The Diagnostic Value of Soluble Triggering Receptor Expressed on Myeloid Cells for Patients with Acute Stone Pyelonephritis.

Soluble triggering receptor expressed on myeloid cells (sTREM-1) is a new biomarker that can be used for the diagnosis and monitoring of urinary system infections. This study aimed to evaluate the diagnostic performance of serum sTREM-1 in patients with a diagnosis of acute stone pyelonephritis (ASP). This prospective study included 46 patients with a diagnosis of ASP and a control group of 23 individuals without urinary system infection. Blood samples were taken from participants upon hospital admission, and basal serum sTREM-1 levels were analyzed using the ELISA method. Serum sTREM-1 concentrations were measured after treatment of ASP patients. Basal leukocyte counts, C-reactive protein (CRP) levels, procalcitonin (PCT), and sTREM-1 (98.6 vs. 68.4 pg/mL, p < 0.001) levels were higher in the ASP group compared to the control group. After treatment, the median leukocyte counts, PCT, and sTREM-1 levels decreased and were similar to those of the control group. The median CRP level also decreased after treatment, but it remained higher than that of the control group. In predicting patients with ASP, the baseline sTREM-1 exhibited a sensitivity of 74.6% and a specificity of 78.2%, while its diagnostic performance was lower than that of leukocyte counts, CRP, and PCT. Despite the findings that levels of sTREM-1 were higher upon hospital admission in patients with ASP and significantly decreased after treatment, the utility of sTREM-1 as a biomarker for predicting patients with ASP remains constrained when compared to established inflammatory markers.

Percutaneous nephrolithotomy in patients with incidental encountered purulent urine at initial puncture.

We are reporting the 39 patients' outcomes who underwent percutaneous nephrolithotomy and purulent urine encountered at the initial steps of surgery. Of 873 patients who underwent PCNL, 48 had purulent fluid during the initial puncture. After excluding those at risk for infection, we studied 39 patients' preoperative and postoperative variables-including postoperative day (POD) 1, 3, 5 fevers. In group 1, 21 patients had a nephrostomy tube placed, and PCNL was postponed. In group 2, 18 patients had successful stone removal in the first session. All surgeries were successful, with no septic events during follow-up. No significant differences in preoperative variables were found. 14% and 22% of patients in groups 1 and 2 had infected fluid (p = 0.470). Four patients in group 1 (19%) and seven patients in group 2 (38.9%) had a high fever (≥ 38 C) on POD1 (p = 0.171), and 1 (5%) in group 1 and 3 (17%) in group 2 had high fever on POD 3 (p = 0.22). No patients remained with high fever on POD5. Mild sepsis was diagnosed in 9.5% of group 1 and 16% of group 2 (p = 0.820), and hospitalization time differed significantly (p < 0.001). Stone size and operation time were correlated with postoperative fever, and prolonged hospital stays were associated with positive blood cultures and postponed procedures. PCNL with proper technique and antibiotics can lead to quicker recovery and reduced hospitalization time in selected patients with pus in their pelvicalyceal system.

Evaluation of pheniramine maleate and zofenopril in reducing renal damage induced by unilateral ureter obstruction. An experimental study.

INTRODUCTION: Obstruction of the ureter may occur due to congenital, iatrogenic or other reasons. This can cause hydronephrosis in the early stage and can lead to cellular inflammation, necrosis and atrophy in the kidney tissue. The aim of this paper is to evaluate the protective effect of pheniramine maleate (PM) and zofenopril on renal damage caused by hydronephrosis due to unilateral partial ureter obstruction. MATERIAL AND METHODS: Twenty-four female Sprague Dawley rats were divided into 4 groups. Group 1: sham group, group 2: partial unilateral ureteral obstruction (PUUO) group, group 3: PUUO + PM group, group 4: PUUO + zofenopril group. Paraoxonase (PON), total antioxidant status (TAS) and total oxidant status (TOS) of tissue and blood samples were measured and calculated. Tissue samples were evaluated histopathologically. RESULTS: An increase in tissue TAS and a decrease in tissue TOS and OSI levels were detected in groups 3 and 4 compared to group 2 (both: p < 0.01). Tissue PON levels showed an increase in groups 3 and 4 compared to groups 1 and 2 (both: p < 0.01). Histopathological evaluation showed a decrease in interstitial inflammation and congestion in groups 3 and 4 compared to the control group (p < 0.001). The decrease was observed to be more significant in group 4 compared to group 3 (p < 0.01). CONCLUSIONS: In our experimental study, we observed that PM and zofenopril reduce the oxidation and tissue damage caused by unilateral partial obstruction.

