Is neutrophil to lymphocyte ratio a predictive factor for recurrence of urethral stricture?
Due to spongiofibrosis and inflammatory processes underlying the pathogenesis of urethral stricture, it is possible that the neutrophil-lymphocyte ratio (NLR) may give essential information about the course of the disease and recurrence possibilities. Our study aims to evaluate the correlation betwe...
Saved in:
Published in | Revista da Associacao Medica Brasileira (1992) Vol. 65; no. 12; pp. 1448 - 1453 |
---|---|
Main Authors | , , , , , , , |
Format | Magazine Article |
Language | English |
Published |
Brazil
01.12.2019
|
Subjects | |
Online Access | Get full text |
Cover
Loading…
Abstract | Due to spongiofibrosis and inflammatory processes underlying the pathogenesis of urethral stricture, it is possible that the neutrophil-lymphocyte ratio (NLR) may give essential information about the course of the disease and recurrence possibilities. Our study aims to evaluate the correlation between NLR and recurrence rates.
A total of 512 patients who underwent direct visual internal urethrotomy (DVIU) due to urethral stricture in our clinic between February 2010 and January 2018 were evaluated retrospectively.
The median follow up for non-recurrent and recurrent groups after DVIU was 30 and 36 months, respectively. During the follow-up, 280 (54.7%) of the patients had recurrences, and 232 (45,3%) had no recurrences. The mean time for recurrence after DVIU was 6,5±1,4 months, with a range of 1-36 months. The mean NLR in the non-recurrence group was 2,02±0,87, with a median of 1.9, and 3,66±2,30, with a median of 3 in the recurrence group. A highly significant statistical difference was observed between two groups in terms of neutrophil count and NLR (p: 0.000 - both). The area under curve value for NLR was 0.767, with a standard error of 0.021 (95% CI 0.727-0.808). The cut-off value of NLR was determined as 2.25, with a 70% sensitivity and 67,7% specificity.
By using NLR, the inflammatory features of the urethral tissue can be predicted, and possible recurrences after surgery can be estimated. Consequently, open urethroplasty techniques can be used in cases with a significant NLR value instead of the recurrent endoscopic procedure. |
---|---|
AbstractList | Due to spongiofibrosis and inflammatory processes underlying the pathogenesis of urethral stricture, it is possible that the neutrophil-lymphocyte ratio (NLR) may give essential information about the course of the disease and recurrence possibilities. Our study aims to evaluate the correlation between NLR and recurrence rates.
A total of 512 patients who underwent direct visual internal urethrotomy (DVIU) due to urethral stricture in our clinic between February 2010 and January 2018 were evaluated retrospectively.
The median follow up for non-recurrent and recurrent groups after DVIU was 30 and 36 months, respectively. During the follow-up, 280 (54.7%) of the patients had recurrences, and 232 (45,3%) had no recurrences. The mean time for recurrence after DVIU was 6,5±1,4 months, with a range of 1-36 months. The mean NLR in the non-recurrence group was 2,02±0,87, with a median of 1.9, and 3,66±2,30, with a median of 3 in the recurrence group. A highly significant statistical difference was observed between two groups in terms of neutrophil count and NLR (p: 0.000 - both). The area under curve value for NLR was 0.767, with a standard error of 0.021 (95% CI 0.727-0.808). The cut-off value of NLR was determined as 2.25, with a 70% sensitivity and 67,7% specificity.
