Protective Effects of Astaxanthin on Nephrotoxicity in Rats with Induced Renovascular Occlusion.

BACKGROUND: Various effects of Astaxanthin were shown in the studies, including its antioxidant, anti-inflammatory, anti-tumor and immunoregulatory effects. OBJECTIVE: The aim of this study was to evaluate the beneficial effects of Astaxanthin on renovascular occlusion induced renal injury and to investigate the possible mechanisms. METHODS: The rats were randomly assigned into three groups as follows: Group 1: control group (n=12), Group 2: renal ischemia-reperfusion injury group (n=12), Group 3: renal ischemia-reperfusion + asthaxantine treated group (n=12). The control group and the renal ischemia-reperfusion group were given 2cc/kg/g olive oil for 7 days before establishing ischemia to renal tissue. Astaxanthin dissolved in olive oil was given orally to the renal ischemia+astaxanthin group for 7 days before inducing renal ischemia. Caspase-(3, 8, 9), GSH, SOD, Total Thiol, TNF-α, IL-6, 8-OHdG were evaluated in each group. RESULTS: Renal IRI was verified by analysing the pathological changes of renal tissues and the renal functions after renal reperfusion. Much less renal tubular damage was determined in the IRI+ASX group in comparison to the IRI group. Caspase-8, -9 and -3 immunoreactivity was observed to be minimal in the control group. Apoptosis was observed to be significantly reduced in the IRI + ASX group with respect to the IRI group and close to the level of the control group (p <0.05). Caspase-3 levels of tissue samples were significantly increased in the IRI group compared to the other groups, but significantly lower in the IRI+ASX group with respect to the IRI group (p<0.05). The TOS and OSI levels, indicating increased oxidative stress, were significantly lower in the IRI+ASX group with respect to the IRI group (p <0.001), but still higher than the control group (p <0.001). In addition to GSH, SOD and Total Thiol levels, TAS levels were also significantly higher in the IRI + ASX group in comparison to the IRI group (p <0.05). TNF-α, IL-6, lipid hydroperoxide, AOPP and 8-OHdG levels were lower in the IRI+ASX group than the IRI group (p <0.001). MPO, IL-6, TNF-α levels, representing the parameters indicating neutrophil infiltration and inflammation of the renal tissues, significantly increased in the IRI group with respect to the other groups (p <0.005). CONCLUSION: When all the data obtained in our study were evaluated, ASX was determined to prevent renal damage due to renovascular occlusion to a great extent, through complex mechanisms involving antioxidant, anti-inflammatory and antiapoptotic effects. Biochemical, histological and oxidative stress parameters were improved due to ASX.

A new surgical technique: transvesical prostate resection

ABSTRACT Objectives: Surgical treatment is indicated in patients where medical therapy fails to prove beneficial or in patients who develop complications related with bladder outlet obstruction. In our study, we developed a new surgical technique which can be defined as Transvesical Resection of Prostate (TVRP) without using the urethra. This method was previously described in our articles (1). Materials and Methods: A 62-years-old male patient, using an alpha blocker agent for 5 years, reported increased discomfort with urination. His findings were as follows: PSA: 1.2 ng/dL, prostate volume: 45 cc, digital rectal examination: benign, IPSS: 30, QoL: 5, Qmax: 6, urine volume: 225 cc, post-mictional residue: 65 cc. Eventually the patient was informed and prostate resection decision was made. Results: Suprapubic catheter was removed 1 day after surgery and the patient was discharged. Urethral catheter was removed 4 days after urine output became clear. No complications developed after the operation. At postoperative 1st month, Qmax was 22, urine volume was 260 cc, post-mictional residue was 40 cc, IPSS was 8, QoL was 1, and the pathology was benign prostate tissue. Conclusions: Urethral stricture is one of the most important postoperative complications of TURP. The incidence of urethral stricture is reported between 2.2% and 9.8% in different series (2-5). In this technique which we developed, urethra is not used and prostate is removed through the bladder, similar to open prostatectomies. For this reason, we suggest that it has an advantage over TURP, regarding urethral stricture development.

Spectral domain optical coherence tomography findings in Turkish sickle-cell disease and beta thalassemia major patients.

