Methylation analysis of histone 4-related gene HIST1H4F and its effect on gene expression in bladder cancer.

Recently, aberrant DNA methylation of the HIST1H4F gene (encodes Histone 4 protein) has been shown in many types of cancer, which may serve as a promising biomarker for early cancer diagnosis. However, the correlation between DNA methylation of the HIST1H4F gene and its role in gene expression is unclear in bladder cancer. Therefore, the first objective of this study is to explore the DNA methylation pattern of the HIST1H4F gene and then further elucidate its effects on HIST1H4F mRNA expression in bladder cancer. To this end, the methylation pattern of the HIST1H4F gene was analyzed by pyrosequencing and the effects of the methylation profiles of this gene on HIST1H4F mRNA expression in bladder cancer were examined by qRT-PCR. Sequencing analysis revealed significantly higher methylation frequencies of the HIST1H4F gene in bladder tumor samples compared to normal samples (p < 0,0001). However, when we evaluated the correlations between hypermethylation of HIST1H4F and the clinicopathological parameters (tumor stage, tumor grade, lymph node metastasis, muscle-invasion), no significant difference was found between the groups (p > 0.05). In addition, we examined the role of hypermethylation of the HIST1H4F gene on HIST1H4F mRNA expression. We found that hypermethylation of HIST1H4F in the exon have no effect HIST1H4F mRNA expression in bladder cancer (p > 0.05). We also confirmed our finding in cultured T24 cell line which HIST1H4F gene is hypermethylated. Our results suggest that hypermethylation of the HIST1H4F seems to be a promising early diagnostic biomarker in bladder cancer patients. However, further studies are needed to determine the role of HIST1H4F hypermethylation in tumorigenesis.

Rare complication of needleless mini-sling procedure: Case report.

The mini-sling procedure is a widely used, minimally invasive treatment for stress urinary incontinence. While bladder perforation and stone formation over the mesh is not an expected complication of the mini-sling procedure, in this case, we report on the management of bladder calculi formed over the mesh, which was passed through the bladder while applying the mini-sling procedure, and was eventually removed using holmium laser. Performing cystoscopy in patients with irritative and obstructive symptoms after the sling procedure will help confirm bladder perforation, and an endoscopic approach using holmium laser is an effective treatment.

Effects of Parenchymal Thickness and Stone Density Values on Percutaneous Nephrolithotomy Outcomes.

BACKGROUND It is unclear whether parenchymal thickness (PT), in combination with stone density measured by Hounsfield Units (HU), affects stone-free rates after PCNL. The aim of the present study was to investigate the relationship between PT in combination with stone density values and the outcomes of PCNL. MATERIAL AND METHODS From 2009 to 2014, data from 216 PCNL patients were prospectively analyzed. In total, 120 patients were included in the study. Using NCCT images, stone burden, stone localization, stone density as HU values, PT, and operative-postoperative parameters were recorded. RESULTS Stone localization, stone type, stone burden, and presence of hydronephrosis were statistically significant factors affecting stone-free status (p<0.001, p<0.001, p<0.01, and p<0.01, respectively). The stone-free rate in patients with thicker renal parenchyma was higher than in patients with lower parenchymal thickness (p<0.01). No correlation was detected between stone density and success rate (p>0.05). Drop in Hb (%) was only correlated with parenchymal thickness (p<0.01). In univariate analyses, factors that affected blood transfusion requirement were PT, BMI, and operative times (p<0.01, p<0.05, and p<0.05, respectively). CONCLUSIONS Stone location, stone burden, and presence of hydronephrosis detected with NCCT were factors affecting PCNL outcome. Stone density values did not correlate with the rate of bleeding or success of PCNL. PT measured by NCCT may predict bleeding and may guide surgeons in determining preoperative blood requirements. The outcome of PCNL appeared to be better in patients with thicker renal parenchyma and should be taken into consideration in the clinical evaluation of patients undergoing PCNL.

Overview of different scoring systems in Fournier's Gangrene and assessment of prognostic factors.

