Novel Algorithm for the Management of Hematospermia.

Hematospermia or hemospermia is traditionally defined as the presence of fresh or altered blood in semen. Several factors might cause hematospermia, including infectious, inflammatory, iatrogenic, traumatic, structural, neoplastic, vascular, and systemic factors. The main aim of evaluation is to identify significant or treatable underlying causes of hematospermia and to re-assure the patient if no causative factor is detected after full evaluation. This review aims novel management of hematospermia, including a detailed history, physical examination, appropriate laboratory investigations, and diagnostic imaging, based on underlying causes of hematospermia.

The presence of SARS-CoV-2 virus in semen samples of patients with COVID-19 pneumonia.

The SARS-CoV-2 set off a pandemic involving millions of people around the world. The topic of discussion is the possible viral detection in different body fluids than respiratory droplets. Therefore, we evaluated the possible presence of SARS-CoV-2 in semen and urine samples. Thirty patients were included in the study aged 35.67 ± 6.84 years. The day after the pharyngeal and/or nose swab of SARS-CoV-2 was positive, urine and semen samples were taken from patients, and the presence of SARS-CoV-2 was investigated. Laboratory tests and chest CT findings were evaluated simultaneously. SARS-CoV-2 was detected in four (13.3%) patients' semen samples and in seven (23.3%) patients' urine samples. White blood cell (WBC), neutrophil, C-reactive protein (CRP), ferritin, alanine transaminase (ALT), lactate dehydrogenase (LDH) and procalcitonin were significantly higher in patients with SARS-CoV-2 in semen (p < .05), though no statistical difference was found in urine (p > .05). Patients with severe pneumonia findings in Chest CT images are likely to be PCR positive in semen and urine samples (p = .005, p = .001). SARS-CoV-2 was not detected in urine and semen samples of patients after they had recovered (average duration 23 ± 4 days). SARS-CoV-2 can be detected in the urogenital fluids of patients with severe clinical conditions and high viral load.

Is there any priority between the alpha blockers on voiding functions after transrectal ultrasound guided prostate biopsy?

OBJECTIVE: Transrectal ultrasound-guided prostate biopsy is the gold standard in the diagnosis of prostate cancer. Major and minor complications may develop at varying rates after prostate biopsies, one of which is voiding impairment. This study aimed to evaluate whether all alpha1-blockers were effective in preventing voiding impairment after a transrectal ultrasound-guided prostate biopsy and if so, was one superior to the others. MATERIAL AND METHODS: This study included 240 patients who underwent a transrectal ultrasound-guided 12-core prostate biopsy and were prospectively randomized. Of the patients, 40 received 10 mg alfuzosin, 40 received 4 mg doxazosin, 40 received 8 mg silodosin, 40 received 0.4 mg tamsulosin, and 40 received 5 mg terazosin beginning on the day before the biopsy and for the following 30 days. The international prostate symptom score (IPSS), maximal flow rate, and post-void residual urine were recorded in all the patients before the procedure and on post-biopsy days 7 and 30. All he patients were followed up and questioned about voiding difficulty and acute urinary retention after the procedure. RESULTS: In all the alpha1-blocker groups, the IPSS and post-void residuals were statistically significantly lower, and the maximal flow rate was statistically significantly greater on post-biopsy days 7 and 30 compared with the baseline values (p<0.05). No patient in any of the alpha1-blocker groups developed acute urinary retention after the biopsy. CONCLUSION: To prevent voiding impairment and deterioration in the quality of life after a prostate biopsy, preemptive therapy with alpha1-blockers may have a protective role, especially in patients with large prostate volumes.

