Tarik Emre Sener

Hybrid Transvaginal NOTES Nephrectomy: Postoperative Sexual Outcomes. A Three-center Matched Study

OBJECTIVE To evaluate our experience in patients undergoing hybrid transvaginal natural orifices transluminal endoscopic surgery (NOTES) nephrectomy and evaluate the sexual functions in the postoperative period. MATERIALS AND METHODS Prospective data of 71 patients with renal tumors who underwent hybrid NOTES radical nephrectomy in three different centers were collected from March 2010 to October 2015. Patient and surgical characteristics were recorded. Sexual function was evaluated using the Female Sexual Function Index questionnaire the day prior to the operation and 3 months after. RESULTS The mean age, tumor size, and operation duration were 66.16 ± 11.21, 8.51 ± 3.31 cm, and 119.94 ± 21.38 minutes, respectively. Five patients were immediately reoperated due to bleeding from uterine veins. The complication risk increases significantly with increasing tumor size. Among the whole cohort, even the Female Sexual Function Index score differences are small; there is a statistically significant decrease in the postoperative period in all domains except sexual satisfaction. In fact, the patients reported unaltered sexual function after surgery and satisfaction with the result when asked directly. In subgroup analyses, in nulliparous patients (n = 60), arousal, sexual desire, orgasm, and satisfaction domains have no significant differences in pre- and postoperative periods. CONCLUSIONS Hybrid NOTES nephrectomy is a feasible, safe operation that can be performed for large renal tumors. Due to incisions in the vaginal wall for specimen retrieval, sexual function can be altered in the postoperative period. So patient selection, preoperative evaluation, and close follow-up are mandatory. With this in mind, we strongly support the use of hybrid transvaginal NOTES nephrectomy for large renal tumors especially in nulliparous patients.

The effect of betulinic acid on TNBS-induced experimental colitis

ABSTRACT: In this study we have investigated the possible protective effect of betulinic acid (BA) on colonic inflammation in rats. Colitis was induced in Sprague-Dawley rats of both sexes by intracolonic administration of 1 ml trinitrobenzene sulphonic acid (TNBS). Colitisinduced rats received orogastrically either betulinic acid (50 mg/kg/day) or vehicle (0.05% DMSO) for 3 days. At the 72nd hour of colitis induction, the rats were decapitated and trunk blood was collected for the measurement of TNF-, IL-1, lactate dehydrogenase (LDH) levels and total antioxidant capacity (AOC). The distal 8 cm of colon were scored macroscopically, and the degree of oxidant damage was evaluated by malondialdehyde (MDA) and glutathione (GSH) levels, myeloperoxidase activity (MPO), collagen content and by histological analysis. Generation of oxidants was evaluated by tissue luminol and lucigenin chemiluminescences (CL). Colitis caused significant increases in the colonic CL values, macroscopic damage scores, MDA, MPO and collagen levels, along with a significant decrease in tissue GSH level. Similarly, serum TNF-, IL-1, as well as LDH were elevated and AOC was reduced in the vehicle-treated colitis group as compared to control group. On the other hand, betulinic acid treatment reversed all these biochemical indices, as well as histopathological alterations induced by TNBS, suggesting that betulinic acid protects the colonic tissue via its radical scavenging and antioxidant activities. KEY WORDS: betulinic acid; colitis; oxidative damage; inflammation; trinitrobenzene sulphonic acid

Antioxidant Agent Quercetin Prevents Impairment of Bladder Tissue Contractility and Apoptosis in a Rat Model of Ischemia/Reperfusion Injury

To examine the possible protective effect of quercetin (QT), which is well known for its antioxidant and protective effects in circumstances of oxidative stress, on urinary bladder tissue in a rat model of ischemia/reperfusion (I/R) injury, which is a known factor for the development of lower urinary tract dysfunction partly mediated by the generation of free radicals causing oxidative damage.

