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Symptomatic presentation of a completely duplicated collecting system with upper-pole ectopic ureteral insertion is rare in the adult. We present a case of a 52-year-old man with recurrent prostatitis and hematuria secondary to an ectopic ureteral insertion from a left upper-pole moiety in a completely duplicated collecting system. He underwent a robot-assisted laparoscopic ureteropyelostomy with good results. We describe our technique in this unusual case.

The purpose of this study was to evaluate the variance of apoptosis in rats in which experimental varicocele was induced and then treated by varicocelectomy. Forty adult male Wistar albino rats were used in this experimental study. Experimental varicocele was created in 30 rats. A total of 5 rats underwent a sham operation, and the remaining 5 rats were the control group. A total of 5 rats from the varicocele group were sacrificed on the 14th postoperative day, and 5 more were sacrificed on the 28th postoperative day to document the level of apoptosis due to varicocele. Varicocelectomy was performed on 20 rats with varicocele on the 14th postoperative day. These 20 rats were divided into 4 groups to evaluate the level of apoptosis in their testis after varicocelectomy. They were sacrificed on days 7, 14, 21, and 28 after varicocelectomy. The testes were fixated by perfusion with 10% formaldehyde and then placed in paraffin blocks. From each testis, 2 samples were stained with hematoxylin and eosin, and 2 samples were stained using the TUNEL method. In each specimen, apoptotic germ cells stained by TUNEL were counted in the cross section of 100 seminiferous tubules. The apoptotic index was defined by calculating the number of apoptotic cells per seminiferous tubule. Apoptotic index 5 total apoptotic germ cell count / 100. In the adult rats on which experimental varicocele was performed, both in the second and fourth week, apoptosis in both left and right testes were significantly higher compared with the control group (with varicocele day 14: 0.25-0.26, with varicocele day 28: 0.28-0.32, control: 0.11-0.13). After varicocelectomy on the 7th and 14th days, the slight increase in the level of apoptosis continued (day 7 left testis: 0.30, day 7 right testis: 0.28; day 14 left testis: 0.25, day 14 right testis: 0.31). After varicocelectomy, apoptosis decreased significantly on day 21 (left testis: 0.16, right testis: 0,22), and on day 28 it was almost equal to the level of the control group (left testis: 0.14, right testis: 0.16). After the creation of unilateral varicocele, the level of apoptosis increased in both the left and right testes. Apoptosis in both testes decreased after surgical treatment.

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The instillation of chemotherapeutic agents after transurethral resection of bladder tumor as an adjuvant treatment in bladder tumors is accepted as being safe if there is no associated bladder perforation. Mitomycin C (MMC) is a widely used agent for the adjuvant treatment of bladder tumors. A patient who developed MMC-induced bladder perforation and perivesical necrosis after an uneventful endoscopic tumor is presented. We suggest that the possible reason for such a complication could be deep resection at the anterior bladder wall. The treatment of the situation continued for an extended period, causing serious discomfort for the patient. Withholding immediate intravesical MMC instillation after resection of tumors on the anterior bladder wall ought to be considered in the early postoperative hours.

BackgroundAnimal studies have shown that nicotine affects the peristalsis of the ureter. The aim of the study is to analyze the effect of smoking on spontaneous passage of distal ureteral stones.Methods88 patients in whom distal ureteral stone below 10 mm diameter diagnosed with helical computerized tomography enhanced images were reviewed. Patients were grouped as either smokers (n:33) or non smokers (n:50). Follow-up for spontaneous passage of stones was limited with 4 weeks. Patients did not receive any additional medical treatment other than non-steroid anti inflamatory drugs only during painful renal colic episodes.Two groups were compared with the chi-square test in terms of passing the stone or not. Stone passage was confirmed with either the patient collecting the stone during urination or by helical CT.ResultsSmoking habits was present in 30(34%) patients and the frequency in both groups were similar (smokers: 23(76%) vs non-smokers: 46(79%)). Spontaneous passage of the stone was observed in 69(78%) patients. The two groups were comparable in terms of patien age, male to female ratio and stone size. Stone passage decreased as stone diameter increased. Total stone passage rates were similar in both groups (smokers: 76% vs. non-smokers: 79%) (p > 0.05). Passage of stones > 4 mm was observed in 46% and 67% of smokers and non-smokers respectively. However passage of stones with a diameter ≤ 4 mm were similar in both groups (smokers: 100% vs non-smokers: 92%) (p > 0.05).ConclusionSmoking has neither a favorable nor un-favorable effect on spontaneous passage of distal ureteral stones. However, spontaneous passage rates in patients with a stone diameter > 4 mm was lower in smokers. These results should be further confirmed with studies including larger numbers of patients.

