Sefa Alperen Öztürk

Amaç: Bu çalışmada testis torsiyonunun hava koşulları ile ilişkisini araştırmayı, ılıman ve subtropikal iklim kuşakları arasında yer alan Türkiye'ye ait sonuçları bildirmeyi amaçladık.Metodoloji: Retrospektif olarak değerlendirdiğimiz çalışmamıza 2012-2022 yılları arasında Süleyman Demirel Üniversitesi Eğitim ve Araştırma Hastanesi acil servisi veya üroloji polikliniğine skrotal ağrı şikayetiyle başvuran, fizik muayene ve skrotal renkli doppler ultrason bulgularına dayanarak testis torsiyonu tanısı konulan; skrotal eksplorasyon yapılan toplam 41 erkek hasta dahil edildi. Başvuru zamanında bu bölgedeki mevsim ve sıcaklık ortalamaları kaydedildi.Sonuçlar: Hastaların ortalama yaşı 26,39 yıldı. Testis torsiyonu 17 hastada sağ tarafta, 24 hastada ise sol taraftaydı. Hastaların 36’sına cerrahi detorsiyon uygulanırken 5 hastaya orşiektomi uygulandı. Orşiektomi yapılan hastalarda iskemi süresi anlamlı olarak daha uzundu (p

Methotrexate (MTX)‐induced nephrotoxicity remains a clinically relevant limitation associated with oxidative stress, inflammation, and apoptosis. Dexpanthenol (DEX), a pantothenic acid derivative, has demonstrated cytoprotective properties; however, its effects on MTX‐induced renal injury and related molecular pathways are not fully elucidated. This study investigated the potential renoprotective effects of DEX with a focus on inflammation‐ and redox‐associated signaling. Thirty‐two male Wistar rats were allocated into four groups: Control, MTX, MTX + DEX, and DEX. Renal injury was assessed by histopathology, immunohistochemical analysis of caspase‐3, NF‐κB, and TNF‐α, biochemical parameters (urea and creatinine), and RT‐qPCR analysis of SIRT1, PGC‐1α, NRF2, and HO‐1 gene expression. MTX administration resulted in marked renal damage characterized by tubular degeneration, hyperemia, and inflammatory infiltration, accompanied by increased caspase‐3, NF‐κB, and TNF‐α expression ( p < 0.001). MTX also significantly suppressed SIRT1, PGC‐1α, NRF2, and HO‐1 gene expression ( p < 0.001). DEX co‐treatment attenuated histopathological injury and significantly reduced pro‐inflammatory and apoptotic markers while restoring SIRT1, PGC‐1α, and HO‐1 expression ( p < 0.01–0.001), with a non‐significant upward trend in NRF2 levels. Biochemically, DEX reduced MTX‐induced urea and creatinine elevation. DEX confers significant protection against MTX‐induced renal injury, likely through modulation of inflammatory and oxidative stress–related regulatory pathways and attenuation of apoptosis. These findings support the potential of DEX as a pharmacological candidate for mitigating drug‐induced nephrotoxicity; however, further studies at the protein and functional levels are warranted.

