Transperineal microwave thermoablation for benign prostatic hyperplasia-related lower urinary tract symptoms in an elderly patient.

Transperineal prostate microwave thermoablation (TPMT) has been established as a safe means of treating benign prostatic hyperplasia (BPH); however, its effectiveness in addressing BPH-related lower urinary tract symptoms (LUTS) remains unexplored. This case study aims to evaluate the efficacy of TPMT in LUTS attributed to BPH. An 84-year-old man with LUTS due to BPH-induced bladder outlet obstruction, unresponsive to previous medical treatments, and failed prostate artery embolization, underwent TPMT. Three coaxial needles were positioned at the midline, right, and left sides of the hypertrophic transitional zone of the prostate. Microwave energy, with parameters determined using liver data and targeted ablation area, was applied at 2,450 MHz in continuous mode. The tissue temperature was monitored using bilateral thermocouple sensors. The patient exhibited no changes in defecation rhythm, abdominal discomfort, or anorectal pain. Temporary postoperative hematuria was promptly resolved through saline irrigation within 6 hours, and hematological evaluations showed normal results. Significant clinical improvements were observed (e.g., prostate volume, prostate-specific antigen levels) accompanied by an increase in peak flow rate. Thus, TPMT appears to be a promising intervention for bladder outlet stenosis and LUTS induced by BPH.

Four-Point Injection Technique of Polyacrylate/Polyalcohol Copolymer in Vesicoureteral Reflux After KidneyTransplant.

OBJECTIVES: Vesicoureteral reflux after kidney transplant is mostly asymptomatic, but recurrent urinary tract infections can cause graft rejection. Although the gold standard treatment is open surgical repair, we believe that endoscopic treatment can be further improved. Here, we investigated the long-term outcomes of 4-point endoscopic injection of polyacrylate/polyalcohol copolymer in patients with vesicoureteral reflux after kidney transplant. MATERIALS AND METHODS: Patients who had undergone 4-point endoscopic injectionofpolyacrylate/polyalcohol copolymer for symptomatic vesicoureteral reflux after kidney transplant and were followed for atleast 3 years were included. Patients with dysfunctional and/or obstructive voiding patterns, unsuccessful primary endoscopic treatment, concomitant injection of native kidney reflux, and incomplete follow-up were excluded. We evaluated patient characteristics, perioperative data, and clinical and radiological outcomes. Urine culture, serum creatinine, and renal ultrasonography were assessed every 3 months. Voiding cystourethrography was performed at month 3 and when recurrence was suspected. Clinical success was defined as absence of febrile urinary tract infection during follow-up, and radiological success was defined as absence of vesicoureteral reflux in the voiding cystourethrography. RESULTS: Of 21 study patients, 14 (66.6%) were female and 7 (33.3%) were male patients. Average age was 37.1 years (range, 12-62 years). According to preoperative voiding cystourethrography, 3 patients (14.2%) had grade II, 13 patients (61.9%) had grade III, and 5 patients (23.8%) had grade IV vesicoureteral reflux. Eighteen patients (85.7%) had clinical success with the first injection, and 20 patients (95.2%) had success with the second injection. Eleven patients (52.3%) demonstrated radiological success. The reflux degree of all patients, except 2, had partially or completely regressed. Ureteral balloon dilatation and double J stent implantation was performed in 1 patient (4.7%) due to ureteral obstruction. CONCLUSIONS: The 4-point injection of polyacrylate/- polyalcohol copolymer provided long-term permanent success for symptomatic vesicoureteral reflux after kidney transplant.

Spinal Anesthesia Provides Longer Administration Time for Postoperative Intravesical Chemotherapy after TUR-B Operation.

