Devrim Tuglu

Citrate Levels in Fresh Tomato Juice: A Possible Dietary Alternative to Traditional Citrate Supplementation in Stone-Forming Patients

OBJECTIVES To detect citrate levels in fresh tomato juice, to reveal whether it can be studied for prevention of recurrent hypocitraturic nephrolithiasis. METHODS Juices of tomato, orange, lemon, and mandarin were extracted and blended with a hand blender, and 10 samples of 100 mL were taken from each. Citrate, oxalate, calcium, phosphorus, magnesium, sodium, potassium, chloride, and pH levels were examined in these. The same variables were re-evaluated after the samples were stored at +4 degrees C for 1 week. RESULTS In fresh tomato juice, higher citrate and magnesium levels as well as lower sodium and oxalate levels were detected as compared with the other juices. No differences were observed with regard to all variables among fresh orange, lemon, and mandarin juices. The level of citrate in the fresh tomato juice was higher at a statistically significant level than that in tomato juice that was stored for 1 week. The amount of oxalate increased in stored tomato juice. CONCLUSIONS Fresh tomato juice is considered a rich source of citrate. Furthermore, a high level of magnesium and a low level of sodium and oxalate content were detected in fresh tomato juice, the usability of which in recurrent hypocitraturic nephrolithiasis can be investigated in clinical studies.

C-reactive protein in early detection of bacteriemia and bacteriuria after extracorporeal shock wave lithotripsy.

OBJECTIVES To evaluate the value of plasma C-reactive protein (CRP) levels in early detection of bacteriuria and bacteriemia after extracorporeal shock wave lithotripsy (ESWL) of calcium and infection stones. METHODS A total of 75 patients who had infection stones (n = 27) and calcium stones (n = 48) were included in the study. All patients had sterile urine before ESWL. The mean age was 41.6 +/- 4.85 and male/female ratio was 2.12. Blood cultures were obtained within 1 hour post-ESWL period. Urine cultures were obtained 3 times just after and on the first and seventh day of ESWL. RESULTS Post-ESWL evaluations showed 3 positive blood cultures with 2 (2.66%) patients in infection stone and 1 (1.33%) patient in calcium stone groups, whereas urine cultures revealed 6 (8%) positive results in infection stones and 4 (5.33%) in calcium stones. The patients who had positive cultures also had elevated plasma CRP levels when compared to the levels in patients with negative cultures (p = 0.000). CONCLUSIONS Bacteriuria and bacteriemia after ESWL have been well-identified entities and may be responsible from some of the post-ESWL complications. CRP can be useful for early detection of such complications.

Local Anesthesia with 20 mL Prilocaine Infiltration : The Ultimate Point for Analgesia during Shockwave Lithotripsy?

PURPOSE The effectiveness of 10 mL and 20 mL local prilocaine infiltration for analgesic purposes during shockwave lithotripsy (SWL) was compared, and the differences in pain intensity and need for additional analgesics were defined. PATIENTS AND METHODS One hundred and twenty-one patients between the ages of 16 and 69 with kidney stones were randomly separated into two groups. The 60 patients in group 1 received 10 mL prilocaine subcutaneously and deep lumbar infiltration into the area 1 cm below the twelfth rib 2 minutes before SWL. The 61 patients in group 2 received 20 mL subcutaneously and deep lumbar infiltration of prilocaine to the same locale, again 2 minutes before the process. All the patients received one session of SWL. For measurement of pain intensity, the 0 to 100 mm visual analog scale (VAS) was used at 1 minute and every 10 minutes during the process. Intravenous fentanyl was administered to patients who had steady or increasing intensity of pain during the process. RESULTS VAS values were statistically significantly higher in patients in group 1 compared with patients in group 2 during the process. While 40 patients received additional analgesia in group 1, only three patients in group 2 needed additional analgesia. CONCLUSION Use of 20 mL subcutaneous and deep lumbar prilocaine infiltration during SWL for analgesic purposes is recommended as an efficient, cost-effective, anesthetist-independent, and reliable method.

