Texture analysis of multiparametric magnetic resonance imaging for differentiating clinically significant prostate cancer in the peripheral zone

BACKGROUND

Texture analysis (TA) provides additional tissue heterogeneity data that may assist in differentiating peripheral zone(PZ) lesions in multiparametric magnetic resonance imaging (mpMRI). This study investigates the role of magnetic resonance imaging texture analysis (MRTA) in detecting clinically significant prostate cancer (csPCa) in the PZ.

METHODS

This retrospective study included 80 consecutive patients who had an mpMRI and a prostate biopsy for suspected prostate cancer. Two radiologists in consensus interpreted mpMRI and performed texture analysis based on their histopathology. The first-, second-, and higher-order texture parameters were extracted from mpMRI and were compared between groups. Univariate and multivariate logistic regression analyses were performed using the texture parameters to determine the independent predictors of csPCa. Receiver operating characteristic (ROC) curve analysis was conducted to assess the diagnostic performance of the texture parameters.

RESULTS

: In the periferal zone, 39 men had csPCa, while 41 had benign lesions or clinically insignificant prostate cancer (cisPCa). Themajority of texture parameters showed statistically significant differences between the groups. Univariate ROC analysis showed that the ADC mean and ADC median were the best variables in differentiating csPCa (p < 0.001). The first-order logistic regression model (mean + entropy) based on the ADC maps had a higher AUC value (0.996; 95% CI: 0.989-1) than other texture-based logistic regression models (p < 0.001).

DISCUSSION

MRTA is useful in differentiating csPCa from other lesions in the PZ. Consequently, the first-order multivariate regressionmodel based on ADC maps had the highest diagnostic performance in differentiating csPCa.

Prognostic role of the endothelial cell-specific molecule-1 histopathologic expression in renal cell cancer

INTRODUCTION

To measure the level of endothelial cell-specific molecule-1 (ESM-1) expression among the Renal Cell Cancer (RCC) variants using by immunohistochemical method and determine the relationship between ESM-1 expression and RCC prognosis.

MATERIALS AND METHODS

ESM-1 immunoreactivity scores (IR) were measured in appropriate renal tumoral tissue blocks of 153 consecutive RCC patients in this retrospective analysis of prospectively collected data. Mean ESM-1 IR scores were calculated in patients who were pathologically diagnosed with clear cell RCC (ccRCC), papillary RCC (pRCC), and chromophobe RCC (chRCC). Progression-free survival and overall survival were evaluated using the log-rank test according to ESM-1 IR scores. Survival rates were calculated using Kaplan-Meier survival analysis.

RESULTS

In the ccRCC group, the mean ESM-1 IR scores of those with local invasion were significantly higher than those without local invasion (P = 0.014). The mean ESM-1 IR score of patients with metastatic ccRCC was significantly higher than those with non-metastatic ccRCC (P < 0.001). Considering all patients regardless of RCC subtype pathologies, the mean ESM-1 IR score in clinical stage 1 tumor was 3.82 ± 1.98, 4.87 ± 1.74 in clinical stage 2, 5.88 ± 2 in clinical stage 3, and 6.60 ± 2.23 in clinical stage 4. The mean ESM-1 IR score of patients with metastatic ccRCC was significantly higher than those with non-metastatic ccRCC (P < 0.001). The mean follow-up period for all patients in this study was 71 months (range 1-120 months). It has been shown that the higher the ESM-1 IR score, the lower the 10-year overall survival and disease-free survival rates (P = 0.026, P = 0.005).

CONCLUSION

Immunohistochemical expression of ESM-1 may be a promising prognostic biomarker in RCC. Currently, some prognostic scoring systems are available for patients with localized and metastasized RCC. Incorporating ESM-1 expression in RCC into these existing prognostic scoring systems could improve these models and enhance the quality of individual oncologic management in RCC patients.

A survey analysis of knowledge levels of urologists about radiation safety and fluoroscopy use

AIMS

To evaluate the awareness of the use of fluoroscopy in endourological procedures, as well as the theoretical and practical applications of preventive measures.

MATERIAL AND METHOD

Between May 2018 and April 2019, a 26-question survey prepared using Google Docs was sent to urologists via email. Personal information, radiation training and behaviours related to radiation and fluoroscopy usage, and the use of protective equipment were queried.

RESULTS

A total of 226 participants fully completed and returned the email survey. Of the 226 participants, 78 (34.5%) were academics, 44 (19.4%) were residents while 104 (46.1%) were experts. More than 60% of the participants stated that they participated in the operation requiring less than five fluoroscopy use per week. The majority of operations requiring fluoroscopy consisted of endourological procedures. The lead apron was used by 93% of the participants, but the use of protective glasses and gloves was very low (3.5%). The majority of academicians, experts and residents did not use dosimeters (76.9%, 82.7% and 81.8%, respectively). More than 50% of the participants did not have literature information about the harmful effects of radiation with the use of fluoroscopy. The most common complaints on the day of fluoroscopy were fatigue and headache.

CONCLUSION

The lack of information regarding the radiation protection measures and harmful effects of radiation is common among urologists in Turkey. Therefore, systematic training programs on fluoroscopy use and radiation exposure should be provided during urology residency.

