The Significance of Serum C-Reactive Protein and Neutrophil–Lymphocyte Ratio in Predicting the Diagnostic Outcomes of Renal Mass Biopsy Procedure

This study aimed to investigate the predictive role of serum C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) on renal mass biopsy outcomes. A total of 71 patients with suspected kidney masses who underwent renal mass biopsy procedure between January 2017 and January 2021 were retrospectively evaluated. Pathological results after the procedure were obtained and pre-procedural serum CRP and NLR levels were extracted from the patients’ data. The patients were grouped into benign and malignant pathology groups according to the histopathology results. The parameters were compared between the groups. Diagnostic role of the parameters in terms of sensitivity, specificity, and positive and negative predictive values was also determined. Additionally, Pearson correlation analysis, and univariate and multivariate cox proportional hazard regression analyses were also performed to investigate the above association with tumor diameter and pathology results, respectively. At the end of the analyses, a total of 60 patients had malignant pathology on histopathological investigations of the mass biopsy specimens, whereas the remaining 11 patients had a benign pathological diagnosis. Significantly higher CRP and NLR levels were detected in the malignant pathology group. The parameters positively correlated with the malignant mass diameter, as well. Serum CRP and NLR determined the malignant masses before the biopsy with sensitivity and specificity of 76.6 and 81.8%, and 88.3 and 45.4%, respectively. Moreover, univariate and multivariate analyses showed that serum CRP level had a significant predictive value for malignant pathology (HR: 0.998, 95% CI: 0.940–0.967, P < 0.001 and HR: 0.951, 95% CI: 0.936–0.966, P < 0.001, respectively). In conclusion, serum CRP and NLR levels were significantly different in patients with malignant pathology after renal mass biopsy compared to the patients with benign pathology. Serum CRP level, in particular, diagnosed malignant pathologies with acceptable sensitivity and specificity values. Additionally, it had a substantial predictive role in determining the malign masses prior the biopsy. Therefore, pre-biopsy serum CRP and NLR levels may be used to predict the diagnostic outcomes of renal mass biopsy in clinical practice. Further studies with larger cohorts can prove our findings in the future

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer

Surgical removal of an unrecognized tapestry needle from the urethra

The variety of intraurethral foreign bodies has been reported in literature. Most of them tend to be self-inserted because of sexual or erotic reasons. We report a 23-year old male patient who had tapestry needle into his urethra, which was not self-inserted. The patient was referred to our institution with dysuria and hematuria. There was microscopic hematuria in urine analysis and no pathologic sign in sonography. The needle was detected in proximal urethra in pelvic X-ray and endoscopic visualization revealed that it was trapped in mucosa. The needle was successfully removed by open surgery. Main treatment for the removal of urethral foreign bodies is usually endoscopic but open surgery may be required in some cases especially cutting foreign bodies

The awareness of patients with non - muscle invasive bladder cancer regarding the importance of smoking cessation and their access to smoking cessation programs

