Predictive value of SIRI and SII for metastases in RCC: a prospective clinical study.

OBJECTIVES: In this prospective cross-sectional clinical study, we aimed to determine the efficiency of preoperative hematological markers namely SIRI (systemic inflammatory response index) and SII (systemic inflammatory index) for renal cell cancer to predict the possibility of postoperative metastases. METHODS: Istanbul Education and Research Hospital, Clinic of Urology and Medical Oncology in the clinic between the dates of June 2022 to 2023 February, a diagnosis of renal cell cancer by surgical or medical oncology units imported into the treatment planning of 72 patients were included in the study. All cases with diagnoses of renal cell carcinoma were searched from hospital records. Patients with secondary malignancy, hematological or rheumatological disorders or ones with recent blood product transfusion or diagnoses of infection within the 1-month-time of diagnoses were excluded for data analyses. The data within complete blood counts (CBC) analyzed just before the time of renal biopsy or surgery were studied for SIRI and SII calculations. Twenty-two metastatic and 50 non-metastatic RCC patients were included. SIRI and SII values were compared among groups to seek change of values in case of metastasis and in non-metastatic patients a cut-off value were sought to indicate malignancy before pathological diagnosis. RESULTS: Mean age of non-metastatic RCC patients were 60.12+/-11.55 years and metastatic RCC patients were 60.25+/-11.72. Histological sub-types of the RCC specimens were clear cell (72%), chromophobe cell (17%), papillary cell (7%) and others (4%). Median SIRI values for non-metastatic and metastatic groups were 1.26 and 2.1 (mean+/-S.D. 1.76 +/-1.9 and 3.12+/-4.22 respectively (p < 0.05). Median SII values for non-metastatic and metastatic groups were 566 and 1434 (mean+/-S.D. 870 +/-1019 and 1537+/-917) respectively (p < 0.001). AUC for detection of metastasis were 0.809 for SII and 0.737 for SIRI. CONCLUSIONS: SIRI and SII indexes seem to show a moderate efficiency to show metastases in RCC.

Higher Serum Endothelial-Specific Molecule-1 (ESM-1/Endocan) Levels are Associated with Poor Pathological Outcomes in Primary Bladder Cancer: A Non-randomized, Prospective, Case-Control Study.

AIM: To compare serum endothelial-specific molecule-1 (ESM-1 or endocan) levels between individuals with primary bladder cancer (BC) who have various pathological features of BC and healthy volunteers. MATERIALS AND METHODS: 154 consecutive patients with primary BC (Group-1) and 52 healthy volunteers (Group-2) were accepted into this prospective, non-randomized, observational research between January 2017 and December 2018. Peripheral blood samples were obtained from each participant to measure serum ESM-1/endocan levels. Group-1 was further divided into subgroups as Group-1A (pTa), Group-1B (pT1) and Group-1C (pT2) based on the transurethral resection of bladder tumour (TURBT) histopathological results. In addition Group-1 was divided into other subgroups based on pathological features of BC including tumor grade, tumor volume and muscle-invasive status. Groups were compared statistically regarding ESM-1/endocan levels. RESULTS: Median age of the individuals was 63 (22) years in Group-1 and 66 (11) years in Group-2 (p = 0.051). There were 140 (90.9%) males and 14 (9.1%) females in Group-1 and 30 (57.7%) males and 22 (42.3%) females in Group-2 (p < 0.001). The serum ESM-1/endocan measurements were lower in Group-2 than in Group-1 (p = 0.018). Of the patients in Group-1, 62 (40.3%) had low-grade tumors and 92 (59.7%) had high-grade tumors. When Group-1 was further divided into other subgroups according to different pathological features of BC such as tumor stage, grade, muscle-invasive status and tumor volume it was detected that there was a statistically meaningful difference between all subgroups of Group-1 and Group-2 in terms of serum ESM-1/endocan levels (p < 0.05 for each). The serum ESM-1/endocan cut-off value (3.472 ng/mL) had a specificity of 57.7%, sensitivity of 59.1%, NPV (negative predictive value) of 32.3% and PPV (positive predictive value) of 80.5% for predicting the presence of BC with an AUC (Area Under the Curve) of 0.609 (95% confidence interval (CI) 0.524-0.694; p = 0.018). CONCLUSIONS: The serum ESM-1/endocan levels can be considered a potentially useful predictor for BC. Higher serum ESM-1/endocan levels are related with poor pathological outcomes in BC.

