Effect of benign testicular mass on fertility: an epidermoid cyst case.

The article discusses the problem of epidermoid cysts - extremely rare but the most common benign intratesticular tumors. The majority of non-palpable testicular lesions, discovered by ultrasonography in a population of infertile men, are benign tumors. The case of a young man who had incidentally diagnosed, during his infertility evaluation, a right testicular mass which was pathologically reported as epidermoid cyst after partial orchiectomy is presented. It was suggested that benign testicular cysts may effect the normal parenchyma of testis even if the normal histopathology. Thus, the excision of these benign lesions especially in infertile population is recommended.

A rarely seen case among retroperitoneal mass lesions: paraganglioma.

Pheochromocytomas are rarely seen cathecolamine-secreting neuroendocrine tumors. Diagnosis, treatment, and prognosis of this rarely seen condition have been discussed. In this study, a retroperitoneal paraganglioma with a diameter of 27 mm was detected in a 29-years old nephrectomized male patient. In our case, in reevaluations performed after definitive establishment of the diagnosis, any abnormal radiological signs suggesting a metastatic lesion were not detected. During the postoperative period the patient was referred to the clinics of endocrinology, and oncology for medical follow-up. In the differential diagnosis of retroperitoneal mass lesions, pheochromocytoma/paraganglioma should not be forgotten. Besides, for malignant tumors chemoradiotherapy, and for benign functional tumors medical treatment should be applied.

A rare entity of benign bladder neoplasm: female lipoma.

Although benign bladder neoplasms constitute less than 5% of all bladder neoplasms, they should be taken into consideration because they can be symptomatic, and have the risk of confusing with other malignant neoplasms. Herein, we reported a 59-year-old female patient consulted to our outpatient clinic with the incidents of hematuria. During cystoscopic examination, a yellow-coloured mass lesion with smooth contours on the right posterolateral wall of the bladder was observed. Histopathological examination of the specimen demonstrated mature adipose tissue contained within submucosal layer without bladder wall invasion. Bladder lipomas are rarely seen pure benign masses which almost all reported ones were men. We think that female cases should also be taken into consideration for differential diagnosis presenting with hematuria.

Influence of stone size, location and impaction on the success of ureteroscopic pneumolithotripsy.

This study was conducted on 336 patients that had undergone ureteroscopic pneumolithotripsy for ureteric stones between August 2005 and June 2008. Patient data were analyzed with respect to stone localization, size and impaction. All ureterorenoscopic procedures were performed under general anesthesia using a 9.5F rigid ureteroscope. A plain film of the kidney ureter bladder was performed on the first postoperative day and week 4 to evaluate treatment efficacy. Patient age was 42, 63+/-15 (14-77) yr. Mean stone size for all groups was 9.77+/-4mm (5-20 mm). A total of 336 patients were treated with ureteroscopic pneumolithotripsy, 129 female and 207 male. The overall initial success rate was 85.71%. The success rate of ureteroscopic pneumolithotripsy, proximal, middle and distal ureter, for Stone location, 76.54%, 85.48%, 90.74%, for Stone size (>10 mm) 54%, 77%, 88 % and for Stone impaction; 50%, 75,6%, 85,4% respectively. There was a statistically significant difference between stone free rates with respect to the proximal ureter stone, increasing stone size (>10 mm) and stone impaction (p<0.05) and a positive correlation with the operative complication rate. It is concluded that it is possible to achieve high success and low complication rates in pneumolithotripsy for distal ureteric stones. Nevertheless, the success rate decreases and complication rate increases with stone locations close to the proximal ureter. Complication rate increases with increasing stone size and/or impacted ureteral stones.

The relationship between anogenital distance and lifelong premature ejaculation.

