Comparison of Bishop's score and cervical length in determining the need for cervical maturation before labor induction.

OBJECTIVES: The aim of this study is to compare the evaluation of cervical length measured by the Bishop score and transvaginal ultrasonography in determining the need for prostaglandin application for cervical ripening in term nulliparous pregnancies. MATERIAL AND METHODS: In our study, a total of 120 patients who were admitted to our hospital between February 2015 and August 2015 were divided into two groups as cervical length group and Bishop score group according to hospitalization order by applying the Permuted Block Randomization method, which is one of the Restricted Randomization methods. Each patient included in the study was evaluated with both the Bishop score and transvaginal ultrasonography. Groups were compared according to the APGAR scores in the 1st and 5th minutes, transition within 12 hours, birthing within 24 hours, birthing with only dinoprostone, birthing with only oxytocin, duration of administration of dinoprostone, duration of oxytocin administration, type of birth, rate of cesarean section, and need for neonatal intensive care. RESULTS: While cervical ripening with dinoprostone was applied to 28 (46.7%) of 60 pregnant women in the Bishop group, labor induction with oxytocin was applied to the remaining 32 (53.3%) pregnant women. In the cervical length group, these values were 33 (55.0%) and 27 (45.0%), respectively. There was no statistically significant difference between study groups in terms of the need for dinoprostone for cervical ripening (p = 0.361). Of those with a Bishop score of 4 or below, 78.6% (n = 22) had a cervical length of over 28 mm, and 71.4% (n = 20) needed oxytocin. Of those with a Bishop score above 4, none of them had a cervical length greater than 28 mm. A statistically significant difference was found between those with a Bishop score of 4 or below and those above 4 in terms of cervical length (p < 0.05). Among those with a Bishop score of 4 or below, the percentage of those with a cervical length above 28 mm was significantly higher than that of those with a Bishop score above 4. CONCLUSIONS: In our study, the delivery time of those with a cervical length of 28 mm and above was significantly higher than those with a cervical length of less than 28 mm, while the bishop score was significantly lower. In order to develop a more objective method that can replace the Bishop scoring system in determining the need for cervical ripening before labor induction, prospective randomized studies that screen larger numbers of patients are needed.

Impact of intravesical hyaluronic acid treatment on bladder inflammation in interstitial cystitis rat model.

OBJECTIVE: To evaluate the effect of intravesical hyaluronic acid (HA) treatment on inflammatory cells and the severity of inflammation in an interstitial cystitis rat model created with hydrogen chloride (HCL) via immunohistochemical studies and myeloperoxidase activity for the first time in the literature. MATERIALS AND METHODS: A total of 30 adult female white Rattus Norvegicus rats were divided into 3 groups as the HCL group, hyaluronic acid treatment (HCL-HA) group and control group. Chemical cystitis was created by administering HCL(400 microL,10 mM) except control group. A single dose of intravesical HA(0.5 mL,0.8 mg/mL) was administered to the treatment group. The bladder tissues of all subjects were immunohistochemically stained. The cell surface markers were used to evaluate inflammatory cell infiltration. Mast cell activation and IL-6 was evaluated to assess the inflammation and severity of inflammation, respectively. Myeloperoxidase activity was measured as it shows neutrophil density. Statistical significance was accepted as P<0.05. RESULTS: It was observed that there was rich monocyte, T lymphocyte, B lymphocyte, and Natural Killer cells infiltration and high IL-6 levels in the bladder tissue after the intravesical hydrogen chloride instillation, especially in the stroma layer(p<0.005). In the HCL-HA group, severity of inflammation had statistically significantly regressed to the levels of the control group(p<0.005). An increase was observed in the bladder myeloperoxidase activity of the HCL group compared to the other two groups(p<0.05). CONCLUSIONS: Single dose intravesical hyluronic acid instillation reduces inflammatory cell infiltration and the severity of bladder inflammation in the rat model of bladder pain syndrome/interstitial cystitis.

