Ahmet Camtosun

Importance of Neutrophil/Lymphocyte Ratio in Prediction of PSA Recurrence after Radical Prostatectomy

BACKGROUND The aim of this study was to research the importance of the neutrophil to lymphocyte ratio (NLR) in prediction of PSA recurrence after radical prostatectomy, which has not been reported so far. MATERIALS AND METHODS The data of 175 patients who were diagnosed with localised prostate cancer and underwent retropubic radical prostatectomy was retrospectively examined. Patient pre-operative hemogram parameters of neutrophil count, lymphocyte count and NLR were assessed. The patients whose PSAs were too low to measure after radical prostatectomy in their follow-ups, and then had PSAs of 0,2 ng/mL were considered as patients with PSA recurrence. Patients with recurrence made up Group A and patients without recurrence made up Group B. RESULTS In terms of the power of NLR value in distinguishing recurrence, the area under OCC was statistically significant (p<0.001) .The value of 2.494 for NLR was found to be a cut-off value which can be used in order to distinguish recurrence according to Youden index. According to this, patients with a higher NLR value than 2.494 had higher rates of PSA recurrence with 89.7% sensitivity and 92.6% specificity. CONCLUSIONS There are certain parameters used in order to predict recurrence with todays literature data.We think that because NLR is easy to use in clinics and inexpensive, and also has high sensitivity and specificity values, it has the potential to be one of the parameters used in order to predict biochemical recurrence in future.

Sarcomatoid Carcinoma of the Prostate

Sarcomatoid carcinoma of the prostate is among the rarest malignant neoplasm types and has been well known for its aggressive clinical course. Patient was admitted with the symptoms of lower urinary tract. Transurethral resection of prostate (TUR-P) was carried out. Revealing Gleason 5 + 3 = 8 prostate adenocarcinoma in TUR-P material. Thereby, a Radical Prostatectomy procedure was planned. In operation, frozen examination revealed adenocarcinoma metastasis to the obturator lymph node. The operation was terminated. In the postoperative 3rd month, the patient was re-admitted with acute urinary system symptoms. A cystoscopy performed and complete resection of the mass was performed. The pathological examination reported that the tumor was compatible with undifferentiated adenocarcinoma owing to presence of poorly differentiated tumoral cells and detection of adenocarcinoma in a relatively small (<1%) focus. 4 month after the operation, the patient underwent another cyctoscopic examination which revealed the prostatic lounge and most of the bladder lumen to be filled with tumoral tissue. The tumoral tissues was resected incompletely. This material was diagnosed to be “Sarcomatoid Malignant Tumor” upon the new evidences of progressive dedifferentiation and predominant sarcomatoid appearance, compared with the former TUR-P materials. Subsequent PET-CT scan depicted multiple metastasis. The patient was referred to oncology department. In conclusion, sarcomatoid carcinoma is a malignant variant that brings along diagnostic and treatment difficulties.

Laparoscopic pyelolithotomy in a horseshoe kidney.

The horseshoe kidney is the most frequent renal anomaly, with a prevalence of 0.25% and a male to female ratio of 2:1. In this article we aimed to report a 50-year-old man who had left kidney stones accompanied with a horseshoe kidney. In this case percutaneous nephrolithotomy was deemed to be a risky procedure due to malrotation of the pelviocalyceal system and possible interposition of bowel loops between kidney and the abdominal wall. Therefore, we preferred laparoscopic pyelolithotomy. At the end of the procedure, the patient was stone-free. We observed no complication. The patient was discharged after 72 hours. We assume that laparoscopic pyelolithotomy is a safe and effective approach for renal pelvic stone in case of horseshoe kidney.

Primary Small Cell Carcinoma in Urinary Bladder: A Rare Case.

Small cell carcinoma of bladder, which does not have a common and accepted treatment protocol, is a rare and highly aggressive tumor. It is mostly pulmonary originated; however, it can rarely be seen in extrapulmonary sites. We presented an interesting and uncommon case, in which the transitional cell tumor was found in the transurethral resection specimen, but the small cell carcinoma was detected in the final radical cystectomy material.

