Adem Tok

The protective effects of tadalafil on renal damage following ischemia reperfusion injury in rats

Ischemia‐reperfusion injury can cause renal damage, and phosphodiesterase inhibitors are reported to regulate antioxidant activity. We investigated the prevention of renal damage using tadalafil after renal ischemia reperfusion (I/R) injury in rats. A total of 21 adult male Wistar albino rats were randomly divided into three groups of seven, including Group 1‐control, Group 2‐I/R, and Group 3‐tadalafil + I/R group (I/R‐T group) received tadalafil intraperitoneally at 30 minutes before ischemia. Inducible nitric oxide synthase, endothelial nitric oxide synthase, malondialdehyde, and total antioxidant capacity levels were evaluated, and histopathological changes and apoptosis in the groups were examined. Tadalafil decreased malondialdehyde levels in the I/R group and increased the total antioxidant capacity level. Histopathological and immunohistochemical findings revealed that tadalafil decreased renal injury scores and the ratios of injured cells, as measured through apoptotic protease activating factor 1, inducible nitric oxide synthase, and endothelial nitric oxide synthase levels. We suggest that tadalafil has protective effects against I/R‐related renal tissue injury.

Haptoglobin Levels in Turkish Patients with Bladder Cancer and its Association with Clinicopathological Features

Although alteration in the haptoglobin phenotype has been reported in patients with bladder cancer, serum haptoglobin levels have not been evaluated. We hypothesized that serum haptoglobin can be used as a biomarker. The aim of this study was to evaluate the expression of haptoglobin in bladder cancer and to determine the relationship with clinicopathological features. A total of 68 serum specimens obtained before surgery were used to investigate haptoglobin expression using the sandwich ELISA technique. Serum haptoglobin levels were higher in the patients with bladder cancer compared to healthy controls (p<0.0001). Additionally, the levels of haptoglobin protein increased with increasing tumor grades (p<0.001) and were significantly higher in patients with metastatic disease and the presence of lymphovascular involvement, lymph node metastases and increasing tumor burden (p<0.0001). This study suggests that elevated haptoglobin levels are associated with a higher stage, grade, and extent of distant metastasis and larger tumor size. Haptoglobin may therefore provide a useful diagnostic and treatment biomarker for patients with bladder cancer.

Are the urology operating room personnel aware about the ionizing radiation

ABSTRACT Purpose: We assessed and evaluated attitudes and knowledge regarding ionizing radiation of urology surgery room staff. Materials and Methods: A questionnaire was sent by e-mail to urology surgery room personnel in Turkey, between June and August 2013. The questionnaire included demographic questions and questions regarding radiation exposure and protection. Results: In total, 127 questionnaires were answered. Of them, 62 (48.8%) were nurses, 51 (40.2%) were other personnel, and 14 (11%) were radiological technicians. In total, 113 (89%) participants had some knowledge of radiation, but only 56 (44.1%) had received specific education or training regarding the harmful effects of radiation. In total, 92 (72.4%) participants indicated that they used a lead apron and a thyroid shield. In the subgroup that had received education about the harmful effects of radiation, the use ratio for all protective procedures was 21.4% (n=12); this ratio was only 2.8% (n=2) for those with no specific training; the difference was statistically significant (p=0.004). Regarding dosimeters, the use rates were 100% for radiology technicians, 46.8% for nurses, and 31.4% for other hospital personnel; these differences were statistically significant (p<0.001). No significant relationship between working period in the surgery room, number of daily fluoroscopy procedures, education, task, and use of radiation protection measures was found. Conclusions: It is clear that operating room-allied health personnel exposed to radiation do not have sufficient knowledge of ionizing radiation and they do not take sufficient protective measures.

Publication rates of full-text journal articles converted from abstracts presented during the 22nd Turkish National Urology Congress

OBJECTIVE To analyze the publication rates of full-text journal articles converted from the abstracts presented in the 22(nd) Turkish National Urology Congress in 2012. MATERIAL AND METHODS A total of 576 abstracts accepted for presentation at the 22(nd) Turkish National Urology Association Meeting were identified from the published abstract book. The abstracts were categorized into subsections such as endourology and pediatric urology. The subsequent publication rate for the studies was evaluated by scanning PubMed Medline. Abstracts published before the proceedings were excluded from the study. RESULTS The abstracts were categorized as being presented orally (n=155), by poster (n=421), or by video (n=78). Of the 28 (18.3%) of 155 oral and 34 (8.15%) of 421 poster presentations, were subsequently published in several journals until March 2015. The publication rates of the abstracts based on urology subsections were as follows: neurology (25%), andrology (18.6%), endourology (17.2%), urolithiasis (15.3%), general urology (12.5%), infectious diseases (7.14%), pediatric urology (6.25%), uro-gynecology (6.06%), reconstructive urology (5.8%), and urooncology (3.8%). The average time to publication was 11.77 (0-33) months. CONCLUSION This is the first study assessing the publication rates of abstracts presented at a Turkish National Urology Congress. It reveals that more qualified randomized studies need to be done to improve the rate of publication.