By using NLR, the inflammatory features of the urethral tissue can be predicted, and possible recurrences after surgery can be estimated. Consequently, open urethroplasty techniques can be used in cases with a significant NLR value instead of the recurrent endoscopic procedure. SUMMARY INTRODUCTION Due to spongiofibrosis and inflammatory processes underlying the pathogenesis of urethral stricture, it is possible that the neutrophil-lymphocyte ratio (NLR) may give essential information about the course of the disease and recurrence possibilities. Our study aims to evaluate the correlation between NLR and recurrence rates. METHODS A total of 512 patients who underwent direct visual internal urethrotomy (DVIU) due to urethral stricture in our clinic between February 2010 and January 2018 were evaluated retrospectively. RESULTS The median follow up for non-recurrent and recurrent groups after DVIU was 30 and 36 months, respectively. During the follow-up, 280 (54.7%) of the patients had recurrences, and 232 (45,3%) had no recurrences. The mean time for recurrence after DVIU was 6,5±1,4 months, with a range of 1-36 months. The mean NLR in the non-recurrence group was 2,02±0,87, with a median of 1.9, and 3,66±2,30, with a median of 3 in the recurrence group. A highly significant statistical difference was observed between two groups in terms of neutrophil count and NLR (p: 0.000 – both). The area under curve value for NLR was 0.767, with a standard error of 0.021 (95% CI 0.727-0.808). The cut-off value of NLR was determined as 2.25, with a 70% sensitivity and 67,7% specificity. CONCLUSION By using NLR, the inflammatory features of the urethral tissue can be predicted, and possible recurrences after surgery can be estimated. Consequently, open urethroplasty techniques can be used in cases with a significant NLR value instead of the recurrent endoscopic procedure. RESUMO INTRODUÇÃO Devido à espongiofibrose e processos inflamatórios subjacentes à patogênese da estenose uretral, pode-se pensar que a relação de linfócitos neutrofílicos (NLR) pode fornecer informações essenciais sobre o curso da doença e as possibilidades de recorrência. O objetivo do nosso estudo é avaliar a correlação entre NLR e taxas de recorrência. MÉTODOS Quinhentos e doze pacientes submetidos à uretrotomia interna visual direta (DVIU) devido à estenose uretral em nossa clínica entre as datas de fevereiro de 2010 e janeiro de 2018 foram avaliados retrospectivamente. RESULTADOS A mediana de acompanhamento para os grupos não recorrentes e recorrentes após a DVIU foi de 30 e 36 meses, respectivamente. Durante o seguimento, 280 (54,7%) dos pacientes tiveram recidivas e 232 (45,3%) não tiveram recidivas. O tempo médio de recorrência após a DVIU foi de 6,5±1,4 mês, com variação de 1-36 meses. A média da RNL no grupo sem recorrência foi de 2,02±0,87 com mediana de 1,9 e 3,66±2,30 com mediana de 3 no grupo com recidiva. Uma diferença estatística altamente significativa foi observada entre dois grupos em termos de contagem de neutrófilos e NLR (p: 0,000 - ambos). A área sob o valor da curva para NLR foi de 0,767 com um erro padrão de 0,021 (IC 95% 0,727-0,808). Valor de corte de NLR determinado como 2,25 com uma sensibilidade de 70%, especificidade de 67,7%. CONCLUSÃO Ao utilizar a RNL, as características inflamatórias do tecido uretral podem ser previstas e possíveis recidivas após a cirurgia podem ser estimadas. Dessa forma, técnicas de uretroplastia aberta podem ser usadas em casos com valor significativo de NLR em vez de procedimento endoscópico recorrente. |
Author | Ozturk, Metin Ishak Tokuc, Emre Urkmez, Ahmet Kayar, Ridvan Artuk, Ilker Kutluhan, Musab Ali Topaktas, Ramazan Ozsoy, Emrah |
