Huseyin Celik

Successful percutaneous nephrolithotomy in children: multicenter study on current status of its use, efficacy and complications using Clavien classification.

PURPOSE In this multicenter study we aimed to evaluate the efficacy and safety of percutaneous nephrolithotomy in children with respect to different features and using the Clavien classification system. MATERIALS AND METHODS Percutaneous nephrolithotomies performed in children at 3 urology departments between March 2006 and May 2010 were included in the study. Results are presented for complex/simple renal stones, tubeless/totally tubeless percutaneous nephrolithotomy, simultaneous bilateral percutaneous nephrolithotomy, instrument size and age groups. Patients were divided into 3 distinct groups, infants and toddlers (3 years or younger, group 1), preschool children (4 to 7 years, group 2) and school children (8 to 16 years, group 3). Perioperative complications are presented according to the modified Clavien classification system. RESULTS A total of 140 percutaneous nephrolithotomies were performed in 130 patients (41.5% female, mean age 10.17 years). There were 23, 25 and 92 renal units in groups 1, 2 and 3, respectively. Pediatric instruments were used in 60 renal units and adult-sized instruments in 80. General assessment of complications showed Clavien grade I complications in 17 patients, II in 4, IIIa in 11 and IIIb in 7. There were no grade IV or V complications. CONCLUSIONS Percutaneous nephrolithotomy can be applied safely in children of varying ages, even infants. Complications, as assessed with Clavien classification, are comparable to those seen in adults provided there is enough experience with the technique.

Distribution and number of Cajal-like cells in testis tissue with azoospermia

We investigated the number and distribution of Cajal‐like cells in patients with azoospermia. A total of 99 patients with non‐obstructive azoospermia were divided into subgroups [19 patientsin hypospermatogenesis group (S1), 40 patients in maturation arrest group (S2), 20 patients in a Sertoli cell‐only syndrome (S3), and 20 patients in a testicular atrophy and fibrosis group (S4)], and 20 patients with obstructive azoospermia group (S0). Sections stained with a c‐kit antibody were studied by light microscopy to determine the number and distribution of Cajal‐like cells in peritubular and perivascular areas of testis. The number of Cajal‐like cells were higher in all the non‐obstructive groups than in the obstructive group (S0: 2.43 cells/mm2, S1: 3.14 cells/mm2, S2: 4.00 cells/mm2, S3: 4.57 cells/mm2, S4: 3.86 cells/mm2) but statistically significantly different (p < 0.05) in the S2 and S3 subgroups only. Distribution of Cajal‐like cells were similar in all groups. The number and distribution of Cajal‐like cells in non‐obstructive groups suggest that these cells may affect spermatogenesis. This cellular type can be responsible for the regulation of cellular motility or spermatogenesis. Electrophysiological and electron microscopic studies are needed to better define morphology and function of Cajal‐like cells in the testis, especially totally the normal testis tissue.

Conventional and ZOOMit DWI for Evaluation of Testis in Patients With Ipsilateral Varicocele

OBJECTIVE The current study aimed to investigate the effects of varicocele on testis parenchyma by using ZOOMit DWI and conventional DWI and to compare both diffusion methods. SUBJECTS AND METHODS Forty-five patients with unilateral varicocele diagnosed by physical examination and color Doppler ultrasound between July 2015 and December 2015 and 32 healthy volunteers were included in the study. ZOOMit and conventional DWI were performed for all patients with a 3-T MRI scanner. RESULTS Apparent diffusion coefficient (ADC) values calculated using both conventional and ZOOMit DWI decreased in the patients with varicocele of the testis, when compared with the healthy volunteer control group. Furthermore, it was determined that conventional and ZOOMit ADC values for the contralateral side without varicocele also decreased when compared with the healthy volunteer control group (p < 0.05). However, there was no statistically significant difference between testes with or without varicocele in terms of conventional ADC values (p = 0.183), whereas ZOOMit ADC values for testes with varicocele were found to be statistically significantly lower than those for testes without varicocele (p < 0.05). A significant negative correlation was found between venous diameter measured both at rest and during the Valsalva maneuver and ZOOMit ADC values in testes with varicocele. CONCLUSION For patients with varicocele, conventional and ZOOMit DWI may be predictive of histopathologic changes in the testis, and ZOOMit DWI may be more effective in the diagnosis, treatment, and postoperative response in patients with varicocele when compared with conventional DWI.

