Urethroplasty Using A Turnover Flap for Correction of Problematic Urethrocutaneous Fistula: A Case Report.

Urethral fistula formation after urethroplasty for hypospadias is a frequent complication. Repeated failures can occur even after multiple attempts at repair. A surgical procedure is described for a problematic resistant urethrocutaneous fistula (UF) with the transverse turnover flap using the Buck's fascia of the corpus cavernosum. A 23-year-old male was admitted to our hospital with recurrent coronal UF. We placed a suprapubic catheter in the bladder and operated the patient with the flap technique combined with glanuloplasty. In 3rd month follow up, the patient had no fistula with normal voiding.

The change in serum Thiol/Disulphide homeostasis after transrectal ultrasound guided prostate biopsy.

OBJECTIVES: The aim of this prospective clinical study was to investigate variations in a novel oxidative stress marker (thiol/disulphide homeostasis) in men who underwent transrectal ultrasound guided prostate biopsy (TRUSB). MATERIALS AND METHODS: A total of 22 men undergoing TRUSB of the prostate were enrolled in the study. Patients with abnormal digital rectal examination and/or total prostate specific antigen (PSA) over 4ng/mL underwent TRUSB with 12 cores. Serum samples were obtained before and just after the procedure to evaluate the possible changes in thiol/disulphide homeostasis. Mean age, total PSA and free PSA, prostate volume and histopathological data were also recorded. RESULTS: Mean age of the study population was 65.05±8.89 years. Significant decreases in native and total thiol levels were documented after the biopsy procedure. However, serum disulphide levels and disulphide/native thiol, disulphide/total thiol and native / total thiol ratios did not significantly change after TRUSB. No correlation was observed between oxidative parameters and total PSA and free PSA levels, prostate volume and histopathology of the prostate. However, mean patient age was significantly correlated with mean native and total thiol levels. CONCLUSION: Significant decreases in serum native and total thiol levels related to the prostate biopsy procedure suggest that TRUSB causes acute oxidative stress in the human body. Since our trial is the first in the current literature to investigate these oxidative stress markers in urology practice, additional studies are warranted.

Does length of prostate biopsy cores have an impact on diagnosis of prostate cancer?

OBJECTIVE: To investigate whether core length is a significant biopsy parameter in the detection of prostate cancer. MATERIAL AND METHODS: We retrospectively analyzed pathology reports of the specimens of 188 patients diagnosed with prostate cancer who had undergone initial transrectal ultrasound (TRUS) guided prostate biopsy, and compared biopsy core lengths of the patients with, and without prostate cancer. The biopsy specimens of prostate cancer patients were divided into 3 groups according to core length, and the data obtained were compared (Group 1; total core length <10 mm, Group 2; total core length 10 mm-19 mm, and Group 3; total core length >20 mm). Biopsy core lengths of the patients diagnosed as prostate cancer, and benign prostatic hyperplasia were compared, and a certain cut-off value for core length with optimal diagnostic sensitivity and specificity for prostate cancer was calculated. RESULTS: Mean age, PSA and total length of cores were 65.08±7.41 years, 9.82±6.34 ng/mL and 11.2±0.2 mm, respectively. Assessment of biopsy core lengths showed that cores with cancer (n=993, median length 12.5 mm) were significantly longer than benign cores (n=1185, median length=11.3 mm) (p<0.001). Core length analysis yielded 12 mm cores have an optimal sensitivity (41.9%) and specificity (62%) for detection of cancer (odds ratio: 1.08). CONCLUSION: Biopsy core length is one of the most important parameter that determines the quality of biopsy and detection of prostate cancer. A median sample length of 12 mm is ideal lower limit for cancer detection, and biopsy procedures which yield shorter biopsy cores should be repeated.

Deficiency of vitamin D and elevated aldosterone in prostate hyperplasia.

