Evaluation of serum fibronectin levels and fibronectin gene polymorphism in patients receiving intravesical BCG therapy for non-muscle invasive bladder cancer and its prognostic value.

BACKGROUND: Bladder cancer continues to be a significant health issue, leading to ongoing research into novel biomarkers and treatment strategies. This study aims to evaluate the potential of serum fibronectin levels and fibronectin gene polymorphisms as biomarkers for predicting the recurrence and treatment response in patients with NMIBC undergoing intravesical BCG therapy. METHODS: Between June 2022 and December 2022, data of 73 patients who applied to the Mersin University Urology Clinic due to NMIBC and were followed and treated in our clinic, receiving intravesical BCG treatment, when necessary, as well as 56 individuals without any malignancy, were prospectively examined. Serum fibronectin levels were measured using the enzyme-linked immunosorbent assay method. PCR testing was applied for the fibronectin gene RS10202709 and RS 35,343,655 gene polymorphisms by using Real-Time PCR. RESULTS: The mean serum fibronectin level in the patient group was 76.794 ± 66.998ng/ml. Simultaneously, it was 50.486 ± 25.156ng/ml in the control group, and these differences in serum fibronectin levels were statistically significant(p = 0.003). Out of the 73 patients included in the study, recurrence of bladder cancer was observed in 53 of them. They were divided into two groups based on the recurrence times: early recurrence and late recurrence. The mean fibronectin level in the early recurrence group was 102 ± 86.1 ng/ml, while it was 44.7 ± 11.8 ng/ml in the late recurrence group. Emphasize the significance of the higher fibronectin levels in the early recurrence group by stating, patients with early recurrence exhibited significantly higher serum fibronectin levels compared to those with late recurrence (p < 0.001), suggesting a potential role for fibronectin as a prognostic biomarker. CONCLUSIONS: The statistically higher concentrations of serum fibronectin levels in patients with bladder cancer observed in our study are a noteworthy finding. These findings suggest that serum fibronectin levels could serve as a valuable prognostic biomarker for early recurrence in NMIBC patients, although their predictive value for BCG treatment response remains limited.

Evaluation of homeobox protein B13 (HOXB13) gene G84E mutation in patients with prostate cancer.

OBJECTIVES: To comprehensively investigate the potential association between prostate cancer (PCa) and the G84E mutation within the Homeobox Protein B13 (HOXB13) gene among individuals of Turkish descent, our study aims to undertake a prospective examination. METHODS: We evaluated 300 patients (150 diagnosed with prostate cancer, 150 controls) who presented in our clinic. Data collected were prospectively examined. DNA isolation was performed using an isolation kit. The HOXB13-G84E mutation (rs138213197) was analyzed in the obtained samples. Data encoding and statistical analysis were performed. RESULTS: The pathological allele for the G84E mutation was T. According to the findings, no mutations were detected in the control group, while the G84E mutation was detected in 17 patients in the patient group, all of whom had the TC genotype. The analysis showed that having the CC genotype reduced the risk of prostate cancer by 0.47 times (OR=0.47, CI=0.415-0.532). Our results did not support a trend toward family history or earlier-onset disease in comparisons between carriers and non-carriers of HOXB13 G84E mutation. Individuals with a positive family history exhibited a higher frequency of the G84E mutation. CONCLUSIONS: We concluded that HOXB13 gene mutation is indeed linked to PCa in Turkish men. However, we did not find a relationship between the HOXB13 gene G84E mutation carrier status and either early-onset PCa or familial PCa in Turkish men.

Cancers and Benign Processes on 68 Ga PSMA PET-CT Imaging Other than Prostate Cancer.

