Intraoperative Ultrasound Can Facilitate Laparoscopic Partial Nephrectomy in Adherent Perinephric Fat.

Background: Adherent perinephric fat (APF) is one of the challenging factors of laparoscopic partial nephrectomy (LPN). The aim of this study was to investigate the effect of intraoperative laparoscopic ultrasound (ILUS) on determining renal tumor localization and dissection in patients with APF who underwent LPN. Methods: Prospectively collected data from 517 patients who underwent LPN from October 2010 to September 2020 in tertiary university hospital were evaluated retrospectively. The cohort was divided into two main groups according to the Mayo Adhesive Probability (MAP) score: Group 1 (MAP score ≤3) and Group 2 (MAP score ≥4). After implementing propensity score-matched analysis including the complexity of tumor, age, and body mass index, Group 1 consisted of 202 patients with ≤3 MAP score and Group 2 included 46 patients. Then, both groups were allocated into two subgroups according to whether ILUS was used. Demographics, perioperative features such as perirenal fatty tissue dissection, tumor excision, operation time, and perioperative outcomes accepted as trifecta, considering warm ischemia time, negative surgical margin, and complications were compared. Results: In Group 1, ILUS use did not seem to affect perioperative outcomes in both subgroups. However, ILUS has a positive effect on perirenal fatty tissue dissection (10 versus 19 minutes, P = .011), tumor excision (4 versus 7 minutes, P = .005), and operation time (78 versus 90 minutes, P = .046) in Group 2. Trifecta outcomes were also better in higher MAP scores and ultrasound-used subgroups (P = .019). Conclusions: ILUS should be considered a helpful and effective instrument in overcoming APF in LPN. It might also have a positive effect on trifecta outcomes.

ApaL1 urokinase and Taq1 vitamin D receptor gene polymorphisms in first-stone formers, recurrent stone formers, and controls in a Caucasian population.

The purpose of this study was to determine differences in genotype distribution and allele frequency of urokinase and vitamin D receptor (VDR) single nucleotide polymorphisms (SNPs) between first-stone formers, recurrent stone formers, and controls in a Caucasian population. A total of 86 first-stone formers, 78 recurrent stone formers, and 167 controls were included. Urokinase and VDR SNPs were tested by gene amplification followed by ApaL1 and Taq1 endonuclease digestion, respectively. Baseline variables, genotype, and allele frequencies were compared between the three groups, using descriptive statistics. Adjusted odds ratios were calculated to estimate the risk for recurrent urolithiasis associated with genotypes. We found that differences in the distribution of ApaL1 SNP and Taq1 SNP genotypes were statistically different between recurrent stone formers and first-stone formers, and between recurrent stone formers and controls. Allele frequency analysis showed that the T allele for ApaL1 SNP and the C allele for Taq1 SNP were significantly associated with recurrent urolithiasis. For Taq1 SNP, logistic regression analysis showed that the C/C genotype was associated with a more than threefold higher risk for recurrent urolithiasis. We conclude that ApaL1 and Taq1 SNPs of the urokinase and VDR genes are associated with recurrent urolithiasis in a Caucasian population.

Risk factors for systemic inflammatory response syndrome following percutaneous nephrolithotomy.

The aim of this study was to analyze the pre- and intraoperative risk factors that affect the development of postoperative systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL). Medical records on 317 adult patients with the complete data who underwent single-stage PCNL and followed at our center were retrospectively studied. Patients' data were collected through a database which was collected prospectively. All patients' vital signs were recorded hourly in the postoperative period and were divided into two groups as patients developing SIRS and not developing SIRS. There were 202 men and 115 women with a mean age of 48 ± 13.7 (range 19-82) years. There were 53 (16.7 %) in the SIRS and 264 (83.3 %) patients in the non-SIRS group. Preoperative positive urine cultures (UCs), intraoperative positive renal pelvic urine cultures (RPUCs), and stone cultures (SCs) were strongly correlated with the development of SIRS (p = 0.001). In the SIRS developers' group, preoperative UCs, intraoperative RPUCs, and SCs were positive in 33.9, 22.5, and 28.6 % of patients, respectively, but only 9.8, 3.3, and 4.2 % for the corresponding specimens in non-SIRS group. Positive preoperative UCs, intraoperative RPUCs, and SCs are important factors indicating the development of postoperative SIRS. Appropriately treated preoperative urinary infections may not prevent infected urine at PCNL. RPUCs and SCs may be the only way to identify the causative organism and direct antimicrobial therapy, so we recommend collecting RPUCs and SCs routinely to identify the offending organism and guide treatment.