BACKGROUND: Epidemiological studies have confirmed the association between vitamin D deficiency and benign prostate hyperplasia (BPH). Lately, serum calcium and parathyroid hormones were shown to stimulate prostate growth, assuming an interplay between elements of the calcium metabolism rather than a sole role of any. Finally, aldosterone actions were found to be affected by vitamin D. OBJECTIVES: We have sufficient reason to believe that human disease, BPH in this case, is a dysfunction of a fine network rather than a failure of a particular substance. Unfortunately, previous studies include results of studies that fall short in combining the overall structure. This study aimed to investigate these four parameters in BPH patients. MATERIAL AND METHODS: Twenty five patients with BPH (median age 62 years) and 30 volunteer healthy controls (median age 63.5 years) were enrolled. Serum total prostate specific antigen (PSA), intact parathormone (PTH), calcium, 25-hydroxy vitamin D (25-(OH) 2D), aldosterone and lipids were measured. RESULTS: We found serum aldosterone levels significantly higher in BPH patients (p = 0.04). BPH patients had significantly higher serum PSA levels (p < 0.0001). 25-(OH) 2D levels were lower in the BPH group (p = 0.05). Median serum 25-(OH) 2D levels in both groups were lower than the threshold reference limit (20 ng/mL). CONCLUSIONS: The co-existence of vitamin D deficiency and elevated levels of aldosterone in BPH, presented for the first time in literature, strongly favors a link between the renin-angiotensin system (RAS), vitamin D and BPH pathogenesis. Our findings may influence studies with larger groups of subjects.

Impact of iron supplementation on sexual dysfunction of women with iron deficiency anemia in short term: a preliminary study.

INTRODUCTION: Iron deficiency anemia (IDA) is a common micronutrient deficiency worldwide. It is an important health problem especially in women of reproductive age. IDA may cause anxiety, which is the major factor for female sexual dysfunction (FSD). AIM: The aim of the present study was to determine the impact of IDA on FSD in women of reproductive age. METHODS: In total, 207 women were enrolled. Women with IDA who were admitted in an outpatient clinic of family medicine were asked to complete Beck Anxiety Inventory (BAI), Female Sexual Function Index (FSFI), and Quality of Life (QoL) questionnaires. Questionnaires were completed before and after IDA treatments. Blood samples were obtained for measurements of hemoglobin, hematocrit, levels of serum iron, and iron-binding capacity. MAIN OUTCOME MEASURES: Outcomes of blood samples were used for diagnosing of IDA. BAI, FSFI, and QoL scores were evaluated. Paired samples t-tests and Pearson correlation analyses were used to assess relationship between findings of IDA treatments and other parameters. RESULTS: The mean age was 33.6 ± 8.4 years. There were statistical significant differences between pre- and posttreatment in terms of hemoglobin, hematocrit, serum iron, and serum iron-binding capacity. BAI scores were decreased and FSFI scores, which were statistically significant, increased after IDA treatments (P < 0.001). However, QoL scores were developed without statistical significance. CONCLUSION: There is a risk for anxiety as well as FSD in IDA women of reproductive age. Treatment of IDA can significantly improve sexual functions and QoL in these women population in short term.

Is perioperative examination of frozen sections necessary in nephron-sparing surgery?

AIM: To evaluate the role of perioperative freezing in the management of surgical procedures in patients with malignant renal masses. MATERIALS AND METHODS: The study group consisted of 17 patients diagnosed with renal masses who underwent nephron-sparing surgery. The group included 5 females and 12 males aged from 44 to 68 years (mean = 54.6). The mean mass size was 5.5 cm. Mass locations were as follows: 9 were in the lower pole, 4 were in the mid-pole, and 6 were in the upper pole. Perioperative freezing was not carried out. The patients were followed-up in a period ranging from 3 months to 7 years. RESULTS: Tumor pathology was reported as renal cell carcinoma in all cases, and surgical margins were negative in all of them. One patient died after 1 year because of tumor metastasis. In another patient, the tumor reoccurred in the same kidney and a radical nephrectomy was performed. Other patients were followed without recurrence. CONCLUSION: Imaging of the renal vascular system and freezing during surgery is not necessary for nephron-sparing surgery for renal cell carcinoma; however, we should be careful in terms of capsule invasion because of tumor recurrence.

Protective effects of the nuclear factor kappa B inhibitor pyrrolidine dithiocarbamate in bladder ischemia-reperfusion injury in rats.

