Correlation between pre-radical prostatectomy standardized SUVmax ratios detected on 68Ga-PSMA-I&T PET/CT and final histopathology outcomes: an in-depth analysis

OBJECTIVE

To evaluate the predictive potential of the maximum standardized uptake value(SUVmax) value of intraprostatic tumors derived from preoperative 68Ga-PSMA-I&T PET/CT (SUVT), and its ratios to SUVmax in the liver (SUVTLR) and parotid gland (SUVTPR) with respect to histopathological findings.

MATERIALS AND METHODS

Data from patients who underwent radical prostatectomy (RP) for prostate cancer (PC) at our clinic between 2017 and 2020 were assessed. Patients with a secondary malignancy, a history of transurethral prostate resection, prior treatment for PC, or who received salvage RP were excluded. Whole-body images obtained using the same device, as per the guidelines, were reviewed by two nuclear medicine specialists with more than a decade of experience to reach a consensus for each lesion. The relationships between age, PSA, Prostate Volume, clinical T stage, biopsy International Society of Urological Pathology grade (ISUP), D'amico risk group, intraprostatic tumor volume (HPTV) identified in the final histopathological specimen review, HP-ISUP grade, seminal vesicle invasion (SVI), extracapsular invasion (ECI), positive surgical margine (PSM), SUVT, SUVTLR, and SUVTPR were analyzed.

RESULTS

The mean age of the 64 included patients was 64.1 ± 5.3. A statistically significant correlation was found between SUVT, SUVTLR, SUVTPR values, and histopathologic stage parameters, such as biopsy ISUP, D'amico Risk Classification, HP-ISUP, HPTV (p < 0.05). PSMATV, SUVT, and SUVTLR were statistically significant predictors of extracapsular invasion, while PSA, PSMATV, and SUVTLR were significant predictors of SVI (p < 0.05).

CONCLUSION

The standardized SUVT, SUVTLR, and SUVTPR values could be employed as noninvasive markers to assist in predicting postoperative histopathological findings, particularly ECI, SVI, and PSM.

"Modified" Penile Inversion Vaginoplasty: First Case Series of a Turkish Single Center

Purpose

The aim of this study was to share our outcomes, including complications and their management, of a "modified" penile inversion vaginoplasty (PIV) technique applied to transgender individuals, which we presume to be the first reported case series of a single center from Turkey.

Methods

A cross-sectional study, including adult transgender cases who underwent male to female gender-affirming surgery in our institution, between January 2015 and December 2019, was planned. The same "modified" PIV technique, in which the spatulated urethra was incorporated to the penile skin flap, was applied to all cases. Demographic data including case characteristics, medical history with prior operative details, and complications detected during follow-up examination were collected prospectively.

Results

The mean age of 30 cases included in the study was 31.03±7.05 years. The mean length of hospitalization after the surgical procedures was 10.13±2.24 days. The mean vaginal depth measured at postoperative 1st year follow-up examination was 14.2±2.95 cm. Satisfactory neovaginal moistening was reported by 24 (80%) cases. In 8 (26.6%) of 30 cases, no complication was reported at all. Intraoperative (rectal injury) and postoperative (meatal stenosis, vaginal narrowing, scars, infections, etc.) complications occurred in 22 (63.4%) cases. Postoperative satisfaction rates including mental, physical, and social health in general were found to be 81.84% (66-98%).

Conclusion

The "modified" PIV can be used as a preferred technique showing high satisfactory outcomes, especially in cases with short penile skin or circumcision, due to the achievable lubricity and vaginal width/depth.

Linguistic and clinical validation of the Turkish version of Acute Cystitis Symptom Score for the diagnosis and patient-reported outcome in acute uncomplicated cystitis

PURPOSE

The Acute Cystitis Symptom Score (ACSS) was developed as a self-reporting questionnaire for diagnosing and monitoring acute uncomplicated cystitis (AC) in female patients. The study aims at the translation of the ACSS into Turkish from the original Uzbek including its linguistic, cognitive and clinical validation.

MATERIALS AND METHODS

After forward and backward translation of the ACSS from Uzbek to Turkish and vice versa, the cognitive assessment of the Turkish ACSS was performed on 12 female subjects to achieve the final study version.

RESULTS

The clinical validation was performed on a total of 120 female respondents including 64 Patients with AC and 56 controls without AC. For clinical diagnosis of AC, the predefined summary score of the typical symptoms of >6 showed high values (95% confidence interval) for sensitivity (0.88 [0.77-0.94]), specificity (0.98 [0.91-1.00]), and diagnostic accuracy (0.93 [0.86-0.97]). All patients were followed up between five to nine days after the baseline visit. Forty-four (68.75%) patients used antimicrobial treatment, whereas the rest (31.25%) preferred non-antimicrobial treatment. The severity scores of the typical symptoms and the quality of life were reduced significantly at follow-up. Using different (favored) thresholds for successful and non-successful treatment a clinical success rate between 54.7% and 64.1% (60.9%) was achieved.

CONCLUSIONS

After translation from the original Uzbek and cognitive assessment, the Turkish ACSS showed similar good results for clinical diagnosis and patient-reported outcome as in other languages validated so far and could therefore now be used for clinical studies as well as in everyday practice.

