Murat Demirbas

Plasma Kinetic Vaporization of the Prostate: Clinical Evaluation of a New Technique

PURPOSE We evaluated our results with bipolar plasma kinetic electrovaporization in the treatment of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS Twenty-one patients with infravesical obstruction by BPH have been treated with bipolar plasma kinetic electrovaporization. International Prostate Symptom Score (IPSS) with a quality of life (QOL) scoring questionnaire, uroflowmetry (maximum flow rate; Qmax), transrectal ultrasonography (TRUS), and residual urine volume and prostate specific antigen (PSA) measurements had been performed before surgery. The IPSS scores, prostate volumes, and residual urine volumes were reevaluated during the third postoperative month. Uroflowmetry was repeated on postoperative days 7, 15, 30, and 90. Total PSA and free PSA measurements were repeated on postoperative days 3, 5, 7, 15, 30, and 90. RESULTS The results of 20 patients could be evaluated. The median age of these patients was 61 years. The median volume of the prostates was 42 cc (95% CI 56-53). The median operation time and postoperative hospitalization were 55 minutes (95% CI 40-65) and 3 days (95% CI 3-5), respectively. The mean period of time needed for vaporizing 1 g of tissue was calculated as 2.8 +/- 1.3 minutes. Postoperative day 90 values of IPSS, QOL, prostate volume, residual urine volume, and Qmax showed significant improvement compared with preoperative values (p < 0.05). The median preoperative PSA value was 1.64 mg/mL (95% CI 1-3.6). The value showed a statistically significant increase 24 hours after the intervention (p < 0.0001), but the PSA values on the 30th (p = 0.041) and 90th (p = 0.025) days were below preoperative values. CONCLUSION The IPSS with QOL scores, prostate volumes, and residual urine volumes showed significant decreases and Qmax values showed a significant increase after bipolar plasma kinetic electrovaporization. This treatment modality causes a temporary increase in the PSA concentration, as do other interventional treatment methods, but the measurements on the 30th and 90th days were below preoperative values.

Extracorporeal shockwave lithotripsy for solitary distal ureteral stones: Does the degree of urinary obstruction affect success?

BACKGROUND AND PURPOSE Extracorporeal shockwave lithotripsy (SWL) is a safe and effective way to treat stones in the distal ureter, but the impact of urinary obstruction on outcome is not clear. We investigated the relation between the degree of stone-induced urinary obstruction and the outcome of SWL treatment in patients with solitary distal ureteral stones. PATIENTS AND METHODS A series of 165 consecutive patients with solitary distal ureteral stones underwent SWL (Multimed 9200 Lithotriptor, Elmed Medical Systems, Turkey) between October 2002 and September 2003 at two separate centers. Distal ureteral stones were defined as those located below the lower border of the sacroiliac joint. Patients were divided into four groups according to the degree of stone-induced urinary obstruction: group I (N = 62) had no urinary system dilation; group II (N = 40) had mild dilation, group III (N = 35) moderate dilation, and group IV (N = 28) severe dilation. In addition to degree of obstruction, stone size, average fluoroscopy time, total number of shockwaves applied, number of sessions required to achieve stone-free status, and stone clearance time were recorded. Treatment failure was defined as persistence of fragments after three SWL sessions. RESULTS Overall, 152 (92.1%) of the patients became stone free after SWL. There were no statistically significant differences among the groups with respect to any of the factors studied. CONCLUSION In cases where there is a solitary calculus in the distal ureter, the degree of urinary obstruction caused by the stone does not affect the success of stone clearance with SWL.

Early tissue reactions in the rat bladder wall after contact with three different synthetic mesh materials

To investigate bladder tissue reactions to three types of implanted mesh material, i.e. polypropylene, polyglactin and polypropylene‐polyglactin combined.

Comparison of changes in tissue oxidative-stress markers in experimental model of open, laparoscopic, and retroperitoneoscopic donor nephrectomy

PURPOSE We evaluated the oxidative stress in renal tissue during three types of surgery: open donor nephrectomy (ODN), laparoscopic donor nephrectomy (LDN), and retroperitoneoscopic donor nephrectomy (RDN). The aim was to find out which is the appropriate procedure for harvesting a donor kidney. MATERIALS AND METHODS Twenty-four New Zealand White rabbits were randomized to four groups, each consisting of six rabbits. Group I (control) was subjected to 180 minutes of anesthesia, and transperitoneal nephrectomy was performed without creation of warm ischemia. In group II (ODN), after 180 minutes of anesthesia, warm ischemia was created for 5 minutes, and nephrectomy was performed. Group III (LDN) was subjected to 5 minutes of warm ischemia after 180 minutes of pneumoperitoneum at 12 mm Hg, and the kidney was removed. In group IV (RDN), after pneumoretroperitoneum at 12 mm Hg for 180 minutes, warm ischemia was created for 5 minutes, and nephrectomy was performed. Renal tissues were analyzed to determine malondialdehyde (MDA) and reduced glutathione (GSH) as oxidative-stress markers. RESULTS Renal tissue GSH levels were decreased, whereas MDA levels were increased in groups II through IV compared with the control group (p<0.05). There was no statistically significant difference between the ODN, LDN, and RDN groups in the renal oxidative-stress markers. CONCLUSION No differences were detected in oxidative-stress markers in renal tissue samples between ODN, LDN, and RDN. Therefore, we believe LDN and RDN can be used for live donor kidney harvesting as effectively as ODN without creating greater oxidative stress, which can have deleterious effects on a donor kidney.

