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Renal cell carcinoma (RCC) is the predominant type of kidney cancer. Mammalian target of rapamycin (mTOR) inhibitor everolimus is currently used as a second-line therapy for sorafenib or sunitinib-refractory metastatic RCC patients. The clinical limitation confronted during everolimus therapy is the onset of drug resistance that decreases the efficacy of the drug. Elevated level of anti-apoptotic Bcl-2 protein is proposed to be an emerging feedback loop for the acquired drug-resistance in various cancer types. In this study, the Bcl-2 inhibitor ABT-737 was used in combination with everolimus to enhance its anti-tumor effectiveness in everolimus-resistant RCC cell lines. Everolimus and ABT-737 combination synergistically led to a decrease in the proliferation of primary site A-498 and metastatic site Caki-1 RCC cell lines, which was accompanied by a reduction in protein levels of cell cycle and mTOR pathway proteins. In both RCC cell lines, everolimus-ABT-737 combination not only induced apoptosis, caspase and PARP-1 cleavage but also a decrease in Bcl-2 protein levels in parallel with a concomitant increase in Bim and Noxa levels. In order to confirm our in vitro findings, we have generated everolimus-resistant RenCa cell line (RenCares) to establish a RCC mouse xenograft model. Animals co-treated with everolimus and ABT-737 exhibited a complete suppression of tumor growth without any notable toxicity. This study thus proposes the everolimus-ABT-737 combination as a novel therapeutic strategy for the treatment of RCC to overcome the current clinical problem of everolimus resistance. © Ivyspring International Publisher. Türkiye Bilimsel ve Teknolojik AraÅ?tirma Kurumu: 114S332 This work was partly supported by The Scientific and Technological Research Council of Turkey (Grant number 114S332) and Yeditepe University Hospital. A. H. Nayman is a recipient of doctoral fellowships from the Yeditepe University. H. Siginc is a recipient of doctoral fellowship from The Scientific and Technological Research Council of Turkey. We thank Emrah Nikerel (Yeditepe University, Turkey) for advices concerning the statistical analysis. We would also like to acknowledge Burcin Asutay and Engin Sumer (Yeditepe University, Turkey) for their technical support.

Background: Prostate cancer is one of the most common solid tumors and the second leading cause of the death due to malignancy in men. Caspase 9 (CASP9) is a member of the intrinsic pathway and plays a central role in the apoptosis. Patients and Methods: Genotyping of the CASP9 (rs1052576) polymorphism were performed using real-time polymerase chain reaction for blood samples of prostate cancer patients (n=69) and controls (n=76). Results: There were no significant differences between the groups in the frequency of CASP9 genotypes (chi 2 = 1.363; p=0.506). Patients with CASP9 (rs1052576) CT genotype were 12.8 fold higher in pathological stage of pT2a compared to any other stages of cancer (OR=0.078, 95% CI= 0.009-0.062; p=0.004). Also TT genotype carriers were 11.3 times lower in pathological stage of pT2a (OR=11.33, 95% CI= 2.39-53.748; p=0.000). C allele carriers were 11.36 fold higher in pathological stage of pT2a compared to any other stages of cancer (OR=0.088, 95% CI= 0.019-0.418; p=0.002). Conclusion: CASP9 (rs1052576) C allele was decreasing the risk for pathological stage of patients with prostate cancer and also CT genotype had positive impact on pathological stage of patients with prostate cancer. CASP9 (rs1052576) TT genotype was seemed to be associated with higher risk of pathological stage. Those results implicated that CASP9 variations could be associated with severity of prostate cancer.

BACKGROUND: Apolipoprotein E (ApoE) is a potential inhibitor of cell proliferation, immune regulation and modulation of cell growth and differentiation; it also has a substantial role in antioxidant activity. ApoE has a potential role in prostate cancer progression.MATERIALS AND METHODS: ApoE genotyping was performed using real-time polymerase chain reaction (RT-PCR) for blood samples from a group of patients with prostate cancer (n=68) and a control group (n=78).RESULTS: The frequency of the E3/E3 genotype was significantly higher in patients compared to controls (p=0.004). E3/E3 genotype carriers were 3.6-fold more likely to be patients than controls (odds ratio=3.67, 95% confidence interval=1.451-9.155; p=0.004). Additionally, the patients with E3/E3 genotype had significantly higher Gleason score (p=0.017), and more patients with this genotype had a Gleason score higher than 7 (p=0.007). Individuals carrying the E4 allele were significantly more common in the control group (p=0.006). The frequency of the E3/E4 genotype was found to be significantly higher in controls compared to patients (p=0.007), and patients were significantly less likely to have this genotype than controls (odds ratio=0.89, 95% confidence interval=0.833-0.967, p=0.007). Individuals carrying the E2/E3 genotype had a significantly lower Gleason score (p=0.049)-all of the patients with this genotype had a Gleason score lower than 7 (p=0.024).CONCLUSION: E3/E3 genotype may be a potential risk factor for prostate cancer and high Gleason scoring. The E4 allele maybe a risk-reducing factor for prostate cancer. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

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Background: Cytokine-mediated immune and inflammatory responses are considered to play an important role in the pathogenesis of prostate cancer. The present study investigated certain interleukin-1 beta (IL1 beta) polymorphisms and their association with prostate cancer. Materials and Methods: Genotyping of the IL1B-31(rs 1143627 G>A) and IL1B-511(rs 16944 A

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Purpose: The aim of this study was to compare the diffusion tensor parameters of prostate cancer, prostatitis and normal prostate tissue. Materials and Methods: A total of 25 patients with the suspicion of prostate cancer were included in the study. MRI was performed with 3 T system (Intera Achieva, Philips Medical Systems, The Netherlands). T2 TSE and DTI with ss-EPI were obtained in each subject. TRUS-guided prostate biopsy was performed after the MRI examination. Images were analyzed by two radiologists using a special software system. ROI's were drawn according to biopsy zones which are apex, midgland, base and central zone on each sides of the gland. FA and ADC values in areas of cancer, chronic prostatitis and normal prostate tissue were compared using Student's t-test. Results: Histopathological analysis revealed carcinoma in 68, chronic prostatitis in 67 and was reported as normal in 65 zones. The mean FA of cancerous tissue was significantly higher (p < 0.01) than the FA of chronic prostatitis and normal gland. The mean ADC of cancerous tissue was found to be significantly lower (p < 0.01), compared with non-cancerous tissue. Conclusion: Decreased ADC and increased FA are compatible with the hypercellular nature of prostate tumors. These differences may increase the accuracy of MRI in the detection of carcinoma and to differentiate between cancer and prostatitis. © 2010 Elsevier Ireland Ltd.