Higher Serum Endothelial-Specific Molecule-1 (ESM-1/Endocan) Levels are Associated with Poor Pathological Outcomes in Primary Bladder Cancer: A Non-randomized, Prospective, Case-Control Study

Aim: To compare serum endothelial-specific molecule-1 (ESM-1 or endocan) levels between individuals with primary bladder cancer (BC) who have various pathological features of BC and healthy volunteers. Materials and Methods: 154 consecutive patients with primary BC (Group-1) and 52 healthy volunteers (Group-2) were accepted into this prospective, non-randomized, observational research between January 2017 and December 2018. Peripheral blood samples were obtained from each participant to measure serum ESM-1/endocan levels. Group-1 was further divided into subgroups as Group-1A (pTa), Group-1B (pT1) and Group-1C (pT2) based on the transurethral resection of bladder tumour (TURBT) histopathological results. In addition Group-1 was divided into other subgroups based on pathological features of BC including tumor grade, tumor volume and muscle-invasive status. Groups were compared statistically regarding ESM-1/endocan levels. Results: Median age of the individuals was 63 (22) years in Group-1 and 66 (11) years in Group-2 (p = 0.051). There were 140 (90.9%) males and 14 (9.1%) females in Group-1 and 30 (57.7%) males and 22 (42.3%) females in Group-2 (p < 0.001). The serum ESM-1/endocan measurements were lower in Group-2 than in Group-1 (p = 0.018). Of the patients in Group-1, 62 (40.3%) had low-grade tumors and 92 (59.7%) had high-grade tumors. When Group-1 was further divided into other subgroups according to different pathological features of BC such as tumor stage, grade, muscle-invasive status and tumor volume it was detected that there was a statistically meaningful difference between all subgroups of Group-1 and Group-2 in terms of serum ESM-1/endocan levels (p < 0.05 for each) (AU)

Discriminant Efficacy of mpMRI for Variant Pathology Associated with Prostate Adenocarcinoma.

Purpose - Implementation of multiparametric magnetic resonance imaging (mpMRI)  for prostate adenocarcinoma's variant pathology requires awareness. The aim of this retrospective study was to investigate the discriminant efficacy of multiparametric magnetic resonance imaging modality for variant pathology associated with prostate adenocarcinoma. Methods - Consecutive 247 prostate cancer patients who underwent radical prostatectomy in our university-based hospital between October 2014 and October 2019, were retrospectively reviewed. Data of mpMRI-associated contrast enhancements, T2 signals, apparent diffusion coefficients (ADC), ages and PSA values were compared. Clinical and demographic data of patients were noted including associated variant pathologies and reports of preoperative mpMRI images. Results - Among the patients, 63 (26%) had variant pathology and 14 (22%) had mpMRI before primary prostate biopsy. The group with variant pathology and the control group had similar perfusion curves and increased contrast when compared for mpMRI parameters, but different ADC values for each of the adjusted b-values for 400, 800 and 1400. Conclusion - Our study demonstrates that mpMRI appears to have no role in distinguishing rare variant pathologies associated with prostate adenocarcinoma despite different ADC values.

No Tumor Suppressor Role for LKB1 in Prostate Cancer.

To elucidate the pathogenesis of prostate diseases, following in silico analysis, the LKB1 gene was selected for further investigation. The LKB1 gene has been associated with poor prognosis and is frequently mutated in different types of cancers. In this study, 50 benign prostatic hyperplasia (BPH) and 57 prostate cancer (PCa) tissues, including matched normal tissue for the patients, were analyzed by qRT-PCR and DNA sequencing for LKB1 expression and the mutation profile, respectively. Expression of LKB1 was increased in 60.7% of the PCa tissues compared with noncancerous tissue samples (p ≤ 0.001). However, LKB1 expression was lower when compared with normal tissues in BPH (p = 0.920). Four coding sequence alterations were detected in BPH. Three silent mutations were located in codons 9, 32, and 275 and a missense mutation was observed in codon 384. Six alterations were identified in the intronic regions of the LKB1 gene in both PCa and BPH. Five mutations were observed in both patient groups. A new alteration in intron 6 was observed in a patient with PCa. The LKB1 gene may be associated with benign transformations rather than the tumors in prostate pathogenesis when its expression and mutation status are considered. However, the mechanism of LKB1 in PCa needs further studies.

Hypospadias surgery on YouTube: is it valid?

