Coşkun Büyüksu

Serum lipid levels in benign prostatic hyperplasia

The relationship between serum lipid levels and measures of benign prostatic hyperplasia was investigated. The study was community based. All the participants had undergone a urological investigation which included International Prostate Symptom Score (I-PSS) and Quality of Life Score (QoL), serum lipid concentrations and determination of prostate volume with transrectal ultrasonography. Body mass index was calculated with the formula of weight (kg)/surface area (m2) respectively. Men were considered obese if their body mass index was over 25xa0kg/m2. BPH was defined by prostate volume greater than 20xa0ml and I-PSS greater than seven. Comparisons of serum lipid levels between men with BPH and without BPH were done. There was no correlation for serum lipid levels with either mean I-PSS and QoL scores. However, triglyceride and cholesterol levels were the lowest in severe symptomatic men than men with low symptoms. Using clinical definition of BPH that prostate volume was greater than 20xa0ml and I-PSS was greater than seven, men with BPH had not significantly different serum lipid levels from men without BPH. Our population-based data reflect that there was no relationship between serum lipid levels and certain physiological measures of lower urinary tract symptoms and clinical benign prostatic hyperplasia.

Does asymptomatic inflammation increase PSA? A histopathological study comparing benign and malignant tissue biopsy specimens.

Aim: To determine the effect of inflammation on postage-specific antigen (PSA) levels in patients who were performed transrectal ultrasonography (TRUSG) guided prostate biopsy because of high PSA levels. Materials and method: 376 tissue specimens of 47 patients with BPH and 176 tissue specimens of 22 patients with prostate adenocancer were analysed histopathologically. Digital rectal examination, TRUSG, and PSA measurements were performed to all the patients before biopsy. Sextant biopsy was performed. Two pathologists examined all the biopsy specimens in blinded fashion. Inflammation pattern was categorized as glandular, periglandular, stromal and perivascular and intensity of inflammation graded from 1 to 3. Results: The mean age of the patients was 66.2 years. The mean serum PSA level of the initial biopsy was 8.7 ng/ml in the BPH and 13.4 ng/ml in the prostate Ca. No relation was found between the serum total PSA levels and prostate volume or patient’s age in BPH patients (P=0.258). In BPH patients stromal, periglandular, glandular inflammations did not increase PSA levels. Perivascular inflammation increased PSA levels significantly. Conclusion: The inflammation in perivascular field increases serum PSA levels (P=0.007). Although high serum PSA levels shows correlation with cancer in biopsy, there is no such significant relation with rebiopsy results and PSA levels at last studies. Because of this, these patients’ biopsy samples must be reinspected for infection findings and atipic biopsy or high grade PIN. The result of our study showed that histological perivascular infection within the prostatic gland is a significant factor to serum PSA levels in BPH. If you have negative biopsy sample, pathology must indicate the place of the infection. Follow up of this patient and rebiopsy time are decided according to the result of this negative biopsy sample.

Comparison of the nuclear matrix protein 22 with voided urine cytology in the diagnosis of transitional cell carcinoma of the bladder

Several urinary markers for transitional cell carcinoma have been investigated, including urine cytology, bladder tumor antigen, autocrine motility factor receptor and fibrin degradation products. Unfortunately, they have poor overall sensitivity. The United States Food and Drug Administration have recently approved nuclear matrix protein (NMP 22) for the detection of occult or rapidly recurring disease after transurethral resection of bladder tumor. The objective of the current study was to assess the sensitivity of NMP 22 for the detection of bladder carcinoma, as well as to correlate the NMP 22 values with multiplicity of tumor, tumor size, configuration, stage and grade respectively. A total of 78 patients (38 with bladder cancer) provided a urine sample which was divided into appropriate aliquots for each of urine cytology and NMP 22. Comparative results demonstrate a clear superiority of NMP 22 in bladder cancer detection (52.6% vs 31.6% sensitivity), while specificity was in favor of urine cytology (100% vs 82.5%). For superficial tumors, sensitivity was 78.5% for NMP 22 and 41.6% for cytology and for invasive cancers, sensitivity was 90% for NMP 22 and 60% for cytology. Urinary NMP 22 levels were significantly correlated with tumor grade and were significantly higher in large tumors than small tumors. NMP 22 test results showed sufficient sensitivity in comparison with urine cytology for the detection of transitional cell carcinoma. However, we do not think that it is a useful tool as a substitute for endoscopic examination for the detection and surveillance in bladder cancer.

