Emre Sener

α-LIPOIC ACID PROTECTS AGAINST RENAL ISCHAEMIA–REPERFUSION INJURY IN RATS

1 Oxygen free radicals are important components involved in the pathophysiological processes observed during ischaemia–reperfusion (I/R). The present study was designed to assess the possible protective effect of a‐lipoic acid (ALA) on renal I/R injury. 2 Wistar albino rats were unilaterally nephrectomized and subjected to 45 min renal pedicle occlusion followed by 24 h reperfusion. Saline or ALA (100 mg/kg, i.p.) was administered 15 min prior to ischaemia and immediately before the reperfusion period. At the end of 24 h, rats were decapitated and trunk blood was collected. Creatinine, blood urea nitrogen (BUN) and lactate dehydrogenase (LDH) activity were measured in serum samples, whereas tumour necrosis factor (TNF)‐a, interleukin (IL)‐1b, IL‐6, 8‐hydroxydeoxyguanosine (8‐OHdG) and total anti‐oxidant capacity (AOC) were assayed in plasma samples. 3 Kidney samples were taken for the determination of tissue malondialdehyde (MDA) and glutathione (GSH) levels, as well as Na+/K+‐ATPase and myeloperoxidase (MPO) activity. The formation of reactive oxygen species in renal tissue samples was monitored using a chemiluminescence (CL) technique with luminol and lucigenin probes. Oxidant‐induced tissue fibrosis was determined by tissue collagen content and the extent of tissue injury was analysed microscopically. 4 Ischaemia–reperfusion caused a significant increases in blood creatinine, BUN, LDH, IL‐1b, IL‐6, TNF‐a and 8‐OHdG, whereas AOC was decreased. In kidney samples from the I/R group, MDA, MPO, collagen and CL levels were found to be increased significantly; however, glutathione levels and Na+/K+‐ATPase activity were decreased. Conversely, ALA treatment reversed all these biochemical indices, as well as histopathological alterations induced by I/R. 5 In conclusion, these data suggest that ALA reverses I/R‐induced oxidant responses and improves microscopic damage and renal function. Thus, it seems likely that ALA protects kidney tissues by inhibiting neutrophil infiltration, balancing the oxidant–anti‐oxidant status and regulating the generation of inflammatory mediators.

Different patterns of pelvic ureteral endometriosis. What is the best treatment? Results of a retrospective analysis

OBJECTIVE Endometriosis is an estrogendependent disease. The incidence of urinary tract endometriosis (UE) increased during the last few years and, nowadays, it ranges from 0.3 to 12% of all women affected by the disease. The ureter is the second most common site affected. The ureteral endometriosis is classified in extrinsic and intrinsic. The aim of this study is to individuate the best treatments for each subset of ureteral endometriosis. MATERIALS AND METHODS 32 patients diagnosed with surgically treated UE were retrospectively reviewed. The patients were divided into 3 subsets (intrinsic UE, extrinsic UE with and without obstruction). The patients with intrinsic UE (n = 10) were treated with laser endoureterotomy. The patients with extrinsic UE (n = 22) were divided in two subsets with (n = 16) and without (n = 6) hydronephrosis. All the patients underwent ureteral stenting, and resection and reimplantation was performed in the first group, and when the mass was > 2.5 cm (n = 3) Boari flap was performed. Laparoscopic ureterolysis (shaving) was performed in the second group. RESULTS In the extrinsic subset of UE, we obtained an high therapeutic success (84%). Conversely, in the intrinsic subset there was a recurrence rate of the disease in 6/10 of the patients (60%). CONCLUSIONS Ureterolysis seems to be a good treatment in extrinsic UE without obstruction. Resection and reimplantation allows excellent results in the extrinsic UE with obstruction. In the intrinsic subset, the endoureterotomy approach is inadequate.

Comment on “Comparison of silodosin to tamsulosin for medical expulsive treatment of ureteral stones: a systematic review and meta-analysis”

bladder, there are substantial differences in the disposal receptor; particularly in women, there is a greater presence of alpha receptors at the level of the trigonus and in the peri-meatal areas. Starting from this concept, especially in juxta-vesical stones there should be differences in the percentage of spontaneous expulsion. However, in the major trials that have investigated the benefits of alpha blockers in the medical expulsive therapy are not reported significant differences between the genders. Another study that can suggest different mechanisms in stone expulsion is the one done by Shokeir et al. In this trial, the authors demonstrated that the administration of sildenafil citrate, increasing in the ureteric smooth musculature the levels of cAMP and cGMP, facilitates the stone expulsion [3]. In fact smooth muscle tone in the lower urinary tract is controlled by various adrenergic, cholinergic and non-adrenergic non-cholinergic neurotransmitters released from nerve terminals and endogenous factors from vascular endothelial sources. KÜhn et al. confirmed the relaxing properties of inhibitors of PDE4 and PDE5 on isolated human ureteric smooth musculature and showed that these effects were due to an elevation in intracellular levels of cAMP or cGMP. Later, PDE5 was shown to play a central role in relaxant responses of lower urinary tract tissue mediated by nitric oxide (NO) and cGMP pathways. At the state of the art, we strongly believe that medical expulsive therapy has an important role on the management of ureteric stone; nevertheless, more studies evaluating the role of intracellular second messengers and with more stringent exclusion criteria are needed before solid conclusion can be drawn. We read with great interest the last review on medical expulsive therapy for ureteral stone by Özsoy et al [1]. We congratulate the authors for their rigorous scientific method with which the study of meta-analysis was conducted. However, we think that controversial aspects remain. In fact since 2006 after several meta-analysis studies, the medical expulsive therapy was widely adopted and still remains the first treatment line to facilitate spontaneous passage and to reduce colic pain. The last European Association of Urology guidelines (EAU) confirm the use of a-blocker drugs as primary option treatment for ureteral stone. However, the last manuscript by Pickard et al. published in 2015 is not mentioned in the review, even if it is not within the inclusion criteria, and we think that various considerations must be made. Pickard showed the patients in treatment with nifedipine or tamsulosin had no benefit versus placebo for stone passage, analgesia and timing in passage [2]. The study was conducted with unquestionable methods and it had more patients than the meta-analysis data; nevertheless, the status of the excretory axes was not considered throughout the baseline assessment for patients. We have another hypothesis that can suggest relative benefits from the administration of alpha blockers and it is an “anatomic theory.” In fact, several studies on disposal of alpha receptors have shown that while in the ureter, the receptors disposition is the same for both genders, in the