Visceral adiposity index is useful for evaluating obesity effect on erectile dysfunction.

Studies show that erectile dysfunction (ED) is associated with obesity, and it has been shown that the possibility of developing sexual dysfunction in obese men is 30% higher compared to those with normal weight. Obesity is measured using various methods, for example waist circumference (WC) measurement or body mass index (BMI), but recently, visceral adiposity index (VAI) has also been utilised to better assess obesity and metabolic syndrome. In our study, the potential link between VAI and ED was investigated. The data of 176 patients who presented to the urology outpatient clinic with erection complaints were retrospectively screened. A control group was also established with 122 men without complaints of erectile dysfunction. The erectile functions of all participants were determined using the International Erectile Function Index-5 (IIEF-5) scoring. In addition, their serum fasting blood glucose, total testosterone (TT), triglyceride (TG), low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol levels were measured. The physical examination comprised the measurement of WC, height and weight, and BMI. The mean age of the participants was 58.7 ± 8.4 for the ED group and 57.1 ± 7.5 for the control group. The mean VAI was statistically significantly higher in the ED group (5.32 ± 2.77) compared to the control group (4.11 ± 1.93) (p < 0.001). Since VAI contains both physical and metabolic parameters, our findings suggest that it discloses the effects of WC, BMI, HDL and TG more clearly. VAI is considered useful for the assessment of the effect of obesity on ED patients.

Impact of overactive bladder on retrograde ejaculation.

PURPOSE: To evaluate the impact of overactive bladder disorder on patients diagnosed with retrograde ejaculation. MATERIALS AND METHODS: Retrospective analysis of prospective collected database made. Questionnaires conducted in urology polyclinics in five different centers. MAIN OUTCOME MEASURE(S): International Index of Erectile Function - 5 (IIEF - 5), Overactive Bladder 8 - Question Awareness Tool (OAB - V8), urodynamics, semen analysis. The participants of the study were n = 120 patients. There was retrograde ejaculation (RE) in only n = 47 patients (non / minimal symptomatic patients), n = 73 patients had RE and overactive (OAB) complaints (symptomatic patients) and received anticholinergic treatment (trospium), n = 37 control group patients who only had OAB and received an anticholinergic. RESULTS: While no difference was observed in overactive bladder examination and urodynamic values between the non / minimal symptomatic group and the symptomatic group (p > 0.05), sperm was detected and identified as fructose positive in post - ejaculation urine in the symptomatic group. Thus, it was possible to demonstrate the differences between symptomatic patients and non - symptomatic patients. Consequently, following three - month daily treatment with trospium 30 mg 2 x 1 in the control group and the symptomatic group, it was observed that an evident increase was observed in the sperm count and ejaculate volume in the symptomatic group and that no change was observed in the control group (p < 0.05). CONCLUSION: This clinical study is the first of its kind in terms of revealing the coexistence of RE with OAB upon performing urodynamics and showing that treatment is possible in selected patients.

Low serum melatonin levels are associated with erectile dysfunction.

OBJECTIVE: Melatonin is a hormone secreted from the pineal gland and has anti-oxidative and anti-inflammatory effects. Oxidative stress is considered as an important factor in the etiology of erectile dysfunction (ED), and in many experimental models, positive results have been obtained with melatonin treatment. This study aimed to measure serum melatonin levels in ED patients and to investigate the possible relationship between ED and melatonin levels. MATERIALS AND METHODS: Sixty-two patients diagnosed with mild, moderate or severe ED according to the five-item International Erectile Function Index (IIEF-5) and 22 healthy individuals were included in the study. The serum melatonin levels, anthropometric data, and other biochemical and hormonal parameters of all the subjects were recorded. Detailed anamnesis was also obtained in terms of diabetes, hypertension, cardiovascular diseases, smoking status, and alcohol use. RESULTS: The serum melatonin level was found 34.2±13.3 ng/dL in the mild ED group, 33.3±14.7 ng/dL in the moderate ED group, 34.8±17.2 ng/dL in the severe ED group, and 44.6±16.5 ng/dL in the control group. The serum melatonin levels were significantly lower in all ED groups compared to the control group (p=0.019). There was no significant difference in the serum melatonin levels between the three ED groups. Diabetes, hypertension, cardiovascular diseases, smoking and alcohol use were not significantly different between the ED groups (p>0.05). CONCLUSION: We consider that if our findings are supported by further studies with larger populations, the measurement of the serum melatonin level may have a future role in the diagnosis and treatment of ED.

