Effects of using a double J stent after renal trasplantation [Böbrek nakli·sonrasi çi·ft J stent kullaniminin etki·le?i]

Introduction: In modern urology, ureteral stents are playing significant role in avoiding complications after endoscopic or open surgery. In this study, the association between double J stent and ureteral complications, urinary tract infections and creatinine levels in renal transplant recipients after renal transplantation was prospectively assessed. Materials and methods: Between January 2002 and March 2005, 60 recipients after renal transplantation from relative living donors in Cukurova University were observed prospectively. Lich-Gregoir reimplantation was used as ureteroneocystostomy technique. 4.8 French 12 cm double J stent was placed in 30 recipients (Group I). No double J stent was placed in 30 recipients (Group II). Double J stents were removed 14 days after renal transplantation. More than 105 colonies of bacteria in urine culture were considered as urinary tract infection. The creatinine levels and urine volumes of recipients were documented for 7 days postoperatively. Results: There was no difference between two groups according to age, sex, donor's age, operation time and cold ischemia time. Ureteral complications were seen in 6 recipients in group II (no double J) while no complication was seen in group I (p=0.024). Urinary tract infection occurred in 6 recipients in group I and in 3 recipients in group II (p=0.72). The average creatinine level in group I was lower than group II in postoperative 1st, 2nd and 3rd days (p=0.024, p=0.029 and p=0.041) while there was no significant difference preoperatively (p=0.688). There was no significant difference between two groups in after postoperative 4th, 5th, 6th and 7th days (all p>0.05). The average urine volume in group I was more than group II in postoperative 1st day (p=0.017). Conclusion: Ureteral complications after renal transplantation may cause graft loss and mortality. The ureteral stents were used successfully to avoid and reduce the complications. Some centers have suggested that brief stenting could stop minor leakage due to partial disruption of the ureterovesical anastomosis and prevent early obstruction secondary to anastomotic edema or small tunnel hematoma. However, using double J stent routinely was not suggested in some centers because of the stent complications like urinary tract infection, hematuria, stent migration, stone formation, frequency, flank pain, suprapubic pain, dysuria, reflux, stent fracture. As a result, we believe that the double J stents have a significant role in avoiding the ureteral complication and in forming the ureterovesical anastomosis. However, double J stents have to be removed as soon as possible in the recipients who are under serious immunosupressive treatment. Further studies with larger series are necessary to confirm these results

Retroperitoneoscopic nephroureterectomy via three trocars in pediatric patients with end-stage reflux nephropathy

PubMedID: 20879861Background and Purpose: In children with end-stage reflux nephropathy, nephroureterectomy can be performed either open or laparoscopically. It is not common to use a three-trocar retroperitoneal approach for nephroureterectomy with complete ureteral excision in the pediatric age group. We report the results of pediatric retroperitoneoscopic nephroureterectomies by using three trocars only. Patients and Methods: Between August 2003 and November 2009, 13 children-seven boys and six girls-with end-stage reflux nephropathy underwent retroperitoneoscopic nephroureterectomy. The operations were performed by using three trocars with the patient in a flank position under general anesthesia. Renal blood vessels were individually dissected and divided followed by the transection of the ureter at the level of the ureterovesical junction. Results: The mean age of the patients was 6.5±4.4 years (15 months-14 years). Eight of the operations were performed on the left and five on the right side. Mean operative time was 137±47 minutes (75-230min). Estimated blood losses were minimal. Mean hospitalization time was 2.2±0.9 days (2-5 d). No major intraoperative complication was seen. Overall postoperative analgesic requirement was minimal. Cosmetic results were excellent at the initial postoperative visit. Conclusion: Retroperitoneoscopic nephroureterectomy by using three trocars is feasible and safe with excellent outcomes in pediatric patients with end-stage reflux nephropathy. Copyright 2010, Mary Ann Liebert, Inc

