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OBJECTIVES: This study aims to assess the efficacy of Clam enterocystoplasty (CECP) surgery for the treatment of non-neurogenic refractory urgency urinary incontinence (UUI). METHODS: We conducted a retrospective evaluation of 17 female patients who underwent CECP for non-neurogenic refractory UUI between May 2010 and November 2022. RESULTS: The median of ICIQ-SF was 19 (15-21) before treatment, which decreased to a median of 0 (0-5) after treatment (p = 0.01). The average preoperative pad use among the participants was 4 (3-6), while it became 0 postoperatively (p < 0.01). The median preoperative cystometric bladder capacity was 251 ml (100-350 ml), increasing to 456 ml (400-650 ml) postoperatively (p < 0.01). According to the Clavien-Dindo classification system, the majority of patients experienced either no complications (66%) or minor complications (CD I/CD II) (33%) within the initial 90 days following surgery. CONCLUSIONS: "Clam" iliocystoplasty emerges as a secure and successful treatment option in the patient group whose symptoms persist after first, second, and third-line treatments with the diagnosis of urge incontinence.
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Incontinência Urinária de Urgência , Procedimentos Cirúrgicos Urológicos , Humanos , Feminino , Incontinência Urinária de Urgência/etiologia , Incontinência Urinária de Urgência/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos/métodos , Resultado do Tratamento , Anastomose Cirúrgica/efeitos adversosRESUMO
Introduction: Studies have reported that coronavirus disease 2019 (COVID-19) may cause erectile dysfunction (ED), however, its role in the pathophysiology of ED has not yet been fully elucidated. We aimed to elucidate COVID-19's effects on cavernosal smooth muscle, which has a pretty important role in erection physiology, by corpus cavernosum electromyography (cc-EMG). Materials and methods: Twenty-nine male patients aged 2050 years who applied to the urology outpatient clinic due to ED were included in the study. Nine patients that had COVID-19 and were treated as outpatients were classified as group 1, 10 patients who were hospitalized due to COVID-19 were classified as group 2, and 10 patients who did not have COVID-19 were classified as the control group (group 3). Patients underwent diagnostic evaluation including International Index of Erectile Function (IIEF)-5 form, penile color Doppler ultrasonography (CDUS), cc-EMG, and fasting serum levels of reproductive hormones (0711am). Results: According to penile CDUS and hormonal values results, there was no significant difference between the groups. According to cc-EMG results, amplitudes and relaxation capacities of the cavernosal smooth muscle of patients in group 3 were significantly higher than those in the other groups. Conclusions: COVID-19 can cause ED not only by psychogenic and hormonal factors but also with cavernosal smooth muscle damage. (AU)
Introducción: Los estudios han informado que la COVID-19 puede causar disfunción eréctil, sin embargo, su papel en la fisiopatología de la disfunción eréctil aún no se ha aclarado por completo. Nuestro objetivo era dilucidar los efectos de la COVID-19 en el músculo liso cavernoso, que tiene un papel bastante importante en la fisiología de la erección, mediante electromiografía del cuerpo cavernoso (cc-EMG). Materiales y métodos: Se incluyeron en el estudio 29 pacientes varones de 20 a 50 años de edad que solicitaron la consulta externa de urología debido a disfunción eréctil. Nueve pacientes que tenían COVID-19 y fueron tratados como pacientes ambulatorios se clasificaron como grupo 1, 10 pacientes que fueron hospitalizados debido a COVID-19 se clasificaron como grupo 2 y 10 pacientes que no tenían COVID-19 se clasificaron como grupo control (grupo 3). Los pacientes se sometieron a una evaluación diagnóstica que incluyó el índice internacional de función eréctil (IIEF)-5, ecografía Doppler color del pene (CDUS), cc-EMG y niveles séricos en ayunas de hormonas reproductivas (07-11 am). Resultados: De acuerdo con los resultados de los valores de CDUS y hormonales del pene, no hubo diferencias significativas entre los grupos. De acuerdo con los resultados de cc-EMG, las amplitudes y las capacidades de relajación de las actividades EMG del músculo liso cavernoso de los pacientes del grupo 3 fueron significativamente mayores que las de los otros grupos. Conclusiones: La COVID-19 puede causar disfunción eréctil no solo por factores psicógenos y hormonales, sino también por daño del músculo liso cavernoso. (AU)
