Questionnaire-guided evaluation of the effectiveness of long-term intravesical 0.2% chondroitin sulfate therapy in interstitial cystitis.

INTRODUCTION AND HYPOTHESIS: To investigate the long-term feasibility, safety and effectiveness of intravesical chondroitin sulfate therapy in patients with one or more forms of chronic cystitis. METHODS: The study included 62 female patients with interstitial cystitis/painful bladder syndrome (IC/PBS) who received intravesical chondroitin sulfate (40 ml/80 mg) therapy between 2014 and 2018. A total of 15 doses of intravesical treatment were applied, once weekly in the first month and once monthly from the second month onward. A 3-day voiding diary, a visual analog scale (VAS), the O'Leary Sant Indexes (ICSI/ICPI), the Pelvic Pain and Urgency/Frequency Symptom (PPUFS) Scale and PPUF Bother scores were recorded and evaluated through prospective comparison before treatment and at the first month and first year. Patients were also assessed using the Global Response Assessment (GRA) at the end of the first month and first year to assess the effectiveness of responses to treatment. RESULTS: In the first month of treatment, 0.2% chondroitin sulfate was ineffective in 22.5% of patients, with mild improvement observed in 40.0% and moderate-good improvement in 37.0%. Evaluation at the end of the first year revealed mild improvement in 21.0% of patients and moderate-good improvement in 79.0%. Statistically significant improvements were observed in all scoring systems at 1 and 12 months compared with pre-treatment values (p < 0.001). CONCLUSION: Long-term intravesical chondroitin sulfate therapy is a safe and highly successful therapeutic modality that produces significant improvement in patients' quality of life and symptoms in the treatment of IC/PBS.

The effect of desloratadine on ischemia reperfusion induced oxidative and inflammatory renal injury in rats.

Purpose: To examine the effect of desloratadine on kidney ischemia-reperfusion (I/R) injury in albino Wistar male rats using biochemical and histopathological methods.Methods: The treated with ischemia-reperfusion + 5 mg/kg desloratadine (IRD) group (n-6) was given 5 mg/kg desloratadine by gavage orally, and applied renal ischemia-reperfusion (BIR) group (n-6) and control (SG) group undergoing Sham operation (n-6) rats were given distilled water as solvent one hour before ketamine anesthesia. During the anesthesia period, ischemia was induced for 2 h unilaterally in the left kidney of all rats followed by reperfusion for 6 h. The kidneys of the SG group had sham operation without any intervention.Results: Our biochemical test results showed that malondialdehyde (MDA), nuclear factor kappa (NF-κB), tumor necrosis factor alpha (TNF-α), interleukin one beta (IL-1ß), creatinine, and blood urea nitrogen (BUN) levels were significantly increased in the BIR group compared to the healthy control and IRD groups treated with desloratadine. Histopathological results were revealed tubular dilatation, tubular necrosis, loss of brushy margins, cast formation, and apoptotic bodies in tubular epithelial cells in the BIR group. There were no histopathological findings except for the swelling of tubule epithelial cells and the accumulation of proteinous material in some tubule lumens in renal tissue of desloratadine-treated rats.Conclusions: Experimental results suggested that desloratadine may be useful in the treatment of renal I/R injury.

Serum paraoxonase 1 and 3 activities in benign and malignant diseases of the prostate and changes in levels following robotic-assisted laparoscopic radical prostatectomy

Background/aim: This study aimed to examine serum paraoxonase 1 and 3 (PON1 and PON3) activities in benign and malignant diseases of the prostate, to determine lipid profile and malondialdehyde (MDA) levels, and to investigate changes in levels following robotic-assisted laparoscopic radical prostatectomy (RALRP). Materials and methods: A total of 137 patients, including a control group, were enrolled in the study and assigned into four groups. Group 1 (n = 33) consisted of patients previously undergoing RALRP with no recurrence, group 2 (n = 36) consisted of patients diagnosed with prostate cancer (PCa) and undergoing RALRP, and group 3 (n = 34) consisted of patients diagnosed with benign prostatic hyperplasia. The control group (n = 34) consisted of healthy individuals. Serum low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride, cholesterol, prostate-specific antigen (PSA), PON1, PON3, and MDA values were measured. In addition, group 2 MDA, PON1, PON3, and PON1/HDL levels were investigated preoperatively and at the first month postoperatively. Results: Significant changes were found in PON1, PON3, and MDA levels. PON1 and PON3 levels decreased significantly in patients with PCa, while MDA levels increased. PON1 and PON3 increased postoperatively in the PCa group, while MDA decreased. BPH group PON1, PON3, and MDA levels were higher than those of the control group. Conclusion: An increase in free oxygen radicals in the body or a decrease in endogenous antioxidant enzyme levels can result in malignant and benign diseases of the prostate. Surgical excision of malignant tissue in PCa causes a decrease in oxidative stress.

