Role of urine glycosaminoglycan levels in the diagnosis and follow-up in men with lower urinary tract symptoms.

OBJECTIVE: The aim of this study was to investigate whether urinary glycosaminoglycans (GAG) levels reflect clinical status in men with lower urinary tract symptoms and if they could be used as a marker in management of overactive bladder (OAB). METHODS: A total of 34 patients were recruited who were admitted with LUTS and diagnosed as having clinically bladder outlet obstruction (BOO) due to prostate enlargement. These newly diagnosed, never treated patients underwent routine investigation, consisting of history, physical examination, PSA, ultrasound, uroflowmetry, assessment of symptoms scored by both International Prostate Symptom Score (IPSS) and Marmara- Overactive Bladder Questionnaire (M-OBQ). The patients were divided into two groups as those with an initial M-OBQ score < 12 (group 1) and ≥ 13 (group 2). Alfa blocker was initiated in eligible patients. Further evaluations included prostate volume measurement, pre- and post-treatment urinary GAG levels, IPSS and M-QAOB values and maximum urine flow rate (Qmax). RESULTS: Before treatment, urinary GAG level was 21.5 mg/gCr (6.1-45.5) in Group 1, and 23.35 mg/gCr (15.6-32.6) in Group 2 (p =0.845). After the treatment, the GAG level in Group 1 and Group 2 were found to be 19.8 mg/gCr (7.4-70.5) and 18 (7.6- 41.7), respectively (p = 0.511). No difference in GAG levels was found in subgroup analysis for patients with or without OAB. CONCLUSIONS: In recent years, there have been many studies investigating the relationship between LUTS and urinary markers. However, in our prospective study, no relationship was found between pre- and post- treatment urinary GAG levels in patients with LUTS with or without OAB.

Erectile dysfunction in patients with major burn injury: The significance of follow-up.

BACKGROUND: There were few prospective studies investigating the relationship between the burn injury and erectile dysfunction (ED). The aim of this study was to prospectively explore the alteration in erectile functions regarding major burn. METHODS: This study was conducted as a prospective survey in patients with major burn injury. The study group consisted of burn cases with at least 20% of body surface area affected according to the Wallace Rule of Nines. Initially International Index of ED-5 (IIEF-5) was administered to the patients in the burn unit, and it was repeated in the 2rd and 6th months. Burn types, the severity of burns, age of patients, and alteration in IIEF-5 scores were compared. RESULTS: The study included 63 male patients. The median age of the patients was 35 (20-73) years, and the median burn percent-age was 22 (20-60). The rate of ED was markedly increased during follow-up as 8%, 39.7%, and 25.4% at baseline, 3rd, and 6th month evaluation, respectively. The median initial IIEF-5 score of the patients was 23 (5-25). Subgroup analysis revealed that IIEF-5 score of patients with electrical and flame burn significantly decreased at 3rd month compared with the baseline values. The median IIEF-5 score of patients with electrical burn increased at 6th month compared with 3rd month (p=0.042). Binary logistic regression analysis showed that age and service period, and IIEF-5 Score at 3rd month and burn grade were all statistically significantly associated with the normal erectile function (IIEF-5>=18), at 3rd month and 6th month, respectively. CONCLUSION: The current trial demonstrated that IIEF-5 scores of patients with major burn can show significant impairment in long term, and it seems a time-dependent process. This is the first prospective trial showing that IIEF can be utilized to monitor erectile function of burn patients in a longer follow-up program.

Nation-wide analysis of the impact of Covid-19 pandemic on daily urology practice in Turkey.

OBJECTIVE: To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic. METHODOLOGY: The centres participating in the study were divided into three groups as tertiary referral centres, state hospitals and private practice hospitals. The number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9-March-2020 and 31-May-2020. All these variables were recorded for the same time interval of 2019 as well. The weekly change of the workload of urology during pandemic period was evaluated, also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019. RESULTS: A total of 51 centres participated in the study. The number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the 3rd week of pandemics in state hospitals and tertiary referral centres; however, the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared, a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid-19 pandemic compared with normal life. CONCLUSIONS: Covid-19 pandemic significantly affected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non-deferrable surgeries by urologists in concordance with published clinical guidelines.

Tadalafil versus alpha blockers (alfuzosin, doxazosin, tamsulosin and silodosin) as medical expulsive therapy for < 10 mm distal and proximal ureteral stones.

