Ali Memis

Prevalence and associated factors of enuresis in turkish children

OBJECTIVE: Enuresis, which is frequently diagnosed amongst schoolchildren, is an important psychosocial problem for both parents and children. In the present study we aimed to determine the prevalence and associated factors of enuresis in Turkish children and to identify common methods for its management. MATERIALS AND METHODS: A cross sectional epidemiological study was performed among primary school children living in Ankara, Turkey. A self-administered questionnaire was prepared for this study and distributed to the parents of 1,500 schoolchildren whom aged 6-12 years. RESULTS: Of the 1,500 questionnaires distributed, 1,339 (89%) were completed. The overall prevalence of nocturnal and diurnal enuresis were 17.5% (n = 234) and 1.9% (n = 25), respectively. Although male gender, low age, history of enuresis among parents, low educational level of the parents, deep sleep, increased number of siblings, increased number of people sleeping in the childs room, history of enuresis among siblings, poor school performance and history of recurrent urinary tract infections (UTI) were significantly associated with enuresis, but not with severe enuresis. The percentage of children with enuresis seen by physician for treatment was 17.2%. The most preferred treatment option for enuresis was medications (59.5%), whereas alarm treatment was the least preferred (2.4%). CONCLUSIONS: Our results with enuresis prevalence and associated factors were comparable to other epidemiologic studies from various countries. Furthermore we demonstrated that families in Turkey do not pay sufficient attention to enuresis and most of enuretic children do not receive professional treatment.

Effect of correcting serum cholesterol levels on erectile function in patients with vasculogenic erectile dysfunction.

Objective. This study evaluated the effect of correction of serum cholesterol levels on erectile function and sildenafil treatment in patients with erectile dysfunction who have only hypercholesterolaemia as a risk factor for erectile dysfunction. Material and methods. Twenty-five patients with a single risk factor (hypercholesterolaemia, serum cholesterol >200 mg/dl) for erectile dysfunction were included in the study. The patients were recommended to take sildenafil (minimum two 100 mg tablets/week) 1 h before sexual intercourse for 4 weeks. After 1 month washout period, the patients received a single dose of atorvastatin 10 mg/day for 1 month. Similarly, after a 1 month washout period, atorvastatin 10 mg/day and sildenafil (minimum two 100 mg tablets/week) were administered for 1 month as combination therapy. Erectile function was evaluated before and after all treatment regimens using the International Index of Erectile Function (IIEF). Results. Following each treatment modality mean IIEF scores were significantly higher than baseline IIEF scores (p<0.01). The IIEF score after sildenafil treatment was significantly higher than in the atorvastatin treatment group (p<0.01); and the IIEF score after combined treatment was significantly higher than in the sildenafil and atorvastatin treatment groups. Conclusions. Correction of serum cholesterol levels with atorvastatin could improve erectile function in patients who have only hypercholesterolaemia as a risk factor for erectile dysfunction. Furthermore, atorvastatin could improve sildenafils effects on erectile function in hypercholesterolaemic patients with erectile dysfunction.

Impact of metabolic syndrome on erectile dysfunction and lower urinary tract symptoms in benign prostatic hyperplasia patients

Introduction. The aim of this study was to investigate the relationship among metabolic syndrome (MetS), erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH). Methods. Our study included 106 patients with BPH, 33 (31.1%) of whom had MetS. Blood pressures, waist circumferences, serum levels of fasting blood glucose, high density lipoprotein and triglyceride of patients were recorded. Erectile functions of the patients were evaluated by International Index of Erectile Function (IIEF). Patients were divided into two groups according to IIEF scores, namely ‘mild/no ED’ and ‘moderate/severe ED’. IIEF scores of ED groups were between 17 and 30 and 6–16 in turn. LUTS severities were assessed by International Prostate Symptom Score (IPSS) and classified as mild (IPSS 0–7), moderate (IPSS 8–19) and severe (IPSS 20–35). Results. There was a significant difference between ED groups concerning MetS presence (p = 0.032). MetS presence was not found to be associated with the severity of LUTS (p = 0.144). There was no correlation between ED groups regarding LUTS severity (p = 0.303). Conclusion. Results of the present study showed a correlation between MetS presence and ED. In the light of our results, MetS seems to play an important role in the etiopathogenesis of ED in patients with BPH.

