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1.
J Coll Physicians Surg Pak ; 30(3): 324-326, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32169146

RESUMO

Among the Kluyvera species, K. ascorbata has been isolated from only a few adult cases. Furthermore, there is little or no information in the literature as to whether the species of Kluyvera can cause a clinically significant infection in pregnant women. We report a case of urosepsis caused by K. ascorbata in a 23-year pregnant woman at 26 weeks of gestation who presented with left flank pain. Ultrasonography showed left grade 3 hydronephrosis, ureteral dilatation, and a 10-mm distal ureteral stone. The patient underwent laser lithotripsy and JJ placement. Ten days later, she was readmitted with urosepsis and empirical antibiotherapy and aggressive hydration were initiated. On the third day, K. ascorbata growth was detected in the urine culture. Based on the clinical status of the patient and the antimicrobial susceptibility testing, the treatment was switched to ertapenem 1×1 g/day and was continued for 14 days. Among the Kluyvera species, K. ascorbata is the most frequent pathogen which may be isolated from pregnant women and can cause urosepsis. To the best of authors' knowledge, this is the first report showing the isolation of K. ascorbata in a pregnant woman which caused urosepsis.

2.
Int Braz J Urol ; 45(6): 1153-1160, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808403

RESUMO

PURPOSE: To identify the factors increased fluoroscopy time during percutaneous nephrolithotomy and investigate the relationship between the 3D segmentation volume ratio of stone to renal collecting system and fluoroscopy time. MATERIALS AND METHODS: Data from 102 patients who underwent percutaneous nephrolithotomy were analyzed retrospectively. Volume segmentation of both the renal collecting system and stones were obtained from 3D segmentation software with the images on CT data. Analyzed stone volume (ASV), renal collecting system volume (RCSV) measured and the ASV-to-RCSV ratio was calculated. Several parameters were evaluated for their predictive ability with regard to fl uoroscopy time. RESULTS: The stone-free rate was 55.9% after the percutaneous nephrolithotomy. Complications occurred in 31(30.4%) patients. The mean fluoroscopy time was 199.4±151.1 seconds. The fl uoroscopy time was significantly associated with the ASV-to-RCSV ratio (p<0.001, r=0.614). The single tract was used in 77 ( 75.5%) cases while multiple tracts were used in 25 (24.5%) cases. Fluoroscopy time was significantly associated with multiple access (p<0.001, r=0.689). On univariate linear regression analysis, longer fluoroscopy time was related with increased stone size, increased stone volume, increased number of access, increased calyx number with stone, increased ASV-to-RCSV, increased operative time and decreased stone essence. On multivariate linear regression analysis, the number of access and the ASV-to-RCSV were independent predictors of fluoroscopy time during percutaneous nephrolithotomy. CONCLUSIONS: The distribution of the stone burden volume in the pelvicalyceal system is a significant predictor for prolonged fluoroscopy time during percutaneous nephrolithotomy. Measures to decrease FT could be benefi cial in patients with a high ASV-to-RCSV ratio for precise preoperative planning.


Assuntos
Fluoroscopia/métodos , Cálculos Renais/patologia , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Adulto , Índice de Massa Corporal , Intervalo Livre de Doença , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Exposição à Radiação , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento
3.
Andrologia ; 51(9): e13368, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31482615

RESUMO

The aim of this study is to investigate whether serum vitamin D level predicts the risk of Peyronie's disease. Calcium and inflammatory cytokines play an important role during fibrocalcification of the plaques in Peyronie's Disease. TGF-ß1 is one of the most fibrogenic cytokines. Increasing serum vitamin D levels is considered that induce expression of TGF-ß1. Serum vitamin D levels and TGF-ß1 are related with calcifications of some soft tissues in previous studies. One hundred and three Peyronie patients and 162 healthy volunteers were included in the study. In both groups, demographic data, medical history, physical examination and erectile capacity were recorded. Serum 25-hydroxyvitamin D, total cholesterol, low-density lipoprotein, high-density lipoprotein, triglyceride and testosterone levels were measured. The mean level of serum 25 (OH) D was significantly higher in men with Peyronie's disease compared with the controls (32.6 ± 7.9 ng/ml vs. 18.5 ± 6.6 ng/ml respectively. p < 0.001). There is a relationship between Peyronie's disease and high serum vitamin D levels. Also, increased low-density lipoprotein and total cholesterol levels, diabetes mellitus, and cardiovascular diseases were associated with Peyronie's disease.


