Our urethrocutaneous fistula repair results in adults after hypospadias surgery / Nuestra reparación de fístula uretrocutánea resulta en adultos después de la cirugía de hipospadias

Introduction: Our aim was to evaluate and share our urethrocutaneus fistula repair results in adult patients who had been operated for hypospadias in their childhood. Material and methods: The data of totally 48 patients who had been treated for urethrocutaneous fistula after hypospadias surgery in our department from May 2008 to January 2015 analyzed retrospectively. Patients’ age at fistula repair, age at first hypospadias surgery, fistula size, localization and number, distal urethral obstruction status and surgical outcomes of fistula repairs were recorded. All patients were controlled three months after the repair for surgical outcomes. Results: Fistula repair performed in 45 patients. Mean age was 21.46 (20-26). Nineteen patients (42.2%) underwent first hypospadias surgery under the age of 7 years; 8 patients (17.7%) between 7 and 15 years, 18 patients between 15 and 20 years. Tubularized incised plate urethroplasty (TIPU) was performed in 40 patients (88.9%), extragenital tissue was used in 5 patients (11.1%). Twenty two patients (48.9%) had 1 or 2 operations, 17 patients (37.8%) had 3-5 operations and 6 patients (13.3%) had 6 or more operations. Thirteen (28.9%) coronal, 24 (53.3%) subcoronal, 6 (13.3%) penile and 2 (4.4%) penoscrotal fistulas were observed. While a single fistula was observed in 35 patients, multiple fistulas were seen in 10 patients. A fistula diameter les than 5mm was detected in 37 patients, and larger than 5mm in 8 patients. Fistula recurrence was observed in 3 patients at follow-up examinations carried out at 3 months postoperatively. The number of operations was more than 5, the fistula diameter was larger than 5mm and the fistulas were coronal in all three recurrent fistulas. Conclusion: According to our results fistula size, previous surgery and well-vascularised, one or two layer tissue were the important factors in the success of fistula repair after hypospadias surgery

Introducción: Nuestro objetivo fue evaluar los resultados de la reparación de la fístula uretrocutánea en pacientes adultos que habían sido operados por hipospadias en su infancia. Materiales y métodos: Los datos de los pacientes que habían sido tratados por fístula uretrocutánea después de la cirugía de hipospadias en nuestro departamento de mayo de 2008 a enero de 2015 analizaron retrospectivamente. Se registraron la edad de los pacientes en la reparación de la fístula, la edad en la primera cirugía de hipospadias, el tamaño de la fístula, la localización y el número, el estado distal de obstrucción uretral y los resultados quirúrgicos de las reparaciones de fístulas. Todos los pacientes fueron controlados tres meses después de la reparación de los resultados quirúrgicos. Resultados: Reparación de la fístula realizada en 45 pacientes. La edad media fue 21.46 (20-26). Diecinueve pacientes (42,2%) fueron sometidos a una primera cirugía de hipospadias menor de 7 años de edad; 8 pacientes (17,7%) entre 7 y 15 edades, 18 pacientes entre 15 y 20 años. Veintidós pacientes (48,9%) tenían una o dos operaciones, 17 pacientes (37,8%) tenían 3-5 operaciones y 6 pacientes (13,3%) tenían 6 o más operaciones. Se observaron 13 (28,9%) coronas, 24 (53,3%) subcoronales, 6 (13,3%) pene y 2 (4,4%) fístulas penoscótalas. Mientras que la fístula aislada observada en 35 pacientes, se observaron múltiples fístulas en 10 pacientes. Se detectó diámetro de la fístula menor de 5mm en 37 pacientes, mayor de 5mm en 8 pacientes. La recurrencia de la fístula se observó en 3 pacientes en los exámenes de control. El número de cirugías fue superior a 5, el diámetro de la fístula fue mayor de 5mm y las fístulas se encontraban en el nivel coronal en las tres fístulas recurrentes. Conclusión: De acuerdo con los resultados de la fístula tamaño, las cirugías anteriores y bien vascularizada de una o dos capas de tejido fueron los factores importantes en el éxito de la reparación de la fístula después de la cirugía hipospadias

Our urethrocutaneous fistula repair results in adults after hypospadias surgery.