Correlation Between Spiritual Well-being and Quality of Life in Patients With Urinary Incontinence: A Cross-sectional Descriptive Study.

Urinary incontinence (UI) increases the risk of medical complications and psychosocial, physical, and emotional problems. PURPOSE: This cross-sectional descriptive study investigated the correlation between spiritual well-being (SWB) and quality of life (QOL) in patients with UI. METHODS: Patients with UI visiting an outpatient urology clinic of a university hospital in Turkey were invited to participate. Data were collected using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being 12 Item Scale (FACIT-Sp-12) (range 0-48 with higher scores indicating better SWB) and the Incontinence Quality of Life Questionnaire (I-QOL) (range 0-100 with higher scores indicating better QOL). RESULTS: The sample consisted of 383 patients. Most were female (235; 61%), had completed high school (169; 44%), had experienced UI for an average of 3.54 years (SD 3.44), and were between 21 and 92 years of age (mean 52.7; SD 14). The mean I-QOL score was 65.31 ± 19.71 with subscores ranging from a low of 59.69 for social embarrassment to a high of 71.44 for psychosocial impact. The average FACIT-Sp-12 score was 28.00 ± 6.08. Overall I-QOL and FACIT-Sp-12 scores were weakly positively correlated (r = .235). CON- CLUSION: In this study both QOL and SWB scores were good; higher UI-specific QOL scores and some subscores were asso-ciated with higher SWB scores and subscores. Incontinence QOL should be determined together with SWB in patients with UI.

The effect of coenzyme Q and selenium on kidney in rats with partial unilateral ureteral obstruction.

OBJECTIVE: In this study, we aimed to investigate the antioxidant effects of selenium and coenzyme Q on renal damage in a partial unilateral ureteral obstruction (PUUO) in a rat model. MATERIAL AND METHODS: A total of 24 Sprague-Dawley rats were divided into four groups as Group 1 Control Group, Group 2, PUUO Group, Group 3 PUUO + coenzyme Q group, Group 4 PUUO + selenium group. Paraoxonase (PON), total antioxidant capacity (TAC), and total oxidant levels (TOS) were analyzed biochemically from tissue and blood samples. Tissue samples were examined histopathologically. RESULTS: The TAC in the tissues was found to be statistically significantly increased in Groups 3 and 4, compared to Group 2. Tissue TOS was found to be significantly reduced in Groups 3 and 4, compared to Group 2. Serum PON levels were significantly increased in Group 3 and 4, compared to Group 1 and 2. Histopathological examination showed that interstitial inflammation and congestion were lesser in the coenzyme Q and selenium groups than in the PUUO group. A more significant decrease was found in the selenium group than in the coenzyme Q group. CONCLUSION: Our study results showed that coenzyme Q and selenium reduced the oxidation and the damage in tissue in PUUO in rats.

The Effects of Nocturnal Blood Pressure Paterns and Autonomic Alterations on Erectile Functions in Patients with Hypertension.