Lipopolysaccharide (LPS)-induced sepsis is one of the leading causes of acute kidney injury (AKI). Gallic acid (GAL), a natural polyphenolic compound, exhibits potent antioxidant, anti-inflammatory, and cytoprotective properties. This study aimed to investigate the renoprotective effects of GAL. Thirty-two adult male Wistar rats were randomly divided into four groups (n = 8): Control, LPS (5 mg/kg, i.p.), LPS + GAL (100 mg/kg i.p. administered immediately before LPS), representing a preventive treatment design and GAL-alone. Renal tissues were examined histologically using hematoxylin-eosin staining and toll-like receptor 4(TLR4), nuclear factor kappa B(NF-κB), and interleukin-1 beta (IL-1β) immunoexpression by immunohistochemical staining. mRNA expression levels of sirtuin 1(SIRT1), adenosine monophosphate-activated protein kinase(AMPK), forkhead box O3(FOXO3), phosphoinositide 3-kinase (PI3K), protein kinase B(AKT1), glutathione peroxidase 4(GPX4), aquaporin 4 (AQP4), glycogen synthase kinase-3 beta(GSK3β) were assessed. Serum creatinine (CRE) and urea levels were analyzed to determine renal functional status. LPS administration caused marked renal injury, characterized by severe hyperemia, hemorrhage, tubular necrosis, and increased TLR4, NF-κB, and IL-1β expression. GAL treatment attenuated these changes, with a significant reduction only in hyperemia scores, while decreases in hemorrhage, neutrophil infiltration, and necrosis remained nonsignificant. GAL administration was associated with reversal of the LPS-related decrease in PI3K, AKT1, AMPK, FOXO3, SIRT1, GPX4 and AQP4 mRNA expression, along with reduced GSK3β mRNA expression. Serum CRE levels improved with GAL, whereas the urea reduction was not statistically significant. GAL showed a renoprotective effect in this preventive model of LPS-induced AKI and was associated with reduced inflammatory marker expression together with favorable changes in PI3K/AKT1/FOXO3/SIRT1-related mRNA profiles. These findings suggest that GAL may have prophylactic against early endotoxin-associated renal injury.

Purpose To create a reproducible and standardized urethral stricture model in rats, evaluating both histomorphologic findings and gene expression data. In studies involving experimental animals, more standardization is needed for the creation of a urethral stricture model. Methods Sixteen male rats were randomized into two groups. The Sham group (n:8) underwent only a penoscrotal incision, while the stricture group (n:8) had their urethras exposed through a penoscrotal incision, followed by electrocauterization to the corpus spongiosum. On the 15th day, blood and urethral tissues were harvested for histologic and molecular analyses. Histomorphologic, immunohistochemical, and reverse transcription polymerase chain reaction analyses were performed. Results The stricture group exhibited more severe and intense spongiofibrosis, inflammation, epithelial desquamation, and congestion in vascular structures compared to the controls (p < 0.05). The urethral tissue in the stricture group showed an increased ratio of inflammation parameters, including Collagen 1A1, Collagen 3A1, elastin, Transforming growth factor β1, α Smooth muscle actin, Platelet-derived growth factor α, and Platelet-derived growth factor β. Transforming growth factor β1, Platelet-derived growth factor α, and Platelet-derived growth factor β each correlated highly with the other six parameters (r > 0.60, p < 0.05). Conclusion Developing electrocoagulation-induced urethral stricture in rats is a simple, reliable, inexpensive, and reproducible. Reporting histologic data with qualitative and semi-quantitative scoring will enhance data standardization, aiding reader understanding and analysis. Transforming growth factor β and Platelet-derived growth factor play key roles in fibrosis during stricture development. Incorporating these cytokines in urethral stricture animal model studies can demonstrate successful stenosis creation.