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Humanos , Masculino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Pandemias , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/complicações , Disfunção Erétil/epidemiologia , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , Eletromiografia , Ereção Peniana/fisiologiaRESUMO
INTRODUCTION: Studies have reported that coronavirus disease 2019 (COVID-19) may cause erectile dysfunction (ED), however, its role in the pathophysiology of ED has not yet been fully elucidated. We aimed to elucidate COVID-19's effects on cavernosal smooth muscle, which has a pretty important role in erection physiology, by corpus cavernosum electromyography (cc-EMG). MATERIALS AND METHODS: Twenty-nine male patients aged 20-50 years who applied to the urology outpatient clinic due to ED were included in the study. Nine patients that had COVID-19 and were treated as outpatients were classified as group 1, 10 patients who were hospitalized due to COVID-19 were classified as group 2, and 10 patients who did not have COVID-19 were classified as the control group (group 3). Patients underwent diagnostic evaluation including International Index of Erectile Function (IIEF)-5 form, penile color Doppler ultrasonography (CDUS), cc-EMG, and fasting serum levels of reproductive hormones (07-11am). RESULTS: According to penile CDUS and hormonal values results, there was no significant difference between the groups. According to cc-EMG results, amplitudes and relaxation capacities of the cavernosal smooth muscle of patients in group 3 were significantly higher than those in the other groups. CONCLUSIONS: COVID-19 can cause ED not only by psychogenic and hormonal factors but also with cavernosal smooth muscle damage. CLINICAL TRIAL REGISTRATION NUMBER: NCT04980508.
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COVID-19 , Disfunção Erétil , Humanos , Masculino , COVID-19/complicações , Disfunção Erétil/epidemiologia , Disfunção Erétil/etiologia , Disfunção Erétil/tratamento farmacológico , Músculo Liso/fisiologia , Ereção Peniana/fisiologia , Projetos Piloto , Adulto Jovem , Adulto , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: The most common complications after radical prostatectomy (RP) are erectile dysfunction (ED) and urinary incontinence (UI). After RP, patients may require endoscopic urethral procedures (EUP) for other urological diseases such as hematuria, urinary system stone disease, and suspicion of bladder tumor. In clinical practice we observed that EUP performed after robot assisted RP (RARP) can cause an increase in the UI level. In this study, we investigated whether there is a change in the UI level in patients that underwent EUP after RARP and whether this change was affected by the duration of the procedure and type of endoscopic device used. MATERIAL AND METHODS: Twenty-six patients were included who underwent EUP after RARP in this study. The patients were divided into three groups based on the endoscopic device used: group 1 rigid cystoscopy (n = 9), group 2 flexible cystoscopy (n = 7), and group 3 semi-rigid ureterorenoscopy (URS) (n = 10). The Turkish version of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) and the number of pads used daily was questioned before the EUP and 1 month after the procedure. RESULTS: While a significant increase in ICIQ-SF score was observed in group 1 (p = 0.027), no significant increase was observed in group 2 and group 3 (p > 0.05). No significant difference was observed between the number of pads used preoperatively and the postoperative first month in all groups (p > 0.05). There was no significant correlation between increased operation time and both the pad usage and ICIQ-SF score (p > 0.05). CONCLUSION: The use of small diameter endoscopic instruments and flexible instruments is important for patient comfort and to avoid damage to urethrovesical anastomosis in patients who need to undergo EUP after RP.
