Comparison of Classic and Inguinal Obturator Nerve Blocks Applied for Preventing Adductor Muscle Contractions in Bladder Tumor Surgeries: A Prospective Randomized Trial.

PURPOSE: Obturator nerve block (ONB) has been performed in surgeries of transurethral resection of bladder tumors (TUR-BT) for the prevention of the development of obturator muscle contraction. Currently, classic and inguinal approaches are frequently being used. In the present study, we aimed to compare the success rate, performance speed, and complication risks of both approaches. MATERIALS AND METHODS: Sixty-six patients who underwent TUR-BT under spinal anesthesia were randomly selected, and ONB was performed on the tumor location side using classic (n = 33) or inguinal (n = 33) approaches. Ten milliliters of 0.25% bupivacaine were administered using a peripheral nerve stimulator in both approaches.Two endpoints were defined in the study: Primary endpoint; the duration of the determination of the obturator nerve and number of interventions when each participant is assessed in at the end of the ONB procedure. Secondary endpoint; development of contractions, and complications each participant is assessed during the TUR-BT and 24 hours after ONB. (Clinical Trial Registration Number: ACTRN12617001050347)Result: General anesthesia was applied to the five patients in the classic ONB group who detected diffuse or bilateral tumors. These patients were excluded from the study. Contractions developed in 4 patients in each group, no statistically significant difference was detected between the groups (14.3%, n = 4 versus 12.1%, n = 4) (P = 1.00). No complications were detected in both groups during the TUR-BT and 24 hours after ONB. We found that the inguinal approach provided a statistically significant advantage regarding the number of punctures (1.9 ± 0.9 versus1.5 ± 0.7) (P = .036), and duration of the procedure (99.1 ± 48.4 seconds versus 76.0 ± 31.9 seconds) (P=.029) compared with the classic approach. CONCLUSION: Although complications and success rates were similar in both groups, the inguinal method may be abetter approach because it is faster and requires fewer punctures.

A retrospective analysis of mathieu and tip urethroplasty techniques for distal hypospadias repair; A 20 year experience.

OBJECTIVE: We aimed to identify the changes in the application rate of two surgical techniques in distal hypospadias repair in years and compare the most popular two surgical repair techniques for distal hypospadias in terms of surgical outcomes, the factors that affect the outcomes, which were performed over a 20 year period. METHODS: In this study, the records of 492 consecutive patients that had undergone an operation for distal hypospadias in the urology clinic of Ankara between May 1990 and December 2010 using either Mathieu or TIPU surgical techniques were reviewed retrospectively. The patients who had glanular, coronal, and subcoronal meatus, were accepted as distal hypospadias cases. Among the 492 examined medical records, it was revealed that 331 and 161 surgical interventions were performed by using the Mathieu urethroplasty technique (Group-1) and TIP urethroplasty technique (Group-2), respectively. Group-1 was divided into two subgroups; namely Group-1a (patients with primary hypospadias) and Group-1b (patients with previous hypospadias operation). Likewise, Group-2 was divided into two subgroups; namely group-2a and group-2b. The patients' ages, number of previously urethroplasty operations, localization of the external urethral meatus prior to the operation, chordee state, length of the newly formed urethra, whether urinary diversion was done or not, post-operative complications and data regarding the follow-up period were evaluated, and the effects of these variables on the surgical outcome were investigated via statistical analyses. The primary objective of this study is to identify the changes in the application rate of two surgical techniques in distal hypospadias repair over the a 20 year period, and the secondary objectives are to compare the most popular two surgical repair techniques for distal hypospadias in terms of surgical outcomes, and the factors affecting the outcomes. Independent samples t test and Pearson's Chisquare test was used for statistical analysis. p<0.05 was considered as statistically significant. RESULTS: There were no statistically significant differences between the subgroups in terms of age, length of the neo-urethra, number of previously performed urethroplasty operations, surgical success rates, or complications (p>0.05). The concurrent utilization of the cystostomy and urethral stent was significantly more frequent in group-1 (p<0.05; Pearson's Chi-square test). It was determined that over time, TIP urethroplasty has become a more preferred technique for the repair of distal hypospadias. CONCLUSIONS: Both surgical techniques have similar success rates in distal hypospadias cases. TIP urethroplasty has become the method of choice over time.

