Correlation Between Residual Volume of Male Patients After Uroflowmetry and Random Residual Volume.

OBJECTIVES: Our aim was to examine correlation between Post-void residual urine (PVR) after uroflowmetry and random PVR. METHODS: Male patients reporting to the Urology outpatient clinic with LUTS were selected. Patients' age, prostate volume, bladder capacity, voided volume, maximum flow rate, average flow rate, random PVR and PVR after uroflowmetry were recorded. We evaluated the correlations between these parameters. Also we assessed if there was a difference between random PVR and PVR after uroflowmetry. We divided PVR after uroflowmetry and random PVR into three groups: Group 1: 0-50 mL, Group 2: 51-100 mL and Group 3: >100 mL. Also we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2: >400 mL. We compared these groups to determine whether a significant difference. RESULTS: Seventy-seven patients applying to the urology outpatient clinic were assessed between 2013 and 2014. PVR after uroflowmetry was significantly higher than random PVR (P < 0.001). When we divided PVR after uroflowmetry and random PVR into three groups there was a significant difference between the groups (P = 0.02). When we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2: >400 mL, PVR after uroflowmetry was different, but random PVR was similar (P < 0.001, P = 0.72). CONCLUSIONS: PVR after uroflowmetry seems to be incorrectly high in patients whose bladder capacity is above 400 mL.

Comparison of factors affecting the short-term presentation of results in the surgery of distal hypospadias in adults / Comparación de factores que afectan la presentación a corto plazo de los resultados en la cirugía de hipospadias distales en adultos

Introduction. To determine the factors affecting the success of distal hypospadias repair in adults. Material and methods. Medical records of adult patients who underwent distal hypospadias repair in our clinic were reviewed. Patient's age, external urethral meatus location, hypospadias status, anesthesia type, diversion type, nelaton diameter and surgeons were recorded as factors affecting surgery success. Only patients, operated with tubularisation incised plate urethroplasty (TIPU) technique, were included. Results were classified as successful, stricture, fistula and slough. We compared the factors affecting the success. SPSS 16.0 were used for statistical assessment and logistic regression analysis was used to determine success. p<0.05 was considered to show statistical significance. Results. One hundred and eight patients underwent distal hypospadias repair in our clinic. Mean age was 21.44±2.0. 38 patients had distal penile, 67 patients had subcoronal, 2 patients had coronal and 1 patient had glandular hypospadias. Eighty eight patients had primary, 12 secondary, 5 tertiary and 3 cripple hypospadias. Seventy eight patients underwent TIPU under local anesthesia, and 30 patients underwent under spinal anesthesia. Suprapubic catheter was used in 92 patients and transurethral catheter was used in 16 patients. Sixteen different surgeons performed the operations. Seventy operations were successful. Three stricture, 24 fistula, and 11 slough were determined. Overall success rate was 64.81%. Patient's age, external urethral meatus location, anesthesia type, diversion type, nelaton diameter and the surgeon difference did not affected surgical outcomes. Only hypospadias status (primary/redo) affected the success (p=0.037). Conclusion. The only factor affecting surgical outcomes of distal hypospadias repair in adults seems to be hypospadias status. It might be due to the lack of second layer in the redo operations (AU)

Introducción. Determinar los factores que influyen en el éxito de la reparación de hipospadias distal en adultos. Materiales y métodos. Se revisaron las historias clínicas de los pacientes adultos que se sometieron a reparación de hipospadias distal en nuestra clínica. Los siguientes factores se consideraron factores que afectan al éxito de la operación:la edad del paciente, la localización del meato uretral externo, el estado de hipospadias, el tipo de anestesia, el tipo de desvío, el diámetro nelaton y los cirujanos. Solo se tuvieron en cuenta los pacientes operados con la técnica de plato incidido tubularizaciónuretroplastia (TIPU). Los resultados fueron clasificados como: exitoso, estenosis, fístulas y Slough. Se compararon los factores que influyeron en el éxito de la operación. Se utilizóSPSS 16.0 para la evaluación estadística, mientras que el análisis de regresión logística se utilizó para determinar el éxito. Para mostrar significación estadística, se usóla cifra p <0,05. Resultados. Ciento ocho pacientes fueron sometidos a reparación de hipospadias distal en nuestra clínica. La media de edad fue de 21.44 ± 2.0. 38 pacientes tenían pene distal, 67 pacientes, tenían hipospadiassubcoronal, 2 pacientes,coronal y 1 paciente,glanular. Ochenta y ocho pacientes lo tenían primario, 5 secundario y 3,terciario. Setenta y ocho pacientes fueron sometidos a TIPU bajo anestesia local y a 30 pacientes se les realizó bajo anestesia epidural. Se utilizóun catéter suprapúbico en 92 pacientes y una sonda transuretral, en 16 pacientes. Dieciséis cirujanos diferentes se encargaron de llevar a cabo las operaciones; setenta de las cuales tuvieron éxito y hubo, además,tres casos de estenosis, 24 fístulas y 11 Slough. En general la tasa de éxito fue del 64.81%. La edad del paciente, la localización del meato uretral externo, el tipo de anestesia, el tipo de desvío, el diámetro del Nelatony el hecho de haber sido realizados por diferentes cirujanos no afectaron a los resultados quirúrgicos. Solo el estado de hipospadias (primari/reconstrucción) afectó al éxito (p=0.037). Conclusión. El único factor que influye en los resultados quirúrgicos de reparación de hipospadias distal en adultos parece ser el estado de los propios hipospadias. Podría ser debido a la falta de aplicación de la segunda capa en las operaciones reconstructoras (AU)

