Ahmet Fuat Peker

Pain Scores and Early Complications of Transrectal Ultrasonography-Guided Prostate Biopsy: Effect of Patient Position

Background: The aim of the study was to evaluate the pain scores and complications of transrectal ultrasonography (TRUS)-guided prostate biopsy and to compare lithotomy position (LP) versus left lateral decubitis position (LLDP). Methods: A total of 340 patients were referred for TRUS-guided biopsy. In group 1 (n = 170), biopsies were performed in LP (n = 170), and in group 2 (n = 170) biopsies were performed in LLDP (n = 170). In 68 patients, biopsies were repeated. We constituted two additional groups: in group 3 (n = 33) patients underwent biopsies in LP and LLDP, respectively, and in group 4 (n = 35) patients underwent biopsies in LLDP and LP, respectively. Pain score, infection rates, hematospermia, hematuria, rectal bleeding, and serious complications were compared between group 1 and group 2. Pain scores were compared between the four groups. Results: There were no differences between group 1 and group 2 for age, prostate volume, prostate-specific antigen level, biopsy time, hematuria, infection, hematospermia, and rectal bleeding. Pain scores were lower in group 2 than in group 1. Also, for LLDP, pain scores were lower in group 3 and group 4. Conclusion: The effect of position on pain scores in TRUS biopsy patients has not been previously described. Our study indicates that pain scale values are lower in LLDP than in LP.

Varicocele and antisperm antibodies.

Semen analysis and immunofluorescent antisperm antibodies were tested in 65 patients with varicocele. The mean sperm count and motility values in our study were 36.8±2.9 million per ml and 38.4±2.5 per cent, respectively. Both parameters were found not to differ significantly in three grades of varicocele. Immunofluorescent antisperm antibodies were detected in 24.6 per cent of the cases. A significant correlation was demonstrated between the presence of the antibodies and genital infection.

Splenogonadal fusion in adults: presentation of three cases and review of the literature.

Splenogonadal fusion (SGF) is a rare congenital anomaly in boys and girls. It commonly presents as a testicular mass treated with an unnecessary orchiectomy. We present 3 cases of SGF diagnosed in adulthood and discuss the published literature focusing on several aspects of this rarity. These cases of SGF of both types presented with the usual complaints. In our first case, orchiectomy was performed since the left testis was hypoplastic and testicular neoplasm could not be ruled out. The testicles could be preserved in the latter 2 cases. The second case is the continuous-type SGF associated with contralateral testicular aplasia and, to our knowledge, this is the first reported case of continuous SGF associated with testicular aplasia. Knowledge of this entity may help prevent unnecessary orchiectomy.

Tubularized Incised Plate Urethroplasty for Distal and Mid–Penile Hypospadias

Tubularized incised plate urethroplasty was performed to repair 20 distal and 5 mid–penile hypospadias cases. In distal hypospadias repair meatal stenosis occurred in 1 patient and urethral fistula in another. The overall complication rate in this group was thus 10%. Among midpenile hypospadias cases meatal stenosis was observed in 1 (20%) patient. As a conclusion, tubularized incised plate urethroplasty was found to be a successful method for treating distal hypospadias and encouraging results were obtained in mid–penile hypospadias cases.

Intraurethral prostatic cyst: a rare cause of infravesical obstruction.

A case is reported here of symptomatic intraurethral anterior midline prostatic cyst in a 52-year-old man whom transurethral resection of the cyst was performed successfully establishing the resolution of voidingsymptoms.

Retroperitoneal lymph node mapping with intratesticular injected patent blue dye in rats