PURPOSE: Hypertension (HT) is known to be of the main risk factors for erectile dysfunction (ED). But non-dipping (<%10 drop in the night) of HT is not investigated truly. The aim of this study was to test the hypothesis that the non-dipper hypertensive patients are more prone to develop erectile dysfunction. MATERIALS AND METHODS: This was a cross-sectional clinical study. 70 HT patients diagnosed by Ambulatory blood pressure monitoring (ABPM) were classified into 3 groups (No ED, mild to moderate and severe) according to their International Index of Erectile Function (IIEF) scores. All three groups were compared for their dipping status by ABPM, heart rate variability (HRV) by holter monitoring. RESULTS: In our study non-dipper hypertensives had statistically more erectile dysfunction (P=0.004). Also severe ED patients with non-dipping pattern had decreased dipping blood pressure levels then those of ED(-) patients with non-dipping HT (P= .003)(Daytime Systolic/Nighttime Diastolic Blood Pressure= 0.8 ± 0.07 / 3.90 ± 1.5, respectively). LF/HF daytime/ nighttime in holter reflecting sympathetic overactivity (P< .001). CONCLUSION: Autonomic dysfunction especially sympathetic overactivity is associated with both non dipping pattern of HT and erectile dysfunction as a common pathologic pathway, besides there might be an association between ED and non dipping HT.

Investigation of the antioxidant effects of pheniramine maleate and nebivolol on testicular damage in rats with experimentally induced testis torsion.

PURPOSE: To investigate the biochemical, histopathologic, and spermatogenetic changes in the detorsionated testicle after experimental torsion and to study the antioxidant effects of pheniramine maleate and nebivolol. METHODS: Twenty-four Sprague-Dawley male rats were divided into 4 groups: Group 1: Sham; Group 2: Torsion/Detorsion (T/D); Group 3: T/D + Pheniramine maleate (PM); Group 4: T/D + Nebivolol (NB) group. Paroxanase (PON), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stres index (OSI) were measured, and spermatogenetic and histopathologic evaluation was performed in tissue and blood samples. RESULTS: The evaluation of tissue TAS indicated no statistically significant difference in Group 3 compared to Group 2. A statistically significant increase was detected in Group 4 compared to Group 2. Serum PON levels revealed a statistically significant increase in Groups 3 and 4 compared to Groups 1 and 2. The Johnsen testicular biopsy score decreased in Groups 3 and 4, but the decrease was not statistically significant. CONCLUSIONS: Pheniramine maleate and nebivolol have antioxidant effects against ischemia-reperfusion damage. They also support tissue recovery, which is more significantly observed by nebivolol.

Investigation of the antioxidant effects of pheniramine maleate and nebivolol on testicular damage in rats with experimentally induced testis torsion

Abstract Purpose: To investigate the biochemical, histopathologic, and spermatogenetic changes in the detorsionated testicle after experimental torsion and to study the antioxidant effects of pheniramine maleate and nebivolol. Methods: Twenty-four Sprague-Dawley male rats were divided into 4 groups: Group 1: Sham; Group 2: Torsion/Detorsion (T/D); Group 3: T/D + Pheniramine maleate (PM); Group 4: T/D + Nebivolol (NB) group. Paroxanase (PON), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stres index (OSI) were measured, and spermatogenetic and histopathologic evaluation was performed in tissue and blood samples. Results: The evaluation of tissue TAS indicated no statistically significant difference in Group 3 compared to Group 2. A statistically significant increase was detected in Group 4 compared to Group 2. Serum PON levels revealed a statistically significant increase in Groups 3 and 4 compared to Groups 1 and 2. The Johnsen testicular biopsy score decreased in Groups 3 and 4, but the decrease was not statistically significant. Conclusions: Pheniramine maleate and nebivolol have antioxidant effects against ischemia-reperfusion damage. They also support tissue recovery, which is more significantly observed by nebivolol.

Medical and alternative therapies in urinary tract stone disease.

Nephrolithiasis is a serious problem for both patients and the health system. Recurrence stands out as a significant problem in urinary system stone disease, the prevalence of which is increasing gradually. If recurrence is not prevented, patients may go through recurrent operations due to nephrolithiasis. While classical therapeutic options are available for all stone types, the number of randomized controlled studies and extensive meta-analyses focusing on their efficiency are inadequate. Various alternative therapeutic options to these medical therapies also stand out in recent years. The etiology of urolithiasis is multifactorial and not always related to nutritional factors. Nutrition therapy seems to be useful, either along with pharmacological therapy or as a monotherapy. General nutrition guidelines are useful in promoting public health and developing nutrition plans that reduce the risk or attenuate the effects of diseases affected by nutrition. Nutrition therapy involves the evaluation of a patient's nutritional state and intake, the diagnosis of nutrition risk factors, and the organization and application of a nutrition program. The main target is the reduction or prevention of calculus formation and growth via decreasing lithogenic risk factors and increasing lithogenic inhibitors in urine. This review focuses briefly on classical medical therapy, along with alternative options, related diets, and medical expulsive therapy.

