The protective effect of roflumilast and ibuprofen on testicular ischemia reperfusion injury: An experimental study.

BACKGROUND: The aim of the present study is to investigate the efficiency of roflumilast and ibuprofen in an experimental rat testicular ischemia reperfusion injury model in the light of histological and biochemical data. METHODS: A total of 32 prepubertal male rats were randomly divided into four groups as G1: Control Group (testicular torsion/detorsion + saline (0.9% of 2 ml) was applied). G2: Sham Group only right scrotal incision was performed; G3: Ibuprofen Group (tes-ticular torsion/detorsion + ibuprofen administration); and G4 Roflumilast Group (testicular torsion/detorsion + roflumilast adminis-tration). Oxidative markers such as malondialdehyde (MDA), myeloperoxidase (MPO), total sulfhydryl (TSH), and nitrite (NO) levels as well as histopathological changes were analyzed. RESULTS: Tissue MPO, MDA, and NO levels were significantly higher and TSH levels significantly lower in control group compared to sham group (p<0.001). The histopathologic scores of drug groups (Groups 3 and 4) were significantly lower than group 1 (p<0.001). In comparison of Group 3 and Group 4 with each other, the mean values of MPO and MDA were statistically significantly lower in Group 4 (p<0.001). A higher mean value of TSH was found in Group 3 without statistically significance (p=0.32). There was also an insignificant decrease in mean NO values of Group 3 compared to Group 4 (p=0.44). In comparison of drug groups, Group 4 had statistically insignificant better scores. CONCLUSION: Our results indicate that administrating ibuprofen and roflumilast reduced testicular ischemia reperfusion injury in rat testis torsion model. In comparison, roflumilast is found to be more beneficial.

Impact of urinary incontinence on anxiety status during pregnancy: A prospective case-control study.

OBJECTIVES: To evaluate the impact of the presence and severity of urinary incontinence (UI) on pregnancy-related anxiety. STUDY DESIGN: This prospective case-control study included 160 pregnant women. Pregnant women with UI (n = 80) were compared with continent pregnant women (n = 80; control group) in terms of scores on the Incontinence Consultation Questionnaire-Short Form (ICIQ-SF) and the Pregnancy-related Anxiety Questionnaire-Revised 2 (PRAQ-R2) scale. Gynaecological examination was performed, and pelvic organ prolapse was diagnosed using the Pelvic Organ Prolapse Quantification system. UI was classified as stress UI (SUI), urge UI (UUI) or mixed UI (MUI). RESULTS: The total PRAQ-R2 score was significantly higher in all pregnant women with UI, as well as the UI subgroups, compared with the control group [mean ± standard deviation; 21.77 ± 8.1 (UI), 19.39 ± 6 (SUI), 20.13 ± 7.2 (UUI) and 28.1 ± 9.5 (MUI) vs 15.76 ± 5.9 (control group); p < 0.0001, p = 0.002, p = 0.012 and p < 0.0001, respectively). Significant positive correlation was found between the total ICIQ-SF and total PRAQ-R2 scores (r = 0.533; p < 0.0001). The score for the fear of giving birth domain in PRAQ-R2 was higher in women with SUI and MUI compared with the control group (9.5 ± 4 and 11.1 ± 2.6 vs 5.43 ± 2.4; p < 0.0001). Concern about own appearance was greater in the UUI and MUI groups compared with the control group (9.68 ± 4.5 and 7.8 ± 3.1 vs 4.85 ± 2.3; p < 0.0001). CONCLUSION: To the authors' knowledge, this is the first study to report the impact of the presence and severity of UI on pregnancy-related anxiety. The current findings show that anxiety may be an important psychosocial consequence of UI in pregnancy. This may lead to a clinical approach focusing on both the physical and psychological well-being of pregnant women with UI.

Protective effects of Ranolazine on testicular torsion and detorsion injury in rats.

Ranolazine is a drug used in refractory chronic stable angina. In this study, it was aimed to evaluate the protective effect of ranolazine in a testis torsion model in light of objective biochemical and pathological data. A total of 24 pre-pubertal male Wistar albino rats were separated into three groups of 8 as the sham group, control group and ranolazine group. Testis torsion was applied for 3 hr to all the rats in Group Control and Group Ranolazine. In Group Control, 0.9% NaCl was applied 1 hr after the torsion. In Group Ranolazine, ranolazine 30 mg/kg was dissolved in a 0.9% NaCl solution and was administered intraperitoneally 1 hr after torsion. Histopathological evaluation was made using the Cosentino score. As a result of the objective biochemical and pathological criteria used in this study, this protective effect of ranolazine was observed in testis torsion. The results obtained in this study may suggest that ranolazine is a drug that could be applied after detorsion to patients diagnosed with torsion.

