Objective: To evaluate the protective effect of tramadol on renal tissue in rats with induced renal ischemia-reperfusion injury (I/R injury), and its effects on oxidative stress.
Material and methods: Thirty adult, male Wistar rats weighing 250–300 g were selected as subjects. Rats were randomized into 3 groups: group 1, sham; group 2, renal I/R injury; and group 3, renal I/R+Tramadol. In order to obtain ischemia in groups 2 and 3, renal artery was clamped for 1 h. Total oxidant status (TOS) and total antioxidant capacity (TAC) were analyzed using biochemical assays in the serum samples.
Results: TOS values were measured as 1.68±0.4 in group 1, 3.35±1.0 in group 2, and 3.49±0.9 in group 3. When group 1 was compared with group 2 and group 3, the TOS values of group 1 were significantly lower (p<0.05), whereas there was no difference between group 2 and group 3 (p>0.05). TAC values were measured as 1.65±1.4 in group 1, 1.85±0.1 in group 2, and 2.79±0.6 in group 3. The antioxidant status of group 1 was not significantly different from that of group 2 (p>0.05), whereas there was a significant difference between group 1 and group 3 (p>0.05).
Conclusions: Tramadol has positive effects on antioxidant levels in renal I/R injury. We think that tramadol may be used in patients who underwent renal surgery and have I/R injury risk. There is a need for studies on this subject including human series.
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Objective: Ejaculatory duct obstruction (EDO) is an uncommon but potentially treatable cause of male factor infertility. However, there are limited data on transurethral resection of the ejaculatory ducts (TURED) as a treatment option. A systematic review was therefore conducted to assess its efficacy and identify patient subgroups that benefit from the procedure.
Material and methods: A database search of PubMed, Embase, and Scopus (up to January 2019) and the World Health Organization trial registry was performed to identify all studies assessing infertile men with EDO undergoing TURED. The primary outcome measures included semen parameters and natural pregnancies. The secondary outcomes included complications, symptomatic improvement, and a change from in vitro fertilization to intrauterine insemination.
Results: Of 3,277 articles screened, 29 studies with 634 patients were included in the study. Although outcomes varied considerably among studies, a general increase in all semen parameters postoperatively was observed. Semen volume (n=23 studies) improved in a median of 83.0% of patients (interquartile range [IQR]: 37.5). Sperm motility and concentration (n=10 and n=21 studies) improved in a median of 63.0% (IQR: 15.0) and 62.5% (IQR: 16.5) of patients, respectively. The natural pregnancy rate across the studies was a median of 25.0% (IQR: 15.7). Improvements in both the outcomes were greater in patients with congenital etiologies and partial EDO. Differences in surgical technique did not appear to affect outcomes.
Conclusion: TURED is associated with improvements in semen parameters and offers a chance of restoring fertility in previously subfertile men. Although results are promising, the current evidence remains limited owing to predominantly retrospective studies with small sample sizes.
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Objective: The Epstein criteria (EC) used to select men for active surveillance do not predict biologically insignificant diseases. Minimal residual disease (MRD) is an undetected microscopic disease that remains after radical prostectomy (RP) and is a biological classification associated with the risk of treatment failure. Subtypes of MRD, the 10-year biochemical failure free survival (BFFS), and restricted mean biochemical failure free survival time (RMST) were determined and compared in EC patients treated with RP.
Material and methods: Consecutive patients with a Gleason 6 biopsy treated at a single institution were divided into those who did or did not fulfill the EC and underwent RP. One month after surgery, samples were taken for the detection of circulating prostate cells (CPCs) and bone marrow micrometastasis. MRD was defined as negative for both CPCs and micrometastasis; patients were positive for micrometastasis and CPCs separately. BFFS for up to 10 years and RMST were determined for each MRD subgroup for EC positive and negative patients.
