A New Promising Pathway in Aggressive Prostate Cancer: Treg/mir-let8c/lin28b.

PURPOSE: The progress of prostate cancer entails complex contemporaneous tumor developmental events in diverse stages that they are still yet to be clarified. miRNAs might accompany to balance between regulatory and cytotoxic T cells in tumors. Here, we investigated miRNAs and Regulatory T cell (Treg) marker FOXP3 expressions within prostate cancer spectrum. METHODS: Thirty-eight prostate cancer patients enrolled within two groups to the study as having Gleason Score ≤ 7 (Group-1) and ≥ 8 (Group-2) that compared to 19 benign prostate hyperplasia controls. Twelve miRNAs expressions were analyzed by real time PCR from paraffin-embedded prostate tissue samples. Correlations between serum PSA levels, immunohistochemical staining of CD3, CD4, FOXP3 and miRNA expressions were analyzed. RESULTS: In our study, hsa-let7c-3p significantly 1,52 (p=0.018) and 1,84 (p=0.0095) fold down- regulated whereas, miR-141-3p was significantly 2,36 (p=0.0006) and 2,24 (p=0.001) fold upregulated in the prostate cancer patients compared to benign prostate hyperplasia in group 1 and 2, respectively. Only CD4 (p=0.004) and PSA (p<0.001) have statistically significant differences among groups when compared to benign prostate hyperplasia. miR-143-p, miR-221-3p, hsa-let7c-3p and miR-17-3p expressions were significantly correlated with regulatory T cell marker FOXP3 expression. CONCLUSIONS: For the first time, we reported significantly altered expression levels of miRNAs (miR-let7c, miR221, miR-146a, miR-141, miR-143, miR17) and correlations between Treg marker FOXP3 in the aggressive prostate cancer patients suggesting that prostate cancer progression might be under the regulation of crosstalk between Tregs and miRNAs.

Female circumcision debate: A muslim surgeon's perspective.

In this study, we aimed to address female circumcision (FC) from sociocultural, medical, ethical, and religious/Islamic perspectives through the understanding of a Muslim surgeon. FC is performed primarily in Africa today, and its prevalence varies across countries. None of the sociocultural justifications developed historically for FC is scientifically valid. FC provides no health benefits; on the contrary, severely impairs the physical, psychological, and social health of the victim in the short and long term. As for sexual health and satisfaction, the outcome is disastrous. Hoodectomy as another relevant surgical intervention, however, can be distinguished as an exception because it can rarely be for the benefit of the woman. When we assess FC ethically, we see that all of the generally accepted, major principles of biomedical ethics are violated. If we consider FC from an Islamic perspective, the Quran does not contain any verses to ground or adjudicate arguments on FC. The hadiths reporting about the justification of FC have been determined by the hadith scholars to be weak. They have not been accepted as sound justificatory sources that a fatwa can be based on. The author, along with many contemporary Islamic scholars, believes that FC should be abandoned.

Laparoscopy versus robotic-assisted pyeloplasty in children: preliminary results of a pilot prospective randomized controlled trial.

PURPOSE: The aim of this randomized controlled trial (RCT) is to compare the outcomes of conventional laparoscopic pyeloplasty (LP) versus robotic-assisted laparoscopic pyeloplasty (RALP) in the treatment of ureteropelvic junction obstruction (UPJO) in children. METHODS: A total of 53 patients with UPJO were randomized as LP (Group 1, n: 27) and RALP (Group 2, n: 26). Redo cases and patients with anatomical abnormalities were excluded. Urinary ultrasound was performed at postoperative 3, 6 and 12 months; whereas, diuretic renal scintigraphy was performed at 1 year. Failure was defined as progressive hydronephrosis on ultrasound, decline in renal function, or symptom relapse. All parameters were statistically compared. RESULTS: The mean age of the patients was 55.53 ± 57.25 months. There were no statistical differences between the groups in terms of patient gender, body mass index, laterality, preoperative renal function, renal pelvis antero-posterior diameter and presence of crossing vessel. Mean total operative time in LP group was longer than RALP (139 min vs 105 min, respectively, p = 0.001). The hospital stay was similar between the two groups. After a mean follow-up of 12.43 ± 5.34 months, the complication and success rates were found comparable. Only two patients required re-do pyeloplasty in LP group. The mean total cost of RALP procedure was approximately four times higher than LP. CONCLUSIONS: This is the first RCT comparing LP and RALP in pediatric population. Both LP and RALP are safe and effective in children with comparable success and complication rates. Operative time was longer for LP; whereas, total cost was higher for RALP.