Background Imaging plays an important role in the evaluation of prostate cancer patients. In recent years, much attention has been focused on gallium 68 prostate-specific membrane antigen positron emission tomography-computed tomography ( 68 Ga PSMA PET-CT) in prostate cancer patients and has been widely used for staging, restaging, and therapy response for these patients. The aim of this study was to report 68 Ga PSMA PET-CT in other cancers and benign processes incidentally detected on 68 Ga PSMA PET-CT in patients with prostate cancer. Materials and Methods A total of 600 68 Ga PSMA PET-CT scans were performed for initial staging, restaging, detection of suspected recurrence, and therapy response in prostate cancer patients between December 2018 and June 2020. A total of 38 patients with histopathologically proven prostate cancer were included in the current study with other malignancies and benign processes. Mainly histopathology in most of cases and clinical and radiological follow-up in few cases after PET/CT scanning served as the standard of reference. Results A total of 38 patients (age range: 52-85 years; mean age: 68.6) with prostate cancer final histopathology results were included in the study. A total of 51 lesion sites were evaluated in 38 patients. Forty-one lesion regions of these 51 regions were based on histopathological diagnosis, whereas 10 of them were based on clinical follow-up and conventional radiological follow-up as differential criteria. Thirty of 51 lesion regions were evaluated as malignant and 21 were benign lesions. The most common 68 Ga PSMA ligand avid malignancy was lung adenocarcinoma (6/38). Conclusions Prostate-specific membrane antigen (PSMA) is a cell surface glycoprotein and mainly expressed in prostate epithelium. 68 Ga PSMA PET-CT imaging is very sensitive and specific imaging modality in prostate cancer patients. However, other malignancies and some benign processes may also have 68 Ga PSMA ligand avidity and some prostate cancer metastases may imitate other malignancies.

Novel Algorithm for the Management of Hematospermia.

Hematospermia or hemospermia is traditionally defined as the presence of fresh or altered blood in semen. Several factors might cause hematospermia, including infectious, inflammatory, iatrogenic, traumatic, structural, neoplastic, vascular, and systemic factors. The main aim of evaluation is to identify significant or treatable underlying causes of hematospermia and to re-assure the patient if no causative factor is detected after full evaluation. This review aims novel management of hematospermia, including a detailed history, physical examination, appropriate laboratory investigations, and diagnostic imaging, based on underlying causes of hematospermia.

Is there any priority between the alpha blockers on voiding functions after transrectal ultrasound guided prostate biopsy?

OBJECTIVE: Transrectal ultrasound-guided prostate biopsy is the gold standard in the diagnosis of prostate cancer. Major and minor complications may develop at varying rates after prostate biopsies, one of which is voiding impairment. This study aimed to evaluate whether all alpha1-blockers were effective in preventing voiding impairment after a transrectal ultrasound-guided prostate biopsy and if so, was one superior to the others. MATERIAL AND METHODS: This study included 240 patients who underwent a transrectal ultrasound-guided 12-core prostate biopsy and were prospectively randomized. Of the patients, 40 received 10 mg alfuzosin, 40 received 4 mg doxazosin, 40 received 8 mg silodosin, 40 received 0.4 mg tamsulosin, and 40 received 5 mg terazosin beginning on the day before the biopsy and for the following 30 days. The international prostate symptom score (IPSS), maximal flow rate, and post-void residual urine were recorded in all the patients before the procedure and on post-biopsy days 7 and 30. All he patients were followed up and questioned about voiding difficulty and acute urinary retention after the procedure. RESULTS: In all the alpha1-blocker groups, the IPSS and post-void residuals were statistically significantly lower, and the maximal flow rate was statistically significantly greater on post-biopsy days 7 and 30 compared with the baseline values (p<0.05). No patient in any of the alpha1-blocker groups developed acute urinary retention after the biopsy. CONCLUSION: To prevent voiding impairment and deterioration in the quality of life after a prostate biopsy, preemptive therapy with alpha1-blockers may have a protective role, especially in patients with large prostate volumes.

Trends in benign prostatic hyperplasia surgery over the years: A multicenter 14-year retrospective study.

