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 different perspective for morbidity related to Fournier's gangrene: which scoring system is more reliable to predict requirement of skin graft and flaps in survivors of Fournier's gangrene?

PURPOSE: To identify the prognostic factors that might predict morbidity related to Fournier's gangrene (FG) and particularly requirement of skin grafting and flaps. We also evaluated the validities of different severity indexes. METHODS: Thirty male patients with complete data who were treated for FG between January 2012 and December 2018 were retrospectively evaluated. Fournier's Gangrene Severity Index (FGSI), Uludag Fournier Gangrene Severity Index (UFGSI) and Age-Adjusted Charlson Comorbidity Index (ACCI), Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, the Combined Urology and Plastics Index (CUPI) and neutrophil-lymphocyte ratio (NLR) were calculated for 27 surviving patients. These patients were divided into two groups: Group I (14 patients with primary skin closure) and Group II (13 patients with requiring skin grafting and flaps). RESULTS: Body temperature (p = 0.026), heart rate (p < 0.001), respiratory rate (p = 0.029), creatinine (p = 0.002), white blood cell count (p = 0.014), hemoglobin levels (p = 0.018), involvement of pelvic floor or beyond (p = 0.018), length of hospital stay (p = 0.049), previous endourologic instrumentation (p = 0.035), requirement of cystostomy (p = 0.041), colostomy (p = 0.046), orchiectomy (p = 0.034) and intensive care unit (p = 0.046) were found to be significantly higher in Group II. All six different scoring systems were significantly higher in the patients who underwent skin grafting and flaps. In multivariate analysis, heart rate, FGSI, UFGSI, NLR, requirement of colostomy and intensive care unit were determined as independent factors for predicting requirement of skin grafting and flaps. CONCLUSION: FGSI, UFGSI and NLR are more reliable parameters for predicting skin reconstruction method (with the threshold values of 4.5, 5.5, and 7.87, respectively).

The protective effect of Papaverine and Alprostadil in rat testes after ischemia and reperfusion injury

ABSTRACT Objective: To investigate the effect of papaverine and alprostadil on testicular torsion-detorsion injury in rats. Materials and Methods: A total of 40 male Wistar-Albino rats were used in this study. Four hours of right testicular torsion was applied to each group, excluding sham oper- ated group. The torsion-detorsion (T/D), T/D + papaverine and T/D + alprostadil groups received saline, papaverine and alprostadil at the same time as surgical detorsion, respectively. At 14 days after the surgical detorsion, ischaemic changes and the degree of damage were evaluated with Cosentino scoring and the Johnson tubular biopsy score (JTBS). Results: JTBS was determined as 8.8±2.7 in the Sham group, 5.08±1.9 in the T/D+papaverine group, 5.29±2.3 in the T/D +alprostadil group and 2.86±1.9 in the TD group. The JTBS was determined to be statistically significantly high in both the T/D + papaverine group and the T/D + alprostadil group compared to the T/D group (p=0.01, p=0.009). In the T/D + papaverine group, 3 (43%) testes were classified as Cosentino 2, 3 (43%) as Cosentino 3 and 1 (14%) as Cosentino 4. In the T/D +alprostadil group, 5 (50 %) testes were classified as Cosentino 2, 3 (30 %) as Cosentino 3 and 2 (20%) as Cosentino 4. Conclusion: The present study indicated that spermatic cord administration of alprostadil and papaverine showed a protective effect against ischemia/reperfusion injury after right-side testes torsion and histological changes were decreased after testicular ischemia reperfusion injury.

The protective effect of Papaverine and Alprostadil in rat testes after ischemia and reperfusion injury.

OBJECTIVE: To investigate the effect of papaverine and alprostadil on testicular torsion-detorsion injury in rats. MATERIALS AND METHODS: A total of 40 male Wistar-Albino rats were used in this study. Four hours of right testicular torsion was applied to each group, excluding sham operated group. The torsion-detorsion (T/D), T/D + papaverine and T/D + alprostadil groups received saline, papaverine and alprostadil at the same time as surgical detorsion, respectively. At 14 days after the surgical detorsion, ischaemic changes and the degree of damage were evaluated with Cosentino scoring and the Johnson tubular biopsy score (JTBS). RESULTS: JTBS was determined as 8.8±2.7 in the Sham group, 5.08±1.9 in the T/ D+papaverine group, 5.29±2.3 in the T/D +alprostadil group and 2.86±1.9 in the TD group. The JTBS was determined to be statistically significantly high in both the T/D + papaverine group and the T/D + alprostadil group compared to the T/D group (p=0.01, p=0.009). In the T/D + papaverine group, 3 (43 %) testes were classified as Cosentino 2, 3 (43%) as Cosentino 3 and 1 (14 %) as Cosentino 4. In the T/D +alprostadil group, 5 (50 %) testes were classified as Cosentino 2, 3 (30 %) as Cosentino 3 and 2 (20%) as Cosentino 4. CONCLUSION: The present study indicated that spermatic cord administration of alprostadil and papaverine showed a protective effect against ischemia/reperfusion injury after right-side testes torsion and histological changes were decreased after testicular ischemia reperfusion injury.

Which Should be Preferred for Moderate-Size Kidney Stones? Ultramini Percutaneous Nephrolithotomy or Retrograde Intrarenal Surgery?