BACKGROUND: Many diseases have been associated with anogenital distance, as an indicator of intrauterine androgen exposure. OBJECTIVES: The aim of this study was to investigate the association between lifelong premature ejaculation and anogenital distance. MATERIALS AND METHODS: The study included 140 participants: 70 with lifelong premature ejaculation (group 1) and 70 without any ejaculatory complaints (group 2). Premature Ejaculation Diagnostic Tool and stopwatch intravaginal ejaculatory latency time were recorded from all participants in order to evaluate ejaculatory function. Two variants of anogenital distance were measured: anogenital distance (from anus to the posterior base of the scrotum) from anus to the posterior base of the scrotum and anogenital distance (from anus to the cephalad insertion of the penis) to the cephalad insertion of the penis. We compared differences between groups and correlations between anogenital distance variants and patients' characteristics. RESULTS: The groups were similar in terms of age, BMI, and total testosterone levels. The mean anogenital distance (from anus to the posterior base of the scrotum) scores were 59.45 ± 10.76 vs. 55.02 ± 10.13 (p = 0.01), and anogenital distance (from anus to the cephalad insertion of the penis) scores were 128.37 ± 22.2 vs. 126.78 ± 16.21 (p = 0.63) in groups 1 and 2, respectively. Significant correlation was observed between anogenital distance (from anus to the posterior base of the scrotum) and Premature Ejaculation Diagnostic Tool scores (r = 0.199, p = 0.019) and intravaginal ejaculatory latency time (r = -0.185, p = 0.028). There were no statistically significant differences between anogenital distance (from anus to the posterior base of the scrotum) scores and total testosterone levels and between anogenital distance (from anus to the cephalad insertion of the penis) and Premature Ejaculation Diagnostic Tool scores or intravaginal ejaculatory latency time. CONCLUSIONS: These results suggest that longer anogenital distance is associated with higher possibility of lifelong premature ejaculation. However, further studies are needed to confirm our results.

Paraoxonase activity in patients with erectile dysfunction.

Paraoxonase (PON1) is a high-density lipoprotein (HDL)-associated enzyme that protects low-density lipoprotein (LDL) and HDL from peroxidation. In this study, PON1 activities were determined in patients with erectile dysfunction (ED) to investigate the relationship between ED and atherosclerosis. Forty patients, who had been diagnosed with ED by the medical and sexual anamnesis and routine laboratory tests, were included in the study. Thirty healthy, sexually active, married and age-matched men were selected as the control group. The patients and controls who underwent surgical or medical treatment in 1-week time and had a systemic disease such as malignancy, liver and renal insufficiency, and active infection and who smoked cigarettes were excluded. PON1 activities were measured spectrophotometrically. Unpaired samples t-test, correlation analyses and multiple linear regression analyses were used for statistical analyses. The results are given as mean+/-standard deviation of mean. The mean ages of the patient and the control groups were 31.05+/-6.90 (range 22-51) and 29.40+/-6.26 (range 19-46), respectively (P=0.307). Serum PON1 levels of the patient and the control groups were found to be 119.05+/-62.11 and 185.04+/-55.64, respectively. The difference between the groups was quite significant (P=0.001). Epidemiological and experimental studies indicate that PON1 activation was lower in individuals who had a tendency to develop atherosclerosis due to comorbidities such as diabetes, familial hypercholesterolemia and kidney disease. In this study, PON1 activity level was found to be significantly lower in ED patients than in control group. The decrease of PON1 activity may have a role in the ethiopathogenesis of ED, and the atherosclerosis development may be faster in the patients due to decreased activity of PON1, which is an antiatherogenic enzyme.

Comparison of oxidative/antioxidative status of penile corpus cavernosum blood and peripheral venous blood.

The aim of the study is to determine and to compare the oxidative and antioxidative status of penile corpus cavernosum and peripheral venous blood. A total of 28 adult healthy males were included in the study. Whole blood was simultaneously withdrawn from penile corpus cavernosum and the cubital vein and their plasma separated. Total antioxidant capacity (TAC), vitamin C, total protein, albumin, uric acid, bilirubin and total peroxide (TP) levels of both plasma samples were measured and compared. While TAC, total protein, albumin, bilirubin and uric acid levels were higher, vitamin C levels were lower in cavernosal blood than that of peripheral blood. On the other hand, TP level was found to be higher in penile blood samples than that of peripheral blood. We thought that the normal erectile process of the penile cavernosal body leads to increased production of oxidants as in the mechanism of ischaemia-reperfusion; however, the increase of TAC can prevent development of oxidative injury.

A case of female epispadias without exstrophy treated with a novel vulvoplasty method.

