Omer Kutlu

Role of TNF-related apoptosis-inducing ligand (TRAIL) in the pathogenesis of varicocele-induced testicular dysfunction.

The higher frequency of varicocele in men with infertility has drawn attention and resulted in increased research at the molecular level towards treatments. The aim of this study was to investigate the role of tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) and its receptors in varicocele-induced testicular dysfunction in an experimental rat model. The rats were divided into three groups: control, sham and varicocele. Varicoceles in rats were induced by partial ligation of the left renal vein and left testes. The rats were analyzed 13 weeks after surgery. The degree of DNA fragmentation within cells in the testis was determined using terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end labeling (TUNEL) assay. Tubule degeneration was evaluated using the Johnsen score. The expression of TRAIL and its receptors was detected by immunohistochemical and Western blotting techniques. The apoptotic index, Johnsen score and the expression of TRAIL and TRAIL receptors were examined. The data are presented as the mean±s.d. and were analyzed using computer software. The Kruskal-Wallis and Dunns multiple comparison tests were used in the statistical analyses. The germ cell apoptotic index was increased in rats with varicoceles when compared with the sham and control groups (P=0.0031). The Johnsen score was significantly decreased in the varicocele group when compared with the sham and control groups (P<0.0001). Immunohistochemical and Western blotting analyses showed that after varicocele induction, the expression of TRAIL-R1 and TRAIL-R4 in germ cells was increased and the expression of TRAIL-R2 was decreased. There are no significant differences among the groups in terms of TRAIL and TRAIL-R3 receptor expression. The results of this study indicate that TRAIL and its receptors may have a potential role in the pathogenesis of varicocele-induced testicular dysfunction.

Endoscopic Treatment of Ureteric Strictures: Acucise, Cold-Knife Endoureterotomy and Wall Stents as a Salvage Approach

Objective: To evaluate the factors influencing the results of endoureterotomy using cold-knife and cutting balloon dilatation, and permanent ureteral wall stents in patients with benign ureteral strictures after different operations affecting the ureter. Materials and Methods: Over a 4-year period, in 18 patients, endoscopic cold-knife and Acucise endoureterotomies were performed in 13 and 7 renal units, respectively. Eight Memoterm permanent ureteral wall stents were inserted into 7 patients when endoureterotomy failed. Successful outcome was defined by the absence of re-stricture assessed both clinically and radiologically. Results: The strictures were secondary to ureterolithotomy in 6, ureteroscopy in 3, gynecological procedures in 4, abdominal surgeries in 2, transplantation in 2 and continent urinary diversion in 1. The right and left ureters were unilaterally affected in 5 and 11 patients, respectively (5 of them had a solitary kidney), while the remaining 2 patients had bilateral ureteral strictures. We achieved total ureteral patency of 3 (43%) and 7 (54%) renal units with Acucise and cold-knife incision, respectively. Obstructive uropathy was resolved in 6 renal units (75%) of 8 using ureteral wall stents. Conclusion: Endoureterotomy with cold-knife or Acucise cutting balloon dilatation is effective in the treatment of iatrogenic ureteral strictures, but only in a selected group. Based on our results, the favorable prognostic criteria for endoureterotomy are the length (≤1.5 cm), the nonischemic nature of the stricture and adequate renal function. As a salvage approach, permanent self-expanding ureteral wall stents with a 75% success rate may provide a satisfactory outcome for decompression of an obstructed system.

Tibial nerve stimulation diminishes mast cell infiltration in the bladder wall induced by interstitial cystitis urine

Objectives. To investigate whether the urine of interstitial cystitis (IC) patients has a toxic effect on the bladder wall, as determined by mast cell infiltration, and to evaluate the preventive effect of tibial nerve electric stimulation (TNES) on bladder mastocytosis induced by IC urine. Material and methods. The bladders of female rats were catheterized and instilled with IC urine (Group IC; n=10) and normal urine (Group NU; n=5) obtained from humans, saline (Group S; n=5) and protamine sulphate (Group PS; n=10) for 6 weeks. Additionally, in five rats instilled with IC urine and five instilled with PS, TNES was also performed (Groups IC + TNES and PS + TNES). Results. In the lamina propria of the bladder, the mean number of mast cells per square millimetre was significantly higher in Groups IC (32.5±12.3) and PS (39.4±11.1) than in Groups S (11.9±4.3) and NU (13.7±3.5). After TNES, the corresponding values were decreased significantly to 15.3±5.4 and 15.3±4.1 in Groups IC + TNES and PS + TNES, respectively (p<0.001). A significant reduction in mast cell infiltration in the detrusor was also determined after TNES compared with the value in Group IC (4.6±1.6 vs 12.1±3.0; p<0.001). Conclusions. We demonstrated that IC urine may result in increased mast cell infiltration in the bladder wall. TNES may play a therapeutic role by diminishing the mast cell count in the bladder wall, which has a strong relationship with nociceptive neural endings.

Effects of Androgen Ablation Therapy in TRAIL Death Ligand and Its Receptors Expression in Advanced Prostate Cancer

Background: It is not known whether androgen ablation therapy (AAT) influences TRAIL death ligand and its receptors expression of prostate cancer (PCa) cells. Aim: To investigate whether hormonal therapy alters the expression of TRAIL death ligand and TRAIL receptors in patients with advanced PCa. Patients and Methods: 26 untreated and 20 AAT-treated advanced PCa patients were included in the study. The patients who received AAT were divided into two groups based on hormone sensitivity status. TRAIL ligand and receptor expression were determined by a conventional immunohistochemistry method. Results: TRAIL death ligand and TRAIL-R2 death receptor were upregulated in PCa patients who received AAT. Hormone-refractory PCa patients exhibited lower levels of TRAIL death receptor (TRAIL-R1 and TRAIL-R2) expression compared to hormone-sensitive PCa patients. Conclusions: AAT alters TRAIL death ligand and its receptors expression in patients with PCa.