Scintigraphic evaluation of renoprotective effects of coenzyme Q10 in a rat renal ischemia-reperfusion injury.

PURPOSE: Renal ischemia-reperfusion injury (RIRI) may occur secondary to several reasons leading to renal failure. Coenzyme-Q10 (CoQ10) is a well-known antioxidant. However, the effects CoQ10 against RIRI have not been evaluated. Our aim was to evaluate protective effects of CoQ10 to renal ischemia-reperfusion by biochemical, immunohistochemical and scintigraphic findings. METHODS: Thirty Wistar-albino rats were randomly separated into groups of 10; Group Sham; Group ischemia-reperfusion (IR) had left renal pedicle clamping; Group CoQ10+IR had IR and CoQ10. Twenty-four hours later after reperfusion, scintigraphy was performed and after that, rats were sacrificed. To demonstrate effects of RIRI, serum urea and creatinine levels and tissue levels oxidative stress markers were evaluated. Both kidneys were subjected to histopathological evaluation and to confirm RIRI-induced immunohistochemical aspects of apoptosis, terminal-deoxynucleotidyl-transferase mediated-deoxyuridine-triphosphate-nick-end-labeling assay and caspase-3 were assessed. RESULTS: Tissue oxidative stress, histopathologic changes, apoptosis scores and quantitative scintigraphic parameters were significantly higher in Group IR compared with Group Sham. Although tissue oxidative stress levels and histopathologic changes were not significant, quantitative scintigraphic parameters of contralateral kidney of Group IR were significantly increased. Compared with Group IR, Group CoQ10+IR presented decreased tissue oxidative stress levels; decreased scores of histopathology and apoptosis; and decreased quantitative scintigraphic parameters with increased split renal function in ischemic kidney. CONCLUSIONS: Our results suggest that other than its antioxidant properties, CoQ10 shows antiperoxidative, antiapoptotic and antiinflammatory potential in protecting renal functioning of ischemic kidney. Furthermore, our results show that renal scintigraphy is a feasible method to detect early changes in renal functioning after RIRI.

Bosniak Classification and other Variables in the Prediction of Renal Cystic Masses.

OBJECTIVE: To evaluate the variables of cystic renal lesions to predict the renal tumors. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Urology Department, Ankara Yüksek Ihtisas, Samsun Research and Training Hospitals, Turkey, from January 2013 to June 2017. METHODOLOGY: Records of patients with renal cystic lesions were retrospectively evaluated. Preoperative CT results in terms of diameter number and enhancement; and clinical variables such as gender body mass index [(weight (kg)/ height²(m)] and smoking status were recorded. Student's t-test and ANOVA were used for determing significance, which was set at p<0.05. RESULTS: Due to pathology results, all group I patients were benign, 7.9% (3/38) of group II, 31.8% (7/22) of group II-F, 55.3% (21/38) of group III, 69% (40/58) group IV patients were found to be malignant. For clinical factors, obesity and smoking, while for radiological parameters, about 59.3 +11.7 HU enhancement were found to be predictor significant of malignancy (all p<0.05). No significant difference was observed between cystic lesion diameter number or laterality (right/left) and malignancy. CONCLUSION: Renal cysts have a high malignancy possibility in the patients with history of smoking in the past or actively, high BMI, and preoperative CT with about 59.3 +11.7 HU post-contrast enhancement.

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.

Efficacy of Silodosin Dose in Medical Expulsive Therapy for Distal Ureteral Stones: A Retrospective Study.

PURPOSE: We aimed to investigate the efficacy of silodosin 4 mg/day and 8 mg/day for medical expulsive therapy(MET) of lower ureteral stones. MATERIALS AND METHODS: We retrospectively analyzed the medical records of 161 patients admitted to urologyclinics of Ahi Evran University Medical Faculty and Ankara Training and Research Hospital with distal ureteralstones and treated with MET with different doses of silodosin between January 2013 and August 2015. 81 patientswere treated with silodosin 4mg/day in group-1 and 80 patients with silodosin 8mg/day in group-2. Age, gender,complaints on admission, stone size, the distance between the stone and ureterovesical junction, stone passage rate,duration of stone passage after starting MET, and adverse effects were noted from the charts of the patients, andthe groups were compared. RESULTS: There were 81 patients in group-1, and 80 patients in group-2. Two groups were similar for age (P =.38)and gender (P =.92). Spontaneous stone passage was seen in 41 (50.9%) patients in group-1, and in 59 (73.8%)patients in group 2. The groups were different for spontaneous stone passage rate (P =.002). In group-1, 10 (25%)patients that could not pass their stones spontaneously and were treated with extracorporeal shockwave lithotripsy(SWL), and 30 (75%) of them were treated with ureterolithotripsy. Eight (38%) patients that could not undergoureterolithotripsy and/or anesthesia and were not able to pass their stones were treated with SWL, and 13 (62%)patients were treated with ureterolithotripsy in group-2. All of the patients were stone free at the end of the treatment. CONCLUSION: A dose of 8 mg/day should be preferred if silodosin is to be preferred for MET in lower ureteral stones.

