Turkish journal of urology最新文献

Objective: Recent years have seen a steep rise in minimally invasive surgical therapy (MIST) for benign prostate hyperplasia (BPH). Prostatic urethral lift (UroLift) is a mechanical intervention aimed at reducing lower urinary tract symptoms, which affect patients with BPH.

Material and methods: A narrative synthesis of all studies regarding UroLift is performed over the last decade, evaluating its impact on International Prostate Symptom Score (IPSS), quality of life (QoL), Qmax, Benign Prostate Hypertrophy Impact Index, and sexual health metrics.

Results: The studies included have demonstrated significant improvements in the objective parameters measured. UroLift has a low side-effect profile and is comparable to transurethral resection of the prostate in QoL changes and is superior with respect to recovery time and ejaculatory function.

Conclusion: Our findings suggest that UroLift may be an appropriate treatment for individuals undergoing treatment for BPH who are concerned with sexual and ejaculatory functions. More studies are needed to determine who is eligible for UroLift, as well as the long-term impact of UroLift on individuals with BPH.

Objective: Transurethral resection of the prostate (TURP) is the commonest surgical procedure for the treatment of benign prostatic obstruction (BPO). Bipolar-TURP (BTURP) is being increasingly used as compared to the long-established Monopolar TURP (MTURP). In this systematic review, we compared the outcomes of BTURP vs MTURP.

Material and methods: A systematic review was conducted using PubMed, EMBASE, Scopus, Google Scholar, and the Cochrane library using relevant search terms from inception of databases till June 2020. Using PRISMA methodology, 18 randomized control trials were reviewed comparing MTURP vs BTURP with a total of 8,393 patients.

Results: A significant drop in serum sodium was seen in four studies in MTURP vs BTURP and while there was zero incidence of TUR syndrome in BTURP group, there were 1-16 episodes of TUR syndrome across studies in the MTURP group. A significant fall in hematocrit was seen in three of nine studies with MTURP and one with a significant difference in blood transfusion rates. There were no significant differences in the incidence of clot retention across the studies with 1-5 cases in BTURP group vs 2-12 cases in MTURP group. There were no significant differences related to the duration of catheterization, operative time, resection volume, length of stay, quality of life, postoperative urethral stricture, and sexual function.

Conclusion: Although both BTURP and MTURP improve urinary symptoms, BTURP is associated with less risk of hyponatremia, TUR syndrome, and blood loss compared to MTURP. There seems to be no significant difference in length of stay, urethral stricture, quality of life, and operative duration.

The recent outbreak of the 2019 novel coronavirus disease (COVID-19) has raised a tremendous global concern among people, especially those with pre-existing comorbidities. Kidney transplant (KT) recipients represent a susceptible category of patients due to the long-term administration of immunosuppressive therapy. However, data on how COVID-19 is affecting these patients are scarce. We aim to systematically review the current findings regarding survival and clinical outcomes of KT recipients with COVID-19 infection. A comprehensive literature search was conducted from PubMed and Embase published up to May 2021. Studies reporting data on the incidence of COVID-19 infection among KT recipients were included. The primary outcomes analyzed in this study, including mortality rate, mechanical ventilation requirement, intensive care unit (ICU) admission, and acute kidney injury (AKI) occurrence, were measured as a pooled prevalence rate (PR) with 95% confidence intervals (CIs). All analyses were performed using STATAVR 16. A total of 30 studies comprising 3,146 KT recipients with COVID-19 infections were included. The pooled PR of mortality among KT recipients with COVID-19 infection was 21% (95% CI, 18% to 25%), ICU admission, 24% (95% CI, 20% to 28%), mechanical ventilation, 18% (95% CI, 15% to 21%), and AKI, 48% (95% CI, 42% to 53%). Meta-regression analysis showed that age was significantly associated with a higher mortality rate (P < .01). Mortality rate associated with age and relatively poor clinical outcomes were high among KT recipients with COVID-19 infection. Further studies addressing preventive measures for this at-risk population should be encouraged.

Objective: Renal cancer is the most lethal among urological cancer. Treatments of renal cell carcinoma (RCC) may be possible by immune checkpoint inhibitors and drug treatment targeting different molecules. We aimed to determine the apoptotic effect of betulinic acid and its effects on expressions of apoptosisassociated genes AKT-1 and mTOR in RCC cells.

Material and methods: In this study, we investigated the apoptotic activity of betulinic acid in CAKI-2 cell line and its effect on AKT-1 and mTOR gene expression levels. In order to do so, following analyses were conducted: WST-1 to identify the toxic effect of betulinic acid, Caspase-3/BCA to detect caspase enzyme activity, Annexin-V and ELISA to determine for apoptotic effect, and finally, real-time PCR for expression levels of AKT-1 and mTOR.