Multiple urethral anomalies: Parameatal urethral cyst, penile curvature, incomplete hypospadiac anterior duplication of the urethra and distal hipospadias.

The male genitourinary system is quite complex. There are numerous known anomalies of the male urethra either as isolated cases or in combination with other disorders. An improved understanding of the embryology and anatomy of the normal male urethral development might help explain the causes of the various urethral abnormalities. We contribute to the etiology of congenital anomalies with this multiple urethral anomalies case.

The antioxidant effect of dexmedetomidine on testicular ischemia-reperfusion injury.

PURPOSE: To investigate the protective effect of dexmedetomidine (Dex) on testicular damage induced by ischemia-reperfusion injury in rats. METHODS: Sham group underwent left scrotal exploration only (group 1). The ischemia-reperfusion only group underwent left testicular torsion and detorsion (group 2). The ischemia-reperfusion plus Dex group underwent left testicular torsion, received 50 µg/kg Dex (group 3) and 100 µg/kg Dex (group 4) intraperitoneally at minute 180 of ischemia and then underwent detorsion. We determined histopathological findings and performed specific biochemical analyses. RESULTS: Increasing doses of Dex significantly increased TAS, and significantly decreased OSI. Analyzing the antioxidant effects of increasing doses of Dex in torsion and contrlateral testicles: Dex 100 µg/kg statistically significant increased the tissue total antioxidant status (TAS) and oxidative stress index (OSI) when compared with Dex 50 µg/kg but not found significantly change on the tissue total oxidant status (TOS). However, Dex did not significantly improve these histological alterations. CONCLUSION: The antioxidant effects of dexmedetomidine on testicular ischemia-reperfusion injury in ipsilateral and contrlateral testis, but in the histopathological level, there was no difference statistically according to Johnsen's scoring system between groups at both sides.

The antioxidant effect of dexmedetomidine on testicular ischemia-reperfusion injury

PURPOSE: To investigate the protective effect of dexmedetomidine (Dex) on testicular damage induced by ischemia-reperfusion injury in rats. METHODS: Sham group underwent left scrotal exploration only (group 1). The ischemia-reperfusion only group underwent left testicular torsion and detorsion (group 2). The ischemia-reperfusion plus Dex group underwent left testicular torsion, received 50 µg/kg Dex (group 3) and 100 µg/kg Dex (group 4) intraperitoneally at minute 180 of ischemia and then underwent detorsion. We determined histopathological findings and performed specific biochemical analyses. RESULTS: Increasing doses of Dex significantly increased TAS, and significantly decreased OSI. Analyzing the antioxidant effects of increasing doses of Dex in torsion and contrlateral testicles: Dex 100 µg/kg statistically significant increased the tissue total antioxidant status (TAS) and oxidative stress index (OSI) when compared with Dex 50 µg/kg but not found significantly change on the tissue total oxidant status (TOS). However, Dex did not significantly improve these histological alterations. CONCLUSION: The antioxidant effects of dexmedetomidine on testicular ischemia-reperfusion injury in ipsilateral and contrlateral testis, but in the histopathological level, there was no difference statistically according to Johnsen's scoring system between groups at both sides. .

Fahr syndrome unknown complication: overactive bladder.

A 38-year-old male patient was admitted to our outpatient department because of frequency and urgency incontinence. During evaluation it was detected that the patient was suffering from frequency which was progressive for one year, feeling of incontinence, and urgency incontinence. There was no urologic pathology detected in patient's medical and family history. Neurologic consultation was requested due to his history of boredom, reluctance to do business, balance disorders, and recession for about 3 years. Brain computerized tomography (CT) scan revealed that amorphous calcifications were detected in the bilaterally centrum semiovale, basal ganglia, capsula interna, thalami, mesencephalon, pons and bulbus, and the bilateral cerebellar hemispheres. We have detected spontaneous neurogenic detrusor overactivity without sphincter dyssynergia after evaluating the voiding diary, cystometry, and pressure flow study. We consider the detrusor overactivity which occurred one year after the start of the neurological symptoms as the suprapontine inhibition and damage in the axonal pathways in the Fahr syndrome.