A New Diagnostic and Prognostic Marker in Endometrial Cancer: Neopterin.

OBJECTIVE: In this study, we investigated the correlation between serum and urinary neopterin levels as well as the stage of the disease in women with endometrial cancer.Increased neopterin concentrations are reported in patients with activation of macrophages by interferon-γ, which includes the following: viral infections, autoimmune disorders, allograft rejection, and various malignant tumors. In patients with several types of cancer, high-neopterin concentrations in body fluids like serum/plasma, urine, ascites, and cerebrospinal fluid indicate the course of the disease, and it is associated with poor prognosis. In the light of foregoing, we aimed to investigate the role of neopterin as a prognostic biomarker in endometrial cancer. MATERIALS AND METHODS: Serum neopterin concentrations were determined by enzyme-linked immunosorbent assay and urinary neopterin by high-performance liquid chromatography in 41 patients with endometrial cancer (group 2) and 41 healthy women (group 1). RESULTS: Increased urinary neopterin levels were observed in patients with endometrial cancer (P < 0.001), and the difference in the urinary neopterin levels between low and high stages of endometrial cancer was significant (P < 0.01; stage I-II vs stage III-IV, respectively). Serum neopterin levels did not show a significant difference in each group. CONCLUSIONS: This study suggests that urinary neopterin levels are relevant in evaluating the endometrial cancer stage and follow-up of the disease. As a result, using neopterin and cancer antigen 125 together would be useful in determining the prognosis of endometrial cancer and its posttreatment progression.

Complications and associated factors of pediatric extracorporeal shock wave lithotripsy.

PURPOSE: We determined the safety, efficacy and complications of extracorporeal shock wave lithotripsy in managing pediatric urolithiasis and analyzed possible factors affecting the complication rate. MATERIALS AND METHODS: We retrospectively reviewed 128 patients younger than 16 years who had undergone extracorporeal shock wave lithotripsy with a Lithostar® lithotripter between January 2000 and December 2010. Stone clearance and complications were assessed at postoperative week 1, and months 1 and 3. Success was defined as no radiological evidence of stone, or fragments 4 mm or less. Treatment failure was analyzed to find any correlation with stone size. Complications were assessed with a specific focus on rehospitalizations during postoperative week 1. RESULTS: The overall success rate was 93.5% (115 of 123 patients). Repeat treatment rate was 56.1% (69 patients). Extracorporeal shock wave lithotripsy failed in 8 children, who subsequently required ancillary procedures. Mean stone size in the treatment failure group was 17.03 mm, compared to 13.04 mm in the successfully treated group. A total of 22 patients (17.8%) had complications in postoperative week 1 but only 19 (15.4%, 12 boys and 7 girls) were rehospitalized at that time. Presence of a metabolic risk factor was the only predictive factor for complications. By comparison, we found a lower success rate and higher ancillary procedure rate in the group with complications. CONCLUSIONS: Extracorporeal shock wave lithotripsy is effective for pediatric urolithiasis, with a small but substantial morbidity rate. Parents should be informed about possible rehospitalization following extracorporeal shock wave lithotripsy due to complications independent of stone size.

Experience on semirigid ureteroscopy and pneumatic lithotripsy in children at a single center.

