Güner Kemal Özgür

ACCELERATED SUPERFRACTIONATED RADIOTHERAPY WITH CONCOMITANT BOOST FOR INVASIVE BLADDER CANCER

PURPOSE To determine the toxicity and clinical effectiveness of accelerated superfractionated radiotherapy with delayed concomitant boost (ASCBRT) in locally invasive carcinoma of the bladder. METHODS AND MATERIALS Between July 1997 and December 2001, 87 patients (unsuitable or refusing cystectomy) with invasive bladder cancer underwent ASCBRT. The mean patient age was 66 years (range 40-90). The stage distribution was as follows: 2 T1, 51 T2, 13 T3, and 21 T4. Initially, the whole pelvis was treated by 1.8-Gy conventional daily fractions up to a total dose of 45 Gy. A small field boost covering gross disease was added as a second daily fraction (1.5 Gy) during the last 3 weeks of the 5-week schedule up to a total dose of 67.5 Gy. The interfraction interval was a minimum of 6 h. The patients were evaluated in follow-up for toxicity, local control, and survival. RESULTS All but 2 patients completed the study protocol. Grade 3 acute urinary toxicity was observed in 2 patients. Grade 2 and 3 late bladder toxicity was observed in 12 patients and 1 patient, respectively. Grade 2 and 3 late bowel toxicity was observed in 5 and 3 patients, respectively. The 3-year actuarial local control, distant disease control, cause-specific survival, and overall survival rate was 64%, 78%, 58%, and 46%, respectively. Multivariate analysis revealed T stage as independent predictor of complete response. For Stage T2 and T3, the 3-year local control rate was 77% and 48%, respectively. At the last follow-up, 53 patients (61%) were still alive with a survival time between 6 and 62 months. CONCLUSION ASCBRT is feasible with acceptable tolerance even in relatively old patients with Stage T3 or greater tumor. The encouraging locoregional control and survival results of this institutional experience, favorable compared with conventional radical and other accelerated fractionated (with or without a concomitant boost) RT series, make ASCBRT worthy of further study in a Phase III trial.

The effect of diclofenac sodium and papaverine on isolated human ureteric smooth muscle

Objectives: The pain assocaited with ureteralobstruction is caused by a rise in intraluminalpressure above the obstruction which producesan increase in tension of the ureteral smoothmuscle. A reduction in pressure will result indecreased tension and relief of pain. In thisstudy we used papaverine and a prostaglandinsynthesis inhibitor, diclofenac sodium todecrease ureteral tension and compaired theireffects on isolated human ureteric smoothmuscle.Materials and methods: Experiment havebeen carried out with isolated ring preparationof human ureter. The tissue displayedspontaneous activity and contracted whenexposed to KCI (40 mM). Papaverine(10−5 M) and diclofenac sodium(10−8–10−5 M) were applied on theprecontracted segments and isometric variationwas recorded with Nihon-Kohden TB-612 isometrictransducer. Their relaxant responses werecomparatively examined.Results: Mean relaxation obtained bydiclofenac sodium and papaverine wererespectively 43.19% and 28.96%. Our studyshowed that diclofenac sodium may be morepotent than papaverine in the treatment ofrenal colic.

Comparison of the protective effect of dipyridamole and acetylsalicylic acid on long-term histologic damage in a rat model of testicular ischemia-reperfusion injury☆

