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.

The effect of asymptomatic histological prostatitis on sexual function and lower urinary tract symptoms / Efecto de la prostatitis histológica asintomática sobre la función sexual y los síntomas de tracto urinario inferior

OBJECTIVE: Prostatitis affects 10-14% of men of all ages and ethnicities. More than 50% of the men experience episodes of prostatitis at one time of their lives. Patients with CP typically have longlasting genitourinary/pelvic pain and obstructive and/or irritative voiding symptoms. Sexual dysfunction and psychological symptoms are frequently added to these symptoms. We also investigated the relationship between sexual functions, and lower urinary system symptoms, and asymptomatic histological prostatitis detected on transrectal ultrasound-guided (TRUS) biopsy performed with the indication of high PSA levels. METHODS: Sixty cases compliant with the study criteria among patients who underwent prostate biopsies between September 2014 and June 2015 with the indication of higher PSA levels were included in the study. All patients were requested to complete IIEF-5 and IPSS forms one day previously. Based on histological analysis of biopsy materials, the patients were allocated into groups of BPH (simple BPH without histological prostatitis) (n:30) and histological chronic prostatitis (combination of BPH and histological prostatitis) (n:30). RESULTS: Mean age of the cases was 65.73±5.01 (range, 56-75 yrs) years. PSA levels ranged between 4-15ng/ml. A statistically significant intergroup difference was not found regarding mean age, BMIs, PSA levels, incidence rates of hypertension and coronary artery disease (p > 0.05). Prostate volumes of the HCP group were higher than those of the BPH group , with statistically significant differences (p:0.001; p < 0.01). Questionnaire forms of the patients included in the study were statistically evaluated, and mean IPSS score of the HCP group was found to be higher when compared with that of the BPH group, with statistically significant differences. (p:0.016; p < 0.05). However mean IIEF score of the BPH group was higher than that of the HCP group, with statistically significant differences (p:0.039; p < 0.05). DISCUSSION: These findings suggested the presence of a correlation between chronic inflammation and lower urinary tract symptoms (LUTS). In addition, statistically significant lower IIEF values in patients with histological chronic prostatitis relative to those without suggested negative effects of even asymptomatic inflammation on sexual functions and mechanism of erection

OBJETIVO: La prostatitis afecta al 10-14% de varones de todas las edades y etnias. Más del 50% de los hombres experimentan episodios de prostatitis alguna vez en sus vidas. Los pacientes con prostatitis crónica (PC) típicamente tienen dolor genitourinario/ pélvico y síntomas del tracto urinario inferior obstructivos y/o irritativos de larga duración. A estos síntomas se añaden frecuentemente la disfunción sexual y los síntomas psicológicos. También investigamos la relación entre la función sexual y síntomas del tracto urinario inferior y la prostatitis asintomática detectada por biopsia de próstata guiada por ecografía transrectal realizada con la indicación de niveles de PSA elevados. MÉTODOS: Incluimos en el estudio sesenta casos que cumplían con los criterios de inclusión, entre los pacientes sometidos a biopsia de próstata entre septiembre 2014 y junio 2015 con la indicación de PSA elevado. Se requería que todos los pacientes completaran el cuestionario IEEF-5 e IPSS un día antes. En base al análisis histológico de los materiales de biopsia, los pacientes fueron asignados a grupos de HBP (HBP simple sin prostatitis histológica) (n=30) y prostatitis crónica histológica (combinación de HBP y prostatitis histológica) (n=30). RESULTADOS: La edad media de los casos fue de 65,73±5,01 años (Rango 56-75 años). Los niveles de PSA oscilaron en el rango entre 4-15ng/ml. No se encontraron diferencias estadísticamente significativas en edad media, IMC, nivel de PSA, tasas de incidencia de hipertensión y enfermedad coronaria entre los grupos (p > 0,05). Los volúmenes prostáticos del grupo de PC histológica eran mayores que los del grupo de HBP, con significación estadística (p:0,001; p < 0,01). Los cuestionarios de los pacientes incluidos en el estudio fueron evaluados estadísticamente, y se encontró que la media del resultado del IPSS e el grupo de PC histológica era mayor, con significación estadística, que el del grupo de HBP (p:0,016; p < 0,05). Sin embargo, el resultado medio del IIEF en el grupo de HBP era más alto, con diferencias estadísticamente significativas, que el del grupo de PC histológica (p:0,039; p < 0,05). DISCUSIÓN: Estos hallazgos sugieren la presencia de una correlación entre la inflamación crónica y los síntomas del tracto urinario inferior. Además, unos valores menores de IIEF en pacientes con prostatitis crónica histológica en relación con los pacientes sin PC, con diferencias estadísticamente significativas, sugería efectos negativos sobre las funciones sexuales y los mecanismos de erección incluso de la inflamación asintomática

