[A different approach to the percutaneous nephrostomy by urologists]. / Un abordaje diferente a la nefrostomía percutánea por urólogos.

INTRODUCTION: Percutaneous nephrostomy (PCN) tube placement is generally performed in radiologic departments worldwide. However, there are a few urologist-directed studies about PCN performed with ultrasound guidance. Needle direction using a convex abdominal ultrasound probe might be difficult in unexperienced hands. In order to perform this procedure easily, we propose that a probe placed on flank or intercostal region and a long grooved needle director that never allows needle movement would be useful. We considered a transrectal ultrasound (TRUS) probe was suitable to resolve this issue. MATERIAL AND METHOD: From January 2007 to April 2011, a total of 113 percutaneous renal access (PRA) were performed using a TRUS probe in 102 patients, aged 20 to 84 years old. Because of the insufficient imaging capability of the TRUS probe in obese patients whose body mass index (BMI) greater than 30kg/m(2) were excluded. Forty two PRA were performed under local anesthesia and this group was named local anesthesia (LA) group. Seventy one PRA were performed for nephrostomy insertion under local anesthesia supplemented by deep sedation and this cluster was named deep sedation (DS) group. RESULTS: Targeted calyx puncture and guide wire placement was performed in all patients (100%) but success rate of tube insertion in each group was different. Successful PCN insertion rate was 69.1% (29 of 42 cases) in LA group and 95.8% (68 of 71 cases) in DS group. No major vascular injury and/or adjacent organ injury to bowel, liver, spleen or lung was seen in any patient. CONCLUSION: Guidance of TRUS probe, deep sedation, and modified dilators may offer a high success rate to the urologists with little experience in PCN insertion which they would find it difficult to perform.

El artefacto de centelleo en la caracterización de los cálculos urinarios / Role of twinkling artifact in characterization of urinary calculi

Introducción: La caracterización de los cálculos renales está cada vez cobrando mayor importancia como paso previo a la toma de decisiones terapéuticas tales como la nefrolitotomía percutánea (NLP) y la litotricia extracorpórea por ondas de choque (LEOC). En algunos estudios se ha publicado que el artefacto de centelleo (artefacto de ecografía de flujo en color) puede ser de utilidad en la detección de piedras en el riñón. En este estudio se pretende dilucidar si la presencia o ausencia del artefacto de centelleo tendría alguna relación con la composición química de los cálculos. Material y método: En un estudio prospectivo se incluyó a pacientes con cálculos renales de ≥ 0,5cm. Se examinó a 70 pacientes mediante rayos X, pielografía intravenosa, tomografía computarizada sin contraste y ecografía doppler espectral y a color. El artefacto se consideró de grado 1 si sólo ocupaba una parte de la sombra acústica, considerándose de grado 2 si ocupaba la totalidad de la sombra. Se trató a los pacientes con cálculos de menos de 2cm con LEOC, y a aquellos con piedras de mayor tamaño se les derivó a tratamiento con NLP. Resultados: No se detectó artefacto alguno (grado 0) en 11 sujetos, detectándose el grado 1 en 25 y el grado 2 en 24. Se encontró una relación significativa entre el aumento en artefactos de centelleo y tamaño del cálculo (p<0,001). Al analizar la relación entre composición de los cálculos y artefacto de centelleo se detectó el artefacto en prácticamente todas las piedras de oxalato de calcio —dihidrato y fosfato de calcio, mientras que en el caso de los cálculos de oxalato de calcio— monohidrato y ácido úrico se detectó el artefacto únicamente en algo más de la mitad de ellos. En el grupo LEOC se observó que, al aumentar el grado del artefacto de centelleo, descendía el número de sesiones de LEOC necesario (p<0,001). En el grupo NLP se encontró el artefacto de centelleo en todos los pacientes (100%) con piedras de superficie irregular. Conclusión: La irregularidad de la superficie lítica es el factor más influyente en la formación del artefacto de centelleo en piedras de riñón. Dicho artefacto puede tener utilidad a la hora de prever la predisposición a la fragmentación de los cálculos en pacientes derivados a tratamiento con aplicación de LEOC. Podría pronosticarse que aquellos casos en los que el tamaño de la piedra fuese de más de 2cm y no se detectase artefacto de centelleo serían de oxalato de calcio - monohidrato, que es una de las piedras con mayor predisposición a la fragmentación (AU)

