Serdar Çelik

Association Between Ureteral Jet Dynamics and Nonobstructive Kidney Stones: A Prospective-controlled Study

OBJECTIVE To evaluate the possible alterations in ureteral jet dynamics which inform physicians about ureteral physiology and peristaltism in nonobstructive kidney stone formers with this prospective-controlled study. MATERIALS AND METHODS All patients with flank pain eligible for the study underwent Doppler ultrasonoghraphy examination for evaluation of ureteral jet dynamics and non-contrast-enhanced computed tomography for diagnostic reasons. Patients with unilateral nonobstructive lower-pole kidney stone ≤1 cm were defined as group 1 and patients with no evidence of urinary tract stone as group 2. Ureteral jet dynamics were compared between the affected and healthy renal units in group 1 and also between affected renal units in group 1 and all renal units in group 2. RESULTS There were 31 and 20 patients in groups 1 and 2, respectively. Mean average jet flow rates (JETave) were significantly lower in affected renal units in group 1 when compared with healthy renal units in group 1 and also when compared with group 2 (10.9 ± 7.6 cm/s, 13.6 ± 5.9 cm/s, and 12.5 ± 3.9 cm/s, respectively; P <.05). Affected renal units were more likely to have continuous jet flow pattern. Odds ratio was 19.3 for patients with JETave <9 cm/s compared with patients with JETave ≥9 cm/s in terms of kidney stone formation. CONCLUSION Decreased JETave and continuous jet flow pattern, both of which may refer to decreased ureteral peristaltism, may precede kidney stone formation. Ureteral jet dynamics should be evaluated in patients with previously known risk factors and especially patients with JETave <9 cm/s need close follow-up. However, further prospective cohort trials may enlighten our findings.

Son los criterios de vigilancia activa suficientes para predecir el cáncer de próstata de estadio avanzado

OBJECTIVES To examine the treatment outcomes of the prostate cancer (PCa) patients treated by radical prostatectomy (RP) who could be good candidates for active surveillance (AS) and test the confidence and reliability of the AS criterias for predicting advanced stage disease (RP Gleason score≥7 or Pathological stage T3). METHODS Between 2005 and 2012 the records of the 401 patients who underwent RP with a diagnosis of PCa were examined. Of these patients, 173 were found to be candidates of AS. The inclusion criteria were as follows; clinical stage T2a or less, PSA<10ng/ml, 2 or fewer cores involved with cancer, no single core with 50% or greater maximum involvement of cancer, and no Gleason grade greater than 3 in the specimen. RESULTS Univariate analyzes revealed that patients with advanced stage disease have higher prostate specific antigen density (PSAD), higher maximum percent (max%) in positive cores and higher RP tumor volumes. In multivariate analyzes PSAD, max% in positive cores and RP tumor volumes were statistically significant determinants for advanced stage disease. ROC analyzes revealed that the RP tumor volume is a good test on advanced stage disease. CONCLUSIONS Decreasing the cutoff values for PSAD and max% in positive cores should be considered for AS inclusion criteria. If we could calculate the tumor volume before RP, we can minimize the treatment failures (over or undertreatment) of PCa. Perhaps new biopsy protocols, tissue biomarkers, and molecular imaging technology may refine AS criteria.

Does leaving residual fragments after percutaneous nephrolithotomy in patients with positive stone culture and/or renal pelvic urine culture increase the risk of infectious complications?

The residual fragments in patients with preoperative and intraoperative culture positivity may serve as an infection focus. The aim of this study was to assess the importance of residual fragments for developing SIRS in patients with stone culture and/or RPUC positivity. After obtaining institutional review board approval, a total of 729 patients who undergone PCNL for renal stones were included in this study. Residual fragments accepted to be positive if any fragment was detected irrespective of size. All patients were followed-up postoperatively for SIRS criteria. The patients were then followed-up for residual stone-related events and infectious complications. 94 of the 729 patients have developed SIRS postoperatively. SIRS positivity was more common among males and found to be associated with higher stone burden and presence of staghorn stone. Patients with residual fragments after PCNL also had higher rates of SIRS. In the subgroup analysis of 203 patients who had post-PCNL residual fragments, the peroperative stone and/or RPUC positivity was not found to be associated with the development of the SIRS. Although presence of residual fragments after PCNL is associated with SIRS development, stone culture and/or RPUC positivity has no additional risk for development of post-PCNL infectious complications in patients with residual fragments.