Comparison of De Ritis Ratio and other systemic inflammatory parameters for the prediction of prognosis of patients with transitional cell bladder cancer

OBJECTIVE

To investigate the clinical value of preoperative De Ritis ratio (aspartate aminotransferase/alanine aminotransferase) (DRR) in patients with transitional cell bladder cancer (TCBC) at initial diagnosis. The secondary objective was to investigate the status of systemic inflammatory parameters, such as neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR) and platelet-monocyte ratio (PMR).

MATERIALS AND METHODS

The records of patients with primary TCBC who underwent transurethral resection were retrospectively evaluated. The relationship of DRR and systemic inflammatory parameters with clinicopathological findings, recurrence and progression status was evaluated separately.

RESULTS

There was no significant difference in the DRR according to the clinicopathological findings, recurrence and progression. Significant differences were found between the NLR and the patient groups for tumour diameter, tumour stage, tumour grade and progression. In univariate analysis, the LMR was found to be associated with progression, and also the PLR and LMR were found to be associated with recurrence. Decrease in LMR and increase in LMR score demonstrated by multiple analysis was shown as independent predictors of progression and recurrence development.

CONCLUSIONS

This paper shows a positive correlation between poor prognosis in TCBC and the systemic inflammatory markers, namely NLR, LMR, PLR and PMR, but not DRR.

Seasonal fluctuation of erectile dysfunction: A cross-sectional study from a tertiary university hospital across 10 years

Erectile dysfunction (ED) shares several risk factors with diabetes mellitus (DM), hypertension (HT) and coronary vascular disease (CVD), which were well-associated with seasonal fluctuation with the highest peak in winter. In this study, we aimed to determine whether ED demonstrates seasonal fluctuations with the above-mentioned systemic diseases. Database from a tertiary university hospital between 2010 and 2020 was deciphered to retrieve patients diagnosed with ED. Patients with primary bladder tumour and post-procedural ED constituted the negative control groups from the same study period. International index of erectile function questionnaire (IIEF-15) was used to segregate included patients into mild/moderate and severe ED groups. The probability of detecting DM, HT and CVD in patients with severe ED was significantly higher than that of with mild/moderate ED (p < 0.05). More ED symptoms emerged and were diagnosed in the winter seasons even though no statistical significance was observed between patients with mild/moderate and severe ED (p = 0.946, Cramer's V coefficient = 0.19). The seasonal variation of patients with bladder tumour and post-procedural ED groups showed no significant difference (p > 0.05, both). ED admissions are associated with higher peaks in the winter seasons. This may help in daily clinical practice to warrant better clinical and epidemiological interpretation of ED.

Is there a relation between serum methylarginine levels and infertility?

OBJECTIVES

Infertility is defined as the absence of pregnancy within the reproductive period despite regular sexual intercourse. Methylarginines are formed as a result of methylation of arginine residues in proteins and formed in three forms as asymmetric dimethyl arginine (ADMA), symmetrical dimethyl arginine (SDMA) and monomethylarginine (L-NMMA). So, here, we aimed to evaluate arginine and their derivatives levels in fertile and infertile individuals.

METHODS

Present study were consist of 30 oligozoospermia patients (proven by spermiogram analysis) and 30 healthy individuals with normozoospermia group who were applied to the urology department. With blood samples taken from individuals, serum methylarginine and its derivatives levels were analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Clinic data and demographic characteristics of individuals were also recorded at the same time.

RESULTS

The serum ADMA level (0.38 ± 0.07) of the oligozoospermia group was found to be significantly higher than the normozoospermia group (0.35 ± 0.05) (p=0.046). A positive correlation were observed between ADMA and SDMA (r=0.686, p=0.000), HArg and SDMA (r=0.611, p=0.001), citrulline and L-NMMA (r=0.595, p=0.001) in patients with oligosospermia. The increase in SDMA, arginine and HArg levels and a decrease in L-NMMA and citrulline levels were not significant as statistically. Also, the ADMA level was found to be high in individuals with low sperm concentration.

CONCLUSIONS

Consequently, serum ADMA levels of individuals with oligozoospermia were statistically significantly higher than those with normozoospermia. As proposal, determination of ADMA levels may be a potential biomarker parameter in terms of early diagnosis of fertility and infertility.

Comparison of Two Different Bipolar Energy Resources in Transurethral Resection of Bladder Tumors

PURPOSE

To determine whether the use of different bipolar resources is associated with different results on tissue and perioperative parameters in patients undergoing bipolar transurethral bladder tumor resection (bTURBT).

METHODS

In this single-center prospective study, patients diagnosed with bladder tumor randomized to undergo TURBT either with a Gyrus PlasmaKinetic system (n = 62) or Olympus TUR in saline (TURis) system (n = 51). Primary endpoint was to evaluate the alteration of patients' perioperative parameters, while secondary aim was to assess the thermal effect of these 2 different bipolar devices on the resected tissue samples by a grading system determined by tissue characteristics.

RESULTS

One hundred thirteen patients were randomized in the study, and 43 were excluded from the analysis due to the exclusion criteria. There were no significant differences between the groups in terms of mean age, tumor site, number of tumors, operative time, alteration in hemoglobin or hematocrit, blood transfusion rate, catheterization time, and postoperative stay. On the other hand, the ratio of obturator jerk was significantly higher in the Olympus TURis group (p = 0.028). The histopathological analyses of both groups determined muscularis propria and cautery artifact presence without a statistically significant difference (χ2: 0.476, p = 0.788).

