Lymphadenectomy in Muscle Invasive Bladder Cancer

Bladder cancer is the second most common genitourinary malignancy with urothelial cancer comprising nearly 90% of primary bladder tumors. Urothelial carcinoma of the urinary bladder is the fifth most common malignancy in the United States, with an estimated 76,960 new cases and 163,900 deaths in 2016. Radical cystectomy with lymph node dissection remains the standard treatment for patients with muscle-invasive urothelial carcinoma of the bladder, and also for nonmuscle-invasive disease, refractory to intravesical therapy. The current approaches to pelvic lymph node dissections are based on the removal of lymph nodes most commonly harboring metastatic disease, notably the external iliac, obturator, and hypogastric lymph nodes. The boundaries for a standard pelvic lymph node dissection generally include the bifurcation of the common iliac vessels superiorly and the genitofemoral nerve laterally. Extended pelvic lymph node includes the removal of lymph nodes between the bifurcation of the common iliac vessels and the level of the aortic bifurcation, sometimes including distal aortic and caval nodes up to the level of the inferior mesenteric artery, as well as presacral nodes. Extended and superextended dissection has been reported to be associated with superior survival outcome

Anesthesia for Urological Surgery

Because of the variable techniques and patients’ positions used in urological surgery, anesthesia for urologic surgery requires advanced knowledge and special transactions. In this matter, it is important to follow current approaches for anesthesiologists. Different surgical procedures and complications due to different positions or anesthesia were evaluated separately to be more concise. We have researched recent literature and created this chapter about new technologies in urological surgery and development in anesthesia for urological surgery

Investigation the effect of propranolol, metoprolol and carvedilol on spermatogenesis in rat testis

Background: Coronary arterial diseases are one of the increasing disease around the worldwide. Because of common using of the beta blockers, we aimed to investigate the effect of different beta-adrenergic receptor blockers on spermatogenesis in male rats.Methods: Adult male Sprague Dawley rats were obtained. Totally 32 rats homogenized according to their weight and divided into four groups that each one includes eight rats. Three of groups were determined as drug groups and remained groups were determined as a control group. Propranolol 40mg/kg, Metoprolol succinate 60mg/kg, Carvedilol 30mg/kg dosage was given by oral gavage within the saline solution, and the only saline solution was given to control group for 21 days, respectively. After 21 days rats were sacrificed, and testis were extracted. Then, histopathologic evaluation was performed.Results: There was statistical significance both right and left testis volume of experimental between control and carvedilol groups (p<0.05). There was statistical histopathological significance between control and carvedilol (p<0.05), control and propranolol (p<0.05), metoprolol succinate and propranolol (p<0.05), metoprolol succinate and carvedilol groups (p<0.05), respectively.Conclusions: Beta-adrenergic receptor blockers have adverse effects on spermatogenesis. Especially propranolol and carvedilol that were non-selective, effects spermatogenesis worse than selective beta blockers such as metoprolol succinate. Extensive use of these drugs may affect spermatogenesis in male, so male patients who have a complaint of infertility should be questioned regarding the use of beta blockers

The Effect of Obturator Nerve Blockade on Oncological Outcomes of Patients with Lateral Wall Localized Non-Muscle Invasive Bladder Cancer

Objective:To investigate the effect of obturator nerve blockade on oncological outcomes of patients with a diagnosis of lateral wall localized non-muscle invasive bladder cancer.Materials and Methods:One hundred six patients diagnosed with lateral wall localized non-invasive bladder cancer were evaluated between January 2015 and March 2020 in this retrospective, cross-sectional observational study. The patients were divided into two groups: patients receiving only spinal anesthesia and those receiving spinal anesthesia combined with ultrasound-guided obturator nerve blockade. Oncological outcomes of the groups were compared statistically.Results:We observed recurrent tumors in 25 patients (45.5%) in Group 1 and 11 patients (21.6%) in Group 2. Additionally, we observed tumor progression in eight patients (14.5%) in Group 1 and two patients (3.9%) in Group 2. We observed statistical significance in differences between groups regarding tumor size, recurrence rate, adequate muscle tissue sampling, ability for complete resection, and persistent obturator reflex. The efficacy rate of obturator blockade was 92.1% in Group 2. One-year recurrence-free survival (RFS) was 98.0% and 5-year RFS was 23.5% for Group 1, while for Group 2, they were 97.4% and 57.2%, respectively.Conclusion:The obturator reflex is a common and challenging reflex that may cause major complications and result in unintended consequences, such as incomplete resection or tumor recurrence with transurethral resection of bladder tumors. In this study, we demonstrated that combining spinal anesthesia with obturator nerve blockade for lateral wall localized non-muscle invasive bladder cancer may prevent tumor recurrence and reduce peroperative complications

