Bora Irer

Development of vesical calculi following tension-free vaginal tape procedure

We present a case of a bladder stone that had formed around the intravesical portion of tension-free vaginal tape (TVT) material following unnoticed bladder perforation during the procedure. Endoscopic lithotripsy of the bladder calculi was performed and the TVT sling material was removed by an endoscopic approach. High clinical suspicion of bladder complications is necessary when evaluating patients presenting with urinary symptoms after a TVT procedure.

The value of PSA, free-to-total PSA ratio and PSA density in the prediction of pathologic stage for clinically localized prostate cancer.

Objective: The ability of prostate-specific antigen (PSA), free/total PSA and PSA density to predict the pathologic stage in prostate cancer has not been clear yet. In this study, we evaluated the value of PSA subgroups in the prediction of pathologic stage after radical prostatectomy. Methods: A total of 42 subjects 55–78-years-old who underwent radical retropubic prostatectomy were included in the study. Preoperative PSA, free/total PSA and PSA density (PSAD) values were compared according to the pathologic stages of radical prostatectomy specimens. Receiver operating characteristics (ROC) curves were measured for each parameter. Results: The clinical stage that was estimated for all patients was between T1N0M0 and T2bN0M0. Pathologic examination revealed organ-confined disease in 18 patients. The area under curve (AUC) for organ confinement was 0.553 for PSA, 0.446 for free/total PSA ratio and 0.706 for PSAD. Cut-off values providing the best sensitivity and specificity in ROC analysis for PSA, free/total PSA and PSAD were 7.1, 0.15, and 0.17, respectively (likelihood ratio: 0.9, 1 and 2). The positive predictive values at these cut-off values were 0.54, 0.56, and 0.70, respectively. Only PSAD cut-off values was found statistically borderline significant for predicting organ-confined disease. Conclusion: While PSAD is more helpful than PSA and free/total PSA ratio for prediction of organ-confined disease, none of these parameters are significant predictor of pathologic stage for clinically localized prostate cancer.

Relationship between Complications due to Prostate Biopsy and the Scores of Pain and Discomfort

Introduction: Transrectal ultrasound (TRUS)-guided prostate biopsy is routinely performed in the prostate-specific antigen era. In this study, we evaluated morbidity and complications observed in patients undergoing TRUS-guided prostate biopsy following intrarectal lidocaine application and the relation of these complications to pain and discomfort. Patients and Methods: Between January 2000 and August 2002, a total of 128 patients underwent TRUS-guided prostate biopsy. The procedure was carried out following an intrarectal application of 10 cm3 2% lidocaine gel. Immediately after the biopsy, pain and discomfort scores were determined using a 10-point linear visual analog scale. The patients were seen 10 days later and questioned for complications. Results: At least one complication was observed in 107 patients (84%). Most frequent complications were macroscopic hematuria (90%), hematochezia (36%), and hematospermia (13%). The mean pain and discomfort scores of the patients were found to be correlated to each other (p < 0.01). The complication-negative group had significantly lower pain and discomfort scores (p < 0.01). The scores of the patients with hematochezia were significantly higher than the scores of the patients with other complications (p < 0.01). Conclusions: Minor complications like hematuria, hematochezia, and hematospermia are frequently seen in patients undergoing TRUS-guided prostate biopsies. The pain and discomfort scores may be predictors of minor complications, particularly of rectal bleeding.

Predictive Value of the International Prostate Symptom Score for Positive Prostate Needle Biopsy in the Low-Intermediate Prostate-Specific Antigen Range

