The association between intron 4 VNTR, E298A and IVF 23+10 G/T polymorphisms of ecNOS gene and sildenafil responsiveness in patients with erectile dysfunction.

The objective of the study was to determine the association between intron 4 variable number of tandem repeats (VNTR), E298A and IVF 23+10 G/T polymorphisms of ec-NOS gene and sildenafil responsiveness in patients with erectile dysfunction (ED). Ninety-six patients who were evaluated for ED between November 2003 and June 2004 and 167 healthy individuals representing the normal population as controls were included in the present study. The patients were evaluated by medical history, five-item version of International Index of Erectile Function, serum glucose, testosterone levels and lipid profiles. Sixty-seven patients received four consecutive doses of sildenafil from 25 to 100 mg according to the response. The ec-NOS gene intron 4 VNTR, E298A and IVF 23+10 G/T polymorphisms were evaluated in the isolated DNA blood samples obtained from the patient group with ED (n=96), from the group received sildenafil (n=67) and from the healthy group (n=167). Genotype distributions of ec-NOS gene intron 4, E298A and IVF 23+10 G/T polymorphisms in the patient group were similar to those in the healthy group. The frequency of the ec-NOS gene intron 4 genotype were found as bb=41.7%, ab=50% and aa=8.3% in the sildenafil responders and bb=93.5% and ba=6.5% in the sildenafil non-responders. This finding was statistically significant. Statistical analysis of ec-NOS gene E298A and IVF 23+10 G/T polymorphisms did not reveal any significant difference between sildenafil responders and non-responders. These findings may indicate that 'a' allele of ec-NOS gene intron 4 VNTR polymorphism associates with a better sildenafil response.

Ureteroscopic treatment of proximal ureter stones with the aid of an antegrade occlusion balloon catheter.

PURPOSE: To define the role of an antegrade occlusion balloon catheter in preventing migration of proximal ureteral stones to the dilated proximal ureter during endoscopic treatment. MATERIAL AND METHODS: An occlusion balloon catheter was used in 8 of 21 patients with proximal ureteral stones who underwent ureterorenoscopy. Five of the eight patients had solitary kidneys admitting with anuria and had percutaneous nephrostomy. In the other three patients, percutaneous nephrostomy and occlusion balloon catheters were placed a day before the procedure, since these patients had total obstruction and massive dilatation of the proximal ureter and renal collecting system. The balloons of occlusion catheters were inflated with 1 ml of sterile saline proximal to the stones just before ureterorenoscopy. RESULTS: All stones could be reached by ureterorenoscopy and treated successfully with the aid of an ultrasonic lithotripter, and no stone migration to the upper dilated collecting system was observed. Just after the operation, while the patient was still lying on the operation table, the occlusion catheter was removed. The nephrostomy catheter was removed a day later. All patients were totally stone-free after the procedures. CONCLUSION: Occlusion balloon catheters increase the ureteroscopic treatment success rate in proximal ureter stones. This should be kept in mind especially when dilatation of the proximal collecting system is prominent and in cases with unsuccessful previous intervention with a retrograde stone cone catheter.

Covered metallic ureteral stent in the management of malignant ureteral obstruction: preliminary results.

OBJECTIVES: To evaluate the effectiveness of ureteral Dacron-covered metallic stents in the management of malignant ureteral obstruction. METHODS: Covered metallic stents were placed unilaterally using a percutaneous approach in an antegrade fashion into nine ureters of 8 patients with bilateral malignant ureteral obstruction. The contralateral kidneys were drained by percutaneous nephrostomy in 7 patients. The primary diagnoses were rectal cancer in 5 patients and cervical, bladder, and prostate cancers in the remaining cases. RESULTS: Covered metallic stents could be successfully placed in all patients. Only one of nine ureters was stented with a double J-stent. In a mean follow-up of 9 months (range 1 to 14), 7 of 8 patients died because of their primary disease. During the follow-up period, none of the stents were obstructed, displaced, or infected. CONCLUSIONS: Dacron-covered metallic stents appear to be successful in the treatment of patients with malignant ureteral obstruction. The preliminary outcome encourages and justifies the application of this drainage method.

Endoscopic treatment of complete bladder neck obstruction by transurethral Seldinger technique.

