Predictive value of Prognostic Nutritional Index (PNI) for the severity of vasculogenic erectile dysfunction.

PURPOSE: Our aim was to investigate the association of prognostic nutritional index (PNI) score with erectile dysfunction (ED), therefore, we prospectively evaluated the relationship between penile doppler ultrasonography (PDU) findings, PNI and Sexual Health Inventory for Men (SHIM) scores in patients with ED. METHODS: A total of 414 patients' characteristics, laboratory findings, SHIM and PNI scores were recorded. The PNI is calculated using the formula: 10 × serum albumin + 0.005 × total lymphocyte count. PDU was performed in patients with a SHIM score of 17 and below, while patients with a SHIM score ≥ 18 were recruited for the control group. Correlation analysis was performed to evaluate the relationship between PNI, SHIM scores and PDU parameters. The predictive value of variables for severe ED was assessed with regression analysis. RESULTS: A significant difference was demonstrated between the ED subgroups and control group for total cholesterol (p = 0.04), serum albumin (p = 0.03), total lymphocyte count (p = 0.02), BDI score (p < 0.001), and PNI score (p = 0.03). A strong positive correlation between PNI score and PSV (rho = 0.73; p = 0.001), a moderate negative correlation between PNI score and EDV (rho = - 0.54; p = 0.02), and a moderate positive correlation between PNI and SHIM scores (rho = 0.61; p = 0.02) were demonstrated. PNI score ≤ 40 (OR: 3.49; p = 0.01), age (OR: 2.15; p = 0.03) and total cholesterol (OR: 2.03; p = 0.04) were determined as significant predictors of severe ED in multivariate analysis. CONCLUSION: Our results demonstrated that PNI score is significantly lower in patients with severe and moderate ED. It has been also revealed that the PNI score is an independent predictive factor for severe ED.

Noninvasive treatment of intraperitoneal urinary system perforations with percutaneous placement of a peritoneal drainage catheter

Background/aim: Intraperitoneal urinary system perforation is a rare but serious complication of endoscopic urologic surgery. Percutaneous placement of a peritoneal drainage catheter is already mainly used for diagnostic purposes. We present our experience with percutaneous drainage catheters for conservative management of intraperitoneal urinary system perforations occurring during endoscopic urologic surgery with close monitorization in selected cases. Materials and methods: Urinary system perforations had developed in 21 (0.8%) of 2603 patients undergoing endoscopic urologic surgery at our department in 2014­2016. The perforation was intraperitoneal in only 5 (0.19) of all the patients. A percutaneous peritoneal drainage catheter with the guidance of ultrasonography was placed in four of the patients. Results: Conservative management by draining excess fluid with a drainage catheter percutaneously placed under close monitorization was successful in four out of five patients with urinary system perforation occurring during endoscopic urologic surgery. The remaining patient was treated successfully with open laparotomy because of fulminant evidence of peritonitis. Conclusion: Our findings and experience may suggest that conservative management of intraperitoneal urinary system perforations occurring during endoscopic urologic surgery by percutaneous drainage catheter under close monitorization is feasible in carefully selected patients.

Age- and sex-dependent alteration of functions and epigenetic modifications of vessel and endothelium related biomarkers.

Aging is a main risk factor for development of cardiovascular diseases associated with the impairment of endothelial function in both sexes. In the present study, age-related changes in vascular responsiveness, epigenetic modifications of vessel wall, and blood biomarkers related to endothelial functions were examined in an age- and sex-dependent manner. Acetylcholine (ACh)-induced relaxations of the aorta were decreased in 3-, 6-, and 12-month-old rats compared to those in 1-month-old female rats. In males, maximum relaxations related to ACh were higher in 1- and 6-month-old rats than in 3- and 12-month-old rats. Plasma levels of nitric oxide (NO) and asymmetric dimethylarginine (ADMA) decreased with age in female rats, and total antioxidant capacity (TAC) and hydrogen sulfide (H 2S) levels displayed biphasic alterations. In male rats, plasma levels of NO, TAC, and ADMA decreased with age, and H2S levels increased. Aging also caused a sex-dependent alteration in epigenetic modification of vessels. Expressions of H3K27me2, H3K27me3, H3K36me2, and H3K36me3 were much higher in vessels of 12-month-old female rats compared to those in younger age groups. These results indicate that vascular functions, epigenetic modifications of vessels, and plasma levels of endothelium-related biomarkers are affected by age and sex. These findings could be important for the assessment of vascular status over the course of the life span.