Results: EC positive men (137/426) were significantly older (p<0.05) and had negative MRD, pT2 (pathologically organ confined) disease (<0.02), and lower frequency of upgrading (p<0.02). Of the EC positive men, 71% were MRD negative, 13% were positive for micrometastasis, and 16% were positive for CPCs with respective 10-year BFFS of 99%, 89%, and 21% (<0.001) (hazard ratio: 1.00, 1.76, 4.03, respectively) with no signficant differences between the 10-year BFFS or RMST for MRD subgroups for EC positive and negative patients.
Conclusions: EC predict pT2, MRD negative disease; however, 29% are MRD positive with a high risk of treatment failure.
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Objective: Management of nephrolithiasis during pregnancy can be challenging because of the potential risks to the mother and fetus. Diagnosis and treatment can be a dilemma owing to the anatomical and physi-ological changes, besides the limitation in the use of X-rays. The aim of this article was to identify any case series or case reports where percutaneous nephrolithotomy (PCNL) was used as a treatment modality for nephrolithiasis in pregnancy.Material and methods: A review of the literature was performed using Medline, EMBASE, CINAHL, and Scopus from 1990 to October 2019. A search was conducted using the following search terms: “urolithiasis,” “renal stones,” “stone disease,” “kidney stones,” “pregnancy,” “pregnant,” “percutaneous nephrolithotomy,” “PNL,” and “PCNL.” The initial search strategy retrieved 52 articles, but after going through them, only 7 were suitable for inclusion in this review.Results: Overall, seven studies reported regarding 16 patients who underwent PCNL procedure during pregnancy. The patients were aged 18–34 years and had the procedure between 11 and 32 weeks of gestation. Most stones were in the renal pelvis or pelvic-ureteric junction and sized 8–40 mm, with the most common indication for the intervention being refractory pain. Most treatments used ultrasound guidance, and X-ray fluoroscopy was employed only in two cases. No complications occurred to the mother or fetus in any of the case reports, suggesting that PCNL is a safe and feasible treatment for patients with persistent symptoms when conservative treatment has failed.Conclusion: All the reported cases of PCNL achieved stone-free status with no complications. Although PCNL has been evidenced to be safe, it must be performed by experienced endourologists after careful con-sultation with the obstetricians. Patient counseling and multidisciplinary team decision-making are para-mount in such complex scenarios
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Objective: The aim of this study was to invastigate the effect of body mass index (BMI) on semen param-eters and reproductive hormone levels in infertile males.Material and methods: Overall, 858 infertile male patients, aged between 18 and 55 years, referred to our infertility clinic were included in the study. Patients without risk factors, besides obesity, that could affect se-men parameters or reproductive hormones were evaluated. Patients were separated into the following three groups: non-obese (<25 kg/m2), overweight (25–29.9 kg/m2), and obese (≥30 kg/m2). Age, semen parameters, and reproductive hormones were evaluated and compared among the groups. In addition, subgroups based on sperm concentration were compared.Results: Total testosterone and testosterone-estradiol ratio negatively correlated with BMI (p<0.001). A positive correlation was observed between BMI and age (p<0.001). Even when adjusted for age, the decrease in total testosterone was significant in all groups parallel to the increase in BMI. Although age, prolactin level, and total testosterone had a significant relationship in univariate analysis, the only significant param-eters were prolactin and total testosterone according to multivariate analysis. There were no significant differences between BMI and semen parameters. No significant difference related to BMI was observed among the infertile groups [severe oligospermia (34.3%), oligospermia (18.2%), and normospermia (47.6%)].Conclusion: A significant negative correlation was observed between increasing BMI and total testosterone. No relationship was observed between BMI and semen parameters except progressive motility. Neverthe-less, prospective longitudinal clinical trials with larger sample sizes involving weight loss are needed to understand the precise relationship of BMI with reproductive hormones and semen parameters in the same individual.
