Ali Atan

The Impact of Transrectal Prostate Needle Biopsy on Sexuality In Men and Their Female Partners

OBJECTIVES To evaluate sexuality in men who have undergone transrectal prostate needle biopsy (TPNB) and their female partners. METHODS Ninety-seven men underwent TPNB because of high prostate-specific antigen level (>or=2.5 ng/mL) and/or abnormal digital rectal examination findings and their female partners were included in this study. Men were evaluated for erectile function before biopsy, and the first and sixth months after the biopsy with the 5-item version of the International Index of Erectile Function (IIEF-5). Female partners completed the Female Sexual Function Index (FSFI) in the same periods together with the men. We assessed IIEF-5 and FSFI score alterations after the biopsies. RESULTS The mean ages of men and their partners were 61.2 (40 to 81) years and 56.8 (34 to 70) years, respectively. The mean IIEF-5 scores were 19.1 +/- 5.8, 17.1 +/- 5.9, and 16.8 +/- 7.5 before the biopsy, and 1 and 6 months after the biopsy, respectively. We found significant differences among prebiopsy IIEF-5 scores and postbiopsy first- and sixth-month IIEF-5 scores (P <0.001). On the contrary, there was no significant difference between the postbiopsy first- and sixth-month IIEF-5 scores (P = 0.335). In the female partners, the mean prebiopsy, postbiopsy first- and sixth-month total FSFI scores were 18.0 +/- 6.8, 16.2 +/- 6.8, and 16.0 +/- 8.4, respectively (P <0.001). In first- and sixth-month postbiopsies, all FSFI subscores were significantly lower than the prebiopsy subscores. CONCLUSIONS TPNB seems to have negative impact on erectile function. Male sexual dysfunction after TPNB also has a negative effect on female sexual function. We believe that couples should be informed about the risk of erectile dysfuncton before TPNB.

Pressure-flow studies: An evaluation of within-testing reproducibility—validity of the measured parameters

The within‐examination variation in selected test parameters in repeated pressure‐flow studies was determined in a retrospective study of consecutive pressure‐flow examinations in 105 patients. It was further evaluated to see whether there was a systematic change in the measured parameters during retesting. To see if variation and reproducibility were influenced by the procedure of investigation, i.e., transurethral or suprapubic, patients were grouped according to the method employed. Finally, the effect of detrusor instability on the measurements was evaluated. Using the Abrams‐Griffiths nomogram, patients were classified as obstructed, equivocal, or unobstructed. The test‐retest variations in classification were evaluated.

Effects of short-term dutasteride and Serenoa repens on perioperative bleeding and microvessel density in patients undergoing transurethral resection of the prostate.

Objective. To evaluate the effects of short term use of dutasteride and Serenoarepens before transurethral resection of the prostate (TURP) on the amount of intraoperative blood loss and microvessel density (MVD) of prostatic stromal and suburethral tissues in the patients with benign prostatic hyperplasia. Patients and methods. The study involved 75 male patients who planned to have a TURP. The patients were randomly divided into three groups. The control group comprised 21 patients. Group 2 comprised 27 patients who used dutasteride 5 mg/day, and group 3 comprised 27 patients who used S. repens 160 mg/day for 5 weeks before the operation. The amount of intraoperative haemorrhage was calculated. Total blood loss, total blood loss/time, total blood loss/weight of resected tissue and total blood loss/weight/time were calculated for each patient and all were recorded. Sections from the prostatic stromal and suburethral tissues were examined for suburethral and prostatic MVD. Results. The total amount of intraoperative blood loss, total blood loss/time, total blood loss/weight of resected tissue, total blood loss/weight/time, serum haemoglobin level change, prostatic MVD and suburethral MVD of the groups were compared. No significant statistical differences were found between the groups for any of these variables (p > 0.05). Conclusions. Dutasteride and S. repens therapies were not superior to control in terms of the decrease in total blood loss during TURP. Moreover, MVD showed no statistical differences in the treatment groups compared with the control group.

Differential renal function in the prediction of recovery in adult obstructed kidneys after pyeloplasty