The activity and discussion points of #Circumcision through Twitter; a microblogging platform.

OBJECTIVES: Our objective was to elucidate the discussion points of circumcision on social media (SoMe) by looking at the Twitter activity. MATERIAL AND METHODS: Twitter searched for #circumcision hashtag via www.tweetarchivist.com , www.twitonomy.com , www.symplur.com . Total tweet numbers, most influencers, top users were documented. Tweets including female circumcision were excluded. The contents of the tweets were classified into four subgroups (medical, religious, social, and political) by two independent reviewers. All kinds of tweet activities were statistically analyzed. RESULTS: A total of 9795 users generated 15,989 tweets about circumcision in a 1 month period. Mean daily tweet activity was 532 for #circumcision. The content analysis revealed that 2224 (15.8%) medical, 1133 (8.0%) religious, 323 (2.2%) social and 10,470 (74.0%) political tweets have been sent out by the users. Contributors originated from 174 countries from 6 continents. Media organizations were accounted for 52% of the top 25 influencers in circumcision hashtag. The most common hashtags accompanying #circumcision were #HIV (4.9%), #babiesgotherpes (3.3%), #muslim (1.8%), #malegenitalmutilation (1.6%) respectively. CONCLUSIONS: There is an increasing discussion about circumcision through SoMe . Our results provided that the discussion points are mostly driven by the media and the activists. The political tweets have been found to be the center of the discussion. SoMe usage should be increased by medical professionals for true information of the public.

Comparison of intravesical (Cohen) and extravesical (Lich-Gregoir) ureteroneocystostomy in the treatment of unilateral primary vesicoureteric reflux in children.

INTRODUCTION: Various intravesical and extravesical techniques have been described for the surgical correction of vesicoureteral reflux (VUR). Among those techniques Cohen (intra-vesical) and Lich-Gregoir (extra-vesical) are the most commonly used ones. However, there are limited studies that compare those two surgical techniques in the literature. OBJECTIVE: In this study, we aim to compare the outcomes of the open intravesical and extravesical procedures for unilateral primary VUR in children. METHODS: We analyzed the records of 118 consecutive children with primary VUR who underwent open ureteral reimplantation surgery by single surgeon from January 2011 to October 2015 at our institution. Among them, intravesical reimplantation was group A, and extravesical reimplantation procedure was group B. We retrospectively analyzed the clinical data of both groups, including age, sex, preoperative reflux grade, presence of lower urinary tract symptoms (LUTS), operative time, postoperative complications and hospitalization period. Success of surgery was defined as the resolution of the VUR as determined by voiding cystourethrography 6 -12 months after surgery. All the parameters were statistically compared. RESULTS: A total of 58 patients were found eligible for the study. In 23 cases intravesical (group A) and in 35 cases extravesical (group B) procedure were performed. The operative time in group A was significantly higher than group B (110.3±16.9 and 87±29.8 min, respectively, p = 0.002). The mean hospital stay was also longer in group A (2.8±0.8 and 1.2±0.6 days, respectively, p = 0.007). The ureteral catheterization periods were 14.1±6.1 days for group A and there was no ureteral catheter placement in group B. The success rate of the two groups were comparable (100% vs 94.9%, p = 0.513). No intraoperative complications were detected in either group. The number of febrile urinary tract infections were similar between the groups after a mean follow up of 18.2 months (p = 0.746). DISCUSSION: Our results confirmed that both Cohen and Lich-Gregoir procedures had equivalent success and complication rates. Lich-Gregoir technique was found superior to Cohen technique in terms of hospital stay and operative time. Moreover, it avoids the necessity of urethral and ureteral stenting which probably might increase the comfort of the patients postoperatively. The main limitations of our study are unrecorded pain scores and amount of analgesics taken the after surgery and retrospective analysis of the data. CONCLUSION: Both the open intravesical and extravesical ureteroneocystostomy procedures are equally effective in the treatment of primary unilateral VUR. Any of the techniques can be opted by the surgeons depending on their surgical experience.

