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Microrobots are of significant interest due to their smart transport capabilities, especially for precisely targeted delivery in dynamic environments (blood, cell membranes, tumor interstitial matrixes, blood-brain barrier, mucosa, and other body fluids). To perform a more complex micromanipulation in biological applications, it is highly desirable for microrobots to be stimulated with multiple stimuli rather than a single stimulus. Herein, the biodegradable and biocompatible smart micromotors with a Janus architecture consisting of PrecirolATO 5 and polycaprolactone compartments inspired by the anisotropic geometry of tadpoles and sperms are newly designed. These bioinspired micromotors combine the advantageous properties of polypyrrole nanoparticles (NPs), a high near-infrared light-absorbing agent with high photothermal conversion efficiency, and magnetic NPs, which respond to the magnetic field and exhibit multistimulus-responsive behavior. By combining both fields, we achieved an "on/off" propulsion mechanism that can enable us to overcome complex tasks and limitations in liquid environments and overcome the limitations encountered by single actuation applications. Moreover, the magnetic particles offer other functions such as removing organic pollutants via the Fenton reaction. Janus-structured motors provide a broad perspective not only for biosensing, optical detection, and on-chip separation applications but also for environmental water treatment due to the catalytic activities of multistimulus-responsive micromotors.

The objective of this study is to evaluate the average radiation exposure in children with renal stones before SWL treatment. Mean radiation exposure values were evaluated in 110 children before SWL treatment. While some children referred to the emergency department (ED) with colic pain, remaining cases referred to outpatient department (OD). Although low-dose NCCT was performed in ED; KUB and abdominal sonography were first performed in other cases referring to OD where CT has been applied if needed. The type of imaging modality used and the mean radiation exposure were evaluated and comparatively evaluated with respect to the department referred, patient as well as stone related parameters. 49 children referred to ED and 61 children referred to OD. Mean stone size was 7.24 ± 0.29 mm. 62 cases had opaque stones. Mean radiation exposure values were higher in children referring to ED than the other cases. However, there was no significant difference between the two groups regarding the mean number of KUB, IVU and sonographic evaluation performed prior to SWL management. There was a significant correlation between the mean radiation exposure and the stone size as well degree of hydonephrosis in a positive manner. Although a significant correlation was present between the mean radiation exposure and stone opacity in a negative manner; there was no correlation with respect to the other related parameters. Unnecessary use of X-ray based imaging modalities in children could be effectively avoided using KUB and US combination beginning from the diagnostic phase of stone disease.

Objective: The effects of surgical technique on respiratory mechanics, arterial oxygenation and hemodynamics in radical prostatectomy operation were investigated., Methods: The study was planned on ASA II-III, 40-65 years old, fourty patients scheduled for radical prostatectomy under general anesthesia. They were divided into two groups: perineal and suprapubic (Group P, n = 20; Group S, n = 20). Heart rate, mean arterial blood pressure, arterial oxygen saturation (SpO2), partial pressure of end-tidal carbon dioxide (PEtCO2), Peak inspiratory pressure (PIP), plato pressure (Pplato), partial pressure of oxygen in arterial blood (PaO2), partial pressure of carbon dioxide in arterial blood (PaCO2) values were evaluated at 10 minutes after induction. After the position applied for surgery in the 30.60 and 90th minutes, the Alveolar-arterial oxygen pressure gradient (P(A-a) O2), the ratio of physiologic dead space over tidal volume (VD/VT), arterial to end tidal CO2 gradient (P(a-et) CO2), static compliance (CS), dynamic compliance (CD) were assessed., Results: In the assessment of groups, there were not statistical differences about mean blood pressure, heart rate, SpO2, PetCO2, PaO2, plateau pressure, and P (A-a) values (p > 0.05). Peak inspiratory pressure was higher in Group P. Peak inspiratory pressure and plateau pressure increased with CO2 insufflation in Group P. PaCO2 and P(a-et) CO2 were higher statistically significantly in Group 0. There was no difference in terms of the PetCO2 values. VD/VT ratios were statistically significantly lower in the Group P., Conclusions: Suprapubic surgery was shown to improve oxygenation and respiratory mechanics without causing any hemodynamic side effect in radical prostatectomy operation.