CONCLUSION

Although the perioperative complications of bTURBT are low in nature, bladder perforation resulted from obturator jerk still poses a risk for extravesical tumor implantation. Urologists should be aware of this risk especially when they are using a TURis system.

Expression of Ring Box-1 protein and its relationship with Fuhrman grade and other clinical-pathological parameters in renal cell cancer

OBJECTIVE

To determine the relationship between RING-box protein 1 (RBX-1) expression and renal cell carcinoma (RCC) with prognostic factors.

METHODS

A total of 88 patients who underwent radical/partial nephrectomy between January 2009 and January 2016 have been included in our study. The age, gender, tumor location, tumor size, and tumor-node-metastasis stage of each patient was evaluated. From the best sections in hematoxylin-eosin stained pathology preparations, tumor histological subtype, Fuhrman nuclear grade, lymphovascular invasion, renal artery/vein invasion, capsule invasion, perirenal fatty tissue invasion, and tumor grade were evaluated. Participants were divided into 2 groups according to Fuhrman grade. Fuhrman grades 1 to 2 comprised Group 1, and Fuhrman grades 3 to 4 comprised Group 2. An immunoreactivity scoring system was used to evaluate RBX-1 expression.

RESULTS

Upon examining all histological subtypes together, it was observed that RBX-1 expression was statistically higher in Group 2 compared to Group 1 (P < 0.008). Upon examining clear RCC cases, it was observed again that Group 2 had a higher RBX-1 expression than Group 1 (P < 0.009). RBX-1 expression was not associated with clinical-pathological parameters including tumor grade, lymphovascular invasion, capsule invasion, or perirenal invasion.

CONCLUSION

RBX-1 expression is closely associated with a highly important prognostic factor in RCC-Fuhrman grade-and it shows promise as a prognostic marker. Further studies are required to reveal the importance of RBX-1 in RCC prognosis and treatment.

Drug resistance restricts the efficacy of short term low dose Mitomycin-C treatment in UMUC-3 bladder cancer cells

OBJECTIVE

Mitomycin-c (MMC) is the most used intravesical adjuvant agent in non-muscle invasive bladder cancer to prevent recurrence. However, a consensus on about appropriate dosage and treatment schedule of MMC is lacking. We, therefore, aimed to evaluate the most appropriate MMC dosage using an in vitro model of high-grade human bladder cancer.

METHODS

UMUC-3 cells, a model for high-grade bladder cancer, were exposed to MMC in different time courses to assess its toxicological effects. XTT cell proliferation kit was used to evaluate the effect of MMC on the proliferation of UMUC-3 cell line. Gene expression analysis for the MDR1, BCL2 and ANXA5 genes was performed by Real-time PCR and flow cytometry analysis were conducted to evaluate the cell death mechanism and acquired resistance after MMC exposure. An ANXA5 kit was used to detect apoptotic cells, and 7-AAD was used to detect necrotic cells.

RESULTS

Cell proliferation was prevented to a large extent (IC50, 0.17-0.081 mg/mL) and cytotoxic effects were observed after 5 μg/mL and 10 μg/mL MMC administrations for 1 and 2-h, after the 4th and 2nd dose cycles, respectively. Moreover, cell death was observed at 5 μg/mL and 10 μg/mL MMC applications for 1-h and 2-h by the sixth and second week, respectively. Flow cytometry exhibits increased subpopulation of drugextruding UMUC-3 cells after a single dose of MMC for 1-h. MMC did not increase the number of apoptotic or necrotic cells; yet, MDR1 (multiple drug resistance) and ANXA5 (apoptotic) expression levels were increased and BCL2 (anti-apoptotic) expression was decreased.

LIMITATIONS

In-vitro nature of the study and working with only one cell culture are inherit limitations of this project.

CONCLUSION

A single dose of MMC administration for 1 or 2-h results in drug-resistance. If maintenance treatment is administered for one hour, it should be continued throughout a 6-week period.

Application of autogenous periosteum as a membrane in sinus lifting

AIM

To evaluate the success level of autogenous periosteum in sinus lifting as a barrier membrane which contributes positively to wound healing and is effective in bone formation without the risk of tissue rejection.

MATERIALS AND METHODS

In this study, 32 male New Zealand rabbits were used and were divided into four groups, in which eight rabbits were placed randomly. Sinus lifting with lateral window technique was applied bilaterally to all rabbits. In the first group, the upper face of the graft materials applied was left open. In the second group, the removed bone walls were placed back over the graft materials. In the third group, synthetic membranes were placed over the graft materials. In the fourth group, the autogenous periosteums obtained from tibias of the rabbits were placed over the graft materials. After 6 weeks, the rabbits in all groups were sacrificed, and the operated regions were examined histologically, and stereological assessments were conducted regarding new bone formation, connective tissue, and osteoblasts.

RESULTS

After a 6-week recovery period, synthetic membrane showed the highest success rate regarding new bone formation. Autogenous periosteum, which achieved the second highest success rate regarding new bone formation, was the first in the number of osteoblasts.

CONCLUSION

Autogenous periosteum was considered to have the potential to be an alternative to synthetic membranes.