Radionuclide Therapy Videos on YouTube as An Educational Material: Has the COVID-19 Pandemic Changed the Quality, Usefulness, and Interaction Features

Introduction

Current treatment approach aims to achieve greater efficacy with fewer side effects, by targeted cancer therapy as much as possible. Radionuclide therapy is a modality that uses cancer theranostics and is increasingly applied for various cancers as a targeted therapy. YouTube is a preferred tool for obtaining medical information from the internet. This study aims to determine the content quality, level of interaction and usefulness as education material of radionuclide therapy YouTube videos and to reveal the impact of the COVID-19 process on these parameters.

Materials and Methods

The keywords were searched on YouTube on August 25, 2018, and May 10, 2021. After removing duplicate and excluded videos, all remaining videos were scored and coded.

Results

Majority of the videos were useful educational material. Most of them were high quality. Popularity markers were unrelated to quality level. After COVID, the power index of videos with high JAMA scores increased. The COVID-19 pandemic did not have a negative effect on video features; the quality of the content increased even more after the pandemic.

Conclusion

Radionuclide therapy YouTube videos have high-quality content and provide useful education material. The popularity is independent of the content quality. During the pandemic, video quality and usefulness characteristics did not change, while the visibility is increased. We consider YouTube to be an appropriate educational material for patients and healthcare professionals to gain basic knowledge of radionuclide therapy. The Covıd-19 pandemic highlighted the power of radionuclide therapy YouTube videos as an educational material.

Could "Retrograde Intrarenal Surgery" be Used as an Efficient Technique in the Treatment of Calyceal Diverticula Stones

OBJECTIVE

To evaluate the efficacy of retrograde intrarenal surgery (RIRS) and holmium laser lithotripsy in the treatment of symptomatic renal calyceal diverticular (CD) stones.

STUDY DESIGN

A case series.

PLACE AND DURATION OF STUDY

Department of Urology, Hisar Intercontinental Hospital, from 2008 and 2019.

METHODOLOGY

Patients who underwent holmium laser lithotripsy with RIRS to manage symptomatic CD stones were evaluated retrospectively. Demographics, stone size, operation and hospital stay duration, the success of treatment and complications were noted.

RESULT

Among the 30 treated patients, 13 patients were female and 17 were male. The mean age was 45.4 ± 11.9 (26-64), the stone diameter was 14.4 ± 4.1 mm, operation time was 70.47±35.7 (35-155) minutes, and mean length of hospital stay was 1.27±0.5 (1-3) days. In those patients who underwent RIRS, 26 (86.7%) were successfully treated while in 4 of 30 patients (13.3%) the procedure was not successful. Complications were observed in 10 (33.3%) patients. Clavien-I complications were demonstrated in 6 patients, Clavien III complications were demonstrated in 3 patients. One patient had urosepsis, 2 patients had ureteral laceration, and one patient with Clavien IV complication had perirenal hematoma.

CONCLUSION

Laser lithotripsy therapy with RIRS is a safe and effective treatment for symptomatic calyceal diverticular stones and can be offered as the first-line treatment for calyceal diverticular stones.

KEY WORDS

Calyceal diverticula, Stone disease, Flexible ureterorenoscopy, Holmium laser, RIRS.

The clinical significance of abnormal ejaculation by silodosin. Is it important?

We aimed to evaluate the effect of the abnormal ejaculation (AEj) on patients using silodosin in terms of drug cessation. We also analysed the possible factors that may affect the decisions of patients with AEj to proceed or change their medication. The patients (n = 118) treated with silodosin 8 mg daily were prospectively analysed. In order to evaluate the erectile function, ejaculatory function, depression and sexual satisfaction; IIEF, MSHQ-EjD, Beck's depression and Golombok-Rust questionnaires were given to patients respectively. Patients were re-evaluated at the 3rd month of their treatment. The rate of AEj was 52.5%. Nearly 42% of the patients with AEj desired to stop their medication whereas it was 7.1% at patients without AEj (p < .001). The pre-treatment International Prostate Symptom Score (IPSS) and the decrease in IPSS score were significantly lower in patients who demand to stop their treatment (p < .05). AEj was significantly higher in patients who wanted to stop their medication (p < .001). Even if they had an AEj, patients who were happy with the clinical efficacy of silodosin did not want to change their drug. In addition to this, pre-treatment ejaculatory status was an important indicator for patients to decide drug cessation due to AEj side effect of silodosin.

The value of hematological inflammatory parameters in the differential diagnosis of testicular torsion and epididymorchitis

OBJECTIVE

Aim of this study is to investigate the effectiveness of mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) values, that can easily be obtained with complete blood count (CBC), in the diagnostic differentiation of testicular torsion and epididymorchitis.

METHOD

Data of patients, who admitted to the urology or emergency departments, diagnosed with acute scrotum, between 2008-2017, were reviewed and retrospectively extracted. Basic characteristics (age, etc.) of patients and blood test results were retrieved. Inflammatory markers such as MPV, NLR and PLR were compared between groups.

RESULT

After determining inclusion/exclusion criteria, a total of 111 patients were divided as testicular torsion, epididymorchitis and control group, including 37 patients each. Mean age of groups were 19.27±6.93, 26.27±6.23 and 23.24±8.49 years, respectively. Statistical significance was found in epididymorchitis and testicular torsion groups compared to the control group according to NLR (P<0.01). PLR showed a statistically significant relationship only with the epididymorchitis group and control group (P=0.46). However, according to MPV values, no statistically significance was found between the groups. Additionally, ROC analyse was performed to evaluate predictive cut-off values of NLR and PLR for the diagnostic differentiation of both groups.

