old male patient diagnosed with mucinous prostate cancer was presented in the current case report.

Efficacy of mirabegron in medical expulsive therapy.

To show the efficacy of mirabegron for medical expulsive treatment, in patients had intramural located distal ureteral stone. A 80 patients had intramural ureteral stone were assessed retrospectively between April 2017 and January 2018. Mirabegron 50 mg/day + diclofenac 100 mg/day (group 1, n = 40), and only diclofenac 100 mg/day (group 2, n = 40) were administered to patients, consecutively. Age, gender, stone size, laterality, and severity of hydronephrosis were recorded. Spontaneous stone expulsion rates (SER), stone expulsion time, and the number of daily colic episodes were evaluated. In the group 1, one (2.5%) patient was excluded due to nasopharyngitis, and one (2.5%) patient was excluded due to 5 mmHg systolic blood pressure increase. In addition, four (10%) patients in group 1, and six (15%) patients in group 2, who did not attend follow-up examinations, were excluded from the study. There was not any statistically significant difference between the two groups in terms of age, gender, stone location, severity of hydronephrosis, stone size (p = 0.736, p = 0.310, p = 0.467, p = 0.801, p = 0.761, consecutively). Spontaneous expulsion ratios were calculated as 73.52% in group 1, and 47.05% in group 2 (p = 0.026). However, there was not any statistically significant difference in terms of stone expulsion time (p = 0.979). SER for patients had ≤ 6 mm stones was higher in group 1 (87.5 vs 52.49%, p = 0.031). In addition, group 2 patients had more pain episodes (1.02 ± 0.52 vs. 1.29 ± 0.57, p = 0.049). In the current study, mirabegron has been shown to be an efficient, safe and a new treatment modality, with lower side effect profile for the intramural located distal ureteral stones.

Comparison of Two Different Anesthesia Methods in Patients Undergoing Percutaneous Nephrolithotomy.

PURPOSE: The study aims to compare the effectiveness, safety and costs of two different anesthesia methods in percutaneous nephrolithotomy (PCNL) operations. MATERIAL AND METHOD: In our study, data was retrospectively examined of 1657 patients who underwent PCNL due to renal calculi between 2009 and 2017. Patients were separated into two groups according to the type of anesthesia; as those who underwent PCNL by general anesthesia (GA) (n = 572) and those under spinal anesthe-sia(SA) (n = 1085). Standard PCNL technique was used in both groups. Gender, age, operation duration, period of hospitalization, stone-free ratio, post-operative narcotic analgesic need and complications were compared between these two groups. RESULTS: A total of 1657 patients consisting of 1064 (64.2%) male patients and 593 (35.8%) female patients were included in the study. The average age of the all patients was 33.2 ± 12.4 (range 16-74) years. The two groups were similar in terms of mean age, gender, stone size, stone location and body mass index. Mean operation time was sig-nificantly shorter in the SA group than in the GA group (81.8 ± 33.9 minute vs. 118.2 ± -42.9 minute respectively, P < .001). Mean period of hospitalization was remarkable shorter in the SA group than in the GA group (30.0 ± 9.9 hours vs. 38.4 ± 11.2 hours respectively, P < .001). Post-operative narcotic analgesic need rate was significantly higher in the GA group than in the SA group (33.4% vs. 10.9%, respectively, P < .001). Anesthesia cost was found significantly lower in the SA group than in the GA group (USD 21.3±2.8 vs. USD 83.6 ± 9.5, respectively, P < .001). Significant difference was not observed between both groups in terms of stone-free ratio, amount of bleed-ing, fluoroscopy time, pre-operative and post-operative complications. CONCLUSION: Compared to those performed with GA, PCNL performed with SA is a safe, effective and low-cost method.

Lack of Any Role of Systemic Inflammatory Responses in Predicting Muscle Invasion by Bladder Cancer.

BACKGROUND: The purpose of this study is to evaluate if there is a relation between platelet:lymphocyte ratio (PLR) and neutrophil lymphocyte ratio (NLR) values and tumour histology and spread in bladder cancer cases. MATERIALS AND METHODS: Bladder cancer patients undergoing TUR-M operation, with histopathologically verified diagnosis, followed-up and treated at the Private Medical Park Gaziantep Hospital between 2010 and 2015, were included in the study. NLR and PLR values were calculated using complete blood count data obtained at the first presentation. RESULTS: A total of 99 patients were included in the study, 7 (7.1%) women and 92 men (92.9%). When NLR was used as the indicator of systemic inflammatory response (SIR), it was determined that 52 (52.5%) of the patients were SIR negative and 47 (47.5%) SIR positive. No significant relation could be detected between NLR and tumour grade and muscle invasion (p=0.948, p=0.480). When PLR was used as SIR indicator, it was determined that 71 (71.7%) of the patients were found as negative and 28 (28.3%) as positive. No significant relation could be detected between PLR and tumour grade and muscle invasion (p=0.651, p=0.494). CONCLUSIONS: In our study we did not detected a relation between tumour histological behavior and PLR and NLR in bladder cancer. However, NLR and PLR are easily calculated, accessible, inexpensive and simple-to-use laboratory data from whole blood counts.