Comparison of two different doses of lidocaine on the pain sensation during transrectal ultrasound-guided prostate biopsy.

OBJECTIVE: To compare two different doses of lidocaine used for periprostatic nerve block on pain perception during transrectal ultrasound (TRUS) guided prostate biopsy. MATERIAL AND METHODS: A total of 288 patients with elevated prostate specific antigen (PSA) levels and/or abnormal digital rectal examination who underwent TRUS-guided prostate biopsy were included in the study. The patients were divided into 3 groups: Group 1 (n=103) prostate biopsy were performed after administering perianal intrarectal application of 10 mL 2% lidocaine gel, Group 2 (n=98) 2 mL of 2% lidocaine injection on each side following rectal installation of lidocaine gel and Group 3 (n=87) 4 mL of 2% lidocaine injection on each side after rectal instillation of lidocaine gel. Patients' pain scores during biopsy procedure were reported using visual analogue score (VAS). Independent sample t test, ANOVA test and Tukey test were used for statistical evaluation. RESULTS: The mean age, prostate volume and PSA level were 65.6±8.4 years, 58.2±34.8 mL, and 11.8±3.4 ng/mL respectively. There were no statistically significant differences in baseline characteristics between the groups. The mean VAS scores were 2.4±1.8 in Group 1, 2.5±1.9 in Group 2 and 1.6±1.6 in Group 3. Patients in Group 3, reported significant pain reduction compared with patients in Groups 1 and 2 (p=0.002, and 0.001, respectively). However, there was no statistically significant difference in VAS scores between Groups 1 and 2 (p=0.815). CONCLUSION: According to our results we recommend the use of perianal intrarectal lidocain gel application, and periprostatic nerve block with injection of 4 ml 2% lidocaine per side combination in TRUS-guided prostate biopsies. Further large-scale randomized control studies are needed to validate these finding.

Evaluation of PCA3 and multiparametric MRI's: collective benefits before deciding initial prostate biopsy for patients with PSA level between 3-10ng/mL.

OBJECTIVE: To analyze the contribution of multiparametric MRI and PCA3 assay, predecision of initial biopsy in PSA level between 3-10 ng/mL patients with normal digital rectal examination(DRE). MATERIALS AND METHODS: PSA level 3-10 ng/mL, patients, with normal DRE results and no previous prostate biopsy history, were included in this study. Each patient underwent multiparametric MRI one week before biopsy. Urine sample taking for PCA3 examination preceded the biopsy. Systematic and targeted biopsies were conducted. Patients with high PSA levels were seperated into two groups as: high PCA3 scored and low PCA3 scored. Then each group was divided into two sub-groups as: MRI lesion positive and negative. Tumor incidence, positive predictive values(PPV) and negative predictive values(NPV) were calculated. RESULTS: 53 patients were included between February 2013 and March 2014. Mean age 61.22 ± 1.06. Mean PSA value 5.13 ± 0.19 ng / mL. Mean PCA3 score 98.01 ± 23.13 and mean prostate size was 48.96 ± 2.67 grams. Fourty nine patients had both PCA3 score and multiparametric MRI. The PCA3's PPV value was 58.33%. If multiparametric MRI lesions are added to high PCA3 scores , the PPV appears to elevate to 91.66%. NPV of PCA3 was 96%. NPV was 95% when there was no lesion in the multiparametric MRI with low PCA3 scores. Sensitivity was 91.66% , specificity was 95% respectively. CONCLUSION: Adding multimetric MRI can also support biopsy decision for patients with high PCA3 value. When PCA3 value is low, patients can be survailled without any need to take a MRI.

TMPRSS2-ERG gene fusion in Turkish patients with localized prostate cancer: results of radical prostatectomy specimens.

