Can Tuygun

Will the Modification of the Gleason Grading System Affect the Urology Practice

The aim of the present study was to determine how the modified Gleason grading (mGG) system affects the score discrepancy between needle biopsy (NB) and radical prostatectomy (RP) and to investigate the effect of the modified scores on nomogram predictions. When the conventional Gleason grading (cGG) and mGG systems were compared, a new Gleason score was obtained in the NBs for 40 out of 97 patients (41.2%; P < .001) and in the RP specimens for 15 out of 97 patients (15.5%; P = .005). The agreement between the NBs and RP specimens rose from 31.9% to 44.3% with the mGG system (P = .017). However, when the predictions calculated with the location of modified Gleason scores in the Memorial Sloan Kettering Cancer Center nomogram were compared with those of the conventional Gleason scores, higher pathological stage and lower life expectancy predictions were obtained. Therefore, when a clinician is making a choice from therapeutic options, this change should be taken into account.

Continuous-type splenogonadal fusion associated with an ipsilateral testicular atrophy: Sonographic findings

Splenogonadal fusion is a rare congenital anomaly in which the spleen is abnormally connected to the gonad. Two types of splenogonadal fusion have been described: continuous and discontinuous. Splenogonadal fusion is frequently associated with cryptorchidism and/or congenital orofacial/limb anomalies. We describe the ultrasound findings in a case of continuous‐type splenogonadal fusion associated with ipsilateral testicular atrophy with correlation with MRI.

The unusual mass of retrovesical space: a secondary hydatid cyst disease.

Hydatic cyst of seminal vesicles is very rarely seen. We report a case who complained of the inability to void, which developed progressively with dysuria, frequency, nocturia, and tenesmus, due to a giant retrovesical hydatid cyst that displaced the bladder and rectosigmoid region.

A comparison of two different incisional approaches in the surgical treatment of renal cell carcinomas

Radical nephrectomy is the golden standard in the surgical treatment of renal cell carcinomas. In radical nephrectomy, the type of incision that is preferred is very important for the success of surgery. Within the last 6 years,we operated 76 renal cell carcinoma cases in our department. In these operations, we used either extra peritoneal flank incision (EFI) or transabdominal subcostal incision (TASI). In this study, we decided to compare the effects of these two incisional approaches on the clinical prognosis of the disease. We realized that TASI was our method of choice in tumors with high stage and large diameters. EFI on the other hand, was chosen for the cases with low stage. Both methods did not differ regarding intraoperative and postoperative complications. We concluded that in the treatment of renal cell carcinoma, the type of incision should be chosen according to the clinical picture of the disease and the experience of the surgeon in order for the operation to be successful.

Clinical experiences with different one-staged surgical methods for primary hypospadias cases

The success of various types of operations for primary hypospadias was assessed taking the location of meatus and the degree of chordee as the basis. Totally 258 patients with primary hypospadias were operated: 94 by meatal and urethral advencement, 110 by perimeatal flap and tube repair and 54 by preputial flap.The rates of success in cases with meatal advencement, perimeatal flap and preputial flap were found as 88%, 81% and 66%respectively.The success of treatment in hypospadias cases is closely related to the age of the patient, the experience of the surgeon and the choice of an appropriate method. However, the presence of chordee and the proximally located meatus are among the leading factors that influence the rate of success.

The Prognostic Importance of Prostate-Specific Antigen in Monitoring Patients Undergoing Maximum Androgen Blockage for Metastatic Prostate Cancer

The changes in serum prostate-specific antigen (PSA) concentrations can be used as a prognostic factor in patients undergoing maximum androgen blockage for metastatic prostate cancer. A total of 149 patients followed in our department were classified into 4 groups on the basis of PSA changes: group 1, those with normalisation of PSA levels within the first 3 months; group 2, those with normalisation of PSA between months 3 and 6; group 3, those with a decrease in PSA, but not reaching normal range; group 4, those with no decrease. The gleason scores and the number of bone metastases were also compared between the groups. Again time to progression in patients with Gleason scores 5-7 (grade 2) and over 7 (grade 3) whose PSA levels decreased between first and 3rd months (mean 21.2 months) were significantly longer than the patients with same gleason scores whose PSA levels decreased between 3rd and 6th months (mean 13.4 months) (p < 0.001). The decrease in PSA level is more important than gleason scores in determining the time to progression. Early normalisation of PSA delays the time to progression and when combined with gleason scores, PSA is an important prognostic factor in predicting the success of the therapy.

Is Early Forceps Application Necessary in the Treatment of Distal Ureteral Stone with Dye-Laser and Pneumatic Lithotripsy?

We report the success and complication rates of pulsed dye-laser and pneumatic lithotripsy methods, as well as emphasizing the importance of early forceps application. Materials and Methods We retrospectively evaluated ureterorenoscopy performed in 900 patients, between April 1996 and May 2004, due to distal ureter stones. Following stone fragmentation, patients with stones ≤4 mm in diameter were accepted as stone-free and patients with stones >4 mm had them removed with forceps. Results In the laser treated group, the 1st stone-free rate in patients with a stone diameter ≤4 mm was 56.9%. In this group, when forceps were used in patients after fragmentation, the total stone-free rate increased to 96.8%. Likewise, while the 1st stone-free rate in the pneumatic group was 71.56%, the total stone-free rate increased to 96.73% after forceps application. Conclusion Both success and complication rates were found to be significantly higher in the pneumatic lithotriptor applied group.

Does Tadalafil Increase The Uptake of Finasteride into Prostate Tissue? A Biochemical and Histological Evaluation in Rats

PURPOSEnTo histopathologically and biochemically evaluate the hypothesis that tadalafil increases the uptake of a second medication into the prostate tissue by increasing the blood supply in the prostate.nnnMETHODSnForty 12-week-old Sprague Dawley male rats were equally divided into 5 groups and were administered drugs orally as follows: Group 1 - no drugs, Group 2 - 10 days of finasteride, Group 3 - 10 days of finasteride + tadalafil, Group 4 - 30 days of finasteride, and Group 5 - 30 days of finasteride + tadalafil. At the end of 10 days of drug administration in Group1, 2, and 3, and at the end of 30 days of drug administration in Group 4 and 5,blood samples were collected from rats and analyzed for serum androgen levels. In addition, prostate tissues were removed for histological examination.nnnRESULTSnThe mean DHT level as well as the minimum and maximum epithelial thicknesses in Group 3 were lower than those in Group 2. However, there was no statistical significant difference (P = 0.989, P = 0.176, and P = 0.070, respectively). The mean DHT level as well as the minimum and maximum epithelial thicknesses in Group 5 were lower than those in Group 4. However, there was no statistical significant difference (P = 0.984, P = 0.147, and P= 0.478, respectively). The mean minimum and maximum epithelial thicknesses in Group 3 and Group 4 were not statistically different (P = 0.488 and P = 0.996, respectively).nnnCONCLUSIONnThe similarity of the mean minimum and maximum epithelial thickness in Group 3 and Group 4 may be indicate that the combination therapy provides an early histological effect. However, the fact that there was no statistical significant difference between Group 2 and Group 3, and between Group 4 and Group 5, in terms of the mean DHT level and minimum-maximum epithelial thicknesses suggests that longer term studies with more rats are necessary to test the validity of our hypothesis.