Yusuf Ozlem Ilbey

Laparoendoscopic Single-Site Surgery Versus Standard Laparoscopic Simple Nephrectomy: A Prospective Randomized Study

BACKGROUND AND PURPOSE Laparoendoscopic single-site surgery (LESS), an attempt to further enhance the cosmetic benefits of minimally invasive surgery while minimizing the potential morbidity associated with multiple incisions, has been developed recently. Our aim was to compare LESS simple nephrectomy (LESS-SN) and conventional transperitoneal laparoscopic simple nephrectomy (CTL-SN). PATIENTS AND METHODS In this randomized study that was conducted between December 2008 and September 2009, 27 patients who needed simple nephrectomy were randomized to either LESS-SN or CTL-SN. All procedures in both groups were performed by the first author, who is experienced in laparoscopic surgery. Patient characteristics, perioperative details, and time to return to work were recorded. Postoperative evaluation of pain and use of analgesic medication were recorded. RESULTS There was no difference in median operative time (117.5 vs 114 min, P = 0.52), blood loss (50.71 vs 47.15 mL, P = 0.60), transfusion rates (0% for both), and hospitalization time (2.07 vs 2.11 days, P = 0.74) between the LESS-SN and CTL-SN groups. Time to return to normal activities was shorter in the LESS-SN group compared with the CTL-SN group (10.7 vs 13.5 days, P = 0.001). Both the visual analogue scale and the postoperative use of analgesics were significantly lower during postoperative days 1, 2, and 3 in patients who underwent LESS-SN, compared with patients who underwent CTL-SN. There were no intraoperative or postoperative complications in both groups. Compared with CTL-SN, LESS-SN was more expensive, but all patients undergoing LESS-SN were very pleased with the cosmetic outcome (no visible scars). CONCLUSION The early experience described in this study suggests that LESS-SN is a safe and effective alternative to CTL-SN that provides surgeons with a minimally invasive surgical option and the ability to hide the surgical incision within the umbilicus; however, a larger series is necessary to confirm these findings and to determine if there are any benefits in pain, recovery, or cosmesis.

Protective effect of curcumin in cisplatin-induced oxidative injury in rat testis: mitogen-activated protein kinase and nuclear factor-kappa B signaling pathways

BACKGROUND The aim of this study was to investigate the cellular/biochemical mechanisms by which cisplatin (CIS) causes testicular toxicity. We evaluated the role of inducible nitric oxide synthase (iNOS) expression, mitogen-activated protein kinase (MAPK) and nuclear factor-kappa B (NF-kB) activation in the pathogenesis of testicular damage induced by CIS, and investigated the effects of curcumin (CMN) against CIS-induced testicular injury in rats. METHODS Rats were divided into five equal groups: (1) control, (2) CIS, (3) CMN, (4) CIS + CMN and (5) CIS + corn oil. After the treatment, body and testicular weights, and plasma testosterone levels were observed, along with the biochemical, histopathological and immunohistochemical changes in testes. RESULTS Testicular weight, plasma testosterone levels, activities of glutathione peroxidase (GSH-Px) and glutathione (GSH) levels significantly decreased, whereas the level of malondialdehyde (MDA) and nitric oxide (NO) significantly increased with CIS compared with the controls. A significant increase in plasma testosterone levels, GSH levels and GSH-Px activity, and a decrease in MDA and NO levels in testicular tissue were observed with CIS + CMN compared with that with CIS alone. There was marked staining for iNOS, MAPK/p38 and NF-kB/p65 expression with CIS compared with the control and CIS + CMN groups. CIS caused irregular seminiferous tubules, reduction of seminiferous epithelial layers, significant maturation arrest and perivascular fibrosis. CMN administration to CIS-treated rats significantly prevented these histopathologic changes. CONCLUSIONS MAPK and NF-kB activation have a significant role in CIS-induced testicular toxicity. CMN has a strong potential for use as a therapeutic adjuvant in CIS gonadotoxicity.

Potential chemoprotective effect of melatonin in cyclophosphamide- and cisplatin-induced testicular damage in rats.