PURPOSE Ischemia reperfusion injury arising from testicular torsion results in a loss of spermatogenesis and a significant increase in germ cell apoptosis. We investigated the effects of dipyridamole and acetylsalicylic acid (ASA), 2 well-known platelet inhibitors, on testicular ischemia reperfusion injury. METHODS Thirty adult male Sprague-Dawley rats were randomly divided into 5 groups (n = 6 for each group): control, sham-operated, torsion/detorsion (T/D), T/D + dipyridamole, and T/D + ASA. Testicular ischemia was achieved by rotating the left testis 720° clockwise for 2 hours. Thirty minutes before torsion, 10 mg/kg dipyridamole was injected transperitoneally in the T/D + dipyridamole group, and 100 mg/kg ASA was injected transperitoneally in the T/D + ASA group. Sixty days after the initial surgical procedure, ipsilateral orchiectomies were performed for histopathologic examination to determine Johnsens mean testicular biopsy score (MTBS), mean seminiferous tubular diameter (MSTD), and apoptotic index (AI) in all groups. RESULTS Unilateral testicular torsion-detorsion led to a significant decrease in Johnsens MTBS and MSTD values in the ipsilateral testis and a significant increase in AI values of the T/D group. There were no significant differences between the T/D + dipyridamole and control groups in terms of MSTD and MTBS values. Although an amount of improvement exits in T/D + ASA group, there were significant differences between the T/D + ASA and control group MSTD and MTBS values. There was no significant difference between the T/D + dipyridamole and control groups in terms of AI values (P > .05), but the differences between the T/D + ASA and control groups were significant despite a slight decline in AI values of the T/D + ASA group. CONCLUSIONS Our findings show that the use of dipyridamole before testicular reperfusion has a potentially protective effect against long-term injury in testicular ischemia reperfusion injury.

Subureteric polydimethylsiloxane injection in the treatment of vesico-ureteric reflux

Endoscopic treatment of vesico-ureteric reflux is a viable alternative to open surgery. We evaluated the effectiveness of polydimethylsiloxane in the endoscopic treatment of vesico-ureteric reflux.In the period between September 1994 and March 1996, 30 ureteral units of 20 children with vesico-ureteric reflux were treated by means of subureteric polydimethylsiloxane injection. Median age was 8 years in the group including 8 female and 12 male patients. Of the 30 ureteral units, 26 had no reflux at the end of the first injection. Two of the remaining four units were not refluxing after the second injection procedure. Contralateral reflux was observed postoperatively in two of the eleven patients who were treated for unilateral disease. It seems that endoscopic polydimethylsiloxane injection is an effective procedure in the treatment of vesicoureteric reflux.

Effect of valproic acid treatment on penile structure in prepubertal rats.

INTRODUCTION The aim of this study was to determine the histological effects of valproic acid (VPA) on the penis in prepubertal rats. METHODS Twelve male Wistar rats (21-24 days old) were divided equally into 2 experimental groups, and given tap water (control group) or 300mg/kg/day VPA via gavage for 30 days. After the penes had been harvested, the antiangiogenic and antifibrogenic properties of VPA were evaluated immunohistochemically using vascular endothelial growth factor (VEGF), inducible nitric oxide synthase (iNOS), transforming growth factor-beta 1 (TGF-β1) and Massons trichrome staining. Apoptosis was determined by caspase-3 and caspase-9 immunoreactions. Results were expressed as histochemical score (HSCORE), a semi-quantitative analysis for the intensity of immunohistochemical reactivity. RESULTS Immunohistochemical HSCORE decreased for VEGF and TGF-β1 staining and increased for iNOS staining in rats treated with VPA compared with the control group. Intensities of caspase-3 and caspase-9 labeling were also significantly increased by administration of VPA. Massons trichrome staining exhibited a fairly diminished level of collagen in the corpus cavernosum of rats treated with VPA. CONCLUSION In the light of these results, the administration of VPA from prepuberty to adulthood led to increased apoptosis and deterioration of the smooth muscle/collagen ratio in rats corpus cavernosum.

Postcircumcisional Ischemia of the Glans Penis Treated with Pentoxifylline

Ischemia of the glans penis is a rare postcircumcision complication. We describe a four-year-old boy developing ischemia of the glans penis 48 h after circumcision. The ischemia completely resolved following treatment with iv pentoxifylline (PTX) for six days, and the patient was discharged without any problems. PTX treatment should be kept in mind as an alternative treatment modality in ischemia of the glans penis which is a serious potential post-circumcision complication.