Introduction: Stone characterization is becoming important before decision of treatment such as percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL). Some studies have reported that the twinkling artifact (color-flow ultrasonography artifact) may be useful to detect urinary stones. This study aims to determine whether the presence or absence of the twinkling artifact is correlated with the chemical composition of the stones. Material and method: Patients with renal stones > 0.5cm were included in a prospective study. Sixty patients were examined with x-ray film, intravenous pyelography, non-contrast computerized tomography, and color and spectral doppler ultrasonography. The artifact was considered grade 1 when occupied only one portion of the acoustic shadowing and when the artifact occupied the entire acoustic shadowing was considered grade 2. Patients with stones smaller than 2cm were treated with SWL and patients with stones larger than 2cm were treated with PCNL. Results: No artifact (grade 0) was detected in 11 subjects, grade 1 in 25 and grade 2 in 24. Significant relationship was found between the increase in twinkling artifact and stone size (p<0.001). When the relation between the composition of the stones and the twinkling artifact was analyzed, artifact was detected nearly in all of the calcium oxalate dihydrate and calcium phosphate stones; whereas the artifact was detected in more than half of the calcium oxalate monohydrate and uric acid stones. In ESWL group it was observed that as the grade of the twinkling artifact increases, the number of required ESWL sessions decreases (p<0.001). In PCNL group twinkling artifact was found in all of the patients (100%) with roughly surfaced stones. Conclusion: The roughness of stone surface is the most important factor in terms of formation of the twinkling artifact in kidney stones. This artifact can be of use in anticipating the breakability of the stones of those patients to be treated with applied ESWL. One might anticipate that cases where the size of the stone is larger than 2cm but no twinkling artifact is detected are calcium oxalate monohydrate, which is one of the stones with highest level of breakability (AU)

[Role of twinkling artifact in characterization of urinary calculi]. / El artefacto de centelleo en la caracterización de los cálculos urinarios.

INTRODUCTION: Stone characterization is becoming important before decision of treatment such as percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL). Some studies have reported that the twinkling artifact (color-flow ultrasonography artifact) may be useful to detect urinary stones. This study aims to determine whether the presence or absence of the twinkling artifact is correlated with the chemical composition of the stones. MATERIAL AND METHOD: Patients with renal stones > 0.5 cm were included in a prospective study. Sixty patients were examined with x-ray film, intravenous pyelography, non-contrast computerized tomography, and color and spectral doppler ultrasonography. The artifact was considered grade 1 when occupied only one portion of the acoustic shadowing and when the artifact occupied the entire acoustic shadowing was considered grade 2. Patients with stones smaller than 2 cm were treated with SWL and patients with stones larger than 2 cm were treated with PCNL. RESULTS: No artifact (grade 0) was detected in 11 subjects, grade 1 in 25 and grade 2 in 24. Significant relationship was found between the increase in twinkling artifact and stone size (p<0.001). When the relation between the composition of the stones and the twinkling artifact was analyzed, artifact was detected nearly in all of the calcium oxalate dihydrate and calcium phosphate stones; whereas the artifact was detected in more than half of the calcium oxalate monohydrate and uric acid stones. In ESWL group it was observed that as the grade of the twinkling artifact increases, the number of required ESWL sessions decreases (p<0.001). In PCNL group twinkling artifact was found in all of the patients (100%) with roughly surfaced stones. CONCLUSION: The roughness of stone surface is the most important factor in terms of formation of the twinkling artifact in kidney stones. This artifact can be of use in anticipating the breakability of the stones of those patients to be treated with applied ESWL. One might anticipate that cases where the size of the stone is larger than 2 cm but no twinkling artifact is detected are calcium oxalate monohydrate, which is one of the stones with highest level of breakability.

[Biochemical changes in cavernosal tissue caused by single sided cavernosal nerve resection and the effects of alpha lipoic acid on these changes]. / Cambios bioquímicos en el tejido cavernoso causados por resección unilateral del nervio cavernoso y efectos del ácido alfalipoico en estos cambios.