A standardized scoring system in the prediction of success and complications of percutaneous nephrolithotomy: guy´s Stone scoring system / Utilización de un sistema de puntuación estandarizado en la predicción del éxito y complicaciones de la nefrolitectomía percutanea: escala stone del Guy`s

OBJECTIVES: In this study, our aim was to determine the role of Guy's stone scoring system (GSS) in the prediction of percutaneous nephrolithotomy (PNL) success and its ability to foresee potential complications in consideration of Clavien grading system (CGS). Material and Methodos: The data of 244 patients who underwent PNL between January 2009 and May 2014 were retrospectively examined. Renal stones were evaluated using GSS with the aid of the patients' preoperative radiological evaluations and their postoperative complications were assessed with CGS. Arch. Esp. Urol. 2015; 68 (9): 710-717 Keywords: Guy's Stone score. Percutaneous nephrolithotomy. Modified Clavien grading system. Stone-free rate. RESULTS: Mean age of the patients (men, n=166; 68% and women, n=78; 32%) was 46.50±13.12 years (range, 16-80yrs). Clinically significant residual stones were not detected in 195 (79.9%) patients, while they were found in 49 (20.1%) patients. Guy's stone scores of 1, 2, 3 and 4 points were estimated in 21.3, 37.7, 29.9, and 11.1% of the cases, respectively. Based on modified Clavien complication grading system, complications were categorized as Clavien grade 1, 2 and 3 in 81.9, 17.2, and 0.8% of the cases, respectively. Clavien Grade 4 and 5 complications were not encountered. A statistically significant correlation was found between Guy's Stone scores and Clavien grades (p < 0.05)- A statiscally and highly significant difference was detected between Guy's Stone scores of the cases with respect to residual stones (p = 0.001; p < 0.01). CONCLUSIONS: Our study findings have revealed that GSS is a successful and easily applicable method for the prediction of success and likelihood of complications of PN

OBJETIVOS: En este estudio nuestro objetivo era determinar el papel de la escala de puntuación STONE de Guy`s (GSS) en la predicción del éxito de la nefrolitotomía percutánea (NLP) y su capacidad de preveer potenciales complicaciones considerando el sistema de gradación de Clavien. MATERIAL Y MÉTODOS: Los datos de 244 pacientes sometidos a NLP entre enero del 2009 y mayo del 2014 fueron evaluados retrospectivamente. Las litiasis renales fueron evaluadas utilizando el GSS con la ayuda de las pruebas radiológicas preoperatorias y las complicaciones postoperatorias se evaluaron con la escala de Clavien. RESULTADOS: La edad media de los pacientes (varones n=166, 68%; y mujeres n=78, 32%) fue 46.50±13.12 años (rango, 16-80 años). En 195 pacientes (79.9%) no se detectaron litiasis residuales clínicamente significativas, mientras que en 49 pacientes (20.1%) sí se encontraron. Con la escala STONE de Guy`s se estimaron puntuaciones de 1,2,3 y 4 puntos en 21.3%, 37.7%, 29.9% y 11.1% de los casos respectivamente. En base a la escala de complicaciones de Clavien modificada las complicaciones fueron categorizadas como Clavien grados 1,2 y 3 en 81.9%, 17.2% y 0.8% de los casos respectivamente. No se encontraron complicaciones de Grado 4 y 5 de Clavien. Se encontró una correlación estadísticamente significativa entre las puntuaciones de la escala STONE de Guy`s y los grados de Clavien (p < 0.02). Se detectó una diferencia estadística y altamente significativa entre las puntuaciones del STONE de Guy`s de los casos con respecto a las de las litiasis residuales (p = 0.001; p < 0.01). CONCLUSIONES: Los hallazgos de nuestro estudio han revelado que la escala Stone de Guy`s es un método exitoso y fácilmente aplicable para la predicción del éxito y la probabilidad de complicaciones de la NLP

