Mehmet Yucel

Acute urodynamic effects of percutaneous posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with Parkinson's disease

Lower urinary tract dysfunction is often occurs in patients with Parkinsons disease (PD), that is primarily induced by neurogenic detrusor overactivity (NDO) and negatively effect the quality of the patients life. The aim of this study is to evaluate the acute effects of posterior tibial nerve stimulation (PTNS) on the urodynamic findings in the PD patients with NDO.

The clinical and urodynamic results of a 3-month percutaneous posterior tibial nerve stimulation treatment in patients with multiple sclerosis-related neurogenic bladder dysfunction†‡

The aim of this study was to investigate the effect of PTNS after 12 weeks, on the urodynamic findings in the Multiple Sclerosis (MS) patients with neurogenic detrusor overactivity (NDO).

Efficiency of Posterior Tibial Nerve Stimulation in Category IIIB Chronic Prostatitis/Chronic Pelvic Pain: A Sham-Controlled Comparative Study

Objectives: To evaluate the efficacy of percutaneous posterior tibial nerve stimulation (PTNS) for treatment of the patients with category IIIB chronic non-bacterial prostatitis/chronic pelvic pain syndrome. Methods: A total of 89 patients with therapy-resistant pelvic pain were randomized to receive either nerve stimulation (n = 45) or sham treatment (n = 44). The National Institutes of Health Chronic Prostatitis Symptom Index and visual analogue scale were used to assess treatment success after 12 weeks of intervention. Objective success was defined as a minimum 50% decrease in the mean scores. A decrease of over 25% to below 50% was considered to be a partial response. Results: An objective response was observed with the pain and symptom scores after 12 weeks of PTNS in 18 (40%) and 30 (66.6%) of the patients, whereas a partial response was observed in 27 (60%) and 15 (33.3%) of the patients, respectively. Mean symptom scores and visual analogue scale scores for pain and urgency were significantly changed from 23.6 ± 6.3 at baseline to 10.2 ± 3.6, 7.6 ± 0.8 at baseline to 4.3 ± 0.6, 5.7 ± 0.8 at baseline to 3.4 ± 0.7, respectively. Scores for the symptoms, urgency and pain were not changed with sham treatment. Conclusions: These results have demonstrated that percutaneous PTNS may relieve pain in the patients with category IIIB chronic non-bacterial prostatitis/chronic pelvic pain syndrome.

Effects of Sildenafil Citrate, Isoniazid, and Streptomycin on Testicular Tissue and Epididymal Semen Quality in Rats

OBJECTIVE To evaluate the effects of isoniazid (INH) and streptomycin (STR) on epididymal semen quality and testicular tissue, and to evaluate the protective effect of sildenafil citrate (SC) on possible testicular toxicity induced by STR and INH in rats. METHODS Eighty adult male Sprague-Dawley rats were divided randomly into 8 groups including control, SC, INH, STR, STR+INH, SC+INH, SC+STR, and SC+INH+STR. After 45 days of treatment, the reproductive organ weights, epididymal semen quality, testicular histopathological findings, levels of serum nitric oxide, testosterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were investigated. RESULTS SC significantly increased the epididymal sperm motility and concentration, and the levels of FSH, LH, and testosterone. The STR group had a significantly higher percentage of sperm head defect than the control group (P < .05). The INH group had lower Johnsen Testicular Biopsy Score than the control group (P < .001). Although SC and INH treatment alone did not affect the epididymal semen quality negatively, the SC+INH group had significantly higher spermatozoon tail and total morphologic defect ratios than the control group (P < .05). CONCLUSION It has been concluded from this study that (1) SC has positive effects on spermatogenesis, sperm production, and semen quality; (2) STR affected the testicular biopsy score and spermatozoon head morphology negatively, but positively affected the other spermatologic traits; (3) INH did not effect the epididymal semen quality negatively, but decreased testicular biopsy score; and (4) SC can prevent the spermatozoon head defects induced by STR and can decrease the testicular toxicity induced by INH.

The protective effects of vitamin E on urinary bladder apoptosis and oxidative stress in streptozotocin-induced diabetic rats.

