Senol Tonyali

Does neutrophil to lymphocyte ratio demonstrate deterioration in renal function

Abstract Introduction: Chronic kidney disease (CKD) is a major health issue worldwide, which leads to end-stage renal failure and cardiovascular events. Neutrophil to lymphocyte ratio (NLR) is a surrogate marker of inflammation and has been widely studied in malignancies, hypertension, heart diseases, and vascular diseases. In this study, we aimed to investigate if NLR represents renal reserve and function after partial or radical nephrectomy. Methods: We conducted a retrospective study consists of patients who had undergone radical/partial nephrectomy in our hospital and/or who admitted to urology and nephrology clinics as an outpatient. Patients were divided into four groups: Group 1 (n =  46): Healthy controls; Group 2 (n =  50): Patients who had undergone unilateral partial nephrectomy; Group 3 (n =  46): Patients who had gone unilateral nephrectomy; Group 4 (n =  82): Patients who had CKD. Results: The mean NLR of each group was as follows: Group 1: 2.14 ± 0.73; Group 2: 3.52 ± 3.74; Group 3: 3.64 ± 3.52, and Group 4: 3.53 ± 2.30. NLR was lower in Group 1 compared to other groups but statistically significant difference was observed only between Group 1 (control) and Group 4 (CKD), 2.14 ± 0.73 versus 3.53 ± 2.30 (p = .005). In non-parametric correlation analysis NLR was found negatively correlated with GFR and positively correlated CKD stage (p = .028 for both correlations). Conclusions: The NLR may constitute a practical predictor of CKD besides Cr in patients who had undergone partial or radical nephrectomy.

Ureteroneocystostomy in primary vesicoureteral reflux: critical retrospective analysis of factors affecting the postoperative urinary tract infection rates

INTRODUCTION To determine the parameters affecting the outcome of ureteroneocystostomy (UNC) procedure for vesicoureteral reflux (VUR). MATERIALS AND METHODS Data of 398 patients who underwent UNC procedure from 2001 to 2012 were analyzed retrospectively. Different UNC techniques were used according to laterality of reflux and ureteral orifice configuration. Effects of several parameters on outcome were examined. Disappearance of reflux on control VCUG or absence of any kind of UTI/symptoms in patients without control VCUG was considered as clinical improvement. RESULTS Mean age at operation was 59.2 ± 39.8 months and follow-up was 25.6 ± 23.3 months. Grade of VUR was 1-2, 3 and 4-5 in 17, 79, 302 patients, respectively. Male to female ratio was 163/235. UNC was performed bilaterally in 235 patients and intravesical approach was used in 373 patients. The frequency of voiding dysfunction, scar on preoperative DMSA, breakthrough infection and previous surgery was 28.4%, 70.7%, 49.3% and 22.4%, respectively. Twelve patients (8.9%) with postoperative contralateral reflux were excluded from the analysis. Overall clinical improvement rate for UNC was 92%. Gender, age at diagnosis and operation, laterality and grade of reflux, mode of presentation, breakthrough infections (BTI) under antibiotic prophylaxis, presence of voiding dysfunction and renal scar, and operation technique did not affect the surgical outcome. However, the clinical improvement rate was lower in patients with a history of previous endoscopic intervention (83.9% vs. 94%). Postoperative UTI rate was 27.2% and factors affecting the occurrence of postoperative UTI were previous failed endoscopic injection on univariate analysis and gender, preoperative BTI, postoperative VUR state, voiding dysfunction on multivariate analysis. Surgery related complication rate was 2% (8/398). These were all low grade complications (blood transfusion in 1, hematoma under incision in 3 and prolonged hospitalization secondary to UTI in 4 patients). In long term, 12 patients are under nephrologic follow-up because of hypertension in 5, increased serum creatinine in 5, proteinuria in 1 and hematuria in 1 patient and all these patients had preoperative scarred kidneys. CONCLUSIONS Despite its invasive nature, UNC has a very high success rate with a negligible percent of complications. In our cohort, the only factor that negatively affected the clinical improvement rate was the history of previous antireflux interventions where the predictive factors for postoperative UTI were previous failed endoscopic injection, female gender, preoperative BTI, persistent VUR and voiding dysfunction.