PURPOSE: To assess probable structural changes using spectral domain optical coherence tomography (SD-OCT) on sickle-cell disease (SCD) and beta thalassemia major (B-TM) patients, without any retinal abnormalities. METHODS: This cross-sectional study included 32 B-TM, 34 SCD patients, and 44 healthy controls. One of the eyes of all participants was evaluated for SD-OCT and choroidal thickness, retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), ganglion cell complex (GCC). RESULTS: Age, gender, and intraocular pressure (IOP) were not statistically different between the three groups. Hemoglobin (Hgb), hematocrite (Htc), and ferritin levels were not statistically different between the SCD and B-TM groups. Choroidal thickness at the subfoveal region was statistically higher in the control group (353.79 ± 71.93) than in the B-TM (317.41 ± 53.44) and SCD (283.21 ± 63.27) groups. In addition, it was statistically higher in the B-TM group than the SCD group (P = 0.05). CMT did not differ among the three groups, average RNFL was only significantly thinner in SCD than in controls, and GCC thickness was significantly thinner in SCD than in controls and B-TM. CONCLUSION: In both diseases, we can show early structural changes even if proliferative or non-proliferative retinopathy or other ocular manifestations were not developed yet.

Feasibility of Transvesical Prostate Resection and Its Effect on Postoperative Complications.

OBJECTIVE: To study the feasibility of transvesical prostate resection and its effect on urethral stricture. MATERIALS AND METHODS: We included 99 patients with symptomatic bladder outlet obstruction who underwent transvesical resection of prostate (TVRP; n = 48) and transurethral (TURP; n = 51) prostatectomy. We examined all the patients by means of digital rectal examination, transrectal ultrasound, and evaluated them by international prostate symptom score, quality of life score, uroflowmetric assessment and PSA level, and established definitive diagnosis. We followed up the patients in first month, third month, and the first year of the operation and monitored once a year in the following years. RESULTS: In this study, totally 99 symptomatic bladder outlet obstruction patients were included (TVRP = 48 and TURP = 51). Mean age of the patients were 66.5 ± 8.2vs 68 ± 9.8years for our patients with TVRP and TURP, respectively. Two groups displayed similar values in terms of improvements in the Qmax and PVR, and there were no statistically significant differences in between. We obtained similar values for resection time and weight of resected prostate tissue in both groups. Urethral stricture was not observed in TVRP group. In TURP group however, stricture was observed in 4 (7.8%) patients in bulbar urethra in sixth month at average. And there was also a concomitant urethral meatal stricture in one of these patients. When the 2 groups were compared, the rate of urethral stricture was statistically significantly higher in the TURP group (P = .001). CONCLUSION: Resection of prostate without using urethra significantly reduces the incidence of urethral stricture due to mucosal damage.

A new surgical technique: transvesical resection of prostate - case series

ABSTRACT Objective: To protect the urethra from instrumentation related urethra injures and stricture, we developed a new surgical technique which can be defined as transvesical resection of prostate without using urethra. Materials and Methods: Our study included 12 consecutive bladder outlet obstruction patients treated with transvesical prostate resection in our clinic between March 2016 and May 2016. Detailed anamnesis, results of physical examination, digital rectal examination, routine lab tests, international prostate symptoms score, transrectal ultrasound, measurement of prostate-specific antigen levels and uroflowmetry was performed in all patients prior to surgery. Results: Hospitalization period following surgery was 1 day. Foley catheter and suprapubic cystostomy catheters were removed in a median period of 3.6 days and 1 day. Median mass of resected adenomas was measured as 21.8 gr. Median maximum flow rate was measured as 6mL/s. Median postvoid residual urine volume was 70.6 cc and median international prostate symptoms score and quality of life scores were 9 and 1.4, respectively. Conclusion: In this study, we would like to show the possible practicality of transvesical resection of prostate technique in this patient group. However, we think that this technique is very useful in special patient groups such as patients with bladder stones, priapism and penile prosthesis.

The factors that affect the prediction of lymph node metastasis in prostate cancer.

