Retraction Note: Obturator nerve block transurethral surgery for bladder cancer: comparison of inguinal and intravesical approaches: prospective randomized trial.

The Editor-in-Chief has retracted this article [1] because it shows significant overlap with a previously published article by Pladzyk et al. [2].

Obturator nerve block transurethral surgery for bladder cancer: comparison of inguinal and intravesical approaches: prospective randomized trial.

AIM: Transurethral resection of bladder tumors close to these areas may stimulate the obturator nerve, causing violent adductor contraction and possible inadvertent bladder perforation. To avoid this reaction, local anesthetic blockade of the obturator nerve as it passes through the obturator canal is effective in stopping adductor spasm during spinal anesthesia. METHODS: Forty-one patients undergoing (transurethral resection of bladder tumor) TUR-BT with spinal anesthesia who required (obturator nerve block) ONB were included in the study. After spinal anesthesia, ONB was performed with an inguinal approach (group 1) (n = 21) or an intravesical approach (group 2) (n = 20). In this study, we used 10 ml of 2 % lidocaine to perform the ONB. RESULTS: The mean age of patients was 60.8 ± 7.5 years. The groups were not different with regards to age, tumor localization and tumor size. There were two bladder perforations in group 1 and six perforations in group 2 (p = 0.130). However, the efficacy of ONB was significantly higher in inguinal approach group compared to intravesical approach group (p = 0.032). CONCLUSION: Obturator nerve block plays an additive role on the quality of analgesia for bladder surgery. Our data suggests that identification of the obturator nerve with ultrasound is easy and the block can be assessed by observing avoidance of bladder spasm.

Effect of transurethral indwelling catheter on serum prostate-specific antigen level in benign prostatic hyperplasia.

OBJECTIVES: The purpose of this prospective study was to determine the influence of indwelling transurethral catheters on the serum prostate-specific antigen (PSA) levels in patients with benign prostatic hyperplasia (BPH). We compared the PSA values of preoperatively catheterized and noncatheterized patients. METHODS: Ninety patients undergoing a prostatectomy for benign disease were included. The indwelling catheter (IC) group and noncatheterized (NC) group each consisted of 45 patients. A total of 83 patients who did not have prostate carcinoma were analyzed by means of PSA, PSA density (PSAD), and pathologic presentations. Prostate pathologies that might elevate PSA values were excluded to demonstrate the correlation of PSA levels and standard urethral catheterization. RESULTS: A statistically significant relationship was determined between an indwelling urethral catheter and an elevated serum PSA value. The average PSA level of the IC group was 2.6 times that of the NC group. CONCLUSIONS: PSA, PSAD, and age-adjusted PSA levels were elevated above normal ranges in patients with BPH who had an indwelling urethral catheter.

Effects of the 5 alpha-reductase inhibitor finasteride on serum levels of gonadal, adrenal, and hypophyseal hormones and its clinical significance: a prospective clinical study.

In the present study, we investigated the effects of a steroid 5 alpha-reductase inhibitor, finasteride, when given orally (5 mg/day), on the serum levels of gonadal, hypophyseal, and adrenal hormones and the clinical significance of these effects. Forty-eight patients with a mean age of 63 (range 49-81) were included in the study. All patients had symptoms of benign prostatic hyperplasia. Serum levels of testosterone, dihydrotestosterone, follicle-stimulating hormone (FSH) luteinizing hormone (LH), prolactin, aldosterone, cortisol, and dehydroepiandrosterone were determined before the study. The degree of symptoms in each patient and serum prostate specific antigen levels were determined together with uroflowmetric studies. Sexual status of the patients was also assessed with a self-administered questionnaire. All patients received finasteride, 5 mg/day, for 6 weeks. All of the above mentioned studies were repeated at month 3 and month 6. All of the patients had baseline hormonal values within the normal range. At month 3, the dihydrotestosterone level decreased by 60%, while the testosterone level increased by 15%. FSH and LH levels decreased by 24% and 16%, respectively. The changes in the serum levels of these hormones were further evident at month 6. No significant changes were noted in the serum levels of prolactin, aldosterone, cortisol, and dehydroepiandrosterone. Thirty-six patients (75%) were judged to be potent before the treatment. Finasteride caused erectile dysfunction in 8 patients (22%) by month 3 and in 12 (33%) by month 6. A substantial improvement was noted in symptoms of benign prostatic hyperplasia in all patients. The serum prostate specific antigen level decreased by 42% and 50% at month 3 and at month 6, respectively. Continued administration of finasteride, 5 mg/day alters the serum levels of testosterone, dihydrotestosterone, FSH, and LH significantly. Finasteride also causes sexual dysfunction in a substantial number of patients and should be offered with caution to patients who have an active sexual life.

