Can haematologic parameters be used for differential diagnosis of testicular torsion and epididymitis?

A differential diagnosis of testicular torsion and epididymitis has serious importance for testicular health. In emergency conditions, if testicular torsion goes unnoticed and epididymo-orchitis is diagnosed, organ loss may occur. This study aimed to evaluate the usefulness of haematologic parameters for the diagnosis of both testicular torsion and epididymo-orchitis and for differential diagnosis of these two diseases. Patients were divided into three groups as those undergoing surgery for testicular torsion, those receiving medical treatment for epididymitis and a healthy control group. All patients had complete blood counts taken with determinations of mean platelet volume (MPV), platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR) and leucocyte counts. These were then compared between groups. Leucocyte, MPV and NLR values were higher in both the epididymitis and torsion groups compared to the controls (p < .001). Platelet counts and PLR were significantly higher in the epididymitis group compared to the other two groups (p < .001). Leucocyte, MPV and NLR values may be used in the diagnosis of epididymitis and testicular torsion. Platelet counts and PLR appear to be useful in differentiating epididymitis from testicular torsion. However, there is a need for prospective studies with larger numbers of patients.

Correlation of neutrophil-lymphocyte ratio and risk scores in non-muscle invasive bladder cancer. / Correlación entre el índice neutrófilo/linfocito y las puntuaciones de riesgo en el cáncer de vejiga no músculo-invasivo.

OBJECTIVES: Aim of this study is to evaluate the correlation between European Organization for Research and Treatment of Cancer (EORTC) risk score and neutrophil-lymphocyte ratio (NLR) in patients with non-muscle invasive bladder cancer and the relationship between NLR and risk groups. METHODS: We retrospectively reviewed data of 212 patients with non-muscle invasive bladder cancer were included in the study. The tumors were graded according to the 1973 World Health Organization grading system and the tumor node metastasis (TNM) 2012 staging system. Patients were categorized low, intermediate and high risk for recurrence and progression, according to European Association of Urology guidelines. Serum values for the NLR were measured on the day before the operation to ascertain the baseline value for neutrophil and lymphocyte counts and statistically analyzed. RESULTS: Of the 212 patients, 193 were male and 19 were female. Mean age was 66.7. Mean NLR score was 3.04±2.11. T1 tumors, G3 tumors, multiple tumors and>3cm tumors seen mostly in patients with NLR>2.41. Low, intermediate and high risk groups compared and NLR rates were significantly higher in high risk group patients (P<.001). When the correlation between NLR and EORTC recurrence and progression scores was evaluated, it was observed that as NLR value increased, recurrence (r=0.252, P<.001) and progression (r=0.145, P=.034) scores increased significantly. CONCLUSIONS: This study demonstrated the association of high NLR value with T1 tumor, high grade, multiple tumor,>3cm tumor and EORTC high risk group in non-muscle invasive bladder cancer patients. There was also a positive correlation between NLR and EORTC recurrence and progression scores.

Luteinizing hormone pulse frequency and amplitude in azoospermic, oligozoospermic and normal fertile men in Turkey.

AIM: To investigate the LH pulse frequency and amplitude in azoospermic and oligozoospermic patients and to compare them with normal fertile subjects. METHODS: In this controlled clinical study, 10 normal fertile male volunteers and 20 infertile patients (10 oligozoospermic and 10 azoospermic) were enrolled. Blood samples were taken every 30 minutes for 12 hours. FSH, LH and T levels were determined. LH was observed at all the blood samples, but FSH and testosterone only at the first, middle and last samples. RESULTS: The mean LH levels were significantly different between all the groups, but there was no statistical difference in the FSH levels between the fertile and oligozoospermic groups. The mean LH levels increased from the fertile towards the azoospermic groups (P<0.01). The LH pulse amplitude and frequency were significantly different between all the 3 groups. The former increased while the latter decreased from the fertile to the azoospermic groups. The T levels were different statistically only between the fertile and the azoospermic groups. CONCLUSION: The more prominent is the testicular defect, the lower will be the LH pulse frequency and the higher the amplitude.

Urethral syndrome and associated risk factors related to obstetrics and gynecology.

OBJECTIVE: To evaluate the risk factors related to gynecology and obstetrics, and the incidence of urethral syndrome in our gynecological practice. STUDY DESIGN: The study comprised 35 patients without urinary tract infection who admitted to our department of gynecology with the complaints of recurrent urinary irritation symptoms, sensation of incomplete emptying and burning sensation during urination after sexual intercourse. A total of 200 women served as controls. RESULTS: We found urethral syndrome in 15% of patients. The incidence of grandmultiparity and the delivery without episiotomy were significantly higher in the study group than controls using univariate analysis. Considering logistic regression analysis, we found that grandmultiparity, two or more abortus, hospital delivery, delivery without episiotomy and pelvic relaxation were risk factors for the urethral syndrome. CONCLUSION: Although urethral syndrome is often detected in gynecological practice, it has not yet been reached utmost importance. Grandmultiparity and delivery without episiotomy are the major risk factors accompanying urethral syndrome.