RE: Concordance of renal stone culture: PMUC, RPUC, RSC and post-PCNL sepsis-a non-randomized prospective observation cohort study

We have read the paper, “Concordance of renal stone culture: PMUC, RPUC, RSC and post-PCNL sepsis-a nonrandomized prospective observation cohort study” [1] with great interest and appreciate the work of the authors. They have tried to determine the association of post PCNL sepsis with preoperative midstream urine cultures (PMUC), renal stone cultures (RSC), and renal pelvic urine culture (RPUC). They found that 24% had positive culture, 3.2% (4/122) PMUC, 14.7% (18/122) RPUC, and 13.9% (17/122) RSC. Seven patients (5.7%) developed postoperative infectious complications. We have a few queries. The authors stated that single-dose third generation cephalosporin was used for prophylaxis. We have read from the paper of Lojanapiwat et al. [2] stating that the bacteria isolated from patients with sepsis revealed more resistance to ceftriaxone, ceftazidime, quinolones, and amoklavin-klavulonik asit, while being relatively more sensitive to amikacin, ampicillin, vancomycin, and carbapenem. And these results guided the authors to rearrange the antibiotics used in the prophylaxis. The antibiogram of the positive cultures were given as multisensitive and multiresistant in the recent paper. We kindly ask the authors what percent of these cultures were third generation cephalosporin resistant? And does it have any impact on anticipating infectious complications in the current study? In the case of infectious complications, two aerobic hemocultures in addition to a new PMUC were obtained from each patient. The results of hemocultures were not given in results section. We think that it is very important data. How many of the patients had positive hemocultures and does it have concordance with PMUC, RPUC, or SC? Stone-free rate was reported as 68.4% for staghorn stones and 85.0% for for non-staghorn stones. In the case of residual stones with positive stone culture what was the approach of the authors? Is it a risk factor for postoperative infectious complication?

A novel use of attenuation value (Hounsfield unit) in non-contrast CT: diagnosis of urinary tract infection

PurposeTo investigate the utility of attenuation value (Hounsfield unit) of the filled bladder on computed tomography (CT) images and the association of these values with simultaneously obtained urine culture results.MethodsBetween January 2016 and December 2017, retrospective data of 58 patients who were admitted to the emergency department for various symptoms were examined. All patients were evaluated with urine dipstick microscopy, urine culture, and abdominal CT simultaneously. Group 1 consisted of patients with positive urine culture (n = 28) and Group 2 consisted of patients with negative urine culture (n = 30). The attenuation value of urine in the bladder at the level of the bladder trigone was measured inside an elliptical drawing covering all the urine inside the bladder excluding the bladder wall on axial non-contrast CT images. The predictive value of this calculated attenuation value for urine culture positivity was evaluated.ResultsThe median attenuation value was − 6 (range − 17.8 to + 11) and 12 (range 0–32) in group 1 and group 2 (p < 0.001). According to cut-off value of − 1 attenuation value, sensitivity for predicting urine culture positivity was 92.9%, whereas specificity was 100% (AUC: 0.977 p < 0.001). Urine culture was positive in all of the 26 patients with attenuation value < − 1, whereas only two of the 32 patients with attenuation value > − 1 had urine culture positivity (p < 0.001 OR 14).ConclusionThe attenuation value of the urine in the defined area of the bladder may aid in the diagnosis of urinary infection with high sensitivity and specificity and without any additional cost.