Effect of long-term alcohol abuse on male sexual function and serum gonadal hormone levels

PurposeThe relationship between chronic alcohol abuse and male sexual dysfunction and pituitary gonadal function abnormalities remains uncertain. The purpose of this study was to assess the effect of chronic alcoholism on sexual functions and serum hormone levels.Materials and methodsForty-five chronically alcoholic men and a control group of thirty healthy non-alcoholic, volunteers were enrolled in the study. Each of the men in the study and control group were interviewed according to a sexual dysfunction questionnaire by an urologist. Blood samples were collected for evaluation of hormone levels. Sera were stored at-70°C for analysis.ResultsThe sexual desire and erection scores of alcoholic men were not statistically different from those of the control group. Fourteen out of the 45 alcoholic men complained of loss of erection during sexual activity. No significant difference in hormone levels between groups was found except for FSH.ConclusionIn the absence of hepatic and gonadal failure in chronically alcoholic men, there is no significant difference in serum hormonal levels, sexual dysfunction form, and sexual functions between alcoholics and normal healthy nonalcoholic men.

A relationship of sex hormone levels and erectile dysfunction: which tests should be done routinely?

Purpose In this study, the relationship between sex hormone levels and erectile dysfunction (ED), as well as the necessity of routinely measuring sex hormone levels were evaluated. Materials and Methods This study included one hundred patients admitted to a urology clinic for sexual dysfunction. To determine the hormone levels, following the history (included IIEF-5 score) and physical examination, triple blood samples were collected at intervals of 15 minutes between 08:00 and 10:00 am. Total and free testosterone, prolactin, follicle stimulating hormone and luteinizing hormone levels were studied. Results Mean age was 43 (23 - 80) years. IIEF-5 score was less than 21 [9.8 - 4.3 (3 - 19)] in all study groups. There was a statistically significant correlation between tT and FSH, as well as between LH and FSH in Pearson (r = - 0.513, p < 0.001, respectively) and also in Spearman tests (r = - 0.224, p = 0.042 and r = - 0.459, p < 0.001, respectively). However, there was no correlation between age and serum hormone levels (p > 0.05). Of the 100 patients, 18 (18%) had low tT, 77 (77%) had normal and 5 (5%) had high tT levels. No statistically significant correlation was found between decreased libido and tT levels (p > 0.05). Twelve (66.6%) of the 18 patients with low tT had normal libido. Conclusion Analyzing the medical history in detail and performing a thorough physical examination can reduce the need for excessive studies and consultations, and enables patients to save time and costs.

Population standards of prostate specific antigen values in men over 40: community based study in Turkey.

Objective: To determine the prostate specific antigen (PSA) population standards of a cluster of Turkish men with no clinical evidence of prostate cancer. Patients and methods: We evaluated PSA values of the men who were living in a well-defined, rural district of Western Anatolia. Two hundred fifty-seven men agreed to participate in this population-based study. They underwent clinical examination, transrectal ultrasonography and serum PSA measurement. The association between serum PSA and age, prostate volume and age, PSA and prostate volume, and PSA density (PSAD) and age were assessed. Distributions of serum PSA levels, prostate volumes (PV), and PSAD values as a function of age were generated. Results: The upper limit of normal PSA concentration were 4.51xa0ng/ml for men aged 40–49xa0years, 4.36xa0ng/ml for 50–59xa0years, 6.17xa0ng/ml for 60–69xa0years, and 10.18xa0ng/ml for over 70xa0years. The upper limit of normal (95th percentile) for the serum PSA concentration increased with age. Across the entire age range, no correlation was found between the serum PSA concentrations and age while significant correlation was found between serum PSA concentration and prostate volume. Conclusion: In this present study, the PSA values in different age intervals showed higher than those observed in previous studies. The PSA values are mainly affected by prostate volume rather than age.

The diagnostic value of the phosphate levels in serum and 24-hour urine samples in patients with recurrent renal stone disease.

