Comparison of factors affecting the short-term presentation of results in the surgery of distal hypospadias in adults / Comparación de factores que afectan la presentación a corto plazo de los resultados en la cirugía de hipospadias distales en adultos

Introduction. To determine the factors affecting the success of distal hypospadias repair in adults. Material and methods. Medical records of adult patients who underwent distal hypospadias repair in our clinic were reviewed. Patient's age, external urethral meatus location, hypospadias status, anesthesia type, diversion type, nelaton diameter and surgeons were recorded as factors affecting surgery success. Only patients, operated with tubularisation incised plate urethroplasty (TIPU) technique, were included. Results were classified as successful, stricture, fistula and slough. We compared the factors affecting the success. SPSS 16.0 were used for statistical assessment and logistic regression analysis was used to determine success. p<0.05 was considered to show statistical significance. Results. One hundred and eight patients underwent distal hypospadias repair in our clinic. Mean age was 21.44±2.0. 38 patients had distal penile, 67 patients had subcoronal, 2 patients had coronal and 1 patient had glandular hypospadias. Eighty eight patients had primary, 12 secondary, 5 tertiary and 3 cripple hypospadias. Seventy eight patients underwent TIPU under local anesthesia, and 30 patients underwent under spinal anesthesia. Suprapubic catheter was used in 92 patients and transurethral catheter was used in 16 patients. Sixteen different surgeons performed the operations. Seventy operations were successful. Three stricture, 24 fistula, and 11 slough were determined. Overall success rate was 64.81%. Patient's age, external urethral meatus location, anesthesia type, diversion type, nelaton diameter and the surgeon difference did not affected surgical outcomes. Only hypospadias status (primary/redo) affected the success (p=0.037). Conclusion. The only factor affecting surgical outcomes of distal hypospadias repair in adults seems to be hypospadias status. It might be due to the lack of second layer in the redo operations (AU)

Introducción. Determinar los factores que influyen en el éxito de la reparación de hipospadias distal en adultos. Materiales y métodos. Se revisaron las historias clínicas de los pacientes adultos que se sometieron a reparación de hipospadias distal en nuestra clínica. Los siguientes factores se consideraron factores que afectan al éxito de la operación:la edad del paciente, la localización del meato uretral externo, el estado de hipospadias, el tipo de anestesia, el tipo de desvío, el diámetro nelaton y los cirujanos. Solo se tuvieron en cuenta los pacientes operados con la técnica de plato incidido tubularizaciónuretroplastia (TIPU). Los resultados fueron clasificados como: exitoso, estenosis, fístulas y Slough. Se compararon los factores que influyeron en el éxito de la operación. Se utilizóSPSS 16.0 para la evaluación estadística, mientras que el análisis de regresión logística se utilizó para determinar el éxito. Para mostrar significación estadística, se usóla cifra p <0,05. Resultados. Ciento ocho pacientes fueron sometidos a reparación de hipospadias distal en nuestra clínica. La media de edad fue de 21.44 ± 2.0. 38 pacientes tenían pene distal, 67 pacientes, tenían hipospadiassubcoronal, 2 pacientes,coronal y 1 paciente,glanular. Ochenta y ocho pacientes lo tenían primario, 5 secundario y 3,terciario. Setenta y ocho pacientes fueron sometidos a TIPU bajo anestesia local y a 30 pacientes se les realizó bajo anestesia epidural. Se utilizóun catéter suprapúbico en 92 pacientes y una sonda transuretral, en 16 pacientes. Dieciséis cirujanos diferentes se encargaron de llevar a cabo las operaciones; setenta de las cuales tuvieron éxito y hubo, además,tres casos de estenosis, 24 fístulas y 11 Slough. En general la tasa de éxito fue del 64.81%. La edad del paciente, la localización del meato uretral externo, el tipo de anestesia, el tipo de desvío, el diámetro del Nelatony el hecho de haber sido realizados por diferentes cirujanos no afectaron a los resultados quirúrgicos. Solo el estado de hipospadias (primari/reconstrucción) afectó al éxito (p=0.037). Conclusión. El único factor que influye en los resultados quirúrgicos de reparación de hipospadias distal en adultos parece ser el estado de los propios hipospadias. Podría ser debido a la falta de aplicación de la segunda capa en las operaciones reconstructoras (AU)

