Turgay Ebiloglu

The role of urinary nerve growth factor for the diagnosis and assessment of the biofeedback success in children with dysfunctional voiding.

INTRODUCTION Dysfunctional voiding (DV) occurs in neurologically normal children who are not able to establish brain control on detrusor muscle contractions (DMCs). It is also reported to be the result of incorrect voiding habits during toilet training. Children contract pelvic floor muscles (PFMs) to suppress DMC and DV begins. Urinary nerve growth factor (uNGF) is necessary for the synthesis and regulation of neurotransmitters, development of dorsal root ganglia (sensory neurons), and development of sympathetic cells during embryonic and post-natal life. uNGF has also a role in the intracellular signal transduction in nerve cells towards the target organ. To our knowledge, no study has investigated the association between uNGF, biofeedback treatment and DV in children. OBJECTIVES The aim was to examine the potential effect of uNGF in the assessment of the effectiveness of biofeedback success in children with lower urinary tract disorders. STUDY DESIGN Fifty-two children with the suspicion of DV and 48 children from a primary school reporting no urinary complaints were enrolled in this study from October 2010 to April 2013 in the Urology Department. uNGF levels were compared. RESULTS The mean uNGF/creatinine (Cr) level was 0.23 ± 0.26 in the control group and 0.96 ± 0.88 in the DV group (p < 0.001). The mean uNGF/Cr levels in the DV group at baseline and at the end of biofeedback therapy at 6 and 12 months were 0.90 ± 0.78, 0.26 ± 0.32, and 0.40 ± 0.50, respectively (p < 0.001) (Figure). DISCUSSION To our knowledge this study is the first to show the correlations between uNGF levels and biofeedback therapy in children with DV. Tissue NGF in 12 patients with overactive bladder (OAB)/detrusor overactivity and 15 healthy women was previously compared and it was suggested that there was no correlation between bladder tissue NGF and OAB. uNGF levels in the bladder in patients with interstitial cystitis and idiopathic sensorial urgency were evaluated previously, and uNGF levels reported. Similar to these reports, most of the previous studies handled uNGF in patients with diseases such as interstitial cystitis, OAB, urinary tract infections, urolithiasis, spinal cord injury, and prostate cancer, and found significantly higher uNGF levels. These studies were generally in adults. A previous study about uNGF comprised 40 children with OAB, in contrast to other studies. According to this study, 40 children diagnosed with OAB were administered anti-muscarinic therapy (oxybutynin 0.3-0.5 mg/kg/day). It was reported that uNGF/Cr levels of the OAB group were higher than control group. In the current study, we evaluated the uNGF difference in DV and the effect of biofeedback treatment on uNGF levels. CONCLUSIONS uNGF levels were higher in children with DV and decreased after biofeedback therapy. uNGF levels could be used for the diagnosis and the assessment of biofeedback success in these children.

Treatment of Resıstant Cyclophosphamide Induced Haemorrhagic Cystıtıs: Revıew of Literature and Three Case Reports.

Haemorrhagic Cystitis (HC) is defined as diffuse inflammatory bladder bleeding due to many aetiologies. Massive HC often arises from anticancer chemotherapy or radiotherapy for the treatment of pelvic malignancies. Phosphamides are the anti-cancer drugs used for treating breast cancer, B-cell lymphoma, leukemia, rheumatoid arthritis and systemic lupus erythaematosis by cross-linking strands of DNA and preventing the cell division. They are also used in bone marrow transplantation for prevention of Graft Versus Host Disease (GVHD). Hepatic metabolism of phosphamide forms acrolein, and acrolein makes ulceration, haemorrhage, edema and necrosis of the urothelium during its excretion by the urine. Infectious causes of HC in immunocomprimesed patients are adenovirus, BK polyoma-virus (BK), JC virus, and Cytomegalovirus (CMV). The present article attempts to make a review of literature for the treatment of intractable HC and report three cases with HC.

Can urinary nerve growth factor distinguish high-grade prostate cancer?