Objective: The study aimed to evaluate the true safety of transient cessation of the antiplatelet medication before extracorporeal shock wave lithotripsy (SWL) on bleeding-related complications., Patients and Methods: Forty cases undergoing SWL for renal pelvic stones were included and depending on the use of antiplatelet medication they were divided into 2 groups namely: group 1, cases under antiplatelet medication in whom the medication was stopped before ESWL; and group 2, cases without any antiplatelet medication. Comparative evaluation of patient, stone and treatment-related parameters were done in both groups., Results: Although microscopic hematuria was present in all cases, the incidence of macroscopic hematuria was higher in cases undergoing antiplatelet medication when compared with the other cases. Regarding the microscopic hematuria again, the mean number erythrocytes per field of analysis was significantly higher in group 1 cases. The mean value of the hematoma size was similar in both groups., Conclusion: Our findings indicate that SWL can be applied safely in patients under antiplatelet therapy following the cessation of medication for a certain period of time. However, among the cases treated with this concept in our study, we clearly observed that the incidence of procedure-related hematoma formation and macroscopic hematuria were more common in such cases than in the normal ones., (© 2016 S. Karger AG, Basel.)

Purpose: To evaluate the possible association between metabolic syndrome (MetS) and infectious complications after prostate biopsy., Methods: A total of 480 men underwent prostatic biopsy due to elevated prostate-specific antigen levels and/or abnormal digital rectal examination. Patients were divided into two subgroups with respect to the presence or absence of MetS. Patients in both groups were closely followed with respect to infectious complications after biopsy and the possible effect of MetS as a certain risk factor on these complications was evaluated with a multivariate analysis., Results: Infectious complications were observed in 33 cases (6.8%), while urinary tract infection (UTI) was detected in 30 (6.2%) cases, sepsis occurred in three (0.6%) cases. The percentage of the cases with infectious complications was 11.0 and 3.4% in men with and without MetS, respectively (p = 0.002). These rates were 3.7 versus 1.5%, respectively, for UTI (p < 0.003) and 0.9 versus 0.4%, respectively, for sepsis in both groups (p = 0.594). Multivariate analysis of the data confirmed that MetS was associated with an increased risk of infective complications (odds ratio 3.44 and 95% CI 1.56-7.58, p < 0.002) after this procedure., Conclusions: MetS could pose a certain increased risk for infectious complications after prostate biopsy. Patients with MetS should be considered as risk cases for this procedure, and they should be evaluated and followed in a very close manner with respect to these complications.

Numerous studies indicate that there might be differences in embryo growth dynamics between male and female embryos. However, current data in humans are scarce and the results are inconclusive or conflicting. This study asks whether there exist gender-specific embryo development kinetics or parameters between human male and female embryos that can be observed by time-lapse technology. Study included data from 139 consecutive cycles (177 embryos transferred, 179 sacs analysed) with positive pregnancy that resulted in 100% implantation. Single- or double-embryo transfers were performed. Cases were analysed for parameters including cleavage time points and duration in each cleavage from two cells to hatching blastocyst stages and time interval between cleavages. Morphokinetic parameters of 78 female and 60 male embryos from a total of 119 cycles (139 sacs were examined after transfer of 138 embryos) were processed for data analysis according to the gender group. A detailed analysis of the data regarding each time point or interval between consecutive events according to these groups showed them to be similar in cell division kinetics, from the early cleavage through their development to blastocyst stage. However, female embryos showed earlier cavitation than male embryos, but the results did not reach statistical significance., (Copyright © 2014 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Purpose: Ischemic priapism, a compartment syndrome, requires urgent treatment in order to nourish the corpora cavernosa. As the first step, aspiration of blood and irrigation of the cavernosal bodies is performed to prevent fibrotic activity and secure erectile capability. During aspiration, there are risks of cardiovascular side effects of adrenergic agonists. We aimed to evaluate a transient distal penile corporoglanular shunt technique in place of aspiration and irrigation techniques for treatment of early ischemic priapism., Materials and Methods: A transient distal penile shunt was applied to 15 patients with early ischemic priapism between January 2011 and May 2012. Priapism duration, history, causes, pain, and any prior management of priapism were assessed in all patients. A complete blood count and penile Doppler ultrasonography were performed, which showed attenuated blood flow in the cavernosal artery. A sterile closed system blood collection set, which has two needles and tubing, was used for the transient distal penile shunt., Results: Ten of 15 patients with early ischemic priapism were successfully treated with this transient shunt technique. No additional procedures were needed after the resolution of rigidity in the 10 successfully treated patients., Conclusions: The transient nature of this technique is an advantage over aspiration and irrigation in the treatment of early ischemic priapism. Our results indicate that the technique can be offered for patients with an ischemic priapism episode of no more than 7 hours.