Testicular Nitric Oxide and Thiobarbituric Acid Reactive Substances Levels in Obstructive Azoospermia: A Possible Role in Pathophysiology of Infertility

Objective. The aim of the study is to evaluate the levels of nitrite/nitrate and thiobarbituric acid reactive substances (TBARS) and their relationship with seminal parameters in experimental obstructive azoospermic rats to explain the possible mechanism of impaired sperm quality in obstructive azoospermia. Methods. A total of 10 male Spraque-Dawley rats underwent bilateral vas resection and ligation (Group-1 = vasectomy group). The findings were compared with control group (Group-2 = sham group, n = 10). Animals were sacrificed 8 weeks after surgery. Testes were removed and used for the evaluation of nitrate/nitrite and TBARS levels and for histology. Epididymal-aspirated seminal plasma was used for semen count and morphological analysis according to the Kruger criteria. Results. Testicular tissue nitrate/nitrite and TBARS levels were 35.7 ± 3.1 μmol/g protein and 3.7 ± 0.1 nmol/g protein in Group-1, and 19.3 ± 0.7 μmol/g protein and 3.1 ± 0.1 nmol/g protein in Group-2, respectively. Both parameters showed statistical differences between the two groups. Testicular tissue nitrate/nitrite and TBARS levels showed negative and statistically significant correlations with sperm motility and morphology. Conclusions. The present study showed that testicular nitrate/nitrite and TBARS levels were increased in obstructive azoospermia. For that reason, we concluded that antioxidant treatment can be recommended to patients before sperm extraction for artificial reproduction due to obstructive infertility after vasectomy reversal.

The antioxidant effect of dexmedetomidine on testicular ischemia-reperfusion injury

PURPOSE To investigate the protective effect of dexmedetomidine (Dex) on testicular damage induced by ischemia-reperfusion injury in rats. METHODS Sham group underwent left scrotal exploration only (group 1). The ischemia-reperfusion only group underwent left testicular torsion and detorsion (group 2). The ischemia-reperfusion plus Dex group underwent left testicular torsion, received 50 µg/kg Dex (group 3) and 100 µg/kg Dex (group 4) intraperitoneally at minute 180 of ischemia and then underwent detorsion. We determined histopathological findings and performed specific biochemical analyses. RESULTS Increasing doses of Dex significantly increased TAS, and significantly decreased OSI. Analyzing the antioxidant effects of increasing doses of Dex in torsion and contrlateral testicles: Dex 100 µg/kg statistically significant increased the tissue total antioxidant status (TAS) and oxidative stress index (OSI) when compared with Dex 50 µg/kg but not found significantly change on the tissue total oxidant status (TOS). However, Dex did not significantly improve these histological alterations. CONCLUSION The antioxidant effects of dexmedetomidine on testicular ischemia-reperfusion injury in ipsilateral and contrlateral testis, but in the histopathological level, there was no difference statistically according to Johnsens scoring system between groups at both sides.

Unknown complication of preputial calculi: preputial skin fistula.

Preputial stone disease is a very rare form of urolithiasis, and very few cases according this pathology have been reported in the literature. Preputial stone disease is primarily regarded as a result of severe phimosis; other causes are smegma solidification and accumulation of urine flow on the preputial area. Preputial stone disease can be associated with complications such as stranguria, dysuria, hematuria, and preputial ballooning during voiding and rarely with urinary retention. In this case, preputial skin fistula as an unknown complication is reported due to preputial stone disease.