Can LDH activity in spermatic vein indicate testicular damage? A preliminary report.

We aimed to investigate the relationship between varicocele and lactic dehydrogenase (LDH), an intracellular enzyme that indicates cellular damage. LDH levels were measured in the blood samples of 17 oligoasthenospermic infertile patients with varicocele which were obtained synchronously from spermatic and peripheral veins during operation. Sperm counts ranged from 1 to 74 million/ml, while motility ranged from 10% to 60%. LDH level in spermatic vein was found statistically higher than the level in peripheral vein (p = 0.042). There was no correlation between sperm counts and LDH level in spermatic vein. We found a significant increase in spermatic vein LDH level in varicocele. We think that further studies are needed to reveal the relationship between spermatic vein LDH level and varicocele.

Evaluation of 42 patients with chronic abacterial prostatitis: are there any underlying correctable pathologies?

Forty-two young men with abacterial prostatitis underwent physical examination, semen analyses, rectal US (TRUS) and magnetic resonance imaging (MRI) of the pelvis. Findings on TRUS showed no distinct differences like capsular irregularity, dilatation of the seminal vesicles and calcified foci in the prostate. In MRI pathologic conditions were noted as transitional zone cysts, prostatic utricle cysts and abscesses of the seminal vesicles. MRI had been found superior to TRUS in imaging the prostate and to predict associated pathologic conditions. It is also concluded that some additional factors as a cause of prostatitis must be determined in patients with chronic abacterial prostatitis.

Testicular needle biopsy: is it a safe and adequate method?

We aimed to investigate if testicular needle biopsy is adequate and safe for the examination of testis. Needle biopsies were performed on 21 testes of 5 patients with advanced prostate cancer and 11 patients with cryptorchidism before orchiectomy. Biopsies were done with the prostatic tru-cut needle. After needle biopsy, the tract and puncture sites were explored and an incisional biopsy was performed on each testis. Both needle specimens and open biopsy specimens were fixed in Bouin's solution and sent for histologic examination. There were small haematomas in two testes and moderate haemorrhage between tunica vaginalis layers in another. The tissues obtained by needle biopsy were sufficient except for two specimens and diagnostic accuracy was perfect. Nevertheless, measurement of the seminiferous tubules of the lamina propria could not be achieved in many cases.

Primary non-mucinous, non-papillary adenocarcinoma of the ureter.

We report a case of primary, non-mucinous, non-papillary ureteral poorly differentiated adenocarcinoma. The primary focus could only be detected during surgical exploration, because computed tomography (CT), ultrasonography (US), intravenous urography (IVU) and other radiologic and endoscopic procedures revealed no primary neoplastic focus, only lymph node and various bone metastases. Total nephroureterectomy with a bladder cuff was performed to decrease pain of the patient and to remove the primary tumoral focus.

Experimental testicular torsion and its effects on the contralateral testicle.

OBJECTIVE: Following experimental unilateral torsion of the testis the histologic effects of unilateral testicular torsion on the contralateral testis were investigated. MATERIALS AND METHODS: Utilizing detorsion or orchiectomy at 4 hours and 8 hours after torsion, the effects of early and late treatment modalities on the contralateral testicle were observed. RESULTS: Morphometry of the contralateral testis revealed some alterations including focal sclerosis, decrease in mean seminiferous tubular diameter and a marked increase of the Leydig cells in some subgroups. CONCLUSION: In spite of some changes, definite evidence for contralateral damage due to ipsilateral torsion contributing to male infertility was hardly observed.

Intraobserver and interobserver reproducibility of WHO and Gleason histologic grading systems in prostatic adenocarcinomas.

In this study a total of 96 patients with prostatic carcinoma were evaluated retrospectively. Sections prepared from paraffin blocks were examined and all cases were scored according to the World Health Organization (WHO) and Gleason grading systems. We investigated intraobserver and interobserver reproducibility of two grading systems in prostatic adenocarcinomas. In our study the intraobserver reproducibilities of the WHO and Gleason systems were 75.0% and 78.1%, respectively. The interobserver reproducibilities of the WHO and Gleason grading systems were 60.4% and 70.8%, respectively. While there was no difference between intraobserver and interobserver variations in the Gleason system (p > 0.05), there was significant difference between intraobserver and interobserver variations in the WHO system (p < 0.05).

A nonsurgical approach to the treatment of phimosis: local nonsteroidal anti-inflammatory ointment application.

