Interstisyel Sistit Hastalarının Mesanelerindeki Sinir Boyanma Yoğunluğunun İdrar Sinir Büyüme Faktörü (Ngf= Nerve Growth Factor) Düzeyi ve Hastalık Semptom Skoru ile Korelasyonu

Interstitial cystitis/ Bladder Pain Syndrome (IC/BPS) is a challenging disease effect millions of people around the world. It presents with suprapubic pain, frequency, urgency and dysuria but there are not any definitive diagnoses and treatment modalities yet. In this original study, we aim to assess the role of nerve fibers and nerve growth factor (NGF) in IC/BPS etiopathology and to demonstrate if there is a correlation between bladder nerve staining concentration, NGF and symptom severity. Thus, there might be no reason for unnecessary, expensive and troublesome tests and treatments. A prospective clinical study was conducted between March 2014 and February 2015 with 15 IC/BPS patients and 18 controls after local ethics committee approval. İnformed consent was obtained from patients and control subjects. Bladder biopsies were obtained from 15 IC/BPS patients and 9 controls. Midstream clean- catch urine specimens were collected from all patients and controls for urine NGF and creatinine measurements. O'Leary Sant İnterstitial Cystitis symptom and problem index was used to asses symptom severity and affects of the disease on patient life. Biopsies fixed in formalin were sectioned to 5-μ thicknesses and stained with S-100 immune histochemical dye. Patients and controls were classified into 3 groups as no staining, mild staining and obvious staining by an experienced urologic pathologist according to bladder nerve fiber staining concentration. The mean age of the IC/BPS patients was 52 years, while that of the control group was 46.9. There was no significant difference between the two groups (p>0.5). S-100 staining was negative 7 (%29.2) of 24 patients of those 1 of them was IC/BPS patient and the remaining 6 were controls. Mild staining was demonstrated in 10 IC/BPS patients as well as obvious staining was shown in 4 IC/BPS patients. Mean urine NGF levels normalized to the urine Cr level (NGF/Cr) in IC/BPS patients were significantly higher than that in controls, 0,34726 ±0,225 and 0,09434±0,0813, respectively (p0.5). Mesane biyopsilerinde S-100 sinir boyaması yapılan toplam 24 hastanın 7'inde (%29.2) boyanma olmamıştır. Boyanma olmayan IS/MAS hasta sayısı 1 iken, bu sayı kontrol grubunda 6 kişidir. 10 IS/MAS hastasında hafif boyanma varken 4 IS/MAS hastasında bariz boyanma tespit edilmiştir. IS/MAS hastalarının idrarlarındaki kreatinine göre normalize edilmiş ortalama NGF düzeyleri (NGF/Cr) kontrol grubu hastalarınınkinden anlamlı olarak yüksektir; sırasıyla 0,34726 ±0,225 ve 0,09434±0,0813 (p<0.001). IS/MAS hastalarının ortalama semptom skoru 12,27±2,4 iken, problem skoru 10,9 ±2,3'dür. IS/MAS hastalarındaki sinir boyanma yoğunluğu ve NGF/Cr seviyesi hem O'Leary Sant IC semptom skoru ile (sırasıyla p=0.024 ve p=0.001) hem de problem indeksi ile (sırasıyla p=0.010 ve p=0.028) bağımsız olarak korele idi. Fakat sinir boyanma yoğunluğu ile NGF/Cr seviyeleri arasında korelasyon bulunamamıştır. Bu durum her bir gruptaki hasta sayısının azlığına bağlı olabilir. Bu çalışma IS/MAS hastalarında mesane sinir boyanmasının ve idrar NGF düzeyinin önemini ve semptom ve problem indeks skorlarını üzerine olan etkisini gösteren literatürdeki ilk çalışmadır. İS/MAS hastalığı etyopatogenezinde sinir sisteminin ve ilişkili nöropeptidler ve nörotropinlerin yeri yadsınamaz bir gerçektir. NGF hem tanı hem de semptom ve problem şiddetini değerlendirmek için faydalı bir biyobelirteç olarak kullanılabilir. Hasta sayısının azlığı ve güncel kanıtların sınırlılığı nedeniyle geniş hasta popülasyonu ile yapılacak olan kontrollü randomize çalışmalara ihtiyaç vardır

İMPAKTE ÜRETER TAŞLARINDA POSTOPERATİF ÜRETER DARLIĞI ÖNGÖRÜLEBİLİR Mİ?