The effect of testosterone replacement therapy on bladder functions, histology, apoptosis, and Rho-kinase expression in bladder outlet obstruction and hypogonadism rat model

Background/aim: The effect of testosterone replacement therapy was investigated on bladder functions, histology, apoptosis as well as Rho-kinase expression in the rat bladder outlet obstruction (BOO) and hypogonadism models. Materials and methods: 30 mature male rats divided into 4 groups: sham group (n = 8), BOO group (n = 8), BOO + orchiectomy group (n = 7), BOO + orchiectomy + testosterone (T) treatment group (n = 7). Cystometric findings, apoptosis index, Rho-kinase (ROCK-2) expression, and smooth muscle/collagen ratio were compared. Results: BOO did not change ROCK-2 expression level, compared to sham group (P > 0.05). However, when compared to BOO group (P < 0.01), BOO + orchiectomy led ROCK-2 increase. The testosterone treatment failed to reverse the up-regulation of ROCK-2 induced by orchiectomy although it tended to lower ROCK-2 level. Compared to sham group (P = 0.002), changes in maximal bladder capacity and leak point pressure were higher (P = 0.026, P = 0.001), and bladder compliance was lower in BOO group. Also, the apoptosis index was different between the two groups (P = 0.380). Smooth muscle/collagen ratio was higher in BOO + orchiectomy + T group than in BOO + orchiectomy group (P = 0.010). Conclusions: The research draws attention to alternating treatment approaches in case of the presence of hypogonadism and BOO.

Hematospermia is rarely related to genitourinary cancer: lessons learned from 15 years of experience with 342 cases.

We investigated the prevalence of hematospermia among the 161,258 men with ≥18 years old, presenting to outpatient clinics with urologic complaints, between January 2003 and December 2017. We also recorded underlying causes of hematospermia to determine frequency of genitourinary cancer in 342 men who presented with hematospermia. Further evaluations such as urine/semen culture, Meares-Stamey four glass test, transrectal/scrotal ultrasound, pelvic magnetic resonance imaging (MRI), cystourethroscopy, and prostate biopsy were performed in the presence of additional symptoms and findings or recurrence of hematospermia after treatment of patients with monosymptomatic hematospermia. The prevalence of hematospermia was detected as 0.21% (342/161,258) among the urological patients. The mean age of the patients was 45.05 ± 14.04 years (range 18-85), and the median duration of hematospermia was 15 days (range 1-7200). In 306 (89.5%) of the patients, hematospermia was resolved after medical therapy for infections/inflammations, surgery for ductal obstruction and cysts, prostate and testicular cancer. However, 36 (10.5%) had persistent hematospermia. The most relevant etiologic cause of hematospermia was inflammation/infections in 169 patients (49.4%), and genitourinary cancers were detected in only 11 patients (3.2%) as prostate cancer in 8 and testicular cancer in 3. Hematospermia is seen frequently due to inflammatory or infectious causes, and is rarely associated with genitourinary cancer. However, genitourinary cancers should be kept in mind in the differential diagnosis of patients with recurrent/persistent hematospermia and associated symptoms, such as hematuria, lower urinary tract symptom, and scrotal pain/swelling.

Comparison of Long-Term Results and Couples' Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation.

INTRODUCTION: No study has compared surgical outcomes and couples' satisfaction among the 3 types of implants, with all brands available on the markets. AIMS: To compare long-term complications, mechanical reliability, and couples' satisfaction with penile implant types and brands in patients who underwent penile prosthesis implantation. We also investigated whether there are risk factors that might predict couples' dissatisfaction. METHODS: This retrospective study included 883 patients with erectile dysfunction who underwent penile prosthesis implantation. Of the patients, 349 had malleable penile implant, 26 had 2-piece implants, and 508 had 3-piece implants. MAIN OUTCOME MEASURE: Couples' satisfaction after surgery was evaluated with the modified Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire. Surgical outcomes, mechanical reliability, and couples' satisfaction were compared according to type and brand of the penile implants in all patients. RESULTS: The mean age and follow-up period of the patients were 57.74 ± 9.59 years and 67.81 ± 49.11 months, respectively. The couples' satisfaction rates were significantly higher in the 3-piece implant group than in the malleable group (P < .001), but there was no significant difference between the 2-piece and 3-piece implant groups. There was no difference in terms of couples' satisfaction according to the brand of the implants. Of the patients who had malleable implants, 27 (7.7%) underwent 3-piece penile prosthesis implantation due to dissatisfaction; however, only 1 (0.2%) of the patients with a 3-piece implant was switched to a malleable implant (P < .001). The highest rate of revision surgery due to penile corporal perforation was in the malleable group (2.6%), whereas the highest rate of revision surgery due to penile implant malfunction occurred in the 3-piece implant group (5.5%) (P = .021 and .001, respectively). To analyze risk factors, using multivariate analysis, presence of complication was the only predictor that might cause couples' dissatisfaction (P = .003). CONCLUSIONS: 3-piece and 2-piece implants have higher couples' satisfaction rates than the malleable implant. Brands of implants did not have any effect on the couples' satisfaction. Regarding detail of the complications, the 3-piece implant has a lower rate of penile corporal perforation and a higher rate of penile implant malfunction than the malleable implant. Patients with erectile dysfunction who need a penile implant should be informed about surgical outcomes, brands, and types of penile implants. Prosthesis choice should be customized to individual patient's expectations/conditions and tailored accordingly. Çayan S, Asci R, Efesoy O, et al. Comparison of Long-Term Results and Couples' Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation. J Sex Med 2019;16:1092-1099.

