Attention deficit hyperactivity disorder (ADHD) is characterised by a range of symptoms, such as excessive mobility, difficulty in maintaining attention and inadequate impulse control. ...Methylphenidate (MPH) is widely prescribed as a treatment for ADHD. In the literature, studies investigating the effects of MPH on the lower urinary tract (LUT) are limited.
The aim of the study was to evaluate MPH-induced LUT symptoms (LUTSs) in patients with ADHD without a diagnosis of voiding dysfunction (VD).
After ethical committee approval, volunteers aged 7–17 y were divided into two groups, with group 1 composed of individuals diagnosed with ADHD but not VD and group 2 (control) composed of healthy individuals. Lower urinary tract symptoms and quality of life, in addition to uroflowmetry test results and postvoiding residual volume (PVRV), were evaluated in both groups at baseline and again 4 wk later. The individuals in group 1 were treated with MPH after baseline screening. The dysfunctional voiding scoring system questionnaire was used for scoring LUTSs. Postvoiding residual volume was measured by ultrasound. Bladder capacity (BC) was calculated as the sum of voided volume (VV) and PVRV. The means of the maximum flow rate (Q max), mean flow rate (Q mean), VV, PVRV and BC were recorded.
After exclusions, there were 43 participants in group 1 and 39 participants in group 2. There was no significant difference between the mean age of groups (p = 0.727). Compared with the baseline, VV and BC increased significantly in group 1 (p = 0.001 and p = 0.002, respectively) at the 4-wk follow-up. There was no significant difference in these parameters in group 2.
This study demonstrated that VV and BC increased after MPH treatment in patients with ADHD without a diagnosis of VD. The mechanism underlying this effect is unclear, but it may be associated with dopaminergic and noradrenergic effects.
The findings of the present study can inform further studies on the mechanism underlying the effect of MPH on the LUT. In a future study, the authors suggest evaluating the effects of MPH in a urodynamic study in patients with ADHD diagnosed with VD.Summary TableThe significant results of the study group (group 1).Summary TableEvaluated parametersInitial (mean ± SD); (n = 43)4th week (mean ± SD); (n = 43)p valueVV (ml)216.86 ± 36.63232.09 ± 37.480.001∗BC (ml)222.79 ± 38.85237.09 ± 39.450.002∗VV = voided volume; BC = bladder capacity; SD = standard deviation. ∗ Bolded results are statistically significant p values.
We aimed to evaluate the impact of the resection technique (tumor enucleation (TE) or standard partial nephrectomy (SPN)) on trifecta outcomes in patients having undergone partial nephrectomy (PN).
...We retrospectively analyzed the clinical and pathologic parameters in patients with localized renal cell carcinoma (pT1-2N0M0) who had undergone PN between January 2001-December 2018 at one of 15 different tertiary referral centers. Multivariable logistic regression analysis was applied to investigate independent predictors of trifecta failure, decreased postoperative renal functions (decreased estimated glomerular filtration rate (eGFR) > 10%), perioperative complications (Clavien-Dindo > 1), and positive surgical margins.
A total of 1070 patients with a mean age 56.11 ± 11.88 years were included in our study. PN was performed with TE in 848 (79.25%) and SPN in 222 (20.75%) patients. Trifecta failure rate was 56.2% for TE and 64.4% for SPN (p = 0.028). On multivariable analysis, TE was associated with less trifecta failure (p = 0.025) and eGFR decrease >10% rates (p = 0.024). On the other hand, there was no statistically significant difference between TE and SPN according to positive surgical margins (p = 0.450) and complication > Clavien-Dindo grade 1 (p = 0.888) rates. The only independent predictive factor for complications > Clavien-Dindo 1 was the Charlson comorbidity index (CCI) (p = 0.001).
TE is associated with less trifecta failure than SPN. This result is mainly due to better preservation of renal function with TE.
The purpose of this study was to examine the effectiveness and safety of percutaneous nephrolithotomy with ultrasonography-guided renal access in the flank position without the use of fluoroscopy in ...any stage of the procedure. Percutaneous nephrolithotomy was performed in flank position under the guidance of ultrasound (USG) without the use of fluoroscopy between December 2008 and January 2010 on 43 patients who had kidney stones bigger than 20 mm. Access to the kidney's proper calyx was achieved by dilatation through the guide wire placed after insertion of the needle through the needle director under the guidance of transrectal ultrasound probe placed on the patient's flank area. A convex USG probe was used for imaging during dilatation and lithotripsy instead of fluoroscopy. Access to the targeted calyx was achieved successfully in all patients (100%). The percentage stone free rate was 86.1% (37 patients). Residual stones were detected in six patients. Their dimensions ranged from 5 to 12 mm. The mean stone diameter was 29 (20-41) mm, duration of surgery was 87.1 ± 43.2 (55-210) min and duration of hospital stay was 3.1 (2-8) days. Blood transfusions were given to two patients; none of the patients had major intraoperative or postoperative complications. In comparison with standard percutaneous nephrolithotomy, percutaneous nephrolithotomy in flank position under ultrasonographic imaging instead of using fluoroscopy seems to be safe and effective. This procedure has to be limited to selected cases with one or maximum two big stones in the pelvis or in a single calyx in absence of complex intrarenal anatomy. Both surgical team and the patients were protected from the harmful effects of radiation. Regarding anesthesia, flank position is more comfortable for the patient than prone position.
