Tufan Tarcan

ATHEROSCLEROSIS-INDUCED CHRONIC ISCHEMIA CAUSES BLADDER FIBROSIS AND NON-COMPLIANCE IN THE RABBIT

PURPOSEnThe overall goal was to determine whether chronic ischemia and hypercholesterolemia interfere with bladder function and structure. The roles of atherosclerosis-induced chronic ischemia and hypercholesterolemia in bladder fibrosis and non-compliance were studied in the rabbit. The relationship between ischemia-induced changes in the expression of transforming growth factor-beta1 (TGF-beta1) and basic fibroblast growth factor (bFGF) and the severity of bladder fibrosis was also investigated.nnnMATERIALS AND METHODSnMale New Zealand White rabbits were divided into chronic bladder ischemia (CBI, n = 11), hypercholesterolemia (Hch, n = 8) and control (n = 8) groups. The CBI group underwent balloon endothelial injury of the iliac arteries and received a 0.5% cholesterol diet. The Hch group received a 0.5% cholesterol diet alone. The control group was placed on a regular diet. After 16 weeks, iliac artery and bladder wall blood flow measurements, cystometrograms (CMG) and aorto-iliac arteriograms were obtained in all animals. Iliac arteries and bladder tissues were processed for histological staining and computer-assisted histomorphometric image analysis. The expressions of TGF-beta1 and bFGF in bladder tissue were determined by immunohistochemical staining utilizing monoclonal antibodies.nnnRESULTSnAt 16 weeks, arteriography and histology showed significant diffuse atherosclerotic occlusive disease of the aorto-iliac arteries in the CBI group. Iliac artery and bladder wall blood flows were significantly decreased in the CBI group compared with the Hch and control groups. Atherosclerosis-induced CBI shifted the volume-pressure curve to the left and caused severe bladder fibrosis. Hypercholesterolemia also caused fibrosis and non-compliance but to a much lesser extent compared with those caused by CBI. In histomorphometry, the percentage of detrusor smooth muscle was moderately decreased in the Hch group and severely decreased in the CBI group compared with the control group. In immunohistochemical stains of bladder tissues, bFGF expression was similar in the three groups of animals. TGF-beta1 expression was significantly greater in bladder tissues from the CBI group compared with the Hch and control groups.nnnCONCLUSIONSnOur studies show that atherosclerosis-induced chronic ischemia increases TGF-beta1 expression in the bladder leading to fibrosis, smooth muscle atrophy and non-compliance. Hypercholesterolemia also interferes with bladder structure and compliance but to a significantly lesser extent compared with CBI. Our studies suggest that arterial insufficiency and hypercholesterolemia, common aging-associated disorders, may play important roles in the pathophysiology of voiding dysfunction in the elderly.

LONG-TERM FOLLOWUP OF NEWBORNS WITH MYELODYSPLASIA AND NORMAL URODYNAMIC FINDINGS: : IS FOLLOWUP NECESSARY?

PURPOSEnA subset of newborns with myelodysplasia have normal bladder function on urodynamic assessment. We analyzed long-term followup in this population to determine the necessity for subsequent urological surveillance.nnnMATERIALS AND METHODSnWe retrospectively analyzed the records of 25 of 204 newborns (12%) with myelodysplasia in whom neurourological evaluation was normal after surgical repair of the spinal defect. Initial assessment included complete urodynamic study, renal ultrasound, urinalysis and urine culture. These patients were reevaluated every 3 months until age 3 years, semiannually until age 6 years and yearly thereafter. The longest followup was 18.6 years.nnnRESULTSnOf the 25 newborns 22 had myelomeningocele and 3 had meningocele. During a mean followup of 9.1 years urodynamics subsequently showed neurourological deterioration in 8 children (32%). No changes in urodynamics were observed in any patient older than 6 years. All children with neurourological deterioration underwent magnetic resonance imaging, which confirmed a tethered spinal cord that was then surgically corrected. After the untethering procedure 2 patients (25%) regained normal voiding function, whereas in 6 (75%) mild or moderate neurogenic bladder dysfunction persisted.nnnCONCLUSIONSnNewborns with myelodysplasia and initially normal urodynamic studies are at risk for neurological deterioration secondary to spinal cord tethering, especially during the first 6 years of life. Close followup of these children is important for the early diagnosis and timely surgical correction of tethered spinal cord, and for the prevention of progressive urinary tract deterioration.

Mesenchymal stem cell therapy in treatment of erectile dysfunction: Autologous or allogeneic cell sources?: MSC in treatment of ED

To compare the efficacy of intracavernosal injection of autologous and allogeneic mesenchymal stem cells as potential treatment of erectile dysfunction in an experimental rat model.

