Preservation of shock-wave-induced renal histologic changes by dermatan sulfate.

OBJECTIVES: To evaluate the protective effects of glycosaminoglycan (GAG) administration on shock-wave-induced renal histologic alterations, an experimental study using dermatan sulfate administration (DS) in rabbits was performed. METHODS: The study included 45 white New Zealand rabbits; 36 were divided into two groups before shock-wave application. Animals in the first group (n = 18) received no specific medication before or after shock-wave treatment; animals in the second group (n = 18) received subcutaneous DS administration for a period of 2 months, beginning 2 weeks before shock-wave application. Following different numbers of shock-wave application (500, 1000, or 1500 shock waves), histopathologic evaluation of treated kidneys was made under light microscopy after 24 hours and 3 months. Nine animals were used for the control group. RESULTS: During 24-hour examination, most of the kidneys in both groups demonstrated varying degrees of histopathologic alterations, depending on the number of shock waves applied. Among the most prominent pathologic features were protein deposition with free erythrocytes in the tubular lumen, glomerular hemorrhage, tubular dilation and degeneration, protein in Bowman's capsule, hyperemia, and mononuclear cell infiltration at the interstitial level. As opposed to the 24-hour evaluation findings, long-term (3-month) follow-up examination revealed histopathologic alterations that decreased but did not totally disappear in animals receiving no DS. Glomerular basement membrane thickening, mononuclear cell infiltration and limited protein deposition in some tubules, together with cortical interstitial fibrosis, were observed to some extent in these animals. On the other hand, no severe histopathologic alteration with normal glomerular basement membrane appearance was noted in animals receiving DS medication. CONCLUSIONS: Our results indicated a long-term favorable protective effect of DS administration on morphologic abnormalities in rabbits undergoing shock-wave treatment. Although tubular alterations persisted to some extent, mononuclear cell infiltration has been limited and the natural appearance of the basement membrane has been well preserved in most of the treated animals.

Stone recurrence after shockwave lithotripsy: possible enhanced crystal deposition in traumatized tissue in rabbit model.

To evaluate the possible traumatizing effect of high-energy shockwaves (HESW) on new stone formation as indicated by crystal deposition in the renal parenchyma, we performed an experimental study in 50 rabbits. During severe oxaluria induced by continuous ethylene glycol (0.75%) administration, animals in the first group (N = 15) received 500 to 1500 shockwaves. Animals in the second group (N = 15) underwent no specific therapy apart from ethylene glycol administration. In a third group of animals (N = 15), only shockwave administration was applied. Sham group animals constituted the last group in our study (N = 5). Three months after shockwave application, tissue sections obtained from treated and untreated kidneys were evaluated histopathologically under light and transmission electron microscopy (TEM) for the presence and degree of crystal deposition in the cortical parenchymal region subjected to HESW. Crystal deposition was evident in the intercellular region and intratubular parts of the parenchyma in animals subjected to HESW application, especially in those receiving relatively high (1000 or 1500) numbers of shockwaves. On the other hand, no crystal formation and deposition was detectable in animals undergoing only ethylene glycol therapy or shockwave administration alone. Sham group animals demonstrated no significant renal histopathology. The traumatic effects of HESW should be evaluated as a factor in new stone formation after SWL.

Protective effect of verapamil on renal tissue during shockwave application in rabbit model.

Although extracorporeal shockwave lithotripsy (SWL) is the treatment of choice for symptomatic urinary calculi, it has been shown in number of studies that adverse effects of high-energy shockwaves may be encountered in short- and long-term follow-up. To evaluate the possible protective effect of verapamil administration on renal tissue, both magnetic resonance imaging (MRI) and histopathologic examination were performed after SWL in rabbits. Thirty-five animals were divided into three groups. The 15 animals in the first group were fed verapamil (0.1 mg/kg) for 3 days. Another 15 animals received no medication but underwent SWL, and the remaining 5 animals received anesthesia alone (sham group). The animals were then subdivided into three groups according to the shockwave number applied (1000, 15,000, or 2000) and the aforementioned evaluations were performed 24 hours and 3 months after the procedure. We found prominent histopathologic alterations in animals not receiving any medication before SWL. Persistence of these pathologic alterations during 3 months of follow-up indicated the importance of preservation of renal architecture during high-energy shockwave application. On the other hand, animals under verapamil medication prior to SWL demonstrated only a limited degree of histopathologic alteration. Demonstration of a normal histologic pattern after 3 months supported the preservation of tissue structure by such medication. No significant histopathologic alteration could be observed in the sham-group animals, as expected. Our study demonstrates that verapamil is protective against shockwave-induced renal tubular damage. Such medications may be useful to avoid the proven histopathologic and functional side effects of high-energy shockwaves.