Objectives
Our aim was to examine correlation between Post‐void residual urine (PVR) after uroflowmetry and random PVR.
Methods
Male patients reporting to the Urology outpatient clinic with LUTS were ...selected. Patients' age, prostate volume, bladder capacity, voided volume, maximum flow rate, average flow rate, random PVR and PVR after uroflowmetry were recorded. We evaluated the correlations between these parameters. Also we assessed if there was a difference between random PVR and PVR after uroflowmetry. We divided PVR after uroflowmetry and random PVR into three groups: Group 1: 0–50 mL, Group 2: 51–100 mL and Group 3: >100 mL. Also we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2: >400 mL. We compared these groups to determine whether a significant difference.
Results
Seventy‐seven patients applying to the urology outpatient clinic were assessed between 2013 and 2014. PVR after uroflowmetry was significantly higher than random PVR (P < 0.001). When we divided PVR after uroflowmetry and random PVR into three groups there was a significant difference between the groups (P = 0.02). When we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2: >400 mL, PVR after uroflowmetry was different, but random PVR was similar (P < 0.001, P = 0.72).
Conclusions
PVR after uroflowmetry seems to be incorrectly high in patients whose bladder capacity is above 400 mL.
Objectives: Extracorporeal shock wave (ESW) lithotripsy is the preferred treatment modality for uncomplicated kidney stones. More recently free oxygen radical production following ESW application has ...been considered to be crucial in shock wave-induced renal damage. It has been shown that ozone therapy (OT) has ameliorative and preventive effects against various pathological conditions due to increased nitro-oxidative stress. In current study, we aimed to evaluate the efficacy of OT against ESW-induced renal injury. Methods: Twenty-four male Sprague-Dawley rats were divided into three groups: sham-operated, ESW, and ESW + OT groups. All groups except sham-operated group were subjected to ESW procedure. ESW + OT group received 1 mg/kg/day of oxygen/ozone mixture intraperitoneally at 2 h before ESW, and OT was continued once a day for consecutive three days. The animals were killed at the 4th day, and kidney tissue and blood samples were harvested for biochemical and histopathologic analysis. Results: Serum ALT and AST levels, serum neopterin, tissue nitrite/nitrate levels, and tissue oxidative stress parameters were increased in the ESW group and almost came close to control values in the treatment group (p < 0.05, ESW vs. ESW + OT). Histopathological injury scores were significantly lower in treatment group than the ESW group (p < 0.05, ESW vs. ESW + OT). Immunohistochemical iNOS staining scores in ESW group were higher than those of sham-operated group (p < 0.05, ESW vs. sham-operated), iNOS staining scores in OT group were significantly lower than the ESW group (p < 0.05, ESW + OT vs. ESW). Conclusion: OT ameliorates nitro-oxidative stress and reduces the severity of pathological changes in the experimental ESW-induced renal injury of rat model.
Our aim was to evaluate and determine the frequency of Transmembrane protease, serine 2 (TMPRSS2)-ERG fusion in Turkish patients with clinically localized prostate cancer by using ...immunohistochemistry and reveal its relationship with clinicopathologic variables.
Radical prostatectomy specimens of 99 patients, who underwent radical retropubic prostatectomy for localized cancer, between January 2002 and December 2011 were analyzed in the study. To detect ERG fusions, monoclonal ERG antibodyclone ID: EPR3864 (Epitomics, San Diego, CA, USA) and monoclonal anti-ERG antibody (9FY) (BiocareMedical, LLC, USA) were used. The immunistochemical expression of ERG protein was assessed as positive or negative regardless of stain intensity. Patients' age, total and primary Gleason scores, PSA levels, prostate volumes, tumor volumes, tumor stages and perineural invasion status were analysed retrospectively. Total fusion rate and correlation between the variables and fusion were evaluated.
Mean age, prostate volume, tumor volume, PSA value of 99 patients were 62.02 years (±5.93), 50.02 cc (±20.67), 3.19 cc (±4.16), and 9.34 ng/mL (±3.37) respectively. TMPRSS2-ERG fusion was seen in 46 (46.5%) of 99 patients. When the variables analysed with independent samples t test to predict fusion (+) status, none of them was found to be statistically significant. When evaluated by logistic regression analysis for (+) or (-) status, only tumor stage was found to be statistically significantly correlated with fusion (p=0.049).
The incidence of TMPRSS-ERG fusion in patients with localised prostate cancer in our study with Turkish population was found as 46.5%. Only tumor stage correlated with TMPRSS2-ERG fusion.