Comparison of Patient's Satisfaction and Long-term Results of 2 Penile Plication Techniques: Lessons Learned From 387 Patients With Penile Curvature.

OBJECTIVE: To compare the patient's satisfaction and long-term results of 2 penile plication procedures in patients with penile curvature. METHODS: This retrospective study included 387 patients with congenital penile curvature (n = 260) and Peyronie's disease (n = 127) who underwent surgical correction of penile curvature with penile plication procedures. Of the patients, 202 underwent plication of tunica albuginea with the Lue's 16-dot technique, while 185 underwent highly superficial excision of tunica albuginea with the modified Nesbit corporoplasty. Surgical outcomes and patient's satisfaction were compared between the 2 techniques in all patients. RESULTS: The mean duration of surgery was significantly shorter in the 16-dot plication technique (48.1 ±â€¯7.5 minutes), compared with the modified Nesbit corporoplasty (63 ±â€¯16.9 minutes) (P = .001). Complete penile straightening was achieved in 87.6% of the patients who underwent 16-dot plication technique and in 89.7% of the patients who underwent modified Nesbit plication, revealing no difference (P = .514). The rates of penile sensory loss (P = .001) and de-novo erectile dysfunction (P = .016) were significantly higher in the modified Nesbit corporoplasty than in the 16-dot plication technique, but rate of suture related complications was significantly higher in the 16-dot plication technique than in the modified Nesbit corporoplasty (P = .001). The patients with congenital penile curvature had significantly less ratio of postoperative penile length loss and de-novo erectile dysfunction than Peyronie's disease patients. CONCLUSION: Overall, both surgical techniques have very high success and satisfaction rates with very low complication rates. However, the types of complications are significantly different between the 2 surgical procedures. Therefore, patients with penile curvature should be informed about outcomes of penile plication procedures, and surgical method should be preferred based on patient's preference and surgeon's experience.

The short-term efficacy of intravesical instillation of hyaluronic acid treatment for bladder pain syndrome/interstitial cystitis.

OBJECTIVE: The aim of the study was to evaluate the short term efficacy of intravesical instillation of hyaluronic acid in patients with Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC). MATERIAL AND METHODS: The study included 54 women with BPS/IC who received intravesical instillation of hyaluronic acid treatment (120 mg/50 mL) for 6 weeks. Visual Analogue Scale (VAS), The O'Leary Sant Questionnaire (ICSI/ICPI) forms of the patients were filled by the clinician and the health technician separately before and 3 months after the treatment. Demographic characteristics of the patients were recorded, and effectiveness of the treatment was investigated according to these data. RESULTS: Decrease in mean VAS and mean total scores of ICSI and ICPI was observed after three months of intravesical instillation of hyaluronic acid treatment (55%, p<0.05 and 48.5%, p<0.05 and 45.5%, p<0.05, respectively). In most of the patients, all scores of VAS, ICSI and ICPI improved (minimum: 75.9%, maximum: 94.4%). Mostly the symptoms of nocturia and pollakiuria were seen, and treated after the instillation treatment. CONCLUSION: It has been observed that in the short-term follow-up of intravesical instillation of hyaluronic acid treatment, the symptoms have highly improved. Also, Turkish versions of ICSI and ICPI forms were reliable and comprehensible.