Assuntos
Induração Peniana/etiologia , Vitamina D/análogos & derivados , Adulto , Estudos de Casos e Controles , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Induração Peniana/sangue , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Vitamina D/sangue
4.
Urolithiasis ; 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31378836

RESUMO

The purpose of the study was to investigate variables that may predict ureteral stone impaction and create a new model to predict more accurately stone impaction based on preoperative NCCT findings. Data of 238 patients who underwent URS were analyzed. Stone size, stone location, Hounsfield unit (HU) value of the stone, ureteral wall thickness (UWT) and grade of hydronephrosis were recorded. HU values of the ureter which are measured proximal and distal to the stone were recorded. Subsequently, we determined the factors that could predict the stone impaction in univariate and multivariate logistic regression analysis. After the AUC analysis for these factors, we created a new model to predict more accurately stone impaction. The formula was named Impacted Stone Formula (ISF). Stone impaction verified endoscopically. Predictors of impacted stones were evaluated using univariate and multivariate logistic regression analyses. Diagnostic value for the prediction of stone impaction was analyzed with receiver operating characteristic (ROC) incline. Overall, there were 196 patients included in the study. Multivariate regression analysis revealed that the HU below/above ratio, UWT, and grade of hydronephrosis were the crucial predictors of stone impaction (OR 20.53, p < 0.001; OR 10.55, p < 0.001; OR 5.95, p = 0.004, respectively). The ROC analysis revealed a cutoff value of 15.15 (AUC 0.958, p < 0.001, sensitivity 91.0%, specificity 97.7%) for the ISF. In conclusion, ISF is the most precise preoperative predictor of impacted stones in patients with ureteral stones. ISF could be used by the urologists before treatment to help preoperative planning and perioperative clinical course.

5.
World J Mens Health ; 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31385470

RESUMO

PURPOSE: Peyronie disease (PD) occurs as a result of recurrent microvascular injuries or trauma of the tunica albuginea, although its precise etiology is unknown. Mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT), which are parameters indicative of platelet activity, are considered to be functional markers of platelets involved in the pathophysiology of related inflammatory and vascular diseases. In this study, we aimed to examine the relationship between PD and platelet indices. MATERIALS AND METHODS: We evaluated participants who presented to the andrology department of our institution between December 2015 and May 2018. Ninety-two men with PD and 80 healthy volunteers were included in this study. Participants who had received medical treatment affecting platelets or had any hematologic or systemic diseases were excluded from the study. RESULTS: The mean age of men with PD was 53.8±10.2 years, and the mean age of the control group was 52.2±8.0 years (p=0.465). There were no significant differences in the mean IIEF-5 scores, platelet count, MPV, PDW, or PCT between the patients with and without PD (p<0.05). CONCLUSIONS: No correlations were found between PD and platelet indices. Large-scale prospective cross-sectional studies are needed to elucidate the etiopathogenesis of PD.

6.
J Coll Physicians Surg Pak ; 29(6): S62-S64, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31142426

RESUMO

We report and discuss a rare case of inguino-scrotal urinary bladder herniation (IBH) complicated with a big urinary bladder stone and contralateral indirect inguinal bowel hernia. A 68-year male patient presented to the outpatient urology department with a 4-year history of right inguino-scrotal pain and swelling, which was gradually increasing in size, and of intermittent swelling in the left groin. Physical examination revealed right irreducible inguino-scrotal hernia and reducible left inguinal hernia extending to the groin. Computerised Tomography (CT) revealed that the right side of urinary bladder was herniating through the inguinal canal into the right hemiscrotum along with a 22 mm urinary bladder stone. The patient underwent bilateral Lichtenstein tension-free mesh hernioplasty through inguinal incisions and transurethral laser cystolithotripsy in the same session. To the best of the authors' knowledge, this is the first reported case of bilateral inguinal hernia with concomitant bladder stone in the literature.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Escroto/patologia , Tomografia Computadorizada por Raios X/métodos , Cálculos da Bexiga Urinária/cirurgia , Doenças da Bexiga Urinária/cirurgia , Bexiga Urinária/diagnóstico por imagem , Idoso , Hérnia Inguinal/diagnóstico por imagem , Humanos , Canal Inguinal/diagnóstico por imagem , Masculino , Escroto/cirurgia , Telas Cirúrgicas/efeitos adversos , Resultado do Tratamento , Cálculos da Bexiga Urinária/diagnóstico por imagem , Doenças da Bexiga Urinária/complicações , Doenças da Bexiga Urinária/diagnóstico
7.
Urolithiasis ; 47(6): 557-565, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30109429