OBJECTIVE: In this study we aimed to evaluate prognostic factors for the survival of patients with Fournier's gangrene (FG), and overview different validated scoring systems for outcome prediction. MATERIAL AND METHODS: We retrospectively analyzed the data of 39 patients treated for FG in our clinic. Data were collected on medical history, symptoms, physical examination findings, vital signs, laboratory parameters at admission and at the end of treatment, timing and extent of surgical debridement, and the antibiotic treatment used. The Fournier's Gangrene Severity Index (FGSI) and Charlson Comorbidity Index (CCI) were used to predict outcome. The data were analyzed in relation with the survival of the patients. Mann-Whitney U test, chi -square test, Wilcoxon signed rank test, and Cox regression analysis were used for the statistical analysis. RESULTS: Of 39 patients analyzed, 8 (20.5%) died and 31 (79.5%) survived. The median FGSI score on admission was 2 (0-9) for the survivors and 6 (2-14) for the non-survivors (p=0.004). The median CCI scores of the survivors and non-survivors were 2 (0-10) and 6.5 (5-11), respectively (p=0.001). Except for urea, albumin and hematocrit levels, no significant differences were found between survivors and non-survivors for other laboratory parameters on admission. Lower albumin levels and advanced age were found to be associated with mortality. CONCLUSION: High blood urea, low albumin, and low hematocrit levels were associated with poor prognosis. High CCI and FGSI scores could be associated with a poor prognosis in patients with FG.

Reduced Pain and Anxiety with Music and Noise-Canceling Headphones During Shockwave Lithotripsy.

OBJECTIVE: We assessed the effects of music and noise-canceling headphones (NCHs) on perceived patient pain and anxiety from extracorporeal shockwave lithotripsy (SWL). PATIENTS AND METHODS: Patients with renal calculi scheduled for SWL were prospectively enrolled. All 89 patients between the ages of 19 and 80 years were informed about this study and then randomized into three groups: Group 1 (controls), no headphones and music; Group 2, music with NCHs (patients listened to Turkish classical music with NCHs during SWL); and Group 3, music with non-NCHs (patients listened to Turkish classical music with non-NCHs during SWL). Hemodynamic and respiratory parameters were recorded before and just after the SWL session. All patient visual analog scale (VAS) and State-Trait Anxiety Inventory (STAI) scores were recorded just after the SWL procedure. RESULTS: There were significant differences in VAS scores among the groups (5.1, 3.6, and 4.5, respectively, p < 0.001), including between Groups 2 and 3 (p = 0.018). There were also significant differences in STAI-State anxiety scores among the groups (43.1, 33.5, and 38.9, respectively, p = 0.001), including between Groups 2 and 3 (p = 0.04). CONCLUSIONS: Music therapy during SWL reduced pain and anxiety. Music therapy with NCHs was more effective for pain and anxiety reduction. To reduce pain and anxiety, nonpharmacologic therapies such as music therapy with NCHs during SWL should be investigated further and used routinely.

Prevalence of nocturnal enuresis and its influence on quality of life in school-aged children.

OBJECTIVE: According to the ICCS definitions, enuresis is defined by an intermittent, wetting during sleep after organic causes have been ruled out with a minimum wetting frequency of once per month. Previous studies reported a prevalence rate of 9-12%. Eighty to 90% of enuresis cases are identified as primary enuresis and are based on genetic predisposition, biological and developmental factors. On the other hand, secondary enuresis frequently arises from psychological factors. In this study we aimed to determine the prevalence and associated factors of nocturnal enuresis (NE) among primary school children. METHOD: We initiated a prospective cross-sectional epidemiological study from January 2013 to May 2013 by sending a questionnaire to parents of 4250 school children, aged 6-13 years. The questionnaire consisted of three parts. The first part investigated the demographic characteristics of the child and family, such as age, gender, number of siblings, and enuresis history of the parents and siblings. The second part consisted of questions about the presence and frequency of bedwetting, presence of constipation/fecal incontinence, and presence of daytime incontinence (DI). The last part surveyed school performance and the effect of enuresis on quality of life of parents and children. Logistic regression analyses were conducted to determine the significant predictive factors for NE. RESULTS: The overall prevalence of enuresis was 9.52%. The prevalence of NE among boys and girls was 12.4% and 6.5%, respectively. Daytime incontinence was present in 18% of children. Of enuretic children, 59.2% had a positive family history of enuresis. Constipation was found in 13.2% of children with enuresis and there was no significant association between NE and the presence of constipation. In addition, 48% of enuretic children had poor school performance. CONCLUSIONS: The current study demonstrated that age, male gender, parents' history of enuresis, and siblings' history of enuresis were significant predictive factors for NE. The majority of the parents did not have adequate interest in enuretic children and most of the children were not treated. Physicians should inform parents of enuretic children with the aim of solving this problem to prevent future issues and development of adulthood lower urinary tract symptoms (LUTS).

