Determination of chemical components of the endemic species Allium turcicum L. plant extract by LC-MS/MS and evaluation of medicinal potentials

The Allium turcicum L. (Zuzubak) plant as a cultivated vegetable have various health benefits and consumed as a food. Due to the shortcoming evidence in literature and the importance of this plant in folk medicine, in the present study, for the first time, we evaluated the bioactive profile of components (using LC-MS/MS), cytotoxicity, anticancer, antioxidant, and antibacterial prospectives of Zuzubak methanol extract. Reported results show that the extract is rich in bioactive compounds and has anticancer activity with breast cancer cells (MCF-7), human prostate cancer cells (DU-145), and Human osteosarcoma cancer Cell lines of (IC50) in dose dependent manner in the concentration range of 31.25 μg/mL and 2000 μg/mL for 24 and 48 h. Western blotting results determined that the extract significantly suppressed the growth of U2OS, MCF-7, and DU-145 cancer cells by down expression of Ang-1 (angiogenic protein) and Beclin-1 (autophagy protein) and overexpression of Bax (a proapoptotic protein). The oxidative stress indices showed a reduction in RPE-1 and MCF-7 cells and an upsurge in U2OS and DU-145 cells. Additionally, the antimicrobial assay showed suppression of the growth of various pathogenic microorganisms in 4.00-8.00 μg/concentrations of Zuzubak extract using the microdilution method. The phytochemicals identified showed promising anticancer, antioxidant effects, and antimicrobial properties, representing a valuable herbal source for drug development studies.

The synergistic effects of betanin and radiotherapy in a prostate cancer cell line: an in vitro study

BACKGROUND

Prostate cancer is among the most common cancers in men with an increasing incidence rate. Radiation therapy (RT) is a therapeutic strategy for the management of prostate cancer after surgery; nonetheless, it has different side effects on neighboring healthy cells/tissues. Moreover, radioresistance has been an increasing phenomenon in the recent years. Therefore, there is an urgent need for the introduction of a safe and effective radiosensitizing agent. Accordingly, the recent trend in the development of novel drugs is accompanied by a push toward natural compounds. Our study evaluated the effects of betanin combined with RT as a potential radiosensitizing agent in the PC-3 cell line.

METHODS AND RESULTS

MTT assay was utilized to determine the growth inhibitory impact of betanin. The possible synergistic effect was evaluated with CompuSyn software upon Trypan blue exclusion test. Apoptosis-related gene expression was evaluated via Real-time PCR and the protein expression of P21 was determined using western blotting. A synergistic anticancer effect with an optimal combination index of 0.61 was achieved by treating PC-3 cells with betanin and RT. The results pointed out that betanin synergistically triggered RT-mediated apoptosis and cell cycle arrest through modulating gene and protein expression in comparison with each of the monotherapies.

CONCLUSION

These findings shed light on the synergistic antitumor effect of betanin and RT in prostate cancer, indicating the potential use of betanin as a radiosensitizer agent.

Buccal mucosa graft tube urethroplasty for the treatment of bulbopenile urethral trauma accompanied with massive tissue loss due to improvised explosive device injury

Urinary diversion with suprapubic cystostomy and delayed urethroplasty is recommended for the treatment of penetrating posterior urethral traumas. A devastating urethral trauma caused by a blast injury due to an improvised explosive device is an extremely rare clinical condition and treatment options are limited due to accompanying massive tissue and muscle loss. Staged urethral reconstruction using a pedicled gracilis muscle flap with a skin or buccal mucosa graft is the preferred treatment option for complex urethral traumas. In case of a devastated urethra due to an intensive explosive device injury, treatment options are limited, especially if the gracilis muscle cannot be used. We report the case of a 30-year-old male patient with a devastated bulbopenile urethra and massive local tissue and adjacent muscle loss including the gracilis muscle. The patient was successfully treated by buccal mucosa graft tube urethroplasty. Urethral stricture recurred but was successfully treated by means of endoscopy. At 24 months' follow-up, the patient was continent and urinated normally.

Post-chemotherapy modified template retroperitoneal lymph node dissection in patients with nonseminomatous germ cell tumours

INTRODUCTION/BACKGROUND

Although a full bilateral template RPLND is thought to be the standard of care for the management of postchemotherapy retroperitoneal residual masses for nonseminomatous germ cell tumors (NSGCT), in the past decade modified templates have become increasingly popular. In this study, we aimed to present our oncological and perioperative outcomes of consecutive seventeen NSGCT patients who underwent a modified template unilateral PC-RPLND for retroperitoneal residual disease.

MATERIALS AND METHODS

We retrospectively evaluated the medical records of 17 consecutive NSGCT patients who underwent modified template unilateral PC-RPLND in our university hospital between 2017 and 2020. All patients had normal serum tumour markers with residual disease in the retroperitoneum. Surgical characteristics including the size of the retroperitoneal residual mass, residual tumor pathology, removed lymph nodes, positive percentage of removed lymph nodes, accompanying operations, complications, mean operation time and hospital stay, and long-term results including survival and antegrade ejaculation were evaluated.

RESULTS

Eleven patients underwent left and six right-sided surgery. Median residual lymph node diameter was 41mm. Median hospitalisation time was 3.5 days. Median follow-up time was 10.5 months. Necrosis/fibrosis was seen in 6 patients, and teratoma in 11 patients. No viable tumour was seen. No patients died in the follow-up period. None of the patients relapsed during follow-up. Ten/seventeen patients had antegrade ejaculation.

CONCLUSIONS

Modified template unilateral PC-RPLND leads to very good oncological outcomes with decreased perioperative morbidity as well as better antegrade ejaculation rates. Low volume retroperitoneal disease seems to fit this procedure best.

Determination of Face and Content Validity of Cadaveric Model for Holmium Anatomic Endoscopic Enucleation of the Prostate Training: An ESUT AEEP Group Study

Background

Bench and virtual reality nonbiological simulator models for anatomic endoscopic enucleation of the prostate (AEEP) surgery have been reported in the literature. These models are acceptable but have limited practical applications.

Objective

To validate a fresh-frozen human cadaver model for holmium AEEP training and assess its content validity.

Design, setting, and participants

Holmium AEEP operations on fresh-frozen cadavers performed by an experienced surgeon were recorded, and a video, including the main steps of the operation, was produced.