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Objectives: There is a small risk of ureteral injury during laparoscopic radical prostatectomy (LRP). It is important to recognise and repair such ureteral injuries immediately. Laparoscopic reconstructive surgery has proven to be feasible for the treatment of ureteral injury. We report our experience of ureteral injuries during LRP including the incidence, mechanism of injury, management, prevention and outcome. Materials and methods: During a 9-year period, 2,164 LRP's were performed at our clinic. Three cases were complicated by lower ureteral injuries including two complete and one partial transection. The complete transections occurred during posterior dissection of the bladder neck and seminal vesicles, and the partial transection during an extended lymph node dissection. All were recognised and managed intraoperatively. We performed Lich-Gregoir (LG) extravesical ureteral reimplantation for complete transections, and primary repair for the partial ureteral transection. Results: Overall, the incidence of ureteral injuries was 0.13%. Laparoscopic reconstructive surgery was performed successfully in all cases without complication. This added 71, 46 and 59 min, respectively, to LRP operative time. The postoperative course was uneventful in all patients. Hospital stay was 8 days. After 30, 17 and 14 months of follow-up, intravenous urography (IVU) demonstrated good drainage. Conclusion: Recognition and repair of ureteral injuries during LRP requires a high index of suspicion, and expertise in laparoscopic technique. Laparoscopic reimplantation or primary repair of these injuries during LRP is, in experienced hands, a safe, feasible and minimally invasive procedure with the benefits of laparoscopic surgery maintained for the patient. © Springer-Verlag 2009.

Background: Use of an augmented reality (AR)-based soft tissue navigation system in urologic laparoscopic surgery is an evolving technique. Objective: To evaluate a novel soft tissue navigation system developed to enhance the surgeon's perception and to provide decision-making guidance directly before initiation of kidney resection for laparoscopic partial nephrectomy (LPN). Design, setting, and participants: Custom-designed navigation aids, a mobile C-arm capable of cone-beam imaging, and a standard personal computer were used. The feasibility and reproducibility of inside-out tracking principles were evaluated in a porcine model with an artificially created intraparenchymal tumor in vitro. The same algorithm was then incorporated into clinical practice during LPN. Interventions: Evaluation of a fully automated inside-out tracking system was repeated in exactly the same way for 10 different porcine renal units. Additionally, 10 patients underwent retroperitoneal LPNs under manual AR guidance by one surgeon. Measurements: The navigation errors and image-acquisition times were determined in vitro. The mean operative time, time to locate the tumor, and positive surgical margin were assessed in vivo. Results and limitations: The system was able to navigate and superpose the virtually created images and real-time images with an error margin of only 0.5 mm, and fully automated initial image acquisition took 40 ms. The mean operative time was 165 min (range: 135-195 min), and mean time to locate the tumor was 20 min (range: 13-27 min). None of the cases required conversion to open surgery. Definitive histology revealed tumor-free margins in all 10 cases. Conclusions: This novel AR tracking system proved to be functional with a reasonable margin of error and image-to-image registration time. Mounting the pre- or intraoperative imaging properties on real-time videoendoscopic images in a real-time manner will simplify and increase the precision of laparoscopic procedures. © 2009 European Association of Urology.

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BACKGROUND: Data on utilizing complexed prostate specific antigen (cPSA) offering increased diagnostic performance over other available clinical parameters in diagnosis of prostate cancer is still controversial. Our objective was to determine diagnostic performance of cPSA compared to total prostate specific antigen (tPSA) and corresponding ratios for possible routine application. METHODS: In a prospective study including overall 315 consecutive men, 177 patients with suspicious digital rectal examination, and/or tPSA value > 2.5 ng/ml underwent prostate biopsy. Serum samples for tPSA, cPSA and free PSA were analyzed using automated chemiluminometric technology. RESULTS: Area under the curve (AUC) for cPSA, although greater, was not statistically different compared to that of tPSA (p = 0.253). AUCs of f/c, f/t and c/t ratios were all found significantly inferior. At clinically relevant 2.37 ng/ml threshold, cPSA performed with 85% sensitivity and significantly higher specificity of 63.1%, compared to same sensitivity and specificity of 57.2% at a 3.00 ng/ml cut off for tPSA. CONCLUSIONS: Utilizing automated assay systems at predetermined cut off value for cPSA we would be able to save 27.1% of the biopsies while missing 13.4% of the cancers. Therefore, results of this study indicate higher discriminatory power of cPSA in diagnosis of prostate cancer for clinically relevant 2.5-4 ng/ml tPSA range.

Experimental as well as clinical findings reported in the literature suggest that treatment with shock wave lithotripsy (SWL) causes renal parenchymal damage mainly by generating free radicals through ischaemia /reperfusion injury mechanism. Although SWL-induced renal damage is well tolerated in the majority of healthy cases with no permanent functional and/or morphologic side effects, a subset of patients with certain risk factors requires close attention on this aspect among which the ones with pre-existing renal disorders, urinary tract infection, previous lithotripsy history and solitary kidneys could be mentioned. It is clear that in such patients lowering the number of shock waves (per session) could be beneficial and has been applied by the physicians as the first practical step of diminishing SWL induced parenchymal damage. On the other hand, taking the injurious effects of high energy shock wave (HESW) induced free radical formation on renal parenchyma and subsequent histopathologic alterations into account, physicians searched for some protective agents in an attempt to prevent or at least to limit the extent of the functional as well as the morphologic alterations. Among these agents calcium channel blocking agents (verapamil and nifedipine), antioxidant agents (allopurinol, vitamin E and selenium) and potassium citrate have been used to minimize these unestimated adverse effects. Additionally, therapeutic application of these agents on reducing stone recurrence particularly after SWL will gain more importance in the future in order to limit new stone formation in these cases. Lastly, as experimental and clinical studies have demonstrated, combination of anti-oxidants with free radical scavengers may provide superior renal protection against shock wave induced trauma. However, we believe that further investigations are certainly needed to determine the dose-response relationship between the damaging effects of SWL application and the protective role of these agents.

Splenosis is a well-known entity, caused by autotransplantation of splenic tissue as a result of trauma or splenectomy. Patients are generally asymptomatic, and this entity is diagnosed during routine diagnostic imaging. Cystic changes in splenic implants have been defined before but, as to our knowledge, radiological demonstration of cystic components has not been published in the literature. It is well-known that unusual locations of the splenic implants create diagnostic problems, sometimes leading to unnecessary surgical interventions. In this report splenosis, mimicking a renal tumour, with cystic changes in the biggest splenule, and diagnosis with ferrumoxide-enhanced MRI is presented. © 2007 The Authors.