İMPAKTE ÜRETER TAŞLARINDA POSTOPERATİF ÜRETER DARLIĞI ÖNGÖRÜLEBİLİR Mİ?11Şenol Tonyalı , Mazhar Ortaç1İstanbul Üniversitesi İstanbul Tıp Fakültesi, Üroloji Anabilim Dalı, İstanbulAmaç:İmpakte üreter taşı nedeniyle flexible ya da semi-rigid üreterorenoskopi (URS) yapılan hastalarda üreter darlığını predikte eden faktörleri ortaya koymak.Materyal ve Metod:Kliniğimizde tek cerrah tarafından Nisan 2019-Aralık 2019 tarihleri arasında impakte üreter taşınedeniyle fURS ya da semi-rigid URS operasyonu geçiren hastalar çalışmaya dahil edildi. Üreter taşı yanında böbrek taşı olan ve bu taşa da müdahale edilen hastalar çalışmadan dışlandı. Hastaların demografik özellikleri, taş yerleşimi ve boyutu, URS öncesi nefrostomi olup olmaması, semptom süresi, postoperatif DJS kalış süresi ve intraoperatif üreter mukoza görünümü değerlendirilen parametreler idi.Bulgular:Çalışmaya 11’i erkek, 9’ü kadın olmak üzere toplam 20 hasta dahil edildi. Hastaların yaş ortalamaları 47.1± 11.8 yıl idi. Hastalardan 3’ünün taşı üst üreterde, 6’sininki orta üreterde, 9’ununki distal üreterde, 2 tanesininki ise tüm üreter boyunca yerleşmiş idi. Hastaların ikisinde multiple taş mevcuttu. Hastaların 19’unda (%95) ortalama 1.1±0.5 seansta taşsızlık elde edildi. Ortalama 147.5 gün takipte 6 (%30) hastada üreter darlığı saptandı. Darlıkların beş tanesi endoürolojik yöntemlerle yönetilirken bir hasta nefrostomi ile takipedildi. Proksimal üreter taşlarının darlık oluşturma oranı diğerlerinden anlamlı olarak yüksekti,p=0.016.İşlem öncesi nefrostomi ile takip edilmiş olan hastalarda darlık oranı daha yüksekti, p=0.004. Yapılan çok değişkenli regresyon analizinde taş lokalizasyonu, taş boyutu, taşa bağlı pyelonefrit hikayesi, semptom süresi, nefrostomi varlığı, işlem sonrası DJS kalış süresi parametrelerinden hiç biri impakte üreter taşlarında postoperatif darlık oluşumunu predikte edemedi; sırasıyla p=0.83, p=0.27, p=0.99,p=0.27, p= 1.0, p=0.54.Sonuç: İmpakte üreter taşlarının tedavisi sonrası meydana gelebilecek olan üreter darlığına taş ve hasta kaynaklı pek çok faktör neden olabilir. Cerrahi teknik yanında üriner sistem anatomisi ve yapısı ile hastanın doku iyileşmesi belirleyici faktörler olabilir

Evaluation of the Side Effect Profile of Intracavitary Bacillus Calmette-Guérin Treatment in Non-muscle-invasive Bladder Cancer

Objective:To reveal the association of side effect profiles seen in patients receiving intravesical bacillus Calmette-Guérin (BCG) immunotherapy for non-muscle-invasive bladder cancer (NMIBC) treatment with patient age and possible changes over time due to the use of different BCG strains.Materials and Methods:We retrospectively analyzed the medical records of all patients who received BCG for NMIBC in our hospital between January 2013 and December 2017. Investigated parameters included patients’ demographics, treatment dates, local and systemic side effects (dysuria, hematuria, cystitis, headache, arthralgia/myalgia, chills, fever, fatigue, epididymo-orchitis, renal abscess, pneumonia, hepatitis, and sepsis), need for hospitalization and antituberculous therapy, discontinuation of therapy, and doses received.Results:The study included 89 patients (84 male, 5 female) with a mean age of 67.4±10.2 years. The most common side effects were dysuria (41.6%), chills (31.5%), hematuria (30.3%), fever (29.2%), cystitis (24.7%), and fatigue (23.6%). Ten patients (11.2%) were hospitalized due to treatment-related side effects. Ten patients discontinued treatment due to side effects. Sixty-two patients (69.7%) experienced at least 1 local or systemic side effect. There was no significant difference between patients younger and older than 70 years in terms of side effect rates (69.8% vs 69.4%, p=0.576). In addition, a significant difference was not observed in complication rates when we compared treatment before and after 2016 (65.3% vs 75%, p=0.322).Conclusion:Intracavitary BCG can be the treatment of choice in NMIBC even in patients at an advanced age. The absence of a significant change in complication rates over the years despite changing strains may be evidence that strains have a similar side effect profile