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Procedimentos Cirúrgicos Robóticos , Robótica , Incontinência Urinária , Masculino , Humanos , Projetos Piloto , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Estudos Prospectivos , Incontinência Urinária/etiologia , Prostatectomia/efeitos adversos , Prostatectomia/métodosRESUMO
Priapism is one of the most common urologic emergencies and is characterized by a prolonged and painful erectile state unrelated to sexual stimulation or sexual desire. Neoplasm-associated priapism is a rare condition and is usually caused by corporeal metastases of other pelvic area malignancies. Primary penile malignancy-related malignant priapism is extremely rare. In this reported case, an 82-year-old male presented with priapism. The penile doppler ultrasound and pelvic magnetic resonance imaging were compatible with ischemic priapism and corporal mass. Subsequently, the patient underwent total penectomy and bilateral superficial inguinal lymphadenectomy. The pathology report was consistent with primary penile squamous cell cancer (SCC), so the patient underwent adjuvant radiotherapy. However, he developed multiple metastases and could survive for about six months. The patient had undergone radical cystectomy (RC) and urethrectomy 19 and 2 years ago due to urothelial carcinoma, respectively. To the best of our knowledge, this is the second case of malignant priapism due to primary penile SCC and represents one of the longest urethral recurrence periods after RC. When a patient presents with malignant priapism, primary penile malignancies should be considered in differential diagnosis, even if the patient has a history of pelvic area malignancies.
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This study investigates the use of corpus cavernosum electromyography (CC-EMG) recording as a diagnostic tool for identifying the presence of pelvic autonomic dysfunction (PAD) in patients with LUTS and concurrent ED. Fifty patients were included in the study, and the electromyographic and urodynamic findings were compared. The 50% relaxation degree was accepted as a threshold value for PAD. According to relaxation degree in CC-EMG recordings, patients were grouped as; Group 1 (with PAD) = 23 patients with a relaxation degree of less than 50%. Group 2 (without PAD) = 27 patients with a relaxation degree greater than 50%. The mean age of the patients was 58 ± 3.2 (50-71) years. The comparison of the urodynamic parameters and transrectal ultrasound revealed that the postvoiding residual urine volume (PVR) (p = 0.0007), P det Qmax (p = 0.0005), and P det compliance (0.003) values were statistically significantly lower in Group 2. The mean IIEF-5 and IIEF-15 scores of the patients in Group 1 were 2.5 ± 0.7 and 8.1 ± 1.1 respectively. In Group 2, mean IIEF-5 and IIEF-15 scores were 7.2 ± 2.9, and 17.2 ± 3.5 (p: 0.00023 and p: 0.0009). The mean I-PSS score was 22.8 ± 3 in Group 1 and 16 ± 2.3 in Group 2 (p = 0.001). The mean relaxation degree (RD) in Group I was 30.73 ± 6.8%, and in Group 2 was 66.3 ± 5.1%. The mean amplitude values of the patients in Group I were 261.41 ± 112.97 before papaverine injection, and in Group 2 were 246 ± 101.28 respectively. The inter-group difference was statistically significant (p < 0.05). The mean amplitude value of the patients in Group I after papaverine injection was 182.73 ± 60.71, and in Group 2, that value was 83.2 ± 29.19. The inter-group difference was also significant (p < 0.05). Increased electrical bursts and decreased relaxation responses on CC-EMG indirectly indicated an increase in the contractility of the bladder sphincter. Therefore, we concluded that CC-EMG could be a diagnostic tool for PAD and cavernous autonomic dysfunction.
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Disfunção Erétil , Sintomas do Trato Urinário Inferior , Humanos , Masculino , Pessoa de Meia-Idade , Eletromiografia , Sintomas do Trato Urinário Inferior/diagnóstico , PapaverinaRESUMO
Priapism is a prolonged unintended erectile state unrelated to sexual stimulation or sexual desire. There is a very rare relationship between the use of alpha blockers and the development of priapism. Here, we describe 2 cases of alpha blocker induced priapism and a literature review. One of these cases is related to the use of silodosin and the other is related to the use of tamsulosin. So far, 18 alpha blocker induced priapism cases have been reported. We are presenting the first case of silodosin induced priapism and the eighth case of priapism secondary to tamsulosin. Despite silodosin having a much greater affinity for the α1-a receptor than the α1-b receptor, as represented in this case it can cause this rare side effect. Before starting alpha blocker treatment, side effects such as priapism, which may be very rare but may cause serious problems, should be kept in mind. (AU)