Objective: The aim of this study is to investigate the value of phosphate levels in serum and urine in patients with recurrent renal stone disease. Materials and methods: The patients (n:60) were divided into two groups as first-time stone disease (group 1) and recurrent renal stone disease (group 2). The demographical datas and their historical information were recorded and physical examination was done. The sera and urine for 24 hr were obtained from patients to measure electrolyte levels especially phosphorus. In addition, based on presenting serum phosphate levels, patients were divided into the hypophosphatemia group, less than 2.5 mg/dl; normophosphatemia group, between 2.5-5.2 mg/dl; and hyperphosphatemia group greater than 5.2 mg/dl. Results: The mean age of study group was 45 (21-70) years. Thirty-six patients (60%) were in group 1 and 24 patients (40%) were in group 2. No statistically correlation was found between stone recurrence and phosphate levels both in serum and urine. There was only a statistical association of K levels in 24-hour urine samples between group 1 and 2. Conclusion: There was no significant association between stone recurrence and initial phosphate levels in the serum or in urine. We do not propose to determine phosphate levels routinely in management of patients with stone disease.

The effects of extensive vas mobilization on testicular histology during orchiopexy.

We were aware that extensive mobilization of vas deferens during orchiopexy could cause secondary infertility due to testicular damage and/or functional obstruction of the vas deferens. We decided to perform this experimental study in order to document the effects of this procedure on the testis.Thirty adult fertility-proven New Zealand white rabbits were randomly divided into 3 groups. Ten rabits underwent extensive mobilization of the vas deferens and the other 10 rabbits had vasectomy on the left side. The remaining 10 rabits were explored on the left side only and were considered sham controls.Four weeks later all rabbits underwent bilateral orchiectomy. Mean seminiferous tubular diameters and Johnsens testicular biopsy scores were noted.Comparison of the three groups showed that vas mobilization and vasectomies cause no effect on the viability of testis, however, significant testicular histological changes, which were different from the controls and contralateral testis, were observed.We concluded that during any surgical intervention involving the inguinal canal, vascular and neural supports of the vas deferens should be preserved as much as possible in order to avoid iatrogenic damages to the testis.

Testicular Sperm Retrieval Method: Histological Effects of Location of Incision

This research was conducted to evaluate the effects of a transverse vs. longitudinal incision for testicular sperm retrieval. Rats were divided into 4 groups: I: control, II: sham operation, III: longitudinal incision TSRM, IV: transverse incision TSRM. Group II (sham operation) had a dissection of left testis/spermatic cord, then closure of wound. Group III underwent dissection of left testis, then a “longitudinal” incision (15 mm long) of testis, which was fully opened then closed again and sutured with 5-0 Vicryl® sutures. Group IV underwent dissection of the left testis, opening of the testis with a “transverse” incision, then closure with 5-0 Vicryl®. The seminiferous tubule diameter was 0.118–0.224 mm in all groups. Inflammation and abscess formation occurred in one testis each in the sham and longitudinal incision groups, and in two testes in the transverse incision group. There were no differences in histopathology or scoring between the longitudinal and the transverse incision.

Is it necessary to use sexual health inventory for men (SHIM) routinely

This study was conducted to evaluate the prevalence of erectile dysfunction (ED) according to the Sexual Health Inventory for Men (SHIM) and its relationship with age and education. Six hundred and thirty-nine male patients aged ≥20 years attending a urology clinic were studied. After a detailed history and physical examination, all patients were evaluated with SHIM. Scores were categorized into 5 groups: severe (1–7), moderate (8–11), mild-moderate (12–16), mild (17–21) and normal (22–25). The patients were classified into three groups according to their application to the urology clinic: A - patients attending specifically for ED; B - patients not ED based on SHIM and attending not for ED; C - patients ED based on SHIM, but attending not for ED. In addition, patients were partitioned into 3 age groups according to their age: 20–35, 35–55 and >55 years. Educational levels were of 2 groups: lower education and higher education. Erectile dysfunction was determined in 3.7% in the 20–35 years group, 55% in 35–55 years and 41% in >55 years (P < 0.01). In men having ED through SHIM and attending not for ED, the ratio of ED was higher in the lower education than in the higher education groups (p = 0.01). SHIM is a diagnostic tool used for ED, and routine application of SHIM for patients attending the urology clinic is advisable.