Extragonadal germ cell tumors: clinicopathologic findings, staging and treatment experience in 14 patients.

Extragonadal germ cell tumors (EGCT) are a rare group of neoplasms histologically identical to testicular counterparts. Fourteen cases of primary mediastinal and retroperitoneal germ cell tumors were treated with chemotherapy and radiotherapy between 1987 and 1999 in Ankara Oncology Hospital. There were 9 (64%) complete remissions (CR),one (7%) partial remission (PR) and 2 (14%) stable diseases (SD). The remaining 2 patients were lost due to dissemination of disease. The median duration of response was 19 months. Our modified chemotherapeutic results were similar to original doses of PVB and BEP but toxicity was less. The neccesity of a uniform staging system and treatment programs are discussed.

Treatment of iatrogenic ureteral injuries during various operations for malignant conditions.

In the present study we report twenty-nine patients with iatrogenic injuries and management during various operations for malignant conditions. The patients were reviewed in order to identify and study the incidence, type of treatment administered and outcome. The study group was composed of 29 patients with 31 iatrogenic injuries between 1992 and 1999. General surgical, gynecological and urological procedures accounted for 24 (83%), 4 (14%), and 1 (3%) injuries respectively. Twenty-eight injuries were diagnosed at operation and three after an interval of 5, 17 and 45 days. Of the injuries, 51% occurred in the lower third of the ureter, 30% in the upper third and 19% in the middle third. Complete transsection, excision, ligation and partial transection accounted for 19 (61%), 9 (29%), 2 (7%), and 1 (3%) respectively. Treatment consisted of end-to-end ureteroureteral anastomosis in 18 cases; ileal interposition in 4 cases; transureteroureterostomy and ureteroneocystostomy in 2 cases; surgical repair, nephrectomy, ureterocutaneostomy and ileal loop in each of the remaining cases. Primary healing was obtained in all patients. General surgical procedures are the most common cause of iatrogenic injuries during malignant conditions. The proper identification and, when necessary, identification of the ureter at the pelvic brim, should decrease the incidence of iatrogenic ureteral injury. When identified at injury and treated immediately such injuries seldom lead to loss of renal function. We do not advocate to perform nephrectomy for any type of ureteric injury since the preservation of the kidney should be the aim of a surgeon.

Quantitative evaluation of biopty gun testis needle biopsy. Correlation between biopsy score of varicocele-bearing testis and sperm count.

OBJECTIVE: To investigate the applicability of quantitative evaluation of needle biopsy of the testis and any correlation between biopsy score and sperm parameters in infertile or subfertile men with varicocele. STUDY DESIGN: A total of 45 infertile men with clinical left varicocele were included in the study. All patients underwent left varicocelectomy and bilateral biopty gun needle biopsy of both testes. Spermiograms were obtained before and three months after the operation. The biopsy specimens were evaluated for Johnsen and Agger score, Leydig cell score, germ cell/Sertoli cell ratio, mean tubular diameter, peritubular fibrosis, and tubular and basement membrane hyalinization. RESULTS: Mean sperm count, motility and normally configured motile sperm counts increased 20%, 25% and 60% by month 3, respectively (P < .05). We did not observe any significant change in normally configured sperm counts. A mean of 14 tubuli per testis were obtained with single-pass needle biopsy. Johnsen and Agger scores, Leydig cell scores, mean tubular diameter and germ cell/Sertoli cell ratios of both testes were comparable. However, there was significantly less peritubular fibrosis, tubular hyalinization and basal membrane hyalinization in the right testis when compared to the varicocele-bearing left testis (P < .05). We found positive correlations between Johnsen and Agger score of varicocele-bearing left testis and preoperative normally configured motile sperm counts (Pearson's r = .34 and P < .05 and Pearson's r = .41 and P < .05, respectively). The Leydig cell score of varicocele-bearing testis correlated inversely with sperm counts (Pearson's r = -0.37, P < .05). CONCLUSION: These observations may prove of prognostic value in infertile or subfertile men with varicocele.