Outcome measurements and statistical analysis

The video and an accompanying questionnaire were subsequently distributed electronically to ESUT AEEP study group experts and associates (N = 32) for assessment of the AEEP training model. A ten-point Likert global rating scale was used to measure the content validity.

Results and limitations

A total of 26 answers were returned (81%). The experts agreed on the model’s suitability for AEEP training (mean Likert score: 8). According to the responses, “identifying anatomic structures and landmarks” was the most valuable aspect of the model in terms of AEEP training (median Likert score: 9). Conversely, the experts found the model’s ability, in terms of demonstrating laser and tissue reactions, to be weak (median Likert score: 6)

Conclusions

Based on the content validity assessment, the fresh-frozen cadaver-training model for laser AEEP seems to be a promising model for demonstrating and learning the correct prostate enucleation technique.

Patient summary

An increasing number of researchers have proposed that anatomic endoscopic enucleation of the prostate (AEEP) should replace transurethral resection of the prostate surgery and become the gold standard for treatment of bladder outlet obstruction due to benign prostatic hyperplasia. AEEP requires anatomic familiarity for enucleation, technical knowledge, and a solid training program before starting with the first cases. This is the first cadaver study to assess the content validity of a fresh-frozen human cadaver model for AEEP training.

Primary bladder neck obstruction is one of the rare causes for renal failure in young adult males

Background

Primary bladder neck obstruction (PBNO) is one of the causes of bladder outlet obstruction (BOO) and rarely results in renal failure. We are presenting the clinical characteristics of young male patients with PBNO and renal failure.

Methods

Medical records of patients between 18 and 40 years old with PBNO and renal failure were retrospectively reviewed (2014–2020). Patients with anatomical cause of BOO, and any urological or systemic disease or previous history of any surgical procedure associated with renal failure and/or lower urinary tract dysfunction were excluded. Serum creatinine measurement, ultrasonography, uroflowmetry, cystoscopy, and videourodynamics were performed.

Results

Seven male patients were identified, and the mean age of the patients was 28.8 years. Symptom duration was > 5 years in all patients. Two patients presented with difficult voiding, and five patients presented with both storage and voiding lower urinary tract symptoms (LUTS). Three patients were previously misdiagnosed as overactive bladder. At presentation, serum creatinine levels were between 1.7 and 2.4 mg/dl. One patient was under hemodialysis treatment and waiting for renal transplantation. Mean detrusor pressure at maximum measured flow rate, mean maximum flow rate (Qmax), and mean average flow rate (Qave) was 67.6 cm H2O, 9.5 ml/s, and 5.5 ml/s, respectively. With α-blocker treatment, serum creatinine levels were stable or decreased after 12 months follow-up and mean Qmax and Qave were increased to 14.8 ml/s and 10.1 ml/s, respectively.

Conclusions

PBNO is a common disease in young men presenting with a long history of LUTS. Videourodynamics is mandatory for accurate diagnosis, but having a high clinical suspicion for PBNO is key to ensure the diagnosis. Clinicians should pay more attention to PBNO in young male patients with a long history of LUTS to prevent misdiagnosis, incorrect treatment, and possible decrease in renal function by years.

Examination of clinical data and semen analysis results of patients undergoing orchiectomy for testicular tumor

OBJECTIVE

Testicular tumor constitutes 1% of male neoplasms. Infertility can be determined in patients with testicular tumors before orchiectomy due to the deterioration of spermatogenesis. The aim of this study was to show the clinical, radiological, and pathological characteristics and spermiogram results of patients with testicular tumor and their relationship with each other.

METHODS

The data of patients who underwent orchiectomy due to testicular tumor between 2016 and 2019 were reviewed retrospectively. These data included sociodemographic data of the patients, pretreatment spermiogram characteristics, level of serum tumor markers, characteristics of the ultrasonography, type of orchiectomy, and histopathological examination.

RESULTS

This study included 53 male patients, with a mean age of 33.51±12.86 years. The mean levels of all tumor markers were above the reference levels. The mean tumor size was 34.68±23.32 mm. Multiple localizations and microlithiasis were detected in 11.3 and 13.2% of the tumors, respectively. The most common masses were hypoechoic (n=37; 69.8%) and hypervascular (n=47; 81%). Spermiogram and cryopreservation were performed in 29 (54.7%) of 53 patients preoperatively. The mean sperm concentration before orchiectomy was 24.21×106 /mL and group A sperm motility 0.79%, group B sperm motility 39.10%, group C sperm motility 9.83%, and group D sperm motility 22.69% in testicular tumors.

CONCLUSION

Spermatogenesis adversely affected before the treatment due to local and systemic effects of testicular cancer. Fertility expectations can be increased in the subsequent years by semen analysis and referral to cryopreservation.

Penile prosthesis implantation: A single center 25 years of experience

OBJECTIVES

We analyzed the long-term results of malleable and inflatable penile prosthesis: the rates of complications, revision surgery and patient satisfaction.

MATERIALS AND METHODS

Between January 1996 and December 2020, a total of 138 patients underwent implantation of a malleable or inflatable types penile prosthesis. The data of the patients were derived from the patient files and digital recording system. The patients were contacted face-to-face interaction if possible. If it is not possible, phone connection was made.

RESULTS

The median age of patients was 56 (21-83) years. Fourteen (10.2%) 1-piece, 46 (33.3%) 2-piece and 78 (56.5%) 3-piece penile prosthesis were implanted. The mostly used perioperative antibiotic was teicoplanin+amikacin in 107 patients. Total complication rate was 30% (n=42). Prosthesis infection constituted 9% (n=13) of these complications. The total satisfaction rate was 89.1%. There was no correlation between the complications and antibiotic regimen or prosthesis type (P=0.488, P=0.454, respectively). The rate of infection showed a slight increase in 3-piece penile prosthesis without any statistically significance (P=0.633). The patients with complications expressed more dissatisfaction compared to those without complications (P=0.001).

CONCLUSIONS

In our series, penile prosthesis implantation seems to be a recommended treatment method with high patient satisfaction in the treatment of refractory erectile dysfunction.

LEVEL OF EVIDENCE

4.

