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.

Hematospermia is rarely related to genitourinary cancer: lessons learned from 15 years of experience with 342 cases.

We investigated the prevalence of hematospermia among the 161,258 men with ≥18 years old, presenting to outpatient clinics with urologic complaints, between January 2003 and December 2017. We also recorded underlying causes of hematospermia to determine frequency of genitourinary cancer in 342 men who presented with hematospermia. Further evaluations such as urine/semen culture, Meares-Stamey four glass test, transrectal/scrotal ultrasound, pelvic magnetic resonance imaging (MRI), cystourethroscopy, and prostate biopsy were performed in the presence of additional symptoms and findings or recurrence of hematospermia after treatment of patients with monosymptomatic hematospermia. The prevalence of hematospermia was detected as 0.21% (342/161,258) among the urological patients. The mean age of the patients was 45.05 ± 14.04 years (range 18-85), and the median duration of hematospermia was 15 days (range 1-7200). In 306 (89.5%) of the patients, hematospermia was resolved after medical therapy for infections/inflammations, surgery for ductal obstruction and cysts, prostate and testicular cancer. However, 36 (10.5%) had persistent hematospermia. The most relevant etiologic cause of hematospermia was inflammation/infections in 169 patients (49.4%), and genitourinary cancers were detected in only 11 patients (3.2%) as prostate cancer in 8 and testicular cancer in 3. Hematospermia is seen frequently due to inflammatory or infectious causes, and is rarely associated with genitourinary cancer. However, genitourinary cancers should be kept in mind in the differential diagnosis of patients with recurrent/persistent hematospermia and associated symptoms, such as hematuria, lower urinary tract symptom, and scrotal pain/swelling.

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.

Are predictive factors in sperm retrieval and pregnancy rates present in nonobstructive azoospermia patients by microdissection testicular sperm extraction on testicle with a history of orchidopexy operation?

The aim in this study is to evaluate predictive factors on sperm retrieval and pregnancy rates by microdissection testicular sperm extraction in non obstructive azoospermia patients with a history of orchidopexy operation. A total of 148 patients were included, and their medical files were evaluated. Data related to possible predictive factors on sperm retrieval and pregnancy rates such as age at orchidopexy operation, unilateral or bilateral presence of undescended testis before orchidopexy, testis volumes and hormone levels were statistically analysed. It revealed that the mean ages in patients with unilateral and bilateral orchidopexy operations were 35.37 (±4.84) and 33.94 (±5.91) respectively. Mean testis volume in the unilateral orchidopexy group was 7.59 (±3.12) ml on the right testis and 7.37 (±2.86) ml on the left testis. Mean FSH levels were detected as 22.71 (±11.86) mIU/ml in the unilateral group and 28.19 (±12.40) mIU/ml in the bilateral group. In our study, we have shown that the age at which patients undergo orchidopexy and the unilateral or bilateral presence of cryptorchidism has no correlation with sperm retrieval and pregnancy rates.

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.

Retrograde intrarenal surgery technique without using fluoroscopy and access sheet in the treatment of kidney stones

Background/aim: In this study, we aimed to present our results on single-guidewire flexible ureteroscopy and retrograde intrarenal surgery without fluoroscopy and an access sheet, and to evaluate the efficacy and safety of this procedure retrospectively. Materials and methods: Our routine technique can be described as the evaluation of the ureter using a semirigid ureterorenoscope (URS), leading in the guidewire through the semirigid URS, pulling the semirigid URS back, inserting the flexible URS with the aid of the guidewire, inserting the laser probe through the flexible URS, and performing laser lithotripsy. Results: Our study included 400 male and 198 female patients with a mean age of 36.8 ± 16 (14­80) years. The mean stone size was 8.7 ± 4 (8­20) mm, and the mean operation time was 56 (32­106) min. Postoperative fever was observed in 24 (4%) of the patients, and 30 (5%) patients had hematuria as a minor complication. A stone-free status was observed in 466 (78%) patients, while 102 (17%) patients had clinically insignificant minor stone fragments and 30 patients had clinically significant stone residue. Conclusion: The retrograde intrarenal surgery procedure using only a guidewire without fluoroscopy and an access sheet in the treatment of kidney stones is technically safe and effective.