Does extracorporeal shockwave lithotripsy therapy affect thiol-disulfide homeostasis?

OBJECTIVE: Extracorporeal Shockwave Lithotripsy (ESWL) is a non-invasive method that is effective at crushing stones in the upper urinary tract. Disturbance of the thiol/disulfide homeostasis, in favor of the disulfide, has been shown to be involved in the disease pathogenesis. METHODS: A total of 36 individuals that underwent ESWL had blood samples collected before ESWL (0hrs), 6hrs, and one week after the ESWL. Sera native and total as wells as disulfide amount was measured using an automated method sodium borohydrate (NaBH4) reduction. In addition, Ischemia Modified Albumin (IMA) levels were measured using colorimetric assay method. RESULTS: Native thiol level was reduced at the 6th hour following ESWL compared to baseline. While the ratios of disulfide level, Disulfide/Total Thiol (DTT), Disulfide/Native Thiol (DNT) and IMA level were increased at the 6th hour following ESWL compared to baseline, they were found to be similar with their baseline values at the end of 1st week. Total thiol and native /total thiol did not show any significant change. CONCLUSIONS: ESWL treatment disrupts thiol/disulfide homeostasis and the structure of albumin at the acute term. Therefore, it increases protein oxidation and leads to increased oxidative stress. However, this state is transient and returns to normal within the proceeding days.

Effect of tadalafil 5mg daily treatment on the ejaculatory times, lower urinary tract symptoms and erectile function in patients with erectile dysfunction.

OBJECTIVE: To investigate the effect of a 5mg daily tadalafil treatment on the ejaculation time, erectile function and lower urinary tract symptoms (LUTS) in patients with erectile dysfunction. MATERIALS AND METHODS: A total of 60 patients diagnosed with erectile dysfunction were retrospectively evaluated using the international index of erectile function questionnaire-5 (IIEF-5), intravaginal ejaculatory latency time (IELT) and international prostate symptoms scores (IPSS). After the patients were treated with 5mg tadalafil once a day for three months, their erection, ejaculation and LUTS were assessed again. The fasting levels of blood glucose, total testosterone, low-density lipoprotein cholesterol, highdensity lipoprotein cholesterol and total cholesterol were measured. The independentsamples t-test was used to compare the pre- and post-treatment scores of the patients. RESULTS: The mean age of the 60 participants was 50.4±7.9 and the mean baseline serum total testosterone, total cholesterol, and fasting blood sugar were 444.6±178.6ng dL-1, 188.7±29.6mg/dL-1,104 (80-360) mg dL-1, respectively. The mean baseline scores were 2.2±1.4 min for IELT, 9.5±3.7 for IIEF-5 and 14.1±4.5 for IPSS. Following the three-month daily 5mg tadalafil treatment, the scores were found to be 3.4±1.9 min, 16.1±4.7, and 10.4±3.8 for IELT, IIEF and IPSS, respectively. When the baseline and post-treatment scores were compared, a statistically significant increase was observed in the IELTs and IIEF-5 values whereas there was a significant decrease in IPSS (p<0.01). CONCLUSION: A daily dose of 5mg tadalafil can be safely used in the treatment of erectile dysfunction and LUTS, that prolongs the ejaculatory latency time.

Lack of evidence of HPV etiology of prostate cancer following radical surgery and higher frequency of the Arg/Pro genotype in Turkish men with prostate cancer.