Bladder neck contracture is usually a complication of prostatectomy and the treatment of choice in such a condition should be endoscopic surgery. However, in a few patients the bladder neck may be completely obstructed preventing retrograde access into the bladder. A case is presented of complete bladder neck obstruction occurring after transurethral resection of prostate, which was treated after an access was provided by using transurethral Seldinger technique.

Objective penile vascular response to intraurethral prostaglandin E2 (dinoprostone).

PURPOSE: Intraurethral prostaglandin E2 (PGE2) administration is a noninvasive treatment modality for erectile dysfunction. The purpose of this study was to evaluate the objective effects of this agent by measuring peak systolic velocities of cavernosal arteries after intraurethral PGE2 administration and comparing with the results obtained with an intraurethral placebo gel and intracavernous papaverine injection. MATERIALS AND METHODS: The study group consisted of 22 consecutive impotent volunteers with a mean age of 46 years who had normal penile arterial responses as determined by penile arterial responses on papaverine-stimulated penile duplex ultrasonography. The peak systolic velocity in cavernosal arteries was recorded after intracavernous injection of 60 mg of papaverine. All patients received 1 mg of intraurethral PGE2 gel and placebo at 15-day intervals. The peak systolic velocities were recorded after each treatment. RESULTS: Mean peak systolic velocity achieved by intraurethral administration of PGE2 gel (25 +/- 8 cm/s) was less than that achieved by intracavernous papaverine (40 +/- 6 cm/s) but higher than that obtained by placebo (15 +/- 4 cm/s). Twelve patients had erections, while 9 had partial and 1 had no erection with intraurethral PGE2. Placebo did not cause any erections. No serious side effects were observed. CONCLUSION: Intraurethral administration of PGE2 appears to be an effective and simple method for increasing penile arterial flow and can be used during penile Doppler ultrasonography to stimulate the penile arterial system.

Neurofibroma of the bladder wall in von Recklinghausen's disease.

Neurofibromatosis, or von Recklinghausen's disease, is an autosomal dominant disease with multiple neurofibroma and café-au-lait spots. However, neurofibroma in the bladder wall is a rare condition in von Recklinghausen's disease. A 31-year-old man with neurogenic voiding dysfunction due to sacral meningocele and acute urinary retention with neurofibroma of the bladder wall is presented with detailed radiologic evaluation. Patients with von Recklinghausen's disease should be carefully evaluated if urological symptoms exist.

Practical approach to terminate urinary extravasation: percutaneous fistula tract embolization with N-butyl cyanoacrylate in a case with partial nephrectomy.

A 35-year-old woman who underwent partial nephrectomy had prolonged postsurgical urinary extravasation that led to a percutaneous fistula. A double-J catheter used as a ureteral stent during surgery was in place. A percutaneous pigtail nephrostomy was inserted on the 15th postoperative day but drainage continued. Antegrade pyelography demonstrated extravasation at the lower pole calyx. The double-J stent was removed on the 21st postoperative day, and a retrograde pyelogram showed no obstruction. Because drainage still was excessive on the 25th postoperative day, the fistula tract was embolized percutaneously with N-butyl cyanoacrylate, a tissue adhesive material. Drainage ceased immediately after the procedure, and control pyelography confirmed no extravasation. The patient was discharged on the 28th postoperative day. The patient had no additional complications at 36-month follow-up.

Bladder stones around a migrated and missed intrauterine contraceptive device.

Bladder stones occasionally develop because of foreign bodies in the bladder. Bladder stones in a 30-year-old woman were found to have formed around an intrauterine contraceptive device that had gone missing many years previously and had migrated into the bladder. Plain abdominal radiograms should be a part of the evaluation in patients with a history of an unretrieved intrauterine contraceptive device.

Anterior urethral valve as a cause of end-stage renal disease.

Although posterior urethral valves are predominant as a cause of obstructive uropathy in children, anterior urethral valves may also appear as the underlying etiologic factor in end-stage renal disease that results from obstruction. Two cases are presented of anterior urethral valve patients that were admitted with end-stage renal disease. The first case was successfully treated with diverticulectomy and urethral reconstruction in preparation for renal transplantation. The second case, however, had been on cystostomy drainage for 6 years and also had a contracted bladder. A more extensive lower urinary tract reconstruction was delayed. Children with poor stream and recurrent infections should be evaluated carefully and anterior urethral valve or diverticula should be considered in differential diagnosis of obstructive lesions.

