Sedat Soyupek

Sildenafil citrate as a phosphodiesterase inhibitor has an antioxidant effect in the blood of men

Background and objective:  Sildenafil citrate enhances the action of nitric oxide by preventing the hydrolysis of cGMP, and is widely used to treat erectile dysfunction. We investigated the effects of sildenafil citrate administration on lipid peroxidation and antioxidant redox enzymes in blood of healthy men.

Androgen deprivation therapy for prostate cancer: Effects on hand function

OBJECTIVES Prostate cancer is the most frequently diagnosed malignancy. Luteinizing hormone-releasing hormone (LH-RH) agonists are used in most patients with locally advanced and metastatic prostate cancer, and decrease testosterone production. We aimed to find out the effects of androgen deprivation therapy with LH-RH agonist on the hand function, quality of life, and mood of the patients with prostate cancer. SUBJECTS A total of 20 patients with locally advanced prostate cancer and 20 age-matched healthy men were included in the study as LH-RH and control groups, respectively. MAIN MEASURES Age, body mass index, occupation and dominant hand, physical activity level, Beck depression inventory scores, 15D quality of life questionnaire scores, and Duruoz hand index scores were recorded. Handgrip strength was tested in the dominant hand using the Jamar hand dynamometer (Sammons Preston, Inc., Bollingbrook, IL). The Grooved Pegboard Test was used to test manual dexterity. Serum concentrations of total and free testosterone, estradiol levels were measured. RESULTS There were no differences between the groups in body mass index, physical activity level, and age (P > 0.05). Serum total and free testosterone, estradiol level, and the mean grip strength score were statistically lower in the LH-RH group. Manual dexterity was diminished in the LH-RH group (P < 0.001). The Duruoz hand index, and Beck depression inventory and 15D quality of life questionnaire scores were statistically lower in the LH-RH group (P < 0.005). We found a correlation between handgrip strength, dexterity, Beck depression inventory scores, 15D quality of life questionnaire scores, and total and free testosterone. CONCLUSION Men with low testosterone levels caused by androgen deprivation therapy have worse grip strength, dexterity, 15D quality of life questionnaire scores, and depressive symptoms than age-matched men who have not received androgen deprivation therapy.

Caffeic acid phenethyl ester modulates methotrexate-induced oxidative stress in testes of rat.

The aim of this study was to investigate the possible protective role of caffeic acid phenethyl ester on testicular toxicity of methotrexate in rats. Nineteen male rats were divided into three groups as follows: group I, control; group II, methotrexate-treated; group III, methotrexate + caffeic acid phenethyl ester-treated. In the second day of experiment, a single dose of methotrexate was intraperitoneally administered to groups II and III, although a daily single dose of caffeic acid phenethyl ester was intraperitoneally administered to group III for 7 days. At the end of the experiment, the testes of the animals were removed and weighed. In the tissue, the level of lipid peroxidation as malondialdehyde and activities of superoxide dismutase were higher in the methotrexate group than in the control group. Lipid peroxidation levels and superoxide dismutase activities were decreased in caffeic acid phenethyl ester + methotrexate group compared with methotrexate group. The activities of catalase in the methotrexate group decreased insignificantly although its activities were significantly increased by caffeic acid phenethyl ester administration. The activity of glutathione peroxidase did not change in the groups. There was significant difference in body weight between control and methotrexate-induced groups. In conclusion, the administration of methotrexate causes elevation of oxidative stress although treatment with caffeic acid phenethyl ester has protective effects on the oxidative stress in testes.

Topiramate and vitamin e modulate antioxidant enzyme activities, nitric oxide and lipid peroxidation levels in pentylenetetrazol-induced nephrotoxicity in rats.

