Ersin Cimentepe

Nigella sativa protects against ischaemia/reperfusion injury in rat kidneys

BACKGROUND Renal ischaemia followed by reperfusion leads to acute renal failure in both native kidneys and renal allografts, which is a complex pathophysiologic process involving hypoxia and free radical (FR) damage. The oil of Nigella sativa (NSO) has been subjected to considerable pharmacological investigations that have revealed its antioxidant activity in different conditions. But there is no previously reported study about its effect on ischaemia/reperfusion (I/R) injury of kidneys. The aim of this study was to investigate the possible effects of NSO in I/R-induced renal injury in rats. METHODS Thirty healthy male Wistar albino rats were randomly assigned to one of the following groups: control, sham, I/R, NSO+I/R, I/R+NSO and NSO. I/R, NSO+I/R and I/R+NSO rats were subjected to bilateral renal ischaemia followed by reperfusion and then all the rats were killed and kidney function tests, serum and tissue oxidants and antioxidants were determined and histopathological examinations were performed. RESULTS Pre- and post-treatment with NSO produced reduction in serum levels of blood urea nitrogen (BUN) and creatinine caused by I/R and significantly improved serum enzymatic activities of superoxide dismutase (SOD) and glutathion peroxidase (GSH-Px) and also tissue enzymatic activities of catalase (CAT), SOD and GSH-Px. NSO treatment resulted in lower total oxidant status (TOS) and higher total antioxidant capacity (TAC) levels and also significant reduction in serum and tissue malondialdehyde (MDA), nitric oxide (NO) and protein carbonyl content (PCC) that were increased by renal I/R injury. The kidneys of untreated ischaemic rats had a higher histopathological score, while treatment with NSO nearly preserved the normal morphology of the kidney. CONCLUSIONS In view of previous observations and our data, with the potent FR scavenger and antioxidant properties, NSO seems to be a highly promising agent for protecting tissues from oxidative damage and preventing organ damage due to renal I/R.

Randomized clinical trial comparing transurethral needle ablation with transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: results at 18 months.

PURPOSE To compare the efficacy and safety of transurethral needle ablation (TUNA) and transurethral resection of the prostate (TURP) for the treatment of benign prostatic hyperplasia (BPH) during an 18-months follow-up. PATIENTS AND METHODS A series of 59 patients older than 40 years were included in this study. The entry criteria were prostate size <70 g, maximum urinary flow rate (Q(max)) <15 mL/sec, International Prostate Symptom Score (IPSS) >13, and no suspicion of prostate cancer according to the clinical or laboratory findings. Of the patients, 26 (44%) were treated with TUNA and 33 (56%) with TURP. At 3 and 18 months of follow-up, Q(max), postvoiding residual volume (PVR), IPSS, and the quality of life (QOL) score were compared with the baseline values. The results were also compared in patients undergoing TUNA v TURP. RESULTS Improvements in Q(max), PVR, IPSS, and QOL score were statistically significant for both groups at 3 and 18 months of follow-up. The increase in the mean Q(max) of the TURP group was higher than that in the TUNA group, whereas no significant differences were found in the two groups regarding improvements in IPSS and QOL score. There were no complications associated with the TUNA procedure, while 16 retrograde ejaculation, 4 erectile impairment, 2 urethral stenosis, and 1 urinary incontinence cases were observed after TURP. CONCLUSIONS The TUNA procedure is an effective and safe minimally invasive treatment with negligible adverse effect for selected patients with symptomatic BPH compared with TURP. It should be considered as an alternative treatment option for younger patients who want to preserve sexual function.

