Management of Priapism: Results of a Nationwide Survey and Comparison with International Guidelines.

OBJECTIVE: The aim of this study is to evaluate current urologic practice regarding the management of priapism in Turkey and compare with international guidelines. METHODS: Urologists and urology residents were invited to an online survey consisting of 30 multiple-choice questions on priapism-related clinical practices that were consid- ered most important and relevant to practices by using Google Forms. RESULTS: Total number of responses was 340. Respondents reported that they recorded a detailed patient's medical history and physical examination findings (n = 340, 100%) and laboratory testing, which includes corporal blood gas analysis (n=323, 95%). Participants announced that they performed Doppler ultrasound for 1/4 cases (n = 106, 31%), but 22% of the participants (n=75) replied that they performed in >75% of cases. Participants (n=311, 91%) responded that the first-line treatment of ischemic priapism is decompression of the corpus cavernosum. Moreover, most respondents (n = 320, 94%) stated that sympathomimetic injection drugs should be applied as the second step. About three-quarters of respondents (n = 247, 73%) indicated adrenaline as their drug of choice. Phosphodiesterase type 5 inhibitors seems to be the most pre- ferred drug for stuttering priapism (n=141, 41%). Participants (n=284, 84%) replied that corpora-glanular shunts should be preferred as the first. A large number of par- ticipants (n = 239, 70%) declared that magnetic resonance imaging can be performed in cases with delayed (>24 hours) priapism to diagnose corporal necrosis. Most of the participants (84%) responded that penile prosthesis should be preferred to shunts in cases with delayed (>48 hours) priapism. CONCLUSION: It would be appropriate to improve the training offered by professional associations and to give more training time to the management of priapism during residency.

The Role of Educational Level and Cognitive Status in Men Undergoing Artificial Urinary Sphincter Implantation.

OBJECTIVE: To examine the relationship between education level, cognitive function of patients and the success/ revision rates of artificial urinary sphincter (AUS) implantation in men with postprostatectomy incontinence. METHODS: Between January 2010 and March 2018, 163 patients (mean age, 68 ± 6.8 years) with moderate-to-severe stress urinary incontinence who underwent AUS implantation were retrospectively examined. Demographic data, body mass index, comorbidities, surgical technique, previous strictures, and radiation therapy were recorded. Incontinence was measured by daily pad use and evaluated by International Consultation on Incontinence Questionnaire-short form. Patients' overall improvement was assessed using the Patient Global Impression of Improvement questionnaire. Education level was determined using the International Standard Classification of Education. Cognitive status was assessed using the Mini-Mental State Examination. Treatment success was defined as the need for ≤1 pad/day at last follow-up. RESULTS: AUS was successful in 77.3% of patients. The International Consultation on Incontinence Questionnaire-short form score improved significantly from 19.9 ± 2.9 to 4.4 ± 5.4 (P = .001). The median outcome reported subjectively on the Patient Global Impression of Improvement scale was 2.1 ± 1.5 (1-7) and self-reported as "much better." Patients' education level had statistically no significant relationship with AUS success and revision rates. Similarly, there was no significant relationship between cognitive status, educational level and the need for revision of AUS (P >.05). However, patients with moderate cognitive impairment and a body mass index >30 showed significantly lower AUS success rates (P <.05). CONCLUSION: AUS implantation is safe and effective treatment option especially for nonobese and cognitively intact patients of all educational levels.

Single-incision midurethral sling shows less pain and similar success rate in a short-term follow-up compared to the transobturator tape method in the treatment of stress urinary incontinence.