Restorative effects of red onion (Allium cepa L.) juice on erectile function after-treatment with 5α-reductase inhibitor in rats

Benign prostatic hyperplasia (BPH) is one of the most prevalent conditions among aged men. The use of 5α-reductase inhibitors (5-ARIs) to treat BPH was linked to erectile dysfunction (ED). Many medicinal plants and secondary metabolites are used in the management of ED. Onion (Allium cepa L.) is an economically affordable vegetable with vital phytochemicals and biological functions. The study aimed to identify the beneficial effects of onion juice on dutasteride (a 5-ARI)-induced ED. Rats were divided into two groups (n = 5 per group): control and dutasteride-treated rats (0.5 mg/kg/day). Dutasteride was administered in drinking water for 12 weeks. Experiments were performed at the end of the 12th week. In vivo erectile responses were measured before and after intracavernosal injection of onion. Relaxant responses to onion juice were examined in the corpus cavernosum (CC). Acetylcholine (ACh)-, electrical field stimulation (EFS)-, sodium nitroprusside (SNP)-induced relaxation responses in CC tissues were evaluated in the absence and presence of onion juice. Total intracavernosal pressure (ICP) and ICP/ mean arterial pressure were significantly reduced in dutasteride-treated rats (1881.14 ± 249.72 mmHg, P < 0.001;0.26 ± 0.03, P < 0.01) as compared to control rats (4542.60 ± 429.19 mmHg, 0.51 ± 0.05), which was normalized after the intracavernous administration of onion (3288.60 ± 185.45 mmHg, 0.58 ± 0.04). Onion markedly induced relaxant responses in control (72.5 ± 4.7) and dutasteride-treated (66.5 ± 2.7) groups after precontraction with phenylephrine. Relaxation responses to onion were partially inhibited after precontraction with KCl (32.5 ± 3.1, P < 0.001). The relaxant responses to ACh (14.9 ± 4.2, P < 0.01) were diminished in dutasteride-treated CC) compared to control CC (59.8 ± 3.4), which was enhanced after the incubation with onion (36.6 ± 4.8). There were no differences in relaxation response to SNP among all groups. However, relaxation response to SNP was reduced in dutasteride-treated CC at 1 μM (P < 0.05) and 10 μM dosages (P < 0.001), which was partially increased after the incubation with onion at 10 μM dosage (P < 0.01). The presence of onion did not change the reduction in EFS-caused relaxation in the dutasteride-treated group. The current data suggest that red onion juice has a restorative effect on erectile function and endothelium-dependent relaxation response following the treatment of dutasteride.

Lymph node density in retroperitoneal lymph node dissection as a novel marker for predicting recurrence in patients with germ cell testicular cancer: A case-control study and long-term clinical experience of a tertiary referral hospital

INTRODUCTION AND OBJECTIVES

In this retrospective study, we aimed to evaluate lymph node (LN) density in retroperitoneal lymph node dissection (RPLND) to analyze whether residual mass after chemotherapy might behave as predicting factor for recurrence in patients with germ cell testicular cancer (GCTC).

MATERIALS AND METHODS

The data of 185 patients that were operated between 12/2004 and 02/2017 because of GCTC were reviewed retrospectively. LN density was calculated. The patients were compared statistically in terms of demographic features, tumor characteristics, serum tumor marker levels, treatment strategies, and pathological results according to GCTC subtypes. Correlation analysis was performed to determine the parameters related to recurrent disease.

RESULTS

The median follow-up was 79 (31-179) months and the median age of the patients was 23 (16-71). The median tumor size was 4 (1-18) cm. Five (2.7%) patients had metastatic disease at initial diagnosis. Seminoma, non-seminomatous-GCT and mix type-GCTC was detected in 62 (33.5%), 60 (32.4%) and 63 (34.1%) patients, respectively. Following inguinal orchiectomy, 48 (25.9%) patients underwent follow-up, 126 (68.1%) patients underwent chemotherapy and 11 (5.9%) patients underwent radiotherapy. A total of 21 (11.4%) patients underwent post-chemotherapy RPLND. Early and late recurrence was seen in 3 (1.6%) and 2 (1.1%) of the patients, respectively. A mild to moderate, negative, but significant correlation was found between the recurrence and the number of LNs containing metastatic deposits and LN density (r= -0.490, P=.024 and r= -0.450, P=.041, respectively).

CONCLUSIONS

There was a negative correlation between the number of LNs containing metastatic deposits and LN density and recurrent disease.

The clinical features and treatment options of intratesticular epidermoid cysts

In this study, we aimed to define the clinico-radiological data and treatment options for intratesticular epidermoid cysts (IEC). MATERIALS AND METHODS: We retrospectively reviewed the medical records of the patients that under went surgery for testicular mass between 1995 and 2017. Data of the patients whose histopathological evaluation revealed IEC were recorded.  RESULTS: A total of 20 patients with IEC were identified.While three of 20 patients were excluded due to incomplete data, the remaining 17 patients with pathologically proven IEC were reviewed and analyzed in the study. The mean patient age was 22.2 years (range, 17-29 years). All patients were presented with painless testicular swelling and/or mass. Serum tumor markers of all patients were within the ranges. Four patients treated with radical orchiectomy (23.5%), while 13 patients under went partial orchiectomy (76.5%). The mean size ofthe IEC was 17.7x15.1 mm (range, 26x10 mm). IEC swere mostly located in the middle pole of the testes (10of 17 patients, 58.8%). CONCLUSIONS: This study is designed in retrospective nature, but the patient population is one the largest reported in the literature. According to our study, we can easily state that partial orchiectomy can be performed safely after FSA in patients that have IECs.

Assessment of In Vitro Antigenotoxic Effect of Nigella Sativa Oil

Objectives

Cyclophosphamide (CP) is an alkylating agent widely used as an antineoplastic and immunosuppressive agent. The genotoxicity of CP has been studied in a variety of in vivo and in vitro systems and is routinely used as a positive control in genotoxicity tests. Traditional medicine Nigella sativa L., (N. sativa), Ranunculaceae family, especially in the Eastern Mediterranean countries, especially in many countries, and is widely used in many countries as a spice and folk medicine since the time of Dioscorides used as a plant. In this study, it was aimed to show the protective effects of N. sativa oil at different concentrations against the genotoxic effects of CP by micronucleus test.

Materials and Methods

For this purpose, healthy cells were treated in vitro with N. sativa oil at concentrations of 1, 5, 10 μg/mL and CP as positive control for 68 hours. The micronuclei were then counted.

