Umut Gönülalan

Skin-to-Stone Distance Has No Impact on Outcomes of Percutaneous Nephrolithotomy

Objective: Skin-to-stone distance (SSD) is a stronger factor than body mass index in predicting the success of shock wave lithotripsy. We aimed to evaluate the impact of SSD on outcomes of percutaneous nephrolithotomy (PCNL). Materials and Methods: The medical records of 1,280 patients who had undergone PCNL between April 2007 and February 2012 were evaluated retrospectively. 192 patients who had had preoperative non-contrasted computed tomography and single renal access were included the study. According to this median SSD value, patients were divided into two groups: group 1 (SSD ≤94 mm) (n = 92) and group 2 (SSD >94 mm) (n = 90). The groups were compared according to operative and postoperative parameters. Results: We found no significant differences between the two groups with regard to stone-free rate, operation time, fluoroscopy time, hospitalization time, visual analog score of pain, stone burden, transfusion rates and complication rates. On the other hand, the mean body mass index of group 1 was significantly lower than that of group 2 (p < 0.05). Conclusions: In this retrospective review of patients undergoing PCNL, we found that SSD has no impact on operative and postoperative outcomes. These results were in accordance with the safety of PCNL in obese patients.

Acetylsalicylic acid protects erectile function in diabetic rats

We aimed to evaluate the effect of acetylsalicylic acid (ASA) treatment on diabetes‐induced erectile dysfunction. Adult male Sprague–Dawley rats were divided into four groups as follows: (i) control (C), (ii) diabetic (D), (iii) ASA‐treated control (C+ASA) and (iv) ASA‐treated diabetic (D+ASA) groups. In groups 2 and 4, diabetes was induced by injection of 35 mg kg−1 streptozotocin. ASA (100 mg kg−1 day−1, orally) was administrated to rats in groups 3 and 4 for 8 weeks. Both intracavernosal pressure (ICP) and mean arterial blood pressure (MAP) were measured in in vivo studies. In organ bath, the relaxation responses to acetylcholine (ACh), electrical field stimulation (EFS) and sodium nitroprusside were tested in corpus cavernosum (CC) strips. The mRNA expression for neuronal nitric oxide synthase (nNOS) was calculated using reverse transcription polymerase chain reaction technique. In in vivo experiments, diabetic rats displayed reduced ICP/MAP values, which were normalised with ASA treatment. The relaxant response to high‐dose ACh and EFS at low frequencies (1–8 Hz) in CC strips from the D+ASA group were significantly higher when compared to the D group. Treatment with ASA normalised the raised mRNA expressions of nNOS in diabetic penile tissues. ASA may be involved in mRNA of protein synthesis of NO released from nonadrenergic and noncholinergic cavernosal nerve in diabetes.

The effect of diabetes mellitus on α1-adrenergic receptor subtypes in the bladder of rats.

OBJECTIVE To detect the possible alterations on density or sensitivity of α1-adrenergic subtypes in diabetic bladder by reverse transcriptase-polymerase chain reaction technology and in vitro studies. METHODS Experimental diabetes was induced by administration of streptozotocin with a single injection through the tail vein. Rats were divided into control and diabetic groups. Contractile responses of bladder strips from each group were obtained for postassium chloride, adenosine triphosphate, and electrical field stimulation (0.5-32 Hz) in organ bath. Electrical field stimulation responses of strips were evaluated in the presence of PPADS (nonselective P2 antagonist), atropine (cholinergic antagonist), 5 MU (α-1a-adrenergic antagonist), BMY-7378 (α-1d-adrenergic antagonist), and finally CED (α-1b-adrenergic antagonist). mRNA expression of α1-adrenergic subtypes was determined for each group. RESULTS The difference between contractile responses related to electrical field stimulation with incubation with PPADS, atropine, 5 MU, BMY-7378, and CED, respectively, was not significant in the control and diabetic groups (P > .05). The electrical field stimulation responses of strips at 0.5-2 Hz without incubation were significantly different between the control and diabetic groups (P < .05). The contractile responses of strips with PPADS + atropine + 5 MU and BMY-7378 incubations in the diabetic group were significantly lower than in the control group in all doses (P < .05), The mRNA expression of α-1a-adrenergic in the diabetic group was significantly lower than in the control group (P < .05). No change was found in the expression of mRNA of α-1b-adrenergic. CONCLUSION These results support the probability of changes in presynaptic and autonomic receptor sensitivity. We believe that α-1a-adrenergic and α-1d-adrenergic subtypes should be kept in mind in the treatment of diabetic cystopathy.