The modified ultra-mini percutaneous nephrolithotomy technique and comparison with standard nephrolithotomy: a randomized prospective study.

To compare the success and complications of ultra-mini percutaneous nephrolithotomy (UPNL) and standard percutaneous nephrolithotomy (SPNL) techniques. We prospectively analyzed 50 patients who underwent SPNL, and 47 patients who underwent UPNL. The patients with a stone size equal to or smaller than 25 mm and we used flipping a coin as the randomization technique. The mean stone size was 20.9 ± 3.6 mm in SPNL, and 20.3 ± 3.0 mm in ultra-mini PNL groups. Stone free rates were 88 % (44/50 patients) and 89.3 % (42/47 patients) in SPNL and UPNL groups, respectively, without any significant difference in between (p = 0.33). No major complications were seen in the UPNL group. PNL has been modified into micro PNL and UPNL parallel to the technological advances to decrease the complications of PNL. When performed as we do UPNL may be an alternative method to SPNL without any additional smaller-calibred nephroscope and with a similar high success rate.

Overview of different scoring systems in Fournier's Gangrene and assessment of prognostic factors.

OBJECTIVE: In this study we aimed to evaluate prognostic factors for the survival of patients with Fournier's gangrene (FG), and overview different validated scoring systems for outcome prediction. MATERIAL AND METHODS: We retrospectively analyzed the data of 39 patients treated for FG in our clinic. Data were collected on medical history, symptoms, physical examination findings, vital signs, laboratory parameters at admission and at the end of treatment, timing and extent of surgical debridement, and the antibiotic treatment used. The Fournier's Gangrene Severity Index (FGSI) and Charlson Comorbidity Index (CCI) were used to predict outcome. The data were analyzed in relation with the survival of the patients. Mann-Whitney U test, chi -square test, Wilcoxon signed rank test, and Cox regression analysis were used for the statistical analysis. RESULTS: Of 39 patients analyzed, 8 (20.5%) died and 31 (79.5%) survived. The median FGSI score on admission was 2 (0-9) for the survivors and 6 (2-14) for the non-survivors (p=0.004). The median CCI scores of the survivors and non-survivors were 2 (0-10) and 6.5 (5-11), respectively (p=0.001). Except for urea, albumin and hematocrit levels, no significant differences were found between survivors and non-survivors for other laboratory parameters on admission. Lower albumin levels and advanced age were found to be associated with mortality. CONCLUSION: High blood urea, low albumin, and low hematocrit levels were associated with poor prognosis. High CCI and FGSI scores could be associated with a poor prognosis in patients with FG.

The effect of ureteroscope size in the treatment of ureteral stone: 15-year experience of an endoscopist.

OBJECTIVE: We aimed to investigate the ureter stone treatment results performed by using different- caliber semirigid ureteroscopes (URS). MATERIAL AND METHODS: Adult patients who were treated for ureteral stones by a single endoscopist between January 2000 and March 2015 were analyzed. The patients were divided into 3 groups in accordance with the caliber of the ureteroscope used: 10/10.5 F Storz (Karl Storz, Tuttlingen, Germany) (January 2002-January 2005) URS was used in group 1, 8.9/9.8 F Storz (February 2005-December 2011) URS was used in group 2, and 6/7.5 FWolf (Richard Wolf, Knittlingen, Germany) (January 2012-March 2015) URS was used in group 3. Patients' age and gender, size and site of stones, stone-free rates (SFR), intra- and perioperative complication rates, and durations of surgery were compared among the groups. Intraoperative complications were classified according to modified Satava, and perioperative complications were classified according to modified Clavien classification systems. RESULTS: A total of 2461 patients treated for ureteral stones were analyzed. There were 583 patients in group 1 (10/10.5 F Storz), 1302 patients in group 2 (8.9/9.8 F Storz), and 576 patients in group 3 (6/7.5 F Wolf). SFR were 83.7%, 87.4%, and 92.2% in groups 1, 2, and 3, respectively (p=0.01). Duration of surgery was 30.34±10.36 min in group 1, 31.61±10.10 min in group 2, and 42.40±7.35 min in group 3 (p=0.01). The overall complication rates classified according to modified Satava classification were 10.8%, 7.6%, and 6.9% (p=0.01) while grade 3 modified Satava complication rates were 1.9%, 1.5%and 0.5% in groups 1, 2, and 3, respectively (p=0.01). CONCLUSION: In this study, we found that more frequent use of a small- caliber URS resulted in a longer duration of surgery and an increased rate for JJ stent insertion, however it facilitated a safer and more successful ureteroscopy procedure.

