Bulent Altay

Photoselective Potassium Titanyl Phosphate (KTP) Laser Vaporization Versus Transurethral Resection of the Prostate for Prostates Larger Than 70 mL: A Short-Term Prospective Randomized Trial

OBJECTIVES To compare the short term outcomes of photoselective vaporization (PVP) and transurethral resection of the prostate (TURP) for glands larger than 70 mL in a prospective randomized trial. METHODS Seventy-six consecutive patients with enlarged prostatic adenomas of 70 to 100 mL were randomly assigned for surgical treatment with TURP (n = 37) or PVP (n = 39). International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5) scores, maximum flow rates (Qmax), postvoid urine residues (PVR), and transrectal ultrasound (TRUS) volumes were recorded. Operative data, complications, catheter removal, and hospitalization periods were also recorded. Patients were reassessed at 3 and 6 months. RESULTS Baseline characteristics of both groups were similar. Mean preoperative TRUS volume was 88 +/- 9.2 mL in the TURP group and 86.1 +/- 8.8 mL in the PVP group. The procedure was significantly shorter for the TURP group (51 +/- 17.2 minutes versus 87 +/- 18.3 minutes, P <0.05), catheter removal (3.9 +/- 1.2 days and 1.7 +/- 0.8 days, P <0.05), and hospital stay (4.8 +/- 1.2 days versus 2 +/- 0.7 days, P <0.05) were shorter in the PVP group. A significant difference in IPSS, Qmax and PVR values was observed within the follow-up period in favor of the TURP. The percentage volume reduction was significantly higher in TURP group. Reoperation was necessary in 7 patients in PVP but none in TURP group. CONCLUSIONS Although PVP offers advantageous over TURP with regard to intraoperative and perioperative safety, early functional results of TURP are superior to PVP in patients with enlarged prostates larger than 70 mL.

Effect of Being Overweight on Stone-Forming Risk Factors

OBJECTIVES To evaluate the possible role of being overweight on stone-forming risk factors. METHODS A total of 264 patients were included in the study. After a detailed stone disease history, the systolic and diastolic blood pressure was precisely measured and recorded for all patients, and the body mass index, 24-hour urine composition, and serum stone-forming risk parameters were evaluated in overweight (n = 164; 52 men and 112 women; group 1) and normal (n = 100; 44 men and 56 women, group 2) patients. Of the 264 patients, 110 were men and 154 were women (male/female ratio 1:1.4); none had undergone any medical or dietetic treatment before study entry. RESULTS The evaluation of the stone-forming risk factors in both groups revealed that obesity increased the excretion of these substances in group 1. Of the 164 patients in group 1, most (58; 35.3%) demonstrated hyperoxaluria compared with group 2 (P <0.001). Also, the mean urinary oxalate level was 44.91 +/- 24.89 mg/24 hours in group 1 and was 26.67 +/- 24.59 mg/24 hours in group 2 (P <0.001). Similarly, patients in group 1 had elevated mean urinary calcium excretion and lower citrate excretion compared with those in group 2 (P = 0.045 and P = 0.032, respectively). CONCLUSIONS Our results have clearly shown that being overweight might be associated with an elevated risk of stone formation in both sexes owing to alterations in urine composition. People who are overweight could be more prone to stone formation and should be carefully evaluated and followed up regarding this aspect.

Evaluation of urinary oxalate levels in patients receiving gastrointestinal lipase inhibitor.

Objective: The purpose of this study was to examine the possible effects of a gastrointestinal lipase inhibitor “Orlistat (Xenical)” on the intestinal absorption of oxalate and thereby on the urinary levels of oxalate excretion in overweight patients.

A comparison of 120 W laser photoselective vaporization versus transurethral resection of the prostate for bladder outlet obstruction by prostate cancer.