Protective role of natural antioxidant supplementation on testicular tissue after testicular torsion and detorsion

Objectives . To investigate the impact of garlic extract (GE), which is known for its antioxidant activity, on a testicular torsion/detorsion model in animals and to help understand how to prevent both ischemic and reperfusion injuries after testicular torsion and detorsion. Material and methods. Six groups of rats (n=7 in each group) were used. The animals in the control group (Group I) did not receive any treatment. The animals in the sham group (Group II) underwent scrotal incision and testicular fixation only. The animals in Groups III–VI underwent 720° of left testicular torsion for 2 h; subsequent detorsion was performed for 2 h in Groups IV and VI only. Animals in Groups V and VI were treated exactly the same as those in Groups III and IV, respectively except that they were pretreated with oral GE for 5 days at a dosage of 5 ml/kg. Both testicles in all rats were removed and tissue malondialdehyde (MDA) levels and enzymatic activities of xanthine oxidase (XO) were studied, in addition to a histological evaluation after hematoxylin–eosin staining. Results. Testicular MDA levels and XO activities were higher in Group III compared to Group II (p<0.05). Pretreatment with GE prevented these increases. Detorsion caused more damage and resulted in a further increase in MDA levels but MDA levels were not increased in animals pretreated with GE. Histologically, torsion caused some separation between germinative cells in the seminiferous tubules, which became much more prominent in Group IV and was attenuated by GE pretreatment. There were no significant changes in any of the above-mentioned enzymatic activities or histopathologic changes in the contralateral testicle in any of the groups. Conclusions. We believe that both testicular torsion and detorsion result in testicular tissue damage by means of lipid peroxidation, which is evident by an increase in the tissue levels of MDA. Dietary supplementation with GE seems to attenuate the generation of toxic free radicals, as evidenced indirectly by low tissue MDA levels.

An unusual cause of renal colic: Hydatiduria

Hydatid disease of the urinary tract is seen rarely. Hydatiduria may be a finding of renal involvement, but it is a rare cause of renal colic. A case is reported of renal hydatid disease that was diagnosed during the investigation of renal colic. A 38‐year‐old woman presented with renal colic. She had a history of episodes of renal colic and occasional voiding of grape‐like material. No calculus was found in the urinary tract by plain film or ultrasonographic examination. The histopathologic examination of this material revealed daughter cysts that are pathognomonic for hydatid disease. Ultrasound and computed tomography confirmed this diagnosis and right nephrectomy was performed without cyst perforation or any spilling of cyst content. Albendazole, 10 mg/kg per day, was given for 4 weeks (2 weeks preoperatively and 2 weeks postoperatively).

Voiding position does not affect uroflowmetric parameters and post-void residual urine volume in healthy volunteers

Objective: To investigate the effect of voiding position using uroflowmetry and post‐void residual (PVR) urine volume assessment in healthy men and women. Material and Methods: The study population comprised 72 healthy volunteers. The mean (range) ages of the male (n=36) and female (n=36) subjects were 30 (18–40) years and 32 (21–44) years, respectively. The uroflowmetric studies were repeated in the standing, sitting and crouching positions for men and in the sitting and crouching positions for women. At least three measurements were obtained for all voiding positions for each volunteer. PVR volumes were measured using transabdominal ultrasound after each voiding. Maximum flow rate (Qmax), average flow rate (Qave), voided volume (VV) and PVR values obtained in each voiding position were compared with those obtained in the other positions. Comparisons were done using one‐way ANOVA. Results: The mean Qmax and Qave values obtained in the sitting, crouching and standing positions in men were 24.29±0.73 and 15.67±0.37, 23.28±0.64 and 15.56±0.33, and 23.58±0.63 and 15.81±0.34 ml/s, respectively. The mean VV and PVR values obtained in the sitting, crouching and standing positions in men were 297.5±12.71 and 13.52±1.02, 306.3±13.46 and 14.02±1.08, and 309.9±13.14 and 12.92±0.95 ml, respectively. In women, the mean Qmax and Qave values obtained in the sitting and crouching positions were 28.09±0.66 and 18.26±0.36, and 27.98±0.59 and 17.31±0.35 ml/s, respectively. The mean VV and PVR values obtained in the sitting and crouching positions in women were 331.8±13.28 and 11.82±0.99, and 326.9±12.87 and 12.79±1.07 ml, respectively. There were no significant differences in any of the parameters between voiding positions in either group. Conclusion: Urinary flow rates and PVR urine volume do not seem to be affected by voiding position in healthy men and women.