The prevalence of overactive bladder syndrome and urinary incontinence in a Turkish women population; associated risk factors and effect on Quality of life.

AIMS: To investigate the prevalence and risk factors of overactive bladder syndrome and urinary incontinence in Turkish women; furthermore, to assess the impact on the quality of life. MATERIALS AND METHODS: A cross-sectional, epidemiological study was carried out in women of reproductive age to define overactive bladder syndrome, urinary incontinence, ICIQ-SF score and medical care seeking. RESULTS: The women's average age was 34.4 ± 5.26 years. The prevalence of UI was 26.9%. Stress UI was the predominant form. The prevalence of UI increased with age, BMI, number of pregnancies and children delivered. The prevalence of OAB was 20.7%. Women with OAB were older and had greater number of pregnancies than women without OAB. History of nocturnal enuresis was a significant risk factor for OAB and UUI. Women with MUI had more frequent and more abundant leakage of urine. 10.7% of women sought medical care for their condition. CONCLUSIONS: Although prevalence estimates differ across studies, the available evidence indicates that UI and OAB are highly prevalent conditions among women. UI had negative effect on QoL, but only severely-affected women sought medical care. Public health and clinical management programs are needed to determine diagnosis and management of these social problems.

Pediatric extracorporeal shock wave lithotripsy: multi-institutional results.

AIM: To evaluate the efficacy, auxiliary procedures and complications of pediatric extracorporeal shock wave lithotripsy (ESWL) performed with electrohydraulic lithotripters. METHODS: Children with urolithiasis, aged between 0 and 15, were retrospectively evaluated. ESWL was performed by using two different electrohydraulic lithotripters, Elmed Multimed Classic (Elmed Medical Systems, Ankara, Turkey) and E-1000 (EMD Medical Systems, Ankara, Turkey), between January 2008 and December 2012 in four different referral centers in Turkey. RESULTS: 85.5% of patients were stone-free at 3 months. Further ESWL treatment was needed in 33.7% of the cases (one session, n = 55; two sessions, n = 15; three sessions, n = 13). Steinstrasse occurred in 10 patients but 8 of them cleared completely during the follow-up period. Urinary tract infection was detected in 3 (3.9%), fever in 3 (3.9%) and a small subcapsular hematoma in one (1.3%) patient, respectively. When the stones were divided into two groups as those with diameters <10 mm and ≥10 mm, it was found that the stone-free rate was associated with stone diameter, and that the smaller diameters had higher but statistically insignificant stone-free rates (P = 0.196). CONCLUSION: ESWL yields favorable results with low rates of complication and auxiliary procedures in selected pediatric patients.

Does Metabolic Syndrome or its Components Correlate With Lower Urinary Tract Symptoms in Benign Prostatic Hyperplasia Patients?