Results

No significant increase in micronucleus frequency was observed when the application of N. sativa oil at concentrations of 1, 5, 10 μg/mL compared with the negative control. There was a decrease in the number of micronucleus in all three concentrations (1, 5, 10 μg/mL) compared to the CP group in the groups treated with N. sativa oil and CP.

Conclusion

It has been shown that N. sativa oil may have protective effects against genotoxicity agents in vitro. But more work is needed to understand the mechanism of the genotoxicity effects of N. sativa oil.

Anesthesia management for robotic assisted radical prostatectomy. Single center experince

AIM

The aim of this study was to present our experiences for anesthesia management in patients undergoing robot-assisted radical prostatectomy (RARP) in light of current literature data.

MATERIAL AND METHODS

This clinical retrospective study included 103 patients who underwent robot-assisted radical prostatectomy. All patient data were obtained from the patient files and anesthesia follow-up forms. Demographic datas, intraoperative fluids, blood products requirement and blood gas parameters were recorded.

RESULTS

A total 15 of 103 patients data were lack, the remaining 88 patients were evaluated. Combination of crystalloid and colloid was used for intravenous fluid management. About 11% of patients required transfusion during surgery. The mean pH and pO2 values of the patients were observed to decrease whereas pCO2 and lactate values increased.

DISCUSSION

Radical Prostatectomy can be performed either using open technique as a traditional approach or laparoscopic or robot-assisted technique as a minimally invasive approach. Today, minimally invasive approaches have replaced traditional open prostatectomy. Anaesthesia management of these minimally invasive techniques is very different and challenging from open technique in many aspects.

CONCLUSION

Although minimally invasive techniques have good surgical outcomes such as less blood loss, smaller surgical incision, and shorter hospitalization, these techniques bring new problems that anesthesiologists have to deal with. Increased RARP operations has led to the anesthesiologists more likely to encounter perioperative problems.

KEY WORDS

Anesthesia, Minimally invasive techniques, Radical prostatectomy.

Does preoperative use of silodosin affect the stages of F-URS procedure?

OBJECTIVES

To evaluate the effect of silodosin on stages of the flexible ureterorenoscopy (F-URS) procedures.

METHODS

Between November 2015 and August 2017, a total of 76 patients suffering from 10-30 mm kidney stone were enrolled in this randomized prospective study. Patients were randomly divided into 2 groups for treatment: Group 1 had F-URS with preoperative daily uptake of 8 mg silodosin for 10 days, and group 2 had F-URS without silodosin uptake. None of the patients had preoperative JJ stenting. Stages of the F-URS was defined as entrance to bladder time (ETBT) with a semirigid ureterorenoscope (R-URS), entrance to ureteric orifice time (ETUOT) with R-URS using a guide wire and proceeding 2 cm inside the ureter, application of access sheath time (AAST) using the guide wire advanced through R-URS, F-URS time (FURST) + lithotripsy with laser time (LT), and total operation time (OT). We compared the time of each stage between two groups.

RESULTS

There were 38 patients group1 and 2, respectively. There was one ureteral access sheath (UAS) application failure in group 1, and 3 failures in group 2 (p=0.307). The ETBT, ETUOT, and AAST were significantly short in group 1 than group 2 (p=0.001,0.007,0.002).

CONCLUSIONS

Although preoperative use of silodosin facilitated only an insignificant positive effect on UAS placement failure, it eased the F-URS procedure by reducing the ETBT, ETUOT, and AAST in seconds. More studies are needed to make an exact conclusion.

The cognitive fusion prostate biopsy using a smart phone in the diagnosis of prostate cancer

OBJECTIVES

In this research, we designed a cognitive fusion(CF) prostate biopsy(PB) (CFPB) technique by examining the multiparametric MRI of prostate (MP_MRI-P) images in a smart-phone near the trans-rectal ultrasound (TRUS) device, and examined the results.

METHODS

Between January 2011 and January 2017, a total of 344 men who had PB enrolled in this study. Group 1 had a minimum of a 12-core standard TRUS PB (TRUSPB). Group 2 had CFPB while examining the MP_ MRI-P images in a smartphone near the TRUS device. A minimum 12 cores + cognitive targeted 1-3 biopsy were taken. The detection of Pca and significant Pca in group 1 and 2 were evaluated and compared. Then, the effect of MP_MRI-P findings on the detection of prostate cancer (Pca) and significant Pca were evaluated.

RESULTS

Group 1 and 2 included 138 and 206 patients. After the PB, 45(32.8%) and 33(23%) patients ingroup 1, and 74(35.9%) and 60(29%) patients in-group 2 were detected to have Pca and significant Pca, respectively (p=0.001 for both). Higher PIRADS caused significant detection of Pca and significant Pca (p=0.004 and 0.002). Nodule in MP_MRI-P caused significant detection of Pca and significant Pca (p=0.001 and 0.001). Especially, when PSA was <10ng/ml, higher PIRADS and nodule in MP_MRI-P caused significant detection of Pca and significant Pca (p=0.02 and 0.019 for PIRADS, and p=0.01 and 0.042 for nodules).

CONCLUSIONS

In the advanced hands with our new technique, the CFPB using prebiopsy MP_MRI-P seems to be an effective method to detect Pca and significant Pca.

The analgesic efficacy of ultrasound guided unilateral transversus abdominis plane block in the pain management of shock wave lithotripsy

OBJECTIVES

We conducted this study to evaluate the analgesic efficacy of ultrasound guided unilateral transversus abdominis plane (TAP) block when used in combination with oral diclofenac administration during extracorporeal shock wave lithotripsy (SWL).

DESIGN AND SETTING

The study is a retrospective clinical experimental study conducted in a university hospital between January 2017 and January 2018.

METHODS

42 SWL eligible patients were divided into three groups. Group 1 (n: 15) received no medication due to patient's preference. Group 2 (n: 15) received 50 mg oral diclofenac 30 minutes prior to the procedure, and Group 3 (n: 12) received both oral diclofenac and unilateral ultrasound (US) guided TAP block 30 minutes before the procedure. Patient`s characteristics, SWL data and "visual analogue pain scale" (VAS) scores were collected and compared between groups.

