Can urinary caspase-3 and cytochrome c levels be used as predictive biomarkers in the management of unilateral antenatal hydronephrosis?

PURPOSE

We aimed to investigate the urinary caspase-3 and cytochrome c levels in patients with unilateral antenatal hydronephrosis and to determine whether changes in urinary biomarker levels could be useful for both predicting the need for surgical intervention due to ureteropelvic junction obstruction (UPJO) and postoperative surgical success.

METHODS

Sixty-five children with a history of unilateral antenatal hydronephrosis and postnatal anteroposterior diameter ≥ 10 mm were included in this prospective case-control study between January 2013 and December 2021. The obstruction group consisted of 33 patients (28 boys, 84.8%) who underwent open dismembered pyeloplasty due to UPJO. The non-obstructive dilatation (NOD) group consisted of 32 patients (27 boys, 84.4%) with stable or improving hydronephrosis and no significant reduction in ipsilateral split renal function during follow-up, whereas 34 healthy children were enrolled in the study as a control group. Urinary urinary caspase-3 and cytochrome c levels using ELISA were measured.

RESULTS

The median preoperative urinary caspase-3 level was significantly higher in the obstruction group when compared to the NOD group (4.82 ng/mgCr vs. 2.61 ng/mgCr, p = 0.013) as well as the control group (4.82 ng/mgCr vs. 1.72 ng/mgCr, p = 0.002). In the postoperative period, urinary caspase-3 levels significantly decreased compared to preoperative measurements (4.82 ng/mgCr vs. 2.51 ng/mgCr, p = 0.006) and became similar to the control group (2.51 ng/mgCr vs. 1.72 ng/mgCr, p = 0.422). On the other hand, no significant differences were observed in urinary cytochrome c levels between the groups. All patients who underwent pyeloplasty achieved postoperative resolution in hydronephrosis and improved drainage on MAG-3, so none of the patients required re-do pyeloplasty. Postoperative decrease in caspase-3 level was found to be compatible with adequate urine drainage on MAG-3 scan. The cut-off value of urinary caspase-3 to predict patients requiring pyeloplasty was found to be 3.31 ng/mg creatinine with 63.6% sensitivity, 62.5% specificity (AUC = 0.679). In the multivariable analysis, urinary caspase-3 level (OR: 1.653, p = 0.019), anteroposterior pelvic diameter (OR: 1.401, p = 0.001), and split renal function on MAG-3 (OR: 1.277, p = 0.011) were found to be independent factors in determining patients who require surgery.

CONCLUSION

Based on our preliminary findings, urinary caspase-3 levels could be a useful biomarker not only for predicting the need for surgical intervention but also for determining the postoperative surgical success in children with UPJO.

Does neo-adjuvant chemotherapy improve the negative effect of lymphovascular invasion in survival after radical cystectomy?

PURPOSE

There is a lack of studies in the literature to evaluate the impact of the specific benefit of the use of neo-adjuvant chemotherapy (NAC) on the negative effect of lymphovascular invasion (LVI) on prognosis. We aimed to evaluate the survival differences of patients according to the presence of LVI with and without administration of NAC before radical cystectomy (RC).

MATERIALS AND METHODS

We retrospectively evaluated data of the patients who underwent RC with pelvic lymphadenectomy and urinary diversion for bladder cancer recorded in the bladder cancer database of the Turkish Uro-oncology Association between 2007 and 2021. Patient demographics, follow-up time and overall survival (OS) were noted.

RESULTS

A total of 633 subjects included in the analyses. Median follow-up time was 24 months (IQR 12-54). Five years OS of the whole cohort was 55.1%. This was 54.7% and 59.9% in NAC- and NAC+ groups (P = 0.683), respectively. It was also 35.7% and 65.7% in LVI+ and LVI- patients (P < 0.0001), respectively. There was a significant difference between LVI+ and LVI- patients (33.2% vs. 68.2%, P < 0.0001) in NAC- group, but similar 5-year OS was found (53.2% vs. 64.5%, P = 0.552) in NAC+ group. In multivariable analyses, female gender, pN stages, presence of variant histology and LVI were significant independent predictive factors for OS in the whole cohort and in the NAC- group. However, gender association, pN stages and LVI lost significance in NAC+ group.

