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E88 Ureteral peristalsis responses to physiotherapeutic procedure used for alleviation of stone removal in patients with urolithiasis
thursday 8 september 2011 / european urology supplements 10 (2011) 475–500
E86 Increased cardiovascular disease risk may be linked to systematic endothelial dysfunction in calcium oxalate disease F. Yencilek1 , H. Aydin2 , O. Tanriverdi3 , G. Yanikkaya Demirel4 , H. Koyuncu1 , K. Sarica1 . 1 Yeditepe University Medical Faculty, Dept. of Urology, Istanbul, 2 Yeditepe University Medical Faculty, Dept. of Internal Medicine, Section of Endocrinology and Metabolism, Istanbul, 3 Sisli Etfal Educational and Research Hospital, Dept. of Urology, Istanbul, 4 Sisli Etfal Educational and Research Hospital, Dept. of Immunology, Istanbul, Turkey Introduction and Objectives: Patients with renal stone disease are prone to increased cardiovascular disease risk. Systemic endothelial dysfunction (ED) is an early initiating event in the development of cardiovascular diseases. Quantification of circulating endothelial cells (CECs) in peripheral blood is a novel method of assessing ED. This study was planned to determine whether ED which was determined via quantification of CECs, was induced by hyperoxaluria in a rat model. Material and Methods: A total of 42 Sprague Dowley rats have been included into study. Group IA, B and C (n = 6): Hyperoxaluria-induced group; Group II (n = 6): Control group. Rats were euthanized either at 24 hours (group A), 14 days (group B) or 28 days (group C) and blood samples were collected for the analysis of CECs and 24-hour urine for oxalate excretion. Circulating endothelial cells were determined via flow cytometric method with the help of anti-CD 146-coated M-450 Dynabeads. Results: Compared to controls, the amount of CECs was found to be higher in hyperoxaluric group (p < 0.05). They began to increase immediately after induction of hyperoxaluria at 24hour samples and stayed high throughout 28-day period. The amount of CECs were positively correlated with urinary oxalate excretion (p = 0.03, r = 0.53). Conclusions: Results indicate systemic endothelial dysfunction in hyperoxaluric rats. This may contribute to the pathogenesis of increased risk of cardiovascular diseases in urolithiasis. E87 Antioxidants and papillary renal stones A. Costa-Bauza, F. Grases, R.M. Prieto, I. Gomila, P. Sanchis. University of Balearic Islands, University Institute of Health Sciences Research (IUNICS), Palma De Mallorca, Spain Introduction and Objectives: Several reports about the genesis of calcium oxalate monohydrate (COM) papillary calculi have been published since Randall’s first description of papillary calcification. It seems clear that renal epithelial cell injuries have a decisive role in development of such renal calculi, and the lithogenic effect of ethylene glycol (EG) must be mainly attributed to oxidative damage caused by the high level of oxalate generated by EG. Thus, although the EG rat model can be questioned as a general model to study renal stone formation, it must be considered as an interesting model for evaluation of renal papillary stone development, at least for those stones where genesis is linked to oxidative cell damage. The aim of the present study was to evaluate the antilithiasic activity of several antioxidants using such rat model. Material and Methods: 36 male Wistar rats were assigned randomly to four groups (n = 9): a control group, a catechin (CAT) treatment group, an epicatechin (EPI) treatment group, and a group treated with a folk herbal extract with antioxidant properties (FHE). After 16 days of treatment, calcium oxalate lithiasis was induced in the rats using EG. After 8 days (treatment + EG), 24-h rat urine was collected, the animals were sacrificed and their kidneys were removed for histological and chemical analysis. Results: The calcium concentration in kidney tissue was significantly lower in the CAT-treated (2.4±0.3 mg/g), EPI-
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treated (1.8±0.3 mg/g) and FHE-treated (2.1±0.3 mg/g) groups, than in the control group (5.4±1.4 mg/g). Examination of paraffin-embedded kidney sections showed that control group rats had the greatest amount of calcification. There were no significant differences between control and treated groups with respect to urinary calcium, magnesium, oxalate and citrate concentrations. Conclusions: These results demonstrate the ability of antioxidants to prevent the development of papillary and intratubular calcification linked to oxidative cell damage. E88 Ureteral peristalsis responses to physiotherapeutic procedure used for alleviation of stone removal in patients with urolithiasis A.A. Dudareva, L.A. Khodyreva, I.S. Mudraya. Research Institute of Urology, Moscow, Russia Introduction and Objectives: Different physical factors are supposed to be useful in complex conservative treatment of urolithiasis. The aim of the present study was to investigate the acute