The predictive value of platelet to lymphocyte and neutrophil to lymphocyte ratio in determining urethral stricture after transurethral resection of prostate

OBJECTIVE

The pathology of urethral stricture disease is still unclear however progressive inflammation may contribute to the development of urethral stricture. The platelet-to- lymphocyte ratio (PLR) is a new and simple marker that indicates inflammation. In this study we aimed to investigate the predictive value of neutrophil to lymphocyte ratio (NLR) and PLR in patients with urethral stricture who underwent transurethral resection of prostate (TURP).

MATERIAL AND METHODS

A total of 208 patients who underwent bipolar-TURP were included in this study. Patients who had previously undergone surgery due to any urethral pathology, posterior urethral strictures, previous or ongoing treatment for any cancer, hematologic disorders, presence of an active infection at the time of surgical intervention, and prior blood transfusion were excluded. PLR, NLR and red cell distribution width (RDW) levels were measured. In order to investigate the predictive values of NLR and PLR variables, binary logistic regression analysis was performed.

RESULTS

No statistically significant differences were observed between the groups in terms of age, NLR, RDW, prostate size and operative times. Statistically significant differences were presented only in the median PLR- values. For predicting urethral stricture, the optimal cut-off value was 112.5, (sensitivity: 0.84, specificity: 0.64; AUC=0.762, 95% CI 0.684-0.84).

CONCLUSION

In this study we showed that PLR can be used to determine urethral stricture as a cost-effective, common, and simple biomarker in patients after TURP.

Necessity of routine histopathological evaluation subsequent to bladder neck contracture resection

INTRODUCTION

Bladder neck contracture is a well-known complication following some urologic surgical procedures. Regardless of the surgical procedure, any specimen resected should be submitted for histopathological evaluation worldwide. However, the charges of histopathological evaluation may bring a heavy burden to the hospital and health care system. Also, waiting the period of the pathological evaluation process can be an anxious time for patients. Hence, we aimed to investigate the necessity of routine histopathological evaluation of bladder neck contracture bladder neck contraction specimens.

MATERIAL AND METHODS

Patients undergoing bladder neck contraction resection, from 2010 to 2015 were identified. Patient demographics, type of surgery and histopathological diagnosis and cost of histopathological analyses of the specimens were recorded and analyzed.

RESULTS

Findings of the histopathologic evaluations of 340 bladder neck specimens were reviewed. Out of these, 294 had underwent transurethral resection of the prostate, 38 open prostatectomy, and 8 radical prostatectomy. Evidence of malignant disease involving prostate cancer was present in only 2 specimens. Both of the specimens had a known preexisting history of malignant disease. The remaining 338 specimens showed chronic inflammation (n = 176), chronic active inflammation (n = 64), adenomatous hyperplasia (n = 78) or cystitis (n = 20).

CONCLUSIONS

Our results indicate that routine histopathological examination of bladder neck contraction specimens is clinically unnecessary. We recommend that the surgeon should decide the need for histological examination on individual basis, depending on known preoperative risk factors.

Benign prostatic hyperplasia and prostate cancer differentiation via platelet to lymphocyte ratio

BACKGROUND

The aim of the current study is to evaluate NLR and PLR inflammation markers in PCa and BPH.

METHODS

Clinical and pathological data such as age, prostate volume, PSA, NLR, and PLR levels of 201 patients were retrospectively reviewed. Pathological sample results of these patients were categorized either as benign or malign. The benign group consisted of chronic prostatitis and BPH and the malign group of PCa. The PSA levels were divided into three categories as PSA: 0-4 ng/ml, PSA: 4-10 ng/ml, and 10 ng/ml and above.

RESULTS

In the benign category, the mean PLR values for PSA: 0-4 ng/ml is 131.8 ± 31.2, for PSA: 4-10 ng/ml 124.7 ± 83.9 and 10 ng/ml and above 124 ± 53 in chronic prostatitis group and in the BPH group for PSA: 4-10 ng/ml 120.3 ± 45.1, for PSA: 4-10 ng/ml 126 ± 54.2, and 10 ng/ml and above 191.4 ± 176.1. In the malign category, the mean PLR values of PCa patients is for PSA: 0-4 ng/ml 122.8 ± 43.8, for PSA: 4-10 ng/ml 123 ± 43.8, and above 10 ng/ml 179.1 ± 94. Related to the variables of age, NLR, and mean prostate volume, there were no statistically significant differences. Statistically significant differences were observed in the mean PLR values only if the PSA level was 10 ng/ml and above (p: 0.044) in the BPH and PCa groups. The correlation of the PCa Gleason score and PSA, NLR and PLR parameters in the malign category revealed no statistically significant differences (P > 0.05).

CONCLUSION

Effective malign and benign differentiation of prostate pathologies based on noninvasive inflammation biomarkers such NLR and PLR necessitate clinical studies with larger patient series.

Association of ring box-1 protein overexpression with clinicopathologic prognostic parameters in prostate carcinoma

AIM

To determine the expression of Ring Box-1 (RBX-1) protein in prostate carcinoma (PCa) and the association between RBX-1 expression and clinicopathologic prognostic parameters.

MATERIAL AND METHODS

Relevant data such as age, preoperative serum PSA values, and tumor stage were obtained from 51 patients' with PCa record who underwent radical prostatectomy between January 2010 and March 2014. Hematoxylin-eosin stained pathology slides were evaluated by 2 pathologists blinded to patients' data in order to determine Gleason grade groups, tumor stage, tumor volume, capsule invasion, lymphovascular invasion, perineural invasion, and seminal vesicle invasion. Immunoreactivity scoring system (IRS) was used to determine RBX-1 expressions.