Leiomyoma of the Bladder in a 23-year-old Male: Case Report -

Leiomyoma is a rare mesenchymal tumor that can occur in patients of any age. In the genitourinary system the tumor arises most frequently in the uterus, but can occur in any region. The tumor is seen more frequently in women than in men, and can be symptomatic or asymptomatic. Here we present a 23-year-old man who had symptomatic leiomyoma of the bladder.

The Importance of Peripheral and Local Blood Analysis for Evaluation of Nitric Oxide and Asymmetric Dimethylarginine Before and After Varicocelectomy

We read with interest the recently published article in the esteemed Biological Trace Element Research, by Kiziler et al. [1]. The exact pathologic mechanism of varicocele disease was unknown but it has been presumed to be related to the unique angle of the junction of left-side spermatic vein with renal vein coupled with increased hydrostatic pressure or vascular deficiency [2]. Also, the effect of increased reactive oxygen species and nitric oxide (NO) has been implicated as an important role in varicocele. Moreover, in many studies, it was found that NO level had almost nearly double level in the internal spermatic vein than in the peripheral circulation [3, 4]. However, in the current study, NO was shown as lower in the internal spermatic vein than the peripheral circulation in the related Figure 2 even though there was no statistical comparison done between these parameters. On the other hand, the samples of the femoral vein blood were used instead of the internal spermatic vein blood as postoperative control. As we know from the previous studies, it may not reflect the true outcomes. Cohen et al. and Ito et al. demonstrated that the blood in the internal spermatic vein contained much more detrimental metabolic products, catecholamine, prostaglandins, etc. than the peripheral circulation in varicocele patients [5, 6]. Moreover, Mostafa et al. reported high level of ROS and decreased level of antioxidants in the internal spermatic vein of varicocele associated infertile patients compared with the peripheral venous blood [4]. Asymmetric dimethylarginine (ADMA), an endogenous competitive inhibitor of the nitric oxide synthase (NOS), is known to be associated with endothelial dysfunction, vascular diseases, and atherosclerotic changes. Also, ADMA can uncouple NOS resulting in the formation of superoxide radicals and low-density lipoproteins and oxidized low-density lipoproteins can inducemore ADMA formation in oxidative stress [7]. In that case, we expect ADMA level to decrease in the internal spermatic vein after varicocelectomy surgery. In this manner, the present study has contradiction with the previous studies.

Are neutrophil-lymphocyte and platelet-lymphocyte ratios valuable in predicting prostate cancer? -

Introduction and Hypothesis: We retrospectively evaluated the prognostic impact of neutrophil-lymphocyte ratio (NLR) as a marker for inflammatory and immune state in men with prostate cancer. Materials and Methods: This retrospective study was conducted in a single urology clinic to review the medical data of 558 patients who underwent transrectal prostate needle biopsies between 2007 and 2014. Prior to transrectal prostate needle biopsies, patient histories, physical examinations, and routine laboratory tests including blood biochemistry, urinaly- sis and urine cultures, free PSA and total PSA, rectal examination, transrectal ultrasound findings, and pathology results were evaluated. Results: Benign biopsy results were found in 287 patients (Group 1) using neutrophil / lymphocyte (NLR) and platelet / lymphocyte ratio (PLR). When calculating malignancy in 271 patients (Group 2), there was no significantly difference in NLR and PLR values between benign and malign prostate diseases (p=0.14 and p=0.369, respectively). Conclusion: With reference to the survey prior to the biopsy, NLR and PLR ratio values do not appear to be helpful in the differentiation of benign prostatic hyperplasia and prostate cancer.