Oxidative stress before and after surgery in benign prostatic hyperplasia patients.

The aim was to assess oxidative stress in benign prostatic hyperplasia patients and also to evaluate the effect of operation in late (60 days) post-operative period. This study was conducted with 16 patients with benign prostatic hyperplasia and 16 healthy subjects. Serum malondialdehyde, blood 8-hydroxy-2'-deoxyguanosine/deoxyguanosine, erythrocyte superoxide dismutase, serum total coenzyme Q10 and coenzyme Q10 levels were measured. Independent samples t test was used to analyse the differences between control group and patients, while paired t test was used to analyse the differences between pre-operative and post-operative periods. Malondialdehyde and total coenzyme Q10 levels were lower in patients, while 8-hydroxy-2'-deoxyguanosine/deoxyguanosine level was increased. However, superoxide dismutase activity and coenzyme Q10 levels did not differ. After 60 days of operation, 8-hydroxy-2'-deoxyguanosine/deoxyguanosine and superoxide dismutase activity decreased, while total coenzyme Q10 level increased. However, malondialdehyde and coenzyme Q10 levels were not affected. The international prostate symptom scores of the patients were also decreased after the operation. The results suggest that blood 8-hydroxy-2'-deoxyguanosine/deoxyguanosine level may reflect the oxidative stress better than the malondialdehyde level, and surgical operation attenuates the oxidative stress in late post-operative period in benign prostatic hyperplasia patients.

The effect of taxifolin on experimental testicular ischaemia reperfusion injury in rats. A biochemical and histopathological analysis.

OBJECTIVES: The aim of the study is to investigate the protective effect of taxifolin (3,5,7,3,4-pentahydroxy flavanone), a strong antioxidant, against testicular I/R injury in rats biochemically and histopathologically. MATERIALS AND METHODS: 50mg/kg taxifolin was administered to taxifolin+testicular torsion-detorsion (TTTD, n-10) group of Albino Wistar male rats by oral gavage. Distilled water .5ml as a solvent was administered to testicular torsion-detorsion (TTD, n-10) and Healthy Control (SG, n-10) groups using the same method. An hour after the administration of taxifolin and distilled water, anaesthesia (ketamine 60mg/kg) was administered to all animal groups. TTD and TTTD group animals were subjected to testicular torsion at 720 degrees for four hours during anaesthesia. At the end of this period, testicular detorsion was applied and perfusion was allowed for four hours. Sham operation was applied to SG group. RESULTS: Our biochemical experiment results showed that the amount of malondialdehyde (MDA) in testicular tissue of TTD group presented a significant increase compared to SG and TTTD groups whereas total glutathione (tGSH) and superoxide dismutase (SOD) levels decreased. In addition, while TTD group presented severe histopathological damage in germinal epithelium cell and seminiferous tubule, mild damage was observed in TTTD group. CONCLUSIONS: The results of our experiment indicate that taxifolin could be useful in the treatment of testicular I/R damage.

Comparison of Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging in Patients with Prostate Biopsy Indications.

OBJECTIVE: This article aims to evaluate the efficacy of multiparametric magnetic resonance imaging before standard tru-cut biopsy in making prostate cancer diagnosis. MATERIALS AND METHODS: A total of 160 patients with prostate biopsy indications were prospectively evaluated between May 2017 and October 2018. Multiparametric magnetic resonance imaging was taken after obtaining a written informed consent from all patients. Cognitive transrectal ultrasound-guided biopsy was performed based on multiparametric magnetic resonance imaging results. Standard tru-cut biopsy was included to reduce false-negative rate. Statistical analysis was performed using the Statistical Package for Social Sciences version 20.0 software. RESULTS: The mean age of the patients was 65.94 ± 7.90 (48-84) years. Around 19.37% of the patients had a specificity in the digital rectal exam. The mean prostate-specific antigen value of the patients with adenocarcinoma was 42.1 ng/mL and it was 10.2 ng/mL in patients with benign prostate hyperplasia. It was observed that the prostate-specific antigen values in prostatic adenocarcinomas were significantly higher than those in benign prostate hyperplasia (P < .001). The results of multiparametric magnetic resonance imaging and the biopsy were 100% similar in terms of zones in patients with adenocarcinoma. All of the biopsy results of the patients who were evaluated to have normal prostate tissue in multiparametric magnetic resonance imaging were evaluated as benign prostate hyperplasia; on the other hand, 13.6% of PI-RADS 2 lesions, 14% of PI-RADS 3 lesions, 31.8% of PI-RADS 4 lesions, and 85.7% of PI-RADS 5 lesions were determined to be adenocarcinoma. It was observed that the prevalence of adenocarcinoma increased as the risk elevated in multiparametric magnetic resonance imaging (P < .001). CONCLUSION: Multiparametric magnetic resonance imaging evaluated by experienced radiologists may be instructive of urologists and reduce the need for unnecessary biopsies.

