İlke Onur Kazaz

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.

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.

Investigation of tyrphostin AG 556 for testicular torsion-induced ischemia reperfusion injury in rat

OBJECTIVE To investigate the effects of tyrphostin AG 556, a tyrosine kinase inhibitor (TKI) in an experimental model of testicular ischemia-reperfusion (I/R) injury. MATERIAL AND METHODS Twenty-four adult male rats were randomly divided into four groups (n = 6): sham, torsion/detorsion (T/D), T/D + dimethylsulfoxide (DMSO) (vehicle group), and T/D + DMSO + tyrphostin AG 556. Testicular torsion was achieved by rotating the left testis 720° clockwise for 4 h. Thirty minutes before detorsion, 3 mg/kg tyrphostin AG 556 was injected transperitoneally in the AG 556 group and DMSO was injected transperitoneally in the DMSO group. After 2 h of reperfusion arterial blood samples were collected for biochemical analysis for malondialdehyde (MDA), ischemia modified albumin (IMA), SCUBE1 (signal peptide-CUB [complement C1r/C1s, Uegf, and Bmp1] and EGF [epidermal growth factor] like domain-containing protein 1), total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) parameters, and ipsilateral orchiectomies were performed for histopathological examination based on the semi-quantitative Johnsens mean testicular biopsy score (MTBS) in all groups. RESULTS Tyrphostin AG 556 exhibited a protective effect against I/R injury in testicular torsion. Of the biochemical parameters evaluated as a result of testicular I/R, IMA, MDA, and TOS levels were significantly elevated. There was no significant difference in terms of these biochemical parameters between the sham and AG 556 groups. Significant histopathological injury was determined by comparing the T/D and sham groups. According to histopathological injury scores, significant differences were determined between T/D and AG 556 groups and between AG 556 and sham groups. AG 556 had a superior improving effect on Johnsens scores than DMSO. CONCLUSIONS Our results suggest that the use of tyrphostin AG 556 prior to testicular reperfusion has a protective effect against testicular I/R injury.

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.

The possible protective effects of dipyridamole on ischemic reperfusion injury of priapism

ABSTRACT Purpose To investigate the protective effects against ischemia reperfusion injury of dipyridamole in a model of induced priapism in rats. Materials and Methods Twenty-four male Sprague-Dawley rats were divided into four groups, control, P/R, P/R+DMSO and P/R+D. 3ml blood specimens were collected from vena cava inferior in order to determine serum MDA, IMA, TAS, TOS and OSI values, and penile tissue was taken for histopathological examination in control group. Priapism was induced in P/R group. After 1h, priapism was concluded and 30 min reperfusion was performed. In P/R+DMSO group 1ml/kg DMSO was administered intraperitoneally 30 min before reperfusion, while in P/R+D group 10mg/kg dipyridamole was administered intraperitoneally 30 min before reperfusion. Blood and penis specimens were collected after the end of 30 min reperfusion period. Sinusoidal area (µm2), tears in tunica albuginea and injury parameters in sinusoidal endothelium of penis were investigated. Results Histopathological examination revealed no significant changes in term of sinusoidal area. A decrease in tears was observed in P/R+D group compared to P/R group (p<0.05). Endothelial injury decreased in P/R+D group compared to P/R group (p>0.05). There were no significant differences in MDA and IMA values between groups. A significant increase in TOS and OSI values was observed in P/R+D group compared to P/R group. A significant decrease in TAS levels was observed in P/R+D group compared to the P/R group. Conclusions The administration of dipyridamole before reperfusion in ischemic priapism model has a potential protective effect against histopathological injury of the penis.

Antifibrogenic role of valproic acid in streptozotocin induced diabetic rat penis

We investigated the therapeutic effects of valproic acid (VPA) on erectile dysfunction and reducing penile fibrosis in streptozocin (STZ)‐induced diabetic rats. Eighteen male rats were divided into three experimental groups (Control, STZ‐DM, STZ‐DM plus VPA) and diabetes was induced by transperitoneal single dose STZ. Eight weeks after, VPA and placebo treatments were given according to groups for 15 days. All rats were anesthetised for the measurement of in vivo erectile response to cavernous nerve stimulation. Afterward penes were evaluated histologically in terms of immune labelling scores of endothelial nitric oxide synthase (eNOS), vascular endothelial growth factor (VEGF) and transforming growth factor‐β1 (TGF‐β1). Slides were also evaluated in terms of collagen/smooth muscle ratio and penile apoptosis. After the treatment with VPA, erectile responses were found as improved when compared with STZ‐DM rats but not statistically meaningful. eNOS and VEGF immune expressions diminished in penile corpora of STZ‐DM rats and improved with VPA treatment. VPA led to decrease in TGF‐β1 expression and collagen content of diabetic rats’ penes. Penile apoptosis was not diminished with VPA. In conclusion, VPA treatment seems to be effective for reducing penile fibrosis in diabetic rats and more prolonged treatment period may enhance erectile functions.