OBJECTIVE: The aim of this study is to show the surgical trend over the past 14 years using the data from five major centers in Turkey with accumulated experience in benign prostatic hyperplasia (BPH) surgery. MATERIAL AND METHODS: This study included 94,954 patients with low urinary tract symptoms (LUTSs) secondary to BPH. By using electronic databases, we identified 7,163 patients who underwent BPH surgery, including monopolar transurethral prostate resection (M-TURP), bipolar transurethral prostate resection (BTURP), transurethral incision of the prostate (TUIP), open prostatectomy (OP), and holmium laser enucleation of the prostate (HoLEP) from 2006 to 2019. The years were grouped as 2006-2010, 2011-2015, and 2016-2019. RESULTS: The total number of outpatient treatments for BPH increased by 72.9% from 5,379 in 2006 to 9,302 in 2019. Until 2019, the annual number of surgeries increased from 375 to 937 (increasing 150%). All surgical approaches for BPH, except TUIP, were most frequently performed between the ages of 60 and 69. The rate of surgery including M-TURP, B-TURP, and TUIP was statistically different between 2006 and 2010, 2011 and 2015, and 2016 and 2019 (P < .001), except OP (P » .071). The highest increase was observed in HoLEP in the first half of the 2010s compared to the second half of the 2010s. The rate of M-TURP decreased from 77.9% to 17.9% from 2016 to 2019. CONCLUSION: With the aging population, the number of patients diagnosed and treated with BPH is increasing. B-TURP as a resection technique and HoLEP as an enucleation technique replace M-TURP. Healthcare services and government spending should be organized according to these data.

Fertility outcomes and predictors for successful sperm retrieval and pregnancy in 327 azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction.

BACKGROUND: Although few studies have reported fertility outcomes, no study has reported risk factors that might predict sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism in a large series. OBJECTIVES: To investigate fertility outcomes and predictors for successful sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction (mTESE). MATERIALS AND METHODS: This retrospective observational study included 327 azoospermic men with a history of cryptorchidism who underwent mTESE. Fertility outcomes including sperm retrieval, fertilization rate, number of transferred embryos, pregnancy, miscarriage, and live birth rates were recorded. RESULTS: Sperm retrieval was observed in 172 (52.6%) of the patients. The mean fertilization, pregnancy, and live birth rates were 55.2%±20.5, 53.5%, and 44.8%, respectively. The sperm retrieval rate was significantly higher at the orchidopexy age of ≤ 9.5 years (70.8%) than the orchidopexy age of > 9.5 years (42.1%) (P = .000). Patients with total testicular volume of ≥ 13.75 mL had significantly higher sperm retrieval rate (65.2%) than the patients with total testicular volume of < 13.75 mL (45.5%) (P = .001). Patients with total testosterone level of ≥ 300.5 ng/dL had significantly higher sperm retrieval rate (65.6%) than the patients with total testosterone level of < 300.5 ng/dL (40.3%) (P = .000). Patients with follicle-stimulating hormone (FSH) level of ≤ 17.25 mIU/ml had significantly higher sperm retrieval rate (72.3%) than the patients with FSH level of > 17.25 mIU/mL (44.4%) (P = .000). Younger male and female ages, and higher fertilization rates were the parameters that might predict pregnancy. CONCLUSIONS: Infertile azoospermic men with a history of cryptorchidism have high sperm retrieval rate with mTESE. Patients who had orchidopexy at the age of ≤ 9.5 years, and having total testicular volumes of ≥ 13.75 mL with total testosterone level of > 300.5 ng/dL and FSH level of ≤ 17.25 mIU/mL have higher success rate for sperm retrieval.

The effect of partial and total laryngectomy on couples' sexual functions in men with larynx cancer.