Background/Aim: Vesicoureteral reflux (VUR) is a condition that causes urine to flow in reverse, from the bladder back into the ureters and occasionally into the kidneys. It becomes a vital cause of urinary tract infections. Conventionally, VUR’s severity is evaluated through imaging via voiding cystourethrography (VCUG). However, there is an unresolved debate regarding the precise timing and type of surgery required, making it crucial to classify VUR grades uniformly and accurately. This study’s primary purpose is to leverage machine learning, particularly convolutional neural network (CNN), to effectively identify and classify VUR in VCUG images. The aspiration is to diminish classification discrepancies between different observers and to create an accessible tool for healthcare practitioners. Methods: We utilized a dataset of 59 VCUG images with diagnosed VUR sourced from OpenI. These images were independently classified by two seasoned urologists according to the International Reflux Classification System. We utilized TensorFlow, Keras, and Jupyter Notebook for data preparation, segmentation, and model building. The CNN Inception V3 was employed for transfer learning, while data augmentation was used to improve the model’s resilience. Results: The deep-learning model attained exceptional accuracy rates of 95% and 100% in validation and training, respectively, after six cycles. It effectively categorized VUR grades corresponding to the global classification system. Matplotlib tracked loss and accuracy values, while Python-based statistical analysis assessed the model’s performance using the F1-score. Conclusion: The study’s model effectively categorized images, including those of vesicoureteral reflux, which has significant implications for treatment decisions. The application of this artificial intelligence model may help reduce interobserver bias. Additionally, it could offer an objective method for surgical planning and treatment outcomes. '+st+' Cetin N, Gencler A, Kavaz Tufan A. Risk factors for development of urinary tract infection in children with nephrolithiasis. J Paediatr Child Health. 2020;56(1):76-80. DOI: https://doi.org/10.1111/jpc.14495 Weitz M, Schmidt M. To screen or not to screen for vesicoureteral reflux in children with ureteropelvic junction obstruction: a systematic review. Eur J Pediatr. 2017;176(1):1-9. DOI: https://doi.org/10.1007/s00431-016-2818-3 Wadie GM, Moriarty KP. The impact of vesicoureteral reflux treatment on the incidence of urinary tract infection. Pediatr Nephrol. 2012;27(4):529-38. DOI: https://doi.org/10.1007/s00467-011-1809-x Siomou E, Giapros V, Serbis A, Makrydimas G, Papadopoulou F. Voiding urosonography and voiding cystourethrography in primary vesicoureteral reflux associated with mild prenatal hydronephrosis: a comparative study. Pediatr Radiol. 2020;50(9):1271-6. 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The past, present and future role of artificial intelligence in imaging. Eur J Radiol. 2018;105:246-50. DOI: https://doi.org/10.1016/j.ejrad.2018.06.020 Batuello JT, Gamito EJ, Crawford ED, Han M, Partin AW, McLeod DG, et al. Artificial neural network model for the assessment of lymph node spread in patients with clinically localized prostate cancer. Urology. 2001;57(3):481-5. DOI: https://doi.org/10.1016/S0090-4295(00)01039-6 Poulakis V, Witzsch U, de Vries R, Emmerlich V, Meves M, Altmannsberger HM, et al. Preoperative neural network using combined magnetic resonance imaging variables, prostate-specific antigen, and Gleason score for predicting prostate cancer biochemical recurrence after radical prostatectomy. Urology. 2004;64(6):1165-70. DOI: https://doi.org/10.1016/j.urology.2004.06.030 Wu S, Chen X, Pan J, Dong W, Diao X, Zhang R, et al. An artificial intelligence system for the detection of bladder cancer via cystoscopy: a multicenter diagnostic study. J Natl Cancer Inst. 2022;114(2):220–7. DOI: https://doi.org/10.1093/jnci/djab179 Fenstermaker M, Tomlins SA, Singh K, Wiens J, Morgan TM. Development and Validation of a Deep-learning Model to Assist with Renal Cell Carcinoma Histopathologic Interpretation. Urology. 