A retrospective analysis of mathieu and tip urethroplasty techniques for distal hypospadias repair; a 20 year experience / Análisis retrospectivo de las técnicas de uretroplastia de Mathieu y TIP (Tubularized Incision Plate) para la reparación del hipospadias distal. Veinte años de experiencia

OBJECTIVE: We aimed to identify the changes in the application rate of two surgical techniques in distal hypospadias repair in years and compare the most popular two surgical repair techniques for distal hypospadias in terms of surgical outcomes, the factors that affect the outcomes, which were performed over a 20 year period. METHODS: In this study, the records of 492 consecutive patients that had undergone an operation for distal hypospadias in the urology clinic of Ankara between May 1990 and December 2010 using either Mathieu or TIPU surgical techniques were reviewed retrospectively. The patients who had glanular, coronal, and subcoronal meatus, were accepted as distal hypospadias cases. Among the 492 examined medical records, it was revealed that 331 and 161 surgical interventions were performed by using the Mathieu urethroplasty technique (Group-1) and TIP urethroplasty technique (Group-2), respectively. Group-1 was divided into two subgroups; namely Group-1a (patients with primary hypospadias) and Group-1b (patients with previous hypospadias operation). Likewise, Group-2 was divided into two subgroups; namely group-2a and group-2b. The patients' ages, number of previously urethroplasty operations, localization of the external urethral meatus prior to the operation, chordee state, length of the newly formed urethra, whether urinary diversion was done or not, post-operative complications and data regarding the follow-up period were evaluated, and the effects of these variables on the surgical outcome were investigated via statistical analyses. The primary objective of this study is to identify the changes in the application rate of two surgical techniques in distal hypospadias repair over the a 20 year period, and the secondary objectives are to compare the most popular two surgical repair techniques for distal hypospadias in terms of surgical outcomes, and the factors affecting the outcomes. Independent samples t test and Pearson's Chi-square test was used for statistical analysis. p < 0.05 was considered as statistically significant. RESULTS: There were no statistically significant differences between the subgroups in terms of age, length of the neo-urethra, number of previously performed urethroplasty operations, surgical success rates, or complications (p > 0.05). The concurrent utilization of the cystostomy and urethral stent was significantly more frequent in group-1 (p < 0.05; Pearson's Chi-square test). It was determined that over time, TIP urethroplasty has become a more preferred technique for the repair of distal hypospadias. CONCLUSIONS: Both surgical techniques have similar success rates in distal hypospadias cases. TIP urethroplasty has become the method of choice over time