Role of spinning top urethra in dysfunctional voiding.

Abstract Objective. The role of spinning top urethra (STU) in children with dysfunctional voiding was evaluated retrospectively. Material and methods. From 1995 to 2002, the records of 154 children with dysfunctional voiding were reviewed retrospectively. Of the children 110 (71%) were girls and 44 (29%) were boys (mean age 8 years, range 4–14). All children were neurologically normal and no exhibited physical signs of occult spinal dysraphism. Patients were divided into two groups according to their width of proximal urethra: group I had STU and the group II had normal urethral width. The groups were compared with each other for gender, voiding symptoms, urinary tract infection (UTI), vesicoureteral reflux (VUR) and urodynamic observations. Results. There were 84 children (mean age 8.3 ± 2.2 years, range 4–14) in group I and 70 (mean age 8.0 ± 2.1 years, range 4–14) in group II; no significant age difference was found between the two groups (p = 0.4674). Group I consisted of 66 (71%) girls and 18 (29%) boys and group II 44 (63%) girls and 26 (37%) boys. STU was observed more in girls than boys in group I (p = 0.0316). UTI was observed in 57 patients (68%) in group I and 34 (49%) in group II (p = 0.0154). Mean duration of symptoms was 42 ± 24 months (range 6–118) and 39 ± 23 (range 3–120) months in groups I and II, respectively (p = 0.6302). Postvoid residual urine (PVR) more than 10% of expected bladder capacity was detected in 15 patients (18%) in group I and seven (10%) in group II. No association was found between the meaningful PVR and STU (p = 0.1653). The presence of detrusor overactivity during filling was observed in 54 patients (64%) in group I and 42 (60%) in group II (p = 0.4676). Diminished bladder compliance (< 10 ml/cmH2O) was detected in 34 patients (40%) in group I and 17 (24%) in group II (p = 0.0335). The mean voiding pressure was measured as 56 ± 29 cmH2O in group I, which was significantly higher than in group II (49 ± 25 cmH2O) (p = 0.0373). The mean flow rate during the emptying phase of urodynamics was 16 ± 8 and 15 ± 6 ml/s in groups I and II, respectively (not significant, p = 0.2686). VUR was detected in 16 patients (19%) in group I and two (3%) in group II (p = 0.0018). Conclusions. STU was related to recurrent UTIs, VUR, poor bladder compliance and more serious functional urinary obstruction. Furthermore, STU may be a consequence of a neurogenic maturation defect in detrusor–sphincter coordination resembling that of urofacial syndrome, because development of this situation was found to be independent of the duration of symptoms.

Effects of Chemical Sympathectomy on Contralateral Testicular Histology and Fertility in Unilateral Vasectomy

Unilateral obstruction or injury to the vas deferens can result in significant injury to the contralateral testicle. Although various pathways have been proposed, the mechanism of contralateral testicular deterioration remains controversial. The present animal study was performed to evaluate the effects of unilateral vasectomy on ipsilateral and contralateral testicular histology and fertility in rats that were chemically sympathectomized neonatally. The study comprised 40 male albino rats: 20 received a placebo and the other 20 underwent chemical sympathectomy neonatally. When 60 days old, each group of 20 rats was divided into two groups that underwent either a sham operation or an operation to create unilateral left vasectomy. Eight weeks after surgery, each male rat was housed with two known fertile female rats for 25 days, and then their testes were harvested. Mean seminiferous tubular diameters (MSTD) and mean testicular biopsy scores (MTBS) were determined for each testis. Although MSTD and MTBS were not significantly different between groups, chemical sympathectomy prevented the decrease in total fertility rates of the rats with unilateral left vasectomy in our study. Prevention of this decrease by chemical sympathectomy suggests that the sympathetic nervous system may play a role in the testicular degeneration associated with vasectomy.

Effect of doxazosin on expression of eNOS in rat kidney in the presence of partial bladder outlet obstruction.

BACKGROUND The role of nitric oxide in the pathogenesis of renal injury has begun to be appreciated. We therefore designed this study to demonstrate the relationship between endothelial nitric oxide synthase (eNOS) expression and doxazosin in the kidneys of rats with surgically created partial bladder outlet obstruction (BOO), to further understand the role of doxazosin in the prevention of renal parenchymal damage by partial BOO. MATERIAL AND METHODS A total of 35 adult female Wistar rats, mean weight 250 g, were randomly allocated to 3 experimental groups: group1, sham-operated (n=10); group 2, partial BOO group (n=14) and group 3, partial BOO group treated with doxazosin (n=11). Partial BOO in rats was surgically induced. Results were assessed by eNOS immunohistochemistry. RESULTS eNOS staining in kidneys in group 1 (16.45 ± 1.63) was significantly higher than in group 2 (5.09 ± 0.61) (p<0.05). After 15 days of doxazosin treatment in addition to partial BOO (group 3), eNOS staining in the kidney (11.80 ± 1.63) was significantly higher than in group 2 (5.09 ± 0.61) (p<0.05). In samples taken after 15 days of doxazosin treatment in addition to partial BOO, eNOS staining in kidneys (11.80 ± 1.63) was lower than in the sham-operated group (16.45 ± 1.63), but the difference was not significant (p>0.05). CONCLUSION These findings may provide insight into the beneficial and restorative effects of α(1)-adrenoceptor antagonists on eNOS expression in the kidney, when used to treat symptoms of benign prostate hyperplasia and hypertension.

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.