OBJECTIVE: Our aim was to evaluate and determine the frequency of Transmembrane protease, serine 2 (TMPRSS2)-ERG fusion in Turkish patients with clinically localized prostate cancer by using immunohistochemistry and reveal its relationship with clinicopathologic variables. MATERIAL AND METHODS: Radical prostatectomy specimens of 99 patients, who underwent radical retropubic prostatectomy for localized cancer, between January 2002 and December 2011 were analyzed in the study. To detect ERG fusions, monoclonal ERG antibodyclone ID: EPR3864 (Epitomics, San Diego, CA, USA) and monoclonal anti-ERG antibody (9FY) (BiocareMedical, LLC, USA) were used. The immunistochemical expression of ERG protein was assessed as positive or negative regardless of stain intensity. Patients' age, total and primary Gleason scores, PSA levels, prostate volumes, tumor volumes, tumor stages and perineural invasion status were analysed retrospectively. Total fusion rate and correlation between the variables and fusion were evaluated. RESULTS: Mean age, prostate volume, tumor volume, PSA value of 99 patients were 62.02 years (±5.93), 50.02 cc (±20.67), 3.19 cc (±4.16), and 9.34 ng/mL (±3.37) respectively. TMPRSS2-ERG fusion was seen in 46 (46.5%) of 99 patients. When the variables analysed with independent samples t test to predict fusion (+) status, none of them was found to be statistically significant. When evaluated by logistic regression analysis for (+) or (-) status, only tumor stage was found to be statistically significantly correlated with fusion (p=0.049). CONCLUSION: The incidence of TMPRSS-ERG fusion in patients with localised prostate cancer in our study with Turkish population was found as 46.5%. Only tumor stage correlated with TMPRSS2-ERG fusion.

Clinical and histopathological results of the adult patients with unilateral cryptorchidism.

OBJECTIVE: To evaluate the clinical and histopathological results of adult unilateral cryptorchidism patients. MATERIAL AND METHODS: Data from adult unilateral cryptorchidism patients that underwent orchiectomy in our clinic between between January 2004 and March 2013 were retrospectively evaluated. Patients were divided into three groups as intra-abdominal, inguinal canal and superficial inguinal region according to the location of the undescended testes. Patients were also grouped according to their testicular volume (<4 cc, 4.1-12 cc, and >12 cc). Histopathology results of orchiectomy specimens were classified as follows: 1. Sertoli cells only, testicular atrophy and vanished testis (anorchia) 2. Hypospermatogenesis, and 3. Maturation arrest. Patients were grouped as normospermia, azoospermia and oligo/astheno/teratospermia groups according to semen analysis results. Correlations between testicular localization, testicular size, semen analysis and pathology results were evaluated. Incidental tumor detection rates were also calculated. RESULTS: Two hundred and forty-four adult unilateral cryptorchidism patients underwent orchiectomy in our clinic. There was no a significant relationship between location of the testis and testicular pathology results (p=0.707). Most common semen analysis results was normospermia in patients with high testicular volume group however azoospermia and oligoasthenospermia observed commonly in patients with low testicular volume group. There was a significant relationship between testicular volume and semen analysis results (p=0.023). No significant relationship was observed between semen analysis and pathological results (p=0.929). After an evaluation of all factors with possible effects on the semen analysis results, only testicular volume (p=0.036) was found to have a significant impact. Only one case (0.4%) was incidentally diagnosed seminoma after a review of 233 patients with available histopathological results on record. CONCLUSION: Adult unilateral cryptorchidism has a minimal effect on male fertility or even this effect can be overlooked. Low detection rates of incidental germ cell tumors also make an orchiectomy decision questionable in such cases.

Evaluation of PCA3 and multiparametric MRI's: collective benefits before deciding initial prostate biopsy for patients with PSA level between 3-10ng/mL

ABSTRACT Objective To analyze the contribution of multiparametric MRI and PCA3 assay, pre- decision of initial biopsy in PSA level between 3-10 ng/mL patients with normal digital rectal examination(DRE). Materials and Methods PSA level 3-10 ng/mL ,patients, with normal DRE results and no previous prostate biopsy history, were included in this study. Each patient underwent multiparametric MRI one week before biopsy. Urine sample taking for PCA3 examination preceded the biopsy. Systematic and targeted biopsies were conducted. Patients with high PSA levels were seperated into two groups as: high PCA3 scored and low PCA3 scored. Then each group was divided into two sub-groups as: MRI lesion positive and negative. Tumor incidence, positive predictive values(PPV) and negative predictive values(NPV) were calculated. Results 53 patients were included between February 2013 and March 2014.Mean age 61.22 ± 1.06. Mean PSA value 5.13 ± 0.19 ng / mL. Mean PCA3 score 98.01 ± 23.13 and mean prostate size was 48.96 ± 2.67 grams. Fourty nine patients had both PCA3 score and multiparametric MRI. The PCA3’s PPV value was 58.33%. If multiparametric MRI lesions are added to high PCA3 scores , the PPV appears to elevate to 91.66%. NPV of PCA3 was 96%. NPV was 95% when there was no lesion in the multiparametric MRI with low PCA3 scores. Sensitivity was 91.66% , specificity was 95% respectively. Conclusion Adding multimetric MRI can also support biopsy decision for patients with high PCA3 value. When PCA3 value is low, patients can be survailled without any need to take a MRI.