OBJECTIVES Endolymphatic injection of several dyes have been previously studied to identify retroperitoneal lymphatic structure in animals and humans with malignant diseases. However, there have been no studies, to our knowledge, that demonstrate the utility of injecting patent blue dye into the testicular parenchyma to detect retroperitoneal lymphoid structure. The aim of this experimental study was to investigate whether intratesticular patent blue dye injection is feasible and is an accurate method for retroperitoneal lymph node mapping in rats. MATERIALS AND METHODS Twenty male albino Wistar rats were included in the study and divided over two equal groups. The first group underwent patent blue violet (PBV) injection into the spermatic funiculus, while the second group underwent PBV injection into the testicular parenchyma. After the injection, the color changes in the retroperitoneal lymphatic structures and the urinary bladder were anticipated. The time interval between the injection and the staining of lymphatic structures and urinary bladder was measured for each intervention. Blue stained retroperitoneal nodal tissues were dissected and removed. These nodal tissues were examined histologically. RESULTS After PBV injection, intense staining of the ipsilateral spermatic cord lymphatics was seen and anticipated color changes in the retroperitoneal lymphatic structures and urinary bladder were evaluated visually. Both application routes of dye resulted in the same distribution of retroperitoneal lymph nodes in the same time frame. All retroperitoneal nodular tissues removed were noted histologically to be lymph nodes and were found to be consistent with the ipsilateral lumbar lymph and the ipsilateral suprarenal lymph nodes according to the staining order in both groups. No toxic effects were observed histologically. There were no statistically significant differences in the time intervals between the two groups. CONCLUSIONS We demonstrated that both funicular and intratesticular injections of patent blue dye are feasible and accurate methods for retroperitoneal lymph node mapping in rats. This shows that intralymphatic dye injection is not absolutely necessary to detect retroperitoneal lymphatic structures and may have applications beyond testis cancer.

Embolization therapy in two subtypes of priapism

Two subtypes of priapism have been described based on the pathophysiologic mechanism. The more common type, termed stasis priapism, is characterized by a low flow state in which inadequate venous outflow creates an acidotic hypoxic environment leading to a painful prolonged erection. The other less common subtype, high flow priapism, is arteriogenic. We used embolization therapy in one case with long lasting stasis priapism and in the other with high flow priapism due to bilateral arteriosinusoidal fistulae in the penis. In both cases we used polyvinyl alcohol for embolization and sexual potency preservation.Priapism is the persistence of erection that does not result from sexual desire. Hauri et al. described two variants of priapism [4]. In high flow priapism (non-ischaemic) there is unregulated arterial inflow to the lacunar spaces due to a lacerated cavernous artery associated with previous perineal and penile trauma. In stasis priapism, the second type, the basis abnormality could be due to a more pronounced or prolonged blood entrapment inside the vascular spaces of the corpora cavernosa sustained by an unknown cause [2]. There are many treatment methods especially for low flow ischaemic variant [3]. We report two different kinds of priapism and embolization therapy in both of them with polyvinyl alcohol.

Low sperm recovery from the undescended testis with testicular sperm extraction in postpubertal cryptorchids : preliminary report

As postpubertal cryptorchid testes are generally atrophic and have high malignancy risk, orchiectomy is recommended as the treatment method. However, a few case reports advocated orchiopexy due to finding sperm afterwards. The present clinical study aimed at determining the possibility of finding spermatozoa in postpubertal cryptorchid testis with testicular sperm extraction (TESE). Initially testicular biopsy and later TESE was performed in the undescended testis of 22 unilateral postpubertal cryptorchids and in one of the testes of three bilateral postpubertal cryptorchids. Histopathological assessment of testicular biopsy specimen showed that three patients had maturation arrest and 22 had seminiferous tubular atrophy. By TESE, spermatozoa were found in only one specimen of 25 testes. Our results show that the expectancy to find spermatozoa in postpubertal cryptorchid testis is extremely low by current sperm recovery methods and orchiectomy is still the accurate method of treatment.

Priapism in a Patient Receiving Long-Term Chlorpromazine Therapy

Priapism is an uncommon urologic emergency with a variety of known etiologies including the use of psychotropic medications. We report a priapism case who has taken chlorpromazine for 3 years.

Giant congenital diverticulum of the anterior urethra with stone in a male

Congenital diverticula in male patients are rare. We report an unusual case of a giant congenital diverticulum of the anterior urethra with a stone in a 21-year-old patient. He had had intermittent dysuria and postvoiding dribbling since childhood, but the diagnosis was only made later, at his admitting medical examination for military service. Treatment consisted of open urethroplasty and removal of the stone. His recovery was uneventful and the patient was asymptomatic 2 years after the operation.