Emin Aydur

Management of Abnormal Postvoid Residual Urine in Children With Dysfunctional Voiding

OBJECTIVES To evaluate the effect of biofeedback therapy on the residual urine volume in children with dysfunctional voiding. METHODS This prospective study was conducted in children with dysfunctional voiding associated with abnormal postvoid residual urine (PVR) from June 2002 to 2007. The children were divided randomly into 2 groups. Group 1 was treated with standard urotherapy combined with biofeedback therapy and group 2 was treated with only standard urotherapy. The outcomes of uroflow-electromyography pattern, urinary tract infection (UTI), and PVR were recorded before and at the end of sixth month of treatment. RESULTS A total of 94 patients were enrolled in this study. Groups 1 and 2 consisted of 62 and 32 patients, respectively. The voiding pattern became normal in 80.6% (50/62) and 56.2% (18/32) of patients in groups 1 and 2, respectively. The PVR resolved in 40 of 62 (64.5%) patients in group 1 and in 11 of 32 (34.4%) children in group 2. Before the treatment, UTI was noted in 22.5% of patients (14/62) in group 1 and 21.8% of patients (7/32) in group 2. After the treatment, UTI was observed in 3.2% of patients (2/62) and in 9.3% (3/32) of patients in groups 1 and 2, respectively. Although both treatment modalities changed the voiding pattern, rate of febrile UTI, and PVR positively, these outcomes were better in a combination group. CONCLUSIONS The combination of standard urotherapy with the biofeedback therapy improved the results significantly.

Fibroepithelial polyp originating from the glans penis in a child

Abstract A fibroepithelial polyp is a benign neoplasm that occurs throughout the urinary tract. In this article, we report a pediatric case of a fibroepithelial polyp originating from the glans penis. To our knowledge, this is a previously unreported lesion arising from the glans penis.

Proteasome inhibitor bortezomib increases radiation sensitivity in androgen independent human prostate cancer cells.

OBJECTIVES To investigate the effects of a strong proteasome inhibitor, bortezomib alone or in combination with radiotherapy on androgen-independent DU145 human prostate cancer cells. Proteasomes play important roles in cell cycle, proliferation, apoptosis, angiogenesis, and cellular resistance to chemotherapy and radiotherapy. METHODS Increasing concentrations of bortezomib alone or in combination with radiation were applied to DU145 cells and IC(50) values that inhibited cell growth by 50% were determined by 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyltetrazolium-bromide assay. Apoptosis was determined using annexin V staining by flow cytometry. mRNA levels of proapoptotic caspase-3 and antiapoptotic Bcl-2 genes were examined by reverse transcriptase polymerase chain reaction. RESULTS The IC(50) value of bortezomib was found to be 28 microm although 400- and 800-cGy radiation decreased the cell proliferation by 14% and 28%, respectively. In 400- and 800-cGy radiation applied DU145 cells, IC(50) value of bortezomib decreased to 23- and 12 microm, respectively. Exposure to 5 microm bortezomib for 48 hours caused apoptosis in 35% of the population whereas 800-cGy radiation resulted apoptosis in 14% of cells. However, 42% of DU145 cells that were exposed to 800 cGy and 5 microm bortezomib underwent apoptosis. Reverse transcriptase polymerase chain reaction results showed a significant decrease in mRNA levels of antiapoptotic Bcl-2 gene and an increase in proapoptotic caspase-3 gene expression in the combination group compared to control group. CONCLUSIONS Bortezomib increases radiation sensitivity in androgen-independent human DU145 prostate cancer cells through inhibition of Bcl-2 and induction of caspase-3 genes.