OBJECTIVES To determine whether vitamin E has protective effects or not on streptozotocin-induced diabetic rats in diabetic urinary bladder dysfunction, with interrelationships between oxidative stress and apoptosis. METHODS Thirty-two Wistar albino male rats were divided into 4 groups. Group A (n = 8), control; group B (n = 8), diabetic control; group C (n = 8), control + vitamin E; and group D (n = 8), diabetic + vitamin E. Vitamin E was injected 40 mg/kg every other day intraperitoneally for 2 weeks. In the diabetic groups, diabetes was induced by a single intraperitoneal injection of 65 mg/kg of streptozotocin. Apoptosis studies were performed using apoptosis detection kit and the TUNEL (TdT-mediated dUTP nick-end labeling) technique. The levels of glucose, malondialdehyde (MDA), superoxide dismutase, catalase, and glutathione peroxidase were detected in hemolysate. RESULTS It was observed that apoptosis number in urothelial cells of the bladder in diabetic rats increased significantly compared with control and decreased after vitamin E treatment. MDA levels of the diabetic group were significantly higher than those on the control and vitamin E groups. Diabetic + vitamin E group had significantly increased MDA levels compared with control group, although these values were lower than those in the diabetic group. All enzyme activities of the vitamin E group did not differ compared with the control group. In diabetic + vitamin E group, superoxide dismutase and glutathione peroxidase activities were similar to controls. Catalase activity of the diabetic + vitamin E group decreased significantly compared with control, although it was higher than that in the diabetic group. CONCLUSIONS Our study revealed that vitamin E decreases apoptosis and may be protective for uroepithelial cells of diabetic bladder.

Is Repeat Transurethral Resection Effective and Necessary in Patients with T1 Bladder Carcinoma

Introduction: We investigated the efficacy and necessity of repeat transurethral resection (Re-TUR) in T1 bladder cancer. Patients and Methods: From September 2004 to September 2009, 62 patients with pathologically confirmed T1 bladder tumours were investigated. Re-TUR was routinely performed within 3–6 weeks following the initial resection. The pathological results of the Re-TUR were reviewed, and the risk of recurrence was investigated. Results: Of the 62 patients who underwent Re-TUR, 22 had a residual tumour pathologically. Visible residual tumours were detected in 9 patients (14.5%). The risk of having a residual tumour was directly correlated with the diameter of the initial tumour in T1 tumours (p = 0.007). Conclusions: Upstaging to T2 of the disease led to radical cystectomy in 11.29% of the patients in our series. Re-TUR should be routinely performed on all patients, especially on patients with high-grade tumours and with tumour diameters greater than 3 cm in T1 bladder cancer.

Evaluating Ureteral Wall Injuries with Endoscopic Grading System and Analysis of the Predisposing Factors

OBJECTIVE To analyze the predictive factors for intraoperative ureteral wall injury due to semirigid ureteroscopy (URS) used in the treatment of ureteral calculi. METHODS The data of 437 patients who had URS due to ureteral stones were prospectively analyzed. The ureteral wall injuries that occurred during URS were reviewed endoscopically at the end of surgery and divided into two groups as low grade (grades 0 and 1) and high grade (grades 2, 3, and 4) according to classification of ureteral wall injuries. Those two groups were compared for patient and stone characteristics and perioperative findings. RESULTS Ureteral wall injury was seen in 133 (30.4%) patients after surgery. According to the endoscopic classification of the lesions after URS, grades 0, 1, 2, and 3 injury were seen in 69.5%, 16.4%, 11.2%, and 2.7% of the patients, respectively. There were no grade 4 injuries in our series. Two groups showed statistically significant differences for the location (prox- vs distal and mid-ureter) and size of the stone (9.9 mm vs 14.03 mm), presence of preoperatively urinary tract infection (UTI) (12% vs 50.8%), needed balloon dilatation (9.8% vs 36.1%), duration of surgery (33.6 min vs 43.3 min), and surgical success rate (90% vs 76%) (p = 0.01, for all). Stone size, location, duration of surgery, and presence of preoperative infection were determined as independent prognostic factors for mucosal injury. CONCLUSION The ureteral wall injury grading system may be used for standardized reporting of ureteral lesions after ureteroscopy. Big, proximal ureteral stone, longer operation time, and presence of UTI are the risk factors for ureteral wall injury during URS.

Conventional monopolar transurethral resection of prostate in patients with large prostate (≥80 grams)