OBJETIVO: Identificar los cambios en la tasa de aplicación de dos técnicas quirúrgicas en la reparación del hipospadias distal durante los años, y comparar las dos técnicas más populares de reparación quirúrgica del hipospadias distal realizadas durante 20 años en términos de resultados quirúrgicos y los factores que afectan a los resultados. MÉTODOS: En este estudio revisamos retrospectivamente las historias clínicas de 492 pacientes consecutivos intervenidos por hipospadias distal en la clínica urológica de Ankara entre mayo de 1990 y diciembre de 2010 utilizando las técnicas de Mathieu o TIP. Los pacientes que tenían un meato glandular, coronal o subcoronal se aceptaron como casos de hipospadias distal. Entre los 492 casos, 331 fueron intervenidos con la técnica de Mathieu (Grupo 1) y 161 con la técnica de Uretroplastia TIP (Grupo 2). El grupo 1 se subdividió en dos subgrupos: Grupo 1a (pacientes con hipospadias primario) y Grupo 1b (pacientes con historia de hipospadias intervenido previamente). Igualmente, el Grupo 2 se subdividía en dos subgrupos: Grupo 2a y Grupo 2b. Se evaluaron las edades de los pacientes, el número de uretroplastias previas, la localización del meato uretral externo antes de la operación, el estado de la corda, la longitud de la uretra nuevamente formadas, si se hizo derivación urinaria o no, las complicaciones postoperatorias y los datos relativos al periodo de seguimiento, y se hizo análisis estadístico de los efectos de estas variables en los resultados de la cirugía. El objetivo primario del estudio es identificar los cambios en la tasa de aplicación de las dos técnicas quirúrgicas con los años, y los objetivos secundarios comparar las dos técnicas de reparación del hipospadias distal más populares en términos de resultados quirúrgicos, factores que afectan a los resultados; técnicas que fueron realizadas a lo largo de 20 años. Para el análisis estadístico se utilizaron el test de la t para muestras independientes y el test del Chi cuadrado de Pearson. Se consideró una p > 0,05 como estadísticamente significativa. RESULTADOS: No había diferencias estadísticamente significativas entre los subgrupos en términos de edad, longitud de la neouretra, número de uretroplastias previas, tasa de éxitos o complicaciones (p > 0,05). La utilización concomitante de cistostomía y stent uretral fue significativamente más frecuente en el grupo 1 (p < 0,05; test del Chi cuadrado de Pearson). Se determinó que con el tiempo la Uretroplastia TIP se había convertido en la técnica más preferida para la reparación del hipospadias distal. CONCLUSIONES: Ambas técnicas quirúrgicas tienen tasas de éxito similares en los casos de hipospadias distal. La Uretroplastia TIP se ha convertido con el tiempo en el método de elección

Does a retropulsion prevention device equalize the surgical success of Ho:YAG laser and pneumatic lithotripters for upper ureteral stones? A prospective randomized study.

To establish if a retropulsion prevention device for ureteral stones equalizes surgical success and push-back rates of Ho:YAG laser and pneumatic lithotripters for upper ureteral stones. Patients with upper ureteral stones (n = 267) were treated endoscopically at the Department of Urology between April 2014 and December 2015. Patients were randomly assigned to pneumatic and Ho:YAG laser lithotripters as group-1 and group-2, respectively. Lithotripsy was performed with Stone ConeTM in both groups. The surgical success rate on the first postoperative day was 81.5 % (n = 106) and 90.6 % (n = 116) for group-1 and group-2, respectively, and the difference between the groups was statistically significant (p < 0.05). The relation between stone size and surgical success was statistically significant for both groups (p < 0.01). Surgical success for the stones closer than 2 cm to the UPJ was 23.1 % for the pneumatic group versus 64 % for the laser group (p < 0.01). Lithotripsy time was significantly longer in group-2 (16.48 ± 4.74 min) than group-1 (12.24 ± 3.95 min) (p < 0.01). Ho:YAG laser lithotripsy is more successful than pneumatic lithotripsy for upper ureteral stones and a retropulsion prevention device does not equalize the surgical success of Ho:YAG laser and pneumatic lithotripters for upper ureteral stones on the first postoperative day and one month after surgery. Although the success rate of the first month after surgery is higher in group-2, the difference is not statistically significant.

Penile enhancement with rectus muscle fascia and testicular tunica vaginalis grafts: an experimental animal study.

PURPOSE: To enhance rat penises experimentally with rectus muscle fascia (RMF) and testicular tunica vaginalis grafts (TVG). METHODS: Twelve Wistar albino rats were distributed into two equal Groups, A and B. There were six rats in each group. RMF and TVG were used to enhance rat penises in Groups A and B, respectively. Circumferences of the penises were measured preoperatively and at three different times after the operation. Two, two and eight rats were killed 10 days, 1 month and 2 months after the operation, respectively, for histopathological examinations. RESULTS: When we compared the measurements of preoperative and immediately postoperative circumferences, the mean increase was 23.4 ± 2.9 % in Group A and 19.9 ± 1.7 % in Group B. According to paired t test, the difference was significant (p < 0001), but the comparison between preoperative and postoperative first-month measurements was not found to be significant (p > 0.05). Histological examinations revealed an intensive inflammatory process at 10 days after the operation. Grafts were found to be totally absorbed in the first- and second-month examinations. CONCLUSION: In our study, implanted TVG and RMF could not survive because of insufficient vascularization and failure to maintain satisfactory surgical success. More studies are needed to increase the effectiveness of surgical techniques.