Predictive values of vascular endothelial growth factor and microvessel-density levels in initial biopsy for prostate cancer.

Angiogenesis is an important factor in the development and progression of prostate cancer (PCA). We aimed to investigate the values of vascular‐endothelial‐growth‐factor (VEGF) expression level and microvessel density (MVD) in the prediction of PCA diagnosis at repeated prostate biopsy (re‐PBx). We retrospectively evaluated 167 patients with re‐PBx according to elevated prostate‐specific antigen levels, suspicious digital rectal examination, and the presence of premalignant lesions. Patients with PCA on re‐PBx were included in the cancer group (n = 17). Patients with benign prostatic hyperplasia or normal tissues on re‐PBx were included in the control group (n = 21). The groups were compared according to the expression level of VEGF and MVD in initial prostate biopsy. There was no statistically significant difference between groups according to age and serum prostate‐specific‐antigen values. The mean VEGF scores of the cancer and control groups were 232.64 ± 11.14 and 183.09 ± 14.56, respectively (p < 0.05). The mean MVD of the biopsy samples in the cancer and control groups were 246.47 ± 17.59 n/mm2 and 197.33 ± 16.26 n/mm2, respectively (p < 0.05). The cutoff values of VEGF scores and MVD were set as 200 and 215, respectively, for PCA detection in our study. Our results showed that the expression level of VEGF and MVD significantly increased in the initial prostate‐biopsy samples of patients with PCA diagnosed with re‐PBx. The evaluation of VEGF expression level and MVD might have an important value in the prediction of PCA at re‐PBx. The expression level of VEGF and MVD should be kept in mind as PCA‐related histopathological changes that indicate the increased angiogenesis in prostatic tissue.

Embryonal paratesticular rhabdomyosarcoma: a case of young adult patient who has inguinal relapse

Scrotal rhabdomyosarcomas originating from paratesticular tissue are most frequently seen in childhood and young adulthood. These are rarely seen malignant tumors. We present a young male with inguinal relapse in the early period that we had achieved a good clinical outcome with chemotherapy and radiotherapy protocols.

A Rare Cause of Urachal Adenocarcinoma: Urachal Diverticle

Urachus is the remnant of the embryologic allantois and the fetal bladder, extending form the bladder roof to the umbilicus. It degenerates in the prenatal period into a tissue band known as the median umbilical ligament. Incomplete degeneration may lead to urachal diverticle development. It is difficult to diagnose unless it is considered in differential diagnosis and imaging modalities are employed. This paper describes a patient treated with partial cystectomy for urachal diverticle, and the pathologic examination revealed urachal adenocarcinoma.

Nephrogenic adenoma of the ureter.

Nephrogenic adenoma (NA) is an uncommon benign lesion of the urothelial tract. The diagnostic features that are useful in the recognition of this benign entity are: the characteristic mixture of various architectural patterns, associated stromal edema and inflammation, hyaline sheath around tubules, and lack of mitotic activity. Although NA appears with hematuria or obstruction, frequently found incidentally in endoscopy or imaging modalities.

An unusual complication of a double-J ureteral stent: renal parenchymal perforation in a solitary kidney.

Double-J ureteral stenting is commonly used in urological practice and has various complications. We report a patient with a renal parenchymal perforation and perirenal hematoma due to a double-J ureteral stent in a solitary kidney. This complication of ureteral stents is rarely observed and is life-threatening.