OBJECTIVE: We aimed to demonstrate the effects of clinical evaluations as well as biopsy characteristics in terms of lymph node involvement (LNI) despite the small number of patients in our study. MATERIALS AND METHODS: A total of 221 patients who underwent radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND) in our clinic between 2010 and 2015 and who met the inclusion criteria were enrolled in our study group. All of the patients were evaluated in terms of age, prostate-specific antigen (PSA) value before transrectal ultrasound-guided prostate biopsy (TRUSPB), digital rectal examination, Gleason score (GS) on TRUSPB, percentage of positive cores on TRUSPB, total number of positive cores, highest percentage of cancer in positive cores, and number of lymph nodes removed at RP. Pathological examination of the data of RP specimens, PSA values in follow-up after surgery, and follow-up periods was recorded. The TNM 2009 classification was used for staging. RESULTS: In the evaluation of LNI risk, as regards the assessment of predictors and outcomes with respect to the univariate and multivariate analyses, LNI was found in the univariate analysis to be associated with GS, clinical stage, number of lymph nodes removed according to the D'Amico risk classification. In the multivariate analysis, however, the number of lymph nodes removed was found significant. CONCLUSION: Risk stratification should be considered in patients with prostate cancer while selecting the patients who would undergo pelvic lymphadenectomy. In addition, ePLND should be performed to patients undergoing lymphadenectomy.

A new surgical technique: transvesical resection of prostate - case series.

OBJECTIVE: To protect the urethra from instrumentation related urethra injures and stricture, we developed a new surgical technique which can be defined as transvesical resection of prostate without using urethra. MATERIALS AND METHODS: Our study included 12 consecutive bladder outlet obstruction patients treated with transvesical prostate resection in our clinic between March 2016 and May 2016. Detailed anamnesis, results of physical examination, digital rectal examination, routine lab tests, international prostate symptoms score, transrectal ultrasound, measurement of prostate-specific antigen levels and uroflowmetry was performed in all patients prior to surgery. RESULTS: Hospitalization period following surgery was 1 day. Foley catheter and suprapubic cystostomy catheters were removed in a median period of 3.6 days and 1 day. Median mass of resected adenomas was measured as 21.8 gr. Median maximum flow rate was measured as 6mL/s. Median postvoid residual urine volume was 70.6 cc and median international prostate symptoms score and quality of life scores were 9 and 1.4, respectively. CONCLUSION: In this study, we would like to show the possible practicality of transvesical resection of prostate technique in this patient group. However, we think that this technique is very useful in special patient groups such as patients with bladder stones, priapism and penile prosthesis.

Does preoperative neutrophil/lymphocyte rate have an effect on survival of the bladder cancer patients who received radical cystectomy?

INTRODUCTION: Radical cystectomy (RC) is the standard treatment model in invasive bladder cancer patients. Risk definitions before RC is mainly based on pathological results. Neutrophil/lymphocyte (N/L) rate is one of the inflammation markers. Some other studies reported negative prognostic results with increased N/L rates. In our study, we reviewed the relationship between preoperative N/L rate and clinicopathological results following RC. MATERIALS AND METHODS: Data gathered from 296 bladder cancer patients that received RC between 2002 and 2012 were retrospectively reviewed. All patients received preoperative routine hematological and biochemical tests and metastasis screening. All patients were treated with radical cystoprostatectomy and standard pelvic lymph node dissection. The cutoff value for N/L rate was calculated using a web-based "cutoff finder" software. RESULTS: Patient mean age was calculated as 65.7 years. Mean follow-up period was 24.5 (2-84) months. Cancer-related death was seen in 132 (44.6%) patients. Multivariate analysis showed age, lymph node metastasis, and low N/L rate as significant in cancer-specific survival. CONCLUSION: In our study, age, lymph node metastasis presence, and preoperative low N/L rates were detected as independent risk factors in RC cases. N/L rate, which is relatively easy to assess during preoperative period, could be beneficial in planning postoperative adjuvant treatments in those patients.

Does a previous prostate biopsy-related acute bacterial prostatitis affect the results of radical prostatectomy?

