CORRELATION BETWEEN INFLAMMATORY BLOOD MARKERS AND RECURRENCE RATES FOLLOWING URETHRAL STRICTURE TREATMENT

Öz

Objective To investigate the relationship between inflammatory markers routinely examined in blood tests and their ratios with the development of recurrence after urethral stricture treatment. Material and Method A total of 142 patients who underwent internal urethrotomy were included in the study. Data were retrospectively reviewed. Patient ages, comorbidity status, medical treatments used, habits, previous surgical procedures, pre- and post-procedural İduroflowmetry values, stricture locations and lengths, and preoperative and postoperative urine and blood test results were recorded. Results The recurrence rate within the first year after internal urethrotomy was determined to be 25.4%. The mean recurrence period was 8.9±1.9 months, ranging from 1 to 12 months, with a median recurrence period of 6 months. When the etiological factors causing urethral stricture were examined, iatrogenic causes were observed to be the most common. There were statistically significant differences in lymphocyte count, platelet count, platelet-lymphocyte ratio, and red cell distribution width-platelet ratio between the group with recurrence and the group without recurrence (p<0.05). Conclusion Platelet-lymphocyte ratio and red cell distribution width-platelet ratio can be used to predict possible recurrences after internal urethrotomy. The main advantages of both parameters are their simplicity, cost-effectiveness, and easy accessibility for clinical use.

Anahtar Kelimeler

• Inflammation
• Internal urethrotomy
• Recurrence
• Urethral stricture

ÜRETRAL DARLIK TEDAVİSİ SONRASI GELİŞEN NÜKS ORANLARI İLE İNFLAMATUAR KAN BELİRTEÇLERİ ARASINDAKİ İLİŞKİ

Öz

Amaç Rutin kan tetkiklerinde çalışılan inflamatuar belirteç ve bu belirteçlerin birbirleriyle oranları ile üretra darlığı tedavisi sonrası gelişen nüks arasındaki ilişkiyi ortaya koymak. Gereç ve Yöntem Çalışmaya internal üretrotomi operasyonu geçiren 142 hasta dahil edildi. Veriler retrospektif olarak tarandı. Hastaların yaşları, eşlik eden komorbidite durumları, kullandıkları tıbbi tedaviler, alışkanlıkları, geçirdikleri cerrahi operasyonlar, işlem öncesi ve sonrasında takiplerdeki üroflowmetre değerleri, darlık lokalizasyonları ve uzunlukları, preoperatif ve post operatif idrar ve kan tahlilleri kaydedildi. Bulgular İnternal üretrotomi operasyonu sonrası ilk bir yılda nüks gelişme oranı %25,4 olarak tespit edildi. Ortalama nüks süresi 8,9±1,9 aydı ve bu süre 1-12 ay arasında değişmekteydi, ortanca nüks süresi ise 6 ay olarak hesaplandı. Üretra darlığına neden olan etyolojik faktörler incelendiğinde, iyatrojenik nedenlerin en yaygın neden olduğu gözlemlendi. Nüks gelişen grup ile gelişmeyen grup arasında lenfosit sayısı, platelet sayısı, platelet-lenfosit oranı, red cell distribution width- platelet oranı bakımından istatistiksel olarak anlamlı farklar bulundu (p<0,05). Sonuç Platelet-lenfosit oranı ve red cell distribution width-platelet oranı, internal üretrotomi sonrası olası nüksler önceden tahmin etmek için kullanılabilir. Her iki parametrenin de basit, ekonomik ve kolayca erişilebilir olması, klinik kullanım açısından en büyük avantajlarıdır.