CONCLUSION

Inflammatory markers, obtained from routinely performed low-cost CBC, might be used as adjuvant parameters to differentiate acute scrotal pathologies like testicular torsion and epididymorchitis.

Predictive and prognostic impact of preoperative complete blood count based systemic inflammatory markers in testicular cancer

PURPOSE

To determine the utility of preoperative complete blood count (CBC) based systemic inflammatory markers in the prediction of testicular cancer and its prognosis.

MATERIAL AND METHODS

Between 2008-2017 the data of all testicular tumor patients undergoing radical orchiectomy were retrospectively analyzed. Patient baseseline characteristics (age, tumor stage, tumor markers, etc.) and results of routine preoperative blood tests including mean platelet volume (MPV), red cell distribution width (RDW), lymphocyte ratio (LR) and neutrophil ratio (NR) were retrieved. In addition, neutrophil to lymphocyte ratio (NLR) was calculated.

RESULTS

Mean age of the tumor and control group was 36.0±15 and 30.50±11 years, respectively. Mean RDW, NR and NLR were significantly higher in the tumor group with p values<0.001; whereas LR and MPV were signifi cantly higher in the control group (p<0.001). Receiver Operating Characteristic (ROC) analyses of LR, NR, RDW, MPV, and NLR are shown in Table-3. The cut off values for RDW and NR were found as 13,7 (Area under the curve (AUC): 0.687, sensitivity = 42.2%, specifi city = 84.8%) and 55.3 (AUC:0.693, sensitivity 72.2%, specifi city 62%), respectively. Area under the curve for NLR in tumor group was 0.711, with a threshold value of 1.78 and sensitivity=81.8% and specifi city=55.4% (AUC:0.711/sig<0.001) that together with RDW exhibited the best differential diagnosis potential which could be used as an adjuvant tool in the prediction of testicular tumor and its prognosis.

CONCLUSION

Several systemic inflammatory markers, which are obtained by routinely performed cost-effective blood tests, could demonstrate incremental predictive and prognostic information adjuvant to preoperativly achieved testiscular tumor markers.

Comparison of prostate cancer detection rates between the Vienna nomogram and the 10-core biopsy protocol

OBJECTIVE

To compare the Vienna nomogram and the 10-core prostate biopsy protocol regarding whether there is superiority in prostate cancer detection.

METHODS

Between January and December 2012, a total of 215 patients applying to our outpatient clinic with lower urinary tract symptoms were evaluated, prospectively. Patients with a prostate-specific antigen level of 2.5-10 ng/mL and/or suspicious digital rectal examination were included in the study. Exclusion criteria were determined as recent pelvic radiotherapy, lower urinary tract surgery, history of acute urinary retention, or indwelling urinary catheter. Biopsies were taken systematically with at least 10 cores considering prostate volume and patient age. According to Vienna nomogram, in patients requiring 6- or 8-core biopsies, tissue sampling was completed to 10 cores (our standard protocol), whereas in patients requiring more than 10 cores additional tissue sampling was performed.

RESULTS

After the determination of inclusion/exclusion criteria, 170 patients were enrolled in our study. The median (min-max) age, prostate-specific antigen value, and prostate volume were 65 (48-86) years, 7.6 ng/dL (2.5-10), and 55 cc (17-150), respectively. Prostate cancer was detected in 49 (28.8%) patients with transrectal ultrasound-guided prostate biopsy according to the Vienna nomogram. We found that our standard 10-core biopsy protocol would have diagnosed prostate cancer in 46 (27.1%) patients in the same study group showing no statistically significant difference (p > 0.005).

CONCLUSION

The findings of this study suggest that considering cancer detection rates no statistically significant differences were found between both methods. Further prospective research in this aspect is needed to define the ultimate prostate biopsy protocol.

Contrary effects of coenzyme Q10 and vitamin E after testicular ischemia/reperfusion in a rat model validated with glucose metabolism imaging

OBJECTIVE

To evaluate the efficacy of antioxidants in cellular-level post-ischemia/reperfusion injury of the testis and to validate these effects with ¹⁸F-fluorodeoxyglucose positron emission tomography.

METHODS

Fifty-six adult male rats were randomly divided into seven groups-Group 1: sham; Group 2: ischemia/reperfusion only group; Group 3: ischemia was induced and vitamin E (100 mg/kg) was administered intraperitoneally 30 min before reperfusion; Group 4: vitamin E was given intraperitoneally without ischemia/reperfusion; Group 5: ischemia was induced and coenzyme Q10 (10 mg/body weight) was administered intraperitoneally 30 min before reperfusion; Group 6: coenzyme Q10 was administered intraperitoneally without ischemia/reperfusion; Group 7: ischemia was induced and coenzyme Q10 + vitamin E was administered intraperitoneally 30 min before reperfusion. After detorsion, fluorodeoxyglucose was applied to all groups according to the animals' weight and fluorodeoxyglucose positron emission tomography was performed after 1 h. In pursuit of imaging, orchiectomy was performed for histopathological and biochemical evaluations.

