The aim of this study was to compare the clinical results of plasmakinetic resection of the prostate (PRP) with standard transurethral resection (TUR) of the prostate (TURP). A total of 240 patients (mean age 63.5; age range 52-90 years), with symptomatic benign prostatic hyperplasia were randomized into two groups and treated with two different techniques (TURP and PRP). We evaluated pre-operative, per-operative and post-operative (first and 12th months) findings of all patients. The mean catheterization time was 3 and 4.5 days in the PRP and standard TURP groups, respectively (Po0.001). We observed the improvements in maximum flow rates in PRP group were significantly higher than TURP group (Po0.001). TUR of the prostate using plasmakinetic energy seems to be a promising treatment alternative to conventional TURP. It has the advantages of low intraoperative and post-operative complications, short convalescence, excellent intraoperative hemostasis, absence of fluid absorption and TUR syndrome.

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Objectives: To evaluate the efficacy of semirigid ureteroscopy in the management of ureteral stones located in different parts of the ureter. Methods: 1,503 patients were treated with semirigid ureteroscopy. All ureteral stones were either removed only by a basket catheter or disintegrated by pneumatic lithotripsy. Success rates, auxiliary procedures, complication rates and operation time were comparatively evaluated according to stone location. Results: Overall, mean stone size and age were 12.1 ± 3.7 mm and 43.2 ± 9.72 years, respectively. While 1,416 patients (94.2%) were completely stone-free, the procedure was unsuccessful in 87 cases (5.8%). The success rate was relatively low in the proximal ureter (71.7%) when compared with the mid (94.8%) and distal ureter (98.9%) (p = 0.021). Mean operation time was 25.4 ± 11.7 min. Longer duration of operation and higher complication rate were found in proximal ureteral calculi. Stone migration to the kidney and hematuria were the main reasons of failure in the proximal ureter and ureteral stenting was needed for 56.4% of patients with upper ureteral stone. Conclusions: Semirigid ureteroscopy can be the treatment of choice in lower and midureteral stones. However, it is an invasive and less successful treatment modality for proximal ureteral stones with relatively high complication rates.

We evaluated the possible effects of a calcium entry blocking agent "verapamil" on new stone formation and/or regrowth of residual fragments after shock wave lithotripsy (SWL) during long-term follow-up (>30 months) and compared the results with the success rates of adequate fluid intake. A total of 70 patients treated with SWL were randomly divided into three different groups, in the first two of which the patients received different preventive measures with respect to stone recurrence and/or regrowth. While 25 patients received a calcium channel blocking agent, verapamil hydrochloride, beginning 3 days before SWL and continued 4 weeks after the procedure, an additional 25 patients were put in an enforced fluid intake program and the remaining 20 patients received no specific medication and/or measure apart from close follow-up. Patients were followed regularly with respect to the clearance/regrowth of the residual fragments and that of new stone formation during long-term follow-up (within a mean follow-up of 30.4 months). The overall stone recurrence rate was 14% (10/70). Of the patients who became stone free (12/25, 48%) in group I, only one patient (1/12, 8.3%) showed a new stone formation during long-term follow-up. The figure was 40% (4/10) in group II patients and 55% (5/9) in group III patients receiving no specific medication. Regarding the residual stone fragments (<5 mm) after SWL, again high fluid intake was found to be the most effective on stone regrowth rates (2/13, 15.3%). Patients treated with verapamil also had acceptable regrowth rates (3/15, 20%). Finally, verapamil treatment significantly improved the clearance of residual fragments; while 7 out of 15 patients with residual fragments passed these particles successfully, (46.5%) in this group; these figures were 46% (6/13) and 18% (2/13) in the remaining groups. Residual fragments located in lower calyces demonstrated a poor clearance rate with higher regrowth rates. Verapamil administration was found to be effective enough to limit the regrowth of residual fragments and also to facilitate residual fragment clearance after SWL. Patients receiving this medication seemed to pass the retained fragments easily in a shorter time than the others.

Hypoxia-inducible factor-1alpha (HIF-1alpha) is a critical regulatory protein of cellular response to hypoxia. In this study, we evaluated the relationship of HIF-1alpha with clinicopathologic parameters such as tumor stage and grade, as well as angiogenic profile and proliferation index. The immunoreactivity of HIF-1alpha was assessed in 70 cases of primary bladder urothelial carcinoma. Vascular endothelial growth factor (VEGF) and microvessel density (MVD) were used to evaluate the angiogenic profile. MVD was calculated by immunohistochemical staining of endothelial cells with CD34. Proliferation index was determined by the percentage of Ki-67 nuclear staining in tumor cells. There was a significant relationship between HIF-1alpha immunoreactivity and stage, as well as histologic grade of the tumor (P < 0.001). HIF-1alpha immunoreactivity was also closely related to VEGF expression (P < 0.001), MVD (P = 0.002) and proliferation index (P < 0.001). VEGF, MVD and proliferation index were found to be closely related to tumor stage and histologic grade. There was no correlation between HIF-1alpha immunoreactivity and lamina propria (P = 0.13), muscularis propria (P = 0.009) or vascular invasion (P = 0.1). In this study, HIF-1alpha expression was found to be closely related to prognostic parameters in bladder urothelial carcinoma. For this reason, it may be a useful marker to determine the prognosis and to choose the appropriate treatment modality.