OBJECTIVE: One of the most important complications of radical prostatectomy operation is erectile disfunction (ED). Oxidative stress patterns and apoptotic changes may happen in smooth muscles and endothelial cells of corpus cavernosum after neuropraxia or neurectomy. Alpha lipoic acid (ALA) shows its antioxidant properties by eliminating free radicals. In this experimental study we investigated the effects of ALA on rehabilitation of cavernosal tissue and nitric oxide synthase (NOS) containing nerve fibers on erectile tissue. MATERIALS AND METHODS: In this study four groups were formed by inclusion of 63 adult fertile rats. Control group (n: 9), sham operation group (n: 18), 18 rats underwent unilateral neurectomy of a 5-mm. segment of the cavernous nerve (group DI) and another 18 rats group which ALA received after unilateral neurectomy (group DII). Assessments were done 3 weeks after neurectomy. RESULTS: We assessed number of NOS containing nerve fibers via nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase staining. According to NADPH diaphorase staining group DII significantly recovered comparing group DI (48.89±19.00 and 17.22±6.67 respectively) (p<0.05). SOD activity is reduced in both; group DI and group DII (31.42±6.06 and 40.38±4.24). Nitrite+nitrate levels were elevated significantly in both group DI and group DII (0.52±0.05 and 0.44±0.02 micromole/gr wet tissue respectively) when compared with other groups (p<0.05). There is no statistical difference between results of group DI and Group DII (p>0.05). CONCLUSION: This study confirms that neurectomy caused decrease of intracavernous pressure and number of NOS fibers. Neurectomy and surgical trauma caused oxidative stress in rat corpus cavernosum. As a potent antioxidant ALA has positive effects on cavernosal tissue regeneration and rehabilitation by reducing oxidative stress. In this aspect, ALA may have a potential advantage in penile rehabilitation after radical prostatectomy.

Cambios bioquímicos en el tejido cavernoso causados por resección unilateral del nervio cavernoso y efectos del ácido alfalipoico en estos cambios / Biochemical changes in cavernosal tissue caused by single sided cavernosal nerve resection and the effects of alpha lipoic acid on these changes

Objetivo: Una de las complicaciones más importantes de la prostatectomía radical es la disfunción eréctil. Se pueden producir patrones de agresión oxidativa y cambios apoptóticos en los músculos lisos y en las células endoteliales del cuerpo cavernoso después de neuropraxia o neurectomía. El ácido alfalipoico (AAL) tiene propiedades antioxidantes, ya que elimina radicales libres. En este estudio experimental investigamos los efectos del AAL en la rehabilitación del tejido cavernoso y las fibras con sintasa del óxido nítrico (NOS) en el tejido eréctil. Materiales y métodos: Se formaron cuatro grupos en este estudio mediante la inclusión de 63 ratas fértiles adultas: 9 en el grupo de control, 18 en el grupo de operación simulada, 18 ratas sometidas a neurectomía unilateral de un segmento de 5 mm del nervio cavernoso (grupo DI) y otras 18 ratas que recibieron AAL después de la neurectomía unilateral (grupo DII). Las evaluaciones se realizaron 3 semanas después de la neurectomía. Resultados: Determinamos el número de fibras nerviosas que contenían NOS mediante tinción del fosfato del dinucleótido de nicotinamida adenina diaforasa. Según dicha tinción, el grupo DII se recuperó significativamente en comparación con el grupo DI (48,89±19,00 y 17,22±6,67, respectivamente) (p<0,05). La actividad de la superóxido dismutasa disminuyó en los grupos DI y DII (31,42±6,06 y 40,38±4,24 U/g de tejido húmedo). Las concentraciones de nitrito+nitrato aumentaron significativamente en el grupo DI y en el grupo DII (0,52±0,05 y 0,44±0,02 µmol/g de tejido húmedo, respectivamente) en comparación con los otros grupos (p<0,05). No hubo diferencias estadísticas entre los resultados del grupo DI y el grupo DII (p>0,05). Conclusión: Este estudio confirma que la neurectomía disminuye la presión intracavernosa y el número de fibras con NOS. La neurectomía y el trauma quirúrgico causaron agresión oxidativa en el cuerpo cavernoso de las ratas. Como potente antioxidante, el AAL tiene efectos positivos de regeneración y rehabilitación del tejido cavernoso al disminuir la agresión oxidativa. En este sentido, el AAL ofrece una posible ventaja en la rehabilitación del pene después de la prostatectomía radical (AU)