ÖZETMesanede en sık rastlanan tümörler ürotelyal karsinomlar olmakla birlikte mesane kanserlerinin %10-20' sinde farklı diferansiyasyon gösteren tümörlerde bulunabilir. Bunlardan biride sarkomatoid ve lenfoepitelyoma benzeri diferansiyasyon gösteren ürotelyal karsinomdur. Daha çok erkeklerde ve ileri yaşta görülür. Tanı anında genelde ileri evredirler. Agresif neoplaziler olup sürvileri kötüdür. Literatürde çeşitli tedavi modaliteleri belirlenmiş olup kesin bir standart yoktur. Bu yazıda ender rastlanan sarkomatoid ve lenfoepitelyoma benzeri diferansiyasyon gösteren ürotelyal mesane karsinomu vakasına uyguladığımız parsiyel sistektominin sonucu literatür eşliğinde tartışılmıştır. (JAREM 2014; 1: 35-7) Anahtar Sözcükler: Mesane, sarkomatoid, ürotelyal karsinom, parsiyel sistektomi ABSTRACT Urothelial carcinomas are the most common tumor types in urinary bladder; however, there may exist different differentiations in 10-20% of bladder cancer, one of which is urothelial carcinoma that has sarcomatoid-and/or lymphoepithelioma-like differentiation. It is usually seen in males in older age and diagnosed during later stages. They are aggressive malignancies and have low survival. Although there are various treatment models determined in the literature, no certain standard is identified. In this study, we report a case of sarcomatoid-and lymphoepithelioma-like differentiated urothelial carcinoma of the urinary bladder that was treated by partial cystectomy and its results in light of the literature. (JAREM 2014; 1: 35-7) Key Words: Urinary bladder, sarcomatoid, urothelial carcinoma, partial cystectomy GİRİŞ Ürolojik kanserler içinde prostat kanserinden sonra ikinci sırada yer alan mesane tümörleri, erkeklerde görülen kanserler içinde dördüncü, kadınlarda ise sekizinci sırada yer almaktadır (1). Mesanede en sık %90-95 oranla ürotelyal hücreli kanser görülür, tanı sırasında yaklaşık %10-20'sinde farklı diferansiyasyon gösteren tü-mörlerde görülebilir (2). Sarkomatoid diferansiyasyon Torenbeek ve ark. (3) 4191 mesane kanserli hastayı inceledikleri çalışmasında %0.31 olarak bildirilmektedir (3). Erkek: Kadın oranı 4:1 olup pik insidans 7. dekattadır (4).Biz, oldukça kötü prognoza sahip sarkomatoid ve lenfoepitelyoma benzeri diferansiyasyon gösteren ürotelyal karsinomun klinik, seyir, teşhis ve tedavi aşamalarıyla farklı bir vaka sunmayı amaç-ladık. OLGU SUNUMUElli altı yaşında erkek hasta pıhtılı makroskopik hematüri şikayet-leri ile kliniğimize başvurdu. Fizik muayenesi, serum biyokimyası ve kan sayımı normaldi. Üriner sistem ultrasonografide (USG) mesane posterior duvarda 50x45x35 mm boyutlarında kitle lezyon tespit edildi ve üst üriner sisteme ait patoloji izlenmedi (Resim 1).Hastaya transüretral rezeksiyon (TUR) planlandı. Sistoskopi önce-si yapılan bimanuel muayenede ele gelen kitle ve fiksasyon yoktu. Mesane arka duvar kubbe bileşkesinde yaklaşık 5 cm çapında papillo-solid tümoral odak izlendi ve rezeksiyon yapıldı (TUR-MT), mesaneden multipl ve prostatik üretradan örnekleme yapıldı. Cerrahi şifa ile eksterne ed...

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