Histopathological effects of β-hCG and vitamin C on the detorsioned testicle in rats with unilateral testicular torsion

BACKGROUND

Testicular torsion is still an urgent surgical condition and without any treatment it can cause infertility. The main pathophysiology of testicular torsion ischaemic injury however; the main sequalae of detorsion is reperfusion injury. Furthermore; treatments to prevent ischemic reperfusion injury due to decreased blood flow are important to preserve testicular function.

AIMS

Human chorionic gonadotropin β (β-hCG) is an anabolic hormone that supports steroidogenesis and spermatogenesis. Vitamin C (Vit-C) is one of the water-soluble vitamins and is also a potent antioxidant in ischemic damage. Moreover, it has protective effects by increasing blood and lymph flow in the testicles. The aim of this study is to investigate the effects of β-hCG, Vit-C and their combination on ischemic reperfusion injury occurring after surgical treatment of testicular torsion.

STUDY DESIGN

Animal research studies.

METHODS

The study was performed on 25 male Wistar albino rats. The animals were divided equally into 5 groups. In the first group "Control Group," left orchiectomy was performed. In the second group "Sham Group," a 720° clockwise torsion was created and after 4 h of left testicular torsion it was detorsioned for 4 h and then left orchiectomy was performed. In the third group same procedure was applied with 30 mg vitamin C was administered via intraperitoneal route once a week for 3 weeks. In the fourth group after same surgical procedures 75 IU β-hCG was administered via intraperitoneal route once a week for 3 weeks. In the fifth group after 4 h left testicle torsion it was detorsioned for 4 h then, 75 IU β-hCG and vitamin C together were administered via intraperitoneal route once a week for 3 weeks. Left orchiectomy was performed after 3 weeks in the third, fourth and fifth groups. Specimens were evaluated histologically.

RESULTS

Testicular tissue histopathological evaluations were performed. A high histopathological stage indicates more testicular damage, and a low one was indicated less testicular damage. The average histopathological grade of vitamin C + β-hCG group was significantly higher than the average histopathological grade of the control, the sham group and vitamin C group. The average histopathological grade of the vitamin C group was significantly lower than the average histopathological grade of sham and β-hCG groups. The ratio of the testicular atrophy of the Vitamin C + β-hCG group (100%) was higher than sham (40%) and β-hCG (40%) groups with a significant difference. A significant statistical difference was found among all groups histopathological grades of testicular tissue.

CONCLUSION

In animals taking vitamin C, an improvement of histopathological findings and a significant decrease in histological stages has been provided. However, it was observed that the histological findings of β-hCG and β-hCG + vitamin C groups worsened. It was found that β-hCG increased oxidative damage in the testicles and this damage can be so severe that exceeding the capacity of potent antioxidants such as Vitamin C. We believe that β-hCG can be harmful to testicles exposed to oxidative damage.

Failure of ureteral access sheath insertion in primary flexible ureteroscopy for renal stones: is there any relation with inflammation?

PURPOSE

To investigate the relationship between failure to insert a ureteral access sheath (UAS) with inflammation and other clinical parameters in patients treated with flexible ureteroscopy for renal stones.

METHODS

This study included patients who underwent flexible ureteroscopy for the treatment of renal stones in our centre between 2015 and 2020. Patients who underwent any surgical procedure on the ipsilateral ureter and had a history of spontaneous stone passage were excluded. Patients were divided into two groups based on UAS insertion success (group 1) or failure (group 2). Both groups were compared with a view to clinical characteristics, preoperative neutrophil, lymphocyte, monocyte and platelet counts and ratios of these counts, all being considered inflammatory markers. A multivariate logistic regression analysis was performed to determine the independent variables affecting UAS insertion success.

RESULTS

There were 113 (59.1%) patients in group 1, while group 2 consisted of 78 (40.9%) patients. The rates of male gender, coronary artery disease and preoperative ipsilateral hydronephrosis were significantly higher in group 2, while platelet counts and platelet-lymphocyte ratios were significantly lower. Our analysis revealed four independent predictors for UAS insertion failure: female gender (odds ratio [OR]=2.1) increased the rate of UAS insertion success, while hydronephrosis (OR=1.6), low platelet counts and PLR increased the rate of UAS insertion failure (OR=0.99, OR=0.98, respectively).