Relationship between nocturnal penile tumescence parameters, International Index of Erectile Function symptom scores and sildenafil responses

Objective. To evaluate the correlation between International Index of Erectile Function (IIEF) questionnaire scores, nocturnal penile tumescence parameters and sildenafil response in patients with erectile dysfunction using a minimal investigations approach. Material and methods. A total of 97 patients without any risk factors for erectile dysfunction were included. After completing the IIEF questionnaire, nocturnal penile tumescence monitoring was performed in all patients for 1 or 2 nights. Subsequently, sildenafil was given at a dosage of 50 or 100 mg according to the response. The relationship between nocturnal penile tumescence results, the severity of erectile dysfunction according to the IIEF questionnaire and sildenafil response was evaluated using Pearsons χ2 test. Results. Based on the questionnaire scores, 25 patients (25.8%) had mild, 44 (45.4%) had moderate and 28 (28.8%) had severe erectile dysfunction. Forty-four patients (45.4%) had normal and 53 (54.6%) had abnormal parameters after nocturnal penile tumescence recording. The sildenafil response was positive in 63 patients (64.9%) who were given 50 mg and in 26 (26.8%) who were given 100 mg. However, eight patients (8.2%) did not respond to sildenafil. While the severity of erectile dysfunction according to IIEF scores and the sildenafil response did not show any correlations with nocturnal penile tumescence results, there was a statistically significant relationship between sildenafil response and the severity of erectile dysfunction. Conclusion. Changing concepts in the evaluation of ED have resulted in the use of effective therapeutic applications consistent with the degree of symptoms of patients without the waste of time caused by performing expensive, invasive, ineffective and time-consuming diagnostic tests

Medical and alternative therapies in urinary tract stone disease.

Nephrolithiasis is a serious problem for both patients and the health system. Recurrence stands out as a significant problem in urinary system stone disease, the prevalence of which is increasing gradually. If recurrence is not prevented, patients may go through recurrent operations due to nephrolithiasis. While classical therapeutic options are available for all stone types, the number of randomized controlled studies and extensive meta-analyses focusing on their efficiency are inadequate. Various alternative therapeutic options to these medical therapies also stand out in recent years. The etiology of urolithiasis is multifactorial and not always related to nutritional factors. Nutrition therapy seems to be useful, either along with pharmacological therapy or as a monotherapy. General nutrition guidelines are useful in promoting public health and developing nutrition plans that reduce the risk or attenuate the effects of diseases affected by nutrition. Nutrition therapy involves the evaluation of a patients nutritional state and intake, the diagnosis of nutrition risk factors, and the organization and application of a nutrition program. The main target is the reduction or prevention of calculus formation and growth via decreasing lithogenic risk factors and increasing lithogenic inhibitors in urine. This review focuses briefly on classical medical therapy, along with alternative options, related diets, and medical expulsive therapy.

Fahr Syndrome Unknown Complication: Overactive Bladder

A 38-year-old male patient was admitted to our outpatient department because of frequency and urgency incontinence. During evaluation it was detected that the patient was suffering from frequency which was progressive for one year, feeling of incontinence, and urgency incontinence. There was no urologic pathology detected in patients medical and family history. Neurologic consultation was requested due to his history of boredom, reluctance to do business, balance disorders, and recession for about 3 years. Brain computerized tomography (CT) scan revealed that amorphous calcifications were detected in the bilaterally centrum semiovale, basal ganglia, capsula interna, thalami, mesencephalon, pons and bulbus, and the bilateral cerebellar hemispheres. We have detected spontaneous neurogenic detrusor overactivity without sphincter dyssynergia after evaluating the voiding diary, cystometry, and pressure flow study. We consider the detrusor overactivity which occurred one year after the start of the neurological symptoms as the suprapontine inhibition and damage in the axonal pathways in the Fahr syndrome.

Window technique on circumcision.

Objective:To remove the preputium by using a simple, quick and safe method without damaging glans, frenulum and urethra as well as with a good cosmetic result.Patients and methods:The procedure, remind the guillotine technique at first, but completely different from it. Basically, a long haemostat is applied onto preputium and skin and subdermal tissue were incised; a small window is opened at dorsal of preputial mucosa and it is excised, while observing glans and frenulum.Results:The circumcisions were performed in a quick, safe and pretty bloodless way. There was no case with glans amputation, frenulum short cut or urethral damage, even if a clamp includes the foreskin with a part of glans or excess frenulum unnoticedly.Conclusion:This technique is simple, quick, relatively bloodless operation with cosmetically good result. Morever it is quite safe against to amputation of glans, frenular short cut or urethral fistula formation.