Erectile dysfunction in patients with major burn injury: The significance of follow-up.

BACKGROUND: There were few prospective studies investigating the relationship between the burn injury and erectile dysfunction (ED). The aim of this study was to prospectively explore the alteration in erectile functions regarding major burn. METHODS: This study was conducted as a prospective survey in patients with major burn injury. The study group consisted of burn cases with at least 20% of body surface area affected according to the Wallace Rule of Nines. Initially International Index of ED-5 (IIEF-5) was administered to the patients in the burn unit, and it was repeated in the 2rd and 6th months. Burn types, the severity of burns, age of patients, and alteration in IIEF-5 scores were compared. RESULTS: The study included 63 male patients. The median age of the patients was 35 (20-73) years, and the median burn percent-age was 22 (20-60). The rate of ED was markedly increased during follow-up as 8%, 39.7%, and 25.4% at baseline, 3rd, and 6th month evaluation, respectively. The median initial IIEF-5 score of the patients was 23 (5-25). Subgroup analysis revealed that IIEF-5 score of patients with electrical and flame burn significantly decreased at 3rd month compared with the baseline values. The median IIEF-5 score of patients with electrical burn increased at 6th month compared with 3rd month (p=0.042). Binary logistic regression analysis showed that age and service period, and IIEF-5 Score at 3rd month and burn grade were all statistically significantly associated with the normal erectile function (IIEF-5>=18), at 3rd month and 6th month, respectively. CONCLUSION: The current trial demonstrated that IIEF-5 scores of patients with major burn can show significant impairment in long term, and it seems a time-dependent process. This is the first prospective trial showing that IIEF can be utilized to monitor erectile function of burn patients in a longer follow-up program.

The Effectiveness of Caudal Block with Low Doses of Dexmedetomidine and Pethidine in Transrectal Prostate Biopsy: Preliminary Results.

PURPOSE: To evaluate the effectiveness of caudal block (CB) using dexmedetomidine and pethidine instead of local anesthesia (LA) for prostate needle biopsy and the effect of CB on urinary retention. MATERIAL AND METHODS: A transrectal ultrasound-guided prostate needle biopsy (TRUS-Bx) was performed on 68 patients with a mean age of 65 ± 2.18 years. CB with a combination of dexmedetomidine and pethidine without LA was administered to the patients. The pain levels of the patients were determined using numeric rating scale (NRS) scores to evaluate the effectiveness of CB. Preoperative and postoperative postvoid residual urine volumes (PRUV) were also calculated. RESULTS: The CB success rate was 93.15%. The NRS scores were 0.79 ± 0.19 and 0.89 ± 0.22 during probe entry and manipulation and biopsy, respectively, without any significant differences between them (p = 0.382). The mean PRUVs before and after biopsy did not differ significantly (41 ± 15.6 vs. 71.93 ± 22.3, p = 0.379). The degree of sedation, as assessed using the Ramsay scale, was 2 or 3 in all patients. CONCLUSION: The combination of dexmedetomidine and pethidine for CB in TRUS-Bx provided quality analgesia for the patient and prevented the development of postoperative urinary retention.

The Significance of Asymptomatic Kidney Stones as a Predictive Factor for Sepsis in Critically Ill Older Adults.

OBJECTIVE: The objective of this study was to investigate the impact of kidney stones (KSs) on critically ill older adults (CIOA) staying longer than 24 hours in the ICU. Sepsis is one of the leading causes of mortality for ICU patients. KS disease is a well-known risk factor for bacteriuria and urinary tract infection. METHODS: A total of 256 CIOA were initially evaluated from April 2017 through February 2019. Patients who had urinary ultrasonography and computed tomography within 12 months prior to ICU admission were included. Patients with an additional urological pathology, under the age of 65 years, and with ICU stays of 24 hours or less were excluded. Consequently, 151 patients were eligible and constituted the study group. These patients were divided into 2 subgroups, according to the presence or absence of KSs. These 2 groups were compared with regard to urine culture (UC) results, presence of urosepsis, and septic shock. RESULTS: The mean age was 80.66 (±7.76) years. There were 18 patients with KSs and 133 without KSs. A total of 71 patients had a positive UC. Repeat UC positivity (p = 0.002) and resistant microorganisms (p = 0.034) were significantly more frequent in the KS group. The incidences of both urosepsis (p<0.001) and septic shock (p<0.001) were also significantly higher in patients with KSs. CONCLUSION: The presence of KSs in CIOA is frequently associated with urosepsis and septic shock. Large prospective trials are required to evaluate the impact of KSs on the prognosis of patients in the ICU.