Medical ozone therapy reduces shock wave therapy-induced renal injury.

OBJECTIVES: Extracorporeal shock wave (ESW) lithotripsy is the preferred treatment modality for uncomplicated kidney stones. More recently free oxygen radical production following ESW application has been considered to be crucial in shock wave-induced renal damage. It has been shown that ozone therapy (OT) has ameliorative and preventive effects against various pathological conditions due to increased nitro-oxidative stress. In current study, we aimed to evaluate the efficacy of OT against ESW-induced renal injury. METHODS: Twenty-four male Sprague-Dawley rats were divided into three groups: sham-operated, ESW, and ESW + OT groups. All groups except sham-operated group were subjected to ESW procedure. ESW + OT group received 1 mg/kg/day of oxygen/ozone mixture intraperitoneally at 2 h before ESW, and OT was continued once a day for consecutive three days. The animals were killed at the 4th day, and kidney tissue and blood samples were harvested for biochemical and histopathologic analysis. RESULTS: Serum ALT and AST levels, serum neopterin, tissue nitrite/nitrate levels, and tissue oxidative stress parameters were increased in the ESW group and almost came close to control values in the treatment group (p < 0.05, ESW vs. ESW + OT). Histopathological injury scores were significantly lower in treatment group than the ESW group (p < 0.05, ESW vs. ESW + OT). Immunohistochemical iNOS staining scores in ESW group were higher than those of sham-operated group (p < 0.05, ESW vs. sham-operated), iNOS staining scores in OT group were significantly lower than the ESW group (p < 0.05, ESW + OT vs. ESW). CONCLUSION: OT ameliorates nitro-oxidative stress and reduces the severity of pathological changes in the experimental ESW-induced renal injury of rat model.

Erectile dysfunction after radical prostatectomy: effect of quality of life and psychology / Disfunción eréctil después de prostatectomía radical: efecto en la calidad de vida y psicología

Objective. Radical prostatectomy may have a significant impact on quality of life (QoL) because of erectile dysfunction, depression and incontinence. In this study, the mood and QoL of patients who underwent radical prostatectomy due to localized prostate Ca and were non-relapsed at least 12 months after operation were evaluated. Materials and methods. We evaluated 35 patients who underwent radical prostatectomy operation between 2000 and 2011 and showed no reduction during 12 months observation. IIEF, Beck Depression test, and EORTC 3.0 quality of life were given and scored. In this study, the effects of erectile dysfunction according to Beck depression test and QoL scores and correlation between the mood and QoL are evaluated. Results. In our study, ED groups categorized as mild, moderate and severe had no correlation with Beck depression scores (p = 0.874). But only the patients with severe and moderate erectile dysfunction had moderate and severe depression scores. Negative correlation was determined (p = 0.013) when Beck Depression scores with IIEF scores without categorizing ED groups. Correspondingly, negative correlation was determined (p = 0.048) between QoL and IIEF scores, whereas positive correlation was determined (r = 0.756 and p < 0.001) between QoL and Beck Depression scores. Conclusions. We observed that an increase of erectile dysfunction elevated depression symptoms and resulted in bad quality of life. During tumor control, it is important to use methods that do not affect QoL (AU)

Objetivo. La prostatectomía radical podría impactar de manera significativa en la calidad de vida (QoL) debido a la disfunción eréctil, la depresión y la incontinencia. En este ensayo se analiza el estado anímico y la QoL de los pacientes que se sometieron a prostatectomía radical debido a un cáncer de próstata localizado y no recidivante al menos 12 meses después de la intervención. Material y método. Se evaluaron 35 pacientes que se sometieron a prostatectomía radical entre los años 2000 y 2011 y no mostraron ninguna reducción durante los 12 meses de control. Se entregaron y analizaron los resultados en los test IIEF, Inventario de Depresión de Beck y EORTC 3.0 de calidad de vida. En este estudio se examinan los efectos de la disfunción eréctil conforme al Inventario de Depresión de Beck y la puntuación de QoL, así como la correlación entre el estado anímico y la calidad de vida. Resultados. En nuestro estudio, los grupos clasificados con disfunción eréctil leve, moderada o grave no guardaron correlación con las puntuaciones de depresión de Beck (p = 0,874). Únicamente los pacientes con una disfunción eréctil grave o moderada arrojaron resultados de depresión moderada o grave. Se estableció una correlación negativa (p = 0,013) de los datos de Depresión de Beck con los del IIEF sin clasificar los grupos con disfunción eréctil. Asimismo, se ratifica una correlación negativa (p = 0,048) entre el IIEF y la QoL, si bien sí existe una correlación (r = 0,756 y p < 0,001) entre los datos de la QoL y el Inventario de Depresión de Beck. Conclusiones. Observamos que un aumento en la disfunción eréctil eleva los síntomas de depresión y acarrea una peor calidad de vida. Es importante utilizar métodos que no afecten la calidad de vida para el control de los tumores (AU)