ABSTRACT Objective To The standard technique for obtaining a histologic diagnosis of prostatic carcinomas is transrectal ultrasound guided prostate biopsy. Acute prostatitis which might develop after prostate biopsy can cause periprostatic inflammation and fibrosis. In this study, we performed a retrospective review of our database to determine whether ABP history might affect the outcome of RP. Materials and Methods 441 RP patients who were operated in our clinic from 2002 to 2014 were included in our study group. All patients' demographic values, PSA levels, biopsy and radical prostatectomy specimen pathology results and their perioperative/ postoperative complications were evaluated. Results There were 41 patients in patients with acute prostatitis following biopsy and 397 patients that did not develop acute prostatitis. Mean blood loss, transfusion rate and operation period were found to be significantly higher in ABP patients. Hospitalization period and reoperation rates were similar in both groups. However, post-op complications were significantly higher in ABP group. Conclusion Even though it does not affect oncological outcomes, we would like to warn the surgeons for potential complaints during surgery in ABP patients.

Does a previous prostate biopsy-related acute bacterial prostatitis affect the results of radical prostatectomy?

OBJECTIVE: To The standard technique for obtaining a histologic diagnosis of prostatic carcinomas is transrectal ultrasound guided prostate biopsy. Acute prostatitis which might develop after prostate biopsy can cause periprostatic inflammation and fibrosis. In this study, we performed a retrospective review of our database to determine whether ABP history might affect the outcome of RP. MATERIALS AND METHODS: 441 RP patients who were operated in our clinic from 2002 to 2014 were included in our study group. All patients' demographic values, PSA levels, biopsy and radical prostatectomy specimen pathology results and their perioperative/postoperative complications were evaluated. RESULTS: There were 41 patients in patients with acute prostatitis following biopsy and 397 patients that did not develop acute prostatitis. Mean blood loss, transfusion rate and operation period were found to be significantly higher in ABP patients. Hospitalization period and reoperation rates were similar in both groups. However, post-op complications were significantly higher in ABP group. CONCLUSION: Even though it does not affect oncological outcomes, we would like to warn the surgeons for potential complaints during surgery in ABP patients.

Effect of delayed radical cystectomy for invasive bladder tumors on lymph node positivity, cancer-specific survival and total survival.

INTRODUCTION: Radical cystectomy (RC) is the main treatment option for patients with muscle-invasive bladder cancer (MIBC) and non-muscle-invasive bladder cancer (NMIBC), which carry the highest risk of progression. In this study, we investigated the effect of time from transurethral resection of the bladder (TUR-B) to cystectomy on lymph node positivity, cancer-specific survival and overall survival in patients with MIBC. METHODS: The records were reviewed of 530 consecutive patients who had RC and pelvic lymphadenectomy procedures with curative intent performed by selected surgeons between May 2005 and April 2016. Our analysis included only patients with transitional cell carcinoma of the bladder; we excluded 23 patients with other types of tumor histology. RESULTS: Patients who underwent delayed RC were compared with patients who were treated with early RC; both groups were similar in terms of age, gender, T stage, tumor grade, tumor differentiation, lymph node status and metastasis status. However, when both groups were compared for disease-free survival and overall survival, patients of the early-RC group had a greater advantage. CONCLUSIONS: The optimal time between the last TUR-B and RC is still controversial. A reasonable time for preoperative preparation can be allowed, but long delays, especially those exceeding 3 months, can lead to unfavorable outcomes in cancer control.

Effects of previous unsuccessful extracorporeal shockwave lithotripsy treatment on the performance and outcome of percutaneous nephrolithotomy.

OBJECTIVE: To evaluate the effects of previous unsuccessful extracorporeal shockwave lithotripsy (ESWL) treatment on the performance and outcome of percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: Of 1625 PCNL procedures performed in our clinic, 393 renal units with similar stone burden and number of accesses was included in the present study. We categorised the study patients into two groups according to whether they underwent ESWL within 1 year prior to PCNL or not. Accordingly, Group 1 comprised 143 (36.3%) ESWL-treated patients and Group 2 comprised 250 (63.7%) non-ESWL-treated patients. RESULTS: Residual stones were detected in 36 (25.1%) of the ESWL-treated patients (Group 1) and in 60 (24%) of non-ESWL-treated patients (Group 2). There were no statistically significant differences between the groups for length of hospital stay (LOS), nephrostomy tube removal time, and the presence of residual stones. When we evaluated the groups for both the preoperative and postoperative haemoglobin (Hb) drop and blood transfusion rate, manifest Hb declines and more transfusions were required in the ESWL-treated patients (both P = 0.01). CONCLUSIONS: In our study, previous ESWL treatment had no influence on the PCNL stone-free rate, operation time, incidence of postoperative complications, and LOS, in patients with similar stone burdens. However, bleeding during PCNL was more prevalent in the ESWL-treated patients, so close attention should be paid to bleeding in patients who have been pretreated with ESWL.