OBJECTIVE: To compare the efficacy, complications, quality of life, and patient satisfaction rates in women treated for stress urinary incontinence (SUI) using the adjustable anchored single-incision midurethral sling (SIMS) and standard midurethral sling (MUS) procedures. MATERIAL AND METHODS: A total of 113 women between October 2012 and October 2016 underwent either the adjustable SIMS (n=54) or MUS (n=57) procedure. The postoperative pain profile was assessed using a 10-point visual analog scale at the fixed time-point quality of life and an additional postoperative 3rd week appointment. We asked our patients the following two questions to evaluate their satisfaction with surgery and their preference: "Would you have this kind of surgery again?" (Q1), and "Would you recommend this type of surgery to another patient with same symptoms?" (Q2). For the evaluation of patient complaints, the Incontinence Impact Questionnaire (IIQ-7) and Urinary Distress Inventory (UDI-6) were used before and after the procedure. RESULTS: Women in the SIMS group had a significantly lower postoperative pain profile for up to 3 weeks (p<0.001). There was no significant difference in perioperative complications and postoperative continence rates between the groups. With regard to Q1 and Q2, a significant difference was found between the groups (p=0.003 and p=0.002, respectively). While the questionnaire scores of the IIQ-7 and UDI-6 were also significantly improved at postoperative evaluations (p<0.001), there was no significant difference between the two groups. CONCLUSION: SIMS is associated with a significantly improved postoperative pain profile and earlier return to work when compared to MUS.

Are predictive factors in sperm retrieval and pregnancy rates present in nonobstructive azoospermia patients by microdissection testicular sperm extraction on testicle with a history of orchidopexy operation?

The aim in this study is to evaluate predictive factors on sperm retrieval and pregnancy rates by microdissection testicular sperm extraction in non obstructive azoospermia patients with a history of orchidopexy operation. A total of 148 patients were included, and their medical files were evaluated. Data related to possible predictive factors on sperm retrieval and pregnancy rates such as age at orchidopexy operation, unilateral or bilateral presence of undescended testis before orchidopexy, testis volumes and hormone levels were statistically analysed. It revealed that the mean ages in patients with unilateral and bilateral orchidopexy operations were 35.37 (±4.84) and 33.94 (±5.91) respectively. Mean testis volume in the unilateral orchidopexy group was 7.59 (±3.12) ml on the right testis and 7.37 (±2.86) ml on the left testis. Mean FSH levels were detected as 22.71 (±11.86) mIU/ml in the unilateral group and 28.19 (±12.40) mIU/ml in the bilateral group. In our study, we have shown that the age at which patients undergo orchidopexy and the unilateral or bilateral presence of cryptorchidism has no correlation with sperm retrieval and pregnancy rates.

Do success rate, complications of transobturator tape procedure differ based on experienced surgeon or residents? / ¿Son diferentes las tasas de éxito y complicaciones de la malla transobturatriz entre cirujanos expertos y residentes?

OBJECTIVES: To investigate the postoperative surgical complications and patient satisfaction with the outside-in transobturator tape (TOT) procedure performed by an experienced surgeon compared to those performed by residents in training. METHODS: Patients who received TOT surgery performed by a resident under supervision of a faculty were included in group 1 (n = 31) whereas, patients operated by the same faculty were included in group 2 (n = 26). Both groups were compared for demographic data, procedure results, satisfaction rates as well as intraoperative and early postoperative (urinary retention, vaginal erosion, dyspareunia, infection, abnormal discharge) complications. Statistical Package for Social Sciences for Windows was used for statistical analyses. For continuous variables Mann-Whitney U test and for categorical variables Chi-square, Fishers exact tests were used. RESULTS: Stress incontinence in groups 1 and 2 were either completely cured or improved in 87.1% and 84.6%, respectively. The question" Would you like to have an operation like this again?" was answered positively by 26 (83.9%) of patients in group 1 and by 22 (84.6%) in group 2. There was no significant difference between two groups for the complication rates occurred within 90-days period. However, there was a significantly higher groin pain persisting more than three weeks in group 1 (38.7%) compared to group 2 patients (7.7%). CONCLUSIONS: There was statistically significant increased groin pain in the early period in TOT procedures performed by the residents. However, the complications observed in both groups did not affect the success rate or patient satisfaction.