Extracorporeal shockwave lithotripsy (ESWL) has dramatically changed the treatment of urinary lithiasis and has been the first treatment option for the majority of patients for more than two decades. Despite its significant benefits, it induces acute renal injury that extends from the papilla to the outer cortex. We evaluated the severity of the inflammatory response to ESWL by measuring the urinary excretion of the cytokines TNF-α, IL-1α, and IL-6. The study included 21 selected patients and 14 control subjects. All patients underwent the same ESWL procedure (2,500 shockwaves at 100 shockwaves/min and 0.039 J from the lithotripter). Urine TNF-α, IL-1α, and IL-6 levels were measured using standard ELISA kits. In the study population (patients and controls), we did not detect TNF-α in the urine samples. The levels of both IL-1α (2.5 pg/ml) and IL-6 (3.8 pg/ml) measured before ESWL were not significantly different from the control group (2.5 and 5.2 pg/ml, respectively; p > 0.05). Twenty-four hours after ESWL, in contrast to IL-1α (4 pg/ml), urine IL-6 (19.7 pg/ml) increased significantly (p < 0.05). Fourteen days after ESWL, IL-1α increased to 5 pg/ml, while IL-6 (7 pg/ml) decreased to the control level. Urine cytokine levels may be used to evaluate the inflammatory response to ESWL. After ESWL, IL-6 levels increased in the early phase, while IL-1α levels increased later. These two markers may be used to measure the severity of inflammation. In contrast to IL-1α and IL-6, urine TNF-α excretion was not increased by ESWL. We believe that the inflammatory response to ESWL can be detected by the urinary excretion of IL-1α for up to 14 days.

Objective: To compare the dynamics of early development between embryos cultured in single and sequential media., Design: Randomized, comparative study., Setting: Private IVF centre., Patients: A total of 446 metaphase II oocytes from 51 couples who underwent oocyte retrieval procedure for intracytoplasmic sperm injection. Forty-nine resulted in embryo transfer., Intervention: Oocytes were split between single and sequential media produced by the same manufacturer and cultured in a time-lapse incubator., Main Outcome Measures: Morphokinetic parameters until the embryos reached the 5-cell stage (t5), utilization, clinical pregnancy and implantation rates., Results: Embryos cultured in single media were advanced from the first mitosis cycle and reached 2- to 5-cell stages earlier. There was not any difference between the durations for cell cycle two (cc2 = t3-t2) and s2 (t4-t3). The utilization, clinical pregnancy and implantation rates did not differ between groups. The proportion of cryopreserved day 6 embryos to two pronuclei oocytes was significantly higher in sequential than in single media., Conclusions: Morphokinetics of embryo development vary between single and sequential culture media at least until the 5-cell stage. The overall clinical and embryological parameters remain similar regardless of the culture system.

Hemangiopericytoma, which is derived from pericytes, is rarely seen in the kidney and adical nephrectomy with or without chemotherapy is the treatment of choice in most of the cases. We report a fifty-year-old male patient presenting with gross hematuria that radiologic evaluation confirmed due to a solid mass in the right kidney. Its clinical manifestations and radiologic tests were similar to renal cell carcinoma. Radical nephrectomy was performed and the pathological examination revealed the specimen as hemangiopericytoma. No additional treatment was added and the patient remained disease free at the end of the first year follow up after radical nephrectomy.