Tubularized incised plate urethroplasty in adults under local anaesthesia / / Uretroplastia en adultos mediante incisión y tubularización de la placa uretral bajo anestesia local

Introduction: Our aim was to assess our TIP urethroplasty results in adults with local anaesthesia. Materials and methods: Medical records of adult patients who underwent TIP urethroplasty due to distal hypospadias in our clinic between April 2006 and May 2013 were reviewed. Patient's age, external urethral location, preoperative calibration size of urethra, primary or secondary or more, circumsized or uncircumsized conditions were recorded. The records were categorized as circumcised–uncircumcised, urethral stent calibration 16 Fr and above or 14 Fr and below, primer or seconder and above, special group or the others. SPSS 16.0 were used for statistical assessment and chi-square test was used to determine success. p < 0.05 was considered to show statistical significance. Results: 51 patients underwent distal hipospadias repair under local anaesthesia in our clinic between April 2006 and May 2013. Mean age was 21.3. 24 patients had coronal, 26 patients had subcoronal, 1 patient had glanuler hypospadias. 40 patients were primary, 7 secondary, 4 tertiary. 38 patients were circumsized. 13 patients were uncircumsized. Mean preoperative calibration was 14.8 Fr, mean urethral stent calibre was 15, 1 Fr, mean stent duration time was 5.9 day. Suprapubic catheter was used for drainage at 48 patients. 22(52.3%) were successful, 20(47.6%) were unsuccessful of 42 patients with follow up. 13 patients that had fistula underwent fistula repair after 3 months later under local anaesthesia. 2 patients had stricture and they underwent meatotomy and dilatation. On one patient, second TIP urethoplasty operation was performed because the first operation was unsuccessful. Operation was very successful and it upgraded our over all success to 90.4%. An optimal group as primary, uncircumcised, 16 Fr neourethra was formed and were compared with the other groups. Success rate between optimal group and others was not different statistically. Conclusion: Our success rate was similar to literature. This survey reveals that distal hypospadias repair can be performed under local anaesthesia (AU)

Introducción: Nuestro objetivo fue evaluar los resultados obtenidos para la uretroplastia mediante incisión y tubularización de la placa uretral (TIP) con anestesia local en adultos. Materiales y métodos: Se revisó el historial clínico de los adultos que se sometiedon a una uretroplastia TIP debido a hipospadias distales entre abril del 2006 y mayo del 2013. Se catalogaron los parámetros de edad, ubicación externa de la uretra, calibración uretral preoperatoria, primario o secundario o más, circuncisión o no. Los valores se clasificaron como circuncidado-no circuncidado, calibración del stent uretral de 16 Fr o mayor o 14 Fr o menor, primario o secundario o más, grupo especial o el resto. Para valorar el éxito, el análisis estadístico se realizó con el sistema SPSS 16.0 y la prueba de la χ2. Los resultados p < 0,05 no se consideraron significativos. Resultados: Se intervino a 51 pacientes para reparación de hipospadias con anestesia local entre abril del 2006 y mayo del 2013. La media de edad fue de 21,3. Las hipospadias fueron coronales en 24 pacientes, subcoronales en 26 y granulares en uno. 40 pacientes fueron de tipo primario, 7 de tipo secundario y 4 de tipo terciario. 38 pacientes estaban circuncidados, 13 no lo estaban. La calibración media preoperatoria fue de 14,8 Fr, la calibración meadia del stent uretral due de 15,1 Fr, la duración media del stent fue de 5,9 días. Se utilizó una sonda suprapúbica para drenaje en 48 pacientes. De los 42 pacientes que acudieron a seguimiento, 22 (52,3%) consiguieron un resultado satisfactorio y 20 (47,6%) fueron casos fallidos. 13 pacientes que presentaron una fístula se sometieron a la reparación de la misma con anestesia local tres meses después. 2 pacientes presentaron estenosis y se sometieron a una meatotomía y dilatación. Uno de los pacientes precisó una segunda uretroplastia TIP debido a que la primera operación fue fallida. Esta segunda intervención fue muy satisfactoria y aumentó el nivel de éxito hasta el 90,4%. Se formó un grupo óptimo formado por pacientes primarios, no circuncidados, 16 Fr neouretra para compararlo con el resto de grupos. Estadísticamente no se apreciaron cambios entre el grupo óptimo y el resto de grupos. Conclusión: Nuestro nivel de éxito fue similar al de la literatura. Esta encuesta revela que la reparación de hipospadias distales puede realizarse con anestesia local (AU)

Attention-deficit hyperactivity disorder in patients with premature ejaculation: a pilot study.