RESULTS

A statistically significant difference was determined in terms of RBX-1 expression between non tumoral prostate tissue, high grade prostatic intraepithelial neoplasia (H-PIN) and carcinoma foci (P = 0.001). RBX-1 expression in the Gleason pattern 4 was higher than the Gleason pattern 3 and H-PIN foci as well as non tumoral prostate tissue. Likewise, in cases with PSA levels of>10.1ng/ml, RBX-1 expression was higher than those≤10ng/ml. Moreover, RBX-1 expression of stage II cases was higher than stage I (P = 0.019), RBX-1 expression of stage III higher than stage I cases (P = 0.044). However, RBX-1 expression was not related with clinicopathologic parameters including patient age, tumor volume, lymphovascular invasion, perineural invasion, seminal vesicle invasion, or capsule invasion.

CONCLUSIONS

RBX-1 protein is overexpressed in PCa and associated with clinicopathologic prognostic parameters related with biological potential of the aggressive disease. Further studies of basic and molecular science are needed to reveal clinical and therapeutic implications of RBX-1 in PCa.

A novel cannulation technique for difficult urethral catheterization

INTRODUCTION

To propose a novel cannulation technique for difficult urethral catheterization procedures.

TECHNIQUE

The sheath tip of an intravenous catheter is cut off, replaced to the needle tip and pushed through the distal drainage side hole to Foley catheter tip, and finally withdrawn for cannulation. In situations making urethral catheterization difficult, a guide wire is placed under direct vision. The modified Foley catheter is slid successfully over the guide wire from its distal end throughout the urethral passage into the bladder.

RESULTS

The modified Foley catheter was used successfully in our clinic in cases requiring difficult urethral catheterization.

CONCLUSIONS

This easy and rapid modification of a Foley catheter may minimize the potential complications of blind catheter placement in standard catheterization.

Comparison of Anesthesia Methods in Treatment of Staghorn Kidney Stones with Percutaneous Nephrolithotomy

PURPOSE

To compare the efficacy and safety of percutaneous nephrolithotomy (PNL) in the treatment of staghorn calculi (SC) under spinal anesthesia (SA) versus general anesthesia (GA).

MATERIALS AND METHODS

Patients with SC who treated with PNL from 2011 to 2014 were retrospectively reviewed. In total, 100 patients were divided into 2 groups according to anesthesia type: SA (group 1, n = 47) and GA (group 2, n = 53). Demographics, perioperative parameters, and postoperative analgesic requirements were compared between the two groups.

RESULTS

There was no significant difference in terms of age, sex, American Society of Anesthesiologists score, body mass index, or stone size between the two groups (P = .40, .30, .18, .20, and .50, respectively). The mean procedure times were 84.7 and 87.5 min in the SA and GA groups, respectively (P = .68). The complication rates were similar in the SA and GA groups (19.1% vs. 13.2%, respectively; P = .421). The stone-free rates were also similar in the SA and GA groups (61.7% vs. 52.8%, respectively; P = .374). No statistically significant difference was found in analgesic requirements.

CONCLUSION

SA is a safe method without the risks of GA and may be used for conditions in which GA is contraindicated or in patients with concerns about GA. Our outcomes indicated that SC can be treated safely and effectively under SA.

Spontaneous Nephrocutaneous Fistula With Tuberculous Autonephrectomy: A Case Report of a Delayed Diagnosis

INTRODUCTION

Spontaneous nephrocutaneous fistula is a rare manifestation of renal disease that can occur due to various etiologies, such as renal calculus, chronic pyelonephritis, stricture of the ureteropelvic junction, and renal tuberculosis (TB). An autonephrectomy with a nephrocutaneous fistula due to renal tuberculosis can be diagnosed quite late if it is not suspected.

CASE PRESENTATION

We report a case of a spontaneous nephrocutaneous fistula with tuberculous autonephrectomy. A 40-year-old white male with recurrent flank pain and intermittent purulent drainage from his right flank region for the previous 14 years was admitted to our outpatient clinic. Fistulography and computerized tomography demonstrated a 51 × 60 mm area with a soft-tissue appearance that implied autonephrectomy of the right kidney, and a fistula tract with a 9 mm diameter between the skin and the retroperitoneal space. The patient was successfully treated with nephroureterectomy and excision of the fistulous tract, followed by antituberculous treatment. The pathological examination of the surgical specimen revealed chronic atrophic pyelonephritis, calcifications, and necrotizing granulomatous inflammation suggestive of TB.

CONCLUSIONS

Urogenital TB is difficult to diagnose due to the lack of specific symptoms and signs. In the case of a nonfunctioning kidney without an obvious cause and a chronic spontaneous nephrocutaneous fistula, the possibility of associated renal TB should be kept in mind, especially in immunocompromised patients or in places where TB is a common health problem.

The effectiveness of local steroid injection after internal urethrotomy to avoid recurrence

OBJECTIVE

Local steroid injection to the stricture region after internal urethrotomy (IU) is a promising technique to avoid the recurrence, although the effectiveness and safety of this technique is still controversial. We aimed to determine the efficacy and safety of local steroids as applied with the IU procedure.