The results of ultrasound-guided percutaneous nephrostomy tube placement for obstructive uropathy: A single-centre 10-year experience.

OBJECTIVE: The aim of this study was to determine the results of ultrasound-guided percutaneous nephrostomy tube placement performed solely by urologists. We present our relevant one decade experience in a tertiary care hospital. MATERIAL AND METHODS: We evaluated technical success and complication rates of ultrasound-guided percutaneous nephrostomy tube placement for obstructive uropathy in our clinic, between December 2004 and January 2015. Data were retrieved retrospectively from patients' files. This procedure was performed by urologists and two different methods for renal access were employed: Seldinger technique and direct puncture technique. Percutaneous nephrostomy tube placement was considered successful if the tube was placed in the renal pelvis and drained urine spontaneously and adequately. Complications were classified according to the Guideline of Society of Interventional Radiology Guidelines for Percutaneous Nephrostomy. RESULTS: Four hundred and fifteen percutaneous nephrostomy tube placements were performed in 354 patients (165 men and 159 women) suffering from obstructive uropathy due to several benign (57.3%) or malign (42.7%) diseases. The mean age in this study group was 43.2 years (range 27 to 81). We were found that 228 procedures were performed by using the Seldinger technique and 187 using direct puncture technique. The overall technical success, major and minor complications rates were 96.1%, 11.1%, and 7.7%, respectively. The Seldinger technique and direct puncture technique were compared: technical success rate was 97.8% vs. 94.1% (p=0.052). There was no difference between the two techniques in terms of major and minor complication rates. CONCLUSION: Ultrasound-guided percutaneous nephrostomy tube placement is a safe, easy and effective technique for providing temporary or permanent drainage of an obstructed renal pelvi-calyceal system. This procedure can be performed effectively and safely by an urologist.

The Effect of Testosterone Replacement Therapy on Penile Hemodynamics in Hypogonadal Men With Erectile Dysfunction, Having Veno-Occlusive Dysfunction.

Hypogonadism may cause veno-occlusive dysfunction (VOD) by structural and biochemical alterations in the cavernosal tissue. The aim of the study was to investigate the effect of testosterone replacement therapy (TRT) on penile hemodynamics in hypogonadal men with erectile dysfunction and VOD. The study included 32 hypogonadal men with erectile dysfunction, having VOD. All patients underwent penile color Doppler ultrasonography (PCDU) at the beginning and 6 months after the initial evaluation. Erectile function was evaluated with the 5-item version of the International Index of Erectile Function (IIEF-5); hypogonadism was evaluated by testosterone measurement and the Aging Male Symptoms (AMS) scale. All patients received transdermal testosterone 50 mg/day for 6 months. Clinical and radiological findings were compared before and 6 months after the TRT. The mean age was 58.81 ± 4.56 (52-69) years. Mean total testosterone levels were 181.06 ± 39.84 ng/dL and 509.00 ± 105.57 ng/dL before and after the therapy, respectively ( p < .001). While all patients had physiological serum testosterone levels (>320 ng/dL) after the therapy, three cases (9.3%) had no clinical improvement of hypogonadism symptoms. Cavernosal artery peak systolic velocity (PSV) and resistive index (RI) significantly increased, and end diastolic velocity (EDV) significantly decreased after TRT. VOD no longer existed in 21 (65.6%) of the cases. This study demonstrated that TRT may restore penile hemodynamics in hypogonadal men with VOD.

The effect of testosterone treatment on prostate histology and apoptosis in men with late-onset hypogonadism.

OBJECTIVES: To investigate the effect of testosterone replacement therapy (TRT) on prostate histology and apoptosis in men with late-onset hypogonadism (LOH). METHODS: The study included 25 men, having LOH with prostate-specific antigen (PSA) level of 4 ng/ml or less. All patients underwent transrectal ultrasound guided prostate biopsy at baseline, and received testosterone undecanoate treatment for 1 year. Prostate biopsy was repeated at the end of 1 year of testosterone therapy. In addition to clinical and biochemical parameters, prostate histology and apoptotic index (AI) were compared before and after the TRT. RESULTS: The mean serum total testosterone significantly increased from 178.04 ± 51.92 to 496.28 ± 103.73 ng/dl (p = 0.001). No significant differences were observed in serum total and free PSA level, prostate volume and maximal urinary flow rate. There were also no significant differences in AI, stroma/epithelial cells ratio, Ki-67 positive cells and atrophy score of prostate tissue before and after the TRT. CONCLUSIONS: This study demonstrated that TRT did not affect serum PSA level, prostate volume and maximal urinary flow rate. This study also suggests that TRT does not cause the risk for prostate cancer development, because of no significant differences in prostate histology after TRT.