Methods and rates of punishment implemented by families to enuretic children in Turkey.

PURPOSE: Nocturnal enuresis is a serious health problem affecting a significant portion of the population. In this study, we investigated the frequency of punishment methods in nocturnal enuresis (NE) in Turkey and its relationship with other parameters. MATERIALS AND METHODS: A total of 501 children (301 boys and 200 girls) who were admitted to our outpatient clinic due to nocturnal enuresis were included in the study. Mean age was 9.39 years (range 5-18). Prepared questionnaire form inquiring educational status of the family, frequency and implementation and duration of punishment methods was applied to patients and families. RESULTS: At least one punishment method was applied to 291 (58.1%) of children with NE. Punishment methods of parents were detected as condemnation (257 patients, 51.3%), depriving desires of the child (120 patients, 23.9%), humiliating the child in the presence of other children (113 patients, 22.6%), reprimanding- threatening with punishment (203 patients, 40.5%). This application was found to continue for longer than 1 year in 52% of punished children. Families graduated of high school and above were found to use punishment methods significantly more than others. CONCLUSION: According to the results of our study, a quite high proportion of enuretic children were detected to be exposed to punishment methods. Even, some parents consider that these methods are a part of nocturnal enuresis treatment. We, the doctors, should endeavor more for raising awareness of the community in order to diminish this worrisome behavior.

Methods and Rates of Punishment Implemented by Families to Enuretic Children in Turkey

Purpose Nocturnal enuresis is a serious health problem affecting a significant portion of the population. In this study, we investigated the frequency of punishment methods in nocturnal enuresis (NE) in Turkey and its relationship with other parameters. Materials and Methods A total of 501 children (301 boys and 200 girls) who were admitted to our outpatient clinic due to nocturnal enuresis were included in the study. Mean age was 9.39 years (range 5-18). Prepared questionnaire form inquiring educational status of the family, frequency and implementation and duration of punishment methods was applied to patients and families. Results At least one punishment method was applied to 291 (58.1%) of children with NE. Punishment methods of parents were detected as condemnation (257 patients, 51.3%), depriving desires of the child (120 patients, 23.9%), humiliating the child in the presence of other children (113 patients, 22.6%), reprimanding- threatening with punishment (203 patients, 40.5%). This application was found to continue for longer than 1 year in 52% of punished children. Families graduated of high school and above were found to use punishment methods significantly more than others. Conclusion According to the results of our study, a quite high proportion of enuretic children were detected to be exposed to punishment methods. Even, some parents consider that these methods are a part of nocturnal enuresis treatment. We, the doctors, should endeavor more for raising awareness of the community in order to diminish this worrisome behavior. .

Hormonal evaluation in premature ejaculation.

INTRODUCTION: Premature ejaculation (PE) is a frequently encountered sexual dysfunction in men. It significantly impairs quality of life of the affected male and his partner. The aim of this study is to investigate the role of hormonal factors in patients with PE. PATIENTS AND METHODS: 107 male patients aged between 26 and 64 years (mean 45.1 ± 10.36) who consulted our outpatient clinics with complaints of PE and 94 healthy males (48.1 ± 11.81 years) as a control group were included in the study. RESULTS: When mean serum hormone concentrations of both groups were compared, levels of prolactin and free T4 were found to be significantly higher in the PE group relative to the control group (p < 0.05). At least one of the hormonal parameters was abnormal in 36 cases (33.6%) with PE, compared to only 22 (23.4%) of the controls. The number of hyperprolactinemic cases was found to be significantly increased in the PE group (p < 0.05). CONCLUSION: We feel that during the evaluation of this problem, which affects great numbers of men and their partners throughout the world, consideration of potential effects of hormonal factors might be beneficial.

Significance of atypical small acinar proliferation and high-grade prostatic intraepithelial neoplasia in prostate biopsy.