Introduction Transurethral resection of the prostate (TURP) is still regarded as the gold standard for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostate obstruction in prostates between 30 and 80 mL. Endoscopic treatment of large prostate is not adequately discussed in literature. Our objective was to evaluate the efficacy and safety of TURP in large prostate glands (≥80 ml) in patients with BPH. Material and methods From May 2004 to September 2012, 62 patients with high volume of BPH (≥80 ml) treated with TURP by single surgeon, were evaluated retrospectively. Perioperative and postoperative full blood count and serum electrolytes, complications, operative time, weight of resected prostate tissue, time for catheter removal, and hospitalization time were recorded. Conventional TURP was performed using a standard technique. Results The mean PSA levels and prostate volumes were 8 ±5.38 ng/ml and 90.93 ±13.95 gm, respectively. The mean operating time was 55.96 ±8.04 minutes. The mean amount of tissue resected was 52.21 ±7.59 gm. Compare with baseline, there were significant improvements in International Prostate Symptom Score (IPSS), Quality of Life (QoL), maximum urinary flow rate (Qmax), and postvoiding residual urine after surgery. There was no major bleeding complication. There was no TUR syndrome or intraoperative death. Requiring re–catheterization was detected for 3 (4.8%) patients. Transient urge incontinence was observed for 3 (4.8%) patients. Bulbar urethral stricture was developed for 2 (3.2%) patients. Conclusions Morbidity of the TURP is decreased with the technological improvements. Conventional monopolar TURP can be effectively performed in large prostate (≥80 mL) with the experience.

Magnetic Resonance Imaging Is a Complementary Method to Stereological Measurement of Testicular Volume

OBJECTIVES The objective of our research was to determine the accuracy and precision of the Cavalieri principle with images obtained from magnetic resonance imaging (MRI) in estimation of the actual testicular volume in humans. METHODS We performed volume measurements of 42 testes from 21 patients scheduled for bilateral orchiectomy for prostate cancer. We performed volume estimation measurements with ultrasonography (US), Praders orchidometer (PrOM), and Cavalieri principle MRI (we used views in axial sagittal and planes) before orchiectomy. We measured actual testes volume with the fluid displacement technique after orchiectomy. Differences and correlations between estimated and actual volumes were evaluated. For all patients, we compared right and left testicular volumes independently with these measurements. RESULTS Mean +/- SD actual testicular volume and estimated testicular volumes with US, PrOM, and Cavalieri principle using MRI axial and sagittal images were 15.3 +/- 3.3 and 17.7 +/- 3.0 cm(3), 20.0 +/- 3.5 cm(3), and 16.0 +/- 3.7 and 16.0 +/- 3.6 cm(3), respectively. Estimated and measured volumes were not different from each other. US and PrOM measured volumes were correlated with the actual volume. However, r-values with Pearson correlation test for estimated volumes measured with the Cavalieri principle with MRI were higher than US and PrOM (r-values were 0.934 and 0.961 vs 0.919 and 0.757, respectively). CONCLUSIONS The results of this study demonstrate that testicular volume measurements with the Cavalieri principle using images obtained from MRI may be considered a complementary method to traditional techniques to estimate the actual testicular volume.

Effects of captopril, telmisartan and bardoxolone methyl (CDDO-Me) in ischemia-reperfusion-induced acute kidney injury in rats: an experimental comparative study.

Renal ischemia‐reperfusion (IR) injury is one of the most common causes of acute kidney injury. This study investigated the effects of captopril (CAP), telmisartan (TEL) and bardoxolone methyl (BM) in animals with renal IR injury. Adult male Wistar–Albino rats were divided into six groups: control, vehicle, IR, IR with CAP, IR with TEL and IR with BM. Before IR was induced, drugs were administered by oral gavage. After a 60‐min ischemia and a 120‐min reperfusion period, bilateral nephrectomies were performed. Serum urea, creatinine, neutrophil gelatinase‐associated lipocalin (NGAL) levels, tissue total oxidant status (TOS), total antioxidant status (TAS), total thiol (TT), asymmetric dimethylarginine (ADMA) levels, superoxide dismutase (SOD) activity and glutathione peroxidase (GSH‐Px) activity were measured. Tissue mRNA expression levels of peroxisome proliferator‐activated receptor‐ɣ (PPAR‐ɣ), nuclear factor erythroid 2‐related factor 2 (Nrf2) and nuclear factor kappa‐light‐chain‐enhancer of activated B cells (NF‐κB) were analyzed. In addition, renal tissues were evaluated histopathologically and immunohistochemically. All tested drugs reduced renal damage, apoptosis, urea, creatinine, NGAL, TOS, nitric oxide (NO) and ADMA levels, NF‐κB, inducible nitric oxide synthase (iNOS) and endothelin‐1 (ET‐1) expressions (P < 0.001). All tested drugs increased SOD activity, GSH‐Px activity, TAS levels, TT levels, endothelial nitric oxide synthase (eNOS) expression, dimethylarginine dimethylaminohydrolases (DDAHs) expression, Nrf2 expression and PPAR‐ɣ expression (P < 0.001, P < 0.003). These results suggest that CAP, TEL and BM pretreatment could reduce renal IR injury via anti‐inflammatory, antioxidant and anti‐apoptotic effects.