Intermittent tamsulosin therapy in men with lower urinary tract symptoms.

PURPOSE: We investigated in what is to our knowledge the first prospective study the safety and efficacy of intermittent tamsulosin therapy in patients with lower urinary tract symptoms. MATERIALS AND METHODS: This study was performed between January 2001 and February 2003 in 140 patients. In phase 1 of this study patients received 1, 0.4 mg tamsulosin capsule daily for 3 months and were reevaluated after 3 months. At this assessment uroflowmetry, International Prostate Symptom Score and ultrasonographic estimation of residual urine were determined. In phase 2 responders to tamsulosin therapy were then randomized into 1 of 3 groups, namely group 1--continued 4 mg tamsulosin once daily every day, group 2--0.4 mg tamsulosin once daily every other day and group 3--discontinued tamsulosin. Efficacy assessments were done again at 4, 12 and 24 weeks. RESULTS: There were no statistically differences among the patients in groups 1 and 2 at 6 months for International Prostate Symptom Score, maximum or average urine flow, or residual urine. Differences between patients in groups 1 and 3 were statistically significant at 6 months. Differences between patients in groups 2 and 3 were also statistically significant at 6 months for these parameters. CONCLUSIONS: Tamsulosin at a dose of 0.4 mg once daily and 0.4 mg once daily every other day for lower urinary tract symptoms provide comparable improvements in urinary flow and symptoms. Each treatment was well tolerated.

Is there significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithotripsy?

OBJECTIVE: To determine whether there is a significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithothripsy (ESWL). METHODS: Ninety-six patients with proximal ureter stones underwent ESWL. The procedure was performed in the supine position in 48 of them (group 1) and in the prone position in the other 48 patients (group 2). Stone-free rates, repeat ESWL rates, shocks per patient and shocks per session were compared in both groups. RESULTS: The mean session number per patients was 1.64+/-0.75 in group 1 and 1. 33+/-0.59 in group 2 (p = 0.224). The stone-free rates 3 months after ESWL were 88.3% in group 1 and 90.6% in group 2. The difference between the results was statistically insignificant (p<0.05). Therefore, these two parameters were similar in both groups. On the other hand, the number of shocks per session was 4,863.54+/-2, 114.85 in group 1 and 3,704.16+/-1,726.75 in group 2. This difference was statistically significant (p = 0.011). The patients tolerated the supine position better in general. Patients in the prone position experienced discomfort on inspiration and expiration and pain localized to the lumbar vertebrae. CONCLUSION: These results suggest that the supine position decreases the number of shocks per session in the treatment of proximal ureter stones with ESWL and this will be cost-effective.

Nephrogenic adenoma of the bladder after intravesical bacillus Calmette-Guérin treatment.

A 60-year-old female patient was subjected to transurethral resection of transitional cell carcinoma of the bladder and was given intravesical bacillus Calmette-Guérin treatment for 6 weeks. The control cytoscopy performed after 6 months revealed a polypoid lesion at the trigon and the lesion was resected. The pathological examination of the specimen showed no evidence of cancer but the presence of a metaplastic lesion that was nephrogenic adenoma.

Use of bladder mucosal graft for urethral reconstruction.

BACKGROUND: The ideal tissue for complex urethral reconstruction has yet to be determined, especially in patients with deficient preputium. The use of bladder mucosa as a free graft could be an alternative in these problem cases. METHODS: Bladder mucosa graft urethroplasty was performed on 14 patients with penoscrotal or scrotal hypospadias. The mean age of the patients was 18.7 (range 14-23) years. Ten cases were subjected to primary urethral reconstruction while four cases had previous hypospadias repair. RESULTS: Complete urethral replacement by the bladder mucosa tube was performed in six patients. Meatal problems occurred in two (33.33%) patients and proximal fistula formed in one (16.67%) patient. A bladder mucosa graft was combined with preputial or tunica vaginalis grafts distally in eight cases, and one patient in the tunica vaginalis group developed fistula at the anastomosis of the bladder mucosa and tunica vaginalis grafts. The overall complication rate was 28.6%. CONCLUSIONS: Our initial results showed that bladder mucosa grafts can be used successfully for urethral reconstruction especially when combined with preputial or tunica vaginalis grafts distally.

[Isolated ureteropelvic junction laceration following blunt body trauma]. / Künt vücut travmalarini takiben izole üreteropel vik bileske (UPJ) yaralanmalari.

The purpose of the study is to investigate the radiologic and clinical treatment methods following the rarely seen UPJ laceration due to blunt body trauma. In this study there are eight patients with isolated UPJ laceration, admitted to Gülhane Military Medicine Academy, Firat University Medical Faculty Urology department, and Elazig Military Hospital Urology Service. They are one child (12 years old) and 7 adults (6 male, 1 female) ranged 18-61 years old. Abdominal USG(Ultrasonography), IVP(Intravenous Pyelography), abdominal CT(Computed Tomography), and retrograde-antegrade pyelography were used for diagnosis. They were treated with percutaneous nephrostomy, double J stent implantation and reconstructive open surgical procedures. All patient were cured with the culmination of urinary extravasation and ureteropelvic patency.