BACKGROUND: This study aims to evaluate video clips of hypospadias surgery on YouTube and to assess their competence for basic steps of hypospadias surgery. METHODS: The YouTube was screened for videos of hypospadias surgery between 1 December 2018 and 20 December 2018. Videos were divided into three groups based on the subjective utility checklist scores as follows: highly compatible (group 1; ≥7 points), moderately compatible (Group 2; 5-6 points), and less compatible (group 3; ≤4 points). Groups were compared statistically. RESULTS: A total of 100 videos were included in this study. The mean total score was 4.48±1.97. There were 15 (15%) videos in group 1, 42 (42%) in group 2, and 43 (43%) in group 3. There was a statistically significant difference in the total score, duration of videos, and like/dislike ratios among the groups (P<0.001, for all). There was a strong and significant correlation between the total scores and the step of glanuloplasty and skin closure (r: 0.805, P<0.001 and r: 0.770, P<0.001, respectively). CONCLUSIONS: Our study results suggest that the educational content of the videos of hypospadias surgery on YouTube is unsatisfactory. We believe that such videos must contain information regarding the surgical steps of glanuloplasty, skin closure, flap transposition, and urethroplasty and detailed information about the suture materials.

Shock wave lithotripsy deteriorates male sexual functions related to the treatment-driven anxiety: A prospective, non-randomized, self-controlled study. / La litotricia extracorporea deteriora la función sexual masculina en relación a la ansiedad por el tratamiento: un estudio prospectivo, no randomizado auto-controlado.

OBJECTIVES: This study aims to investigatel ongitudinal changes in sexual functions (SF), anxiety status, and health-related quality of life (HRQoL) after shock wave lithotripsy (SWL) in male urolithiasis patients. METHODS: Between February 2015 and April 2017, 85 consecutive male patients with kidney or ureter stones and treated with SWL were included. Patients were evaluated for SF, anxiety status, and HRQoL with questionnaire forms before and at the third month after SWL. Correlation between baseline and third-month scores of International Index of Erectile Function-15 (IIEF-15) subdomains and anxiety was evaluated. Uni- and multivariable linear regression analyses were used to identify changes in IIEF-15 subdomain scores at three months. RESULTS: Mean age was 42.80 ± 9.42 years. Significantly decreased IIEF-15 subdomain scores, increased anxiety and Short Form-36 (SF-36) subdomain scores were achieved at three months (p<0.05, for each). The baseline median values of erectile function (IIEFEF), orgasmic function (IIEF-OF), sexual desire (IIEF-SD), intercourse satisfaction (IIEF-IS), and overall satisfaction (IIEF-OS) were 26, 9, 8, 12, and 8, respectively. The same scores were 26, 9, 6, 9, and 8 at month 3, respectively. According to multivariable analysis, the difference in Beck Anxiety Inventory (BAI) scores was an independent risk factor for both changing in IIEF-SD and IIEF-IS (b= -0.094, 95%CI: -0.179 - -0.009, p=0.030 and b= -0.197, 95%CI: -0.350 - -0.044, p=0.012, respectively). The difference in the State Anxiety (STAISA) scores was an independent risk factor for changing in IIEF-IS (b= -0.075, 95%CI: -0.146 - -0.004,p=0.039). CONCLUSIONS: SWL may lead to impaired SF related to treatment-driven anxiety and significantly improve HRQoL of male patients in short term.