The role of apoptosis and the effect of epidermal growth factor on proapoptotic BNIP 3 in an experimental rat priapism model

Background/aim: This study aimed to investigate the effects of apoptosis-inducing Bcl-2/adenovirus E1B 19 kDa-interacting protein 3 (BNIP 3) and antiapoptotic epidermal growth factor (EGF) on the pathophysiology of experimental low-flow priapism. Materials and methods: Twenty-four adult Sprague-Dawley rats were divided into four equal groups. Group I was the control group. Ischemic priapism was induced for 4 h in Group II rats. In Group III, intraperitoneal EGF at 10 µg/kg was given for 7 days before induction of ischemic priapism for 4 h. In Group IV, intraperitoneal EGF at 20 µg/kg was given for 7 days before induction of ischemic priapism for 4 h. The western blot method was used to determine BNIP 3 expression levels and the TUNEL method was used to determine the apoptotic cells in the cavernosal tissue samples. Results: Although BNIP 3 expression levels were significantly higher in all three study groups compared to the controls, BNIP 3 was significantly higher in EGF-administered groups when compared to Group II (P < 0.05). The TUNEL score of group II was significantly higher than those of the other groups. Conclusion: Decreased apoptosis in cavernosal tissues obtained by antagonizing the apoptotic effect of BNIP 3 with EGF may facilitate the development of new conservative treatment methods via those pathways.

Prevalence of sexual dysfunction and urinary incontinence and associated risk factors in Turkish women.

OBJECTIVES: Female sexual dysfunction (FSD) and urinary incontinence (UI) are associated risk factors that might cause each other. No study has investigated prevalence of FSD and UI in the same population. The aims of the study were to investigate the prevalence of FSD and UI and associated risk factors in the same population. STUDY DESIGN: The study included 1217 women in 20 provinces, representing the geographical regions of Turkey. Women aged ≥18 years with active sexual life in the last 6 months were enrolled. FSD, overactive bladder, UI, depression, and sexual distress were investigated using validated scales. Risk factors that might predict FSD and UI were determined in the same population. RESULTS: The prevalence of FSD and UI was 52.5% and 14.6%, respectively. Comparing the women with and without FSD, those with FSD were older, had higher body mass index (BMI), less physical exercise, older spouses, lower educational level, and lower rates of smoking and alcohol consumption. The rates of women in menopause and those with a spouse/partner having erection problem and the rates of UI, depression, and sexual distress were higher in the FSD group. Age of spouse, low educational level, not smoking, not consuming alcohol, menopause, not giving consent to spouse/partner to use sexual performance-enhancing drugs when necessary, depression, and sexual distress were the significant risk factors for FSD. Of the women with UI, 56% had overactive bladder symptoms, 32% had stress UI, and 12% had mixed type UI. Comparing the women with and without UI, those with UI were older, had higher BMI, lower educational level, and older spouses. The rate of menopausal women and the rates of FSD, depression, and sexual distress were higher in the UI group. Menopause and FSD were the significant risk factors for UI. CONCLUSIONS: This is the first study to investigate prevalence of FSD and UI in the same population. UI deteriorates sexual functions of women. Therefore, both conditions should be assessed when women complain of either sexual or urinary problems.

Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of renal stones greater than 2 cm.

OBJECTIVE: To evaluate the safety and efficacy of retrograde intrarenal surgery (RIRS) in the treatment of kidney stones greater than 2 cm and to compare its results with those of percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: We retrospectively analyzed a total of 143 patients: 86 patients (53 males and 33 females) who underwent PCNL and 57 patients (37 males and 20 females) who underwent RIRS between October 2009 and October 2013. RESULTS: The mean duration of operation was 100.26±33.26 min in the RIRS group and 75.55±21.5 min in the PCNL group (p<0.001). The hospital stay was significantly shorter in the RIRS group (1.56±0.8 vs. 4.57±2.1 days in the RIRS and PCNL groups, respectively; p<0.001). Stone-free rates after one session were 66.6% and 91.8% of the RIRS and PCNL groups, respectively. The stone-free rate of the RIRS group improved to 87.7% after the second session. Blood transfusions were required in two patients in the PCNL group. Complication rates were higher in the PCNL group. CONCLUSION: This study revealed that RIRS can be an alternative to PCNL in the treatment of kidney stones with a diameter of 2-4 cm especially in patients with comorbidities.

Utility of semiquantitative strain elastography for differentiation between benign and malignant solid renal masses.

