The effect of alpha blockers on uroflowmetric parameters in different voiding positions.

INTRODUCTION: We assessed the effect of different voiding positions on uroflowmetric parameters and post-void residual (PVR) urine volume in symptomatic benign prostatic hyperplasia (BPH) patients. We also evaluated the effect of alpha blockers on PVR in different voiding positions. METHODS: The study was performed with 110 BPH patients over 50 years old. In total, 4 uroflowmetries were performed in all patients: 2 patients in the sitting position and 2 in the standing position. PVR was measured with transabdominal ultrasonography. Also, patients were divided into two groups according to the alpha adrenergic blocker treatment; the effect of this treatment on their uroflowmetric parameters in different positions was evaluated. RESULTS: MAXIMUM FLOW RATE (QMAX) AND AVERAGE FLOW RATE (QAVE) WERE SIGNIFICANTLY HIGHER IN PATIENTS IN THE SITTING POSITION, BUT THERE WERE NO DIFFERENCES IN OTHER UROFLOWMETRIC PARAMETERS AND PVR VOLUME (QMAX: 15.5±5.9 mL/s vs. 13.7±5.2 mL/s, Qave: 11.4±4.6 mL/s vs. 10.7± 3.9 mL/s, respectively; p < 0.05). The Qmax and Qave were significantly higher in sitting position, compared to the standing position, in both alpha adrenergic treatment and non-treated groups; again, there were no differences in other uroflowmetric parameters and PVR volume. CONCLUSION: Qmax and Qave values were significantly higher in the sitting position. Alpha blockers did not affect any change.

Effect of lisinopril on renal tissue damage in unilateral ureteral obstruction in rats.

In this study, it was aimed to investigate apoptosis in renal injury and the effect of lisinopril in rat model, which constitute unilateral ureteral obstruction. The retroperitoneal ureter was ligated with a 4.0 silk for the experimental model of ureteral obstruction in Wistar albino rats. Untreated group (n = 20) received no treatment. For the lisinopril-treated group (n = 20), 20 mg/kg/day of drug was given orally. Ultrastructural differences were analyzed using electron microscopic technique; apoptotic distribution was analyzed using the TUNEL method. After electron microscopic evaluation, on the 4th and 14th day in the untreated group, edema in the glomeruli, loss of microvillus and apoptotic cells in proximal tubule cells and sclerosis in the glomeruli were detected. On the 4th day in the lisinopril-treated group, the kidney was ultrastructurally normal and a less number of apoptotic cells were only observed on the 14th day. On light microscopic examination on the 4th and 14th day in the untreated group, while the glomeruli were normal in structure, the boundary of the proximal tubule was disrupted and some picnotic cells in both the proximal and collecting tubules were observed. In both 4th and 14th day of the lisinopril-treated group, kidney showed normal structure, although in some places picnotic cells in the collecting tubules were observed. In conclusion, lisinopril was effective and it may prevent early renal damage in the direct obstruction model.

Does washing the biopsy needle with povidone-iodine have an effect on infection rates after transrectal prostate needle biopsy?

PURPOSE: To determine the effect of washing the biopsy needle with povidone-iodine solution on infection rates after transrectal ultrasonography-guided prostate biopsy. PATIENTS AND METHODS: 180 patients with transrectal prostate biopsy were included. Infection was excluded with midstream urine culture before biopsy, and patients were divided into two groups. In group 1 (n = 84), the needle was washed with povidone-iodine after each material reception during biopsy, and in group 2 (n = 96), it was not. At day 3 and 2 weeks after the biopsy, patients were checked. On day 3, midstream urine was cultured and patients were checked for fever, hematuria, rectal hemorrhagia, hematospermia and urinary retention. Also, the effect of rectal preparation on infection rate was evaluated. RESULTS: There was no significant difference between the patients' ages, PSA levels and prostate volumes. In total, 11 patients (6.1%; 4 from group 1 and 7 from group 2) developed infectious complications. There was no statistically significant difference between the groups. Fever, asymptomatic bacteriuria and urinary system infection rates were also not statistically different between the groups. The most frequent complication was hematuria with 83 cases (46.1%), but they did not need hospitalization and no patient had acute urinary obstruction. CONCLUSIONS: Washing the biopsy needle with povidone-iodine did not have an effect on the infection rates. Antibiotic prophylaxis and cleaning the biopsy equipment is adequate for low infection rates.