PURPOSE: In clinical practice, atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) are two common findings on prostate biopsies. Knowing the frequency of a prostate cancer diagnosis on repeat biopsies would aid primary treating physicians regarding their decisions in suspicious cases. MATERIALS AND METHODS: One hundred forty-three patients in whom biopsies revealed ASAP or HGPIN or both were enrolled in the present study; prostate cancer was not reported in the biopsy specimens and at least one repeat biopsy was performed. Age, digital rectal examination findings, prostate volumes, and free and total prostate-specific antigen (PSA) levels and the biopsy results of the patients were recorded. RESULTS: Of the 97 patients with ASAP on the first set of biopsies, prostate cancer was diagnosed in the second and third biopsies of 32 and 6 patients, respectively. Prostate cancer was not detected in the second or third biopsies of the 40 patients with HGPIN in the first biopsy. Of the 6 patients with ASAP+HGPIN in the first biopsy, prostate cancer was detected in 3 patients in the second biopsy and in 1 patient in the third biopsy. CONCLUSIONS: The diagnosis of ASAP is a strong risk factor for prostate cancer. A repeat biopsy should be performed for the entire prostate subsequent to the diagnosis of ASAP. In patients with HGPIN according to the biopsy result, the clinical decision should be based on other parameters, such as PSA values and rectal examination, and a repeat biopsy should be avoided if the initial biopsy was performed with multiple sampling.

Laser acupuncture therapy for primary monosymptomatic nocturnal enuresis.

PURPOSE: Monosymptomatic nocturnal enuresis is the nighttime bed-wetting that occurs among children without lower urinary tract symptoms or bladder dysfunction, and affects a considerable part of the population. In our study the effect of laser acupuncture therapy on patients with primary monosymptomatic nocturnal enuresis was evaluated in a prospective, randomized, placebo controlled, single-blind study. MATERIALS AND METHODS: A total of 91 children with a mean age of 8.6 years who presented to our outpatient clinic with primary monosymptomatic nocturnal enuresis and had not received any medical therapy were included in the study. The children were randomized into 2 groups. In group 1 laser acupuncture was performed 3 times a week for 4 weeks, whereas the same program via a nonlaser light to the same points was performed on the children in group 2 (placebo group). The number of weekly bed-wetting episodes before therapy was recorded, and the children were reevaluated 15, 30, 90 and 180 days after treatment. RESULTS: The mean number of bed-wetting episodes was 1.7 per week 6 months after laser therapy. In the placebo group the mean number of weekly bed-wetting episodes was 3.1. Laser acupuncture therapy was significantly more beneficial compared to placebo in terms of complete dryness, partial improvement and a decrease in the mean number of weekly bed-wetting episodes. CONCLUSIONS: Laser acupuncture therapy, a noninvasive, painless, short-term therapy with a low cost, can be considered as an alternative therapy for patients with primary monosymptomatic nocturnal enuresis.

Nocturnal enuresis in Turkey: prevalence and accompanying factors in different socioeconomic environments.

AIM: To study the prevalence of nocturnal enuresis and the impact of associated familial factors in Turkish children with a different socioeconomic status. METHODS: A specific questionnaire was distributed to 3,000 parents of primary school children (6-12 years old). Of these children, 1,500 attended primary schools in Umraniye, a suburban region of Istanbul (group 1), and the other 1,500 children visited schools in Suadiye, a well-developed part of Istanbul (group 2). The first part of the survey investigated the familial conditions of the children (financial status, family history of enuresis, and family size). The second part of the questionnaire surveyed the demographic and physical characteristics of the children. The last part was designed to investigate the opinions and beliefs of the parents about nocturnal enuresis and treatment modalities. The prevalence rates of nocturnal enuresis and associated familial factors of these children from two different regions of Istanbul were compared. RESULTS: Of the 3,000 questionnaires distributed, 2,589 (86.3%) were returned and included in the final analysis. The mean age of group 1 and 2 children was 8.88 +/- 1.4 and 8.9 +/- 1.5 years, respectively (p > 0.05). The gender of the subjects was equally distributed (48.6% males and 51.4% females). Enuresis was present in 334 children (25.5%) of group 1 and in 205 children (16%) of group 2. Enuresis was significantly more common in group 1 (p < 0.01). The families consisted of 4.69 +/- 1.4 and 4.1 +/- 1.1 persons, respectively (p < 0.01). A yearly income of USD 7,000 was achieved in group 2 by 54%, in group 1 by only 0.7% (p < 0.01). Only 26 children of group 1 (7.8%) and 22 children of group 2 (10.8%) were noted to receive medical enuresis treatments, with no statistically significant difference between the groups (p > 0.01). The parents of the enuretic children from the suburban region of Istanbul were found to consider the condition a normal developmental entity. They believed that enuresis will resolve spontaneously and that no treatment is necessary. On the contrary, the parents of the enuretic children in the well-developed region of the city believed that enuresis is a psychological problem and that intensive psychological assistance is essential for the management. CONCLUSIONS: Our study indicates that the prevalence of nocturnal enuresis in Turkey is comparable to that reported in the literature. The parents consider that enuresis nocturna is not a fatal disorder, that the drugs used in the treatment may be harmful, and that no medical assistance is required. Trained health personnel and physicians should inform the parents about enuresis in order to prevent possible behavioral and self-esteem problems.