BACKGROUND: Metabolic Syndrome (MS) has become a global public health and has been suggested to be a risk factor for Lower Urinary Tract Symptoms (LUTS). Studies evaluating the association between the rate of the MS and LUTS often showed controversial results. OBJECTIVES: The purpose of this study was to reveal the relevance of MS and its components on the frequency and severity of the LUTS that were seen with Benign Prostate Hyperplasia (BPH) in Turkish men or not. PATIENTS AND METHODS: In this study, 237 patients referred to urology policlinic with BPH were retrospectively scanned between April 2009 and April 2013. Patients with normal digital rectal examination and the Prostate Specific Antigen (PSA) level of ≤ 4 ng/mL were evaluated using the International Prostate Symptom Score (IPSS) and all the data of the patients' body, including Body Mass Index (BMI), lipid parameters, preprandial blood glucose, and waist circumference. Seventy-four patients (31.3%) with mild IPSS (0-7) was group 1; 97 patients (40.9%) with moderate IPSS (8 - 19) group 2 and 66 patients (27.8%) with severe IPSS (20-35) were defined as group 3. group 4 consisted of 117 healthy controls. Three groups and controls were compared about MS and its components. The diagnosis criteria of The Society of Endocrinology and Metabolism of Turkey were used in MS diagnosis. Also, BMI, lipid parameters, preprandial blood glucose, waist circumference, and blood pressure were used as MS parameters. RESULTS: The average age of patients in group 1 was 69.8 ± 7.2; in group 2, 69.1 ± 7.4; 68.3 ± 7.1 in group 3 and 70.2 ± 7.2 in the control group. Metabolic syndrome was determined at 37 patients (50%) in group 1, 45 patients (46.5%) in group 2, 32 patients (48%) in group 3 and 52 patients (44.4%) in controls and no statistically significant correlation was detected between LUTS and MS in BPH (P = 0.113). In the comparison of the four groups in the point of MS parameters, no significant correlation was detected in the levels of total cholesterol (P = 0.337), fasting glucose (P = 0.291), BMI (P = 0.452), Low Density Lipoprotein (LDL, P = 0.069) and triglyceride (P = 0.307). CONCLUSIONS: In our study, the evidence is not enough to support the hypothesis of the relevance between MS and LUTS. Wide-ranging, prospective and multicentric studies are needed to research the relevance between MS and LUTS in BPH.

Can urinary nerve growth factor and bladder wall thickness correlation in children have a potential role to predict the outcome of non-monosymptomatic nocturnal enuresis?

INTRODUCTION: Measurement of bladder wall thickness (BWTh) by ultrasound has been introduced as a new and promising technique to assess bladder dysfunction, and increased levels of nerve growth factor have also been reported in the bladder tissue and urine of patients with sensory urgency and detrusor overactivity (DO). OBJECTIVE: In this study we aimed to generate a clinically useful tool with urinary nerve growth factor levels and ultrasonographic BWTh to find possible pathogenetic clues and prognostic indicators as guides for the choice of therapy of non-monosymptomatic nocturnal enuresis. METHODS: A total of 110 children, aged 6-16 years old, were involved in this prospective study. Group 1 consisted of children with non-monosymptomatic nocturnal enuresis (n = 40), Group 2 of children with monosymptomatic nocturnal enuresis (n = 40) and Group 3 of children with healthy normal controls (n = 30). Children were evaluated with detailed history and physical examination, including neurologic examination; they were asked to complete a self-reported questionnaire and a 3-day bladder diary with the aid of their parents. The number of wet nights, the number of voids per night, the presence of daytime voiding symptoms (urgency, urge incontinence, incontinence, holding maneuvers, frequency), fluid intake, and any history of urinary tract infections (UTIs) were recorded. Monosymptomatic nocturnal enuresis and non-monosymptomatic nocturnal enuresis diagnosis was made using the International Children's Continence Society definition. Urinary nerve growth factor levels were measured by enzyme-linked immunosorbent assay and BWTh was measured transabdominally by a uroradiologist who specialized in pediatric ultrasonography. Urinary nerve growth factor levels were normalized by urinary creatinine levels and compared in all subgroups. RESULTS: The mean age of the study group was 9.6 (range 6-16) years. The mean BWTh was significantly increased in Group 1 compared with Group 2 (4.33 ± 1.12 mm, 2.33 ± 1.03 mm; p < 0.001) and healthy controls (4.33 ± 1.12 mm, 1.86 ± 0.57 mm; p < 0.001, respectively). Urinary levels of nerve growth factor corrected to urine creatinine (NGF/Cr) significantly increased in Group 1 with to Group 2 (2.75 ± 1.15 vs. 0.58 ± 0.15; p < 0.001) and controls (2.75 ± 1.15 vs.0.28 ± 0.10; p < 0.001, respectively). In receiver operating characteristic analysis, BWTh was found to have sensitivity of 95% and specificity of 85.7% (3.00 area under the curve [AUC] 0.937; 95%) and NGF/Cr had sensitivity of 97.5% and specificity of 98.6% (0.885; AUC, 999; 95%) in predicting lower urinary tract symptoms (LUTS) for non-monosymptomatic nocturnal enuresis (NMNE) (Figure). DISCUSSION: In our study we have investigated that BWTh together with urinary NGF levels normalized to the concentration of urinary creatinine (NGF/Cr) may predict daytime voiding problems in children with primary nocturnal enuresis (PNE). The main basis of this study is previous findings which demonstrated that ultrasonography (US)-based measurement of BWTh is a useful diagnostic parameter for LUTS in children, and that increased levels of NGF in bladder tissue and urine such as sensory urgency, DO, and overactive bladder (OAB) was indicated by clinical and experimental studies. The present study demonstrated that urinary NGF/Cr levels and BWTh measurements were significantly increased in patients with NMNE with daytime urinary symptoms (urgency, urge-incontinence, incontinence, frequency) showing symptoms of an OAB than controls and MNE. CONCLUSION: BWTh measurements and NGF/Cr values, as non-invasive tools, may guide therapy and improve outcomes in the treatment of children with NMNE. Further studies including a larger number of patients would be of great interest.