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Introduction: 46 XX male syndrome (de la Chapelle syndrome) is a rarely seen genetic disorder causing male infertility. It is generally a result of unequal crossing over between X and Y chromosomes. Case report: A 26-year-old infertile male was referred to the Urology Department. He had normal external male genital phenotype and secondary sex characters. No gynecomastia was noted. At physical examination soft and atrophic testes were palpated. Laboratory analysis and testis biopsies indicated nonobstructive azospermia. Chromosomal analysis showed 46 XX karyotype. Conclusion: In the literature, there are various phenotypic properties of 46 XX male patients. Thus, translocation of the sex determining region (SRY) the gene probably cannot be the only reason for XX male syndrome. There might be some other abnormalities leading to de la Chapelle syndrome.

Introduction: Glycosaminogylicans (GAG) play as a promotor and inhibitor in some phases of stone formation. Sialic acid (SA) is a low-molecular weight aminosaccaride and found in the molecular structure of GAG and on the surface of many cells. Plasma SA level increases in inflamatory diseases, glomerulonephritis and metabolic abnormalities. Unfortunately, there are only a few studies investigating the relationship between SA level in urine and urological diseases. In this study, the relationship between calcium oxalate crystalization and free, total and complex sialic acid levels in urine and plasma has been investigated. Additionally, possible effect of potassium citrate on this relationship was also studied. Material and Methods: Thirty wistar female rats were included in this study. They were randomly divided in three groups. 0.12 ml of %5 ethylene glycole was dissolved in water and given to the rats in group 1 by feeding tube two times a day and every other day 0.5 microgram vitamin D3 was added to their drinking water to expose them hyperoxlacuric and hypercalciuric, respectively. Rats in group 2 were exposed to the same procedure as group1. Additionally, 5 mg/day K-Citrat was added to their diet. No special diet program was applied in group 3 (control group). At the end of 30 days, 24 hours urine samples were collected by using metabolic cages and blood samples were taken from each rat. Free and total SA levels were calculated by the technique of measuring thiobarbituric acid as mmol/liter (Warren's method). One way ANOVA test was applied for statistical analysis. Result: Calcium levels measured in plasma and urine were higher in group 1 and 2 than the control group. Similarly, oxalate levels in urine were also higher in group 1 and group 2., The differences were statistically significant when compared with the control group (p

Glikozaminoglikanlar taş oluşumunun bazı aşamalarında promoter, bazı aşamalarında ise inhibitor gibi davranmaktadır. Düşük molekül ağırlıklı bir aminosakkarid olan sialik asit (SA) glikozaminoglikanlanın yapısında bulunur. Kontrollü deney grupları oluşturarak kalsiyum-okzalat kristalizasyonu ile idrarda serbest ve bağlı SA ilişkisini ve potasyum sitratm bu ilişki üzerine etkisini araştırdık. Çalışmamızda Wistar cinsi dişi sıçanlardan 10'arlı 3 ayrı grup oluşturuldu. Grup l 'e 0.12 mi %5 etilen glikol l mi normal çeşme suyunda çözündürülerek 2x1 feeding tüple verilip hiperoksalürik ve günaşırı 0.5 mikrogram vitamin ds sularına karıştırılıp hiperkalsiürik hale getirildi. Grup 2, Grup l'den farklı olarak sularına 5mg/gün K-Sitrat eklendi. Grup 3'e normal beslemne yapıldı. Bütün sıçanlardan 30. günde metabolik kafesler kullanılarak 24 saatlik idrar ve kan örnekleri alındı. İdrarda serbest ve total SA düzeyleri Warren'in tarif ettiği tiobarbüritik asit tekniği ile standart eğrilere göre mmol/litre cinsinden hesaplandı. İstatistiksel analizde One way ANOVA test'i kullanıldı.Seram ve idrar kalsiyum, idrar okzalat düzeyleri grup l ve 2'de grup 3'e göre artmış olup istatistiksel anlamlı bulundu. Serum total ve bağlı SA düzeyi üç grupta normal sınırlar içerisinde fakat serbest SA grup l ve 2'de kontrol grubuna göre düşük bulundu ve bu istatistiksel anlamlı idi. İdrar total ve bağlı SA düzeyleri grup l ve 2'de grup 3'e göre azalmış bulundu ve bu istatistiksel anlamlı iken kendi aralarında istatistiksel anlamlılık yoktu. Her üç grup idrar serbest SA düzeyi arasında istatistiksel anlamlılık bulunmadı. Kristalüri ile idrar ve serum SA düzeyleri arasında anlamlı ilişki vardır. Potasyum sitrat'ın seram ve idrar SA üzerine anlamlı bir etkisi yoktur. Introduction: Glycosaminogylicans (GAG) play as a promoter and inhibitor in some phases of stone formation. Sialic acid (SA) is a low-molecular weight aminosaccaride and found in the molecular, structure of GAG and on the surface of many cells. Plasma SA level increases in inflammatory diseases, glomerulonephritis and metabolic abnormalities. Unfortunately, there are only a few studies investigating the relationship between SA level in urine and urological diseases. In this study, the relationship between calcium oxalate crystalization and free, total and complex sialic acid levels in urine and plasma has been investigated. Additionally, possible effect of potassium citrate on this relationship was also studied. Material and Methods: Thirty Wistar female rats were included in this study. They were randomly divided in three groups. 0.12 ml of %5 ethylene glycole was dissolved in water and given to the rats in group 1 by feeding tube two times a day and every other day 0.5 microgram vitamin D3 was added to their drinking water to expose them hypcroxlacuric and hypercalciuric, respectively. Rats in group 2 were exposed to the same procedure as group l Additionally, 5 mg/day K-Citrat was added to their diet. No special diet program was applied in group 3 (control group). At the end of 30 days, 24 hours urine samples were collected by using metabolic cages and blood samples were taken from each rat. Free and total SA levels were calculated by the technique of measuring thiobarbituric acid as mmol/liter (Warren's method). One way ANOVA test was applied for statistical analysis. Result: Calcium levels measured in plasma and urine were higher in group 1 and 2 than the control group. Similarly, oxalate levels in urine were also higher in group 1 and group 2., The differences were statistically significant when compared with the control group (p

Objective: The aim of this study was to determine the effect of indomethacin, an anti-inflammatory agent, on apoptosis and crystal deposition developing as a consequence of tubular cell injury induced by hyperoxaluria in an animal model. Materials and methods: Fifty New Zealand rabbits were divided into 3 groups. The first 2 groups were fed with hyperoxaluric diet and Group 3 was the control group with no supplementary procedure or treatment. While the animals in Group 1 were given only hyperoxaluric diet, Group 2 animals was applied indomethacin in addition to the hyperoxaluric diet. Animals were sacrificed at the early (7th day) and late (28th day) periods and renal tis-sue specimens were sent for the pathological analysis of crystal deposition and apoptosis. Results: The presence and degree of crystal deposition were significantly less in the specimens obtained from indomethacin-treated group during both the early and late periods (p