A rarely seen case among retroperitoneal mass lesions: paraganglioma.

Pheochromocytomas are rarely seen cathecolamine-secreting neuroendocrine tumors. Diagnosis, treatment, and prognosis of this rarely seen condition have been discussed. In this study, a retroperitoneal paraganglioma with a diameter of 27 mm was detected in a 29-years old nephrectomized male patient. In our case, in reevaluations performed after definitive establishment of the diagnosis, any abnormal radiological signs suggesting a metastatic lesion were not detected. During the postoperative period the patient was referred to the clinics of endocrinology, and oncology for medical follow-up. In the differential diagnosis of retroperitoneal mass lesions, pheochromocytoma/paraganglioma should not be forgotten. Besides, for malignant tumors chemoradiotherapy, and for benign functional tumors medical treatment should be applied.

Effect of surfactant types on the biocompatibility of electrospun HAp/PHBV composite nanofibers.

Bone tissue engineering literature conveys investigations regarding biodegradable polymers where bioactive inorganic materials are added either before or after electrospinning process. The goal is to mimic the composition of bone and enhance the biocompatibility of the materials. Yet, most polymeric materials are hydrophobic in nature; therefore, their surfaces are not favorable for human cellular adhesion. In this sense, modifications of the hydrophobic surface of electrospun polymer fibers with hydrophilic and bioactive nanoparticles are beneficial. In this work, dispersion of hydroxyapatite (HAp), which is similar to the mineral component of natural bone, within biodegradable and biocompatible polymer poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) with the aid of a surfactant has been investigated. Non-ionic TWEEN20 and 12-hydroxysteric acid (HSA), cationic dodecyl trimethyl ammonium bromide (DTAB) and anionic sodium deoxycholate and sodium dodecyl sulfate (SDS) surfactants were used for comparison in order to prepare stable and homogenous nanocomposite suspensions of HAp/PHBV for the electrospinning process. Continuous and uniform composite nanofibers were generated successfully within a diameter range of 400-1,000 nm by the mediation of all surfactant types. Results showed that incorporation of HAp and any of the surfactant types strongly activates the precipitation rate of the apatite-like particles and decreases percent crystallinity of the HAp/PHBV mats. Mineralization was greatly enhanced on the fibers produced by using DTAB, HSA, and especially SDS on where also osteoblastic metabolic activity was similarly increased. The produced HAp/PHBV nanofibrous composite scaffolds would be a promising candidate as an osteoconductive bioceramic/polymer composite material for tissue engineering applications.

Effect of benign testicular mass on fertility: an epidermoid cyst case.

The article discusses the problem of epidermoid cysts - extremely rare but the most common benign intratesticular tumors. The majority of non-palpable testicular lesions, discovered by ultrasonography in a population of infertile men, are benign tumors. The case of a young man who had incidentally diagnosed, during his infertility evaluation, a right testicular mass which was pathologically reported as epidermoid cyst after partial orchiectomy is presented. It was suggested that benign testicular cysts may effect the normal parenchyma of testis even if the normal histopathology. Thus, the excision of these benign lesions especially in infertile population is recommended.