Tubularized incised plate urethroplasty in adults under local anaesthesia / / Uretroplastia en adultos mediante incisión y tubularización de la placa uretral bajo anestesia local

Introduction: Our aim was to assess our TIP urethroplasty results in adults with local anaesthesia. Materials and methods: Medical records of adult patients who underwent TIP urethroplasty due to distal hypospadias in our clinic between April 2006 and May 2013 were reviewed. Patient's age, external urethral location, preoperative calibration size of urethra, primary or secondary or more, circumsized or uncircumsized conditions were recorded. The records were categorized as circumcised–uncircumcised, urethral stent calibration 16 Fr and above or 14 Fr and below, primer or seconder and above, special group or the others. SPSS 16.0 were used for statistical assessment and chi-square test was used to determine success. p < 0.05 was considered to show statistical significance. Results: 51 patients underwent distal hipospadias repair under local anaesthesia in our clinic between April 2006 and May 2013. Mean age was 21.3. 24 patients had coronal, 26 patients had subcoronal, 1 patient had glanuler hypospadias. 40 patients were primary, 7 secondary, 4 tertiary. 38 patients were circumsized. 13 patients were uncircumsized. Mean preoperative calibration was 14.8 Fr, mean urethral stent calibre was 15, 1 Fr, mean stent duration time was 5.9 day. Suprapubic catheter was used for drainage at 48 patients. 22(52.3%) were successful, 20(47.6%) were unsuccessful of 42 patients with follow up. 13 patients that had fistula underwent fistula repair after 3 months later under local anaesthesia. 2 patients had stricture and they underwent meatotomy and dilatation. On one patient, second TIP urethoplasty operation was performed because the first operation was unsuccessful. Operation was very successful and it upgraded our over all success to 90.4%. An optimal group as primary, uncircumcised, 16 Fr neourethra was formed and were compared with the other groups. Success rate between optimal group and others was not different statistically. Conclusion: Our success rate was similar to literature. This survey reveals that distal hypospadias repair can be performed under local anaesthesia (AU)

Introducción: Nuestro objetivo fue evaluar los resultados obtenidos para la uretroplastia mediante incisión y tubularización de la placa uretral (TIP) con anestesia local en adultos. Materiales y métodos: Se revisó el historial clínico de los adultos que se sometiedon a una uretroplastia TIP debido a hipospadias distales entre abril del 2006 y mayo del 2013. Se catalogaron los parámetros de edad, ubicación externa de la uretra, calibración uretral preoperatoria, primario o secundario o más, circuncisión o no. Los valores se clasificaron como circuncidado-no circuncidado, calibración del stent uretral de 16 Fr o mayor o 14 Fr o menor, primario o secundario o más, grupo especial o el resto. Para valorar el éxito, el análisis estadístico se realizó con el sistema SPSS 16.0 y la prueba de la χ2. Los resultados p < 0,05 no se consideraron significativos. Resultados: Se intervino a 51 pacientes para reparación de hipospadias con anestesia local entre abril del 2006 y mayo del 2013. La media de edad fue de 21,3. Las hipospadias fueron coronales en 24 pacientes, subcoronales en 26 y granulares en uno. 40 pacientes fueron de tipo primario, 7 de tipo secundario y 4 de tipo terciario. 38 pacientes estaban circuncidados, 13 no lo estaban. La calibración media preoperatoria fue de 14,8 Fr, la calibración meadia del stent uretral due de 15,1 Fr, la duración media del stent fue de 5,9 días. Se utilizó una sonda suprapúbica para drenaje en 48 pacientes. De los 42 pacientes que acudieron a seguimiento, 22 (52,3%) consiguieron un resultado satisfactorio y 20 (47,6%) fueron casos fallidos. 13 pacientes que presentaron una fístula se sometieron a la reparación de la misma con anestesia local tres meses después. 2 pacientes presentaron estenosis y se sometieron a una meatotomía y dilatación. Uno de los pacientes precisó una segunda uretroplastia TIP debido a que la primera operación fue fallida. Esta segunda intervención fue muy satisfactoria y aumentó el nivel de éxito hasta el 90,4%. Se formó un grupo óptimo formado por pacientes primarios, no circuncidados, 16 Fr neouretra para compararlo con el resto de grupos. Estadísticamente no se apreciaron cambios entre el grupo óptimo y el resto de grupos. Conclusión: Nuestro nivel de éxito fue similar al de la literatura. Esta encuesta revela que la reparación de hipospadias distales puede realizarse con anestesia local (AU)