RESUMO

In our study, we examined the effect of the three-dimensional (3D) stone segmentation volume and its ratio to the renal collecting system on complication rates. Data from141 patients who underwent PCNL surgery were analyzed retrospectively. Volume segmentation of both the renal collecting system and stones was obtained from 3D segmentation software with the images on CT data. After creation of a 3D surface volume rendering of renal stones and the collecting system, segmentation of the renal collecting system volume (RCSV) and analyzed stone volume (ASV) was analyzed and the ASV-to-RCSV ratio was calculated. Univariate analysis and multivariate logistic regression model were used to determine factors that affected complication status. Diagnostic value for the prediction of complication rates was analyzed using receiver operating characteristic (ROC) incline. Overall, there were 141 (92 male and 49 female) eligible patients included in the current study. The overall complication rate for PCNL monotherapy was 31.9%. Multivariate regression analysis (forward stepwise) revealed that the ASV-to-RCSV ratio and number of tracts were independent risk factors for developing complications (OR 1.17, p < 0.001; OR 7.87, p = 0.002; respectively). The ROC analysis revealed a cut-off value of 16.23% (AUC 0.869, p < 0.001, sensitivity 93.3%, specificity 78.1%) for the ASV-to-RCSV ratio. The distribution of stone burden volume in the pelvicalyceal system, which is calculated as a numerical value using the 3D volume segmentation method, is an important predictor of the complication rate before PCNL. The ASV-to-RCSV ratio as a quantitative value may be an instrument for urologists before surgery to help preoperative planning.

8.
Int Urol Nephrol ; 51(1): 27-32, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30448887

RESUMO

PURPOSE: The aim of the study was to determine the effect of anticholinergics used for overactive bladder treatment on the sexual function of women. METHODS: Between January 2016 and August 2018, over 18 years old, 216 sexual active women with OAB and 165 healthy women as control group were prospectively enrolled in the study. Five different anticholinergics were used for the treatment. Female Sexual Function Index (FSFI), eight-item overactive bladder awareness tool (OAB-V8), and Beck Depression Inventory form were completed before and after 3 months. Baseline and post-treatment scores were compared with a control group of age-matched healthy women. RESULTS: Patients with OAB reported at baseline significantly worse sexual function in all FSFI domains compared to healthy control group (21.47 ± 3.22 vs. 26.79 ± 5.56, p < 0.01). Three months after treatment, over 85% of participants reported clinically relevant improvements in sexual function, with statistically significant changes in mean FSFI scores. CONCLUSIONS: Treatment of OAB with anticholinergics can improve sexual function of sexual active women with OAB. Patients may be informed about this potential benefit of anticholinergic treatment, to improve their sexual function.


Assuntos
Antagonistas Colinérgicos , Depressão , Disfunções Sexuais Fisiológicas , Bexiga Urinária Hiperativa , Adulto , Antagonistas Colinérgicos/administração & dosagem , Antagonistas Colinérgicos/classificação , Depressão/diagnóstico , Depressão/fisiopatologia , Depressão/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Disfunções Sexuais Fisiológicas/tratamento farmacológico , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/psicologia , Resultado do Tratamento , Turquia , Bexiga Urinária Hiperativa/complicações , Bexiga Urinária Hiperativa/tratamento farmacológico
9.
Aging Male ; : 1-6, 2018 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-30290715

RESUMO

BACKGROUND: To investigate the usefulness of serum procalcitonin (PCT) in the early diagnosis of urinary tract infection (UTI) and urosepsis following transrectal prostate biopsy. METHODS: In this prospective observational study, 227 patients who underwent transrectal ultrasound-guided prostate biopsy were evaluated. The relationship between urosepsis and age, serum PCT, C-reactive protein, prostate-specific antigen (PSA), prostate volume, PSA density and pathologic results following biopsy was assessed. Serum PCT level was measured in all patients immediately before the biopsy and at the post-biopsy day 2. RESULTS: Of the 227 patients, 11 (4.8%) developed UTI with positive urine culture without urosepsis and 5 (2.2%) developed urosepsis within 30 days after biopsy. The concentration of PCT was within the normal range before the biopsy. Procalcitonin concentration at post-biopsy day 2 was significantly higher in patients who developed urosepsis (1.91 ± 2.99 ng/ml vs. 0.05 ± 0.08 ng/ml; p = .004) compared with non-UTI patients. Only elevated PCT level at post-biopsy day 2 was a statistically significant independent predictor of post-biopsy urosepsis. The area under the ROC curve for the prediction of urosepsis was 0.976 (95%CI: 0.941-1.000) and a cut-off 0.095 ng/ml in the level of PCT at post-biopsy day 2 yielded a sensitivity of 100% and specificity of 93.8% in detecting urosepsis following biopsy. CONCLUSIONS: Procalcitonin appears to be a useful early biomarker to predict the urosepsis following prostate biopsy. Patients with elevated PCT value should be closely monitored after the biopsy.