RESULTS

A significant effect of group on catalase, maximum standardized uptake value, and seminiferous tubule diameters (p < 0.005) was observed. According to this, combining ischemia/reperfusion with vitamin E increased the maximum standardized uptake value significantly higher than in all other groups; in addition, catalase was significantly higher than in Groups 4-6. Histopathological outcomes revealed that "sham" had significantly larger seminiferous tubule diameter than Groups 2-4. Also, "ischemia/reperfusion" was the only group which had significantly smaller seminiferous tubule diameters than Groups 6 and 7.

CONCLUSION

In contrast to vitamin E, coenzyme Q10 provided remarkable regression of oxidative stress-induced enzymes and revealed consistent effects on histopathological outcomes, which were validated with fluorodeoxyglucose positron emission tomography imaging.

Reliability of thermocautery-assisted circumcision: retrospective analysis of circumcision performed voluntarily in countries of low socioeconomic status

Objective:

The objective of this study was to evaluate the reliability of thermocautery-assisted circumcision performed voluntarily in patients of poor countries.

Material and methods:

Between 2016 and 2019, 32,000 children aged 7 days to 17 years were circumcised in multiple countries. The patients’ urological examinations were done before the administration of local anaesthesia. Patients revealed to have undescended testicle, inguinal hernia, hypospadias, varicocele, penile rotation anomaly, epispadias and infection were not circumcised. All procedures were performed under local anaesthesia by using thermocautery. Afterwards, mucosa and skin were sutured using absorbable suture and the circumcised penis was dressed. Patients were instructed to remove the dressing after 3 days.

Results:

Bleeding, requiring surgical intervention and drug reactions were not observed. The most observed complication was mucosal oedema, which occurred in approximately one-quarter of patients (26%, 8320/32,000) and continued for 3–5 days after the surgery. The most serious complication was a trapped penis, which occurred in 25 patients (0.078%). In six (0.018%) cases, meatal stenosis developed. Wound infection developed in only 10 (0.03%) cases, through the formation of an aseptic environment. Penile adhesion was seen in 35 cases (0.1%) and improved with anti-inflammatory treatment without any surgical intervention.

Conclusion:

Thermocautery-assisted circumcision can be used as an effective, safe and useful technique with few complications and rapid healing rates.

The association of Intron 4 VNTR and Glu298Asp polymorphisms of the nitric oxide synthetase 3 gene and vasculogenic erectile dysfunction in Turkish men

Several studies have focused on the impaired role of endothelial nitric oxide synthase (NOS3) gene polymorphism and its association to erectile dysfunction (ED). However, currently controversial results have been reported due to their significant heterogeneity. The present study aimed to assess the genotypic distribution and the allelic frequency of Intron 4 VNTR and Glu298Asp gene polymorphisms in vasculogenic ED patients compared to healthy controls of a specific region of Turkey. A total of 75 patients with ED (median age: 56, IQR:10.5) and 75 healthy controls (median age: 56, IQR:10.5) were prospectively analyzed. All subjects were equally evaluated by the same physician with detailed history-taking, physical examination, International Index of Erectile Function (IIEF) questionnaire, and blood tests (incl. glucose, testosterone, triglyceride and total cholesterol level). Those with an IIEF score under 26 were considered to have ED, by classifying them according to their scores as mild (22-25), moderate (11-21) and severe (1-10) ED. Color doppler ultrasonography was carried out in patients with an IIEF score <22. Hypertension, diabetes mellitus, coronary artery disease, and smoking status were significantly associated with the ED group compared to control subjects with p values of <0.001, <0.001, 0.002 and <0.001, respectively. Overall genotype frequencies was 47 (31%) a/a, 22 (15%) a/b, 82 (55%) b/b for Intron 4 VNTR and 56 (37%) GG, 78 (52%) GT, 16 (11%) TT for the Glu298Asp polymorphism. The frequencies of Intron 4 VNTR a/a allele and Glu298Asp GT allele were associated with severe ED, while a/b and TT were associated with moderate or mild, and b/b and GG were associated with no ED. In contrast to Glu298Asp, statistically significant differences in genotypic frequencies of Intron 4 VNTR gene polymorphism between ED and control subjects was established. Abbreviations: NO: nitric oxide, NOS: nitric oxide synthase, NOS3: endothelial nitric oxide synthase, NOS2: inducible nitric oxide synthase, NOS1: neuronal nitric oxide synthase, HT: hypertension, DM: diabetes mellitus, CAD: coronary artery disease, ED: erectile dysfunction, IIEF: international index of erectile function, VNTR: variable number of tandem repeats, CDU: color doppler ultrasonography, PCR: polymerase chain reaction.

Correlation of Ultrasonically Determined Bladder Wall Thickness and Prostatic Calcification With the Urinary, Psychosocial Dysfunction, Organ Specific, Infection and Neurological/Systemic Symptoms, and Tenderness Scoring System

OBJECTIVE

To evaluate ultrasonically determined bladder wall thickness (BWT) and prostatic calcification presence, in men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and to correlate the findings with patient characteristics and the urinary, psychosocial dysfunction, organ specific, infection and neurological/systemic symptoms, and tenderness (UPOINT) classification system.