Unexpected difficult airway with hypogonadotropic hypogonadism.

BACKGROUND: A critical aspect of safe general anesthesia is providing adequate ventilation and oxygenation. Failed endotracheal intubation and inadequate ventilation with insufficient oxygenation may lead to serious complications, even death. Anesthesiologists rarely encounter unexpected difficult airway problems in daily routine. Management of an unexpectedly difficult airway consists of laryngeal mask ventilation, gum-elastic bougie and video laryngoscopy-assisted intubation. Gum-elastic bougie is the easiest and cheapest tool used in case of an unexpected difficult intubation occurring in the operating room. CASE: A 53-year-old male patient with hypogonadotropic hypogonadism presented as an unexpected difficult intubation after the induction of anesthesia. No pathological finding or predictor of difficult intubation was present. In addition, bag-mask ventilation was poor and inadequate. The patient was finally successfully intubated with a gum-elastic bougie. CONCLUSION: A difficult airway has been described in patients with a variety of endocrine disorders, including pituitary diseases, but not with hypogonadism. There may be an unrevealed relationship between hypogonadism and difficult airway. Gum-elastic bougie is still the most attainable and effective tool in the operation room in this situation.

Viburnum opulus: could it be a new alternative, such as lemon juice, to pharmacological therapy in hypocitraturic stone patients?

OBJECTIVE: Citrate, potassium, and calcium levels in Viburnum opulus (V. opulus) and lemon juice were compared to evaluate the usability of V. opulus in mild to moderate level hypocitraturic stone disease. MATERIALS AND METHODS: V. opulus and lemon fruits were squeezed in a blender and 10 samples of each of 100 ml were prepared. Citrate, calcium, sodium, potassium, magnesium, and pH levels in these samples were examined. RESULTS: Potassium was found to be statistically significantly higher in V. opulus than that in lemon juice (p = 0.006) whereas sodium (p = 0.004) and calcium (p = 0.008) were found to be lower. There was no difference between them in terms of the amount of magnesium and citrate. CONCUSIONS: Because V. opulus contains citrate as high as lemon juice does and it is a potassium-rich and calciumand sodium-poor fluid, it can be an alternative to pharmaceutical treatment in mild-to-moderate degree hypocitraturic stone patients. These findings should be supported with clinical studies.

Ways in which SWL affects oxidant/antioxidant balance.

Many damages can occur in the kidneys following extracorporeal shock wave lithotripsy (SWL) and some of these damages are thought to emerge as a result of oxidative stress. The objective of this study is to evaluate the impact of SWL application on kidneys in stone patients on oxidative stress parameters in 24-h urine. The study included 20 patients scheduled for SWL. total antioxidant capacity (TAC) and total oxidant status (TOS) measurements were made on 24-h urines of the patients before and after SWL. The oxidative stress index (OSI) was calculated based on these values. Following SWL, while TOS increased in 24-h urine (p = 0.006), TAC remained unchanged (p = 0.312). OSI increased following the procedure (p = 0.004). SWL application disrupts the oxidant/antioxidant balance in favor of oxidants, which leads to oxidative stress. TOS, TAC and OSI may be useful in the determination of the existence of oxidative stress following SWL.

Quantitative analysis of colonization with real-time PCR to identify the role of Oxalobacter formigenes in calcium oxalate urolithiasis.