OBJECTIVES: The aim of this study was to assess the possible role of HPV in the development of prostate cancer (PCa) and investigate the distribution of the p53 codon 72 polymorphism in PCa in a Turkish population. MATERIALS AND METHODS: A total of 96 tissues, which had been obtained using a radical surgery method, formalin-fixed and parafin-embedded, were used in this study. The study group consisted of 60 PCa tissues (open radical prostatectomy) and the control group contained 36 benign prostatic hyperplasia tissues (BPH) (transvesical open prostatectomy). The presence of HPV and the p53 codon 72 polymorphism was investigated in both groups using real-time PCR and pyrosequencing. RESULTS: The results of the real-time PCR showed no HPV DNA in any of the 36 BPH tissue samples. HPV-DNA was positive in only 1 of the 60 PCa samples (1.7%). The HPV type of this sample was identified as HPV-57. The distribution of the three genotypes, Arg/Arg, Arg/Pro and Pro/Pro was found to be 45.6, 45.6, and 8.8% in the PCa group and 57.1%, 34.3% and 8.6% in the control group, respectively. Compared with the control group, patients with PCa had a higher frequency of the Arg/Pro genotype and Proline allele (odds ratio (OR)=1.67, 95% confidence interval (CI)=0.68-4.09, p=0.044; OR=1.13, 95% CI=0.76-1.68, p=0.021, respectively). CONCLUSIONS: The results of the study do not support the hyphothesis that prostate cancer is associated with HPV infection but indicated that Proline allele can be a risk factor in the development of PCa in the Turkish population.

Prostatic Urethral Lift: A New Minimally Invasive Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia.

INTRODUCTION: Prostatic urethral lift (PUL) is a minimally invasive procedure for the treatment of lower urinary tract symptoms (LUTSs) secondary to benign prostatic hyperplasia (BPH). The PUL procedure involves the placement of implants that retract the obstructing prostate lobes. This procedure achieves quantifiable improvements in functional outcomes and quality of life (QoL), while preserving erectile and ejaculatory functions. METHODS: Seventeen patients diagnosed with BPH who had undergone the UroLift® procedure between March 2011 and June 2015 were retrospectively evaluated. The parameters evaluated in the pre-operative, intra-operative and 1-year post-operative period were demographic data, and pre-operative, intra-operative and 1-year post-operative results were obtained from the International Prostate Symptom Score (IPSS), Uroflowmetry QoL index, International Index of Erectile Function (IIEF) and Male Sexual Health Questionnaire (MSHQ) for ejaculatory function (MSHQ-EjD). RESULTS: The average improvements from baseline to 12 months after intervention were significant for the total IPSS 9.6. There was a 4.2-point increase in Qmax, a 0.9-point improvement in QoL and a 32% decrease in PVR. No statistically significant difference was found in the IIEF and MSHQ-EjD scores when the pre-operative and post-operative 3rd and 12th month scores were evaluated (p > 0.05). CONCLUSIONS: PUL offers rapid improvement in voiding and storage symptoms, QoL and flow rate that is durable to 12 months after intervention. PUL is a minimally invasive procedure that has the moderate effect in treating troublesome LUTS secondary to benign prostatic obstruction and preserving total sexual function.

Results of tadalafil treatment in patients following an open nerve-sparing radical prostatectomy.

PURPOSE: To evaluate the effect of postoperatively administering a low daily dose of tadalafil on the erectile function of patients who underwent a nerve-sparing radical prostatectomy (NSRP) due to localized prostate cancer (PCa). MATERIALS AND METHODS: Of 138 patients, who underwent NSRP due to PCa between 2012 and 2014, 55 patients who had not had pre-operative erectile dysfunction (ED) were included in the study. The mean age of the patients was 64 (54-72). On the 15th day after surgery, after ultrasound evaluation, all 55 patients started on a daily dose of 5 mg tadalafil that was continued for 2.5 months. The erectile function of patients was evaluated pre-operatively, post-operatively, and at the 3rd and 6th month after surgery using the International Index of Erectile Function (IIEF-5) test. None of the patients was treated with hormonal therapy or radiotherapy before or after surgery. RESULTS: Three patients were excluded from the study due to the adverse effects of tadalafil and two patients elected to discontinue the treatment. Of the remaining 50 patients whose pre-operative erectile function had been found normal, at 3 months after surgery, 36 (72%) had normal erectile function; of the remaining patients in the study six (12%) presented with mild, two (4%) with moderate, and six (12%) with severe ED. Six months after surgery, 35 patients (70%) had normal erectile function while seven (14%) had mild, three (6%) moderate and five (10%) severe ED. There was no statistically significant difference between the results obtained at the 3rd and 6th month follow-up (p > 0.05). Three patients reported adverse effects with tadalafil including flushes in 2 (3.6%) and a headache in 1 (1.8%). CONCLUSIONS: The administration of a 5 mg post-operative dose of tadalafil to patients that had undergone a bilateral NSRP was found to have a positive effect on the recovery and maintenance of erectile function. However, there is still a need to investigate a larger series of cases.