Background: Cytokine-mediated immune and inflammatory responses are considered to play an important role in the pathogenesis of prostate cancer. The present study investigated certain interleukin-1? (IL1?) polymorphisms and their association with prostate cancer. Materials and Methods: Genotyping of the IL1B-31(rs 1143627 G>A) and IL1B-511(rs 16944 A

To assess the impact of a diagnosis of bladder cancer on smoking behavior and to analyze the role of the physician in smoking cessation. Nonmuscle-invasive bladder cancer patients completed a phone survey of their smoking habits. They were asked about smoking behavior before and after the diagnosis of cancer and whether they had been informed by their physician about the relation between smoking and bladder cancer. Two hundred-twelve patients responded to the survey. The mean age was 60.03±6.36 years. Ninety-three of the 135 current smokers (68.9%) were advised to quit smoking, whereas nine of 20 nonsmokers (45%) were not commented about the future risks of smoking. The results showed that 13% of the current smokers and 35% of the current nonsmokers were not warned about the relation of bladder cancer with smoking. Statistical significance was not seen in terms of sex, disease stage, and tumor grade at diagnosis. The relation between smoking and bladder cancer has been well established. However, some patients are not informed to quit smoking by their physicians. © 2015, TIP ARASTIRMALARI DERNEGI. All rights reserved.

Purpose: To compare the efficacy of RIRS and PNL in lower pole stones ?2 cm. Materials and and Methods: A total of 109 patients who underwent PNL or RIRS for solitary lower pole stone between April 2009 and December 2012, were retrospectively analyzed. Lower pole stone was diagnosed with CT scan. Stone size was assessed as the longest axis of the stone. All patients were informed about the advantages, disadvantages and probable complications of both PNL and RIRS before the selection of the procedure. Patients decided the surgery type by themselves without being under any influences and written informed consent was obtained from all patients prior to the surgery. Patients were divided into two groups according to the patients' preference of surgery type. Group 1 consisted of 77 patients who underwent PNL and Group 2 consisted of 32 patients treated with RIRS. Stone free statuses, postoperative complications, operative time and hospitalization time were compared in both groups. Results: There was no statistical significance between the two groups in mean age, stone size, stone laterality, mean follow-up periods and mean operative times. In PNL group, stone-free rate was 96.1% at first session and 100% after the additional procedure. In Group 2, stone-free rate was 90.6% at the first procedure and 100% after the additional procedure. The final stone-free rates and operative times were similar in both groups. Conclusions: RIRS should be an effective treatment alternative to PNL in lower pole stones larger than 2 cm, especially in selected patients.

Some in vitro and animal studies have shown endothelial dysfunction in hyperoxaluria models indicating its role in pathogenesis of urolithiasis and relation to CVD. The aim of this study was to investigate endothelial function in patients with urolithiasis in relation to urinary stone risk factors and metabolic parameters. A total of 120 subjects without any known CVD (60 with urolithiasis and 60 healthy subjects) were included into study. Fasting blood and 24-h urine samples were collected to study metabolic parameters (glucose and lipids) and urine stone risk factors (oxalate, citrate, uric acid, and calcium, pH). Endothelial function was assessed as flow-mediated dilation (FMD) at the brachial artery. Age, sex, and body mass index were similar in patients and controls. Of urine stone risk factors, oxalate and citrate were higher in patients than controls. Fasting blood glucose, total LDL cholesterol, and triglyceride were higher, and HDL cholesterol was lower in patients than controls. Although within normal limits systolic blood pressure was higher in patient group, patients with urolithiasis had a lower %FMD than controls. Percent FMD was negatively correlated with urinary oxalate/creatinine ratio (p = 0.019, r = -0.315), calcium/creatinine ratio (p = 0.0001, r = -0.505) age (p

Background: Prostate cancer is one of the most common solid tumors and the second leading cause of the death due to malignancy in men. Caspase 9 (CASP9) is a member of the intrinsic pathway and plays a central role in the apoptosis. Patients and Methods: Genotyping of the CASP9 (rs1052576) polymorphism were performed using real-time polymerase chain reaction for blood samples of prostate cancer patients (n=69) and controls (n=76). Results: There were no significant differences between the groups in the frequency of CASP9 genotypes (χ2=1.363; p=0.506). Patients with CASP9 (rs1052576) CT genotype were 12.8 fold higher in pathological stage of pT2a compared to any other stages of cancer (OR=0.078, 95% CI= 0.009-0.062; p=0.004). Also TT genotype carriers were 11.3 times lower in pathological stage of pT2a (OR=11.33, 95% CI=2.39-53.748; p=0.000). C allele carriers were 11.36 fold higher in pathological stage of pT2a compared to any other stages of cancer (OR=0.088, 95% CI=0.019-0.418; p=0.002). Conclusion: CASP9 (rs1052576) C allele was decreasing the risk for pathological stage of patients with prostate cancer and also CT genotype had positive impact on pathological stage of patients with prostate cancer. CASP9 (rs1052576) TT genotype was seemed to be associated with higher risk of pathological stage. Those results implicated that CASP9 variations could be associated with severity of prostate cancer.

Purpose The aim of the study was to evaluate the efficacy and safety of bilateral single-session retrograde intrarenal surgery in the treatment of bilateral renal stones. Materials and Methods From December 2008 to February 2012, 42 patients who had undergone bilateral single-session retrograde intrarenal surgery (RIRS) and laser lithotripsy were included in the study. The procedures were performed in the lithotomy position on an endoscopy table under general anesthesia, beginning on the side in which the stone size was smaller. Plain abdominal radiography, intravenous urograms (IVU), renal ultrasonography (USG) and / or non-contrast tomography (CT) scans were conducted for all patients. The success rate was defined as patients who were stone-free or only had residual fragment less than 4 mm. Results A total of 42 patients (28 male, 14 female) with a mean age 39.2 ± 14.2 were included in the present study. The mean stone size was 24.09 ± 6.37 mm with a mean operative time of 51.08 ± 15.22 minutes. The stone-free rates (SFR) were 92.8% and 97.6% after the first and second procedures, respectively. The average hospital stay was 1.37 ± 0.72 days. In two patients (4.7%), minor complications (Clavien I or II) were observed, whereas no major complications (Clavien III-V) or blood transfusions were noted in the studied group. Conclusions Bilateral single-session RIRS and laser lithotripsy can be performed safely and effectively with a high success rate and low complication rate in patients with bilateral renal stones.

