Emre Huri

Hemostatic role of a folkloric medicinal plant extract in a rat partial nephrectomy model: controlled experimental trial.

PURPOSE Ankaferd BloodStopper is a mixture of 5 plants used in traditional Turkish medicine as hemostatic agent for external traumatic, postoperative and dental bleeding. We investigated the hemostatic efficacy of Ankaferd BloodStopper for partial nephrectomy. MATERIALS AND METHODS A total of 24 Wistar rats were divided into 4 groups of 6 each. Group 1 underwent partial nephrectomy with hilar control as the conventional technique. Group 2 underwent the conventional technique with hemostatic agent application. Group 3 underwent hemostatic agent application to the renal parenchyma. In Group 4 partial nephrectomy was performed and the hemostatic agent was used without hilar control. Warm ischemia and partial nephrectomy times, and the number of hemostatic agent applications were recorded. Histopathological evaluations were completed. The Fisher, Kruskal-Wallis and Mann-Whitney U tests were used for statistical analysis. RESULTS Mean kidney size was 2 x 2.5 x 0.05 cm. Mean partial nephrectomy time was 3.7, 2.7, 1.8 and 3.2 minutes in groups 1 to 4, respectively, which was significantly different between groups 1 and 3 (p = 0.007). Warm ischemia time in group 3 was less than in group 1 (p = 0.011). The number of hemostatic agent applications was higher in groups 3 and 4 compared to those in group 2 (p = 0.003). Glomerular necrosis was detected at a higher rate in group 1 compared to that in groups 3 and 4 (p = 0.015). Calcification formed significantly more in group 1 than in groups 2 to 4 (p <0.05). Erythrocyte aggregation was greater in groups 2 to 4 than in group 1 (p = 0.015). Giant cell reaction, fibrosis, inflammation and microvascular proliferation were not statistically different among the groups (p >0.05). CONCLUSIONS Ankaferd BloodStopper decreases partial nephrectomy and warm ischemia times, and provides hemostasis. Erythrocyte aggregation confirmed the hemostatic action of the agent, while the absence of glomerular necrosis and calcification may have positive relevance.

Use of porcine small intestinal submucosa in bladder augmentation in rabbit: long-term histological outcome.

Aim:  To investigate long‐term histological features of bladder augmentation using porcine small intestine submucosa (SIS) in a rabbit model.

First Clinical Experience of Ankaferd BloodStopper as a Hemostatic Agent in Partial Nephrectomy

Open partial nephrectomy is an effective and safe alternative treatment modality to radical nephrectomy for small renal tumors. Many techniques that use hemostatic agents have been described to provide hemostasis during this procedure. Ankaferd BloodStopper® (ABS) is a unique folkloric medicinal plant extract that has been used historically in Turkish traditional medicine as a hemostatic agent. ABS has therapeutic potential to manage hemorrhage and this agent should be investigated in clinical trials. In the present case, we evaluated the effectiveness of ABS in partial nephrectomy and reviewed the literature.

Using porcine acellular collagen matrix (Pelvicol®) in bladder augmentation: experimental study

PURPOSE Evaluate the rabbit augmented bladder with Pelvicol. MATERIALS AND METHODS Twenty New Zealand rabbits were divided into 4 groups. Bladder augmentation was performed using a 10 x 10 mm sized porcine acellular collagen matrix. The material was placed on the dome of the bladder wall as a patch with 5-0 polyglycolic sutures. The bladder was resected on the 7th, 14th day, 30th and 90th days, and processed for histological analysis. RESULTS No stone formation was found in the first, second and fourth weeks. In the first week, there was inflammatory appearance and roughness in the reconstructed area when compared to other sites on the bladder wall. The material could not be seen in some bladders because of acute inflammatory reaction. The normal bladder epithelium was found on the part of the bladder wall that follows the surface of the eroded material. In the second week, edema was observed through the bladder wall. Perivesical fat tissue increased and it was not easy to distinguish it from the surrounding area. In the fourth week, the bladder wall was thickened and there was a sensation of hardness present. The inner and outer surface of the material was darker than in the other bladders. In the third month, there was no inflammatory reaction; however, there was micro calcification and irregular detrusor regeneration. CONCLUSIONS Pelvicol cannot be suitable material for bladder augmentation because of the resultant micro calcification, thickening of the bladder wall and irregular development of detrusor regeneration.

Phosphodiesterase 5 inhibitors attenuate renal tubular apoptosis after partial unilateral ureteral obstruction: an experimental study.

