Demokan Erol

Effect of intraurethral Mitomycin‐C on healing and fibrosis in rats with experimentally induced urethral stricture

Abstract  Background:  In the pathogenesis of urethral stricture, fibrosis is associated with an excessive collagen increase. After the recognition that topical application of Mitomycin‐C (MMC) inhibits fibroblast proliferation and is effective in preventing scar formation, many studies have been carried out on this subject outside the scope of urology. The aim of the present study is to observe the intraurethral impact of the employment of low doses of MMC on scar formation and fibrosis in experimental rat model.

Effects of the 5α-Reductase Inhibitor Finasteride on Serum Levels of Gonadal, Adrenal, and Hypophyseal Hormones and its Clinical Significance: A Prospective Clinical Study

Abstract In the present study, we investigated the effects of a steroid 5α-reductase inhibitor, finasteride, when given orally (5 mg/day), on the serum levels of gonadal, hypophyseal, and adrenal hormones and the clinical significance of these effects. Forty-eight patients with a mean age of 63 (range 49–81) were included in the study. All patients had symptoms of benign prostatic hyperplasia. Serum levels of testosterone, dihydrotestosterone, follicle-stimulating hormone (FSH) luteinizing hormone (LH), prolactin, aldosterone, cortisol, and dehydroepiandrosterone were determined before the study. The degree of symptoms in each patient and serum prostate specific antigen levels were determined together with uroflowmetric studies. Sexual status of the patients was also assessed with a self-administered questionnaire. All patients received finasteride, 5 mg/day, for 6 weeks. All of the above mentioned studies were repeated at month 3 and month 6. All of the patients had baseline hormonal values within the normal range. At month 3, the dihydrotestosterone level decreased by 60%, while the testosterone level increased by 15%. FSH and LH levels decreased by 24% and 16%, respectively. The changes in the serum levels of these hormones were further evident at month 6. No significant changes were noted in the serum levels of prolactin, aldosterone, cortisol, and dehydroepiandrosterone. Thirty-six patients (75%) were judged to be potent before the treatment. Finasteride caused erectile dysfunction in 8 patients (22%) by month 3 and in 12 (33%) by month 6. A substantial improvement was noted in symptoms of benign prostatic hyperplasia in all patients. The serum prostate specific antigen level decreased by 42% and 50% at month 3 and at month 6, respectively. Continued administration of finasteride, 5 mg/day alters the serum levels of testosterone, dihydrotestosterone, FSH, and LH significantly. Finasteride also causes sexual dysfunction in a substantial number of patients and should be offered with caution to patients who have an active sexual life.

13 Years' Experience of Penile Fracture

Thirty-two cases of penile fracture in 1983-1996 were retrospectively reviewed and the patients were recalled for assessment of current status. The time from injury to repair ranged from 8 to 31 hours. The tear in the tunica albuginea was repaired with absorbable interrupted sutures. All patients were discharged on the day after operation. Skin loss required dermal grafting one month postoperatively in one patient. Erectile function returned within 2 days and coitus was achieved on average 13 days after the repair. Two patients had slight penile curvature which did not impede coitus. At long-term follow-up all patients reported satisfactory function.

Analysis of meatal location in 1,244 healthy men. Definition of the normal site justifies the need for meatal advancement in pediatric anterior hypospadias cases.

Abstract The normal site of the external urethral meatus on the glans penis and the need for meatal advancement in patients with anterior hypospadias was studied. The location of the external meatus was analyzed in 1,244 men (mean age 28 years) with classification of the meatal position in relation to the tip of the glans and corona. The quality of erections and sexual intercourse, the presence of a penile curvature, urinary stream, and ability to void in a standing position were assessed in an interview. In 1,198 men (96.3%) the meatus was located on the distal third of the glans, in 43 (3.5%) on the middle third, (B), and in 3 (0.2%) on the posterior third. In no case was it located below the corona. One of the 3 men with the meatus on the posterior third had an associated mild penile curvature that did not cause difficulty in sexual intercourse. This study suggests that the normal site of the external meatus is at the tip of the glans. The definition of the normal site and the percentage of men with a normal meatal position justifies the need for meatal advancement in patients with anterior hypospadias when the goals of current hypospadias surgery are considered.

Factors affecting outcome of one-stage anterior hypospadias repair: analysis of 422 cases.

Abstract The repair of hypospadias is among the most difficult problems in urology, as it demands the construction of a well-functioning urethra and a good cosmetic appearance. We performed a retrospective analysis of 422 cases subjected to one-stage anterior hypospadias repair between 1982 and 1999 in our clinic and investigated the effects of factors like degree of hypospadias, surgical technique, and the surgeons experience on outcome. The operations used were MAGPI (91), urethral advancement (10), Mathieu (260), modified Allen-Spence (50), onlay island flap (5), and double-faced island flap (6) procedures. The early complication rate was 18%, while the final success rate following secondary interventions was 95%. The complications included fistula formation in 49 cases (12%), flap necrosis in 12 (3%), meatal problems in 12 (3%), residual chordee in 4 (1%), and urethral stricture in 1 (<1%). Complication rates were significantly higher if the meatus was proximal or there was severe chordee and in the first 6 years of the study. The flap procedures were associated with a higher complication rate. It is concluded that one-stage procedures are successful in the repair of anterior hypospadias in experienced hands with proper patient selection.