OBJECTIVES: To evaluate the effect of tadalafil compared with four alpha blockers (alfuzosin, doxazosin, tamsulosin and silodosin) as medical expulsive treatment for ureteral stones in male adults. MATERIALS AND METHODS: Male adults who were admitted to urology clinic with flank pain and diagnosed with non complicated < 10 mm ureteral stone on non-contrast computed tomography (NCCT) between June 2014-September 2015 were retrospectively evaluated. A total of 273 patients with ureteral stone were divided into five groups. Alfuzosin 10 mg/daily, doxazosin 8 mg/daily, tamsulosin 0.4 mg/daily, silodosin 8 mg/daily and tadalafil 5 mg/daily for 6 weeks were prescribed respectively. Stone localization, diameter, volume and Hounsfield units were noted as NCCT findings. The patients were divided into the two groups based on their stone localization as distal and mid-proximal stones. These two groups were evaluated separately. Expulsion rate were noted at the end of 6 weeks. NCCT and treatment findings were compared between five drug groups in distal and mid-proximal stones separately. RESULTS: Age was higher in tadalafil group in distal stones (p = 0.032). Expulsion rate was found 78.1% for alfuzosin, 75.7% for doxazosin, 76.5% for tamsulosin, 88.6% for silodosin and 90% for tadalafil in distal (p = 0.44) and 21.7%, 30%, 30%, 30% and 54.5% in mid-proximal stones (p = 0.034) respectively. CONCLUSIONS: Expulsion rate was higher in silodosin and tadalafil for distal ureteral stones but the difference didn't meet statistical significance. However the expulsion rate was significantly higher in tadalafil than in the other groups for mid-proximal ureteral stones. The result of this study showed that tadalafil may increases ureteric stone expulsion.

Computed tomography findings predicting the success of silodosin for medical expulsive therapy of ureteral stones.

Aim of the study is to investigate the relationship between non-contrast computed tomography (NCCT) findings and stone expulsion rate with medical expulsive therapy (MET) using silodosin for ureteral stones in male adults. Between January 2014 and June 2015, we retrospectively reviewed the patient charts with uncomplicated ureteral stones on NCCT images, who were treated with silodosin for MET. Stone diameter, volume and hounsfield units (HU) measured by NCCT and treatment findings were noted at the end of treatment. Patients were divided into three groups according to the localization as distal, mid and proximal ureteral stones. NCCT and treatment findings were compared between MET success and failure groups in different localizations. Stone expulsion rate was 81.3% for 134 distal, 45.5% for 22 mid and 27.7% for 47 proximal stones. Stone diameter, volume, and HU were significantly lower for success groups with distal and proximal stones (p < 0.05). In ROC analysis the cut-off values for stone volume and HU were detected as 48.7 mm3 and 598 HU for success group with proximal stones. Stone expulsion rate was found to be 24 times more (OR = 24; p = 0.001) in patients with <598 HU and 14 times more (OR = 14; p = 0.002) in patients with <48.7 mm3 proximal stones. Lower stone diameter, volume and HU were significant predictors of success with silodosin for MET for ureteral stones. Patients with <598 HU and/or <48.7 mm3 proximal stones may be prescribed silodosin for MET.

Second primary cancers in patients with urothelial cancers.

PURPOSE: To investigate the second primary cancers (SPCs) in patients with urothelial cancer (UC). MATERIALS AND METHODS: The records of 2,339 patients whose UC was diagnosed between January 1974 and December 2012 were reviewed. All data about characteristics of patients, of UC and, of SPC was, recorded digitally. We investigated the prevalence and the type of second or higher order cancers, and the factors associated with SPC. RESULTS: Total 260 patients (11.1%) had SPC, 14 had a third primary cancer and one had a fourth primary cancer. The most common SPC with UC was lung cancer (29.6%). Of all 260 with SPC, 64 (24.6%) had synchronous (within the 6 months) SPC, 120 (46.2%) had subsequent SPC and, 76 (29.2%) had antecedent SPC. The mean duration of SPC was 56 months in patients with subsequent SPC and 75.8 months in patients with antecedent SPC. The mean age at the time of diagnosis of UC was higher in patients with SPC. The ratio of male gender, body mass index, blood type, status of smoking and, occupational risk was similar in both groups. Total amount of smoking and the mean follow-up were higher in patients with SPC. CONCLUSIONS: The majority of the patients with UC have long life expectancy. In patients with UC, the risk of having another cancer is quite higher than normal population. The physicians managing patients with UC should look for SPC.

Co-existent breast and renal cancer.

The concomitant presence of breast cancer with one or more other types of cancer such as colon, vulva, lung, larynx, liver, uterus and kidneys has been presented in the literature. However, synchronous breast and renal cancer is very uncommon. Herein we present a woman with synchronous breast and renal cancer, and review the literature. A 77-year-old post-menopausal woman was admitted to our clinic complaining of left sided breast mass. On physical examination, there was a 3 cm palpable mass in the upper outer quadrant of the left breast along with a conglomerate of lymph nodes in the left axilla. Ultrasonography and mammography showed a 3 cm solid, hypoechoic mass in the upper outer quadrant and left axillary lymphadenopathy. The tru-cut biopsy of the lesion revealed invasive ductal carcinoma. The bone scintigraphy, thoracic and cranial computerized tomographies were normal. The abdominal computerized tomography identified a 3×3 cm solid renal mass with heterogeneous contrast enhancement in the posterior segment of the lower pole, which was suspicious for renal cell carcinoma. Breast conserving surgery and axillary lymph node dissection was performed, and the pathology specimen demonstrated invasive ductal carcinoma. The patient was discharged on postoperative day 5. Three weeks later partial nephrectomy was performed by urology department for the solid renal mass, and the pathology result showed clear cell-renal carcinoma with Fuhrman grade 3. The patient is being followed-up for renal carcinoma, and underwent radiotherapy for breast cancer. Hormonotherapy for breast cancer is still continuing.