The effects of two different antioxidant combinations on sperm parameters.

BACKGROUND: Studies demonstrate that getting antioxidants in the course of treatment has a positive impact beneficial effect on fertility, especially on the quality of sperm. Because of that reason antioxidants are recommended as a potentially influential treatment for infertility in men. However, it is argued that this treatment is not based on sufficient evidence and has no effect on the rate of healthy pregnancy. OBJECTIVE: In this study, two different antioxidant combinations with different doses and contents were evaluated in terms of their effect on sperm parameters. MATERIALS/METHODS: A total of 122 patients diagnosed with idiopathic infertility were enrolled in our multicenter study. The patients were divided into two different groups: The first group used a combination 2 × 1 sachet form (l-carnitine 1 g, acetyl-l-carnitine 0.5 g, fructose 1 g, citric acid 0.50 mg, selenium 50 µg, coenzyme Q10 20 mg, vitamin C 90 mg, zinc 10 mg, folic acid 200 µg, and vitamin B12 1.5 µg) and the second group used a combination tablets form 2 × 1 (l-carnitine 500 mg, selenium 50 µg, coenzyme Q10 20 mg, vitamin C 60 mg, zinc 15 mg, folic acid 400 µg, vitamin E, and ginseng 15 µg) for 6 months. The total semen volume, the total sperm number, sperm concentration, sperm motility, and lastly morphological findings of the patients were compared at the end of 6 months. RESULTS: The mean age of the patients participating in the study was 30.8 ± 6.05 years. No significant difference was found between the two groups in terms of baseline sperm count. There was a significant difference between the baseline and sixth-month values of the patients using both combinations. However, no significant statistical difference was found between the groups according to the sixth-month data. The combinations of both antioxidants had a positive effect on sperm parameters, and the use of different doses and contents had a similar effect. CONCLUSION: Both antioxidants respectively had a positive effect on sperm parameters and also the use of different doses and contents had a similar effect.

Short-term effects of COVID-19 on semen parameters: A multicenter study of 69 cases.

OBJECTIVE: COVID-19, which is known to be caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global health problem that can cause multiorgan damage because of its use of the angiotensin-converting enzyme 2 (ACE2) receptor in its pathophysiology. We aimed to investigate whether SARS-CoV-2 had a short-term effect on spermatogenesis, which plays an important role in male reproductive health as it has abundant ACE2 expression in testicular tissue. MATERIAL AND METHODS: This multicenter study included 69 patients aged 20-45 years, who admitted to our hospitals between April 2020 and October 2020 with a history of a positive test result for SARS-CoV-2 based on the nasopharyngeal or oropharyngeal swab samples and had recovered from the disease at least three months earlier and who had undergone a spermiogram test in the hospital database within the last year before the onset of disease. The patients were divided into two groups according to their COVID-19 symptoms being mild or moderate, depending on whether they had received home treatment or required hospitalization for oxygen therapy. Semen samples taken before and after COVID-19 were compared within and between the groups in terms of sperm parameters. RESULTS: The mean age of the patients included in the study was 30.4±4.8 years in the mild symptomatic COVID-19 group and 31.06±4.2 years in the moderate symptomatic group. When the spermiogram samples of the patients before and after COVID-19 were evaluated, it was found that motility and vitality significantly decreased in the mild symptomatic group, while the decrease in all semen parameters was statistically significant in the moderate symptomatic group. CONCLUSION: Although the mechanism by which COVID-19 causes testicular involvement remains uncertain, its short-term results on spermatogenesis reveals that COVID-19 negatively affects sperm parameters.

A new proof for the relationship between erectile dysfunction and atherosclerosis: fragmented QRS?

