Should manual detorsion be a routine part of treatment in testicular torsion?

BACKGROUND: It was aimed to investigate the efficiency and reliability of the manual detorsion (MD) procedure in patients diagnosed with testicular torsion (TT). METHODS: A retrospective analysis was made of the data of 57 patients diagnosed with TT, comprising 20 patients with successful MD (Group I), 28 patients who underwent emergency orchiopexy (Group II), and 9 patients applied with orchiectomy (Group III). The groups were compared in respect of age, and duration of pain. The success rate of MD, the time of testicular fixation (TF), any problems encountered in follow-up, and follow-up times were analyzed in Group I. Data were analyzed with P-P pilot, Mann-Whitney U, Kruskal Wallis and Chi-square tests. A value of p < 0.05 was considered statistically significant. RESULTS: MD was successful and detorsion could be achieved in 20 of 26 patients. The groups were similar in respect of age (p = 0.217). The median duration of pain was 3 (1-8), 4 (1-72), and 48 (12-144) hours in Groups I, II, and III, respectively, and determined as similar in Groups I and II (p = 0.257), although a statistically significant difference was determined between the 3 groups (p < 0.001). TF was applied to Group I after median 10 (0-45) days, and no parenchymal disorder was determined in the median follow-up period of 21.5 (2-40) months. CONCLUSION: MD that can be easily and immediately performed after the diagnosis of TT decreases ischemia time. This seems to be an efficient and reliable procedure when applied together with elective orchiopexy, as a part of the treatment.

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 Sexual Intercourse Be an Alternative Therapy for Distal Ureteral Stones? A Prospective, Randomized, Controlled Study.

OBJECTIVE: To investigate the effect of sexual intercourse on spontaneous passage of distal ureteral stones. MATERIAL AND METHODS: The patients were randomly divided into 3 groups with random number table envelope method. Patients in group 1 were asked to have sexual intercourse at least 3-4 times a week. Patients in group 2 were administered tamsulosin 0.4 mg/d. Patients in group 3 received standard medical therapy alone and acted as the controls. The expulsion rate was controlled after 2 and 4 weeks. Differences in the expulsion rate between groups were compared with the chi-square test for 3 × 2 tables. P <.05 was considered as statistically significant. RESULTS: The mean stone size was 4.7 ± 0.8 mm in group 1, 5 ± 1 mm group 2, and 4.9 ± 0.8 mm group 3 (P = .4). Two weeks later, 26 of 31 patients (83.9%) in the sexual intercourse group, and 10 of 21 patients (47.6%) in tamsulosin group passed their stones, whereas 8 of 23 patients (34.8%) in the control group passed their stones (P = .001). The mean stone expulsion time was 10 ± 5.8 days in group 1, 16.6 ± 8.5 days in group 2, and 18 ± 5.5 days in group 3 (P = .0001). CONCLUSION: Our results have indicated that patients who have distal ureteral stones ≤6 mm and a sexual partner may be advised to have sexual intercourse 3-4 times a week to increase the probability of spontaneous passage of the stones.

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.

Accuracy of unenhanced computerized tomography interpretation by urologists in patients with acute flank pain.

PURPOSE: The aim was to compare the findings of non-contrast computerized tomography (NCCT) evaluated by urology specialists with the findings of experienced radiologists, who are accepted as a standard reference for patients who present with acute flank pain. MATERIALS AND METHODS: Five hundred patients evaluated with NCCT were included in the study. The NCCT images of these patients were evaluated by both radiologists and urology specialists in terms of the presence of calculus, size of calculus, the location of calculus, the presence of hydronephrosis, and pathologies other than calculus, and the results were compared. RESULTS: The evaluations of urology specialists and standard reference radiology specialists are consistent with each other in terms of the presence of calculus (kappa [κ]: 0.904), categorical stone size (κ: 0.81), the location of calculus (κ: 0.88), and hydronephrosis (κ: 0.94). However, the evaluations of urology specialists in detecting pathologies other than calculus, which may cause acute flank pain or accompany renal colic, were found to be inadequate (κ: 0.37). The false-negative rate of detecting pathologies outside of the urinary system by the urology specialists is calculated as 0.86. CONCLUSION: Although the urology specialists can evaluate the findings related to calculus sufficiently with NCCT, they may not discover pathologies outside of the urinary system.

Retrograde intrarenal surgery in cross-fused ectopic kidney.

Cross-fused renal ectopia is a rare congenital anomaly in which both kidneys are fused and located on the same side. We report a case of right-to-left cross-fused renal ectopia and nephrolithiasis, in whom retrograde intrarenal surgery was used to treat the stone disease. To our knowledge, this is the first case of retrograde intrarenal surgery of a crossed-fused ectopic kidney.

¿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)

Intraperitoneal stone migration during percutaneos nephrolithotomy.

Percutaneos nephrolithotomy (PNL) is the standard care for renal stones larger than 2 cm. The procedure has some major and minor complications. Renal pelvis laceration and stone migration to the retroperitoneum is one of the rare condition. We report the first case of intraperitoneal stone migration during PNL.