Effect of varicocelectomy on serum inhibin B levels in infertile patients with varicocele

Objective. In recent years serum inhibin B level has been proposed as a major indicator for Sertoli cell function and spermatogenesis. This study evaluated the effect of varicocelectomy on serum inhibin B levels and semen parameters in infertile patients with varicocele. Material and methods. Thirty consecutive patients with varicocele who were complaining of infertility with oligoasthenospermia on sperm analysis were included in the study. All the patients underwent subinguinal varicocelectomy. Spermogram, serum inhibin B levels and hormone analysis were performed at 6-month postoperative follow-up. Results. The mean age of the patients was 24.06±3.6 years. There was no statistically significant difference between the mean serum follicle-stimulating hormone, luteinizing hormone, prolactin and testosterone levels of the patients before and after the treatment (p>0.05). There was a statistically significant improvement in sperm concentration, forward progressive motility and serum inhibin B levels after the treatment (p<0.05). Conclusion. Serum inhibin B level as an endocrine marker combined with a spermogram could provide efficient data for evaluating the effect of varicocelectomy on spermatogenesis.

Effect of Finasteride Treatment on Suburethral Prostatic Microvessel Density in Patients with Hematuria Related to Benign Prostate Hyperplasia

Introduction: In the present study we evaluated the effect of short-term finasteride treatment on microvessel density (MVD)which is an indicator of prostatic angiogenesis in patients with hematuria secondary to benign prostatic hyperplasia (BPH). Materials and Methods: 30 patients who were candidates for BPH surgery were prospectively included in the study. All patients had history of gross hematuria and evaluated by ultrasonography and cystoscopy. The patients were randomized two groups before surgery. The treatment group consisted of 13 patients who were given 5 mg finasteride daily for 4 weeks before surgery. The control group consisted of 17 patients who did not receive finasteride before surgery. During surgery, resected suburethral and hyperplastic prostate specimens were sent for histopathologic MVD determination separately. Results: Mean MVD in the suburethral portion of prostate was significantly lower in patients treated with finasteride when compared with controls (9.08 ± 5.6 and 13.94 ± 5.90, respectively, p < 0.05). Mean MVD for the hyperplastic portion of prostate was similar for the finasteride and control groups (14.21 ± 7.10 and 19.75 ± 9.73, respectively, p > 0.05). Conclusion: The potential role of finasteride on hematuria related to BPH may be the suppressive effect on MVDin the suburethral tissue of prostate.

Effect of transurethral resection of prostate on prostatic resistive index.

Introduction: In the present study, we evaluated the effect of transurethral resection of the prostate (TUR-P) on prostatic resistive index (RI) in patients with benign prostatic hyperplasia(BPH). Patients and Methods: Forty BPH patients who were candidates for prostatectomy were prospectively included in the study. Prostatic RI was measured using power Doppler imaging (PDI) before TUR-P. In the postoperative follow-up, all patients were reevaluated with PDI, International Prostate Symptom Score (IPSS) and uroflowmetry. Results: Mean age, IPSS and maximal urine flow rate (Qmax) of the patients was 65.8 ± 7.6 years, 24.6 ± 7.1 and 7.7 ± 3.8 ml/s, respectively. The mean prostatic RI of the patients before TUR-P was 0.79 ± 0.02. Prostatic RI positively correlated with total prostate volume and IPSS (r = 0.57, p = 0.0001, and r = 0.42, p = 0.008, respectively) and negatively correlated with Qmax (r = –0.37, p = 0.029) prior to treatment. After TUR-P, mean IPSS and prostatic RI significantly decreased (6.5 ± 4.3 and 0.68 ± 0.03, respectively; p < 0.05), whereas mean Qmax was increased (15.7 ± 5.7, p < 0.05). Conclusions: Our data demonstrated that prostatic RI of the patients with BPH significantly decreased after TUR-P. We believe that prostatic RI could be a useful parameter for the follow-up of patients who underwent TUR-P.