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Special birth defects and neurological diseases can cause neurogenic detrusor overactivity (NDO). First-line pharmacotherapy is the antimuscarinic therapy, which can be limited by side effects or non-effectiveness. Therefore, pharmacological treatment of NDO in children includes off-label use of intravesical injections of botulinum toxin type A (BTA). In this review article, various clinical studies in which BTA was used for the treatment of NDO of different etiologies in children are discussed, including studies about children with acquired NDO. An electronic literature search was performed using PubMed, and studies published prior to March 2019 are reported. BTA injections are a clinically and urodynamically effective and safe treatment for NDO in children. The treatment is also important in protecting the upper urinary tract from damage and improving concomitant bowel dysfunctions. Fibrotic, acontractile bladders with poor bladder compliance and/or a very small initial bladder capacity and/or the presence of an open bladder neck all contributed to poor responses. A combined injection into the detrusor and external urethral sphincter may improve the clinical outcome in the detrusor–sphincter dyssynergia. New application methods are promising, such as the electromotive drug administration, to avoid general anesthesia. Furthermore, the minimal clinically effec-tive dosage, inclusion criteria, and prognostic factors remain to be established.
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Objective: Urethral injury occurs in 10% of patients who suffer from pelvic fractures. Urethroplasty is performed after an interval of 3 months to stabilize the perineal hematoma. It has been reported that the rate limiting step in anastomotic urethroplasty is finding the posterior urethra. Even for the most experienced surgeons, at times, this step can be challenging. The aim of the present study was to describe a novel tech-nique for understanding the three-dimensional (3D) anatomy which would also help in surgical planning and making urethroplasty easy, a step ahead of conventional imaging. Material and methods: Ours is a tertiary referral center with an experience of >1307 cases of pelvic fracture urethral distraction defects. This study was conducted between January 2018 and July 2018. Ethics approval was obtained. No patients incurred any cost for the study. A computerized tomography scan was performed with the bladder filled with contrast saline, and the same solution was injected into the anterior urethra, with a gauze piece tied around the glans. 3D images were then reconstructed, and data were transferred to the 3D Ultimaker™ printer. 3D models were printed to mimic the anatomy of pelvic fracture urethral distraction.Results: A total of 10 models were created. The models, along with conventional urethrogram, were shown to fellows and observers. Visually, they gave a score of 4.3/5. In correlation with urethroplasty, understand-ing the anatomy of the posterior urethra was also important.Conclusion: 3D printing can be applied to pelvic fracture urethral injury to understand the anatomy of the posterior urethra, its distance from the rectum, length of gap, relation to the posterior urethra, direction of displacement of the urethra, and if pubectomy is required or not.
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Objective: To determine the possible role of potassium sensitivity test (PST) in predicting the success of hydrodistention (HD) in patients with bladder pain syndrome/interstitial cystitis (BPS/IC).
Material and methods: Patients who underwent PST before diagnostic cystoscopy and HD were evaluated to collect data regarding the visual analog score (VAS) to assess pain, the voiding diary for frequency of urination/nocturia, mean urine volume per void, interstitial cystitis symptom index, and problem index before HD. Patients were requested to provide the VAS of pain at 1 month and 6 months post-HD. A reduction 2 or more on the VAS of pain was considered as a response adequate to be noted.
Results: The median age of the patients was 46 years. The PST was positive for 27 patients (27/39; 69.2%). At 1 month post-HD, out of the 27 patients with positive PST, 23 (85.2%) were found to have been responsive to HD and 4 (14.8%) were non-responsive. Of the 12 (12/39; 30.8%) patients who showed a negative PST, 7 (58.3%) were non-responsive and 5 (41.7%) were responsive to HD. A logistic regression analysis revealed that PST (p=0.009) was the only parameter that was able to predict HD efficacy at 1 month post-HD.
Conclusion: PST was found to be a predictive factor for the short-term efficacy of HD. BPS/IC patients with positive PST are likely to be more susceptible to the damage of mucosal afferent nerve endings, which results in them benefiting from HD to a greater degree.
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