Ilker Akyol

Posttreatment with Aminoguanidine Attenuates Renal Ischemia/Reperfusion Injury in Rats

Acute renal failure secondary to ischemia/reperfusion (I/R) injury is associated with significant mortality and morbidity. Aminoguanidine (AG), an inducible nitric oxide synthase inhibitor with antioxidant properties, has been reported beneficial in renal I/R injury. The aim of the present study was to investigate the effect of AG on renal I/R injury and compare the effectiveness of different AG treatment modalities. Sprague-Dawley rats were randomly assigned to one of four groups. The control group (n = 6) received sham operation. The I/R group (n = 6), AG-I group (n = 8), and AG-II group (n = 8) received bilateral renal ischemia for 45 min followed by 24 hours of reperfusion. The AG-I group received AG (50 mg/kg) intraperitoneally four hours and 10 minutes before the induction of ischemia. The AG-II group received AG (50 mg/kg) intraperitoneally four hours and 10 minutes after the initiation of reperfusion. Serum urea and creatinine levels increased significantly in the I/R and AG-I groups compared to the control group. Kidney samples from rats in the I/R and AG-I groups revealed severe tubular damage at histopathological examination. Posttreatment with AG significantly reduced serum urea and creatinine levels and improved histopathological lesions compared with the I/R group. Although pretreatment with AG failed to protect kidneys against I/R injury in this experimental model, posttreatment with AG attenuated renal dysfunction and histopathological changes after I/R injury.

An Important Issue in the Management of Elimination Dysfunction in Children: Parental Awareness of Constipation

The scale of parental awareness concerning childrens bowel habits and its effects on voiding dysfunction were investigated. Parents of toilet-trained children older than 4 years were given questionnaires during the first interview and after follow-up of their childrens bowel habits for symptoms and signs of constipation and urinary complaints. Diagnosis of constipation was made according to the Rome III criteria. Eighty-nine patients were included in the study. The number of constipated patients almost doubled after the observation period. Most of the urinary problems resolved upon treatment of constipation. History at first interview was misleading in 42% of the patients who would benefit from a simple treatment. Most of the parents were unaware of their childrens bowel habits. Before proceeding with more complicated tests or treatment of voiding dysfunction, the symptoms and signs of constipation should be sought during a close parental observation period.

Verrucous hemangioma of the glans penis.

Verrucous hemangioma (VH) is a hyperkeratotic lesion usually presenting in infancy, occurring primarily on the extremities. We report a 5-year-old boy with VH in the glans penis and discuss briefly the hyperkeratotic vascular stains, which constitute a heterogenous group. During a 7-year follow-up, the patient received various local treatments, but the lesion regrew to its original size after each treatment until the second deep excision after which no more recurrences have been observed for 3 years now. VH in this location has never been reported.

The significance of potassium chloride sensitivity test and urinary uronic acid level in the diagnosis of chronic pelvic pain syndrome

ObjectivesNoninvasive tests are needed for the diagnosis of chronic pelvic pain syndrome. We evaluated the significance of potassium chloride sensitivity test and urinary CTAB-precipitable uronate level in patients with chronic pelvic pain syndrome (CPPS).MethodsWe included 25 patients with interstitial cystitis (IC), and 30 patients with chronic prostatitis (CP) who applied to our outpatient clinic with the complaints of frequency, dysuria and pain on urination between the years 2003 and 2005. Thirty-five subjects were studied as healthy controls. All patients underwent cystoscopy, cystometry, voiding diary, sodium chloride, and potassium chloride filling tests. Visual analog scale (VAS) was used to determine pain scores. Patients with CP also underwent NaCl and KCl voiding tests. Urinary CTAB-precipitable uronate levels were obtained in all subjects.ResultsKCl test had a good sensitivity for IC. As for the patients with CP, KCl voiding test was useful, but KCl filling test was not. Urinary CTAB-precipitable uronate level was found to be significantly higher in patients with IC and CP than controls, and in patients with IC than in patients with CP.ConclusionsThe results of our study suggest that KCl voiding test is a good candidate to be used in the diagnostic workup of patients with category III CP, and urinary CTAB-precipitable uronate level measurement may be a noninvasive diagnostic aid for IC and CP.

