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Aim: We aimed to assess the relationship between urinary stone disease which is accepted as a component of metabolic syndrome and epicardial adipose tissue (EAT) thickness. Methods: The study included 45 patients and 39 healthy controls. EAT thickness was measured by echocardiography in all subjects.

Objective: To investigate the effect of biofeedback therapy on children with desmopressin-resistant primary monosymptomatic enuresis (MsE). Material and methods: The study comprised both retrospective and prospective sections. A total of 262 medical files of patients who were diagnosed as enuresis between November 2012 and January 2015 were retrospectively screened. Patients with neuropathic bladder, daytime voiding problems, anatomical pathology and enuresis-related diseases were excluded from the study. The demographic data and family characteristics of 29 children with desmopressin-resistant primary MsE were recorded. After biofeedback treatment patients whose frequency of enuretic episodes decrease by more than 50% were included in the successful biofeedback treatment group (SBTG), while other patients were categorized in the unsuccessful biofeedback treatment group (USGBT). The outcomes of uroflowmetry, voided volume, postvoiding residue (PVR) and total bladder volume/age-adjusted normal bladder capacity (TBV/NBC) were recorded before and at the sixth month of the treatment. Results: The mean age of 29 patients included in the study was 9.14 +/- 3.07 (6-15) years. Of patients, 16 were male (55.2%) and 13 were female (44.8%). Before biofeedback treatment the frequency of enuresis was 25.1 +/- 5.76 days/month, while after treatment this was calculated as 8.52 +/- 10.07 days/month. After treatment 8 patients (28.6%) achieved complete dryness. Twenty patients (69%), benefited from biofeedback (SBTG), while there were 9 patients (31%) in the USBTG group. There was no significant difference between the SBTG and USBTG groups in terms of age, body mass index and sex. The average bladder capacity of the patients increased from 215 mL to 257 mL after biofeedback treatment (p

Mortality is a major problem in renal transplant patients, and appropriate preoperative evaluation is very important. We retrospectively reviewed the left ventricle ejection fraction (LVEF) of renal transplant patients.The clinical records of 1763 patients who had preoperative LVEF results and who underwent renal transplantation at Akdeniz University Faculty of Medicine during the years 2004-2014 were studied. The LVEF limit was set at 55%. LVEF, age, gender, diabetes mellitus, hypertension, type of dialysis were assessed by linear multiple regression analysis on survival.There were a total of 1763 renal transplant patients. Those with LVEF of55% were identified as having left ventricular dysfunction. The mean LVEF was 59.4 ± 9.1 in the 43 patients who died after renal transplantation, while it was 62.6 ± 7.4 in the survivors (p = 0.02). The mortality rate in the LVEF 55% group was 6.8% (11/162 patients), while mortality in the LVEF ≥ 55% group was 2% (32/1601 patients, p 0.001). LVEF was found to be the most powerful variable on survival by the linear multiple regression analysis, RLVEF may predict mortality in renal transplant patients. LVEF is known to be lower in patients with high cardiac mortality, who may require greater modifications of the postoperative risks.

Objective To investigate the relationship between platelet activation parameters that are involved in the vascular response, the atherothrombotic process, and erectile function, in which epithelial dysfunction plays a significant role. Materials and methods A study was performed on patients who had a color Doppler ultrasound (CDUS) of the penis due to erectile dysfunction. The patients were divided into two groups: those with normal CDUS findings, and those with vascular dysfunction on CDUS. Patients were also divided into two groups according to their scores using the International Index of Erectile Function (IIEF). The relationships between platelet activation factors, vascular parameters, and severity of the disorder were analyzed. Results A total of 91 patients who fulfilled the inclusion criteria were included in the study. CDUS showed vascular dysfunction in 55 patients (Group I), while the findings were normal in 36 patients (Group II). Age, cholesterol level, disease duration, mean platelet volume (MPV), and platelet distribution width (PDW) were compared between Groups I and II, with Group I showing significantly higher values. The parameters that could affect Doppler ultrasound results were analyzed using multivariate regression analysis. This showed that PDW and disease duration were independent prognostic factors ( p = .021 and p = .005, respectively). When the patients were divided into two groups according to their IIEF scores, in those with mild (Group A) and severe disease (Group B), it was found that there were significant differences between the groups with age, disease duration, and PDW, while two groups were found similar in terms of MPV, cholesterol levels, and hormone parameters. Conclusion It is supposed that increased platelet activation parameters, and PDW in particular, give important information for disease progression and follow-up of vascular dysfunction in erectile dysfunction.

The objective of the present study was to determine whether preischemic administration of syringic acid (SA) would attenuate renal ischemia-reperfusion injury (IRI). Rats were divided into three groups: Sham group; IR group; and IR + SA group. The effects of SA were examined using biochemical parameters including serum ischemia-modified albumin (IMA), total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), tissue superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT) and malondialdehyde (MDA). The apoptosis status and histopathological changes were evaluated. After calculating the score for each histopathological change, the total score was obtained by summing all the scores. In the SA group, MDA, IMA, TOS, and OSI decreased significantly compared to the IR group. After SA administration, the increase in GPx activity was found to be significant. Apoptosis decreased significantly in the SA group compared with the IR group. The total score significantly decreased after administration of SA. Taken together, our findings suggest that SA preconditioning is effective in reducing tissue damage induced in kidney IRI. Renal histology also showed convincing evidence regarding the protective nature of SA.