Prediction of stone-free status after single-session retrograde intrarenal surgery for renal stones.

OBJECTIVE To determine the possible factors effecting stone-free status (SFS) after single-session retrograde intrarenal surgery (RIRS) for renal stones. MATERIAL AND METHODS We retrospectively analyzed the charts of 100 consecutive patients who underwent RIRS. Unilateral procedures performed for single renal stones were included in the study. The studied parameters included patient demographics, stone characteristics (size, volume, location and attenuation according to Hounsfield unit [HU]), operation time, presence of preoperative double-J stent (DJS), use of ureteral access sheath (UAS) and SFS. RESULTS The study population consisted of 100 patients where 43 of them were stone free and remaining 57 had residual stones. The mean age of the patients was 47.2±13.4 years. The mean stone size (largest dimension), stone attenuation and stone volume were 14.8±5.8 mm, 1010±416 HU and 937±929 mm3, respectively. The mean operative time was 60.8±24.2 minutes. Mean stone size, volume and HU were higher in the RS group compared to SF group but without any statistically significant difference, 15.2±6.1 vs. 14.2±5.3 mm, 1056±1037 mm3 vs. 780±745 mm3 and 1061±374 HU vs. 942±462 HU, respectively (p=0.490, p=0.135 and p=0.226). In multivariate regression analysis stone location and UAS use were found to be the significant predictors of SFS. Patients with lower pole stones are 2.25 times likely to have residual stones after RIRS compared to patients having stones at other localizations (p<0.001). CONCLUSION Stone volume could be a more reliable parameter than stone size in predicting RIRS success. Lower pole stone location and UAS use could be considered the most significant predictors of SFS after single session RIRS for single renal stones.

Does the New Proposal for Prostate Cancer Grading Correlate With CAPRA Score

PURPOSE To determine if there is a correlation between the newly proposed Gleason grading system by the International Society of Urological Pathology and the Cancer of the Prostate Risk Assessment (CAPRA) score. MATERIAL AND METHODS The records of all patients that underwent radical prostatectomy at our hospital between 2007 and 2013 were retrospectively reviewed. The study parameters included patient demographics, the percentage of pre-operative prostate biopsies positive for PCa, biopsy Gleason Score (GS), and pre- and post-operative PSA values. RESULT The study included 146 patients with complete medical records and follow-up data. Mean age of the patientswas 66.6 ± 6.08 years. According to the newly proposed Gleason grading system, 97 (66.4%) patients were grade 1, 20 (13.7%) were grade 2, 8 (5.5%) were grade 3, 11 (7.5%) were grade 4, and 10 (6.8%) were grade 5. The distribution of CAPRA scores was as follows: 1: n = 43 (29.5%); 2: n = 53 (36.3%); 3: n = 22 (15.1%); 4: n = 14 (9.6%); 5: n = 8 (5.5%); 6: n = 4 (2.7%); 7: n = 1 (0.7%); 8: n = 1 (0.7%). Correlation analysis showed that theCAPRA score was significantly correlated with GS based on the newly proposed Gleason grading system (CorrelationCoefficient=0.361, P < 0.001). CONCLUSION As a strong correlation was noted between these 2 independent grading systems, we think clinicians that seek to predict the prognosis in PCa patients should take into consideration both the newly proposed ISUP grading system and the CAPRA score.

The Safety and Efficacy of Adjuvant Hemostatic Agents During Laparoscopic Nephron-Sparing Surgery: Comparison of Tachosil and Floseal Versus No Hemostatic Agents