El priapismo es un estado eréctil prolongado no intencionado y no relacionado con la estimulación o el deseo sexual. Existe una relación muy infrecuente entre el uso de alfabloqueantes y el desarrollo de priapismo. Describimos aquí dos casos de priapismo inducido por alfabloqueantes y una revisión de la literatura. Uno de estos casos guarda relación con el uso de silodosina, y el otro con el uso de tamsulosina. Hasta el momento se han reportado 18 casos de priapismo inducido por alfabloquantes. Presentamos aquí el primer caso de priapismo inducido por silodosina y el octavo caso de priapismo secundario a tamsulosina. A pesar de que silodosina tiene mucha mayor afinidad por el receptor α1-a que el receptor α1-b, según lo representado en este caso, puede causar este efecto secundario raro. Antes de iniciarse tratamiento con alfabloquantes deben tenerse en cuenta los efectos secundarios, tales como priapismo, que pueden ser muy raros pero pueden causar problemas graves. (AU)
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Humanos , Masculino , Pessoa de Meia-Idade , Priapismo/tratamento farmacológico , Pênis/anormalidades , Antagonistas Adrenérgicos alfa/uso terapêutico , Tansulosina , Priapismo/classificaçãoRESUMO
OBJECTIVE: To determine the predictive value of high-sensitive C-reactive protein (hs-CRP)/albumin ratio in systemic inflammatory response syndrome (SIRS) after semi-rigid ureteroscopy (URS). MATERIAL AND METHODS: Between April 2021 and October 2021, 148 patients who had ureteral stone treatment with a ureteroscope in our hospital were included. Preoperative hs-CRP/albumin ratio was obtained by dividing the hs-CRP level by the albumin level. High-sensitivity modified Glasgow prognostic score (hs-mGPS) was obtained according to hs-CRP and albumin values. Two groups were identified as post-URS SIRS positive and negative. Inflammation biomarkers were evaluated in groups. RESULTS: There was a statistically significant difference between groups in terms of preoperative hs-CRP, albumin, and hs-CRP/albumin ratio (p < 0.001, p = 0.003, and p < 0.001, respectively). The optimal cutoff value for the hs-CRP/albumin ratio was 0.04651. While the risk of developing SIRS after surgery was 72.73% in patients with a hs-CRP/albumin ratio higher than 0.04651, the chance of not developing SIRS was 87.5% in patients below this value. The probability of developing SIRS was found to be significantly different in hs-mGPS (p < 0.001). CONCLUSION: Our study indicated that hs-CRP/albumin ratio can predict post-URS SIRS. Larger-scale, multicentric prospective studies should certainly be done to validate the predictive value of hs-CRP/albumin ratio in post-URS SIRS.
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OBJECTIVE: We evaluated predictive features of pre-operative computed tomography and magnetic resonance imaging for advanced disease in renal cell carcinoma. MATERIALS AND METHODS: 92 patients with pathologically confirmed diagnosis of renal cell carcinoma were included in our study. Patients were divided into two groups according to preoperative imaging as computed tomography (CT) (55 patients) and magnetic resonance imaging (MRI) (37 patients). Within the imaging groups, the patients were divided into two groups according to pathological tumor stage: 1-2 (pT1-2) versus ≥ pT3a. It was evaluated whether there was a difference between the two groups in terms of the presence of pre-operative imaging (CT and MRI) features. Predictive value of these features for ≥ pT3a disease was evaluated both for CT and MRI. RESULTS: The cut-off value for the Gerota's fascia thickness in predicting ≥ pT3a disease was calculated as 0.205 cm. Positive predictive value (PPV) for Gerota's fascia thickness was 52.4% (31.0-73.7) and 66.7% (40.0-93.3) for CT and MRI respectively. The PPV value for renal capsule invasion was 75.0% (53.8-96.2) and 90.0% (71.4-108.6) for CT and MRI respectively. PPV of perirenal fat invasion for CT and MRI was 69.2% (44.1-94.3) and 81.8% (59.0-104.6) respectively. CONCLUSION: Renal capsular invasion and perirenal fat invasion are reliable signs for locally advanced (≥ pT3a) renal cell carcinoma both in CT and MRI. Gerota's fascia thickness has relatively low PPV value for prediction of locally advanced disease. Presence of enlarged collateral vessels, tumor necrosis, perinephric stranding are not reliable signs. For all predictors MRI seems more reliable than CT.
