Technique of Ileobladder and Kidney Transplant in Rats and Pigs.

OBJECTIVES: Kidney transplant is the best choice for treatment of patients with advanced chronic renal disease. However, small, poorly compliant, and unstable bladders can result in major problems for patients. Here, we aimed to develop and evaluate a new ileobladder model. MATERIALS AND METHODS: Fifteen rats (250-300 g) and 5 pigs (~100 kg) were cared for according to institutional and published guidelines. After general anesthesia, laparotomy was done through midline incision. Ileal loops were prepared for ileobladder. After cystectomy (0.5 cm above the trigone in rats, 1 cm above the trigone in pigs), anastomoses were done between antimesenteric sides of ileal loops and bladder remnant with 6/0 Prolene suture. Three other pigs received simultaneous renal transplant. RESULTS: One rat died on day 1 postsurgery from multiorgan hemorrhage. Two rats survived for 5 days, 3 rats for 7 days, and 3 rats for 11 days; 6 rats were killed for pathologic evaluation after 3 months. One pig survived for 22 days and 1 for 9 days. Of the 3 pigs that received a simultaneous renal transplant, 2 pigs were alive and doing well 80 and 72 days after surgery with normal urinary discharge (1 pig was killed for pathologic evaluation after 3 days). When ileobladder was opened, complete recovery of the anastomosis line was observed. Pathologic examination of the anastomosis sites reported a normal healing process with moderate inflammation and the muscular wall of the intestine showed hypertrophia that nearly reached the size of the bladder muscularis propria. CONCLUSIONS: Although we had some complications because no draining procedure was used, in terms of technique, our new ileobladder model is promising for providing functional bladder volume. A larger scale series in the clinical setting is planned. This technique can be useful for small bladders and bladder physiology disorders.

Does pelvic injury trigger erectile dysfunction in men?

PURPOSE: Pelvic ring fractures constitute 3%-8% of all fractures of the skeletal system and are generally related with high energy trauma. Sexual dysfunction following pelvic fracture has a high incidence, and affects the male patients both physically and psychologically. In this study, we aimed to investigate the impact and frequencies of comorbidities such as erectile dysfunction (ED) with adverse sociocultural and psychological consequences for the patient who had a pelvic ring fracture. METHODS: This study included 26 men who corresponded to the inclusion criteria and agreed to participate our study. RESULTS: According to fracture types, most of our cases were Tile type A1 and type A2. Severe and moderate ED were detected in 46.1% (12/26) of these patients via the International Index of Erectile Function-5 questionnaire. CONCLUSION: ED develops following pelvic fractures, especially in Tile type B and C pelvic fractures.

Minimum 1-year results of mesh spiral-sling procedure in managing refractory and primary disabling stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: We present our minimum 1-year results with a mesh spiral-sling procedure (MSSP) for managing refractory and disabling stress urinary incontinence (SUI) in women. METHODS: Thirty-four women were treated with MSSP between 2007 and 2011. Six had incomplete data and were excluded from analysis. Study cohort comprised 21 women with refractory (mean number of previous surgeries 2.2; range 1-6) and seen with primary disabling SUI. All patients had marked intrinsic sphincter deficiency (ISD) with a Valsalva leak-point pressure (VLPP) <60 cm H2O. Preoperative workup included assessing the impact of voiding symptoms using the International Consultation on Incontinence Questionnaire--Short Form (ICIQ-SF), estimating the daily number of pads, and urodynamic studies. Preoperative and postoperative findings were compared using the Wilcoxon signed-rank test. RESULTS: Intraoperative unilateral bladder-neck perforation occurred in two women during dorsal urethrolysis. With a mean follow-up of 26 months (range 12-48), SUI was cured in 71.4% of patients. Distal urethral reconstruction with vaginal mucosal flaps was performed in two patients with short urethral length (<2.5 cm) due to recurrence of SUI 10 months after MSSP. Mean ICIQ-SF score decreased from 19.4 ± 3.6 preoperatively to 7.3 ± 2.8 postoperatively (p = 0.001). Mean daily pad number decreased from 5.2 preoperatively to 1.2 postoperatively (p = 0.02). Urethral or vaginal erosion was not observed in any case during follow-up. CONCLUSION: Using spiral slings may be a viable option in managing refractory and disabling SUI.

Multidrug resistance 1 (MDR1) 3435C/T genotyping in childhood drug-resistant epilepsy.

INTRODUCTION: A mutation at nucleotide position 3435 in exon 26 of the multidrug resistance 1 (MDR1) gene is the most frequently studied polymorphism in relation to multidrug resistance. However, there are conflicting data as to whether the CC or TT genotype of the 3435C>T polymorphism is associated with drug resistance. METHODS AND RESULTS: We investigated the association between this polymorphism in drug-resistant childhood epilepsy by comparison with drug-responsive patients. In total, 59 patients with drug-resistant epilepsy, defined as having four or more seizures within a 12-month period while using three or more AEDs, 60 children with drug-responsive epilepsy who had remained seizure-free for 12months on their current AED regimen and 76 healthy children were involved in this study. Genotype frequencies in drug-resistant patients were as follows: 32.2% CC, 44.1% CT, 23.7% TT; in the drug-responsive group: 20.0% CC, 50.0% CT, 30.0% TT; in the control group: 24.3% CC, 50.0% CT, 25.7% TT. Comparison of drug-resistant and drug-responsive patients revealed no significant difference in genotype frequency. The findings of the epilepsy patients were not significantly different from those of the healthy control subjects. CONCLUSIONS: Our study does not support any significant association between the MDR1 polymorphism and drug-resistant childhood epilepsy.

The effect of repetitious concussions on cognitive functions in rats.

AIM: In this study, we aimed to investigate the effect of repetitious concussions on the spatial learning and memory function in rats. MATERIAL AND METHODS: 46 adult, male Sprague-Dawley rats were assigned to three homogenous groups by stratified random sampling according to their basal performance during the first four days of the Morris water maze (MWM), as Control (n=10), Sham (n=10) and Concussion (n=26) groups. On the 12th day, the MWM experiment was repeated to evaluate the memory function. Rats in the concussion group were then subjected to the first head trauma. Some of the trauma-applied rats were sacrificed for histopathological examination 4 hours (n=4) and 24 hours (n=3) after the trauma. The spatial memory function of the rest of the rats was re-evaluated by MWM on the 20th day. Some of the rats were then subjected to the second head trauma (n=13), four of which were then sacrificed at the 4th hour, and three of which were sacrificed at the 24th hour. On the 27th day, six rats that had received single concussion and the remaining six that had received two concussions were re-evaluated for retention development by the third MWM experiment. RESULTS: Escape latency curves showed a decrease in Sham and Control groups on the 20th and 27th days, and an increase in concussion group on the 20th day but no statistical significance was found between the groups. CONCLUSION: Repetitious concussions did not significantly affect spatial learning-memory functions in rats, and may lead to a counter-adaptive mechanism against concussive injury.