Comparative study of extracorporeal shock wave lithotripsy outcomes for proximal and distal ureteric stones.

OBJECTIVE: To assess the efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy for isolated proximal ureteral calculi and compare it to that for isolated distal calculi. PATIENT AND METHODS: We treated 68 patients with isolated ureteral stones using MPL 9000. Stones were located in the proximal and distal ureters in 44 and 24 patients, respectively. Patients were stratified according to stone burden and degree of obstruction. Data of all patients were prospectively collected for stone burden, stone localization, number of sessions, number of shock waves, stone-free rates (SFRs), complications, re-treatment rates and auxiliary procedures. Outcomes regarding ureteral localization were compared. RESULTS: The overall SFR was 85.3% with a 41.2% re-treatment and 17.6% auxiliary procedure rate. The mean number of shock waves applied for each stone was not different among the two ureteral locations. The SFRs were 86.3% and 79.1% for proximal and distal ureteral stones, respectively (P=0.17). For the group with stones <100 mm(2), the SFR was 85.4% and 89.5% for the proximal and distal ureter, respectively. Although the degree of obstruction did not affect SFR of the entire group (P=0.12) and the proximal ureter group (P=0.96), it adversely affected SFR in the distal ureter (P=0.017). CONCLUSIONS: ESWL outcomes for the ureteral calculi support the use of lithotripsy particularly for stones <100 mm(2). Treatment efficacy was not significantly different among stones localized in proximal and distal ureters. Degree of obstruction did not affect the ESWL outcomes in the proximal ureter, but it adversely affected SFR in the distal ureter.

Comparative results of shockwave lithotripsy for renal calculi in upper, middle, and lower calices.

BACKGROUND AND PURPOSE: To assess the results of shockwave lithotripsy (SWL) for renal calculi in upper, middle, and lower calices according to the stone burden. PATIENT AND METHODS: A series of 52 female and 66 male patients with a mean age of 47.8 years and isolated single caliceal stones who underwent SWL monotherapy were enrolled. Stone burden, stone location, number of sessions/shockwaves, and auxiliary procedures were noted for each patient. Stones were located in the upper, middle, and lower calices of 35, 43, and 40, patients respectively, with mean stone burdens of 81.4 mm2, 75.2 mm2, and 96.3 mm2, respectively. Patients were evaluated with intravenous urography, plain film, or ultrasonography. Success was determined 3 months after the last session. Re-treatment rates were calculated. The effect of anatomic factors on the success of treatment for lower-caliceal stones also was determined. RESULTS: The mean stone burden, median number of treatment sessions, and mean number of shockwaves were 84.2 mm2, 2, and 4344, respectively. The auxiliary procedure rate was 16.1%, and the re-treatment rate was 71.2%. Failure was noted in 26 patients (22%). The stone-free rates for stones in the upper, middle, and lower calices were 82.8%, 83.4%, and 67.5%, respectively (P = 0.14). The stone-free rates for stones <100 mm2 and 100 to 200 mm2 were 91.2% and 65.5%, respectively (P = 0.001). The efficiency quotient was 49.8, 44.8, and 32.5 for upper-, middle-, and lower-caliceal stones, respectively. Infundibular length (P = 0.006) and infundibular width (P + 0.036) were significant in determining the stone-free rate after treatment of lower-caliceal stones. CONCLUSIONS: We recommend SWL as the first choice for treatment of stones <200 mm2 in the upper and middle calices. Extracorporeal lithotripsy is one of the options for lower-caliceal stones <200 mm2 but has high re-treatment and auxiliary-procedure rates in these cases.