The aim of the present study was to evaluate the effects of phosphodiesterase 5 inhibitors on renal tubular apoptosis and also on expressions of endothelial and inducible nitric oxide synthases (eNOS and iNOS) in the ipsilateral kidney after partial unilateral ureteral obstruction (PUUO) in a rat model. Forty Wistar albino rats were divided into five groups. In Groups 1–4, left experimental PUUO was created. Sildenafil, vardenafil, and tadalafil were administrated to the rats of Groups 2–4, respectively. The pills were orally given to the rats for 30 days. Group 5 was defined as sham. After 30 days, all rats were sacrificed, and nephrectomy was performed. The renal specimens were examined histopathologically. Left hydroureteronephrosis was observed in Groups 1–4. Mean apoptotic cell count and eNOS and iNOS levels were significantly increased in Group 1 when compared with the other groups. The rats in Groups 2–4 showed significantly decreased apoptotic cell count and eNOS and iNOS values in the renal tubular tissue in accordance with Group 1 (p < 0.05). There were significant differences in apoptotic cell counts between sildenafil group and the other two study groups. The sildenafil group demonstrated lesser apoptotic cell count than the vardenafil (p = 0.021) and tadalafil (p = 0.009) groups. PUUO increases the renal tubular apoptosis and elevates NOS concentrations in renal tubular tissue after PUUO. Phosphodiesterase 5 inhibitors have a protective effect against the tubular apoptosis.

Effect of Simple Malrotation on Percutaneous Nephrolithotomy: A Matched Pair Multicenter Analysis

PURPOSE In this multicenter study we compared the outcome of percutaneous nephrolithotomy in patients with and without malrotated kidneys. MATERIALS AND METHODS A total of 44 patients (group 1) at 6 institutions who underwent percutaneous nephrolithotomy for kidneys with simple malrotation were enrolled in our study. Attending physicians in our group also provided the same number of cases of percutaneous nephrolithotomy done for nonmalrotated (normal) kidneys (group 2). Group 2 patients were selected by match pairing. Operative and postoperative data on the 2 groups were compared using the chi-square, Student t and Fisher exact tests. RESULTS As a result of match pairing, the 2 groups were similar in age, gender, body mass index, and stone size and site. Mean ± SD stone size was 5.9 ± 3.5 cm(2) in group 1. Multiple access attempts were required in 9 (20.5%) and 7 cases (15.9%) in groups 1 and 2, respectively (p >0.05). Mean fluoroscopy time was 7.0 ± 3.9 minutes in the malrotated kidney group and 7.3 ± 4.5 minutes in the nonmalrotated kidney group (p >0.05). The mean hemoglobin decrease after percutaneous nephrolithotomy was significantly higher in group 1 (-1.9 vs -1.3 gm/dl, p = 0.008) but the blood transfusion rate was similar in the 2 groups. The procedure success rate in groups 1 and 2 was 77.3% and 79.5%, respectively (p >0.05). CONCLUSIONS Percutaneous nephrolithotomy is safe and effective even in patients with larger kidney stones and malrotated kidneys.

Correlation Between Duration of Varicocele and Apoptosis in Testicular Tissue in an Experimental Model

OBJECTIVES To experimentally demonstrate the negative effect of a waiting period for treatment in patients with varicocele. METHODS A varicocele group of 30 rats and a sham group of 10 were used. All rats in the varicocele groups underwent ligation in the left testicle proximal to the site at which the internal spermatic vein drains into the renal vein to constrict the vein by 50%. In the sham group, the renal vein was dissected but not ligated. One month later, the first 15 rats in the experimental group and the first 5 rats in the sham group underwent laparotomy and bilateral orchiectomy. At 2 months postoperatively, the same procedures were performed on the second group of rats (15 varicocele rats and 5 sham rats). The apoptotic index was evaluated by group and interval after varicocele or sham operation. For apoptosis detection, modification of in situ end labeling was used. RESULTS At 1 and 2 months after creation of the varicocele or sham operation, the apoptosis rate in the left varicocele group was significantly greater than in the sham group (P <0.001) or in the right testicles (P <0.001). Although an increase in the apoptosis rate was seen in the second month compared with the first month, the difference was not statistically significant (P = 0.875). The histopathologic finding of atrophy was more significant in the second month than in the first month in the varicocele group. CONCLUSIONS The results of our study have indicated that the increase in apoptosis at the end of the first month in the varicocele group was significant and that this apoptosis continued with time. Because the histopathologic injury, which is parallel to apoptosis, increased, we believe that treatment in the early phase of varicocele is important for prevention of probable injury.

