Omer Onur Cakir

LUTS and sleep disorders: emerging risk factor.

Lower urinary tract symptoms (LUTS) are commonly associated with benign prostatic hyperplasia (BPH) and represent significant bother among aging men. Bothersome LUTS secondary to BPH, including nocturia, significantly impact men’s general health-related quality of life (QoL) as do sleep disturbances. However, very few studies have examined the relationship between the severity of BPH-related urinary symptoms and sleep disturbances. This review analyzes the recent studies that report the association between the bother and severity of LUTS secondary to BPH and the severity of sleep disturbance. In addition, we address the relationship between treating LUTS and the influence that it has on treating the sleep disorders.

Catheter dwell time and diameter affect the recurrence rates after internal urethrotomy

OBJECTIVE Cold-knife direct vision internal urethrotomy (DVIU) is frequently used as the first-line treatment for urethral stricture disease. Although the steps of the procedure are defined in detail, the duration of catheterization and the diameter of the catheter to be used after the operation are not clearly defined. The aim of this study is to evaluate the effects of catheter dwell time and diameter on recurrence rates of urethral stricture disease after DVIU. MATERIAL AND METHODS Data of 193 consecutive treatment naïve bulbar urethral stricture patients who underwent DVIU between January 2009 and June 2013 were retrospectively analyzed. Patient demographics and stricture characteristics were noted. Catheter dwell times were grouped as <5 and ≥5 days. The diameters of catheters used were 16, 18 and 22 Fr. The association between recurrence rates, catheter dwell times, and diameter were evaluated with Tukeys test and Pearsons correlation test, respectively. RESULTS Overall 193 patients with a mean age of 64.51±12.99 (range: 17 to 85) years were enrolled in the study. Urethral stricture disease recurred in 45 (23.31%) patients within the first year after DVIU. Mean duration of catheterization was 7.47±4.03 and 4.79±1.94 days in patients with and without recurrences, respectively (p=0.0001). Catheter dwell times for ≥5 days were also associated with increased recurrence (p=0.0001). Of the patients with recurrent strictures, 16, 18 and 22Fr catheters were placed in 22.22%, 20% and 57.78% of the patients, respectively. Increased catheter diameter was also associated with higher recurrence rates (p=0.004). CONCLUSION Shortening the postoperative duration of catheterization and decreasing the catheter size may result in improved recurrence rates after DVIU. Further prospective randomized trials are necessary to confirm these findings.

Re: Singh A et al. Robot-assisted retroperitoneal lymph node dissection: Feasibility and outcome in postchemotherapy residual mass in testicular cancer. Indian J Urol 2017;33:304-9

1. Goel S, Mandhani A, Srivastava A, Kapoor R, Gogoi S, Kumar A, et al. Is povidone iodine an alternative to silver nitrate for renal pelvic instillation sclerotherapy in chyluria? BJU Int 2004;94:1082‐5. 2. Kant L. Deleting the ‘neglect’ from two neglected tropical diseases in India. Indian J Med Res 2016;143:398‐400. 3. Heldwein FL, Rhoden EL, Morgentaler A. Classics of urology: A half century history of the most frequently cited articles (1955‐2009). Urology 2010;75:1261‐8. 4. Nason GJ, Tareen F, Mortell A. The top 100 cited articles in urology: An update. Can Urol Assoc J 2013;7:E16‐24. 5. Newble D, Cannon R. Helping students learn. A Handbook for Medical Teachers. 4th ed. New York: Kluwer Academic Publishers; 2001. p. 5‐7. This is an open access article distributed under the terms of the Creative Commons Attribution‐NonCommercial‐ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‐commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Serum antioxidant enzyme levels are decreased in patients with urinary calcium oxalate stones

PURPOSE To compare the serum antioxidant enzyme levels between patients with urinary stone disease and healthy volunteers to determine the effect of cellular oxidative stress on urinary calcium oxalate stones formation.Materials & Methods: A total of 51 patients with proven urinary calcium oxalate stones (female 35.3%, mean age: 49.3 years) and 37 healthy subjects (female 45.9%, mean age: 44.1 years) were included. The serum levels of antioxidant catalase, glutathione peroxidase, superoxide dismutase and lipid peroxidation were measured in serum samples taken from the peripheral venous circulation. RESULTS Mean serum catalase level of patient group was insignificantly higher than healthy subjects (7.54 mmol- H2O2/mg/sec versus 6.16 mmolH2O2/mg/sec, respectively; P = .06) whereas mean superoxide dismutase level (1.56 U/ml versus 3.86 U/ml, P = .047), glutathione peroxidase level (6.70 U/ml versus 8.19 U/ml, P = .022) and lipid peroxidation level (2.35 nmol/ml versus 3.31 nmol/ml, P = .034) of patient group were significantly lower than healthy subjects. Patients with family history of urinary stone disease had significantly lower mean serumlevels of catalase (P = .037), superoxide dismutase (P = .047) and glutathione peroxidase (P = .01), compared with patients without family history. CONCLUSION The findings of this study provide evidence regarding the role of oxidative stress in the development of urinary calcium oxalate stones. Future clinical trials are necessary to elucidate the actual mechanisms of the calcium oxalate stone formation in the environment with increased oxidative stress.