Effects of carbon dioxide pneumoretroperitoneum on free radical formation in remote organs and use of verapamil as an antioxidant

BACKGROUND AND PURPOSE Pneumoretroperitoneum (Prp) acts as an ischemia/reperfusion (I/R) model. Ischemia/reperfusion (I/R) injury causes production of reactive oxygen species, which affect organs remote from the sites of I/R. The aim of this study was to assess the remote organ changes after Prp and to explore the effects of antioxidants. MATERIALS AND METHODS Eighteen adult rabbits were randomized to three groups, each consisting of six rabbits. Group I (control) underwent balloon dissection of the left retroperitoneal space without gas insufflation. In group II (Prp), carbon dioxide at 10 mm Hg was applied for 2 hours after the balloon dissection (ischemia period) and for 1 hour after desufflation (reperfusion period). In group III (Prp + antioxidant), 5 minutes before the experiment, verapamil at 0.2 mg/kg was given intravenously and the same procedure was employed as in group II. Hepatic, pulmonary, opposite kidney, and treated kidney malondialdehyde (MDA) and reduced glutathione (GSH) levels were evaluated to show response to Prp. RESULTS Pneumoretroperitoneum exerted oxidative stress on all tissues with an increase of MDA (P < 0.05) and a decrease of GSH (P < 0.05). The verapamil-treated group showed lower values of MDA (P < 0.05) and higher values of GSH (P < 0.05) than group II. CONCLUSION Pneumoretroperitoneum increased oxidative stress in all remote organs tested. Verapamil reduced the oxidative stress. We concluded that Prp should be employed carefully in patients with limited vital organ capacity. Verapamil administration may be considered for protection against tissue injury attributable to oxidative stress in these patients.

Expression of cathepsin D in bladder carcinoma: correlation with pathological features and serum cystatin C levels.

Aims and background The aim of this study is to evaluate the expression of cathepsin D in primary bladder cancer and to determine its relationship with conventional pathological features and serum cystatin C levels. Methods The immunohistochemical cathepsin D expression and staining patterns of epithelial and stromal cells were investigated in 21 patients with primary bladder carcinoma. Serum cystatin C levels were determined by immunoturbidimetry and compared with matched controls. Results There were 7 papillary neoplasms of low malignant potential, 7 low-grade and 7 high-grade carcinomas. Six tumors were invasive. Statistical analysis showed a significant inverse relationship between cathepsin D expression of the tumor cells and tumor grade and stage (P = 0.018 and P = 0.046, respectively). Serum cystatin C levels of the controls and patients varied between 0.39 mg/L and 1.99 mg/L (P >0.05). There was no significant relation between cathepsin D expression in tumor tissue and serum cystatin C levels. Conclusions Loss of cathepsin D expression in bladder carcinomas may be associated with high-grade and invasive tumors. Thus, increased cathepsin D expression by tumor cells may be related to local tumor invasion at an early stage, but it seems that extracellular cystatin C is not affected by cathepsin D expression of tumor or stromal cells, and cystatin C concentrations are not directly correlated with the progression of primary bladder carcinomas.

Effect of retroperitoneoscopic donor nephrectomy on tissue oxidative stress markers in rabbit pneumoretroperitoneum model.

BACKGROUND AND PURPOSE Laparoscopic donor nephrectomy causes increased renal oxidative stress. There are no data about the effects of the retroperitoneoscopic route. The aim of our study was to evaluate the oxidative stress occurring in renal tissues during retroperitoneoscopic donor nephrectomy in a rabbit model. MATERIALS AND METHODS Eighteen adult rabbits were randomized to three groups, each consisting of six rabbits. Group I (control) underwent 50-mL balloon dissection of the left retroperitoneal space without CO(2) insufflation. Group II (pneumoretroperitoneum) received a 3-hour CO(2) insufflation at a pressure of 10 mm Hg in the retroperitoneal space after balloon dissection. Group III (pneumoretroperitoneum with warm ischemia), in addition to the procedure applied in Group II, underwent left renal artery clamping for 3 minutes and reperfusion for the next 5 minutes. Bilateral nephrectomy was performed in all animals for analysis of oxidative stress markers. Concentrations of malonyldialdehyde (MDA), protein carbonyl, and reduced glutathione (GSH) were measured in renal tissue samples. RESULTS The MDA and protein carbonyl content were increased both in the donor (P = 0.004 and P = 0.004, respectively) and in the remaining kidneys (P = 0.009 and P = 0.028, respectively) in Group II compared with Group I. There were no statistically significant increases in oxidative stress markers between Group II and Group III in donor kidneys. However, there were statistically significant decreases in MDA in the remaining kidneys in Group III compared with Group II (P = 0.009). CONCLUSION Pneumoretroperitoneum causes increased oxidative stress in both donor and remaining kidneys. Short-term warm ischemia and reperfusion do not exert an additive effect on pneumoretroperitoneum-associated oxidative stress in donor kidneys.