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Carcinoma de Células Renais , Neoplasias Renais , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Imageamento por Ressonância Magnética , Estadiamento de Neoplasias , Tomografia Computadorizada por Raios X/métodosRESUMO
Priapism is a prolonged unintended erectile state unrelated to sexual stimulation or sexual desire. There is a very rare relationship between the use of alpha blockers and the development of priapism. Here, we describe 2 cases of alpha blocker induced priapism and a literature review. One of these cases is related to the use of silodosin and the other is related to the use of tamsulosin. So far, 18 alpha blocker induced priapism cases have been reported. We are presenting the first case of silodosin induced priapism and the eighth case of priapism secondary to tamsulosin. Despite silodosin having a much greater affinity for the α1-a receptor than the α1-b receptor, as represented in this case it can cause this rare side effect. Before starting alpha blocker treatment, side effects such as priapism, which may be very rare but may cause serious problems, should be kept in mind.
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Priapismo , Antagonistas Adrenérgicos alfa/efeitos adversos , Humanos , Masculino , Priapismo/induzido quimicamente , Tansulosina/efeitos adversosRESUMO
BACKGROUND: A total of 78 patients aged 11 to 17 years were diagnosed with congenital ventral penile curvature and underwent surgery with the dorsal plication technique between 2005 and 2014. AIM: To investigate the long-term outcomes of 72 patients who underwent dorsal penile plication for the treatment of congenital ventral penile curvature without hypospadias. METHODS: In all cases, the intervascular space between the deep dorsal vein and dorsal artery was dissected, and tunical plication was carried out with non-absorbable 3-0 polyamide sutures and the complication and satisfaction rates of the patients were determined in the postoperative seventh year. OUTCOMES: At the final postoperative follow-up, the patients' satisfaction with the operation was found to be 95.8%. RESULTS: Shortening of the penis (0.5-1 cm) in five cases, recurrence with less than a 20-degree curvature in two cases, palpable sutures in two cases was observed and no patients reported erectile dysfunction. STRENGTHS & LIMITATIONS: The limitations of our study can be considered as the absence of pharmacological erection in the preoperative evaluation, failure to evaluate penile length at the last postoperative follow-up due to the continued development of the penis, inability to evaluate erectile function at the beginning, postoperative erectile capacity being assessed in only some of the operated cases, all operations being performed by a single surgeon in the same center, and the absence of standardized questionnaires for postoperative satisfaction or adverse events. CONCLUSION: According to the results of this study, dorsal plication is a relatively simple method with a low risk and high success rate for the treatment of congenital ventral penile curvatures. Akdemir F, Kayigil Ö, Okulu E. DORSAL Plication Technique for the Treatment of Congenital Ventral Penile Curvature: Long-Term Outcomes of 72 Cases. J Sex Med 2021;18:1715-1720.
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Disfunção Erétil , Hipospadia , Induração Peniana , Humanos , Masculino , Ereção Peniana , Pênis/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Biochemical recurrence (BCR) can be seen in the early or late period after radical prostatectomy (RP). Various models have been developed to predict BCR. OBJECTIVE: In our study, we evaluated the accuracy of four pre-operative models (GP score, PRIX, D'Amico risk classification, CAPRA) in predicting BCR after RP in Turkish patients. METHODS: Age, preoperative total prostate-specific antigen (PSA) values, clinical stages, total number of cores taken in biopsy, number of positive cores, preoperative biopsy Gleason score (GS), follow-up time and presence of BCR after RP were recorded. BCR was defined as a total PSA value >0.2 ng/dL twice consecutively after RP. Classifications or scoring was performed according to pre-operative models. The 1-, 3- and 5-year BCR-free rates of the patients were determined for each model. Also, the accuracy of four predictive models for predicting 1-, 3- and 5-year BCR was evaluated. RESULTS: For all pre-operative models there was a statistically significant difference between risk groups in BCR-free rates at 1-, 3- and 5-year after RP (P < .001). The Harrell's concordance index for 1-year BCR predictions was 0.802, 0.831, 0.773 and 0.745 for the GP score, PRIX, CAPRA and D'Amico, respectively. For 3-year BCR predictions, it was 0.798, 0.791, 0.723 and 0.714 for the GP score, PRIX, CAPRA and D'Amico and respectively. Finally, The Harrell's concordance index for 5-year BCR predictions was 0.778, 0.771, 0.702 and 0.693 for the GP score, PRIX, CAPRA and D'Amico, respectively. CONCLUSION: In the prediction of BCR, the accuracy of GP scoring and PRIX seems slightly higher than CAPRA and D'Amico risk classification. Surely our results should be supported by head to head comparisons within other larger cohorts.
