Actual medical management of stone diseases in pediatric population

Although the prevalence of urolithiasis is nearly 2 - 3% in childhood, the risk of recurrence may range between 6.5 - 54%. There has been an increase in stone disease in the pediatric age groups. The stone disease in children has multifactorial etiology. After the diagnosis, detailed metabolic evaluation is required. High recurrence rates, therapeutic irregularities and deficiency in diagnosis may lead to co-morbidities such as loss of kidney. After the exact diagnosis, surgical options such as stone extraction and correction of the anatomical anomalies come into question. Besides these, medical and supportive treatments are needed for preventing recurrence, urinary infection and, preserving renal function. Supportive care includes increased fluid intake and dietary modifications. Medical treatment depends on the cause of urinary stone disease. Morbidities of pediatric urolithiasis can be prevented by early diagnosis, detailed metabolic analysis, regular follow- up and medical treatment protocols

Impact of transurethral resection on urinary flow rate in children with posterior urethral valve in short term follow-up

To evaluate the correction rate of urinary flow rate after posterior urethral valve [PUV] resection for predicting success after operation. This retrospective study was performed between March 2006 and February 2013 at the Department of Pediatric Urology, Akdeniz University School of Medicine, Antalya, Turkey. Of the 67 patients with PUV, 52 patients were enrolled. Physical examinations, urine and blood analyses, uroflowmetry [UFM] including maximum flow rate [Qmax] and average flow rate [Qavg], and post voiding residual urine volume [PVR] were recoded. The UFM, PVR, voiding cystourethrography, serum creatinine levels were recorded in clinical visits. Additional operations were performed if there were symptoms of urinary obstruction. Statistical analyses were carried out. The mean age was 9 +/- 2.9 years. The mean follow-up was 10.6 +/- 4.2 months. There was a significant difference between preoperative and postoperative serum creatinine [p=0.028], Qmax [p=0.001], Qavg [p=0.002], and PVR [p=0.001]. Postoperative serum creatinine was significantly positively correlated with postoperative PVR [p=0.024]. In logistic regression analysis, success on PUV resection was associated with preoperative Qavg [p=0.016] and PVR [p=0.004], and postoperative Qavg [p=0.039] and PVR [p=0.030]. Of the 42 [80.7%] patients, significant improvements in UFM, PVR, and serum creatinine levels were obtained after first operation. In 10 patients, re-operations were performed. Short-term effectiveness of PUV resection may be predicted by changes in UFM and PVR parameters in selected patients

Increased peripheral CD4[+] CD25[high] Treg in prostate cancer patients is correlated with PSA

To determine peripheral frequencies of CD4[+]CD25[high]Foxp3[+] regulatory T cells [Treg] in prostate cancer [PCa] patients, and to investigate if there is a correlation between peripheral Treg and total serum prostate specific antigen [PSA] levels in PCa patients. Peripheral blood mononuclear cells from 56 subjects undergoing diagnostic prostate biopsies PSA >/= 2.5ng/ml were analyzed for Treg numbers. Association between the peripheral Treg and serum PSA values was first determined in the entire population, including people with no prostate pathology, PCa, and benign prostate hyperplasia [BPH] patients, and second, in 9 PCa patients before and after curative prostatectomy. In this study, the 3 groups were compared. This project was performed in the Akdeniz University Immunology laboratory, and the Urology outpatient clinic, Antalya, Turkey from December 2008 to January 2010. Peripheral Treg frequencies were significantly increased in the PCa patients [n=19, 3.23 +/- 1.59] compared with BPH patients [n=27, 1.66 +/- 0.80], and healthy subjects [n=10, 1.08 +/- 0.43] [p=0.007]. The percentage of Treg in BPH patients was also significantly higher than healthy subjects [p=0.007]. The increase of Treg in BPH and PCa patients was positively correlated with total serum PSA levels [r=0.75; p=0.007]. Peripheral Treg densities are correlated with PSA in BPH and PCa patients, suggesting that PSA may have a role in Treg induction and/or maintenance

Recent neuroanatomical studies on the neurovascular bundle of the prostate and cavernosal nerves: clinical reflections on radical prostatectomy / 亚洲男科学杂志(英文版)

The neurovascular bundle of the prostate and cavernosal nerves have been used to describe the same structure ever since the publication of the first studies on the neuroanatomy of the lower urogenital tract of men, studies that were prompted by postoperative complications arising from radical prostatectomy. In urological surgery every effort is made to preserve or restore the neurovascular bundle of the prostate to avoid erectile dysfunction (ED). However, the postoperative potency rates are yet to be satisfactory despite all advancements in radical prostatectomy technique. As the technology associated with urological surgery develops and topographical studies on neuroanatomy are cultivated, new observations seriously challenge the classical teachings on the topography of the neurovascular bundle of the prostate and the cavernosal nerves. The present review revisits the classical and most recent data on the topographical anatomy of the neurovascular bundle of the prostate and cavernosal nerves and their implications on radical prostatectomy techniques.