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.

Core Length: An Alternative Method for Increasing Cancer Detection Rate in Patients with Prostate Cancer.

PURPOSE: We determine whether the lengths of benign and malignant cores affect cancer detection rates in patients with prostate cancer (PCa). MATERIALS AND METHODS: We evaluated retrospectively 512 patients in our clinic who had undergone 12 core transrectal ultrasound (TRUS)-guided prostate biopsies. The cores were divided into two groups: one with cancer (group 1) and one without cancer (group 2). We also classified Gleason scores as poorly differentiated (scores of 7-10) and moderately differentiated (scores of 5-6); these scores were compared with each other in terms of the core length. The core lengths of the groups were compared using a Student's t-test. A P value of less than .05 was considered to be statistically significant. RESULTS: Of the 512 patients, 76 (15%) had PCa. In total, we evaluated 912 cores of prostate biopsy samples from the 76 patients. Since 92 cores included insufficient tissue and rectal mucosa, we were not able to evaluate them. The remaining 820 cores were divided into two groups. Cancer was detected in 302 cores; 518 cores were benign in nature. The average core length in group 1 was 11.9 ± 4.4 mm, and the average core length in group 2 was 11.1 ± 5.1 mm (P = .015). The core lengths of poorly differentiated and moderately differentiated cancers were similar: 12.3 ± 4.2 mm and 11.7 ± 4.5 mm, respectively (P = .25). CONCLUSION: Increasing cancer detection rates in cores may be related to core length in TRUS-guided prostate biopsies in PCa patients.

Early postoperative effects of ureterorenoscopy on morbidity and renal functions in ureteral stone patients with nondialysis-requiring renal insufficiency.

In this study, we aimed to investigate the effects of ureterorenoscopy (URS) on morbidity and renal functions in patients with ureteral stones and nondialysis-requiring renal insufficiency. The data of 3200 patients who had ureterorenoscopic lithotripsy and diagnostic URS were analyzed retrospectively. Age, urea and creatinine levels in the preoperative period and 4 h after surgery, the size of the stone, duration of surgery, percentage change in urea and creatinine levels [(last level-first level/first level) × 100] and postoperative complications were noted. Student's t-test was used for the intergroup analysis of continuous variables. p < 0.05 was considered as statistically significant. There were 90 patients in nondialysis-requiring renal insufficiency group (group 1) and 101 patients in the control group (group 2). Percentage changes of urea and creatinine levels in the renal insufficiency and the control groups were found as -0.3% ± 3.3, 0.67% ± 3.9 and 2.3% ± 23.2, 2.5% ± 31.6 (p = 0.24 and p = 0.56), respectively. In group 1, three (3.3%) patients had postoperative febrile urinary infection, however febrile infections were not seen in any of the patients in group 2 (p = 0.06). Our results indicated that URS might be used safely in ureteral stones of the patients with nondialysis-requiring renal insufficiency.

Synchronous bladder and prostate cancers in the specimens of radical cystoprostatectomy: a multicenter retrospective analysis.

The purpose of this study was to evaluate the features of prostate cancer that have been incidentally detected in radical cystoprostatectomy specimens of bladder cancer patients. The researchers of the current study retrospectively evaluated the data from 119 men who underwent radical cystoprostatectomy at four referral institutions in Ankara, Turkey. Of the 21 prostate cancer patients, 17 (81%) were aged ≥ 60 years; 10 (47.6%) had clinically significant diseases; three had a Gleason score of 6, three had a Gleason score of 7, three had a Gleason score of 8, one had a positive surgical margin along with extracapsular invasion of the tumor and a high Gleason score, and three patients had a tumor volume of ≥ 0.5 cm(3), of which two also had a high Gleason score. Patients were followed-up for a mean of 29 ± 10.2 months; the overall survival was 96.6% (n = 115) during that period. Preoperative digital rectal examination and prostate-specific antigen values did not differ between the benign and prostate cancer groups. There was no survival advantage in the insignificant prostate cancer and benign prostate groups. No additional benefit for predicting prostate cancer was found with digital rectal examination and prostate-specific antigen tests, although some clinicians advised such. In patients aged < 60 years, organ-sparing cystectomy seems reasonable. In prostate-sparing surgery, candidates who are aged >60 years, the preoperative work-up may routinely include prostate biopsy, especially the apex. Preoperative findings of multifocality of bladder cancers and the presence of carcinoma in situ have the risk of prostatic involvement.