Impaired elasticity of aorta in patients with erectile dysfunction.

OBJECTIVES: The close relationship between the elasticity of the aorta and cardiovascular disease has aroused the interest of investigators in performing studies related to aortic stiffness parameters. We investigated the aortic stiffness parameters in patients with erectile dysfunction (ED) without known cardiovascular disease and diabetes were investigated. METHODS: The study included 40 men with ED (aged 56 +/- 8 years) according to the Doppler penile ultrasound findings and the five-item version of the International Index of Erectile Function score (group 1) and 25 healthy men (aged 53 +/- 5 years; group 2) underwent fasting serum glucose and lipid level determination. Echocardiography (using a 3.75-MHz transducer) and exercise treadmill test were performed. The diameter change, pulse pressure, aortic strain index, and distensibility index as aortic stiffness parameters were investigated in patients with ED and compared with those of healthy subjects. RESULTS: The average International Index of Erectile Function-5 score of those with ED (group 1) and the control groups (group 2) was 11.2 and 23.2, respectively. Body mass index, age, fasting serum glucose, and lipid profile were not significantly different between the two groups. All patients had negative results on the exercise stress test; and the echocardiography parameters were similar. The percentage of aortic strain (group 1, 4.64 +/- 2.43 versus group 2, 10.21 +/- 5.13, P = 0.021) and the value of the distensibility index (group 1, 0.21 +/- 0.15 versus group 2, 0.51 +/- 0.20 cm2/dyn/10(-3), P <0.001 were significantly lower in the ED group than were those of the control group. CONCLUSIONS: The results of our study have shown that the aortic strain index and distensibility index are impaired in patients with ED. This suggests that ED is a generalized vessel disease rather than a disorder peculiar to the penile arteries.

A prospective randomized and placebo-controlled study for the evaluation of antibiotic prophylaxis in transurethral resection of the prostate.

AIM: To evaluate the risk of bacteriuria after transurethral resection of the prostate and the preventive effects of different kinds of antibiotics. PATIENTS AND METHODS: Urine was collected for culturing 1 week before the operation and on postoperative days 2 and 10. The patients were divided into four groups: group 1 patients were given a first-generation cephalosporin (cefazolin 1 g), group 2 patients received a second-generation cephalosporin (cefuroxime 750 mg), group 3 patients were given a third-generation cephalosporin (ceftazidime 1 g), and group 4 patients received a placebo. RESULTS: The 2nd-day postoperative bacteriuria rates were similar in all groups. On the 10th day, the incidence rates of bacteriuria in group 4 and group 1 patients were 40 and 31%, respectively (p = 0.661). In group 2, the bacteriuria incidence rate was 6.6%, and when compared with the placebo group, the difference was considered significant (p = 0.002). The difference between group 3 and group 4 was also significant (p = 0.003). There were statistically significant differences between group 1 and group 2 (p = 0.008) and between group 1 and group 3 (p = 0.01). CONCLUSIONS: Our study demonstrated that postoperative bacteriuria incidence rates are high, even in patients who underwent transurethral resection of the prostate with sterile urine, but it can be reduced by using antibiotic prophylaxis with cefuroxime or ceftazidime.

Value of urinary flow patterns in the follow-up of children who underwent Snodgrass operation.