OBJECTIVES: The aim of this study was to determine the role of semiquantitative strain elastography for differentiation of benign and malignant solid renal masses. METHODS: Seventy-one patients with solid renal masses were prospectively examined with ultrasound elastography after grayscale sonography. Strain elastography was used to compare the stiffness of the renal masses and renal parenchyma. The ratio of strain in a renal mass and nearby renal parenchyma was defined as the strain index value. Mean strain index values for benign masses (n = 29; 24 angiomyolipomas and 5 oncocytomas) and malignant masses (n = 42; 34 renal cell carcinomas, 4 transitional cell carcinomas, 3 metastases, and 1 lymphoma) and mean strain index values for angiomyolipomas and renal cell carcinomas were compared. RESULTS: There were no significant differences in the mean age of the patients, mean diameter of the masses, and mean probe-mass distance between benign and malignant groups. The mean strain index value ± SD for malignant masses (4.05 ± 2.17) was significantly higher than the value for benign masses (1.43 ± 0.94; P < .05). The mean strain index value for renal cell carcinomas (4.30 ± 2.27) was significantly higher than the value for angiomyolipomas (1.28 ± 1.01; P < .0001). CONCLUSIONS: Strain elastography may be a useful imaging technique for differentiation between benign and malignant solid renal masses.

Classical vs. unit area method in the evaluation of differential renal function in unilateral hydronephrosis.

BACKGROUND: There are some problematic results in determination of differential renal function (DRF) by means of Tc-99m DMSA renal scintigraphy in hydronephrotic kidneys. In this study the classical method (CM) and unit area methods (UAM) in the estimation of DRF in unilateral hydronephrosis before and after intervention were compared. METHODS: Twenty patients (12 M, 8 F; mean: 42.6±18.5 years old) who were candidates for surgery or intervention because of unilateral hydronephrosis were the subjects of this study. All the patients were evaluated by Tc-99m DMSA scintigraphy before and 3-6 months after the intervention. In order to estimate DRF both CM and UAM (obtained by division of the counts including the kidney ROI to pixel of the same ROI) were performed. Bland-Altman analyses were performed in order to compare the DRF values obtained from both methods. RESULTS: The agreement between CM and UAM was poor in the preoperative estimation, however, the agreement was good after the operation or intervention. CONCLUSIONS: In this study it seems that DRF estimation with CM in unilateral hydronephrosis might be problematic in the determination of surgery thus UAM might be introduced as the method of choice in the determination of DRF in unilateral hyronephrosis.

Utility of ADC measurement on diffusion-weighted MRI in differentiation of prostate cancer, normal prostate and prostatitis.

To determine the utility of apparent diffusion coefficient (ADC) values in differentiation of prostate cancer from normal prostate parenchyma and prostatitis we obtained ADC values of 50 patients at b 100, 600 and 1,000 s/mm(2) diffusion gradients. The ADC values of prostate cancer group were significantly lower than normal prostate and prostatitis group at b 600 and 1,000 s/mm(2) gradients. The ADC values at high diffusion gradients may be used in differentiation prostate cancer from normal prostate and prostatitis.

Second pathways in the pathophysiology of ischemic priapism and treatment alternatives.

OBJECTIVE: To evaluate the early therapeutic alternatives such as bosentan, an endothelin receptor blocker, theophylline, an adenosin receptor blocker, and a nonselective phosphodiesterase enzyme inhibitor, zinc protoporphyrin (ZnPP), a heme oxygenase 1 inhibitor, for the therapy of ischemic priapism in the rat models. METHODS: Twenty-four Sprague-Dawley rats were randomly divided into 4 equal groups: control group, ZnPP group, bosentan group, and theophylline group. Erection was provided by vacuum constriction method and maintained for 4 hours for achieving the priapism in all groups. The rats in the control group were administered 1 mL/kg saline intraperitoneally (ip). The rats in group 2 were administered 25 mg/kg ZnPP ip. The rats in group 3 were administered 0.25 mg/kg bosentan ip. The rats in group 4 were administered 100 mg/kg theophylline ip. Six rats from each group were decapitated after 6 hours of drug administration. Then endothelin 1, adenosine deaminase, heme oxygenase 1 enzymatic activity, and apoptosis index in the cavernous tissues were estimated. RESULTS: Cavernous tissue endothelin 1, adenosine deaminase, heme oxygenase 1 enzymatic activity levels, and apoptosis index were significantly decreased in bosentan, theophylline, and ZnPP-treated rats compared with the controls. CONCLUSION: Inhibition of priapism induced apoptosis with bosentan, theophylline, and ZnPP seems promising on preserving erectile function.