OBJETIVOS: Investigar las complicaciones quirúrgicas postoperatorias y la satisfacción del paciente con la operacion de malla transonbturatriz fuera-adentro realizada por un cirujano experto en comparación con la realizada por residentes en formación.MÉTODOS: Las pacientes operadas de TOT por un residente bajo supervisión de un adjunto se incluyeron en el grupo 1 (n = 31) y las operadas por el mismo adjunto se incluyeron en el grupo 2 (n = 26). Se compararon los datos demográficos, resultados de la operación, tasas de satisfacción así como las complicaciones intraoperatorias y postoperatorias tempranas (retención urinaria, erosión vaginal, dispareumia, infeccion, flujo anormal). Para el análisis estadístico se utilizó el software SPSS para Windows. Se utilizaron el test de la U de Mann- Whitney para variables continuas y los de Chi cuadrado y Prueba exacta de Fisher para variables categóricas. RESULTADOS: La incontinencia urinaria de esfuerzo en los grupos 1 y 2 fue bien completamente curada, bien mejoró en 87,1% y 84,6%, respectivamente. La pregunta ¿volvería a someterse a la misma operación? fue respondida positivamente por 26 (83,9%) de los pacientes en el grupo 1 y 22 (84,6%) en el grupo 2. No había diferencias estadísticamente significativas entre los grupos en la tasa de complicaciones en los primeros 90 días. Sin embargo, el dolor en la ingle que persistía más de 3 semanas era significativamente mayor en el grupo 1 (38,7%) en comparación con las pacientes del grupo 2 (7,7%). CONCLUSIONES: Hay un aumento estadisticamente significativo del dolor en el muslo en el periodo postoperatorio temprano de las operaciones de TOT realizadas por residentes. Sin embargo, las complicaciones observadas en ambos grupos no afectaron a la tasa de éxitos o a la satisfaccion del paciente.

Do success rate, complications of transobturator tape procedure differ based on experienced surgeon or residents? / ¿Son diferentes las tasas de éxito y complicaciones de la malla transobturatriz entre cirujanos expertos y residentes?

Objectives: To investigate the postoperative surgical complications and patient satisfaction with the outside-in transobturator tape (TOT) procedure performed by an experienced surgeon compared to those performed by residents in training. Methods: Patients who received TOT surgery performed by a resident under supervision of a faculty were included in group 1 (n=31) whereas, patients operated by the same faculty were included in group 2 (n=26). Both groups were compared for demographic data, procedure results, satisfaction rates as well as intraoperative and early postoperative (urinary retention, vaginal erosion, dyspareunia, infection, abnormal discharge) complications. Statistical Package for Social Sciences for Windows was used for statistical analyses. For continuous variables Mann-Whitney U test and for categorical variables Chi-square, Fishers exact tests were used. Results: Stress incontinence in groups 1 and 2 were either completely cured or improved in 87.1% and 84.6%, respectively. The question "Would you like to have an operation like this again?" was answered positively by 26 (83.9%) of patients in group 1 and by 22 (84.6%) in group 2. There was no significant difference between two groups for the complication rates occurred within 90-days period. However, there was a significantly higher groin pain persisting more than three weeks in group 1 (38.7%) compared to group 2 patients (7.7%). Conclusions: There was statistically significant increased groin pain in the early period in TOT procedures performed by the residents. However, the complications observed in both groups did not affect the success rate or patient satisfaction

Objetivos: Investigar las complicaciones quirúrgicas postoperatorias y la satisfacción del paciente con la operacion de malla transonbturatriz fuera-adentro realizada por un cirujano experto en comparación con la realizada por residentes en formación. Métodos: Las pacıentes operadas de TOT por un residente bajo supervisión de un adjunto se incluyeron en el grupo 1 (n = 31) y las operadas por el mismo adjunto se incluyeron en el grupo 2 (n = 26). Se compararon los datos demográficos, resultados de la operación, tasas de satisfacción así como las complicaciones intraoperatorias y postoperatorias tempranas (retención urinaria, erosión vaginal, dispareumia, infeccion, flujo anormal). Para el análisis estadístico se utilizó el software SPSS para Windows. Se utilizaron el test de la U de Mann- Whitney para variables continuas y los de Chi cuadrado y Prueba exacta de Fisher para variables categóricas. Resultados: La incontinencia urinaria de esfuerzo en los grupos 1 y 2 fue bien completamente curada, bien mejoró en 87,1% y 84,6%, respectivamente. La pregunta ¿volvería a someterse a la misma operación? fue respondida positivamente por 26 (83,9%) de los pacientes en el grupo 1 y 22 (84,6%) en el grupo 2. No había diferencias estadísticamente significativas entre los grupos en la tasa de complicaciones en los primeros 90 días. Sin embargo, el dolor en la ingle que persistía más de 3 semanas era significativamente mayor en el grupo 1 (38,7%) en comparación con las pacientes del grupo 2 (7,7%). Conclusiones: Hay un aumento estadisticamente significativo del dolor en el muslo en el periodo postoperatorio temprano de las operaciones de TOT realizadas por residentes. Sin embargo, las complicaciones observadas en ambos grupos no afectaron a la tasa de éxitos o a la satisfaccion del paciente