CONCLUSION

Our results suggest that male gender and ipsilateral hydronephrosis are associated with increased UAS insertion failure. Although we found a relationship between relatively low platelet levels and UAS insertion failure, we think that further studies are needed to investigate this matter.

The role of preoperative ultrasound in the diagnosis of penile fractures and the effect of tunica defect length on postoperative functional outcomes

PURPOSE

This study aimed to investigate the rate of tunica defect detection by postoperative penile ultrasound (US) and the effect of tunica defect length (TDL) on functional outcomes.

METHODS

Forty-six patients who underwent early penile fracture surgery in our hospital between July 2010 and December 2018 were included in the study. Each diagnosis was made via history, physical examination and US. Functional outcomes were assessed at 3, 6 and 12 months postoperatively. The International Index of Erectile Function-5 (IIEF-5) score was used to assess erectile function. US detection rates for tunica defects, as well as whether the rates changed according to TDL, were also analysed. The TDL cut-off value for US detection was determined to be 11 mm using the receiver operating characteristic curve. The impact of TDL on functional outcomes was also evaluated using this cut-off value.

RESULTS

The main cause of fractures in 34 patients (74%) was sexual intercourse. One patient (2.2%) had penile curvature, and 16 (34.8%) had penile nodules in the follow-ups. US had a higher detection rate in the group with TDL >11mm (94% vs 25%). IIEF-5 scores at the postoperative third month were statistically lower in patients with TDL >11mm (n = 34) compared with those with ≤11 mm (n = 12). The rate of penile nodules was found to be statistically higher in the group with TDL >11mm at the end of the 1-year follow-up period (44.1% vs 8.3%).

CONCLUSIONS

US is a valuable tool for the detection of tunica defects especially with >11mm length. In addition, TDL >11 mm in penile fractures is associated with lower IIEF-5 scores in the early postoperative period and higher rates of penile nodules.

Sexual intercourse before exercise has a detrimental effect on lower extremity muscle strength in men

INTRODUCTION

The question of whether sexual intercourse can harm athletic performance is a long-debated topic since first sport competitions were invented. Therefore, due to the lack of solid evidence, we aimed to evaluate the effects of sexual intercourse on muscle training performance.

MATERIALS AND METHODS

Physically and sexually active, 50 men (age=29.3±1.14 years) were enrolled in the study. Participants completed three weight training sessions and all sessions were at the same time of the day. The maximum weight was adjusted in the first session. In the second and third sessions, they performed five repetitions of the squat with their maximum weight for each set with a total of five sets after participating in and abstaining from sexual intercourse the night before, respectively. The duration of sexual intercourse was measured with a stopwatch.

RESULTS

The mean duration of sex was measured to be 13.8±3.61 min. Furthermore, the mean lifted weight before sex was calculated to be 109.4±11.41 kg and the mean lifted weight after sex was calculated to be 107±11.05 kg. According to obtained data, sexual intercourse has a significant detrimental effect on maximum weight in squat training (p=0001).

CONCLUSION

Results demonstrate that sexual intercourse within 24 hours before exercise have detrimental effect on lower extremity muscle force, which suggests that restricting sexual activity before a short-term activity may be necessary.

The impact of the pelvicalyceal anatomy characteristics on the prediction of flexible ureteroscopy outcomes

Background

The anatomical architecture is a prominent factor in the outcomes of flexible ureteroscopy (FURS).

Aims and Objectives

The aim to regard the success of procedures based on Pelvicalyceal body that called Sampaio classification system.

Materials and Methods

A total of 125 FURS procedures were reviewed between December 2012 and December 2016 in our department. Seven patients were excluded from the study due to the horseshoe kidney in two cases and recurrent cystine stone configuration in five patients. The patient's renal collecting system anatomy characteristics are regarded, and they are classified into four main groups based on the mid-renal-zone anatomy assessed according to Sampaio Classification.

