Comparison of long-term outcomes of laparoscopic and robot-assisted laparoscopic partial nephrectomy.

In this study, we compared the long-term oncological and functional outcomes of laparoscopic partial nephrectomy (LPN) and robot-assisted laparoscopic partial nephrectomy (RAPN) performed in the treatment of renal tumors. The data of 142 patients (RAPN = 71, LPN = 71) were evaluated. Demographic data, perioperative and postoperative outcomes, long-term (5-year) overall survival (OS) and cancer-specific survival (CSS) rates of the patients were compared between the two groups. A P value of less than 0.05 was considered statistically significant. The mean follow-up time was 61.38 months. There were more complex tumors in the RAPN group (P = 0.014). The duration of warm ischemia time (WIT) was shorter in the RAPN group (P = 0.019). Perioperative and postoperative outcomes were similar. There were no differences between the groups in terms of 5-year metastasis-free survival, OS, and CSS rates. Hypertension, diabetes, and preoperative estimated glomerular filtration rate (eGFR) were the predictive factors for renal insufficiency; and preoperative eGFR, WIT, and positive surgical margin were the predictive factors for 5-year CSS. We concluded that RAPN is an important minimally invasive treatment method for partial nephrectomy with long-term favorable results, especially in complex tumors. Comparisons of two methods should be made with comparative, prospective, randomized, high case number studies, and the place of RAPN in the treatment of these tumors should be clarified.

The relationship between lower urinary tract symptoms associated with benign prostatic hyperplasia and erectile dysfunction: the role of autonomic hyperactivity.

BACKGROUND/AIM: To investigate whether autonomic nervous system (ANS) hyperactivity may be a potential cause for the relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). MATERIALS AND METHODS: Twenty-four patients were recruited for this study. Complete physical examinations, urine analysis, uroflowmetry, and postvoid residual urine volume (PVRU) analysis were performed. The potential impact of some factors such as hyperglycemia, obesity, and hyperlipidemia were analyzed. These values were correlated with the various symptom scores. We performed an electromyographic and an electrocardiographic evaluation. The alterations after treatment with 2 different alpha-blockers were also analyzed. RESULTS: The electromyographic and electrocardiographic assessments revealed a minimal increase in ANS activity and it did not change significantly after treatment (P > 0.05). After treatment, maximum flow rate increased and PVRU decreased significantly (P < 0.001 and P < 0.001, respectively); total and free testosterone levels increased significantly (P = 0.0068 and P = 0.0071, respectively). There was a statistically significant difference between the 2 treatment groups regarding the outcomes of the Danish Prostate Symptom Score questionnaire (P = 0.047). CONCLUSION: This current study suggested that the effect of ANS hyperactivity is not the fundamental factor underlying the relationship between LUTS and ED.

Effect of lisinopril on renal tissue damage in unilateral ureteral obstruction in rats.

In this study, it was aimed to investigate apoptosis in renal injury and the effect of lisinopril in rat model, which constitute unilateral ureteral obstruction. The retroperitoneal ureter was ligated with a 4.0 silk for the experimental model of ureteral obstruction in Wistar albino rats. Untreated group (n = 20) received no treatment. For the lisinopril-treated group (n = 20), 20 mg/kg/day of drug was given orally. Ultrastructural differences were analyzed using electron microscopic technique; apoptotic distribution was analyzed using the TUNEL method. After electron microscopic evaluation, on the 4th and 14th day in the untreated group, edema in the glomeruli, loss of microvillus and apoptotic cells in proximal tubule cells and sclerosis in the glomeruli were detected. On the 4th day in the lisinopril-treated group, the kidney was ultrastructurally normal and a less number of apoptotic cells were only observed on the 14th day. On light microscopic examination on the 4th and 14th day in the untreated group, while the glomeruli were normal in structure, the boundary of the proximal tubule was disrupted and some picnotic cells in both the proximal and collecting tubules were observed. In both 4th and 14th day of the lisinopril-treated group, kidney showed normal structure, although in some places picnotic cells in the collecting tubules were observed. In conclusion, lisinopril was effective and it may prevent early renal damage in the direct obstruction model.

Comparative study of extracorporeal shock wave lithotripsy outcomes for proximal and distal ureteric stones.

OBJECTIVE: To assess the efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy for isolated proximal ureteral calculi and compare it to that for isolated distal calculi. PATIENT AND METHODS: We treated 68 patients with isolated ureteral stones using MPL 9000. Stones were located in the proximal and distal ureters in 44 and 24 patients, respectively. Patients were stratified according to stone burden and degree of obstruction. Data of all patients were prospectively collected for stone burden, stone localization, number of sessions, number of shock waves, stone-free rates (SFRs), complications, re-treatment rates and auxiliary procedures. Outcomes regarding ureteral localization were compared. RESULTS: The overall SFR was 85.3% with a 41.2% re-treatment and 17.6% auxiliary procedure rate. The mean number of shock waves applied for each stone was not different among the two ureteral locations. The SFRs were 86.3% and 79.1% for proximal and distal ureteral stones, respectively (P=0.17). For the group with stones <100 mm(2), the SFR was 85.4% and 89.5% for the proximal and distal ureter, respectively. Although the degree of obstruction did not affect SFR of the entire group (P=0.12) and the proximal ureter group (P=0.96), it adversely affected SFR in the distal ureter (P=0.017). CONCLUSIONS: ESWL outcomes for the ureteral calculi support the use of lithotripsy particularly for stones <100 mm(2). Treatment efficacy was not significantly different among stones localized in proximal and distal ureters. Degree of obstruction did not affect the ESWL outcomes in the proximal ureter, but it adversely affected SFR in the distal ureter.