The incidence and risk factors of resistant E. coli infections after prostate biopsy under fluoroquinolone prophylaxis: a single-centre experience with 2215 patients.

We evaluated the incidence and risk factors of resistant Escherichia coli infections after the prostate biopsy under flouroquinolone prophylaxis. From January 2003 to December 2012, we retrospectively evaluated the records of 2215 patients. The risk factors were described for infective complications and resistant E. coli in positive cultures was calculated. Of 2215 patients, 153 had positive urine cultures, such as 129 (84·3%) E. coli, 8 (5·2%) Enterococcus spp., 6 (3·9%) Enterobacter spp., 5 (3·2%) Pseudomonas spp., 3 (1·9%) MRCNS, and 2 (1·3%) Klebsiella spp. Of the positive urine cultures which yielded E. coli, 99 (76·7%) were evaluated for fluoroquinolone resistance. Of those, 83 (83·8%) were fluoroquinolone-resistant and composed of 51 (61·4%) extended-spectrum beta-lactamase (ESBL)-positive. Fluoroquinolone-resistant E. coli ratios were 73·4 and 95·9% before 2008 and after 2008, respectively (P = 0·002). The most sensitive antibiotics for fluoroquinolone-resistant E. coli strains were imipenem (100%), amikacin (84%) and cefoperazone (83%). The use of quinolones in the last 6 months and a history of hospitalization in the last 30 days were found to be significant risk factors. We found that resistant E. coli strains might be a common microorganism in patients with this kind of complication. The risk factors for development of infection with these resistant strains were history of the use of fluoroquinolones and hospitalization.

Comparison of single-session aspiration and ethanol sclerotherapy with laparoscopic de-roofing in the management of symptomatic simple renal cysts.

OBJECTIVE: The aim of the study was to compare the efficacy and cost-effectiveness of single-session aspiration and ethanol sclerotherapy with laparoscopic de-roofing in the management of symptomatic simple renal cysts. MATERIAL AND METHODS: Between March 2010 and December 2012, patients with simple renal cysts presenting with pressure and pain symptoms were divided into two groups. In Group 1 following local anesthetic administration, single session percutaneous aspiration with 95% ethanol sclerotherapy (n=38) and in Group 2 transperitoneal laparoscopic de-roofing under general anesthesia (n=42) were performed. The data were evaluated retrospectively and demographic characteristics, duration of operation and hospitalization, complication rates, cost effectiveness, radiological and symptomatic success rates at six month- follow-up were compared between the two groups. RESULTS: The mean age and gender of the patients, cyst diamater, side and localization of the cyst and indications for intervention were similar in two groups. The median course of treatment and hospitalization were signifcantly decreased in Group 1 (respectively 33 min versus 59 min and 6 hours versus 24 hours, p<0.001). As complications in Group 1 fever in two patients (5.3%) and in Group 2 bleeding requiring transfusion in one patient (2.4%) were observed (p=0.495). Total cost was calculated as $ 131.7 in Group 1 and $ 729.8 in Group 2. After the sixth month follow-up control radiological success rates were found to be signifcantly higher in Group 2, while symptomatic success rate is similar in both groups (63.2% versus 95.2%, p<0.001; 94.7% versus 97.6%, p=0.498, respectively). CONCLUSION: Single-session percutaneous aspiration with alcohol sclerotherapy and laparoscopic de-roofing are safe and effective methods in the treatment of symptomatic simple renal cysts. While radiological recurrence rate was higher in single session percutaneous aspiration with alcohol sclerotherapy, however similar symptomatic recurrence rates were seen with laparoscopy. Therefore single session percutaneous aspiration combined with alcohol sclerotherapy seems to be an important option in the treatment of simple renal cysts when considering the duration of the operation, hospitalization and total costs of the process.