The Management of Phimosis Seen after Circumcision with Thermocautery.

OBJECTIVE: One of the most frequent complications after circumcision by thermocautery is phimosis. In this study, we aimed to present the functional and cosmetic results of the modified sleeve technique for the correction of this iatrogenic phimosis. MATERIALS AND METHODS: The study group included iatrogenic phimosis cases who underwent circumcision using thermocautery during the last eight years. Initially, steroid creams were applied on these patients for six weeks. Patients who did not respond to this treatment underwent surgery using the modified sleeve technique. Control visits were performed at the first and fourth postoperative weeks. RESULTS: A total of 32 patients with a median age of 5.1±1.1 years were included in the study out of 13285 circumcisions by thermocautery. No positive treatment outcomes were obtained by topical steroids, and all patients proceeded to surgery by modified sleeve technique. Median operative time was 25±2.3 minutes. Cosmetic and functional outcomes were satisfactory in all cases. CONCLUSION: There is no place for topical steroids in management of iatrogenic phimosis after thermocautery is observed, thus, early surgery is advised to avoid emotional stress. Our modified sleeve technique can achieve maximum cosmetic and functional outcomes without leading to extreme shortening of the penile skin and mucosa.

Epidermoid cyst of the urinary bladder: a case report.

Epidermoid cyst of the bladder is a very rarely encountered benign lesion. Up to our knowledge, we present the second case of epidermoid cyst of the urinary bladder in literature. We report a case of epidermoid cyst developed in a 59-year-old patient followed up with bladder tumor.

Clinical Case Discussion: Bilateral Synchronous Testicular Cancer and Organ-sparing Surgery.

In cases of bilateral synchronous testicular cancer, organ-sparing surgery can be performed safely, if appropriate surgical rules are respected and if a stringent follow-up protocol is obeyed. If fertility is a concern, a simultaneous TESE procedure can be performed.

Case report: HIV negative isolated scrotal Kaposi's sarcoma.

INTRODUCTION: Kaposi's sarcoma (KS) is a rare angioproliferative disorder of the vascular endothelium. The development of KS requires Human Herpes Virus 8 (HHV-8) infection. An associated HIV infection is usually seen. Isolated scrotal KS has rarely been reported. In this article, we present a case of KS that primarily involved the scrotum in a HIV negative patient. PRESENTATION OF CASE: A 71-year old male patient admitted to the outpatient department due to nodular lesions on the scrotum. The patient declared that these lesions were present for nearly 5 years. Past medical history revealed that he underwent left thoracotomy and upper lobectomy in 2006 for adenosquamous lung carcinoma. Then, he received a single cycle of adjuvant chemotherapy consisted of docetaxel and cisplatin. Physical examination revealed 3 black small nodules on the scrotum. The anti-HIV test was negative. All scrotal lesions were surgically excised. The pathological investigation revealed KS of the lymphangioma-like type. DISCUSSION: The pathogenesis of KS has still not been clearly elucidated. However, it is known that all forms of KS are associated with HHV-8 infections. A defect in immune system was almost always necessary. Therefore, KS is usually associated with HIV infection. KS of the penis has been reported in HIV negative patients. Very few cases of scrotal KS have been presented. In a recent review, only 1 patient had scrotal KS out of 32 cases with HIV negative KS. In our case, the patient received a cycle of chemotherapy that might affect his immune system. The lymphangioma-like type is a common morphological sub-type. While lymph edemas are commonly observed in this sub-type, no edema in the lymphs was present in our case. CONCLUSION: Classical KS is generally observed in the lower extremities, it can rarely affect scrotal skin as isolated lesions. Therefore, a careful physical examination should also include scrotum for these patients.

Case report: Large adrenal ganglioneuroma.

INTRODUCTION: Ganglioneuromas are localized tumors derived from neural crest tissues. Characteristically, they originate in the posterior mediastinum. Pure adrenal gangliomas are extremely rare. PRESENTATION OF CASE: A left adrenal mass with the size of 68mm×50mm×86mm on magnetic resonance imaging was documented in a 53-year-old female patient. Endocrine tests revealed a non-functioning adrenal mass. The actual size of the mass was macroscopically measured to be 16cm×8.5cm×6cm after the surgery. Histopathological examination indicated ganglioneuroma. DISCUSSION: Most adrenal ganglioneuromas can incorrectly be diagnosed as other adrenal tumors, since they are rare neurogenic benign tumors with no specific imaging properties. They have a slow growth pattern and usually asymptomatic. Our case represents a huge adrenal ganglioneuroma in a female patient with nondiagnostic flank pain. Radiological imaging showed a large adrenal mass with no differentiation from other adrenal tumors. Endocrine evaluation should be performed for such adrenal masses. Since our case had a relatively large size, open surgery was preferred. Pathology revealed the definitive diagnosis. CONCLUSION: This case suggests that ganglioneuromas can wrongly be diagnosed as other adrenal tumors. It is significant that a proper differential diagnosis should be performed by using hormonal and imaging techniques. Nevertheless, pathological examination is usually required for definitive diagnosis.