Objective: To evaluate the contribution of magnetic resonance imaging for prostate cancer diagnosis and decide the most beneficial, accurate and appropriate MRI method. Materials and Methods: The ...study was planned as prospective and single-centered. Patients , with 3-10 ng/ml serum PSA level and normal digital rectal examination results , scheduled for initial prostate biopsy were included in the study between February 2013 and March 2014. Each patient were screened by diffusion MRI, MRI spectroscopy, dynamic-contrast MRI and T2 sequenced MRI one week prior to biopsy. The lesion seen in at least two MRI was accepted as meaningful , therefore, multiparametric MRI was evaluated. Transrectal ultrasound guided biopsies were targeted to lesions seen in MRI. Additional biopsies were directed to the lesions observed by TRUS and MRI. As a result, MRI was regarded as the best methot because of tumor detection rates, sensitivity and density in multivariate analysis. Results: Patients mean age was 61.22 ± 1.0,.the mean PSA value 5.13 ± 0.19 ng / ml, mean prostate size 48.96 ± 2.67 grams. The mean of core biopsy was12.73 ± 0.13 . Of 53 patients , in 19 prostate cancer was detected Tumor core detection mean was 3.21 ± 0.45 . ASAP in 2 patients, gleason 3 + 3 tumor in 13patients, gleason 3 + 4 tumor in 4 patients was observed. Overall tumor detection rate was 35.8%. . Evaluating all MRI methods we concluded that highest sensitivity was in spectroscopic MR. Maximum spesificity was in dynamic contrast-enhanced MRI. Highest positive predictive value was in dynamic contrast-enhanced MRI. Highest negative predictive value was in spectroscopic MRI. In multivariate analysis (logistic regression analysis) determining imaging methods affecting the biopsy results,we ended up that all methods, except TRUS, affect biopsy results. The most affecting methods were multiparametric MRI and contrast-enhanced dynamic MRI and MRI spectroscopy, T2 sequential MRI, respectively. Diffusion MRI was on the borderline because of 0.05 p-value . Conclusion: More tumors were detected and observed in the lesions in the MRI pre_biopsy. The most benefical accurate and detectful methot is multiparametric MRI to locate and detect these lesions.
To evaluate the clinical and histopathological results of adult unilateral cryptorchidism patients.
Data from adult unilateral cryptorchidism patients that underwent orchiectomy in our clinic between ...between January 2004 and March 2013 were retrospectively evaluated. Patients were divided into three groups as intra-abdominal, inguinal canal and superficial inguinal region according to the location of the undescended testes. Patients were also grouped according to their testicular volume (<4 cc, 4.1-12 cc, and >12 cc). Histopathology results of orchiectomy specimens were classified as follows: 1. Sertoli cells only, testicular atrophy and vanished testis (anorchia) 2. Hypospermatogenesis, and 3. Maturation arrest. Patients were grouped as normospermia, azoospermia and oligo/astheno/teratospermia groups according to semen analysis results. Correlations between testicular localization, testicular size, semen analysis and pathology results were evaluated. Incidental tumor detection rates were also calculated.
Two hundred and forty-four adult unilateral cryptorchidism patients underwent orchiectomy in our clinic. There was no a significant relationship between location of the testis and testicular pathology results (p=0.707). Most common semen analysis results was normospermia in patients with high testicular volume group however azoospermia and oligoasthenospermia observed commonly in patients with low testicular volume group. There was a significant relationship between testicular volume and semen analysis results (p=0.023). No significant relationship was observed between semen analysis and pathological results (p=0.929). After an evaluation of all factors with possible effects on the semen analysis results, only testicular volume (p=0.036) was found to have a significant impact. Only one case (0.4%) was incidentally diagnosed seminoma after a review of 233 patients with available histopathological results on record.
Adult unilateral cryptorchidism has a minimal effect on male fertility or even this effect can be overlooked. Low detection rates of incidental germ cell tumors also make an orchiectomy decision questionable in such cases.
Summary
Objective
The purpose of this study is to determine the effectiveness of the diffusion-weighted magnetic resonance imaging (DWI) of the differentiation of benign and malignant testicular ...masses.
Methods
Fifteen male patients who admitted to our clinic with the diagnosis of testicular mass detected by ultrasound were enrolled to this study. The patients were between 20 and 61 years old (mean 25.7). Apparent diffusion coefficient (ADC) values were measured from ADC maps of lesion and normal testicular tissue. In addition, mean signal intensity (SI) measurements were obtained by using
b
: 1,000 of normal testicular tissue and lesion with three regions of interest (ROI). SI ratio values are obtained by dividing the value lesion SI to the normal testicular parenchyma SI. Histopathology of orchiectomy materials and ADC values and lesion SI rates were compared statistically.
Results
There were no significant correlation (
p
= 0.97) between ADC values of benign and malign lesions and histopathological diagnosis in Student’s
t
test. There were statistically significant relationship with the histopathology of the lesion and the SI ratio in Student’s
t
test (
p
= 0.027).
Conclusions
DWI is an effective method in differentiation of benign and malignant testicular masses. Important information can be obtained about nature of testis masses with quantitative measurements of the ADC and ratio of SI.
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