To Save or not to Save the Kidney: Relieving Unilateral Obstruction May Significantly Improve an Initially Low Split Renal Creatinine Clearance

Objective The aim of this study was to evaluate the change in acute/subacute unilateral renal function after the relief of complete unilateral ureteral obstruction by nephrostomy. Materials and Methods Thirty patients were prospectively enrolled in the study. All had ureteral stone, which were located in the upper ureter in 24 (80%) and in the middle ureter in 6 (20%) patients. As all patients had high-grade hydronephrosis, a percutaneous nephrostomy catheter was placed for the relief of obstruction. At the first week of urinary diversion, 24-hour creatinine clearance (CC) of both affected and normal kidneys were evaluated. In order to determine the difference, same evaluation was performed on the fourth week of nephrostomy placement. Results The mean age of the patients was 44.6 (36-54) years. The mean CC of the affected kidney was 38.8 similar to 4.9 ml/min in the first week of urinary diversion and increased to 42.5 similar to 5.4 ml/min at the end of the fourth week (p<0.001). All patients showed an improvement in CC levels ranging between 2.3% and 17.3% with a mean rate of 8.5 similar to 4.7%. Conclusion According to our results, kidney function may improve during the first month after the relief of obstruction. This improvement may be significant for borderline renal function to determine the curative treatment of an obstructed kidne

Assessment of Voiding Dysfunction and Nocturnal Enuresis Rates in Primary School Children in an Anatolian City with a Validated Dysfunctional Voiding Scoring System Questionnaire

Objective:To investigate the prevalence of voiding dysfunction (VD) and nocturnal enuresis (NE) in Turkish primary school children using a previously validated Dysfunctional Voiding Scoring System (DVSS) questionnaire and a self-administered questionnaire.Materials and Methods:The previously validated DVSS questionnaire was completed by the parents of 3015 randomly selected children. Another questionnaire was also administered for studying VD and NE rates, demographic characteristics, and learning or behavioral problems of children.Results:Of all children, 6.6% (n=199) had a score suggesting VD and 6.1% (n=185) had NE. No significant differences were found between children with and without VD in terms of age, gender, and fluid intake. Children with VD had significantly high rates of constipation (19.7% vs 5.2%; p<0.001) and fecal soiling (32.1% vs 5.1%; p<0.01) compared with children without VD. Children with a higher DVSS score had more frequent behavioral or psychological problems (20.7% vs 4.7%; p<0.01) and learning disabilities (14.7% vs 5.5%; p<0.01). VD had no correlation with overall maternal education level and the type of school (government or private).Conclusion:VD and NE are highly frequent in early childhood and positively correlated with children’s learning disabilities and psychological problems

Pre-emptive Use of Riboflavin in a Rat Model of Bilateral Cavernous Nerve Injury

Objective: Erectile dysfunction is commonly encountered after radical prostatectomy due to cavernous nerve injury (CNI). We investigated the effects of riboflavin (Rb) on bilateral CNI in a rat model. Materials and Methods: Twenty-four male rats were divided into four groups: control (C), patients with bilateral CNI, those with CNI receiving postoperative Rb treatment (CNI+Rb), and those with CNI receiving pre- and post-operative Rb treatment (Rb+CNI+Rb). Bilateral CNI was performed in all groups except for C. The CNI+Rb group was treated with 30 mg/kg Rb daily after CNI for two weeks; the Rb+CNI+Rb group was treated with 30 mg/kg Rb daily one week before CNI and then for two weeks after injury. Mean arterial pressure (MAP) and intracavernosal pressure (ICP) were measured 14 days after CNI in all groups. Tissue malondialdehyde, cyclic guanosine monophosphate, nerve growth factor, superoxide dismutase and total nitric oxide synthase (NOS) activities, neuronal NOS (nNOS) and inducible NOS (iNOS) were analyzed. Results: ICP/MAP ratio was significantly lower in the CNI (p<0.01) and CNI+Rb groups (p<0.05) compared to the control group, however, the Rb+CNI+Rb group had results comparable to the C group in terms of nNOS and iNOS expression in the Western Blot analysis. Conclusion Rb exerted anti-oxidative and anti-inflammatory effects on CNI in a CNI rat model. Rb can be a potential beneficial agent to improve erectile function in nerve-sparing radical prostatectomy patients as a preemptive penile rehabilitation strategy, although further clinical studies are needed

To Save or not to Save the Kidney: Relieving Unilateral Obstruction May Significantly Improve an Initially Low Split Renal Creatinine Clearance

Objective The aim of this study was to evaluate the change in acute/subacute unilateral renal function after the relief of complete unilateral ureteral obstruction by nephrostomy. Materials and Methods Thirty patients were prospectively enrolled in the study. All had ureteral stone, which were located in the upper ureter in 24 (80%) and in the middle ureter in 6 (20%) patients. As all patients had high-grade hydronephrosis, a percutaneous nephrostomy catheter was placed for the relief of obstruction. At the first week of urinary diversion, 24-hour creatinine clearance (CC) of both affected and normal kidneys were evaluated. In order to determine the difference, same evaluation was performed on the fourth week of nephrostomy placement. Results The mean age of the patients was 44.6 (36-54) years. The mean CC of the affected kidney was 38.8±4.9 ml/min in the first week of urinary diversion and increased to 42.5±5.4 ml/min at the end of the fourth week (p<0.001). All patients showed an improvement in CC levels ranging between 2.3% and 17.3% with a mean rate of 8.5±4.7%. Conclusion According to our results, kidney function may improve during the first month after the relief of obstruction. This improvement may be significant for borderline renal function to determine the curative treatment of an obstructed kidne