[Investigation of prevalance and risk factors for hospital-acquired urinary tract infections in patients with severe burn injury]. / Ciddi yanik travmasi olan hastalarda hastane kaynakli idrar yolu enfeksiyonu sikligi ve risk faktörlerinin arastirilmasi.

BACKGROUND: This study aimed to investigate the prevalence and risk factors for hospital-acquired urinary tract infections in patients with severe burn injuries. METHODS: In this study, patients treated due to their burn injuries of greater than 20% between August 2009 and April 2012 in Bozyaka Training and Research Hospital Burn Center were assessed retrospectively. Sixty nine patients (30 [43.5%] males, 39 [56.5%] females; mean age 40.1±16.7 years) were included into the study. RESULTS: DM, duration of the catheter and catheter care showed a statistically significant correlation with hospital-acquired urinary tract infections (p<0.005). DISCUSSION: A large number of hospital-acquired urinary tract infections are associated with urinary catheterization. In addition, removing urinary catheter within the shortest time possible is another issue to be considered for the prevention of these infections. If the catheter has to remain for a longer time, regular catheter care is recommended.

The effect of alpha blockers on uroflowmetric parameters in different voiding positions.

INTRODUCTION: We assessed the effect of different voiding positions on uroflowmetric parameters and post-void residual (PVR) urine volume in symptomatic benign prostatic hyperplasia (BPH) patients. We also evaluated the effect of alpha blockers on PVR in different voiding positions. METHODS: The study was performed with 110 BPH patients over 50 years old. In total, 4 uroflowmetries were performed in all patients: 2 patients in the sitting position and 2 in the standing position. PVR was measured with transabdominal ultrasonography. Also, patients were divided into two groups according to the alpha adrenergic blocker treatment; the effect of this treatment on their uroflowmetric parameters in different positions was evaluated. RESULTS: MAXIMUM FLOW RATE (QMAX) AND AVERAGE FLOW RATE (QAVE) WERE SIGNIFICANTLY HIGHER IN PATIENTS IN THE SITTING POSITION, BUT THERE WERE NO DIFFERENCES IN OTHER UROFLOWMETRIC PARAMETERS AND PVR VOLUME (QMAX: 15.5±5.9 mL/s vs. 13.7±5.2 mL/s, Qave: 11.4±4.6 mL/s vs. 10.7± 3.9 mL/s, respectively; p < 0.05). The Qmax and Qave were significantly higher in sitting position, compared to the standing position, in both alpha adrenergic treatment and non-treated groups; again, there were no differences in other uroflowmetric parameters and PVR volume. CONCLUSION: Qmax and Qave values were significantly higher in the sitting position. Alpha blockers did not affect any change.

Relationship between circumcision scar thickness, postcircumcision mucosal cuff length measures and premature ejaculation.

OBJECTIVE: The etiology of premature ejaculation (PE) is unknown. Over the past two decades several studies have suggested that lifelong and acquired PE may be caused by somatic disorders and/or neurobiological disturbances. One controversial factor is the effect of circumcision on ejaculation. This prospective study investigated the relationship between postcircumcision penile mucosal cuff length, circumcision scar thickness and the PE syndromes. Features of PE patients were compared with those of a normal healthy control (NHC) group. MATERIAL AND METHODS: In total, 160 circumcised men were studied: 80 men with PE and 80 men in the NHC group. The following data and measurements were evaluated: age, type of PE syndrome, intravaginal ejaculation latency time (IELT), circumcision scar thickness and postcircumcision mucosal cuff length. RESULTS: In terms of the mean IELT, a statistically significant difference was detected between the PE syndromes (p < 0.05), and between the PE patients and the control group (p < 0.05). Among the four PE syndromes, there was no significant difference related to the mean mucosal cuff length and mean circumcision scar thickness (p > 0.05). No significant difference was observed between the two groups for mean mucosal cuff length (p > 0.05) or mean circumcision scar thickness (p > 0.05). CONCLUSION: In this study, no relationship was observed between PE and postcircumcision penile mucosal cuff length and circumcision scar thickness. Further studies are required to evaluate the positive and negative effects of circumcision on PE syndromes.