Effect of transurethral indwelling catheter on serum prostate-specific antigen level in benign prostatic hyperplasia

OBJECTIVES The purpose of this prospective study was to determine the influence of indwelling transurethral catheters on the serum prostate-specific antigen (PSA) levels in patients with benign prostatic hyperplasia (BPH). We compared the PSA values of preoperatively catheterized and noncatheterized patients. METHODS Ninety patients undergoing a prostatectomy for benign disease were included. The indwelling catheter (IC) group and noncatheterized (NC) group each consisted of 45 patients. A total of 83 patients who did not have prostate carcinoma were analyzed by means of PSA, PSA density (PSAD), and pathologic presentations. Prostate pathologies that might elevate PSA values were excluded to demonstrate the correlation of PSA levels and standard urethral catheterization. RESULTS A statistically significant relationship was determined between an indwelling urethral catheter and an elevated serum PSA value. The average PSA level of the IC group was 2.6 times that of the NC group. CONCLUSIONS PSA, PSAD, and age-adjusted PSA levels were elevated above normal ranges in patients with BPH who had an indwelling urethral catheter.

Serum concentrations of sex hormones in men with severe lower urinary tract symptoms and benign prostatic hyperplasia.

Objective: To find out the impact ofage-related changes in serum concentrations ofsex hormones on the development of severe lowerurinary tract symptoms and benign prostatichyperplasia (BPH).Patients and methods: The study groupconsisted of 61 consecutive patients subjectedto prostatectomy for BPH between 2000–2001 inour clinic. Forty-five randomly assigned, ageand socioeconomically matched cases without any lower urinary tract symptoms were taken asthe control group. Both clinical BPH andcontrol groups were divided to 3 age groups(namely 50–59, 60–69 and ≥70 years) andage-related changes in serum concentrations ofsex hormones were investigated.Results: Prostate adenoma weight was foundto be increased significantly (p = 0.02) withadvancing age in clinical BPH group. There wasno difference between serum concentrations ofmeasured sex hormones between small and largeprostates except for serum estradiol levels,which were found to be significantly higher inpatients who had an adenoma weight of >50 g(p = 0.047). Similar results were obtained inboth clinical BPH and control groups withrespect to age-related changes in serumconcentrations of sex hormones. Briefly therewas an age-related decrease in serum freetestosterone levels and increase in serumestradiol, prolactin and gonadotropin levels.Serum free testosterone concentration wassignificantly higher in the control group forages 60–69 (p = 0.015) while total testosteronewas higher in BPH patients for patients olderthan 70 years of age(p = 0.027). No othersignificant change was documented between 2groups. An age-dependent increase in serumE/freeT ratio was documented in both clinicalBPH and control patients whereas serum freeT/Tratio was decreased in the BPH group withadvancing age (p = 0.008).Conclusion: The decrease in serum freetestosterone concentrations with a relativerise in serum estradiol levels with advancingage might be an important factor in thedevelopment of BPH. However it is likely thatserum concentrations of sex hormones playlittle impact on the clinical severity ofBPH.

An unusual cause of urinary retention: a primary retrovesical echinococcal cyst

We present a patient with symptoms of frequency, a mild decrease in urinary stream, and urinary retention due to a huge hydatid cyst located in the retrovesical region. Chest radiography and abdominal computed tomography did not reveal any other site of hydatid disease involvement. Since the cyst was in intimate contact with the seminal vesicles and the vasa deferentia, part of the hydatid sac wall adherent to these structures was left behind during the surgical excision. The patient was free of voiding symptoms, and no other episode of urinary retention had occurred at 6 months of follow-up. Pelvic computed tomography did not reveal recurrence of hydatid disease at 6 months postoperatively.

Lessons from 197 Mathieu hypospadias repairs performed at a single institution

Abstract Over a 15-year period, 197 Mathieu hypospadias repairs were performed at our institution. The present study reports our experience with this operation with an analysis of factors associated with unfavorable results. Cosmetic results were either excellent or satisfactory in all but 4 cases (2%). Overall, 42 patients (21%) voided with a fistula. A history of a previous operation, flap length, type and structure of the suture, suturing technique, existence of chordee and torsion, and circumcision status were analyzed as prognostic factors. Fifteen years were divided into three equal time intervals, and the success rates of these intervals were also compared. The length of the flap, (< vs ≥20 mm), suture structure (monofilament versus multifilament), and suture type (6-0 vs 5-0) were found to be factors with a significant influence on success rates (P < 0.05). The fistula rates of the three 5-year intervals were 52%, 28%, and 11%, respectively. The difference between time periods was also significant (P < 0.01). On multivariate analysis, only the difference between time intervals remained significant. The present analysis suggests that experience could be considered the most important factor affecting the success rate of hypospadias surgery. We recommend not changing the type of operation so often that not enough experience can be gained. The best results can be achieved in the most experienced hands.

Isolated renal and retroperitoneal hydatid cysts

Four patients (3 male, 1 female) with isolated renal and 1 female patient with isolated retroperitoneal cysts were reviewed. The mean age of the patients was 46 (25–64). The most common presenting symptom was pain. Two cases were discovered incidentally by the observance of renal calcification onabdominal x-ray. Indirect hemagglutination test was positive in all cases but eosinophilia was present only in 1 (20%) case. Nephrectomy was performed to 1 patient who presented with hydaturia and had a large communicating cyst involving most of the kidney. Total cystectomy was performed in other renal cysts. Total cystectomy with wide excision of the involved muscle was performed to the retroperitoneal hydatid cyst.Patients were followed by an average of 23.8 (9–50) months with indirect hemagglutination test and USG. No evidence for recurrence was found up to date.