Purpose: Serum prostate-specific antigen (PSA) has a restricted predictive value for prostate cancer in the low-intermediate PSA range (2.5–10 ng/ml). Our aim was to determine the predictive value of the International Prostate Symptom Score (IPSS) for positive prostate needle biopsy (PNB) in patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsy with a low-intermediate PSA level. Patients and Methods: Between 2001 and 2004, the data of 389 consecutive patients applying for any urologic complaint to our department and who underwent TRUS-guided prostate biopsy due to an elevated serum PSA and/or abnormal digital rectal examination (DRE) were retrospectively analyzed. A total of 158 eligible patients with a low-intermediate PSA level were included in the study. The patient’s age, PSA, free PSA, free/total PSA, prostate volume, PSA density (PSAD), pre-biopsy IPSS were compared in the positive and negative biopsy groups. Results: Fifty-eight of 158 patients (37%) who underwent TRUS-guided prostate biopsy had positive PNBs. Forty-eight patients (30%) had abnormal DREs. In the positive PNB group, the mean age was older and PSAD was higher, but the means of the prostate volumes and total IPSS were lower (p < 0.05). Multivariate analysis demonstrated that age and IPSS were independent predictors of a positive PNB (p < 0.05). The odds ratio of mild IPSS for positive PNB controlled for age was 3.0 (95% CI 1.5–6.7). Receiver-operating characteristics analysis revealed a mild IPSS (AUC = 0.640) and was a considerable predictor for positive PNB as well as PSAD (AUC = 0.648). The sensitivity and specificity of IPSS with a cutoff value of 7.5 points were 31 and 87% for prediction of prostate cancer detection. Conclusion: In the low-intermediate PSA range, mild IPSS may be a predictive factor for positive PNB with a similar specificity of PSAD.

Increased expression of NKX3.1 in benign prostatic hyperplasia.

OBJECTIVES To establish the role of the NKX3.1 gene in the development of benign prostatic hyperplasia by comparing the expression of NKX3.1 in messenger ribonucleic acid (mRNA) and protein levels in young adult prostate and BPH tissues. METHODS Normal prostate tissue samples (n = 4) were obtained from prostate biopsies of patients less than 40 years of age who underwent diagnostic cystoscopy for microscopic hematuria. Benign prostatic hyperplasia tissues (n = 12) were obtained from patients who underwent transurethral prostate resection for bladder outlet obstruction. The RNAs isolated from these tissue samples were analyzed with quantitative reverse transcriptase polymerase chain reaction; the proteins were analyzed with Western blotting and immunohistochemistry. RESULTS The mean NKX3.1 mRNA transcript expression was 19.17 +/- 3.05 vs 1.24 +/- 1.32 in BPH and normal tissues, respectively, and NKX3.1 protein expression of BPH was approximately 2.4-fold higher than in normal prostate tissue. Reverse transcriptase polymerase chain reaction and Western blot analyses revealed that NKX3.1 gene expression in BPH patient tissues were higher compared with normal prostate tissues. Immunohistochemistry results indicated that most of the BPH tissues stained diffusely, and there was no BPH tissue that lacked NKX3.1 expression. CONCLUSIONS NKX3.1 expression is elevated in BPH tissues when compared with normal tissues, which may be important in the development of BPH.

Prevalence and Possible Risk Factors for Urinary Incontinence: A Cohort Study in the City of Izmir

Introduction: This study aimed to evaluate the prevalence and possible risk factors of urinary incontinence (UI) among women aged 18 or older living in the city of Izmir, located in the Aegean coast of Turkey. Methods: A questionnaire and the validated International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) were filled by urologists (O.D., V.S., A.E., O.B., and B.I.) with face-to-face interview. The participants with urge UI (UUI) and stress UI (SUI) were compared in terms of risk factors, quality of life (QoL) scores, severity of incontinence, status of doctor consultation, and total ICIQ-SF scores. Results: A total of 719 women were included and the prevalence of UI was 50.3% in our study. The key risk factors for UUI were hypertension and diabetes mellitus; the key risk factors for SUI were hypertension, multiparity, body mass index, and lower education level. Average QoL (ICIQ-SF 5) score for UUI was worse than SUI (3.8 ± 2.5 vs. 3.3 ± 2.4; p = 0.042) and seeking treatment for UI was significantly higher in participants with UUI when compared to those with SUI (45.1 vs. 24%; p ≤ 0.001). Conclusions: Physicians should be aware that risk factors may differ according to specific UI subtypes when evaluating patients with UI.