The aim of the present study was to evaluate the protective effects of the NF-кB inhibition with pyrrolidine-dithiocarbamate (PDTC) in ischemia-reperfusion (I/R) injury in the rat bladder. Twenty-four Sprague-Dawley male rats were divided into three groups. Group I; (n = 8) control, group II; (n = 8) I/R group; group III (n = 8) I/R and PDTC treatment. Superoxide dismutase (SOD), catalase (CAT), and gluatathione-S-transferase (GST) enzymes was studied in bladder tissue. Lipid peroxidation (as TBARS) levels in tissue homogenate were measured with thiobarbituric acid reaction. All the slides were stained with NF-кB, p53 and HSP60 immunohistochemistry for detection genome destruction and tissue stress, respectively. Our results show that the mean TBARS levels were significantly higher in group II (p < 0.05). The TBARS levels were significantly decreased in group III compared with the group II (p < 0.05). CAT, SOD and GST activities were decreased in group II, but these enzymes levels were significantly increased in group III according to the group II (p < 0.05). Under microscopic evaluation NF-кB expression increased significantly in group II compared to the group I (p < 0.05) and then decreased in group III (p < 0.05). HSP60 and p53 expression in group II was increased significantly compared with group I. Under microscopic evaluation we detected that HSP60 and p53 expression was increased significantly in group II compared with group I. In group III PDTC administration was decreased the HSP60 and p53 expression, this difference was statistically significant (p < 0.05). The results of the present study have demonstrated that NF-кB inhibition with PDTC protects and provides beneficial effects on ischemia/reperfusion stress related bladder tissue destruction.

Ischemia modified albumin levels and oxidative stress in patients with bladder cancer.

BACKGROUND: Impaired oxidative/antioxidative status plays an important role in the pathogenesis of many diseases like cancer. The aim of this study was to evaluate the levels of the novel marker ischemia modified albumin (IMA) and albumin adjusted-IMA (Adj-IMA) in patients with bladder cancer (BC) as well as its association with total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI). MATERIALS AND METHODS: Forty male patients with BC (mean age, 67.4±12 years) and forty age-sex matched healthy persons (mean age 56.0±1.7 years) were included in this study. Serum levels of IMA, TAS, TOS were analyzed and Adj- IMA and OSI was calculated. RESULTS: Serum IMA, TOS and OSI values were significantly higher in patients with BC compared to controls (p<0.0001, p=0.01 and p=0.01, respectively), whereas TAS was significantly lower in BC patients (p=0.04). There was no significant difference for serum albumin-adjusted IMA levels between groups (p=0.4). CONCLUSIONS: In this study, it was found that there was an impaired oxidative/antioxidant status in favor of oxidative stress in BC patients. This observation was not confirmed by Adj-IMA calculation. There is no published report about serum concentrations of IMA in patients with BC. Further studies are needed to establish the relationship of IMA and oxidative stress parameters in BC and the significance of IMA to other cancers.

Enhanced HDL-cholesterol-associated anti-oxidant PON-1 activity in prostate cancer patients.

Increases in the generation of reactive oxygen species and decreases in antioxidant enzyme activities with aging have been reported in the prostate, and are also observed in age-related disorders such as atherosclerosis, Alzheimer's disease, and cataracts. Several studies have demonstrated that proteins are targets for reactive oxidants in cells, and that oxidized proteins accumulate during aging, oxidative stress and in some pathological conditions. However, only a limited number of studies have actually evaluated oxidative damage in relation to HDL-cholesterol-associated antioxidant enzyme activities or have assessed its relationship with prostate cancer. In this study, we examined the effect of HDL-cholesterol-associated antioxidant enzyme activities, paraoxonase1, arylesterase and new oxidative stress parameters (total oxidant status, total antioxidant status [and oxidative stress index]) in newly-diagnosed prostate cancer patients and healthy controls. There were no significant differences in oxidative stress parameters and lipid parameters between prostate cancer patients and controls, however, paraoxonase1 enzyme activity, and non-HDL-cholesterol levels were higher in prostate cancer patients than controls. The results of this study were derived from a small number of subjects, but might represent an important working hypothesis for further research in a larger number of cases to clarify the role of paraoxonase1 overproduction on the prostate and its clinical relevance.

Conventional monopolar transurethral resection of prostate in patients with large prostate (≥80 grams).