PURPOSE: The aim of this study was to investigate the tolerability of postoperative early intravesical chemotherapy session after transurethral resection of the bladder tumor (TUR-B) according to the different anesthesia types. METHODS: The study was conducted between February 2017 and June 2020. Patients who were given intravesical mitomycin (MMC) 40 mg after TUR-B were included. Patients' risk categories (low, medium, and high) were determined according to the European Association of Urology (EAU) risk stratification system based on the tumor number, size (<3 and ≥3 cm), T stage (Ta and T1), and grade (low and high). Patients were divided into 2 groups according to the applied anesthesia technique as group S (spinal) and group G (general). The patients' visual analog scale (VAS) scores were recorded every 30 min for 2 h after urethral clamping. The patients' pain scores were recorded using the VAS questionnaire form at 30th (VAS1), 60th (VAS2), 90th (VAS3), and 120th (VAS4) min after the urethral clamping. Requirement of analgesic, urethral clamp removal time, total instillation time, and discharged urine volume were recorded. Complications and complication grade (1-5) were recorded according to the Clavien-Dindo system. RESULTS: A total of 232 consecutive patients who received intravesical MMC were included. Sociodemographic characteristics of group S (n = 113) and group G (n = 119) were similar (p < 0.05). There were no significant differences in tumor size, number of tumors, concomitant CIS, and T stage in both groups (p > 0.05). High-grade tumors were higher in group S (23.9 vs. 11%; p = 0.008). Requirement of analgesic (53.9 vs. 91.5%; p = 0.00) and termination of therapy <60' (2 vs. 26%; p = 0.00) and <120' (32.7 vs. 76.4%; p = 0.00) were significantly lower in group S. The mean instillation time (108.05 ± 19.40 vs. 85.67 ± 24.66 min; p = 0.00) was found significantly higher for group S. In group G, mean VAS1-4 scores were significantly higher than in group S (p < 0.05). Linear correlation analyses showed that the VAS score is correlated with the instillation time (p < 0.05). The rates of minor (I-III) (7 vs. 8%; p = 0.706) and major (IV-V) (0.9 vs. 1.6%; p = 0.590) complications were similar in both groups. CONCLUSION: The patients' tolerability of intravesical MMC treatment can be improved by spinal anesthesia. It provides longer instillation time and less pain during intravesical chemotherapy.

Urological injuries in the civil war of Libya.

BACKGROUND: In this article, we aimed to evaluate results of patients who acquired various injuries during Libya civil war who then were transferred to our facility with genitourinary trauma for further assessment and treatment. METHODS: A total of 121 wounded patients, including 21 (17.3%) with 1 or more combined urogenital injuries, were treated at Yeni Yüzyil University Private Gaziosmanpasa Hospital from October 2014 to September 2016. RESULTS: Of the 21 patients, 13 (61.9%) were injured by explosive weapons, while the rest 8 (38.1%) had bullet wounds. The 21 urogenital injuries were to the kidney in 7 cases (33.4%), ureter in 5 (23.8%), bladder in 5 (23.8%), scrotum in 2 (9.5%), and penis in 2 (9.5%). There was associated damage to organs other than the urogenital system in 21 patients (100%). Two patients had nephrectomies performed on-site medical facility. The rest of patients had no urogenital organ resections. Urogenital trauma had higher rates of liver damage, generalized infection, blood transfusions, and longer hospital stay. CONCLUSION: Knowing that war related surgery patients should be approached as a distinct and non-standard category, every case must be evaluated individually. Patients should be evaluated in a multidisciplinary approach and physicians should be aware of infections affecting morbidity and mortality.

Prognostic value of endocan in prostate cancer: clinicopathologic association between serum endocan levels and biochemical recurrence after radical prostatectomy.

PURPOSE: To assess the diagnostic capability of serum endocan level in association with clinicopathologic features and its impact on biochemical progression-free survival in patients with prostate cancer (PCa). METHODS: A total of 86 patients with localized prostate cancer were treated with open radical prostatectomy (RP). The control group included 80 patients who were referred to the urology outpatient clinic with normal rectal examination and prostate-specific antigen (PSA) levels. The patients' characteristics, baseline PSA value, and serum endocan levels were recorded. The patients were followed up with the measurement of PSA concentration every 3 months during the first year, thereafter every 6 months until 5 years, then yearly after surgery. The primary endpoint of follow-up was the time of biochemical recurrence. RESULTS: The median serum endocan levels were 3.14 ng/mL in the RP group and 2.98 ng/mL in the control group (p = 0.122). A total of 86 patients who underwent RP for PCa were divided into 2 groups based on a cutoff serum endocan level of 1.8 ng/mL. The distribution of Gleason score and biochemical failure rate were significantly higher in patients with serum endocan ≥1.8 ng/mL (p = 0.031 and p = 0.047). The biochemical recurrence-free time for endocan ≥1.8 ng/mL and <1.8 ng/mL were 38 and 56 months, respectively (p = 0.041). Spearman correlation analysis showed a linear relationship between endocan expression and Gleason score (p = 0.025, p = 0.511). Multivariate analysis revealed that elevated serum endocan level (≥1.8 ng/mL) was a significant predictor of biochemical progression-free survival (hazard ratio 2.44; 95% confidence interval 1.78-3.23; p = 0.001). CONCLUSIONS: The current study indicates that endocan has a close relationship with tumor recurrence in PCa.

