Atilla Semercioz

The inhibitory role of melatonin on isolated guinea‐pig urinary bladder: an endogenous hormone effect

To investigate the effects of melatonin, an endogenous hormone, on acetylcholine and KCl‐induced contractions of isolated guinea‐pig detrusor muscle.

Is Only Perianal Anesthesia with Lidocaine-Prilocaine Cream Sufficient to Decrease the Pain during Transrectal Ultrasound-Guided Prostate Biopsy? A Prospective Randomized Study

Aims: To determine the optimal place to apply the local anesthetic agent and to investigate the efficacy of lidocaine-prilocaine cream on the perianal and intrarectal region during prostate biopsy. Methods: The study included 80 patients. Patients were randomized into four groups: group 1 served as the control group and was administered no anesthesia; group 2 received 5 ml lidocaine-prilocaine cream perianally; group 3 received 5 ml lidocaine-prilocaine cream intrarectally, and group 4 received lidocaine-prilocaine cream perianally and intrarectally. Pain scores during probe insertion, biopsy procedure, and the overall pain score were assessed. Mean pain scores in each group were compared statistically. Results: In group 1, the mean pain score was significantly higher during probe insertion than that during biopsy (p < 0.001). For the mean overall pain scores, there was no significant difference between groups 1 and 3 (p = 0.942), but the results of group 1 were statistically different from groups 2 (p = 0.001) and 4 (p < 0.001). When we compared the biopsy pain scores, there was no significant difference among the groups (p > 0.05). During probe insertion, subjects in groups 2 and 4 reported significantly lower pain scores than the control group (p = 0.002, p = 0.001, respectively). Conclusions: Perianal anesthesia with lidocaine-prilocaine cream may solely be sufficient to decrease the pain during prostate biopsy.

Penile amputation in Buerger's disease-an unusual cause of organ loss.

We report a case of Buergers disease in a 70-year-old man which involved the penile arterial system and subsequently led to penile amputation.

Catheter dwell time and diameter affect the recurrence rates after internal urethrotomy

OBJECTIVE Cold-knife direct vision internal urethrotomy (DVIU) is frequently used as the first-line treatment for urethral stricture disease. Although the steps of the procedure are defined in detail, the duration of catheterization and the diameter of the catheter to be used after the operation are not clearly defined. The aim of this study is to evaluate the effects of catheter dwell time and diameter on recurrence rates of urethral stricture disease after DVIU. MATERIAL AND METHODS Data of 193 consecutive treatment naïve bulbar urethral stricture patients who underwent DVIU between January 2009 and June 2013 were retrospectively analyzed. Patient demographics and stricture characteristics were noted. Catheter dwell times were grouped as <5 and ≥5 days. The diameters of catheters used were 16, 18 and 22 Fr. The association between recurrence rates, catheter dwell times, and diameter were evaluated with Tukeys test and Pearsons correlation test, respectively. RESULTS Overall 193 patients with a mean age of 64.51±12.99 (range: 17 to 85) years were enrolled in the study. Urethral stricture disease recurred in 45 (23.31%) patients within the first year after DVIU. Mean duration of catheterization was 7.47±4.03 and 4.79±1.94 days in patients with and without recurrences, respectively (p=0.0001). Catheter dwell times for ≥5 days were also associated with increased recurrence (p=0.0001). Of the patients with recurrent strictures, 16, 18 and 22Fr catheters were placed in 22.22%, 20% and 57.78% of the patients, respectively. Increased catheter diameter was also associated with higher recurrence rates (p=0.004). CONCLUSION Shortening the postoperative duration of catheterization and decreasing the catheter size may result in improved recurrence rates after DVIU. Further prospective randomized trials are necessary to confirm these findings.

Isolated renal hydatıc cyst; from an unusual course to diagnosis

An isolated renal cyst hydatic in a 65 year old man with unusual symptomatology, course and complications were presented.

Milk of calcium cyst mimicking renal calculi: a case report.

A milk of calcium cyst mimicking renal stone in a 51-year-old man was presented to remind the possibility of milk of calcium when a well-defined round density was observed on the renal shadow of the plain abdomen film and the importance of graphics or CT scans taken in different positions to see the changes in the calcium gravidation to prevent unnecessary surgical interventions due to misdiagnosis.

Does the prostate volume always effect cancer detection rate in prostate biopsy? Additional role of prostate-specific antigen levels: A retrospective analysis of 2079 patients

OBJECTIVE We aimed to determine whether the effect of prostate volume on cancer detection rates is influenced by serum prostate-specific antigen (PSA). MATERIAL AND METHODS A total of 2465 men who underwent transrectal ultrasound-guided biopsy were retrospectively evaluated. Standard 10-core prostate biopsy was performed in all cases. Patients were divided into three groups according to the serum PSA levels: ≤10 ng/mL (Group 1), 10-20 ng/mL (Group 2) and >20 ng/mL (Group 3). In each group age, serum PSA levels and prostate volumes were compared in patients with and without prostate cancer. RESULTS A total of 2079 patients were included in the study group. Cancer detection rates were 16%, 25%, 53% in Groups 1, 2 and 3, respectively (p=0.001). In Group 1, there was a significant difference in mean prostate volume of patients with and without prostate cancer (p=0.01). However, this difference was not seen in Group 2 or 3 (p=0.06 and p=0.08, respectively). The mean age and PSA level which are the other determinants of prostate cancer diagnosis were similar between patients with and without cancer in the Group 1, thus prostate volume was the only determinant of the diagnosis. CONCLUSION According to our findings, prostate volume is an important factor for prostate cancer diagnosed with prostate biopsy only in patients with a PSA level of ≤10 ng/mL.