INTRODUCTION: Transurethral resection of the prostate (TURP) is still regarded as the gold standard for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostate obstruction in prostates between 30 and 80 mL. Endoscopic treatment of large prostate is not adequately discussed in literature. Our objective was to evaluate the efficacy and safety of TURP in large prostate glands (≥80 ml) in patients with BPH. MATERIAL AND METHODS: From May 2004 to September 2012, 62 patients with high volume of BPH (≥80 ml) treated with TURP by single surgeon, were evaluated retrospectively. Perioperative and postoperative full blood count and serum electrolytes, complications, operative time, weight of resected prostate tissue, time for catheter removal, and hospitalization time were recorded. Conventional TURP was performed using a standard technique. RESULTS: The mean PSA levels and prostate volumes were 8 ±5.38 ng/ml and 90.93 ±13.95 gm, respectively. The mean operating time was 55.96 ±8.04 minutes. The mean amount of tissue resected was 52.21 ±7.59 gm. Compare with baseline, there were significant improvements in International Prostate Symptom Score (IPSS), Quality of Life (QoL), maximum urinary flow rate (Qmax), and postvoiding residual urine after surgery. There was no major bleeding complication. There was no TUR syndrome or intraoperative death. Requiring re-catheterization was detected for 3 (4.8%) patients. Transient urge incontinence was observed for 3 (4.8%) patients. Bulbar urethral stricture was developed for 2 (3.2%) patients. CONCLUSIONS: Morbidity of the TURP is decreased with the technological improvements. Conventional monopolar TURP can be effectively performed in large prostate (≥80 mL) with the experience.

Findings concerning testis, vas deference, and epididymis in adult cases with nonpalpable testes

In this study, we aimed to state the relationship between testis, epididymis and vas deference, in adult cases with nonpalpable testis. Between January 1996 and December 2009, we evaluated 154 adult cases with nonpalpable testes. Mean age was 23 years (20-27 years). Explorations were performed by open inguinal incision, laparoscopy, and by inguinal incision and laparoscopy together on 22, 131 and 1 patient, respectively. Of all the unilateral cases, 32 were accepted as vanishing testis. In five of these cases, vas deference was ending inside the abdomen, and in the others, it was ending inside the scrotum. In the remaining 99 unilateral and 22 bilateral cases, 143 testes were found in total. Testes were found in the inguinal canal as atrophic in one case, at the right renal pedicle level with dysmorphic testis in one case, and anterior to the internal ring between the bladder and the common iliac vessels at a smaller than normal size in 119 cases. One (0.69 percent) case did not have epididymis. While epididymis was attached to the testis only at the head and tail locations in 88 (61.53 percent) cases, it was totally attached to the testis in 54 (37.76 percent) cases. There is an obviously high incidence rate of testis and vas deference anomalies, where epididymis is the most frequent one. In cases with abdominal testes, this rate is highest for high localised abdominal testes.

Is microsurgery necessary in grade 3 varicocele?

PURPOSE: To compare the results of microsurgical and naked eye varicocelectomy in patients with grade 3 varicocele. MATERIALS AND METHODS: This study was conducted on 84 patients with grade 3 varicocele, between 2007 and 2009. Patients were randomized into two groups, equal in number. Thereafter, microsurgical varicocelectomy was performed in the first group, while the other group underwent naked eye varicocelectomy. Groups were compared in terms of operation duration, number of ligated internal and external spermatic veins, early and late postoperative complications, and postoperative color Doppler ultrasonography findings. Parametric and nonparametric values were compared using Student's t test and Chi-Square test, respectively. RESULTS: The mean duration of surgery was 19 ± 2.3 minutes (range, 12 to 25 minutes) in the naked eye surgery group and 43 ± 3.9 minutes (range, 25 to 75 minutes) in the microsurgery group (P = .008). The number of ligated internal and external spermatic veins, the incidence of early and late postoperative complications, and color Doppler ultrasonography findings were not significantly different between the two groups (P = .12, P = .09, P = .17, and P = .22, respectively). CONCLUSION: In patients with grade 3 varicocele, microsurgery and naked eye surgical methods proved similar results in terms of success and complications. Because the operation time of the classical varicocelectomy is significantly shorter, it may be preferred in this subset of patients.

Polyorchidism: sonographic and magnetic resonance imaging findings.

Polyorchidism is a rare anomaly and frequently associated with criptorchidism, inguinal hernia and testicular torsion. It is also reported as increased risk of testicular malignancy. We report a case of 23 year old man with left supernumerary testis in the left hemiscrotum. He presented with painless mass in his left hemiscrotum. Normal physical examination and laboratory tests including spermiogram were examined. Both ultrasound and MRI examinations revealed polyorchidism without malignancy or any other concomitant features. In most cases sonography alone is diagnostic. MRI may provide additional information in complicated cases of polyorchidism. Conservative treatment with sonographic follow-up is the choice of treatment in uncomplicated cases.

Findings concerning testis, vas deference, and epididymis in adult cases with nonpalpable testes.