Retrograde intrarenal surgery technique without using fluoroscopy and access sheet in the treatment of kidney stones

Background/aim: In this study, we aimed to present our results on single-guidewire flexible ureteroscopy and retrograde intrarenal surgery without fluoroscopy and an access sheet, and to evaluate the efficacy and safety of this procedure retrospectively. Materials and methods: Our routine technique can be described as the evaluation of the ureter using a semirigid ureterorenoscope (URS), leading in the guidewire through the semirigid URS, pulling the semirigid URS back, inserting the flexible URS with the aid of the guidewire, inserting the laser probe through the flexible URS, and performing laser lithotripsy. Results: Our study included 400 male and 198 female patients with a mean age of 36.8 ± 16 (14­80) years. The mean stone size was 8.7 ± 4 (8­20) mm, and the mean operation time was 56 (32­106) min. Postoperative fever was observed in 24 (4%) of the patients, and 30 (5%) patients had hematuria as a minor complication. A stone-free status was observed in 466 (78%) patients, while 102 (17%) patients had clinically insignificant minor stone fragments and 30 patients had clinically significant stone residue. Conclusion: The retrograde intrarenal surgery procedure using only a guidewire without fluoroscopy and an access sheet in the treatment of kidney stones is technically safe and effective.

Current concepts of the acontractile bladder.

The acontractile bladder (AcB) is a urodynamic-based diagnosis wherein the bladder is unable to demonstrate any contraction during a pressure flow study. Although it is often grouped with underactive bladder, it is a unique phenomenon and should be investigated independently. The purpose of the present review was to examine the current literature on AcB regarding its pathology, diagnosis, current management guidelines, and future developments. We performed a review of the PubMed database, classifying the evidence for AcB pathology, diagnosis, treatment, and potential future treatments. Over the 67 years covered in our review period, 42 studies were identified that met our criteria. Studies were largely poor quality and mainly consisted of retrospective review or animal models. The underlying pathology of AcB is variable with both neurological and myogenic aetiologies. Treatment is largely tailored for renal preservation and reduction of infection. Although future developments may allow more functional restorative treatments, current treatments mainly focus on bladder drainage. AcB is a unique and understudied bladder phenomenon. Treatment is largely based on symptoms and presentation. While cellular therapy and neuromodulation may hold promise, further research is needed into the underlying neuro-urological pathophysiology of this disease so that we may better develop future treatments.

Evaluation of Prolidase Activity, Oxidative Stress, and Antioxidant Enzyme Levels in Testicular and Penile Tissues after Human Chorionic Gonadotropin Treatment in Rats by Predicting Infertility and Erectile Dysfunction.