Aim: Pyeloplasty is a widely accepted method for the treatment of ureteropelvic junction obstruction (UPJO). Surgery has long been thought to affect postoperative renal function. However, controversies still exist on the functional studies that can be used to indicate which renal units will benefit from surgery. In this study, the correlation between differential renal function (DRF) and other preoperative parameters was examined to determine which parameter more accurately predicts recovery of renal function in adult obstructed kidneys.Materials &Methods: In this study, the authors evaluated 32 patients with UPJO. In all patients, standart diuretic Tc-99m DTPA renal scans were performed preoperatively and 6 months after surgery. Patients were divided into two groups according to the preoperative DRF (≥ 30%, n = 22, group I and < 30%, n = 10, group II). Second type classification was made according to the postoperative DRF improvement as improved (group A, n = 13) and not improved (group B, n = 19). These groups were then compared regard to variables which were defined as symptoms, age at operation and ultrasonographic findings. We also evalulated whether preoperative parenchymal function is important to predict improvement in drainage half-time (Tl/2).Results: While preoperative drainage half-time was 39.6 ± 15.9 minutes, postoperative half-time decreased to 16.9 ± 6.8 minutes (p < 0.001). The mean DRF did not improved significantly after surgery compared with preoperative values (32.03 ± 9.42% versus 36.16 ± 9.60%). When comparing the patients with preoperative DRF ≥ 30% (group I, DRF 38 ± 0.8%) to those who had an initial DRF below 30% (group II, DRF 22.8 ± 5.2%), postoperative DRF was 41.22 ± 5.72 in group I and 25.00 ± 6.22 in group II. The difference was significant (p < 0.01 ). The patients in group I and II showed improvement in 50% and 20%, respectively. Age, clinical presentation and ultrasonographic findings did not affect functional outcome after pyeloplasty. We could not find any correlation between preoperative DRF and the degree of improvement in Tl/2.Conclusion: Renal function improves after pyeloplasty with regard to the initial level of split renal function in adult obstructed kidneys. Improvement may not be observed especially in patients with DRF less than 30%.

Is Type 2 Diabetes Mellitus a Cause of Severe Erectile Dysfunction in Patients With Metabolic Syndrome

OBJECTIVES To determine the effect of type 2 diabetes mellitus (T2DM) as a major risk factor for severe erectile dysfunction (ED) in patients with metabolic syndrome (MS). METHODS The study included 93 patients aged 30-70 years who had MS and ED. MS patients were divided into 2 groups: 37 patients with neither T2DM nor abnormal fasting glucose level (group 1) and 56 patients with T2DM (group 2). The severity of ED was determined according to the first 5-question version of the International Index of Erectile Function (IIEF-5). The MS was defined according to the 2005 International Diabetes Federation consensus definition. Logistic regression analysis, t test, and chi(2) tests were used to investigate the impact of T2DM on ED severity. RESULTS The mean age of the patients was 55.5 years (P = .313). Eleven patients in group 1 (29.7%) and 42 patients in group 2 (75%) had severe ED (IIEF-5 score <or=7; P < .001). Abnormal blood pressure (BP), serum high-density lipoprotein (HDL), and serum triglyceride (TG) ratios were found to be 48.6%, 75.7%, and 86.5% in group 1 and 51.8%, 53.6% and 73.2% in group 2, respectively (P(BP) = .933; P(HDL) = .053; P(TG) = .205). The IIEF-5 scores were higher in group 1 patients than in group 2 patients (12.6 vs. 7.5; P(IIEF-5) < .001). Presence of T2DM was significantly associated with severe ED, and the relative risk was as high as 7.1 (P(T2DM) < .001). CONCLUSIONS In our study, the presence of T2DM was strongly associated with severe ED in patients with MS. We believe that components of MS should be taken into consideration in the diagnosis and treatment of ED.

Pressure-flow studies: short-time repeatability.

The within and between examination variation in selected test parameters and test results in repeated pressure‐flow studies was determined in a prospective study of consecutive pressure‐flow examinations in 22 patients. The patients were pressure‐flow tested twice within a month. Furthermore, it was evaluated whether there was a systematic change in the measured parameters during retesting. By using the Abrams‐Griffiths nomogram, patients were classified as obstructed, equivocal, or unobstructed. Within and between examination variations in classification were evaluated. We found a systematic variation in Pdet.Qmax during testing, which in the absence of statistically significant systematic variations in Pdet.Close and Qmax, indicates a physiological effect of repeated pressure‐flow studies, resulting in a less‐obstructed second voiding. Supporting this, we found that all patients who changed group of classification of bladder outlet obstruction in the first examination shifted to a group of less obstruction, as did 66% of the patients who changed group of classification of bladder outlet obstruction in the second examination. Still, 80, respectively 85%, of the patients remained in the same group of classification of bladder outlet obstruction during retesting in the first and second examinations, respectively. Classifying the degree of bladder outlet obstruction by Qmax, Pdet.Qmax, and Pdet.Close 85% of the patients reproduced their test results accurately in both examinations and taking only the first voiding in both examinations into account 95% reproduced their test results. Neurourol. Urodynam. 18:205–214, 1999.