PURPOSE: To investigate effect of total or partial laryngectomies with or without adjuvant treatments on couples' sexual functions. METHODS: The study included 39 male patients with laryngeal cancer and their female partners who were sexually active. Twenty-six patients underwent total laryngectomy, and 13 had partial laryngectomy. Sexual functions were assessed with the International Index of Erectile Function (IIEF-5) questionnaire for erectile functions, the Male Sexual Health Questionnaire (MSHQ-4) for ejaculatory functions and the Female Sexual Function Index (FSFI) for female partners' sexual functions. RESULTS: The mean IIEF score significantly decreased from 21.51 ± 8.78 to 16.13 ± 9.6 after the surgery (p = 0.000). The mean MSHQ score significantly decreased from 12.95 ± 3.14 to 10.32 ± 4.59 after the surgery (p = 0.000). To investigate risk factors that might predict decreasing in post-operative erectile and ejaculatory function of the male patients, presence of pre-operative erectile dysfunction (p = 0.04) and additional treatment with chemo-radiation therapy were the predictors for decreases in erectile (p = 0.006) and ejaculatory functions (p = 0.036). The mean FSFI total score significantly decreased from 25.83 ± 7.42 to 13.45 ± 10.09 after the surgery (p = 0.000). CONCLUSION: Laryngectomies have negative impact on male erectile and ejaculatory functions, and also have negative effect on female partners' sexual functions. Presence of pre-operative erectile dysfunction and additional chemo-radiation therapy were the predictors to decrease in erectile and ejaculatory functions after surgery. Therefore, male patients and their female partners should be informed in light of these findings before laryngeal surgery and adjuvant therapy.

The role of COL6A1and PD-1 expressions in renal cell carcinoma.

OBJECTIVE: The COL6A1 is a gene encoding the alpha 1 polypeptide subunit of collagen 6 (COL6A1), an extracellular matrix protein subunit. Programmed cell death receptor-1 (PD-1) and its ligand, programmed cell death receptor ligand-1 (PD-L1) have been shown to have a prognostic significance in clear cell renal cell carcinomas (RCCs). In this study, we evaluated the expressions of COL6A1 and PD-1 in four different RCC subtypes. MATERIALS AND METHODS: A total of 161 radical nephrectomy and nephron-sparing surgery cases with RCCs from five different health care centers were included in this study. Clinical data of the cases were taken from electronic records of the institutions. The pathological data were collected by an expert uropathologist and re-evaluated with slides obtained from paraffin blocks of the cases. The correlation of COL6A1 and PD-1 expression with sex, age, tumor type, lymphovascular invasion (LVI), World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade, and tumor stage (pT) was analyzed with the Pearson chi-squared test. RESULTS: Patients with sarcomatoid RCC and clear cell RCC had significantly higher COL6A1 scores and intensities than in other types of RCC (p=0.004 and p=0.002, respectively). WHO/ISUP grade and, COL6A1 and PD-1 staining scores also showed positive correlation (r=0.230, p=0.004 and r=0.277, p=0.001, respectively for COL6A1 and r=0.191, p=0.018 and r=0.166, p=0.041, respectively for PD-1). The staining scores and intensities of COL6A1 and PD-1 were not different between the patients with positive and negative LVI (p>0.05). CONCLUSION: In high-grade RCCs, we found the relationship between immunohistochemical staining scores of COL6A1 and PD-1 proteins and clinical, demographic, and histopathological parameters. Our results proved that COL6A1 and PD-1 are really promising proteins as prognostic parameters and for targeted immunotherapy.

Effect of microsurgical varicocele repair on sexual functions and testosterone in hypogonadal infertile men with varicocele.

OBJECTIVE: To investigate effect of microsurgical varicocele repair on sexual functions and serum total testosterone level in infertile hypogonadal men with varicocele, and also to determine factors that might predict improvement in total testosterone level after surgery. METHODS: The study included 202 infertile hypogonadal men (total testosterone level of <3.5 ng/mL) with varicocele who underwent microsurgical sub-inguinal varicocele repair. RESULTS: Mean serum total testosterone level significantly increased from 2.55 ± 0.66 ng/mL to 3.72 ± 1.34 ng/mL after varicocelectomy (p = .000), and 105 patients (52%) had serum total testosterone level of ≥3.5 ng/mL after the surgery. Mean international index of erectile functions (IIEF-EF) score significantly increased from 27.47 ± 2.96 to 28.61 ± 2.02, post-operatively (p = .000). Of the patients who had pre-operative IIEF-EF score of ≤26, 65.5% had IIEF-EF score of ≥26 after varicocelectomy. Of the patients who had pre-operative decreased libido, 86.6% had post-operative increased libido. Only older patient age was the predictor for having total testosterone level of ≥3.5 ng/mL after the surgery (p = .031). CONCLUSIONS: Data suggest that serum total testosterone level, IIEF-EF score and sexual libido significantly increase after varicocele surgery. As the age increases, total testosterone level increased after varicocele surgery. Therefore, varicocele repair could be offered to hypogonadal men with clinically varicocele.