10.
World J Mens Health ; 36(3): 255-262, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30168299

RESUMO

PURPOSE: To investigate the pathophysiological role of superoxide anion and total reactive oxygen species (ROS) production by the spermatozoa of men with varicocele and its relationship with varicocele grade and semen parameters. MATERIALS AND METHODS: This prospective study included 34 men with grade II-III varicocele, regardless of their fertility status. The control group consisted of 13 healthy men. Semen characteristics were examined according to the 2010 World Health Organization criteria. The swim-up method was used for sperm preparation. Total ROS and superoxide anion production was assayed by luminol- and lucigenin-dependent chemiluminescence (CL), respectively. RESULTS: The men with varicocele had significantly higher total ROS and superoxide anion levels than the healthy control subjects (2.9±0.4 relative light unit (RLU) vs. 2.4±0.1 RLU, p=0.001 for luminol-dependent CL and 2.8±0.4 RLU vs. 2.3±0.2 RLU, p=0.002 for lucigenin-dependent CL). Cases of grade III varicocele had significantly higher superoxide anion and total ROS levels than grade II cases and control subjects (p<0.001). Superoxide anion and total ROS levels were negatively correlated with all semen parameters. CONCLUSIONS: The superoxide anion levels produced by spermatozoa were significantly higher in varicocele patients than in control subjects. ROS production was related to increased varicocele grade, impaired semen concentration, and abnormal morphology in men with varicocele. Our findings suggest that superoxide anion overproduction may be an important step in the cascade of ROS-related damage to spermatozoa, resulting in impaired semen parameters in patients with varicocele.

11.
Int J Impot Res ; 30(6): 335-341, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30068978

RESUMO

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is often associated with erectile dysfunction (ED). However, the underlying pathophysiological mechanisms of ED occurrence are still unclear in patients with CP/CPPS. The aim of the study was to investigate superoxide anion (O2•-) and total reactive oxygen species (ROS) production in semen of men with category IIIA CP/CPPS and their association with ED. This prospective study included 33 men with category IIIA CP/CPPS. Control group consisted of 13 healthy men. Total ROS and O2•- production were assayed by luminol and lucigenin-dependent chemiluminescence (CL) methods, respectively. ED was evaluated using the IIEF-5 questionnaire. Patients with CP/CPPS had significantly higher seminal total ROS and O2•- levels than healthy control subjects (2.9 ± 0.5 relative light unit (RLU) vs. 2.4 ± 0.2 RLU, p < 0.001; luminol-dependent CL and 2.5 ± 0.4 RLU vs. 2.3 ± 0.2 RLU, p = 0.02; lucigenin-dependent CL, respectively). Seminal O2•- and ROS levels were negatively correlated with IIEF-5 scores (r = -0.556, r = -0.536; p < 0.001, respectively). These results may suggest O2•-/ROS overproduction could be one of the important mechanisms in the etiology of ED development in CP/CPPS patients.


Assuntos
Disfunção Erétil/complicações , Prostatite/complicações , Espécies Reativas de Oxigênio/química , Sêmen/química , Adulto , Estudos de Casos e Controles , Disfunção Erétil/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Ereção Peniana , Estudos Prospectivos , Análise de Regressão , Índice de Gravidade de Doença , Inquéritos e Questionários , Turquia
12.
Aging Male ; : 1-6, 2018 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-29616850

RESUMO

BACKGROUND: The aim of this study was to evaluate the relationship between mean platelet volume (MPV) and vitamin D levels according to ED severity. METHODS: Between October 2015 and September 2017, patients who applied to the andrology outpatient clinic with an ED complaint were retrospectively reviewed. Patients with diabetes, hypertension, hyperlipidemia, malignancy, late-onset hypogonadism and smokers were not included in the study. The International Erectile Function Index-Erectile Function (IIEF-EF) questionnaire was used to assess the levels of erectile function. According to this scoring system, patients were divided into two groups. IIEF score: between 17 and 25 = mild ED (Group 1) and IIEF score between 16 and 0 = moderate-severe ED (Group 2). Blood samples of the patients were taken from antecubital vein and MPV and 25-hydroxyvitamin D [25(OH)D] levels were evaluated. RESULTS: Ninety patients were included in the study (Group 1: n = 41, Group 2: n = 49). The mean age of the patients was 41.07 ± 8.56 and the mean body mass index (BMI) was 27.59 ± 3.91. 25(OH)D levels were found to be statistically lower in Group 2 (18.85 ± 6.09; 13.98 ± 7.10; p = .001). MPV levels were found to be statistically higher in Group 2 (10.05 ± 0.81; 10.78 ± 1.16; p = .001). Correlation between IIEF-EF scores and 25(OH)D levels was positive (p = .03, r = 0.22). There was negative correlation between IIEF-EF scores and MPV and between 25(OH)D levels and MPV levels [p = .003 for IIEF-EF/MPV, p = .04, r = -0.23 for 25(OH)D/MPV]. CONCLUSION: There is a significant positive correlation between ED severity and 25(OH)D levels and there is a significant negative correlation between ED severity and MPV levels.