The prognostic importance of platelet–lymphocyte ratio (PLR) is already known for various artery diseases. In this study, the relationship between PLR and severity of erectile dysfunction (ED) is examined in patients with impotence. The data from patients suffering from erection problems was screened retrospectively. Detailed medical history, age, International Index of Erectile Function-5 (IIEF-5) scores, fasting blood glucose, lipid, whole blood count, and hormone profile values were examined. Patients with no ED were selected as the control group. All men answered the IIEF-5 questions and were then classified according to their scores. Patients were determined to have severe ED (scores 5–7), moderate ED (scores 8–16), or mild ED (scores 17–21). An IIEF-5 score greater than 21 was accepted for the control group. The PLR values from both patient and control groups were evaluated. Demographic data were similar in both groups. Mean PLR value was 104 in control and 118 in the patient group (p

Sexuality is an indispensable part of life. When a problem is encountered related to this topic, the quality of life is negatively affected. Therefore, every problem related to sexuality is extremely private and important to an individual. This study aims to investigate the use of myocardial perfusion scintigraphy (MPS) for advanced assessment of patients with known or suspected coronary artery disease, cardiovascular disease, and in the intermediate risk group for SD. The study included 250 patients (150 male, 100 female, mean age 54±12.10) sent by the Cardiology Clinic to the Nuclear Medicine Clinic for MPS due to suspected cardiovascular disease (CVD). The questionnaire study was applied by two methods as face-to-face interviews or online. Data on sociodemographic characteristics and cardiovascular diseases together with risk factors for sexual activity were collected using a general information form. Patients were divided into three categories of risk depending on major risk factors for cardiovascular diseases: low, intermediate, and high risk. On comparing the risk scores between the groups, it was seen that there was a statistically clear reduction in the intermediate risk group of patients with SD according to MPS scoring. MPS is a cost-effective, reliable, and accurate non-invasive diagnostic method necessary for routine use to assess cardiovascular disease and in the intermediate risk group for SD.

PubMed ID: 26460579, Objectives: The objective of this study is to investigate whether patients with androgenetic alopecia were at risk in terms of urinary system stone disease. Patients and methods: Patients with no baldness (Hamilton-Norwood Scala [HNS] stage I) were categorized as Group I, those with hair loss in the frontal region (HNS stages II, III, IIIa, and IVa) as Group II, those with hair loss in the vertex region (HNS stage III-vertex, V) as Group III and those with hair loss in both vertex and frontal regions (HNS stages IV, Va, VI, and VII) as Group IV. Patients in all groups were compared in terms of presence of stone, and the presence of any association between alopecia and urolithiasis, with common etiological risk factors, was investigated. Results: Three hundred and two male patients were included in the study. The presence of urolithiasis was detected in 28.9% of patients in Group I; 26.5% of Group II; 36.9% of Group III; and 44.4% of Group IV (p = 0.085). Among patients aged under 60, urinary stone disease was detected in 30.8% of patients in Group I; 26.4% of Group II; 41.2% of Group III; and 53.8% of Group IV (p = 0.001). In patients aged over 60, urolithiasis was detected in 12.5% of patients in Group I; 26.9% of Group II; 32.2% of Group III; and 37.8% of Group IV (p = 0.371). Conclusions: We determined a significant correlation between vertex pattern and total alopecia with urolithiasis in patients younger than 60 years old. © 2015 Taylor & Francis.

Resumen Objetivos Evaluar la eficacia y seguridad de la cirugia intrarrenal retrograda (CIRR) para tratar los calculos renales en pacientes de diferentes grupos de edad. Pacientes y metodos Se realizo un analisis retrospectivo de 947 pacientes que se sometieron a CIRR para calculos renales entre enero de 2008 y enero de 2014. La edad en la CIRR se analizo tanto como una variable continua como categorica, y los pacientes fueron clasificados en 3 grupos de edad; ≤ 15 anos en la cirugia (grupo i , n = 51), 16-60 anos (grupo ii , n = 726) y> 60 anos (grupo iii , n = 170). Se compararon los 3 grupos con respecto a las caracteristicas del calculo, los parametros operativos y los resultados postoperatorios. Resultados La tasa de ausencia de calculos fue del 78,4% en el grupo i , 77,5% en el grupo ii , y 81,1% en el grupo iii (p = 0,587). Un analisis de regresion logistica multivariante mostro que solo el tamano del calculo y el numero de calculos tuvieron una influencia significativa en las tasas de ausencia de calculos despues de CIRR. Se produjo un 13,7% de complicaciones intraoperatorias en el grupo i , 5,6% en el grupo ii , y 7,6% en el grupo iii . Las tasas de complicacion global en ninos eran mas altas que en pacientes adultos, pero las diferencias no fueron estadisticamente significativas. Se descubrio que solo el tiempo de operacion esataba asociado con el aumento del riesgo de complicaciones intraoperatorias. Las complicaciones medicas perioperatorias se desarrollaron en 8 pacientes (0,8%) en el grupo ii y 2 pacientes (1,1%) en el grupo iii . Un hombre de 48 anos de edad murio a causa de shock septico 5 dias despues de la cirugia. Conclusiones Se observo que la CIRR era un procedimiento seguro y eficaz en todos los grupos de edad de pacientes con calculos, por lo tanto, la edad no debe ser considerada como un factor limitante.