OBJETIVO: Este estudio tiene como objetivo investigar los cambios longitudinales en la función sexual, estado de ansiedad y calidad de vida después de la litotricia extracorpórea en pacientes varones conlitiasis. MÉTODOS: Entre febrero 2015 y abril 2017, 85 pacientes varones consecutivos con litiasis renales o ureterales tratados con litotricia extracorpórea fueron incluidos. Los pacientes fueron evaluados en relación a la función sexual, estado de ansiedad, y calidad de vida con cuestionarios de calidad de vida antes y a los 3 meses de la litotricia extracorpórea. Correlación entre los resultados de International Index of Erectile Function-15 (IIEF-15) iniciales y a los 3 meses en los dominios de ansiedad, fueron evaluados. Análisis de regresión univariada y multivariada fue utilizada para identificar cambios en IIEF-15 a los 3 meses. RESULTADOS: La edad media fue de 42,80 ± 9,42 años. Una caída significativa de los resultados de los subdominios de IIEF-15 con incremento de la ansiedad y Short Form-36 (SF-36) fueron conseguidos a los 3 meses (p<0,05, para cada uno). Los resultados medios en función eréctil (IIEF-EF), función orgásmica (IIEF-OF), deseo sexual (IIEF-SD), satisfacción en las relaciones (IIEF-IS), y satisfacción general (IIEF-OS) fueron 26, 9, 8, 12, y 8, respectivamente. Los mismos resultados fueron 26, 9, 6, 9, y 8 a los 3 meses, respectivamente. En el análisis multivariado, la diferencia en Beck Anxiety Inventory (BAI) fue un factor de riesgo independiente para ambos, cambiando en IIEF-SD y IIEF-IS (b= -0,094, 95%CI: -0,179 ­ -0,009, p=0,030 y b= -0,197, 95%CI: -0,350 ­ -0,044, p=0,012, respectivamente). La diferencia en el State Anxiety (STAI-SA) fue un factor de riesgo independiente para cambio en IIEF-IS (b= -0,075, 95%CI: -0,146 ­-0,004, p=0,039). CONCLUSIONES: La litotricia extracorpórea comporta cierto grado de disfunción sexual relacionada con la ansiedad del tratamiento y mejora significativamente la calidad de vida en los pacientes varones a corto plazo.

Shock wave lithotripsy deteriorates male sexual functions related to the treatment-driven anxiety: A prospective, non-randomized, self-controlled study / La litotricia extracorporea deteriora la función sexual masculina en relación a la ansiedad por el tratamiento: un estudio prospectivo, no randomizado auto-controlado

OBJECTIVES: This study aims to investigate longitudinal changes in sexual functions (SF), anxiety status, and health-related quality of life (HRQoL) after shock wave lithotripsy (SWL) in male urolithiasis patients. METHODS: Between February 2015 and April 2017, 85 consecutive male patients with kidney or ureter stones and treated with SWL were included. Patients were evaluated for SF, anxiety status, and HRQoL with questionnaire forms before and at the third month after SWL. Correlation between baseline and third-month scores of International Index of Erectile Function-15 (IIEF-15) subdomains and anxiety was evaluated. Uni- and multivariable linear regression analyses were used to identify changes in IIEF-15 subdomain scores at three months. RESULTS: Mean age was 42.80 ± 9.42 years. Significantly decreased IIEF-15 subdomain scores, increased anxiety and Short Form-36 (SF-36) subdomain scores were achieved at three months (p < 0.05, for each). The baseline median values of erectile function (IIEFEF), orgasmic function (IIEF-OF), sexual desire (IIEF-SD), intercourse satisfaction (IIEF-IS), and overall satisfaction (IIEF-OS) were 26, 9, 8, 12, and 8, respectively. The same scores were 26, 9, 6, 9, and 8 at month 3, respectively. According to multivariable analysis, the difference in Beck Anxiety Inventory (BAI) scores was an independent risk factor for both changing in IIEF-SD and IIEF-IS (b= -0.094, 95%CI: -0.179 - -0.009, p = 0.030 and b= -0.197, 95%CI: -0.350 - -0.044, p = 0.012, respectively). The difference in the State Anxiety (STAISA) scores was an independent risk factor for changing in IIEF-IS (b= -0.075, 95%CI: -0.146 - -0.004, p = 0.039). CONCLUSIONS: SWL may lead to impaired SF related to treatment-driven anxiety and significantly improve HRQoL of male patients in short term