Development of a quality of life scale specific for patients with benign prostatic hyperplasia.

PURPOSE: The improvement of quality of life (QoL) should be the major concern in any proposed treatment modality for any disorder. The objective of this study was to develop a new easy to use benign prostatic hyperplasia (BPH)-specific QoL scale that may guide the treatment policy in BPH. METHODS: A total of 118 items addressing BPH-specific QoL were produced. After an elimination process, a 20-question scale was developed. This new scale, Short Form (SF)-36 and International Prostate Symptom Score (IPSS), was then administered to 50 healthy men (control group), and 108 BPH patients who received medical or surgical treatment. Reliability assessment consisted of internal consistency evaluation by the Cronbach's alpha reliability test. In construct validity, factor analysis was performed using principal component analysis with Varimax rotation. Response to change of this new form was also evaluated. RESULTS: Cronbach's alpha coefficient of this scale was found to be 0.8464. Item-total correlation coefficients were between 0.3298 and 0.7886 (p < 0.0001). Factor analysis for construct validity revealed four factors. The correlation coefficients were found to be r = 0.801 (p < 0.0001) with the total IPSS, and this new QoL scale had a relatively sufficient correlation with all domains of the SF-36. Moreover, a QoL score obtained by the summation of individual grades of each item may provide valuable information just like total IPSS. The mean QoL score was 4.96 ± 9.58 and 20.28 ± 9.14 in controls and BPH patients, respectively (p < 0.0001). Moreover, QoL score significantly improved by both medical and surgical treatment. CONCLUSIONS: The new BPH-specific QoL was shown to be reliable and valid.

Free prostate-specific antigen is a better tool than total prostate-specific antigen at predicting prostate volume in patients with lower urinary tract symptoms.

OBJECTIVE: To evaluate the relationships among age, total prostate-specific antigen level (PSA), free PSA level, and prostate volume. METHODS: A total of 656 patients complaining of lower urinary tract symptoms who attended our urology outpatient department were enrolled. The standard assessment for lower urinary tract symptoms was applied, including serum total and free PSA determinations and transabdominal prostate volume measurement. Patients with a history of transurethral surgery, prostate cancer, and conditions other than benign prostatic hyperplasia that could affect the PSA levels were excluded. A linear regression model was used to estimate the prostate volume. Receiver operating characteristic curves were constructed to evaluate the ability of serum PSA and free PSA to estimate threshold prostate volumes and to select the optimal serum PSA and free PSA cutoff values. RESULTS: The linear regression model included age (P < .000), total PSA (P < .006), and free PSA (P < .000) as independent predictors of prostate volume. Consequently, an easy to use equation was developed to estimate the prostate volume. Free PSA performed better than total PSA at predicting the prostate volume. An area under the curve of 0.668 ± 0.022 at predicting prostate volume >40 cm(3) with total PSA increased to 0.721 ± 0.021 with free PSA. Moreover, free PSA with a cutpoint of 0.495 ng/mL correctly estimated a prostate volume of >40 and <40 cm(3) in 71% and 66% of the cases, respectively. CONCLUSION: The prostate volume can be estimated using easily obtained serum PSA levels, and free PSA had a better performance.

The effect of maximum voided volume on response to desmopressin therapy in children with enuresis.

PURPOSE: This study was aimed to determine the effect of maximum voided volume (MVV) on the efficacy of desmopressin, which is commonly used to treat primary monosymptomatic nocturnal enuresis (PMNE) in children and adolescents. MATERIALS AND METHODS: Bladder capacity was measured with different methods in 52 patients with PMNE, and the effect of bladder capacity on desmopressin therapy was investigated. RESULTS: Patients with PMNE in whom MVV was 70% or less of estimated bladder capacity were found to be unresponsive to desmopressin therapy. CONCLUSION: The MVV can be measured before desmopressin therapy in patients with PMNE as a marker to predict treatment success. Our results suggest that desmopressin should not be used in patients with low MVV.

Randomized comparison of efficacy of paracetamol, lornoxicam, and tramadol representing three different groups of analgesics for pain control in extracorporeal shockwave lithotripsy.