Humic acid is an antioxidant molecule used in agriculture and livestock breeding, as well as in medicine. Our aim was to investigate the potential renoprotective effects of humic acid in a renal ischemia reperfusion model. Twenty-one rats were randomly divided into three equal groups. Intraperitoneal serum or humic acid was injected at 1, 12, and 24 h. Non-ischemic group I was evaluated as sham. The left renal artery was clamped in serum (group II) and intraperitoneal humic acid (group III) to subject to left renal ischemic reperfusion procedure. Ischemia and reperfusion time was 60 min for each. Total antioxidant status, total oxidative status, oxidative stress index, and ischemia-modified albumin levels were analyzed biochemically from the serum samples. Kidneys were evaluated histopatologically and immunohistochemically. Biochemical results showed that total oxidative status, ischemia-modified albumin, and oxidative stress index levels were significantly decreased, but total antioxidant status was increased in the humic acid group (III) compared with the ischemia group (II) On histopathological examination, renal tubular dilatation, tubular cell damage and necrosis, dilatation of Bowman's capsule, hyaline casts, and tubular cell spillage were decreased in the humic acid group (III) compared with the ischemia group (II). Immunohistochemical results showed that apoptosis was deteriorated in group III. Renal ischemia reperfusion injury was attenuated by humic acid administration. These observations indicate that humic acid may have a potential therapeutic effect on renal ischemia reperfusion injury by preventing oxidative stress.

Purpose: To evaluate the predictive role of the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet count (PLT) in the diagnosis of testicular torsion (TT) and testicular viability following TT. Materials and Methods: We analyzed two study groups in this retrospective study: 75 patients with a diagnosis of TT (group 1) and 56 age-matched healthy subjects (group 2). We performed a complete blood count as a part of the diagnostic procedure, and NLR, PLR, MPV, and PLT values were recorded. We compared the patient and control groups in terms of these parameters. Then, TT patients were divided into two subgroups according to the time elapsed since the onset of symptoms. Subsequently, we evaluated the relationship between the duration of symptoms and these parameters. Results: There were significant differences between groups 1 and 2 in NLR, PLR, and PLT (p

OBJECTIVE In this study we planned to investigate the relationship between presence of kidney stones and stone burden with hypertension (HT), diabetes mellitus (DM) and body mass index (BMI). METHODS A total of 574 patients were included in the study. None of the patients had a history of stones. The 121 patients with kidney stone identified on ultrasound evaluation and the 453 patients with no stones were compared in terms of HT, BMI and DM. The stone burden of 121 patients with diagnosed stones was compared in terms of the same variables. RESULTS Of the 121 patients with kidney stones 30 (24.7%) had HT, while 66 (14.5%) of the 453 patients without stones had HT (p=0.007). BMI values of those with and without stones were 27.2 ± 4.93 kg/m(2) and 25.29 ± 4.12 kg/m(2), respectively (p

Aim: This survey study questioned family physicians about their approaches to lower urinary tract symptoms (LUTS) and about the clinical application of total and free prostate-specific antigens (tPSA and fPSA). Material and Method: The survey link was prepared online and sent to an email group for family physicians. The survey had 14 questions, none of which identified the respondents, concerning approaches to male patients with LUTS. Some questions were multiple choice and others allowed multiple answers to be chosen. The results were graphed and interpreted. Results: A total of 350 family physicians responded online. While 250 (72%) were family physician assistants or experts, 214 (61%) worked in family health centers. Of the 300 (85%) family physicians who had seen male patients with LUTS, only 64 (20%) stated that they performed a prostate examination. While 298 (99%) of the physicians prescribed alpha blockers, 234 (78%) physicians stated they requested a tPSA, and 134 (44%) answered that they requested an fPSA. Of the 134 physicians, 104 requested an fPSA without regard to the tPSA value. Discussion: The study identified differences in the approaches of family physicians to male patients with LUTS. DRE was not performed for the majority of patients and, as a result, unnecessary requests for fPSA were made. Increased awareness of approaches to LUTS patients can be provided for family physicians at events such as in-service training and scientific congresses.

Intrauterine device (IUD) is widely used for the long duration of protection, cost-effectiveness and for being a reversible contraceptive method as well as having low complication rates. Despite low complication rates, various IUD-related complications, such as spontaneous aborts, bleeding, infection, and uterine perforation may occur. Although perforation of the uterus by an IUD is not uncommon, bladder perforation is a rare complication. A regular follow-up of patients with IUDs for the complications and training of clinicians for insertion and removal are mandatory to provide better and safe family planning services. Here, we report a case of a patient with uterine perforation with a calcified IUD migration into the the bladder.

Fournier's gangrene is a rare but highly mortal infectious disease characterised by fulminant necrotising fasciitis involving the genital and perineal regions. The objective of this study is to analyse the demographics, clinical feature and treatment approaches as well as outcomes of Fournier's gangrene. Data were collected retrospectively from medical records and operative notes. Patient data were analysed by demographics, aetiological factors, clinical features, treatment approaches and outcomes. Twelve patients (five female and seven male) were enrolled in this study. The most common aetiology was perianal abscess (41·6%). Wound cultures showed a mixture of microorganisms in six (50%) patients. For faecal diversion, while colostomy was performed in six cases (50%), Flexi-Seal was used in two cases (16·6%). In four patients (33·4%), no faecal diversion was performed. Negative pressure wound therapy (NPWT) system was effective in the last four patients (33·4%). The mean hospitalisation period in patients who used NPWT was 18 days, while it was 20 days in the others. NPWT in Fournier's gangrene is a safe dressing method. It promotes granulation formation. Flexi-Seal faecal management is an alternative method to colostomy and provides protection from its associated complications. The combination of two devices (Flexi-Seal and NPWT) is an effective and comfortable method in the management of Fournier's gangrene in appropriate patients.