Systematic review of treatment methods for recurrent varicoceles to compare post-treatment sperm parameters, pregnancy and complication rates.

We aimed to define which method would be the best for the treatment of recurrent varicoceles. We analysed 21 studies to compare post-treatment improvement in semen parameters, spontaneous pregnancy and complication rates between the treatment methods. Overall spontaneous pregnancy rate was significantly higher in the surgical methods (44.3%) than in the radiological interventions (17.9%; p = .007). Post-treatment improvement rates in sperm parameters were significantly higher in the open surgical methods (77.5%) than in the radiological interventions (62.5%; p = .032). Post-treatment recurrence rates were 3.8% in the open surgical methods, 17.6% in the laparoscopic surgery and 3.3% in the radiological interventions. However, technical failure rate was 11.8% in the radiologic interventions. To analyse open surgical methods, recurrence rate was 0.6% in the microsurgical methods and 19% in the macroscopic methods, revealing significant difference (p < .001). Post-treatment testicular atrophy rate was significantly higher in the laparoscopic surgery (2.9%) than in the open surgery (0.3%; p = .033). In conclusion, surgical methods have higher pregnancy rates and higher improvement rate in sperm parameters than radiological interventions for the treatment of recurrent varicocele. Microsurgical redo varicocelectomy has lower recurrence and testicular atrophy rates than macroscopic varicocelectomy series. Therefore, patients with recurrent varicoceles should be informed based on these findings.

Comparison of Long-Term Results and Couples' Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation.

INTRODUCTION: No study has compared surgical outcomes and couples' satisfaction among the 3 types of implants, with all brands available on the markets. AIMS: To compare long-term complications, mechanical reliability, and couples' satisfaction with penile implant types and brands in patients who underwent penile prosthesis implantation. We also investigated whether there are risk factors that might predict couples' dissatisfaction. METHODS: This retrospective study included 883 patients with erectile dysfunction who underwent penile prosthesis implantation. Of the patients, 349 had malleable penile implant, 26 had 2-piece implants, and 508 had 3-piece implants. MAIN OUTCOME MEASURE: Couples' satisfaction after surgery was evaluated with the modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire. Surgical outcomes, mechanical reliability, and couples' satisfaction were compared according to type and brand of the penile implants in all patients. RESULTS: The mean age and follow-up period of the patients were 57.74 ± 9.59 years and 67.81 ± 49.11 months, respectively. The couples' satisfaction rates were significantly higher in the 3-piece implant group than in the malleable group (P < .001), but there was no significant difference between the 2-piece and 3-piece implant groups. There was no difference in terms of couples' satisfaction according to the brand of the implants. Of the patients who had malleable implants, 27 (7.7%) underwent 3-piece penile prosthesis implantation due to dissatisfaction; however, only 1 (0.2%) of the patients with a 3-piece implant was switched to a malleable implant (P < .001). The highest rate of revision surgery due to penile corporal perforation was in the malleable group (2.6%), whereas the highest rate of revision surgery due to penile implant malfunction occurred in the 3-piece implant group (5.5%) (P = .021 and .001, respectively). To analyze risk factors, using multivariate analysis, presence of complication was the only predictor that might cause couples' dissatisfaction (P = .003). CONCLUSIONS: 3-piece and 2-piece implants have higher couples' satisfaction rates than the malleable implant. Brands of implants did not have any effect on the couples' satisfaction. Regarding detail of the complications, the 3-piece implant has a lower rate of penile corporal perforation and a higher rate of penile implant malfunction than the malleable implant. Patients with erectile dysfunction who need a penile implant should be informed about surgical outcomes, brands, and types of penile implants. Prosthesis choice should be customized to individual patient's expectations/conditions and tailored accordingly. Çayan S, Asci R, Efesoy O, et al. Comparison of Long-Term Results and Couples' Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation. J Sex Med 2019;16:1092-1099.