Predictive value of hounsfield unit in urinary system stones applied with eswl

This study claims to examine the relationship between the Housfield unit (HU) value and the success of Electro Shock Wave Lithotripsy (ESWL) treatment. Data of 142 patients were evaluated retrospectively in this cross-sectional observational study. The threshold value for stone density is calculated as 991.20 HU in the ROC analysis. The patients are seperated into two groups with respect to this value, and their demographic characteristics, stone characteristics and success rates after ESWL treatment are statistically compared. For the variables that are statistically crucial in the univariate analysis, logistic regression analysis are used as a multivariate analysis. The mean age of all patients were 45.25±11.72 years and the mean body mass index (BMI) is 28.42±3.98 kg/m2. While our stone-free rate was 66.2% in our study, the mean stone size was 11.25±3.83mm, the Hounsfield unit value was 1007.55±337.75 HU, and the stone-skin distance was 108.02±20.02mm, respectively. We observed a crucial difference in between the Housfield unit value and stone size in univariate and multivariate analyzes between the two groups, and the stone-free rate after ESWL. The Hounsfield unit value, measured by the non-contrast computed tomography method, is a parameter for the prediction in success of patients undergoing Electro Shock Wave Lithotripsy treatment. Also, stone density above 991.20 HU in patients having urinary system stone disease requires the evaluation of alternative treatments as a condition that reduces the success of the treatment

Urodynamic Evaluation of Female Patients with Metabolic Syndrome

Objective: In this study, our main objective is to show the connection between metabolic syndrome (MetS) and bladder functions by using urodynamic evaluation in female MetS patients.Materials and Methods: 131 female patients referred to our clinic for urodynamic evaluation from April 2014 to December 2014 were included in our study. 85 of these patients were diagnosed with MetS (study group) meanwhile 46 patients did not meet MetS criteria (control group). MetS definitions were taken from National Cholesterol Education Program’s Third Adult Treatment Panel criteria. SPSS 17.0 was used for statistical analysis of data and p&lt;0.05 values were deemed as statistically significant.Results: Urodynamic results of 131 patients were analyzed and patients were divided into study and control groups in accordance with their MetS profile. 85 patients were included in the study group and rest 46 were used as the controls. A statistically significant difference was detected when IPSS results were separated into low, intermediate and severe between study and controls (p=0.007). Moreover, urge-type incontinence was more frequent in MetS patients when compared with control group (p&lt;0.001). However, there was no significant difference between groups in terms of SEAPI scores and IPSS. Patients with MetS had significantly higher detrusor, vesical and abdominal pressure in comparison with control group (p&lt;0.001). No significant difference was found in uninhibited contractions, first urinary sense, strong desire to urinate, Valsalva leak-point pressure (VLPP) and abdominal leak-point pressure (ALPP) parameters between the groupsConclusion: Our results showed that MetS and its components can be associated with neurogenic bladder symptoms due to peripheral neuropathy and urge incontinence. Female patients with MetS have significantly higher post-voiding residue and intravesical pressure in comparison with control group. Further clinical studies with longer and controlled series are necessary for clarification of the metabolic syndrome’s effect on bladder dysfunction on a molecular level

The predictive value of the systemic immune-inflammation Index for the progression of lower urinary tract symptoms in men

Introduction: This retrospective cross-sectional observational study aimed to investigate the predictive value of the systemic immune-inflammation index (SII) for the progression of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Material and method: A total of 280 patients diagnosed with LUTS were analyzed, and their demographic characteristics, laboratory results, urological parameters, and SII levels were recorded retrospectively. Results: Clinical progression of LUTS was observed in 43.2% of the patients, with 23.9% undergoing surgery and 21.4% progressing to acute urinary retention. The study found that elevated SII levels were significantly correlated with disease progression and worse outcomes. Multivariate analysis revealed that peak urinary flow rate, erectile function scores, and platelet levels were risk factors for predicting clinical progression in LUTS/BPH patients. Conclusion: The findings suggest that systemic inflammation and immune dysregulation play a role in BPH pathogenesis and the development of LUTS. Incorporating SII assessment into routine clinical practice could aid in risk stratification, treatment decision-making, and monitoring of disease progression in LUTS/BPH patients

Deep learning model-assisted detection of kidney stones on computed tomography

Introduction: The aim of this study was to investigate the success of a deep learning model in detecting kidney stones in different planes according to stone size on unenhanced computed tomography (CT) images. Materials and Methods: This retrospective study included 455 patients who underwent CT scanning for kidney stones between January 2016 and January 2020; of them, 405 were diagnosed with kidney stones and 50 were not. Patients with renal stones of 0-1 cm, 1-2 cm, and >2 cm in size were classified into groups 1, 2, and 3, respectively. Two radiologists reviewed 2,959 CT images of 455 patients in three planes. Subsequently, these CT images were evaluated using a deep learning model. The accuracy rate, sensitivity, specificity, and positive and negative predictive values of the deep learning model were determined. Results: The training group accuracy rates of the deep learning model were 98.2%, 99.1%, and 97.3% in the axial plane; 99.1%, 98.2%, and 97.3% in the coronal plane; and 98.2%, 98.2%, and 98.2% in the sagittal plane, respectively. The testing group accuracy rates of the deep learning model were 78%, 68% and 70% in the axial plane; 63%, 72%, and 64% in the coronal plane; and 85%, 89%, and 93% in the sagittal plane, respectively. Conclusions: The use of deep learning algorithms for the detection of kidney stones is reliable and effective. Additionally, these algorithms can reduce the reporting time and cost of CT-dependent urolithiasis detection, leading to early diagnosis and management