AIM: Ureteroscopy in children with miniaturized instruments is becoming popular with the advent of pediatric ureteroscopes and laser lithotriptors. We had been performing pediatric ureteroscopies with a 7.5 Fr. semirigid ureteroscope and pneumatic lithotriptor, used in adults as well. Herein, we present our experience in pediatric ureteroscopy with a semirigid 7.5 Fr. ureteroscope and pneumatic lithotriptor with a specific focus on changes in success and complication rates with time. MATERIALS METHODS: We retrospectively reviewed the charts of all patients younger than 18 years old who underwent ureteroscopic intervention with a 7.5 Fr. semirigid ureteroscope and pneumatic lithotriptor at our institute between January 2000 and September 2009. Patient characteristics were recorded including date of surgery, age, sex, stone size and location, ureteroscopy technique, duration of surgery, the result of surgery, complication, postureteroscopy ureteral stenting, follow-up duration and final imaging. RESULTS: A total of 48 children (28 boys, 20 girls) with a mean age of 7.6 years (range: 9 months-18 years) have undergone 54 ureteroscopic intervention. Thirty-eight (79.1%) children were <10 years of age and 17 (35.4%) were <4 years of age. Stone-related ureteroscopy number was 51. Mean stone diameter was 6.6 mm (4-20 mm). Mean duration of surgery was 77 min (25-150 min). Overall success rate was 84.3%, and overall complication rate was 14.8%. CONCLUSIONS: Ureteroscopic management of ureteral stones is safe and effective in children >1 year of age with a 7.5 Fr. semirigid ureteroscope and pneumatic lithotriptor.

Tibial nerve stimulation diminishes mast cell infiltration in the bladder wall induced by interstitial cystitis urine.

OBJECTIVES: To investigate whether the urine of interstitial cystitis (IC) patients has a toxic effect on the bladder wall, as determined by mast cell infiltration, and to evaluate the preventive effect of tibial nerve electric stimulation (TNES) on bladder mastocytosis induced by IC urine. MATERIAL AND METHODS: The bladders of female rats were catheterized and instilled with IC urine (Group IC; n=10) and normal urine (Group NU; n=5) obtained from humans, saline (Group S; n=5) and protamine sulphate (Group PS; n=10) for 6 weeks. Additionally, in five rats instilled with IC urine and five instilled with PS, TNES was also performed (Groups IC + TNES and PS + TNES). RESULTS: In the lamina propria of the bladder, the mean number of mast cells per square millimetre was significantly higher in Groups IC (32.5+/-12.3) and PS (39.4+/-11.1) than in Groups S (11.9+/-4.3) and NU (13.7+/-3.5). After TNES, the corresponding values were decreased significantly to 15.3+/-5.4 and 15.3+/-4.1 in Groups IC + TNES and PS + TNES, respectively (p<0.001). A significant reduction in mast cell infiltration in the detrusor was also determined after TNES compared with the value in Group IC (4.6+/-1.6 vs 12.1+/-3.0; p<0.001). CONCLUSIONS: We demonstrated that IC urine may result in increased mast cell infiltration in the bladder wall. TNES may play a therapeutic role by diminishing the mast cell count in the bladder wall, which has a strong relationship with nociceptive neural endings.

Reduced E-cadherin and alpha-catenin expressions have no prognostic role in bladder carcinoma.

In various human cancers, dysfunction of the E-cadherin-catenin complex is associated with a decrease in cellular and tissue differentiation, and with higher invasive and metastatic potentials. The objective of this study was to investigate E-cadherin and alpha-catenin expression in superficial noninvasive papillary TCC and invasive TCC, and correlate these results with pathological and clinical parameters. We have used immunohistochemistry to localize Ecadherin and alpha-catenin in 56 formalin-fixed, paraffin-embedded tissue blocks from 41 patients with superficial bladder cancer and 15 with invasive bladder cancer. The 46 male and 10 female patients had a mean age of 67 years, with range of 40 to 82 years. The mean follow-up time was 33.4 (range 5-120) months. Tumor grade 1:2:3 ratios were 5:32:19. In superficial bladder tumor, abnormal expression of E-cadherin and alpha-catenin was demonstrated in 37 and 71% of the tumors, respectively. In advanced bladder tumor, abnormal expression of E-cadherin and alpha-catenin was demonstrated in 80 and 100% of the tumors, respectively. Differences in expression of E-cadherin and alpha-catenin could be discerned between superficial and advanced bladder tumors (p=0.004, p=0.024, respectively). However, the association between E-cadherin and alpha-catenin expression and tumor grade was not statistically significant (p>0.05). In addition, the expression of E-cadherin and alpha-catenin did not correlate with tumor number and size (p>0.05). We have demonstrated that abnormal expression of E-cadherin and/or alpha-catenin occurs in more than 85% of bladder carcinomas and correlates significantly only with advanced stage. Nevertheless, these observations need to be confirmed in larger prospective clinical studies.