Comparison of conventional dressings and vacuum-assisted closure in the wound therapy of Fournier's gangrene.

OBJECTIVE: The purpose of our study was to compare Vacuum-assisted closure (VAC) and conventional dressings in the wound therapy of Fournier's gangrene (FG). MATERIALS AND METHODS: The study evaluated 54 patients, retrospectively. Following initial removal of necrotic and devitalized tissue, in Group I patients the wounds were covered with conventional antiseptic dressings and patients continued to be treated with conventional dressings. In Group II patients VAC therapy was initiated. The collected data were compared between groups. RESULTS: The difference between two groups were statistically significant in terms of number of daily dressing (group I: 2, group II: 0,5), VAS (group I: 8, group II: 5), number of daily analgesics (group I: 4, group II: 2), number of daily narcotic analgesics (group I: 1, group II: 0), duration of mobilization per day (group I: 40, group II: 73 minutes) (p < 0.05). CONCLUSIONS: Our study does not determine that a VAC therapy is better than conventional dressings in terms of clinical outcome. However, vacuum dressing appears an effective and successful method, which offers fewer dressing changes, less pain, and greater mobility comparing to conventional dressings in the management of FG patients.

Prognostic value of endocan in prostate cancer: clinicopathologic association between serum endocan levels and biochemical recurrence after radical prostatectomy.

PURPOSE: To assess the diagnostic capability of serum endocan level in association with clinicopathologic features and its impact on biochemical progression-free survival in patients with prostate cancer (PCa). METHODS: A total of 86 patients with localized prostate cancer were treated with open radical prostatectomy (RP). The control group included 80 patients who were referred to the urology outpatient clinic with normal rectal examination and prostate-specific antigen (PSA) levels. The patients' characteristics, baseline PSA value, and serum endocan levels were recorded. The patients were followed up with the measurement of PSA concentration every 3 months during the first year, thereafter every 6 months until 5 years, then yearly after surgery. The primary endpoint of follow-up was the time of biochemical recurrence. RESULTS: The median serum endocan levels were 3.14 ng/mL in the RP group and 2.98 ng/mL in the control group (p = 0.122). A total of 86 patients who underwent RP for PCa were divided into 2 groups based on a cutoff serum endocan level of 1.8 ng/mL. The distribution of Gleason score and biochemical failure rate were significantly higher in patients with serum endocan ≥1.8 ng/mL (p = 0.031 and p = 0.047). The biochemical recurrence-free time for endocan ≥1.8 ng/mL and <1.8 ng/mL were 38 and 56 months, respectively (p = 0.041). Spearman correlation analysis showed a linear relationship between endocan expression and Gleason score (p = 0.025, p = 0.511). Multivariate analysis revealed that elevated serum endocan level (≥1.8 ng/mL) was a significant predictor of biochemical progression-free survival (hazard ratio 2.44; 95% confidence interval 1.78-3.23; p = 0.001). CONCLUSIONS: The current study indicates that endocan has a close relationship with tumor recurrence in PCa.

Role of FLT3 in the proliferation and aggressiveness of hepatocellular carcinoma.

