Inflammatory myofibroblastic tumor of the spermatic cord: two cases and review of the literature.

Inflammatory myofibroblastic tumor (IMT) is a neoplasm of intermediate biological potential. Few cases of spermatic cord IMT have been reported in the literature. Inflammatory myofibroblastic tumor is a consequence of the proliferation of fibroblasts and inflammatory cells. Despite its benign nature, the tumor often clinically mimics intrascrotal malignancy and usually remains undiagnosed preoperatively. The diagnosis of spermatic IMT is difficult preoperatively due to the non-specific findings. Therefore, if testicular tumors cannot be precisely excluded, radical orchiectomy should be performed for the diagnosis and treatment. However, it mainly occurs in children and young adults; spermatic IMT may also be seen among elderly men. Here, we report two cases of inflammatory myofibroblastic tumor involving the spermatic cord. SIMILAR CASES PUBLISHED: There are seven cases entitled "inflammatory myofibroblastic tumor of spermatic cord" in the literature. In our study we present two cases that had a spermatic cord IMT. Furthermore, one of these cases was 82 years of age and is the oldest patient presented in the literature.

Can proliferative hypertrophic scars of the median sternotomy incision predict the occurrence and characteristics of urethral stricture?

OBJECTIVES: To investigate the correlation between the characteristics of urethral stricture and incision scars in patients with urethral stricture and median sternotomy incision. Methods: We identified 368 patients who had undergone internal urethrotomy between January 2014 and December 2017. A total of 49 male patients with a median sternotomy scar and diagnosed with  urethral stricture were retrospectively evaluated. The median sternotomy incision scars were assessed using the Vancouver Scar Scale (VSS) and the patients were divided into 2 groups. Group I consisted of patients with a VSS score of less than 4 points, and those with ≥4 points constituted group II. The groups were compared in terms of age, smoking habit, body mass index, diabetes mellitus, hypertension, urethral stricture etiology, length and localization, and stricture relapse after intervention. RESULTS: The mean total VSS score was 2.0 points in group I and 7.46 points in group II. There was a significant correlation between the VSS total score and the urethral stricture length among the whole study population (correlation coefficient value=0.481; p less than 0.001). The urethral stricture was longer as the VSS score increased. Conclusion: A poorly healed median sternotomy incision scar can predict a poor wound healing in the urethra tissue. Further large scale, multi-center and prospective studies are needed to clarify this relationship.

Association between large prostate calculi and prostate cancer.

OBJECTIVE: We investigated the relationship between large prostate calculi and prostate cancer (PCa) risk. MATERIALS AND METHODS: The medical records of 340 patients who received a prostate biopsy at our institution between January 2015 and August 2016 were reviewed retrospectively. Of the patients, 82 had large prostatic calculi visualised by transrectal ultrasonography and 88 did not or had scarce prostatic calculi. We divided these patients into two groups: patients with large prostatic calculi (group 1) and patients without prostatic calculi (group 2). These groups were compared according to age, total prostate specific antigen (PSA) level, prostate volume, and final pathological diagnosis. RESULTS: The mean age of all patients was 61.4 ± 6.2 years, the mean total PSA was 12.3 ± 17.4 ng/mL, the mean prostate volume was 41.7 ± 17.6 mL, and the overall cancer detection rate was 31.5%. The cancer detection rates were 41.3% and 22.6% in groups 1 and 2, respectively (p = 0.018). No significant differences in mean age, mean total PSA, or mean prostate volume were observed between the groups. CONCLUSIONS: In the present study, large prostatic calculi were associated with PCa. However, more study is needed to examine the relationship between large prostatic calculi and PCa in more detail. The effects of particularly large prostate calculi in the development of PCa will be a necessary focus of future research.

The sufficiency of 6 core sextant prostate biopsy in patients with prostate specific antigen (PSA) values over 20 ng/mL.