OBJECTIVES: Prolidase plays a vital role in collagen turnover, matrix remodeling, and cell growth. We aimed to evaluate the association between treatment with chorionic gonadotropin and infertility and erectile dysfunction by investigating tissue prolidase activity, oxidative stress, and levels of antioxidant enzymes. MATERIALS AND METHODS: The 16 male Wistar albino rats used in this study were randomly divided into 2 groups: rats treated with human chorionic gonadotropin (hCG) and control rats (n = 8 in each group). The rats in the hCG group were subcutaneously injected with 50 IU hCG daily for 15 days, while the rats in the control group were subcutaneously injected isotonic saline. All of the rats were sacrificed by a lethal overdose of sodium pentobarbital at the first month after hCG administration. Prolidase activity and levels of malonyl aldehyde, glutathione reductase, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) were estimated in the testicular and penile tissue. The testicles and penis were transversely dissected and placed in formalin. RESULTS: Levels of prolidase and malonyl aldehyde in the testicular and penile tissues were significantly higher in the hCG group than in the control group (p < 0.001), while levels of glutathione reductase, SOD, GSH-Px, and CAT were significantly lower in the hCG group than in the control group (p < 0.001). CONCLUSIONS: In this study, we observed that treatment with hCG increased prolidase activity and oxidative stress and decreased the antioxidant capacity of penile and testicular tissues; therefore, this may affect fertility and erectile function.

The role of apoptosis and the effect of epidermal growth factor on proapoptotic BNIP 3 in an experimental rat priapism model

Background/aim: This study aimed to investigate the effects of apoptosis-inducing Bcl-2/adenovirus E1B 19 kDa-interacting protein 3 (BNIP 3) and antiapoptotic epidermal growth factor (EGF) on the pathophysiology of experimental low-flow priapism. Materials and methods: Twenty-four adult Sprague-Dawley rats were divided into four equal groups. Group I was the control group. Ischemic priapism was induced for 4 h in Group II rats. In Group III, intraperitoneal EGF at 10 µg/kg was given for 7 days before induction of ischemic priapism for 4 h. In Group IV, intraperitoneal EGF at 20 µg/kg was given for 7 days before induction of ischemic priapism for 4 h. The western blot method was used to determine BNIP 3 expression levels and the TUNEL method was used to determine the apoptotic cells in the cavernosal tissue samples. Results: Although BNIP 3 expression levels were significantly higher in all three study groups compared to the controls, BNIP 3 was significantly higher in EGF-administered groups when compared to Group II (P < 0.05). The TUNEL score of group II was significantly higher than those of the other groups. Conclusion: Decreased apoptosis in cavernosal tissues obtained by antagonizing the apoptotic effect of BNIP 3 with EGF may facilitate the development of new conservative treatment methods via those pathways.

Ion channel gene expressions in infertile men: A case-control study.

BACKGROUND: Infertility is described as not receiving pregnancy despite unprotected and regular sexual intercourse in a 1 yr period. It is detected by 15% of the couples. Male and female factor in the etiology may be detected in similar rates. OBJECTIVE: The present study aims to investigate ion channel gene expression in semen samples of infertile male compared with fertile men. MATERIALS AND METHODS: A total of 150 men who applied to the urology clinic due to infertility were divided into five equal groups: asthenozoospermia, oligozoospermia, oligoasthenoteratozoospermia, teratozoospermia, and normozoospermia (control). All paticipants were evaluated with Cation Channel Spermia (CatSper) 1, 2, 3, 4, Proton Voltage Gated Ion Channel1 (Hv1), Potassium Channel Subfamily U1 (KCNU1), and transmembrane protein (TMEM16A) gene expression in semen samples. RESULTS: "CatSper1, 4, HV1, KCNU1, and TMEM16A gene expression were detected higher in the oligozoospermia group compared to the controls. CatSper1, 2, 3, 4, KCNU1, and TMEM16A gene expression in the asthenozoospermia group and CatSper1, 2, 3, 4, KCNU1, and TMEM16A gene expression in the teratozoospermia group were detected lower compared to the controls. CatSper1, 4, HV1, and TMEM16A gen expression were higher in the oligoasthenoteratozoospermia men than the controls while CatSper3 gen expression was detected as lower." CONCLUSION: It was detected that these ion channels have an effect on sperm progressive motility and morphology. It may be considered that mutations in these ion channels may result in infertility.

Untreated Isolated Torsion of the Epididymis in an Adolescent.