Results: Our study showed that different concentrations of betulinic acid induced apoptosis in renal cancer; however, no effect was observed in healthy cells. In gene expression analysis, there was statistically significant decrease in AKT-1 expression level while increasing mTOR expression level.

Conclusion: We suggested that betulinic acid with its apoptotic effect on RCC line and nontoxic effect on healthy cell line and the effects on AKT/mTOR pathway may be a potential anticancer drug promising for future studies.

Objective: In this multicenter prospective study, we aimed to evaluate the use of holmium:yttrium-- aluminum-garnet laser during retrograde intrarenal surgery for kidney stones and the relationship between laser-related parameters and procedure-related perioperative parameters.

Material and methods: The 769 patients whose laser setting parameters (fiber thickness, number of shots, frequency (max.), laser power (max.), and total energy) were completely registered were included in this study program. The intraoperative ureteral lesions were evaluated using postureteroscopic lesion scale (PULS) scores and the postoperative complications with the modified Clavien-Dindo classification system.

Results: The maximum levels of laser power and the frequency were used in the middle calyceal stones; the value of total energy consumed was found to be higher gain in cases with multiple stones (all parameters P < .05). There was a significant positive correlation among (mean number of shots [P < .001, r ¼ 0.46], frequency [P ¼ .009, r ¼ 0.1], maximum power [P < .001, r ¼ 0.11], total energy [P < .001, r ¼ 0.25]), anesthesia time (P < .001, r ¼ 0.42), surgery time (P < .001, r ¼ 0.47), and stone size. The mean number of shots increased (P < .001, r ¼ 0.25), and the frequency level decreased (P < .001, r ¼ -0.17) significantly with increasing Hounsfield unit (HU) values. Again, the mean number of shots and maximum laser power increased in correlation with the increasing hospitalization time (P ¼ .004, r ¼ 0.09 and P ¼ .02, r ¼ 0.07, respectively). In addition, it was observed that higher laser subparameter values and thicker fibers were used in PULS grade 2.

Conclusion: As the stone size and HU values increased, laser-setting parameters were found to show significant variability. The increase in different parameters of the laser setting was found to be associated with longer anesthesia time, surgery time, and hospitalization period and increased risk of local trauma with PULS grade.

Ureteral stents may induce complications that may disrupt the quality of life of patients. Several factors that may cause these symptoms are the design, material, diameter, length, and position of the stent. The impact of its diameter varies among current reports, thus we aimed to compare the symptoms between 6 Fr and 5 Fr or less ureteral stents. A systematic search and screening were performed in the Embase, Medline, and Scopus databases. Eligible studies included randomized controlled trials (RCTs). Cochrane risk of bias tool 2 was used to evaluate the studies. Seven RCTs were included in this review. Urinary symptoms were discussed qualitatively. From the included studies, the use of a relatively smaller stent diameter yielded an overall lower rate of Ureteral Stent Symptom Questionnaire score and urinary symptoms compared to a stent with a larger diameter. There was no significant difference in migration rate (OR: 1.55, 95% CI: 0.67-3.57, P ¼ .31), visual analogue scale (MD: 0.42, 95% CI: 2.04 to 1.20, P ¼ .61), analgesic use duration (MD: 0.06, 95% CI: 1.02 to 0.91, P ¼ .91), and stone-free rate probability (OR: 1.29, 95% CI: 0.48-3.45, P ¼ .62) between patients with 5 Fr or less and 6 Fr ureteral stents. Smaller ureteral stent size is suggested for reducing ureteral stent-related symptoms, without significant differences in the incidence of stent migration, pain, analgesic use, and stone-free rate.

Objective: Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic disease, with consequent high morbidity. Increasing evidence suggests that bladder afferent hyperexcitability, through neurogenic bladder inflammation and urothelial dysfunction, plays a key role in the pathophysiology of BPS/IC. The rationale of using phosphodiesterase type 5 inhibitors (PDE5i) would be to decrease bladder afferent hyperactivity. Detrusor relaxation, improvement of microcirculation, and a decrease in adrenergic nociceptive overactivity would be other effects in bladder tissue. We aimed to evaluate the efficacy, tolerability, and safety of a daily low dose of 5mg tadalafil in refractory BPS/IC patients.

Material and methods: A total of 14 refractory BPS/IC female patients, previously evaluated with a physical examination, bladder diary, bladder-pain related visual analogue score, O'Leary-Sant Scores (OSS) for symptoms and problems, and quality of life (QoL) question from International Prostate Symptom Score, were treated with 5mg of tadalafil, for 3months. Re-evaluations occurred at 4 and 12weeks. Adverse events were assessed and recorded.