The objective of this study is to assess the efficacy of an alpha-1 adrenergic receptor blocking agent on the spontaneous passage of proximal ureteral calculi ?10 mm. 92 patients having single radio-opaque proximal ureteral stone ?10 mm were randomized into two groups. Group 1 patients (n = 50) were followed with classical conservative approach and patients in Group 2 (n = 42) additionally received tamsulosin, 0.4 mg/day during 4 weeks follow-up. The stone passage rates, stone expulsion time, VAS score, change in colic episodes, and hospital re-admission rates for colicky pain were compared. The patients were furthermore stratified according to stone diameters

End-stage renal disease (ESRD) affects sexual function. The etiology of sexual dysfunction in ESRD is multifactorial and hypogonadism is not uncommon. In a cohort of 96 men with ESRD, scores on International Index of Erectile Function (IIEF) correlated with bioavailable testosterone (T; P0.01). We further evaluated the effects of administration of T on ED in hypogonadal men on hemodialysis. Nine men with ED and hypogonadism (baseline bioavailable T 3.82 nmol l 1), received 5 g T-gel (1% (10 mg g 1) per day treatment for 6 months. The IIEF and frequency of sexual intercourse per week were used to assess treatment efficacy. T administration significantly increased serum T levels to the normal range, and was associated with statistically significant improvements of the scores of the IIEF domains (erectile function from 7.68.0 to 12.87.8; intercourse satisfaction from 3.44.5 to 4.83.1; orgasmic function from 4.83.1 to 3.42.9; sexual desire from 3.42.9 to 4.40.6; overall sexual satisfaction from 2.61.3 to 3.81.0). But scores of the IIEF did not normalize. Frequency of weekly sexual intercourse increased from 0.40.4 to 1.10.8 (P0.05) after 6 months. There were no adverse effects. We conclude that restoring T levels to normal in men with ESRD improved scores on the IIEF and frequency of weekly sexual intercourse. © 2010 Nature Publishing Group All rights reserved.

Objectives: To evaluate the possible role of being overweight on stone-forming risk factors in children. Methods: A total of 94 children (43 boys and 51 girls, male/female ratio 1:1.8) who were taking no medication or dietary modifications before treatment were included in the study. After a detailed stone disease history, the systolic and diastolic blood pressures were precisely measured and recorded for all patients. The body mass index, 24-hour urine values, and serum stone-forming risk parameters were evaluated in 44 overweight (17 boys and 27 girls; group 1) and 50 normal (26 boys and 24 girls; group 2) children. The results of each group were compared using the Wilcoxon rank sum test. Results: The evaluation of the stone-forming risk factors in both groups revealed that the overweight status might be responsible for the increased excretion of these substances in such children. Most of the children in group 1 demonstrated hypocitraturia and hyperoxaluria (9/44, 20.5%) compared with the patients in group 2. Although the mean urinary oxalate level was 0.74 ± 0.81 mg/kg/24 h for boys and 0.69 ± 0.72 mg/kg/24 h for girls in group 1, relatively lower values were noted in group 2 (0.42 ± 0.52 and 0.45 ± 0.57 mg/kg/24 h for the boys and girls, respectively). Similarly, the children in group 1 had elevated mean urinary calcium and lower citrate excretion compared with the group 2 patients. Conclusions: Overweight status in children might be associated with an elevated risk of stone formation in both sexes owing to the alterations in urine composition. Obese children could be more prone to stone formation, and they should be evaluated and followed up for this aspect. Crown Copyright © 2009.

Purpose. To evaluate the results of patient symptoms and radiologic outcomes of cystoretroperitoneal shunt (CRS) technique in the treatment of symptomatic simple renal cysts.Patients and Methods. In a prospective study, 37 patients with a simple renal cyst were treated with ultrasound-guided percutaneous CRS-catheter. Radiological success was indicated as no recurrence of the cyst or a reduction in cyst volume by at least half.Results. CRS technique was performed successfully in 36 patients with a simple renal cyst. The mean size of all cysts decreased from 8.8 cm (range 7 to 14) to 1.7 cm (range 0 to 9; ). Symptomatic success (pain relief) was achieved in 29/36 (80.5%) of patients, and radiographic success was achieved in 23/36 (63.8%) of patients, with a median follow-up of 16 months (range 6 to 24).Conclusion. Ultrasound-guided percutaneous CRS technique for simple renal cysts is fast, safe, effective, and inexpensive.

Introduction Premature ejaculation (PE) is the most common male sexual dysfunction. Monosymp tomatic enuresis (ME) is nocturnal bed wetting, without any daytime symptoms. Recent clinical stud ies report an association between lifelong PE and ME. The purpose of this study was to compare the intravaginal ejaculatory time (IELT) between lifelong PE in men with and without ME. The goal was to determine if there is an association between the severity of ME and of IELT. Material and methods A total of 137 men with lifelong PE were included in this study. Subjects were asked if they had childhood ME. The characteristics and mean IELTs of patients with and without ME were compared using the student’s t–test, and the correlation between severity of ME and IELT was assessed with trend test. Results Of the 137 lifelong PE patients, 57 reported ME. There was a strong negative correlation in patients with ME between the severity of enuresis and IELT, with IELT being shorter in patients with severe ME. Conclusions A strong correlation between IELT and the severity of ME suggests a common underlying mechanism. Further studies are required to confirm these findings and elucidate the exact pathophysiology.

Background: Lower urinary tract (LUT) discomfort is a common complaint after transurethral resection of the prostate (TURP), and it may lead to agitation and restlessnes. We have evaluated the efficacy of morphine for preventing TURP-related LUT discomfort symptoms. Methods: This was a prospective randomised study including 60 patients (American Society of Anesthesiologists class I and II) who were scheduled to undergo TURP. The patients were divided into two equally sized groups (group M: morphine, group C: control). A standartized anesthesia method was used. Group M patients received morphine 0.04 mg/kg intravenous (iv) in 100 ml of normal saline followed by an infusion of morphine for 24 h (0.01 mg/kg/h); group C patients received 100 ml normal saline 20 min before the expected extubation time, followed by a normal saline infusion which looked identical to that of the morphine infusion. The incidences and severity of LUT discomfort, postoperative pain, sedation level, postoperative nausea and vomiting (PONV) and respiratory depression were recorded at 0, 1, 2, 6, 12 and 24 h postoperatively. Results: The incidence of LUT discomfort was lower in group M patients at all time points during the study (p < 0.05) except for 2 h postoperatively, and the severity of LUT discomfort was also lower this group at 0, 12 and 24 h postoperatively (p = 0.001, p = 0.04 and p = 0.02, respectively). Pain (numeric rating scale) scores were lower in group M patients at 0 (p = 0.003) and 6 h (p < 0.001). The need for rescue analgesic was lower in group M patients (19 patients in group C, 10 patients in group M; p = 0.04). The incidence of PONV was higher in group M patients (p = 0.03). The incidence of pruritus, respiratory depression and over-sedation were similar among the groups. Conclusion: Based on these results, we conclude that morphine effectively reduces LUT discomfort after TURP at a cost of postoperative nausea and vomiting. © 2013 Japanese Society of Anesthesiologists.