Author_xml | – sequence: 1 givenname: Ahmet orcidid: 0000-0001-8357-7734 surname: Urkmez fullname: Urkmez, Ahmet organization: . Haydarpasa Numune Research & Training Hospital, Dept. of Urology, Istanbul, Turkey – sequence: 2 givenname: Ramazan orcidid: 0000-0003-3729-3284 surname: Topaktas fullname: Topaktas, Ramazan organization: . Haydarpasa Numune Research & Training Hospital, Dept. of Urology, Istanbul, Turkey – sequence: 3 givenname: Emrah orcidid: 0000-0003-2886-8824 surname: Ozsoy fullname: Ozsoy, Emrah organization: . Haydarpasa Numune Research & Training Hospital, Dept. of Urology, Istanbul, Turkey – sequence: 4 givenname: Emre orcidid: 0000-0002-9493-8790 surname: Tokuc fullname: Tokuc, Emre organization: . Haydarpasa Numune Research & Training Hospital, Dept. of Urology, Istanbul, Turkey – sequence: 5 givenname: Musab Ali orcidid: 0000-0001-7117-9210 surname: Kutluhan fullname: Kutluhan, Musab Ali organization: . Fatih Sultan Mehmet Research & Training Hospital, Dept. of Urology, Istanbul, Turkey – sequence: 6 givenname: Ilker orcidid: 0000-0002-6099-062X surname: Artuk fullname: Artuk, Ilker organization: . Haydarpasa Numune Research & Training Hospital, Dept. of Urology, Istanbul, Turkey – sequence: 7 givenname: Ridvan orcidid: 0000-0002-1765-919X surname: Kayar fullname: Kayar, Ridvan organization: . Haydarpasa Numune Research & Training Hospital, Dept. of Urology, Istanbul, Turkey – sequence: 8 givenname: Metin Ishak orcidid: 0000-0002-1868-2316 surname: Ozturk fullname: Ozturk, Metin Ishak organization: . Haydarpasa Numune Research & Training Hospital, Dept. of Urology, Istanbul, Turkey |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31994624$$D View this record in MEDLINE/PubMed |
BookMark | eNo9kMtqwzAQRUVJadI0f1CKfsCu3pZXpYQ-AoFu2lUXQrJHxOBYRpYL-fvapM1iuMww5y7OLVp0oQOE7inJqSzJI9VEZSXTLFcypyynQugrtLqcF2hFKBGZYJws0WYYGkcYKaRkVN-gJadlKRQTK_S9G3AHY4qhPzQtTgG3p2N_CNUpAY42NQFb3Eeomyo1P4C9rVKI2E8ToRpjhK4CHDweI6RDtC0eUpx-p_XpDl172w6w-cs1-np9-dy-Z_uPt932eZ9VvGQps76uheTSSaiBOebKouRFQTQIW1NHvbZeO9CcaWWJdlIpD54JCop7UDVfI3HurWIYhgje9LE52ngylJhZl5m9mNmLUdJQZmZdE_ZwxvrRHaG-QP9y-C_Sbmmo |
CitedBy_id | crossref_primary_10_4111_icu_20230302 crossref_primary_10_1007_s00345_024_05017_x crossref_primary_10_12998_wjcc_v12_i14_2324 crossref_primary_10_1016_j_fjurol_2024_102670 crossref_primary_10_17343_sdutfd_1383534 crossref_primary_10_1016_j_ucl_2022_09_001 crossref_primary_10_1177_03915603221132033 crossref_primary_10_1177_15353702221090872 |
Cites_doi | 10.12688/f1000research.9427.1 10.1016/S0022-5347(17)35572-6 10.1016/j.urology.2017.04.037 10.1136/postgradmedj-2018-135806 10.1590/S1677-5538.IBJU.2014.0593 10.1016/j.juro.2017.05.006 10.1016/j.juro.2018.04.081 10.1089/end.2012.0606 10.4081/aiua.2015.4.295 10.1080/21681805.2018.1505945 10.1080/13685538.2019.1588873 10.5489/cuaj.4872 10.1038/nrurol.2013.275 10.1620/tjem.215.199 10.1016/j.juro.2009.05.023 10.1016/j.juro.2010.05.028 10.1177/0391560318758195 10.1016/j.urology.2011.02.051 10.5152/tud.2017.14478 10.1590/1806-9282.63.12.1065 10.1016/j.juro.2013.06.082 |
ContentType | Magazine Article |
DBID | CGR CUY CVF ECM EIF NPM AAYXX CITATION |
DOI | 10.1590/1806-9282.65.12.1448 |
DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed CrossRef |
DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) CrossRef |
DatabaseTitleList | MEDLINE CrossRef |
Database_xml | – sequence: 1 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: EIF name: MEDLINE url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search sourceTypes: Index Database |
DeliveryMethod | fulltext_linktorsrc |
Discipline | Medicine |
EISSN | 1806-9282 |
EndPage | 1453 |
ExternalDocumentID | 10_1590_1806_9282_65_12_1448 31994624 |
Genre | Journal Article |
