Examining the aetiopathogenesis of varicoceles: the relationship between retroperitoneal adipose tissue and testicular venous drainage.

This study evaluated the effect of retroperitoneal adipose tissue on testicular venous drainage and tested the nutcracker phenomenon by clinical and imaging findings. A total of 95 patients were included. The patients were evaluated with a detailed medical history and physical examination for varicocele. Their weight, height and waist circumference were also recorded. Body mass index was calculated as weight (kg)/height squared (m(2) ). Pampiniform plexus diameters were measured by scrotal colour Doppler ultrasonography, and retroperitoneal adipose tissue was evaluated by noncontrast abdominal computed tomography. We determined an almost significant correlation between BMI and varicocele presence by physical examination (P = 0.06). However, there was a significant relationship between WC and varicocele identified by physical examination (P = 0.021). There was a positive and significant relationship between BMI and pampiniform plexus diameters. Furthermore, we detected a negative correlation between retroperitoneal adipose tissue measurements and CDU findings. Additionally, there was a significant correlation between WC, pampiniform plexus diameters and CT findings. It is concluded that increasing BMI and increasing WC may play a protective role in the development of varicocele. There is a need for further studies to verify the effect of obesity on varicocele formation.

The azoospermia factor locus-c region was found to be related to Klinefelter syndrome in Turkish patients.

We looked for a possible association between Klinefelter syndrome (KFS) and microdeletions in the Y chromosome in Turkish KFS patients. We examined the frequency of KFS in male patients with proven non-obstructive azoospermia and the types of Y chromosome microdeletions in these KFS patients. Fifty azoospermic patients and 50 fertile men were included in this study. KFS was found in 14 azoospermic patients. Y chromosome microdeletions were found in eight KFS patients. Azoospermia factor locus c (AZFc) was the most commonly deleted interval in KFS patients. All KFS patients had elevated plasma follicle-stimulating hormone and luteinizing hormone concentrations, but they had normal plasma testosterone concentrations. Testis biopsy of five samples with Y microdeletions revealed Sertoli cell-only syndrome. No Y microdeletions were found in the fertile group. We concluded that there could be an association between the AZFc region and KFS. Screening for this should be part of diagnostic work-up, particularly in those considering assisted reproduction.

Caffeic acid phenethyl ester modulates methotrexate-induced oxidative stress in testes of rat.

The aim of this study was to investigate the possible protective role of caffeic acid phenethyl ester on testicular toxicity of methotrexate in rats. Nineteen male rats were divided into three groups as follows: group I, control; group II, methotrexate-treated; group III, methotrexate + caffeic acid phenethyl ester-treated. In the second day of experiment, a single dose of methotrexate was intraperitoneally administered to groups II and III, although a daily single dose of caffeic acid phenethyl ester was intraperitoneally administered to group III for 7 days. At the end of the experiment, the testes of the animals were removed and weighed. In the tissue, the level of lipid peroxidation as malondialdehyde and activities of superoxide dismutase were higher in the methotrexate group than in the control group. Lipid peroxidation levels and superoxide dismutase activities were decreased in caffeic acid phenethyl ester + methotrexate group compared with methotrexate group. The activities of catalase in the methotrexate group decreased insignificantly although its activities were significantly increased by caffeic acid phenethyl ester administration. The activity of glutathione peroxidase did not change in the groups. There was significant difference in body weight between control and methotrexate-induced groups. In conclusion, the administration of methotrexate causes elevation of oxidative stress although treatment with caffeic acid phenethyl ester has protective effects on the oxidative stress in testes.

Leptin expression in the testicular tissue of fertile and infertile men.

There have been several studies about the presence of leptin in serum and testicular tissue, and none of them compares the leptin expression in the testicular tissue of fertile and infertile men. We assessed the presence of leptin expression in the testicular tissue of fertile and infertile men. 20 azoospermic infertile men were included in the study. All patients underwent testicular sperm extraction (TESE) for ICSI. For the detection of leptin, the immunohistochemistry was carried out. Intensity of immunohistochemical staining was subjectively estimated and expressed as negative (-), weak positive (+), intermediate positive (++) and strong positive (+++). Testicular tissues of 5 fertile patients, aged 50-60 years, was stained with leptin for control group. Mann-Whitney U test was used as the statistical method. There was no statistically significant difference in leptin staining between infertile patients and control group (p < 0.05). Leptin staining in tubuli seminiferi and Leydig cells were generally equal or Leydig cells were stained (+) much. This difference was not statistically significant. We found that there is leptin staining in Leydig cells and tubuli seminiferi. There is no difference in normal and infertile men for leptin staining properties in testicular tissue. This condition suggests that the effect of leptin on reproductive functions originates from a systemic effect related to central neuroendocrine system, androgen levels or spermatogenic existence rather than its direct effect on testicular tissue.