2020;144:152-7. DOI: https://doi.org/10.1016/j.urology.2020.05.094 Hobbs KT, Choe N, Aksenov LI, Reyes L, Aquino W, Routh JC, et al. Machine Learning for Urodynamic Detection of Detrusor Overactivity. Urology. 2022;159:247-54. DOI: https://doi.org/10.1016/j.urology.2021.09.027 Katz JE, Abdelrahman L, Nackeeran S, Ezeh U, Visser U, Deane LA. The Development of an Artificial Intelligence Model Based Solely on Computer Tomography Successfully Predicts Which Patients Will Pass Obstructing Ureteral Calculi. Urology. 2023;174:58-63. DOI: https://doi.org/10.1016/j.urology.2023.01.025 Çelik Ö, Aslan AF, Osmanoğlu UÖ, Çetin N, Tokar B. Estimation of renal scarring in children with lower urinary tract dysfunction by utilizing resampling technique and machine learning algorithms. J Surg Med. 2020;4(7):573-7. DOI: https://doi.org/10.28982/josam.691768 Lorenzo AJ, Rickard M, Braga LH, Guo Y, Oliveria JP. Predictive Analytics and Modeling Employing Machine Learning Technology: The Next Step in Data Sharing, Analysis, and Individualized Counseling Explored with a Large, Prospective Prenatal Hydronephrosis Database. Urology. 2019;123:204-9. DOI: https://doi.org/10.1016/j.urology.2018.05.041 Serel A, Ozturk SA, Soyupek S, Serel HB. Deep Learning in Urological Images Using Convolutional Neural Networks: An Artificial Intelligence Study. Turk J Urol. 2022 Jul;48(4):299-302. DOI: https://doi.org/10.5152/tud.2022.22030 Serrano-Durba A, Serrano AJ, Magdalena JR, Martín JD, Soria E, Domínguez C, et al. The use of neural networks for predicting the result of endoscopic treatment for vesico-ureteric reflux. BJU Int. 2004;94:120–2. 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DOI: https://doi.org/10.1016/j.jpurol.2021.10.009 Copyright (c) 2024 Osman Ergün, Tekin Ahmet Serel, Sefa Alperen Öztürk, Hüseyin Bulut Serel, Sedat Soyupek, Burak Hoşcan This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Objective: Losses in muscle strength and decreases in physical functions, and therefore a decrease in quality of life, have been observed in prostate cancer patients receiving androgen deprivation therapy (ADT). Irisin is a new exercise-induced myokine, released from the muscles. It is predicted that muscle tissue irisin release as a result of muscle loss, may be affected in patients receiving ADT. The aim of this study is to compare irisin levels, together with muscle strength and physical functions, in patients receiving ADT, patients not receiving ADT, and healthy individuals. Material and methods: A total of 21 healthy individuals (control group: CG); 28 local- or local-advanced prostate cancer patients, not receiving ADT (non-ADT group); and seven prostate cancer patients receiving luteinizing hormone releasing hormone agonist (ADT group) were included in the study. Blood biochemistry (lipid profile, hormones, prostate specific antigen, glucose, insulin, and creatine phosphokinase) and irisin analyses were conducted. Physical functions were assessed by using the Five Times Sit to Stand (5TSTS), climbing stairs, walking pace, and functional reach (FRT) tests. Lower extremity isometric muscle strength was measured using an isokinetic dynamometer. Results: It was observed that the 5TSTS test results were higher (p=0.03), but FRT results were lower (p=0.04) in the ADT group. It was found that isometric muscle strength in lower extremities was significantly lower in the ADT group (p˂0.05). Plasma irisin levels did not reveal a significant difference between the groups (p=0.31). Conclusion: It was determined that muscle strength and physical function test performances of prostate cancer patients receiving ADT were worse, but their irisin levels were similar to patients who were not receiving ADT, and the healthy CG. Muscle strength and physical functions of patients who are receiving ADT, and who will start receiving ADT should be monitored, and protective measures should be taken.