PURPOSE: Extracorporeal shockwave lithotripsy (SWL) is the mainstay treatment modality for upper urinary tract stones. However, it is a relatively painful procedure and so an efficient analgesia is required for better clinical success. The ideal method of anesthesia has not been standardized. The objective of this randomized study, for the first time in the literature, was to compare the efficacy of three common analgesics, each belonging to a different group, in pain control during SWL. PATIENTS AND METHODS: In this randomized controlled study, 90 patients with upper urinary tract stones undergoing SWL were randomly divided into three groups. Group I (n = 30) received 1 g of paracetamol, group II (n = 30) received 8 mg of lornoxicam, and group III (n = 30) had 1 mg/kg of tramadol. No premedication was applied in all groups. Pain scores by visual analog scale (VAS), blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation were noted before procedure and at 1 minute and every 5 minutes during the SWL. Supplementary analgesic consumption was recorded. Moreover, all adverse effects and both patient and urologist satisfaction were documented. RESULTS: Demographic parameters of the three groups were similar. All monitored parameters were also not different among the groups. The mean VAS scores at all measured times during SWL were below 4 except for two occasions, indicating a relatively efficient overall pain control provided by these three medications. Moreover, the mean VAS scores were similar among these three groups at all measured times during SWL except for those at 5 and 20 minutes at which groups III and II showed lesser pain control, respectively. No difference was observed in the amount of supplementary analgesia, which was required at higher voltages in a majority of patients. There was no significant difference in side effects. CONCLUSION: This study suggests that paracetamol, lornoxicam, and tramadol can be safely and efficiently preferred in pain control during SWL.

Single vs. double dartos interposition flaps in preventing urethrocutaneous fistula after tubularized incised plate urethroplasty in primary distal hypospadias: a prospective randomized study.

INTRODUCTION: This prospective study was designed to compare symmetrical overlapping double flaps with a single dartos flap in regard to fistula formation as an adjunct to tubularized incised plate urethroplasty (TIPU). PATIENTS AND METHODS: 77 consecutive children with primary coronal or subcoronal hypospadias were randomized into 2 groups. A single layer dartos flap was used to cover the anastomotic site in the first group (37 patients). A wider dorsal dartos flap bisectioned in the midline was utilized in the second group of 40 patients. The complication rates were compared. RESULTS: There was no difference between the 2 groups in terms of age, and meatal location. Postoperative median follow-up was 34 months. Urethrocutaneous fistula occurred in 3 patients (8.1%) of the monolayer group. No fistula developed in the second group with double flaps. CONCLUSIONS: The current study proposes that the use of double dorsal flaps, although statistically not significant, better prevents fistula formation compared to monolayer dartos flaps following TIPU operation.

Prospective evaluation of the efficacy of antibiotic prophylaxis before cystoscopy.

BACKGROUND: The aim of this study was to prospectively compare single-dose intravenous antibiotic prophylaxis vs. no prophylaxis before minor cystoscopic procedures, including punch biopsy and transurethral resection (TUR) of small bladder tumors. MATERIALS AND METHODS: A total of 200 patients with a mean age of 47.3 years old (range: 19-84 years old) with initial negative urine cultures were recruited. All patients underwent a diagnostic cystoscopy. Patients were then randomized into 2 groups: One group that did not receive antibiotics (100 patients) and the other group that received antibiotic treatment (100 patients with a single intravenous dose of cefoperazone). All patients had urine analysis and urine cultures on the second day after the operation. Additionally, clinical parameters including fever and dysuria were recorded. In 15% of the patients, incidental additional interventions such as punch biopsy or TUR of a small bladder tumor that were similarly distributed in both groups were performed. RESULTS: In 1 patient from the antibiotic group and 2 patients from the no prophylaxis group, the urine cultures after cystoscopy were positive. No statistically significant difference was observed between these groups based on the microbiological and clinical parameters. CONCLUSION: The current study provides evidence that no antibiotic prophylaxis is required before diagnostic cystoscopy in patients without bacteriuria. But, the absolute risk of infection was small, suggesting that a much larger study is required.

High power diode laser vaporization of the prostate: preliminary results for benign prostatic hyperplasia.