Results of tadalafil treatment in patients following an open nerve-sparing radical prostatectomy.

PURPOSE: To evaluate the effect of postoperatively administering a low daily dose of tadalafil on the erectile function of patients who underwent a nerve-sparing radical prostatectomy (NSRP) due to localized prostate cancer (PCa). MATERIALS AND METHODS: Of 138 patients, who underwent NSRP due to PCa between 2012 and 2014, 55 patients who had not had pre-operative erectile dysfunction (ED) were included in the study. The mean age of the patients was 64 (54-72). On the 15th day after surgery, after ultrasound evaluation, all 55 patients started on a daily dose of 5 mg tadalafil that was continued for 2.5 months. The erectile function of patients was evaluated pre-operatively, post-operatively, and at the 3rd and 6th month after surgery using the International Index of Erectile Function (IIEF-5) test. None of the patients was treated with hormonal therapy or radiotherapy before or after surgery. RESULTS: Three patients were excluded from the study due to the adverse effects of tadalafil and two patients elected to discontinue the treatment. Of the remaining 50 patients whose pre-operative erectile function had been found normal, at 3 months after surgery, 36 (72%) had normal erectile function; of the remaining patients in the study six (12%) presented with mild, two (4%) with moderate, and six (12%) with severe ED. Six months after surgery, 35 patients (70%) had normal erectile function while seven (14%) had mild, three (6%) moderate and five (10%) severe ED. There was no statistically significant difference between the results obtained at the 3rd and 6th month follow-up (p > 0.05). Three patients reported adverse effects with tadalafil including flushes in 2 (3.6%) and a headache in 1 (1.8%). CONCLUSIONS: The administration of a 5 mg post-operative dose of tadalafil to patients that had undergone a bilateral NSRP was found to have a positive effect on the recovery and maintenance of erectile function. However, there is still a need to investigate a larger series of cases.

Prostatic Urethral Lift: A New Minimally Invasive Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia.

INTRODUCTION: Prostatic urethral lift (PUL) is a minimally invasive procedure for the treatment of lower urinary tract symptoms (LUTSs) secondary to benign prostatic hyperplasia (BPH). The PUL procedure involves the placement of implants that retract the obstructing prostate lobes. This procedure achieves quantifiable improvements in functional outcomes and quality of life (QoL), while preserving erectile and ejaculatory functions. METHODS: Seventeen patients diagnosed with BPH who had undergone the UroLift® procedure between March 2011 and June 2015 were retrospectively evaluated. The parameters evaluated in the pre-operative, intra-operative and 1-year post-operative period were demographic data, and pre-operative, intra-operative and 1-year post-operative results were obtained from the International Prostate Symptom Score (IPSS), Uroflowmetry QoL index, International Index of Erectile Function (IIEF) and Male Sexual Health Questionnaire (MSHQ) for ejaculatory function (MSHQ-EjD). RESULTS: The average improvements from baseline to 12 months after intervention were significant for the total IPSS 9.6. There was a 4.2-point increase in Qmax, a 0.9-point improvement in QoL and a 32% decrease in PVR. No statistically significant difference was found in the IIEF and MSHQ-EjD scores when the pre-operative and post-operative 3rd and 12th month scores were evaluated (p > 0.05). CONCLUSIONS: PUL offers rapid improvement in voiding and storage symptoms, QoL and flow rate that is durable to 12 months after intervention. PUL is a minimally invasive procedure that has the moderate effect in treating troublesome LUTS secondary to benign prostatic obstruction and preserving total sexual function.

Intravesical Prostatic Protrusion: A Potential Marker of Alpha-blocker Treatment Success in Patients With Benign Prostatic Enlargement.