Anahtar Kelimeler

• İnflamasyon
• İnternal üretrotomi
• Üretra darlığı
• Nüks

Kaynakça

1. 1. McGeorge S, Chung A, Desai DJ. Trends in urethral stricture management over two decades. BJU Int 2019;124:37–41.
2. 2. Hampson LA, McAninch JW, Breyer BN. Male urethral strictures and their management. Nat Rev Urol 2014;11(1):43-50.
3. 3. Sangkum P, Gokce A, Tan RB, Bouljihad M, Kim H, Mandava SH, et al. Transforming Growth Factor-β1 Induced Urethral Fibrosis in a Rat Model. J Urol 2015;194(3):820-7.
4. 4. Krane LS, Gorbachinsky I, Sirintrapun J, Yoo JJ, Atala A, Hodges SJ. Halofuginone-coated urethral catheters prevent peri- urethral spongiofibrosis in a rat model of urethral injury. J Endourol 2011;25(1):107-12.
5. 5. Sangkum P, Yafi FA, Kim H, Bouljihad M, Ranjan M, Datta A, et al. Collagenase Clostridium histolyticum (Xiaflex) for the Treatment of Urethral Stricture Disease in a Rat Model of Urethral Fibrosis. Urology 2015;86(3):647.e1-6.
6. 6. Sangkum P, Yafi FA, Kim H, Bouljihad M, Ranjan M, Datta A,et al. Effect of adipose tissue-derived stem cell injection in a rat model of urethral fibrosis. Can Urol Assoc J 2016;10(5-6):E175-E180.
7. 7. Aktas G, Sit M, Dikbas O, Erkol H, Altinordu R, Erkus E, et al. Elevated neutrophil-to-lymphocyte ratio in the diagnosis of Hashimoto’s thyroiditis. Rev Assoc Med Bras 2017;63(12):1065-8.
8. 8. Costa CH, Rufino R, Lapa e Silva JR. Inflammatory cells and their mediators in COPD pathogenesis. Rev Assoc Med Bras 2009;55(3):347-54.