In patients with coronary artery disease (CAD), fragmented QRS (fQRS) is a practical marker of myocardial ischemia evaluated on electrocardiography (ECG).The current study investigated the connection between FQRS and erectile dysfunction (ED), which is commonly accepted as an early sign and independent predictor of CAD. The study consisted of a 190 ED patients; 47 of them having severe, 44 moderate, 49 mild-to-moderate, and 50 mild ED, and a control group of 51 otherwise healthy adult men. None of the participants had a history of cardiac disease. There was a significant difference among the groups in terms of fQRS; severe, moderate, and mild-to-moderate ED groups had significantly higher rates of fQRS presence on ECG (27.5%, 23.5%, and 22.5%, respectively) in comparison with those of mild ED and the control groups (13.7% and 12.7%, respectively) (p < 0.001). In patients presenting with ED complaints, a fQRS finding on a simple ECG recording may serve as a first sign of the presence of CAD. As far as we know, the present study is the first in the literature assessing the possible relationship between ED and fQRS. On the ECG, the existence of fQRS was considered to be connected with ED; thus, including this basic parameter into the clinical decisions for ED patients may initiate an extensive diagnostic approach for their underlying cardiovascular diseases.

Is there any relationship between serum levels of total bilirubin and the severity of erectile dysfunction?

OBJECTIVE: Recent studies have shown that atherosclerosis is associated with erectile dysfunction and the serum bilirubin level. In this study, the serum total bilirubin levels of patients with erectile dysfunction were measured to investigate the relationship between the levels of erectile dysfunction and total bilirubin. METHODS: A total of 94 patients with erectile dysfunction were divided into three groups; severe erectile dysfunction (33 patients), moderate erectile dysfunction (31 patients), and mild erectile dysfunction (30 patients). In addition, a control group was formed with 31 healthy men. The International Index of Erectile Function-5 Questionnaire was used to measure the quality of erection in all the groups. The body mass index was calculated for all the participants. The serum glucose, low-density lipoprotein and high-density lipoprotein, cholesterol, triglyceride, total bilirubin, and total testosterone levels were also determined. RESULTS: No statistically significant difference was observed between the groups in terms of the mean age, hypertension, smoking status, alcohol use, cardiovascular diseases, hepatobiliary disease, diabetes mellitus, and levels of total testosterone, low-density lipoprotein-cholesterol, and triglyceride. However, high-density lipoprotein, body mass index, and total bilirubin were significantly lower compared to the control group (p < 0.001). The serum total bilirubin level was found to be 0.41 ± 0.21 ng/dL in the severe erectile dysfunction, 0.43 ± 0.19 ng/dL in the moderate erectile dysfunction, and 0.48 ± 0.11 ng/dL in the mild erectile dysfunction groups (p < 0.001). CONCLUSION: Considering the significant differences between the erectile dysfunction and control groups in terms of serum total bilirubin levels, a low level of bilirubin may have a role in the etiology of erectile dysfunction.

Effect of obturator nerve block during transurethral resection of lateral bladder wall tumors on the presence of detrusor muscle in tumor specimens and recurrence of the disease.

We investigated the effect of spinal anesthesia combined with obturator nerve block (ONB) during the transurethral resection of lateral bladder wall tumors (TUR-BT) on the presence of detrusor muscle tissue in tumor specimens and on tumor recurrence. TUR-BT was performed on 96 patients with a lateral bladder wall tumor under spinal anesthesia in our clinic between January 2011 and December 2015. The patients were divided into two groups: 49 patients only received spinal anesthesia and 47 patients received spinal anesthesia combined with ONB. The groups were retrospectively compared in terms of adductor muscle contraction, bladder perforation, complete tumor resection, presence of muscle tissue in the pathology material, and recurrence rate during follow-up. The obturator reflex was significantly observed in the non-ONB group (p < 0.05). In the ONB group, the percentages of complete resection and detrusor muscle tissue were significantly higher (p = 0.003 and p = 0.001, respectively). The postoperative recurrence rate was found to be significantly higher in the non-ONB group than in the ONB group (p = 0.025). Spinal anesthesia combined with ONB during TUR-BT prevent obturator reflex and facilitate complete resection including detrusor muscle tissue, independent from the size or number of tumors, thus reducing the recurrence of the disease.

Evaluation of testicular catch-up growth in adolescent microsurgical varicocelectomy.

