Does extracorporeal shock wave lithotripsy cause hearing impairment in children?

PURPOSE: We evaluated the possible effects of noise created by high energy shock waves on the hearing function of children treated with extracorporeal shock wave lithotripsy. MATERIALS AND METHODS: A total of 65 children with normal hearing function were included in the study. Patients were divided into 3 groups, ie those becoming stone-free after 1 session of shock wave lithotripsy (group 1, 22 children), those requiring 3 sessions to achieve stone-free status (group 2, 21) and healthy children/controls (group 3, 22). Extracorporeal shock wave lithotripsy was applied with patients in the supine position with a 90-minute frequency and a total of 2,000 shock waves in each session (Compact Sigma, Dornier MedTech, Wessling, Germany). Second energy level was used with a maximum energy value of 58 joules per session in all patients. Hearing function and possible cochlear impairment were evaluated by transient evoked otoacoustic emissions test at 1.0, 1.4, 2.0, 2.8 and 4.0 kHz frequencies before the procedure, 2 hours later, and 1 month after completion of the first shock wave lithotripsy session in groups 1 and 2. In controls the same evaluation procedures were performed at the beginning of the study and 7 weeks later. RESULTS: Regarding transient evoked otoacoustic emissions data, in groups 1 and 2 there was no significant alteration in values obtained after shock wave lithotripsy compared to values obtained at the beginning of the study, similar to controls. CONCLUSIONS: A well planned shock wave lithotripsy procedure is a safe and effective treatment in children with urinary stones and causes no detectable harmful effect on hearing function.

Endoscopic treatment of vesicoureteral reflux with polyacrylate polyalcohol copolymer and dextranomer/hyaluronic acid in adults.

PURPOSE: Aim of this study is to examine the effectiveness of dextranomer/hyaluronic acid copolymer and polyacrylate polyalcohol copolymer in endoscopic treatment of vesicoureteral reflux disease in adult patients with and without chronic renal failure. MATERIALS AND METHODS: Thirty two patients (12 female, 20 male) with a total of 50 renal units were treated for vesicoureteral reflux. There were 26 (81%) chronic renal failure patients. The success of treatment was evaluated by voiding cystouretrography at 3rd and 12th months after subureteric injection. The persistence of reflux was considered as failure. Patients were divided into two groups according to injected material. Age, sex, grade of reflux and treatment results were recorded and evaluated. RESULTS: Reflux was scored as grade 1 in seven (14%), grade 2 in 16 (32%), grade 3 in 21 (42%) and grade 4 in six (12%) renal units. There was not patient with grade 5 reflux. Fourteen renal units (28%) were treated with dextranomer/hyaluronic acid copolymer (group 1) and 36 renal units (72%) were treated with polyacrylate polyalcohol copolymer (group 2). The overall treatment success was achieved at 40 renal units (80%). The treatment was successful at 11 renal units (79%) in group 1 and 29 renal units (81%) in group 2 (p = 0.71). There was not statistically significant difference between two groups with patients with chronic renal failure in terms of treatment success (p = 1.00). CONCLUSIONS: The effectiveness of two bulking agents was similar in treatment of vesicoureteral reflux disease in adult patients and patients with chronic renal failure.

Endoscopic treatment of vesicoureteral reflux with polyacrylate polyalcohol copolymer and dextranomer/hyaluronic acid in adults

Purpose Aim of this study is to examine the effectiveness of dextranomer/hyaluronic acid copolymer and polyacrylate polyalcohol copolymer in endoscopic treatment of vesicoureteral reflux disease in adult patients with and without chronic renal failure. Materials and Methods Thirty two patients (12 female, 20 male) with a total of 50 renal units were treated for vesicoureteral reflux. There were 26 (81%) chronic renal failure patients. The success of treatment was evaluated by voiding cystouretrography at 3rd and 12th months after subureteric injection. The persistence of reflux was considered as failure. Patients were divided into two groups according to injected material. Age, sex, grade of reflux and treatment results were recorded and evaluated. Results Reflux was scored as grade 1 in seven (14%), grade 2 in 16 (32%), grade 3 in 21 (42%) and grade 4 in six (12%) renal units. There was not patient with grade 5 reflux. Fourteen renal units (28%) were treated with dextranomer/hyaluronic acid copolymer (group 1) and 36 renal units (72%) were treated with polyacrylate polyalcohol copolymer (group 2). The overall treatment success was achieved at 40 renal units (80%). The treatment was successful at 11 renal units (79%) in group 1 and 29 renal units (81%) in group 2 (p = 0.71). There was not statistically significant difference between two groups with patients with chronic renal failure in terms of treatment success (p = 1.00). Conclusions The effectiveness of two bulking agents was similar in treatment of vesicoureteral reflux disease in adult patients and patients with chronic renal failure. .

Effects of ejaculation on serum prostate-specific antigen levels.

OBJECTIVE: The aim of this study is to evaluate the effect of ejaculation on serum total, free and complex prostate-specific antigen (PSA) levels and their effect on biopsy decisions. MATERIAL AND METHODS: Our study includes 47 men older than 45 years with symptomatic benign prostatic hyperplasia (BPH). Patients' PSA levels were under 2.5 ng/mL, and there were no known conditions to preclude ejaculation. Eight patients with similar demographic, and clinical characteristics were chosen as a control group. With three days of sexual abstinence, blood samples were drawn for the measurement of baseline PSA levels, and then the patients were told to ejaculate. One, 5, 24 and 72 hours after ejaculation, serum total, free and complexed PSA levels were measured. Serum PSA sampling was performed at the same intervals in the control group without ejaculation. RESULTS: The mean age of the patients was 59.13±1.38 years in the study group, and 63.75±3.13 years in the control group. The mean international prostate symptom scores (IPSS) were 11.78±1.12 and 11.63±3.32 in the study, and the control groups, respectively. The mean baseline total, free, and complexed PSA values were 1.07±0.09, 0.31±0.03, and 0.71±0.08 ng/mL, respectively. In the study group, total PSA value was found to be 1.29±0.12 ng/mL (p=0.008) at first hour after ejaculation, and this change was statistically significant when compared with baseline values. Mean total PSA level rose up to 1.28±0.13 ng/mL (p=0.05) by the 5(th) hour after ejaculation, but this change was not statistically significant relative to the baseline values. Mean free PSA level rose after the first hour postejaculation to 0.37±0.04 ng/mL (p=0.01) and after the fifth hour postejaculation to 0.37±0.04 ng/mL (p=0.002), and these changes were statistically significant relative to the baseline values. There were no statistically significant changes at the other sampled times as for the total, free or complexed PSA serum levels. When all three values were considered individually, in only 2.12% of the patients, biopsy decisions could be affected by the elevation in PSA levels. CONCLUSION: When the PSA value is borderline with respect to biopsy decisions, the effect of ejaculation on serum PSA levels may be clinically important. In these patients, ejaculation must be questioned, and repeated. PSA levels should be evaluated 24 hours after ejaculation. There were no statistically significant changes in the levels of complex PSA values. Further studies are needed to clarify the relationship between complexed PSA and ejaculation.