Is single-dose fosfomycin trometamol a good alternative for asymptomatic bacteriuria in the second trimesterof pregnancy?

Untreated asymptomatic bacteriuria has been associated with acute pyelonephritis, which may have a role in many maternal and fetal complications. Acute pyelonephritis in pregnancy is related to anemia, septicemia, transient renal dysfunction, and pulmonary insufficiency. A randomized study was conducted to assess the clinical and microbiological efficacy of a single dose of fosfomycin trometamol for the treatment of asymptomatic bacteriuria in the second trimester of pregnancy compared with a 5-day regimen of cefuroxime axetyl. Forty-four women received fosfomycin trometamol and 40 women received cefuroxime axetyl. There were no statistically significant differences between both groups regarding the mean age and mean duration of pregnancy. Therapeutic success was achieved in 93.2% of the patients treated with fosfomycin trometamol vs 95% of those treated with cefuroxime axetyl. A single dose of fosfomycin trometamol is a safe and effective alternative in the treatment of asymptomatic urinary tract infections in the second trimester of pregnancy.

An insidious risk factor for cardiovascular disease: Benign prostatic hyperplasia

Patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTSs) have a considerably higher prevalence of cardiovascular disease (CVD) than the general population in old age. Many hypotheses have been created to explain traditional clinical risk factors of CVD, including age, male gender, cigarette smoking, inheritance, high blood pressure (BP), obesity, elevated fasting plasma glucose, diabetes mellitus, dyslipidemia, decreased physical activity and metabolic syndrome; or nontraditional risk factors such as oxidative stress, inflammation, vascular calcification, malnutrition, homocysteine and genetic variation. Although these risk factors are important in CVD pathophysiology and clinical presentation, there is still no single theory sufficient to provide an adequate explanation for all the properties of CVD. We speculate that by causing nocturia-induced sleep disturbances, BP variability, increased sympathetic activity, non-dipping BP variations; BPH may be an insidious risk factor for CVD. Benign prostate hyperplasia may be related to increased BP, coronary ischemic hearth disease or other cardiovascular pathologic conditions. This attention on BPH may produce a new approach to the diagnosis and treatment of CVD. Although the underlying mechanisms are still exactly unclear, further prospective randomized controlled studies are needed to identify if patients with BPH/LUTS is higher risk for CVD.

Oral β-Glucan Protects Kidney against Ischemia/Reperfusion Injury in Rats

Background: Ischemia-reperfusion (I/R) injury is one of the leading causes of acute renal failure. β-(1→3)-Glucans are glucose polymers with a variety of stimulatory effects on the immune system. We designed this study to determine the possible protective effect of the orally administered soluble β-glucan against I/R injury. Methods: 30 rats were randomly divided into 5 experimental groups (control, sham operated, β-glucan, I/R and I/R+β-glucan groups, n = 6 each). β-Glucan was administered orally to 6 rats of the β-glucan and I/R+β-glucan groups. The rats were subjected to bilateral renal ischemia followed by reperfusion in the I/R and I/R+β-glucan groups. All of the rats were then sacrificed and kidney function tests, serum and tissue oxidants and antioxidants were evaluated. Results: The serum urea and cystatin C levels were significantly higher in the I/R group compared to the I/R+β-glucan group (p < 0.01). The serum and tissue antioxidant markers (SOD, GSH-Px) were significantly lower in the I/R group than the I/R+β-glucan group (p < 0.01). The serum oxidant markers (NO and PC) were significantly higher in the I/R group than the I/R+β-glucan group (p < 0.01). Conclusion: Based on the present data, we conclude that increased antioxidants and decreased oxidants modulated by β-glucan attenuated the renal I/R injury.