Does varicocelectomy affect DNA fragmentation in infertile patients?

INTRODUCTION: The aims of this study were to investigate the effect of varicocelectomy on DNA fragmentation index and semen parameters in infertile patients before and after surgical repair of varicocele. MATERIALS AND METHODS: In this prospective study, 72 men with at least 1-year history of infertility, varicocele and oligospermia were examined. Varicocele sperm samples were classified as normal or pathological according to the 2010 World Health Organization guidelines. The acridine orange test was used to assess the DNA fragmentation index (DFI) preoperatively and postoperatively. RESULTS: DFI decreased significantly after varicocelectomy from 34.5% to 28.2% (P = 0.024). In addition all sperm parameters such as mean sperm count, sperm concentration, progressive motility and sperm morphology significantly increased from 19.5 × 10(6) to 30.7 × 10(6), 5.4 × 10(6)/ml to 14.3 × 10(6)/ml, and 19.9% to 31.2% (P < 0.001) and 2.6% to 3.1% (P = 0.017). The study was limited by the loss to follow-up of some patients and unrecorded pregnancy outcome due to short follow-up. CONCLUSION: Varicocele causes DNA-damage in spermatozoa. We suggest that varicocelectomy improves sperm parameters and decreases DFI.

The Relationship between Acidic Urinary pH and Overactive Bladder; Alkalization of Urine Improves the Symptoms of Overactive Bladder.

BACKGROUND: To determine association between urine pH and OAB symptoms and to determine if urinary alkalization improves overactive bladder (OAB) symptoms. METHODS: 659 patients with OAB were enrolled in this study between June 2012 and May 2014. 329 patients (group 1) were included in the final analysis. 201 adults were used as a control group (group 2). 24-hour urinary pH and the validated Turkish version of the OAB-V8 questionnaire were performed in patients. A 24-hour urine pH <6.2 was considered acidic urine. In the second part, a diet program was performed for 4 weeks in 30 participants. Urine pH values and OAB-V8 scoring results were recorded before the diet program and 2 and 4 weeks after the diet program. RESULTS: Acidic urinary pH was determined in 61.4% of patients with OAB. There was a significant association between the presence of acidic urine and OAB. Also, the OAB-V8 scores of patients were significantly higher in patients with acidic urine than nonacidic urine. OAB-V8 scores of patients showed statistically significant improvement after diet therapy (17.87 ± 6.52 vs. 10.43 ± 7.17; p < 0.001). CONCLUSIONS: We found that acidic urinary pH was closely associated with OAB, and alkalization of urine improved lower urinary tract symptoms. We suggest that urinary pH should be considered as a parameter in treatment planning of patients with OAB.

Does metabolic syndrome or its components associate with prostate cancer when diagnosed on biopsy?