Evaluation of Sexual Dysfunction, Lower Urinary Tract Symptoms and Quality of Life in Men With Obstructive Sleep Apnea Syndrome and the Efficacy of Continuous Positive Airway Pressure Therapy

OBJECTIVE To determine the presence of lower urinary tract symptoms (LUTS), nocturia, sexual dysfunction (SD), and the status of quality of life (QOL) in men with obstructive sleep apnea syndrome (OSAS) and after continuous positive airway pressure (CPAP) treatment, the changes in the presence of these conditions and the improvements of QOL. MATERIALS AND METHODS In this study, 126 patients with suspicious diagnosis of OSAS were enrolled prospectively. International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire-Male LUTS (ICIQ-MLUTS), Overactive Bladder Symptoms Score (OABS-V8), Nocturia Quality of Life (Nqol), voiding diary, International Index of Erectile Function (IIEF-15) questionnaire, and Short form 36 (SF-36) to assess the presence of SD, LUTS, nocturia, and the status of QOL were filled by patients before polysomnography. The same forms were filled in the third month of treatment by the patients directed to CPAP treatment due to moderate and severe OSAS. RESULTS There were significant differences in IPSS, IIEF, OABSS, ICIQ-MLUTS, Nqol and SF-36 scores, frequency of nocturia, and night-time urine volume according to OSAS severity. Among the factors affecting the QOL, there was strong correlation between ED and SF-36 sub-domains compared with the other factors. After CPAP treatment significant changes and improvements on these symptoms and QOL were observed. CONCLUSION In patient with OSAS, the severity of SD and LUTS and their effect on QOL differ according to the severity of OSAS and CPAP treatment improves the negative impact of these conditions on QOL.

The effect of SWL and URS on health-related quality of life in proximal ureteral stones

Abstract Objectives: We aimed to compare the effect of shock wave lithotripsy (SWL) and ureteroscopic lithotripsy (URS) on health-related quality of life (HRQoL) for the treatment of proximal ureteral stones. Material and methods: Between April 2014 and July 2015, patients with proximal ureteral stones who were successfully treated with URS or SWL in seven different centers were included. Patients were divided into two groups according to stone size: stones ≤10 mm and >10 mm. HRQoL subscales which were evaluated by the Medical Outcome Study Short-Form 36-item survey (SF-36) Turkish version were compared for URS and SWL in these two groups one month after the performed procedure. Results: A total of 273 patients were included in the study. While 116 (52.5%) patients were treated with ureteroscopic lithotripsy, SWL was used for 105 (47.5%) patients. Fifty-two patients were excluded from the study. In proximal ureteral stones ≤10 mm, there were no statistically significant differences for any of the eight subscales of the SF-36 questionnaire. Regarding stones >10 mm, it was found that the three subscales of the SF-36 questionnaire – role limitations because of physical health problems (RP), bodily pain (BP), and general health perception (GH) – were significantly lower in the SWL group compared with the URS group. Conclusions: Patients with proximal ureteral stones >10 mm who were treated with URS generally may have a more favorable HRQoL than those treated with SWL in short-term follow-up.

Time-course changes of nLDL-induced erectile dysfunction

Hyperlipidemia is an important risk factor for atherosclerosis and is frequently seen in patients with erectile dysfunction (ED). This study was designed to evaluate whether the acute effect of native low-density lipoprotein (nLDL) on intracavernosal pressure (ICP) is reversible and related to plasma asymmetrical dimethylarginine (ADMA), endogenous inhibition of endothelial nitric oxide synthase (eNOS) levels and eNOS expression in cavernous tissues. Hyperlipidemia was induced by a single dose of intravenous 4 mg kg−1 nLDL. Experiments were performed 72 h (72H), 2 weeks (2W) and 8 weeks (8W) after nLDL injection. Endothelium-dependent relaxations, the ratio of ICP to mean arterial pressure (MAP; ICP/MAP), plasma ADMA levels and eNOS mRNA and protein levels were evaluated. The ICP/MAP ratio decreased in both the 2W and 8W groups. Endothelium-dependent relaxation responses to acetylcholine in the rat thoracic aorta were damaged in the 8W group. Plasma ADMA levels increased in the 8W group. mRNA expression of eNOS decreased in a time-dependent manner, whereas the protein expression increased. These results suggest that acute nLDL injection-induced impairments in erectile functions during an 8-week period are irreversible and might be related to an increase in ADMA levels and changes in the regulation of the eNOS/NO pathway.