A rare complication of penile prosthesis: Inguinal hernia / / Una rara complicación de prótesis de pene: hernia inguinal

Inflatable penile prosthesis (IPP) implantation is a successful method for treatment of erectile dysfunction. IPP placements have rare complications. In this paper, we present a highly unusual case of an inguinal hernia as a short-term complication of a 3-piece IPP implantation. The patient was a 55-year-old man with erectile dysfunction due to diabetes mellitus. He presented 3 weeks after implantation with a strong cough. On exploration, the reservoir was seen in direct inguinal hernia sac. After removing the reservoir from the sac, the hernia was repaired with mesh and the reservoir was placed in the space of Retzius again. The patient is symptom free at follow-up (AU)

Implantación de prótesis de pene inflable (IPP) es un método exitoso para el tratamiento de la disfunción eréctil. Implantaciones de PPI tienen complicaciones raras. En este artículo, presentamos un caso de hernia inguinal que es una complicación rara ocurriendo a corto plazo después de la implantación de PPI a tres piezas. El paciente era un hombre de 55 anos ˜ con disfunción eréctil debido a diabetes mellitus. Presentó 3 semanas más tarde después de la implantación con una tos fuerte. En la exploración, el reservoir se observó en el saco de la hernia inguinal directa. Después de retirar el resorvoir del saco, la hernia se reparó con malla y el resorvoir fue colocado de nuevo en el espacio de Retzius. Ningún síntoma fue observado en el paciente al seguimiento (AU)

Our results of active surveillance for localized prostate cancer patients.

OBJECTIVE: Active surveillance has become a management option for low-risk prostate cancer patients, while keeping the curative treatment option available. In this study, we evaluated the our results of active surveillance for localized prostate cancer patients. MATERIAL AND METHODS: Patients diagnosed with localized prostate cancer who chose an active surveillance protocol were followed with PSA measurements, digital rectal examinations, and TRUS-guided biopsies. The patients' data and rebiopsy results were evaluated. The results were compared with the results of the patients who had definitive treatment. RESULTS: Forty-one patients on active surveillance and 34 patients with at least one rebiopsy were included in the study. Twenty-seven patients who had more than one rebiopsy were followed for an average of 27.7 (12-78) months. Twelve patients (44.4%) had undergone definitive treatment including radical prostatectomy (n=9), and radiotherapy (n=3). There were 17 patients under surveillance after a second biopsy, and 9 (33%) of them had a third biopsy. Among these 9 patients, 7 patients were kept under surveillance, and 2 (7%) them had a fourth biopsy. Active surveillance of 15 out of 17 patients who have not undergone definitive treatment is still ongoing. CONCLUSION: Active surveillance is a treatment option refrains low-risk prostate cancer patients from the complications of an early or unnecessary definitive treatment and related reduction in the quality of their lives. while keeping the curative treatment option available. Active surveillance can be applied safely with the appropriate patient selection, regular examinations and tests.

Granulomatous prostatitis diagnosed during intravesical BCG treatment.

The histopathological report of the biopsy material retrieved from hyperemic areas of the bladder during control cystoscopy of a 70-year-old man who had a bladder cancer diagnosis three years previously, indicated the presence of a carcinoma in situ (CIS). Intravesical immunotherapy treatment was initiated. After severe symptoms of dysuria emerging during intravesical immunotherapy with BCG, the immunotherapy treatment dosage was lowered. His treatment was then discontinued due to the progression of symptoms. A biopsy was performed due to higher prostate spesific antigen (PSA) and digital rectal examination abnormalities which indicated granulomatous prostatitis. An antituberculosis treatment was initiated because the PPD test result was 25 mm and the QuantiFERON test was positive. After one month, the patient's PSA levels were reduced, and his clinical status improved. The symptoms of severe dysuria, sterile pyuria, abnormal digital rectal examination findings and high PSA levels during intravesical BCG treatment should remind us diagnosis of granulomatous prostatitis. It should not be forgotten that diagnosis of granulomatous prostatitis was established histopathologically, and the patient benefited from medical treatment.