Prevalence of stress urinary incontinence in both sexes at or after age 15 years: a cross-sectional study.

PURPOSE: We determine the prevalence of stress urinary incontinence among males and females at or after age 15 years in an education and research health district. MATERIALS AND METHODS: During a personal interview questionnaires were given to a total of 2,053 people at or after age 15 years in an education and research health district near Ankara, Turkey. In addition to the particular questions about stress incontinence, the medical history, including congenital or acquired diseases of clinical significance, operations and details relevant to positive findings were obtained. Groups with or without stress incontinence were compared in regard to age and sex, and parity in women. Subgroups that emerged as to the presence of nocturia and/or urgency incontinence were examined in regard to systemic diseases, operations, congenital anomalies and regular medications. RESULTS: A total of 229 people (11.1%) had stress incontinence, with a female predominance of 20.8% versus 1.0% (p <0.05). People 65 years old or older experienced stress incontinence 6.24 times more than those in the 15 to 24-year age group. In contrast, females had increasing stress incontinence prevalence by age as noted by relevant odds ratios. Stress incontinence prevalences among women in the 35 to 44 and 45 to 54-year age groups were about 39 and 35 times higher than those of men in the corresponding age groups. As expected the incontinence prevalences increased with the number of births in women. Nocturia was absent in 50.2% of all subjects, whereas 26.7% reported nocturia at all times and 23.0% had nocturia sometimes. Persistent nocturia was present in 21.1% of males and 32.1% of females. Persistent nocturia and urgency were apparently greater in patients with systemic diseases and/or those who had undergone surgery. Urgency incontinence was present in 9.7% of the entire population with a distinct female predominance of 16.3% versus 2.7%. CONCLUSIONS: Stress incontinence occurred in both sexes at or after age 15 years with a female predominance. The prevalence of stress incontinence increases with age and parity in women. Urgency and nocturia are more prevalent in people with systemic diseases and those who have undergone previous pelvic or neurosurgical operations.

Percutaneous management of ulcerative glandular hypervascularization after Virag-I operation.

A 42-year old man was admitted with glans ulcer, meatal stenosis, urinary retention and impotence. He had undergone a Virag-I operation because of impotence at another hospital 2 months earlier. The deep dorsal vein was isolated under local anesthesia and blocked by coils and embolized by n-butyl cyanoacrylate in a retrograde fashion. After 2 months, the glans had healed completely. The patient has no further urinary problem and is potent.

Is there significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithotripsy?

OBJECTIVE: To determine whether there is a significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithothripsy (ESWL). METHODS: Ninety-six patients with proximal ureter stones underwent ESWL. The procedure was performed in the supine position in 48 of them (group 1) and in the prone position in the other 48 patients (group 2). Stone-free rates, repeat ESWL rates, shocks per patient and shocks per session were compared in both groups. RESULTS: The mean session number per patients was 1.64+/-0.75 in group 1 and 1. 33+/-0.59 in group 2 (p = 0.224). The stone-free rates 3 months after ESWL were 88.3% in group 1 and 90.6% in group 2. The difference between the results was statistically insignificant (p<0.05). Therefore, these two parameters were similar in both groups. On the other hand, the number of shocks per session was 4,863.54+/-2, 114.85 in group 1 and 3,704.16+/-1,726.75 in group 2. This difference was statistically significant (p = 0.011). The patients tolerated the supine position better in general. Patients in the prone position experienced discomfort on inspiration and expiration and pain localized to the lumbar vertebrae. CONCLUSION: These results suggest that the supine position decreases the number of shocks per session in the treatment of proximal ureter stones with ESWL and this will be cost-effective.

Embolization of the deep dorsal vein for the treatment of erectile impotence due to veno-occlusive dysfunction.

