Hüsnü Tokgöz

Fournier's Gangrene: Overview of Prognostic Factors and Definition of New Prognostic Parameter

OBJECTIVES To identify the prognostic factors and the new parameters that might predict a worse outcome in nonsurvivors compared with survivors of Fourniers gangrene (FG) and evaluated the validity of the Fourniers Gangrene Severity Index (FGSI) in patients with FG. METHODS The medical records of 18 patients with FG who were treated and followed up in our clinic were reviewed. Data were collected in terms of medical history, symptoms, and physical examination findings. The biochemical, hematologic, and bacteriologic study (aerobic and anaeorobic wound cultures) results at admission and at the final evaluation, the physical examination findings, the timing and extent of surgical debridement, and the antibiotic therapy were also recorded. The Charlson Comorbidity Index (CCI) and FGSI were evaluated stratified by survival. RESULTS The results were evaluated for 2 groups: those who survived (n = 14) and those who did not (n = 4). The admission FGSI score was 5.00 +/- 2.91 (range 0-10) for survivors compared with 13.5 +/- 2.62 (range 9-15) for nonsurvivors (P = .001). The CCI score was 3 +/- 1.5 in survivors and 7 +/- 2.2 in nonsurvivors (P = .008). Individual laboratory parameters such as hypomagnesemia, hemoglobin, hematocrit, alkaline phosphatase, creatinine, and the heart and respiratory rates were associated with a worse prognosis. In addition, a FGSI >9, rectal involvement, colostomy diversion, and a high CCI were associated with high mortality. CONCLUSIONS Low magnesium levels might be a new parameter for a worse prognosis. High CCI and FGSI scores might be associated with a worse prognosis in patients with FG. A FGSI threshold of 9 was a predictor of mortality during the initial assessment.

Ambulatory and Office Urology Long-term Fluoroquinolone Use Before the Prostate Biopsy May Increase the Risk of Sepsis Caused by Resistant Microorganisms

OBJECTIVES To evaluate the effect of long-term fluoroquinolone treatment before the biopsy in terms of post procedure sepsis. Three-week fluoroquinolone management before the biopsy may lower serum prostate specific antigen (PSA) levels and prevent unnecessary biopsies. METHODS A total of 558 patients were referred to our clinic for transrectal ultrasound (TRUS)-guided prostate biopsy. Of the patients, 205 had received levofloxacin 500 mg once a day for 3 weeks before the biopsy to lower the serum PSA levels (group 1). A total of 353 patients had not received any antibiotics before the procedure (group 2). In terms of the postbiopsy sepsis rate, group 1 and group 2 as well as patients who underwent biopsies in the early period and the latter period of the study were compared. RESULTS Sepsis was diagnosed in 17 patients (3.0%) after biopsy. Of these patients, 11 (5.4%) and 6 (1.7%) were in group 1 and group 2, respectively (P = .0297, OR: 3.28, 95% CI: 1.10-10.13). Sepsis was diagnosed in 7 patients (1.9%) and 10 patients (5.0%) in the early and the latter period of the study, respectively (P = .0771, OR: 0.38, 95% CI: .13-1.09). Escherichia coli was the causative agent in all patients with a positive culture. In addition, 1 patient also had meticillin-resistant Staphylococcus epidermidis (MRSE). All of the E. coli isolates were resistant to fluoroquinolones, and 55.6% were positive for extended spectrum β-lactamases (ESBL). CONCLUSIONS Long-term fluoroquinolone use to prevent unnecessary prostate biopsy may result in postbiopsy sepsis caused by fluoroquinolone resistant microorganisms.

Effect of Dexmedetomidine on Testicular Torsion/Detorsion Damage in Rats

Background and Objective: We assessed the antioxidant activity of dexmedetomidine (DEX) during an ischemic period in a rat model of testicular torsion/detorsion (T/DT) by using biochemical and histopathological methods. Methods: Wistar Albino male rats weighing 250–300 g were divided into three groups: sham (group S, n = 7); torsion/detorsion (group T/DT, n = 7), and DEX treatment (group DEX, n = 7). In the T/DT group, right testes were rotated 720° for 1 h. Group S served for normal basal values. Rats in group T/DT were operated to make T/DT, this group served as a control group. Group DEX received intraperitoneal DEX 10 µg · kg–1 after the 30-min torsion period. For measurement of total antioxidant enzyme activities and malondialdehyde (MDA) levels, testes of 7 animals in each group were excised after 4 h of reperfusion. Germ cell apoptosis was evaluated using the apoptosis protease-activating factor 1 (APAF-1) antibody in all groups and also on the expressions of endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) were assessed within the bilateral testes. Results: Mean MDA levels in group T/DT were significantly higher than in groups S and DEX (p < 0.05). There were also significant decreases in mean total antioxidant activities in group T/DT when compared to groups S and DEX (p < 0.05). These values were significantly higher in group DEX than group T/DT. Germ cell apoptosis, eNOS and iNOS levels were significantly higher in group T/DT when compared to groups S and DEX (p < 0.05). Conclusions: DEX treatment has potential biochemical and histopathological benefits by preventing ischemia/reperfusion-related cellular damage in an experimental testicular torsion model. Preference of DEX for anesthesia during the detorsion procedure may attenuate ischemia-reperfusion injury.