MATERIAL AND METHODS

Between January 2008 and December 2017, data of 1294 patients diagnosed with chronic prostatitis, in a single urology clinic, meeting a number of selective inclusion/exclusion criteria, were retrospectively analyzed. Patients, compliant to fill out all requested questionnaires, between the ages of 21-65 years were included to the study. Exclusion criteria were noncompliance of filling out required questionnaires, acute and/or chronic bacterial prostatitis, history of genitourinary cancer, history of recent prostate surgery, and diagnosis of neurological diseases affecting the bladder.

RESULTS

The median patient age and UPOINT subdomain was determined as 37 (IQR = 13, range 21-65) and 2 (IQR = 1, range 0-5), respectively. Median values for BWT, National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), and International Index of Erectile Function were 3 (IQR = 1, range 2-6, 7), 4 (IQR = 6, range 1-23), and 25 (IQR = 10, range 1-30), respectively. The presence of calcification demonstrated a significant association with total NIH-CPSI score and BWT, whereas its relation with age and total UPOINT score was insignificant. However in contrast to calcification status, BWT ≥3.3 showed a strong and statistically significant relation to all the described measurements.

CONCLUSION

Measurement of BWT can be used as an accessible and objective method for the diagnose of CP/CPPS according to UPOINT scoring system.

Bilateral same-session flexible ureterorenoscopy for renal and/or ureteric stone disease treatment

Objective

To evaluate the effectiveness and safety of bilateral same-session flexible ureterorenoscopy (f-URS) in the treatment of bilateral renal and/or ureteric stone disease.

Patients and methods

From October 2007 to December 2015, 62 patients who had undergone bilateral, same-session f-URS were included in the study. The procedures were performed under general anaesthesia, in lithotomy, and initiated on the side in which the patient was clinically symptomatic or on the side in which the stone was smaller. Plain abdominal radiography, intravenous urography, renal ultrasonography and/or non-contrast computed tomography scans were conducted in all patients. The success rate was defined as, patients who were stone-free or only had residual fragments of <3 mm.

Results

A total of 62 patients (43 male, 19 female), with a mean (SD) age of 39 (15.1) years, were included. The mean (SD) stone size was 23.2 (6.11) mm with a mean (SD) operative time of 58.8 (16.24) min. The stone-free rates were 90.3% and 100% after the first and second procedures, respectively. The mean (SD) hospital stay was 1.58 (0.72) days. There were minor complications (Clavien–Dindo grade I–II) in 10 (16%) patients and major complications (Clavien–Dindo III–IV), e.g. distal ureter laceration and laser injury of the ureter, in two patients.

Conclusion

Same session bilateral f-URS is a successful and safe method for bilateral renal and/or ureteric stones.

Does Mild Hydronephrosis Induced by Full-Bladder Improve Outcomes in Patients Undergoing Shock Wave Lithotripsy for Lower Calyceal Stones?: A Prospective Randomized Study

PURPOSE

To compare the outcomes, sessions and shock wave numbers in patients undergoing standard procedure shock wave lithotripsy (SWL) and patients undergoing SWL with mild hydronephrosis induced by full-bladderfollowing oral hydration before SWL procedure for lower calyceal stones.

MATERIALS AND METHODS

Between January 2014- January 2016 a total of 371 patients who underwent SWL, for lower pole calyceal stones ? 2 cm, were included into the study. 127 patients were treated in the supine position (Group A), 123 in the prone position (Group B) and 121 in the prone position with full bladder and mild hydronephrosis checked by ultrasound before procedure (Group C). There were 286 men and 85 women with a mean ± SD age of 36 ± 11 yearsResults: The mean (SD) stone sizes within the group A, group B and group C were 11 mm (±3 mm), 12 mm (±4.1 mm) and 11 mm (± 3.8 mm) respectively. No significant difference was found in age (P = .18) and stone size between 3 groups (P = .07). The median interquartile range (IQR) number of shocks within the group A, group B and group C were 7600 (3855), 6500 (4300) and 6700 (4915) respectively. Significant difference was found in number of shock waves among 3 groups (P < .01). The difference between groups according to stone expulsion rate wasfound significant in all sessions (P = .01).

CONCLUSION

The present study suggests that mild hydronephrotic status induced by full-bladder before SWL can lower cost and patient discomfort by decrease in number of sessions and increase in stone clearance.

Valuation of Neutrophil/Lymphocyte Ratio in Renal Cell Carcinoma Grading and Progression

Introduction

We investigated the association of the neutrophil/lymphocyte ratio (NLR) with tumor size and Fuhrman grade in nonmetastatic renal cell carcinoma (RCC) cases.

Materials and methods

Data of nonmetastatic RCC (T1-4N0M0) cases, operated between 2010 and 2016, were retrospectively reviewed and 103 patients were included in the study. The patients were divided into two groups according to tumor diameter (Group 1 T < 4 cm, Group 2 T ≥ 4 cm) and into three groups according to Fuhrman grade. Twenty-eight patients with a tumor diameter of 4 cm or less in Group 1 and 75 patients with a tumor diameter greater than 4 cm in Group 2 were compared. In both grouping systems, the NLR, mean platelet volume (MPV), red cell distribution width (RDW), white blood cell (WBC), red blood cell (RBC), platelet (PLT), lymphocyte, and neutrophil values and age were compared.