Objective: One of the most important complications of radical prostatectomy operation is erectile disfunction (ED). Oxidative stress patterns and apoptotic changes may happen in smooth muscles and endothelial cells of corpus cavernosum after neuropraxia or neurectomy. Alpha lipoic acid (ALA) shows its antioxidant properties by eliminating free radicals. In this experimental study we investigated the effects of ALA on rehabilitation of cavernosal tissue and nitric oxide synthase (NOS) containing nerve fibers on erectile tissue. Materials and methods: In this study four groups were formed by inclusion of 63 adult fertile rats. Control group (n: 9), sham operation group (n: 18), 18 rats underwent unilateral neurectomy of a 5-mm. segment of the cavernous nerve (group DI) and another 18 rats group which ALA received after unilateral neurectomy (group DII). Assessments were done 3 weeks after neurectomy. Results: We assessed number of NOS containing nerve fibers via nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase staining. According to NADPH diaphorase staining group DII significantly recovered comparing group DI (48.89±19.00 and 17.22±6.67 respectively) (p<0.05). SOD activity is reduced in both; group DI and group DII (31.42±6.06 and 40.38±4.24). Nitrite+nitrate levels were elevated significantly in both group DI and group DII (0.52±0.05 and 0.44±0.02 micromole/gr wet tissue respectively) when compared with other groups (p<0.05). There is no statistical difference between results of group DI and Group DII (p>0.05). Conclusion: This study confirms that neurectomy caused decrease of intracavernous pressure and number of NOS fibers. Neurectomy and surgical trauma caused oxidative stress in rat corpus cavernosum. As a potent antioxidant ALA has positive effects on cavernosal tissue regeneration and rehabilitation by reducing oxidative stress. In this aspect, ALA may have a potential advantage in penile rehabilitation after radical prostatectomy (AU)

Intravesical oxybutynin affects bladder permeability.

To investigate the effects of intravesical application of oxybutynin chloride on bladder permeability we designed an animal model. Female Guinea pigs were given 3 different test solutions: phosphate buffered saline (PBS), 50% acetone and 1.27 x 10(-2) M oxybutynin chloride solution. Then 99mTc-DTPA 45 microCi in 2 ml normal saline was instilled into the bladder lumen in each animals and allowed to dwell for 30 minutes. At the end of exposure time, the net count data in each 1 ml serum sample were corrected for radioactive decay and converted to the total percentage of administered dose. 99mTc-DTPA absorption percentages of both acetone and oxybutynin groups were significantly higher than that of PBS group (mean 3.2 +/- 2.9% p < 0.001). Intravesical oxybutynin application increases bladder permeability 5 times compared with PBS administration. This observation can also explain how rapid absorption of oxybutynin through the bladder into the systemic circulation occurs.

Experience with renal gunshot injuries in a rural setting.

OBJECTIVES: To investigate the high nephrectomy rate in patients with gunshot injury at Dicle University Medical School Research Hospital and to determine the factors that affect our nephrectomy decision. METHODS: During a 4-year period, 71 patients were hospitalized for renal injuries at our hospital. Renal gunshot injuries (RGIs) were noted in 45 kidneys of 42 patients (59.1%). Twenty-five patients underwent nephrectomy (55.5%). Twenty kidneys were reconstructed (44.4%). The hospital records were reviewed retrospectively. In these two groups of patients, the following clinical data were entered into a computer data base and compared: presence and type of hematuria, type and degree of renal injury, hemodynamic status, results of imaging studies, surgical technique, type of weapon, reason for nephrectomy, associated organ injury, injury severity score, complications, and mortality. RESULTS: The patients who underwent renal repair and those who underwent nephrectomy had a mean injury severity score of 33.6 +/- 7.5 and 42.0 +/- 9.9, respectively (P <0.001). The main grade of injury was 4.4 +/-0.8 in nephrectomy patients and 2.8 +/- 0.9 in the patients for whom renal salvage was possible (P <0.05). Patients who required nephrectomy, as a group, appeared to have a higher rate of high-velocity bullet injury (HVBI) (76%) (P <0.05) and higher numbers of associated abdominal injury (P <0.05). CONCLUSIONS: HVBI makes extensive tissue debridement imperative and reconstruction difficult. We believe that in RGIs caused by a high-velocity bullet, nephrectomy is more likely to be required. Hemodynamic instability was the major reason for our intraoperative nephrectomy decision. a subcategory of RGI.

