THE DIAGNOSTIC ACCURACY OF A COMBINATION OF PREOPERATIVE 68-Ga PSMA PET/CT AND MULTIPARAMETRIC MRI IN LOCALIZED PROSTATE CANCER.

INTRODUCTION: Prostate cancer (PCa) is a common and leading course of cancer-related death in men. Although there are studies on multiparametric magnetic resonance imaging (MpMRI) with good diagnostic results in detecting clinically significant prostate cancer, new methods have been investigated due to the low positive predictive values. In this context, Prostate Specific Membrane Antigen Positron Emission Tomography (PSMA PET) emerges as an alternative imaging method to MpMRI. This study aims to compare 68Ga PSMA I&T-PET/CT and MpMRI in determining tumor location. METHODS: Preoperative MpMRI and 68Ga PSMA I&T-PET/CT scans and pathology specimens of who underwent radical prostatectomy for PCa at our clinic between 2018-2021 were retrospectively evaluated. PSMA I&T-PET/CT, MpMRI, combined imaging were compared for tumor localization according to histopathological data. RESULTS: In terms of tumor localization, MpMRI demonstrated overall accuracy rates 75.9% (p kappa (κ) 0.0001* (0.525)). 68Ga PSMA I&T-PET/CT showed 71.5% (p κ 0.0001* (0.438)). For the combined imaging approach overall accuracy rate were calculated as 79.2% (p κ 0.0001* (0.576)). Additionally, high diagnostic accuracy was achieved for the combined imaging approach, particularly in the intermediate ISUP group. Moreover, SUVmax was calculated as 6.37. CONCLUSION: The combined use of 68Ga PSMA I&T-PET/CT and MpMRI has high diagnostic rates. However, the high cost is a significant disadvantage that limits their routine combined use.

Retrospective comparison of the semen preparation techniques for intrauterine insemination: Swim-up versus density gradient method.

OBJECTIVE: Our study aims to retrospectively examine the relationship between two different sperm preparation methods used in IUI among eight years in terms of pregnancy and live birth rates. METHODS: We evaluated the data of semen samples between December 2012 and March 2020. Three hundred eighty-four samples prepared with Conventional Swim-up (CSW) and 361 samples prepared with Density Gradient-Swim up (DGC-SW) obtained from men applying for IUI were analyzed. Spermiogram results of the semen samples given by men applying for IUI were examined. Data about sperm preparation method, post washed sperm parameters, pregnancy, and live birth rate were collected. Statistical analysis was performed. RESULTS: Basal progressive sperm count was significantly higher in pregnant couples in both CSW and DGC-SW groups (p = 0,032, p = 0,035, respectively). In each group, the post washed total progressive motile sperm count obtained by CSW and DGC-SW methods were significantly higher in pregnant patients (p < 0.05). There was no significant difference between CSW and DGC-SW methods in pregnancy achievement (p = 0,399, χ2 = 0,712). Live birth and miscarriage rates were not different between the groups (p = 0,243, χ2 = 2.827). CONCLUSION: In conclusion, there is no significant difference between CSW and DGC-SW for pregnancy and live birth rates. Our results suggest that both sperm preparation techniques used in IUI are not superior to each other. In other words, the choice of sperm preparation method does not affect the pregnancy rate in couples undergoing IUI.

Do seasonal variations in ambient temperature, humidity and daylight duration affect semen parameters? A retrospective analysis over eight years.

We aimed to evaluate the possible effects of seasonal variation on semen parameters. We retrospectively analysed the data of 6,116 semen samples collected at a university hospital for eight years. The past ambient temperature, relative humidity and daylight duration records, and birth registry of the province were obtained to examine the relationship of seasonal changes in semen parameters with annual birth rates and environmental factors. The mean age was 33.03 ± 6.86 years. We found a significant difference between months for sperm concentration (p < .0001), total sperm count (p < .0001), progressively motile sperm count (p < .0001) and normal sperm morphology (p = .028). The sperm concentration and total count were significantly lower in July and August compared with December, May and June. The progressively motile sperm count in October was 23.6% less than the value of May. The temperature and temperature-humidity index were negatively correlated with semen parameters. The highest number of births was in the summer. However, no correlation was present between deliveries and the semen concentration regarding months (rs  = 0.199, p = .083). In conclusion, we observed significant seasonal and monthly differences in sperm concentration, sperm count and progressively motile sperm count. Increased ambient temperature due to seasonal changes may be a detrimental factor for semen parameters.

Prevalence of daytime urinary incontinence and related risk factors in primary school children in Turkey.

