Relationship between the Severity of Coronary Artery Disease and Catheter-Associated Urethral Stricture in Patients with Acute Coronary Syndrome.

Background: Different arterial segments throughout the vascular system develop similar grades of atherosclerosis concomitantly. Urethral ischemia has been proposed as a cause of urethral stricture. Therefore, we aimed to investigate the relationship between coronary artery disease severity using a SYNTAX score and urethral stricture occurrence after urethral catheterization in patients with non-ST-segment-elevation acute coronary syndrome (ACS). Methods: This retrospective study consisted of 306 men with urethral catheters that were diagnosed with ACS and underwent coronary angiography between January 2016 and January 2018 in Kars Kafkas University and Osmaniye Government Hospital, Turkey. Hospital records were reviewed to collect the follow-up data of the patients regarding the occurrence of urethral stricture after urethral catheterization. The study population was divided into 2 groups according to urethral stricture development, and both groups were compared statistically. Results: SYNTAX scores were significantly higher in patients with urethral stricture than in those without urethral stricture (14.86±7.11 vs. 29.25±9.79; P<0.001). The SYNTAX score (OR=1.27; 95% CI: 1.16-1.39; P<0.001), diabetes, and serum albumin were found to be the independent predictors of urethral stricture. The receiver operating characteristic curve analysis showed that the cutoff value of the SYNTAX score for urethral stricture prediction was greater than 22.5, with 76.7% sensitivity and 85.1% specificity (AUC=0.88, 95% CI: 0.84-0.91; P<0.001). Conclusion: Coronary artery disease severity graded according to the SYNTAX score is an independent predictor of urethral stricture occurrence in ACS patients with a urethral catheter inserted.

The effect of testosterone therapy on lower urinary tract symptoms/bladder and sexual functions in men with symptomatic late-onset hypogonadism.

OBJECTIVE: To prospectively investigate the effect of testosterone therapy on lower urinary tract symptoms (LUTS)/bladder and sexual functions in men with symptomatic late-onset hypogonadism (SLOH). METHODS: The study included 25 men (age range 38 to 73 years) presented with sexual dysfunction, having SLOH, at a single university hospital. All men received testosterone replacement therapy with transdermal testosterone 50-100 mg gel per day for one year. Urodynamic studies with pressure-flow analysis, measurement of prostate volume, prostate specific antigen (PSA) and free PSA level, International Prostate Symptom Score (IPSS), Aging Male Symptom (AMS) scale and International Index of Erectile Function (IIEF-5) score were recorded in all men before and after one year of the treatment. RESULTS: The mean AMS score significantly decreased from 40.4 +/- 7.3 to 28.8 +/- 5.31 (p = 0.001), and mean IIEF-5 score significantly increased from 8.84 +/- 3.76 to 14.36 +/- 3.62 (p = 0.001). The mean maximal bladder capacity and compliance significantly increased (p = 0.007 and p = 0.032, respectively), and mean detrusor pressure at Qmax significantly decreased from pre-treatment to post-treatment (p = 0.017). CONCLUSION: This study suggests that in addition to improvement in sexual functions, testosterone therapy may also improve LUTS/bladder functions by increasing bladder capacity and compliance and decreasing detrusor pressure at maximal flow in men with SLOH.

The effect of testosterone alone and testosterone + estradiol therapy on bladder functions and smooth muscle/collagen content in surgically menopause induced rats.

OBJECTIVES: The aim of the study was to investigate the effect of testosterone alone and testosterone+estradiol therapy on bladder functions and smooth muscle/collagen content in surgically menopause induced rat model. METHODS: The study included 34 female Sprague-Dawley rats, and the rats were divided into four groups. After bilateral oophorectomy, during a 60 days period, six rats received IM saline injection for one time, as a control group, and nine rats received testosterone undecanoate 100mg/kg IM for one time, and nine rats received testosterone undecanoate 100mg/kg IM for one time + daily 0.50mg nasal spray of 17beta estradiol. Ten rats were taken as sham group. Urodynamic studies were performed in all groups before and after the study. The rats were sacrificed after 60 days, and cystometric findings and smooth muscle/collagen ratio of the bladders were compared between the groups. RESULTS: Increase in maximal bladder capacity and compliance were significantly higher in the testosterone treatment group and testosterone + estradiol treatment group than in the control group (p = 0.01 and p = 0.002, respectively for bladder capacity; p = 0.04 and p = 0.005, respectively for bladder compliance). Smooth muscle/collagen ratio of the bladders was significantly higher in the testosterone and testosterone + estradiol treatment groups than in the control group (p = 0.04 and p = 0.008, respectively). CONCLUSIONS: This study shows that bladder functions may deteriorate in postmenopausal period. In addition to estrogen replacement therapy, testosterone has a significant role to increase bladder smooth muscle, leading to improvement in bladder functions in postmenopausal women with urogenital system dysfunction.

Laparoscopic transperitoneoscopic nephroureterectomy in a patient with situs inversus totalis.

This article discusses the case of a 78-year-old female with painless gross hematuria. Chest X-rays showed dextrocardia with situs inversus, and whole-body computed tomography scanning showed a renal mass in the right renal pelvis, no evidence of metastasis, and mirror-image organs with left-to-right transposition, which resulted in a diagnosis of situs inversus totalis (SIT). A laparoscopic transperitoneoscopic right nephroureterectomy was scheduled. To our knowledge, our case is the second case of laparoscopic nephroureterectomy in renal pelvic urothelial carcinoma with SIT to be presented, but it is the first case of laparoscopic transperitoneoscopic nephroureterectomy. Laparoscopic transperitoneoscopic nephroureterectomy was successfully performed in a renal pelvic urothelial carcinoma patient with SIT with a correct description of renal vascularity and abdominal anatomy.

An alternative method for determining daily bladder perception.

OBJECTIVES: To avoid the unphysiologic nature of cystometry, we searched a new tool for evaluating bladder perceptions. METHODS: The study group consisted of 25 (14 girls and 11 boys) primary monosymptomatic enuretic children with a mean age of 11 (range 8-16). Four children were excluded due to neuromuscular dysfunctions of the bladder, which was demonstrated with the help of cystometry. All children filled a voiding chart 3 times daily to record the duration elapsed till normal desire (ND(daily)) and strong desire (SD(daily)). During cystometry, the amounts of infused medium (cystometric ND(ml) and cystometric SD(ml)) and the duration (cystometric ND(sec) and cystometric SD(sec)), till ND and SD were perceived and recorded. RESULTS: Mean cystometric ND(ml) was 209.9 +/- 107.2 and ND(sec), 318.1 +/- 135.5, whereas mean cystometric SD(ml) was 273.0 +/- 103.1 and SD(sec), 415.7 +/- 136.8. To evaluate the reliability of elapsed time instead of milliliters, as a parameter, cystometric ND/SD values were calculated and a strong correlation was found between the 2 (ND/SD(sec) = 0.77 +/- 0.19 and ND/SD(ml) = 0.77 +/- 0.19, r = 0.9795, P = .000). Although there was a strong correlation between 3 ND(daily) (r = 0.9576, P = .000), between 3 SD(daily) (r = 0.9706, P = .000), and 3 ND/SD(daily) (r = 0.8706, P = .000), no significant correlation was determined between mean ND(daily) and cystometric ND(sec) (r = 0.3410, P = .2032), and also between mean SD(daily) and cystometric SD(sec) (r = 0.2740, P = .2402). CONCLUSIONS: Daily durations of sensations do not correlate with those perceived during cystometry. However, as the results of 3 consecutive daily recordings have a strong correlation, comparison of the reliability of these methods is still needed.