Amaç Double J stent takımında evrensel olarak kabul görmüş bir metot yoktur. Kliniğimizde uyguladığımız metodun başarı ve komplikasyon oranlarını ortaya koyarak bizim ile aynı teknik alt yapı ve imkanlara sahip klinikler için bir öngörü ortaya koymaktır. Gereç ve Yöntem Kliniğimizde Ocak 2019 ile Ocak 2022 tarihleri arasında double J stent takılan 774 hastanın verileri geriye dönük olarak tarandı. Stente bağlı komplikasyon oranları ve stent migrasyonuna etkili olabilecek bağımsız risk faktörleri analiz edildi. Bulgular 774 hastaya 907 adet double J stent takıldı. Hastaların yaş ortalaması 54,3±20,1 (20-90) idi. Hastalara double J stent takılma nedenleri: üreter taşı (%46,5), böbrek taşı (%19,1) ve üreter darlığı (%34,4) idi. Tüm hastaların 91 (%11,8) adedinde ek müdahaleyi gerektiren ciddi stent migrasyon vardı. Sonuç Bizim çalışmamız litertürdeki double J stent takma tekniği ile stent migrasyonu arasındaki ilişkiyi araştıran ilk çalışma olma özelliğini taşımaktadır. Double J stent migrasyon oranımız (%11,8) hemen hemen güncel literatürde stent boyu çeşitli formülasyonlar ile hesaplanarak bulunan ve skopi altında takılan stentlerde görülen migrasyon oranına yakındır.

Amaç Üriner sistem taş hastalıkları ülkemizde ve dünyada sık görülmektedir. Flexıble üreterorenoskop (flex URS) ilk defa 1964 yılında Marshall tarafından tanımlanmıştır ve ilerleyen teknoloji ile birlikte 1987 yılında cerrahi teknik olarak kılavuzlarda yerini almıştır. Endikasyonları hızla genişlemektedir. Bu çalışmamızda kliniğimizde retrograde intrarenal cerrahi (RIRS) uygulanan hastaların verileri retrospektif olarak değerlendirilmiştir. Gereç ve Yöntem Mart 2017 ile Ocak 2019 tarihleri arasında Süleyman Demirel Üniversitesi Tıp Fakültesi (SDÜ) üroloji kliniğinde RIRS yapılmış 106 hastanın demografik verileri, taş boyutları, lokalizasyonları, skopi süresi, taşsızlık oranları ve postoperatif komplikasyonlar retrospektif olarak değerlendirildi. İşlem sonrası tüm hastalar 4 hafta sonra direkt üriner sistem grafisi ve bilgisayarlı tomografi görüntüleme yöntemleriyle değerlendirildi. Bulgular RIRS uygulanan 106 hastanın (66 erkek, 40 kadın) ortanca yaşı 52 (23-73) yıl olup, ortalama taş boyutu 13,9 (7-19) mm olarak hesaplandı. Ortalama operasyon ve floroskopi süresi sırayla;74 (30-135) dakika, 62 (20-136) saniyedir. İşlem öncesinde hiçbir hastada DJ kateteri yoktu ancak tüm hastalara işlem sonunda DJ kateteri yerleştirildi ve kateter 4 hafta sonra lokal anestezi altında çekildi. On bir (%10,3) olguda üreter darlığı nedeniyle, 8(%7,5) olguda da rezidü taş nedeniyle 2. seans yapıldı.RIRS yapılan taşların 19 (%17,9) üst kalikste, 9(%8,4) orta kalikste, 40 (%37,7) alt kalikste, 38(%35,8) olguda renalpelviste olduğu değerlendirildi. Hastalarımızın % 82,1’ inde ilk seansta taşsızlık sağlandığı bulundu. İkinci seans sonrası taşsızlık oranı % 92,5 olarak tespit edildi. Hastaların ortalama yatış süreleri 1,5 gün (1-9) gündü. Beş hastada postoperatif dönemde üriner sistem enfeksiyonu gelişti. RIRS uygulanan hastalarda cerrahi ya da cerrahi dışı nedenle mortaliteye rastlanmadı. Sonuç RIRS, taş cerrahisinde etkinlik ve komplikasyonlar açısından güvenilir bir yöntemdir. Özellikle ESWL dirençli taşlarda, obez, kas iskelet deformiteli hastalarda, soliter taşlı böbrekte, gebelikte, kanama diyatezinde önemli cerrahi alternatifitir. Teknolojik ilerlemeler ile birlikte tekniğin avantajları da düşünüldüğünde ilerleyen zamanlarda daha aktif kullanılacağı ve yaygınlaşacağı görüşündeyiz.