OBJECTIVE: To investigate the value of anatomic and blood-flow measurements of the prostate via ultrasound in identifying medical treatment response of patients with lower urinary tract symptoms due to benign prostatic enlargement. A secondary objective of the study was to compare transabdominal-transrectal measurements. MATERIALS AND METHODS: Male patients (age range 50-80) with lower urinary tract symptoms who applied to our outpatient clinic to be diagnosed with benign prostatic enlargement that were eligible for medical management were included in the prospective study. Patients (n = 49) were administered with tamsulosin for management. At baseline evaluation, all patients underwent International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), transabdominal and transrectal ultrasound [prostate volume (PV), post-void rezidu and intravesical prostatic protrusion (IPP)], and prostate subcapsular resistive index value measurement. Follow-ups were carried out 1 and 3 months after treatment. At these time-points, patients were assessed with IPSS and uroflowmetry. RESULTS: IPP were identified to be negatively correlated with baseline Qmax values (P = .001, R = -0.485) and positively correlated with PSA (P = .013, R = 0.353) and PV (P = .003, R = 0.420). PV was related with resistive index (P = .026, R = 0.318) and PSA (P = .001, R = 0.619). Subsequent to medical treatment on the follow-ups, an overall improvement in the IPSS and Qmax was identified (P = .001). However, a negative correlation was identified in the change that occurred between IPSS and IPP (P = .004, R = -0.410). Other parameters were not correlated (P > .05) with the change in IPSS and Qmax. Transabdominal and transrectal measures were similar (P = .001). CONCLUSION: This study has shown that increased IPP values are associated with lower response to alpha-receptor specific management. Transabdominal measurements are sufficient for the evaluation compared with transrectal measurement.

Impact of Rho-Kinase Inhibitor Hydroxyfasudil in Protamine Sulphate Induced Cystitis Rat Bladder.

OBJECTIVES: The objective of the present study was to evaluate anti-inflammatory effects of hydroxyfasudil in a protamine sulfate (PS) induced cystitis rat model. Additionally, we investigated prevention of bladder overactivity (BO), and tissue damage in these experiments. METHODS: Animals were divided into four groups. In Groups 1 and 2, chemical induced cystitis model was created by administrating intravesical PS with PE50 catheter by the transurethral route. In Group 1, Rho-kinase inhibitor hydroxyfasudil was administered intaperitoneally, and in Group 2, subjects were administered a corresponding volume of saline in the same way. In Group 3, vehicle was administered intravesically and hydroxyfasudil was administrated intraperitoneally. Group 4 was a control Group, and the vehicle was administered intravesically and intraperitoneally. Micturition frequencies were recorded. Biochemical analyses were performed for oxidative stress, and pathological evaluations were investigated. In vitro contractions of bladder tissue strips were measured in tissue-bath. RESULTS: There were significantly lower Lipid peroxidase levels and higher levels of Glutathione in Group 1 than Group 2 (P = 0.016, P = 0.001, respectively). There was generally more inflammation in Group 2 than the other groups as determined by microscopy. There were significantly higher frequencies of micturition, lower volume, and mean voided maximum urine output after PS administration in Groups 1 and 2. In vitro contraction responses of bladder strips to potassium chloride and acetylcholine were statistically higher in Group 2 than Groups 1 and 3. CONCLUSIONS: Significant reduction of inflammation by affecting the anti-oxidant defense systems was provided by hydroxyfasudil. Decreased in vitro responses to contractions of bladder smooth muscle strips were obtained. Hydroxyfasudil may be a potential new therapeutic option for inflammation and BO, in rat bladder.

Safety and Efficacy of Bipolar Versus Monopolar Transurethral Resection of the Prostate: A Comparative Study.

PURPOSE: Transurethral resection of the prostate (TURP) is considered gold standard for surgical treatment of benign prostatic hyperplasia (BPH). In this study, we aimed to compare post-operative clinical outcomes and adverse effects between monopolar and bipolar TURPs. MATERIALS AND METHODS: The study included 590 patients who underwent TURP by a single urologist (E.H.) between June 2006 and June 2014 with a diagnosis of BPH. Patients were divided into two groups as monopolar TURP (group 1, n = 300) and bipolar TURP (group 2, n = 290). Patients receiving oral anticoagulants or aspirin and those with prostate cancer diagnosis were not included in the study. Data regarding pre-operative age, International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post voiding residual urine volume (PVR), serum prostate specific antigen (PSA) levels and prostate volume (Vp) of the patients were gathered from medical records. Groups were compared in terms of catheterization, operation time, hemoglobin (Hb) decrease, and IPSS, Qmax, and PVR values at post-operative 12th month follow-up visit. RESULTS: From pre-operative to post-operative period, IPSS, Qmax and PVR showed significant improvements within both groups (P < .001). When groups were compared with each other, bipolar TURP group had significantly lesser catheterization time and hemoglobin decrease than monopolar TURP group, while no significant differences were detected regarding all other variables. CONCLUSION: Bipolar and monopolar TURPs are both effective and safe treatment modality for BPH. Bipolar TURP is superior to conventional monopolar TURP in terms of catheterization time and Hb decrease.