The urinary flow patterns and the Toguri nomogram were compared in the intermediate functional results of the tubularized-incised plate urethroplasty (TIPU) to repair distal and midpenile hypospadias by using uroflowmetry. 28 children who were toilet trained, were able to void volitionally, and had no fistulas following hypospadias repair were eligible for the study. The study did not include children who had persistent fistula, meatal stenosis or urethral stricture, and did not return for follow-up. The mean age was 8.4 years and the mean follow-up period was 18 months. The urinary flow pattern, maximum (Q(max)) and average flow rate (Q(ave)) were measured; the results were expressed as percentiles and compared to the Toguri values from normal children. The Q(max) and Q(ave) were considered normal if they were in >25th percentile, equivocally obstructed in the 5-25th percentile and obstructed if <5th percentile. The flow pattern was classified as bell ring shape, plateau or intermittent. According to the Toguri nomogram, 22 of 28 patients (78.5%) were considered normal, 4 patients (14.2%) as equivocally obstructed, and 2 patients (7.1%) as obstructed group. A normal bell-shaped flow curve was obtained in 23 (82.1%) of the children. 4 patients (14.2%) had a plateau flow pattern. Only 1 of the patients had an intermittent shape flow curve. The flow pattern was normal bell-shaped for all of the patients, except 1, with Q(max) above the 25th percentile according to the Toguri nomogram. Of children with Q(max) below the 5th percentile, both of them had a plateau flow pattern and were found to have an asymptomatic meatal stenosis, which was improved with urethral dilatation. However, of the 4 patients with Q(max) between 5 and 25 percentiles, 2 had a plateau flow pattern and the others had a bell-shaped flow pattern. The flow patterns of the 2 patients determined as obstructive by the Toguri nomogram were plateau-shaped. TIPU provides satisfactory functional results for distal and midpenile hypospadias; uroflowmetry is an important noninvasive tool to evaluate this technique. There are no studies in the literature which only used flow patterns for the evaluation of urination for follow-up after the hypospadias repair. Our study showed that the evaluation of obstruction according to the Toguri nomogram may not be necessary in patients with a normal bell-shaped flow pattern in uroflowmetry.

Human chorionic gonadotropin deteriorates the histology of rat testes.

OBJECTIVES: It is not yet certain whether early hormonal treatment in cryptorchidism is safe for germ cells. We investigated the histologic effects of human chorionic gonadotropin (hCG) therapy on descended testes of rats. DESIGN AND SETTING: Thirty male Wistar albino rats were randomized into two groups. The rats of the hCG group (n=15) were administered 50 IU/kg/day hCG once daily via the subcutaneous route for 15 days. Fifteen rats received subcutaneous isotonic saline and acted as controls. At the first month, testicular tissue was obtained after scarification in both groups. The histological examination was performed to evaluate the seminiferous tubular diameter, germinal membrane thickness, and the percentage of the open seminiferous tubule lumen in each testis to compare the two groups. RESULTS: The percentage of the open seminiferous tubular lumen in testicular tissues of hCG-treated rats was higher than that of controls (p<0.05). The mean germinal membrane thickness in testicular tissues of the hCG group was statistically lower than that of the control group (p<0.05). There was no statistical difference between mean seminiferous tubular diameter in testicular tissues of hCG-treated rats and controls, as expected (p>0.05). Additionally, there were two interesting cases of Sertoli cell only appearance in the hCG group. CONCLUSIONS: We may assume that hCG impairs the seminiferous tubule histology in normal testes of rats. Thus, further experimental studies on dose dependency and the reversibility of these effects are warranted.

A rare case of an adult giant hydroureteronephrosis due to ureterovesical stricture presenting as a palpable abdominal mass.

The giant hydroureteronephrosis is a rare condition. We report a case of a unilateral giant hydroureteronephrosis in an adult patient presenting as palpable abdominal mass secondary to ureterovesical junction (UPJ) stricture. A 51-year-old man presented with a 2-year history of a palpable abdominal mass. Physical examination revealed a grossly distended abdomen that the upper margin of distension was at the level of the epigastrium and the lower one at the suprapubic region. Abdominal ultrasound and computerized tomography demonstrated a very large cystic mass in the right side of retroperitoneum involving all the space from superiorly right sub-diaphragmatic area to the bladder inferiorly. The patient underwent exploration and a right giant hydroureteronephrosis as involving all the retroperitoneal space crossing midline to the left with a liquid content of approximately 7 l caused by stricture at the ureterovesical junction was seen. The hydronephrotic sac was thin and right nephroureterectomy was performed by opening the sac and draining-off the liquid. The literature was reviewed and the management of giant hydronephrosis was discussed.

Sparing surgery for an epiderom cyst of the testis: a case report and literature review.