Oxalate is the most common component of kidney stones and elevated urinary levels induce renal tubular cell toxicity and death which is essential for crystal attachment. Endothelial cells, in some studies have been shown to regulate certain functions of renal proximal tubule cells. The aim of this study was to evaluate the effect of endothelial cells on tubular cell apoptosis in a coculture system mimicking the in vivo renal physiological settings. The human umbilical vein endothelial cells (HUVEC) and human renal proximal tubule epithelial cells (RPTEC) were exposed to increasing concentrations (0-1.0 mM) of oxalate with or without 10 µM PDTC pretreatment for 24 h. In HUVEC, RPTEC and HUVEC-RPTEC co-cultures, the cell viability was measured using the WST-1 assay and cell death with the TUNEL analysis using the flow cytometry. The treatment of RPTECs with oxalate lead to 8.9-26.2% cell death which was reduced to 0-1.6% with the PDTC pretreatment. The death rate of RPTECs was significantly increased by 15-19% at different oxalate concentrations when co-cultured with HUVECs. In contrast, cell viability was not substantially altered in PDTC pretreated RPTECs that were co-cultured with HUVECs. Apoptosis was the way of cell death as similar rate of apoptosis was observed in cell culture systems. Although cell viability of RPTECs was further reduced when co-cultured with HUVECs, it was restored with the pretreatment of PDTC. This is the first study focusing on the role of endothelial cells on RPTEC apoptosis following hyperoxaluria. © Springer-Verlag 2012.

Objectives To evaluate the causes of emergent stent placement during the postoperative early period after uncomplicated ureteroscopy in 23 patients. Methods Of 276 uncomplicated ureteroscopy procedures performed for the management of ureteral calculi, double-J stent placement was necessary on an emergent basis in 23 patients because of intolerable colic pain and extreme patient discomfort. All stents were inserted within 24 hours after the procedure. Results Of the 23 patients requiring emergent stent placement, 14 were men and 9 were women. The stones had been located in the lower ureter in 11, mid-ureter in 6, and upper ureter in 6 patients. All patients had undergone an uncomplicated procedure with no complication evident either during or immediately after ureteroscopic stone management. The intraoperative findings for the 23 patients revealed extensive edema formation, unrecognized small stones embedded in the edematous ureteral wall, unpassed small fragments gathered at the orifice, obstructing blood clots, and kinking of the ureter. A retrospective evaluation of the operative CD recordings and radiographic findings clearly showed that a longer operative time, repeated access, management of a large stone, impacted calculi with ureteral wall edema, a mildly narrowed ureteral segment, ignored caliceal small calculi, and a recent history of urinary tract infection contributed to the need for postoperative intervention. Conclusions Ureteral catheterization, at least in the form of overnight stent placement, might prevent the formation of transient ureteral obstruction, with resultant postoperative patient discomfort and colic pain evident in selected cases. © 2011 Elsevier Inc.

Objective: To evaluate the natural course of the stone disease in pediatric patients from different perspectives among which the spontaneous passage and stone recurrence rates evaluated during the follow-up. Materials and methods: A total of 142 children referring with primary urinary stone disease were evaluated and followed. All children in the study were divided into two groups with respect to the age (Group 1: 0-5 years and Group 2: 6-15 years). Children were followed with respect to spontaneous passage rates, recurrence-regrowth rates, physical as well as the renal growth rates. Results: Stone recurrence has been noted in 44% of patients in group 1, this value was 31% in group 2. Children with at least one identifiable metabolic abnormality tended to have higher recurrence rates than the others despite conservative measures. The average stone recurrence rate in children without any metabolic abnormality was 14% and nearly 50% in children with an identifiable metabolic abnormality. Conclusions: We may emphasize that due to the high recurrence and re-growth rates, all children with urinary stone disease should be followed closely with regular visits. The evaluation of metabolic risk factors in children with renal stone disease is the basis of medical treatment aimed at preventing recurrent stone events and the growth of pre-existing calculi. © 2010 Springer Science+Business Media, B.V.

Both the prevalence of cardiovascular risk factors and event rate are increased in patients with urolithiasis. Screening is recommended to all patients who have high cardiovascular risk. The aim of this study was to document 10-year risk of cardiovascular disease and mortality in asymptomatic patients with urolithiasis. Consecutive 200 patients with calcium oxalate urolithiasis were compared with 200 age- and sex-matched healthy controls. Ten-year cardiovascular disease risk was calculated with the Framingham Risk Score and mortality risk with SCORE risk score. Calcium, oxalate, and citrate excretion were studied as urinary stone risk factors. The results indicate that patients with urolithiasis had higher total cholesterol (p < 0.0001), lower HDL-cholesterol (p < 0.0001), and higher systolic blood pressure (p < 0.0001) and hsCRP (p < 0.0001) compared with controls. Patients with urolithiasis had a higher Framingham Risk Scores [OR 8.36 (95% CI 3.81-18.65), p = 0.0001] and SCORE risk score [OR 3.02 (95% CI 1.30-7.02), p = 0.0006] compared with controls. The Framingham and SCORE risk score were significantly correlated with urinary calcium (p = 0.0001, r = 0.460, and p = 0.005, r = 0.223, respectively) and oxalate excretion (p = 0.0001, r = 0.516, p = 0.001, r = 0.290, respectively). In multiple linear regression analysis, urinary calcium and oxalate excretion, age, sex, total cholesterol, HDL-cholesterol, hsCRP and smoking were the independent predictors of 10-year cardiovascular disease risk and urinary calcium and oxalate excretion, age, sex, total cholesterol, fasting blood glucose for 10-year cardiovascular mortality. In conclusion, patients with calcium oxalate urolithiasis carry high risk of cardiovascular disease and mortality. All patients should be screened at the initial diagnosis of urolithiasis for the risk factors. © 2011 Springer-Verlag.

The aim of this study was to evaluate the possible relationship between varicocele and saphenofemoral insufficiency in patients diagnosed with primary varicocele. A total of 70 patients with the primary diagnosis of varicocele were included into the study. A total of 30 age-matched healthy adults were also included in the study as a control group. Varicocele was diagnosed by palpation and observation of each spermatic cord in standing position before and during a valsalva maneuver. Additionally, scrotal Doppler and lower extremity venous Doppler ultrasonography were performed. Patients who were with spermatic varicose vein larger than 3.0 mm were included in the study group as a varicocele patient. At the lower extremity venous Doppler ultrasonography, a retrograde flow lasting longer than 0.5 seconds during normal breathing or at the valsalva maneuver was considered to be meaningful for saphenofemoral junction insufficiency. Thirty-six (51.35%) patients had insufficiency in saphenofemoral junction in the study group (6 [8.5%] bilateral, 30 [42.85%] unilateral) whereas 8 (26.6%) had insufficiency in the control group (2 [6.6%] bilateral, 6 [20%] unilateral insufficiency). The patients with primary varicocele had a statistically significant (P 5 .02) higher rate of venous insufficiency in their saphenofemoral junctions when compared with the control group. In the present study, the rate of saphenofemoral insufficiency has been found to be statistically higher in patients with primary varicocele compared with healthy men. Depending on the common presence of valvular insufficiency, we believe that the presence of varicocele should be investigated in the young population suffering from saphenofemoral junction insufficiency.