Impact of cadaveric surgical anatomy training on urology residents knowledge: a preliminary study.

OBJECTIVE Cadaveric dissection is used as a major tool for anatomy education at the medical school. In this study we aimed to determine how a uro-anatomy cadaveric dissection course would impact urology residents knowledge. MATERIALS AND METHODS A three days course was given to 50 urology residents by experienced trainers in 1-3 June 2012 at Ege University Medical Schools Anatomy Department, İzmir, Turkey. Efficacy of the course was assessed using a multiple choice questionnaire of 20 questions given before and after the course. RESULTS Completed questionnaires before and after the course were available for 25 residents (50%) that were included. Residents answered correctly to 11.7 out of 20 questions (59%) before the course and 13.0 out of 20 (65%) after (p<0.05). In individuals analysis, 16 residents (64%) increased their scores, 4 (16%) had similar scores and 5 (20%) had lower scores. The number of correct answers for 6 out of the 20 questions was lower following the course. CONCLUSION This cadaveric surgical anatomy course was effective in improving surgical anatomy knowledge for most urology residents but not all and helped to identify ways to improve the course in the future.

Effects of occupational therapy on quality of life of patients with metastatic prostate cancer. A randomized controlled study

Objectives: To evaluate the efficiency of occupational therapy relative to a home program in improving quality of life (QoL) among men who were treated for metastatic prostate cancer (MPC). Methods: Fifty-five men were assigned randomly to either the 12-week cognitive behavioral therapy based occupational therapy (OT-CBSM) intervention (treatment group) or a home program (control group) between March 2012 and August 2014 in the Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey. The Canadian Occupational Performance Measure (COPM) was used to measure the occupational performance and identify difficulties in daily living activities. The QoL and symptom status were measured by The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire C30 and its Prostate Cancer Module. A 12-week OT-CBSM intervention including client-centered training of daily living activities, recreational group activities, and cognitive behavioral stress management intervention were applied. Results: The COPM performance and satisfaction scores, which indicate occupational participation and QoL increased statistically in the treatment group in relation to men who were included in the home-program (p≤0.05). Conclusion: A 12-week OT-CBSM intervention was effective in improving QoL in men treated for MPC, and these changes were associated significantly with occupational performance.

Experiences in laparoscopic removal of upper ureteral stones: multicenter analysis of cases, based on the TurkUroLap Group.

BACKGROUND AND PURPOSE Laparoscopic surgery for ureteral stones was restricted to special cases-those with large or impacted ureteral stones. We present special cases of patients who underwent laparoscopic ureterolithotomy at various clinics in Turkey. PATIENTS AND METHODS Forty-one patients were included in the study from five urology clinics in which laparoscopic surgery was being performed. After a disease-specific history and physical examination, age and sex were recorded. The mean patient age was 41.8 years (30 men and 11 women). Urinalysis, determination of creatinine level, intravenous urography, and ultrasonography were performed. The parameters of stone size, presence of hydronephrosis, previous shockwave lithotripsy, previous ureteroscopic stone therapy, type of laparoscopic approach, operative time, ureteral incision, insertion of a Double-J stent, amount of drainage, hospitalization period, and perioperative complications were evaluated. RESULTS Mean ureteral stone size was 22 mm. The retroperitoneoscopic approach was preferred in 35 (85.3%) patients, while the transperitoneal approach was used in 6 (14.7%) patients. Grade I hydronephrosis was detected in 4 patients, grade 2 in 22 patients, and grade 3 in 12 patients. In six patients, a history of shockwave lithotripsy was confirmed. The ureteral wall was incised with a cold knife in 5, scissors in 16, J-hook in 3, and a monopolar or bipolar dissector in 17 patients. In six patients, a Double-J stent was inserted, while in one patient, the operation was converted to an open procedure. The mean operative time was 124 minutes. The mean amount of drainage was 220 ml. Mean hospitalization time was 4.8 days. In five (12.5%) of seven patients, persistent drainage was a major complication that was managed by insertion of a Double-J stent. All patients were discharged stone free. CONCLUSION Increased hospitalization and operative time can be related to the large stone sizes and prolonged urine leakage. In our opinion, however, the overall success of laparoscopic ureterolithotomy makes it a feasible and effective procedure, especially for stones that could not be managed easily with ureteroscopic stone therapy.