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Recidiva Local de Neoplasia , Neoplasias da Próstata , Humanos , Masculino , Antígeno Prostático Específico , Prostatectomia , Neoplasias da Próstata/cirurgia , Estudos RetrospectivosRESUMO
Ischaemic priapism is the most common form of priapism and requires urgent treatment. In this study, we evaluated the effectiveness of the caverno-dorsal vein shunt on resolution of ischaemic priapism and on the post-operative long-term erectile function in patients presenting with priapism. The study included 10 patients admitted to our hospital for priapism between 2010 and 2018. The median age of the patients was 31 (24-66) years. The median priapism time was 13.5 (7-38) hours. The blood gas measurements were taken from the corpus cavernosum, and the drainage of the corpus cavernosum was performed as an emergency intervention. Then, the corpus cavernosum was irrigated with 0.01% adrenaline 5 times in 20-min intervals. The caverno-dorsal vein shunt procedure was performed in cases without regression of priapism. Two months after, the operation shunt was closed. Detumescence occurred in all patients. Eight of 10 patients maintained their erectile function. In 2 patients, severe erectile dysfunction occurred at post-operative 2 months following a priapism attack and penile prosthesis implantation was performed in these 2 patients. Our study showed that caverno-dorsal vein shunt procedure is effective in providing detumescence and maintaining potency in cases with ischaemic priapism. In our opinion, caverno-dorsal vein shunt can be considered as the first treatment of choice for refractory low-flow priapism.
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Disfunção Erétil , Priapismo , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Ereção Peniana , Pênis/cirurgia , Período Pós-Operatório , Priapismo/etiologia , Priapismo/cirurgiaRESUMO
PURPOSE: We analyzed the role of oxidative stress in detrusor overactivity (DO) by measuring serum total antioxidant capacity (TAC), total oxidant status (TOS), binding capacity of exogenous cobalt to human albumin (IMA), serum advanced oxidation protein products (AOPP), paraoxonase (PON), and arylesterase. MATERIALS AND METHODS: The study included 38 female patients diagnosed with DO and 29 healthy female subjects forming the control group. Serum total antioxidant capacity (TAC), total oxidant status (TOS), binding capacity of exogenous cobalt to human albumin (IMA), serum advanced oxidation protein products (AOPP), paraoxonase (PON), and arylesterase were analyzed. The results of serum TAC, TOS, IMA, AOPP, PON, and arylesterase of the subjects in both groups were compared. RESULTS: There was no difference between the groups in terms of age. When compared to the control group, serum TAC and IMA levels were statisticaly lower (P < 0,001) and higher (P = 0,003), respectively. However, TOS, AOPP, PON, arylesterase levels were similar in both groups ( p > 0.05 ). CONCLUSION: There seems to be an association between DO and oxidative damage according to our results, this can be measured by analyzing TAC and IMA in this patient group.
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Estresse Oxidativo , Bexiga Urinária Hiperativa/metabolismo , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Urethral pain syndrome is a subgroup of chronic pelvic pain syndromes and comprises a relatively challenging patient group in urological practice. Several different treatments have been used for the management of the condition from a mostly empirical basis. In this article, we present the results of a small cohort of young male patients treated with sertraline and gabapentin therapy. MATERIAL AND METHODS: The data of 52 patients was retrospectively evaluated and 31 patients' data was included in this study. Clinical symptom scores, including International Prostate Symptoms Score, Hamilton Anxiety Rating Scale, Visual Analog Scale for Pain, Quality of Life due to Lower Urinary Tract Symptoms, and Urinary, Psychosocial, Organ Specific, Infection, Neurologic/Systemic, Tenderness of Skeletal Muscles (UPOINT) classifications were retrospectively analyzed from the patient records and charts. RESULTS: We observed improvement in clinical scores involving anxiety, lower urinary tract symptoms, quality of life, and pain. Statistical analysis revealed significant amelioration of the symptoms with gaba- pentin and sertraline treatment in our cohort. CONCLUSIONS: Gabapentin and sertraline treatment may be considered in the second step management of urethral pain syndrome. To draw an evidence-based recommendation, prospective and comparative studies should be conducted in the future.