OBJECTIVE: The incidence of varicocele is approximately 15% in adolecent men. Early treatment with varicocele is aimed to resolve testicular hypotrophy and ensure catch-up growth. The aim of this study was to evaluate ipsilateral catch-up growth rates relative to contralateral testicular growth in adolescents with varicocele undergoing microsurgical subinguinal varicocelectomy. MATERIAL AND METHODS: Fifty adolescents with unilateral grade 2-3 varicoceles were included in the study. All patients underwent microsurgical subinguinal left varicocelectomies performed by the same experienced surgeon. All patients were evaluated clinically and using orchidometric measurements to define the grade of varicocele and testicular volume at presentation and follow-up. The number of internal and external spermatic veins, testicular arteries and lymphatic vessels preserved during the subinguinal microsurgical varicocelectomy were recorded. The mean follow-up period was 26 months (range 6-48 months). RESULTS: At presentation, mean patient age was 12.9±2.1 years. Mean testicular preoperative volumes were 7.1±4.3 mL for the right and 5.4±3.4 mL for the left testis. There were significant differences between mean volumes of the right and left testis (p=0.002). At the final postoperative follow-up visit, mean testicular volumes were 10.8±5.1 mL (range 3-25) for the right and 9.9±4.3 mL (range 2-20) for the left, and the difference between the right and left testicular volumes was insignificant (p=0.47). In our series, catch-up growth was observed in 70% (35/50) of our patients. CONCLUSION: Adolescent varicocelectomy is associated with a higher percentage of patients showing testicular catch-up growth. In our study, similarly to the available literature the catch-up growth rate was found as 70% and observed to have positive effects of adolescent varicocelectomy on testicular growth.

Safety and Efficacy of Bipolar Versus Monopolar Transurethral Resection of the Prostate: A Comparative Study.

PURPOSE: Transurethral resection of the prostate (TURP) is considered gold standard for surgical treatment of benign prostatic hyperplasia (BPH). In this study, we aimed to compare post-operative clinical outcomes and adverse effects between monopolar and bipolar TURPs. MATERIALS AND METHODS: The study included 590 patients who underwent TURP by a single urologist (E.H.) between June 2006 and June 2014 with a diagnosis of BPH. Patients were divided into two groups as monopolar TURP (group 1, n = 300) and bipolar TURP (group 2, n = 290). Patients receiving oral anticoagulants or aspirin and those with prostate cancer diagnosis were not included in the study. Data regarding pre-operative age, International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post voiding residual urine volume (PVR), serum prostate specific antigen (PSA) levels and prostate volume (Vp) of the patients were gathered from medical records. Groups were compared in terms of catheterization, operation time, hemoglobin (Hb) decrease, and IPSS, Qmax, and PVR values at post-operative 12th month follow-up visit. RESULTS: From pre-operative to post-operative period, IPSS, Qmax and PVR showed significant improvements within both groups (P < .001). When groups were compared with each other, bipolar TURP group had significantly lesser catheterization time and hemoglobin decrease than monopolar TURP group, while no significant differences were detected regarding all other variables. CONCLUSION: Bipolar and monopolar TURPs are both effective and safe treatment modality for BPH. Bipolar TURP is superior to conventional monopolar TURP in terms of catheterization time and Hb decrease.

Association between pre-biopsy white blood cell count and prostate biopsy - related sepsis.

INTRODUCTION: Despite all preventive measures and improved biopsy techniques, serious, life-threatening complications of prostate biopsy, including sepsis, still exist. In the present study, in order to identify the risk factors that may be associated with sepsis development after prostate-biopsy, we aimed to analyze retrospectively the data of our patients who underwent transrectal ultrasound-guided prostate biopsy. MATERIAL AND METHODS: We retrospectively reviewed the data of 889 patients who underwent prostate biopsy at our clinic. We compared pre-biopsy parameters (age, prostate volume, white blood cell (WBC) count, fasting blood glucose, free and total prostate specific antigen levels) between patients who developed sepsis and those who were sepsis-free following prostate biopsy. RESULTS: 28 patients (3.1%) developed sepsis. Among the risk factors evaluated, only pre-biopsy WBC count was found to be a significant risk factor for biopsy-related sepsis. A 5.1 fold increase was detected in the risk for sepsis development, when the cut-off value of WBC was accepted as 11.165/µL, OR: 5.1 (95% CI: 2.3-11.5). The post-biopsy sepsis development rate in patients with pre-biopsy WBC count greater and less than 11.165/µL was 13.7% (n = 10) and 3% (n = 18) respectively. CONCLUSIONS: Patients with a pre-biopsy WBC count greater than 11.165/µL should be informed of the increased risk of developing post-biopsy sepsis.