In this study, we aimed to state the relationship between testis, epididymis and vas deference, in adult cases with nonpalpable testis. Between January 1996 and December 2009, we evaluated 154 adult cases with nonpalpable testes. Mean age was 23 years (20-27 years). Explorations were performed by open inguinal incision, laparoscopy, and by inguinal incision and laparoscopy together on 22, 131 and 1 patient, respectively. Of all the unilateral cases, 32 were accepted as vanishing testis. In five of these cases, vas deference was ending inside the abdomen, and in the others, it was ending inside the scrotum. In the remaining 99 unilateral and 22 bilateral cases, 143 testes were found in total. Testes were found in the inguinal canal as atrophic in one case, at the right renal pedicle level with dysmorphic testis in one case, and anterior to the internal ring between the bladder and the common iliac vessels at a smaller than normal size in 119 cases. One (0.69%) case did not have epididymis. While epididymis was attached to the testis only at the head and tail locations in 88 (61.53%) cases, it was totally attached to the testis in 54 (37.76%) cases. There is an obviously high incidence rate of testis and vas deference anomalies, where epididymis is the most frequent one. In cases with abdominal testes, this rate is highest for high localised abdominal testes.

Is repeat transurethral resection effective and necessary in patients with T1 bladder carcinoma?

INTRODUCTION: We investigated the efficacy and necessity of repeat transurethral resection (Re-TUR) in T1 bladder cancer. PATIENTS AND METHODS: From September 2004 to September 2009, 62 patients with pathologically confirmed T1 bladder tumours were investigated. Re-TUR was routinely performed within 3-6 weeks following the initial resection. The pathological results of the Re-TUR were reviewed, and the risk of recurrence was investigated. RESULTS: Of the 62 patients who underwent Re-TUR, 22 had a residual tumour pathologically. Visible residual tumours were detected in 9 patients (14.5%). The risk of having a residual tumour was directly correlated with the diameter of the initial tumour in T1 tumours (p = 0.007). CONCLUSIONS: Upstaging to T2 of the disease led to radical cystectomy in 11.29% of the patients in our series. Re-TUR should be routinely performed on all patients, especially on patients with high-grade tumours and with tumour diameters greater than 3 cm in T1 bladder cancer.

Burned-out testis tumour that metastasized to retroperitoneal lymph nodes: a case report.

INTRODUCTION: Burned-out testicular tumour is a very rare clinical entity. There is no clinical finding in the testicle, because it regresses spontaneously with no treatment, and generally presents with metastases. Abdominal masses in young male patients may sometimes be caused by a metastatic burned-out testicular tumour. We report a patient with a burned-out testicular tumour that metastasized to retroperitoneal lymph nodes. CASE PRESENTATION: A 28-year-old man complained of an abdominal mass and continuously increasing pain over the previous 2 months. A midabdominal mass, atrophy and minimal induration in the right testis were revealed on physical examination. Ultrasound findings revealed focally increased echogenicity, which is typical of burned-out tumours. Inguinal orchiectomy was performed, and the histological examination of the biopsy specimen revealed a large area of hyalinization, tubular hyalinization, interstitial fibrosis and focal Leydig cell hyperplasia, with no abnormal pathological findings in the epididymis and spermatic cord. The final pathological diagnosis was concluded as "burned-out" testicular tumour. Surgical treatment was followed by appropriate chemotherapy and in the follow-up, the abdominal mass was observed to regress. The patient is currently free of disease 5 years after diagnosis. CONCLUSION: For the detection of intratesticular lesions, especially in patients with extragonadal metastatic involvement and normal palpation findings for the testis, scrotal sonography is very important. A burned-out testicular tumour should be considered and testis biopsies should be performed if there is any risk factor of malignancy.

Posttraumatic ventral urethral fistula: a case report.

INTRODUCTION: We present the first case reported in the medical literature of a patient with a posttraumatic urethral fistula accompanied by retraction urethral catheter with balloon. CASE PRESENTATION: A 69-year-old man was admitted to our hospital with the recurrence urinary tract infection. The patient reports history of urethral trauma, which is retraction urethral catheter with balloon 2 years ago. Cystoscopy and fistulography were performed, and urethrocutaneous fistula was detected. Initial surgical treatment consisted of surgical debridement of fistula tissue, and a urethral catheterization was performed. After 4 weeks of the operation the urethral fistula resolved. In a follow-up period of 24 months no recurrence and no urinary tract infection were occurred. CONCLUSION: Self retraction of the urethral catheter with balloon may result with clinically important urethral fistula. A wide range of possible options such as complete excision of the fistula tract and primary closure may be considered for individual cases.