Rho-kinase levels in testicular ischemia-reperfusion injury and effects of its inhibitor, Y-27632, on oxidative stress, spermatogenesis, and apoptosis.

OBJECTIVE: To investigate testicular Rho-kinase levels and the effects of its inhibitor, Y-27632, on oxidative stress, spermatogenesis, and apoptosis in testicular ischemia-reperfusion rat model. METHODS: The study included 29 adult Wistar-Albino male rats weighing 150-200 g. The rats were divided into 3 groups. Group 1 underwent sham operation (n = 10). In group 2, left testicular torsion-detorsion was performed (n = 9). In group 3, Rho-kinase inhibitor Y-27632 (5 mg/kg) was injected intraperitoneally 30 minutes before detorsion (n = 10). Two months later, bilateral orchiectomy was performed in all the groups. Rho-kinase levels by Western blotting, apoptosis with terminal deoxynucleotidyl transferase dUTP nick end labeling method, testicular damage and spermatogenesis with modified Johnsen score, testicular total antioxidative status, and total oxidative status were measured. RESULTS: In the torsion-detorsion (T/D) group, Rho-kinase level increased significantly, compared with the sham group (P = .025). In the Y-27632 treatment group, Johnsen scores were significantly higher, and apoptosis indexes were significantly lower, compared with the T/D group (P = .001). Significantly higher total antioxidative status levels and lower total oxidative status levels were observed in the Y-27632 treatment group, compared with the T/D group (P = .001 and P = .002, respectively). CONCLUSION: Testicular ischemia-reperfusion significantly increased Rho-kinase levels in rats, and administration of Rho-kinase inhibitor, Y-27632, before detorsion might prevent ischemia-reperfusion injury.

The young urologists' academic problems in the context of law and ethics.

The European Association of Urology defines a young urologist as an urologist under the age of 40 or the urologist who has completed their residency within the last 5 years, irrespective of their current academic position. The time interval between the residency and higher specialization in urology is an important time period for them to learn how to stand on their feet and realize their plans of academic career. Young urologists who want academic transition have encountered various problems nowadays in Turkey. The aim of this review is to raise awareness about the problems of young urologists during academic life in the context of law and medical ethics.

Complications of transrectal ultrasound-guided 12-core prostate biopsy: a single center experience with 2049 patients.

OBJECTIVE: Currently, transrectal ultrasound-guided (TRUS) systematic prostate biopsy is the standard procedure in the diagnosis of prostate cancer. Although TRUS-guided prostate biopsy is a safe method, it is an invasive procedure that is not free from complications. In this prospective study we evaluated the complications of a TRUS-guided 12-core prostate biopsy. MATERIAL AND METHODS: The study included 2049 patients undergoing transrectal ultrasound-guided 12-core prostate biopsy used in the diagnosis of prostate cancer. The indications for the prostate biopsy were abnormal digital rectal examination findings and/or an elevated serum total prostate specific antigen (PSA) level (greater than 4 ng/mL). The participants received prophylactic oral ciprofloxacin (500 mg) the night before and the morning of the biopsy, followed by 500 mg orally twice daily for 2 days. To prevent development of voiding disorders, the patients also received oral alpha blockers for 30 days starting the day before the procedure. A Fleet enema was self-administered the night before the procedure for rectal cleansing. The complications were assessed both 10 days and 1 month after the biopsy. RESULTS: The mean age, serum total PSA level and prostate volume of the patients were 65.4±9.6 years, 18.6±22.4 ng/mL and 51.3±22.4 cc, respectively. From these 2.042 biopsies, 596 cases (29.1%) were histopathologically diagnosed as prostate adenocarcinoma. Minor complications, such as hematuria (66.3%), hematospermia (38.8%), rectal bleeding (28.4%), mild to moderate degrees of vasovagal episodes (7.7%), and genitourinary tract infection (6.1%) were noted frequently. Major complications were rare and included urosepsis (0.5%), rectal bleeding requiring intervention (0.3%), acute urinary retention (0.3%), hematuria necessitating transfusion (0.05%), Fournier's gangrene (0.05%), and myocardial infarction (0.05%). CONCLUSION: TRUS-guided prostate biopsy is safe for diagnosing prostate cancer with few major but frequent minor complications. However, patients should be informed and followed-up after biopsy regarding possible complications.