Squamous Metaplasia and Its Management in Non-malignant Bladder Diseases

Objective: To reveal possible associations between non-malignant bladder disease and malignancy by evaluating the pathologic examination results of patients who underwent cystectomy for non-malignant diseases and to suggest a point of view for disease management. Materials and Methods: Medical records of patients, who underwent cystectomy in our clinic between January 2005 and January 2015 for non-malignant diseases, were examined retrospectively. Results: A total of 14 patients were included in the study. The mean age of the patients was 58.7±9.3 years. Of the patients eight of them were followed up with interstitial cystitis (IC), five with neurogenic bladder and one with hemorrhagic cystitis. Time from diagnosis to cystectomy was 6.1±5.8 years on average in IC patients, 13.8±9.8 years in neurogenic bladder patients and 10 years in hemorrhagic cystitis patients. No malignancy finding was observed according to the pathologic examination results of the cystectomy specimens. However, either chronic or active inflammation was observed in all the patients. In addition to other pathologies non-keratinized squamous metaplasia was detected in five patients. Conclusion: Patients with non-malignant diseases should be followed-up with cystoscopy and bladder biopsy as a pre-malign lesion caution. Although cystectomy and urinary diversion are surgery methods with high complication rates, they could be suggested to well-informed patients as treatment alternatives

Renal autotransplantation at three academic institutions in Turkey

Objective: The objective of this study is to present the experience of 3 institutions performing renal autotransplantation (RAT) and to discuss surgical techniques employed and the results in the light of the medical literature. Materials and Methods: A total of 14 patients (11 male and 3 female) with a mean age of 47 +/- 8 years (35-61 years), who underwent RAT procedure at 3 different institutions between October 2006 and November 2014, in Turkey, were evaluated retrospectively. Indications for RAT procedure are ureteral avulsion, renal artery aneurysm and intimal dissection caused by percutaneous transluminal renal artery angioplasty (PTRA). Twelve patients with ureteral avulsion, 1 patient with renal artery aneurysm and 1 patient with intimal dissection caused by PTRA were followed-up for 103 months. Seven (50%) open and 7 (50%) laparoscopic nephrectomies were performed. Nine patients (64.3%) were right-sided and 5 patients (35.7%) were left-sided. Complications of grade III and above as per Clavien-Dindo classification were assessed. Results: Mean time from injury to RAT was 21.2 +/- 40.1 days. However, 5 (35.7%) patients were treated on the same day of the injury. As per Clavien-Dindo classification, 2 (14.2%) grade IVa and 1 (7.1%) grade IIIa complications were reported. However, no significant correlation was observed between the complications and graft loss regarding type and side of the nephrectomy performed (p = 0.462 and p = 0.505, respectively) and timing of the intervention (p = 0.692). Conclusion: RAT is a safe procedure in combination with minimally invasive laparoscopic technique in carefully selected patients; however, it requires expertise and proficiency in laparoscopy, reconstructive urology and transplantation. Nevertheless RAT should be considered as the last resort, when other modalities fail

Trends in radiation protection use and radiation exposure of European endourologists: an ESUT-YAU Endourology Group prospective trial

We have carried a theoretical study of the K^- p to M B gamma reaction with M B = K^-p, bar{K}^0 n, pi^- Sigma^+, pi^+ Sigma^-, pi^0 Sigma^0, pi^0 Lambda, for K^- lab. momenta between 200 and 500 MeV/c, using a chiral unitary approach for the strong K^-p interaction with its coupled channels. The Lambda(1405) resonance, which is generated dynamically in this approach, shows up clearly in the d sigma/dM_I spectrum, providing new tests for chiral symmetry and the unitary approach, as well as information regarding the nature of the resonance. The photon detection alone, summing all channels, is shown to reproduce quite accurately the strength and shape of the Lambda(1405) resonance. Analogous reactions in nuclei can provide much information on the properties of this resonance in a nuclear medium