Short-term Results of Retrograde Intrarenal Surgery in the Management of Kidney Stones in Children: A Safe and Efficacious Procedure

Amaç: Çocukluk çağı böbrek taşlarının tedavisinde retrograd intrarenal cerrahinin uygulanabilirliğinin gösterilmesi. Yöntemler: Kliniğimizde Aralık 2012-Şubat 2013 tarihleri arasında böbrek taşlarının tedavisi için retrograd intrarenal cerrahi uygulanan 14 hastanın bilgileri geriye dönük olarak incelendi. Tüm hastalarda işlem 7,5 Fr FlexXTM 2 fleksibl üreterorenoskop (Karl Storz GmbH & Co. KG, Tuttlingen, Germany) cihazı kullanılarak gerçekleştirildi. Hiçbir hastada üreteral akses kılıf kullanılmadı. Üretere giriş yapılamayan hastalarda pasif dilatasyon için 2 hafta süre ile çift j kateter takılarak işlem ertelendi. Taşlar lazer ile fragmante edildi ve iki milimetreden küçük fragmanlar kendiliğinden düşmesi için yerinde bırakıldı. Tüm hastalara işlem sonrası çift j kateter takıldı ve takiplerde üriner sistem ultrasonografisi ve direkt grafi kullanıldı.

Lower Urinary Tract Symptoms and Benign Prostate Diseases in Older Men

Benign prostatic hyperplasia is one of the most common urologic disorders among older men. Incidence and prevalence of BPH both increase with advancing age, although the condition should not be considered a normal or inevitable part of the aging process. A variety of pharmacologic, surgical and minimally invasive surgical therapies are available to treat this condition. This chapter reviews BPH in eldelry men including associated lower urinary tract symptoms and treatment outcomes in this population.

Nitric Oxide Synthase is Necessary for Normal Urogenital Development

Introduction Neuronal nitric oxide synthase (NOS-I) is significantly decreased with Cavernous Nerve (CN) injury in Erectile Dysfunction (ED) models. Increased apoptosis and collagen deposition accompany decreased NOS/CN injury, however these changes are typically attributed to the altered signaling of other factors, and a contribution of NOS in maintenance of urogenital structures has not previously been examined. Morphological changes in the corpora cavernosa occur at the same time as decreased NOS, suggesting a potential connection between decreased/inhibited NOS and morphological changes associated with ED. In this study we propose that NOS impacts urogenital morphology during development and will examine this hypothesis by NOS inhibition with L-NAME. Methods Primary outcomes were H&E, western and TUNEL to determine if penis, prostate and bladder morphology were altered with L-NAME treatment of Postnatal day 4 (P4) Sprague Dawley rats for 8 days. Tissue weight and immunohistochemical analysis for NOS were performed. Secondary evaluation of NOS-I regulation by Sonic Hedgehog (SHH) was examined by SHH inhibition in the pelvic ganglia (PG) and NOS-I protein was quantified by western in the PG/CN and penis. Nos abundance was quantified by RT-PCR during urogenital development and after CN injury. Results Apoptosis increased and penis, prostate and bladder morphology were altered with L-NAME. NOS inhibition decreased bladder weight 25%. SHH inhibition decreased NOS-I 35% in the PG/CN and 47% in the penis. Nos-III expression spiked within the first two weeks after birth in the penis but remained abundant in the adult. In the prostate, Nos-III was abundant immediately after birth and declined steadily with age. Nos-I expression in the PG/CN decreased sharply with CN injury and returned to baseline by 7 days. Conclusions NOS is required for normal urogenital development. Since NOS is decreased with ED, it may contribute to the abnormal morphology observed in ED patients and animal models.

Nerve growth factor signaling following unilateral pelvic ganglionectomy in the rat ventral prostate is age dependent

Benign prostatic hyperplasia (BPH) is a serious health concern and is an underlying cause of lower urinary tract symptoms (LUTS) in many men. In affected men, LUTS/BPH is believed to result from benign proliferation of the prostate resulting in bladder outlet obstruction. Postnatal growth of the prostate is controlled via growth factor and endocrine mechanisms. However, little attention had been given to the function of the autonomic nervous system in prostate growth and differentiation. Nerve growth factor (NGF) is a prostatic mitogen that has a trophic role in autonomic sensory end organ interaction. In this study, we examine how the autonomic nervous system influences prostate growth as a function of age by quantifying NGF in the rat ventral prostate (VP) after pelvic ganglionectomy. Unilateral pelvic ganglionectomy was performed on postnatal days 30 (P30), 60 and 120 Sprague-Dawley rats in comparison to sham controls (n=39). Semiquantitative RT-PCR, Western blotting and immunohistochemical analysis for NGF were performed on denervated, intact (contralateral side) and sham control VP 7 days after surgery. Ngf RNA expression was significantly increased in the denervated and intact hyperplastic VP. Western blotting showed age-dependent increases in NGF protein at P60 in the contralateral intact VP. NGF was localized in the nerves, basal cells and columnar epithelium of the prostatic ducts. Denervation causes age-dependent increases in NGF in the VP, which is a potential mechanism by which the autonomic nervous system may regulate prostate growth and lead to BPH/LUTS.