Is minimal invasive technique harmful in treatment of urethral stricture?

OBJECTIVE: Our goal was to evaluate the effect of previous history of direct vision internal urethrotomy (DVIU) on success rate of open urethroplasty in patients with bulbar urethral stricture. PATIENTS AND METHODS: We analyzed 133 patients who underwent open urethroplasty for bulbar urethral stricture between January 2008 and May 2017. Patients with penile and fossa navicularis stricture were excluded. We evaluated the effect of previous history of DVIU on success rate of open urethroplasty in patients with urethral stricture. Success of open urethroplasty was defined as disappear of voiding symptoms with maximum flow rate above 15 ml/s. The patients were followed for complications and outcome. RESULTS: Mean age was 54.05 ± 16.5 years. Mean length of stricture was 23.74 ± 10.23 mm. Mean follow-up was 39.77 ± 28.0 months. A total of 76 patients (57.1%) had no history of DVIU. On the contrary, 15.8% had history of DVIU once, 12% had twice, and 15.2% had more than twice. Success rate of open urethroplasty in patients who had no history of DVIU was 84%. However, this success rate was 71.4% in patients who had history of DVIU (P = 0.001). CONCLUSION: DVIU is easy, simple, and noninvasive technique in treatment of urethral stricture, so it is frequently used among urologists. However, it could not be an alternative technique to open urethroplasty. Internal urethrotomy can be used in some certain indications. Success rate of open urethroplasty can be affected by previous history of any endoscopic procedures.

Active surveillance or radical prostatectomy? Which treatment is best?

OBJECTIVE: We evaluated the patients who are candidates for active surveillance and treated with radical prostatectomy. These patients were compared with other patients who had not met the criteria of active surveillance. METHODS: In total, 135 patients were included in the study. The patients were divided into two groups. The patients in Group 1 had less than three positive cores, Gleason 6 (3 + 3) and PSA level equal to or less than 10 ng/ml. Patients in Group 2 had three or more positive cores, Gleason 6 (3 + 3) and PSA level equal to or higher than 10 ng/ml. Pathological results of each groups were compared. RESULTS: The patients' ages were between 52 and 76, and 50 and 77 in groups 1 and 2, retrospectively. There were 69 and 66 patients in groups 1 and 2, retrospectively. The mean age of patients, PSA levels, PSA density, and prostate volumes were 63.89 ± 5.89 years, 5.82 ± 1.84 ng/ml, 0.14 ± 0.07 and 51.21 ± 31.75 cc (Group 1) and 65.77 ± 6.36 years, 13.65 ± 17.11 ng/ml, 0.63 ± 1.03 and 45.44 ± 26.77 cc (Group 2). T2a, T2c, T3a and T3b were reported in 28 patients, 36 patients, 3 patients and 2 patients after pathological evaluation in Group 1,respectively. T2a, T2c, T3a and T3b were reported in 13 patients, 47 patients, 5 patients and 1 patient in the other group, respectively. CONCLUSION: The final pathology showed that there is no difference in the positive surgical margin, proportion of insignificant prostate cancer and Gleason upgrading between groups. The clinicians must be aware of the fact that active surveillance can be misdiagnosed in some patients (Tab. 2, Ref. 20).

Analysis of expression of TNF-alpha and TGF-beta3 in intrinsic ureteropelvic junction obstruction.

OBJECTIVES: Ureteropelvic junction (UPJ) obstruction is of critical importance to understand the histopathology of UPJ obstruction in terms of therapy planning and follow-up. For this purpose, our study was conducted with TNF-α and TGF-ß markers to investigate possible underlying problems in intrinsic UPJ obstruction. METHODS: Of the patients who had undergone surgery in our clinic, 36 UPJ segments of patients who had undergone dismembered pyeloplasty surgery due to UPJ obstruction and 14 UPJ segments of the patients who had undergone nephrectomy were collected to form 2 groups. All histological sections were examined by applying immunohistochemical transforming growth factor beta 3 (TGF-ß3) and tumour necrosis factor alpha (TNF-α) monoclonal antibody dyes. RESULTS: The mean staining values for TNF-α in mucosal tissue and mucosa were 0.53±0.84 and 0.58±0.84, respectively in the obstruction group, whereas the values observed in the control group were 0.86±0.36 and 0.93±0.47, respectively. While the mean staining values in the obstruction group in mucosal tissue and mucosa for TGF-ß3 were 1.75±0.73 and 2.17±0.77, respectively, the values established in the control group were 1.14±0.66 and 1.43±0.93, respectively. The difference between the obstruction and control groups were statistically significant for both values (p<0.05). CONCLUSION: Only a limited number of studies have been carried out on this particular issue. Data from the present study indicate that TGF-ß3 and TNF-α may play a role in the histopathogenesis of UPJ obstruction (Tab. 1, Fig. 1, Ref. 18).

Efficacy of alfuzosin and sildenafil combination in male patients with lower urinary tract symptoms.

Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) are frequently encountered in ageing males. We compared the efficacy of alfuzosin 10 mg alone or in combination with sildenafil 50 mg in the treatment of LUTS due to benign prostatic hyperplasia. One hundred male patients older than 45 years were randomized to two groups containing 50 patients each; one group receiving alfuzosin 10 mg and the other group alfuzosin 10 mg combined with sildenafil 50 mg. International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Q(max)), prostate volume and post-void residual urine were evaluated. The mean age was 60.2 ± 17.8. Mean data of evaluated parameters in both groups at the end of 3rd month compared with baseline values are given respective order as; 5.1 (26.8%) and 5.8 (28.2%) points decreases in IPSS; 1.6 (41.1%) and 1.8 (45%) points decreases in QoL; and 3.4 (29.6%) and 3.4 (33%) points increases in Q(max) . The outcomes of our study cannot be interpreted in such a way to report that alpha blocker-PDE5 inhibitor combination has a better efficacy than alpha blocker treatment alone in patients with LUTS.

Question for a questionnaire: the International Index of Erectile Function.

The aim of this study was to analyze the impact of patient age and education level on the comprehension of the Turkish version of Index of Erectile Function (IIEF), and to determine the patient characteristics that make this questionnaire less reliable. In this study, 238 male patients presenting to our clinic were enrolled. The patients were asked to complete the Turkish version of the IIEF questionnaire upon arrival by themselves and then once again during their second visit with the assistance of a physician. 'Accurate' comprehension of the IIEF was considered to be the consistency between the 'self-administered' and 'physician-assisted' IIEF scores. The impact of patient age and education level on the 'accurate' comprehension of the IIEF was analyzed. There was a significant difference between the 'self-administered' and 'physician-assisted' IIEF scores in patients ≥ 60 years of age (P=0.045) and primary school graduates (P=0.015). Age ≥ 60 years and being primary school graduate are factors lowering the comprehension of the Turkish version of the IIEF by the patients. Older patients and patients with lower education could benefit from the assistance of a physician while completing this questionnaire.