OBJECTIVE: In this study, we aimed to investigate sufficiency of 6 core prostate biopsy in patients with PSA levels elevated above 20 ng/mL. MATERIALS AND METHODS: The medical record of the patients who received prostate biopsy at our institution between August 2011 to August 2016 who had serum total PSA values above 20 ng/mL, were reviewed retrospectively. In this study, we included 40 patients who received 6 core prostate biopsy and 40 patients who received 12 core prostate biopsy. A total number of 80 patients were enrolled in this study. Patients were divided into two groups, a 6 core biopsy group and a 12 core biopsy group. These groups are compared according to age, total PSA, prostate volume and final pathological diagnosis. RESULTS: Based on final pathological diagnosis, 2 patients (5%) had benign pathology and 38 patients (95%) had PCa in both group 1 and 2. The cancer detection rate in both groups was 95%. Although there were higher values of mean age, mean total PSA, and mean prostate volume in group 1, there was no statistically significantly difference at this variables in both groups. CONCLUSION: Although taking 6 core biopsies is not recently recommended, we proved that 6 core biopsy is adequate for patients with PSA values above 20 ng/mL.

Predictive factors of successful salvage microdissection testicular sperm extraction (mTESE) after failed mTESE in patients with non-obstructive azoospermia: Long-term experience at a single institute.

OBJECTIVE: To observe the clinical practice of salvage microdissection testicular sperm extraction (mTESE) in patients with non-obstructive azoospermia (NOA) and to determine the factors that may predict the presence of spermatozoa in preoperative salvage mTESE. METHODS: We retrospectively reviewed the medical records of 445 patients with the diagnosis of NOA, who had undergone the mTESE operation consecutively in our institution between the dates of March 2008 and June 2017. The study included a total of 49 patients with failure to detect spermatozoa in the first mTESE and who had then undergone salvage mTESE. In order to investigate the factors that predict the result of salvage mTESE, the patients were classified into two groups according to the outcome of salvage mTESE, as those with and without spermatozoa retrieval. Patients in these two groups were compared with regard to age, body mass index, history of varicocele, history of cryptorchidism, duration of infertility, outcomes of genetic analysis, results of hormone profiles and the testicular histopathology results of the first mTESE. RESULTS: The sperm retrieval rate following salvage mTESE was observed to be 42.8%. Statistically a significant difference was determined between the mean follicle stimulating hormone (FSH) values of the groups (p = 0.013). No significant difference was observed between the groups with regard to the remaining parameters. CONCLUSION: It was observed that among the factors that predict the success of sperm retrieval in salvage mTESE in patients with NOA and previous unsuccessful sperm retrieval in mTESE operation, only the pre-operative FSH level was observed to significantly correlate with the success in salvage mTESE.

The effect of the American Society of Anesthesiology classification scores on complications associated with percutaneous nephrolithotomy.

OBJECTIVES: We aimed to evaluate the effect of American Society of Anesthesiology (ASA) classification scoring and age on complications and surgical outcomes during and after percutaneous nephrolithotomy (PCNL) operation. MATERIAL AND METHODS: The records of 263 patients, above the age of 18 years, that underwent PCNL surgery between October 2014 and May 2017 were evaluated retrospectively. The patients were divided into three groups based on their ASA risk scores (ASA 1, 2, 3) and into two groups based on their age (younger and older than 65 years). Postoperative complications were assessed according to the ASA groups and age and according to the Clavien classification system. RESULTS: The number of patients in the ASA 1, 2, and 3 groups were 97 (36.8%), 131 (49.8%) and 35 (13.3%), respectively. Four patients in ASA4 were not included in the study. There was no significant difference in ASA 1, 2, 3 groups in terms of changes in Hgb values, mean duration of operation, and mean hospital stay. When ASA1 was compared to ASA3 and ASA2 was compared to ASA3, there was no significant difference in the incidence of all complication rates. There were 159 (60.4%) patients in the young group and 104 (39.5%) patients in the elderly group. Postoperative PCNL complications of these 2 groups were compared according to Clavien classification system and no significant difference was found in incidence of complications. CONCLUSIONS: We believe that PCNL operation can be performed effectively and safely in both ASA3 patients and patients above the age of 65 years.

Comparison of two different renal access techniques in one-stage percutaneous nephrolithotomy: triangulation versus eye of the needle.