PURPOSE: The etiology of both adult-type ADHD and PE is not completely understood, but the studies revealing common etiologic factors for both conditions suggest a high likelihood of coexistence. We aimed to find out the prevalence of ADHD among adult males with lifetime PE. METHODS: The patients with lifetime PE were included in the study. Both patients and controls were evaluated with the 10-item premature ejaculation index of Althof and Rosen for premature ejaculation, Wender Utah rating scale (WURS) and Conner's adult ADHD rating scales (CAARS) for determining the presence of attention-deficit hyperactivity disorder syndrome. RESULTS: A total of 38 patients and 27 controls were included in the study. Patient and control groups were similar in terms of age and (p < 0.878), but different IELT (p < 0.001). ADHD was detected in 16 (42.1 %) of patients with PE, while ADHD symptoms were detected in only 1 (3.7 %) of control patients. Distribution of patients in the study group according to ADHD types was as follows: Type 1, Type 2, Type 3 in 2 (5.3 %), 4 (10.5 %), and 10 (26.3 %) patients, respectively. CONCLUSIONS: ADHD is significantly more frequent among patients with PE than controls. The close relationships between these two diseases must be examined by prospective studies.

Association between the androgen levels and erectile function, cognitive functions and hypogonadism symptoms in aging males.

PURPOSE: Aging in men is characterized by a moderate decrease in plasma testosterone (T) levels. However, the association between partial androgen deficiency of the aging male and clinical symptoms and the ideal screening test are controversial. In this study, we investigated the association between the androgen levels and erectile function, cognitive functions and hypogonadism symptoms in aging males. MATERIALS AND METHODS: We investigated the association between total (TT), calculated free (FT) and bioavailable (BT) testosterone, and various clinical and laboratory parameters in 103 healthy males, 50-80 years old. Biochemical assessment was done after overnight fasting. Questionnaires were used to test for hypogonadism symptoms, erectile and cognitive functions. RESULTS: TT levels were not correlated with aging in this study. However, FT and BT were found to decrease with age due to rising sex hormone binding globulin. TT levels were strongly correlated with FT and BT levels (respectively p = 0.0001, p = 0.0001). TT, FT and BT were only correlated with cognitive functions (p = 0.012, p = 0.004, p = 0.02 respectively). There was no correlation between TT, FT and BT levels and erectile function and hypogonadism symptoms. CONCLUSION: T values in our study sample did not correlate with clinical signs and symptoms of hypogonadism. Thus, according to our data, symptoms in the aging male should not be indiscriminately assigned to a decrease in TT, FT or BT levels.

Epididymoorchitis due to Brucella melitensis: review of 19 patients.

INTRODUCTION: We describe the clinical characteristics, treatment and long-term outcome of 19 patients with Brucella epididymoorchitis treated at the Department of Urology. MATERIALS AND METHODS: Between 1998 and 2005, a total of 19 cases with epididymoorchitis due to Brucella melitensis were diagnosed at our hospital. The diagnosis of Brucella was made by isolating Brucella species from blood culture or epididymal aspiration or by standard tube agglutination testing and slide agglutination testing together with clinical findings. RESULTS: Seven cases (36.8%) had undulant fever. Brucella species was isolated from blood cultures in 11 patients and from epididymal aspiration in 3 patients. Rose Bengal tests were positive in all patients. Total recovery was obtained in 12 cases with a 6-week treatment. Five patients (26.3%) did not respond to therapy and another 2 (10.5%) relapsed. CONCLUSIONS: Brucella orchitis should be considered in the differential diagnosis of scrotal pathologies where Brucella is endemic.

The significance of potassium chloride sensitivity test and urinary uronic acid level in the diagnosis of chronic pelvic pain syndrome.