Comparison of Cajal-like cells in pelvis and proximal ureter of kidney with and without hydronephrosis

ABSTRACT Objectives: To evaluate effects of Cajal-like cells on human renal pelvis and proximal ureter on peristalsis. Materials and Methods: 63 patients submitted to nephrectomy due to atrophic non-functional kidney associated with hydroureteronephrosis were included as study group and 30 cases with nephrectomy due to other reasons were included as control group. Samples from renal pelvis and proximal ureters were obtained and sections of 5μ form paraffin blocks of these samples were prepared; layers of lamina propria and muscularis mucosa were examined by immune-histochemistry using CD117 in order to determine count and distribution of Cajal-like cells. Results: During immune-histochemical examinations of sections, obtained from renal pelvis and proximal ureter of hydronephrotic kidneys by CD117, Cajal-like cells number determined in lamina propria and muscularis propria was statistically significantly lower compared to control group (p<0.001). Distribution of Cajal-like cells in renal pelvis and proximal tubulus was similar under examination by light microscope, and also both groups were not different from each other regarding staining intensity of Cajal-like cells by c-kit. Conclusion: Significantly reduced number of Cajal-like cells in study group compared to control group, shows that these cells may have a key role in regulation of peristalsis at level of renal pelvis and proximal ureter in urinary system.

Primary Small Cell Carcinoma in Urinary Bladder: A Rare Case.

Small cell carcinoma of bladder, which does not have a common and accepted treatment protocol, is a rare and highly aggressive tumor. It is mostly pulmonary originated; however, it can rarely be seen in extrapulmonary sites. We presented an interesting and uncommon case, in which the transitional cell tumor was found in the transurethral resection specimen, but the small cell carcinoma was detected in the final radical cystectomy material.

Expression of maspin in testis tumors with germ cells andits relation with angiogenesis factors.

BACKGROUND/AIM We aimed to evaluate the importance of maspin expression in testicular tumors with germ cells, its effect on prognosis, and the relation with angiogenesis factors. MATERIALS AND METHODS The paraffin blocks of the orchiectomy materials of 32 patients who had undergone orchiectomy due to testicular tumors were taken within the scope of the study. The specimens of the cases included in the study group were reexamined under light microscope. RESULTS While just one maspin-positive sample was found in the seminoma cases, maspin stained positively in 6 of the nonseminoma germ cell tumors (NSGCTs). No statistical difference was found between maspin and tumor stage, size, alpha fetoprotein values, vascular endothelial growth factor, Ki-67, and CD31. A statistically positive correlation was only determined between maspin and p53 (P < 0.001). CONCLUSION Maspin protein, whose expression in some tumors is accepted as a poor prognostic factor, is also expressed in testicular tumors with germ cells. However, according to our study, it is difficult to say whether this protein is a favorable or poor prognostic factor in testicular tumors and to understand how the effect mechanism works. The positive correlation between maspin and p53 in the NSGCTs makes us think that maspin might have displayed an effect on the p53 pathway.

Leiomyoma of the Bladder in a 23-year-old Male: Case Report -

Leiomyoma is a rare mesenchymal tumor that can occur in patients of any age. In the genitourinary system the tumor arises most frequently in the uterus, but can occur in any region. The tumor is seen more frequently in women than in men, and can be symptomatic or asymptomatic. Here we present a 23-year-old man who had symptomatic leiomyoma of the bladder.