PURPOSE: We evaluate the effectiveness of deep dorsal vein embolization for the treatment of venous impotence. MATERIALS AND METHODS: A total of 32 impotent patients with veno-occlusive dysfunction underwent deep dorsal vein embolization. The condition was suspected based on findings of penile Doppler ultrasonography and cavernosometry. The diagnosis was confirmed with pharmacocavernosography that appeared to delineate venous leakage. During the procedure we isolated and cannulated the deep dorsal vein through a small dorsal penile incision with the patient under local anesthesia. We used a mixture of the tissue glue, N-butyl cyanoacrylate, and lipodol for embolization, with a total volume of 5 ml. injected antegrade into the previously catheterized dorsal vein under fluoroscopic control. As soon as we observed the occluded veins we performed repeat pharmacocavernosography. At 3-month followup patients were reassessed with history and cavernosometry. Followup ranged from 12 to 36 months (median 25). RESULTS: Of 32 patients 22 (68.7%) regained sexual activity, which was confirmed by cavernosometry. The remaining 10 patients (31.3%) experienced little if any clinical response, which correlated with cavernosometry. There were no significant side effects. CONCLUSIONS: Deep dorsal vein embolization for venogenic impotence is simple, effective and safe, and appears to be cost-effective. The results obtained in this limited number of patients are promising and justify trials in larger groups.

Effect of lower infundibulopelvic angle, lower infundibulum diameter and inferior calyceal length on stone formation.

The effect of anatomical factors such as lower infundibulopelvic angle (LIPA), lower infundibulum diameter (LID) and inferior calyceal length (ICL) on renal stone formation was investigated. These parameters were measured from noncalculous kidneys of 40 healthy kidney donors. The same parameters from 119 patients with single, unilateral, nonobstructive lower calyceal stone were also measured. LID and ICL were significantly higher in calculous kidneys when compared to the control group. On the other hand, the difference between the LIPA of the two groups was not significant. It is concluded that LID and ICL could be good indices in determining lower calyceal stone formation.

The role of pentoxifylline in the treatment of erectile dysfunction due to borderline arterial insufficiency.

OBJECTIVE: To investigate the effects of pentoxifylline on penile blood flow and potency in patients with erectile dysfunction due to borderline arterial insufficiency. PATIENTS AND METHODS: Following a routine diagnostic evaluation, 36 patients with borderline arterial disease diagnosed using penile duplex ultrasonography were included in the study. Of these patients, 20 (mean age 54 years, range 40-66) received 1.2 g of pentoxifylline daily, divided into three doses orally, for 2 months and 16 (mean age 54 years, range 34-65) received a placebo. Peak systolic velocities (PSVs) before and after the treatment were compared with those in patients receiving a placebo. The clinical improvement in erectile function was also evaluated. RESULTS: Twelve of 20 patients receiving pentoxifylline had an increase in PSV at the end of the treatment period. The mean change in PSV achieved by pentoxifylline treatment (6.25 cm/s) was significantly higher than that achieved by the placebo (0.38 cm/s). Seven patients had a positive response (successful coitus achieved after treatment with pentoxifylline). No serious side-effects occurred. CONCLUSION: Pentoxifylline was well tolerated and could increase penile arterial inflow, shown objectively as an increase in PSV on penile duplex ultrasonography. These findings should encourage further studies of the efficacy of pentoxifylline in the treatment of impotence.

Techniques of corporoplasty for penile curvature: review of 18 patients.

Penile curvature which can be acquired or combined with some congenital anomalies may cause trouble in sexual function or can affect the psychological status of the individual. Whatever the causes or the results are, this condition has been tried to be corrected for many years by many different techniques. Eighteen patients with penile curvature have been reviewed. Thirteen patients underwent Nesbit procedure, in 3 patients plication of the tunica albuginea was done and in 2 patients longitudinal incision and horizontal closure of the tunica albuginea were performed. In all cases the results were both functionally and cosmetically satisfying. The advantages and disadvantages of these techniques are discussed, with a review of the relevant literature.

A prostaglandin synthesis inhibitor, diclofenac sodium in the treatment of primary nocturnal enuresis.

Various treatment modalities have been used in Primary Nocturnal Enuresis (PNE) and pharmacotherapy is widely accepted. Prostaglandins increase detrusor pressure, decrease urethral pressure and lead to sodium excretion. They also antagonize hydro-osmotic effect of vasopressin by competing with this hormone. According to these functions of prostaglandins it is suggested that inhibition of prostaglandin synthesis may have value in the management of PNE. We evaluated the efficacy or oral diclofenac sodium treatment in 78 patients. We conclude that diclofenac sodium, an inhibitor of prostaglandin synthesis, is a good alternative agent for nocturnal enuresis particularly as a supplementary treatment combined to Imipramine, with 60% complete response and 13.3% recurrence rate.

Scrotal calcinosis.

Calcinosis is a rare benign lesion of the scrotum. A new case with scrotal calcinosis is presented and the relevant literature is reviewed.