PURPOSE To compare the effectiveness of TachoSil and Floseal during laparoscopic nephron-sparing surgery (LNSS), and to evaluate postoperative complications, especially hemorrhage and urinary leakage. MATERIALS AND METHODS The medical records of all patients that underwent LNSS for a small renal mass (SRM) performed by the same experienced surgeon were retrospectively analyzed. The patients were divided into the following 3 groups, based on hemostatic agent: group 1: no adjuvant hemostatic agent (no AHA); group 2: TachoSil; group 3: Floseal. RESULTS The study included 79 patients; no AHA group: n = 18; TachoSil group: n = 25; Floseal group: n = 36. The 3 groups were similar in terms of diameter [29.6 ± 11.5 mm, 26.4 ± 13.4 mm and 30.4 ± 9.6 mm, respectively (P = .218)] and PADUA scores [6.9 ± 0.9, 6.7 ± 1 and 6.9 ± 0.9, respectively (P =.540)]. Mean duration of surgery was significantly shorter in the Floseal group (120.9 ± 23.1 minutes) than in the no AHA group (156.6 ± 34.4 minutes). Mean ischemia time was longest in the no AHA group (24.3 ± 4 minutes) and shortest in the Floseal group(21.3 ± 4.3 minutes). Intra-abdominal (IA) catheter drainage on postoperative day 1 was significantly higher in the no AHA group thanin the TachoSil and Floseal groups [156.9 ±78.3 mL vs. 72.6 ± 64.5 and 60.8 ± 30.2 mL, respectively (P < .05)]. Mean duration of hospitalization was 3.2 ± 0.5 days in the no AHA group that was significantly longer than in the Floseal group (2.8 ± 0.7 days) (P = .043). There were not any differences in intraoperative complications, the transfusion rate, surgical margin positivity, or postoperative complications between the 3 groups (P = .596, P =.403, P = 1.0, P = .876, respectively). However, pseudoaneurism as a late term complication occurred in 27.7% patients in the no AHA group. CONCLUSION TachoSil and Floseal are safe and effective adjuvant treatments for patients undergoing LNSS. They might be useful especially in preventing pseudo aneurisms, shortening intraoperative ischemia time and hospital stay and decreasing postoperative drainage. Shortened operation and warm ischemia time may also be attributed to long learning curve of LNSS.

Urinary and Fecal Diversion Following Pelvic Exenteration: Comparison of Double-Barrelled and Plain Wet Colostomy

PURPOSE To assess early and late-term outcomes of patients who had undergone pelvic exenteration and simultaneous fecal and urinary diversion with plain wet colostomy (PWC) or double-barrelled wet colostomy (DBWC). MATERIALS AND METHODS The medical records of all patients who had undergone pelvic exenteration and urinary diversion between 2006 and 2017 at our hospital were reviewed retrospectively. RESULTS In total, 15 patients with a mean age of 56 ± 13 years were included in the study. Simultaneous urinary and fecal diversions were carried out as PWC (n = 8), or DBWC (n = 7). No significant differences were found between PWC and DBWC groups in terms of operation time (373.7 ± 66.5 versus 394.2 ± 133.2 min, P = .955), estimated blood loss (862.8 ± 462.4 versus 726.2 ± 489.4 mL, P = .613), length of hospital stay (13.2 ± 9.1 versus 14.1 ±6.9 days), early complications (25% versus 28.6%, P = 1.0) and late term complications (37.5% versus 42.9%, P = 1.0). The rate of recurrent pyelonephritis in PWC group was higher than DBWC group but not statistically significant (37.5% versus 14.3%, P = .569). Overall survival (OS) of the patients was 385 ± 91 days. There was no difference between OS of patients with PWC and DBWC (414 ± 165 versus 352 ± 70 days, P = .618). CONCLUSION PWC and DBWC are valid options for creating simultaneous urinary and fecal diversion after extensive pelvic surgery in patients with short life expectancy. DBWC might be superior to PWC in terms of decreased risk of recurrent pyelonephritis.

Renal Autotransplantation with Autologous Saphenous Vein Graft in a Patient with Takayasu Arteritis and Existing Renal Artery Stent in Her Solitary Kidney

Takayasu arteritis is a disease that results in the granulomatous inflammation of large vessel walls. Takayasu arteritis is generally observed in young females during the second or third decades of life. This disease is treated by the revascularization of the affected organs either by surgery or by endovascular interventions. In this study, we present a case where renal autotransplantation was performed on a lady with an autologous saphenous vein graft subsequent to numerous previous endovascular interventions for her solitary kidney due to Takayasu arteritis-induced renal artery stenosis. The patient was prevented from becoming dialysis dependent through this surgical intervention. Renal autotransplantation is the choice of treatment, especially for those in whom endovascular interventions have failed. Patient management must include the partnership of an experienced vascular surgeon, transplant urologist, rheumatologist, nephrologist and radiologist.