OBJETIVO: Este estudio tiene como objetivo investigar los cambios longitudinales en la función sexual, estado de ansiedad y calidad de vida después de la litotricia extracorpórea en pacientes varones con litiasis. MÉTODOS: Entre febrero 2015 y abril 2017, 85 pacientes varones consecutivos con litiasis renales o ureterales tratados con litotricia extracorpórea fueron incluidos. Los pacientes fueron evaluados en relación a la función sexual, estado de ansiedad, y calidad de vida con cuestionarios de calidad de vida antes y a los 3 meses de la litotricia extracorpórea. Correlación entre los resultados de International Index of Erectile Function-15 (IIEF-15) iniciales y a los 3 meses en los dominios de ansiedad, fueron evaluados. Análisis de regresión univariada y multivariada fue utilizada para identificar cambios en IIEF-15 a los 3 meses. RESULTADOS: La edad media fue de 42,80 ± 9,42 años. Una caída significativa de los resultados de los subdominios de IIEF-15 con incremento de la ansiedad y Short Form-36 (SF-36) fueron conseguidos a los 3 meses (p < 0,05, para cada uno). Los resultados medios en función eréctil (IIEF-EF), función orgásmica (IIEF-OF), deseo sexual (IIEF-SD), satisfacción en las relaciones (IIEF-IS), y satisfacción general (IIEF-OS) fueron 26, 9, 8, 12, y 8, respectivamente. Los mismos resultados fueron 26, 9, 6, 9, y 8 a los 3 meses, respectivamente. En el análisis multivariado, la diferencia en Beck Anxiety Inventory (BAI) fue un factor de riesgo independiente para ambos, cambiando en IIEF-SD y IIEF-IS (b= -0,094, 95%CI: -0,179 - -0,009, p = 0,030 y b= -0,197, 95%CI: -0,350 - -0,044, p = 0,012, respectivamente). La diferencia en el State Anxiety (STAI-SA) fue un factor de riesgo independiente para cambio en IIEF-IS (b= -0,075, 95%CI: -0,146 - -0,004, p = 0,039). CONCLUSIONES: La litotricia extracorpórea comporta cierto grado de disfunción sexual relacionada con la ansiedad del tratamiento y mejora significativamente la calidad de vida en los pacientes varones a corto plazo

Incidental ureteral fibroepithelial polyp.

Although rare, fibroepithelial polyp of the ureter is the most common type of benign urinary tract mesodermal tumor. It may cause symptoms such as hematuria, dysuria, and flank pain or be asymptomatic. Here we report incidental intraoperative detection of a left ureteral fibroepithelial polyp during an elective gyno-oncological surgery for left-sided ovarian thecoma.

Segmental ischemia in testicular torsion.

Testicular torsion is a rare but important entity in the discipline of urology, as urgent action is required to save the testicle anatomically and functionally. Occurring mainly in the young prepubertal or pubertal male, testicular torsion is also seen in young adults. The annual incidence has been estimated to be 4.5 cases per 100,000 male subjects. The outcome of testicular torsion, in cases of unsuccessful emergent intervention, is total or partial infarction of the testicular tissue. We present a case of partial testicular ischemia due to testicular torsion.

Downregulation of Rab25 activates Akt1 in head and neck squamous cell carcinoma.

Several studies have suggested that Ras-associated binding 25 protein (Rab25) is involved in the pathogenesis of human cancer. Although it has been demonstrated that the development of head and neck squamous cell carcinoma (HNSCC) is the result of an accumulation of multiple sequential genetic and epigenetic alterations in key genes with important functions in cell growth and the cell cycle, recent studies have indicated that HNSCC is a complex and heterogenous disease. To the best of our knowledge, there is no data regarding the regulation of the Rab25 gene at the mRNA or protein level in HNSCC. Furthermore, available data on Rab25 expression in other types of cancer are conflicting. The aim of the present study was to investigate whether Rab25 is involved in the development and/or progression of HNSCC, and to analyze the mechanisms underlying its effects in this type of cancer. The expression of Rab25 mRNA in HNSCC tissues and adjacent non-tumor tissue samples was measured using reverse transcription-quantitative polymerase chain reaction, while the level of the Rab25, Akt1 and phosphorylated-Akt1 proteins was measured using western blotting. Expression of Rab25 mRNA and protein was downregulated in 69.1% and 56.1% of tumor tissue samples, respectively. This downregulation was associated with an increase in p-Akt1 expression, in the absence of a change in total Akt1 protein levels, in tumor tissues compared with normal tissues. The current findings suggest that Rab25 acts as a tumor suppressor in HNSCC.

Exosomal lncRNA-p21 levels may help to distinguish prostate cancer from benign disease.

Exosomes are membranous vesicles containing various biomolecules including lncRNAs which are involved in cellular communication and are secreted from many cells including cancer cells. In our study, investigated the exosomal GAS5 and lincRNA-p21 lncRNA levels in urine samples from 30 patients with prostate cancer (PCa) and 49 patients with benign prostatic hyperplasia. Quantification of lncRNA molecules was performed by real-time PCR. We observed a significant difference in the exosomal lincRNA-p21 levels between PCa and BPH patients whereas the GAS5 levels did not reveal a difference. Our data suggest that the discriminative potential of exosomal lincRNA-p21 levels may help to improve the diagnostic prediction of the malignant state for patients with PCa.

Prostate biopsy in the elderly: histologic findings and treatment necessity.