Megacystis secondary to myenteric plexus pathology. Presentation of two cases.

Herein, 2 cases of megacystis secondary to myenteric plexus pathology are reported. Unlike the entity of visceral myopathy, there was ganglion cell loss both in the bladder and in the colon of these 2 cases. Moreover, they did not present any gastrointestinal symptoms. Megacystis was the common pathology in these patients, whereas 1 of them suffered from unilateral vesicoureteral reflux. We could not find any similar report dealing with this phenomenon up to this time in the literature.

Acupuncture therapy in the management of persistent primary nocturnal enuresis--preliminary results.

OBJECTIVE: This study aimed to assess the comparative therapeutic efficacy of traditional Chinese acupuncture. MATERIAL AND METHODS: During the period from January 1997 to April 1999, 50 children (23 boys, 17 girls) suffering from primary persistent nocturnal enuresis, aged 9-18 years, were included in the study. The response rate was monitored at 2 and 4 weeks, and then every 3 months by recording dry nights on a calendar. RESULTS: The efficacy of treatment, which was expressed as a percentage of dry nights, was high. Within 6 months, 43 (86%) patients were completely dry and 2 (10%) patients were dry on at least 80% of nights. CONCLUSIONS: Treatment using acupuncture in patients with persistent enuresis nocturna appeared to be most efficacious both in terms of the percentage of dry nights at the end of treatment and in relation to the stability of results, even after the end of the study.

Prostatic fluid-free insulin-like growth factor-1 in relation to prostate cancer.

OBJECTIVES: To establish the feasibility of measuring free insulin-like growth factor-1 (IGF-1) in prostatic fluid and to determine if there is a difference in free IGF-1 levels in the prostatic fluid of patients with prostatic adenocarcinoma and in normal men. PATIENTS AND METHODS: Prostatic fluid samples were collected from men with histologically confirmed prostate cancer and from control subjects with no malignancy. Prostatic fluid and serum free IGF-1 levels were measured in duplicate by radioimmunoassay, and the differences analysed using the Mann-Whitney U-test and Pearson correlation. RESULTS: Prostatic fluid free IGF-1 concentrations did not differ significantly (P = 0.23) and there was no difference in serum free IGF-1 levels between the groups. While serum PSA level was significantly correlated with age (P < 0.001) the free IGF-1 level of prostatic fluid was not. There was also no correlation between prostatic fluid free IGF-1 and serum PSA levels. CONCLUSIONS: Free IGF-1 can be detected in prostatic fluid with acceptable sensitivity. However, the free IGF-1 level in prostatic fluid does not help to detect patients with prostate cancer and is not a tumour marker.

Comparative early results of the sandwich technique and transurethral electroresection in benign prostatic hyperplasia.

No study has yet reported the comparative results of the sandwich technique and transurethral electroresection in the management of benign prostatic hyperplasia. Thirty patients with benign prostatic hyperplasia were divided into two groups, each consisting of 15 patients. The first group underwent the sandwich technique (transurethral electrovaporization-transurethral electroresection-transurethral electrovaporization) and the second group had transurethral electroresection alone (TURP). Preoperatively all patients underwent a digital examination and the determination of prostatic volume by transrectal ultrasonography, and a symptom score (IPSS), the maximal flow rate (Q (max)), post-void residual urine (PVR). Six months after the operation, all the variables were remeasured and the values compared with those before treatment and between the groups. The improvements in symptom score, residual urine and maximum flow rate were slightly better after the sandwich technique than after TURP but the differences between the two groups were not statistically significant. Additionally, lower amounts of irrigant solution were used (P>0.05) and operative time was shorter in the sandwich group (P>0.05). Although the duration of catheterization in the sandwich group was lower than that of the TURP group (1.6 and 2.26 days respectively (P<0.05)), three patients (20%) required catheterization. Although the improvements in the objective parameters 6 months after, early indications showed that the sandwich technique results were almost the same as after TURP. There might be several advantages of this technique, particularly the fact that no blood transfusion is required and earlier removal of urethral catheter.Prostate Cancer and Prostatic Diesases (2001) 4, 242-244.

Free insulin-like growth factor-1 and unilateral complete ureteral obstruction in the rat.