Accessory scrotum attached to a perineal lipoma in an adult male

Abstract Accessory scrotum is a condition in which a scrotum is located in the perineal region, in addition to the presence of normally located primary scrotum, testes and penis. The condition is extremely rare and the majority of reported cases have been diagnosed in infants. Herein, we present a case of accessory scrotum attached to a perineal lipoma in a 40‐year‐old man. The perineal mass was present at birth and grew very slowly over the years. There were no other congenital abnormalities or problems related to this anomaly. The case was easily managed by complete excision of the accessory scrotum and perineal lipoma. Gross and microscopic examination of the surgical specimen revealed an accessory scrotum attached to an encapsulated perineal lipoma. The present case demonstrates an adult prognosis of a patient born with this type of abnormality. To our knowledge, it is the first case of its kind to be reported in the literature.

How To Manage Acute Urethral False Passage Due To Intermittent Catheterization In Spinal Cord Injured Patients Who Refused Insertion Of An Indwelling Catheter

PURPOSE Acute urethral false passage is an important complication of clean intermittent catheterization in spinal cord injured patients. Temporary urethral stenting with an indwelling catheter is generally an excellent conventional therapeutic option to treat patients with acute false passage. However, how can acute false passage be managed in a patient who refuses insertion of an indwelling catheter? MATERIALS AND METHODS For 3 years 5 male patients with acute urethral false passage due to catheterization refused urethral stenting because indwelling catheter insertion would prevent sexual intercourse. We placed a nitinol prostatic stent successfully in the false urethral passage in all 5 patients. The stents were left in place for 3 to 6 months. RESULTS The stent migrated in 1 patient and it was replaced. During a retention period of 3 to 6 months all patients continued clean intermittent catheterization without any difficulty and achieved sexual intercourse. On urethral cystoscopy we observed that all false passages disappeared without a gross tissue reaction. The stents were then removed without any complications. During a mean followup of 11.8 months (range 4 to 25) none of these patients had another false passage. All continued to perform clean intermittent catheterization without any further difficulty. CONCLUSIONS Temporary placement of a removable endourethral stent is a safe and effective method for managing acute urethral false passage in patients on clean intermittent catheterization who refuse insertion of an indwelling catheter. This approach makes further clean intermittent catheterization possible and improves patient quality of life.

Splenogonadal fusion in adults: presentation of three cases and review of the literature.

Splenogonadal fusion (SGF) is a rare congenital anomaly in boys and girls. It commonly presents as a testicular mass treated with an unnecessary orchiectomy. We present 3 cases of SGF diagnosed in adulthood and discuss the published literature focusing on several aspects of this rarity. These cases of SGF of both types presented with the usual complaints. In our first case, orchiectomy was performed since the left testis was hypoplastic and testicular neoplasm could not be ruled out. The testicles could be preserved in the latter 2 cases. The second case is the continuous-type SGF associated with contralateral testicular aplasia and, to our knowledge, this is the first reported case of continuous SGF associated with testicular aplasia. Knowledge of this entity may help prevent unnecessary orchiectomy.

Brucellar epididymo-orchitis: a retrospective multicenter study of 28 cases and review of the literature.

OBJECTIVE To review retrospectively the clinical symptoms, laboratory findings and treatment outcomes of patients with Brucellar epididymo-orchitis. MATERIAL AND METHOD Retrospective data of 28 patients with Brucellar epididymo-orchitis who admitted to four medical centers between 2005 and 2013 were retrospectively reviewed. Positive blood culture, positive Rose Bengal test results or high agglutination titres of ≥ 1/160 with the positive clinical and ultrasonographic findings of orchitis were accepted as the main criteria for Brucellar epididymo-orchitis. RESULTS The mean patient age was 31 ± 16.9 years. Testicular involvement was on the left side in 16 patients and on the right side in 11 patients, one had bilateral disease. Testicular pain and swelling were the most common symptoms and elevation of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leucocytosis were the most common laboratory findings. Initial treatment was orchidectomy in six patients due to malignancy suspicion. All but three patients were successfully treated with antibiotic combinations of rifampicin, doxycycline and streptomycin. Two of three treatment resistant patients underwent orchidectomy. CONCLUSION Brucellosis is a common cause of epididymo-orchitis in endemic regions. Early diagnosis and treatment is crucial in the management and thus it must be kept in mind in endemic and non-endemic regions.