Objectives: To investigate whether congenital renal vein anomalies are involved in the etiology of hematuria by analyzing abdominal multidetector computed tomography (MDCT) results. Methods: Six hundred and eighty patients undergoing MDCT for various abdominal pathologies in whom possible causes of hematuria were excluded were retrospectively assessed in terms of left renal vein anomalies, such as circumaortic left renal vein (CLRV), retroaortic left renal vein (RLRV) and multiple renal vein (MRV). Patients with CLRV, RLRV or MRV and patients with normal left renal veins were compared in terms of the presence of hematuria. Results: Left renal vein anomalies were detected in 100 patients (14.7%). RLRV, CLRV and MRV were identified in 5.4, 2.5 and 6.8% of patients, respectively. Hematuria was determined in 8.1% of patients with an RLRV anomaly and in 10.5% of patients with no RLRV anomaly (p = 0.633). Hematuria was detected in 23.5% of patients with a CLRV anomaly and 10.1% of those without (p = 0.074), and in 21.7% of patients with an MRV anomaly and 9.6% of those without (p = 0.009). Conclusions: In addition to increasing risk of complication during retroperitoneal surgery, numeric congenital renal vein anomalies are also significant in terms of leading to clinical symptoms such as hematuria.

We read with interest the article by Bozkurt et al in which they compared the outcomes of percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (UL) to treat large (≥1.5 cm), impacted, upper ureteral stones.1 An impacted stone was defined as a stone that did not allow any passage on contrast graphies, stayed at the same localization for more than one month, and resulted in dilation in the collecting system. In some publications, an impacted stone is defined as a stone that cannot be bypassed either by a wire or a catheter.2,3 As understood from the definition, impacted stones that do not allow a catheter to pass to the kidneys are frequently encountered. The authors should explain more clearly and carefully whether retrograde catheterization was easily performed in the PCNL group, and if it was not possible, whether additional instrumentation was used and what approach was chosen. The authors deemed the procedure unsuccessful when the stone could not be reached in a single session and when residual stone ≥4 mm was detected at the one-month postoperative visit. The authors give the success rate for 41 URS patients as 82.3%. However the stone-free rate among these patients is given as 82.9% and it is stated that three patients could not be reached during URS. The authors need to be more precise about treatment success rate, stonefree situation, and percentages given. Finally, for all ureter stones included in the study, one of the inclusion criteria was localization of stone between the lower border of L4 spine and ureteropelvic junction. Only a nephroscope was used during PNL treatment. How PNL was performed on a ureteral stone at L4 level is not explained. The treatment method or stone localization in the PNL group needs to be explained more clearly.

Renal angiomyolipoma (AML) is the most common mesenchymal tumor of the kidney composed of fat, smooth muscle and blood vessels. Although AML is usually asymptomatic, it may sometimes be symptomatic because of retroperitoneal haematoma. The treatment modalities are the stabilization of the patient pursued by either selective transarterial embolization as a first line treatment or the second option of surgery. Dilated and tortuous renal artery anomalies can be observed in AML and may complicate selective embolization. In our study we present a case with large AML developing spontaneous rupture. Selective angioembolization for pseudoaneurysms was unsuccessful due to aberrant artery and torsioned vessel structures, finally the patient underwent surgical treatment.

Objective: To compare the results of transperitoneal laparoscopic nephrectomy in patients with atrophic and hydronephrotic kidneys. Material and methods: Clinical data were collected from 35 patients who had undergone laparoscopic nephrectomies for atrophic or hydronephrotic non-functioning kidneys between January 2010 and March 2014. Comparative analysis was carried out between the two groups examining demographic characteristics, imaging modalities, etiology, operative times, port numbers, conversion to open surgery, complications, pre- and post-operative hemoglobin and creatinine values, transfussion rates and length of hospital stays. Results: Laparoscopic nephrectomy was performed for atrophic kidneys in 20 (57%) patients and for hydronephrotic kidneys in 15 (42%) patients. In the atrophic group, 3 patients (15%) required transfusion because of bleeding but none of the patients required conversion to open surgery. In the hydronephrotic group one patient (6.6%) required transfusion and conversion to open surgery because of bleeding. Both of the groups were similar in terms of postoperative hospital stay but compared to the atrophic kidneys, hydronephrotic ones were associated with a longer total operative times (90.1 min vs. 73.6 min, p=0.03). Any serious complication (except for bleeding) and mortality were not encountered in both groups. Conclusion: Laparoscopic nephrectomy is a safe and effective minimally invasive technique that can be used in atrophic and hydronephrotic non-functioning kidneys.

PURPOSE: We report our experience with a Lich-Gregoir reimplantation (LGR) technique that included fixation of the ureter during detrusorraphy to preserve the integrity of the newly created submucosal tunnel, performed as an outpatient anti-reflux procedure. METHODS: Ninety-seven children (mean age: 7.9 years) with primary VUR underwent LGR between 1995 and 2008. Twenty-one had bilateral VUR, 8 had ureteral duplication, 9 had megaureter, and 13 had previous subureteric injections. Through a Pfannenstiel incision the ipsilateral ureter was mobilized up to the ureterovesical junction without disturbing ureterotrigonal integrity. A 3-5 cm detrusorotomy was extended from the ureterovesical junction towards the umbilicus, the ureter was placed on the mucosa, and detrusorraphy was performed with a loosely running 3/4-0 polyglactin suture that passed through the detrusor on one side of the incision, taking a 1-2 mm “bite” of the ureteral adventitia, and detrusor on the other side. Postoperative ultrasonograms and voiding cystograms (VCUG) were obtained at 1 and 3 months, respectively. Children were then followed up for clinical symptoms of urinary tract infection with annual ultrasonograms. RESULTS: The mean operative time was 56 min. Eighty-one percent of the children were treated as outpatients. Transient voiding difficulties occurred in 2 children with a bilateral procedure. Reflux was cured in 116 ureters (98%) with a mean follow-up of 58 months (range: 6-128). Ipsilateral obstruction was not evident during ultrasound surveillance. CONCLUSIONS: LGR is an outpatient procedure with a high success rate and a low morbidity. Integrity of the newly created submucosal tunnel is important for long-term success, which may be facilitated by our modified detrusorraphy technique.