Results

Total stone-free rate (SFR) during the postoperative 1^st-month evaluation was noncontrast computerized tomography 75 (63.6%). The evaluation of the SFR in all subgroup of cases based on Sampaio classification noticed easily, SFR was significantly lower in subgroup A2 (30.4%) (P = 0.00), significantly higher in subgroup B2 (P = 0.008). The comparative analysis of the operative duration defined that it was the shortest (75.3 ± 18.1 min) in Type B1 subgroup cases, and the longest (84.7 ± 25.7 min) in the Type A2 subgroup cases. Even though this duration was found to be relatively higher in Type A2 subgroup cases than the others, this difference was not statistically significant (P = 0.271). Fluoroscopy time was noted to be the shortest (11.9 ± 13.4 s) in B1 subgroup and the longest in A2 subgroup with a statistically significant different (median: 21.3 ± 30.4) (P = 0.04). While 6 (5.1%) cases had Clavien 2 and 3 (2.5%) cases, demonstrated Clavien 3a complications.

Conclusion

The calyceal structure of the kidney affects the SFR; therefore, a detailed classification of pelvicalyceal could improve the outcomes, decrease the rate of auxiliary procedures and prevent the complications.

The correlation between atherogenic indexes and erectile dysfunction

Aside from the ordinary plasma lipid level measurements, the ratios based on individual plasma lipid levels such as atherogenic index of plasma (AIP), Castelli's risk index 1/2 (CRI-1/2), and atherogenic coefficient (AC) are the novel parameters to evaluate the patients with a high risk of CVD. In this study, we aim to evaluate the relationship between AIP, AC, and CRI-1/2 with increased risk of ED. Between April 2018 and February 2019, 253 patients, who were diagnosed as a vasculogenic ED in our clinic, were enrolled in the study. While the first group (n = 134) consisted of patients with moderate and mild ED (IIEF-EF: 17-30), the second group (n = 119) consisted of patients with severe ED. In addition to the mean values of lipid parameters; CRI-1 (total cholesterol/HDL), CRI-2 (LDL/HDL) AIP (log10(triglycerides/HDL), and AC (non-HDL/HDL) were calculated. The mean age was 44.02 ± 10.41 (24-70), and the mean BMI was 27.80 ± 4.12 (18.52 ± 41.97). However, CRI-1 and AIP values were found to be higher in the severe ED group compared to the mild ED group (CRI-1: 4.50 ± 1.47, 4.88 ± 1.30; p = .039; AIP: 0.489 ± 0.315, 0.617 ± 0.283; p = .007). Our results demonstrated that CR-1 and AIP have a positive correlation with the severity of ED. Moreover, we can suggest that patients with higher CR-1 and AIP values are likely to have more severe ED in the future.

Regression of the Sweet's syndrome after Bacillus Calmette-Guérin therapy: A bladder cancer case report

The Sweet's syndrome is a rare dermatosis which can be related to underlying malignancies. In this case we presented a case, who applied to our clinic with severe dermatosis and hematuria. We diagnosed high grade non-muscle invasive bladder tumor, which was treated with transurethral resection of bladder-tumor and six cycle of Bacillus Calmette-Guérin therapy. After the treatment the dermatosis was regressed almost completely. However, recurrent bladder tumor was detected at the first control cystoscopy.

Sarcoidosis is a rare cause of infertility: A case report

In this paper, we presented a patient, who applied to our clinic because of infertility. After an intensive investigation, we diagnosed systemic sarcoidosis with testicular involvement. Urogenital sarcoidosis is a rare and insidious condition, however, it can lead to infertility. Therefore, following the diagnosis, we applied systemic steroid therapy to the patient. Within one year, the patient had a child without assisted reproductive techniques. According to our experience, in this case, we concluded that infertility without an etiology should be investigated elaborately. Furthermore, urogenital sarcoidosis should keep in mind as a rare etiology.

A purely penoscrotal approach: Reservoir placement of an inflatable penile prosthesis (IPP) in an orthotopic neobladder patient. Case report

INTRODUCTION

The inflatable penile prosthesis (IPP) is the last step in drug-resistant erectile dysfunction treatment. IPP implantation can be challenging, especially following a cystoprostatectomy with an orthotopic neobladder. There is no consensus about surgical techniques for placement of an IPP reservoir in such patients. In this paper, we present a case of an IPP and reservoir placement with a single penoscrotal incision.

CASE

A 55-year-old patient, who underwent radical cysto-prostatectomy with an orthotopic neobladder seven years ago, presented with severe erectile dysfunction. His oncologic status was stable, and he was in remission. He also had high blood pressure and took medication for it. He previously used different medical treatments, such as oral phosphodiesterase-5 inhibitors (PDE5i), intraurethral prostaglandin E2 (PGE2) installations, and Trimix injections. As far as we know, he had no benefit from these treatments. A three-piece IPP was recom- mended. After a discussion of surgical techniques, we chose the penoscrotal approach, and the ectopic reservoir was placed through the inguinal canal, guided by a forefinger.