Endoscopic treatment of ureteric strictures: acucise, cold-knife endoureterotomy and wall stents as a salvage approach.

OBJECTIVE: To evaluate the factors influencing the results of endoureterotomy using cold-knife and cutting balloon dilatation, and permanent ureteral wall stents in patients with benign ureteral strictures after different operations affecting the ureter. MATERIALS AND METHODS: Over a 4-year period, in 18 patients, endoscopic cold-knife and Acucise endoureterotomies were performed in 13 and 7 renal units, respectively. Eight Memoterm permanent ureteral wall stents were inserted into 7 patients when endoureterotomy failed. Successful outcome was defined by the absence of re-stricture assessed both clinically and radiologically. RESULTS: The strictures were secondary to ureterolithotomy in 6, ureteroscopy in 3, gynecological procedures in 4, abdominal surgeries in 2, transplantation in 2 and continent urinary diversion in 1. The right and left ureters were unilaterally affected in 5 and 11 patients, respectively (5 of them had a solitary kidney), while the remaining 2 patients had bilateral ureteral strictures. We achieved total ureteral patency of 3 (43%) and 7 (54%) renal units with Acucise and cold-knife incision, respectively. Obstructive uropathy was resolved in 6 renal units (75%) of 8 using ureteral wall stents. CONCLUSION: Endoureterotomy with cold-knife or Acucise cutting balloon dilatation is effective in the treatment of iatrogenic ureteral strictures, but only in a selected group. Based on our results, the favorable prognostic criteria for endoureterotomy are the length (< or =1.5 cm), the nonischemic nature of the stricture and adequate renal function. As a salvage approach, permanent self-expanding ureteral wall stents with a 75% success rate may provide a satisfactory outcome for decompression of an obstructed system.

Should we switch over to tolterodine in every child with non-neurogenic daytime urinary incontinence in whom oxybutynin failed?

OBJECTIVES: To assess the clinical efficacy of tolterodine prescribed to children with non-neurogenic daytime urinary incontinence secondary to overactive bladder who had previously failed to improve with oral oxybutynin treatment and its relation to the side-effect profile and compliance status. METHODS: We evaluated 92 children presenting with daytime wetting, with or without nocturnal enuresis, who were receiving oral oxybutynin treatment. Children with chronic urinary tract infections, a neurologic lesion, an anatomic abnormality of lower urinary tract, voiding abnormality, and less than 1 year of oxybutynin treatment were excluded. Of the remaining 41 children (mean age 7.2 years, range 5 to 14 years), 30 agreed to switch to tolterodine and 11 continued receiving oxybutynin. Anticholinergic side effects, compliance, and clinical efficacy were assessed in the follow-up. RESULTS: Of the 30 patients who switched to tolterodine, a complete response was in 18 patients (60%), partial improvement in 11 (37%), and no improvement in 1 (3%) after a mean of 14.4 months (range 12 to 16 months) of oxybutynin treatment. The anticholinergic side-effect score was 7.2, 9.3, and 11, respectively, for those with a complete response, partial improvement, and no improvement in the compliant group. The noncompliant group had the greatest side-effect score (16.9). The fairly compliant group had a side-effect score of 12.3. After a mean of 7.1 months (range 6 to 9 months) of tolterodine use, a complete response was reported in 24 patients and partial improvement in 5 (17%). In 1 patient, treatment failed completely. However, his side-effect score decreased from 11 to 2. All tolterodine users were compliant with treatment. CONCLUSIONS: The results of this study in children with non-neurogenic daytime urinary incontinence have shown that tolterodine may increase the efficacy of pharmacotherapy, particularly in patients noncompliant to oxybutynin. Additional investigation of the anticholinergic side-effect scores and compliance tables is required to improve the clinical results of pharmacotherapy in incontinence due to overactive bladder in children.