Purpose: Reconstruction of post-prostatectomy strictures involving the fossa navicularis and external urethral meatus following benign prostatic hyperplasia treatment is challenging in terms of creating a functional and cosmetically appealing penis. We reviewed our results with the use of ventral transverse island fasciocutaneous penile flap in the reconstruction of these strictures.Materials and Methods: Between 1997 and 2007 a total of 26 men (mean age 59 years, range 49 to 76) with post-prostatectomy distal urethral strictures underwent urethral reconstruction with a ventral transverse island fasciocutaneous penile flap. All patients had undergone multiple urethral dilatations. Stricture length was less than 1.5 cm in all cases. Urethral catheter was removed within 3 weeks. Followup included an initial uroflowmetry obtained 1 month after removal of the catheter followed by re-assessment at third month. The patients were followed for urinary pattern changes and/or irritative symptoms with a mean followu...

To research the effect of listening to music during shock wave lithotripsy (SWL) on the patient's pain control, anxiety levels, and satisfaction.The study comprised 400 patients from three hospitals. Half of patients listened to music during their first SWL session but not during their second session. The other half had no music for the first session but the second session was accompanied by music. During all sessions, with and without music, pulse rates, blood pressure, State-Trait Anxiety Inventory-State Anxiety scores (STAI-SA), Visual Analog Scale (VAS scores for pain), willingness to repeat procedure (0 = never to 4 happily), and patient satisfaction rates (0 = poor to 4 = excellent) were assessed.There was no statistical difference between the two groups in terms of blood pressure and pulse rates. In both groups, the STAI-SA and VAS pain scores were lower in the session when music was listened to (p0.001). The patients requested more SWL treatment be completed while listening to music and their satisfaction was greater.Music lowered the anxiety and pain scores of patients during SWL and provided greater satisfaction with treatment. Completing this procedure while the patient listens to music increases patient compliance greatly and reduces analgesic requirements.

Medical ozone has therapeutic properties as an antimicrobial, anti-inflammatory, modulator of antioxidant defense system. Major ozonated autohemotherapy (MOA) is a new therapeutic approach that is widely used in the treatment of many diseases. The objective of the present study was to determine whether preischemic application of MOA would attenuate renal ischemia-reperfusion injury (IRI) in rabbits. Twenty-four male New Zealand white rabbits were divided into four groups, each including six animals: (1) Sham-operated group, (2) Ozone group (the MOA group without IRI), (3) IR group (60 min ischemia followed by 24 h reperfusion), and (4) IR + MOA group (MOA group). The effects of MOA were examined by use of hematologic and biochemical parameters consisting of neutrophil to lymphocyte ratio (NLR), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), ischemia-modified albumin (IMA), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI). In addition, the histopathological changes including the tubular brush border loss (TBBL), tubular cast (TC), tubular necrosis (TN), intertubular hemorrhage and congestion (IHC), dilatation of bowman space (DBS), and interstitial inflammatory cells infiltration (IECI) were evaluated. In the IR group, compared to the Sham group, biochemical parameters indicating oxidative stress, NLR, IL-6, TNF-α, IMA, TOS, and OSI have increased. MOA reduced inflammation and oxidative stress parameters. Although TAS values have decreased in the IR group and increased in the MOA-pretreated group, no significant changes in TAS values were detected between the IR and MOA groups. The total score was obtained by summing all the scores from morphological kidney damage markers. The total score has increased with IR damage when compared with the Sham group (13.83 ± 4.30 vs 1.51 ± 1.71; p = 0.002). But, the total score has decreased significantly after application of MOA (5.01 ± 1.49; p = 0.002; compared with the IR group). MOA preconditioning is effective in reducing tissue damage induced in kidney ischemia-reperfusion injury. The protective effect of MOA is mediated via reducing inflammatory response and regulating of reactive oxygen species (ROS). Renal histology also showed convincing evidence regarding MOA's protective nature against kidney injury induced renal ischemia-reperfusion. Consequently, MOA might be helpful in protecting the kidneys from IR-induced damage in humans, probably through the anti-inflammatory effect and reducing the total oxidant status.

The aim of this article is to investigate the possible impact of timing of ultrasound (US) during the day or week on its diagnostic accuracy. We analyzed the records of 500 patients who underwent an initial urinary US, followed by a noncontrast computed tomography (NCCT) for the assessment of urinary stone disease. The sensitivity, specificity, negative and positive predictive values, negative and positive likelihood ratio, and overall diagnostic accuracy rates of US and were analyzed at different times of the day or week. The specificity and diagnostic accuracy of urinary US showed a decline toward the middle of the week followed by a steady rise by the end of the week, higher sensitivity for urinary US was noticed around mid-week. On the other hand, when urinary US results are subgrouped according to the time of the day they are performed, the specificity remained generally stable but the sensitivity and diagnostic accuracy showed lowest levels between 11:00 a.m. and 02:00 p.m. and between 04:00 p.m. and 05:00 p.m. Although some observational differences between sensitivity, specificity, and diagnostic accuracy of urinary US performed at different times of the day or week are seen, these differences were not statistically significant. Our study showed no significant influence of US timing on its diagnostic accuracy. A larger randomized prospective series is necessary to evaluate the impact of different factors on “precision” and “accuracy” in US reporting and, hence, the diagnostic accuracy of urinary US in identifying urinary stone disease.