OBJECTIVES: To determine the effect of unilateral ureteral obstruction on renal free insulin-like growth factor-1 (IGF-1) content in the kidneys and the possible role of free IGF-1 in compensatory growth in the nonobstructed kidney in an experimental model. METHODS: The content of free IGF-1 and total protein in the obstructed and nonobstructed kidneys were measured 7 days after unilateral ureteral obstruction. The weights of the kidneys were also determined. The results were compared with those of the sham-operated animals. RESULTS: The mean renal free IGF-1 level of the obstructed kidneys was significantly lower than the mean renal free IGF-1 level of the sham-operated kidneys (P = 0.03), and the mean renal free IGF-1 level of the nonobstructed kidneys was significantly higher than the mean renal free IGF-1 level of the sham-operated kidneys (P <0.0001). The serum free IGF-1 levels in the two groups were not different. The mean weight of the obstructed and nonobstructed kidneys was significantly higher than those of the sham-operated kidneys (1.49 +/- 0.09 and 1.03 +/- 0.03 versus 0.88 +/- 0.02 g, P <0.0001 and P = 0.006, respectively). The obstructed kidneys had significantly lower mean protein content than the nonobstructed kidneys and had significantly higher mean protein content than the sham-operated kidneys (P <0.0001 and P = 0.0004, respectively). CONCLUSIONS: Our results reveal that compensatory renal growth is driven by a rise in the free IGF-1 concentration after unilateral ureteral obstruction.

[Prevalence of benign hypertrophy of the prostate in Turkish men hospitalized in urology]. / Prévalence de l'hypertrophie bénigne de la prostate chez les hommes turcs hopitalisés en urologie.

OBJECTIVES: The prevalence of clinical benign prostatic hyperplasia (BPH) is known in Western European countries and in North America, but epidemiological data are lacking for Eastern European and Balkan countries. The objective of this study was to determine the prevalence of BPH in this region. METHODS: We analysed the data obtained on patients with BPH reported by urologists from 48 hospitals in Turkey, in 1996. This analysis is based on 84,149 case files for patients aged 40 to 80 years and more. RESULTS: The overall prevalence of clinical BPH was 18.5%. The age-specific predominance of BPH reached a maximum for the 60-69 years age-group. A majority of cases of BPH were treated medically (54.7% of cases). CONCLUSION: The data are discussed in the light of our current knowledge. Our presentation is the first report concerning the prevalence of clinical BPH in our region, but it needs to be completed to determine the prevalence of clinical BPH in relation to age, country and race in the Balkans and the Middle East.

Effect of transrectal ultrasonography of the prostate on serum prostate-specific antigen levels and free/total prostate-specific antigen ratio.

To study the effect of transrectal ultrasonography (TRUS) on serum total prostate-specific antigen (PSA), free PSA and free/total (f/t) PSA ratio and to determine the reliability of serum total and free PSA levels and f/t PSA ratio after such interventions, serum free and total PSA levels and f/t PSA ratios were determined before, immediately after and 24 h after TRUS in 44 patients who were referred to our department by their general practitioner for prostate screening. The duration of TRUS procedure and prostate volume and age were evaluated to determine whether the serum PSA levels following TRUS had changed. The total PSA and free PSA levels and f/t PSA ratio did not show any significant rise immediately after DRE and TRUS. The duration of the TRUS procedure did not appear to affect the PSA values. Age and prostate volume were not correlated with the PSA levels. Our findings revealed no significant changes in f/t PSA ratio and serum free and total PSA level, suggesting that serum free and total PSA levels and f/t PSA ratio may be more reliable parameters in the early period after TRUS.

Effect of ultrasound in the treatment of primary nocturnal enuresis.

OBJECTIVE: This study aimed to determine the efficacy of ultrasound therapy in patients with primary nocturnal enuresis. MATERIAL AND METHODS: Thirty-five patients with enuresis were included the study. Patients were divided into two groups: 27 patients with enuresis were treated with ultrasound with irradiation and heating, and eight patients with enuresis were treated with ultrasound without irradiation or heating (placebo group). Ultrasound therapy was performed using the Therasonic 350 machine. The ultrasound therapy was applied to the skin of lumbosacral region. A treatment course of ultrasound comprised 10 sessions of 0.8 W/cm2 intensity applied daily for 8 min. Symptoms were evaluated I week, and 3, 6 and 12 months after the treatment. RESULTS: Twenty-two (81.5%) patients responded to the ultrasound therapy at the first week after the treatment. The effect of ultrasound started immediately after the treatment and continued during the 12 months of the follow-up period. CONCLUSION: Ultrasound therapy seems to be effective in the treatment of primary nocturnal enuresis in the 1 year follow-up period.

Mast cell variations in tumour tissue and with histopathological grading in specimens of prostatic adenocarcinoma.