Concurrent Inguinal Hernia Repair During Robot-Assisted Transperitoneal Radical Prostatectomy: Single Center Experience.

OBJECTIVE: To evaluate outcomes of concurrent inguinal hernia (IH) repair with mesh during transperitoneal robot-assisted radical prostatectomy (RARP). MATERIAL AND METHODS: Data of 26 patients (31 procedures) undergoing IH repair concurrently with RARP between January 2017 and January 2020 were evaluated retrospectively. Patients' demographics, intraoperative and postoperative variables were recorded. Patients were assessed based on prostate-specific antigen recurrence, IH recurrence, mesh infection, seroma formation and groin pain quarterly in the first year, and every six month thereafter. RESULTS: The median age was 64.5 years in our population. IH was detected preoperatively in 46.2% of patients (n = 12) and intraoperatively in 53.8% (n = 14). Twenty-one (80.8%) patients (11 of them had right IH and 10 of them had left IH) had unilateral hernias and 5 patients (19.2%) had bilateral hernias. Twenty-three (88.4%) IHs were direct, three (11.6%) were indirect. The median operative time and estimated blood loss were 192.5 (range: 140-250) min and 100 (range: 10-170) mL, respectively. The median duration of IH repair, time of drainage, length of hospitalization, and catheterization were 32.5 (range: 14-40) min. 2 (range: 2-6) days, 6 (range: 5-8) days and 7 (range: 5-7) days, respectively. No perioperative complication due to RARP or IH repair was observed. During a median follow-up time was 18 months, no scrotal hematoma, seroma formation or mesh infection was identified. CONCLUSION: IH repair performed during the same session at RARP is a safe and applicable procedure.

Time dependant functional and morphological recovery of the kidney after relief of obstruction in patients with impacted ureteral stones.

OBJECTIVES: To assess the course of functional and morphological recovery of the kidney following the relief of obstruction with ureteral JJ stent in cases with unilateral impacted stones. MATERIALS AND METHODS: A total of 42 adult patients who were admitted to our clinic with unilateral obstructing impacted ureteral stones requiring JJ stent placement were included in the study. The course of functional recovery was assessed by evaluating the serum creatinine levels, renal resistive index (RRI) values and urinary levels of kidney injury molecule-1, neutrophil gelatinaseassociated lipocalin as well as microalbumin before at 1 day, 1 week and 4 weeks after JJ stent placement. Course of morphologic recovery was evaluated by evaluating the degree of hydronephrosis, kidney size, perirenal straining and ureteral diameter. RESULTS: Our results showed that all relevant parameters began to decrease after 24 hours and continue to normalize during 1 week evaluation; majority of these variables indicating the functional and morphological recovery were in normal range after 4 weeks. Decompression of the obstructed kidneys with JJ stent placement in patients with impacted ureteral stones was found to be effective enough with recovery of normal renal functional and morphological status after a minimum time period of 4 weeks. Morphological recovery of affected kidneys following JJ stenting was obtained with a significant difference between baseline and 1-month evaluation findings (p = 0.001, p < 001, p < 001, respectively). KIM-1 excretion began to decline to normal levels after 4 weeks (3.52 ± 0.99 ng/ml versus 2.84 ± 0.66 ng/ml, p < 0.001). The same findings were observed for the urinary excretion levels of NGAL, which normalized at the 1-month evaluation (604.55 ± 140.28 ng/ml versus 596.87 ± 80.17 ng/ml p = 0.895). Urinary microalbumin excretion levels however remained high even until 1-month follow-up with a statistically significant difference when compared with the normal excretion values (p < 0.001). There was a statistically significant difference in RRI values between baseline and 1-month follow-up findings in obstructed kidney (p < 0.001). CONCLUSIONS: Elective management of the obstructing impacted ureteral stone(s) will be safer with limited risk of infective complications after functional and morphological normalization in such kidneys following 4 weeks of JJ stent placement.