RESULTS

A total of 44 eligible patients were included in the study. When compared between groups, patient's characteristics including age, body mass index, and SWL data including stone size, SWL number, total energy transmitted and duration of the procedure, were similar and there was no statistical significance. Between groups statistical significance was achieved in only VAS scores. Mean VAS scores in groups 1,2, and 3 were 6.3 ± 1.8, 4.3 ± 2.3, and 1.3 ± 1.0, respectively. No complication was seen in any of the groups.

CONCLUSION

Pain relief during SWL operations is still a challenging issue for many clinicians. Our study demonstrates that, among many other anesthetic/analgesic agents and techniques described, unilateral US guided TAP block and diclofenac combination is a feasible option for pain relief during SWL procedures.

Application of ureteral access sheath under direct visualization: Description of a technique for difficult ureters

To introduce a new technique for the placement of ureteral access sheaths (UAS) when there is failure in standard UAS placement. MATERIALS AND METHODS: Between March 2014 and June 2016, a total of 25 patients had difficulty while UAS placement during F-URS procedures. The placement of UAS in these patients was accomplished by utilizing the technique outlined in this study. The causes of difficulty in UAS placement, kinds of UAS deformation, ureteric injuries, and operation time were recorded for all procedures conducted in this study. RESULTS: The pre-operative and post-operative mean stone sizes, Hgb, urea, and creatinine levels were 10.64 (5-19)mm and 1.8 (2-4)mm (p<0.000); 13.9 (10.50-16.73)g/dL and 12.81 (9.4-16.6)g/dL (p = 0.0001); 30.73 (15-48)mg/dL and 28.83 (16- 41)mg/dL (p = 0.067); 1.07 (0.74-1.79)mg/dL and 1.10 (0.77-1.75)mg/dL (p = 0.242), respectively. The causes of difficulty in UAS placement were mainly the failure of insertion at ureteric orifice due to orifice shape and angle (not stenosis) in 18 (72%), narrow ureter in 3 (12%), twisted ureter in 3 (12%) and duplex ureter in 1 (4%) of patients. Angulation deformity with kinking was observed in 10 (40%) of operations. No buckling or kinking due to external force was noted. Providing a smooth insertion force of the F-URS accomplished insertion in patients with angulation deformities without difficulties. Mild mucosal heamorragia was observed in 16 (64%) patients. Mean operation time was 57 minutes and each operation ended with success. CONCLUSIONS: Application of UAS under direct visualization provides a safer UAS placement, makes the F-URS more applicable, and we think this technique decreases the operation time when there is difficulty in UAS placement.

The outcome of percutaneous nephrolithotomy on ≥50 mm staghorn and multiple calyceal stones

Objective

To determine the success rate of percutaneous nephrolithotomy (PNL) in kidney stones over 50 milimeters.

Material and methods

Twenty-four patients with a renal stone size of >50 mm between January 2007 and December 2016 were enrolled. Stone-free and complication rates were investigated.

Results

Twenty-one (87.5%) patients were male and 3 (12.5%) were female. Fifteen (62.5%) stones were located in the right, and 9 (37.5%) in the left kidney. Twenty-one (87.5%) patients were operated using single-access, and three (12.5%) patients were double-access. Thirteen (54%) patients were found to have no stone after operation and 11 (46%) patients had residual stones. Extracorporal shock wave lithotripsy was applied to 5 of 11 patients with residual stones, while flexible ureteroscopy was applied to 6 of them. After additional treatments, 8 (33.5%) patients were observed to be stone free. The stone-free rate was 87.5%. The mean operation time was 135.43 (85-240) minutes. Hemoglobin levels before and after operation were 14.8 (12-16.7) and 12.6 (9.3-15.5), respectively (p=0.001). The hospital stay was 6.04 (4-8) days. Complications were observed in four patients (16.6%).

Conclusion

PNL has high stone-free rate on staghorn type large stones compared with multiple calyceal scattered large stones.

Bilateral massive perirenal subcapsular effusion: A case report

Bilateral perirenal subcapsular effusion is a rare condition with several underlying etiologies. A 27-year-old woman presented with a 3-day history of bilateral flank pain and edema on the dorsum of her feet. Imaging, biochemical, and clinical evaluations revealed bilateral massive perirenal subcapsular effusion secondary to nephrotic syndrome. The patient was successfully treated with bilateral percutaneous drainage. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:597-599, 2017.

Oxidative stress parameters in patients with prostate cancer, benign prostatic hyperplasia and asymptomatic inflammatory prostatitis: A prospective controlled study

BACKGROUND

The imbalance between oxidant and reductant mechanisms creates a nidus for the etiopathogenesis of several diseases. In this study, we aimed to compare the oxidative stress (OS) parameters in patients who were diagnosed with prostate cancer (pCa), benign prostatic hyperplasia (BPH) or asymptomatic inflammatory prostatitis (AIP), according to the histopathologic examination of transrectal ultrasonographic prostate biopsy and transurethral prostate resection specimens.

OBJECTIVES

In this study, we aimed to compare oxidative stress between histologically proven prostate cancer, hyperplasia and prostatitis.

MATERIAL AND METHODS

According to histopathologic examinations, 97 patients were divided into 3 study groups: group 1: pCa (n = 30), group 2: BPH (n = 41), and group 3: AIP (n = 26). Finally, 30 patients were enrolled in a control group. MDA levels, CuZn-SOD, Se-GPx, CAT activities, and trace element levels were evaluated.

RESULTS

A statistically significant difference between prostate cancer and other groups were documented in terms of MDA activity. Contrary to AIP, a statistically significant difference has also been encountered between BPH and the control group. Decreased CuZn-SOD enzyme levels were found in PCa and BPH patients without statistical significance. Increased CAT activity was also documented in PCa, BPH and AIP patients. No significant difference in GPX activity was documented between the groups, except BPH and control group. Trace element levels were low in the patients with prostate cancer and BPH when compared with the control group.

CONCLUSIONS

Despite the data regarding OS in PCa patients, there is a paucity of data regarding BPH and especially AIP patients. Our study revealed obvious oxidative stress in BPH and PCa patients as opposed to AIP. Assessing the oxidative stress in these patients may assist in the future prevention, diagnosis and also treatment. However, the question whether the presence of OS-related parameters and drugs could be used for the diagnosis or management of prostatic diseases, needs to be addressed in future larger and better studies with a more rational basis.