Role of diffusion MRI and apparent diffusion coefficient measurement in the diagnosis, staging and pathological classification of bladder tumors.

OBJECTIVES: Our aim was to investigate the role of simultaneous apparent diffusion coefficient (ADC) measurement and diffusion-weighted MRI (DWMRI) in the diagnosis and differentiation of bladder masses. METHODS: We examined 45 patients presenting with hematuria by dynamic and diffusion MRI (at b100, b600, b1000 gradients) and cystoscopy. Thirty healthy volunteers without hematuria were also included in the study. Results from imaging techniques were compared to cystoscopic and histopathologic findings. The ADC values of benign and malignant bladder masses, and bladder tissue in healthy subjects were measured and compared with each other. RESULTS: The mean ADC values of benign (n = 10) and malignant lesions (n = 35) were significantly lower than the mean ADC values of adjacent bladder walls and bladder walls of healthy subjects at all 3 gradients (p < 0.05). However, no significant difference was detected between benign and malignant lesions (p > 0.05). Mean ADC values of invasive tumors were significantly lower than superficial malignancies at b600 and b1000 gradients. The mean ADC values of transitional cell tumors were significantly higher than squamous cell tumors at b100 and b600 gradients. CONCLUSION: Simultaneous measurement ofADC and DWMRI provided useful information in the diagnosis, staging and histopathological classification of bladder tumors.

Inflammatory pseudotumor of the kidney.

Inflammatory pseudotumor of the kidney is a rare benign condition with unknown etiology that can mimic malignancy. We report a case of inflammatory pseudotumor of the kidney. A 59-year-old male patient was admitted with a complaint of right flank pain and hematuria. Ultrasonography and magnetic resonance imaging of the patient revealed a 9 cm × 10 cm mass originating from the renal parenchyma with posterior extension. Operative findings revealed a mass adhering to the psoas muscle. Histopathologic examination demonstrated spindle-shaped fibroblast cells accompanying inflammatory cells. The pathological diagnosis was renal inflammatory pseudotumor. Repeated US and computed tomography revealed complete remission.

Detection of bladder tumors with 3-dimensional sonography and virtual sonographic cystoscopy.

OBJECTIVE: Bladder tumors are among the most common types of malignant neoplasms of the urinary tract. The purpose of this study was to evaluate the potential value of 3-dimensional (3D) sonography and sonographic cystoscopy in detection of bladder tumors. METHODS: Thirty-one patients with suspected or known bladder tumors were included this study. All patients underwent 3D sonography and conventional cystoscopy within 15 days. The number, size, location, and morphologic features of the lesions were evaluated on gray scale, 3D virtual, and multiplanar reconstruction images obtained from the patients. The results of 3D sonographic cystoscopy were compared with the findings from conventional cystoscopy, which was considered the reference standard. RESULTS: Twenty-eight (90.3%) of 31 3D virtual sonographic cystoscopic studies had good or excellent image quality. Conventional cystoscopy revealed 47 lesions in 22 of 28 patients; 3D sonographic virtual cystoscopy showed 41 (87.2%) of 47 lesions. Three-dimensional virtual sonography alone had sensitivity of 96.2%, specificity of 70.6%, a positive predictive value of 93.9%, and a negative predictive value of 80% for tumor detection. The combination of gray scale sonography, multiplanar reconstruction, and 3D virtual sonography had sensitivity of 96.4%, specificity of 88.8%, a positive predictive value of 97.6%, and a negative predictive value of 84.2% for tumor detection. CONCLUSIONS: Three-dimensional sonography is a promising alternative noninvasive technique for use in detection of bladder tumors, their localization, and perivesical spreading. The location, size, and morphologic features of the tumors shown on 3D sonography agreed well with the findings of conventional cystoscopy.

Pseudoaneurysm and renal arteriovenous fistula after nephrectomy: two cases treated by transcatheter coil embolization.

Pseudoaneurysms and arteriovenous fistulas of renal arteries are rare clinical lesions. Invasive renal procedures may lead to pseudoaneurysm or arteriovenous fistulas (AVFs). We report two pseudoaneurysms and arteriovenous fistula cases that were treated by transcatheter embolization with metallic coils. The first case is left main renal artery pseudoaneurysm after nephrectomy in a patient with a solid renal tumor. The second case is right main renal artery AVF with giant pseudoaneurysm after both gunshot injury and nephrectomy. On the basis of color Doppler sonography and computed tomography (CT) findings, cases were diagnosed as pseudoaneurysm after nefrectomy. Contrast-enhanced CT scans showed a hyperdense area within the hematoma consistent with pseudoaneurysm. Endovascular treatment with coil embolization succeeds to total occlusion in renal artery pseudoaneurysm. Delayed hemorrhage related to postnephrectomy may be life-threatening conditions because of diagnostic difficulties. AVF and pseudoaneurysm can be treated safely and successfully by transcatheter arterial embolization.