The aim of this study is to determine results of high prostate specific antigen (PSA) or abnormal digital rectal examination driven prostate biopsies performed in our Department in men aged 75 or more and to show the characteristics of pathology results. The hospital records of the patients who had high PSA or abnormal digital rectal examination driven prostate biopsy in two common university based research hospitals have been reviewed retrospectively. Patients aged 75 years or older at the date of biopsy whose records provided pathology results and full medical history were evaluated for the study. A total of 103 patients were evaluated with a mean age of 79.4±3.4 years. More than half of the patients (55.1%) were in their seventh decade and the rest were in the eighth decade. Median PSA value was 15.0 (range 2.1-4500) ng/ml. In most of the biopsies (67%), PSA levels were lower than 20 ng/ml. In almost half of the patients (48%), digital rectal examination was abnormal. In 68.9% of the patients, there were at least one or more associated co-morbid diseases. Gleason scores were 7 or higher in 73%, and 8 or higher in 37% of the patients with prostate cancer. Four of the 70 (6%) patients had bone metastases. Castrations were applied to most of the patients with prostate adenocarcinoma (%79). High percentage of high grade (Gleason 7 or more) prostate adenocarcinoma in the elderly refutes the perception of prostate cancer in this age group as clinically insignificant. Therefore, it is to be kept in mind that prostate cancer in the elderly an be clinically significant and prostate biopsies are to be performed when necessary.

Sexual function status in women with obstructive sleep apnea syndrome.

INTRODUCTION: Several co-morbid diseases have been shown to affect sexual functions in both genders. In the literature, sexual function status in men with obstructive sleep apnea syndrome (OSAS) has been studied; however, sexual functions in women with OSAS have not yet been studied. AIMS: In this prospective study, we aimed to determine sexual function status in women with OSAS and its relationship with the disease parameters of OSAS. METHODS: Women, who were diagnosed with OSAS with polysomnography performed in the sleep center of our university hospital, formed the study population. Women with any genital deformity, postmenopausal women, and women without a regular partner were excluded from the study. General demographic properties, medical histories, polysomnography parameters, and frequency of intercourse per month were noted for each patient. Patients completed the Sexual Function Questionnaire Version 2 (SFQ-V2) and Epworth Sleepiness Scale. The patients were grouped as mild, moderate, and severe OSAS according to the level of respiratory disturbance index (RDI). MAIN OUTCOME MEASURES: Scores of sexual function domains were determined from SFQ, and their relationships with parameters of polysomnography and demographics were studied. RESULTS: Twenty-five patients were included in the study. Mean age was 48.1 +/- 2.7 years. All were married with a mean marriage duration of 25.6 +/- 3.3 years. Mean frequency of intercourse per month was 3.3 +/- 1.8. All domains of sexual functions except pain and enjoyment significantly decreased with increasing severity of OSAS. When we controlled for factors of age and co-morbid diseases, correlation analyses showed significant negative correlation between levels of RDI and all domains of sexual functions except pain and enjoyment (P < 0.05). CONCLUSIONS: Obstructive sleep apnea syndrome negatively impacts sexual function in women independent of age and associated co-morbid diseases.

Ultrastructural stages of biofilm development of Escherichia coli on urethral catheters and effects of antibiotics on biofilm formation.

OBJECTIVES: Biofilm formation on biomaterials by various kinds of bacteria renders the infection chronic, and the bacteria can become resistant to the immune system and antibiotics. Developmental biofilm stages of Escherichia coli on urethral catheters have not yet been thoroughly demonstrated. We aimed to show biofilm formation of E. coli on urethral catheters, and the effects of various antibacterial agents on this formation using scanning electron microscopy. METHODS: Using urine infected with uropathogenic E. coli type O4 (10(5) to 10(6) colony forming units/mL), biofilm was formed on latex/silicone balloon catheters in a modified Robbin's device. The study included an infected-only group and four antibiotic study groups (ciprofloxacin, cefuroxime, gentamicin, and trimethoprim). The catheters were infused with the antibiotic solutions once before placement in the modified Robbin's devices. Ten 5-mm catheter samples were taken for all groups on the first, fourth, and seventh days. The 4 and 12-hour and 2-day samplings were also taken from the infected-only group. The catheter samples were evaluated by scanning electron microscopy and given scores according to the level of formation. RESULTS: The biofilm layers emerged between 4 and 12 hours after infection in the infected-only group and had developed completely between 12 and 24 hours. The antibiotics, especially cefuroxime, significantly delayed this process for up to 4 days. However, the biofilm had developed completely in almost all catheter samples after 4 to 7 days. CONCLUSIONS: Biofilm of E. coli on urethral catheters had completed their maturation at 12 to 24 hours. For short-term urethral catheterization, a single dose of antibiotic can delay the development of biofilm for up to 4 days but eventually cannot prevent it.