PURPOSE: To investigate the association between metabolic syndrome and prostate cancer risk in Turkish men. METHODS: We examined data from 220 patients with prostate cancer and 234 men in a control group with benign biopsy results, who had a serum prostate-specific antigen (PSA) level ⩾ 4 ng/ml, or an abnormal digital rectal examination finding and who underwent transrectal ultrasound-guided prostate biopsy at two main training and research hospitals between February 2009 and April 2013. Metabolic syndrome was diagnosed according to The Society of Endocrinology and Metabolism of Turkey metabolic-syndrome criteria. Age, total PSA, waist circumference, body mass index, lipid profiles, fasting blood sugar level, blood pressure level and metabolic syndrome were considered for analysis. RESULTS: A total of 454 patients were enrolled: 85 cases in group 1 (38.6% of 220 prostate cancer cases) and 104 control subjects in group 2 (40.4% of 234 controls) were diagnosed with metabolic syndrome. Higher ages and lower high-density lipoprotein-cholesterol were two parameters that were significant only in the prostate cancer group with metabolic syndrome. There was no significant predictor factor for prostate cancer alone; however, higher triglycerides (odds ratio [OR], 1.286; 95% confidence interval [CI] 1.09-1.82 and 1.142; 95% CI 1.06-1.62) and fasting glucose levels (OR, 1.222; 95% CI 1.08-1.61 and 1.024; 95% CI 1.07-1.82) were significant predictors in both the prostate cancer group and control group. CONCLUSIONS: We found little evidence to support the hypothesis that increased incidence of metabolic syndrome (or its components) contributes to increased incidence of prostate cancer. A larger, prospective, multicentre investigation is mandatory to confirm if there is any relationship between metabolic syndrome and prostate cancer.

Does previous stone treatment in children generate a disadvantage or just the opposite?

In this study we aimed to determine the effects of previous open renal surgery, percutaneous nephrolithotomy and extracorporeal shockwave lithotripsy (ESWL) on the results and complications of subsequent percutaneous nephrolithotomy (PCNL) in pediatric patients. We reviewed the files of all 105 patients with 116 renal units (RU) undergoing PCNL at two main institutions between December 2000 and February 2014. The 116 RUs were divided into four groups: primary PCNL patients with 44 RU (37.9%) were categorized as group 1, 29 RU (25%) with a history of failed ESWL on the same side were categorized as group 2, 23 RU (19.8%) with previous PCNL surgery were categorized as group 3 and 20 RU (17.2%) with open renal surgery were categorized as group 4. Patient characteristics, mean operative time, mean fluoroscopy time, time to access the collecting system, hemoglobin change, number of more than 1 access, stone-free rates, postoperative hospitalization time and complications in four groups were compared. There were no differences between the groups in age, sex, mean stone size and stone laterality. Mean operative time, mean fluoroscopy time, time to access the collecting system, hemoglobin change, complication rates, number of more than one access hospitalization times were similar in the each group (p > 0.05 for each parameter). The stone-free rates after PCNL were 81.8% in group 1, 79.3% in group 2, 78.3% in group 3 and 80 % in group 4 (p = 0.67). Percutaneous nephrolithotomy is effective and safe in children who have previously had open nephrolithotomy, history of ESWL or PCNL without no more complications than are seen with primary PCNL of kidneys and with similar success rate.

Urothelial cancer of bladder in young versus older adults: clinical and pathological characteristics and outcomes.

Bladder urothelial carcinoma is rare in young adults and occurs more commonly in older individuals. The aim of this study was to compare the clinical behavior, pathologic characteristics, and prognosis of urothelial carcinoma of urinary bladder in young versus older adults. A retrospective review of our records between 2007 and 2013 identified 56 patients (42 males and 14 females) with transitional cell carcinoma of the bladder who were less than 40 years old. Clinical and pathological parameters of patients who were less than 40 years of age were compared with those of a series of patients older than 40 years of age (the control group) during the same period. A survival analysis was performed using the Kaplan-Meier method and log-rank test, and Cox regression was performed to identify clinical parameters that affected the clinical outcomes. The mean age was 29.21 years (range, 5-40 years) for patients less than 40 years old and 61.66 years (range, 41-75) for those older than 40 years. The mean follow-up was 40.26 months (range, 12-65 months) for young patients and 42.57 months (range, 12-72 months) for the older patients. Young bladder cancer patients had smaller-sized tumors (less than 3 cm), less high-grade cancers, higher papillary urothelial neoplasms of low malignant potential, and low-grade tumors than patients older than 40 years. Multivariate logistic regression analysis predicted tumor recurrence in young patients with high-grade tumors [odds ratio (OR), 1.959; 95% confidence interval (CI), 1.235-2.965; p = 0.046] and tumors larger than 3 cm (OR, 1.772; 95% CI, 1.416-1.942; p = 0.032). The 5-year overall survival rate was 100% for young patients and 88.1% for older patients. No difference was observed in the recurrence-free (p = 0.321) and progression-free (p = 0.422) survival rates between the two groups. We concluded that although the clinical stage distribution, natural history, and outcomes of bladder urothelial cancer in young adults are similar to those in their older counterparts, clinicians must be aware that patients under 40 years of age presented with higher-grade and larger (>3 cm) tumors and are more likely to experience tumor recurrence.