Vardenafil Reduces Testicular Damage Following Ischemia/Reperfusion Injury in Rats

We investigated the effect of intraperitoneal vardenafil (1 mg/kg) administration during an ischemic period in a rat model of testicular torsion/detorsion (T/D). Twenty‐one adult Wistar rats were equally randomized into a control group, a T/D group and a vardenafil group. The control group was designed to collect basal values for biochemical and histopathological parameters. The T/D group underwent testicular torsion for 1 hour. The vardenafil group received vardenafil (1mg/kg) intraperitoneally at 30 minutes after torsion. All rats were sacrificed 4 hours after reperfusion to evaluate the tissue levels of malondialdehyde and total antioxidant status. Germ cell apoptosis was evaluated using the apoptosis protease activating factor 1 antibody in all groups. The expressions of endothelial nitric oxide synthase (NOS) and inducible NOS were also assessed in both testes of all rats. The malondialdehyde levels in the T/D group were significantly higher than in the control and vardenafil groups. There were also significant decreases in total antioxidant status in the T/D group compared with the control and vardenafil groups. Vardenafil treatment significantly reduced apoptosis protease activating factor 1, endothelial NOS and inducible NOS levels in the vardenafil group compared with the T/D group. Administration of 1 mg/kg vardenafil during testicular torsion decreased ischemia/reperfusion cellular damage. Our results indicate that the reduction in oxidative stress by vardenafil may play a major role in its cytoprotective effects.

Coenzyme Q10 treatment reduces lipid peroxidation, inducible and endothelial nitric oxide synthases, and germ cell–specific apoptosis in a rat model of testicular ischemia/reperfusion injury

In this experimental study, we assessed the preventive effects of coenzyme Q(10) (CoQ(10)) in a rat model of ischemia/reperfusion injury. The results of this study show that CoQ(10) administration before the reperfusion period of testicular torsion provides a significant decrease in testicular lipid peroxidation products and expressions of inducible nitric oxide synthase, endothelial nitric oxide synthase, and germ cell-specific apoptosis.

Comparison of Local Anesthetic Effects of Tramadol With Prilocaine During Circumcision Procedure

OBJECTIVES To compare the local anesthetic effects of tramadol hydrochloride with prilocaine for circumcision procedure. METHODS This study included 40 patients with American Surgical Association-I scores. Patients were randomly allocated to receive either 5% tramadol (2 mg/kg) plus adrenaline (0.0125/mL) (group 1, n = 20) or 2% prilocaine plus adrenaline (0.0125/mL) (group 2, n = 20). The degree of burning sensation and pain at the injection site were documented. Sensory block was assessed 1 minute after injection and the patients were asked to grade touch and pinprick sensation. Five minutes after drug administration, incision was performed and intensity of pain, felt by the patient was evaluated on a 4-point scale (0-3). Pain at the injection site and local skin reactions were also recorded. RESULTS Mean ages were 9.7 and 10.3 years for groups 1 and 2, respectively. Mean duration of surgery was 19.6 minutes. In control visit, 2 of 20 (10%) in group 1 and 10 of 20 (50%) children in group 2 reported extra need for oral ibuprofen (P <.05). First analgesic medication time was 9.5 (+/- 2.1) hours in group 1 and 8.7 (+/- 3.1) hours in group 2 (P >.05). Total postoperative ibuprofen consumptions were 10 and 50 mg for groups 1 and 2, respectively (P <.05). CONCLUSIONS A combination of tramadol 5% plus adrenaline can provide a safe and effective local anesthesia during circumcision procedure and postoperative period in children.

Protective value of a folkloric medicinal plant extract against mortality and hemorrhage in a life-threatening renal trauma model.

OBJECTIVES To compare the efficacy of a folkloric medicinal plant extract (Ankaferd Blood Stopper [ABS]) with that of oxidized cellulose (Surgicel) in a life-threatening renal injury model. ABS is a mixture of 5 plants that has historically been used in Turkish traditional medicine. It has been approved by the Ministry of Health to manage external hemorrhage and dental surgery bleeding in Turkey. METHODS Twenty-two Wistar albino rats underwent partial nephrectomy after intravenous heparin anticoagulation (2000 U/kg). The cut surface received 1 of 3 therapies, namely no treatment, Surgicel (Johnson & Johnson, New Brunswick, NJ) or ABS (Trend Teknoloji Iaç AS, Istanbul, Turkey). Blood pressure was continually monitored. Survival time, total blood loss, and mean arterial pressure were recorded for 60 minute or until death. Rats that were alive (mean arterial pressure>or=20 mm Hg) at the end of 60 minutes were sacrificed with blood withdrawal with the help of catheters. RESULTS All animals that received no treatment died within 60 minutes of follow-up. One of 7 in the Surgicel group, and 5 of 7 animals in the ABS group, survived. Mean survival times for the Surgicel and ABS groups were 42.7 and 53.4 minutes, respectively. Rats in the ABS and Surgicel groups survived significantly longer than rats in the control group (P<.05). There were no significant differences between the ABS and the Surgicel groups in survival (P=.128). CONCLUSIONS ABS is as effective as Surgicel in achieving hemostasis and lengthening survival time following partial nephrectomy in an experimental rat model.