OBJECTIVE To evaluate the effect of melatonin on cyclophosphamide (CP)- and cisplatin-induced testicular toxicity with use of sperm parameters and biochemical and histopathologic approaches. DESIGN Experimental study. SETTING Vakif Gureba Hospital, Istanbul, Turkey. ANIMALS Six-week-old adult male Wistar albino rats (N = 48). INTERVENTION(S) Cyclophosphamide was administered to rats by gavage at a single dose of 100 mg/kg body weight, only once. Cisplatin was injected intraperitoneally at single doses of 7 mg/kg/d for five consecutive days. Melatonin was both administered separately and coadministered with CP and cisplatin intraperitoneally at a dose of 10 mg/kg body weight. MAIN OUTCOME MEASURE(S) Body and testicular weight, epididymal sperm characteristics, plasma T, and histopathologic structure of the testicular tissue were determined. Malondialdehyde (MDA) and reduced glutathione (GSH) levels and glutathione peroxidase (GSH-Px) activity were assessed in testicular tissue. RESULT(S) Body and testicular weight, epididymal sperm count, motility and morphology, plasma T levels, the activities of GSH-Px, and GSH levels were significantly decreased whereas the level of MDA was significantly increased in rats of the CP and cisplatin group. Melatonin treatment increased GSH levels and GSH-Px activity, decreased MDA level in testicular tissue, and increased plasma T level. Cyclophosphamide and cisplatin caused irregular seminiferous tubules, reduction of seminiferous epithelial layers, significant maturation arrest, and perivascular fibrosis. Melatonin significantly improved histopathologic changes. CONCLUSION(S) Melatonin may prevent CP- and cisplatin-induced testicular damage.

Atorvastatin Prevents Gentamicin-Induced Renal Damage in Rats through the Inhibition of p38-MAPK and NF-kB Pathways

Background and aims. Gentamicin (GM) is still considered to be an important antibiotic against life-threatening, gram-negative bacterial infections despite its known nephrotoxic effects. We aimed to evaluate the potential protective effect of atorvastatin (ATO) against GM-induced nephrotoxicity in rats. Materials and methods. The rats were randomly divided into five groups of six animals each: control, GM (100 mg/kg/day), ATO (10 mg/kg/day), GM + ATO, and GM + Vehicle. Kidney function tests, tissue oxidative stress parameters, and histopathological and immunohistochemical studies clarified GM nephrotoxicity. Results. GM caused a marked reduction in renal functions and increased oxidative stress parameters. Histopathological examination revealed tubular necrosis especially in the renal cortex in GM rats. On immunohistochemical evaluation, GM rat showed more intense expressions of mitogen-activated protein kinase (MAPK), nuclear factor kappa B (NF‐kB), and inducible nitric oxide synthase (iNOS) compared with control. Kidney function tests and tissue oxidative stress parameters were normalized in the GM + ATO group. Histopathological and immunohistochemical pictures were also greatly ameliorated. Conclusions. ATO acts in the kidney as a potent scavenger of free radicals to prevent the toxic effects of GM via the inhibition of MAPK and NF-kB signaling pathways and iNOS expression.

120-W GreenLight Laser Photoselective Vaporization of Prostate for Benign Prostatic Hyperplasia: Midterm Outcomes

OBJECTIVES To evaluate the safety and efficacy of 120-W high-performance system (HPS) laser photoselective vaporization of the prostate (PVP) in the treatment of patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. METHODS Two experienced surgeons performed 120-W HPS laser PVP. The baseline characteristics, perioperative data, complications, and postoperative outcomes were evaluated at 3, 6, 12, 24, and 36 months postoperatively. RESULTS A total of 550 consecutive patients, with a mean age of 67.6 years, underwent PVP with a 120-W HPS laser. The mean prostate volume was 72.93 cm3, with a mean prostate-specific antigen level of 3.57 ng/mL. The mean operative duration and the mean applied energy was 61.3 minutes and 164.06 kJ, respectively. No major complication occurred intraoperatively or postoperatively. The mean follow-up was 17.80 months. Significant improvements were observed postoperatively in the mean International Prostate Symptom Score, quality of life score, maximal urinary flow rate, and postvoid residual urine volume. The mean catheterization time was 18.5 hours. The complications included delayed hematuria in 26 (4.8%), recatheterization in 24 (4.4%), reoperation owing to residual prostatic adenoma in 46 (8.5%), urethral stricture in 19 (3.5%), and bladder neck contracture in 6 (1.1%) patients. CONCLUSIONS PVP with a 120-W HPS laser for benign prostatic hyperplasia has been proved to be a safe and effective procedure for our patients, including those treated with oral anticoagulants. The functional outcome in larger prostates was similar to that in smaller glands.