Is Prostate Biopsy Recommended in Turkish Men with a Prostate-Specific Antigen Level between 2.5 and 4 ng/mL?

BACKGROUND: Prostate cancer is the most common solid tumor. The incidence of prostate cancer shows regional and racial differences. The ideal PSA threshold for prostate biopsy is still being debated. OBJECTIVE: We aimed to investigate cancer detection rates in Turkish men who underwent transrectal ultrasound-guided prostate biopsy (TRUSPB) who had prostate-specific antigen (PSA) levels in the range of 2.5 to 4.0 ng/mL and compare them with the rates of cancer in patients with PSA levels in the range of 4.0 to 10.0 ng/mL. METHODS: All Turkish men who underwent TRUSPB in our clinic between January 2012 and May 2014 were included; that is, 101 patients (Group 1) with PSA level in the range of 2.5 to 4.0 ng/mL and 522 patients (Group 2) with PSA level in the range of 4.0 to 10.0 ng/mL. Mean PSA level, age, prostate volume, and cancer detection rates were evaluated. RESULTS: The mean age was 60.5 and 64 years in Group 1 and Group 2, respectively (P = 0.06). The mean PSA level was determined as 3.1 and 6.8 ng/mL in Group 1 and Group 2, respectively (P = 0.03). The cancer detection rate was 12.7% in Group 1 (n = 13) and 30.8% in Group 2 (n = 161), which revealed a statistically significant difference between the 2 groups (P = 0.001). In Group 1, 9 of 13 patients (69%) had Gleason score of 6, 3 (23%) had Gleason score of 7, and 1 (8%) had a Gleason score of 8. CONCLUSIONS: The cancer detection rate is lower in Turkish men with PSA level in the range of 2.5 to 4.0 ng/mL when compared with men with PSA level in the range of 4.0 to 10.0 ng/mL. Furthermore, most patients in whom cancer was detected who have a PSA level in the range of 2.5 to 4.0 ng/mL are low risk. Therefore, the benefit of TRUSBP in Turkish men with PSA level between 2.5 and 4 ng/mL is low.

Correlation between lower urinary tract symptoms and objective measures of uroflowmetry.

Indroduction: Benign prostate hyperplasia (BPH) is the most commonly diagnosed benign adenoma which causes serious clinical symptoms by bladder outlet obstruction. BPH patients suffer from negative changes in their quality of life and restriction of their daily activities due to the disease symptoms. Our main objective in this study is to evaluate the relationship between BPH and LUTS as described by International Prostate Symptoms Score and objective non-invasive parameters related to BPH. MATERIALS AND METHODS: 238 Patients over 40 years with clinical BPH, LUTS and/or prostate volumes greater than 25 ml who presented to urology department were included in the study. All patients included in the study were subjected to a standardized diagnostic panel which included patient history, physical examination, biochemistry panels and urinalysis. RESULTS: Results showed an increase in symptom scores with age. As symptom scores go from mild to severe; Qmax values showed a decrease meanwhile prostate volume, PSA and postvoid residue increased. Again, in terms of erectile dysfunction, erectile dysfunction complaints increased with increased IIEF symptom scores. When all these results were evaluated, a positive correlation was seen between uroflowmetry parameters with patient symptoms, PSA and IIEF scores. CONCLUSION: From our study results, we can conclude that uroflowmetry is a very useful tool in monitoring lower urinary system complaints.

Predictive factors for stone disease in patients with renal colic.