ABSTRACT Objectives Smoking is the most important risk factor for bladder cancer and smoking cessation is associated with reduced risk of tumor recurrence and progression. The aim of this study is to assess the awareness of non-muscle invasive bladder cancer (NMIBC) patients regarding the importance of smoking cessation, determine their access to smoking cessation programs and the effects of smoking cessation on recurrence rates of NMIBC. Materials and Methods NMIBC patients who were followed with cystoscopy were included in the study. Their demographic properties were recorded, along with their smoking habits, awareness regarding the effects of smoking on bladder cancer and previous attempts for smoking cessation. Moreover, the patients were asked whether they applied for a smoking cessation program. Recurrence of bladder cancer during the follow-up period was also noted. Results A total of 187 patients were included in the study. The mean age was 64.68±12.05 (range: 15-90) and the male to female ratio was 167/20. At the time of diagnosis, 114 patients (61.0%) were active smokers, 35 patients (18.7%) were ex-smokers and 38 patients (20.3%) had never smoked before. After the diagnosis, 83.3% of the actively smoking patients were advised to quit smoking and 57.9% of them quit smoking. At the time of the study, 46.52% of the NMIBC patients were aware of the link between smoking and bladder cancer, whereas only 4.1% of the smoking patients were referred to smoking cessation programs. After a mean follow-up of 32.28±11.42 months, 84 patients (44.91%) had recurrence; however, current smoking status or awareness of the causative role of smoking on NMIBC did not affect the recurrence. Conclusion In our study group, the majority of the NMIBC patients were not aware of the association between smoking and bladder cancer. Although most of the physicians advised patients to quit smoking, a significant amount of the patients were still active smokers during follow-up. Only a small proportion of patients were referred to smoking cessation programs. Urologists should take a more active role in the battle against smoking and refer those patients to smoking cessation programs. Larger study populations with longer follow-up periods are needed to better demonstrate the beneficial effects of smoking cessation on recurrence rates

Rare but lethal disease of childhood: metastatic, muscle invasive bladder cancer

Bladder cancer is the most common malignancy of urinary tract and the seventh most common cancer in men with the peak incidence in the sixth decade of life. Our knowledge about bladder tumors in pediatric age group mainly relies on case series. The reported cases are mostly low grade and non-muscle invasive. We herein present a case of a 17- year-old male with metastatic high-grade muscle-invasive bladder cancer who was presented with macroscopic hematuria and flank pain

A Novel Dosimeter For Measuring The Amount Of Radiation Exposure Of Surgeons During Percutaneous Nephrolithotomy: Instadose™

Introduction The aim of this study was to demonstrate the efficacy of Instadose™, a novel dosimeter designed for radiation workers to provide a measurement of the radiation dose at any time from any computer; to determine the amount of radiation exposure during percutaneous nephrolithotomy (PNL); and to evaluate the factors that affect the amount of radiation exposed. Material and methods Two experienced surgeons wore Instadose™ on the outer part of their lead aprons during the PNL procedures performed between December 2013 and July 2014. Patient demographics and stone characteristics were noted. Factors affecting radiation dose were determined. Fluoroscopic screening time was compared with the amount of radiation in order to validate the measurements of Instadose™. Results Overall, 51 patients with a mean age of 43.41 ±18.58 (range 1–75) years were enrolled. Male to female ratio was 35/16. The amount of radiation was greater than 0.01mSv in only 19 (37.25%) cases. Stone location complexity (p = 0.380), dilation type (p = 0.584), stone size (p = 0.565), dilation size (p = 0.891) and access number (p = 0.268) were not associated with increased radiation exposure. Instadose™ measurements were correlated with fluoroscopic screening time (r = 0.519, p = 0.001). Conclusions Instadose™ is a useful tool for the measurement of radiation exposure during PNL. The advantage of measuring the amount of radiation exposure after each PNL operation is that it may aid urologists in taking appropriate precautions to minimize the risk of radiation related complications.PubMe

The awareness of patients with non - muscle invasive bladder cancer regarding the importance of smoking cessation and their access to smoking cessation programs