Effects of flexible ureteroscopy on renal blood flow: a prospective evaluation

Abstract Objective: This study aimed to investigate the effects of flexible ureteroscopy (F-URS) on renal blood flow using renal Doppler ultrasound (US). Materials and method: Patients undergoing F-URS were scheduled for Doppler US preoperatively and postoperatively. Peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI) were reported. Technical details, operation time, stone characteristics and complications were recorded. Patients were grouped as 9.5/11.5–Flex-X2, 10/12–Flex-X2, 10/12–Flex-XC, 12/14–Flex-X2 and 12/14–Flex-XC, with 28, six, three, seven and two patients in each group, respectively. Results: Forty-six patients with a mean age of 41.24 years and stone volume of 1685 mm³ were enrolled. The PSV, EDV, PI and RI of renal arteries in all groups in preoperative and postoperative periods were similar. Arcuate artery measurements in all groups were also similar in preoperative and postoperative periods, without any significant difference except in two parameters: RI in the 9.5/11.5–Flex-X2 group and PSV in the 12/14–Flex-X2 group. The resistive index in the arcuate artery of the 9.5/11.5–Flex-X2 group was increased from 0.59 to 0.62 cm/sec postoperatively. The PSV in the arcuate artery of the 12/14–Flex-X2 group was decreased from 30.9 to 27.2 cm/sec. Three patients had urinary tract infections postoperatively and two had sepsis. Conclusion: This study suggests that compatible ureteroscope–ureteral access sheath combinations with a lumen difference of more than 1.5 Fr can provide safe outcomes in terms of renal blood flow. F-URS can safely be performed in terms of renal perfusion and complication rates with appropriate equipment and instruments.

Resveratrol treatment may preserve the erectile function after radiotherapy by restoring antioxidant defence mechanisms, SIRT1 and NOS protein expressions

Radiotherapy (RT) for prostate cancer (PC) can cause erectile dysfunction (ED) by damaging neurovascular structures with oxidative stress. In this study, we evaluated the effects of resveratrol, an antioxidant, on post-RT ED. Fifty rats in five groups were evaluated; control (C), prostate-confined radiotherapy with short- and long-term vehicle or resveratrol treatment. Cavernosal tissues were obtained to analyze glutathione (GSH), nitric oxide (NO), cyclic guanosine monophosphate (cGMP), 8-hydroxy-2′-deoxy-guanosine (8-OHdG) levels and superoxide dismutase (SOD), caspase-3 activities, sirtuin-1, Foxo-3, nNOS, and eNOS protein expressions. Intracavernosal pressures (ICP) were measured for the long-term treatment group. In the RT + long-term vehicle treatment group, tissue GSH, NO, cGMP, and SOD activity were decreased while 8-OHdg levels and caspase-3 activities were increased. Radiotherapy caused a decrease in sirtuin-1, nNOS, and eNOS protein expressions. These parameters were reversed by resveratrol treatment. Foxo-3 protein expressions were unaltered in the RT + short-term vehicle treatment group and started to increase as a defense mechanism in the RT + long-term vehicle group; however, resveratrol treatment caused a significant increase in Foxo-3 expressions. Resveratrol preserved the metabolic pathways involved in erectile function and provided functional protection. Resveratrol can be used as a supplementary agent in patients undergoing radiotherapy to preserve erectile function.

The Effects of Melatonin on Ethylene Glycol-induced Nephrolithiasis: Role on Osteopontin mRNA Gene Expression

OBJECTIVE To evaluate the protective effects of melatonin (Mel) on an ethylene glycol (EG)-induced nephrolithiasis model in rats. MATERIALS AND METHODS Thirty-two Wistar albino rats were divided into 4 groups: control, EG, prevention Mel (Mel + EG + Mel), and therapeutic Mel (EG + Mel). EG (0.75%) was added to drinking water to create nephrolithiasis model. The EG group received EG and the Mel + EG + Mel group received both EG and Mel for 8 weeks. In the EG + Mel group, EG is given for 8 weeks and Mel is given for the last 4 weeks of the experiment. At the end of experimental period, urine, blood samples, and tissues were collected. RESULTS In 24-hour urine samples, calcium, citrate, and creatinine levels were decreased and oxalate levels were increased in the EG group, whereas Mel prevention and Mel treatment reversed these parameters back to control levels. Malondialdehyde, glutathione activities, myeloperoxidase, superoxide dismutase levels, and caspase-3 activity showed improvements in the Mel-treated groups when compared with the EG group. 8-Hydroxydeoxyguanosine, matrix metalloproteinase 9 levels, N-acetyl-β-glucosaminidase activity, and osteopontin mRNA expression were elevated in the EG group and decreased back to control levels in the Mel + EG + Mel and EG + Mel groups. Histological examination showed improvement in the Mel-treated groups when compared with the EG group. CONCLUSION Mel can prevent crystalluria and kidney damage due to crystal formation and aggregation. It can be considered as a potential prophylactic and protective agent in high-risk patients with urinary stone formation or recurrence if supported by further clinical studies.