OBJECTIVES: Noninvasive tests are needed for the diagnosis of chronic pelvic pain syndrome. We evaluated the significance of potassium chloride sensitivity test and urinary CTAB-precipitable uronate level in patients with chronic pelvic pain syndrome (CPPS). METHODS: We included 25 patients with interstitial cystitis (IC), and 30 patients with chronic prostatitis (CP) who applied to our outpatient clinic with the complaints of frequency, dysuria and pain on urination between the years 2003 and 2005. Thirty-five subjects were studied as healthy controls. All patients underwent cystoscopy, cystometry, voiding diary, sodium chloride, and potassium chloride filling tests. Visual analog scale (VAS) was used to determine pain scores. Patients with CP also underwent NaCl and KCl voiding tests. Urinary CTAB-precipitable uronate levels were obtained in all subjects. RESULTS: KCl test had a good sensitivity for IC. As for the patients with CP, KCl voiding test was useful, but KCl filling test was not. Urinary CTAB-precipitable uronate level was found to be significantly higher in patients with IC and CP than controls, and in patients with IC than in patients with CP. CONCLUSIONS: The results of our study suggest that KCl voiding test is a good candidate to be used in the diagnostic workup of patients with category III CP, and urinary CTAB-precipitable uronate level measurement may be a noninvasive diagnostic aid for IC and CP.

Sertoli cell tumor of the testis: a case with late metastasis.

We report on a 20-year-old male who underwent a radical orchidectomy when he was 12 years old which revealed a Sertoli cell tumor in his right testis, and who presented with a 5 x 3 cm retroperitoneal metastatic mass 8 years after orchidectomy. Current experience on Sertoli cell tumor of the testis (SCTT) is insufficient to prognosticate the clinical behavior of the primary tumor on the long term. Case reports in the literature on patients with late metastases suggest a very long followup after orchidectomy may be required.

Comparing the therapeutic outcome of different alpha-blocker treatments for BPH in the same individuals.

OBJECTIVE: Alpha-blockers are the most widely used agents to treat lower urinary tract symptoms in males, and switching between alpha-blockers is a frequent management option when the desired effect could not be obtained. There is no data in the literature that reveal the outcome of treatments with different alpha-blockers within the same patient. We sought the answer to this question in a setting where the same individuals were treated with two different agents during different time frames. MATERIALS AND METHODS: Forty males with benign prostatic hyperplasia (BPH) applying to the Department of Urology with lower urinary tract symptoms (LUTS) were enrolled in the study consecutively. Patients were evaluated with detailed medical history, IPSS forms, digital rectal examination (DRE), urinary ultrasound, PSA, and uroflowmetry. The subjects received terazosin 5 mg daily for 3 months, and controlled release form of alfuzosin 10 mg daily for another 3 months, leaving a 1-month clearance period in between. The above-mentioned detailed evaluations were carried out before and after each alpha-blocker regimen. RESULTS: Mean age and PSA level was 63.3+/-1.6 years (45-80), and 2.1+/-0.4 ng/ml (0.16-6.3 ng/ml). IPSS and Qmax values before treatment with terazosin and alfuzosin were similar. Improvements in IPSS and Qmax values after treatments with both terazosin and alfuzosin were significant. There was no statistically significant difference between the drugs in terms of percent improvements in IPSS and Qmax with alpha-blocker treatment. No untoward effect except for transient dizziness in one case with terazosin treatment was encountered. CONCLUSION: Different alpha-blockers, which are used during different time frames in the same individuals, provide similar efficiency outcome. When the desired effect in the treatment for BPH could not be obtained with one alpha-blocker, there may not be any benefit in switching to another one.

Repairing urethrocutaneous fistula in adults: is a catheter necessary?