Results: Urinary frequency, OSS, and QoL were significantly improved at 1-month follow-up (10 6 2.5, 21.9 6 4.1, and 4 6 1.5, respectively, P < .05). Pain intensity and volume voided were significantly improved at a 3-month follow-up (3.5 6 2 and 266.7 6 60.5, P < .05). Patients referred to urinary frequency as the most important parameter improved at 4weeks, and pain at 3months. No differences between ulcerated and nonulceratedpatients were observed. Two patients dropped out due to unsatisfactory results and two due to persistent headache and/or tachycardia, but both events were resolved after discontinuing the drug.

Conclusion: Daily low-dose tadalafil is an easy, well-tolerated, and effective treatment for refractory BPS/IC in women.

Prostate biopsy is a standard urological procedure and a valuable tool for identifying prostate cancer. To assess the effect of music on outpatient prostate biopsy, we aimed to conduct a systematic review of literature to understand if music reduced the use of analgesics and anxiolytics. The systematic review was performed in line with the Cochrane guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The databases searched included MEDLINE, Scopus, CINAHL, Clinicaltrials.gov, EMBASE, Cochrane library, and Google Scholar, from inception of databases to February 2021. The primary outcome measures were the effect of music on pain and anxiety from the procedure. The initial search yielded 212 articles and after going through titles and abstracts, and six studies (570 patients) were included for the final review. It included five randomized-controlled trials and one case-control study. These studies were done in Korea, USA, Taiwan, and Turkey. Patients had a combination of either local anesthetic gel or periprostatic nerve block or intravenous pethidine. The choice of music was varied and most offered a choice of music to patients. Four of the six studies showed significantly reduced pain and anxiety with the use of music, and the willingness for repeat procedures was higher in two studies. This review has demonstrated that listening to music is associated with reduced anxiety and pain during prostate biopsy. It is likely to, therefore, increase procedural satisfaction, and willingness to undergo the procedure again considering repeated biopsy is sometimes needed in these patients. As music is simple, inexpensive, and easily accessible, it should be routinely offered to patients for outpatient and office-based urological procedures.

Objective: Analyzing protein kinase C (PKC) alpha, iota, and zeta as well as levels of Mxi-2 and Vim3 in regressive clear cell renal carcinomas (ccRCCs) and urine samples.

Material and methods: Fresh samples of ccRCCs (predominantly pT1a/b) with different degrees of regression (<10%, 30%, 50%, and 70%) vs normal renal tissue and oncocytomas were studied by Western blot, using antibodies of different PKC isoforms. Urine samples from these tumors were analyzed by ELISA (PKC isoforms, Mxi-2, and Vim3).

Results: With increasing degree of regression beyond 10%, nuclear Mxi-2 and Vim3 were highly overexpressed in fresh tumor samples. In urine samples, Vim3 was significantly overexpressed in oncocytoma and downregulated in RCCs with 70% regression. Western blot analysis shows that PKC alpha and iota levels were significantly increased in fresh tumor tissue samples (tumors with 30% regression). PKC zeta was expressed in normal kidney and significantly increased in oncocytoma but not found in ccRCCs. In patients' urines, Mxi-2 was significantly reduced (regression > 50%), while PKC isoform alpha was significantly increased by advanced regression rate. PKC iota in patients' urine was overexpressed in oncocytoma and reduced in all ccRCC urines.

Conclusion: Tumor regression in ccRCC tissue shows strong nuclear overexpression of Mxi-2, Vim3, and PKC alpha and iota. In respective urines, PKC alpha was overexpressed; PKC iota was decreased. Mxi-2 and Vim3 decreased with increasing regression rates. These reagents could serve as noninvasive ccRCC markers for regression.

Objective: The objective of this study is to evaluate and compare urethral plate tubularization vs Mathieu in circumcised Megameatus intact prepuce (MIP) repair. Many techniques were described for MIP, which account for 5% of hypospadias cases and usually diagnosed at time of, or even after circumcision.

Material and methods: Forty-six circumcised MIP cases were prospectively enrolled in this prospective study, which was carried out in April 2017 and March 2020. Patients were randomly allocated into two groups. Group one operated by simple urethral plate tubularization and group two by the Mathieu technique. Hypospadias objective scoring evaluation (HOSE) scores, success rate, operative time, and the need for relaxing incision or scrotal flaps for skin closure were compared.

Results: Forty-three circumcised cases (22 in group one and 21 in group two) completed at least 6 months of follow-up. Ages ranged from 12 to 39 months (mean 18.06 6 6.35) in group one and from 10 to 32 months (mean 19.5 6 7.14) in group two. There was no significant difference between cases with accepted outcome based on HOSE scores (14) of the two groups (P value ¼ .942). Three fistulae and one meatal stenosis were the complications in group one (18.2%). In group two, two patients complicated with fistula (9.5%) (P value ¼ .674). Significant differences were present only in the operative time (P ¼ .001) and in the need of relaxing incision or scrotal skin flaps (P ¼ .012) both were more in group two.

Conclusion: Mathieu and tubularized incised plate urethroplasty both are good options for circumcised MIP repair.