PURPOSE: Urinary incontinence is one of the major urinary symptoms in children and adolescents and can lead to major distress for the affected children and their parents. In accordance with the definitions of the Standardization Committee of the International Children's Continence Society, daytime urinary incontinence (DUI) is uncontrollable leakage of urine during the day. The aim of this cross-sectional study was to investigate the prevalence and associated risk factors of DUI in Turkish primary school children. MATERIALS AND METHODS: The questionnaire, which covered sociodemographic variables and the voiding habits of the children, was completed by the parents of 2,353 children who were attending primary school in Denizli, a developing city of Turkey. The children's voiding habits were evaluated by use of the Dysfunctional Voiding and Incontinence Symptoms Score, which is a validated questionnaire. Children with a history of neurological or urological diseases were excluded. RESULTS: The participation rate was 91.9% (2,164 people). The overall prevalence of DUI was 8.0%. The incidence of DUI tended to decrease with increasing age and was not significantly different between genders (boys, 8.8%; girls, 7.3%; p=0.062). Age, maternal education level, family history of daytime wetting, settlement (urban/rural), history of constipation, urinary tract infection, and urgency were independent risk factors of DUI. CONCLUSIONS: Our findings showed that DUI is a common health problem in primary school children. In an effort to increase awareness of children's voiding problems and the risk factors for urinary dysfunction in the population, educational programs and larger school-based screening should be carried out, especially in regions with low socioeconomic status.

Erectile function and late-onset hypogonadism symptoms related to lower urinary tract symptom severity in elderly men.

The aim of this study was to evaluate the relationship between lower urinary tract symptoms (LUTSs), erectile dysfunction (ED) and symptomatic late-onset hypogonadism (SLOH) in ageing men in the Aegean region of Turkey. Five hundred consecutive patients >40 years old who had been in a steady sexual relationship for the past 6 months and were admitted to one of six urology clinics were included in the study. Serum prostate-specific antigen and testosterone levels and urinary flow rates were measured. All patients filled out the International Prostate Symptom Score and Quality of Life (IPSS-QoL), International Index of Erectile Function (IIEF) and Aging Males' Symptoms (AMS) scale forms. Of the patients, 23.9% had mild LUTSs, 53.3% had moderate LUTSs and 22.8% had severe LUTSs. The total testosterone level did not differ between groups. Additionally, 69.6% had ED. The presence of impotence increased with increasing LUTS severity. Symptomatic late-onset hypogonadism (AMS >27) was observed in 71.2% of the patients. The prevalence of severe hypogonadism symptoms increased with the IPSS scores. A correlation analysis revealed that all three questionnaire scores were significantly correlated. In conclusion, LUTS severity is an age-independent risk factor for ED and SLOH. LUTS severity and SLOH symptoms appear to have a strong link that requires etiological and biological clarification in future studies.

Antiapoptotic effect of angiotensin-II type-1 receptor blockade in renal tubular cells of hyperoxaluric rats.

In this study, we investigated the protective effect of losartan as an AT1 receptor antagonist by evaluating the expression of apoptosis-regulatory genes that contribute to the progressive damage in the renal tubules of hyperoxaluric rats. Rats were divided into 4 groups of 10 each; control (C), ethylene glycol (EG), ethylene glycol + losartan (EG + L) and Losartan (L). For 4 weeks 0.8% EG, as a precursor for oxalate, was administered to EG and EG + L and losartan (300 mg/l) was administered to groups EG + L and L. Urine and blood samples were collected for biochemical determination. Bcl-2, bax, caspase-3 and TGF-beta 1 antibodies were used for immunohistochemistry. Apoptosis was determined by TUNEL method. A marked increase in urinary oxalate levels of the rats in EG and EG + L groups was found. In the EG group a diffuse amount of oxalate crystals into the tubular lumina and interstitium in the cortex was observed. In the EG group GBM thickening, interstitial fibrosis and tubular atrophy with infiltration of mononuclear cell findings reduced in the EG + L group were presented as well. In the EG group, immunoreactivity of TGF-beta 1 was increased in glomeruli and tubuli. In the EG + L group, immunoreactivity of TGF-beta 1 was decreased compared to the EG group. Bax expression increased in the renal tubules of EG group and reduced in the EG + L group comparing to the control. In the EG + L group, the immunoreactivity of bcl-2 was increased in glomeruli. In EG + L treated group, number of caspase-3 immunopositive cells were decreased compared to all groups (P < 0.01). Apoptotic cells were increased in the EG-treated group compared to the other groups. Decreased apoptotic cell number was observed in the EG + L compared to the EG group (P < 0.01). Our findings suggest that losartan may provide a beneficial effect against tubulointerstitial damage and decrease renal tubular apoptosis caused by hyperoxaluria.

Does two episodes of acute urinary retention lead to additional ischemia-reperfusion injury in rat bladder?