Antigenotoxic properties of Paliurus spina-christi Mill fruits and their active compounds

Background

Paliurus spina-christi Mill. (PS) fruits are widely used for different medical purposes in Turkey. Like in many medicinal herbs the studies concerning their activity, the activities of PS are also not well clarified. The aim of this study is to evaluate the antigenotoxicity of the compounds isolated and identified from the extracts of PS fruits.

Methods

The active compounds were separated, isolated, and determined by chromatographic methods and their structural elucidation was performed by Nuclear Magnetic Resonance (NMR) methods. The compounds were obtained from either ethyl acetate (EA) or n-butanol extracts. The cytotoxicities of the compounds using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and the antigenotoxic activities of the compounds using the alkaline single cell gel electrophoresis techniques (comet assay) were evaluated in Chinese hamster lung fibroblast (V79) cell lines.

Results

The isolated major compounds were identified as (+/−) catechins and gallocatechin from EA fraction and rutin from n-butanol fraction of PS fruits. Their chemical structures were identified by ¹H-NMR, ¹³C-NMR, HMBC, and HMQC techniques. Half-maximal inhibitory concentration of catechins, gallocatechin, and rutin were found to be 734 μg/mL, 220 μg/mL, and 1004 μg/mL, respectively. The methanolic extract of PS (1-100 μg/mL) alone did not induce DNA single-strand breaks while catechins (1-100 μg/mL), gallocatechin (1-50 μg/mL), and rutin (1-50 μg/mL) significantly reduced H₂O₂-induced DNA damage.

Conclusion

It has been suggested that PS fruits and their compounds catechins, gallocatechin and rutin may have beneficial effects in oxidative DNA damage. It seems that PS fruits may be used in protection of the disorders related to DNA damage.

A prospective controlled study to determine the duration of antibiotherapy in the patients with elevated serum PSA levels

BACKGROUND

The aim of this study was to determine the duration that antibiotherapy should have in order to make total prostate-specific antigen (tPSA) levels decrease to normal ranges in patients without prostatitis symptoms but with total PSA levels around 4.01-9.9 ng/dL.

METHODS

A total of 129 male patients were enrolled and divided into either study group (N.=102) or control group (N.=27). The study group received a 21-day treatment with ofloxacin 400 mg/day, while the control group did not receive any treatment. tPSA and free PSA levels were measured on the 7th, 14th and 21st day, and at the 3rd, 6th, and 12th month of the study. tPSA levels and the number of patients whose tPSA levels decreased ≤4.0 ng/dL levels was recorded and analyzed for statistical significance.

RESULTS

At 7, 14, and 21 days mean tPSA values were all lower than baseline values and the differences were statistically significant (P<0.05). Of 102 patients 31, 38 and 36 patients had decreased tPSA levels at 7, 14, and 21 days, respectively. But when we compared 7th day mean tPSA levels with days 14 and 21, we found no statistical differences (P>0.05). Sixty-six patients had persistently high tPSA levels and 64 of them underwent prostate biopsy. Prostate cancer was detected in 8 of them (12.5%).

CONCLUSIONS

A seven-day course of antibiotherapy is enough to normalize PSA levels in gray-zone patients. If recurrence of PSA increase is seen during follow-up, antibiotherapy can be useful again in those patients who previously benefited from it, while it will prove unnecessary in those who did not have their tPSA level normalized by it.

Management behaviors of the urology practitioners to the small lower calyceal stones: the results of a web-based survey

Lower pole calyceal stones (LPS) represent lower spontaneous passage rates and, therefore, require several interventional treatment approaches. The aim of this survey study was to investigate the attitudes of the urology practitioners and the factors affecting their decision making in the management of small asymptomatic LPS. A total of 149 urologists participated to the study via email through the internet-based website. Participating urologists were asked to complete a 29-question survey including personal and academic data, level of surgical experience, available equipment for interventional approaches, which treatment do they prefer for small LPS (≥5 mm and <1 cm), and factors affecting their treatment decision. All data were analyzed to make inferences related with treatment decision and factors affecting decision-making. Mean participant age was 41.57 (26-62) years. The most preferred approach was observation/medical treatment option (52.3 %), subsequently SWL (25.5 %), RIRS (16.1 %), miniPNL (5.4 %) and standard PNL (0.7 %) were chosen by the participants. On the other side, SWL and medical treatment were at the forefront (52 and 16.1 %) among children. In the multivariate analysis of participants' age, academic status, surgical experience and institution, none was significantly associated with treatment decision-making (p > 0.05). The most important factors associated with decision making were calyceal dilatation (85.9 %) and patient preferences (81.2 %). The other factors effecting treatment decision were reported to be recurrent disease (70.5 %), the duration of the stone (74.5 %), patient age (95.3 %), current guidelines (87.9 %), stone density (50.3 %), body mass index (BMI) (73.8 %) and other morbid diseases (91.9 %). Our surveys' greatest value is in demonstrating the preferred treatment options and factors effecting decision-making in the treatment of LPS. The most preferred option in our population was follow-up and medical treatment. The most influencing factors on decision-making were age, patients' preferences, presence of calyceal dilatation, body mass index, comorbid conditions, available options for stone treatment and the surgeon's experience on the existing opportunities.

Testis-Sparing Surgery in Small Testicular Masses Not Suspected to Be Malignant

Fifteen patients with small testicular masses not suspected to be malignant were included in the study, and permanent and frozen section analyses were evaluated. As a result frozen analysis, preoperative externalization of the suspected malignancy with a physical examination, ultrasonographic evaluation, and serum tumor marker analysis were concluded as key points for accurate decision making between TSS and radical orchiectomy.

BACKGROUND

We aimed to determine the safety, efficacy, and the concordance of permanent and frozen section analysis (FSA) of testis-sparing surgery (TSS) in patients who had small testicular masses that were not suspected to be malignant.

PATIENTS AND METHODS

Fifteen patients who underwent TSS were included in the study. TSS was performed for the patients who had testicular lesions <25 mm and testicular lesion volume <30% of the whole testis. All patients had normal serum tumor marker levels and ultrasonographic evaluation did not indicate malignancy. Surgery was performed via an inguinal approach with temporary cord occlusion and FSA of the lesions. Benign findings allowed for TSS, and cancer prompted total orchiectomy.