To the Editor: Sir, we read with great interest the published article by Liss et al. [1] entitled “Urinary nerve growth factor as an oncologic biomarker for prostate cancer aggressiveness.” The authors have suggested that urinary nerve growth factor (uNGF) was able to distinguish high-grade prostate cancer (PCa) before radical prostatectomy, and NGF might be a biomarker for higher-grade PCa and may provide unique information about patients with PCa pending further confirmatory studies. However, we think there are some points that should be mentioned as contributory factors. The authors have defined restricted exclusion criteria. They should also state whether the patients have one of following diseases, which could possibly affect NGF levels: neuropsychiatric diseases such as epilepsy, depression, schizophrenia, and eating disorders or cardiometabolic diseases such as atherosclerosis and metabolic syndrome [2]. Moreover, they should define whether the patients have urolithiasis, overactive bladder, interstitial cystitis, bladder outlet obstruction, or coincidental upper urinary tract malignancies, which were shown to affect uNGF levels [3,4]. Urinary biomarkers are frequently reported as a normalized ratio to urinary creatinine (Cr) concentration to control for variations in urine flow rate. The implicit assumption is that urinary Cr excretion is constant across and within individuals, such that changes in the ratio will reflect changes in biomarker excretion [5]. Therefore, NGF/Cr ratio is more reliable than log10 NGF, and the findings of the authors are not satisfactory. The authors did not find statistically significant difference between groups when they used the NGF/Cr ratio; we believe that this ratio is superior to log10 NGF value to make inferences although they found difference when they used log10 NGF.

Oxidative stress parameters in patients with prostate cancer, benign prostatic hyperplasia and asymptomatic inflammatory prostatitis: A prospective controlled study

BACKGROUND The imbalance between oxidant and reductant mechanisms creates a nidus for the etiopathogenesis of several diseases. In this study, we aimed to compare the oxidative stress (OS) parameters in patients who were diagnosed with prostate cancer (pCa), benign prostatic hyperplasia (BPH) or asymptomatic inflammatory prostatitis (AIP), according to the histopathologic examination of transrectal ultrasonographic prostate biopsy and transurethral prostate resection specimens. OBJECTIVES In this study, we aimed to compare oxidative stress between histologically proven prostate cancer, hyperplasia and prostatitis. MATERIAL AND METHODS According to histopathologic examinations, 97 patients were divided into 3 study groups: group 1: pCa (n = 30), group 2: BPH (n = 41), and group 3: AIP (n = 26). Finally, 30 patients were enrolled in a control group. MDA levels, CuZn-SOD, Se-GPx, CAT activities, and trace element levels were evaluated. RESULTS A statistically significant difference between prostate cancer and other groups were documented in terms of MDA activity. Contrary to AIP, a statistically significant difference has also been encountered between BPH and the control group. Decreased CuZn-SOD enzyme levels were found in PCa and BPH patients without statistical significance. Increased CAT activity was also documented in PCa, BPH and AIP patients. No significant difference in GPX activity was documented between the groups, except BPH and control group. Trace element levels were low in the patients with prostate cancer and BPH when compared with the control group. CONCLUSIONS Despite the data regarding OS in PCa patients, there is a paucity of data regarding BPH and especially AIP patients. Our study revealed obvious oxidative stress in BPH and PCa patients as opposed to AIP. Assessing the oxidative stress in these patients may assist in the future prevention, diagnosis and also treatment. However, the question whether the presence of OS-related parameters and drugs could be used for the diagnosis or management of prostatic diseases, needs to be addressed in future larger and better studies with a more rational basis.

The biofeedback treatment for non-monosymptomatic enuresis nocturna

Enuresis is a child older than 5 years wetting in discrete portions during sleep. It has two subgroups: monosymptomatic enuresis nocturna (MSEN) and non‐monosymptomatic enuresis nocturna (NMSEN). In this research, we specifically aimed to examine the effect of biofeedback in NMSEN.