INTRODUCTION: Many patients present to urology and emergency departments for acute renal colic complaints. There are many different imaging studies that can be used in patients with a pre-diagnosis of acute renal colic. In this study, we would like to assess the efficacy of using clinical and laboratory results in patients with flank pain complaint as a predictive factor of urinary system stone disease. MATERIALS AND METHODS: All patients were assessed using spinal non-contrast complete abdominal computerized tomography and urine analysis. Presence of stones and their number and size were recorded. RESULTS: 516 patients who were included in the study were divided into 2 groups according to urinary stone presence. Group 1 (n = 388) consisted of patients with stones meanwhile patients in Group 2 (n = 128) were stone-free. According to these results, male sex, presence of microscopic hematuria, stone history in the family, nausea and emesis in addition to pain and accompanying urinary symptoms were detected as predictive factors in diagnosing urinary stone disease by multivariate analysis. CONCLUSION: From our study results, we can conclude that uroflowmetry is a very useful tool in monitoring lower urinary system complaints.

Can We Use Single-step Dilation as a Safe Alternative Dilation Method in Percutaneous Nephrolithotomy?

OBJECTIVE: To examine the outcomes of the patients who underwent percutaneous nephrolithotomy with single-step dilatation technique in our clinic. MATERIALS AND METHODS: A total of 932 patients who underwent percutaneous nephrolithotomy by using single-step dilation technique in the period between 2008 and 2015 in our clinic were included in the study. Data of the patients were analyzed, such as age, sex, stone burden, operative time, fluoroscopy time, operation success, and perioperative and postoperative complications. RESULTS: An analysis of the data of 932 patients revealed similar operation success and complication rates as in the literature. Mean age of the patients included in the study was 48.9 years. Mean operative time was 66.6 minutes and mean fluoroscopy time was 139 seconds. Postoperative residual stone was detected in 17.1% of the patients. Postoperative fever was observed in 29 patients (3.1%), and sepsis developed in 11 (1.1%) of them. Additional postoperative procedures were required in 29 patients (3.1%). No patient was lost due to complications. Our data were compatible with the literature. CONCLUSION: Single-step dilation technique can be used as an effective and safe alternative dilation method in adult patients.

Is a second look necessary in multiple and/or large Ta tumors?

INTRODUCTION: Most of the bladder cancers are tumors without muscle invasion at the time of diagnosis. Transurethral resection is the standard treatment in bladder tumors without muscle invasion. Proper review of transurethral resection is important for correct risk classification. In this study, our main objective was to show that a "second look" in patients with multiple and/or > 3 cm tumors regardless of T stage during the early term can be helpful in detection of possible residues and determining risk classification. MATERIALS AND METHODS: 156 patients with primary, multiple and/or > 3 cm tumors were included in the study. Patients were divided into 3 groups as Group 1 (Ta), Group 2 (T1 without second TUR) and Group 3 (T1 with second TUR). Macroscopic tumor occurrence rates were compared in their 3rd month control cystoscopy. RESULTS: Macroscopic tumor detection rates in patients' 3rd month control cystoscopy were 21 (46.7%) in Group 1, 18 (30%) in Group 2 and 4 (7.8%) in Group 3. When compared with Group 3 patients, Group 1 and Group 2 had higher statistically significant macroscopic tumor detection rates (p = 0.001) CONCLUSION: A second look in patients with multiple and/or > 3 cm tumors during early term will enable the surgeons to detect possible tumors and do a better job in risk classification.

Percutaneous nephrolithotomy with one-shot dilation method: Is it safe in patients who had open surgery before?

INTRODUCTION: This study aimed to evaluate whether one-shot dilatation technique is as safe in patients with a history of open-stone surgery as it is in patients without previous open-stone surgery. METHODS: Between January 2007 and February 2015, 82 patients who underwent percutaneous nephrolithotomy (PNL) surgery with one-shot dilation technique who previously had open-stone surgery were retrospectively reviewed and evaluated (Group 1). Another 82 patients were selected randomly among patients who had PNL with one-shot dilation technique, but with no history of open renal surgery (Group 2). Age, gender, type of kidney stone, duration of surgery, radiation exposure time, and whether or not there was any bleeding requiring perioperative and postoperative transfusion were noted for each patient. RESULTS: The stone-free rates, operation and fluoroscopy time, and peroperative and postoperative complication rates were similar in both groups (p>0.05). CONCLUSIONS: Our experience indicated that PNL with one-shot dilation technique is a reliable method in patients with a history of open-stone surgery.