effects of physiotherapy (PT) based on deep oscillations of electrostatic field on ureteral function in patients during diagnostic ureteroscopy. Material and Methods: Assessment of ureteral peristalsis was carried out in 8 patients by impedance method with a special probe connected to a 6-channel impedance converter RPKA2–01. The probe was introduced into a patient’s ureter and 3-minute monitoring of the ureteral function was performed initially, then during each PT regime. Three various pulsed electrostatic field frequencies (14–25 Hz, 65–85 Hz, and 120–180 Hz) were applied via two external electrodes on the front abdominal wall in projection of ureter. Results: The overt effects of examined physical factors were documented by immediate changes in peristalsis amplitude, peristalsis rate, ureteral wall tone, and the character and direction of contractile waves travelling along the ureter. These parameters of ureteral contractile function changed individually in patients and depended on the frequency of applied electrostatic field and initial ureteral status. On the whole, peristalsis rate increased at all frequencies by 30–50%, no average significant changes were noted for the peristalsis amplitude, but ureteral wall tone decreased by 14% and 22% (p < 0.001) in response to electrostatic oscillations at frequencies 85 and 180 Hz, respectively. The chaotic contractions frequently (30%) observed prior to PT were replaced by antegrade (48%) or cystoid (43%) peristalsis accompanied by an inhibition of retrograde contractions. In 3 patients that demonstrated pronounced ureteral contractions (1.19±0.28 Ohm) before PT the peristalsis amplitude decreased by 9–26% at all frequencies. The opposite changes in ureteral function were recorded in 4 patients with initially weak peristalsis (0.19±0.03 Ohm): the peristalsis amplitude increased by 137% at frequency 180 Hz. Prior to PT, one patient demonstrated chaotic ureteral contractions with pronounced tonic component in the distal ureter. After PT, the tone of ureteral wall decreased by 48–55%, the contractions increased in amplitude and assumed antegrade and cystoid character. Conclusions: The data obtained directly show that the PT with deep oscillations of electrostatic field can be useful in complex stone removal treatment due to relaxing effect that depends on ureteral functional condition. The findings suggest that PT with the above frequencies is capable to affect the ureteral contractile function by normalizing the character of its peristalsis, decreasing ureteral wall tone, and individually stimulating the weak ureteral contractions or decreasing strong retrograde contractile waves.
E86 Increased cardiovascular disease risk may be linked to systematic endothelial dysfunction in calcium oxalate disease F. Yencilek1 , H. Aydin2 , O. Tanriverdi3 , G. Yanikkaya Demirel4 , H. Koyuncu1 , K. Sarica1 . 1 Yeditepe University Medical Faculty, Dept. of Urology, Istanbul, 2 Yeditepe University Medical Faculty, Dept. of Internal Medicine, Section of Endocrinology and Metabolism, Istanbul, 3 Sisli Etfal Educational and Research Hospital, Dept. of Urology, Istanbul, 4 Sisli Etfal Educational and Research Hospital, Dept. of Immunology, Istanbul, Turkey Introduction and Objectives: Patients with renal stone disease are prone to increased cardiovascular disease risk. Systemic endothelial dysfunction (ED) is an early initiating event in the development of cardiovascular diseases. Quantification of circulating endothelial cells (CECs) in peripheral blood is a novel method of assessing ED. This study was planned to determine whether ED which was determined via quantification of CECs, was induced by hyperoxaluria in a rat model. Material and Methods: A total of 42 Sprague Dowley rats have been included into study. Group IA, B and C (n = 6): Hyperoxaluria-induced group; Group II (n = 6): Control group. Rats were euthanized either at 24 hours (group A), 14 days (group B) or 28 days (group C) and blood samples were collected for the analysis of CECs and 24-hour urine for oxalate excretion. Circulating endothelial cells were determined via flow cytometric method with the help of anti-CD 146-coated M-450 Dynabeads. Results: Compared to controls, the amount of CECs was found to be higher in hyperoxaluric group (p < 0.05). They began to increase immediately after induction of hyperoxaluria at 24hour samples and stayed high throughout 28-day period. The amount of CECs were positively correlated with urinary oxalate excretion (p = 0.03, r = 0.53). Conclusions: Results indicate systemic endothelial dysfunction in hyperoxaluric rats. This may contribute to the pathogenesis of increased risk of cardiovascular diseases in urolithiasis. E87 Antioxidants and papillary renal stones A. Costa-Bauza, F. Grases, R.M. Prieto, I. Gomila, P. Sanchis. University of Balearic Islands, University Institute of Health Sciences Research (IUNICS), Palma De Mallorca, Spain Introduction and Objectives: Several reports about the genesis of calcium oxalate