Concised Form for Lower Urinary Tract Dysfunction Symptom Scale in Children

INTRODUCTION Symptom Scales (SS) are questionnaires for evaluating and following up of special illnesses. SS used for the diagnosis and follow-up of Lower Urinary Tract Dysfunction (LUTD) in children is called LUTD Symptom Scale (LUTDSS). AIM Aim of the present study was to identify the questions which are more important for the diagnosis of LUTD in children and create a simpler SS. MATERIALS AND METHODS From January 2005 to March 2015, 631 children between the age 5 and 15 were enrolled in this study. Eleven children with active urinary tract infections were excluded from the study. Two hundred sixty three children from the nursery and secondary school saying that they have no urinary complaints and having LUTDSS <9 were designed as control group. Three hundred fifty seven children with LUTDSS score ≥9 were thought as having LUTD and diagnoses were verified with 3-day bladder diaries and 2-time Uroflow-EMG-PVR tests. The answered questions of LUTDSS in patient and control group were compared. RESULTS Children with daytime incontinence (first question of questionnaire) were 47.7 (4.8-510) times (p=0.01), children with enuresis (third question) were 59.53 (6.2-961) times (p=0.001), children with pause while urinating (eighth question) were 28.7 (4.4-2090) times (p=0.001), children with urgency (tenth question) were 54.7 (29.3-604) times (p=0.039) more likely to have LUTD than the children not having these complaints. The area under ROC curve created by using 1,3,8, and 10 questions was calculated 86.4%. CONCLUSION The diagnosis and control of LUTD can be made by using only 1., 3., 8. and 10. questions, and these 4 questions could form simpler SS for LUTD in children.

Flexible Ureterorenoscopy versus Mini-Percutaneous Nephrolithotomy for the Treatment of Renal Stones

PURPOSE To compare the pain status and stone free rates of flexible ureterorenoscopy (F-URS) versus mini-percutaneousnephrolithotomy (mini-PNL) for the treatment of 1-to 2-cm renal stones. MATERIALS AND METHODS This study was retrospectively designed with match paired method. Between January 2013 and December 2016, 387 patients underwent stone surgery for renal stones, 45 patients underwent FURS and 45 patients underwent mini-PNL. 90 patients were divided into two groups according to the surgical procedures. Group 1 patients underwent F-URS, and Group 2 patients underwent mini-PNL. During the intraoperative andpostoperative periods, pain management for all patients was standardized. Pain scores were determined using a visual analogue scale (VAS) completed at 2, 6, 12 and 24 hours postoperatively. The stone free status, hemoglobin levels, fluoroscopy time (FT), operation time (OT), hospitalization time (HT), return to work time (RWT), and complications were noted for each patient. RESULTS Of all patients, the mean age was 41.1 ± 12.1 years and the mean stone size was 13.9 ± 2.9 mm. The VAS scores were significantly higher in the mini-PNL group at 2, 6, 12 and 24 hours (P < .05). The stone-free status and complication rates were similar between the two groups (P > .05); however, the hemoglobin decreases and the fluoroscopy, operation, hospitalization and return to work times were higher in the mini-PNL group than in the F-URS group (P < .05). CONCLUSION F-URS is less painful than mini-PNL for the treatment of 1- to 2-cm renal stones. However, the stone free rate is similar between the two procedures while mini-PNL is superior in terms of fluoroscopy, operation, hospitalization and return to work duration. We think that F-URS is more comfortable and less painful than mini-PNL and achieves a similar stone free rate for the treatment of 1- to 2-cm renal stones.

Our experience with ureterocystoplasty in bilateral functional kidneys

OBJECTIVE We have reviewed the data of the patients in order to evaluate the effectiveness of our ureterocystoplasty technique in augmentation cystoplasty operation. MATERIAL AND METHODS Data of a total of 16 patients with bilateral functional kidneys who had undergone augmentation ureterocystoplasty between January 1995 and June 2018 which were retrieved during the retrospective archive scanning were included in the study. Ultrasonography (USG), serum blood urea nitrogen and creatinine values and Technetium-99 DTPA (Tc-99 DTPA) scan were used to evaluate the renal function of the patients. Intravenous pyelography (IVP) and USG were used to evaluate the ureters before surgery. Magnetic resonance (MR) urographies were performed in our center. RESULTS Of the total 16 patients, 10 were male and 6 were female, while ages ranged from 1 to 24 years. Among 16 patients, the most common cause of neurogenic bladder etiology was meningomyelocele. In the urodynamic studies performed before the operation, it was determined that the bladder capacities of the patients were between 40-180 mL and the bladder compliances were 1.0-4.0 cc/cmH2O. At postoperative 3rd months, it was determined that the bladder capacities of the patients were between 180-330 mL and the bladder compliances were between 6.0-24.0 cc/cmH2O. CONCLUSION Augmentation ureterocystoplasty seems to be an appropriate technique in which successful results are obtained with appropriate patient selection. Besides, complications that may occur due to use of ileal segment are avoided.