Possible association of the 5-HTTLPR serotonin transporter promoter gene polymorphism with premature ejaculation in a Turkish population

We evaluated the genotypes of the serotonin transporter gene (5-HTT) in patients with premature ejaculation (PE) to determine the role of genetic factors in the etiopathogenesis of PE and possibly to identify the patient subgroups. A total of 70 PE patients and 70 controls were included in this study. All men were heterosexual, had no other disorders and were either married or in a stable relationship. PE was defined as ejaculation that occurred within 1 min of vaginal intromission. Genomic DNA from patients and controls was analyzed using polymerase chain reaction, and allelic variations of the promoter region of the serotonin transporter gene (5-HTTLPR) were determined. The 5-HTTLPR (serotonin transporter promoter gene) genotypes in PE patients vs. controls were distributed as follows: L/L 16% vs. 17%, L/S 30% vs. 53% and S/S 54% vs. 28%. We examined the haplotype analysis for three polymorphisms of the 5-HTTLPR gene: LL, LS and SS. The appropriateness of the allele frequencies in the 5-HTTLPR gene was analyzed by the Hardy-Weinberg equilibrium using the chi2-test. The short (S) allele of the 5-HTTLPR gene was significantly more frequent in PE patients than in controls (P<0.05). We suggest that the 5-HTTLPR gene plays a role in the pathophysiology of all primary PE cases. Further studies are needed to evaluate the relationship between 5-HTTLPR gene polymorphism and patient subgroup (such as primary and secondary PE) responses to selective serotonin reuptake inhibitors as well as ethnic differences.

Melatonin Attenuates Unilateral Ureteral Obstruction–Induced Renal Injury by Reducing Oxidative Stress, iNOS, MAPK, and NF-kB Expression

PURPOSE To investigate whether melatonin (MLT) treatment has any protective effect on unilateral ureteral obstruction (UUO)-induced kidney injury in rats. MATERIALS AND METHODS Six animals were included in each of the following five groups: group 1, sham operation but no treatment; group 2, unilateral ureteral ligation but no treatment; group 3, sham operation + MLT; group 4, unilateral ureteral ligation + MLT; group 5, unilateral ureteral ligation +5% ethanol (the vehicle of MLT). The injected dose of MLT was 1 mg/kg/day (intraperitoneal). MLT and vehicle were injected daily, beginning 5 days before the unilateral ureteral ligation or sham operation and until 10 days after it. At 10 days after UUO, all rats were sacrificed with high-dose ketamine. Malondialdehyde, glutathione, nitric oxide (NO), and 8-hydroxydeoxyguanosine levels and inducible NO synthase (iNOS), p38-mitogen-activated protein kinase (p38-MAPK), and nuclear factor kappa B (NF-kB) expression were studied. Histopathological examination of the obstructed kidney was also performed. RESULTS UUO was accompanied by a significant increase in malondialdehyde, NO, and 8-hydroxydeoxyguanosine along with a significant decrease in glutathione levels in the kidney tissue, as well as a significant elevation in iNOS, p38-MAPK, and NF-kB expression. MLT treatment resulted in reduction of the parameters of oxidative stress and the iNOS, p38-MAPK, and NF-kB expression. MLT treatment also reduced the development of leukocyte infiltration and interstitial fibrosis in UUO rats. CONCLUSIONS MLT may prevent UUO-induced kidney damage in rats by reducing oxidative stress. The mechanism for this is likely mediated via reduction in the expression of iNOS, p38-MAPK, and NF-kB, since MLT reduces the activation of these pathways.