Comparison of Patient's Satisfaction and Long-term Results of 2 Penile Plication Techniques: Lessons Learned From 387 Patients With Penile Curvature.

OBJECTIVE: To compare the patient's satisfaction and long-term results of 2 penile plication procedures in patients with penile curvature. METHODS: This retrospective study included 387 patients with congenital penile curvature (n = 260) and Peyronie's disease (n = 127) who underwent surgical correction of penile curvature with penile plication procedures. Of the patients, 202 underwent plication of tunica albuginea with the Lue's 16-dot technique, while 185 underwent highly superficial excision of tunica albuginea with the modified Nesbit corporoplasty. Surgical outcomes and patient's satisfaction were compared between the 2 techniques in all patients. RESULTS: The mean duration of surgery was significantly shorter in the 16-dot plication technique (48.1 ±â€¯7.5 minutes), compared with the modified Nesbit corporoplasty (63 ±â€¯16.9 minutes) (P = .001). Complete penile straightening was achieved in 87.6% of the patients who underwent 16-dot plication technique and in 89.7% of the patients who underwent modified Nesbit plication, revealing no difference (P = .514). The rates of penile sensory loss (P = .001) and de-novo erectile dysfunction (P = .016) were significantly higher in the modified Nesbit corporoplasty than in the 16-dot plication technique, but rate of suture related complications was significantly higher in the 16-dot plication technique than in the modified Nesbit corporoplasty (P = .001). The patients with congenital penile curvature had significantly less ratio of postoperative penile length loss and de-novo erectile dysfunction than Peyronie's disease patients. CONCLUSION: Overall, both surgical techniques have very high success and satisfaction rates with very low complication rates. However, the types of complications are significantly different between the 2 surgical procedures. Therefore, patients with penile curvature should be informed about outcomes of penile plication procedures, and surgical method should be preferred based on patient's preference and surgeon's experience.

The short-term efficacy of intravesical instillation of hyaluronic acid treatment for bladder pain syndrome/interstitial cystitis.

OBJECTIVE: The aim of the study was to evaluate the short term efficacy of intravesical instillation of hyaluronic acid in patients with Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC). MATERIAL AND METHODS: The study included 54 women with BPS/IC who received intravesical instillation of hyaluronic acid treatment (120 mg/50 mL) for 6 weeks. Visual Analogue Scale (VAS), The O'Leary Sant Questionnaire (ICSI/ICPI) forms of the patients were filled by the clinician and the health technician separately before and 3 months after the treatment. Demographic characteristics of the patients were recorded, and effectiveness of the treatment was investigated according to these data. RESULTS: Decrease in mean VAS and mean total scores of ICSI and ICPI was observed after three months of intravesical instillation of hyaluronic acid treatment (55%, p<0.05 and 48.5%, p<0.05 and 45.5%, p<0.05, respectively). In most of the patients, all scores of VAS, ICSI and ICPI improved (minimum: 75.9%, maximum: 94.4%). Mostly the symptoms of nocturia and pollakiuria were seen, and treated after the instillation treatment. CONCLUSION: It has been observed that in the short-term follow-up of intravesical instillation of hyaluronic acid treatment, the symptoms have highly improved. Also, Turkish versions of ICSI and ICPI forms were reliable and comprehensible.

Fate of Recurrent or Persistent Varicocele in the Era of Assisted Reproduction Technology: Microsurgical Subinguinal Redo Varicocelectomy Versus Observation.