RESULTS

The total operative time was 60 minutes, and the estimated blood loss was minimal. There were no perioperative complications. The patient was discharged on postoperative day one. He could start to use the IPP in the first month. His sexual and urinary functions were normal, and there was no abdominal bulging from the ectopic reservoir at the three-month follow-up.

CONCLUSIONS

In conclusion, ectopic placement of the reservoir through a single penoscrotal incision appears to be a safe and acceptable surgical technique for postoperative ED following a radical cystoprostatectomy with an orthotopic neobladder.

Plication without degloving - Safe and effective approach for correcting lateral and dorsal penile curvature: Case series

Penile curvature deformities are often manageable with surgical reconstruction methods. We aimed to show the safety and efficacy of ventral and dorsal plication techniques without degloving in our two patients who have penile curvature. Two young adults, aged 20 and 23 years, presented to our clinic with lateral and dorsal penile curvatures. This problem has been sustaining since their teenage. Following the required preparations, two surgical techniques were used, namely Nesbit and Lue's "16-dot" technique. Patients completed a satisfaction survey at a mean of 6 months later the surgery. Although both patients reported a subjective decrease in penile length, their satisfaction rate was high. Penile plication without degloving is a safe and effective technique for correcting dorsal and lateral penile curvatures.

A rare malformation of urinary system: Right ectopic thoracic kidney

An ectopic kidney is a common developmental anomaly of the urinary system. However, the thoracic kidney (TK) is the rarest state form of an aberrant kidney. The aim of this case report is defining the symptoms in TK diagnosis and constructing a treatment model will promote the best outcomes. These patients come to the physician with the various symptoms, and they could be diagnosed incidentally. In our case, we describe 40 years female patient with severe respiratory problems and upper back pain. In the pulmonary clinic, suspected mass was diagnosed with chest X-ray, and computerized tomography detected nontraumatic nonhernia associated, a truly ectopic TK. Moreover, the thoracic surgeon and urologist team decided to exploration and reconstructed the right ectopic kidney. The 1^st month of the control of patient symptoms was disappeared. Overall, TK should be kept in mind in the differential diagnosis of thoracic tumors. Surgical exploration and reconstruction should be thought in patients who have severe respiratory symptoms.

The effects of different types of statins on proliferation and migration of HGF-induced Human Umbilical Vein Endothelial Cells (HUVECs)

BACKGROUND AND AIM

Statins are HMG-CoA reductase inhibitors within the framework of cholesterol biosynthesis and used to lower the low-density lipoprotein (LDL). There are other aspects of statins can deploy a protective effect, even without the LDL's lowering. The aim of this study is to investigate the effects of different type of statins on proliferative and migrative behaviors of Hepatocyte Growth Factor (HGF) induced human umbilical vein endothelial cells (HUVECs).

MATERIALS AND METHODS

Human umbilical vein endothelial cells were isolated and cultured. Groups were designed in order to observe the effects of every individual substance. HUVECs were stimulated with HGF, statins and farnesylpyrophosphat ammonium salt (FPP) or geranylgeranyl-pyrophosphate (GGPP), respectively. Cell proliferations were counted 48 hours after initial stimuli and distances between migration fronts were used in migration analyses.

RESULTS

All types of statins showed significant anti-migrative and anti-proliferative characters. Simvastatin and fluvastatin but not cerivastatin, were able to inhibit the HGF-depending migration and showed a significant effect on the inhibition of the isoprenylation (GGPP). Only simvastatin influenced the HGF-depending migration via inhibiting the isoprenylation process through GGPP. Cerivastatin significantly decreased the proliferation and Fluvastatin significantly enhanced the migration behaviors of HUVECs when they were co-incubated with methyl-8-cyclodextrin (MCD).

CONCLUSIONS

Statins countermand the proproliferative and as well as the promigrative effect of HGF on HUVECs. The mechanisms which provoke this effect are dependent on the type of statin. Direct interactions of statins with lipid rafts play a significant role in the endothelial cell mechanisms.