Effect of positive surgical margins on biochemical failure, biochemical recurrence-free survival, and overall survival after radical prostatectomy: median long-term results.

The aim of this study was to investigate the median long-term effects of positive surgical margin (PSM) and other prognostic factors on biochemical recurrence-free survival, overall survival, and biochemical failure in patients who underwent radical prostatectomy. Our study included 121 patients with pT2-3N0 disease treated between March 2006 and August 2012. The patients were divided into two groups: those with PSM and those with negative surgical margin (NSM). We analyzed the age, clinical and pathological stages, preoperative and postoperative Gleason scores, duration of the follow-up, adjuvant chemo-/radiotherapy, biochemical failure, biochemical recurrence-free survival, and overall survival in these patients. PSM was found in 25 (20%) patients, whereas 96 patients had NSM. The median follow-up time was 46.6 months (range 12-72 months) for the PSM group and 48.3 months (range 7-149 months) for the NSM group. The biochemical failure rate was 24% in the PSM group and 8.3% in the NSM group (p = 0.029). The biochemical recurrence-free survival was found as 76% in the PSM group and 91.7% in the NSM group. The difference between the groups was not statistically significant (p = 0.06). The overall survival was 100% in both groups. The surgical margins of the radical prostatectomy material is an important pathological indicator for biochemical failure at mid long-term follow-up. We did not find any effect of PSM on overall survival or biochemical recurrence-free survival.

Does the endoscopic treatment of lower ureter stones affect uroflowmetric values? A prospective clinical trial.

OBJECTIVES: The aim of this study was to document if stones at the lower ureter alter the micturition capability of the patients and to investigate whether endoscopic removal of these stones restores normal urinary flow rates or not in the 3 months of follow-up. METHODS: Forty patients with lower ureteral stone (group 1) and 20 control subjects with proximal ureteral stone (group 2) were enrolled into the study. All patients underwent uroflowmetry testing before and 3 months after the treatment for endoscopic stone removal. The mean average and peak flow rates with a sufficient voided volume (≥150 ml) were evaluated before and after surgery and compared between the groups. RESULTS: Mean values of the peak flow rates before and after surgery were 20.3 and 27.5 ml/s in group 1 and 22.5 and 23.6 ml/s in group 2, and the mean average flow rate values before and after surgery were 10.5 and 13.6 ml/s in group 1 and 11.4 and 12.1 ml/s in group 2. Statistically significant differences were determined between before and after ureteroscopy values were determined in terms of average (p < 0.05) and peak flow rates (p < 0.01) in group I; however, there no significant difference was seen in the control group. CONCLUSION: We document for the first time in the literature that patients with lower ureteric stones have a reduction in their urinary stream which resolves with endoscopic removal of the stones.

Idiopathic giant atonic bladder (6000 mL in volume) present for 15 years with no urinary symptoms.

Urinary retention is common in patients with neurologic disorders. We present a case of asymptomatic idiopathic giant bladder from which 6000 mL urine was drained. This is the largest volume of bladder that we found in the literature.

Acupuncture versus paroxetine for the treatment of premature ejaculation: a randomized, placebo-controlled clinical trial.