MATERIAL-METHOD

A total of 83 patients data with urethral stricture in men were examined retrospectively. Patients classified in two groups who had steroid injection with internal urethrotomy or not. Metil prednisolone 40 mg was injected with transurethral injection needle in the stricture region at the 5, 7 and 12 o'clock sites at the same session with internal urethrotomy. Procedure was considered successful if patient did not report any voiding difficulty and maximum flow rate &gt; 15 mL/second for a voided volume of at least 150 mL after removal of the catheter. Patient's age, time to recurrence, previous recurrences were evaluated.

RESULTS

The mean age was 56.4 (18-83) years. Of those patients 33/83 had recurrent stenosis. Nineteen out of these 33 recurrent stenosis patients were treated with local steroid injection and 14/33 had no injection. Only two patients of the steroid treated group had recurrence. Despite that 12 patients had recurrence in the steroid non-treated group. Also the primary stenosis patients showed no recurrence at the steroid+ IU group.

CONCLUSIONS

The use of local steroids with IU seems to decrease the high stricture recurrence rate following IU. When local steroids were administered with complementary intention, the disease control outcomes are encouraging. Further robust comparative effectiveness studies are now required.

Effective radiation exposure evaluation during a one year follow-up of urolithiasis patients after extracorporeal shock wave lithotripsy

Introduction

To determine and evaluate the effective radiation exposure during a one year follow-up of urolithiasis patients following the SWL (extracorporeal shock wave lithotripsy) treatment.

Material and methods

Total Effective Radiation Exposure (ERE) doses for each of the 129 patients: 44 kidney stone patients, 41 ureter stone patients, and 44 multiple stone location patients were calculated by adding up the radiation doses of each ionizing radiation session including images (IVU, KUB, CT) throughout a one year follow-up period following the SWL.

Results

Total mean ERE values for the kidney stone group was calculated as 15, 91 mSv (5.10-27.60), for the ureter group as 13.32 mSv (5.10-24.70), and in the multiple stone location group as 27.02 mSv (9.41-54.85). There was no statistically significant differences between the kidney and ureter groups in terms of the ERE dose values (p = 0.221) (p >0.05). In the comparison of the kidney and ureter stone groups with the multiple stone location group; however, there was a statistically significant difference (p = 0.000) (p <0.05).

Conclusions

ERE doses should be a factor to be considered right at the initiation of any diagnostic and/or therapeutic procedure. Especially in the case of multiple stone locations, due to the high exposure to ionized radiation, different imaging modalities with low dose and/or totally without a dose should be employed in the diagnosis, treatment, and follow-up bearing the aim to optimize diagnosis while minimizing the radiation dose as much as possible.

Selective Low-Dose Spinal Anesthesia for Transrectal Prostate Biopsy: A Prospective and Randomized Study

PURPOSE

To evaluate the use of spinal anesthesia by reducing anesthetic agent dose to provide better analgesia with minimal side effects without sacrificing the outpatient setting for prostate biopsy. In this study, efficacy and tolerability of selective low-dose spinal anesthesia versus intrarectal local anesthesia (IRLA) plus periprostatic nerve blockade (PPNB) were compared.

METHODS

Between September 2012 and April 2013, 100 patients, aged 40 to 80 years, prostate-specific antigen (PSA) ≥4 ng/mL, abnormal digital rectal examinations, and enrolled for biopsy were included in the present study. Ensuring double blindness, pain was assessed using the visual analog scale (VAS). Anal sphincter relaxation, patient satisfaction with the anesthesia technique, and motor response were evaluated.

RESULTS

Differences between the two groups, considering age, American Society of Anesthesiologist score, total PSA, prostate volume, anesthesia duration, and cancer presence, were not statistically significant. Pain experienced during probe insertion, biopsy, and 30 minutes after biopsy was significantly lower in the low-dose spinal anesthesia group (P < 0.0001). Anal sphincter relaxation degree was significantly higher in the spinal group (P < 0.001). Patient procedure-related overall satisfaction level was significantly higher in the spinal anesthesia group (P < 0.001). In the spinal anesthesia group, no motor blockade was observed. Between the two groups, no statistically significant difference was seen with regard to complications (P > 0.05).

CONCLUSION

Selective low-dose spinal anesthesia provides better pain relief than PPNB plus IRLA without sacrificing the day case setting in ambulatory practice. It is also associated with high patient satisfaction and willingness for a repeated biopsy without differences in procedure duration, tolerance, and complications.

Management of patients with retroperitoneal tumors and a review of the literature

Background

Retroperitoneal tumors (RTs) develop insidiously and are generally seen as large masses, and 50% of RTs are larger than 20 cm at the time of diagnosis. In this article, we share our experience of 5 years of surgical management of RTs.

Methods

We evaluated 28 RT cases operated on in three education hospitals in Turkey from January 2008 onwards, with regard to patients’ demographic characteristics, complaints, weight loss figures, the location and size of the tumor, blood transfusion, intra-operational time, metastases (in malignant cases), additional organ resection, histological grade, local recurrences, average life expectancy, and post-operative treatment methods.