CONCLUSION

Presence of LVI significantly reduced OS, and the NAC treatment improved the negative effects of LVI on OS. Our findings encourage the use of NAC before RC.

Graft survival and postoperative complications following orthotopic renal transplantation

The iliac fossa is the most commonly used site to place the graft in renal transplantation in adults. However, iliac fossa may not be used in various conditions. Thus, orthotopic renal transplantation becomes a viable alternative for these selected patients. Given the technically challenging surgery and limited number of patients, data on the long-term outcomes on this regard are scarce. This narrative review serves as an update on the clinical outcomes after orthotopic renal transplantation, focusing on overall recipient survival and renal graft survival, as well as postoperative complications. We found that studies to date showed a comparable survival rate in both recipients and renal grafts in the postoperative follow-up period after orthotopic renal transplantation with a lower complication rate compared to the published data on heterotopic renal transplantation. The results of our review may encourage transplant centers to reevaluate their policies to consider orthotopic renal transplantation as an alternative technique in cases where heterotopic kidney transplantation is not possible.

Scheduled or immediate cystoscopy: Which option reduces pain and anxiety?

INTRODUCTION

Office-based flexible cystoscopy is a common outpatient procedure in daily urology practice. Sometimes, cystoscopy procedures are performed on the initial day or scheduled on the following days. We designed this study to compare immediate versus scheduled cystoscopy in terms of anxiety and pain.

METHODS

In this study, 160 patients were prospectively randomized to undergo office-based flexible cystoscopy by the same urologist between November 2017 and January 2018. Participants were grouped as scheduled for a cystoscopy on the third day of their application (group 1) and immediate cystoscopy on the same day of the application (group 2). A visual analog scale (VAS), State-Trait Anxiety Inventory (STAI) and Beck Anxiety Inventory (BAI) were completed by the patients.

RESULTS

Among men, immediate cystoscopy group experienced an increased state anxiety score compared to scheduled group (51.21 ± 8.108 vs 35.29 ± 10.553; p < 0.001). BAI scores were 16.51 ± 8.078 for group1 vs 31.92 ± 8.403 for group2 (p < 0.001). The mean VAS score was 3 ± 1.183 and 4.55 ± 1.155 in group1 and group2, respectively (p < 0.001). Among women, both the trait anxiety score and state anxiety score were found significantly low in scheduled group (mean trait anxiety scores 44.71 ± 6.051 and 49.3 ± 6.670, mean state anxiety scores were 33.71 ± 8.776 and 44.15 ± 7 in group1 and 2, respectively; p < 0.0001). BAI scores were also low in scheduled group (19.02 ± 7.786 vs 34.13 ± 8.367). Additionally, the mean VAS score was significantly high in immediate cystoscopy group compared to scheduled cystoscopy group (3.50 ± 0.784 vs 2.61 ± 0.919; p < 0.001).

CONCLUSION

To reduce anxiety and pain, informing patients properly about the cystoscopy and scheduling the procedure would be helpful for a better cooperation of the patient.

Stones hounsfield unit value and predictors of urinary leakage after PCNL

Background

To evaluate the predictive factors of urinary leakage (UL) following percutaneous nephrolithotomy (PNL) and to investigate the relationship between Hounsfield unit (HU) of stone and UL.

Methods

We retrospectively reviewed the data of 728 patients who underwent PNL between January 2012 and January 2017. In total, 396 patients were eligible for the study. Patient demographics, renal factors, stone properties and operative details were collected. The association between UL and these variables were assessed by univariate and multivariate analysis.

Results

There was no statistically significant correlation considering age, body mass index and the presence of hypertension. The presence of diabetes mellitus (DM) was significantly correlated with UL (p < 0.001). Kidney related factors such as parenchymal thickness, hydronephrosis grade (HN), previous stone treatment, and stone related factors, such as stone surface area, stone burden, stone localization and HU value of stone, were found to affect UL status significantly (p < 0.001). Operation time, fluoroscopy time, treatment outcome, j stent use, percutenous nephrostomy (PCN) catheter stay time and the hospitalization time also had significant effect on UL (p < 0.001). Multivariable logistic analysis showed that presence of DM, parenchymal thickness, HU values, HN, operation time, j stent use, and PCN catheter stay time are independently related with UL following PCNL. Moreover, we determined a HU cut-off value of 933 with ROC analysis, which demostrated 84.9% sensitivity and 67.1% specificity for predicting UL.