Flurbiprofen alone and in combination with alfuzosin for the management of lower urinary tract symptoms.

INTRODUCTION: We aimed to investigate the effectiveness and safety of flurbiprofen, a non-steroidal anti-inflammatory drug with dual cyclooxygenase inhibition, and α-blocker alfuzosin, both alone and in combination with each other for lower urinary tract symptoms suggestive of benign prostatic obstruction (LUTS/BPO). MATERIAL AND METHODS: Ninety patients complaining of moderate-to-severe LUTS/BPO were randomly assigned into 3 groups (30 patients each) to receive alfuzosin XL 10 mg, or flurbiprofen SR 200 mg, or combination of alfuzosin XL 10 mg and flurbiprofen SR 200 mg, once daily for 4 weeks. Patients were evaluated using the international prostate symptom score (IPSS) (total and IPSSstorage, IPSSempty subscores), uroflow-metry (maximum (Qmax) and average (Qave) flow rates) and postvoid residual urine (PVR) both at baseline and following the drug therapy course. RESULTS: There was no difference among the 3 groups regarding age and baseline values of prostate volume, IPSS, IPSSstorage, IPSSempty, Qmax, Qave and PVR (P >0.05). IPSS, IPSSstorage, IPSSempty, and PVR decreased significantly in all the 3 groups after drug therapies (P <0.01). However, Qmax and Qave significantly improved only in the combination group (P <0.01). CONCLUSIONS: Addition of flurbiprofen increased the therapeutic effectiveness of alfuzosin by further improving symptoms in patients with LUTS/BPO. Combination therapy also improved urine flow compared to baseline. Monotherapy with flurbiprofen was not superior to alfuzosin.

Urethrogluteal fistula developing secondary to the use of clean intermittent self-catheterization: first case report in the literature.

Clean intermittent self-catheterization is the standard method for bladder evacuation in these patients today. The patient was diagnosed with urethrogluteal fistula and gluteal-perineal abscess by radiological evaluation. Gluteal drainage decreased after cystostomy. In our paper, a case of urethrogluteal fistula and pelvic urinoma that developed as a result of the use of clean intermittent self-catheterization (CISC), which is rarely found in the literature, is presented.

The importance of prostate volume in prostate needle biopsy.

OBJECTIVE: Although ultrasound-guided prostate needle biopsy is the gold standard method in the diagnosis of prostate cancer, biopsy schemes and the number of repeated biopsies are still controversial today. It is known that the rate of prostate cancer decreases with increasing prostate volume. In this study, we evaluated the effects of prostate volume on cancer detection in our patient series. MATERIAL AND METHODS: In our clinic, data for 992 patients who had gray zone PSA levels (2.5-10 ng/mL) and whose 10 core biopsies were taken between 2004 and 2010 were evaluated. Among them, 500 patients from whom 6 to 8 biopsies were taken, whose information was lacking and who had suspicious cancer findings after digital rectal examination were excluded from the study. Patient ages, free/total PSA levels (f/TPSA), PSA densities (PSAD), Gleason scores, and prostate volumes were compared between patients with (Group 1) or without biopsy-proven prostate cancer (Group 2). Student's t-test was used for statistical analysis. RESULTS: According to biopsy findings, prostate cancer was detected in 74 patients while no cancer was detected in 418 patients. The mean age of Groups 1, and 2 were 65±8.6, and 64±8.1 years, respectively The mean prostate volume in Groups 1, and 2 were 45±23 cc, and 58±26 cc, respectively. CONCLUSION: In line with the literature, the average prostate volume of the prostate cancer group was significantly lower. This supports the notion that cancer detection is more probable in small prostates than in high-volume prostates.