Results

The mean age of the patients was 49 years (range, 18 to 78 years). Twenty (71.43%) were female, and 8 (28.57%) were male. The primary complaint was abdominal pain in 18 patients (64.28%). CT scans were performed in 17 (61%) patients, 10 (35.4%) underwent abdominal MR imaging, and 1 (3.6%) underwent both abdominal CT and abdominal MR imaging. A mass was palpated in the pelvis (suprapubic region) in seven (25%) of the patients during physical examination. The largest tumors were detected in the left lumbar area. The mean tumor size was 12.78 cm (range, 2 to 30 cm). The mean intra-operational time was 192 min (range, 70 to 380 min). The mean hospitalization period was 11 days (range, 8 to 23 days). Seven (25%) patients were reported to have benign tumors, while 21 (75%) were reported to have malignant tumors. The most frequently seen malignant pathology was liposarcoma (eight cases; 38.09%) followed by leiomyosarcoma (five cases; 23.8%) and malignant fibrous histiocytoma (four cases; 19.04%). The earliest local recurrence was detected in the 12th month and the latest in the 28th month. A total of 11 (52.3%) of the total of 21 malignant cases experienced local recurrence within 3 years. The 3-year average life expectancy was 85.7% in the 18 malignant cases.

Conclusions

Due to the low response rate of all but two types of RT to chemotherapy, the best remaining treatment option is surgery with wide resection margins, whereby all macroscopic traces of tumor are removed.

The effect of bladder sensation on uroflowmetry parameters in healthy young men

AIMS

To investigate the effect of the bladder sensation grade on uroflowmetry parameters.

METHODS

Fifty healthy volunteering young men were enrolled in the present study. In total, three uroflowmetry evaluations were made. Qmax , Qave , VV, and PVR urine was obtained three times in three described bladder sensation grades, nearly at the same time of the day.

RESULTS

The mean age of the participants in the present study is 29.08 ± 3.8 years. The mean Qmax values of the volunteers were 17.4 ± 4.8 ml/s, 24.1 ± 6.0 ml/s, and 29.6 ± 6.5 ml/s in the first, second, and third, voiding desire grades, respectively. The mean Qave values were 9.9 ± 2.1 ml/s, 12.9 ± 2.9 ml/s, and 15.9 ± 4.0 ml/s for each of the voiding desire grades mentioned. A statistically significant difference was obvious for all three bladder sensation grades in terms of Qmax and Qave values (P = 0.000). However, no statistically significant difference was seen regarding the PVR urine volumes. The mean voided volume in the first, second and third uroflowmetry were 140 ± 42 ml, 245 ± 64 ml, and 449 ± 105 ml, respectively. The highest Qmax and Qave values were obtained when the desire to void was urgent.

CONCLUSIONS

The findings of the study show that, uroflowmetry evaluations are to be made if the patients have a strong desire to void. Only thus the highest Qmax values can be obtained; yet, the degree of perceived bladder sensation does not have a statistically significant impact on PVR quantity. Neurourol. Urodynam. 35:622-624, 2016. © 2015 Wiley Periodicals, Inc.

Does the presence of hydronephrosis have effects on micropercutaneous nephrolithotomy?

PURPOSE

To evaluate the effects of presence of hydronephrosis on micropercutaneous nephrolithotomy (micro-PNL) surgery.

PATIENTS AND METHODS

A retrospective analysis of 112 patients who underwent microperc surgery between December 2012 and April 2014 was performed. Patients were evaluated in two groups according to whether the presence of hydronephrosis. Stone size and location, fluoroscopy and operation time, stone-free rates and patient-related parameters were prospectively recorded into a centralized computer-generated system.

RESULTS

A total of 58 patients in Group 1 with hydronephrosis and 54 patients in Group 2 with no hydronephrosis were analyzed. There was no statistically significant difference in terms of stone sizes and body mass indexes (BMI) in comparison of groups (155.2 ± 93.06 vs. 143.70 ± 70.77 mm(2), p = 0.856 and 27.6 ± 4.2 vs. 26.7 ± 3.2 kg/m(2), p = 0.625). The success rates were similar (91.3 vs. 92.5%, p = 0.341). While the mean operation time and fluoroscopy time in Group 1 were 44.2 ± 23.62 min and 105.3 ± 47 s, it was 38.8 ± 26.4 min and 112.53 ± 68.3 s in Group 2, but there was no statistical difference in comparison of both groups. The mean attempts of percutan puncture were 1.35 ± 0.47 in Group 1 and 1.76 ± 0.31 in Group 2 (p = 0.185). We also found no statistical differences regarding mean hemoglobin change and hospitalization time, respectively (p = 0.685 and p = 0753). In comparison of grades of hydronephrosis, there was no statistically significant difference in subgroups analysis.

CONCLUSIONS

The presence of hydronephrosis does not affect success rates and operative time in micro-PNL procedures significantly. Micropercutaneous nephrolithotomy is technically feasible and efficacious both in hydronephrotic and non-hydronephrotic kidneys.

Prognostic value of preoperative neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios, and multiphasic renal tomography findings in histological subtypes of renal cell carcinoma

Background

To determine the relationship between renal cell carcinoma subtypes and the associated mortality and biochemical parameters. An additional aim was to analyze multiphasic multidetector computed tomography findings.

Methods

This study is a hospital-based retrospective investigation, using 211 patients with a diagnosis of renal cell carcinoma upon computed tomography examination. The histological subtypes included clear cell in 119 patients, chromophobe cell in 30 patients, papillary cell in 25 patients, mixed cell in 32 patients, and sarcomatoid cell in 4 patients.