The cutoff level of free/total prostate specific antigen (f/t PSA) ratios in the diagnosis of prostate cancer: A validation study on a Turkish patient population in different age categories

We investigated an optimal cutoff level of free/total PSA ratios (f/t PSA) in predicting prostate cancer in different age groups, focusing on the avoidance of unnecessary prostate biopsies. A total of 4955 men were enrolled into the study. Serum tPSA, fPSA, and f/t PSA ratios were determined for the study population. All males who had suspicious digital rectal examination and tPSA > 4 ng/mL underwent transrectal ultrasonography‐guided prostate biopsy. Receiver operating characteristic (ROC) curves for each group were generated by plotting the sensitivity versus 1‐specificity for the f/t PSA ratio. The sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were obtained using various f/t PSA ratio cutoffs for different age groups. There were 657 patients with a PSA level of 4–10 ng/mL. According to sensitivity and specificity f/t% PSA cutoff points were determined to be 10%, 15%, 15%, and 10% in 50–59 years, 60–69 years, >70 years, and all ages categories, respectively, in patients with initial PSA level of 4–10 ng/mL. f/t PSA ratio had an area under the curve (AUC) value of 0.81 (95% confidence level: 0.80–0.82) for all age groups in detecting prostate cancer. f/t PSA ratio has an AUC value of 0.669 (0.632–0.705) in detecting prostate cancer among patients with a PSA level of 4–10 ng/mL. Ten percent of f/t PSA ratio had the highest specificity with PLR and 30% f/t PSA ratio had the highest sensitivity with lower NLR in the all‐age categories. The current study shows that the use of f/t PSA ratio in patients with PSA levels of 4–10 ng/mL should enhance the specificity of PSA screening and decrease the number of unnecessary biopsies. The age‐related changes warrant further investigation in a large, multicentric, and multinational population to improve the clinical use of f/t PSA cutoffs.

Comparison of the analgesic effects of dexketoprofen and diclofenac during shockwave lithotripsy: a randomized, double-blind clinical trial.

BACKGROUND AND PURPOSE This prospective, randomized, and double-blind clinical study aimed to assess the analgesic efficacy of single-dose intramuscular (IM) injection of dexketoprofen (group DE) compared with single-dose IM injection of diclofenac (group DI) in patients who were undergoing shockwave lithotripsy (SWL). PATIENTS AND METHODS A total of 70 men with single renal or ureteral stones were randomly separated into two groups. The 40 men in group DI received 75 mg IM diclofenac sodium and 30 men in Group DE received 50 mg IM dexketoprofen trometamol 30 minutes before SWL. A 10-point visual analog scale was used to evaluate pain. RESULTS The age, body mass index, and mean stone burden were comparable between the two groups (P > 0.05). The mean visual analog scale score for group DE was statistically lower compared with the score for group DI (P = 0.02). In 34 (85%) of the 40 men in group DI, the SWL procedure was performed with no, minor, or tolerable pain. In group DE, however, 28 (93.3%) of 30 patients evaluated the pain severity as no, minor, or tolerable (p = 0.01). No major/minor adverse effects were observed in group DI, whereas in one patient in group DE, dyspepsia after injection was noticed (P = 0.423). CONCLUSIONS The severity of SWL-related pain was significantly better tolerated with dexketoprofen trometamol. During an SWL procedure, the analgesic efficacy of dexketoprofen was greater than that of diclofenac sodium. Although statistically insignificant, a little increased risk for gastric irritation was noticed with dexketoprofen.

The protective effects of tadalafil on renal damage following ischemia reperfusion injury in rats

Ischemia‐reperfusion injury can cause renal damage, and phosphodiesterase inhibitors are reported to regulate antioxidant activity. We investigated the prevention of renal damage using tadalafil after renal ischemia reperfusion (I/R) injury in rats. A total of 21 adult male Wistar albino rats were randomly divided into three groups of seven, including Group 1‐control, Group 2‐I/R, and Group 3‐tadalafil + I/R group (I/R‐T group) received tadalafil intraperitoneally at 30 minutes before ischemia. Inducible nitric oxide synthase, endothelial nitric oxide synthase, malondialdehyde, and total antioxidant capacity levels were evaluated, and histopathological changes and apoptosis in the groups were examined. Tadalafil decreased malondialdehyde levels in the I/R group and increased the total antioxidant capacity level. Histopathological and immunohistochemical findings revealed that tadalafil decreased renal injury scores and the ratios of injured cells, as measured through apoptotic protease activating factor 1, inducible nitric oxide synthase, and endothelial nitric oxide synthase levels. We suggest that tadalafil has protective effects against I/R‐related renal tissue injury.