BLADDER METASTASIS OF GASTRIC SIGNET-RING CELL CARCINOMA

Metastatic lesions in urinary bladder represent less than 2% of all bladder neoplasms.1 Most of them reach to bladder by direct invasion (the female genital tract, prostate and lower gastrointestinal tract). The other primary tumors originate from the skin, stomach, breast, or lung.2 Signet-ring cell carcinomas identified in the bladder are rare entities and may represent metastases from other primary sites, usually from the gastrointestinal tract. Signet-ring cell carcinoma is a subtype of mucin producing adenocarcinomas, and is associated with aggressive clinical course and early metastatic disease.3 We present a case with gastric signet-ring cell carcinoma metastasing to urinary bladder. Case report A 58-year-old woman complaining of dysphagia, diffuse hypogastric pain, a weight loss of 7–8 kg in the past month was diagnosed as having carcinoma of stomach by endoscopic biopsy. Abdominal tomography revealed a malignant tumoral mass in gastric lesser curvature and lymph nodes without any metastasis. Radical gastrectomy and lymph node dissection were performed. The histopathological examination of the resected specimen revealed stomach adenocarcinoma with signet-ring-cell component and 15 metastatic lymph nodes. Lymphovascular and perineural invasion was positive. TNM classification was T3N3M0(Fig. 1). The patient was given adjuvant chemotherapy (4 cycles of 5-fluorouracil and calcium folinate) and radiotherapy (45 Gy-25 days). Ten months later, she was admitted with pain, anorexia, poor oral intake, nausea and vomiting. On physical examination, a decreased skin turgor tonus was found. There was no defensive rebound and ascites. There was no anemia in the laboratory tests, and the tumor markers were normal. Gastroscopy was performed and no recurrence was detected. Abdominal magnetic resonance imaging was reported that “a mass lesion was detected (metastasis?, bladder ca?) that can not be distinguished from the bladder wall in the superolateral vicinity of the left bladder.”(Fig. 2) In the precense of microscopic hematuria, cystoscopy showed a solid lesion approximately 5 cm in size at left bladder wall. In the thorax CT there was no metastasis. A complete TUR-B was performed. The histopathological examination of the resected specimen was adenocarcinoma metastasis with neoplastic cells contain focally signet-ring cell components. In immunohistochemical analyses, CK7 (+), CK20 focally (+), Gata 3 (−), Uroplakin (−) and histochemical analyses, mucicarmine (+), PAS/AB (+), intra-extracelluler mucin (+)(Fig. 3). After TUR-B the patient was given chemotherapy (6 cycles of capecitabine and oxaliplatin). Nine months later, the recurrence was detected in the bladder and TUR-B was performed, three cycles of irinotecan and capecitabine and then three cycles of irinotecan, capecitabine and oxaliplatin was given to the patient. The patient is under follow-up (medical oncology, urology and radiation oncology clinics), and is considered disease free with bone scintigraphy and abdominal computered tomography in the 6th months after the cessation of last chemotherapy. Open in a separate window Fig. 1 Histopathologic appearance of gastric adenocarcinoma with ring cells; cytokeratin staining (A), hematoxylin eosin staining(B).

Primary Neuroendocrine Tumor of the Prostate with Bone Metastasis

DOI: 10.4328/JCAM.768 Received: 03.08.2011 Accepted: 11.08.2011 Printed: 01.01.2014 J Clin Anal Med 2014;5(1): 67-8 Corresponding Author: Ersagun Karagüzel, Karadeniz Teknik Üniversitesi Tıp Fakültesi Üroloji AD. Trabzon, Türkiye. T.: +90 4623775908 GSM: +905325029672 F.: +90 4623250518 E-Mail: ersagunkaraguzel@gmail.com Özet Prostatın primer nöroendokrin tümörleri çok nadir ve biyolojik davranışları henüz çok iyi açıklanamamış tümörlerdir. Bu makalede primer prostat nöroendokrin tümörü ve kemik metastazı olan bir olgu sunulmaktadır. Altı aydır sık idrara çıkma, işemede zorluk ve mesanesini tam boşaltamama şikayetleri mevcut olan 50 yaşında erkek hastaya, transüretral prostat rezeksiyonu yapıldı. Patoloji sonucu az diferansiye nöroendokrin karsinom olarak rapor edildi. Hastanın boyun ağrısı nedeniyle yapılan servikal manyetik rezonans tetkikinde sağ paravertebral yumuşak dokuda bir kitle ve C6 vertebrada patolojik kompresyon kırığı tespit edildi. Hastaya kitlenin eksizyonunu takiben, C6 korpektomi ve homojen kemik grefti konulması operasyonu yapıldı. Paravertebral kitlenin patolojik incelenmesi sonucu az diferansiye nöroendokrin tümor metastazı olduğu tespit edildi. Lezyonun prostatın primer nöroendokrin tümörünün kemik metastazı olduğu konfirme edilmiş oldu.

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.