Tahir Turan

Requirement of Analgesia for Extracorporeal Shock Wave Lithotripsy and Efficacy of a Nonsteroidal Antiinflammatory Drug: Piroxicam

Objective: In this study, the requirement of analgesia and the analgesic efficacy of a long-acting nonsteroidal antiinflammatory drug (NSAID), piroxicam, were investigated in patients with renal stone disease treated with extracorporeal shock wave lithotripsy (ESWL). Methods: This randomized, placebo-controlled study included 60 patients. Patients were divided into two groups randomly. A single dose of saline (2 ml) was given to the patients in group 1 (n = 20) and 2 ml of 40 mg piroxicam to the patients in group 2 (n = 40). All injections were administered into the gluteal muscle 45 min before ESWL. A verbal rating scale (VRS) was used to evaluate the pain. Groups were compared according to age, sex, weight, height, stone size, number of shock waves, duration of ESWL and VRS scores. Results: There was no statistically significant difference between both groups in demographic data, stone size, number of shock waves and duration of ESWL procedure (p > 0.05). However mean VRS scores were significantly lower in group 2 than in group 1 during and after the ESWL procedure. Conclusion: We considered that analgesic agents should be used to control the pain in second-generation lithotriptors. Piroxicam has clinically significant effects on the pain and also antiinflammatory effects, inhibits ureteric activity, and helps in stone passage.

Free and Total Prostate–Specific Antigen Levels in Saliva and the Comparison with Serum Levels in Men

Objective: We investigated free and total prostate–specific antigen (PSA) levels and free/total (f/t) ratio in the fasting saliva and compared them with the serum levels in normal individuals, in patients with benign prostatic hyperplasia (BPH) and prostate cancer. Our aim was to determine free and total PSA and f/t ratio in saliva and to improve and simplify the differentiation between BPH and prostate cancer by using saliva as an alternative to serum.Methods: Serum and fasting saliva concentrations of free and total PSA were measured in 35 men with BPH, 16 men with stage D prostate cancer, and 25 healthy men. Serum and fasting saliva samples were collected at the same time and were analyzed on the same day at our laboratory with microparticle enzyme immunoassay technology.Results: For the total of 76 men, there was a significant correlation between free and total PSA levels in each sample (r = 0.97 for serum and r = 0.44 for saliva, p<0.001). Although there was a significant difference between three groups for serum–free and total PSA levels and serum f/t ratios, no significant difference was determined between groups for salivary free and total PSA levels and salivary f/t ratios. No correlations were found between patient age and salivary PSA levels.Conclusions: Fasting salivary free and total PSA levels are not effected by high serum levels of prostatic origin. Although there was a significant difference between mean serum and salivary levels of free and total PSA in each group, the f/t ratio of saliva was very close to the serum ratio of normal subjects. Determination of free and total PSA in saliva to improve and simplify the differentiation between prostate cancer and BPH is not suitable for use as alternative measurement of serum.

Prevalence of Daytime Urinary Incontinence and Related Risk Factors in Primary School Children in Turkey

Purpose Urinary incontinence is one of the major urinary symptoms in children and adolescents and can lead to major distress for the affected children and their parents. In accordance with the definitions of the Standardization Committee of the International Childrens Continence Society, daytime urinary incontinence (DUI) is uncontrollable leakage of urine during the day. The aim of this cross-sectional study was to investigate the prevalence and associated risk factors of DUI in Turkish primary school children. Materials and Methods The questionnaire, which covered sociodemographic variables and the voiding habits of the children, was completed by the parents of 2,353 children who were attending primary school in Denizli, a developing city of Turkey. The childrens voiding habits were evaluated by use of the Dysfunctional Voiding and Incontinence Symptoms Score, which is a validated questionnaire. Children with a history of neurological or urological diseases were excluded. Results The participation rate was 91.9% (2,164 people). The overall prevalence of DUI was 8.0%. The incidence of DUI tended to decrease with increasing age and was not significantly different between genders (boys, 8.8%; girls, 7.3%; p=0.062). Age, maternal education level, family history of daytime wetting, settlement (urban/rural), history of constipation, urinary tract infection, and urgency were independent risk factors of DUI. Conclusions Our findings showed that DUI is a common health problem in primary school children. In an effort to increase awareness of childrens voiding problems and the risk factors for urinary dysfunction in the population, educational programs and larger school-based screening should be carried out, especially in regions with low socioeconomic status.