BACKGROUND: Two primary methods used to create appropriate percutaneous renal access under fluoroscopic guidance are the triangulation technique (TT) and the "eye of the needle" (EN) technique. To the best of our knowledge, no study has yet compared the EN versus TT renal access methods that precede one-stage dilatation during percutaneous nephrolithotomy (PCNL). OBJECTIVES: Compare effects of renal access techniques on the stone-free rate of one-stage PCNL, and the influence on outcomes. DESIGN: Retrospective cross-sectional study. SETTINGS: Tepecik Training and Research Hospital, Turkey. PATIENTS AND METHODS: The records of patients with renal stones larger than 2 cm in diameter who underwent PCNL in our hospital between January 2008 and September 2017 were retrieved. Patients who had undergone one-stage PCNL with the EN renal access technique (EN group) were compared with patients who had undergone one-stage PCNL with the TT renal access technique (TT group). MAIN OUTCOME MEASURES: Operative time, stone size, access location, stone side, length of hospital stay, Hounsfield unit (HU), fluoroscopy time, change in hemoglobin level, complications (modified Clavien classification) and stone-free rate. SAMPLE SIZE: 195. RESULTS: Of 272 records, 195 met inclusion criteria. The one-stage PCNL stone-free rate and other outcomes did not differ significantly between the EN (n=91, 46.7%) and TT groups (n=104, 53.3%). CONCLUSION: According to our study, renal access for one-stage PCNL can be achieved using either the EN or TT technique. The renal access technique used does not independently affect the complication rate. LIMITATIONS: Retrospective, small sample size, and no comparison of body mass index. CONFLICT OF INTEREST: None.

The Rare Togetherness of Bladder Leiomyoma and Neurofibromatosis.

Neurofibromatosis Type 1 (Von Recklinghausen disease) is a common, autosomal dominant hereditary disorder characterized by involvement of multiple tissues derived from the neural crest. Urinary system involvement in neurofibromatosis is a rare condition. Leiomyoma of the bladder is a rare benign mesenchymal tumor. In this case, our experience and approach regarding the bladder leiomyoma development in a patient diagnosed with neurofibromatosis are presented and the literature data has been reviewed.

Pathology outcomes in patients with transurethral bladder tumour resection in a Turkish population: A retrospective analysis.

OBJECTIVES: Transurethral bladder tumour resection (TURBT) is the common surgical method used in the diagnosis, staging and treatment of patients with bladder tumour. Most of the rare tumours other than the urothelial carcinomas of the bladder are in advanced stage on diagnosis and necessitate aggressive treatment. In our study, we aimed to the histologic types of bladder cancer and to determine the regional incidence of rare bladder cancer types in our region. MATERIALS AND METHODS: We retrospectively evaluated 815 patients who underwent TURBT surgery between January 2010 and March 2016 in our clinic with a diagnosis of bladder cancer and at least 1 year follow-up. Patients with tumour histopathological examination including histological tumour type, grade and were reported. Thirty-nine patients with an unclear pathology report (neighboring organ invasion, cautery artifact, etc) and 17 patients whose data could not be accessed were excluded from the study. The patients who had received chemotherapy or radiotherapy due to any type of malignancy (23) were also excluded from the study. RESULTS: The outcomes of 736 patients operated in our clinics due to bladder tumour were evaluated. The mean age was 65.2 ± 8.4; 135 were female and 601 were male. Among them 711 patients with urothelial carcinoma were reported (94.2%). According to TNM classification, stage Ta was observed in 270 patients (37.9%), stage T1 in 297 (41.7%), and stage T2 in 144 (20.3%). Non-urothelial cancers were reported in 25 cases (3.3%). CONCLUSION: The incidence of bladder carcinoma varies between regions. The results of our study are similar to those of the western countries. Increased smoking and exposure to environmental carcinogenetic agents may lead to altered incidences and histological types of bladder tumours. Revision of regional tumour records may be useful to develop and evaluate future treatment strategies.

Investigation of the effect of body mass index (BMI) on semen parameters and male reproductive system hormones.

AIM: To evaluate the effects of body mass index (BMI) ratio on semen parameters and serum reproductive hormones. MATERIALS AND METHODS: The data of 454 patients who prsented to male infertility clinics in our hospital between 2014 and 2015 were analyzed retrospectively. Weight, height, serum hormone levels and semen analysis results of the patients were obtained. BMI values were calculated by using the weight and height values of the patients and they were classified as group 1 for BMI values ≤ 25 kg/m2, as group 2 for BMI values 25-30 kg/m2 and as group 3 for BMI values ≥ 30 kg/m2. RESULTS: The mean values of BMI, semen volume, concentration, total motility, progressive motility, total progressive motile sperm count (TPMSC), normal morphology according to Kruger, head abnormality, neck abnormality, tail abnormality, FSH, LH, prolactin, T/E2, total testosterone and estradiol parameters of the patients were considered. Patients were divided according to BMI values in Group 1 (n = 165), Group 2 (n = 222) and Group 3 (n = 56). There was no statistically significant difference in terms of all variables between the groups. CONCLUSIONS: We analyzed the relationship between BMI level and semen parameters and reproductive hormones, demonstrating no relationship between BMI and semen parameters. In our study, BMI does not affect semen parameters although it shows negative correlation with prolactin and testosterone levels.