¿La circuncisión puede ser un factor de riesgo para la eyaculación precoz? / ¿La circuncisión puede ser un factor de riesgo para la eyaculación precoz? / Can circumcision be a risk factor in premature ejaculation?

Objective: To determine the relationship between postcircumcisional mucosal cuff length due to performance of circumcision and premature ejaculation (PE). Materials and methods: 180 circumcised men were enrolled in the study, including 60 men with PE circumcision performed by doctors (Group 1), 60 men with PE circumcision performed by non-medical personnel (Group 2) and 60 men without PE. Data considered for analysis consisted of age, circumcision age, education, smoking, penile length, mucosal cuff, penile skin lengths and Intravaginal Ejaculation Latency Time (IELT). Results: The mean age of study group was 32.7 ± 10.4 (range 24---56). The mean of IELT was 0.6 ± 0.1 min (min) in group 1, 0.5 ± 0.1 min in Group 2 and 4.3 ± 0.3 min in healthy group. The mean of penis length was 123.2 ± 12.8 mm in group 1, 124.6 ± 11.7 mm in group 2 and 124.8 ± 13.4 mm in healthy group. The mean of penile mucosa was 11.7 ± 1.7 mm in group 1, 14.8 ± 3.1 mm in group 2 and 12.8 ± 3.1 mm in healthy group. There was no difference between the three groups regarding the length of the penile mucosal cuff (p = 0.89). Patients circumcised by doctors in group 1 had significantly shorter postcircumcisional mucosal cuff length than group 2 patients circumcised by personnel except doctors (p = 0.42); but there was no statistical difference in IELT between group 1 and group 2. Conclusions: The result of this study is that circumcisions performed by doctors have shorter mucosal cuff but the length of mucosa is not a risk factor in premature ejaculation (AU)

Objetivo: Determinar la relación entre la longitud del manguito de la mucosa secundario a circuncisión y la eyaculación precoz (EP). Material y métodos: 180 hombres circuncidados y con EP fueron incluidos en este estudio, de los cuales 60 fueron circuncidados por médicos (grupo 1) y 60 por personal no-médico (grupo 2); también fueron incluidos 60 pacientes sin EP. Datos recogidos para el análisis fueron la edad del paciente en el momento del análisis, la edad en la que se realizo al circuncisión, educación, habito tabáquico, las longitudes del pene, del manguito de la mucosa y de la piel del pene; y la latencia de eyaculación intravaginal (LEIV). Resultados: La media de edad de los pacientes era de 32.7 ± 10.4 a˜nos (rango 24-56). La media de LEIV era 0.6± 0.1 minutos (min) en el grupo 1; 0.5 ± 0.1 min en el grupo 2 y 4.3 ± 0.3 min en el grupo sano. La media de la longitud del pene era 123.2 ± 12.8 mm en el grupo 1, 124.6 ± 11.7 mm en el grupo 2 y 124.8 ± 13.4 mm en el grupo sano. La media de la mucosa peneana era 11.7 ± 1.7 mm en el grupo 1, 14.8 ± 3.1 mm en el grupo 2 y 12.8 ± 3.1 mm en el grupo sano. No había diferencias entre los grupos respecto la longitud del manguito de la mucosa (p = 0.89). Los pacientes del grupo 1 tenían el manguito de la mucosa del pene más corta que los pacientes del grupo 2 que fueron circuncidados por personal no-médico (p = 0.42), pero no había diferencias estadísticamente significativas en cuanto a LEIV entre grupos. Conclusiones: El manguito de la mucosa del pene es más corta si se realiza por médicos, pero la longitud de la mucosa no es un factor de riego para la eyaculación precoz (AU)

Report of an unusual case: testicular involvement of chronic myeloid leukemia 10 years after the complete response.