RESULTS

The mean patient age was 25.33 (range, 20-36) years. The predominant complaint was swelling (9 patients). The mean lesion diameter was 16 mm (range, 5-26 mm). Fourteen of all cases (93%) had benign pathology and underwent TSS. Only 1 patient, whose FSA revealed malignant formation, underwent radical orchiectomy. Final pathology of this patient was seminoma. Complete histopathologic concordance was observed between the results of frozen and permanent sections. TSS was performed with no intra- or postoperative complications. After a mean follow-up of 23 months (range, 6-44 months) all patients, except 3 who were lost to follow-up, were free of disease.

CONCLUSION

The main key points for accurate decision-making between TSS and radical orchiectomy are intraoperative FSA and preoperative externalization of possible suspected malignancy with physical examination, ultrasonographic evaluation, and serum tumor marker analysis.

Flavoxate in urogynecology: an old drug revisited

INTRODUCTION AND HYPOTHESIS

Since its emergence in 1967, flavoxate has been used to treat several urogenital tract disorders irrespective of the etiology of the underlying disease, but the main indications have been overactive bladder and urge symptomatology. With the advances in anticholinergic drugs, its popularity has decreased in recent decades.

METHODS

In this review we summarize the current status of flavoxate in urogynecological practice focusing on its historical background, mechanism of action, efficacy, clinical experiences, outcomes, side effects and tolerability. We reviewed and analyze all the data and draw the major conclusions. We searched MEDLINE and the Cochrane Library using the keyword "flavoxate", and summarized review articles, original studies and case reports published from 1970 to 2013.

RESULTS AND CONCLUSION

We conclude that the minimal side effects and high tolerability of flavoxate make it worthy of consideration for the treatment of several clinical urogynecological conditions. It deserves more clinical studies to assess its efficacy as no randomized controlled trials have been performed with flavoxate during the last decade. More studies and novel drug formulations may reveal or improve its efficacy in daily practice.

Does hypericin boost the efficacy of high-power laser? A preliminary experimental study on rats

CONTEXT AND OBJECTIVE

Lasers are widely used in treating symptomatic benign prostatic hyperplasia. In current practice, potassium titanyl phosphate (KTP) lasers are the most common type of laser systems used. The aim here was to evaluate the rapid effect of high-power laser systems after application of hypericin.

DESIGN AND SETTING

Experimental animal study conducted in the Department of Urology, Gülhane Military Medical Academy, Ankara, Turkey, in 2012.

METHODS

Sixteen rats were randomized into four groups: 120 W KTP laser + hypericin; 120 W KTP laser alone; 80 W KTP laser + hypericin; and 80 W KTP laser alone. Hypericin was given intraperitoneally two hours prior to laser applications. The laser incisions were made through the quadriceps muscle of the rats. The depth and the width of the laser incisions were evaluated histologically and recorded.

RESULTS

To standardize the effects of the laser, we used the ratio of depth to width. These new values showed us the depth of the laser application per unit width. The new values acquired were evaluated statistically. Mean depth/width values were 231.6, 173.6, 214.1 and 178.9 in groups 1, 2, 3 and 4, respectively. The most notable result was that higher degrees of tissue penetration were achieved in the groups with hypericin (P < 0.05).

CONCLUSIONS

The encouraging results from our preliminary study demonstrated that hypericin may improve the effects of KTP laser applications.

Brucellar epididymo-orchitis: a retrospective multicenter study of 28 cases and review of the literature

OBJECTIVE

To review retrospectively the clinical symptoms, laboratory findings and treatment outcomes of patients with Brucellar epididymo-orchitis.

MATERIAL AND METHOD

Retrospective data of 28 patients with Brucellar epididymo-orchitis who admitted to four medical centers between 2005 and 2013 were retrospectively reviewed. Positive blood culture, positive Rose Bengal test results or high agglutination titres of ≥ 1/160 with the positive clinical and ultrasonographic findings of orchitis were accepted as the main criteria for Brucellar epididymo-orchitis.

RESULTS

The mean patient age was 31 ± 16.9 years. Testicular involvement was on the left side in 16 patients and on the right side in 11 patients, one had bilateral disease. Testicular pain and swelling were the most common symptoms and elevation of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leucocytosis were the most common laboratory findings. Initial treatment was orchidectomy in six patients due to malignancy suspicion. All but three patients were successfully treated with antibiotic combinations of rifampicin, doxycycline and streptomycin. Two of three treatment resistant patients underwent orchidectomy.

CONCLUSION

Brucellosis is a common cause of epididymo-orchitis in endemic regions. Early diagnosis and treatment is crucial in the management and thus it must be kept in mind in endemic and non-endemic regions.

Comparison of probe disinfection procedures in routine ultrasonography: hot water versus antiseptic wiping

OBJECTIVE

It is commonly known that ultrasonography (US) transducers function as both a reservoir and means of transfer for hospital infections. The current study aimed to compare the antimicrobial effectiveness of using >80 °C water versus antiseptic wipes to disinfect US transducers.

METHODS

Subsequent to abdominal inspections in three groups of 20 patients, a swab culture was taken from the transducer in each case. Neither a mechanical nor chemical disinfection was applied to the transducer in the first group. As for the second group, the transducer was placed in >80 °C hot water for five minutes. In the third group, the transducer was wiped clean using antiseptic wipes.

RESULTS

Of the 60 swab samples collected, 40 did not produce any growth. The number of samples exhibiting growth in the first group involved 18 cases of coagulase-negative staphylococcus (CNS), as well as 15 cases of Listeria spp., one case of Corynebacterium spp. and one case of Bacillus spp., while only one case of CNS was observed in the second and third groups, respectively. The culture growth and colony forming units rate were significantly higher in the samples obtained from the first group than in those obtained from the other groups (p<0.01). As for the second and third groups, no significant differences were found in terms of the amount of colonization and growth (p=1.00).

CONCLUSION

Being a practical and a simple method for particular use in developing and underdeveloped countries, where it is hard to access relatively costly transducer disinfection materials, such as antiseptic wipes, hot water disinfection may play an active role in fighting hospital infections.

Intralymphatic delivery of platinum-based chemotherapeutics is possible: an experimental study

PURPOSE

Systemic chemotherapy regimens with cisplatinum have been associated with several toxicities. Thus, a loco-regional therapy approach may greatly reduce the toxicity. For this purpose, we designed this experimental study to investigate whether local chemotherapeutic injection is superior to systemic cisplatinum injection for retroperitoneal lymph nodes.