Scrotal calculi.

OBJECTIVE: Scrotal calculi are freely mobile calcified bodies lying between the layers of the tunica vaginalis of the testes. The etiology of scrotal calculi is unclear. They may develop as a sequela to hematomas or inflammatory changes within the scrotum or loose bodies from torsion and infarction of the appendix testis or epididymis. The aim of our series was to examine the etiopathogenesis of scrotal calculi, which were detected incidentally in various age groups, with reference to the medical literature. METHODS: Among 868 patients, 23 (2.65%) cases of scrotal calculi were diagnosed on sonographic examinations. The ages of the patients ranged between 4 months and 65 years (mean age +/- SD, 28.3+/-11.9 years). RESULTS: On sonographic examination; we found a total of 51 scrotal calculi with a mean size of 4.22+/-2.42 mm (range, 2-10 mm) in 23 patients, an epididymal cyst in 3 patients (13%), epididymitis in 2 patients (8.6%), hydrocele in 3 patients (13%), varicocele in 3 patients (13%), and testicular microlithiasis in 1 patient (4%). Scrotal calculi were solitary in 11 patients and multiple in 12 patients. CONCLUSIONS: The prevalence of scrotal calculi was 2.65%, and a minority of patients had other abnormalities, reflecting the generally benign etiology of these "pearls." To date, no information is available in the literature about the results of chronic irritation due to scrotal calculi. Further studies in larger series need to be performed to elucidate the formation mechanism and natural course of scrotal calculi.

Measuring resistance index in patients with BPH and lower urinary tract symptoms.

PURPOSE: To assess the correlation between resistance index (RI) measured in different zones of the prostate and other more commonly used parameters of benign prostatic hyperplasia (BPH). METHODS: Twenty-six male patients who underwent a detailed evaluation for lower urinary tract symptoms suggestive of BPH were examined with transrectal (TRUS) color Doppler sonography (CDS). The correlation between RI in various prostate zones, and various urinary flow rates, and the International Prostate Symptom Score (IPSS), and prostatic volume measured by TRUS was determined. RESULTS: No significant difference in RI was observed between right and left transition (TZ) and peripheral zones (PZ) in the prostate (P > 0.05). There was a significant correlation between mean RI and maximum urinary flow rate (Qmax) and mean RI in both zones (r = -0.48 for TZ and r = -0.39, P < 0.05 for PZ). Individual measurements in left and right TZ RI were also correlated with Qmax. There was a correlation between prostatic volume and both the right (P < 0.05, r = 0.56) and the left (P < 0.05, r = 0.58) TZ RI, respectively. CONCLUSION: Our results demonstrate the potential value of RI measurement in the evaluation of patients with lower urinary tract symptoms suggestive of BPH.

Role of tissue polypeptide specific antigen in the detection of prostate cancer.

OBJECTIVE: The aim of the present study was to evaluate the role of tissue polypeptide specific antigen (TPS) in the diagnosis of different stages of prostatic cancer (CaP) and to compare the diagnostic efficacy of serum TPS in respect to total prostate-specific antigen (tPSA) and free/total (f/t) PSA ratio. PATIENTS AND METHODS: Patients with BPH (n = 58), localized CaP (n = 37) and metastatic CaP (n = 16) were compared by measuring serum TPS, tPSA and f/t PSA ratio. RESULTS: Serum TPS was significantly increased only in patients with metastatic CaP (p < 0.05) and TPS levels was not significantly different between patients with BPH and localized CaP. Both f/tPSA and tPSA showed better sensitivity, specificity and receiver operating curve analysis in the differential diagnosis of BPH and localized CaP. CONCLUSION: In conclusion, serum TPS measurement was found to be significantly increased in metastatic prostatic carcinoma cases but was not useful in the early detection of prostatic carcinoma. Although there are several studies demonstrating the usefulness of TPS in the differential diagnosis of prostate cancer, there is increasing evidence for the use of this molecule in the late period of the disease or as an adjunct to other molecules in the detection of recurrences.