Re: Daniela Marshall-Kehrel, Cornelia Feustel, Charlotta Persson de Geeter, et al. Treatment with Propiverine in Children Suffering from Nonneurogenic Overactive Bladder and Urinary Incontinence: Results of a Randomized Placebo-Controlled Phase 3 Clinical Trial. Eur Urol 2009;55:729–38

We read with interest the abovementioned article by Marschall-Kehrel et al [1] and thank the authors for this nice study. However, we would like to point out a couple of issues related to the subject. First, it is a well-known fact that making a diagnosis of constipation is often difficult, and parental history is misleading [2]. This is even more important when a medication that could potentially cause and/or worsen constipation is to be prescribed. Should a problem with bowel movements be overlooked, this could complicate the clinical picture or at least cause a delay in the recovery. Therefore, we are curious to know how the researchers made the diagnosis of constipation and what they would recommend on the subject for the practicing pediatric urologist. A second issue is the adverse effects of antimuscarinics on cognitive function, which has been studied in adults and in children taking oxybutynin and tolterodine [3–5]. We expected to find an input or a comment in such a phase 3 study on children receiving propiverine treatment. Finally, the formula for age-expected bladder capacity in Table 2 should be corrected as capacity (in ml) = (age + 2) 30, as defined by Koff [6]. We assume that this is nothing more than a printing error.

Cross-Sectional Analysis of Penile Length in Males 13 to 15 Years Old According to Pubertal Development Stages

PURPOSE Genital development is affected by pubertal process to a great extent, and puberty is a complex phenomenon that is influenced by multiple factors resulting in individual differences. We studied penile length and its relationship to pubertal stage in boys 13 to 15 years old. MATERIALS AND METHODS Healthy boys who were candidates for military high school were evaluated between June and July 2011. Age, residence and body mass index were recorded. Stretched penile length was measured. Pubic hair was assessed according to Tanner and Marshall staging. Genital puberty stage was defined by measurement of testicular volume with Prader orchidometer. Relationship of penile length to age, residence, pubertal stages and body mass index was evaluated statistically. RESULTS A total of 1,539 boys were included in the study. Mean ages and number of patients according to genital stage were as follows. Mean age was 14 years for genital stage 1 (5 patients), 13.9 years (range 13 to 15) for stage 2 (194), 14.07 years (13 to 15) for stage 3 (965) and 14.11 years (13 to 15) for stage 4 (375). Linear regression analysis revealed a significant effect of body mass index, genital stage and pubic hair stage on penile length (p <0.001) but no significant effect of age or residence. Mean penile length was significantly different among different age groups and among pubertal stages. However, mean penile lengths of different age groups within the same pubertal stage were similar. CONCLUSIONS Penile length during puberty should be evaluated individually according to the current pubertal stage. Our study offers a reliable reference table of penile length for pubertal age group.

Postshockwave Lithotripsy Outcome Evaluation in Ureteral Stones: Comparison Between Noncontrast Computed Tomography and Plain Abdominal Radiography

BACKGROUND AND PURPOSE There are no definite data indicating which modality to use to assess the efficacy of shockwave lithotripsy (SWL). Usually, plain abdominal radiography (PAR) is recommended in percutaneous nephrolithotomy (PCNL) afterward and in the follow-up of asymptomatic stones, whereas noncontrast CT (NCCT) is recommended in cases of residual fragments. We compared the efficacies of PAR and NCCT in terms of assessing the outcome of SWL treatment for radiopaque ureteral stones. PATIENTS AND METHODS Those patients with renal colic and a radiopaque ureteral stone of 5 to 20 mm that was detected on PAR were included in the study; body mass index (BMI) values were calculated and recorded. Patients whose PAR revealed opacities suspicious for ureteral stones were evaluated with NCCT at 3-mm slices. Stone status was assessed with PAR and NCCT on post-SWL day 3. Detection of no stone, a residual fragment of ≤ 4 mm, and a residual fragment of >4 mm was defined as success, clinically insignificant residual fragments, and failure, respectively. RESULTS On post-SWL day 3, both PAR and NCCT revealed stones in 31 patients, and no stones were seen in either modality in 29 patients. NCCT revealed stones whereas PAR had negative results for stones in two patients. These patients had upper ureteral stones of 7.5 mm (6-9 mm) before SWL. Mean stone size on NCCT after SWL was 2.5 mm (1-4 mm). Mean BMI of these two patients was 27.72, and mean BMI of the patients with upper ureteral stones that were revealed by both PAR and NCCT was 27.68; these two values were statistically similar. CONCLUSION PAR is capable of detecting clinically significant residual fragments, and patients can be followed up with PAR alone after SWL treatment for radiopaque ureteral stones. This approach both decreases the cost and prevents excessive radiation exposure.