INTRODUCTION: Our aim was to evaluate and share our urethrocutaneus fistula repair results in adult patients who had been operated for hypospadias in their childhood. MATERIAL AND METHODS: The data of totally 48 patients who had been treated for urethrocutaneous fistula after hypospadias surgery in our department from May 2008 to January 2015 analyzed retrospectively. Patients' age at fistula repair, age at first hypospadias surgery, fistula size, localization and number, distal urethral obstruction status and surgical outcomes of fistula repairs were recorded. All patients were controlled three months after the repair for surgical outcomes. RESULTS: Fistula repair performed in 45 patients. Mean age was 21.46 (20-26). Nineteen patients (42.2%) underwent first hypospadias surgery under the age of 7 years; 8 patients (17.7%) between 7 and 15 years, 18 patients between 15 and 20 years. Tubularized incised plate urethroplasty (TIPU) was performed in 40 patients (88.9%), extragenital tissue was used in 5 patients (11.1%). Twenty two patients (48.9%) had 1 or 2 operations, 17 patients (37.8%) had 3-5 operations and 6 patients (13.3%) had 6 or more operations. Thirteen (28.9%) coronal, 24 (53.3%) subcoronal, 6 (13.3%) penile and 2 (4.4%) penoscrotal fistulas were observed. While a single fistula was observed in 35 patients, multiple fistulas were seen in 10 patients. A fistula diameter les than 5mm was detected in 37 patients, and larger than 5mm in 8 patients. Fistula recurrence was observed in 3 patients at follow-up examinations carried out at 3 months postoperatively. The number of operations was more than 5, the fistula diameter was larger than 5mm and the fistulas were coronal in all three recurrent fistulas. CONCLUSION: According to our results fistula size, previous surgery and well-vascularised, one or two layer tissue were the important factors in the success of fistula repair after hypospadias surgery.

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)

May cachexia be an advantage for penile length? / La caquexia puede ser una ventaja para la longitud del pene?

Introduction. The aim of the present study was to assess the relationship between penile length and somatometric parameters, especially cachexia. Material and methods. Weight and heights of all patients were measured and recorded by an internal medicine specialist. Flaccid and stretched states of penis were measured from pubic bone to tip of glans along the dorsum of the penis using a rigid metric ruler by a single urology specialist. Patients with urogenital abnormalities were excluded from the study. Penile length, age, weight and height values were recorded. Body mass index (BMI) was computed as the ratio of weight to the square of height. Patients were divided into three groups according to BMI cachexia, normal weight and obesity. Groups were defined: Group 1: Cachexia, BMI<18.5; Group 2: normal weight BMI, between 18.5 and 25; Group 3: obesity, BMI>30. Mean and median penile lengths were calculated. These three groups were evaluated in terms of whether there is a difference between flaccid and stretched penile length. Also correlation between weight, height and penile length was determined. Statistical analyses were performed using the SPSS for windows ver. 16.0 (SPSS Inc., Chicago, IL, USA). Statistical significance was set at p<0.05. Results. One hundred and twenty four patients enrolled in the study. Fourteen patients were in the cachectic group. Fifty six patients were in the normal weight group. Fifty four patients were in the obese group. Both flaccid and stretched penile lengths were statistically different in these groups (p<0.001; p<0.001). When we compared the groups separately, cachectic group's penile lengths were significantly longer than the normal weight group at both (p<0.01; p=0.02). Cachectic group's penile lengths were significantly longer than the obese group (p<0.001; p<0.001). Also normal weight group's penile lengths were longer than those of the obese group (p<0.001; p<0.001). Conclusion. The present study is the first one assessing the relationship between cachexia and penile length. As a result, cachexia may be an advantage for penile length (AU)

Introducción. El objetivo del presente estudio fue evaluar la relación entre la longitud del pene y los parámetros somatométricos, especialmente la caquexia. Materiales y métodos. El peso y la altura de todos los pacientes fueron medidos y registrados por un especialista en medicina interna. Los estados flácidos y estirados del pene se midieron a partir del hueso púbico hasta la punta del glande a lo largo del dorso del pene, utilizando una regla métrica rígida, por un único especialista en urología. Los pacientes con anormalidades urogenitales fueron excluidos del estudio. Se registraron la longitud del pene, la edad, el peso y las alturas. El índice de masa corporal (IMC) se calcula como el cociente entre el peso y el cuadrado de la altura. Los pacientes fueron divididos en 3 grupos según el IMC: caquexia, peso normal y obesidad. Se definieron los grupos: Grupo 1: caquexia, IMC<18,5; Grupo 2: peso normal, IMC entre 18,5 y 25, y Grupo 3: obesidad, IMC>30. Se calcularon las longitudes del pene media y mediana. Estos 3 grupos fueron evaluados en términos de si había diferencia entre la longitud del pene flácido y estirado. También se determinó la correlación entre el peso, la altura y la longitud del pene. Los análisis estadísticos se realizaron con el programa SPSS® para Windows ver. 16.0 (SPSS Inc., Chicago, IL, EE.UU.). La significación estadística se estableció en p<0,05. Resultados. Ciento veinticuatro pacientes fueron incluidos en el estudio. Catorce pacientes estaban en el grupo de la caquexia. Cincuenta y seis pacientes estaban en el grupo de peso normal. Cincuenta y cuatro pacientes estaban en el grupo obeso. Ambas longitudes del pene flácido y estiradas fueron estadísticamente diferentes en estos grupos (p<0,001; p<0,001). Cuando se compararon las longitudes del pene por separado, las del grupo caquéctico fueron significativamente mayores que las del grupo de peso normal en ambos (p<0,01; p=0,02). Las longitudes del pene del grupo caquéctico fueron significativamente más largas que las del grupo de obesos (p<0,001; p<0,001). También la longitud del pene del grupo de peso normal era mayor que la del grupo de obesos (p<0,001; p<0,001). Conclusión. El presente estudio es el primero en evaluar la relación entre la caquexia y la longitud del pene. Como resultado, la caquexia puede ser una ventaja para la longitud del pene (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.