Diagnosis and treatment in primary bladder small cell carcinoma: Literature review.

Small cell bladder carcinoma is a rare and frequently fatal disease. It can be distinguished from classical urothelial carcinoma microscopically and immunohistochemically. Small cell bladder carcinoma has histologically similar properties with other small cell carcinomas in other organs. It has a worse prognosis when compared to urothelial bladder cancer. Multimodal treatments are recommended although there is no widely accepted consensus regarding to the treatment algorithm because of its rarity. In this review, clinical properties and diagnosis of small cell bladder carcinoma, its histopathological and immunohistochemical properties and treatment modalities are examined.

Do cigarette and alcohol affect semen analysis?

OBJECTIVES: There are a number of studies about the effect of cigarette and alcohol on semen parameters in the literature. There is not a consensus on the relationship between use of cigarette and alchol and semen parameters in those studies. The number of studies in which cigarette and alcohol use are evaluated together is limited. This study was aimed to analyze the effect of cigarette and/or alcohol use on semen parameters. METHODS: In this prospective study, 762 patients who applied to an hospital urology polyclinic between January 2015 and March 2015 due to infertility, were questioned for alcohol and cigarette use in anamnesis. The remaining 356 patients were included in our study. Then, semen analysis of the patients was performed. The patients were divided into five groups according to cigarette use, into five groups according to alcohol use and into four groups according to cigarette and/or alcohol use. Significant differences were analyzed between the groups in terms of semen volume, semen concentration, total motility, forward motility and morphological (normality, head anomaly, neck anomaly, tail anomaly) values. RESULTS: According to cigarette use, only in group 4 (who use more than 20 package-years cigarette) semen volume was significantly lower than the control group (Mann-Whitney U, p = 0.009). There was no significant difference in any of the other parameters and groups compared with the control group (Mann-Whitney U, p > 0,05) CONCLUSION: According to our study, using more than 20 package-years cigarette decreases semen volume. The reason of this result might be the fact that the threshold value, from which the effect of cigarette and alcohol use on the semen parameters has to be determined.

Current approach for urinary system stone disease in pregnant women.

Urinary system stones can be classified according to size, location, X-ray characteristics, aetiology of formation, composition, and risk of recurrence. Especially urolithiasis during pregnancy is a diagnostic and therapeutic challenge. In most cases, it becomes symptomatic in the second or third trimester. Diagnostic options in pregnant women are limited due to the possible teratogenic, carcinogenic, and mutagenic risk of foetal radiation exposure. Clinical management of a pregnant urolithiasis patient is complex and demands close collaboration between patient, obstetrician and urologist. We would like to review current diagnosis and treatment modalities of stone disease of pregnant woman.

The relationship between serum hormone levels (follicle-stimulating hormone, luteinizing hormone, total testosterone) and semen parameters.

OBJECTIVE: The aim of this study was to investigate the effect of serum gonadotropin and total testosterone levels on semen parameters. MATERIALS AND METHODS: Three hundred and eighty-two patients that applied to a male infertility polyclinic were included in our study. Serum gonadotropin and total testosterone levels and semen parameters of the patients were analyzed during the first visit to the clinic. The reference FSH value was 1.5-12.4 mIU/mL, that of LH was 1.7-8.6 mIU/mL and the reference value for total testosterone was 249-836 ng/dL. RESULTS: While there was no statistically significant difference between the patients with low gonadotropin levels and the controls regarding any of the semen parameters (p > 0.05), there was a strong statistically significant difference between the patients with high gonadotropin levels and the controls regarding sperm concentration (p = 0.000), total motility (p = 0.000), progressive motility (p = 0.000), and morphology (p = 0.000). There was a strong statistically significant difference between the patients with low testosterone levels and the controls regarding total motility (p = 0.012) and progressive motility (p = 0.010), and a weak statistically significant difference in morphology (p = 0.042). There was no statistically significant difference in semen volume or sperm concentration (p > 0.05). There was no statistically significant difference in any of the semen parameters between the patients with high testosterone levels and the controls (p > 0.05). CONCLUSIONS: Our findings especially regarding LH and T levels are not in agreement with previous reports. In this regard, there is a need for larger-scale and randomized trials to resolve this discrepancy.