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This study aimed to investigate the long-term outcomes of the surgical combination of revascularization and penile corrective techniques after having obtained promising preliminary results from a previous study. Between 2008 and 2015, the combined treatment was undertaken for 60 patients with Peyronie's disease and erectile dysfunction. A preoperative urological evaluation was performed with penile color Doppler ultrasonography, electromyography of the corpus cavernosum and cavernosometry. All the patients completed 15-item and 5-item IIEFs preoperatively and at postoperative follow-up. The mean age of the patients was 53.78 ± 6.48 years ranging from 47 to 63. The mean follow-up period was 48 (14-68) months. The degree of penile angulation was >40 in all the patients. Urethra dissection was required in five patients. Penile disassembly was performed on one patient due to distal complex corporeal deformity. None of the patients reported complications after surgery. The mean total IIEF score was reported to be 25.4 ± 2.8 before the operation and 52.23 ± 1.2 at the end of the follow-up (p < 0.05). The mean IIEF-5 score was 7.3 ± 1.3 preoperatively and 20.9 ± 1.9 at the end of follow-up (p < 0.05). The results of IIEF-15 for erectile function demonstrated that 32 patients had a cutoff value of >26, indicating no ED. Although all patients had complete penile straightening, 7 (11.66%) reported shortening of the penis but was not dissatisfied with the treatment. The number of patients satisfied with the outcomes of the operation was 53. The statistically significant improvement and satisfactory results achieved with the IIEF questionnaires suggest that the proposed combined treatment could be an alternative to penile prosthesis in highly selected patients with Peyronie's disease, particularly those with erectile dysfunction; however, more studies are needed to confirm these results.
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Disfunção Erétil/cirurgia , Induração Peniana/cirurgia , Pênis/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos , Disfunção Erétil/complicações , Disfunção Erétil/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Ereção Peniana , Induração Peniana/complicações , Induração Peniana/diagnóstico por imagem , Pênis/diagnóstico por imagem , Resultado do Tratamento , Ultrassonografia Doppler em CoresRESUMO
PURPOSE: This study aimed to investigate oxidative stress in etiopathogenesis by analyzing serum total antioxidant capacity (TAC), total oxidant status (TOS), binding capacity of exogenous cobalt to human albumin (IMA), serum advanced oxidation protein products (AOPP), paraoxonase (PON), arylesterase, IgE, and C-reactive protein (CRP) in bladder pain syndrome/interstitial cystitis (BPS/IC). METHODS: The study included 16 female patients diagnosed with BPS/IC and 25 healthy female subjects forming the control group. A bladder biopsy was performed on all patients in the BPS/IC group by carrying out cystoscopy with hydrodistention under general anesthesia. The results of serum TAC, TOS, IMA, AOPP, PON, arylesterase, IgE, and CRP of the subjects in both groups were compared. RESULTS: The mean age of the 16 female patients in the BPS/IC group was 43.6 ± 14.5 years, and the mean age of the 25 healthy subjects in the control group was 42.0 ± 10.3 years. According to the criteria of International Society for the Study of Interstitial Cystitis (ESSIC), eight patients were classified as Type 2A, three patients as Type 2B, four patients as Type 2C, and one patient as Type 3C. In the BPS/IC group, while TAC was found significantly lower than in the control group, IMA, IgE, and CRP were found significantly higher (P < 0.05). When binary logistic regression analysis was performed, the created model was determined to have 81.3 % sensitivity and 80 % specifity. CONCLUSIONS: In the etiology of BPS/IC, mechanism of oxidative damage comes into prominence. In the diagnosis of BPS/IC, IgE, CRP, and TAC are not specific markers when used separately; however, a higher specifity and sensitivity could be reached when used jointly in the suspected patients.