PURPOSE: Comparison of effectiveness and safety of ultramini percutaneous nephrolithotomy (UMPNL) and retrograde intrarenal surgery (RIRS) in treatment of moderate-sized renal stones. MATERIAL AND METHODS: The patients scheduled for surgery attributable to renal stones with the greatest diameter of 10 to 25 mm were prospectively analyzed. Patients were randomized into groups with tossing a coin method. The patients who had UMPNL and RIRS were defined as Group I and Group II, respectively. The groups were compared for demograhic data, stone characteristics, operative and postoperative data, stone-free status, and the complications. Student's t-test and Pearson's Chi square tests were used for statistical analysis. p < 0.05 was considered as statistically significant. RESULTS: There were 30 patients in Group I, and 43 patients in Group II. The groups were similar for age, gender, side of the stone, and surface area characteristics of the stone (p = 0.194, p = 0.470, p = 0.990, and p = 0.487, respectively). Stone-free rate was 80% (n = 24) in UMPNL, and 74.4% (n = 32) in RIRS (p = 0.579). Modified Clavien Classification Grade 1 to 2 and 3A to 3B complications were similar in two groups (p = 0.959 and p = 0.192, respectively). Comparison of stone-free rates was 93.3% in UMPNL, and 42.9% in RIRS groups for lower pole stones (p = 0.009). Groups I and II were significantly different for visual analog scale scores for postoperative pain (4.73 ± 1.25 vs 2.30 ± 1.12), hospital stay (2.46 ± 3.02 vs 1.37 ± 1.48 days), and time to return to normal daily life (11.26 ± 5.55 vs 6.65 ± 4.30 days) (p < 0.001, p < 0.001, and p < 0.001, respectively). CONCLUSION: Both UMPNL and RIRS procedures are effective and safe methods in treatment of middle-sized renal stones. However, UMPNL is more effective than RIRS in treatment of lower pole stones. RIRS is more advantageous when loss from work is taken into consideration.

Urothelial cancer of bladder in young versus older adults: clinical and pathological characteristics and outcomes.

Bladder urothelial carcinoma is rare in young adults and occurs more commonly in older individuals. The aim of this study was to compare the clinical behavior, pathologic characteristics, and prognosis of urothelial carcinoma of urinary bladder in young versus older adults. A retrospective review of our records between 2007 and 2013 identified 56 patients (42 males and 14 females) with transitional cell carcinoma of the bladder who were less than 40 years old. Clinical and pathological parameters of patients who were less than 40 years of age were compared with those of a series of patients older than 40 years of age (the control group) during the same period. A survival analysis was performed using the Kaplan-Meier method and log-rank test, and Cox regression was performed to identify clinical parameters that affected the clinical outcomes. The mean age was 29.21 years (range, 5-40 years) for patients less than 40 years old and 61.66 years (range, 41-75) for those older than 40 years. The mean follow-up was 40.26 months (range, 12-65 months) for young patients and 42.57 months (range, 12-72 months) for the older patients. Young bladder cancer patients had smaller-sized tumors (less than 3 cm), less high-grade cancers, higher papillary urothelial neoplasms of low malignant potential, and low-grade tumors than patients older than 40 years. Multivariate logistic regression analysis predicted tumor recurrence in young patients with high-grade tumors [odds ratio (OR), 1.959; 95% confidence interval (CI), 1.235-2.965; p = 0.046] and tumors larger than 3 cm (OR, 1.772; 95% CI, 1.416-1.942; p = 0.032). The 5-year overall survival rate was 100% for young patients and 88.1% for older patients. No difference was observed in the recurrence-free (p = 0.321) and progression-free (p = 0.422) survival rates between the two groups. We concluded that although the clinical stage distribution, natural history, and outcomes of bladder urothelial cancer in young adults are similar to those in their older counterparts, clinicians must be aware that patients under 40 years of age presented with higher-grade and larger (>3 cm) tumors and are more likely to experience tumor recurrence.

Spinal anesthesia for transurethral resection operations: levobupivacaine with or without fentanyl.

BACKGROUND: The objective ofthe present study was double fold; to compare the characteristics of spinal blocks produced by 0.5% levobupivacaine with and without fentanyl in transurethral resection and to test the hypothesis that, fentanyl added to levobupivacaine, may be used as an alternative to pure levobupivacaine solution, in spinal anesthesia. METHODS: Forty males, aged >60 years, ASA I-III patients scheduled for elective transurethral resection were included in a prospective, randomized, double-blinded study. Following a spinal tap, intrathecal injection in Group L (n=20), 2.5 mL of 0.5% levobupivacaine and in Group LF (n=20), 2.2 mL of 0.5% levobupivacaine with fentanyl 15 microg (0.3 mL) was performed. The characteristics of sensory and motor block, hemodynamic data, side effects, patient and surgeon satisfaction were recorded. Patients were observed until the level of sensory block was S1 and the Bromage score was 0. RESULTS: There were no significant differences between the two groups forpatient demographic, intraoperative, hemodynamic parameters, side effects and satisfaction. The highest level of sensory block was T9 in the Group L, and T6 in the Group LF (p = 0.001). Duration of motor block was shorter in Group LF than in Group L (291.00 +/- 81.08 min in Group L; 213.75 +/- 59.49 min in Group LF) (p = 0.001). CONCLUSION: Both regimes are effective, and the addition of fentanyl to levobupivacaine may offers the advantage of shorter duration of motor block and may be used as an alternative to pure levobupivacaine solution in spinal anesthesia, for transurethral resections.