Report of an unusual case: testicular involvement of chronic myeloid leukemia 10 years after the complete response.

Testicular extra-medullary myeloid cell tumours are rare tumours presenting in most cases with painless testicular swelling. We are representing here along of a case of 21-year-old man with painless scrotal swelling. From his medical history, he was treated by allogenic bone-marrow transplantation and chemotherapy 10 years ago because of chronic myeloid leukemia. The pathology of orchiectomy specimen revealed malign cells with blastic cell infiltration means a late relapse of chronic myeloid leukemia. The patient has been in hematological remission and no evidence of any myeloid disorders by 10 years' follow up. Although testicular involvement is a rare and an unusual event in blast crisis of chronic myeloid leukemia, extramedullary myeloid cell tumour should be considered in the diagnosis of intratesticular tumours.

Predictors of Gleason score upgrading in patients with prostate biopsy Gleason score ≤6.

INTRODUCTION: The discrepancy between prostate biopsy and prostatectomy Gleason scores is common. We investigate the predictive value of prostate biopsy features for predicting Gleason score (GS) upgrading in patients with biopsy Gleason scores ≤6 who underwent radical retropubic prostatectomy (RRP). Our aim was to determine predictors of GS upgrading and to offer guidance to clinicians in determining the therapeutic option. METHODS: We performed a retrospective study of patients who underwent RRP for clinically localized prostate cancer at 2 major centres between January 2007 and March 2013. All patients with either abnormal digital examination or elevated prostate-specific antigen at screening underwent transrectal ultrasound-guided prostate biopsy. Variables were evaluated among the patients with and without GS upgrading. Our study limitations include its retrospective design, the fact that all subjects were Turkish and the fact that we had a small sample size. RESULTS: In total, 321 men had GS ≤6 on prostate biopsy. Of these, 190 (59.2%) had GS≤6 concordance and 131 (40.8%) had GS upgrading from ≤6 on biopsy to 7 or higher at the time of the prostatectomy. Independent predictors of pathological upgrading were prostate volume <40 cc (p < 0.001), maximum percent of cancer in any core (p = 0.011), and >1 core positive for cancer (p < 0.001). CONCLUSIONS: When obtaining an extended-core biopsy scheme, patients with small prostates (≤40 cc), greater than 1 core positive for cancer, and an increased burden of cancer are associated with increased risk of GS upgrading. Patients with GS ≤6 on biopsy with these pathological parameters should be carefully counselled on treatment decisions.

The effect of sildenafil and udenafil on testicular damage following ischemia-reperfusion injury in rats.

PURPOSE: Ischemia-reperfusion injury can cause testicular damage and phosphodiesterase inhibitors are reported to regulate antioxidant activity. We investigated the prevention of ipsilateral and contralateral testicular damage using 2 phosphodiesterase inhibitors after testicular detorsion in rats. MATERIALS AND METHODS: A total of 28 adult male rats were randomly divided into 4 groups of 7 each, including group 1-sham operation, group 2-testicular torsion and detorsion, group 3- testicular torsion and detorsion with sildenafil administration before detorsion and group 4- testicular torsion and detorsion with udenafil administration before detorsion. Tissue levels of malondialdehyde, total sulfhydryl and nitrite were evaluated, and histopathological changes in the groups were examined. RESULTS: Compared to group 1 significantly increased tissue malondialdehyde (p = 0.001), significantly decreased total sulfhydryl (p = 0.038) and insignificantly increased nitrite were found in group 2. Compared to group 2 malondialdehyde decreased significantly and total sulfhydryl increased significantly in groups 3 and 4. The decrease in nitrite was insignificant in the latter 2 groups. Histopathology revealed increased hemorrhage, congestion and edema in group 2 rats. The testicular injury score was lower in groups 3 and 4. In group 2 grades II to IV injury was detected while most specimens in treated groups showed grade II injury. CONCLUSIONS: This study indicates that intraperitoneal administration of sildenafil and udenafil efficiently suppresses radical production while decreasing histological changes after testicular ischemia-reperfusion injury.