Combination of transcutaneous electrical nerve stimulation and ondansetron in preventing cisplatin-induced emesis.

OBJECTIVE: To find out whether the combination of transcutaneous electrical nerve stimulation (TENS) and ondansetron had an increased antiemetic effect. MATERIALS AND METHODS: Fourteen testis and 11 bladder cancer patients were scheduled for 4 cycles of bleomycin-etoposide-cisplatin (BEP) or methotrexate-vinblastine-etoposide-cisplatin (MVEC) combination chemotherapy, respectively. At each cycle the whole cisplatin dose was given in 1 day that is 100 mg/m(2)/day in the BEP and 70 mg/m(2)/day in the MVEC protocols. Ondansetron was given at a dose of 12 mg/day and TENS was applied by commercially available 'Relief Band'(Maven Labs, Inc., Citrus Heights, Calif., USA). The first 3 cycles of each case were blindly randomized to one of the following regimens; TENS vs. ondansetron vs. a combination of both. The regimens were applied during the administration of cisplatin and the patients were asked to report their nausea according to a scale between 0 to 10. Also for each regimen the number of emetic attacks experienced during the administration of cisplatin was recorded by the same observer. Then the scores of each regimen were compared. RESULTS: The mean nausea scores for regimens TENS, ondansetron and TENS + ondansetron were found to be 5.12 +/- 2.54, 3.0 +/- 1.71 and 0.8 +/- 0.96, respectively. Ondansetron was better than TENS in preventing nausea (p = 0.000). However the combination of TENS and ondansetron resulted in a significant decrease in nausea scores when compared to TENS alone (p = 0.000) or ondansetron alone (p = 0.000). The mean number of emetic attacks for the TENS, ondansetron and TENS + ondansetron regimens were 3.16 +/- 1.84, 1.64 +/- 1.44 and 0.56 +/- 0.82, respectively. A statistically significant difference was present between the number of emetic attacks observed with the TENS + ondansetron combination and TENS alone (p = 0.000) or ondansetron alone (p = 0.001). Ondansetron was again better than TENS in preventing emetic attacks (p = 0.001). CONCLUSION: The use of TENS as an adjunct to ondansetron therapy has provided significant benefit in preventing nausea and emetic attacks caused by cisplatin.

Erectile dysfunction following treatments of benign prostatic hyperplasia: a prospective study.

The effects of open prostatectomy, transurethral resection, transurethral vaporization, doxazosin and finasteride on sexual functions of men were investigated in a total of 305 patients with benign prostatic hyperplasia. The sexual functions of the patients were assessed with a questionnaire before treatment and 3 and 6 months after the treatment. A total of 212 (70%) patients were judged to be potent before the treatment. At 3 months, open prostatectomy and transurethral resection caused erectile dysfunction in 2 of 40 (5%) and 5 of 89 (6%) potent patients, respectively. At 6 months, one of the patients from the former and 2 of the patients from the latter groups who developed erectile dysfunction at 3 months stated improvement. Transurethral vaporization caused loss of erectile functions in 4 of 14 potent patients (29%) at the 3-month follow-up and, one of these patients recovered erectile functions at 6 months. Only one of the 33 patients (3%) using doxazosin stated that he lost his erectile functions both at 3 months and 6 months. At 3 months follow-up, finasteride caused loss of erectile functions in 8 of 36 potent patients (22%). Four of these patients underwent surgery (transurethral resection) after 3 months of finasteride use. At the 6-month follow-up, 4 more patients suffered from loss of erectile functions. We suggest that finasteride and transurethral vaporization have the greatest potential of impairing the sexual functions among the treatment options investigated in this study and that they must be carefully offered to the potent patients.