Effect of voiding position on uroflowmetric parameters and post-void residual urine volume in patients with benign prostatic hyperplasia.

Objective: To investigate the effect of position on voiding using uroflowmetry and post-void residual (PVR) urine volume assessment in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Material and Methods: A total of 44 patients (mean age 61.7 years; range 47–72 years) with symptomatic BPH and 44 healthy men (mean age 60.3 years; range 40–67 years) who were used as controls were enrolled in the study. The uroflowmetric studies were performed in both standing and sitting positions. At least two measurements were obtained for both voiding positions for each participant. The PVR volumes were measured by means of a transabdominal ultrasound probe after each voiding. The maximum flow rate (Qmax), average flow rate (Qave), voided volume (VV) and PVR values were compared between the two different voiding positions. Results: The mean Qmax values for the standing and sitting positions in the patient group were 10.2 ± 0.49 and 9.5 ± 0.55 ml/s, respectively and the mean Qave values were 4.7 ± 0.25 and 4.7 ± 0.31 ml/s, respectively. The mean VV values for the standing and sitting positions in the patient group were 292.6 ± 17.19 and 271.1 ± 15.51 ml, respectively and the mean PVR values were 82.2 ± 10.97 and 85.5 ± 12.46 ml, respectively. The mean Qmax values for the standing and sitting positions in the control group were 24.8 ± 0.78 and 25.3 ± 0.78 ml/s, respectively and the mean Qave values were 13.2 ± 0.36 and 13.5 ± 0.33 ml/s, respectively. The mean VV values for the standing and sitting positions in the control group were 275.9 ± 10.79 and 278.0 ± 10.23 ml, respectively and the mean PVR values were 11.9 ± 1.16 and 10.7 ± 1.06 ml, respectively. There were no significant differences between voiding positions regarding the Qmax (p = 0.360), Qave (p = 0.978), VV (p = 0.355) or PVR (p = 0.842) values in the patient group. Similarly, there were no significant differences between voiding positions regarding the Qmax (p = 0.638), Qave (p = 0.537), VV (p = 0.890) or PVR (p = 0.412) values in the control group. Conclusion: The urinary flow rates and PVR urine volume do not seem to be affected by the voiding position (standing or sitting) either in patients with BPH or in healthy men.

Extracorporeal magnetic stimulation for the treatment of stress and urge incontinence in women--results of 1-year follow-up.

Objective: To evaluate the clinical efficacy of extracorporeal magnetic stimulation for the treatment of stress and urge urinary incontinence in women. Material and Methods: A total of 35 patients with stress incontinence and 17 with urge incontinence were enrolled in this study. All patients were evaluated by means of a detailed history of incontinence, a gynecologic examination, urine culture, urinary system ultrasound and a urodynamic study. All patients were asked to keep a 3‐day voiding diary. A pad‐weighing test was done for each patient at their first visit. For treatment, the patients were seated on a special chair containing a magnetic field generator. Pelvic floor muscle stimulation was performed for 20 min (10 min at 5 Hz and 10 min at 50 Hz) twice a week for a total of 8 weeks. The mean follow‐up period was 16.8 months (range 12–32 months). A total of 44 patients completed 1 year of follow‐up and were re‐evaluated by means of voiding diary, pad‐weighing test and cystometric study. Results: Of the 44 patients, 11 (38%) with stress incontinence and 6 (40%) with urge incontinence were cured 1 year after the treatment. In addition, there was an improvement in symptoms in 12 patients (41%) in the stress group and 7 (47%) in the urge group. Pad weight was reduced from 15.4 to 5.8 g in the stress group and from 12.4 to 4.7 g in the urge group (p = 0.000 and 0.001, respectively). Mean Valsalva leak point pressure was increased from 87.3 ± 15.9 to 118.0 ± 11.0 cmH 2 O in the stress group (p = 0.000). Conclusions: Extracorporeal magnetic stimulation therapy offers a non‐invasive, effective and painless treatment for stress and urge incontinence in women.