Safety and Efficacy of Retropubic or Transobturator Midurethral Slings in a Randomized Cohort of Turkish Women

Objective: The aim of this study was to evaluate the safety and efficacy of retropubic (RP) or transobturator (TO) midurethral slings (MUS) in a prospective randomized cohort of Turkish women. Patients and Methods: A total of 54 women with urodynamic stress urinary incontinence (SUI) were randomized to undergo either RP or TO MUS between August 2006 and February 2013 in a tertiary referral center by a single surgeon. All patients had history, physical examination, urodynamic evaluation and quality of life assessments. The validated Turkish versions of the SEAPI, ICIQ-SF and OAB-V8 questionnaires were used. The Advantage® RP and the Obtryx® TO MUS Systems were used for all RP and TO procedures. Results: Twenty-seven patients were randomized to each group. The median follow-up was 48.5 ± 21.8 months. The median hospital stay was 24.0 ± 4.8 h and median operative time was 35.0 ± 19.9 min. The overall objective and subjective cure rates were 92.6 and 79.6%, respectively. The quality of life of all patients significantly increased after the operation compared to their preoperative status. Patients with a poorer subjective cure rate were those with mixed urinary incontinence, whose preoperative SEAPI and OAB-V8 scores were significantly higher. Conclusion: MUS surgery is highly effective and could safely be performed in a cohort of Turkish women with SUI in subspecialty centers by experienced surgeons. There is no significant difference between RP or TO applications in terms of safety and efficacy. Further studies with long-term follow-up data are required.

Is 40 cm H2O detrusor leak point pressure (DLPP) cut-off really reliable for upper urinary tract (UUT) protection in children with myelodysplasia?

INTRODUCTION AND OBJECTIVE: High DLPP is a risk factor for UUT in children with myelodysplasia, where 40 cm H2O is generally considered as the safe limit after McGuire’s study. The purpose of this study is to find out the most accurate cut-off level for the DLPP in terms of UUT protection in children with myelodysplasia. METHODS: We retrospectively reviewed 618 children with myelodysplasia followed at our multidisciplinary clinic between 1996 and 2008. Among these patients, 150 were included in the study based on the availability of urological follow-up data at age of 3 years. Children were assigned to 1 of 2 groups those who had UUT deterioration at age 3 (group 1), which means hydronephrosis, VUR or scar on DMSA, or not (group 2). We compared the incidence of febrile urinary tract infections (FUTI), timing of the primary neurosurgical repair, secondary tethering of the spinal cord (STSC) at age 3 years and urodynamic findings between the groups. RESULTS: Conservative treatment rates are shown in table 1 and urodynamic findings in table 2. Urological follow-up data at age 3 years revealed higher incidences of FUTI and STSC in children in group 1. Different cut-off values of DLPP showed that DLPP above 20 cm H2O has a higher sensitivity for UUT deterioration (table 3). CONCLUSIONS: Determining the cut-off value of the DLPP as 20 cm H2O instead of 40 cm H2O showed a higher sensitivity to predict the risk group for UUT deterioration. Children with myelodysplasia, who have a DLPP between 20 and 40 cm H2O, should be followed closer since % 38.4 of these children in this study had UUT deterioration at age of 3.

The Significance of the Contralateral Testis Size Measurement with Ultrasonography in Predicting Monorchism in Boys with Nonpalpable Testicles

Objective: The aim of this study was to determine the significance of contralateral testis size in predicting monorchism in pediatric patients with unilateral undescended testis. Materials and Methods: The data of patients who underwent surgical operation by a single pediatric urologist for undescended testis between 2013 and 2016 was evaluated retrospectively. The patients were grouped as having monorchism (M), nonpalpable intra-abdominal testis (NPIAT), and palpable undescended testis (PUDT). The dimensions of the testes were measured ultrasonographically and recorded before operation. Patients with nonpalpable testis underwent diagnostic laparoscopy and patients with PUDT underwent inguinal orchiopexy. Results: A total of 57 children with a mean age of 31 (11-60) months were evaluated. Of the children, 12 had M, 9 had NPIAT and 36 had PUDT with a similar mean age (p>0.05). The size of the descended testis was found to be significantly small in NPIAT* and PUDT** groups compared to the M group (*p<0.05, **p<0.001). However, the size of the undescended and descended testes was found to be similar between NPIAT and PUDT groups (p>0.05). Conclusion: The size of the testis in the scrotum might help to localize the position of the undescended testis.

Pain Control and Its Relationship with Histopathological Outcome in TRUS-Guided Prostate Needle Biopsy: A Prospective Non-Randomized Trial

ÖZET insertion in group 3 was not different from that in group 1. There was no significant difference in pathological results between group 1 and groups 2 and 3. Pain scores in patients with chronic prostatitis were statistically higher than those in patients with benign prostatic hyperplasia (BPH) and Pca in groups 2 and 3 (p<0.05).