Böbreği Kurtarmak ya da Kurtarmamak? Tek Taraflı Üreteral Obstrüksiyonun Tedavisi Erken Dönemdeki Düşük Kreatinin Klirensini Anlamlı Olarak Arttırabilir

Amaç Çalışmamızda akut/subakut tek taraflı komplet üreteral tıkanıklığa bağlı böbrek fonksiyonlarının nefrostomi ile tedavi sonrası değişimini göstermek amaçlanmıştır. Gereç ve Yöntem Otuz hasta prostpektif olarak çalışmaya dahil edilmiştir. Hepsinin üreter taşı olup 24'ünde (%80) üst üreter ve 6'sında (%20) orta üreter yerleşimliydi. Tüm hastaların ileri düzeyde hidronefrozu olduğu için perkütan nefrostomi takılması planlandı. Nefrostomi takıldıktan sonra 1. haftada etkilenen böbrek nefrostomiden ve diğer böbrek üretral kreatinin klirensi ölçümü ile değerlendirilmiştir. Değişikliği saptamak için de 1. ayda nefrostomi ve üretral kreatinin klirensleri hesaplanıp 1. haftadaki sonuçlar ile karşılaştırılmıştır. Bulgular Hastalarımızın ortalama yaşı 44,6'dır (36-54). Etkilenen böbreğin 1. haftadaki kreatinin klirensi 38,8±4,9 ml/dak iken 1. aydaki değer 42,5±5,4 ml/dk'ya yükselmiştir (p<0,001). Tüm hastaların kreatini klirens analizlerinde %2,3 ile %17,3 arasında artış saptanmıştır. Sonuç Çalışma sonuçlarımıza göre tek taraflı komplet üreteral tıkanıklığa bağlı bozulan böbrek fonksiyonu nefrostomi takılması sonrası 1. ayda 1. haftaya göre anlamlı olarak düzelmektedir. Bu düzelme böbrek fonksiyonları sınırda olan tek taraflı tıkanıklığı olan hastalarda asıl tedaviye veya nefrektomi yapmaya karar vermede etkili olacaktır.Objective The aim of this study was to evaluate the change in acute/subacute unilateral renal function after the relief of complete unilateral ureteral obstruction by nephrostomy. Materials and Methods Thirty patients were prospectively enrolled in the study. All had ureteral stone, which were located in the upper ureter in 24 (80%) and in the middle ureter in 6 (20%) patients. As all patients had high-grade hydronephrosis, a percutaneous nephrostomy catheter was placed for the relief of obstruction. At the first week of urinary diversion, 24-hour creatinine clearance (CC) of both affected and normal kidneys were evaluated. In order to determine the difference, same evaluation was performed on the fourth week of nephrostomy placement. Results The mean age of the patients was 44.6 (36-54) years. The mean CC of the affected kidney was 38.8&plusmn;4.9 ml/min in the first week of urinary diversion and increased to 42.5&plusmn;5.4 ml/min at the end of the fourth week (p&lt;0.001). All patients showed an improvement in CC levels ranging between 2.3% and 17.3% with a mean rate of 8.5&plusmn;4.7%. Conclusion According to our results, kidney function may improve during the first month after the relief of obstruction. This improvement may be significant for borderline renal function to determine the curative treatment of an obstructed kidney

The Efficacy and Utilisation of Preoperative Magnetic Resonance Imaging in Robot-assisted Radical Prostatectomy: Does it Change the Surgical Dissection Plan? A Preliminary Report

Purpose: We investigated the effect of prostate magnetic resonance imaging (MRI) on the dissection plan of the neurovascular bundle and the oncological results of our patients who underwent robotic radical prostatectomy operation. Materials and Methods: We prospectively evaluated 30 consecutive patients, 15 of whom had prostate MRI before the operation, and 15 of whom did not. With the findings of MRI, the dissection plan was changed as intrafascial, interfascial, and extrafascial technique in the MRI group. Two groups were compared in terms of age, prostate-specific antigen (PSA), and Gleason scores (GSs). Surgical margin status was also checked with the final pathology. Results: There was no significant difference between the two groups in terms of age, PSA, biopsy GS, and final pathological GS. MRI changed the initial surgical plan to a nerve-sparing technique in 7 of the 15 patients. Only one patient in the MRI group had a positive surgical margin on bladder neck. MRI was confirmed as the primary tumour localisation in the final pathology in 93.3% of patients. Conclusion: Preoperative prostate MRI influenced the decision to carry out a nerve-sparing technique in 46% of the patients in our study; however, the change to a nerve-sparing technique did not seem to compromise the surgical margin positivity