Objective: To compare the mid-term outcomes of photoselective vaporization of prostate (PVP) with GreenLight HPS 120 W laser and transurethral resection of the prostate (TURP) for obstructive lower urinary tract symptoms (LUTS) in men with prostate cancer (CaP). Patients and Methods: Seventy four patients with locally advanced (T3/T4) CaP with severe LUTS or acute urinary retention (AUR) were allocated to TURP (n = 36) or PVP (n = 38). International Prostate Symptom Scores (IPSS), maximum flow rates (Qmax) and post-void residual volumes (Vres), PSA levels, prostate volumes, complications, catheter removal and hospitalization periods were recorded. Patients were reassessed at 3, 6, and 12 months. Results: The catheter removal time was significantly longer in the TURP group (3.8 ± 1.1 vs. 1.2 ± 0.7 days, p = 0.02), whereas failure of initial voiding trial was higher in PVP (2.7 vs. 13.1%, p = 0.01). No significant difference in IPSS, Qmax and Vres values was observed within the follow-up period between two groups. A significant difference in urethral stricture rate (8.3 vs. 0%), catheter removal time (3.8 ± 11 vs. 1.2 ± 0.7 days) and hospital stay (2.9 ± 0.6 vs. 1.1 ± 0.5 days) was observed in favor of PVP. Conclusions: Palliative PVP is very safe and effective by means of symptomatic relief in patients with locally advanced CaP.

Double-Blind, Placebo-Controlled, Randomized Clinical Trial of Sublingual or Intramuscular Piroxicam in the Treatment of Renal Colic

Aims: To investigate the therapeutic effect of the fast-dissolving dosage form (FDDF) of sublingual piroxicam on renal colic compared with the intramuscular (IM) injection form of the same agent in a randomized, double-blind, placebo-controlled clinical trial. Methods: 80 patients were assigned to one of two treatment groups: Group 1 received 40 mg piroxicam FDDF sublingual tablets and IM injection of 2 ml distilled water. Group 2 received an IM injection of 40 mg piroxicam and two sublingual tablets of placebo. At baseline and 30 min after the medication, vital signs were recorded and the pain intensity was evaluated by the patient using a numeric rating scale. Results: The overall efficacy of the treatment was 90%. There was no significant difference with respect to the required rescue treatment (p = 0.328), pain relapse within 24 h (p = 0.434) and the decrease in vital signs and numeric rating scale in both groups (p > 0.05). Conclusion: The piroxicam FDDF tablet was found to be as effective as the IM injection form of the same agent in the treatment of renal colic. The FDDF is a good alternative to the parenteral form because of its earlier onset of action and ease of self-administration which increases patient compliance.

Operative Failure during Ureteroscopic Pneumatic Lithotripsy: Factors Affecting Successful Outcome

Aim: We aimed to evaluate the predictive factors that would in turn indicate stone migration and the effects of these factors on the ultimate success of the intervention. Method: Patients were divided into two groups with respect to the migration of the stone treated. Group I: patients demonstrating stone migration during manipulation; group II: no migration of the stones noted. In the second phase of the study, the results of ureteroscopic management in 433 patients were evaluated with respect to the success rates obtained. Parameters such as stone size, stone burden, experience of the surgeon, length of the ureter proximal to the stone treated, and lastly transverse diameter of the ureter were noted in all patients as possible risk factors for stone migration. Results: Statistical analysis of ureteroscopic success in all patients revealed that there was a meaningful correlation with respect to the length of the proximal ureteral portion (p < 0.0001) and surgeon’s experience (p = 0.004). p value for the correlation between stone burden and operative success was 0.056. There was no significant correlation between stone size (p = 0.51), ureter diameter (p = 0.78), and operative success. Conclusion: Stones that are close to the renal pelvis and treated by inexperienced physicians are the ones most likely to migrate to the renal pelvis during manipulation with pneumatic lithotripsy.

The All-Seeing Needle Instead of the Veress Needle in Pediatric Urologic Laparoscopy

PURPOSE To investigate the feasibility of the all-seeing needle for safe entry and creation of pneumoperitoneum in pediatric urologic laparoscopy. PATIENTS AND METHODS A total of 14 children underwent various transperitoneal urologic laparoscopic procedures. The all-seeing needle, which is 4.85F in diameter, was used for safe entry into the abdominal cavity at the site of the umblicus in all cases. The microoptic was integrated with the light system and connected via a zoom ocular enabling direct visualization of the layers between the skin and the peritoneal cavity. Once the intraperitoneal access was obtained, CO2 pneumoperitoneum was created from one port of the three-way connector attached to the proximal part of the needle. Then the laparoscopic trocars were placed under vision of the microoptical system. RESULTS Mean age of the children was 4.5 ± 2.9 years. In all children, the all-seeing needle was safely introduced into the abdominal cavity under direct vision. Then, CO2 pneumoperitoneum was succesfully performed. The mean time for optical puncture was calculated as 1.1 ± 0.8 minutes. No complication was encountered during the introduction of the needle, creation of the pneumoperitoneum, and placement of the trocars. CONCLUSIONS The all-seeing needle appears to be beneficial in safe entry and for creating pneumoperitoneum in laparoscopic pediatric urology cases. It eliminates the disadvantages of the Veress needle, which is blunt insertion, and may possibly prevent complications.