PURPOSE: Vaporization techniques using lasers have gained wide acceptance for benign prostatic hyperplasia as an alternative to transurethral prostate resection. The high power, 980 nm wavelength diode laser is a new promising alternative with a more rapid ablation rate and excellent hemostatic properties, as shown in ex vivo and in vivo animal models. We prospectively evaluated vaporization efficiency of the high power, 980 nm diode laser for bladder outlet obstruction due to benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 47 consecutive patients were included in the study. Inclusion criteria were maximal flow rate 12 ml per second or less with voided volume 150 ml or greater, International Prostate Symptom Score 12 or greater and quality of life score 3 or greater. Patients with a history of neurogenic voiding dysfunction, chronic prostatitis, or prostate or bladder cancer were excluded from analysis. Preoperative maximal flow rate, post-void residual urine, International Prostate Symptom Score, quality of life, International Index of Erectile Function-5, prostate specific antigen and prostate volume were compared with values at 3 and 6 months. Complications were assessed. RESULTS: Month 3 assessment revealed that the mean +/- SD International Prostate Symptom Score decreased significantly from 21.93 +/- 4.88 to 10.31 +/- 3.79 (p = 0.0001). The mean maximal flow rate increased significantly from 8.87 +/- 2.18 to 17.51 +/- 4.09 ml per second (p = 0.0001). Quality of life score changed considerably compared to baseline. All of these values showed slight improvement at month 6. There was no deterioration in erectile function according to the International Index of Erectile Function-5 short form. Post-void residual urine decreased significantly. Prostate volume and prostate specific antigen reductions were also significant. The most common postoperative complications were retrograde ejaculation (13 of 41 patients or 31.7%) and irritative symptoms (11 of 47 or 23.4%), which subsided in the maximal flow rate at 2 weeks. Recatheterization was necessary in 2 patients due to urinary retention after catheter removal. Two patients had temporary combined urge and stress incontinence for 2 weeks. Late bleeding in 1 patient 4 weeks postoperatively necessitated catheterization and irrigation. CONCLUSIONS: The high power diode laser provided significant improvements in International Prostate Symptom Score and the maximal flow rate with low morbidity. Thus, these results of prostate vaporization with the high power diode laser, representing what is to our knowledge the first clinical study in the literature, are encouraging.

Prospective assessment of the efficacy of single dose versus traditional 3-day antimicrobial prophylaxis in 12-core transrectal prostate biopsy.

OBJECTIVES: To prospectively evaluate the efficacy of single dose antibiotic prophylaxis in 12-core transrectal ultrasonography (TRUS) guided prostate biopsy. METHODS: A total of 400 patients who underwent prostate biopsy with TRUS guidance were included. The patients were prospectively randomized in three groups regarding antibiotic prophylaxis. The first group (139 patients) received a single gram of intramuscular ceftriaxone, while the second group (131 patients) had a 3-day course of oral ciprofloxacin. The third group (130 patients) had single oral 500 mg of ciprofloxacin. All patients had urine cultures prior to biopsy and on the second day after biopsy. RESULTS: The study groups were compared in terms of the results of urine cultures and clinical parameters. Overall, only seven patients (1.8% of the cases) had positive urine cultures with no difference between these three groups. Additionally, no significant difference was observed regarding morbidity rates in all groups. Only eight patients (2%) developed major complications requiring hospitalization. There was no increase in the rate of infectious complications when the biopsy core numbers were increased up to 12. CONCLUSIONS: The current study suggests that a single oral dose of antimicrobial prophylaxis is reasonable in TRUS prostate biopsy even in the case of 12-core sampling.

Combined periprostatic and intraprostatic local anesthesia for prostate biopsy: a double-blind, placebo controlled, randomized trial.

PURPOSE: Transrectal ultrasonography guided prostate biopsy is the principle procedure in the histological diagnosis of prostate cancer. Recently a trend toward increasing the number of cores has been popularized. This practice further increases the need for a proper anesthetic application. However, there is no consensus on a standard local anesthetic strategy, while groups at most institutions currently prefer periprostatic anesthesia. We prospectively evaluated the contribution of intraprostatic anesthesia for transrectal prostate biopsies even when the sampling number was doubled to 12 cores. MATERIALS AND METHODS: A total of 200 patients who underwent prostate biopsy with transrectal ultrasound guidance were included. The 2 groups received the usual periprostatic anesthesia. Consequently patients were prospectively randomized into 2 groups. Group 1 received additional intraprostatic lidocaine injection, while group 2 received the same amount of injection of 0.9% NaCl. The efficiency of applied local anesthesia was assessed by a visual analog pain scale. RESULTS: The study groups were comparable regarding patient age, prostate size and cancer rate. Pain scores revealed that the combination of intraprostatic and periprostatic local anesthesia provided significantly better pain control than periprostatic infiltration alone. No difference was observed regarding the morbidity rate in the 2 groups. CONCLUSIONS: The current study suggested that adding intraprostatic local anesthesia provides a significantly efficient strategy during transrectal ultrasound prostate biopsy, even in cases of 12-core sampling. Subsequent trials are needed to establish a standard analgesia policy for prostate biopsy.