Predictive value of Controlling Nutritional Status score and Prognostic Nutritional Index for systemic inflammatory response syndrome/sepsis after percutaneous nephrolithotomy.

PURPOSE: Our aim was to investigate the predictive value of Controlling Nutritional Status (CONUT) score and Prognostic Nutritional Index (PNI) for systemic inflammatory response syndrome (SIRS)/sepsis after percutaneous nephrolithotomy (PNL). METHODS: Demographic and clinical data of 422 patients who underwent PNL were evaluated. The CONUT score was calculated from lymphocyte count, serum albumin, and cholesterol, while the PNI was calculated using lymphocyte count and serum albumin. Spearman's correlation coefficient was used to evaluate the relationship between nutritional scores and systemic inflammation markers. Logistic regression analysis was performed to determine the risk factors for SIRS/sepsis development after PNL. RESULTS: Patients with SIRS/sepsis had a significantly higher preoperative CONUT score and lower PNI compared with the SIRS/sepsis (-) group. A positive significant correlation between CONUT score and CRP (rho = 0.75), CONUT score and procalcitonin (rho = 0.36), and CONUT score and WBC (rho = 0.23) were determined. Additionally, a negative significant correlation was shown between PNI and procalcitonin (rho = - 0.30) and PNI and CRP (rho = - 0.64). The ROC curve analysis showed that the cut-off values for the CONUT score and PNI were 4 (AUC = 0.827) and 42 (AUC = 0.734), respectively. Age, stone size, history of pyelonephritis, residual stone, presence of infection stone, CONUT score ≥ 4, and PNI ≤ 42 were found to be independent predictors for postoperative SIRS/sepsis in multivariate analysis. CONCLUSION: Our results demonstrated that preoperative CONUT score and PNI are potential predictive factors for SIRS/sepsis development after PNL. Therefore, patients with CONUT score ≥ 4 and PNI ≤ 42 are suggested to be closely monitoring due to the risk of post-PNL SIRS/sepsis.

The use of natural killer cell activity and PPD test in the prediction of results in intravesical BCG treatment of patients with nonmuscle-invasive bladder cancer.

PURPOSE: To predict the efficacy of intravesical BCG therapy in patients with nonmuscle-invasive bladder tumors (NIBC) by using components of the cellular immune response such as the tuberculin skin test (PPD) and natural killer (NK) activity measurement. METHODS: Ninety-nine patients who were started on intravesical BCG therapy for NIBC were evaluated prospectively. Patients who were included in the intermediate, high, and very high-risk groups according to the EAU NMIBC Scoring System and who had never received intravesical BCG therapy previously were included. The clinical and demographic characteristics of the patients (age, gender, EAU NMBIC risk group, EORTC progression and recurrence scores, CUETO progression and recurrence scores, presence and types of comorbidity) were recorded. NK activity was measured and the PPD test was applied 3 days before the start of intravesical BCG therapy. The results of PPD were measured in millimeters 72 h after the test. RESULTS: PPD values measured before BCG treatment, as an independent variable, were found to be significantly lower in patients with recurrence. A significant correlation was detected between NK activity results obtained before BCG treatment and recurrence after treatment, when the cutoff was 200-500 pg/dl. There was no significant relationship between the time to recurrence and PPD and NKA measurements. CONCLUSION: We conclude that the results of PPD test and NK activity measurement performed before starting intravesical BCG therapy in NIBC may be a marker that can be used to predict the risk of recurrence under treatment.

Influence of preoperative pain duration on microsurgical varicocelectomy outcomes.

Objective. To investigate the question of whether duration of pain before surgery ultimately affects sperm parameters after varicocelectomy. Methods. Fifty patients with painful grade-3 varicocele were investigated prospectively. The patients were divided into two groups according to their symptom period. The patients having had grade-3 varicocele for less than 1 year were included in Group-1 (Ge, n = 25). Twenty-five patients who had painful grade-3 varicocele for more than 1 year (Gs, n = 25) were classified in Group-2. Semen analysis was performed after 3 days of sexual abstinence twice a month. Total sperm concentration (TSC), rapidly progressive motility (SPa), and slow or sluggish motility (SPb) rates were noted. Pain was evaluated by using 10 cm visual analogue scale (VAS). Results. Postoperative TSC and %SPb were significantly higher in both groups (P = 0.01). There was no difference between two groups for preoperative and postoperative TSC, %SPa, % and SPb values. VAS significantly declined in both groups (P = 0.005). This postoperative decline was not significant for intergroup comparison. Conclusions. Our results show that increase in semen quality and decrease in the pain after microsurgery varicocelectomy do not depend on the duration of the preoperative pain.

Effects of angiogenesis inhibition by spironolactone on isolated vas deferens contractility in an experimental varicocele model in rats.

OBJECTIVE: To investigate the effect of spironolactone, as an angiogenesis inhibitor, on the isometric contractile responses in isolated vas deferens strips from left varicocele-induced rats. METHODS: Twenty-four adult (12-14 months) male Wistar albino rats were randomly assigned to 4 groups (n = 6 in each): (1) Control group, (2) sham-operated group, (3) experimental left varicocele group, and (4) Spironolactone (20 mg/kg/d)-treated experimental left varicocele group. Histopathologic and immunohistochemical (CD31 staining) findings in the rat testis and functional findings in the rat isolated vas deferens were investigated. RESULTS: Angiogenesis increased in the varicocele group and the spironolactone inhibited angiogenesis in the spironolactone-treated group. Spironolactone seemed to change phenylephrine and serotonin responses in the left vas deferens. CONCLUSION: It is possible that by inhibiting angiogenesis, spironolactone treatment negatively impairs testicular morphology and functional (vas deferens) pathways. Varicocele formation seems to elicit an increase to 5-HT sensitivity in rat vas deferens, and this process is prevented by spironolactone pretreatment.