Previous studies have shown that generation of free radicals is increased following pentylenetetrazol kindling, due to increased cytosolic Ca2+ concentrations. Topiramate, a voltage-gated calcium channel inhibitor, has an evident effect in the treatment of childhood epilepsy; however, topiramate may cause nephrotoxicity. We investigated the effects of topiramate and vitamin E administration on pentylenetetrazol-induced nephrotoxicity in rats by evaluation of lipid peroxidation, nitric oxide, glutathione peroxidase, catalase and superoxide dismutase values. Forty male Wistar rats were randomly divided into five equal groups. Group 1 was used as control and group II received a single dose of pentylenetetrazol. Fifty and 100 mg/kg topiramate daily were intragastrically administered to rats in groups III and IV for 7 days, respectively. Intragastric 100 mg topiramate (daily for 7 days) and intraperitoneal vitamin E (150 mg/kg, daily for 3 days) combination were given to animals in group V before a single-dose pentylenetetrazol administration. Serum and kidney samples were taken after 3 hr of pentylenetetrazol administration. Pentylenetetrazol resulted in a significant increase in nitric oxide levels of serum and kidney, and lipid peroxidation levels of kidney although superoxide dismutase and catalase activities in the kidney was reduced by pentylenetetrazol administration. The lipid peroxidation levels in serum and kidneys and the nitric oxide levels in kidneys of groups III, IV and V were decreased by topiramate although the superoxide dismutase and catalase activities in the kidneys were increased. Lipid peroxidation and nitric oxide levels were reduced by the topiramate and vitamin E combination compared to only topiramate. Glutathione peroxidase activity was not affect by pentylenetetrazol, topiramate and vitamin E administrations. In conclusion, topiramate and vitamin E have protective effects on pentylenetetrazol-induced nephrotoxicity by inhibition of free radicals and by support of the antioxidant redox system.

Ileal orthotopic neobladder (modified Hautmann) via a shorter detubularized ileal segment: experience and results.

To evaluate the clinical, urodynamic, functional, radiological and metabolic results of the ileal (modified Hautmann) orthotopic neobladder over 10 years of experience.

Risk Factors for the Formation of a Steinstrasse after Shock Wave Lithotripsy

Introduction: We studied the various stone, renal, and therapy factors that could affect steinstrasse formation after shock wave lithotripsy (SWL) to define their predictive value. Patients and Methods: Between May 1999 and September 2002, 563 patients were treated with a Stonelight V3 lithotriptor. A steinstrasse was recorded in 46 patients. All patient data, stone and renal characteristics, and data of SWL were reviewed. Statistical analyses of patients, stones, and therapy characteristics in correlation with the incidence of steinstrasse formation were performed to assign factors that had a significant impact on the formation of this complication. Results: The overall incidence of a steinstrasse was 8.17%. The steinstrasse was in the pelvic ureter in 84.3% of the cases, in the iliac ureter in 7.84% of them, and in pelvic and iliac ureter in 7.84% of the patients. The incidence of a steinstrasse significantly correlated with stone size and site. The incidence rates of a steinstrasse in renal stones <1 cm, 1–2 cm, and >2 cm were 4.46, 15.87, and 24.3% respectively. The incidence rates of this complication in ureteral stones <1 cm and 1–2 cm were 3.37 and 9.52%, respectively. The incidence rates of a steinstrasse in stones located in upper calices, middle calices, lower calices, and renal pelvis were 6.12, 10.52, 6.36, and 19.32%, respectively. Conclusions: Stone size and site are the significant factors predicting the formation of a steinstrasse. If a patient has a high probability of steinstrasse formation, close follow-up with early intervention or prophylactic pre-SWL ureteral stenting is indicated.

Physical and Mental Workload in Single-Incision Laparoscopic Surgery and Conventional Laparoscopy

Objectives. The aim of the present study is to evaluate mental workload and fatigue in fingers, hand, arm, shoulder in single-incision laparoscopic surgery (SILS) and multiport laparoscopy. Methods. Volunteers performed chosen tasks by standard laparoscopy and SILS. Time to complete tasks and finger and hand strength were evaluated. Lateral, tripod, and pulp pinch strengths were measured. Hand dexterity was determined by pegboard. Electromyography recordings were taken from biceps and deltoid muscles of both extremities. The main outcome measurement was median frequency (MF) slope. NASA-TLX was used for mental workload. Results. Time to complete laparoscopic tasks were longer in the SILS group (P < .05). Decrease of strength in fingers and hand were similar in SILS and standard laparoscopy. Pegboard time was increased in both hands after SILS (P < .05). MF slope of biceps muscle and deltoid muscle in SILS was far away from the reference slope. MF slope of biceps muscle and deltoid muscle in standard laparoscopy was close to reference slope, indicating there was more fatigue in biceps and deltoid muscles of both upper extremities in SILS group. NASA-TLX score was 73 ± 13.3 and 42 ± 19.5 in SILS and multiport laparoscopy, respectively (P < .01). Mental demand, physical demand, temporal demand, performance, effort, and frustration were, respectively, scored 10.7 ± 3.8, 11.7 ± 3.5, 12.2 ± 2.7, 11 ± 3, 13.6 ± 2.7, and 13.5 ± 2.8 in SILS and 6.3 ± 3.1, 6.6 ± 3.3, 7.3 ± 3.3, 7.1 ± 4.1, 7.9 ± 3.9, and 6.6 ± 3.8 in standard laparoscopy (P < .01). Conclusions. SILS is mentally and physically demanding, particularly on arms and shoulders. Fatigue of big muscles, effort, and frustration were major challenges of SILS. Ergonomic intervention of instruments are needed to decrease mental and physical workload.