Pelvic inflammatory myofibroblastic tumour mimicking scrotal mass: an extremely rare case.

Inflammatory myofibroblastic tumour (IMT) is a rare benign mesenchymal tumour. However, IMT may arise from a wide variety of tissues and is very rare in the elderly. IMT may mimic the mass in which it originates. Although IMT has been defined as uncertain behaviour, it is treated surgically. We present a-65-year old man whose mass was diagnosed as IMT extending from scrotum to pelvis. The mass was independent of any surrounding anatomic structures. According to our best knowledge this is the first case in the literature that pelvic IMT was diagnosed in an elderly man and successfully treated surgically with a long term follow-up period. Aetiology of IMT is still unknown, and more studies are needed for exact continuum of IMT.

Comparison of different ligation techniques in laparoscopic varicocelectomy.

AIM: To evaluate the effects of different intracorporeal ligation techniques with titanium clips, Plasma Trisector (Gyrus, USA) (PTG), and surgical silk on bilateral laparoscopic varicocelectomy (LPVx). MATERIALS AND METHODS: Between May 2009 and August 2012, 100 patients who underwent bilateral LPVx were evaluated. The demographic parameters of patients, preoperative radiological findings, semen analysis, operative data, and follow-up were recorded. All of the patients were divided into 3 groups, randomized prospectively. The patients whose veins were ligated by 5-mm titanium clips were included in group I, those whose veins were ligated by PTG were included in group II, and those whose veins were ligated by surgical silk were included in group III. The recorded data of the groups were analyzed. RESULTS: Mean follow-up time was 18.8 + 1.1 months. According to the demographics of age, body mass index, spermiogram, and diameter of veins before surgery, there were no statistical differences between any of the groups (P > 0.05). However, operation time was longer in group III (P < 0.0001), while total numbers ofligated veins did not differ among the groups (P > 0.05). Additionally, hospital stay, oral intake, and complications were not different among the groups (P > 0.05). In follow-up the sperm count analysis was higher than the preoperative count analysis for all of the groups (P < 0.05). CONCLUSION: PTG may provide a shorter operation time than using titanium clips and/or surgical silk in LPVx. Additionally, PTG may increase sperm count with fewer complications than the other ligation techniques in LPVx. Therefore, PTG may be the new candidate electrosurgical standard device for LPVx in the nearby future.

Urethrogluteal fistula developing secondary to the use of clean intermittent self-catheterization: first case report in the literature.

Clean intermittent self-catheterization is the standard method for bladder evacuation in these patients today. The patient was diagnosed with urethrogluteal fistula and gluteal-perineal abscess by radiological evaluation. Gluteal drainage decreased after cystostomy. In our paper, a case of urethrogluteal fistula and pelvic urinoma that developed as a result of the use of clean intermittent self-catheterization (CISC), which is rarely found in the literature, is presented.

Evaluation of open and laparoscopic radical cystoprostatectomy combined with orthotopic neobladder: a single-surgeon experience.

AIM: To compare the outcomes of laparoscopic (LRCP) and open radical cystoprostatectomy (ORCP) with orthotopic urinary diversion for muscle-invasive organ-confined bladder cancer by a single surgeon. PATIENTS AND METHODS: Prospectively documented 15 LRCP and 15 ORCP patients, followed for at least 3 years, were included in our study. The demographic parameters of patients, preoperative radiologic staging, previous operations, surgical outcomes, complications, oncologic results and intermediate-term follow-up, postoperative chemotherapy and follow-up periods were recorded and evaluated. RESULTS: The mean oncologic follow-up was 3 years. Transfusion rate, estimated blood loss, oral intake and narcotic analgesic requirement were statistically less in the LRCP group (p < 0.05). However, operation time and hospital stay were similar in both groups. The complication rates were not significantly different between the two groups. The mean number of dissected lymph nodes was 20.0 ± 1.7 in the ORCP and 22.6 ± 2.0 in the LRCP group. One patient in each group had a margin positive for bladder cancer. CONCLUSIONS: The laparoscopic approach may be feasible for muscle-invasive organ-confined bladder cancer. Furthermore, LRCP provides less blood loss, early oral intake and postoperative pain management. Additionally, continence and sexual function may be provided by LRCP as with ORCP.