[Sexual injuries during consensual sexual activity]. / Istemli cinsel aktivite sirasinda olusan cinsel yaralanmalar.

BACKGROUND: The aim of this study was to retrospectively evaluate sexual injury treated in our clinic. METHODS: We evaluated the results of 31 patients (17 males, 14 females; mean age 31,97±11,64; range 18 to 60 years) with sexual injury during consensual sexual activity, who presented to the emergency department between January 2004 and December 2010. Patients' age, etiology of injury, time passed since trauma, physical/operative examination results, type of treatment, duration of hospitalization, and postoperative complications were investigated. RESULTS: Sexual injury occurred in women as vaginal laceration and in man as penile fracture. All of the cases were treated with early surgical repair. Vaginal injuries were formed in virginal girls during the first sexual intercourse. Cases usually complained of vaginal pain and then bleeding during sexual activity. The commonest site of injury was the posterior vaginal fornix. Etiology of penile fracture was sexual intercourse and masturbation. Sudden pain in the penis, edema, color change, and sudden detumescence were the main complaints. Eleven patients had right, 5 had left and 1 had bilateral tunical ruptures, with defects of 0.5-3 cm in length. The patient with bilateral injury had accompanying incomplete urethral rupture. CONCLUSION: Sexual injury can be diagnosed effectively based on history and physical examination, and may be treated successfully with early surgical procedure.

The effect of aromatase inhibitor letrozole on body mass index, serum hormones, and sperm parameters in infertile men.

We investigated the effect of letrozole, an aromatase inhibitor, on body mass index, serum hormones, and sperm parameters in infertile men with decreased T:E(2) ratios. All sperm parameters increased after letrozole treatment. Letrozole may be effectively used to improve sperm parameters in infertile men with a low serum T:E(2) ratio.

Bladder metastasis of malignant melanoma: a case report and review of literature.

Metastatic malignant melanoma of the bladder is extremely rare in clinical practice with less than 10 cases reported in the last 30 years in the English literature. We report a case of malignant melanoma metastasis into the bladder, and review of the pertinent literature. A 60-year-old woman with a history of malignant melanoma in the distal phalanx on the right middle finger, excised 8 years ago presented with gross hematuria and weight loss. She underwent cystoscopy and complete transurethral resection of the bladder tumor. Pathological examination showed metastatic malignant melanoma of the bladder mucosa. The patient eventually died 7 months after transurethral resection.

The effect of CO2 pneumoperitoneum on serum prostate-specific antigen levels in patients undergoing laparoscopic cholecystectomy.

BACKGROUND: Recently, several studies have shown an elevation of serum prostate-specific antigen (PSA) levels after the events associated with presumed pelvic ischemia. Although it has been shown that CO2 pneumoperitoneum during laparoscopic surgery causes splanchnic ischemia, no study has investigated the PSA levels after this procedure. This study aimed to evaluate the effects of CO2 pneumoperitoneum on serum total PSA (tPSA) and free PSA (fPSA) levels in patients undergoing laparoscopic cholecystectomy. METHODS: This study involved 30 men who underwent elective laparoscopic cholecystectomy. Serum tPSA and fPSA levels and f/tPSA ratios were determined the day before surgery (baseline), immediately before insufflation, after desufflation, and 24 hours and 7 days after surgery. RESULTS: Serum tPSA and fPSA values after desufflation and 24 hours after surgery were significantly higher than the values before insufflation and at baseline (P<0.01), whereas the f/tPSA ratio did not change (P>0.05). PSA levels decreased to baseline levels after 7 days. CONCLUSIONS: Our study showed that CO2 pneumoperitoneum during laparoscopic surgery can cause a rise in serum tPSA and fPSA levels. We think that CO2 pneumoperitoneum during laparoscopic surgery should be added to list of the events in which PSA measurements must be interpreted with caution.