Extracorporeal Magnetic Innervation for the Treatment of Stress Urinary Incontinence: Results of Two-Year Follow-Up

Introduction: Extracorporeal magnetic innervation (ExMI) is a relatively new technology used for pelvic muscle strengthening for the treatment of stress urinary incontinence. We aimed to evaluate the clinical efficacy of extracorporeal magnetic stimulation for the treatment of stress urinary incontinence. Materials and Methods: A total of 30 patients with demonstrable stress urinary incontinence were enrolled in this study. All were neurologically normal with normal urinalysis and none was pregnant. Evaluation before treatment included 3-day bladder diaries, a dynamic pad weight test, urodynamics, and a validated quality of life survey. Treatment sessions lasted 20 min, twice a week, for 6 weeks. After ExMI, all measures were repeated at follow-up including 3-day bladder diary, dynamic pad weight test, urodynamics and quality of life survey. The follow-up was done at 3, 12 and 24 months after ExMI therapy but urodynamics were performed only at first follow-up. Results: After ExMI therapy, 8 out of the 27 patients were cured (29.7%) and 13 patients were improved (48.1%) at 3 months. The cumulative success rate was 77.8%. Six patients did not show any improvement after treatment. Pad weight was reduced from 14.4 ± 10.7 to 6.5 ± 5.1 g. The mean score of quality of life survey at baseline was 61.6 and this increased to 75.4 at 12 weeks. The effect of ExMI approximately continued until the 1st year after therapy but gradually decreased and came close to baseline at the 2nd year after therapy. Conclusion: As a result, ExMI therapy offers a new effective modality for pelvic floor muscle stimulation. ExMI also offers a noninvasive, effective and painless treatment for women with stress urinary incontinence. Further studies are needed to address how long the therapy will continue and benefits will last and whether retreatment or continuation therapy sessions will be necessary.

Antegrade extraperitoneal approach to radical cystectomy and ileal neobladder.

Background: We describe a new operative technique for the surgical treatment of bladder cancer.

The selection of the regional anaesthesia in the transurethral resection of the prostate (TURP) operation

Background and objectives: The aim of ourstudy was to compare the three differentregional anaesthesia methods in patients whounderwent transurethral resection of theprostate (TURP) and to determine the idealanaesthesia method for TURP operation.Methods: Totally 77 ASA II–III patientswere preloaded with 500 ml 0.9% NaCl solutionbefore regional anaesthesia. In group E (n:27)epidural anaesthesia were achieved by applying75 mg bupivacaine heavy + 50 µg fentanyl inthe L3–L4 intervertebral space. In group SP(n:28) 15 mg bupivacaine heavy + 50 µgfentanyl were used for spinal anaesthesia(L3–L4 intervertebral space) while in group SA(n:30) 10 mg bupivacaine heavy + 50 µgfentanyl were used with saddle blockade.Systolic arterial pressure (SAP), heart rate(HR), peripheral oxygen saturation (SpO2),serum sodium measurement was recorded beforeand after hydration and during operation. Themotor block and sensory level have beenmeasured.Results: Intraoperative SAP values were morestable than the other groups in group SA. Thedecrease in HR values were significant 15minutes after prehydration in three groups(p < 0.05). SpO2 values of the groups werestable during the operation. The time to reachthe maximum block was very short in patients inGroup SA (p < 0.0001). There was astatistically significant difference betweenthe groups in terms of motor block values(p < 0.0001). No fully paralysed sample wasseen in Group SA even though there was asufficient surgical anaesthesia.Conclusions: Saddle block has someadvantages compared to spinal and epiduralanaesthesia methods such as achieving adequateanaesthesia, stable haemodynami, the lowerdegree of motor blockage and no full blockagein patients. Saddle block is an the mostoptimal anaesthesia method for TURP operation.