Age and total and free prostate-specific antigen levels for predicting prostate volume in patients with benign prostatic hyperplasia

Abstract Objectives: To investigate the predictive values of free prostate-specific antigen (fPSA), total PSA (tPSA) and age on the prostate volume. Methods: The data of 2148 patients with lower urinary tract symptoms were analyzed retrospectively. The patients who had transrectal ultrasonography guided 10 core biopsies owing to the findings obtained on digital rectal examination and presence of high PSA levels (PSA = 2.5–10 ng/dl), and proven to have BPH histopathologically were included in the study. Age, tPSA, fPSA and the prostate volumes (PV) of the patients were noted. Results: One thousand patients that fulfilled the inclusion criteria were included in the study. The PV of the patients were significantly correlated with age, tPSA and fPSA (p < 0.001 and r = 0.307, p < 0.001 and r = 0.382, p < 0.001 and r = 0.296, respectively). On linear regression model, fPSA was found as a stronger predictive for PV (AUC = 0.75, p < 0.001) when compared to age (AUC = 0.64, p < 0.001), and tPSA (AUC = 0.69, p = 0.013). Conclusions: Although tPSA is an important prognostic factor for predicting PV, the predictive value of fPSA is higher. PV can easily be predicted by using age, and serum tPSA and fPSA levels.

The effect of carbon dioxide pneumoretroperitoneum on free oxygen radicals in rabbit retroperitoneoscopy model.

The aim of this study was to investigate the possible effects of carbon dioxide (CO2) pneumoretroperitoneum on free oxygen radicals in the kidney. Twelve male New Zealand rabbits were divided into 2 equal groups; group 1; control operation group (retroperitoneal space preparation without CO2 insufflation) and group 2; study group (10–12 mm Hg pneumoretroperitoneum for 3 hours with CO2). At the end of the procedure, laparotomy was performed to harvest ipsilateral and contralateral kidney in both groups after three hours. Kidney tissues were homogenized and were assayed for malondialdehyde (MDA), protein carbonyls (for protein oxidation), and reduced glutathione (GSH). Ipsilateral and contralateral kidney tissue levels of the MDA, protein carbonyls and GSH were not different in both the study and the control group (P > 0.05 for all comparisions). Corresponding ipsilateral and contralateral tissue levels of the markers, MDA and protein carbonyls were found to be significantly different in the study group as compared with the control group (P < 0.05 for the four comparisons mentioned). However, neither the ipsilateral nor the contralateral tissue levels of the marker GSH showed statistically relevant difference when the study group was compared with the control group. Oxidative stress was identified as a component of CO2 pneumoretroperitoneum-induced kidney injury using an animal model of retroperitoneoscopy. Oxidative stress is likely to contribute to the impairment of renal function after retroperitoneoscopy using a 10 mm–12 mm Hg CO2 pneumoretroperitoneum.

Induction of spermatogenesis in idiopathic hypogonadotropic hypogonadism with gonadotropins in older men.

We investigated the treatment results in 6 azoospermic idiopathic hypogonadotropic hypogonadism (IHH) cases that remained untreated 41–47 years of age. Medical history, physical examination, hormone profile measurements, peripheral blood karyotype, skull X-ray and/or magnetic resonance imaging were performed. Patients received 1,000 to 5,000 IU hCG, 2–3 times per week, and 75 to 150 IU hMG, 2–3 times per week for 24 months. Serum testosterone levels were assessed every month for maximum 6 months to evaluate optimal dose of treatment and then every 3 months thereafter. Sperm counts were assessed every 3 months. Testosterone level increased from 2.7 ± 0.9 mIU/L to 22 ± 7.04 mIU/L with treatment; testicular volume increased by 4.6 ml during the treatment. Sperm were detected in the ejaculate in 3 out of 6 patients on the 22nd, 18th, and 15th month of treatment. 3 patients underwent testicular biopsy; histopathology revealed tubular hyalinization. Spermatogenesis in older men with IHH was restored by exogenous gonadotropins.