GroupedDBID | 5VS ALMA_UNASSIGNED_HOLDINGS CGR CUY CVF ECM EIF NPM 0R~ 0SF 123 2WC 4.4 53G 6I. AACTN AAEDT AAEDW AAFTH AAIKJ AALRI AAXUO AAYXX ABMAC ABXHO ACGFS ADBBV ADEZE ADVLN AENEX AEXQZ AGHFR AITUG AMRAJ APOWU AZFZN BAWUL BCNDV CITATION DIK DU5 E3Z EBS EJD F5P FDB GROUPED_DOAJ GX1 HZ~ IPNFZ IXB KQ8 NCXOZ O-L O9- OK1 PGMZT RIG RNS RPM RSC SCD SSZ XSB |
ID | FETCH-LOGICAL-c392t-afdd4535b5ede2b2b97937708e4ad1b1f8af8be83286a08b566fef241e63fe6d3 |
ISSN | 0104-4230 |
IngestDate | Fri Aug 23 01:50:34 EDT 2024 Wed Jun 21 02:25:44 EDT 2023 |
IsDoiOpenAccess | false |
IsOpenAccess | true |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 12 |
Language | English |
LinkModel | OpenURL |
MergedId | FETCHMERGED-LOGICAL-c392t-afdd4535b5ede2b2b97937708e4ad1b1f8af8be83286a08b566fef241e63fe6d3 |
ORCID | 0000-0003-2886-8824 0000-0002-1868-2316 0000-0001-7117-9210 0000-0003-3729-3284 0000-0002-6099-062X 0000-0002-1765-919X 0000-0001-8357-7734 0000-0002-9493-8790 |
OpenAccessLink | http://www.scielo.br/pdf/ramb/v65n12/1806-9282-ramb-65-12-1448.pdf |
PMID | 31994624 |
PageCount | 6 |
ParticipantIDs | crossref_primary_10_1590_1806_9282_65_12_1448 pubmed_primary_31994624 |
PublicationCentury | 2000 |
PublicationDate | 2019-12-01 |
PublicationDateYYYYMMDD | 2019-12-01 |
PublicationDate_xml | – month: 12 year: 2019 text: 2019-12-01 day: 01 |
PublicationDecade | 2010 |
PublicationPlace | Brazil |
PublicationPlace_xml | – name: Brazil |
PublicationTitle | Revista da Associacao Medica Brasileira (1992) |
PublicationTitleAlternate | Rev Assoc Med Bras (1992) |
PublicationYear | 2019 |
References | Costa CH (ref7) 2009; 55 Ferguson GG (ref12) 2011; 78 Baskin LS (ref4) 1993; 150 Sukumar S (ref10) 2018; 200 Alwaal A (ref1) 2014; 3 Ohno Y (ref15) 2010; 184 Martino M (ref16) 2013; 190 Yuksel OH (ref8) 2016; 42 Zhang P (ref5) 2008; 215 Grimes N (ref14) 2018; 12 Yıldırım ME (ref20) 2016; 87 Grechenkov A (ref23) 2018; 85 Kluth LA (ref9) 2017; 106 Tolkach Y (ref11) 2016; 5 Velioglu Y (ref18) 2019; 22 Krane LS (ref13) 2013; 27 Qian H (ref17) 2018; 94 Sinanoglu O (ref21) 2018; 15 Hampson LA (ref3) 2014; 11 Lumen N (ref2) 2009; 182 Aktas G (ref6) 2017; 63 Ekerhult TO (ref24) 2018; 52 Gül M (ref19) 2017; 43 Chapman D (ref22) 2017; 198 |
References_xml | – volume: 3 start-page: 209 issue: 2 year: 2014 ident: ref1 article-title: Epidemiology of urethral strictures publication-title: Transl Androl Urol contributor: fullname: Alwaal A – volume: 55 start-page: 347 issue: 3 year: 2009 ident: ref7 article-title: Inflammatory cells and their mediators in COPD pathogenesis publication-title: Rev Assoc Med Bras. contributor: fullname: Costa CH – volume: 5 start-page: 2378 year: 2016 ident: ref11 article-title: Development of a clinical algorithm for treating urethral strictures based on a large retrospective single-center cohort . Version2 publication-title: F1000Res doi: 10.12688/f1000research.9427.1 contributor: fullname: Tolkach Y – volume: 150 start-page: 642 issue: 2 Pt 2 year: 1993 ident: ref4 article-title: Biochemical characterization and quantification of the collagenous components of urethral stricture tissue publication-title: J Urol doi: 10.1016/S0022-5347(17)35572-6 contributor: fullname: Baskin LS – volume: 106 start-page: 210 year: 2017 ident: ref9 article-title: Direct vision internal urethrotomy for short anterior urethral strictures and beyond: success rates, predictors of treatment failure, and recurrence management publication-title: Urology doi: 10.1016/j.urology.2017.04.037 contributor: fullname: Kluth LA – volume: 94 start-page: 489 issue: 1115 year: 2018 ident: ref17 article-title: Red cell distribution width in coronary heart disease: prediction of restenosis and its relationship with inflammatory markers and lipids publication-title: Postgrad Med J doi: 10.1136/postgradmedj-2018-135806 contributor: fullname: Qian H – volume: 42 start-page: 53 issue: 1 year: 2016 ident: ref8 