Effect of adenosine triphosphate, benidipine and their combinations on bevacizumab-induced kidney damage in rats.

BACKGROUND: Bevacizumab-induced vascular endothelial growth factor (VEGF) inhibition may lead to a decrease in adenosine triphosphate (ATP) levels, an increase in intracellular Na+ and Ca2+ concentrations and an increase in reactive oxygen species (ROS) generation, as well as to cell damage. OBJECTIVES: To investigate the biochemical and histopathological effects of ATP, benidipine and ATP in combination with benidipine on bevacizumab-induced kidney damage in rats. MATERIAL AND METHODS: Rats were divided into 5 treatment groups: bevacizumab (BVZ) alone, ATP + bevacizumab (ABVZ), benidipine + bevacizumab (BBVZ), ATP + benidipine + bevacizumab (ABBVZ), and healthy controls (HC). Adenosine triphosphate (25 mg/kg), benidipine (4 mg/kg orally), ATP (25 mg/kg) + benidipine (4 mg/kg), or saline were administered to albino Wistar rats. One hour after treatment, bevacizumab was injected at a dose of 10 mg/kg to induce kidney damage. Two doses of bevacizumab were delivered 15 days apart. Adenosine triphosphate + benidipine were administered once a day for 1 month. RESULTS: Malondialdehyde (MDA), total oxidant status (TOS), creatinine, and blood urea nitrogen (BUN) levels of the BVZ, BBVZ, ABVZ, ABBVZ, and HC groups were ranked from highest to lowest. Conversely, total glutathione (tGSH) and total antioxidant status (TAS) kidney tissue values were ranked from lowest to highest, respectively. Hemorrhage, tubular necrosis and grade 3 focal tubular atrophy were observed in the BVZ group. Atrophy and grade 2 necrosis were observed in the BBVZ group and atrophy and grade 1 necrosis were observed in the ABVZ group. Only grade 1 atrophy was observed in the ABBVZ group. CONCLUSIONS: Adenosine triphosphate reduced bevacizumab-induced renal toxicity significantly more effectively than benidipine. However, the combination of ATP + benidipine further reduced bevacizumab-induced renal toxicity relative to benidipine or ATP alone. These data indicate that ATP + benidipine might be a potential therapeutic strategy for the prevention of bevacizumab-induced renal toxicity.

Protective effect of taxifolin against prooxidant and proinflammatory kidney damage associated with acrylamide in rats.

The current study investigates the biochemical and histopathological effects of taxifolin on acrylamide-induced kidney damage. A 50 mg/kg dose of taxifolin was administered via oral gavage to the taxifolin + acrylamide (TACR) group (n-6) consisting of male albino Wistar rats. The same volume of distilled water used as solvent was orally administered to the acrylamide (ACR) (n-6) and healthy (HG) (n-6) groups. One hour after the administration of taxifolin and distilled water, a 20 mg/kg dose of acrylamide was orally administered to the TACR and ACR groups. This procedure was repeated once a day for 30 days. In the acrylamide group, malondialdehyde (MDA), tumour necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1ß) levels were found to be high, total glutathione (tGSH) levels were found to be low, and there was severe interstitial haemorrhage; additionally, tubular necrosis, tubular atrophy, leucocyte infiltration, and glomerular structures with expanded Bowman's space were observed. In the taxifolin group, where the increase of MDA, IL-1ß, and TNF-α and the decrease of tGSH associated with acrylamide have been prevented, any histopathological finding other than mild necrosis and atrophic tubules was not found. This suggests that Taxifolin would prevent kidney tissue from acrylamide-induced damage would be effective in treating acrylamide-induced nephrotoxicity, inhibiting the increase of MDA, IL-1ß and TNF-α, and decreasing tGSH associated with acrylamide.

Expression of androgen receptor and estrogen receptor-beta in foreskin tissue of hypospadiac and healthy boys. / Expresión de receptores androgénicos y estrogénicos beta en la piel prepucial de hipospadias y niños sanos.