Epidermoid cyst of the testis is relatively rare and accounts for less than 1% of all testicular neoplasms. This condition usually occurs in young men and it is mostly detected by self-examination or routine physical examination. The case of a 27-year-old male with an epidermoid cyst of the testis is discussed. The diagnosis was based on ultrasonography and management was with testicular-sparing surgery. At 2-year follow-up, the patient had had no relapse or metastasis. In epidermoid cysts of the testis, high-frequency ultrasonography is a reliable diagnostic imaging method. Organ-preserving surgery is recommended in the management of these lesions.

Urodynamic findings in children with cerebral palsy.

AIM: More than one-third of children with cerebral palsy are expected to present with dysfunctional voiding symptoms. The voiding dysfunction symptoms of the cerebral palsy patients in the present study were documented. METHODS: Of the study group, 16 were girls and 20 were boys (mean age: 8.2 years). Children with cerebral palsy were evaluated with urodynamics consisting of flow rate, filling and voiding cystometry, and electromyography findings of the external urethral sphincter to determine lower urinary tract functions. Treatment protocols were based on the urodynamic findings. Anticholinergic agents to reduce uninhibited contractions and to increase bladder capacity were used as a treatment. Clean intermittent catheterization and behavioral modification were used for incomplete emptying. RESULTS: Of the children, 24 (66.6%) were found to have dysfunctional voiding symptoms. Daytime urinary incontinence (47.2%) and difficulty urinating (44.4%) were the most common symptoms. Urodynamic findings showed that neurogenic detrusor overactivity (involuntary contractions during bladder filling) with a low bladder capacity was present in 17 (47.2%) children, whereas detrusor-sphincter dyssynergia was present in four patients (11%). The mean bladder capacity of patients with a neurogenic bladder was 52.2% of the expected capacity. CONCLUSIONS: The present study concluded that voiding dysfunction was seen in more than half of the children with cerebral palsy, which is a similar result to other published studies. We propose that a rational plan of management of these patients depends on the evaluation of the lower urinary tract dysfunction with urodynamic studies. These children benefit from earlier referral for assessment and treatment.

Case report: a case of bladder dysfunction due to myasthenia gravis.

Detrusor underactivity, due to myasthenia gravis (MG) is extremely rare. Only 4 cases of de novo dysfunction have been reported. We report a case of detrusor underactivity and increased post-void residual urine in a woman with MG. The patient has been managed by clean intermittent catheterization 6 times a day.

Comparison of transurethral vaporization using PlasmaKinetic energy and transurethral resection of prostate: 1-year follow-up.

PURPOSE: A prospective study was conducted to evaluate the efficacy and safety of PlasmaKinetic vaporization of prostate (PKVP) relative to standard transurethral resection of prostate (TURP) in the surgical management of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Between March of 2001 and February of 2003, 75 patients aged 49 to 80 years (median 66 years) with a complaint of lower urinary-tract symptoms and a mean prostate volume of 50 +/- 6 cc were enrolled in this study. We evaluated the operating time, blood transfusion, postoperative irrigation period, and catheter-removal time. Patients were assessed at baseline and during the follow-up using the International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Q(max)). RESULTS: The mean operation time for PKVP (40.3 +/- 15 minutes) was significantly shorter than that of TURP (55 +/- 11.1 minutes) (P < 0.001). The postoperative irrigation period was significantly shorter in the PKVP group (mean 6 +/- 3 hours) than in the TURP group (mean 20 +/- 8 hours) (P < 0.001). The mean catheter-removal time was significantly later after TURP (68 +/- 21 hours) than after PKVP (35 +/- 9 hours) (P < 0.001). The groups had comparable mean IPSS and Q(max) values at baseline, and both had significant improvement in these parameters after operation. For IPSS, especially at the third month after the operation, PKVP patients showed significantly greater improvement (P < 0.001). There was no difference in Q(max) values between the groups (P > 0.05). Whereas blood transfusion was necessary for two patients in the TURP group, there were no transfusions in the PKVP group. CONCLUSIONS: Because of the short operating time, smaller blood loss, shorter period of irrigation and catheterization, use of isotonic fluid, and absence of electrical current, PKVP is safe and advantageous. Although these early results have shown that this technique may be a good alternative among the minimally invasive methods for the surgical management of BPH, further studies with longer-term results are essential.