OBJECTIVE: To compare sperm parameters, serum hormone levels, and pregnancy and miscarriage rates between the infertile men with recurrent or persistent varicocele who underwent microsurgical subinguinal redo varicocelectomy or had observation only. MATERIALS AND METHODS: The study included 217 primary infertile men with recurrent or persistent varicocele. The patients were divided into 2 groups: 120 men underwent microsurgical subinguinal redo varicocelectomy, and 97 had observation only. Differences in total motile sperm count and serum hormone levels, and pregnancy and miscarriage rates were compared between the 2 groups. RESULTS: The mean total motile sperm count increased from 20.93 ± 2.87 to 45.54 ± 6.28 million in the microsurgical redo varicocelectomy group, and decreased from 16.62 ± 2.75 to 15.6 ± 2.81 million in the control group, revealing significant difference between the 2 groups (P = .000). Increase in total testosterone level was significantly higher in the microsurgical redo varicocelectomy group (+1.36 ± 0.32 ng/mL) than in the control group (-0.23 ± 0.1 ng/mL) (P = .000). Of the couples, 63 achieved pregnancy in the microsurgical redo varicocelectomy group (52.5%), and 38 had pregnancy in the control group (39.2%) (P <.05). Spontaneous pregnancy rate was significantly higher in the microsurgical redo varicocelectomy group (39.7%) than in the control group (15.8%) (P <.01). Use of assisted reproductive technology to achieve pregnancy was significantly lower in the microsurgical redo varicocelectomy group (60.3%) than in the control group (84.2%) (P <.01). CONCLUSION: Microsurgical subinguinal redo varicocele repair improves postoperative sperm parameters, serum total testosterone level, and spontaneous pregnancy rates compared with the controls. It also decreases need for use and level of assisted reproductive technology.

The Effect of Testosterone Replacement Therapy on Penile Hemodynamics in Hypogonadal Men With Erectile Dysfunction, Having Veno-Occlusive Dysfunction.

Hypogonadism may cause veno-occlusive dysfunction (VOD) by structural and biochemical alterations in the cavernosal tissue. The aim of the study was to investigate the effect of testosterone replacement therapy (TRT) on penile hemodynamics in hypogonadal men with erectile dysfunction and VOD. The study included 32 hypogonadal men with erectile dysfunction, having VOD. All patients underwent penile color Doppler ultrasonography (PCDU) at the beginning and 6 months after the initial evaluation. Erectile function was evaluated with the 5-item version of the International Index of Erectile Function (IIEF-5); hypogonadism was evaluated by testosterone measurement and the Aging Male Symptoms (AMS) scale. All patients received transdermal testosterone 50 mg/day for 6 months. Clinical and radiological findings were compared before and 6 months after the TRT. The mean age was 58.81 ± 4.56 (52-69) years. Mean total testosterone levels were 181.06 ± 39.84 ng/dL and 509.00 ± 105.57 ng/dL before and after the therapy, respectively ( p < .001). While all patients had physiological serum testosterone levels (>320 ng/dL) after the therapy, three cases (9.3%) had no clinical improvement of hypogonadism symptoms. Cavernosal artery peak systolic velocity (PSV) and resistive index (RI) significantly increased, and end diastolic velocity (EDV) significantly decreased after TRT. VOD no longer existed in 21 (65.6%) of the cases. This study demonstrated that TRT may restore penile hemodynamics in hypogonadal men with VOD.

Prostate-specific antigen decline pattern in advanced prostate cancer receiving androgen deprivation therapy and relationship with prostate-specific antigen progression.

INTRODUCTION: The aim of this study is to evaluate prostate-specific antigen decline pattern including prostate-specific antigen kinetics following androgen deprivation therapy on prostate-specific antigen progression in the patients with advanced prostate cancer. MATERIALS AND METHODS: Ninety-seven advanced prostate cancer patients receiving maximum androgen deprivation therapy were enrolled in case-control study. Baseline prostate-specific antigen, Gleason Score, bone metastase, nadir prostate-specific antigen, time to nadir prostate-specific antigen, declining slope to nadir prostate-specific antigen, estimated baseline prostate-specific antigen half-time, current prostate-specific antigen, post-nadir prostate-specific antigen time, estimated prostate-specific antigen, estimated decline of baseline prostate-specific antigen as quantitative, and ratio were recorded and calculated. RESULTS: The ratio of prostate-specific antigen progression was significantly lower at the patients who had slower declining slope to prostate-specific antigen, longer time to nadir prostate-specific antigen, and lower estimated decline ratio of baseline prostate-specific antigen (p: .016, p: .020, and p: .026, respectively). CONCLUSIONS: The shorter time to nadir prostate-specific antigen following androgen deprivation therapy, faster declining slope to nadir prostate-specific antigen and higher estimated decline ratio of baseline prostate-specific antigen are associated with higher risk of disease progression in patients with hormone-sensitive prostate cancer.