593 URINE NGF, TGF BETA-1, TIMP-2 AND BLADDER WALL THICKNESS PREDICT UPPER URINARY TRACT DAMAGE AND URODYNAMIC FINDINGS IN CHILDREN WITH MYELODYSPLASIA

INTRODUCTION AND OBJECTIVES: Uroflowmetry or flow rate (FR) is frequently employed in daily paediatric urology (PU) practice both for diagnostic and follow-up purposes. Our goal was to determine the impact of FR in the management of patients seen in a tertiary care center. METHODS: Retrospective chart review of FR without electromyography (EMG) performed consecutively from January 1st to March 31st 2010. Patients that had a FR as part of their PU clinic appointment and available clinical information from the same date were included. Demographics, diagnosis, FR parameters and impact of the FR on management were collected. Impact on management was defined as indication for surgery, introduction of new medications, bladder retraining or biofeedback based on clinical AND FR findings. RESULTS: 524 patients (313 male, 211 female) were included in the study. Mean age was 8.2 years old. In 63 (12%) patients, FR was performed as part of the evaluation for the 1st clinic appointment. Most common diagnoses were: dysfunctional voiding (DV-32.5%), hypospadias (20.2%), vesicoureteric reflux without evidence of DV (VUR-12.8%), monosymptomatic nocturnal enuresis (NE-6.5%), posterior urethral valves (PUV-3.8%), post-circumcision meatal stenosis (MS-3.3%) and hydronephrosis (HN-3.1%). In the DV group, FR contributed to a management decision in 25.2% of patients. In the MS group, surgical intervention was based on symptoms and supported by the FR in 41% of patients; in the PUV group, 50% of patients demonstrated high ( 20cc) post-void residual (PVR), which aided in management decisions. In contrast, there were virtually no changes in management supported by the FR in the NE, HN, VUR and hypospadias groups. In fact, only 2 patients (1.9%) in the post-hypospadias repair group had surgery indicated based on FR findings coupled with symptoms, despite the finding of a prolonged or flat flow curve in 54% of patients in this group. Overall, FR parameters had direct influence in a management decision in only 67 (12.8%) patients. Nonetheless, a repeat test was ordered for 205 out of the remaining 457 patients (44.5%). CONCLUSIONS: In an era of financial restraints and in the context of a busy tertiary PU clinic, judicious use of FR for specific indications may translate into a more cost-effective use of time and resources. As expected, patients with DV were the ones that benefited the most from the test, as did patients with MS and PUV. Patients seen for NE and HN may not need a FR at all. Despite being frequently abnormal, FR in asymptomatic patients post-hypospadias repair had limited impact on management.

1005 THE FUNCTIONAL CONSEQUENCES OF ALLOGENICITY OF ADIPOSE DERIVED STEM CELLS FOR INTRACAVERNOSAL INJECTION AFTER CAVERNOUS NERVE INJURY IN RATS

INTRODUCTION AND OBJECTIVES: Intracavernous injection of adipose derived stem cell(ADSC)s can ameliorate erectile functions after cavernous nerve injury in rats. The use of preprepared allogenic stem cells are desired but no comparative studies exist. The aim of this study is to evaluate functional consequences of either allogenic or autologous use of adipose derived stem cells. METHODS: All rats underwent bilateral paratesticular fat tissue excision at the beginning of the study. ADSCs are isolated from the excised adipose tissue in Marmara University School of Medicine Urologic Research Laboratory. After 15 days of fat excision bilateral cavernous nerve injury is performed which is followed by intracavernosal injection of stem cells or stem cell lysates accordingly to each group. One month after injection Intracavernosal Pressure/ Mean Arterial Pressure(ICP/ MAP) values are calculated after intracavernosal pressure measurement. All rats are sacrificed at the end and penile tissues are taken for immunohistochemical and molecular investigation. RESULTS: A total of 36 Sprague Dawley rats were used. ADSCs isolated from the excised paratesticular fat tissue were characterized with flowcytometry and these cells were demonstrated to be CD90 and CD 44 positive; CD11b, CD 34 and CD45 negative. These stem cells were also differentiated into 2 different tissues to prove their multilineage differentiation capacity. One month after injection ICP/ MAB values in the sham group (Group 1) were significantly higher compared to PBS injection (Group 2) group, 73,1 ( 10,3) ve 47,1 ( 14,2) (Mann Whitney U test p: 0,009), respectively. Both autologous stem cell injection group (Group 5) and allogenic stem cell injection group (Group 3) showed statistically insignificant but still better results when compared to PBS injection (Group 2), 62,1 ( 12,3), 61,0 ( 10,6) and 47,1 ( 14,2) respectively. Autologous or allogenic stem cell lysate injections(Group 4 and 6) were not better than PBS injection. The nNOS staining in corpus cavernosum of rats treated with autologous or allogenic stem cells were stronger. Also nNOS expression was quantitatively better in stem cell injection groups. CONCLUSIONS: ADSC injection can be an effective treatment to regain erectile functions after cavernous nerve injury. The use of either autologous or allogenic stem cells does not change the functional results.