13.
J Endourol ; 30(10): 1132-1137, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27506462

RESUMO

OBJECTIVE: To investigate the impact of three-dimensional (3D) printed pelvicaliceal system models on residents' understanding of pelvicaliceal system anatomy before percutaneous nephrolithotripsy (PCNL). MATERIALS AND METHODS: Patients with unilateral complex renal stones indicating PCNL were selected. Usable data of patients were obtained from CT-scans in Digital Imaging and Communications in Medicine (DICOM) format. Mimics software version 16.0 (Materialise, Belgium) was used for segmentation and extraction of pelvicaliceal systems (PCSs). All DICOM-formatted files were converted to the stereolithography file format. Finally, fused deposition modeling was used to create plasticine 3D models of PCSs. A questionnaire was designed so that residents could assess the 3D models' effects on their understanding of the anatomy of the pelvicaliceal system before PCNL (Fig. 3). RESULTS: Five patients' anatomically accurate models of the human renal collecting system were effectively generated (Figs. 1 and 2). After presentation of the 3D models, residents were 86% and 88% better at determining the number of anterior and posterior calices, respectively, 60% better at understanding stone location, and 64% better at determining optimal entry calix into the collecting system (Fig. 5). CONCLUSION: Generating kidney models of PCSs using 3D printing technology is feasible, and the models were accepted by residents as aids in surgical planning and understanding of pelvicaliceal system anatomy before PCNL.


Assuntos
Internato e Residência , Cálculos Renais/cirurgia , Cálices Renais/anatomia & histologia , Cálices Renais/cirurgia , Litotripsia/métodos , Urologia/educação , Adulto , Humanos , Rim , Cálculos Renais/diagnóstico por imagem , Modelos Anatômicos , Médicos , Projetos Piloto , Impressão Tridimensional , Prostatectomia , Tomografia Computadorizada por Raios X
14.
Turk J Urol ; 41(3): 138-42, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26516597

RESUMO

OBJECTIVE: The prevalence of stone diseases is high in Turkey. Thanks to the technological improvements and to the increase in the number of qualified and experienced specialists in the last thirty years, there has been an increase in the application of minimally invasive methods in the stone disease surgery. This study, with a sample survey of Western Black Sea region, aims at revealing the changes and improvements in the treatment of stone diseases in different centers in Anatolia within the last ten years. MATERIAL AND METHODS: Six centers in 4 of the provinces of the Western Black Sea Region were selected and the patients' files were retrospectively analyzed. The treatment methods that were recommended for and/or applied to the patients diagnosed with urinary stone diseases were recorded by years. The urinary stone diseases were divided into three separate groups; kidney, ureters and bladder. Treatment options were recorded into categories as open surgery, percutaneous nephrolithotripsy, retrograde intrarenal surgery, semirigid ureterorenoscopy, flexible ureterorenoscopy, and ESWL. RESULTS: A total of 26044 patients with stone diseases have been treated in the above-mentioned centers for the last 10 years. The distributions of the stone diseases in relation to their localization were as follows: - kidney stones: 9040 (34.7%), ureter stones: 15264 (58.6%), and bladder stones: 1740 (6.7%). As for the distribution of the treatment in relation to the treatment methods, it was seen that open surgery for 1032 (4%) patients, endoscopic surgery for 15038 (58%) patients, and ESWL for 9974 (38%) patients had been applied. While URS and PCNL are currently the commonly used treatment methods in the Western Black Sea Region, RIRS has begun to be used in a limited number of patients for the last 3 years. CONCLUSION: Though being a little late, the advances in endrourology offer practical applications in the Western Black Sea region as well. Although this study suggests implications for the evaluating of the periphery outcomes of the improvements in stone disease treatments, for the planning of training schemes, and for equipment planning, further research based on more data from more centers is needed to have a nation-wide perspective.

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