Quantitative residual cortical activity measurement: appropriate test for diagnosis of renal artery stenosis?

OBJECTIVES: To evaluate the diagnostic validity of quantitative measurement of residual cortical activity (RCA) in renal artery stenosis (RAS). METHODS: In 45 patients with a high clinical likelihood of renovascular hypertension (RVH) and unimpaired renal function, dynamic imaging was performed after an intravenous bolus injection of 148 MBq (99m)Tc MAG3 for both baseline renoscintigraphy and captopril renography following oral application of 50 mg captopril. RCA was measured according to the Sfakianakis method: RCA = cortical counts at 20 min/counts at peak x100%. An increase in RCA of >/=5% from baseline was considered indicative of RAS. After renography, all patients underwent selective transfemoral angiography with the digital subtraction technique. A luminal reduction of >/=50% was considered as proof of RAS. RESULTS: The number of kidneys that had a change of >/=5% in RCA values was 12 (27.2%) in normal kidneys, 7 (58.3%) in the patients with bilateral RAS, 14 (82.3%) in the patients with unilateral RAS, and 21 (72.4%) in overall kidneys with RAS. The positive test ratio in pathologic groups was significantly higher than normal (p < 0.05). The sensitivity and specificity of the RCA test were 72.4 and 72.7%, respectively; the positive and negative predictive values were 63.6 and 80%, respectively. CONCLUSION: Quantitative measurements of RCA can be used as a diagnostic parameter of renal artery stenosis and may contribute of the diagnostic accuracy of visual interpretation and other renographic diagnostic criteria.

Whole-body microwave exposure emitted by cellular phones and testicular function of rats.

This study investigated whether there are adverse effects due to microwave exposure emitted by cellular phones in male rats. Eighteen Wistar Albino rats were separated into three groups, a sham group and two experimental groups. The rats were confined in Plexiglas cages and cellular phones were placed 0.5 cm under the cages. In the first experimental group, cellular phones were in standby position for 2 h. In the second experimental group, phones were turned to the speech position three times each for 1 min duration over 2 h. Rats in the first and second experimental groups were exposed to microwaves emitted by phones for 2 h/day for a duration of 1 month. After the last exposure the rats were killed. Brain, eyes, ears, liver, heart, lungs, stomach, kidneys, testes, small and large intestines and skin of the rats were observed histologically. The decrease of epididymal sperm counts in the speech groups were not found to be significant (P > 0.05). Differences in terms of normal and abnormal sperm forms were not observed (P > 0.05). Histological changes were especially observed in the testes of rats of the speech groups. Seminiferous tubular diameter of rat testes in the standby and speech groups was found to be lower than the sham group (P < 0.05). Rectal temperatures of rats in the speech group were found to be higher than the sham and standby groups (P < 0.05). The rectal temperatures of rats before and after exposure were also found to be significantly higher in the speech group (P < 0.05). Specific absorption rate (SAR) was determined as 0.141 W/kg.

Immunologic evaluation of a neonate born to an immunosuppressed kidney transplant recipient.

There are only a few reports about immunologic evaluation of neonates who have been exposed to immunosuppressive drugs during fetal life. We followed up immunoglobulins, T, B and natural killer (NK) cell levels in an infant of a kidney transplant recipient who has been exposed to cyclosporine, azathioprine, and prednisolone during his fetal life. B-cell percentage, absolute counts, and immunoglobulin levels were normal at birth, but IgG value was lower than our normal controls at 3 months and low normal at 6 months of age. Serum IgM levels were normal in all determinations, but IgA levels were lower than the control values during the follow-up period. B cell percentage and absolute counts were higher than the control values at 3 and 6 months. T-cell subpopulations were normal except for CD4+/CD8+ ratios that stayed high normal due to increased CD4+ cells. CD16+ (NK cells) absolute counts and percentages were below normal at birth and at 3 months. Clinically, increased susceptibility to infection was not observed during the follow-up period. More immunologic studies are needed on possible effects of in utero exposure to cyclosporine, azathioprine, and prednisolone.