OBJECTIVES: This prospective study aimed to investigate the expression of the androgen receptor(AR) and the estrogen receptor-ß (ER-ß) in foreskint issues in boys with and without distal hypospadias. METHODS: Thirty boys with distal hypospadias were evaluated. Fifteen boys who under went elective circumcision over a period of 18 months served as the control group. The presence of AR and ER-ß in foresk in tissues was investigated immunohistochemically. RESULTS: The percentages of AR in epithelial cells were18.9 ± 27.3% in the hypospadias group and 3.3 ±5.3% in the circumcision group, and the difference betweent he groups was significant (p=0.034). Of the stromal cells, 19.5 ± 26.8% in the hypospadias group and2.6 ± 4.4% in the circumcision group were positive lystained for AR (p=0.004). In the hypospadias group,significantly higher stromal cell percentage of ER-ß was found compared to that in the control group (24± 24.5% and 1.3 ± 1.1%, respectively, p<0.001). Moreover, epithelial cell percentage of ER-ß was higher in the hypospadias group than that in the control group,and the respective values were 6.8 ± 10.1% and 0.9± 1.3% (p<0.0001)CONCLUSION: The percent of AR and ER-ß expression were higher in hypospadias-affected foresk in than in the normal foreskin. Whether the normal function of these receptors reveals, there is a need for more detailed studies.

OBJETIVO: Este estudio prospectivo que pretende investigar la expresión del receptor androgénicoy estrogénico en la piel prepucial en niños con y sin hipospadias distal.MÉTODOS: Treinta niños con hipospadias distal fueron evaluados. 15 niños recibieron una circuncisión electiva en un periodo de 18 meses y sirvieron de grupo control.La presencia de RA y RE-ß en la piel prepucial se investigo por immunohistoquimica. RESULTADOS: El porcentaje de expresión del receptor androgenico en células epiteliales fue de 18,9+/-27,3% en el grupo hipospadias y 3,3+/- 5,3% en el grupo de circuncisión. La diferencia entre ambos grupos fue significativo (p=0,034). En las células estromales,19,5+/- 26,8% en el grupo hipospadias y 2,6+/-4,4% en el grupo circuncisión fueron positivos para el RA (p=0,004). En el grupo de hipospadias, un porcentaje mas elevdo de expresión de RE-b ß se evidencio en comparación al grupo control (24+/-24,5%y 1,3+/-1,1, respectivamente, pel porcentaje de células epiteliales con RE-ß fue superior en el grupo hipospadias que en el grupo control; los valores respectivos fueron 6,8+/-10,1% y 0,9+/-1,3%(p<0,0001).CONCLUSIÓN: En este estudio se sugiere que la expresiónde RA y RE fueron superiores en el grupo conhipospadias que en piel prepucial normal. Se requierenmas estudios para determinar el significado de esta expresión.

Evaluation of the urinary podocalyxin and nephrin excretion levels to determine a safe time interval between two sessions of SWL for renal stones: a non randomized exploratory study.

OBJECTIVES: We aimed to evaluate the role of nephrin and podocalyxin in determining the intervals between shock wave lithotripsy (SWL) sessions and how soon the kidney damage was recovered. METHODS: This work was a prospective study that included 30 patients with unilateral kidney stones. The patients' midflow urine samples were collected before SWL and 1 h, 1 day and 1 week after the procedure. Nephrin and podocalyxin levels in the urine samples were measured by the enzyme-linked immunosorbent assay method. RESULTS: Among the 30 patients who underwent SWL, 19 were males and 11 were females. The mean age of the SWL group was 34.7 ± 13.2. Both biomarkers did not correlate with age, creatinine values, body mass index, stone side, stone size, energy, frequency and shock numbers. Nephrin and podocalyxin levels were significantly higher at the pre-SWL point (p < 0.05). After the procedure, a significant decrease was observed in both biomarker levels (p < 0.05). At the end of first day, these levels started to increase progressively up to the end of the first week (p > 0.05). CONCLUSIONS: Nephrin and podocalyxin may help to determine early period kidney damage associated with SWL. Post-SWL podocalyxin and nephrin values may be used to determine the interval between SWL sessions.

Robotic radical prostatectomy in 93 cases: Outcomes of the first ERUS robotic urology curriculum trained surgeon in Turkey.