CA9 expression as a prognostic factor in renal clear cell carcinoma

PubMedID: 15711113Introduction: We investigated whether CA9 protein could be used as a prognostic tumor marker as well as a diagnostic biomarker in renal clear cell carcinoma. Materials and Methods: Nephrectomy specimens from 92 patients were used in this study. 80 of these were renal cell carcinomas, 10 adenomas and 2 oncocytomas. Of the renal cell carcinomas, 67 were clear cell carcinomas. Immunohistochemical analysis using CA9 monoclonal antibody (M75) was performed on paraffin-embedded specimens. CA9 staining was correlated with tumor stage, grade, lymph node involvement, distant metastasis and cumulative survival time. Results: CA9 was present in 91.2% of clear cell carcinomas. Low staining was a poor prognostic factor, and conversely high staining a good prognostic one. CA9 expression was found to be the best prognostic factor when compared with T stage and grade. Even in low-grade and stage tumors, the presence of low expression correlated with lowered survival times. Conclusions: On the basis of our study, CA9 is a significant molecular marker in renal clear cell carcinomas. Decreased CA9 expression is independently associated with poor survival. CA9 can be used to predict clinical outcome and identify high-risk patients in need for adjuvant immunotherapy and CA9 targeted therapies. Copyright © 2005 S. Karger AG

Public awareness of testicular cancer and self-examination in Turkey: A multicenter study of Turkish Urooncology Society

Background: Testicular self-examination is the easiest and cheapest way to scan testicular cancer. However, the public awareness about testicular self-examination is very low. We aimed to investigate the public awareness of Turkish people about testicular cancer and testicular self-examination. Methods: We performed a survey consisting of 10 questions concerning testicular cancer and testicular self-examination in 799 students in the first year of 12 different medical schools. Aiming for a common method of data collection, the questionnaires were administered to the students during a class just before the lesson started. The whole data from all of the centers were pooled in a common data-base file. Results: Eighty-nine (11.1%) of the participants reported that they had knowledge about testicular cancer, but only 11 (1.4%) of them answered all the questions about testicular cancer correctly. Eight (1%) of the participants reported that they had been performing testicular self-examination routinely once a month. Four (0.5%) of them were both well informed about testicular cancer and had been performing testicular self-examination once a month as suggested. Conclusion: The present study showed that awareness on testicular cancer and testicular self-examination is very low and suggests a need for efforts in Turkey to increase public awareness and education. © 2013 Elsevier Inc

The effects of ureteral obstruction on Cajal-like cells in rats

PubMedID: 19157990Objective: To determine the changes in number and morphology of interstitial cells of Cajal (ICC)-like cells (ICC-LC) at the ureteropelvic junction (UPJ) of rats after experimental distal ureteral obstruction. Materials and methods: Of a total of 109 rats, 20 served as controls (C), 20 underwent sham-operations (SH) and 69 were in the study (S) groups. The UPJs were extracted initially in the C and SH groups, and 7, 14, 30, 60 and 90 days after ligation of the distal ureter in the study groups (S1, S2, S3, S4 and S5, respectively). The sections stained by c-kit anticore were studied under a light microscope. Results: The mean number of ICC-LC was 4.55 ± 2.21 in C, 5.15 ± 3.51 in SH, 7.40 ± 6.88 in S1, 21.16 ± 19.03 in S2, 12.63 ± 8.16 in S3, 10.40 ± 5.09 in S4, and 10.9 ± 6.33 in S5. There was a statistically significant increase in ICC-LC in the study groups, except S1, compared to the C and SH groups. No significant difference was detected in Cajal cell morphology and distribution pattern between groups. Conclusions: Based on the changes in number of ICC-LC at the UPJ after obstruction of the distal ureter compared with the limited data available in the literature, we suggest that ICC-LC have a close relationship with motility of the ureter. © 2008 Journal of Pediatric Urology Company.TF2003LTP16This study had been supported financially by Çukurova University Scientific Research Fund (project number TF2003LTP16)