Results

There were no differences in age, MPV, RDW, neutrophil, WBC, RBC, PLT counts in groups of tumor diameter (Group 1 T < 4 cm, Group 2 T ≥ 4 cm). However, the lymphocyte amount was significantly higher in cases with a tumor diameter less than 4 cm compared to the cases with a tumor diameter greater than 4 cm (p = 0.015). It was observed that the NLR had a tendency to increase in patients with tumor size greater than 4 cm compared to patients with tumor size smaller than 4 cm (p = 0.029). There were no differences in age, MPV, RDW, lymphocyte, neutrophil, WBC, RBC, PLT counts, and the NLR in different Fuhrman-graded cases.

Conclusions

There is a linear relation between the tumor size and the NLR in nonmetastatic RCC cases. Therefore, the NLR is a cheap parameter that can be used to show the tumor size, and thus it can be used to get an idea about the prognosis of the patient.

Malignant Mesothelioma of Tunica Vaginalis Testis: Macroscopic and Microscopic Features of a Very Rare Malignancy

Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is an extremely rare tumour, usually mimicking benign pathologies of the scrotum.

Our case is an 84-year-old male patient who appealed with a painless, left-sided scrotal swelling longer than 2 months. Although the level of tumour markers was normal, ultrasonographic examination results forced us to perform an inguinal scrotal exploration. Multiple small papillary tumours, both on tunica vaginalis and tunica albuginea, were detected intraoperatively. Due to these findings, radical orchiectomy was performed.

A pathological evaluation showed malignant mesothelioma (MM) of the tunica vaginalis testis. Exposure to asbestos is a well-known risk factor. Furthermore, a history of trauma, herniorrhaphy and chronic hydroceles is blamed as a possible risk factor. Scrotal ultrasonography is the mainstay of primary diagnosis and, therefore, it should not be overlooked when dealing with benign scrotal cysts or hydroceles, which are very common pathologies at these decades, too.

Radical inguinal orchiectomy is the primary treatment choice for localised MMTVT disease, whereas in signs of lymph node metastasis, inguinal lymph node dissection is required. Radical resection should be completed with chemotherapy and/or radiotherapy for an advanced or recurrent disease. This case, which is very rarely reported in the literature and detected during inguinal exploration, along with the pathological works that supported the diagnosis, was presented with this report.

Medical Expulsive Therapy for Distal Ureteral Stones: Tamsulosin Versus Silodosin in the Turkish Population

Introduction

Our aim was to contribute a study that includes a higher patient population to the limited number of studies comparing tamsulosin and silodosin in the treatment of distal ureteral stones.

Material and methods

Patients who presented with renal colic to the urology emergency clinic and were diagnosed with ureteral stones and followed-up with conservative treatment between January 2010 and January 2016 were retrospectively screened. According to the inclusion-exclusion criteria, the patients were divided into three groups. Group 1: 150 patients followed with watchful waiting (WW), Group 2: 156 patients who received 0.4 mg of tamsulosin daily, and Group 3: 159 patients who received 8 mg of silodosin daily. The side effects of the used drugs, duration of stone reduction, and expulsion rates were evaluated and compared separately.

Results

A total of 465 patients were included in the study. No statistically significant difference was found in terms of age, gender, and stone size among the groups. The patient characteristics and results are shown in Table 1. The differences in stone expulsion rate between the groups in the first week were calculated using the Chi-square test and found to be non-significant (p = 0.155); whereas, the stone expulsion rates between Group 1 versus Group 2 and Group 1 versus Group 3 were found to be significantly different after the second and third week.

Conclusion

According to our results, no statistically significant superiority between tamsulosin and silodosin was shown in the treatment of distal ureteral stones in the Turkish population.

Metachronous Testicular Cancer After Orchiectomy: A Rare Case

Testicular cancer represents approximately 1% of all cancers diagnosed in males. The prevalence of bilateral testicular germ cell tumor cases varies from 1% to 5%. Intratubular germ cell neoplasia (ITGCN) is a precursor for almost all testicular germ cell tumors (TGCT) and is one of the highest risks of developing contralateral testicular cancer. The radical orchiectomy is still preferred for the treatment of testicular cancer. However, in some cases like solitary testis, bilateral cancer or if the tumor size is under 30% percent of the testicular extent, organ-sparing surgery can be an option. There are just a few published reports of metachronous contralateral testicular cancer, developed after orchiectomy with the histopathology of the intratubular germ cell neoplasia.

Bladder Neck Collagen Injection in the Treatment of Congenital Retrograde Ejaculation: A Case Report

The present study describes the first successful treatment of a congenital retrograde ejaculation case with a submucosal collagen injection to the bladder neck.

A 28-year-old male (height 170 cm, weight 80 kg) attended to the urology outpatient clinic with complaints of scattered urine stream and absence of ejaculation. The laboratory tests, including hormone profile (follicle stimulating hormone, luteinizing hormone, and testosterone) and the routine blood count were within normal ranges, whereas semen analysis demonstrated a total absence of ejaculation. The analysis of post-ejaculate urine specimens revealed an elevated sperm concentration indicative of retrograde ejaculation. The cystoscopy was performed; the prostatic urethra was normal, the verumontanum was in the orthotopic position, and the bladder neck was wide opened. Dextranomer/hyaluronic acid copolymer (Deflux, 8 ml) was injected into the bladder neck at clock positions of one, five, seven, and 11 o'clock. During the same procedure, the large opening in the vesical collum was obliterated. During the first follow-up (four weeks after surgery), the patient was able to produce a normal (2.8 ml) ejaculation volume. The sperm analysis revealed normozoospermia, with 25 million spermatozoa/ml, 26% (a) and 57% (a + b) motility, and 14% normal morphology.