Partial nephrectomy vs. radical nephrectomy for stage I renal cell carcinoma in the presence of predisposing systemic diseases for chronic kidney disease

Aim of this study is to compare the effects of partial nephrectomy (PN) and radical nephrectomy (RN) for stage I renal cell carcinoma (RCC) on renal functions in patients with diabetes mellitus (DM) and/or hypertension (HT). Charts of patients who underwent surgery for stage I RCC in our department were retrospectively reviewed and patients with DM and/or HT were enrolled. Preoperative and postoperative estimated glomerular filtration rates (eGFR) were calculated according to the Modification of Diet in Renal Disease (MDRD) formulation for both RN and PN groups. Groups were compared for patient demographics, preoperative eGFR, postoperative eGFR and ΔeGFR [(preoperative eGFR) – (postoperative eGFR)] which reflects the renal functional loss. There were 85 patients in the RN and 33 patients in the PN groups. Demographic data were similar but the patients in the PN group had smaller tumor size compared to RN group (32.2 ± 11.8 mm vs 47.1 ± 15.2 mm, p < 0.001). Preoperative eGFR did not differ between groups (75 ± 28.4 mL/min/1.73 m2 vs 75.5 ± 23.8 mL/min/1.73 m2 in RN and PN groups, p = 0.929). However, there were significant differences between groups in terms of postoperative eGFR (57.5 ± 21.7 mL/min/1.73 m2 vs 74 ± 27.5 mL/min/1.73 m2 in RN and PN groups, p < 0.001) and ΔeGFR (17.5 ± 4.2 mL/min/1.73 m2 vs 1.5 ± 0.4 mL/min/1.73 m2 in RN and PN groups, p < 0.001). Our findings favor the use of PN over RN for stage I RCC whenever feasible in patients with predisposing systemic diseases for chronic kidney disease for better preservation of renal functions.

Computed tomography findings predicting the success of silodosin for medical expulsive therapy of ureteral stones

Aim of the study is to investigate the relationship between non‐contrast computed tomography (NCCT) findings and stone expulsion rate with medical expulsive therapy (MET) using silodosin for ureteral stones in male adults. Between January 2014 and June 2015, we retrospectively reviewed the patient charts with uncomplicated ureteral stones on NCCT images, who were treated with silodosin for MET. Stone diameter, volume and hounsfield units (HU) measured by NCCT and treatment findings were noted at the end of treatment. Patients were divided into three groups according to the localization as distal, mid and proximal ureteral stones. NCCT and treatment findings were compared between MET success and failure groups in different localizations. Stone expulsion rate was 81.3% for 134 distal, 45.5% for 22 mid and 27.7% for 47 proximal stones. Stone diameter, volume, and HU were significantly lower for success groups with distal and proximal stones (p < 0.05). In ROC analysis the cut‐off values for stone volume and HU were detected as 48.7 mm3 and 598 HU for success group with proximal stones. Stone expulsion rate was found to be 24 times more (OR = 24; p = 0.001) in patients with <598 HU and 14 times more (OR = 14; p = 0.002) in patients with <48.7 mm3 proximal stones. Lower stone diameter, volume and HU were significant predictors of success with silodosin for MET for ureteral stones. Patients with <598 HU and/or <48.7 mm3 proximal stones may be prescribed silodosin for MET.

A Case of Undifferentiated Trophoblastic Bladder Tumor Which Responded to Germ Cell Tumor Treatment Regimen

Mesane tumorlerinin buyuk kismini urotelyal karsinom, skuamoz hucreli karsinom ve adenokarsinom olusturur. Mesanenin trofoblastik differansiasyon gosteren urotelyal karsinomlari cok nadir gozlenen tumorler arasindadir. Human chorionic gonadotropin (β-HCG) ve HPL sekrete eden bu tumorler immunhistokimyasal olarak plasental trofoblastik tumorlerden farkli ozelliklere sahip tumorlerdir. Bu tumorler kotu prognozlu ve metastazlarla seyreden agresif tumorlerdir. Tedavide kemoterapi temel tedavi yontemidir. Most of the bladder tumors are urothelial carcinoma, squamous cell carcinoma and adenocarcinoma. Trophoblastic differentiation of urothelial carcinoma is a rare tumor of the bladder. These tumors secrete Human chorionic gonadotropin (β-HCG) and HPL and they have different immunohistochemical characteristics from placental trophoblastic tumors. These tumors are aggressive tumors with poor prognosis and multiple metastases. Primary treatment method is chemotherapy for these tumors. Summary Ozet