Prostate cancer is the second most common cancer in males. At an early stage, prostate cancer barely causes any symptoms. The presence of symptoms upon presentation usually implies the presence of locally-advanced or metastatic disease. Therefore, early detection of prostate cancer is a necessity. Serum Prostate-Specific Antigen (PSA) test and Digital Rectal Examination (DRE) are used for early detection by the urologist. However serum PSA level is not only affected by the tumours but also other factors. The limitations of serum PSA test led to the introduction and application of various PSA derivatives to improve test sensitivity and specificity. In this review article, we provide a literature review and analysis of the currently available PSA test and its derivatives compared to new and developing potential tumour markers for detection and monitoring of prostate cancer.

Akbas, Alpaslan/0000-0003-1470-5952 WOS: 000374327500015 PubMed: 27513242 Background/aim: The purpose of the present study was to review the complications of ureteroscopy (URS) by using the modified Clavien classification system (MCCS) and to investigate the factors associated with complications. Materials and methods: Data regarding 811 patients who underwent URS for ureteral calculus were analyzed. Peroperative and postoperative complications were recorded. The patients were divided into seven groups depending on the severity of the complications. The association of sex, stone size, number, and localization with each MCCS grade was also evaluated. Results: The average age was 45 years. The success of the procedure after one session was 93.5%. Complications were recorded in 57.9% of the patients. According to the MCCS, grade I, II, IIIa, IIIb, IVa, IVb, and V complications were documented in 29.8%, 7.1%, 8.6%, 11%, 0%, 1.2%, and 0% of the patients, respectively. The factors associated with the complications graded by MCCS were sex, stone size, number of stones, and localization. In addition, in multivariate analysis, history of previous surgeries for urolithiasis, orifice dilatation, and instrument size were associated with complications. Conclusion: According to MCCS, sex, history of previous surgeries for urolithiasis, orifice dilatation, size of the instrument, stone size, number of stones, and localization are associated with different grades of complications in URS.

Purpose: The aim was to compare the findings of non-contrast computerized tomography (NCCT) evaluated by urology specialists with the findings of experienced radiologists, who are accepted as a standard reference for patients who present with acute flank pain. Materials and Methods: Five hundred patients evaluated with NCCT were included in the study. The NCCT images of these patients were evaluated by both radiologists and urology specialists in terms of the presence of calculus, size of calculus, the location of calculus, the presence of hydronephrosis, and pathologies other than calculus, and the results were compared. Results: The evaluations of urology specialists and standard reference radiology specialists are consistent with each other in terms of the presence of calculus (kappa [κ]: 0.904), categorical stone size (κ: 0.81), the location of calculus (κ: 0.88), and hydronephrosis (κ: 0.94). However, the evaluations of urology specialists in detecting pathologies other than calculus, which may cause acute flank pain or accompany renal colic, were found to be inadequate (κ: 0.37). The false-negative rate of detecting pathologies outside of the urinary system by the urology specialists is calculated as 0.86. Conclusion: Although the urology specialists can evaluate the findings related to calculus sufficiently with NCCT, they may not discover pathologies outside of the urinary system.

The present study aimed to evaluate the role of functional polymorphisms of apoptosis-associated Fatty acid synthase (FAS) and fatty acid synthase ligand (FASL) genes in bladder cancer susceptibility as first presentation in a Turkish population.Genotypes of 91 patients with bladder cancer and 101 healthy controls were evaluated for the polymorphism of FAS-1377 G/A and FASL-844 T/C genes by polymerase chain reaction and restriction fragment length polymorphism analysis.The frequency of the FAS-1377 G allele was significantly higher in patients with bladder cancer compared to controls (p0.001). A significantly increased risk for developing bladder cancer was found for the group bearing a T allele for FASL-844 compared to the homozygous FASL-844 CC genotype (p=0.027). FAS-1377 GG genotype and FASL-844 T allele were found to be independently associated with an increased risk of bladder cancer. Additionally, gene-gene interaction analysis revealed that the frequency of FAS-1377AA with FASL-844TC was significantly lower in patients with bladder cancer in comparison to those of controls (p0.001). Extensive studies for gene-gene interaction are still needed.Our study provides new evidence that FAS-1377 G and FASL-844 T alleles may be used as low-penetrant risk factors for bladder cancer development in a Turkish population.

We report a 75-year-old female with a primary urethral malignant melanoma. A mass protruding from inside the urethra was detected on physical examination. Abdominopelvic magnetic resonance imaging revealed a mass extending from the urethra with dimensions of 4 × 2 cm, and periurethral heterogenous fatty planes consistent with infiltration. The histopathologic examination was consistent with HMB45(+) malignant melanoma. We performed cystourethrectomy and bilateral inguinal and pelvic lymphadenectomy in one session. The pathology report revealed primary malignant melanoma of the urethra invading the inferior bladder wall. The patient received no adjuvant therapy because of cardiopulmonary morbidities and the presence of multiple pulmonary metastases. The patient eventually died 13 months after surgery.

Urinary incontinence is a stent-related complication; however, total incontinence is not often seen in emergency departments. We report a patient who presented with a sudden, painless, and total urinary incontinence after extracorporeal shock wave lithotripsy. This is the first case of total incontinence due to migrated ureteral double J stent through the external urethral sphincter into the urethra following extracorporeal shock wave lithotripsy.