Comparison of intraoperative and postoperative complications based on ASA risks in patients who underwent percutaneous nephrolithotomy.

OBJECTIVE In this study we aimed to evaluate intraoperative and postoperative complications which developed according to pre-operative American Society of Anesthesiologists (ASA) risk criteria in patients who had undergone percutaneous nephrolithotomy (PNL). MATERIAL AND METHODS Five hundred and sixty patients who had undergone PNL between 2002 and 2014 were included in the study. Patients operated on the ipsilateral kidney, those with solitary kidney or the cases who had previously undergone more than one access were excluded from this study. Preoperative anesthesia risks were determined according to preoperative classification developed by ASA. Postoperative complications were evaluated using Clavien Complication Grading Scale. RESULTS The mean age of the cases was 47±14 years. The 57% (n=319) of the cases were male, 241 (43%) of them were female. The average indwell time of nephrostomy catheter was 2.88±1.00 (1-8), and length of hospital stay was 4.91±1.54 (2-17) days. When the cases were assessed according to ASA risk groups, intraoperative complications were observed in 9 (5.5%) ASA I, 27 (8.6%) ASA II, and 18 (22%) ASA III patients and and distribution of the patients was statistically significant (p<0.001). When intraoperative complications were evaluated one by one, intraoperative hypotension developed in ASA I (n=3; 1.8%), ASA II (n=20; 6.4%) and ASA III (n=11; 13.4%) risk groups and this distribution (p=0.002) of patients was statistically significant. When assessed according to Clavien Postoperative Scale, postoperative complications developed (p=0.053) in ASAI (n=24; 14.7%), ASA II (n=27, 8.6%) and ASA III (n=13; 15.9%) risk groups, and this distribution of the patients was not statistically significant. In postoperative complications, Grade 3a complications developed in ASA I (n=12; 7.4%), ASA II (n=19; 6%) and ASA III (n=8; 9.8%) risk groups and this distribution was not seen to be statistically significant (p=0.485). CONCLUSION A statistically significant difference observed regarding intraoperative complications in the groups formed according to ASA risk criteria, on Clavien Grading scale no statistically significant difference was observed as for postoperative complications. In this context, we considered that ASA risks are major risk factors for PNL operations in terms of intraoperative complications.

Female Idiopathic Spontaneous Unwelcome Orgasm; A Rare Case Report and Review Of The Literature

Received: 17.03.2016 Accepted: 08.05.2016 1Hinis State Hospital Clinic of Urology, Erzurum, Turkey 2Bülent Ecevit University School of Medicine Departmant of Psychiatry, Zonguldak, Turkey 3Hinis State Hospital Clinic of Neurology, Erzurum, Turkey 4Gediz State Hospital Clinic of Psychiatry, Kütahya, Turkey 5Bülent Ecevit University School of Medicine Departmant of Urology, Zonguldak, Turkey Yazışma adresi: Hüseyin Buğra Karakaş, Hinis State Hospital Clinic of Urology, Erzurum, Turkey e-mail: hubuka26@gmail.com Manuscript was presented in the XI. Eurasian Andrology Congress, Madrid, Spain in February, 2016 as poster presentation aBSTracT

Fluoroless ureteroscopy: in whom and when?

additional information to increase the safety of the procedure. On the other hand, in fluoroless procedures, guidewire insertion, ureteral access sheath placement, and insertion of a flexible ureterorenoscope over the guidewire are done with the tactile and visual cues that require advanced surgical skills. Patients should be assessed meticulously during the preoperative period, and during an operation, fluoroscopy should be ready to use in case of any requirement. Fluoroscopic imaging may be mandatory in complicated cases, such as with patients who have anatomical abnormalities, impacted ureteral stones, or ureteral strictures [6]. (In the studies presenting the feasibility of fluoroless URS, complicated cases are/were excluded.) In conclusion, radiation-free RIRS reduces the intraoperative irradiation of patients and operating room personnel and is feasible and safe for the treatment of renal stones in uncomplicated cases. On the other hand, however, fluoroscopic imaging could be reasonably used during endoscopic procedures in order to achieve highest safety with the minimal radiation exposure.