BACKGROUND: Acupuncture therapy has been used by many researchers in both male and female sexual dysfunction studies. OBJECTIVE: To determine whether acupuncture is effective as a premature ejaculation (PE) treatment compared with paroxetine and placebo. DESIGN, SETTING, AND PARTICIPANTS: The study was conducted with methodologic rigor based on Consolidated Standards of Reporting Trials (CONSORT) criteria. Ninety patients referred to the urology clinic at a tertiary training and research hospital with PE were included in this randomized controlled trial and randomly assigned into paroxetine, acupuncture, and placebo groups. Heterosexual, sexually active men aged between 28 and 50 yr were included. Men with other sexual disorders, including erectile dysfunction; with chronic psychiatric or systemic diseases; with alcohol or substance abuse; or who used any medications were excluded. INTERVENTION: The medicated group received paroxetine 20 mg/d; the acupuncture or sham-acupuncture (placebo) groups were treated twice a week for 4 wk. MEASUREMENTS: Intravaginal ejaculation latency times (IELTs) and the Premature Ejaculation Diagnostic Tool (PEDT) were used to assess PE. IELTs were calculated by using a partner-held stopwatch. Data were analyzed statistically. RESULTS AND LIMITATIONS: Median PEDT scores of paroxetine, acupuncture, and placebo groups were 17.0, 16.0, and 15.5 before treatment, and 10.5, 11.0, and 16.0 after treatment, respectively (p=0.001, p=0.001, and p=0.314, respectively). Subscores after treatment were significantly lower than subscores before treatment in the paroxetine and acupuncture groups but remained the same in the placebo group. Significant differences were found between mean-rank IELTs of the paroxetine and placebo groups (p=0.001) and the acupuncture and placebo groups (p=0.001) after treatment. Increases of IELTs with paroxetine, acupuncture, and placebo acupuncture were 82.7, 65.7, and 33.1 s, respectively. Extent of ejaculation delay induced by paroxetine was significantly higher than that of acupuncture (p=0.001). The most important limitation of the study was the lack of follow-up. CONCLUSIONS: Although less effective than daily paroxetine, acupuncture had a significant stronger ejaculation-delaying effect than placebo.

Single-institution outcomes of open reconstruction techniques for management of pediatric and adolescent post-traumatic urethral strictures.

OBJECTIVES: To assess the long-term results and efficiency of open reconstruction techniques for pediatric and adolescent post-traumatic urethral strictures. METHODS: A total of 75 patients who had undergone open reconstructive urethroplasty for post-traumatic bulbous or posterior urethral obliterative strictures resulting from pelvic fracture urethral injuries were retrospectively analyzed. The mean patient age was 12.3 years (range 6-17). Of the 75 patients, 38 had a bulbar stricture and 37 had posterior urethral obliteration. Perineal end-to-end anastomotic repair, urethral pull-through, and ureteral tube graft urethroplasty were performed in 54, 20, and 1 patient, respectively. All patients were followed up by medical history and a urinary flow rate evaluation at 6 and 12 months postoperatively. RESULTS: The patients were followed up for 12-94 months (mean 43.2). The urethral strictures were successfully treated with end-to-end anastomotic urethroplasty in 37 (68.5%) of 54 patients, urethral pull-through urethroplasty in 14 (70%) of 20 patients, and ureteral tube graft in 1 patient. The total primary success rate was 69.3% (52 of 75 patients). Recurrent stricture developed in 23 patients. Of these 23 patients, 7 and 11 were successfully treated with secondary end-to-end anastomosis and direct vision internal urethrotomy, respectively. The overall success rate was 93.3% (70 of 75 patients). Five patients with treatment failure were still in follow-up, with direct vision urethrotomy performed, as needed. No penile curvature, penile shortening, or urethral diverticula developed. CONCLUSIONS: The results of our study have shown that open urethral reconstruction techniques are effective for primary and secondary surgical interventions in pediatric and adolescent patients with post-traumatic urethral strictures in experienced centers. These techniques provide excellent long-term results with minimal morbidity.

Endoscopic versus open hydrocelectomy for the treatment of adult hydroceles: a randomized controlled clinical trial.