Introduction: We sought to evaluate the association of female sexual dysfunction (FSD) with adrogenetic alopecia (AGA) and metabolic syndrome (MetS) in premenopausal women.Methods: From December 2013 to June 2015, we performed a case-control, prospective study of 115 patients with AGA and 97 age-matched control patients without AGA from among premenopausalwomen who visited dermatology clinics of the two reference hospitals. Comprehensive history, anthropometric measurements, and questionnaire administration were performed for each of the total of 212 women. The Female Sexual Function Index (FSFI) was used to assess the key dimensions of female sexual function. AGA was assessed and graded by an experienced dermatologist according to Ludwig’s classification. The MetS assessment was made according to the NCEP-ATP III criteria.Results: In univariate analysis, age, weight, waist circumference, hip circumference, waist-to-hip ratio, body mass index (BMI), AGA, MetS, cardiovascular event, marital status, hypertension, high fasting plasma glucose, high triglyceride, large waist, total testosterone, and free testosterone were associated with presence of FSD. In logistic regression analysis, age (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.13‒1.30; pConclusions: Our study suggests that age, AGA, MetS, and free testosterone may have strong impact on sexual function in premenopausal women. Further studies with population-based and longitudinal design should be conducted to confirm this finding.

Summary Objective Testicular torsion is an emergency condition that causes testicular injury. Any treatment opportunity reducing the destructive effect of testicular torsion is important for the future life of patients. In this experimental study we investigated the protective effect of mannitol on ischemia–reperfusion (I/R) injury in a rat testes torsion model. Method In total, 32 male Sprague Dawley rats were included. Four experimental groups included eight rats each. Group A was a sham group in which the right testis was brought out through a scrotal incision and then replaced in the scrotum without torsion. In Group B, the right testis was torsioned, by rotating 720° clockwise and fixed to the scrotum with no treatment. In Group C, the same testicular torsion process was performed with saline infusion just after testicular torsion. In group D, mannitol infusion was used just after testicular torsion. Testicles were detorsioned after 3 h and left inside for more than 2 h before orchiectomy. Histopathological, immunohistochemical, and biochemical analyses were performed. Results Testicular architecture was disturbed significantly in the torsion groups without mannitol infusion. However, testicular tissue structure was significantly better in the mannitol-treated group, demonstrating a protective effect. Similar findings were also shown for the proliferating cell nuclear antigen (PCNA) index and antioxidant activity; both were higher in the mannitol group than in the no-treatment and saline groups ( p p Conclusions The seminiferous tubule structure in testicular torsion without mannitol treatment was significantly disturbed, whereas the structural disruption was considerably less in the mannitol group. Mannitol treatment also decreased reactive oxygen radical levels significantly and was able to decrease apoptosis. These results were consistent with other organ model studies that evaluated the protective effects of mannitol treatment in I/R injury. Mannitol infusion had a protective effect against I/R injury in testicular torsion in rats. This experimental study may guide clinicians to evaluate the effectiveness of mannitol in human testicular torsion. Table . Histopathological evaluation of study groups. Apoptotic index PCNA index MTBS MSTD Group A 3.88 ± 0.83 b 36.47 ± 1.36 b 9.23 ± 0.17 b 273.25 ± 5.14 b Group B 25.88 ± 2.91 a , b 22.22 ± 2.34 a , b 4.57 ± 0.22 a , b 209 ± 6.11 a , b Group C 25.52 ± 2.87 a , b 22.51 ± 2.99 a , b 4.76 ± 0.14 a , b 210.63 ± 5.09 a , b Group D 15.25 ± 1.48 a 29.28 ± 1.66 a 6.72 ± 0.25 a 229.63 ± 6.18 a MSTD = mean seminiferous tubular diameter; MTBS = mean testicular biopsy score; PCNA = proliferating cell nuclear antigen; I/R = ischemia-reperfusion. Group A was a sham operation group, Group B (I/R) had 3 h ischemia and 2 h reperfusion, Group C (I/R + Saline) had 3 h ischemia and 2 h reperfusion and saline bolus treatment, Group D (I/R + Mannitol) had 3 h ischemia and 2 h reperfusion and mannitol bolus treatment. a p b p

It manifests itself with flank pain and usually renal involvement is detected at the time of diagnosis. Additionally, distant lymph node metastasis could also be detected. Absence of previous unilateral adrenal gland involvement, presence of pigmented lesions without any signs of endocrine disorder, and negative immunohistochemical endocrine markers are typical characteristics of primary malignant melanoma of the adrenal gland. Presence of an occult primary lesion should also be excluded by autopsy. Pluripotent neural crest cells are localized within adrenal gland medulla. They are precursors of melanocytes, neurons, glial cells of the peripheral nervous system, and adrenal chromaffin cells. Under the influence of microenvironment, and various growth factors, these multipotent cells might transform into different cell types.

OBJECTIVES To review our long-term results with a modified dorsal lumbotomy (DL) approach and evaluate its role as a minimally-invasive alternative for the surgical management of ureteropelvic junction obstruction (UPJO). METHODS Fifty-nine consecutive children (42 males, 17 females, median age: 5.7 years) underwent pyeloplasty with transverse DL (TDL) between 1999 and 2008. Kidney stones, solitary kidney, and bilateral UPJ obstruction was present in 6, 3, and 5 children, respectively. Forty-nine and 10 children received stented dismembered pyeloplasty and Y-V plasty, respectively. Information on the duration of surgery, length of hospital stay, length of time to return to unrestricted activity, and per/postoperative complications was recorded. Children were followed up postoperatively with urinalysis and ultrasonography (US) at first month, diuretic renogram or intravenous urography (IVU) or both at sixth month, and yearly thereafter with US and renal scintigraphy for the emergence of recurrent clinical symptoms, deterioration of differential renal function, or increase in hydronephrosis. RESULTS Median operative time was 78 minutes and median incision length ranged between 3 and 5 cm for all age groups. All children tolerated liquid diet within the evening of surgery and returned to unrestricted activity within 48 hours. Eight-eight percent of all patients were discharged within 2 days, and 88% of children operated after 2004 were discharged in less than 30 hours. Recurrent UPJO was not evident in any case with a median follow-up of 56 months. CONCLUSIONS TDL provides excellent exposure for UPJO repair with a cosmetically appealing scar while maintaining a minimal convalescence advantage. It is particularly beneficial in bilateral pyeloplasty as synchronous bilateral repair can be performed without repositioning the patient.