Transurethral Resection of the Prostate With Monopolar Resectoscope: Single-surgeon Experience and Long-term Results of After 3589 Procedures

OBJECTIVE To present our clinical outcomes and to assess the impact of technological improvements that have occurred recently in transurethral resection of the prostate (TURP) on its morbidity. METHODS The data from the 3589 patients who underwent conventional monopolar TURP for BPH from March 2000 to December 2008 were evaluated retrospectively. Data were analyzed to obtain perioperative and postoperative complications, operative time, weight of prostate chips resected, time to catheter removal, and hospitalization time. Patients were followed at 3 months and then yearly. The follow-up included the International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum urinary flow rate (Q(max.)), and prostate-specific antigen. The significant improvements in mean the IPSS, QoL score, and Q(max.) were observed in postoperative visits. RESULTS Intraoperative perforation of prostatic capsule or bladder neck was observed in 27 (0.75%) patients. In the early postoperative period, clot retention with secondary bleeding was observed in 81 (2.3%) patients. Recatheterization was required in 195 (5.4%) patients. Mild to moderate dysuria was observed in 819 (23%) patients. Urinary tract infection occurred in 234 (6.5%) cases. Severe dysuria, urgency, and urge incontinence was observed in 93 (2.6%) patients in the first week after surgery. During the follow-up period, urethral stricture and bladder neck contracture occurred in 117 (3.2%) and 39 (1.08%) patients, respectively. There was no the iatrogenic incontinence. Re-operation as a result of rest prostatic adenoma was required in 158 (4.4%) patients. CONCLUSION These data demonstrate that a technical improvement in TURP provides a lower complication rate. Conventional monopolar TURP can now be performed with excellent long-term efficacy combined with reduced complications.

Early Experience with Laparoendoscopic single-site pyeloplasty in Children

OBJECTIVE To present our initial clinical experience with laparoendoscopic single-site surgery (LESS) for ureteropelvic junction obstruction (UPJO) in the pediatric age group. MATERIAL AND METHODS Between January and December 2009, 11 consecutive pediatric patients underwent treatment of primary UPJO via a laparoscopic approach. All patients underwent LESS-pyeloplasty. Radiographic success was defined as improvement of hydronephrosis with a patent UPJ on intravenous urography, or improved drainage on diuretic renal scan. RESULTS The mean age of patients was 10 (2-17) years. Crossing lower pole vessel and severe adhesion were found in three (27%) and eight (73%) cases, respectively. The mean operating-room time was 182.5 (160-300) min, and the mean estimated blood loss, including urine, was 97.3 (80-160) mL. Mean hospital stay was 2 (1-3) days. Wound infection at port site and urinary infection occurred in one case each. All parents seem extremely satisfied with postoperative cosmetic outcome. The success rate was 100%. CONCLUSION Preliminary experience with LESS-pyeloplasty in children suggests that outcomes are comparable to conventional laparoscopic surgery but with improved cosmesis; however, a larger study is necessary to confirm these findings and to determine if there are any benefits in postoperative pain or recovery.

Transperitoneal Laparoendoscopic Single-Site Pyeloplasty: Initial Experiences

PURPOSE The purpose of this study was to present our initial clinical experience with laparoendoscopic single-site surgery (LESS) for ureteropelvic junction (UPJ) obstruction. PATIENTS AND METHODS Between May and October 2009, 14 consecutive patients underwent LESS-pyeloplasty (LESS-P) by the same surgeon at our institution. All patients underwent single port transperitoneal Anderson-Hynes laparoscopic dismembered pyeloplasty using the single incision laparoendoscopic surgery port, inserted through a transumbilical incision. Ultrasonography, intravenous urography (IVU) or diuretic renal scan was performed at the third month and semiannually thereafter. Patients were examined clinically every 3 to 6 months, depending on the symptoms. Radiographic success was defined as improvement of hydronephrosis with a patent UPJ on IVU, or improved drainage on diuretic renal scan. RESULTS Anterior crossing vessels, high insertion, and severe adhesion were found in seven (50%), five (35.7%), and two (14.3%) cases, respectively. The mean operating-room time, which includes cystoscopy with retrograde ureteral catheterization and open-end stent placement, was 204.5 minutes (range 160-300 min), and the mean estimated blood loss, including urine, was 102 mL (range 80-170 mL). Mean hospital stay was 2 days (range 1-3 d). Wound infection occurred in one patient. The mean follow-up period was 6.2 months (range, 3-8 mos). The success rate was 100%. CONCLUSION With the advent of the single port and laparoscopic instrument technology, the LESS-P, as minimally invasive surgery, would take the place of the standard laparoscopic pyeloplasty, and it may be a new choice for the management of UPJ obstruction.