Preoperative imaging in renal masses: does size on computed tomography correlate with actual tumor size?

OBJECTIVE: To evaluate the discrepancy between tumor sizes determined from preoperative computed tomography (CT) and surgical specimens and its clinical implications. MATERIAL AND METHOD: The charts of 86 patients who underwent surgical resection of a renal mass between 1995 and 2007 were reviewed retrospectively. Tumor size was determined both from preoperative CT and pathologic specimen. Histopathologic evaluation was done. Wilcoxon test was used to compare the mean radiographic tumor size on CT with the mean pathologic size. P < 0.05 was considered as the threshold for statistical significance. RESULTS: The median age was 59 (21-84). Clinical stage was T1a in 13, T1b in 47, and ≥ T2 in 26; pathologic stage was T1a in 12, T1b in 45, and ≥ T2 in 29 patients. Histological subtype was clear cell, papillary, chromophobe, sarcomatoid, and oncocytic in 72, 7, 5, 1, and 1 patients, respectively. Mean radiographic and pathologic size was 6.33 and 6.43 cm, respectively (p = 0.342). On the average, radiographic measurement underestimated pathologic size by 1 mm. When subgroups of patients according to tumor size were formed as < 4, 4-7, and > 7 cm, mean radiographic size was 2.79, 5.44, and 9.57 cm, mean pathologic size was 3.47, 5.62, and 9.26 cm, respectively. In subgroups of < 4, 4-7, and > 7 cm; radiographic measurement underestimated pathologic size by 0.68 (p = 0.018) and 0.18 cm (p = 0.470) and overestimated by 0.31 cm (p = 0.454), respectively. CONCLUSION: Overall discrepancy between radiographic and pathologic tumor sizes was 1 mm. No significant stage shift due to measurement error was detected. Our findings suggest that CT is an accurate method with which to estimate renal tumor size preoperatively.

The effect of male circumcision on pudendal evoked potentials and sexual satisfaction.

Circumcision is generally considered a simple, rapid operation with medical benefits which accrue throughout life. The influence of circumcision on sexual satisfaction has always been argued. In this study, the assessment of the pudendal evoked potentials (PEP) in adults before and at least 12 weeks after circumcision was done. Healthy males aged between 18-27 years, who were willing to undergo circumcision were included in the study. Before and after circumcision, sexual performance was evaluated with the Brief Male Sexual Function Inventory (BMSFI), consisting of sexual drive, erection, ejaculation, problem assessment, and overall satisfaction sections. Forty-three adult males were enrolled in the study. Mean PEP latency was 41.97 +/- 0.25 (39.90-44.50) ms and 44.73 +/- 0.33 (40.90-47.60) ms before and after circumcision, respectively. Mean difference between pre- and postoperative PEP values was 2.76 ms which was statistically significant (p < 0.001). Mean ejaculatory latency time was significantly longer after circumcision (p < 0.001). In the light of our findings, we conclude that circumcision may contribute to sexual satisfaction by prolonging PEP latency but further studies are warranted also regarding the other dimensions of circumcision.

Effects of blast injury on kidneys in abdominal gunshot wounds.

OBJECTIVES: To determine the rate of renal fragmentation resulting from blast effects and perform microscopic examination of renal arteries after gunshot wounds resulting from a high-velocity bullet. METHODS: A total of 194 patients with gunshot wounds due to blast effects underwent surgical exploration. Of the 194 patients, 35 (18%) had 37 renal unit injuries (2 patients had bilateral renal injury). Of the 37 renal units, 32 were treated with nephrectomy and 5 with renoraphy. During surgical exploration, 7 patients were found to have renal fragmentation resulting from blast effects. The distance between the bullet direction in the body and the renal parenchyma was evaluated. Also, the histologic changes in the renal artery were examined microscopically. RESULTS: Although the renal injury rate from abdominal gunshot wounds due to high-velocity bullets was 18%, the renal fragmentation rate due to blast effect was 0.36%. The mean distance between the bullet direction in the body and the renal parenchyma in patients with renal fragmentation was 2.2 cm (range 1 to 5). Two patients had intimal lacerations and one had minimal thrombosis. CONCLUSIONS: Renal fragmentation from the blast effect in these patients was closely related to the distance between the bullet direction in the body and the renal parenchyma. The possibility was greater for close-range (less than 50 m) gunshots. We believe that the histologic changes in the renal artery are not very important in the patients.

Ulcerative necrosis of the glans penis resulting from polyarteritis nodosa.