We read with great interest the recent article by Kruck et al. [1] on the comparative study of minimally invasive percutaneous nephrolithotomy (MIP), retrograde intrarenal surgery (RIRS) and shock wave lithotripsy (SWL) in renal stone treatment. In this article, authors compared clinical outcome, complications, stone-free rate (SFR) and stonefree survival with regard to stone size and localization. They concluded the significant advantages of the MIP and RIRS procedures for increased SFRs, lower risk of stone persistence and prolonged stone-free survival compared with SWL. We congratulate the authors for their work and thank them for bringing this debatable topic to our attention; however, we feel that some issues described in their paper need further discussion. Over the last decade, with the miniaturization of instruments in percutaneous nephrolithotomy and technological improvements in flexible ureteroscopes, working instruments and laser technology, RIRS, MIP and microperc techniques have become more attractive procedures for the treatment of nonbulky renal urolithiasis [2, 3]. Furthermore, in the recent years, there has been an increasing realization that the SWL has unpredictable and unfavorable results when comparing with other minimally invasive methods [4–6]. On a comparative study of RIRS and SWL, El-Nahas et al. [4] concluded the significant advantages of the RIRS procedure for higher stone-free rate and lower retreatment rate for the management of medium sized lower pole renal stones. Another three comparative studies, evaluating the outcomes of PNL and SWL, showed that the success rate was statistically higher, and retreatment or auxiliary procedures were less for PNL compared with SWL [5–7]. But in all these studies, PNL or RIRS was associated with an increased risk of complications compared with SWL. Similar results were reported in the present study by Kruck et al. [1]. Despite publishing these studies and clinical treatment guidelines, there are no universally accepted paradigms to treat renal stones, due to absence of robustly designed randomized controlled trials [8, 9]. Until the publishing of welldesigned randomized prospective large series examining the efficacy and safety of minimally invasive treatments, SWL will be the most valuable treatment option because of its noninvasive nature, low morbidity rate and high patient acceptance [3]. Therefore, current EAU guidelines recommend SWL remains the method of first choice for stones \2 cm within the renal pelvis, upper or middle calices and for stones\1.5 cm within lower pole calices [9].

We read with great interest the recent article by Bayrak et al. [1] on the comparative study of open surgery and percutaneous nephrolithotomy (PNL) for the management of pediatric kidney stones. In this article, authors compared the groups according to the stone surface area, stone-free rates, hospitalization time, blood transfusion rates and the D-J implantation rates. They concluded that PNL supersedes open surgery in terms of the use of advanced instruments and technological developments for modern pediatric surgery. Renal stones are not common in children, but they are often associated with metabolic disturbances, anatomical abnormalities or infectious diseases. Such events lead to high-risk of stone recurrence [2]. So minimally invasive procedures are very important in this age group patients [3]. Currently, the three minimally invasive techniques are available for renal stones in children: shock wave lithotripsy (SWL), PNL and retrograde intrarenal surgery (RIRS). Majority of renal stones can be managed successfully with these techniques. However, open surgery is still needed in some difficult cases. The European Association of Urology, 2012 guidelines state clearly that the indications of open surgery includes: failure of primary therapy, very young children with complex stones, severe congenital deformities, which limit positioning of endoscopic procedures, abnormal kidney position and congenital malformation requiring simultaneous surgical correction [4]. In the article, the authors concluded the significant advantages of the PNL procedure in terms of reduced hospital stay, requirement of a minimal incision and lower requirement of a secondary process [1]. However, in differents series major complications have been identified as a result of PNL with a rate of 0.03 to 10 % [5, 6]. A viable alternative in this population is RIRS, which may be performed at single or multiple stages depending on stone location and size [7]. In a recent multi-institutional study, Resorlu et al. [3] examined their experience with mini-PNL and RIRS for 1 to 3 cm renal stones in children by evaluating stone-free rates and associated complications . They demonstrated that RIRS is an effective alternative to mini-PNL in children and operation time, hospital stay, radiation exposure and, morbidities of PNL can be significantly reduced with this technique. But also they concluded that mini-PNL continues to be the best choice traetment modality for stones larger than 2 cm in size because of its more effective nature.

Objectives: To compare individuals consuming natural spring water and tap water in terms of presence of urinary tract stone disease. Patients and methods: Patients were divided into two groups on the basis of the type of water: tap water (Group I) vs natural spring water consumers (Group II). The two groups were compared in terms of presence of urolithiasis. In addition to the type of water consumed, participants were investigated in terms of age, sex, occupation, body mass index (BMI) and presence of hypertension (HT) and diabetes mellitus in order to evaluate if they constituted a risk factor for urolithiasis. Results: Two hundred fifty-nine patients consuming tap water and 254 consuming natural spring water were included in this study. Presence of urinary stone disease was determined in 27% of patients in Group I and 26% of Group II (p = 0.794). At multivariate analysis involving all variables that might be correlated with the presence of urolithiasis; male gender, high BMI and presence of HT emerged as being significantly associated with urolithiasis. Conclusions: Although we showed that male gender, presence of HT and high BMI affect stone formation, no difference was demonstated in terms of presence of stone among patients consuming tap or natural spring water.