OBJECTIVE: To compare outcomes of endoscopic treatment of hydrocele with conventional open hydrocelectomy regarding complications and patient satisfaction. METHODS: Patients with clinically significant hydroceles were prospectively enrolled into two treatment groups. Groups 1 and 2 consisted of patients who underwent endoscopic (n = 27) and open surgical treatments (n = 27), respectively. Outcome measures were perioperative and postoperative complications and recurrence rates. RESULTS: Hydrocele recurred in the first two cases in Group 1 during the initial phase of the learning curve of the technique. No recurrence was encountered in Group 2. As a complication, moderate to severe edema occurred in 4 cases in the endoscopic group. In the open surgery group, significant edema and hematoma occurred in 8 and 2 cases, respectively. On the first and tenth postoperative days, endoscopic procedure was found more cosmetically acceptable and covered a more comfortable convalescence period when compared to open surgical group (P < 0.05). In Groups 1 and 2, 88 and 70% of the patients, respectively, declared that they would recommend this procedure to their friends (P < 0.05). CONCLUSIONS: Endoscopic method is a viable option in the treatment of hydrocele. Outstanding feature of the endoscopic method is an earlier achievement of a better cosmetic outcome and a comfortable postoperative period when compared with the conventional treatment.

Hormonal and pathologic changes after chemoablation of testes with hypertonic saline solution as a treatment method alternative to orchiectomy in patients with hormone sensitive metastatic prostatic cancer.

OBJECTIVE: We tried to clarify whether less invasive and lower-cost method of injecting hypertonic saline solution could be an alternative to orchiectomy. MATERIALS AND METHODS: Thirty adult healthy male Wistar rats were used as experimental animals. Three groups were made as 0.9% NaCl administered to the first group, orchiectomy performed to the second group, and 20% saline solution administered to the third group. To measure baseline testosterone values were obtained from all rats 1 day before the procedure. Blood samples obtained to analyze total testosterone from all rats at days 1, 15, and 60 were centrifuged and stored in deep freeze. After blood samples were obtained at day 60, intramuscular 100 IU HCG (Pregnyl) was administered to all rats. Following HCG injection, new blood samples were obtained to analyze testosterone levels at 120 minutes. RESULTS: On microscopic examination, while extensive coagulation necrosis was seen in the third group, in only two samples in this group, an area of intact tissue was observed. Baseline, day 1, day 15, and month 2 testosterone levels of all groups were analyzed. When changes in testosterone levels between baseline values and month 2 control levels were compared, changes in the second and third group were detected statistically significant, and there was no statistically significant difference between these two groups. When month 2 and post-HCG stimulation test serum testosterone levels were compared, a statistically significant increase was found only in the first group. CONCLUSIONS: These data indicate that since there are nearly the same pathological and biochemical results with bilateral orchiectomy and no negative findings were found for comorbidity, bilateral injection of 20% hypertonic saline solution into the testes could be an alternative in the treatment of hormone-sensitive metastatic prostate cancer.

Intrarenal epidermal cyst.

Although renal cystic formations are seen frequently and arise with diverse symptoms, epidermal cyst is a very unusual cause of renal masses. A50-year-old woman was admitted to our clinic because of lumbar pain, hematuria and dysuria that lasted for 2 months. An atrophic and dysfunctional right kidney was identified. Transperitoneal laparoscopic simple nephrectomy was performed. Microscopic examination revealed typical findings of epidermoid cyst. According to the literature, intrarenal epidermal cysts are usually treated by nephrectomy because they cannot be differentiated from renal masses. To the best of our knowledge, this case report of an epidermoid cyst located in the renal parenchyma of a female patient is the first in the English-language literature.

Effect of thioglycolic acid instillation to stop hair growth on the urethral mucosa after urethroplasty with hairy skin in a rat model.