Single session removal of forgotten encrusted ureteral stents: combined endourological approach.

Forgotten ureteral stents represent a difficult problem for urologists; the major complications are infection, migration, encrustation, stone formation, and multifractured stent, and a consensus on the best therapeutic approach is lacking. Here we present our experience with endoscopic management of this challenging problem and discuss the various endourological approaches for treating forgotten encrusted ureteral stents. From January 2005 to December 2010, 19 patients (11 women and 8 men) with encrusted ureteral stents were retrospectively analyzed. Combined endourologic therapies including extracorporeal shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopic lithotripsy (URSL), and cystolithotripsy (CLT) were used to achieve stent removal. A total of 19 patients with encrusted ureteral stents were treated at our center. The mean patient age was 46.2 ± 18.5 years (8-81), the average indwelling time of the stent was 24.7 ± 19.0 months (8-93), and the mean hospital stay was 3.4 ± 4.0 days (range 1-15 days). Using the described combination of techniques, all stents and the associated stones were eventually removed without any complications and patients were rendered stone- and stent-free. A main element of the treatment strategy was to keep the number of interventions as low as possible. The use of various combinations of endourological techniques can achieve effective stent and stone treatment after a single anesthesia session with minimal morbidity and short hospital stay.

Renal hydatid cyst treatment: retroperitoneoscopic "closed cyst" pericystectomy.

Cystic hydatid disease is an endemic disease caused by the larval form of Echinococcus spp. Isolated renal involvement is extremely rare. The treatment methods for renal hydatid disease require some form of intervention, ranging from traditional open techniques to laparoscopic techniques. Herein, we present a large hydatid cyst in the lower pole of the left kidney in a 43-year-old male patient who was treated by the "closed cyst" method via the retroperitoneal laparoscopic approach to prevent soiling of the peritoneal cavity. To our knowledge, this is the first case of a renal hydatid cyst treated by preserving the renal parenchyma by pericystectomy via the retroperitoneoscopic laparoscopic approach in an adult patient. No complications occurred during the perioperative and postoperative periods. After 9 months of follow up, the patient was asymptomatic with no evidence of clinical recurrence. Retroperitoneoscopic laparoscopic closed cyst pericystectomy can be an alternative minimally invasive treatment technique for the treatment of renal hydatid disease.

Experimental unilateral spermatic cord torsion: the effect of polypolymerase enzyme inhibitor on histopathological and biochemical changes in the early and late periods in the ipsilateral and contralateral testicles.