Comparison of renal function after donor and radical nephrectomy

Abstract Glomerular filtration rate (GFR) is directly proportionate to nephron reserves. In this respect, it is known that the patients who underwent radical nephrectomy due to renal tumor are under high risk of chronic kidney disease (CKD) in the long term. In this study, it was aimed to compare post-operative renal functions of patients who underwent radical nephrectomy due to renal malignancy and who underwent donor nephrectomy as renal donors, to observe whether renal failure process develops or not, and to determine the factors that affect post-operative renal functions. 70 patients who underwent donor nephrectomy as renal donors and 130 patients who underwent radical nephrectomy due to renal tumor were studied. When we divided the groups as those with a GFR of below 60 mL/min/1.73 m2 and those with a GFR of above 60 mL/min/1.73 m2, we observed that GFR values of patients who underwent radical nephrectomy had a significantly stronger tendency to stay below 60 mL/min/1.73 m2 compared to patients who underwent donor nephrectomy (p < 0.001). When we divided the groups as those with a GFR of below 30 mL/min/1.73 m2 and those with a GFR of above 30 mL/min/1.73 m2, we observed that there were no patients in donor nephrectomy group whose GFR values dropped below 30 mL/min/1.73 m2 and there was not a statistically significant difference between the groups (p = 0.099). If possible, nephron sparing methods should be preferred for patients to undergo nephrectomy because of the tumor without ignoring oncologic results and it should be remembered that patient’s age and pre-operative renal functions may affect post-operative results in donor selection.

Stauffer Syndrome-Dependent a Giant Renal Tumor

Renalcellcarcinoma is associatedwith a widespectrum of para-neoplasticsyndromes, whichmay be precursors of primaryorrecurrentdisease. Non-metastatichepaticdysfunction in patientssufferingfromrenalcellcarcinoma is known as Staufferssyndrome. It is associatedwiththeproduction of cytokinesbythetumour, andseveralbiochemicalabnormalities, includingelevated serum alkaline phosphataseand γ-glutamyltransferase.

Percutaneous nephrolithotomy in very elderly patients (Age 75 and Over)

Amac: Perkutan nefrolitotomi (PNL),tum dunyada bobrek tasi cerrahi tedavisinde guvenle kullanilan minimal invaziv bir yontemdir. Ilk PNL ameliyati Mart 1998 tarihinde yapilan klinigimizde yetmis bes yas uzeri ilk PNL ameliyati ise Haziran 2000 tarihinde bilateral olarak yapildi. Calismamizda, 75 yas ve ustu hastalara yapilan PNL operasyonlari incelendi. Yontemler: PNL islemleri genel anestezi altinda yapildi. Hastalara, supin pozisyonda sistoskopi yapildiktan sonra ureter orifisinden ureter kateteri C kollu floroskopi esliginde takilarak uretral foley katetere tespit edildi. Sonrasinda hastalar prone pozisyona alinarak floroskopi esliginde Chiba ignesi ile bobrege girildi. Amplatz renal dilatator setiyle 30F’e kadar dilatasyon saglandi. Islem sonrasi renal kilif icerisinden nefrostomi kateteri yerlestirildi. PNL sonrasi 4 mm’den kucuk taslar, klinik onemsiz tas reziduleri kabul edildi. Bulgular: Mart 1998 – Aralik 2014 tarihleri arasinda, 16 yilda toplam 3003 perkutan nefrolitotomi islemi yapildi. Bu hastalardan 27 tanesi 75 yas ve uzeriydi. Bu hastalara, biri bilateral olmak uzere 28 PNL islemi yapildi. Hastalarin yas ortalamasi 79,37 (75-88) yil olarak hesaplandi. 20 (%74) hastada tam tassizlik saglandi. 2 hastada tubeless PNL yapildi. Viseral organ yaralanmasi, sepsis ya da olum gorulmedi. Sonuc: Minimal invaziv bir yontem olan PNL, yuksek guvenlik, dusuk komplikasyon oranlari, daha kisa hastanede kalis suresi, yuksek hasta memnuniyeti saglamasi, daha yuksek tassizlik oranlari ile acik bobrek tasi cerrahisine gore avantajli bir hale gelmistir. Uriner sistem tas hastaliginin cerrahi tedavisinde PNL guvenli ve etkili bir yontemdir