AIM: To determine whether two episodes of acute urinary retention lead to additional ischemia-reperfusion injury due to decompression of the bladder, or not. MATERIALS AND METHODS: Sham, retention and recurrent retention groups consisting of 5, 8 and 8 Wistar Albino male rats were randomized, respectively. After the bladders of rats were emptied with 3F catheter, penile urethras were clamped with aneurism clamp and waited for 30 min after diuresis was forced. At the end of this period, penile clamps were removed and the bladder was again decompressed with 3F catheter and after 30 min removed for examination. In the recurrent retention group, the same process was repeated after an interval of one week. Malonedialdehyde (MDA) levels, indicator of lipid peroxidation and myeloperoxidase (MPO) levels, indicator of leukocyte activation, were examined biochemically in the tissues of the removed bladders. RESULTS: In the retention and recurrent retention groups, the average increase in bladder MDA and MPO values was higher than the values of sham group (P < 0.05), however, no significant difference was determined between retention and recurrent retention groups (P > 0.05). CONCLUSION: In the bladder tissue, due to acute urinary retention and following decompression process, ischemia-reperfusion injury occurs. Two episodes of acute urinary retention do not lead to additional the ischemia-reperfusion injury that develops in the bladder.

The effect of partial unilateral ureteral obstruction release and allopurinol on the renal malondialdehyde and glutathione levels.

PURPOSE: The aim of the present study was to evaluate whether relief of partial unilateral ureteral obstruction (PUUO) with or without antioxidant drug affect renal tissue malonedialdehyde (MDA) and glutathion (GSH) levels. MATERIALS AND METHODS: A total of 25 rats were used in this PUUO study. Partial unilateral ureteral obstruction was created by the burial of the upper one-third of the left ureter in the psoas muscle. The rats were sacrificed on 28th day following PUUO. Relief of the obstruction was performed twenty minutes before sacrifice by cutting the proximal ureter in reperfusion group. 50 mg/kg intraperitoneal allopurinol was administered 20 minutes before relief of obstruction in the antioxidant group. Renal tissue MDA and GSH levels were measured in both kidneys. RESULTS: At the end of the study 5, 7 and 7 rats could only be interpreted in sham, reperfusion and antioxidant groups, respectively. While the mean left and right renal MDA and GSH levels were statistically different from each other in reperfusion group (P < 0.001), there were no significant differences in the sham (P > 0.05) and antioxidant (P > 0.05) group. Both the mean sham group left and right renal tissue MDA or GSH levels were significantly different from reperfusion group, but only the mean sham group left renal tissue MDA and right renal tissue GSH levels were not statistically different from antioxidant group (P < 0.05). The mean left or right renal MDA and GSH tissue levels of the antioxidant group were statistically different from reperfusion group (P < 0.05) except for the right renal tissue GSH level (P > 0.05). CONCLUSION: Partial unilateral ureteral obstruction leads to oxidative injury by relief of obstruction in both kidneys. The antioxidant allopurinol has a beneficial effect on renal MDA and GSH levels in both kidneys.

Urine and serum free IGF-1 levels in patients with bladder cancer: a brief report.

Insulin-like growth factor (IGF)-1, a mitogenic and anti-apoptotic peptide, can affect the proliferation of epithelial cells, and is thought to play a role in cancer development. The free IGF-1 represents the biologically active fraction of IGF-1. We hypothesised that there is a difference in free IGF-1 levels in the urine and serum from patients with TCC and normal subjects. Urine and blood samples were collected from 30 cases of superficial TCC and an equal number control subjects without malignancy. Free IGF-1 levels were measured in duplicate by radioimmunoassay. Specimens of bladder carcinoma were staged histopathologically using the Mostoffi grading system. Statistical analyses were performed using the Mann-Whitney U-test, Pearson correlation and covariate analysis. There was no significant difference in urine and serum free IGF-1 levels between the two groups. The correlation between urine and serum free IGF-1 levels and age was not significant. There was also no significant relationship between free IGF-1 levels and histopathological grading. The results of this pilot study reveal that the free IGF-1 level does not help predict tumour marker in the patients with bladder cancer.

Does digital rectal examination affect uroflowmetry measurements?

AIMS: To determine whether digital rectal examination (DRE) would affect uroflowmetry parameters and whether these findings were not due to the circaidan changes. METHODS: A total of 79 male patients (59 in study and 20 in control group) were included in this study. First uroflowmetry was done at 10:00 am just before the genitourinary physical examination in the study group. Second and third uroflowmetry was performed at the 6th and 24th hour after the first uroflowmetry. The same uroflowmetry tests were done in a control group without DRE. Voided volume and maximum and average flow rate parameters of uroflowmetry were interpreted in our study. The relationship among first, second, and third uroflowmetry parameters were determined in the study and control groups. RESULTS: There were statistically no difference between the mean first, or 6th- or 24th-hour uroflowmetry parameters of the study and control groups (P > 0.05). CONCLUSIONS: We could not find any effect of DRE on uroflowmetry parameters. Studies in a larger patient series would be appropriate for recommending DRE before or after uroflowmetry test.