Epispadias surgery has mainly two components: bladder and genitourethral reconstruction. Herein, a novel vulvoplasty method, an alternative for the latter component, carried out in a rare case of female epispadias was presented. In a 6-year-old girl admitted with complaint of total incontinence, epispadias without evident extrophy associated with adequate bladder capacity was determined. Firstly the vulvoplasty in which a circumferencial skin flap around the urethral meatus was rolled backwards, and secondly bladder neck reconstruction was performed. The vulvoplasty resulted in sufficient cosmetic outcome and continence up to half an hour, and after cervicoplasty total day and night continence at rest or on exertion were obtained. It was concluded that this vulvoplasty with sufficient cosmetic outcome could be considered as a first stage operation in female epispadias, because it could facilitate bladder neck reconstruction by increasing urethral resistance, and contribute to continence.

Assessment of the acute effects of tadalafil on the cardiovascular system based on examination of serum oxidative status and paraoxonase activity in men with erectile dysfunction: a preliminary study.

Phosphodiesterase type 5 inhibitors were initially approved for the treatment of erectile dysfunction in men and were later suggested for some systemic disorders, mostly due to their possible beneficial effects on endothelial functions. Paradoxically, though, phosphodiesterase type 5 inhibitors may have some life-threatening effects, for which there is weak evidence, it appears that they are associated with cardiovascular problems such as myocardial infarction and stroke. This study aimed to investigate the acute effects of tadalafil citrate on the cardiovascular system by evaluating serum oxidative status and paraoxonase-1 activity. Sera of 36 patients with erectile dysfunction were analyzed for total antioxidant status, total oxidant status and paraoxonase-1, before and after the administration of tadalafil citrate. Pre- and post-tadalafil citrate serum levels of total antioxidants, total oxidants and paraoxonase-1 were 1.1+/-0.0 and 1.6+/-0.0 micromol H(2)O(2) equiv l(-1), 10.3+/-1.1 and 6.9+/-1.2 micromol H(2)O(2) equiv l(-1), and 111.6+/-17.8 and 168.0+/-18.1 U l(-1), respectively (P<0.0001 for all results). This preliminary study confirmed that tadalafil citrate exerts a beneficial acute effect on the cardiovascular system by reducing serum levels of oxidative stress and increasing serum levels of paraoxonase-1.

The association of serum prolidase activity and erectile dysfunction.

Prolidase is a cytosolic exopeptidase that cleaves iminodipeptides with carboxy-terminal proline or hydroxyproline and plays a major role in collagen turnover. Collagen is the essential content in atherosclerotic plaque, playing a key role in the stability/instability and progression of endothelial dysfunction in the pathogenesis of erectile dysfunction (ED). Consequently, in this study we sought to determine serum prolidase activity and markers of oxidative stress, such as lipid hydroperoxide and total free sulfhydryl, in vasculogenic ED. We evaluated 92 patients with vasculogenic ED and 50 control subjects by clinical and laboratory investigations. We measured serum prolidase activity and serum total free sulfhydryl levels spectrophotometrically. Serum lipid hydroperoxide levels were determined with ferrous ion oxidation-xylenol orange method. We assessed the association of serum prolidase activity with the presence and severity of vasculogenic ED and clinical characteristics, as well as laboratory parameters. We also assessed the association of serum prolidase activity with the variables according to the vascular status of patients with vasculogenic ED. The comparison included 92 vasculogenic ED patients grouped into 3 categories according to the vascular status of patients with ED-arterial insufficiency (n = 26), veno-occlusive dysfunction (n = 37), and mixed-type impotence (n = 29)-and 50 controls. Receiver-operator characteristics (ROCs) were analyzed to find a cutoff value with the best sensitivity and lowest false-positive rate. Serum prolidase activity (53.5 +/- 5.5 U/L vs 45.7 +/- 4.9 U/L, respectively; P < .001) and serum lipid hydroperoxide levels were significantly increased in patients with vasculogenic ED compared with controls, whereas serum total free sulfhydryl levels were significantly decreased in patients with vasculogenic ED compared with controls (P < .001). The lowest and highest mean serum prolidase activities were detected in control participants and in patients with arterial insufficiency, respectively (analysis of variance P < .001). The overall findings of this study support the predictive accuracy of the serum prolidase activity in our cohort, with a statistically significant ROC value of 0.78. Findings of this study have shown that serum prolidase activity is significantly associated with the presence and severity of vasculogenic ED, and elevated serum prolidase activity might be an independent predictor of ED.