OBJECTIVE: The aim of this study was to investigate the impact of thioglycolic acid on normal urethral mucosa. METHODS: Twenty-four rats were used. Three control and three study groups were formed each consisting of 4 rats. Controls groups were given 0.9% NaCl and study groups received thioglycolic acid instillation. The groups were allocated according to the time of urethral resection and the number of thioglycolic acid instillations (2, 4 or 8 instillations). The urethras of the rats were resected and examined under a light microscope in control and study groups 1, 2 and 3 on days 15, 30 and 60. RESULTS: There was no difference in the urethral mucosa of rats in the study or control groups, and no differences were found when the study groups were compared to each of the other groups at the microscopic level. CONCLUSION: The application of thioglycolic acid is an easy and inexpensive way of clearing urethral hair and does not cause pathological changes in the normal urethral mucosa.

Our 21-year experience with the Thiersch-Duplay technique following surgical correction of penoscrotal transposition.

OBJECTIVES: To assess surgical techniques applied after surgical correction of penoscrotal transposition and their complications. METHODS: The medical records of 64 patients with a mean age of 4.1 years (range 1-24) who underwent surgical correction for penoscrotal transposition and subsequent Thiersch-Duplay urethroplasty in the last 21 years were evaluated retrospectively. RESULTS: All cases underwent Thiersch-Duplay urethroplasty following reconstruction of penoscrotal transposition after a minimum interval of 6 months. Following Thiersch urethroplasty, 41 (64%) cases with successful outcomes had glandular meatuses. Of the remaining 23 (36%) patients 15, 7 and 1 patients underwent second operations for urethrocutaneous fistulas, meatal regressions and urethral diverticulum, respectively. Eleven of 15 patients underwent primary fistula repair and 4 patients, turnover fistula repair. These patients had glandular meatuses following fistula repair. Seven cases with meatal regression and breakdown of the neourethra were reoperated on by using double-face urethroplasty, onlay island flap urethroplasty and free-tube urethroplasty techniques. Finally, all patients had glandular meatuses. One patient with urethral diverticulum underwent successful diverticulum excision and meatoplasty. CONCLUSIONS: Thierch urethroplasty is the most commonly performed technique after surgical correction of penoscrotal transposition; however, additional procedures are needed for the management of its complications.

Retrospective analysis of the results obtained by using Mathieu and TIP urethroplasty techniques in recurrent hypospadias repairs.

OBJECTIVE: To determine the effect of Mathieu and tubularized incised plate (TIP) urethroplasty techniques on the outcome of repair in recurrent hypospadias. MATERIAL AND METHODS: A total of 78 patients who had undergone surgical correction by either Mathieu or TIP urethroplasty after unsuccessful hypospadias surgery were enrolled in this study. Cases were divided into two groups according to the operation technique performed. Surgical success rate of the techniques and the prognostic significance of age, type of diversion used, caliber and length of new urethra, and the number of previous operations were analyzed statistically. RESULTS: Mathieu and TIP urethroplasties were performed in 57 and 21 patients, respectively. No statistically significant relation was found between the groups for age, length of new urethra created, caliber of the urethra, urinary diversion used, mean operation success rates and number of previous operations. From within-group analysis, Mathieu urethroplasty was found to have a statistically significant relationship with the number of previous operations (P=0.025, Mann-Whitney U-test). CONCLUSIONS: Age, length and caliber of new urethra, and diversion type used seem to have no effect on the success rate of Mathieu and TIP urethroplasty in recurrent hypospadias restoration. The success of the Mathieu operation diminished proportionally to the number of previous failed surgeries.

Chemical castration with intratesticular injection of 20% hypertonic saline: a minimally invasive method.