article-title: White blood cell counts and neutrophil to lymphocyte ratio in the diagnosis of testicular cancer: a simple secondary serum tumor marker publication-title: Int Braz J Urol doi: 10.1590/S1677-5538.IBJU.2014.0593 contributor: fullname: Yuksel OH – volume: 15 start-page: 204 issue: 4 year: 2018 ident: ref21 article-title: Long-term effect of colchicine treatment in preventing urethral stricture recurrence after internal urethrotomy publication-title: Urol J contributor: fullname: Sinanoglu O – volume: 198 start-page: 1107 issue: 5 year: 2017 ident: ref22 article-title: Independent predictors of stricture recurrence following urethroplasty for isolated bulbar urethral strictures publication-title: J Urol doi: 10.1016/j.juro.2017.05.006 contributor: fullname: Chapman D – volume: 200 start-page: 837 issue: 4 year: 2018 ident: ref10 article-title: Multi-institutional outcomes of endoscopic management of stricture recurrence after bulbar urethroplasty publication-title: J Urol doi: 10.1016/j.juro.2018.04.081 contributor: fullname: Sukumar S – volume: 27 start-page: 1046 issue: 8 year: 2013 ident: ref13 article-title: Preoperative neutrophil/lymphocyte ratio predicts overall survival and extravesical disease in patients undergoing radical cystectomy publication-title: J Endourol doi: 10.1089/end.2012.0606 contributor: fullname: Krane LS – volume: 87 start-page: 295 issue: 4 year: 2016 ident: ref20 article-title: The effectiveness of local steroid injection after internal urethrotomy to avoid recurrence publication-title: Arch Ital Urol Androl doi: 10.4081/aiua.2015.4.295 contributor: fullname: Yıldırım ME – volume: 52 start-page: 302 issue: 4 year: 2018 ident: ref24 article-title: Sclerosis as a predictive factor for failure after bulbar urethroplasty: a prospective single-centre study publication-title: Scand J Urol doi: 10.1080/21681805.2018.1505945 contributor: fullname: Ekerhult TO – volume: 22 start-page: 187 issue: 3 year: 2019 ident: ref18 article-title: Complete blood count parameters in peripheral arterial disease publication-title: Aging Male doi: 10.1080/13685538.2019.1588873 contributor: fullname: Velioglu Y – volume: 12 start-page: E345 issue: 7 year: 2018 ident: ref14 article-title: The role of neutrophil-lymphocyte ratio as a prognostic indicator in patients undergoing nephrectomy for renal cell carcinoma publication-title: Can Urol Assoc J doi: 10.5489/cuaj.4872 contributor: fullname: Grimes N – volume: 11 start-page: 43 issue: 1 year: 2014 ident: ref3 article-title: Male urethral strictures and their management publication-title: Nat Rev Urol doi: 10.1038/nrurol.2013.275 contributor: fullname: Hampson LA – volume: 215 start-page: 199 issue: 3 year: 2008 ident: ref5 article-title: Increased expression of connective tissue grow factor in patients with urethral stricture publication-title: Tohoku J Exp Med doi: 10.1620/tjem.215.199 contributor: fullname: Zhang P – volume: 182 start-page: 983 issue: 3 year: 2009 ident: ref2 article-title: Etiology of urethral stricture disease in the 21stcentury publication-title: J Urol doi: 10.1016/j.juro.2009.05.023 contributor: fullname: Lumen N – volume: 184 start-page: 873 issue: 3 year: 2010 ident: ref15 article-title: Pretreatment neutrophil-to-lymphocyte ratio as an independent predictor of recurrence in patients with nonmetastatic renal cell carcinoma publication-title: J Urol doi: 10.1016/j.juro.2010.05.028 contributor: fullname: Ohno Y – volume: 85 start-page: 150 issue: 4 year: 2018 ident: ref23 article-title: Risk factors for urethral stricture and/or bladder neck contracture after monopolar transurethral resection of the prostate for benign prostatic hyperplasia publication-title: Urologia. doi: 10.1177/0391560318758195 contributor: fullname: Grechenkov A – volume: 78 start-page: 701 issue: 3 year: 2011 ident: ref12 article-title: Minimally invasive methods for bulbar urethral strictures: a survey of members of the American Urological Association publication-title: Urology doi: 10.1016/j.urology.2011.02.051 contributor: fullname: Ferguson GG – volume: 43 start-page: 325 issue: 3 year: 2017 ident: ref19 article-title: The predictive value of platelet to lymphocyte and neutrophil to lymphocyte ratio in determining urethral stricture after transurethral resection of prostate publication-title: Turk J Urol doi: 10.5152/tud.2017.14478 contributor: fullname: Gül M – volume: 63 start-page: 1065 issue: 12 year: 2017 ident: ref6 article-title: Elevated neutrophil-to-lymphocyte ratio in the diagnosis of Hashimoto’s thyroiditis publication-title: Rev Assoc Med Bras doi: 10.1590/1806-9282.63.12.1065 contributor: fullname: Aktas G – volume: 190 start-page: 1999 year: 2013 ident: ref16 article-title: Prognostic impact of preoperative neutrophil-to-lymphocyte ratio in localized nonclear cell renal cell carcinoma publication-title: J Urol doi: 10.1016/j.juro.2013.06.082 contributor: fullname: Martino M |
SSID | ssib020755218 ssj0027391 |
Score | 1.3407757 |
Snippet | Due to spongiofibrosis and inflammatory processes underlying the pathogenesis of urethral stricture, it is possible that the neutrophil-lymphocyte ratio (NLR)... SUMMARY INTRODUCTION Due to spongiofibrosis and inflammatory processes underlying the pathogenesis of urethral stricture, it is possible that the... |
SourceID | crossref pubmed |
SourceType | Aggregation Database Index Database |
StartPage | 1448 |
SubjectTerms | Adult Aged Follow-Up Studies Humans Lymphocyte Count - methods Middle Aged Neutrophils Recurrence Retrospective Studies ROC Curve Statistics, Nonparametric Time Factors Treatment Outcome Urethra - surgery Urethral Stricture - blood Urethral Stricture - surgery Young Adult |
Title | Is neutrophil to lymphocyte ratio a predictive factor for recurrence of urethral stricture? |
URI | https://www.ncbi.nlm.nih.gov/pubmed/31994624 |
Volume | 65 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1ba9swFBZZB2NPu6_dDT3szbiLZVuWn0YZHe0g3YUECnswkiWRkCYujv3Q_Ln-tR5JvqUrY92LHIRzSHQ-pO9chdBHrpMkjE3ZL1G5H-Uy97kKpB9oyRJOJEDadvs8oyez6Nt5fD4aXQ-ylupKHObbO-tK_kerMAd6NVWy99BsJxQm4DPoF0bQMIz_pOPTjbdWdVUWl_PFhWGRF1egnCK_qpRnNetx0wRALnLX3dverWMTC0vjZncNZoEt1qWq5qWrHFnYmMKtfD8TQQAa6Une6tMG2BM7hoU3cfF2E_MBtPANbDWLktsmUGlKBt6GWblcOZ_10XzV115PwXRfVq627Bdf8W2P2e_bjXMXHq8GvutpsazzZlYNPRdBOsgCaZyZ48gHOufiMsptwGxM_ZSwnR3a3SbRIpEM9lswB9ng7A4i13n4j3MhTk0iZSf8kMbGCdx_e9iG-9bx2CUtGnMJ5GRGSmakZDTOApIZKQ_QQ2I6DZqsgJ_dhkaAjwE9Yr0HIHRXOLZ_vKnlBKmf7vptO1xpx-qx7Gf6FD1p25DjIwfCZ2ik1s_Ro0mTmfEC_T7d4B6LuCpwj0VssYg57rGIHRYxYBH3WMSFxi0WcYfFzy_R7Ovx9MuJ31zc4edAtyufaylBE7GIlVREEJGatUnGTEVcBiLQjGsmFBwmjPIxE2BSaKWBSyoaakVl-ArtrYu12kdYaDCAJdjUoQamTHMmuXnkPOFSCUYPkN8uUXbp-rNkf1PUAXrt1rF7OzTdsSmJ3txT0lv0uAf1O7RXlbV6DwS1Eh8sCGA8-zG5AQmuiUE |
link.rule.ids | 783,787,27937 |
linkProvider | Colorado Alliance of Research Libraries |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Is+neutrophil+to+lymphocyte+ratio+a+predictive+factor+for+recurrence+of+urethral+stricture%3F&rft.jtitle=Revista+da+Associa%C3%A7%C3%A3o+M%C3%A9dica+Brasileira+%281992%29&rft.au=Urkmez%2C+Ahmet&rft.au=Topaktas%2C+Ramazan&rft.au=Ozsoy%2C+Emrah&rft.au=Tokuc%2C+Emre&rft.date=2019-12-01&rft.issn=0104-4230&rft.eissn=1806-9282&rft.volume=65&rft.issue=12&rft.spage=1448&rft.epage=1453&rft_id=info:doi/10.1590%2F1806-9282.65.12.1448&rft.externalDBID=n%2Fa&rft.externalDocID=10_1590_1806_9282_65_12_1448 |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0104-4230&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0104-4230&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0104-4230&client=summon |