PURPOSE: We evaluated the effectiveness of topical application of nonsteroidal anti-inflammatory ointment for phimosis. MATERIALS AND METHODS: A total of 52 children with phimosis was included in this study. Phimosis was graded according to severity. Of the patients 32 were given locally a nonsteroidal anti-inflammatory ointment prepared in ophthalmic usage form from sterile diclofenac sodium ampules (not commercially available). The control group comprised 20 patients given sterile petrolatum ointment. Patients were seen before and after treatment, and graded according to retractibility and appearance of the foreskin. Treatment continued for 4 weeks with 3 applications daily. RESULTS: Of the 32 patients 24 responded to therapy and 8 remained unchanged or had insufficient improvement. Three controls responded to therapy and 17 did not. There were no side effects. CONCLUSIONS: Nonsteroidal anti-inflammatory ointment application for phimosis may be an alternative to surgery and steroid application.

A further study of seminal plasma: lactate dehydrogenase and lactate dehydrogenase-X activities and diluted semen absorbance.

Activities of total lactate dehydrogenase, which plays an important role in providing energy for cell metabolism, lactate dehydrogenase-X, an isoenzyme of lactate dehydrogenase supposed to be specific for germinal epithelium activity, diluted semen absorbance and some other properties have been measured in 51 seminal plasma samples. Aiming to study its clinical use as a marker of seminiferous epithelium activity, determination of isoenzyme-X and investigation of correlation between it and the spermiogram properties were carried out. Besides lactate dehydrogenase and lactate dehydrogenase-X activity, their ratio and diluted semen absorbance were correlated with the different properties of the spermiogram, the best correlation of the enzymes being obtained with the total sperm count and motile sperm count. Correlation of diluted semen absorbance with the total sperm count and motile sperm count was also noted, whereas it did not correlate with sperm concentration and motility rate. The data suggests the clinical utility of these properties as reliable markers for both germinal activity and spermatozoid quality when "total sperm count" and "mobile sperm count" are used to define sperm properties instead of just sperm concentration and motility rate.

Utilising an ileal segment in the posterior urethral replacement procedures using anal sphincter to provide continence in dogs.

We aimed to replace an ileal segment in the place of posterior urethra using the anal sphincter as a continence mechanism. The experiment was carried on three male street dogs. In the first stage, only urethral replacement with an ileal segment was done and pulled through the anal sphincter in a male dog to see if anal sphincter would do any help for continence. A protruding stoma was created on the perineum. Perineal end of the ileal segment was sutured to the bulbous urethra in the other two male dogs to provide urethral patency in the second step of the operation. The dog in which the first operation was made gained continence on the 12th postoperative day. The other two male dogs, in which ileourethral anastomosis were made, became continent on the postoperative 12th and 15th days. No residual urine was found by catheterisation performed after urination. In controls, neither the stoma nor the anastomosis sites developed stenosis. This procedure may be applied in patients with complete incontinence who can not be corrected by any other surgical procedures, and a very good cosmetic result may be obtained.

Undescended testes in adults: clinical significance of resistive index values of the testicular artery measured by Doppler ultrasound as a predictor of testicular histology.

PURPOSE: We evaluated the clinical significance of arterial impedance as a predictor of testicular histology in adults with undescended (inguinal) testes. MATERIALS AND METHODS: We performed arterial impedance and testicular diameter measurements with the use of color Doppler ultrasonography on 22 adults with undescended testes. Arterial impedance of the contralateral descended testes served as controls. All patients later underwent inguinal orchiectomy and the testes were examined histologically. RESULTS: Of the 22 undescended testes, 7 had arterial impedance values below 0.50, and the other 15 had values equal to or above 0.50. All testes with arterial impedance values below 0.50 had histologic scores between 2 and 3, whereas the others had scores of 3 and 8. Arterial impedance values and testicular volumes in the contralateral testes were significantly higher than the undescended testes. Although some of the testes with arterial impedance values above 0.50 had histologic score 3, testes with arterial impedance values below 0.50 never exceeded score 3. Volume differences of the undescended testes were not statistically significant. CONCLUSIONS: Arterial impedance of an undescended testis may have a predictive value and provide more accurate information about its histology than the volume measurement itself.

The role of power Doppler ultrasonography in the diagnosis of acute pyelonephritis.

OBJECTIVE: To assess the ability of power Doppler ultrasonography (PDU) to detect acute pyelonephritis and to compare the findings from PDU with those from enhanced computed tomography (CT). PATIENTS AND METHODS: Eleven patients (mean age 18.5 years, range 5-37) admitted to hospital with a clinical diagnosis of pyelonephritis were assessed with PDU and enhanced CT. the latter providing the reference method. RESULTS: The imaging studies showed normal findings in three patients; a single focus of pyelonephritis was detected by CT in six, whereas a matching defect was detected on PDU in five, with PDU failing to detect an infective focus in one. Multifocal diffuse pyelonephritis was diagnosed correctly by enhanced CT and PDU in two patients. CONCLUSION: Power Doppler ultrasonography had an overall sensitivity of 88% and complete specificity in the evaluation of patients with acute pyelonephritis.