OBJECTIVES: Our aim was to ablate testicular tissue by hypertonic saline solution in a rat model, thereby to discover a minimally invasive alternative method to medical and surgical castration in patients with metastatic prostate carcinoma. METHODS: A total of 40 male Wistar rats were divided into orchiectomy (n = 20) and experimental groups. In the experimental group, 20% (n = 20) hypertonic saline solution was injected into the rat testes. Blood was taken prior to, 1 day, and 30 days after the intervention for testosterone determination. All testicles were surgically removed for pathologic examination. RESULTS: Skin infection, necrosis, and testicular abscess were not detected in any rat. Pathologic examination revealed necrosis in almost all areas of the testicle. The comparison of 0, day 1, and day 30 measurements of total testosterone did not reveal a statistically significant difference between the control and hypertonic saline groups at each of the three time points (Mann-Whitney U-test, P > 0.05). CONCLUSIONS: Intratesticular hypertonic saline injection seems to be an alternative method in the future to its rivals such as orchiectomy and medical castration. This new approach offers a minimally invasive and less expensive method aside from preserving body image in metastatic prostatic carcinoma. However, our conclusions should be supported with more experimental studies before a clinical study is taken into account.

Our 23-year experience in urethrocutaneous fistulas developing after hypospadias surgery.

OBJECTIVES: To determine the role of the fistula characteristics on the outcomes of repair in urethrocutaneous fistulas that develop after hypospadias surgery. METHODS: A total of 160 patients who had undergone urethrocutaneous fistula repair after hypospadias surgery were enrolled in this study. The prognostic significance of the site, size, and number of fistulas, number of the previous operations, and the techniques applied were analyzed by the appropriate statistical methods as the parameters of the study. RESULTS: The fistulas were localized at the distal, mid, or proximal penile region in 69 (43.2%), 60 (37.5%), and 31 (19.2%) patients, respectively. No statistically significant relation was found between the fistula site and the success rate (P >0.05). The fistula size (2 mm or less versus greater than 2 mm) and the number of fistula repairs (single versus two or more) also did not affect the outcome (P >0.05, Pearson chi-square and Fisher's exact tests). CONCLUSIONS: The site, size, and number of the fistula repair seemed to have no impact on the success rate. Well-known aspects of the modern hypospadias surgery (eg, delicate tissue handling, instruments, point coagulation, and vascularity of the tissues) probably play a role in the outcome.

Unilateral idiopathic hydrocele has a substantial effect on the ipsilateral testicular geometry and resistivity indices.

OBJECTIVE: The purpose of this study was to determine whether hydrocele has any effect on the volume and shape of the ipsilateral testis and can be implicated as a cause of testicular ischemia. METHODS: Group 1 consisted of 23 patients with unilateral idiopathic hydrocele, whereas 30 healthy men constituted group 2. All patients underwent scrotal ultrasonography by which testicular dimensions in craniocaudal (D(cc)), anteroposterior (D(ap)), and mediolateral axes were measured, followed by calculation of the D(cc)/D(ap) ratio and testicular volume. By color Doppler analysis, the resistivity index of the subcapsular artery (RI(sc)) and the resistivity index of the intratesticular artery were determined. RESULTS: The mean D(cc)/D(ap) ratio +/- SD for group 1 was 1.7 +/- 0.3 (range, 1.1-2.3), significantly lower than that of group 2, which was 1.9 +/- 0.3 (range, 1.3-2.2) (P = .028). Mean testicular volume values of subjects having hydrocele for more than and less than 6 months were 13.4 +/- 7.3 and 22.5 +/- 5.1 cm3, respectively; the difference between the subgroups was significant (P = .003). For the ipsilateral testis, mean RI(sc) values were 0.70 +/- 0.06 (range, 0.60-0.80) in group 1 and 0.65 +/- 0.06 (range, 0.59-0.83) in group 2. The mean RI(sc) was significantly higher in group 1 (P = .006). CONCLUSIONS: Unilateral idiopathic hydrocele has a tendency for rounding rather than flattening the ipsilateral testis as well as elevating the RI(sc) on the affected side. To the best of our knowledge, no strict spectral Doppler analysis criteria have been proposed for testicular ischemia yet. Therefore, the impact of the difference of the RI(sc) should raise the suspicion for ischemia, and further research is needed to elucidate any effect on spermatogenesis.