The objective of the study was to quantitatively measure the number of Oxalobacter formigenes (O. formigenes) colonizations in the gastrointestinal tract in calcium oxalate-forming patients with real-time polymerase chain reaction (PCR). Calcium oxalate-forming patients (n: 27) were included in the study. Serum calcium, sodium, potassium, urea and creatinine levels, as well as 24 h urine levels of calcium and oxalate were measured. The numbers of O. formigenes colonies in stool samples were detected by real-time PCR. One or two metabolic abnormalities were detected in 15 of 27 patients. The O. formigenes levels in patients with metabolic disturbance were significantly decreased when compared to the patients with no metabolic abnormalities (p: 0.038). The undetectable levels of O. formigenes were encountered in one of five patients with hypercalciuria, in three of four patients with hyperoxaluria and in four of six patients with both hypercalciuria and hyperoxaluria. In nine patients with a history of stone recurrence, O. formigenes colonization was significantly lower than the patients with the first stone attack (p: 0.001). O. formigenes formation ceased or significantly diminished in patients with calcium oxalate stones with a coexistence of both hyperoxaluria and hypercalciuria. The measurement of O. formigenes colonies by real-time PCR seemed to be an inconvenient and expensive method. For this reason, the real-time PCR measurements can be spared for the patients with stone recurrences and with metabolic abnormalities like hypercalciuria and hyperoxaluria. The exact measurement of O. formigenes may also help more accurate programming of O. formigenes-based treatments.

The relationship between serum sex steroid levels and heart rate variability parameters in males and the effect of age.

OBJECTIVES: We evaluated the relationships between sex steroid levels and heart rate variability (HRV) parameters. STUDY DESIGN: The study included 114 male subjects (mean age 46.6±11.3 years) presenting to our department for cardiologic evaluation. Hormonal analysis included serum levels of luteinizing hormone, prolactin, total testosterone (TT), free testosterone, estradiol (E2), and dehydroepiandrosterone sulfate (DHEA-S). Parameters of HRV were derived from 24-hour Holter monitoring. The associations between serum sex steroid levels and HRV parameters were investigated in three age groups (20-39 years; 40-59 years; >60 years). RESULTS: All the participants had normal biochemical results. The three age groups were similar in terms of anthropometric measurements. Among sex steroids analyzed, only serum DHEA-S level was significantly different among the groups (p=0.026), showing a decreasing trend with age. In the evaluation of HRV, all parasympathetic activities decreased (for HFn, pNN50, and rMSDD: p=0.001, p=0.000, and p=0.000, respectively), while only LF/HF among sympathetic activities increased (p=0.000) with age. Partial correlation analysis with control of age and waist circumference showed that TT and DHEA-S were positively correlated with HFn (parasympathetic parameter), and were in negative correlation with LF/HF24 hours and global sympathetic index (GSI) (sympathetic parameters). Serum E2 level was negatively correlated with the parasympathetic parameter of rMSSD, and positively correlated with LF/HF24 hours and GSI. Among serum sex steroids, DHEA-S was the most correlated parameter with autonomic functions. CONCLUSION: Our results showed positive correlations between androgens and parasympathetic activity and between estradiol and sympathetic activity in men, independent from anthropometric factors.

Histamine 1 receptor antagonist in symptomatic treatment of renal colic accompanied by nausea: two birds with one stone?

OBJECTIVES: The pain-relieving efficacy of antagonists of histamine 1 (H1) receptors that are widely found in the ureter and that cause contractions in renal colic was presented in comparison with a placebo. METHODS: Eighty-six patients who presented to the emergency service because of renal colic accompanied by nausea, and who had urinary system stones detected were included in the study. The patients were separated into 2 groups by double-blind, random assignment. The 45 patients in group 1 received 50 mg intramuscular (IM) dimenhydrinate. The 41 patients in group 2 received 2 mL IM saline solution as a placebo. The visual analogous scale (VAS) values were detected at referral of the patients and at 10, 20, and 30 minutes of therapy to detect the pain intensity. Verbal descriptive scale (VDS) was used for evaluation of nausea and vomiting before and after the therapy. RESULTS: VAS values were statistically quite low in group 1 at 10, 20, and 30 minutes of therapy. VDS scores were also statistically significantly low in group 1 at 30 minutes of treatment. CONCLUSIONS: Dimenhydrinate, which is an ethanolamine group H1 receptor blocker, appeared to be effective compared with the placebo in relieving renal colic pain and nausea and vomiting symptoms in patients. Comparative studies with other analgesics will be useful for determining how to use this agent for analgesic purposes in renal colic.