OBJECTIVES: To demonstrate that urethrocutaneous fistulas can be repaired under local anesthesia in adult patients without catheters. METHODS: From 1998 to 2006, 96 patients with urethrocutaneous fistulas underwent repair under local anesthesia. The patients were divided into two groups in terms of whether they did or did not have a catheter placed. The catheterized group included 45 patients and the uncatheterized group included 51 patients. The uncatheterized patients were discharged on the operation day, and the catheterized patients were discharged 1 to 4 days postoperatively. Patients were reevaluated on the 7th postoperative day and after 3 months in terms of wound infection, urethral stricture, and fistula recurrence. RESULTS: All patients tolerated the fistula repair well under local anesthesia. The success rate of fistula repair was 93.3% and 94.1% in the catheterized and uncatheterized groups, respectively. Wound infection was seen in 6 patients in the first group but was not noted in the uncatheterized group. Fistulas recurred in 3 patients in each group (6.6% and 5.8%) after 3 months postoperatively. CONCLUSIONS: Catheterless fistula repair with local anesthesia in adults is an effective, safe, and inexpensive procedure.

An important issue in the management of elimination dysfunction in children: parental awareness of constipation.

The scale of parental awareness concerning children's bowel habits and its effects on voiding dysfunction were investigated. Parents of toilet-trained children older than 4 years were given questionnaires during the first interview and after follow-up of their children's bowel habits for symptoms and signs of constipation and urinary complaints. Diagnosis of constipation was made according to the Rome III criteria. Eighty-nine patients were included in the study. The number of constipated patients almost doubled after the observation period. Most of the urinary problems resolved upon treatment of constipation. History at first interview was misleading in 42% of the patients who would benefit from a simple treatment. Most of the parents were unaware of their children's bowel habits. Before proceeding with more complicated tests or treatment of voiding dysfunction, the symptoms and signs of constipation should be sought during a close parental observation period.

Distal hypospadias repair in adults: the results of 97 cases.

INTRODUCTION: We reviewed our 9-year experience on 97 men with distal hypospadias who had undergone hypospadias surgeries. SUBJECTS AND METHODS: Patients were divided into two groups: group 1 included 17 men who had one or more unsuccessful surgeries in their childhood, and group 2 included 80 men with no previous hypospadias repairs. Meatal positions were glanular in 6, coronal in 35 and subcoronal in 56 patients. Our 97 hypospadias surgeries involved 42 meatal advancement and glanuloplasty, 41 Mathieu and 14 tubularized incised plate urethroplasty procedures. RESULTS: The overall success rate was 88% (86 of the 97 patients). The success rate was 76.5% for group 1 (13 of the 17 patients) and 91.3% for group 2 (73 of the 80 patients). Better voiding function and good cosmetic appearance was achieved in all patients. Urinary flow rates were significantly higher in all groups postoperatively. The success rates were 91.4 and 85% for the patients with preoperative coronal and subcoronal meatal positions, respectively. The success rate was significantly lower in crippled cases and in cases with longer neourethra. CONCLUSION: Although the same techniques are used for children and adults in hypospadias surgery, the results in adults differ from those in children. The success rate for primary adult cases is quite acceptable, but it is decreased in patients having longer neourethra and having multiple previous interventions.

Intravesical heparin and peripheral neuromodulation on interstitial cystitis.

INTRODUCTION: We wanted to evaluate the therapeutic effect of intravesical heparin and peripheral neuromodulation on patients with interstitial cystitis. MATERIALS AND METHODS: From March 2002 to August 2003, 8 female and 2 male subjects conform to the NIDDK criteria and not responsive to the previous conventional treatments were included in the study. Wisconsin pain scores, maximal cystometric capacities, and night and day voiding frequencies were determined and these studies were repeated in the 2nd and 12th months of the treatment with 10,000 units intravesical heparin and peripheral neuromodulation. Frequency of the treatment was once a week during first 8 weeks, once in 2 weeks in the following 8 weeks, and once in 3 weeks four times. Then, it was decreased to once a month. RESULTS: The mean follow-up period was 13 months (12-16 months). Day and night voiding frequency were significantly better in the 2nd and 12th months, when compared to pretreatment values. The Wisconsin pain scores were 62.5 +/- 13.9% and 62.8 +/- 15.2% in the 2nd and the 12th months, respectively. The average increase in the maximum cystometric capacity was 54.8 +/- 27.4% and 52.5 +/- 31.6% in the 2nd and the 12th months, respectively. CONCLUSIONS: Intravesical heparin and peripheral neuromodulation combination seems to be an alternative for patients with interstitial cystitis not responsive to other treatments.