BACKGROUND/AIM: Previously we showed that Fms-like tyrosine kinase (FLT3) changes its cellular localization upon partial hepatectomy, suggesting a role in liver regeneration. FLT3 was also shown to play an important function in cellular proliferation and activation of PI3K and Ras. Thus, we aimed to investigate the role of FLT3 in hepatocellular tumorigenesis utilizing in vitro and in vivo models. MATERIALS AND METHODS: We used Snu398 cells that express FLT3. We investigated these cells' in vitro proliferation and invasion abilities by treatment with the FLT3 inhibitor K-252a or by knocking-down with FLT3 shRNA,. Furthermore, the effect of blocking FLT3 activity and expression during in vivo tumorigenesis was assessed with xenograft models. RESULTS: After K-252a treatment or stable knock-down, these cells' proliferation and migration abilities were highly diminished in vitro. In addition, significant diminution in tumorigenicity of Snu398 cells was also obtained in vivo. When FLT3 knocked-down Snu398 cells were injected into nude mice, we did not detect αSMA expression in these tumors, suggesting a role for FLT3 in in vivo invasiveness. CONCLUSION: Our data provided evidence that FLT3 has a crucial role both in hepatocarcinogenesis and its invasiveness. Therefore, targeting FLT3 and/or its activity may be a promising tool for combating hepatocellular carcinomas.

Intravesical Prostatic Protrusion: A Potential Marker of Alpha-blocker Treatment Success in Patients With Benign Prostatic Enlargement.

OBJECTIVE: To investigate the value of anatomic and blood-flow measurements of the prostate via ultrasound in identifying medical treatment response of patients with lower urinary tract symptoms due to benign prostatic enlargement. A secondary objective of the study was to compare transabdominal-transrectal measurements. MATERIALS AND METHODS: Male patients (age range 50-80) with lower urinary tract symptoms who applied to our outpatient clinic to be diagnosed with benign prostatic enlargement that were eligible for medical management were included in the prospective study. Patients (n = 49) were administered with tamsulosin for management. At baseline evaluation, all patients underwent International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), transabdominal and transrectal ultrasound [prostate volume (PV), post-void rezidu and intravesical prostatic protrusion (IPP)], and prostate subcapsular resistive index value measurement. Follow-ups were carried out 1 and 3 months after treatment. At these time-points, patients were assessed with IPSS and uroflowmetry. RESULTS: IPP were identified to be negatively correlated with baseline Qmax values (P = .001, R = -0.485) and positively correlated with PSA (P = .013, R = 0.353) and PV (P = .003, R = 0.420). PV was related with resistive index (P = .026, R = 0.318) and PSA (P = .001, R = 0.619). Subsequent to medical treatment on the follow-ups, an overall improvement in the IPSS and Qmax was identified (P = .001). However, a negative correlation was identified in the change that occurred between IPSS and IPP (P = .004, R = -0.410). Other parameters were not correlated (P > .05) with the change in IPSS and Qmax. Transabdominal and transrectal measures were similar (P = .001). CONCLUSION: This study has shown that increased IPP values are associated with lower response to alpha-receptor specific management. Transabdominal measurements are sufficient for the evaluation compared with transrectal measurement.

Percutaneous nephrolithotomy: primary patients versus patients with history of open renal surgery.

BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy (PCNL) is the management choice for stones larger than 2 cm or for staghorn calculi. PCNL in secondary or tertiary patients poses some difficulties. In this study, we compared these patients with patients who were operated on for the first time. PATIENTS AND METHODS: A total of 328 PCNLs were performed between January 2003 and June 2007. One hundred and forty-two patients who had undergone open renal surgery in the past (126 secondary and 16 tertiary were compared with patients who had no previous history of open renal stone surgery. The tract was formed by balloon dilators, and in situations where it was necessary, fascial dilators were used. The operation was concluded by inserting a 14Ch Malecot nephrostomy tube in all cases. The number of tracts, operative time, transfusion rate, hospitalization time, and residual stones were recorded. RESULTS: Significant differences are not observed when the results are compared with the primary cases in terms of tract numbers (multiple tracts: 8.5% v 10.2%), operative time (2.3 v 2.2 hours) (P > 0.05), transfusion rate (540 v 495 mL) (P > 0.21), hospitalization time (4.4 v 4.2 days) (P = 0.94), complication rate (1.4% v 3%) (P > 0.05), and residual stones (5% v 3%) (P > 0.05). CONCLUSIONS: Although the anatomic positional differences of the kidney and fibrosis makes access and the procedure technically difficult in secondary or tertiary cases, PCNL can be performed with low complication and high success rates if safety rules are followed strictly. Difficult access can be overcome either by newly developed high-pressure balloons, assistance of fascial dilators, or by mechanical dilators.