Retroperitoneal lymph node mapping with intratesticular injected patent blue dye in rats

OBJECTIVES Endolymphatic injection of several dyes have been previously studied to identify retroperitoneal lymphatic structure in animals and humans with malignant diseases. However, there have been no studies, to our knowledge, that demonstrate the utility of injecting patent blue dye into the testicular parenchyma to detect retroperitoneal lymphoid structure. The aim of this experimental study was to investigate whether intratesticular patent blue dye injection is feasible and is an accurate method for retroperitoneal lymph node mapping in rats. MATERIALS AND METHODS Twenty male albino Wistar rats were included in the study and divided over two equal groups. The first group underwent patent blue violet (PBV) injection into the spermatic funiculus, while the second group underwent PBV injection into the testicular parenchyma. After the injection, the color changes in the retroperitoneal lymphatic structures and the urinary bladder were anticipated. The time interval between the injection and the staining of lymphatic structures and urinary bladder was measured for each intervention. Blue stained retroperitoneal nodal tissues were dissected and removed. These nodal tissues were examined histologically. RESULTS After PBV injection, intense staining of the ipsilateral spermatic cord lymphatics was seen and anticipated color changes in the retroperitoneal lymphatic structures and urinary bladder were evaluated visually. Both application routes of dye resulted in the same distribution of retroperitoneal lymph nodes in the same time frame. All retroperitoneal nodular tissues removed were noted histologically to be lymph nodes and were found to be consistent with the ipsilateral lumbar lymph and the ipsilateral suprarenal lymph nodes according to the staining order in both groups. No toxic effects were observed histologically. There were no statistically significant differences in the time intervals between the two groups. CONCLUSIONS We demonstrated that both funicular and intratesticular injections of patent blue dye are feasible and accurate methods for retroperitoneal lymph node mapping in rats. This shows that intralymphatic dye injection is not absolutely necessary to detect retroperitoneal lymphatic structures and may have applications beyond testis cancer.

Feasibility of MR urography in patients with urinary diversion

Introduction: The aims of this study were to determine the diagnostic value of MR urography and to compare the T2‐ and T1‐weighted MR urography techniques in patients with urinary diversion.

Laparoscopic visualization and dissection of retroperitoneal lymph nodes after patent blue dye injection: a pilot study.

PURPOSE Retroperitoneal lymph node dissection (RPLND) for testicular cancer is an important treatment modality for patients with stage I or IIA disease. Several urologists have previously reported the feasibility and usefulness of laparoscopic RPLND for such patients. The aim of this experimental pilot-feasibility study was to investigate whether visualization of retroperitoneal lymph nodes with patent blue violet (PBV) dye application is a feasible and an effective method during laparoscopic RPLND in a pig model. MATERIALS AND METHODS Four 12-month-old white male pigs were included in the study. After PBV dye injection into the spermatic funicular and intratesticular parenchyma, the color changes in the retroperitoneal region were examined during transperitoneal laparoscopic visualization of the retroperitoneum. The time interval between the injection and the staining of lymphatic structures was measured for each intervention. Blue-stained retroperitoneal nodal tissues were dissected and removed by the laparoscopic approach and histologic examination was performed. RESULTS After PBV dye injection, intense staining of the ipsilateral retroperitoneal lymphatic vessels and nodes was seen. Distribution of the PBV and the color changes of the retroperitoneal lymphatic structures were examined under laparoscopic vision in all pigs. All blue-stained retroperitoneal nodular tissues were removed laparoscopically and examined histologically. Histopathologic examination noted all specimens as lymph nodes with no toxic effects of PBV dye. CONCLUSION We demonstrated that spermatic funicular injection of PVB dye is an effective and accurate method for retroperitoneal lymph node visualization in pigs. The use of this technique in combination with a laparoscopic approach makes RPLND easier and more effective.