Low magnesium levels an important new prognostic parameter can be overlooked in patients with Fournier's gangrene: a multicentric study.

INTRODUCTION: We evaluated low magnesium levels and three different scoring systems including the Fournier's Gangrene Severity Index (FGSI), the Uludag Fournier's Gangrene Severity Index (UFGSI), and the Charlson Comorbidity Index (CCI) for predicting mortality in a multicentric, large patient population with FG. METHODS: The medical records of 99 FG patients who were treated and followed up in different clinics were reviewed. The biochemical, hematological, and bacteriological results from the admission evaluation were recorded. The CCI, FGSI, and UFGSI were evaluated and stratified by survival. RESULTS: The results were evaluated for the following patients: the survivors (n = 82) and the nonsurvivors (n = 17). The magnesium level for the survivors and nonsurvivors was 2.09 ± 0.28 and 1.68 ± 0.23, respectively (p 0.004). The admission FGSI, UFGSI, and CCI scores were significantly higher in nonsurvivors (p 0.001, p 0.001, p < 0.001, respectively). The receiver operating characteristics analysis revealed that the UFGSI was more powerful than the FGSI. The hypomagnesemia, low hemoglobin and hematocrit, low albumin and HCO3 levels; high alkaline phosphatase; and the high heart and respiratory rates, an FGSI >9, rectal involvement, and a high CCI were associated with a worse prognosis. CONCLUSION: Low magnesium levels might be an important parameter for a worse FG prognosis. Monitoring the serum magnesium levels might have prognostic and therapeutic implications in patients with FG. High CCI, FGSI, and UFGSI scores might be associated with a worse prognosis in patients with FG. The UFGSI might be more powerful scoring system than the FGSI.

Comparison of one-year results of transobturator tape method in the stress incontinence treatment according to body mass index.

OBJECTIVE: The purpose of this study was to compare the 1-year results of patients on whom we used the transobturator tape method for the stress incontinence treatment according to body mass index (BMI). MATERIAL AND METHODS: Patients diagnosed with stress incontinence and treated with the transobturator tape method were divided into three groups according to BMI. We recorded the results of preoperative urodynamic studies; durations of operation, catheterization, and hospitalization; and complications of patients. Patients were evaluated 1 year after the operation with respect to the objective/subjective success rates of the operation, patient satisfaction rates, and possible late complications. RESULTS: The obese group was observed to have a significantly higher duration of operation than the normal and overweight groups (p<0.001). The objective and subjective success rates were not significantly different between the groups (p=0.567 and p=0.245, respectively). There was no statistical difference between the groups with respect to the satisfaction rates (p=0.245). There was no significant difference between all three groups with respect to both preoperative and postoperative complication rates (p=0.096). CONCLUSION: The transobturator tape method for stress incontinence treatment has similar objective and subjective success rates, independent of BMI. In the obese patients, the operation time is longer than the others, but there is no difference with respect to the complication rates.

Different presentation types of primary Brucella epididimo-orchitis.

Brucellosis is a zoonotic disease that involved genitourinary system in 2-20% and most commonly cause single sided epididymo-orchitis. In our country Brucella is an endemic disease and causes serious and different diagnosis of acute scrotum and epididymo-orchitis. In this paper six cases of epididymo-orchitis cases which were resistant to classical treatment were discussed according to clinical and laboratory findings. We describe different types of presentation of Brucella epididymo-orchitis with diagnosis and treatment modalities.

A rare complication after renal transplantation: Forgotten stent.

In renal transplantation surgery, double J stents (DJS) are often used to reduce complications, protect the anastomosis between ureter and bladder, provide drainage in ureteral obstructions and enhance healing if there is an ureter injury. Urinary tract infections, hematuria and irritative voiding symptoms are the early complications of DJS. Migration, fragmentation, encrustation and rarely sepsis are among the late complications of DJS. In this report we describe a renal transplantation case whose DJS stent was forgotten because the patient did not attend the regular follow-up and noticed 5 years after surgery.