The role of bipolar transurethral vaporization in the management of benign prostatic hyperplasia.

OBJECTIVES: A prospective randomized study was conducted to evaluate the safety and effectiveness of bipolar plasma vaporization with a novel electrode that produces vaporization of the tissue (transurethral vaporization of the prostate, TUVP) immersed in isotonic saline compared to the standard transurethral resection of the prostate (TURP) in the treatment of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: From February 2009 to February 2010, 90 patients with BPH were randomized into two groups, and underwent conventional TURP (group 1) or TUVP (group 2) utilizing bipolar plasma vaporization with an innovative electrode (Olympus Winter & Ibe GmbH, Hamburg, Germany). International Prostate Symptom Scores (IPSS), transrectal ultrasonographic findings, maximal urine flow rates (Qmax), and postvoiding residual urine (PVRU) volumes of all cases were evaluated preoperatively and 1 month, 3 months, and 1 year postoperatively. Preoperative and postoperative serum hemoglobin, hematocrit and sodium concentrations of all patients were measured. All patients included in the study were monitored for 1 year. RESULTS: In patients in group 1 (n = 47; mean age: 64.7 ± 7.3 years) TURP was performed. The patients in group 2 (n = 43; mean age: 65.4 ± 8.9 years) underwent bipolar TUVP. Cases in the two study groups matched for demographic characteristics and clinical parameters were assessed. The evaluation of IPSS scores, PVRU, Qmax, and prostatic volumes of the patients 1 month, 3 months, and 1 year postoperatively did not reveal any significant differences between the two groups. In group 2 (TUVP), postoperative catheter indwelling times were significantly shorter, and Na serum concentrations were also markedly lower (p < 0.005). CONCLUSION: We detected similar effectiveness and morbidity rates in both groups. Bipolar TUVP has advantages such as shorter catheter indwelling times and hospital stays, and fewer bleeding episodes without any risk of transurethral resection syndrome. We believe that TUVP might be an alternative to TURP which is currently the 'gold standard' treatment in BPH.

Effect of cyanoacrylic glue on penile fracture: an experimental study.

PURPOSE: We investigated the effect of Glubran(R)2 cyanoacrylic glue on rat cavernous tissue after forming penile fractures experimentally as well as the histopathological effect. We also investigated its clinical use. MATERIALS AND METHODS: Experimental penile fracture was formed by incising from the proximal dorsal side of the penis in 32 Wistar Albino rats. The rats were randomly assigned to 4 main groups of 8 each. In the control group the incision was not repaired and it was left to secondary healing. In the glue group cyanoacrylic glue was only applied to the incision region. In the primary repair group the incision was primarily repaired and in the final group cyanoacrylic glue was applied to the incision region following primary repair. Three weeks later penectomy materials were examined histopathologically. RESULTS: When the control group was compared with the other groups, the differences in cavernous tissue healing with fibrosis and hyperemia-bleeding were statistically significant (p = 0.043 and 0.003, respectively). In the glue group fibrosis was observed in 2 rats. This group was the best according to cavernous healing. Although there was no significant difference between the control group and the other groups according to inflammation (p = 0.057), the glue group was better than the primary repair group (p = 0.026). No significant inflammation or hyperemia-bleeding was observed in the glue group. When the experimental groups were evaluated for histopathological parameters, it was observed that the best results were obtained in the glue group. CONCLUSIONS: Cyanoacrylic glue can be used in cavernous surgery due to its hemostatic, adhesive and anti-inflammatory properties.

Use of porcine small intestinal submucosa in bladder augmentation in rabbit: long-term histological outcome.