<div><p>ABSTRACT Objectives Smoking is the most important risk factor for bladder cancer and smoking cessation is associated with reduced risk of tumor recurrence and progression. The aim of this study is to assess the awareness of non-muscle invasive bladder cancer (NMIBC) patients regarding the importance of smoking cessation, determine their access to smoking cessation programs and the effects of smoking cessation on recurrence rates of NMIBC. Materials and Methods NMIBC patients who were followed with cystoscopy were included in the study. Their demographic properties were recorded, along with their smoking habits, awareness regarding the effects of smoking on bladder cancer and previous attempts for smoking cessation. Moreover, the patients were asked whether they applied for a smoking cessation program. Recurrence of bladder cancer during the follow-up period was also noted. Results A total of 187 patients were included in the study. The mean age was 64.68±12.05 (range: 15-90) and the male to female ratio was 167/20. At the time of diagnosis, 114 patients (61.0%) were active smokers, 35 patients (18.7%) were ex-smokers and 38 patients (20.3%) had never smoked before. After the diagnosis, 83.3% of the actively smoking patients were advised to quit smoking and 57.9% of them quit smoking. At the time of the study, 46.52% of the NMIBC patients were aware of the link between smoking and bladder cancer, whereas only 4.1% of the smoking patients were referred to smoking cessation programs. After a mean follow-up of 32.28±11.42 months, 84 patients (44.91%) had recurrence; however, current smoking status or awareness of the causative role of smoking on NMIBC did not affect the recurrence. Conclusion In our study group, the majority of the NMIBC patients were not aware of the association between smoking and bladder cancer. Although most of the physicians advised patients to quit smoking, a significant amount of the patients were still active smokers during follow-up. Only a small proportion of patients were referred to smoking cessation programs. Urologists should take a more active role in the battle against smoking and refer those patients to smoking cessation programs. Larger study populations with longer follow-up periods are needed to better demonstrate the beneficial effects of smoking cessation on recurrence rates.</p></div

Updated epidemiologic study of urolithiasis in Turkey. I: Changing characteristics of urolithiasis

The worldwide prevalence and epidemiologic characteristics of urolithiasis appear to have changed in the last decade. This study aims to update the current understanding of the disease in Turkey. A representative sample, totalling 2,468 participants between 18 and 70 years of age from 33 Turkish provinces, was enrolled in this cross-sectional study conducted with a professional market investigation company. Participants were evaluated with face-to-face interviews by medical students using a standard questionnaire. Of the 2,468 participants, 274 (11.1%) reported a history of urinary stone disease diagnosed by a physician and an additional 52 (2.1%) had at least one lifetime episode of colic pain. The annual incidence of urolithiasis in 2008 was 1.7%. The male:female ratio was 1:1 in participants with urolithiasis. A family history of urolithiasis was found in 28.5% of the first-degree relatives of the stone formers, compared to 4.4% of the first-degree relatives of the stone-free participants (p = 0.01). Compared to other ethnic groups, the population of Turkish origin had a statistically significant decreased risk of urolithiasis (p = 0.006). Though not statistically significant (p > 0.05), urolithiasis showed a trend toward a geographical distribution within the country, in which southeastern Anatolia and the Aegean regions had higher frequencies compared to the Black Sea, and central Anatolian and eastern Anatolian regions. Urinary stone disease is a severe problem in Turkey, with high prevalence and incidence rates, which differ significantly between ethnic groups. Moreover, current findings demonstrate a demographic shift, with an increased prevalence of stone disease in female subjects

Ischemic hepatitis after percutaneous nephrolitotomy: A case report

INTRODUCTION: Ischemic hepatitis (IH) is the necrosis of the centrilobular hepatocytes of liver and is secondary to liver hypoperfusion in most of the cases. The diagnosis is usually based on biochemical findings due to the absence of symptoms and signs. Although the disease course is often mild, and sometimes is even not diagnosed, the outcome is poor if the etiology of hypotension and liver anoxia is not promptly corrected. PRESENTATION OF CASE: A 64-year-old patient who underwent percutaneous nephrolithotomy (PNL) for right renal pelvic stone developed acute IH at first postoperative day as a result of hemorrhage related severe hypotension. After restoring hemodynamic parameters, she completely recovered 2 weeks after the operation. DISCUSSION: IH is a frequent cause of marked serum aminotransferase elevation and most commonly occurs as a result of arterial hypoxemia and insufficient hepatic perfusion. Although no specific treatment of IH exists, stabilizing the hemodynamic parameters of the patient resolves the problem in most of the cases. CONCLUSION: This case is presented to demonstrate that ischemic hepatitis should be kept in mind if severe hemorrhage occurs during PNL