Conclusion

This study has shown that we are more likely to encounter postoperative UL in stones with higher HU values. Therefore, we suggest clinicians to inform patients with this type of kidney stones about the probable complication of UL.

The effect of body mass index on oncological and surgical outcomes in patients undergoing radical cystectomy for bladder cancer: A multicentre study of the association of urooncology, Turkey

OBJECTIVE

We aimed to evaluate the effect of body mass index (BMI) on oncological and surgical outcomes in patients who underwent radical cystectomy (RC) for bladder cancer (BC).

MATERIALS AND METHODS

We retrospectively assessed data from patients who underwent RC with pelvic lymphadenectomy and urinary diversion for BC recorded in the bladder cancer database of the Urooncology Association, Turkey, between 2007 and 2019. Patients were stratified into three groups according to the BMI cut-off values recommended by the WHO; Group 1 (normal weight, <25 kg/m² ), Group 2 (overweight, 25.0-29.9 kg/m² ) and Group 3 (obese, ≥30 kg/m² ).

RESULTS

In all, 494 patients were included, of them 429 (86.8%) were men and 65 (13.2%) were women. The median follow-up was 24 months (12-132 months). At the time of surgery, the number of patients in groups 1, 2 and 3 were 202 (40.9%), 215 (43.5%) and 77 (15.6%), respectively. The mean operation time and time to postoperative oral feeding were longer and major complications were statistically higher in Group 3 compared to Groups 1 and 2 (P = .019, P < .001 and P = .025, respectively). Although the mean overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS) and metastasis-free survival (MFS) was shorter in cases with BMI ≥ 30 kg/m² compared with other BMI groups, differences were not statistically significant (P = .532, P = .309, P = .751 and P = .213, respectively).

CONCLUSION

Our study showed that although major complications are more common in obese patients, the increase in BMI does not reveal a significant negative effect on OS, CSS, RFS and MFS.

How does body mass index affect semen parameters and reproductive hormones in infertile males?

OBJECTIVE

The aim of this study was to invastigate the effect of body mass index (BMI) on semen parameters 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 semen 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 parameters 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. Nevertheless, 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.

Evaluation of sexual dysfunction prevalence in infertile men with non-obstructive azoospermia

OBJECTIVES

To determine the prevalence of sexual dysfunction in male partners of infertile couples and evaluate the effect of childlessness on erectile dysfunction (ED) and sexual relationship stress.

MATERIALS AND METHODS

We collected datas of couples who attended our clinics for infertility between 2009 and 2016. Erectile dysfunction was investigated with the Questionnaires of International Index of Erectile Function-15 (IIEF-15) whereas premature ejaculation (PE) status with the Premature Ejaculation Diagnostic Tool (PEDT). The stress status of the childlessness in terms of sexual intercourse was scored by the Visual analogue scale (VAS) questionnaire. These scores were measured before and after a successful assisted reproductive treatment with the birth of the child.

RESULTS

The median age of the 193 male patients was 31 years (range 23-48). Erectile dysfunction was found in 68 (35.2%) and PE in 42 (21.7%) subjects. One hundred and forty-one couples were treated with assisted reproductive treatments. Forty eight couples had successful pregnancy. The IIEF-15 test was repeated after the birth of the child to the male partners of these couples. We observed that the IIEF-15 scores increased from 16 to 21 (p = 0.014). However there were no significant improvement on their ejaculation status (p > 0.05). The mean VAS scores of male partners was 5.2 (3-10) in the treatment period while it decreased to 4.1 (0-8) after the birth of the chils (p = 0.02). Statistically analysis showed a correlation between VAS and infertility as did IIEF-15.

CONCLUSIONS

We observed that having children has a reducing effect on sexual relationship stress. Infertility is absolutely blamed on the women and men. This condition may have negative effects on male sexual performance and it is closely related with some emerging female sexual disorders. It should be taken into consideration that infertile couples may have sexual dysfunction.