9. 9. Yuksel OH, Verit A, Sahin A, Urkmez A, Uruc F. White blood cell counts and neutrophil to lymphocyte ratio in the diagnosis of testicular cancer: a simple secondary serum tumor marker. Int Braz J Urol 2016;42(1):53-9.
10. 10. Jain SK, Kaza RC, Singh BK. Evaluation of holmium laser vs cold knife in optical internal urethrotomy for the management of short segment urethral stricture. Urol Ann 2014;6:328–333.
11. 11. Wong SSW, Aboumarzouk OM, Narahari R, O’Riordan A, Pickard R. Simple urethral dilatation, endoscopic urethrotomy, and urethroplasty for urethral stricture disease in adult men Cochrane Database Syst Rev 2012;12:006934.
12. 12. Ferguson GG, Bullock TL, Anderson RE, Blalock RE, Brandes SB. Minimally invasive methods for bulbar urethral strictures: a survey of members of the American Urological Association. Urology 2011;78(3):701-6.
13. 13. Qian H, Luo Z, Xiao C, Chen J, Li D, Xu H, et al. Red cell distribution width in coronary heart disease: prediction of restenosis and its relationship with inflammatory markers and lipids. Postgrad Med J 2018;94(1115):489-94.
14. 14. Velioglu Y, Yuksel A. Complete blood count parameters in peripheral arterial disease. Aging Male 2019;22(3):187-91.
15. 15. Krane LS, Richards KA, Kader AK, Davis R, Balaji KC, Hemal AK. Preoperative neutrophil/lymphocyte ratio predicts overall survival and extravesical disease in patients undergoing radical cystectomy. J Endourol 2013;27(8):1046-50.
16. 16. Grimes N, Hannan C, Tyson M, Thwaini A. The role of neutrophil- lymphocyte ratio as a prognostic indicator in patients undergoing nephrectomy for renal cell carcinoma. Can Urol Assoc J 2018;12(7):E345-8.
17. 17. Ohno Y, Nakashima J, Ohori M, Hatano T, Tachibana M. Pretreatment neutrophil-to-lymphocyte ratio as an independent predictor of recurrence in patients with nonmetastatic renal cell carcinoma. J Urol 2010;184(3):873-8.
18. 18. Martino M, Pantuck AJ, Hofbauer S, Waldert M, Shariat SF, Belldegrun AS, et al. Prognostic impact of preoperative neutrophil- to-lymphocyte ratio in localized nonclear cell renal cell carcinoma. J Urol 2013;190:1999-2004.
19. 19. Urkmez A, Topaktas R, Ozsoy E, Tokuc E, Kutluhan MA, Artuk I, et al. Is neutrophil to lymphocyte ratio a predictive factor for recurrence of urethral stricture? Rev Assoc Med Bras 2019; 65:1448-53.
20. 20. Gül M, Altıntaş E, Kaynar M, Buğday MS, Göktaş S. The predictive value of platelet to lymphocyte and neutrophil to lymphocyte ratio in determining urethral stricture after transurethral resection of prostate. Turk J Urol 2017;43:325-9
21. 21. Yahşi S, Ceylan C, Öztürk O, Ceviz K. İdiopatik Üretra Darlığında Nüksü Öngörmede İnflamatuar Belirteçlerin Klinik Önemi. Firat Med J 2023;28(1):51-55.
22. 22. Castiglione F, Dewulf K, Hakim L, Weyne E, Montorsi F, Russo A, et al. Adipose-derived Stem Cells Counteract Urethral Stricture Formation in Rats. Eur Urol 2016;70(6):1032-1041.
23. 23. Barrientos S, Stojadinovic O, Golinko MS, Brem H, Tomic-Canic M. Growth factors and cytokines in wound healing. Wound Repair Regen 2008;16:585–601.
24. 24. Pierce GF, Mustoe TA, Lingelbach J, Masakowski VR, Gramates P, Deuel TF. Transforming growth factor beta reverses the glucocorticoid-induced wound healing deficit in rats: Possible regulation in macrophages by plateletderived growth factor. Proc Natl Acad Sci 1989;86:2229-2233.
25. 25. Pierce GF, Mustoe TA, Altrock BW, Deuel TF, Thomason A. Role of platelet-derived growth factor in wound healing. J Cell Biochem 1991;45:319-326.
26. 26. Wang G, Mivefroshan A, Yaghoobpoor S, Khanzadeh S, Siri G, Rahmani F, et al. Prognostic Value of Platelet to Lymphocyte Ratio in Sepsis: A Systematic Review and Meta-analysis. Biomed Res Int 20226;2022:9056363.
27. 27. Li B, Zhou P, Liu Y, Wei H, Yang X, Chen T, et al. Platelet-to-lymphocyte ratio in advanced Cancer: Review and meta-analysis. Clin Chim Acta 2018 Aug;483:48-56.
28. 28. Gong Z, Xin R, Li L, Lv L, Wu X. Platelet-to-lymphocyte ratio associated with the clinicopathological features and prognostic value of breast cancer: A meta-analysis. Int J Biol Markers 2022;37(4):339-348.
29. 29. Delcea C, Buzea CA, Vîjan AE, Bădilă E, Dan GA. The platelet to lymphocyte ratio in heart failure: a comprehensive review. Rom J Intern Med. 2023;61(2):84-97.
30. 30. Allen LA, Felker GM, Mehra MR, Chıong JR, Dunlap SH, Ghalı JK, et al. Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Card Fail. 2010;1(3):230–238.
31. 31. Cetınkaya E, Senol K, Saylam B, Tez M. Red cell distribution width to platelet ratio: new and promising prognostic marker in acute pancreatitis. World J Gastroenterol. 2014;20:14450– 14454.
32. 32. Taefı A, Huang CC, Kollı K, Ebrahımı S, Patel M. Red cell distribution width to platelet ratio, a useful indicator of liver fibrosis in chronic hepatitis patients. Hepatol Int. 2015;9:454–460.