Effect of total and ionized calcium levels of seminal fluid on sperm motility.

Total and ionized calcium (Ca2+) levels of seminal fluid were assessed in 75 semen samples obtained from infertile patients and fertile patients referred to our clinic with different complaints. Patients who showed only motility disorders on sperm analysis were include into the study program. Forty-five patients showing hypomotility (motility < 60%) and 30 patients with normal motility (motility > or = 60%) on sperm analysis were evaluated comparatively. No significant difference was observed in the seminal fluid concentration of total calcium, regardless of spermatozoa motility immediately after ejaculation. However, the seminal fluid of men with hypomotility exhibited a significantly lower Ca2+ concentration (p < 0.05) when compared with that of men with normal motility. A significant difference was observed in the seminal fluid Ca2+/total calcium rate (p < 0.05) when compared with that of men with normal motility. Further, spermatozoa from men with hypomotility exhibited both a significantly lower progression rate and sperm count. Our study suggests a direct relationship between Ca2+ and sperm motility.

Effects of extracorporeal shock wave lithotripsy on stone forming risk factors.

It has been reported in some definite studies that ESWL causes transient deterioration in renal haemodynamics and function. Again certain parameters in blood and urine have been used in order to assess this functional deterioration and different results are reported. In our present study we aimed to describe the adverse effects of shock waves on the excretion of urinary metabolites such as electrolytes, oxalate and citrate. Evaluation of our results in 30 patients revealed that although exposure to shock waves during ESWL for symptomatic renal calculi causes a slight increase in the urinary level of metabolites, all of these changes remained in normal range and no statistically significant changes in the urinary level of the aforementioned parameters could be demonstrated.

Renal liposarcoma of the sinus renalis.

We report on 42-month follow-up of a case of renal liposarcoma of the sinus renalis with tumour-free survival. It is a rare condition and occurs generally in the 4th and 6th decades of life. Renal liposarcomas are clinically asymptomatic for a long period of time. Symptoms develop only when the tumours become large enough, as in our case. For the differential diagnosis of renal liposarcoma we performed intravenous urography, computerized tomography and colour flow Doppler ultrasonography. After these diagnostic evaluations the patient underwent right radical nephrectomy. Complete surgical resection was performed. Final diagnosis was made by pathological examination. Because of the poor results of either chemotherapy or radiotherapy, we conclude that 42 months of tumour-free survival is related to complete surgical resection with negative surgical margins.

Skin metastasis of bladder carcinoma. A case report.

A case of not commonly encountered metastasis of bladder cancer to skin has been studied. The usual sites of the bladder cancer metastasis are lymph nodes, liver, lung and bone.

Intravesical mitoxantrone for superficial bladder tumors.

Thirty-five patients (33 males, median age 58) with stage T alpha (21 patients) or T1, grade 1 (17 patients) or grade 2 superficial bladder carcinoma, were treated with transurethral resection (TUR) followed by intravesical prophylactic therapy with 10 mg mitoxantrone administered weekly for 6 weeks and then monthly for 10 months. Twenty-five patients were newly diagnosed and 10 had relapsed after previous therapy. Diagnosis was confirmed with cytology and biopsy. The aim of the study was to evaluate the prophylactic effect (relapse rate, disease free interval) and toxicity of intravesical mitoxantrone in superficial bladder carcinoma. Relapses were established with biopsy. After a mean period of 12 months follow-up (median 8.3 months), 63% of patients in the whole group, 72% in the newly diagnosed group and 40% in the group of previously relapsed patients remained relapse free. These rates compare very favorably with the most effective prophylactic agents available. At the end of the follow-up period the median disease-free survival for the whole group was not reached. Therapy was well tolerated with no systemic toxicity and 14 patients reporting grade 1-2 local toxicity. In no patient was treatment discontinued due to toxicity. Mitoxantrone is an effective and safe agent for the post-TUR adjuvant intravesical therapy.