Does an asymmetric lobe in digital rectal examination include any risk for prostate cancer? results of 1495 biopsies.

INTRODUCTION: Despite the well-known findings related to malignity in DRE such as nodule and induration, asymmetry of prostatic lobes, seen relatively, were investigated in a few studies as a predictor of prostate cancer so that there is no universally expected conclusion about asymmetry. We aimed to compare cancer detection rate of normal, asymmetric or suspicious findings in DRE by using biopsy results. MATERIALS AND METHODS: Data of 1495 patients underwent prostate biopsy between 2006-2014 were searched retrospectively. Biopsy indications were abnormal DRE and or elevated PSA level( >4ng/mL). DRE findings were recorded as Group 1: Benign DRE, Group 2: Asymmetry and Group 3: Nodule/induration. Age, prostatic volume , biopsy results and PSA levels were recorded. RESULTS: Mean age, prostate volume and PSA level were 66.72, 55.98 cc and 18.61ng/ mL respectively. Overall cancer detection rate was 38.66 % (575 of 1495). PSA levels were similar in group 1 and 2 but significantly higher in group 3. Prostatic volume was similar in group 1 and 2 and significantly lower in Group 3. Malignity detection rate of group 1,2 and 3 were 28.93%, 34.89% and 55.99% respectively. Group 1 and 2 were similar (p=0.105) but 3 had more chance for cancer detection. CONCLUSION: Nodule is the most important finding in DRE for cancer detection. Only na asymmetric prostate itself does not mean malignity.

Does an asymmetric lobe in digital rectal examination include any risk for prostate cancer? results of 1495 biopsies

ABSTRACT Introduction: Despite the well-known findings related to malignity in DRE such as nodule and induration, asymmetry of prostatic lobes, seen relatively, were investigated in a few studies as a predictor of prostate cancer so that there is no universally expected conclusion about asymmetry. We aimed to compare cancer detection rate of normal, asymmetric or suspicious findings in DRE by using biopsy results. Materials and Methods: Data of 1495 patients underwent prostate biopsy between 2006-2014 were searched retrospectively. Biopsy indications were abnormal DRE and or elevated PSA level(>4ng/mL). DRE findings were recorded as Group 1: Benign DRE, Group 2: Asymmetry and Group 3: Nodule/induration. Age, prostatic volume, biopsy results and PSA levels were recorded. Results: Mean age, prostate volume and PSA level were 66.72, 55.98 cc and 18.61ng/ mL respectively. Overall cancer detection rate was 38.66 % (575 of 1495). PSA levels were similar in group 1 and 2 but significantly higher in group 3. Prostatic volume was similar in group 1 and 2 and significantly lower in Group 3. Malignity detection rate of group 1,2 and 3 were 28.93%, 34.89% and 55.99% respectively. Group 1 and 2 were similar (p=0.105) but 3 had more chance for cancer detection. Conclusion: Nodule is the most important finding in DRE for cancer detection. Only an asymmetric prostate itself does not mean malignity.

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.

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)

Testicular torsion in a patient with Cohen syndrome.

Cohen syndrome is an extremely rare autosomal recessive disorder. A 12-year-old boy with Cohen syndrome applied to a primary health care center because of severe pain in the left groin and was diagnosed with epididymo-orchitis. Despite the administered the antibiotic treatment, pain increased. Therefore, the family brought the patient to the emergency department 16 h after the first diagnosis. The patient had mild mental retardation, myopia, and craniofacial dysmorphism, which are components of Cohen syndrome. There was no blood flow on the left testicle at color Doppler ultrasonography. Further, scrotal exploration was performed because of a high risk of torsion. The left testicle was torsioned, and the color was dark blue. Revascularization could not be achieved by detorsion; left orchiectomy and right testicular fixation were then conducted. In conclusion, to the best of our knowledge, this is the first reported case of testicular torsion in Cohen syndrome. If a patient with this syndrome has acute groin pain, testicular torsion should be immediately ruled out with Doppler ultrasonography. These patients may not clearly and correctly express themselves because of mild mental retardation. Moreover, detailed genitourinary, particularly testicular examination may clarify the omitted pathologies and make them well known in future in this syndrome.