OBJECTIVE: This study presents the surgical, oncological, and functional outcomes of the first 93 robotic radical prostatectomy (RARP) procedures performed in Erzurum, Turkey. These procedures were performed by a single surgeon who had completed the European Association of Urology Robotic Urology Section (ERUS) RARP curriculum in an ERUS-certified training center in Ankara. MATERIAL AND METHODS: The study present the results of 93 RARP procedures performed by a single surgeon. The surgeon performing the operations completed an ERUS training program structured for RARP by two robotic surgeons holding ERUS training certificates in an ERUS-approved academic robotic surgery training center in Ankara. The RARP cases performed by the surgeon after completion of the training between April 2016 and August 2018 were retrospectively evaluated. RESULTS: The mean patient age was 63.62±7.04 years, and the mean preoperative serum prostate-specific antigen level was 8.34±4.96 ng/mL. Preoperatively, 82 and 4 patients had prostate biopsy Gleason scores of 3+3 and 4+3, respectively. Bilateral neurovascular bundle (NVB) sparing, unilateral NVB-sparing, and non-NVB-sparing surgery were performed in 21, 13, and 59 cases, respectively. The mean prostate weight was 85.34±47.57 g. Posterior rhabdosphincter reconstruction was performed in 60 (64.5%) cases. Mean console time, intraoperative blood loss, duration of hospital stay, and urethral catheter removal time were 170.49±36.50 min, 100.70±34.08 cc, 6.84±2.28 days, and 7.40±3.11 days, respectively. During the perioperative period (0-30 days), five minor (prolonged drain output, n=3; rectocele, n=1; gout arthritis, n=1) and six major (inguinal hernia, n=1; incisional hernia, n=2; anastomotic urinary leakage, n=2; myocardial infarction, n=1) complications were identified. No complication was detected during postoperative days 31-90. Postoperative pathological stages included pT2a, pT2b, and pT2c disease in 77 (82.8%), 9 (9.7%), and 7 (7.5%) patients, respectively. The positive surgical margin (SM) rate was 10.7% (n=10), including patients with pT2a (n=6) and pT2c (n=2) diseases. Eleven (11.8%) patients underwent pelvic lymph node (LN) dissection. The mean LN yield was 16.45±4.29. The mean length of follow-up was 11.17±8.01 months. Biochemical recurrence was observed in two patients, one of whom received maximal androgen blockage (MAB), and the other one received pelvic radiotherapy+MAB. All the patients with at least one-year follow-up (n=48, 51.6%) were fully continent (0 pads/day). Of the 40 (43%) patients with no preoperative erectile dysfunction (ED) and with at least three-month follow-up, 18 (45%) had no ED, with or without any additional medication including phosphodiesterase-5 (PDE5) inhibitors. CONCLUSION: RARP is a safe minimally invasive procedure with acceptable morbidity, excellent operative, pathological and oncological outcomes, and satisfactory functional results. The ERUS RARP curriculum provides effective and sufficient training.

Diagnosis and Conservative Management of Ureteral Orifice Injury During Robotic Prostatectomy for a Large Prostate with a Prominent Median Lobe.

Introduction: Robot-assisted laparoscopic radical prostatectomy (RALRP) is now considered the standard treatment for localized prostate cancer. However, challenges may arise when dealing with large prostates with a prominent median lobe because the ureteral orifices may not always be visible during dissection and maybe injured in the process. We describe our experience on the diagnosis and conservative management of ureteral orifice injury in this situation. Case: A Gleason score 3 + 3 prostatic adenocarcinoma was detected during 12-quadrant prostate biopsy performed after measurement of a serum prostate specific antigen value of 8.1 ng/mL in a 65-year-old man presenting with lower urinary tract symptoms. The left ureter orifice was observed to have been injured by scissors at dissection of the neck of the bladder and enlarged median lobe at RALRP. An online video call was made to more experienced robotic surgeons for advice. Diagnosis and management of the ureteral injury are presented. Conclusion: Ureteral orifice injury during an RALRP may be managed conservatively with intraoperative ureteral stenting without the need for reimplantation nor conversion to open surgical techniques. Online video call with experienced robotic surgeons is helpful in the decision process.

The effect of taxifolin on experimental testicular ischaemia reperfusion injury in rats. A biochemical and histopathological analysis / Efecto de la taxifolina en la lesión experimental testicular por reperfusión-isquemia en ratas. Análisis bioquímico e histopatológico