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Produtos da Oxidação Avançada de Proteínas/metabolismo , Antioxidantes/metabolismo , Arildialquilfosfatase/metabolismo , Hidrolases de Éster Carboxílico/metabolismo , Cistite Intersticial/metabolismo , Estresse Oxidativo , Adulto , Proteína C-Reativa/metabolismo , Cistite Intersticial/diagnóstico , Cistoscopia , Feminino , Humanos , Imunoglobulina E/metabolismo , Medição da DorRESUMO
INTRODUCTION: We evaluated and compared the serum oxidative stress and antioxidant enzymes in patients with renal cell carcinoma (RCC) and the control group. MATERIAL AND METHODS: The prospective study consisted of 97 patients with RCC (Group 1) and 80 age and sex matched healthy volunteers (Group 2). Group 1 and 2 were compared concerning serum mean total oxidant status (TOS), total antioxidant capacity (TAC), paraoxonase-1 (PON-1), arylesterase, total thiol, catalase (CAT), myeloperoxidase (MPO) and ceruloplasmin. RESULTS: Patients' mean age was 58.5 ±12.3 and 56.9 ±15.8 years, respectively, in Group 1 and 2. No statistically significant differences were detected between the groups in terms of oxidative stress parameters and antioxidant capacity measured in the serum of patients including, TOS, TAC, PON1, arylesterase, total thiol, CAT, MPO, and ceruloplasmin levels (p >0.05 for all parameters). The PON-1 value was significantly higher in patients with pT1 stage than pT3 stage (p = 0.007). The arylesterase value was significantly higher in patients with Fuhrman's nuclear grade 3 than grade 2 (p = 0.035). There was no correlation between these parameters level and Fuhrman's nuclear grade, stage, or histopathological tumor type. CONCLUSIONS: Our results demonstrated that evaluation of these parameters in the serum of patients with localized RCC may not be used as a marker to discriminate between patients with RCC and healthy people.
RESUMO
OBJECTIVE: Varicocele, which is the abnormal dilatation of internal spermatic veins, is known as the most surgically correctable cause of male infertility. In the evaluation of testicular arterial and venous blood supply, the scrotal colour Doppler ultrasound (CDU) is a valuable diagnostic method. The aim of this study was to investigate how the testicular blood flow is affected after varicocelectomy, and the place of scrotal CDU in the follow-up after varicocelectomy. MATERIAL AND METHODS: Thirty male patients who were diagnosed with left-sided varicocele were prospectively included in the study. Before the varicocelectomy, semen analyses were carried out, and peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI) were measured by CDU. In the third postoperative month, scrotal CDU and semen analysis were performed again and compared with the preoperative results. RESULTS: The arterial flow parameters PSV and EDV increased significantly, and the resistance parameters RI and PI decreased significantly, compared with the preoperative values. Sperm concentration, progressive motility and normal morphology improved in the postoperative semen analysis compared with the preoperative results. The increases in all three parameters were statistically significant. No statistically significant difference in vascular parameters was seen between the patients with improved and unimproved semen analysis. CONCLUSIONS: As confirmed by the results of semen analysis and CDU, testicular blood flow increases after varicocelectomy, resulting in the recovery of the haemodynamics of the testicle. CDU, which is generally used for diagnosis in the varicocele, can also be a valuable method of determining treatment success after surgery.
Assuntos
Período Pós-Operatório , Período Pré-Operatório , Testículo/irrigação sanguínea , Testículo/diagnóstico por imagem , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/cirurgia , Adolescente , Adulto , Hemodinâmica/fisiologia , Humanos , Infertilidade Masculina/etiologia , Canal Inguinal , Masculino , Fluxo Sanguíneo Regional/fisiologia , Análise do Sêmen , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Varicocele/complicações , Varicocele/fisiopatologia , Adulto JovemRESUMO
Teratomas are bizarre neoplasms derived from embryonic tissues that are typically found only in the gonadal and sacrococcygeal regions of adults. Primary retroperitoneal teratomas are rare and present challenging management options. We report a case of a unilateral primary retroperitoneal mature cystic teratoma mimicking an adrenal mass in a 54-year-old male patient. Complete resection of the adrenal mass was performed by the flank approach by using the 11th rib resection. Because of the risk of malignancy, follow-up radiographic studies were performed to ensure the oncologic efficacy of resection. The patient has been free of recurrence for longer than 12 months.