Transüretral Prostat Rezeksiyonu Sonrası Medikal Tedaviye Devam Durumunun Öngörülmesinde Preoperatif Prostat Boyutu Belirleyici midir

GIRIŞ ve AMAC: Benign prostat hiperplazisi (BPH) nedeniyle TURP uygulanan hastalarin kucuk de olsa bir bolumunde postoperatif alt uriner sistem semptomlari (AUSS) devam etmekte ve bu hastalarda medikal tedaviye devam edilmektedir. Biz de calismamizda, TURP uygulanan hastalarda prostat boyutu ile postoperatif ek girisim oranlari ve AUSS nedeniyle medikal tedaviye devam edilme oranlari arasinda iliski olup olmadigini arastirdik. YONTEM ve GERECLER: Preoperatif prostat boyutlarina gore hastalar Grup 1 (prostat hacmi ≥80 ml) ve Grup 2 (prostat hacmi <80 ml) olarak iki gruba ayrildi. Gruplar; preoperatif PSA degerleri ve prostat volumu, eslik eden ko-morbiditeler, postoperatif ek sistoskopi ve sistometri yapilip yapilmadigi, postoperatif medikal tedavi kullanimi acisindan karsilastirildi. BULGULAR: Calismaya toplam 87 hasta dahil edildi. Grup 1’deki 26 hastada prostat boyutu ≥80 ml iken, grup 2’deki 61 hastada prostat boyutu <80 ml idi. 87 hastanin 19’una (%22), postoperatif donemde AUSS’nin devam etmesi nedeniyle, sistoskopi veya sistometri yapildi ya da medikal tedavi yeniden baslandi. Istatistiksel olarak anlamli olmasa da, 80 ml altinda prostat hacmi olup, TURP uygulanan hastalarda, postoperatif AUSS’nin daha sik goruldugu gozlendi. TARTIŞMA ve SONUC: Her ne kadar TURP sonrasi iseme bozukluklarini ve risk faktorlerini belirlemek icin prospektif ve genis serili calismalara ihtiyac olsa da, elde ettigimiz veriler buyuk prostatlarda TURP’nin cerrahi sonuclarinin daha yuz guldurucu olabilecegine isaret etmektedir. Turkce Kisa Baslik: Prostat Hacmi ve Tedaviye Devam Durumu

The outcome of percutaneous nephrolithotomy on ≥50 mm staghorn and multiple calyceal stones

Objective To determine the success rate of percutaneous nephrolithotomy (PNL) in kidney stones over 50 milimeters. Material and methods Twenty-four patients with a renal stone size of >50 mm between January 2007 and December 2016 were enrolled. Stone-free and complication rates were investigated. Results Twenty-one (87.5%) patients were male and 3 (12.5%) were female. Fifteen (62.5%) stones were located in the right, and 9 (37.5%) in the left kidney. Twenty-one (87.5%) patients were operated using single-access, and three (12.5%) patients were double-access. Thirteen (54%) patients were found to have no stone after operation and 11 (46%) patients had residual stones. Extracorporal shock wave lithotripsy was applied to 5 of 11 patients with residual stones, while flexible ureteroscopy was applied to 6 of them. After additional treatments, 8 (33.5%) patients were observed to be stone free. The stone-free rate was 87.5%. The mean operation time was 135.43 (85-240) minutes. Hemoglobin levels before and after operation were 14.8 (12-16.7) and 12.6 (9.3-15.5), respectively (p=0.001). The hospital stay was 6.04 (4-8) days. Complications were observed in four patients (16.6%). Conclusion PNL has high stone-free rate on staghorn type large stones compared with multiple calyceal scattered large stones.