Objectives: The aim of the study is to investigate the protective effect of taxifolin (3,5,7,3,4-pentahydroxy flavanone), a strong antioxidant, against testicular I/R injury in rats biochemically and histopathologically.Materials and methods: 50mg/kg taxifolin was administered to taxifolin+testicular torsion–detorsion (TTTD, n-10) group of Albino Wistar male rats by oral gavage. Distilled water .5ml as a solvent was administered to testicular torsion–detorsion (TTD, n-10) and Healthy Control (SG, n-10) groups using the same method. An hour after the administration of taxifolin and distilled water, anaesthesia (ketamine 60mg/kg) was administered to all animal groups. TTD and TTTD group animals were subjected to testicular torsion at 720 degrees for four hours during anaesthesia. At the end of this period, testicular detorsion was applied and perfusion was allowed for four hours. Sham operation was applied to SG group.Results: Our biochemical experiment results showed that the amount of malondialdehyde (MDA) in testicular tissue of TTD group presented a significant increase compared to SG and TTTD groups whereas total glutathione (tGSH) and superoxide dismutase (SOD) levels decreased. In addition, while TTD group presented severe histopathological damage in germinal epithelium cell and seminiferous tubule, mild damage was observed in TTTD group.Conclusions: The results of our experiment indicate that taxifolin could be useful in the treatment of testicular I/R damage. (AU)

Objetivos: El objetivo del estudio fue analizar el efecto protector de la taxifolina (3,5,7,3,4-pentahidroxi flavanona), un fuerte antioxidante, en la lesión por reperfusión-isquemia (R/I) en ratas, a nivel bioquímico e histopatológico.Materiales y métodos: Se administraron 50 mg/kg de taxifolina a un grupo de ratas macho Albino Wistar con torsión-destorsión y taxifolina+testicular (TTTD, n-10) mediante una sonda oral, y una solución de 0,5 mL de agua destilada a un grupo con torsión-destorsión testicular (TTD, n-10) y a controles sanos (SG, n-10), utilizando el mismo método. Una hora después de la administración de taxifolina y agua destilada, se aplicó anestesia (ketamina 60 mg/kg) a todos los grupos de animales. Los grupos TTD y TTTD fueron sometidos a una torsión testicular a 720 grados por cuatro horas durante la anestesia. Al finalizar este período, se aplicó destorsión testicular, permitiéndose la perfusión durante cuatro horas. Se aplicó un placebo al grupo SG.Resultados: Los resultados de nuestro experimento bioquímico reflejaron que el incremento de malondialdehído (MDA) en el tejido testicular del grupo TTD presentó un aumento significativo en comparación con los grupos SG y TTTD, mientras que disminuyeron los niveles de glutatión (tGSH) y superóxido dismutasa (SOD). Además, mientras que el grupo TTD presentó daño histopatológico severo en las células del epitelio germinal y el tubo seminífero, se observó un daño leve en el grupo TTTD.Conclusiones: Los resultados de nuestro experimento indican que la taxifolina podría ser de utilidad para el tratamiento de la lesión testicular por R/I. (AU)

Expression of androgen receptor and estrogen receptor-beta in foreskin tissue of hypospadiac and healthy boys / Expresión de receptores androgénicos y estrogénicos beta en la piel prepucial de hipospadias y niños sanos

OBJECTIVES: This prospective study aimed to investigate the expression of the androgen receptor(AR) and the estrogen receptor-β (ER-β) in foreskint issues in boys with and without distal hypospadias. METHODS: Thirty boys with distal hypospadias were evaluated. Fifteen boys who under went elective circumcision over a period of 18 months served as the control group. The presence of AR and ER-Beta in foresk in tissues was investigated immunohistochemically. RESULTS: The percentages of AR in epithelial cells were18.9 ± 27.3% in the hypospadias group and 3.3 ±5.3% in the circumcision group, and the difference betweent he groups was significant (p = 0.034). Of the stromal cells, 19.5 ± 26.8% in the hypospadias group and2.6 ± 4.4% in the circumcision group were positive lystained for AR (p = 0.004). In the hypospadias group,significantly higher stromal cell percentage of ER-β was found compared to that in the control group (24 ± 24.5% and 1.3 ± 1.1%, respectively, p < 0.001). Moreover, epithelial cell percentage of ER-β was higher in the hypospadias group than that in the control group,and the respective values were 6.8 ± 10.1% and 0.9 ± 1.3% (p < 0.0001). CONCLUSION: The percent of AR and ER-Beta expression were higher in hypospadias-affected foresk in than in the normal foreskin. Whether the normal function of these receptors reveals, there is a need for more detailed studies