Multidisciplinary evaluation of diabetic impotence.

Patients referring to the Urology and/or Endocrinology Departments of Ankara Medical School with complaints of diabetes mellitus (DM) and related complications were evaluated during the last year. A detailed history was obtained and all of the patients were questioned especially about sexual function problems. Following this evaluation, all patients were divided into two main groups, i.e. patients with sexual disorders, and those with normal sexual function. Factors such as BPH, cerebrosclerosis and other important vascular-neurologic pathologies which may play a role in the etiology of impotence were excluded from the study and 38 patients with sexual dysfunction and 15 with normal sexual activities have undergone further evaluation. Following routine blood and urine analyses, serum hormone levels (testosterone, FSH, LH, prolactin) were determined. Penile color-flow doppler analysis, cavernosometry, cavernosography, bulbocavernous reflex latency time and evaluation of somatosensory evoked potentials were performed. Additionally, all patients were evaluated from the psychiatric aspect using the Hamilton depression scale and MMPI questionnaire. The presence of vascular or neurologic pathology in 89.4% of our patients and of both pathologies in 39.4% of the patients, indicated the importance of multifactorial evaluation of diabetic impotence in order to plan a complete and efficient therapy program.

Selection of patients for intravesical therapy for superficial bladder cancer.

In a nonrandomized retrospective study, 133 patients with superficial transitional cell carcinoma of the bladder were evaluated to identify any clinical prognostic features which indicate the necessity of intravesical therapy (IVT). The risk factors taken into account were stage, grade and multiplicity of the tumour. All patients were treated initially by complete transurethral resection (TUR); 27 patients received no further treatment after resection of the tumour, 106 patients received adjuvant IVT over a period of 6 weeks. The mean follow-up was 23 and 18.8 months in the TUR-only group and TUR+IVT group, respectively. In the TUR-only group 7 and in the TUR+IVT group 29 recurrences were encountered. Patient group with no risk factors (Ta, GI, solitary tumour) or with only one risk factor revealed no statistical difference in terms of the recurrence rate from the identical control group. So it does not seem worthwhile to give additional therapy in the low-risk group. Another notable outcome of this study was that the higher the potential risk factors, the higher the likelihood of recurrence. The results suggest that T1 tumours, multifocal tumours, and high-grade tumours have poor prognosis, making additional treatment necessary.

The place of acupuncture in the management of psychogenic impotence.

Successful sexual functioning is a complex process involving psychological and social responses as well as neurological, biochemical and vascular processes. Today it is believed that more than 50% of the sexual dysfunction cases have an organic etiology. Reflecting the controversy over the management of psychogenic impotence, there are several different methods which are currently in clinical use. In this prospective study we aimed to evaluate the curative effects of acupuncture therapy in men with purely psychogenic impotence. Of the 29 patients treated with this procedure 20 patients demonstrated successful erections following a varying number of acupuncture sessions. In the light of our findings we may conclude that acupuncture may be an effective alternative in the management of purely psychogenic impotence.

Treatment of renal stones in a solitary functioning kidney with extracorporeal shock wave lithotripsy.

Forty extracorporeal shock wave lithotripsy (ESWL) sessions were performed in the treatment of 36 stones in 22 solitary functioning kidneys between October 1990 and October 1991. We inserted a double-J catheter in all patients preoperatively and no serious obstruction such as stone street formation was observed after treatments. Following ESWL therapy, at the end of 3 months follow-up, 14 patients (63.6%) were completely stone free while in 5 patients ESWL therapy was unsuccessful. ESWL became the treatment of choice for stones in solitary kidneys as a result of its highly effective, safe and encouraging outcome.

Vas deferens calculus.

We describe a patient with a radiopaque calculus in the vas deferens that was inappropriately diagnosed as a ureteral calculus.