OBJECTIVE: To determine whether the number of mast cells (MCs) varies in and around prostatic carcinoma tissue, and with histopathological grading. MATERIALS AND METHODS: Specimens of 27 prostatic carcinomas were stained with the toluidine blue and staged histopathologically using the Gleason grading system. The MCs were counted in five high-power microscopy fields within and around the tissue samples, and the results analysed using the Wilcoxon signed-rank test and Spearman's correlation. RESULTS: The mean number of MCs was 1.7 per field within and 3.31 per field around the cancer tissue, the difference between these being significant (P<0. 05). There was a close correlation between the numbers of MCs within the tumour and Gleason grade (r=0.56, P=0.002) but not between grade and counts around the tumour (r=-0.18, P=0.35). CONCLUSION: These results suggest that some MCs aggregate at the periphery of the prostatic adenocarcinoma and that the number of MCs within the tumour tissue is related to tumour differentiation.

Urodynamic evaluation after endoscopic modified bladder neck suspension.

A total of 45 simplified double-needle bladder neck suspensions for genuine stress incontinence were clinically and urodynamically evaluated pre- and postoperatively. After a mean follow-up of 26 months, the subjective cure rate was 82.2% and the objective cure rate was 86.6%. Comparison of the pre- and postoperative urodynamic parameters showed a significant change in the maximum urethral closure pressure, functional urethral length, bladder capacity and maximum urine flow rate but no significant alteration in maximum detrusor pressure and first sensation during bladder filling. In summary, the modified bladder neck suspension effectively restores normal urethral function urodynamically.

Penile necrosis: an unexpected complication following transurethral resection of the prostate.

A 69-year-old man who had undergone a transurethral resection of the prostate for benign prostatic hyperplasia developed necrosis of the glans penis following traction of the urethral catheter

Effect of vibration massage therapy after extracorporeal shockwave lithotripsy in patients with lower caliceal stones.

PURPOSE: To determine whether vibration massage influences the results of extracorporeal shockwave lithotripsy (SWL) in patients with lower caliceal stones. PATIENTS AND METHODS: One hundred three patients with lower caliceal stones were entered in the study. Patients were divided into two groups that received either SWL alone (Group A, N = 52) or with vibration massage (Group B, N = 51). There was no statistically significant difference between the two groups in stone size, duration of follow-up, or patient age. The complication, stone-free, and stone recurrence rates of the groups were compared. RESULTS: There was no statistically significant difference between the groups in the number of shockwaves, number of SWL sessions, or shockwave energy. The renal colic rate was higher in Group B than in Group A (P = 0.03). The stone-free rates in Group A and Group B were 60% and 80%, respectively (P = 0.003). The stone recurrence rate was higher in Group A than in Group B (P = 0.0006). CONCLUSIONS: This retrospective study demonstrates that SWL with vibration massage appears to have a beneficial effect on the passage of fragments in patients with lower caliceal stones.

Treatment with neodymium: YAG laser in patients with chronic prostatitis: a preliminary report.

A group of 30 patients with chronic abacterial prostatitis or prostatodynia, all of whom were unresponsive to conventional treatments, underwent transurethral neodymium: YAG laser therapy. The patients were evaluated with both objective and subjective parameters before and after treatment. Following treatment, the preliminary results at six months showed positive response (complete plus partial) rates in subjective parameters ranging from 47% to 86%. On the other hand, objective parameters including mean international prostate symptom scores (IPSS), mean quality of life indexes (QoL), mean uroflowmetric measurements and mean leukocyte count in expressed prostatic secretions showed marked improvements which were meaningful statistically. In 4 of 7 patients who underwent needle biopsy of the prostate, histology revealed definite inflammatory infiltration changes. Control biopsies following treatment showed almost complete disappearance of these changes. These preliminary results open up a new treatment modality in the management of this condition which has so far responded poorly to conventional therapy.

Epidemiology of enuresis in Turkish children.

To establish the prevalence of enuresis in Turkish children and to identify common methods of managing enuresis, a self-administered questionnaire was distributed to parents of 5754 children aged 7-12 years. From a response rate of 96% the overall prevalence of any reported nocturnal enuresis was 11.5% and diurnal enuresis was 0.5%. The prevalence of enuresis was higher in boys than in girls. Turkish parents primarily administered behavioural techniques for the management of enuresis. These results suggest that prevalence rates for nocturnal enuresis in Turkish children are similar to those in previous studies reported from Western Europe, the USA and Australia.

Skin metastasis of bladder carcinoma. A case report.

A case of not commonly encountered metastasis of bladder cancer to skin has been studied. The usual sites of the bladder cancer metastasis are lymph nodes, liver, lung and bone.