METHODS

A total of 48 male Wistar rats were included to the study. Rats were divided into six groups. In the first three groups, systemic applications of cisplatinum, carboplatinum and oxaliplatin were performed, respectively. In the last three, local administration of cisplatinum, carboplatinum and oxaliplatin was performed, respectively. One hour after the chemotherapeutic agent applications, retroperitoneal lymph nodes were dissected and platinum concentrations were analyzed.

RESULTS

When compared with systemic route, achieving higher platinum concentrations in the local chemotherapeutic application groups was the most spectacular result of the study. Serum platinum concentrations were also lower in the local application groups than systemic ones. When we compared local and systemic applications between three chemotherapeutic agents, the most significant concentration difference was seen in carboplatinum group.

CONCLUSION

The results of this study demonstrate that intralymphatic delivery of cisplatinum, carboplatinum and oxaliplatin leads to higher drug concentrations in the retroperitoneal lymph nodes when compared with intravenous administration.

Bilateral renal metastasis of an inguinal malignant solitary fibrous tumor, 9 years after primary surgical treatment

OBJECTIVE

To report the first case of a bilateral renal solitary fibrous tumor (SFT) as a metastasis of an inguinal malignant SFT.

CLINICAL PRESENTATION AND INTERVENTION

A 60-year-old male patient with a history of a right inguinal 7 × 8 cm soft tissue mass excision 9 years ago was referred to our clinic with abdominal pain. Both physical examination and chest X-ray were normal. Computed tomography revealed bilateral renal tumor. He was successfully treated with left partial and right radical nephrectomy. Histopathological examination showed a metastasis of the previous inguinal SFT.

CONCLUSION

This case showed that although malignant SFT is extremely rare in the urogenital tract, this tumor should be included in the differential diagnosis when identified in the kidneys.

Effects of vardenafil on testicular torsion/detorsion damage: an experimental study in pigs

PURPOSE

To investigate the effects of vardenafil HCl on testicular germ cell apoptosis and the expressions of iNOS and eNOS within the bilateral testes after unilateral torsion/detorsion (T/D) in a pig model.

METHODS

12 male pigs weighing 50-55 kg were divided randomly into three groups (n = 4). Sham operation and T/D was performed in groups 1 and 2, respectively. Group 3 underwent T/D and received vardenafil (0.4 mg/kg) orally 45 min before detorsion. The testes were left in torsion for 2 h. In all groups, both testes were removed 8 h after the operation for histopathological analysis.

RESULTS

Except for group 1, the histopathologic parameters of the ipsilateral testes were higher than in the contralateral testes, and this difference was statistically significant (p < 0.05). Testicular ischemia/reperfusion (I/R) (group 2) resulted in marked increases in germ cell apoptosis, iNOS and eNOS in the ischemic testes compared to the sham-operated group. The pigs treated with vardenafil (group 3) also showed significantly increased apoptotic cells, iNOS and eNOS levels compared to the sham-operated group.

CONCLUSIONS

The results suggest that vardenafil HCl worsened histopathological changes related to oxidative stress in testicular injury and had no protective effect on testicular I/R injury in pigs.

The acute effects of increased intra-abdominal pressure on testicular tissue: an experimental study in pigs

OBJECTIVES

To evaluate the acute effects of increased intra-abdominal pressure (IAP) on testicular germ cell apoptosis and the expressions of endothelial nitric oxide synthase (eNOS), inducible nitric-oxide synthase (iNOS), and Johnson's scores in testicular tissue.

MATERIALS AND METHODS

Twelve male pigs weighing 52 to 55 kg were divided into 2 groups as group 1 (n = 6; gasless [control]) and group 2 (n = 6; 20 mm Hg IAP with CO(2) pneumoperitoneum for 4 hours). In the second group, left laparoscopic nephrectomy was performed during the CO(2) insufflation period. The right testes of pigs were removed. Testicular germ cell apoptosis, expressions of eNOS and iNOS, and Johnson's scores were evaluated for each group.

RESULTS

The control group (group 1) exhibited low apoptotic cell level and low iNOS and eNOS level in testes. IAP (group 2) resulted in marked increases in germ cell apoptosis, eNOS, and iNOS compared with the control group (group 1) (P <.05). However, no significant difference was noted in Johnson's scores between the 2 groups (P >.05). Moreover, Leydig cell hyperplasia, congestion, and necrosis, which were not documented in the control group, were seen in the study group.

CONCLUSIONS

The purpose of the present study was to evaluate whether IAP could affect germ cell apoptosis and NOS concentrations in the testes after laparoscopic procedures in an animal model. In such an animal model simulating laparoscopic procedures, we demonstrated that high-pressure and long-lasting CO(2) insufflation cause testicular changes in the acute period.

Different clinical presentations of pelvic ectopic kidneys: report of two cases and review of the literature

Pelvic kidney is the most common type of renal ectopia. These abnormally positioned kidneys are often clinically asymptomatic. However, they are prone to urinary infection, stone formation and trauma. Admitted patients often complain of lower abdominal pain and urinary infection. Pelvic kidneys may also lead to misdiagnosis when it is associated with hydronephrosis or large cystic structures. Thus, it is rather difficult to pinpoint the origin of the problem. We reported here different clinical presentations of our two patients with pelvic kidneys.

Adult posterior urethral valve: a case report

INTRODUCTION

Posterior urethral valve (PUV) is a congenital obstructive defect of the male urethra with an incidence of 1/8,000 to 1/25,000 live births. PUV is the most common cause of lower urinary tract obstruction in neonates. The diagnosis of PUV is usually made early, and PUV cases have rarely been detected in adults.

CASE PRESENTATION

Here we report the case of a 35 years old man presented with obstructive urinary symptoms. In spite of bladder neck rejection uroflowmetry pointed out infravesical obstruction with max. flow rate 9 ml/s and average flow rate 6 ml/s in uroflowmetry. During cystoscopy mild bladder trabeculation and resected bladder neck were seen. While the cystoscope was taken off, PUV were obtained.

CONCLUSION

Since PUV is a rare condition in adults and the diagnosis of PUVs is also difficult in these groups we must consider this situation during evaluation of adult patients with obstructive symptoms especially during cystourethroscopy.