Results

The mean age of the patients participating in this study was 61.18 ± 11.81 years, and the mortality rate was 10.4% (n = 22) through the 2-year follow-up. The ratios of both the neutrophil-to-lymphocyte upon admission to the hospital and platelet-to-lymphocyte of the non-surviving group were significantly higher than those of the surviving group (p < 0.05). When the analysis of the 2-year survival of the patients was examined according to the median platelet-to-lymphocyte ratio values, the Kaplan-Meier survival curves were significantly different between the surviving and non-surviving groups (p = 0.01). In two-way analysis of variance test, statistically significant results which were influenced by mortality (p = 0.028) and were found between renal cell carcinoma subtypes in the computed tomography density of corticomedullary phase (p = 0.001).

Conclusions

The neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio may represent widely available biomarkers in renal cell carcinoma, and the logistic regression model indicated that neutrophil-to-lymphocyte ratio was a significant predictor for mortality. According to the median platelet-to-lymphocyte ratio values, the Kaplan-Meier survival curves were significantly different between the surviving and non-surviving groups.

Testicular adrenal rest tumor in 11-Beta-hydroxylase deficiency driven congenital adrenal hyperplasia

Testicular adrenal rest tumors (TART) occur often as asymptomatic nodules in corticotropin-dependent lesions aberrant adrenal tissue in congenital adrenal hyperplasia (CAH) patients. The present manuscript is about an unusual case of a 16-year-old CAH patient due to 11β-hydroxylase deficiency. He underwent testicle biopsy because of testicle tumor suspicion and diagnosed with TART.

Micropercutaneous nephrolithotomy (microperc) in a two-year-old with the 'all-seeing needle'

This paper presents the use of the single-step micropercutaneous nephrolithotomy (microperc) procedure for the treatment of a 13-mm renal stone using a 4.85-Fr 'all-seeing needle' in a 2-year-old toddler. In the current literature to date, this is the youngest case. Moreover, the advantages and reliability of this technique in toddler renal stone treatment are also evaluated.

Impact of Guglielmi detachable coils on outcomes of patients with intracranial aneurysms treated by a multidisciplinary team at a single institution

OBJECT

The goal of this study was to investigate the impact of the introduction of the Guglielmi detachable coil (GDC) therapeutic option on the overall management outcome of intracranial aneurysms. The authors accomplished this by assessing patient morbidity and mortality, inflation-adjusted hospital charges, lengths of stay in the hospital and the intensive care unit (ICU), and treatment efficacy.

METHODS

The authors conducted a retrospective analysis of consecutive cases of intracranial intradural aneurysms managed by a single multidisciplinary neurovascular team at a tertiary care, academic referral center during the 24 months preceding the introduction of the GDC procedure (Group I or pre-GDC era, 77 patients) and during the first 24 months after its introduction (Group II or GDC era, 99 patients). Treatment with GDCs was considered for cases of higher clinical grade or poor surgical risk, or in response to patient preference (27 [27%] of 99 patients in Group II). Host and lesion parameters in our cohort were validated against outcome parameters by using univariate and multivariate analyses. The pre-GDC and GDC subgroups of patients were comparable for major disease severity parameters (patient age, lesion location, clinical grade, and hemorrhage severity). There was no significant difference in clinical outcome at 6 months, infarcts on computerized tomography scanning, or aneurysm obliteration rates before and after introduction of GDC treatment. Decreasing trends in duration of hospital and ICU stay and in inflation-adjusted hospital charges occurred well before and thus were unrelated to the introduction of the GDC therapeutic option.

CONCLUSIONS

The results of this study do not demonstrate any significant impact of integration of the GDC modality on clinical outcome, mortality, morbidity, or effectiveness of treatment. Ongoing improvements in hospital charges and length of hospital stay appeared unrelated to the introduction of the GDC option.

Benefits of supplementing St Thomas' Hospital cardioplegic solution with tetraethylammonium on functional and metabolic recovery of isolated rat hearts

This study was designed to evaluate whether the addition of potassium channel blockers, tetraethylammonium, 4-aminopyridine or glibenclamide, to St Thomas' cardioplegia improved myocardial preservation over that achieved by St Thomas' cardioplegic solution alone. Initially, isolated rat hearts were subjected to 30 min of continuous normothermic hypoxic cardioplegia. Control hearts were arrested with St Thomas' cardioplegia followed by tetraethylammonium, glibenclamide or 4-aminopyridine-enriched cardioplegia. Subsequently, in a second experiment, hearts were subjected to 45 min of normothermic global ischaemia, after 3 min of cardioplegia with either tetraethylammonium-enriched or standard St Thomas' cardioplegia. In both regimens, hearts arrested with tetraethylammonium-enriched St Thomas' cardioplegia showed better recovery of contractile function than controls (P<0.001). Creatine kinase levels were significantly lower in the tetraethylammonium group (P<0.001). 4-Aminopyridine treatment caused similar contractility to that of the control group but raised creatine kinase and lactate dehydrogenase levels (P<0.001). Glibenclamide diminished coronary flow autoregulation, and increased lactate dehydrogenase leakage in reperfusion (P<0.05) with similar contractility to controls. The results of this preliminary in vitro study demonstrate that, in rat heart, St Thomas' cardioplegia enriched with tetraethylammonium improves post-ischaemic contractile function and reduces creatine kinase release. It is concluded that high potassium blocks the membrane at the rapid depolarization phase with rapid sodium influx and tetraethylammonium further prevents repolarization by blocking voltage-dependent potassium channels.