Thulium laser vaporesection of the prostate: Can we operate without interrupting oral antiplatelet/anticoagulant therapy?

Purpose Thulium vaporesection of the prostate (ThuVARP) is a new and safe approach for patients receiving anticoagulant therapy in whom transurethral resection of the prostate (TURP) may possess a high bleeding risk. We aimed to demonstrate the efficacy and safety of ThuVARP in patients receiving oral antiplatelet/anticoagulant (OAP/OAC) therapy. Materials and Methods A total of 103 patients who underwent ThuVARP between 2011 and 2013 were enrolled in the study. Patients were divided into 2 groups. Group A consisted of 47 patients who underwent low molecular weight heparin (LMWH) bridging and group B consisted of 56 patients who were operated on while receiving OAP/OAC therapy. Results The drop in hemoglobin levels in the pre- and postoperative periods was significantly higher in group A than in group B. When subgroups were analyzed, the mean drop in hemoglobin was significantly lower in the warfarin and ticlopidine subgroups of group B than in group A. International Prostate Symptom Scores were significantly lower 3, 12, 18, and 24 months after surgery in group A than in group B. Quality of life scores, maximal flow rate values, and postmicturition residual urine volumes (mL) were similar between the 2 groups. A total of 38 and 41 patients in groups A and B, respectively, had no complications. Conclusions Our study showed the safety profile of continuing different OAP/OAC therapies in terms of bleeding problems in patients undergoing ThuVARP. We strongly recommend abandoning LMWH bridging and maintaining the OAP/OAC regimen patients are already receiving.

Ureteroscopy in pregnant women with complicated colic pain: Is there any risk of premature labor?

OBJECTIVE Clinical presentation of ureteral stones during pregnancy is generally with renal colic pain. The aim of this study is to present our experience in the management of renal colic during pregnancy in emergency settings. MATERIALS AND METHODS 208 pregnant patients who presented to emergency department with renal colic pain and underwent ureteroscopy (URS) due to failed conservative therapy were enrolled in the study. Urinary tract stones were diagnosed either with ultrasound (US) examination or during URS. Laser lithotripsy and double J (DJ) stent placement were routinely done in all patients with ureteral stones. The incidence of infective complications and premature uterine contractions (PUC) due to URS were compared. RESULTS No stone was identified in 36.1% (n = 75) of patients with using US and diagnostic URS. Of the remaining 133 patients, 30 (22.6%) had no stone at US but stones were diagnosed during diagnostic URS. The type of anesthesia had no significant effect on PUC. An increased risk of sepsis and PUC was found in patients with fever at the initial presentation. Interestingly, PUC was more frequent in patients with lower serum magnesium levels. There was a significant correlation with time delay until the intervention and the risk of urosepsis and PUC, individually. CONCLUSIONS Ureteroscopy is a safe option for evaluation of pregnant patients with unresolved renal colic. According to the current findings, timing of the operation is the most important factor affecting the septic risks and abortion threat. Surgical intervention with URS must be planned as soon as possible.

Clinical Case Discussion: Bilateral Synchronous Testicular Cancer and Organ-sparing Surgery

In cases of bilateral synchronous testicular cancer, organ-sparing surgery can be performed safely, if appropriate surgical rules are respected and if a stringent follow-up protocol is obeyed. If fertility is a concern, a simultaneous TESE procedure can be performed.

Resistant pediatric priapism: A real challenge for the urologist

Priapism in pediatric patients is a rare entity. We present an 8-year-old boy with known cerebral palsy. He came to the emergency department with sustained painful erection for 12 hours. Physical examination showed rigid penis. Blood count and biochemical analysis were normal. Although penile Doppler ultrasound revealed normal arterial and venous flow, cavernosal blood gas was hypoxic. A total of 50 mL of dark blood was aspirated, and 2 mL of 0.001% adrenalin solution was applied to both corpus cavernosum, twice within 20 minutes, which eventually did not achieve detumescence. A distal Winter shunt was performed at the end of which the penis was semi-flaccid. By the 18th hour of surgery, the penis re-gained painful erection status, so an Al-Ghorab shunt was performed. After the Al-Ghorab shunt, the penis was still in the semi-flaccid state. The next day, an angiography was performed and an arteriovenous fistula was discovered and treated by embolization. The flaccid state was achieved and the patient was discharged the day after the embolization.