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)

The influence of hormonal treatment with beta-human chorionic gonadotropin for cryptorchidism on future fertility in rats.

INTRODUCTION: There have been two treatment modalities for cryptorchidism such that surgical and hormonal; the latter being highly controversial. While some authors suggest that hormonal treatment increases the number and maturation of germ cells in cryptorchid testes, others believe just the opposite. OBJECTIVE: We aimed to find out the sperm counts and testicular index; briefly fertility potential of the normally descended contralateral testes in adulthood period in rats treated with Beta-HCG in early period of their lives. MATERIALS AND METHODS: Three groups, each including 10 rats aged 22 days old, in which delactation and normal feeding can be started, were formed to be Group 1: Sham operated, Group 2: Experimental cryptorchidism (EC) and Group 3: Hormone-treated after experimental cryptorchidism was performed (HT-EC). Left testis was placed in the abdomen in group 2 and 3. In group 1, a sham operation was performed. The rats in EC-HT group received subcutaneous injections of 50 IU/kg Beta-HCG daily for 7 days. Right orchidectomy was performed when they reached reproductive period to evaluate fertility potential with sperm counts and testicular index. Testicular index was calculated according to the formula "testicular length × width/weight of rat". Epididymal sperm count was made with hemocytometer. DISCUSSION: We evaluated the physical characteristics and fertility potential (sperm counts) of contralateral normal testes during adulthood in rats that underwent experimental unilateral cryptorchidism during infancy. A relationship between testis weight and sperm counts were also investigated. We could not find any direct correlation of sperm count with either testicular weight or testicular index in our study. Although the rats had normal testes at birth, we found decreased sperm counts in contralateral normal testes in EC group. This suggests that unilateral cryptorchidism may cause some systemic effects that reach the other testis. Hormone treatment was not beneficial. This is comparable to Nambirajan et al. who reported histological changes and decreased spermatogenic cell count in contralateral scrotal testes in experimentally induced unilateral cryptorchidism in early period of life in rats. Heiskanen et al. reported that treatment with Beta-HCG leads to decreased total sperm counts in the future due to increased germ cell apoptosis caused by hormonal withdrawal after treatment. Cortes et al. also reported decreased number of germ cells in 1-3 year-old boys who underwent surgery after unsuccessful Beta-HCG treatment. The reasons could be delayed testicular descent or adverse effect of hormone treatment though. Our results concurred with them. Apparently, our model has failed to mimic the pathophysiologic mechanisms of congenital cryptorchidism in humans. Furthermore, we applied hormone treatment in normal rats with normally descended testes. Therefore, the "by-product" information of our study is that, unnecessary use of Beta-HCG during infancy may impair future fertility. CONCLUSION: Our study suggests that Beta-HCG treatment may decrease sperm counts and decrease the future fertility potential. We could not find any direct correlation of sperm count with either testicular weight or testicular index.

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.

Attention-deficit hyperactivity disorder in patients with premature ejaculation: a pilot study.

PURPOSE: The etiology of both adult-type ADHD and PE is not completely understood, but the studies revealing common etiologic factors for both conditions suggest a high likelihood of coexistence. We aimed to find out the prevalence of ADHD among adult males with lifetime PE. METHODS: The patients with lifetime PE were included in the study. Both patients and controls were evaluated with the 10-item premature ejaculation index of Althof and Rosen for premature ejaculation, Wender Utah rating scale (WURS) and Conner's adult ADHD rating scales (CAARS) for determining the presence of attention-deficit hyperactivity disorder syndrome. RESULTS: A total of 38 patients and 27 controls were included in the study. Patient and control groups were similar in terms of age and (p < 0.878), but different IELT (p < 0.001). ADHD was detected in 16 (42.1 %) of patients with PE, while ADHD symptoms were detected in only 1 (3.7 %) of control patients. Distribution of patients in the study group according to ADHD types was as follows: Type 1, Type 2, Type 3 in 2 (5.3 %), 4 (10.5 %), and 10 (26.3 %) patients, respectively. CONCLUSIONS: ADHD is significantly more frequent among patients with PE than controls. The close relationships between these two diseases must be examined by prospective studies.