OBJETIVO: Este estudio prospectivo que pretende investigar la expresión del receptor androgénicoy estrogénico en la piel prepucial en niños con y sin hipospadias distal. MÉTODOS: Treinta niños con hipospadias distal fueron evaluados. 15 niños recibieron una circuncisión electiva en un periodo de 18 meses y sirvieron de grupo control.La presencia de RA y RE-Beta en la piel prepucial se investigó por immunohistoquimica. RESULTADOS: El porcentaje de expresión del receptor androgenico en células epiteliales fue de 18,9 +/- 27,3% en el grupo hipospadias y 3,3 +/- 5,3% en el grupo de circuncisión. La diferencia entre ambos grupos fue significativo (p = 0,034). En las células estromales,19,5 +/- 26,8% en el grupo hipospadias y 2,6+/-4,4% en el grupo circuncisión fueron positivos para el RA (p = 0,004). En el grupo de hipospadias, un porcentaje más elevdo de expresión de RE-b β se evidencio en comparación al grupo control (24 +/- 24,5%y 1,3 +/- 1,1, respectivamente, pel porcentaje de células epiteliales con RE-Beta fue superior en el grupo hipospadias que en el grupo control; los valores respectivos fueron 6,8 +/- 10,1% y 0,9 +/- 1,3%(p < 0,0001). CONCLUSIÓN: En este estudio se sugiere que la expresiónde RA y RE fueron superiores en el grupo conhipospadias que en piel prepucial normal. Se requierenmas estudios para determinar el significado de esta expresión

Long-term efficacy and safety of interferon-alpha-2B in patients with mumps orchitis.

The aim of this study was to determine long-term efficacy and safety subcutaneous injection of interferon-alpha-2B in patients with mumps orchitis in terms of testicular volume and other testicular functions. Mumps orchitis was evaluated in 37 patients. Patients were hospitalized and administered 1 × 3,000,000 IU subcutaneous injection of interferon-alpha-2B daily for 7 days. The testicular volumes of all the patients were measured by ultrasonography in the 18th month following treatment termination. The testes volumes were evaluated by descriptive statistics as percentages. Patients were divided into three groups according to testes volumes and differences between the involved and non-involved testicles. Group I included patients with normal testes volume (> 12 ml) and a difference between testes of less than 2 ml or 20%; Group II (atrophic groups) included patients with testes volume of less than 12 ml; and Group III (hypotrophic groups) included patients with testes volume of greater than 12 ml and a difference between testes of more than 2 ml or 20%. Groups were compared in terms of results of semen analysis and serum follicle stimulating hormone (FSH) and luteinizing hormone (LH) levels. Patients' ages ranged between 17 and 41 years (mean: 28.3 years). A total of nine atrophy cases were identified. Sixteen patients were determined to have hypotrophic testes with a difference of 2-10 ml or 20% between the involved and non-involved testicles, despite the absence of testicular atrophy. A comparison of groups revealed that sperm density, total sperm count, total motile sperm count, and motility percentage were significantly higher in Group I than in the other groups, while serum FSH and LH levels were lower in Group I than in the other groups. Although the use of interferon-alpha-2B appears to prevent testicular atrophy and protect testicular function, it leads to a considerable difference in the volume between testicles and a significant loss of testicular function. As a result, further studies are required in order to investigate the efficacy of the drug.

Endoscopic versus open approach of bladder cuff and distal ureter in the management of upper urinary tract transitional cell carcinoma.

OBJECTIVE: Nephroureterectomy with the removal of the ipsilateral ureteral orifice and bladder cuff en bloc remains the gold standard treatment for upper urinary tract urothelial cancer. The distal ureter can be removed with the open surgical technique or endoscopic approach. We compared the outcomes of the endoscopic approach with those of conventional open surgery on the distal ureter. MATERIALS AND METHODS: We collected data from the charts of 30 patients who underwent radical nephroureterectomy at our clinic from January 1997 to January 2007 for upper urinary tract urothelial carcinoma. The patients were divided into two groups according to procedure performed on the distal ureter. Group I (n:12) was comprised of patients who underwent an open surgical procedure, and group II (n:18), was comprised of patients who underwent an endoscopic approach. Both groups were compared in terms of operative time, blood loss, transurethral catheter duration and duration of hospital stay. RESULTS: Patient age and tumor location showed no significant differences between the two groups. The operative time was significantly longer in group I than group II (181 versus 128 minutes; p<0.05). On the other hand, the estimated blood loss, transurethral catheter duration and duration of hospital stay were significantly lower in group II (205 mL versus 435 mL, 5 versus 8.5 days and 5.6 versus 9.2 days, respectively; p <0.05). CONCLUSION: The results of our study show that the endoscopic approach is less invasive than open surgery on the distal ureter. This procedure can easily be performed in the management of upper urinary tract urothelial carcinoma.