[Missed ureteral injuries following surgical exploration with percutaneous nephrostomy and drainage treatment]. / Cerrahi eksplorasyon sonrasi gözden kaçirilan üreter yaralanmalarinda perkütan nefrostomi ve drenaj ile tedavi yaklasimi.

Twelve patients with missed ureteral injury and urinoma due to gunshot are evaluated following surgical exploration. All 12 had underwent surgical exploration at the other hospitals on admission. Fever, malaise, shocking chills, leucocytosis due to urinoma formation are the findings in the late postoperative period and CT (computer tomography) scan revealed urinoma. Intravenous urograms are nondiagnostic in 6 of patients and hematuria is detected in 6(%50) Percutaneous nephrostomy is emphasized as the first step of management for these lately diagnosed ureteral fistulas. Additionally, Urinoma is drained percutaneously. Hence we save the patients from a second operation following severe gunshot trauma. The presence of shock, intraoperative bleeding, colonic injury and blast effect of high velocity missile with delayed tissue necrosis are the cause of missed ureteral injury. At 8 patients, nephrostomy was the solution and total cure is achieved. Mean follow-up period after nephrostomy is 3 months. At 2, we perform psoas-hitch and ureteroneocystostomy, at one psoas-hitch, boary- flep and ureteroneocystostomy and at one ureteroureterostomy due to long ureteral obstruction on urinary fistula. As a conclusion, when treating missed ureteral injuries with urinary fistula and urinoma formation following complicated surgical intervention, percutaneous nephrostomy application and percutaneous drainage of urinoma may be the first step for management. Late surgical reconstitution is the second step when needed.

Extratesticular epidermoid cyst with extension into the pelvis.

We report a case of simple epidermoid cyst of the scrotum with extension into the pelvis. Complete excision was performed transcrotally and the presence of epidermoid cyst confirmed by histopathological examination. Simple excision was sufficient for treatment of this very rare lesion. The patient is now in the follow-up period.

Embolization therapy in two subtypes of priapism.

Two subtypes of priapism have been described based on the pathophysiologic mechanism. The more common type, termed stasis priapism, is characterized by a low flow state in which inadequate venous outflow creates an acidotic hypoxic environment leading to a painful prolonged erection. The other less common subtype, high flow priapism, is arteriogenic. We used embolization therapy in one case with long lasting stasis priapism and in the other with high flow priapism due to bilateral arteriosinusoidal fistulae in the penis. In both cases we used polyvinyl alcohol for embolization and sexual potency preservation. Priapism is the persistence of erection that does not result from sexual desire. Hauri et al. described two variants of priapism. In high flow priapism (non-ischaemic) there is unregulated arterial inflow to the lacunar spaces due to a lacerated cavernous artery associated with previous perineal and penile trauma. In stasis priapism, the second type, the basic abnormality could be due to a more pronounced or prolonged blood entrapment inside the vascular spaces of the corpora cavernosa sustained by an unknown cause. There are many treatment methods especially for low flow ischaemic variant. We report two different kinds of priapism and embolization therapy in both of them with polyvinyl alcohol.

Surgical treatment of urethral diverticula in men.

Two 21-year-old men were treated for congenital diverticulum at the bulbous portion of the anterior urethra. One of the diverticula contained a stone. Acquired anterior urethral diverticulum with ventral displacement of the penile shaft following repair of hypospadias was treated in a 21-year-old man. Correction of the defect involved ventral paramedian vertical incision, excision of the diverticulum with closure at the urethra, and traction sutures for the ventral penile displacement.

Intrarenal pressure following pyeloplasty or percutaneous surgery.

In a study of 37 patients it was shown that recording the intrapelvic pressure is a safe and reliable means of judging the best time to remove a nephrostomy tube. No post-operative complications were encountered and the procedure has the added advantage of avoiding the use of X-rays.

Bladder smooth muscle dysfunction in patients with irritable bowel syndrome.

Urodynamic studies were carried out on 30 patients with irritable bowel syndrome and 30 matched controls. Fifty per cent of the irritable bowel patients compared with only 13% of the control group had evidence of bladder dysfunction (p = 0.006). In the irritable bowel group detrusor instability was observed in 10 patients compared with only one control subject (p = 0.008). A steep cystometrogram occurred in five irritable bowel patients and three controls (NS). Detrusor instability was most common in patients with a bowel habit characterised by alternating constipation and diarrhoea. This is the first study to provide objective evidence that patients with irritable bowel syndrome may have a disorder of smooth muscle or its innervation that is not confined to the gastrointestinal system.