Detection of Chromosomal Aberrations in Prostate Cancer by Fluorescence In Situ Hybridization (FISH)

PURPOSE Fluorescence in situ hybridization (FISH) is a powerful tool for quantitative analysis of chromosomes and genes and can be applied in a variety of specimens, including cell cultures, isolated nuclei from fresh and fixed tissues, and histological tissue sections. For detection of numerical chromosome aberrations, we examined prostatic cancer samples at our department. In addition, we also observed primary and secondary aberrations taking part in the initiation and progression of tumours. MATERIALS AND METHODS FISH using chromosome-specific alpha-satellite DNA probes for chromosomes 7, 8, 9, 10, 17, X and Y was performed on 19 prostatic cancer and 19 benign prostatic hyperplasia (BPH) samples obtained from transurethral resection (TUR) and archival paraffin-embedded blocks. RESULTS Numerical aberrations were observed in 41% of the tumours studied. A range of aberrant copy numbers of chromosome 9 (68%), 7 (63%), 8 (58%), 17 (37%), Y (32%) and 10 (26%) was observed. We did not observe significant aberrations in BPH samples. In prostate cancer patients, chromosomes 7 (47%), 8 (58%) and 9 (63%) were monosomic by FISH. Monosomy 8 and 9 were significant differences (p>0.05) between prostate cancer and BPH patients. CONCLUSIONS FISH analysis could be observed an one of strongest methods of analysis in detecting numerical aberrations of individual chromosomes with application to paraffin-block samples, metaphase and, interphase nuclei. To our knowledge, this analysis is firstly studied in Turkish patients. Therefore, results of this analysis may be important for Turkish patients.

Knotted ureteral stent: a rare complication of ureteral stent usage

The use of ureteral stents has become a routine urological practice. There are many different complications with ureteral stent use. One rare complication is knotting, which can be a very difficult condition to treat. We report a case in which a complete knot was found in the proximal part of an indwelling ureteral stent with a proximal ureteral stone.

Severe Penile Curvature following Otis Urethrotomy

Urethral stricture is a common urological pathology with a high recurrence rate after treatment. Urethral manipulations are among its main causes. In this paper, urethral stricture developed secondary to urethral catheterization and was treated with cold-knife internal urethrotomy and the Otis urethrotomy procedure. During the follow-up period, severe ventral penile curvature preventing sexual intercourse developed due to fibrosis of the corpus spongiosum and tunica albuginea of the penis. This ventral penile curvature was corrected with a separate operation using a tunica vaginalis flap harvested from the left scrotum.

Intrathoracic kidney with a right-sided Bochdalek hernia: a case report

Available online at www.turkishjournalofurology.com İntratorasik böbrek renal ektopinin en nadir görülen türüdür. Tüm renal ektopilerin %5’inden daha azını oluşturmaktadır. Bochdalek hernisi ile beraber intratorasik böbrek görülme insidansının %0.25 olduğu bildirilmektedir.[1] Literatürde en az 200 intratorasik böbrek olgusu tanımlanmış olup, bunların büyük çoğunluğu yetişkin hastalardır. Erkeklerde, kızlara göre iki kat daha sık görülmektedir ve sol/sağ oranı yaklaşık 1.5/1’dir.[1-3] Genellikle asemptomatik seyretmekte olup, insidental olarak çekilen rutin akciğer grafilerinde tespit edilmektedir. Akciğerin ve göğüs duvarının tümörleri; mediastinal, subdiyafragmatik ve retroperitoneal tümörler; infeksiyöz hastalıklar; diyafram hernileri ve diyafram eventrasyonu ayırıcı tanıda en sık rastlanılan patolojilerdir.[4] Biz sağ intratorasik böbreği olan ve sağ Bochdalek herni onarımı geçirmiş olan bir olguyu sunuyoruz.