Testicular extra-medullary myeloid cell tumours are rare tumours presenting in most cases with painless testicular swelling. We are representing here along of a case of 21-year-old man with painless scrotal swelling. From his medical history, he was treated by allogenic bone-marrow transplantation and chemotherapy 10 years ago because of chronic myeloid leukemia. The pathology of orchiectomy specimen revealed malign cells with blastic cell infiltration means a late relapse of chronic myeloid leukemia. The patient has been in hematological remission and no evidence of any myeloid disorders by 10 years' follow up. Although testicular involvement is a rare and an unusual event in blast crisis of chronic myeloid leukemia, extramedullary myeloid cell tumour should be considered in the diagnosis of intratesticular tumours.

Predictors of Gleason score upgrading in patients with prostate biopsy Gleason score ≤6.

INTRODUCTION: The discrepancy between prostate biopsy and prostatectomy Gleason scores is common. We investigate the predictive value of prostate biopsy features for predicting Gleason score (GS) upgrading in patients with biopsy Gleason scores ≤6 who underwent radical retropubic prostatectomy (RRP). Our aim was to determine predictors of GS upgrading and to offer guidance to clinicians in determining the therapeutic option. METHODS: We performed a retrospective study of patients who underwent RRP for clinically localized prostate cancer at 2 major centres between January 2007 and March 2013. All patients with either abnormal digital examination or elevated prostate-specific antigen at screening underwent transrectal ultrasound-guided prostate biopsy. Variables were evaluated among the patients with and without GS upgrading. Our study limitations include its retrospective design, the fact that all subjects were Turkish and the fact that we had a small sample size. RESULTS: In total, 321 men had GS ≤6 on prostate biopsy. Of these, 190 (59.2%) had GS≤6 concordance and 131 (40.8%) had GS upgrading from ≤6 on biopsy to 7 or higher at the time of the prostatectomy. Independent predictors of pathological upgrading were prostate volume <40 cc (p < 0.001), maximum percent of cancer in any core (p = 0.011), and >1 core positive for cancer (p < 0.001). CONCLUSIONS: When obtaining an extended-core biopsy scheme, patients with small prostates (≤40 cc), greater than 1 core positive for cancer, and an increased burden of cancer are associated with increased risk of GS upgrading. Patients with GS ≤6 on biopsy with these pathological parameters should be carefully counselled on treatment decisions.

Does the time from biopsy to radical prostatectomy affect Gleason score upgrading in patients with clinical t1c prostate cancer?

PURPOSE: It is debated whether treatment delay worsens oncologic results in localized prostate cancer (PCa). Few studies have focused on the role of a delay between the time of biopsy and the time of surgery. Thus, we aimed to investigate the effect of the time period between biopsy and surgery on Gleason score upgrading (GSU). MATERIALS AND METHODS: A total of 290 patients who underwent radical retropubic prostatectomy in Ankara Training and Research Hospital were included in the study. The biopsy Gleason score, age, total prostate-specific antigen (PSA) value, prostate volumes, and PSA density (PSAD) were analyzed in all patients. The patients were divided into two groups: patients with GSU (group 1) and patients without GSU (group 2). Variables having a p-value of ≤0.05 in the univariate analysis were selected and then evaluated by use of multivariate logistic regression models. Results were considered significant at p<0.05. RESULTS: GSU occurred in 121 of 290 patients (41.7%). The mean age of the patients was 66.0±7.2 years in group 1 and 65.05±5.60 years in group 2 (p=0.18). The mean PSA values of groups 1 and 2 were 8.6±4.1 and 8.8±4.3 ng/dL, respectively. The mean prostate volumes of groups 1 and 2 were 43.8±14.1 and 59.5±29.8 mL, respectively. The PSAD of group 1 was significantly higher than that of group 2 (0.20 vs. 0.17, p=0.003). The mean time to surgery was shorter in group 2 (group 1, 52.2±22.6 days; group 2, 45.3±15.5 days; p=0.004). According to the logistic regression, time from biopsy to surgery is important in the prediction of GSU. CONCLUSIONS: We suggest that the time period between biopsy and surgery is a significant factor that affects GSU in patients with clinically localized PCa.