Re: Hand-assisted laparoscopic versus laparoscopic nephrectomy as outpatient procedures: a prospective randomized study

Azawi et al. [1] have reported the safety and feasibility of hand-assisted laparoscopic nephrectomy (HALNo) in terms of outpatient procedure in their prospective randomized study. We have read the article with great interest and we want to congratulate the authors because of their praiseworthy study with some contributions. The concept of enhanced postsurgical recovery or outpatient surgical procedure, also termed as fast track surgery (FTS), was initially described by Henrik Kehlet in 1990s [2]. Later on, the technique has been approved in a widespread manner and the advantages and safety of the procedure were proven [3,4]. Currently, FTS has been applied to different fields of surgeries including urology, gynecology, and general surgery and accepted as cost effective and safe by many authors [4–7]. FTS requires several evidence-based perioperative interventions and multimodal approach containing close collaboration between surgeons and anesthesiologists with other healthcare professionals [2]. In the current study, there is no clear statement about the role of anesthesiologist in the postoperative care of the patients. In addition, discharge criteria of the study composed of some objective parameters such as pain, felt safe to discharge. We think evaluation of important vital signs and symptoms including systemic blood pressure, pulse rate, ventilation characteristics of patients and peripheral blood oxygen saturation that managed by anesthesiologist should have included to the discharge criteria. Although the authors determined the Charlson Comorbidity Index, specific individual diseases which may affect postoperative outcomes (Diabetes mellitus, Chronic Obstructive Pulmonary Disease etc.) were not considered. For instance, postoperative blood glycemic status may affect hospital length of stay (LOS) and increase the risk of postoperative complications [8,9]. Moreover, functional capacity of patients commonly described as patient performance status is another important predictor for several postoperative outcomes especially in elderly oncologic patients and it may be associated with hospital LOS [10]. Individual performance status was also not considered in the current study. However, performance status of the study cohort should have evaluated principally by the authors because of that their primer endpoint was hospital LOS. Additionally, intraoperative blood loss, postoperative hemoglobin levels which may affect the early postoperative care and follow-up schedule were also not considered by the authors. Finally, despite the fact that no patients had severe or life threatening event after the early discharge within a few hours, evaluation of the surgical outcomes may be limited for determining the safety and feasibility of the FTS concept in the absence of the above mentioned parameters. A more detailed evaluation of the patients in both groups might have caused decision dilemma for the authors during discharge of some patients. Consequently, the feasibility of the HALNo as an outpatient procedure might have not provided. Therefore, comprehensive and well designed evaluation criteria including such parameters could prevent this query and might have enriched this valuable study.

Effects of the Three-Dimensional Vision System on Surgical Performance, Muscular Fatigue, and Pain During Urologic Laparoscopic Tasks: Results of Objective Assessments and a Mini Questionnaire Survey

BACKGROUND The three-dimensional (3D) vision system was released to the medical market to improve laparoscopic outcomes. We analyzed the muscular pain and fatigue, and the performance outcomes after several laparoscopic urologic tasks were completed with the 3D vision system. METHODS A total of 49 participants with different surgical expertise levels were enrolled in the study. All the participants performed some laparoscopic urologic tasks using two-dimensional (2D) and 3D vision systems separately. A mini questionnaire survey was also completed by the participants. The duration and quality of the tasks and the muscular fatigue and pain were objectively determined. All the parameters were compared between the 2D and 3D systems. RESULTS Although all the tasks were completed in significantly shorter times with the 3D vision system in each expertise level, maximal shortening was seen in the residents. The overall quality scores were significantly higher with the 3D vision system. However, a maximal increase was seen in the residents. The muscular pain of the participants was lower with 3D vision system. The overall handgrip strength significantly increased from 41.2 to 42.4 kg after the tasks with the 3D vision system, but the difference was significant in only the residents. Twenty-seven participants (56.2%) declared that the 3D system contributed to their performance, and most of the participants (83.3%) preferred the 3D system in the questionnaire survey. CONCLUSION 3D technology may be effective for use in urologic laparoscopic training programs of novice surgeons. It may also contribute to the skills of specialists and experts, shortening the surgical time, which may decrease the surgical morbidity.

Re: Singh A et al. Robot-assisted retroperitoneal lymph node dissection: Feasibility and outcome in postchemotherapy residual mass in testicular cancer. Indian J Urol 2017;33:304-9

1. Goel S, Mandhani A, Srivastava A, Kapoor R, Gogoi S, Kumar A, et al. Is povidone iodine an alternative to silver nitrate for renal pelvic instillation sclerotherapy in chyluria? BJU Int 2004;94:1082‐5. 2. Kant L. Deleting the ‘neglect’ from two neglected tropical diseases in India. Indian J Med Res 2016;143:398‐400. 3. Heldwein FL, Rhoden EL, Morgentaler A. Classics of urology: A half century history of the most frequently cited articles (1955‐2009). Urology 2010;75:1261‐8. 4. Nason GJ, Tareen F, Mortell A. The top 100 cited articles in urology: An update. Can Urol Assoc J 2013;7:E16‐24. 5. Newble D, Cannon R. Helping students learn. A Handbook for Medical Teachers. 4th ed. New York: Kluwer Academic Publishers; 2001. p. 5‐7. This is an open access article distributed under the terms of the Creative Commons Attribution‐NonCommercial‐ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‐commercially, as long as the author is credited and the new creations are licensed under the identical terms.