OBJECTIVES: We wanted to show early and late biochemical, histopathological, and apoptotic changes caused by unilateral spermatic cord torsion in ipsilateral and contralateral testicles and the effect of the poly (adenosine triphosphate-ribose) polymerase (PARP) inhibitor, nicotinamide, on these changes in early and late periods. MATERIALS AND METHODS: Forty-seven Wistar albino rats were divided into 2 major groups as early and late periods. Subsequently, each group was divided into subgroups as control, sham, torsion-detorsion (TD), TD treated with saline (TDS), and TD treated with nicotinamide (TDN). Left testicles were subjected to spermatic cord torsion for 4 hours. Thirty-minutes before detorsion, 0.2 mL saline or 10 mg/kg nicotinamide was administered intraperitoneally to the TDS and TDN groups, respectively. Bilateral orchidectomy was performed by the end of the fourth hour in early and 2 months after TD in late groups and the animals were sacrificed. Apoptosis, Johnsen Tubular Biopsy Score, and seminiferous tubule diameter (STD) were used to evaluate histopathological changes. Ischemia-reperfusion injury-related changes were assessed by levels of malondialdehyde (MDA) and total and free glutathione in serum. RESULTS: There were no significant differences between groups in terms of serum MDA and total and free glutathione levels. Rats given nicotinamide had a higher number of spermatogonia in seminiferous tubules in early and late periods when compared with the untreated group (P <.05). In early and late groups, mean STD of contralateral and ipsilateral testicles were higher in rats given nicotinamide when compared with untreated groups. No significance was observed in terms of STD between early and late groups. Late groups treated with nicotinamide had less apoptosis when compared with untreated groups (P <.05). CONCLUSIONS: Nicotinamide may successfully decrease ischemia-reperfusion injury in early and late periods in both testicles.

CYP1A2, CYP2D6, GSTM1, GSTP1, and GSTT1 gene polymorphisms in patients with bladder cancer in a Turkish population.

Genetic differences in the metabolism of xenobiotics have recently been suggested as modifiers of individual susceptibility to bladder cancer (BC). The objective of this study was to investigate the relationship between bladder tumor and variants of cytochrome p450 1A2 (CYP1A2) 734 C --> A, cytochrome p450 2D6 (CYP2D6) 1934 G --> A, glutathione S-transferase M1, (GSTM1 null), glutathione S-transferase T1 (GSTT1 null), and glutathione S-transferase P1 (GSTP1) I105 V. We investigated the distribution of these polymorphisms in 135 BC patients and in 128 age and sex-matched cancer-free controls. The polymorphisms were analyzed using polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) assay and the multiplex PCR method. Genotype and allele frequencies and their associations with BC risk, demographic factors, smoking status, and tumor stage were investigated. The prevalence of GSTT1 null genotype in cases was 23%, compared with 7% in the control group (OR = 3.94, 95% CI = 1.70-9.38, P = 0.001). There was no association between the studied polymorphisms of CYP1A2, CYP2D6, GSTM1, and GSTP1 genes and BC. There was an association between smoking status and BC. These data seem to indicate that GSTT1 gene polymorphism may be associated with BC in the Turkish population studied. Further studies will be needed to clarify the role of such variation in determining susceptibility to BC.

Vitamin D receptor gene polymorphisms in patients with urolithiasis.

Urolithiasis is a multifactorial disease, the onset and severity of which is influenced by both genetic and environmental factors. This study represents an investigation of the role of vitamin D receptor (VDR) gene polymorphisms (ApaI, BsmI, and TaqI) and combined genotypes in urolithiasis in a Turkish population. We studied 110 patients with urinary stones and 150 control subjects. The polymorphic regions were amplified using polymerase chain reaction, followed by digestion with restriction enzymes BsmI, ApaI, and TaqI, and analyzed electrophoretically. Genotype and allele frequencies were calculated, and the association with urolithiasis, family history, and recurrence of stone was investigated. Our data provide no evidence for an association between urolithiasis and VDR ApaI, BsmI, and TaqI genotypes. We also analyzed the effects of VDR ApaI, BsmI, and TaqI genotypes in combination; the "GTT" VDR haplotype, constructed from three adjacent restriction fragment length polymorphisms was overrepresented among the urolithiasis patients. However, no significant differences between heterozygous carriers (OR 1.302; 95% CI 0.527-3.215) and homozygous carriers (OR 3.39; 95% CI 0.719-15.985) were observed in our study population. A significant association was found only between the ApaI polymorphism and family history (P=0.017; chi (2)=5.657). Our data indicate that the VDR ApaI, BsmI, and TaqI polymorphisms do not confer a significant risk for urolithiasis.