Objectives: To evaluate the efficacy of semirigid ureteroscopy in the management of ureteral stones located in different parts of the ureter. Methods: 1,503 patients were treated with semirigid ureteroscopy. All ureteral stones were either removed only by a basket catheter or disintegrated by pneumatic lithotripsy. Success rates, auxiliary procedures, complication rates and operation time were comparatively evaluated according to stone location. Results: Overall, mean stone size and age were 12.1 ± 3.7 mm and 43.2 ± 9.72 years, respectively. While 1,416 patients (94.2%) were completely stone-free, the procedure was unsuccessful in 87 cases (5.8%). The success rate was relatively low in the proximal ureter (71.7%) when compared with the mid (94.8%) and distal ureter (98.9%) (p = 0.021). Mean operation time was 25.4 ± 11.7 min. Longer duration of operation and higher complication rate were found in proximal ureteral calculi. Stone migration to the kidney and hematuria were the main reasons of failure in the proximal ureter and ureteral stenting was needed for 56.4% of patients with upper ureteral stone. Conclusions: Semirigid ureteroscopy can be the treatment of choice in lower and midureteral stones. However, it is an invasive and less successful treatment modality for proximal ureteral stones with relatively high complication rates.

WOS: 000282160600049, PubMed: 20074725, Objective: To compare the factors affecting sexual function in premenopausal women with type 2 diabetes using the female sexual function index (FSFI). Design: Cross-sectional study. Setting: Premenopausal women with type 2 diabetes and healthy volunteers in an academic research environment. Patient(s): Sixty-two type 2 diabetic women were compared with 50 controls. The FSFI scores of the patients were compared according to age, duration of diabetes, marriage, socioeconomic status, parity, menstruation regularity, body mass index (BMI), and smoking. Intervention(s): None. Main Outcome Measure(s): Female sexual function index scores. Result(s): The mean FSFI score in diabetics was lower than in controls. Menstrual irregularity and duration of diabetes affected female sexual function unlike age, BMI, socioeconomic status, duration of marriage, or parity. Regularly menstruating women had higher FSFI scores (27.1 +/- 6.7) than irregularly menstruating women (20.7 +/- 7.4). Type 2 diabetics were divided into three groups according to duration of diabetes. The women having diabetes longer than 10 years had the worse sexual function. Also, smoking affected inversely female sexual well being. Conclusion(s): Menstrual disturbance, smoking, and longer duration of diabetes (more than 10 years) impair FSFI scores in premenopausal women with type 2 diabetes. (Fertil Steril (R) 2010;94:1840-3. (C)2010 by American Society for Reproductive Medicine.)

We investigated the effect of intraperitoneal vardenafil (1 mg/kg) administration during an ischemic period in a rat model of testicular torsion/detorsion (T/D). Twenty-one adult Wistar rats were equally randomized into a control group, a T/D group and a vardenafil group. The control group was designed to collect basal values for biochemical and histopathological parameters. The T/D group underwent testicular torsion for 1 hour. The vardenafil group received vardenafil (1mg/kg) intraperitoneally at 30 minutes after torsion. All rats were sacrificed 4 hours after reperfusion to evaluate the tissue levels of malondialdehyde and total antioxidant status. Germ cell apoptosis was evaluated using the apoptosis protease activating factor 1 antibody in all groups. The expressions of endothelial nitric oxide synthase (NOS) and inducible NOS were also assessed in both testes of all rats. The malondialdehyde levels in the T/D group were significantly higher than in the control and vardenafil groups. There were also significant decreases in total antioxidant status in the T/D group compared with the control and vardenafil groups. Vardenafil treatment significantly reduced apoptosis protease activating factor 1, endothelial NOS and inducible NOS levels in the vardenafil group compared with the T/D group. Administration of 1 mg/kg vardenafil during testicular torsion decreased ischemia/reperfusion cellular damage. Our results indicate that the reduction in oxidative stress by vardenafil may play a major role in its cytoprotective effects. © 2009 Elsevier.

Purpose: The pathogenesis of kidney stones remains elusive. There is some evidence that hyperoxaluria may effect vascular endothelium and many studies link renal stones to atherosclerosis. Also, renal vascular endothelial cells regulate proximal tubular epithelial cell function. We determined the effect of hyperoxaluria on plasma and tissue levels of asymmetrical dimethylarginine. The secondary aim was to determine the effect of verapamil on asymmetrical dimethylarginine. Materials and Methods: A total of 42 Sprague-Dawley rats were included in the study. In groups 1A, 1B and 1C hyperoxaluria was induced with ethylene glycol for 2 weeks. Groups 2A, 2B and 2C received ethylene glycol for 14 days and verapamil for 28 days. Control group 3 received no specific medication but distilled water. Blood samples were obtained at 24 hours and at study end, and kidney samples were obtained at 24 hours, and 7 and 28 days for histopathological evaluation. Results: Plasma asymmetrical dimethylarginine increased early in the hyperoxaluric group (p = 0.0002). The effect was retained at the end of the study period (p = 0.01). There was no increase in asymmetrical dimethylarginine in the verapamil group on short-term and long-term followup. Hyperoxaluria induced a significantly dense staining pattern in renal tissue asymmetrical dimethylarginine vs controls (p = 0.01). Asymmetrical dimethylarginine staining did not differ in the control and verapamil groups. Conclusions: Increased systemic and local tissue asymmetrical dimethylarginine may help explain the pathogenetic mechanisms of hyperoxaluria induced disorders such as nephrolithiasis and atherosclerosis. © 2010 American Urological Association.

Objectives The effect of verapamil on tubular ischemia that is demonstrated by HIF-1a positivity in tubular cells following hyperoxaluria was evaluated in a rabbit model. Methods Thirty-six healthy male rabbits were randomly divided into three groups. Animals in the hyperoxaluric group were fed with 0.75% ethylene glycol. The verapamil group was fed identically to the hyperoxaluric group. Additionally, the verapamil group received verapamil orally (0.1 mg/kg). The control group received no special diet. Six animals in each group were killed on the 7th day of the experiment and the remaining six at the 28th day. Kidneys of the rabbits were examined by histopathologic and immunohistochemical analysis to detect the presence and degree of HIF-1a positivity. Results On the 7th day analysis, severe and moderate degree staining for HIF-1a in hyperoxaluric group were shown in four and two, respectively. In the verapamil group, however, three of six specimens showed nuclear staining (moderate in two and severe in one). Two of six specimens in the control group had minimal staining. The 28th day evaluation showed that two of the hyperoxaluric group had minimal degree nuclear staining but not in the remaining four. No staining was shown in the verapamil and control group animals. Conclusions Hyperoxaluria-related ischemia formation may be responsible for subsequent alterations in renal tubules. As a protective agent, verapamil was found to limit the presence of hypoxic changes as documented by HIF-1 alpha positivity in this study. These data also support the presence ischemic insult after hyperoxaluria induction in animal model. © Springer Science+Business Media, B.V. 2009.