monohydrate (COM) papillary calculi have been published since Randall’s first description of papillary calcification. It seems clear that renal epithelial cell injuries have a decisive role in development of such renal calculi, and the lithogenic effect of ethylene glycol (EG) must be mainly attributed to oxidative damage caused by the high level of oxalate generated by EG. Thus, although the EG rat model can be questioned as a general model to study renal stone formation, it must be considered as an interesting model for evaluation of renal papillary stone development, at least for those stones where genesis is linked to oxidative cell damage. The aim of the present study was to evaluate the antilithiasic activity of several antioxidants using such rat model. Material and Methods: 36 male Wistar rats were assigned randomly to four groups (n = 9): a control group, a catechin (CAT) treatment group, an epicatechin (EPI) treatment group, and a group treated with a folk herbal extract with antioxidant properties (FHE). After 16 days of treatment, calcium oxalate lithiasis was induced in the rats using EG. After 8 days (treatment + EG), 24-h rat urine was collected, the animals were sacrificed and their kidneys were removed for histological and chemical analysis. Results: The calcium concentration in kidney tissue was significantly lower in the CAT-treated (2.4±0.3 mg/g), EPI-
483
treated (1.8±0.3 mg/g) and FHE-treated (2.1±0.3 mg/g) groups, than in the control group (5.4±1.4 mg/g). Examination of paraffin-embedded kidney sections showed that control group rats had the greatest amount of calcification. There were no significant differences between control and treated groups with respect to urinary calcium, magnesium, oxalate and citrate concentrations. Conclusions: These results demonstrate the ability of antioxidants to prevent the development of papillary and intratubular calcification linked to oxidative cell damage. E88 Ureteral peristalsis responses to physiotherapeutic procedure used for alleviation of stone removal in patients with urolithiasis A.A. Dudareva, L.A. Khodyreva, I.S. Mudraya. Research Institute of Urology, Moscow, Russia Introduction and Objectives: Different physical factors are supposed to be useful in complex conservative treatment of urolithiasis. The aim of the present study was to investigate the acute effects of physiotherapy (PT) based on deep oscillations of electrostatic field on ureteral function in patients during diagnostic ureteroscopy. Material and Methods: Assessment of ureteral peristalsis was carried out in 8 patients by impedance method with a special probe connected to a 6-channel impedance converter RPKA2–01. The probe was introduced into a patient’s ureter and 3-minute monitoring of the ureteral function was performed initially, then during each PT regime. Three various pulsed electrostatic field frequencies (14–25 Hz, 65–85 Hz, and 120–180 Hz) were applied via two external electrodes on the front abdominal wall in projection of ureter. Results: The overt effects of examined physical factors were documented by immediate changes in peristalsis amplitude, peristalsis rate, ureteral wall tone, and the character and direction of contractile waves travelling along the ureter. These parameters of ureteral contractile function changed individually in patients and depended on the frequency of applied electrostatic field and initial ureteral status. On the whole, peristalsis rate increased at all frequencies by 30–50%, no average significant changes were noted for the peristalsis amplitude, but ureteral wall tone decreased by 14% and 22% (p < 0.001) in response to electrostatic oscillations at frequencies 85 and 180 Hz, respectively. The chaotic contractions frequently (30%) observed prior to PT were replaced by antegrade (48%) or cystoid (43%) peristalsis accompanied by an inhibition of retrograde contractions. In 3 patients that demonstrated pronounced ureteral contractions (1.19±0.28 Ohm) before PT the peristalsis amplitude decreased by 9–26% at all frequencies. The opposite changes in ureteral function were recorded in 4 patients with initially weak peristalsis (0.19±0.03 Ohm): the peristalsis amplitude increased by 137% at frequency 180 Hz. Prior to PT, one patient demonstrated chaotic ureteral contractions with pronounced tonic component in the distal ureter. After PT, the tone of ureteral wall decreased by 48–55%, the contractions increased in amplitude and assumed antegrade and cystoid character. Conclusions: The data obtained directly show that the PT with deep oscillations of electrostatic field can be useful in complex stone removal treatment due to relaxing effect that depends on ureteral functional condition. The findings suggest that PT with the above frequencies is capable to affect the ureteral contractile function by normalizing the character of its peristalsis, decreasing ureteral wall tone, and individually stimulating the weak ureteral contractions or decreasing strong retrograde contractile waves.