Effects of intravesical dexpanthenol use on lipid peroxidation and bladder histology in a chemical cystitis animal model.

OBJECTIVE: To demonstrate the effects of intravesical dexpanthenol use on bladder histology and lipid peroxidation in a chemical cystitis animal model. METHODS: Thirty-five New Zealand rabbits were divided into 3 groups. Cystitis was conducted with transurethral intravesical hydrochloric acid instillation on the subjects in groups I and II. Then, Group I subjects were transurethrally administered intravesical dexpanthenol therapy twice a week, Group II subjects were given only intravesical isotonic NaCl instillation, and Group III subjects were administered intravesical isotonic NaCl instillation without conducting chemical cystitis to create the same stress. Treatment schemes of all groups were arranged in the same manner. After 6-week therapy, the rabbits were sacrificed and histopathologic investigations were carried out to demonstrate changes in the urinary bladder. Serum and tissue malondialdehyde (MDA) values were examined to investigate the effect of dexpanthenol on lipid peroxidation. RESULTS: We observed that the basal membrane and mucosal integrity were maintained, inflammatory cells were suppressed, and MDA levels decreased in group I, which received dexpanthenol therapy. However, it was also observed that mucosal integrity was spoiled, numerous inflammatory cells were accumulated, and MDA levels were significantly increased in group II, which was administered isotonic NaCl. CONCLUSION: In light of our findings, intravesical dexpanthenol therapy could be a new therapeutic approach in the treatment of interstitial cystitis because of its low cost and acceptable side effects.

The use of artificial neural networks in decision support in vesicoureteral reflux treatment.

AIM: To develop a prediction model based on artificial neural networks (ANN) for the treatment selection in vesicoureteral reflux (VUR). METHODS: A total of 96 children with VUR (145 ureteric units (UU)) were treated at our institution during 2004-2006. An ANN based on quick propagation architecture was created with the commercially available software package. The patients' age and sex, the cause and grade of VUR, the affected ureter, the type of treatment (conservative, subureteric injection, or open surgery), existence of renal scar on DMSA, follow-up times and the number of injections were used as variables. These data were also transferred to a statistical software package and regression analysis was done. RESULTS: In all, 105 UU showed no reflux, 5 UU showed improvements in reflux grade (considered only in the conservative management group), and the remaining 35 UU showed persistence. In the training group (n = 99), ANN showed 98.5% sensitivity, 92.5% specificity, 97% positive predictive value, and 96% negative predictive value in predicting treatment outcome. CONCLUSIONS: We have demonstrated that ANN can accurately predict the resolution of VUR, and thus could be useful in daily clinical practice. This approach would allow urologists to aid in the decision-making process of VUR treatment.

Comparative evaluation of efficacy of use of tamsulosin and/or tolterodine for medical treatment of distal ureteral stones.

OBJECTIVES: To evaluate the activity of the therapeutic agents (tamsulosin and/or tolterodine) used to accelerate the expulsion of stones and to reduce the probable complications during observation of the medical treatment of distal ureteral stones to allow spontaneous passage. METHODS: A total of 120 patients with distal ureteral stones were included in the study. Patients with stones less than 10 mm and allowing urinary flow were included in the study. The patients were studied in four randomly divided groups. Group 1 patients received tamsulosin 0.4 mg/day, group 2 patients received tamsulosin 0.4 mg/day plus tolterodine 2 mg (twice a day), group 3 patients received tolterodine 2 mg (twice a day), and group 4 patients did not receive any medical treatment (control group). RESULTS: Differences among the four groups in patient age and stone dimension were not statistically significant (P >0.05). The stone expulsion rates were greater (P <0.05) in groups 1 and 2 than in groups 3 and 4. A significant variation (P <0.05) regarding the time to stone expulsion was observed in groups 1 and 2. CONCLUSIONS: In our study, the use of tamsulosin for the expulsion of distal ureteral stones was effective; however, the use of tolterodine provided no additional advantages.