Oxidative Stress in BPH.

INTRODUCTION: In the present study, we investigated the relationship between potency of oxidative stress and BPH and this may assist to contribute to the realistic explanation of the ethiopathogenesis of BPH. METHODS: Seventy four newly diagnosed men with BPH (mean age: 54+/-11.2), who had not undergone any previous treatment for BPH, and 62 healthy volunteers (mean age: 55+/-14) were enrolled in the present study. To determine the antioxidative status of plasma, total antioxidant capacity (TAC) was calculated, and to determine the oxidative status of plasma (TOS) total peroxide levels were measured. The ratio of TAC to total peroxide was accepted as an indicator of oxidative stress (OSI). Data are presented as mean SD +/- unless specified. Student t-test and correlation analyses were used to evaluate the statistical significance differences in the median values recorded for all parameters between BPH and control group. RESULTS: Plasma TAC TOS were found in patients and controls (1.70 +/- 0.32, 1.68 +/- 0.19 micromol Trolox Equiv./L), (12.48 +/- 1.98, 12.40 +/- 1.14 micromol / L) respectively. OSI was calculated as 7.57 +/- 1.91, 7.48 +/- 1.33, respectively. Plasma TAC, TOS and OSI levels were not found to be significantly difference between patients and control subjects (p>0.05, p>0.05, p>0.05). CONCLUSIONS: The present study has shown that there were not relationship between potency of oxidative stress and BPH. Further well designed studies should be planned to find out whether the oxidative stress-related parameters play role in BPH as an interesting pathology in regard of the etiopathogenesis.

Clomiphene citrate versus varicocelectomy in treatment of subclinical varicocele: a prospective randomized study.

BACKGROUND: The purpose of the study was to compare the effect of varicocelectomy with that of clomiphene citrate on seminal improvement and pregnancy rates in patients with subclinical varicocele. METHODS: A total of 42 infertile men with left subclinical varicocele were randomized to group I (21 patients, surgery) and group II (21 patients, medical therapy). The patients in group I were treated with varicocelectomy and those in group II with clomiphene citrate, 50 mg/day, orally. Sperm parameters (sperm density, motility and morphology) were recorded before and 6 months after beginning the treatment and pregnancy rates were estimated. In statistical analysis, paired and independent-samples t-tests, Kaplan-Meier and Log rank tests and Fisher's exact test were used. RESULTS: Mean +/- SD age of the series was 32.7 +/- 6.1 years, that of group I was 32.2 +/- 5.5 years and that of group II was 33.1 +/- 6.7 years (P = 0.680). All seminal parameters increased after both surgical and medical treatment, but only increases in sperm density and motility following varicocelectomy were statistically significant. Changes in seminal parameters between groups I and II were statistically insignificant. Pregnancy was seen in two cases in group I and in one in group II (P = 0.500). The cumulative pregnancy rates were 12.5% in group I and 6.7% in group II (P = 0.589). CONCLUSIONS: Clomiphene citrate did not increase sperm density and motility as effectively as subclinical varicocelectomy, but there was no statistically significant difference between surgical and medical therapy methods in terms of seminal improvement and pregnancy rate.

The role of ESWL in the treatment of calculi with anomalous kidneys.

OBJECTIVE: To evaluate the efficacy of Extracorporeal shock wave lithotripsy (ESWL) in renal anomalies. MATERIAL AND METHODS: From 1991 to May 1995. 53 patients with calculi in anomalous kidneys presented to our clinic for treatment with ESWL. Average patient age was 39 years, a range of 6-66 years. These patients (32 male and 21 female) underwent ESWL treatments. ESWL was performed in 27 patients with urolithiasis in duplex system, 18 with horse-shoe kidneys, 4 with unilateral renal agenesis, 2 with pelvic ectopic kidneys, 1 with sigmoid kidney and 1 with L-shaped kidney. RESULTS: Among patients who completed ESWL the rate free of stones was 60.4% and the rate of clinically insignificant residual fragments was 30.2%. No sign of stone disintegration was observed in 2 patients. They underwent open surgery. The shock waves per therapy varied between 811 and 18,101. Double-J stents were placed in 13 patients. CONCLUSION: Most patients with calculi in anomalous kidneys can be managed primarily with ESWL.