AIM: To investigate long-term histological features of bladder augmentation using porcine small intestine submucosa (SIS) in a rabbit model. MATERIALS AND METHOD: Sixteen New Zealand rabbits were used. Porcine SIS was provided by a manufactured formation derived from the pig. After partial cystectomy was carried out on the bladder, a single layer of SIS (Cook-SIS Technology, Cook Biotech Incorporated, West Lafayette, IN, USA) (2 x 5 cm) was sewn to bladder with continuous 5/0 vicryl suture material in a watertight manner. Urinary diversion was not used. The rabbits were killed 12 months later and perivesical fat was removed together with bladder. The 5-microm preparations taken from the samples were stained with haematoxylin-eosin and Mason's trichrome dye. S-100 and F8 stains were also used for immunohistochemical investigations. RESULTS: The macroscopic view of bladder was normal. SIS was indistinguishable from normal bladder wall, but the region of the graft had a slight white coloration. Microscopic observations showed the continuity of transitional epithelium of host bladder tissue on SIS material. Detrusor and serosal layers were formed and these layers were indistinguishable from host bladder. Fibroblasts were scattered among the collagen fibrils. New vessel formations were present without lymphatic proliferation. Nerve regeneration was excellent. No inflammation was observed in normal and regenerated bladder wall. CONCLUSION: At the end of 12 months, the long-term histological features of bladder augmentation with porcine SIS in a rabbit model, such as presence of new vessel formations, nerve regeneration, collagen and smooth muscle regenerations, which were indistinguishable from original bladder, and the absence of inflammation, showed that SIS seems to be a viable alternative to the use of intestine in bladder augmentation.

Effect of phospodiesterase 5 inhibitors on apoptosis and nitric oxide synthases in testis torsion: an experimental study.

To investigate the effects of phosphodiesterase (PDE) 5 inhibitors, sildenafil citrate and vardenafil HCl, on testicular germ cell apoptosis and also on the expressions of eNOS and iNOS within the bilateral testis after a unilateral torsion in a rat model. Forty-eight Wistar Albino rats, weighing between 210 and 262 g, were housed in individual cages. The rats were randomly assigned into four main groups and each group received drugs. Saline, sildenafil citrate and vardenafil HCl were given to each for 1 month and the last received no drug. After 1 month, testicular torsion was created for 1 h of ischemia and the left testis was untwisted and replaced to the scrotum for 2 h of reperfusion. At the end of 3 h, contralateral and ipsilateral testes were removed for histopathologic and biochemical examinations. Under light microscopy; the histopathological patterns of the contralateral testes in all groups were not affected. Mean apoptotic cell, eNOS and iNOS levels were increased in saline study group. The rats treated with vardenafil and sildenafil (groups 2s and 3s) showed significantly increased apoptotic cell, eNOS and iNOS values in ipsilateral testis (P < 0.05). Sildenafil citrate and vardenafil HCl caused an exaggerated testicular apoptosis after IR injury in rats. Additionally these drugs increased the NOSs levels in the testicular tissue.

Comparison of transurethral prostate resection and plasmakinetic prostate resection according to cautery artefacts in tissue specimens.

OBJECTIVES: The objectives were to evaluate cautery artifacts histopathologically in tissue specimens after plasmakinetic prostate resection (PKRP) and transurethral prostatectomy (TURP), and compare the results of the two procedures. MATERIALS AND METHODS: The histopathological specimens of 65 patients who underwent PKRP and TURP were examined retrospectively. Tissue chips for examination were selected randomly. Artifactual pathological patterns that were identified in the specimens included: abnormal cellular orientation and spindling, artifactual cellular detachment from the underlying basement membrane, atypical cytological changes and stromal coagulative necrosis. Each pattern identified was awarded 1 point. The severity of the cautery artefact was graded as absent, mild, moderate or severe according to the sum of points in each specimen. RESULTS: In TURP, the artefacts were graded absent (9%), mild (6%), moderate (18.7%), and severe (65.6%) changes. In PKRP, the artefacts were graded absent (6%), mild (18.1%), moderate (36.3%), and severe (39.4%) changes. While the number of mild and moderate artefacts observed was higher in PKRP (P = 0.023), severe artefacts were observed in higher numbers with TURP (P = 0.034). No prostate cancer was detected during the follow-up period. CONCLUSIONS: It has been observed that the application of TURP causes fewer mild to moderate artefacts and PKRP causes fewer severe artefacts in the histopathological evaluation of specimens in comparison to each other.