Evaluation of Deceased Kidney Donors for Renal Stone Disease: Is Computed Tomography Needed?

Objective: To investigate the clinical consequences of neglected risk of urolithiasis in deceased kidney donors in routine clinical practice, this study focused on different management options for transplanted allograft stones, and tried to find new solutions for more accurate detection of urolithiasis in deceased kidney donors prior to renal transplantation. Methods and Results: The overall prevalence of stone disease in endemic countries is between 7 and 29%. Because of the increased risk for stone disease in epidemic countries, screening renal grafts from deceased donors necessitates more sensitive imaging tests. Despite well established procedures on preoperative living related renal donor evaluation, there is no consensus on a preoperative imaging tool in cadaveric renal donor evaluation. The most commonly used imaging modality in deceased renal donors is ultrasonography. The overall sensitivity and specificity of ultrasonography for kidney stones are 45 and 88%, respectively. Use of a computed tomography scan for renal diseases, especially for urinary stones is now almost a routine test in clinical practice. Its sensitivity for renal stones < 3 mm is 85%, whereas for renal stones > 3 mm it is 100%. Conclusion: The use of radiological modalities i.e. computed tomography with higher sensitivity in deceased donors prior to renal transplantation seems reasonable in urinary stone epidemic countries.

Sexual Dysfunction in Interstitial Cystitis

Background/Aims: Interstitial cystitis (IC)/bladder pain syndrome (BPS) is a debilitating disease characterized with urgency, frequency, and pelvic pain affecting especially women. Sexual dysfunction in female patients with IC/BPS consists of dyspareunia, altered sexual desire and orgasm frequency and insufficient lubrication is reported to negatively affect the patients quality of life. In the present study, we aimed to determine the association between IC/BPS and sexual dysfunction and improvement in sexual dysfunction related to given treatments. Methods: A PubMed/Medline and EMBASE search was conducted using keywords: “interstitial cystitis”, “sexual dysfunction”, and “bladder pain syndrome”. Conclusion: Several studies have been conducted to determine the relation between IC/BPS and sexual dysfunction. And also limited studies focusing on IC/BPS specific treatments reported significant improvements in sexual function after either oral or intravesical treatment. However, given the used different questionnaires, study protocols, patient characteristics, previous treatments and follow-up period, it is not possible to make a head-to-head comparison of the treatment effects on sexual function. Further, randomized controlled studies are needed to confirm these results and make a comparison between effects of various treatment modalities on sexual functioning in IC/BPS.

Renal Autotransplantation at Three Academic Institutions in Turkey

Objective: The objective of this study is to present the experience of 3 institutions performing renal autotransplantation (RAT) and to discuss surgical techniques employed and the results in the light of the medical literature. Materials and Methods: A total of 14 patients (11 male and 3 female) with a mean age of 47 ± 8 years (35-61 years), who underwent RAT procedure at 3 different institutions between October 2006 and November 2014, in Turkey, were evaluated retrospectively. Indications for RAT procedure are ureteral avulsion, renal artery aneurysm and intimal dissection caused by percutaneous transluminal renal artery angioplasty (PTRA). Twelve patients with ureteral avulsion, 1 patient with renal artery aneurysm and 1 patient with intimal dissection caused by PTRA were followed-up for 103 months. Seven (50%) open and 7 (50%) laparoscopic nephrectomies were performed. Nine patients (64.3%) were right-sided and 5 patients (35.7%) were left-sided. Complications of grade III and above as per Clavien-Dindo classification were assessed. Results: Mean time from injury to RAT was 21.2 ± 40.1 days. However, 5 (35.7%) patients were treated on the same day of the injury. As per Clavien-Dindo classification, 2 (14.2%) grade IVa and 1 (7.1%) grade IIIa complications were reported. However, no significant correlation was observed between the complications and graft loss regarding type and side of the nephrectomy performed (p = 0.462 and p = 0.505, respectively) and timing of the intervention (p = 0.692). Conclusion: RAT is a safe procedure in combination with minimally invasive laparoscopic technique in carefully selected patients; however, it requires expertise and proficiency in laparoscopy, reconstructive urology and transplantation. Nevertheless RAT should be considered as the last resort, when other modalities fail.