Although torsion of epididymis is extremely rare, it should be kept in mind in the differential diagnosis of acute scrotal pain in adolescents. We report here a very rare cause of acute scrotum: torsion of the epididymis.

Role of percutaneous posterior tibial nerve stimulation either alone or combined with an anticholinergic agent in treating patients with overactive bladder.

OBJECTIVE: To evaluate the efficacy of percutaneous tibial nerve stimulation (PTNS), either alone or combined with an anticholinergic agent, in treating patients with an overactive bladder (OAB) in whom previous conservative treatment failed. MATERIAL AND METHODS: In this study, we included a total of 30 female patients with OAB in whom all conventional therapies failed between January 2010 and April 2011. Patients were randomly divided into three groups: Group 1, PTNS group; Group 2, patients receiving an anticholinergic agent; and Group 3, patients receiving both PTNS and anticholinergic agent. PTNS treatment continued for 12 weeks with each session lasting 30 min. RESULTS: All parameters of the bladder diary significantly improved in all groups (p<0.05). Similarly, all scores measured by questionnaires (UDI-6, IIQ-7, and OABSS) revealed significant improvements in all groups. When the improvements in symptoms were compared among the groups, there was a statistically significantly higher improvement in groups 1 and 3 than in Group 2. CONCLUSION: PTNS is a safe, simple, and minimally invasive treatment modality in patients with OAB, and it may be suggested either alone or in combination with anticholinergics when conventional treatments fail.

Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of renal stones greater than 2 cm.

OBJECTIVE: To evaluate the safety and efficacy of retrograde intrarenal surgery (RIRS) in the treatment of kidney stones greater than 2 cm and to compare its results with those of percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: We retrospectively analyzed a total of 143 patients: 86 patients (53 males and 33 females) who underwent PCNL and 57 patients (37 males and 20 females) who underwent RIRS between October 2009 and October 2013. RESULTS: The mean duration of operation was 100.26±33.26 min in the RIRS group and 75.55±21.5 min in the PCNL group (p<0.001). The hospital stay was significantly shorter in the RIRS group (1.56±0.8 vs. 4.57±2.1 days in the RIRS and PCNL groups, respectively; p<0.001). Stone-free rates after one session were 66.6% and 91.8% of the RIRS and PCNL groups, respectively. The stone-free rate of the RIRS group improved to 87.7% after the second session. Blood transfusions were required in two patients in the PCNL group. Complication rates were higher in the PCNL group. CONCLUSION: This study revealed that RIRS can be an alternative to PCNL in the treatment of kidney stones with a diameter of 2-4 cm especially in patients with comorbidities.

Second pathways in the pathophysiology of ischemic priapism and treatment alternatives.

OBJECTIVE: To evaluate the early therapeutic alternatives such as bosentan, an endothelin receptor blocker, theophylline, an adenosin receptor blocker, and a nonselective phosphodiesterase enzyme inhibitor, zinc protoporphyrin (ZnPP), a heme oxygenase 1 inhibitor, for the therapy of ischemic priapism in the rat models. METHODS: Twenty-four Sprague-Dawley rats were randomly divided into 4 equal groups: control group, ZnPP group, bosentan group, and theophylline group. Erection was provided by vacuum constriction method and maintained for 4 hours for achieving the priapism in all groups. The rats in the control group were administered 1 mL/kg saline intraperitoneally (ip). The rats in group 2 were administered 25 mg/kg ZnPP ip. The rats in group 3 were administered 0.25 mg/kg bosentan ip. The rats in group 4 were administered 100 mg/kg theophylline ip. Six rats from each group were decapitated after 6 hours of drug administration. Then endothelin 1, adenosine deaminase, heme oxygenase 1 enzymatic activity, and apoptosis index in the cavernous tissues were estimated. RESULTS: Cavernous tissue endothelin 1, adenosine deaminase, heme oxygenase 1 enzymatic activity levels, and apoptosis index were significantly decreased in bosentan, theophylline, and ZnPP-treated rats compared with the controls. CONCLUSION: Inhibition of priapism induced apoptosis with bosentan, theophylline, and ZnPP seems promising on preserving erectile function.