The Importance of Peripheral and Local Blood Analysis for Evaluation of Nitric Oxide and Asymmetric Dimethylarginine Before and After Varicocelectomy

We read with interest the recently published article in the esteemed Biological Trace Element Research, by Kiziler et al. [1]. The exact pathologic mechanism of varicocele disease was unknown but it has been presumed to be related to the unique angle of the junction of left-side spermatic vein with renal vein coupled with increased hydrostatic pressure or vascular deficiency [2]. Also, the effect of increased reactive oxygen species and nitric oxide (NO) has been implicated as an important role in varicocele. Moreover, in many studies, it was found that NO level had almost nearly double level in the internal spermatic vein than in the peripheral circulation [3, 4]. However, in the current study, NO was shown as lower in the internal spermatic vein than the peripheral circulation in the related Figure 2 even though there was no statistical comparison done between these parameters. On the other hand, the samples of the femoral vein blood were used instead of the internal spermatic vein blood as postoperative control. As we know from the previous studies, it may not reflect the true outcomes. Cohen et al. and Ito et al. demonstrated that the blood in the internal spermatic vein contained much more detrimental metabolic products, catecholamine, prostaglandins, etc. than the peripheral circulation in varicocele patients [5, 6]. Moreover, Mostafa et al. reported high level of ROS and decreased level of antioxidants in the internal spermatic vein of varicocele associated infertile patients compared with the peripheral venous blood [4]. Asymmetric dimethylarginine (ADMA), an endogenous competitive inhibitor of the nitric oxide synthase (NOS), is known to be associated with endothelial dysfunction, vascular diseases, and atherosclerotic changes. Also, ADMA can uncouple NOS resulting in the formation of superoxide radicals and low-density lipoproteins and oxidized low-density lipoproteins can inducemore ADMA formation in oxidative stress [7]. In that case, we expect ADMA level to decrease in the internal spermatic vein after varicocelectomy surgery. In this manner, the present study has contradiction with the previous studies.

Are neutrophil-lymphocyte and platelet-lymphocyte ratios valuable in predicting prostate cancer? -

Introduction and Hypothesis: We retrospectively evaluated the prognostic impact of neutrophil-lymphocyte ratio (NLR) as a marker for inflammatory and immune state in men with prostate cancer. Materials and Methods: This retrospective study was conducted in a single urology clinic to review the medical data of 558 patients who underwent transrectal prostate needle biopsies between 2007 and 2014. Prior to transrectal prostate needle biopsies, patient histories, physical examinations, and routine laboratory tests including blood biochemistry, urinaly- sis and urine cultures, free PSA and total PSA, rectal examination, transrectal ultrasound findings, and pathology results were evaluated. Results: Benign biopsy results were found in 287 patients (Group 1) using neutrophil / lymphocyte (NLR) and platelet / lymphocyte ratio (PLR). When calculating malignancy in 271 patients (Group 2), there was no significantly difference in NLR and PLR values between benign and malign prostate diseases (p=0.14 and p=0.369, respectively). Conclusion: With reference to the survey prior to the biopsy, NLR and PLR ratio values do not appear to be helpful in the differentiation of benign prostatic hyperplasia and prostate cancer.

Laparoscopic Transperitoneoscopic Nephroureterectomy in a Patient with Situs Inversus Totalis

This article discusses the case of a 78-year-old female with painless gross hematuria. Chest X-rays showed dextrocardia with situs inversus, and whole-body computed tomography scanning showed a renal mass in the right renal pelvis, no evidence of metastasis, and mirror-image organs with left-to-right transposition, which resulted in a diagnosis of situs inversus totalis (SIT). A laparoscopic transperitoneoscopic right nephroureterectomy was scheduled. To our knowledge, our case is the second case of laparoscopic nephroureterectomy in renal pelvic urothelial carcinoma with SIT to be presented, but it is the first case of laparoscopic transperitoneoscopic nephroureterectomy. Laparoscopic transperitoneoscopic nephroureterectomy was successfully performed in a renal pelvic urothelial carcinoma patient with SIT with a correct description of renal vascularity and abdominal anatomy.