The submucosal bladder neck collagen injection is a minimally invasive technique that quickly restores anterograde ejaculation and should be considered in the patients with congenital or acquired retrograde ejaculation and for those who did not respond to the medical treatment.

Outcome of buccal mucosa urethroplasty in the management of urethral strictures

OBJECTIVE

The objective of the study is to report the outcome of buccal mucosal urethroplasty.

MATERIALS AND METHODS

The follow up data of 15 patients undergoing single stage urethroplasty from September 2010 to September 2015 were retropectively reviewed. They received buccal mucosa graft for urethroplasty. The patients were followed for complications and outcome.

RESULTS

Mean age was 53.7 ± 13.6 The stricture length ranged from 3 to 6 cm (mean 4.4 ± 0.8). The success rate for buccal mucosa urethroplasty (BMU) was 67.7% at 12th month. Three patients presenting with voiding difficulty in the 3rd month and one in the next 12 months, had urethral restenosis. One patient had fistula formation at 6th month postoperatively. Five patients underwent retreatment procedures such as internal urethrotomy, urethroplasty and/or internal urethrotomy.

CONCLUSIONS

The buccal mucosa is easy to obtain and handle, therefore BMU can be safely and effectively managed outside high volume institutions.

Comparison of transurethral incision of the prostate and silodosin in patients having benign prostatic obstruction in terms of retrograde ejaculation

BACKGROUND

To compare the functional outcomes and retrograde ejaculation (RE) after transurethral incision of the prostate (TUIP) or silodosin in bladder outlet obstruction (BOO) secondary to a small prostate.

METHODS

Prospectively collected data from December 2011 through December 2014 of 192 LUTS patients having fertility concerns with prostate volume smaller than 40 ml receiving either TUIP or silodosin treatment were prospectively reviewed. The treatment outcomes were evaluated and compared.

RESULTS

TUIP was performed in 96 cases and silodosin 8 mg was prescribed in 96 cases. At 12th months after TUIP or continuous silodosin treatment, the decrease in mean International Prostate Symptom Score (IPSS) and postvoiding residual urine (PVR) and the improvement of mean maximal flow rate (Qmax) were significant (p = 0.000). The improvement in IPPS and Qmax was significantly higher in TUIP group compared to silodosin group (p = 0.005, p = 0.000) with a lower rate of retrograde ejaculation (RE) in TUIP group. (11/96 vs 33/96) (p = 0.000) Conclusions: Both TUIP and silodosin ensures comparable improvement in PVR, IPSS and Qmax with a lower rate of RE on the TUIP group in prostates weighing less than 40 grams suggesting that TUIP is a better choice in younger patiens seeking preservation of ejaculation with fertility concerns.

Primary Nocturnal Enuresis: A Review

Context

Nocturnal enuresis or bedwetting is the most common type of urinary incontinence in children. It has significant psychological effects on both the child and the family. Enuresis nocturna is defined as the inability to hold urine during the night in children who have completed toilet training. It is termed as being “primary” if no continence has ever been achieved or “secondary if it follows at least 6 months of dry nights. The aim of this review was to assemble the pathophysiological background and general information about nocturnal enuresis.

Evidence Acquisition

This review was performed by evaluating the literature on nocturnal enuresis published between 1970 and 2015, available via PubMed and using the keywords “nocturnal enuresis,” “incontinence,” “pediatric,” “review,” and “treatment.”

Results

Children with nocturnal enuresis produce urine at higher rates during the night, and may have lower bladder capacities. Some children with nocturnal enuresis may also have daytime urgency, frequency, and urinary incontinence. Treatment includes aggressive treatment of accompanying constipation or urinary tract infections, behavioral changes, and medical therapy. Alarm therapy remains the first-line treatment modality for primary nocturnal enuresis. High rates of patient compliance and relapse mean that alternative treatments remain on the agenda.

Conclusions

Nocturnal enuresis is a common problem that has multifaceted effects on both the child and the family. Due to multiple etiologic factors, nocturnal enuresis is still not clearly defined.

Analgesic effects of oligonol, acupuncture and quantum light therapy on chronic nonbacterial prostatitis

Background:

Chronic Nonbacterial Prostatitis (CNBP) is a condition that frequently causes long-term pain and a significant decrease in the quality of life.

Objectives:

The present study aimed to examine the analgesic effects of oligonol, acupuncture, quantum light therapy and their combinations on estrogen-induced CNBP in rats.