Re: Meelan Bul, Xiaoye Zhu, Antti Rannikko, et al. Radical Prostatectomy for Low-Risk Prostate Cancer Following Initial Active Surveillance: Results From a Prospective Observational Study. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2012.02.002

Bul et al. [1] intend to optimize the active surveillance modality using the outcome data from their large radical prostatectomy series, that is, they try to distinguish cases with unfavorable outcomes based on preoperative findings. Their effort should be commended. However, there are some issues that prevent their study from being easily accepted as a reliable reference. In such a study, the most practical method for reaching a conclusion would have been to statistically analyze the groups in terms of the figures in Table 5. Our analysis revealed no statistically significant difference between the groups. In any case, other methodological issues may have already limited the role of such an analysis. First, being a multicenter study, the number of cases is sufficient, but possible interobserver differences among the pathologists limit the strength of the study. Furthermore, we understand that the data for patients who underwent a radical prostatectomy because of ‘‘other’’ reasons were not included in the analysis. Second, Gleason score (GS) >4 + 3 and GS <3 + 4 are accepted as unfavorable and favorable outcomes, respectively, yet GS 3 + 4 remains undefined. Third, biopsy core numbers used in risk classification appear to be adjusted according to the volumes of prostates, and there are biopsies of differing core numbers. However, 2 positive cores may not necessarily imply a similar prognosis in an 8and a 12-core biopsy. Next, time to surgery was reported as 1.3 yr; this period is very short, and whether there is a difference between favorable and unfavorable groups in this regard is unknown. Also, the method of radical surgery (open, laparoscopic, or robotic) was omitted in the article. Although the superiority of one method over the other is debatable, surgical margin positivity might vary according to the surgery type. The grounds on which the authors based their suggestion to obtain follow-up biopsies earlier are not clear in the

Re: Nicola Nicolai, Rosalba Miceli, Andrea Necchi, et al. Retroperitoneal Lymph Node Dissection With No Adjuvant Chemotherapy in Clinical Stage I Nonseminomatous Germ Cell Tumours: Long-Term Outcome and Analysis of Risk Factors of Recurrence. Eur Urol 2010;58:912–8

Working in a department and performing many primary retroperitoneal pelvic lymph node dissection (RPLND) surgeries in patients with nonseminomatous germ cell tumors (NSGCT), and being advocates for the approach, we read the article by Nicolai et al. [1] delightedly, since they revealed theprocedure’s important benefits oncemore. Some points, however, would be of great interest if elaborated further. First of all, the downside of the study is the considerable amount of unavailable data. This is quite understandable for a retrospective study dating back so early but should be kept in mind while judging the results. Nerve-sparing RPLND might be the key for many issues in NSGCTs; having performed this kind of surgery since the 1980s is certainly a success. However, in an article favoring RPLND, it would be necessary to find antegrade ejaculation and perhaps fertility rates, if possible, to be able to compare treatment modalities, since treatment-related complications play an important role in decision making. Additionally, no data in the article show whether avoiding the standard two early courses of bleomycin, etoposide, and cisplatin has a negative effect on survival. The aim of not giving chemotherapy is to avoid its morbidity, including infertility; therefore, fertility figures for the current series are required.

The Influence of Bhcg Treatment on Testicular Apoptosis in Experimental Cryptorchidism Model in Rats

Abstract Purpose We sought to find out how testicular apoptosis is influenced by BHCG treatment in an experimental cryptorchidism model. Material and Methods Three main groups of 22 day-old healthy male Sprague-Dawley rats were formed (Sham-operated (SO), experimental cryptorchidism (EC), hormone treated EC groups (HT)). Each main group was also divided into early and late orchidectomy groups. HT group received 50 IU/kg BHCG daily for 7 days starting on first postoperative day. Eight and 30 days after EC surgery, all rats underwent left orchidectomy to reveal early and late changes in the testes. Apoptosis index (AI) was defined as the mean number of apoptotic cells per tubule. All groups were compared to each other, while each group was evaluated in terms of the differences between early and late periods. Results Study was carried out with 60 rats in 6 groups totally. AI was significantly greater in EC and HT groups than SO group in both early and late periods. AI in HT group was smaller than EC group; the difference was statistically significant in late period while it was not so in early period. AI was found to be significantly decreased with time in all 3 groups. Conclusions Testicular apoptosis was found to be increased in experimental cryptorchidism. In HT group, AI was smaller than that of EC. For this reason, we suggest that hormone treatment in EC may have an effect that prevents or decreases apoptosis in EC model.