Urine and serum free IGF-1 levels in patients with bladder cancer: a brief report

Insulin-like growth factor (IGF)-1, a mitogenic and anti-apoptotic peptide, can affect the proliferation of epithelial cells, and is thought to play a role in cancer development. The free IGF-1 represents the biologically active fraction of IGF-1. We hypothesised that there is a difference in free IGF-1 levels in the urine and serum from patients with TCC and normal subjects. Urine and blood samples were collected from 30 cases of superficial TCC and an equal number control subjects without malignancy. Free IGF-1 levels were measured in duplicate by radioimmunoassay. Specimens of bladder carcinoma were staged histopathologically using the Mostoffi grading system. Statistical analyses were performed using the Mann-Whitney U-test, Pearson correlation and covariate analysis. There was no significant difference in urine and serum free IGF-1 levels between the two groups. The correlation between urine and serum free IGF-1 levels and age was not significant. There was also no significant relationship between free IGF-1 levels and histopathological grading. The results of this pilot study reveal that the free IGF-1 level does not help predict tumour marker in the patients with bladder cancer.

The effect of partial unilateral ureteral obstruction release and allopurinol on the renal malondialdehyde and glutathione levels

Purpose: The aim of the present study was to evaluate whether relief of partial unilateral ureteral obstruction (PUUO) with or without antioxidant drug affect renal tissue malonedialdehyde (MDA) and glutathion (GSH) levels.

Renal tubular apoptosis after complete ureteral obstruction in the presence of hyperoxaluria.

Abstract Hyperoxaluria is a well-known cause of renal stone disease and in vitro studies have shown that oxalate crystals have a stimulatory effect on apoptosis of renal tubular epithelial cells. Total and partial ureteral obstruction also have an accelerating effect on apoptosis of renal tubular epithelial cells. The aim of the present study was to investigate the apoptotic effect of unilateral ureteral obstruction in the presence of hyperoxaluria on the rat kidney. Twenty-eight male Wistar rats were divided into four groups, with seven rats in each. The groups were named G1 (control), G2 (hyperoxaluric), G3 (obstructive) and G4 (hyperoxaluric + obstructive). G2 and G4 rats were given 1% ethylene glycol (a precursor for oxalates) in their drinking water. G1 and G2 rats underwent sham operation, while left proximal ureteral ligation with a 5-zero silk suture was performed on G3 and G4 animals. The rats were sacrificed 2 weeks after the operation; left nephrectomy was then performed. We searched for the apoptotic cells by direct immuno-peroxidase detection of digoxigenin-labeled genomic DNA. The mean ± SD values of the apoptotic cell count was 0.86 ± 0.90 in G1 and 4.33 ± 3.81 in G2. The values for G3 and G4 were 30.17 ± 16.85 and 302.67 ± 184.45, respectively. We found a statistically significant difference between all groups (P < 0.001). When compared with the control group (G1), the mean apoptotic cell count was fivefold that of G2 and 35- and 351-fold those of G3 and G4, respectively. Our study demonstrated that hyperoxaluria with complete ureteral obstruction induces an excessive level of apoptosis, which is responsible for renal damage, and that ureteral obstruction is a more important factor for apoptosis than hyperoxaluria. Considering these data, we also believe that research studies for medical preventive measures must be considered for patients with ureteral obstruction and/or hyperoxaluria.