A rare complication of ureteral double-J stenting after flexible ureteroscopy: renal parenchymal perforation

Double-j (DJ) ureteral stenting is a very common procedure performed after various endourological procedures. Although several complications due to DJ stent insertion were revealed, only three cases of renal parenchymal perforation have been reported to date. We present a case of a 35-year-old woman who had perforation of renal parenchyma without perirenal hematoma following insertion of DJ ureteral stent after flexible ureteroscopy for the treatment of an upper ureteral calculi. Non-contrast computed tomography was used for diagnosis. Patient was successfully managed with repositioning of the stent under fluoroscopic guidance on postoperative second day postoperatively.

Effect of Acute Alcohol Intake on Prostate Tissue and Serum PSA-Like Protein Levels in Rats

Objective: To investigate both the possible changes induced by acute alcohol intake on prostate tissue at the ultrastructural level and its effect on serum prostate-specific-antigen (PSA)-like protein levels in rats. Materials and Methods: 44 male Wistar rats were included in the study in four separate groups; 7 treatment and 4 control animals were selected for each group. The treatment group received 40% ethanol (6 g/kg) while the control group was injected with the same dose of intraperitoneal isotonic saline. The first group was sacrificed after 3 h, the second group after 24 h, the third group after 72 h and the fourth group on day 7. Samples were examined by light and Jeol-100 electron microscope. Total serum PSA-like protein levels were determined by a Tosoh immunoenzymometric analyzer AIA 600. Results: In groups 1–3, electron microscopy showed dilatations in the endoplasmic reticulum cisternae of prostatic acinar cells, disarrangements in apparent Golgi complex and apertures belonging to the basal labyrinth. It was also observed that there was a mass of debris cells inside the acinar lumen, and the secretory epithelium was detached from the basal membrane in some places. No pathology was found in group 4 by light and electron microscopy. In group 1, significant levels of increased serum total PSA-like protein were found compared to controls and other treatment groups (p = 0.006). Conclusions: The fundamental effect of acute alcohol intake on prostate tissue was observed in intermediate stages participating in the exocrine secretion process in the cellular organelles. At the same time, this influences the levels of serum PSA-like protein.

Impact of obesity on functional and oncological outcomes in radical perineal prostatectomy

INTRODUCTION We evaluated the impact of obesity on perioperative morbidity, functional, and oncological outcomes after radical perineal prostatectomy (RPP). METHODS A total of 298 consecutive patients underwent RPP at our institution. Patients were categorized into 3 groups based on their body mass index (BMI): Normal weight <25 kg/m(2) (Group 1), overweight 25 to <30 kg/m(2) (Group 2), and obese ≥30 kg/m(2) (Group 3). We compared the groups with respect to perioperative data, postoperative oncologic, and functional outcomes. Evaluation of urinary continence and erectile function was performed using a patient-reported questionnaire and the International Index of Erectile Function-5 questionnaire, respectively, administered preoperatively and at 3, 6, and 12 months. Limitations included short follow-up time, retrospective design and lack of a morbidly obese group. RESULTS No significant differences were found among the 3 groups with regard to operative time, estimated blood loss, length of hospital stay, catheter removal time, positive surgical margin, and complication rates. At 12 months, 94.7%, 95% and 95% of normal, overweight and obese patients, respectively, were continent (free of pad use) (p = 0.81). At 12 months, 30.6%, 29.8% and 30.4% of patients had spontaneous erections and were able to penetrate and complete intercourse in Group 1, Group 2, and Group 3, respectively (p = 0.63). CONCLUSIONS In this cohort of patients, no clinically relevant risks were associated with increasing BMI.