Paternity Rates and Time to Conception in Adolescents with Varicocele Undergoing Microsurgical Varicocele Repair vs Observation Only: A Single Institution Experience with 408 Patients.

PURPOSE: We compared paternity rates and time to conception between adolescents with varicocele undergoing microsurgical varicocele repair and patients who did not undergo surgery and were followed conservatively. MATERIALS AND METHODS: The study included 408 males 12 to 19 years old at presentation with clinical palpable varicocele. Of the patients 286 underwent microsurgical subinguinal or inguinal varicocele repair and 122 did not undergo varicocele surgery and were followed conservatively. Only men who desired conception were included in the study. We compared postoperative paternity rates, time to conception, administration of fertility treatment, and difference in sperm parameters and serum hormone levels in all men. RESULTS: The paternity rate was 77.3% (221 of 286 patients) in the microsurgical varicocele repair group and 48.4% (59 of 122) in the control group, revealing a highly significant difference (OR 3.63, p <0.005). Mean ± SD time to conception was significantly shorter in the microsurgical varicocele repair group (11.18 ± 6.5 months) than in the control group (16.85 ± 6.9 months, p <0.005). Respective percentages of patients with significant increase in sperm concentration and motility were significantly higher (53.8% and 62.2%) in the microsurgical varicocele repair group compared to the control group (43.4% and 46.7%, p <0.05 for both). CONCLUSIONS: Microsurgical varicocele repair in adolescents with varicocele significantly increases paternity rates and decreases time to conception postoperatively. Patients with varicocele who underwent microsurgical varicocele repair had increased sperm parameters and 3.63 times greater odds of paternity than controls who did not undergo varicocele surgery.

Cholesteatoma in ectopic kidney.

Cholesteatoma in the urinary system is a rarely seen benign condition. Rosina firstly defined this condition in the year 1953. Histopathologically it is characterized with keratinization, and squamous metaplasia of urothelial epithelium associated with desquamation of keratinized layers. Flank pain is the most common symptom that is caused by elimination of keratinous material. In our case we will discuss cholesteatoma developed in an ectopic kidney which has not been described in the literature before.

The incidence and risk factors of resistant E. coli infections after prostate biopsy under fluoroquinolone prophylaxis: a single-centre experience with 2215 patients.

We evaluated the incidence and risk factors of resistant Escherichia coli infections after the prostate biopsy under flouroquinolone prophylaxis. From January 2003 to December 2012, we retrospectively evaluated the records of 2215 patients. The risk factors were described for infective complications and resistant E. coli in positive cultures was calculated. Of 2215 patients, 153 had positive urine cultures, such as 129 (84·3%) E. coli, 8 (5·2%) Enterococcus spp., 6 (3·9%) Enterobacter spp., 5 (3·2%) Pseudomonas spp., 3 (1·9%) MRCNS, and 2 (1·3%) Klebsiella spp. Of the positive urine cultures which yielded E. coli, 99 (76·7%) were evaluated for fluoroquinolone resistance. Of those, 83 (83·8%) were fluoroquinolone-resistant and composed of 51 (61·4%) extended-spectrum beta-lactamase (ESBL)-positive. Fluoroquinolone-resistant E. coli ratios were 73·4 and 95·9% before 2008 and after 2008, respectively (P = 0·002). The most sensitive antibiotics for fluoroquinolone-resistant E. coli strains were imipenem (100%), amikacin (84%) and cefoperazone (83%). The use of quinolones in the last 6 months and a history of hospitalization in the last 30 days were found to be significant risk factors. We found that resistant E. coli strains might be a common microorganism in patients with this kind of complication. The risk factors for development of infection with these resistant strains were history of the use of fluoroquinolones and hospitalization.