New drainage technique in the ureteropelvic junction obstructions. Side-to-side ureterocalicostomy (or ureterocaliceal by-pass) preserving renal pelvis and ureteropelvic junction.

We present a new ureterocalicostomy technique in a patient with intrarenal pelvis together with renal artery compression on the pelvis and ureteropelvic junction (UPJ). The patient had grade 4 hydronephrosis in the left kidney and angulation at the ureteropelvic junction. We performed side-to-side ureterocalicostomy between the ureter and lower calyx of the kidney.

Assessment of testicular cytology by fine-needle aspiration and the imprint technique: are they reliable diagnostic modalities?

OBJECTIVE: To investigate whether testicular cytology may be considered diagnostic in the evaluation of infertile men. PATIENTS AND METHODS: Specimens of testicular tissue obtained either surgically (imprint smear) or through fine-needle aspiration (FNA) were used as a source of cytological smears; 58 testes from 24 men with azoospermia or severe oligospermia and from five men with advanced prostate cancer were evaluated cytologically and compared with the histological diagnosis. RESULTS: FNA caused no apparent trauma. The results from FNA smears generally agreed with the histological findings but four patients with no spermatozoa in the FNA smears were diagnosed histologically as hypospermatogenic and two others judged histologically as having Sertoli-cell-only (SCO) syndrome and spermatogenic arrest had detectable spermatozoa in their FNA smears. There was complete agreement between the results of imprint smears and histological findings in those patients with SCO syndrome and spermatogenic arrest. There were no evident differences in sperm counts between hypospermatogenesis and normal spermatogenesis on the imprint slides, but FNA smears detected this difference. CONCLUSION: FNA of the testis is a relatively non-invasive and reproducible technique for evaluating qualitative and quantitative cytology. However, it is insufficient for diagnosing some testicular pathologies. Imprint smears supplement the histological diagnosis, especially if the histological slides are stained unsatisfactorily.

The role of power Doppler ultrasonography in the diagnosis of prostate cancer: a preliminary study.

OBJECTIVE: To determine the role of transrectal power Doppler ultrasonography (PDU) in the diagnosis of prostate cancer. PATIENTS AND METHODS: Thirty-six patients (mean age 66.4 years, SD 7.7, range 59-82) with possible prostate cancer, suspected from an abnormal digital rectal examination or elevated prostate specific antigen level, underwent transrectal ultrasonography, transrectal PDU and biopsy. The vascularity on PDU was graded on a scale of 0-2, where grade 1-2 was considered positive and grade 0 negative. RESULTS: The vascularity was grade 2 in 11 patients, grade 1 in 11 and grade 0 in 14; 20 of the 36 (56%) patients had prostate cancer. Of the 22 patients positive on PDU, 18 had malignant disease and four benign; two of 20 patients with histopathologically confirmed malignancy had a normal PDU. The sensitivity of PDU was 90%, the specificity 75% and the positive predictive value 82%. CONCLUSION: Focal hypervascularity on PDU was associated with an increased likelihood of prostate cancer. Although ultrasonography alone cannot detect all cancers, even using PDU, the technique appears to increase the sensitivity and to help identify appropriate sites for biopsy.

Effects of sildenafil citrate, acetylcholine, and sodium nitroprusside on the relaxation of rabbit cavernosal tissue in vitro.

OBJECTIVES: To investigate the effect of sildenafil together with the influence of sodium nitroprusside and acetylcholine and further discuss its mechanism of action in vitro. METHODS: Isolated strips of rabbit corpus cavernosum were stimulated isometrically with phenylephrine. Graded relaxations were induced using increasing concentrations of acetylcholine, sodium nitroprusside, and sildenafil alone and in combination. RESULTS: The agents all relaxed the rabbit corpus cavernosal strips in a dose-dependent manner. The inhibitory potentials of the test agents were ranked (from least inhibitory to most inhibitory) as follows: sildenafil, acetylcholine plus sildenafil, sodium nitroprusside, sodium nitroprusside plus sildenafil, acetylcholine. The presence of sodium nitroprusside in the medium reduced the median effective dose for the sildenafil-induced relaxation of the cavernosal tissue from 3.65 x 10(-5) M to 2.73 x 10(-7) M, and the presence of acetylcholine reduced it to 9.79 x 10(-6) M. CONCLUSIONS: Sildenafil enhances the relaxing effect of both sodium nitroprusside and acetylcholine on the phenylephrine-induced contraction of rabbit cavernosal tissue.