Objective: To evaluate the treatment parameters of shockwave lithotripsy (SWL) in lower calyceal calculi in adults and children in a comparative manner., Material and Methods: Between 2006 and 2011, SWL was performed for lower calyceal calculi in 282 adults (mean age 48.5 years, range 28-64) and 54 children (mean age 48 months, range 5-141). The Wolf Piezolith 3000 lithotriptor has been used for SWL. Success rates, auxiliary procedures, additional interventions, and complications were evaluated in detail in a comparative manner., Results: Mean stone size was 7.7 mm (range 5-25) and 8.1 mm (range 5-23) in children and in adults, respectively. Mean SWL sessions were 1.5 (range 1-5) in children and 2.4 (range 1-6) in adults. Although 66.6% of children were stone-free after the first session, 28% of adult patients were stone-free after the first SWL session, showing a statistically significant difference (P = .0001). After the treatments, although a complete stone-free status was obtained in 85% of children, 31.5% of adults were stone-free at 3-month follow-up after SWL (P = .0001). Although no auxiliary procedures were needed in children, 8.2% of adults required them. Likewise, the percentage of additional procedures were higher in adults than children (20.2%)., Conclusion: SWL for lower calyceal calculi has been found to be highly successful in pediatric patients. These results demonstrate that, irrespective of stone size, SWL should be the first treatment alternative in the management of lower calyx stones in children., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Introduction: The aim of this study is to evaluate the anorectal functions of prostate cancer patients who have undergone radical perineal prostatectomy (RPP) or radical retropubic prostatectomy (RRP) surgery., Material and Methods: Thirty-seven patients with an indication for radical prostatectomy were included after informed consent. Anorectal manometry was performed before and one month after the surgery in 22 RPP and 15 RRP patients in our clinic. Clinical assessment was evaluated by anorectal functions with anal incontinence scoring (AIS) (Fernandez; no incontinence = 0; maximal incontinence = 12). Patients with a history of anorectal surgery were excluded from the study. The following data were recorded: external anal sphincteric pressure (EASP), internal anal sphincteric pressure (IASP), minimum ano-rectal reflex volume (MARRV) and minimum rectal sensory volume (MRSV)., Results: In the RPP and RRP groups, the mean age was 66 (56-75) and 64.3 (52-73) years, respectively. In the RPP group, EASP and IASP values showed a significant decrease after the surgery. In the RRP group, EASP and IASP were also decreased after the surgery, but without statistical significance. No significant change was seen in MARRV and MRSV of either group. When the scores of AIS were analysed, no significant clinical difference between pre- or post-operative scores was seen in RPP and RRP groups., Conclusions: Perineal or retropubic surgery may injure pelvic floor muscles and/or supplying nerves, which likely causes anorectal dysfunction. Although there is a significant decrease in early postoperative EASP and IASP after RPP, it has no clinical significance according to AIS.

Purpose: Evaluate the results of urinary continence on patients who had undergone radical perineal prostatectomy (RPP) for clinically localized prostate cancer., Materials and Methods: We analyzed the continence data of 120 patients with pathology of cT1-cT2N0M0 prostate cancer and who had undergone RPP. Continence was assessed on the day of catheter removal, at the end of the first and third month, and the first year postoperatively. The patients who were continent immediately after catheter removal were classified in the group of "immediately continent" while the patients who became continent during the 3 postoperative months were classified as "early continent.", Results: Mean duration of catheterization was 10 (10-25) days. Of 120 patients, 44 (36.7%) were immediately continent. At the end of the first and third months, 65 (54.1%) and 87 (72.5%), respectively, were early continent. At the one-year follow-up, 95.3% of 107 cases whose one-year follow-up data were available were continent. When the relationship between patients' age and continence was analyzed, it was found that the early continence rates were 77.7% (7/9), 73.3% (33/45), 73.4% (36/49), and 64.7% (11/17) in the groups of=49, 50-59, 60-69, and=70 years, respectively (p=0.68)., Conclusions: The majority of patients who underwent RPP rapidly regained continence within 3 months. RPP is an exceptional alternative approach for radical surgery in the treatment of localized prostate cancer.

Dissection of the bladder neck is particularly important in patients who have previously had prostate surgery due to hyperplasia. We describe an endoscope-assisted radical perineal prostatectomy (RPP) technique that facilitates the dissection of the prostate-vesical junction. The technique was employed in four patients with a history of transurethral prostate resection. Before dissecting the prostate from the bladder neck during RPP, we circumscribed the bladder neck perurethrally with a Collins knife. The remaining of the RPP procedure was performed via the traditional approach. The incision of the prostate-vesical junction with the Collins knife protected the bladder-neck integrity and made the dissection of this junction easier. The final pathologic diagnosis was organ-confined prostate cancer with negative surgical margins. All the patients had continence during a 6-month follow-up. The major advantage of this technique is to precisely locate the prostate-vesical junction under direct vision. Our modified technique may prove to be a simple, less invasive, and oncologically safe method to manage the bladder neck perurethrally.

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; P < .001). 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.

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.

During laparoscopic cholecystectomy, the separation of the gallbladder from the liver bed may sometimes cause severe hemorrhages. One reason for severe hemorrhages may be injury to the major branches of the middle hepatic vein (MHV), which may be too close or adherent to the gallbladder. In our institutional experience of 798 laparoscopic cholecystectomies, no major hemorrhage from the gallbladder bed has been encountered. The aim of this prospective study was to investigate the relationship between the major branches of the MHV and the gallbladder bed in our patients. We measured the distance of the closest branches of the MHV from the gallbladder bed by color Doppler ultrasound scan. The mean and the median distances of the closest branch of the MHV to the gallbladder was found to be 17.4 +/- 6.2 mm and 17.7 mm, respectively (range, 6-29.1 mm). In conclusion, the distance of the closest branch of the MHV to the gallbladder bed in our patient population seems to allow for a safe laparoscopic cholecystectomy.