Correlation between Upgrading of Prostate Biopsy and Biochemical Failure and Unfavorable Pathology after Radical Prostatectomy

Objective: To evaluate whether upgrading of the biopsy after radical prostatectomy (RP) affects disease outcome in terms of unfavorable pathology and biochemical failure. Patients and Methods: We retrospectively evaluated the records of 174 patients who underwent RP. Prostate biopsy and RP specimen Gleason scores (GSs) and correlative clinical data were recorded, and a multivariate analysis was applied. Results: Overall (138 patients), the disease of 69 men (50.0%) was upgraded, in 19 (13.8%) it was downgraded, and in 50 (36.2%) it had an identical biopsy and pathological GS. Accuracy rates were significantly higher for GS 8–10 compared to low GSs, with a concordance of 50.0 and 12.2%, respectively (p < 0.01). Multivariate analysis revealed the single independent prognostic factor for a non-organ-confined disease as a RP GS 8–10 (p = 0.035). The factors associated with a positive surgical margin were a biopsy GS 8–10 (p < 0.001) and the presence of biopsy score upgrading (p = 0.02). Biopsy GS ≥8 (p < 0.001) and presence of biopsy score upgrading (p = 0.009) were the two independent predictors of relapse after RP. Conclusion: This study demonstrated that biopsy upgrading was present in almost half of the patients who underwent RP and it was significantly related to positive surgical margins and biochemical relapse after RP.

Evaluation of biochemical recurrence-free survival after radical prostatectomy by cancer of the prostate risk assessment post-surgical (CAPRA-S) score.

BACKGROUND The cancer of the prostate risk assessment (CAPRA) score has been defined to predict prostate cancer recurrence based on the pre-clinical data, then pathological data have also been incorporated. Thus, CAPRA post-surgical (CAPRA-S) score has been developed based on six criteria (prostate specific antigen (PSA) at diagnosis, pathological Gleason score, and information on surgical margin, seminal vesicle invasion, extracapsular extension and lymph node involvement) for the prediction of post-surgical recurrences. In the present study, biochemical recurrence (BCR)-free probabilities after open retropubic radical prostatectomy (RP) were evaluated by the CAPRA-S scoring system and its three-risk level model. MATERIALS AND METHODS CAPRA-S scores (0-12) of our 240 radical prostatectomies performed between January 2000-May 2011 were calculated. Patients were distributed into CAPRA-S score groups and also into three-risk groups as low, intermediate and high. BCR-free probabilities were assessed and compared using Kaplan-Meier analysis and Cox proportional hazards regression. Ability of CAPRA-S in BCR detection was evaluated by concordance index (c-index). RESULTS BCR was present in 41 of total 240 patients (17.1%) and the mean follow-up time was 51.7±33.0 months. Mean BCR-free survival time was 98.3 months (95% CI: 92.3-104.2). Of the patients in low, intermediate and high risk groups, 5.4%, 22.0% and 58.8% had BCR, respectively and the difference among the three groups was significant (P=0.0001). C-indices of CAPRA-S score and three-risk groups for detecting BCR-free probabilities in 5-yr were 0.87 and 0.81, respectively. CONCLUSIONS Both CAPRA-S score and its three-risk level model well predicted BCR after RP with high c-index levels in our center. Therefore, it is a clinically reliable post-operative risk stratifier and disease recurrence predictor for prostate cancer.

Metabolic Syndrome Prevalence in Renal Cell Cancer Patients

PURPOSE Renal cell carcinoma (RCC) is increasingly being recognized as a metabolic disease in recent studies. The aim of the present study was to identify the prevalence of metabolic syndrome (MetS) and its association with RCC among urologic patients. MATERIALS AND METHODS The study included a total of 355 participants (117 adult RCC patients and 238 age matched controls) divided into groups, with and without MetS diagnosed using the criteria of the American Heart Association/The National Heart Lung and Blood Institute. Groups were compared statistically and logistic regression analysis was performed to investigate the impact of MetS criteria on RCC risk. RESULTS Of the 117 RCC patients, 52 (44.4%) and of the 238 controls, 37 (15.5%) had MetS. A significant association (p<0.001) was found between the presence of MetS and RCC (OR: 4.35; 95% CI=2.62- 7.21). As the number of MetS components accumulated from 3 to 5, RCC risk increased likewise from 4 to 6 times. CONCLUSIONS MetS is more prevalent in RCC patients in Turkey compared to controls. Risk increases with the number of coexisting MetS components.

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.