Polyarteritis nodosa (PAN) may be systemic or isolated in distribution and may involve virtually any organ or tissue in the body. We report an unusual case of PAN with the clinical features of both penile and renal involvement in a 21-year-old man diagnosed incidentally by pathologic examination of the nephrectomized left kidney. Systemic and surgical therapeutic procedures were applied and his symptoms resolved within 6 weeks. Penile ulceration is a rare but serious manifestation of PAN that needs prompt and aggressive treatment.

A peripheric neuromodulation technique for curing detrusor overactivity: Stoller afferent neurostimulation.

OBJECTIVE: To perform Stoller afferent neurostimulation (SANS) with and without a low-dose anticholinergic (oxybutynin hydrochloride) in patients with detrusor overactivity and compare the results obtained with the two therapeutic approaches. MATERIAL AND METHODS: A total of 43 patients with symptoms of detrusor overactivity (frequency, urgency, urge incontinence) underwent urodynamic studies (UDS). Those in whom UDS revealed phasic detrusor overactivity were evaluated using a quality of life questionnaire and voiding diaries. Patients were randomized into two groups: Group 1 received SANS alone; Group 2 received SANS combined with a low-dose anticholinergic (5 mg of oral oxybutynin hydrochloride). Both groups were re-evaluated following 8 weeks of therapy. RESULTS: There were 21 patients in Group 1 and 22 in Group 2. The treatment response rate was 61.6% and 83.2% in Groups 1 and 2, respectively. In both groups, the best symptomatic improvements were obtained in patients with urge incontinence. The percentage decreases in the mean number of symptoms of frequency and urgency were 36.7% and 46.1%, respectively in Group 1 and 44.2% and 61.1%, respectively in Group 2. However, there were no statistically significant differences in the effects on frequency and urgency between the two groups. The anticholinergic drug was well tolerated by all patients in Group 2. One patient reported local tenderness, and a small hematoma developed in another following SANS therapy. CONCLUSION: SANS is an easy and inexpensive therapeutic method with low morbidity in patients with an overactive bladder. Combination with a low-dose anticholinergic increases the success rate without causing any significant side-effects.

Evaluation of the role of varicocelectomy including external spermatic vein ligation in patients with scrotal pain.

OBJECTIVES: The aim of the present study was to assess and compare pre- and postoperative scrotal pain in patients with varicocele who underwent varicocelectomy with different approaches. METHODS: The study included 144 consecutive patients with left-sided varicocele who had left scrotal pain for more than 3 months. All patients underwent varicocele ligation using either a subinguinal or inguinal approach with or without external spermatic vein ligation. We asked the patients to complete an 'Assessment Questionnaire for Scrotal Pain' both before and after the surgery. RESULTS: The surgery was successful in 101 (83.4%) of the 121 patients available for follow up. Seventy-four (61.1%) patients reported the complete resolution of pain while 27 patients (22.3%) reported partial resolution. Symptoms worsened in a single case and pain persisted postoperatively in 19 cases (15.7%). There were no statistically significant differences in the characteristics of the pain and grade of varicocele between postoperative groups. A significant difference was observed in postoperative success between patients who had external spermatic vein ligation and those who did not, regardless of the surgical approach (inguinal or subinguinal). All patients who reported complete or partial resolution of pain stated that they would recommend surgery to relatives with the same problem. CONCLUSIONS: Varicocelectomy using either inguinal or subinguinal approaches is an effective and reasonable treatment option in this patient group and should include external spermatic vein ligation for a satisfactory outcome.

Intravesical heparin and peripheral neuromodulation on interstitial cystitis.

INTRODUCTION: We wanted to evaluate the therapeutic effect of intravesical heparin and peripheral neuromodulation on patients with interstitial cystitis. MATERIALS AND METHODS: From March 2002 to August 2003, 8 female and 2 male subjects conform to the NIDDK criteria and not responsive to the previous conventional treatments were included in the study. Wisconsin pain scores, maximal cystometric capacities, and night and day voiding frequencies were determined and these studies were repeated in the 2nd and 12th months of the treatment with 10,000 units intravesical heparin and peripheral neuromodulation. Frequency of the treatment was once a week during first 8 weeks, once in 2 weeks in the following 8 weeks, and once in 3 weeks four times. Then, it was decreased to once a month. RESULTS: The mean follow-up period was 13 months (12-16 months). Day and night voiding frequency were significantly better in the 2nd and 12th months, when compared to pretreatment values. The Wisconsin pain scores were 62.5 +/- 13.9% and 62.8 +/- 15.2% in the 2nd and the 12th months, respectively. The average increase in the maximum cystometric capacity was 54.8 +/- 27.4% and 52.5 +/- 31.6% in the 2nd and the 12th months, respectively. CONCLUSIONS: Intravesical heparin and peripheral neuromodulation combination seems to be an alternative for patients with interstitial cystitis not responsive to other treatments.