Nocturnal polyuria in patients with lower urinary tract symptoms and response to alpha-blocker therapy.

OBJECTIVES: To determine the prevalence of nocturnal polyuria (NP, defined as a nocturnal urine fraction exceeding one third of the daily urine output in elderly men) in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) and clinical responsiveness to alpha-blocker therapy. METHODS: Outpatients with LUTS suggestive of BPH were included. Patients filled out the International Prostate Symptom Score questionnaire and a 7-day voiding diary, and urinalysis, prostate-specific antigen measurement, uroflowmetry, and ultrasonography were performed. Patients with NP were given alpha-blocker therapy (tamsulosin 0.4 mg/day) for 6 weeks and then re-evaluated for NP and urinary symptoms. RESULTS: A total of 58 outpatients were included in the study. Of these, 95% had NP. The mean frequency of nocturia was 2.73 +/- 1.44 per day. A significant correlation was found between NP and the duration of LUTS (r = 0.393, P = 0.035) and the amount of water intake within 3 hours before sleep (r = 0.731, P = 0.001). Of the patients with NP, 20 were given alpha-blocker therapy. After therapy, the peak urinary flow rate had increased significantly, but NP remained unchanged in 75% of the patients. CONCLUSIONS: NP is a common symptom accompanying LUTS suggestive of BPH. Our results showed that it is significantly related to the duration of LUTS and amount of water intake before sleep. NP cannot be treated with alpha-blocker therapy, although there is improvement in LUTS suggestive of BPH.

Relation between acute urinary retention, chronic prostatic inflammation and accompanying elevated prostate-specific antigen.

OBJECTIVE: To determine if there is a relationship between acute urinary retention (AUR), the prostate-specific antigen (PSA) level and chronic inflammation of the prostate. We therefore studied patients with benign prostatic obstruction (BPO) with (n = 64) or without (n = 168) acute urinary retention (AUR) who underwent transurethral resection of the prostate (TURP) in a retrospective case control study. MATERIAL AND METHODS: Between 2001 and 2004, a total of 232 patients underwent TURP due to BPO with or without AUR. The mean values of age, prostate volume, weight of resected prostate and PSA level and the histopathologic results of patients with and without AUR were compared. Chi(2) analysis was used to examine the relationship between prostatic inflammation and AUR. The contribution of each variable to AUR was assessed by means of multiple linear regression. RESULTS: A total of 64 patients (28%) were operated on for AUR due to BPO. There were no statistical differences between patients with or without AUR with respect to the mean values of PSA, percent free PSA, prostate size or weight of the resected prostate tissue. Elevated PSA values (>or=4.0 ng/ml) were detected in 64% and 38% of the patients in the AUR and non-AUR groups, respectively (p = 0.01). Histopathological re-evaluation demonstrated that chronic prostatic inflammation was present in 56% and 37% of the specimens in the AUR and non-AUR groups, respectively (p = 0.014). In the AUR group, the mean PSA level was significantly higher in patients with than without prostatic inflammation (7.75+/-5.26 vs 5.07+/-3.21 ng/ml; p = 0.022). The odds ratio of AUR for patients with chronic prostatic inflammation and elevated PSA was determined as 4.14 (95% CI 1.65-10.41). Multiple linear regression revealed that prostatic inflammation made a significant contribution to AUR. CONCLUSIONS: Chronic prostatic inflammation may be histopathological evidence of both elevated PSA level and AUR; hence it may play a role in the pathophysiology of AUR.

A rare case of acute renal infarction due to atrial fibrillation mimicking renal colic.

A 70-year-old patient with acute renal infarction due to chronic atrial fibrillation is presented. The clinical presentation of the patient was suggestive of renal colic. Computerized tomography was consistent with acute renal infarction and confirmed the diagnosis. After giving anticoagulation and antiarrhythmic treatment, she was discharged with clinical improvement. High clinical suspicion is necessary on an old patient who has thromboembolic risk factors with the complaint of abrupt-onset flank pain.