Materials and Methods:

This experimental study was conducted in Edirne, Turkey, using a simple randomized allocation. A total of 90 adult male Wistar rats were randomized into 9 groups of 10 rats each: Group I, control; Group II, CNBP, Group III, oligonol only, Group IV, acupuncture only; Group V, quantum only; Group VI, oligonol + quantum; Group VII, acupuncture + oligonol; Group VIII, quantum + acupuncture; Group IX, acupuncture + quantum + oligonol. Oligonol treatment was given at a dose of 60 mg/day for 6 weeks. Conceptual vessels (CV) 3 and 4, and bilaterally urinary bladder (Bl) 32 and 34 points were targeted with 1-hour acupuncture stimulation. The quantum light therapy was applied in 5-minute sessions for 6 weeks (3-times/a week). For pain measurements, mechanical pressure was applied to a point 2 cm distal to the root of the tail to elicit pain and consequent parameters (peak force, latency time of response and total length of measurement) were assessed.

Results:

Analgesic effects were observed with all treatment regimens; however, the most prominent median analgesic effect was shown in the quantum light therapy in combination with acupuncture for estrogen-induced CNBP (PF1 = 663.9, PF2 = 403.4) (P = 0.012). Furthermore, we observed that monotherapy with quantum light showed a better analgesic efficacy as compared to oligonol and acupuncture monotherapies (PF1 = 1044.6, PF2 = 661.2) (P = 0.018, P = 0.008, P = 0.018; respectively).

Conclusions:

All treatment modalities showed a significant analgesic effect on CNBP in rats, being most prominent with the quantum light therapy.

Molecular weight effect on latex film formation induced by solvent vapor: an optical transmission study

Two different sets of powder latex film were prepared from high- and low-molecular-weight (HM and LM) poly(methyl methacrylate) (PMMA). The optical transmission method was used to the study film formation induced by organic vapor. Various HM and LM films with the same latex content were prepared separately from the PMMA particles and exposed to vapor of a chloroform-heptane mixture in various volume percents of chloroform. Transmitted light intensities, I(tr), from these films increased in time under vapor exposure, which was attributed to the increase in "crossing density" at the junction surface. The Prager-Tirrell model was employed to obtain the back-and-forth frequency, nu, of the reptating polymer chain during film formation induced by solvent vapor. nu values were obtained and found to be strongly correlated with the percent of chloroform in the solvent mixture and the molecular weight of the polymer chain. It is observed that high-molecular-weight chains reptate much more slowerly than low-molecular-weight chains.

Film Formation from Nanosized Copolymeric Latex Particles: A Photon Transmission Study

The photon transmission technique was used to monitor the evolution of transparency during film formation from nanosized copolymeric latex particles. The latex films were prepared from poly(methyl methacrylate-co-butyl methacrylate) (P(MMA-co-BMA)) particles which were produced by microemulsion polymerization. These films were annealed at elevated temperatures in various time intervals above the glass transition temperature (T(g)) of P(MMA-co-BMA). It is observed that the transmitted photon intensity (I(tr)) from these films increased as the annealing temperature increased. There are three different film formation stages. These stages are explained by the void closure, healing, and interdiffusion processes, respectively. The activation energies for viscous flow (DeltaH approximately 16 kcal/mol), minor chains (DeltaE(H) approximately 27 kcal/mol), and backbone motion (Delta E(b) approximately 132 kcal/mol) were obtained using various models. Void closure (tau(v), T(v)) and healing points (tau(H), T(H)) were determined. Using the time-temperature pairs, void closure and healing activation energies were measured and found to be 21 and 30 kcal/mol, respectively. Copyright 2001 Academic Press.

Packing Effect on Latex Film Dissolution: A UV-Visible Study

Latex films with various thicknesses are formed from pyrene (P) labeled poly (methyl methacrylate) (PMMA) latex particles sterically stabilized by poly isobutylene (PIB). Annealings of latex films were performed above T(g) at elevated temperatures up to 270 degrees C for 30 min time intervals. The UV-Visible (UVV) technique was used for monitoring latex film formation and dissolution. It was observed that thicker films formed more transparent films than thinner films. Absorption of solvent molecules (chloroform) into the annealed latex film was followed by diffusion of PMMA chains into a solvent reservoir. Diffusion of pyrene-labeled PMMA chains was monitored in real time by the absorbance change of pyrene in the polymer-solvent mixture. A diffusion model with a moving boundary was employed to quantify real-time UVV data. Diffusion coefficients of PMMA chains were measured and found to be between 2.6 x 10(-9) and 9.7 x 10(-13) cm(2) s(-1) for the latex films in various thicknesses. It is observed that thicker and more transparent films dissolved much faster than the thinner and turbid films; i.e., highly packed films dissolve more easily. Copyright 1999 Academic Press.

Molecular Weight Effect on Latex Film Formation from Polystyrene Particles: A Photon Transmission Study

The photon transmission method was used to probe the time evolution of film formation from latex particles. Two different latex films were prepared from high molecular weight (HM) and low molecular weight (LM) polystyrene particles at room temperature and were annealed at various temperatures in 2.5-min time intervals above the glass transition. The increase in the transmitted photon intensity (Itr) is attributed to the increase in "crossing density" at the junction surface. The Prager-Tirrell model was employed to interpret the increase in crossing density at the junction surface. The back and forth activation energies were measured for HM and LM films and found to be around 59 and 87 kcal/mol for a reptating polymer chain across the junction surface. Monte Carlo simulations were performed for photon transmission through a rectangular lattice. The number of transmitted photons (Ntr) was calculated as a function of the mean free path of photons. It was observed that Ntr, similar to Itr, increases as the square of the mean free path of photons is increased. Copyright 1999 Academic Press.