Amaç: Bu çalışmanın amacı anti-inflamatuvar bir ajan olan indometazinin, hiperoksalürinin neden olduğu tübüler hücre hasarı sonucu gelişen apopitozis ve kristal birikimi üzerine etkisini hayvan modeli üzerinde belirlemektir. Gereç ve yöntem: Elli Yeni Zelanda tavşanı 3 gruba ayrılmıştır. İlk 2 grup hiperoksalürik diyetle beslenmiş, Grup 3 ise herhangi bir ilave işlem ya da tedavi uygulanmayan kontrol grubunu oluşturmuştur. Grup 1’deki hayvanlara yalnızca hiperoksalürik diyet verilirken, Grup 2’deki hayvanlara hiperoksalürik diyete ek olarak indometazin de uygulanmıştır. Hayvanlar erken (7. gün) ve geç (28. gün) dönemde kurban edilmiş ve renal doku örnekleri, kristal birikimi ve apopitozis açılarından patolojik inceleme için gönderilmiştir. Bulgular: Kristal birikiminin mevcudiyeti ve derecesi, indometazinle tedavi edilmiş olan gruptan elde edilen örneklerde hem erken, hem de geç dönemde anlamlı olarak daha azdı (p, Objective: The aim of this study was to determine the effect of indomethacin, an anti-inflammatory agent, on apoptosis and crystal deposition developing as a consequence of tubular cell injury induced by hyperoxaluria in an animal model. Materials and methods: Fifty New Zealand rabbits were divided into 3 groups. The first 2 groups were fed with hyperoxaluric diet and Group 3 was the control group with no supplementary procedure or treatment. While the animals in Group 1 were given only hyperoxaluric diet, Group 2 animals was applied indomethacin in addition to the hyperoxaluric diet. Animals were sacrificed at the early (7th day) and late (28th day) periods and renal tissue specimens were sent for the pathological analysis of crystal deposition and apoptosis. Results: The presence and degree of crystal deposition were significantly less in the specimens obtained from indomethacin-treated group during both the early and late periods (p

Primary ciliary dyskinesia (PCD), previously known as immotile cilia syndrome, can cause respiratory and reproductive problems. Because of the impaired motion of microtubules the patients suffer upper respiratory tract problems. Infertility is an other issue of these patients. Several attempt have been proposed to bring back sperm motion and to improve intracytoplasmic sperm injection (ICSI) results. With our case we have described the management of a male infertility that causes from immotile cilia. The role of ICSI with incubated and activated ejaculatory sperm by pentoxifylline in the patient of PCD or as commonly named immotile cilia syndrome. © 2008 Springer-Verlag.

Objectives: To evaluate the therapeutic effect of papaverine hydrochloride in the treatment of patients with renal colic pain unresponsive to conventional treatment. Methods: From March 2007 to January 2008, a total of 561 patients with severe renal colic pain due to a ureteral stone were treated with conventional agents (hyoscine-N-butylbromide and diclofenac sodium) in the emergency and urology departments. Of these 561 patients, 110, with no response to the treatment and persistent severe pain, were randomized into 3 groups for additional treatment. The patients in group 1 (n = 37) received intravenous hyoscine-N-butylbromide, those in group 2 (n = 37) received papaverine hydrochloride, and those in group 3 (n = 36) received pethidine. Before and after treatment, all patients completed a visual analog scale (VAS) questionnaire, with a scale of 0 (no pain) to 10 (maximal complaint), to measure their subjective pain. The mean VAS score of each group was compared with that of the other groups. Results: The pretreatment mean VAS scores of all 3 groups were not significantly different statistically from each other (4.02 ± 1.20, 4.36 ± 1.97, and 4.27 ± 1.50; P > .05). However, after treatment, the mean VAS scores of the patients treated with papaverine (0.93 ± 0.29) and pethidine (0.81 ± 0.38) were significantly different from those of the hycosine group (3.67 ± 2.21; P < .001). However, the mean VAS scores of groups 2 and 3 were comparable (P = .67). Unlike opioids, no papaverine-related severe side effects were observed. Conclusions: Our results indicate that papaverine hydrochloride can used in an effective manner in the management of renal colic pain in patients unresponsive to commonly used conventional agents. © 2008 Elsevier Inc. All rights reserved.

The aim of this study was to evaluate the possible effect of a positive family history on the age at the onset of urinary stone disease and the frequency of subsequent symptomatic episodes relating to the disease. Between March 2006 and April 2009, patients with either a newly diagnosed or a previously documented stone disease were included in the study program. They were required to fill in a questionnaire and divided into two groups according to the positive family history of stone disease; group I comprised patients with a family history for urinary calculi and group II those without. Depending on the data obtained from questionnaires, all patients were evaluated in detail with respect to the age at the onset of the stone disease, stone passage and interventions over time, time to first recurrence (time interval between the onset of the disease and the first recurrence), number of total stone episodes and recurrence intervals. 1,595 patients suffering from urolithiasis with the mean age of 41.7 (14-69 years) were evaluated with respect to their past history of the disease. There were 437 patients in group I and 1,158 in group II. There was no statistically significant difierence between the mean age value of two groups (P = 0.09). When both genders in group I were analyzed separately, female patients tended to have higher rate of family history positivity than males. Comparative evaluation of the age at the onset of the disease between the two groups did reveal that stone formation occured at younger ages in patients with positive family history [P = 0.01 (males), P = 0.01 (females)] and the mean age of onset of the disease was lower in males than females in group I (P = 0.01). Patients in group I had relatively more stone episodes from the onset of the disease [P < 0.01 (2-4 episodes), P < 0.01 (?5 episodes)]. Male patients were associated with higher number of stone episodes (P = 0.01). Mean time interval between recurrences was noted to be significantly shorter in group I patients when compared with patients in group II [P < 0.01 (males), P = 0.02 (females)]. In conclusion, our results showed that urinary stone formation may occur at younger ages and that the frequency of symptom episodes may be higher in patients with a positive family history. We believe that the positive family history for urinary stone disease could give us valuable information concerning the onset as well as the severity of the disease. © The Author(s) 2009.