Tamsulosin versus nifedipin in medical expulsive therapy for distal ureteral stones and the predictive value of Hounsfield unit in stone expulsion

Abstract We evaluated the efficacy of tamsulosin and nifedipine in medical expulsive therapy (MET) in patients with distal ureteral stone. In addition, we tried to determine the predictive value of Hounsfield Unit (HU) of the stone in the success of MET. A total of 75 patients with a distal ureteral stone of 5–10 mm diameter were randomly divided into three groups. Group 1 (n = 25) received tamsulosin 0.4 mg/d; group 2 (n = 25) received nifedipine 10 mg/day p.o and group 3 (n = 25) received diclofenac sodium 50 mg p.o. when required. At the beginning of each treatment, the HU of the stone was also measured using a non-contrast computerized tomography in all the patients. The results were evaluated at week four. The mean age of the patients was 36.8 (range, 16–68) years. Stone expulsion was observed in 19 (76%) patients in group 1, 16 (64%) patients in group 2 and 9 (36%) patients in group 3 (pgroup1-3 = 0.004, pgroup2-3 = 0.048 and pgroup1-2 = 0.355). The mean expulsion time was 9, 9.1 and 10.3 d, respectively (pgroup1-3 < 0.001, pgroup2-3 < 0.001 and pgroup1-2 = 0.619). The mean diclofenac sodium dose per patient was 544, 602 and 1408 mg in groups 1, 2 and 3, respectively (pgroup1-3 < 0.001, pgroup2-3 < 0.001 and pgroup1-2 = 0.977). The mean HU of the stone in patients with and without a successful MET was 363 and 389, respectively (p = 0.462). Our results showed that MET with both nifedipine and tamsulosin provided a similar increase in the expulsion rate for distal ureteral stones. HU does not seem to be a predictive parameter for stone expulsion.

Penile length and somatometric parameters: a study in healthy young Turkish men

The purpose of this study was to determine average penile length and to investigate the relationship between penile length and somatometric parameters in a group of young, healthy Turkish men. A total of 1,132 men were included in the study. The age, height and weight of the subjects were recorded. Penile length was measured in both flaccid and stretched states. The correlation between penile length and somatometric parameters was analysed. The mean age of the subjects was 20.3±0.9 years. The mean penile length in flaccid and stretched states was 9.3±1.3 and 13.7±1.6 cm, respectively (P<0.001). There was a positive correlation between flaccid and stretched penile length (r=0.800, P<0.001). The mean testicular volume was 22.0±2.8 cm(3). A weak positive correlation was detected between penile length and mean testicular volume (r=0.143 for flaccid penile length and r=0.140 for stretched penile length, P<0.001 for both). Similarly, weak positive correlations were found between penile length (both flaccid and stretched) and height, weight and body mass index, respectively (P<0.001, for all). These results demonstrate that somatometric parameters are correlated with penile length. We believe that further studies would provide more information about the causal relationship.

Bilateral ureteral fibroepithelial polyps and review of the literature

Abstract Despite being the most common forms of benign ureteral neoplasms, ureteral fibroepithelial polyps are rare and their etiology is still unknown. To our knowledge, we report the fourth case of bilateral fibroepithelial polyps in the English literature with a discussion of clinical features and etiology.

Does disposable needle guide minimize infectious complications after transrectal prostate needle biopsy

OBJECTIVES To investigate the effectiveness of disposable transrectal ultrasound needle guide in the prevention of possible infectious complications after transrectal prostate biopsy. METHODS One hundred ninety-eight patients who underwent transrectal needle biopsy of the prostate were included in the study. Patients were randomly assigned into 2 groups; in group 1 (110 patients), prostate biopsies were taken with reusable needle guide. In group 2 (88 patients), biopsy was performed by using a disposable transrectal needle guide. Patients received 500 mg ciprofloxacin orally twice daily beginning the day before biopsy and continued for 1 week. Infectious complications were recorded as asymptomatic bacteriuria, acute urinary infection, high fever, and bacteremia. RESULTS The mean age of the patients was 63.9 years. The mean age of the patients were 65.1 and 64.4 years in group 1 and 2, respectively (P = 0.428). There were no significant differences between the regarding serum total and free prostate-specific antigen (PSA) levels, total prostate volume, and transitional prostat volume (P(total PSA) = 0.822, P(free PSA) = 0.510, P(prostate volume) = 0.323, P(transitional zone volume of the prostate) = 0.376). Although asymptomatic bacteriuria was found in a total of 14 (7.1%) patients, acute urinary tract infection was diagnosed in 11 (5.5%) patients and high fever was observed in 16 (8.1%) patients. Blood cultures did not show bacteremia in either of the groups. Infectious complication rates were significantly lower in group 2 than the other group (P <0.001). CONCLUSIONS The use of a disposable needle guide helps minimize infection risk after transrectal prostate needle biopsy. The novel disposable needle guide seems to be the alternative to a reusable needle guide.