Engin Kaya

Chronic constipation: facilitator factor for development of varicocele.

AIM To evaluate the possible relationship between varicocele and chronic constipation. METHODS Between April 2009 and May 2010, a total of 135 patients with varicocele or constipation and 120 healthy controls were evaluated. Patients were divided into two groups. In both groups detailed medical history was taken and all patients were examined physically by the same urologist and gastroenterologist. All of them were evaluated by color Doppler ultrasonography. All patients with constipation, except for the healthy controls of the second group, underwent a colonoscopy to identify the etiology of the constipation. In the first group, we determined the rate of chronic constipation in patients with varicocele and in the second group, the rate of varicocele in patients with chronic constipation. In both groups, the rate of the disease was compared with age-matched healthy controls. In the second group, the results of colonoscopies in the patients with chronic constipations were also evaluated. RESULTS In the first group, mean age of the study and control groups were 22.9 ± 4.47 and 21.8 ± 7.21 years, respectively (P < 0.05). In the second group, mean age of the study and control groups were 52.8 ± 33.3 and 51.7 ± 54.3 years, respectively (P < 0.05). In the first group, chronic constipation was observed in 8 of the 69 patients with varicocele (11.6%) and 3 out of 60 in healthy controls (5%), respectively. In this regard, there was no statistical significance between varicocele patients and the healthy control (P = 0.37). In the second group, varicocele was observed in 16 of the 66 patients with chronic constipation (24.24%) and 12 out of 60 in healthy controls (20%) respectively. Similarly, there was no statistical significance between chronic constipation and healthy controls (P = 0.72). Internal/external hemorrhoids were detected in 4 of the 16 patients with chronic constipation and varicocele, in the second group. In the remaining 50 patients with chronic constipation 9 had internal/external hemorrhoids. In this regard, there was no statistical significance between chronic constipation and healthy controls (P = 0.80). CONCLUSION Chronic constipation may not be a major predictive factor for the development of varicocele, but it may be a facilitator factor for varicocele.

The role of urinary nerve growth factor for the diagnosis and assessment of the biofeedback success in children with dysfunctional voiding.

INTRODUCTION Dysfunctional voiding (DV) occurs in neurologically normal children who are not able to establish brain control on detrusor muscle contractions (DMCs). It is also reported to be the result of incorrect voiding habits during toilet training. Children contract pelvic floor muscles (PFMs) to suppress DMC and DV begins. Urinary nerve growth factor (uNGF) is necessary for the synthesis and regulation of neurotransmitters, development of dorsal root ganglia (sensory neurons), and development of sympathetic cells during embryonic and post-natal life. uNGF has also a role in the intracellular signal transduction in nerve cells towards the target organ. To our knowledge, no study has investigated the association between uNGF, biofeedback treatment and DV in children. OBJECTIVES The aim was to examine the potential effect of uNGF in the assessment of the effectiveness of biofeedback success in children with lower urinary tract disorders. STUDY DESIGN Fifty-two children with the suspicion of DV and 48 children from a primary school reporting no urinary complaints were enrolled in this study from October 2010 to April 2013 in the Urology Department. uNGF levels were compared. RESULTS The mean uNGF/creatinine (Cr) level was 0.23 ± 0.26 in the control group and 0.96 ± 0.88 in the DV group (p < 0.001). The mean uNGF/Cr levels in the DV group at baseline and at the end of biofeedback therapy at 6 and 12 months were 0.90 ± 0.78, 0.26 ± 0.32, and 0.40 ± 0.50, respectively (p < 0.001) (Figure). DISCUSSION To our knowledge this study is the first to show the correlations between uNGF levels and biofeedback therapy in children with DV. Tissue NGF in 12 patients with overactive bladder (OAB)/detrusor overactivity and 15 healthy women was previously compared and it was suggested that there was no correlation between bladder tissue NGF and OAB. uNGF levels in the bladder in patients with interstitial cystitis and idiopathic sensorial urgency were evaluated previously, and uNGF levels reported. Similar to these reports, most of the previous studies handled uNGF in patients with diseases such as interstitial cystitis, OAB, urinary tract infections, urolithiasis, spinal cord injury, and prostate cancer, and found significantly higher uNGF levels. These studies were generally in adults. A previous study about uNGF comprised 40 children with OAB, in contrast to other studies. According to this study, 40 children diagnosed with OAB were administered anti-muscarinic therapy (oxybutynin 0.3-0.5 mg/kg/day). It was reported that uNGF/Cr levels of the OAB group were higher than control group. In the current study, we evaluated the uNGF difference in DV and the effect of biofeedback treatment on uNGF levels. CONCLUSIONS uNGF levels were higher in children with DV and decreased after biofeedback therapy. uNGF levels could be used for the diagnosis and the assessment of biofeedback success in these children.

Treatment of Resıstant Cyclophosphamide Induced Haemorrhagic Cystıtıs: Revıew of Literature and Three Case Reports.

Haemorrhagic Cystitis (HC) is defined as diffuse inflammatory bladder bleeding due to many aetiologies. Massive HC often arises from anticancer chemotherapy or radiotherapy for the treatment of pelvic malignancies. Phosphamides are the anti-cancer drugs used for treating breast cancer, B-cell lymphoma, leukemia, rheumatoid arthritis and systemic lupus erythaematosis by cross-linking strands of DNA and preventing the cell division. They are also used in bone marrow transplantation for prevention of Graft Versus Host Disease (GVHD). Hepatic metabolism of phosphamide forms acrolein, and acrolein makes ulceration, haemorrhage, edema and necrosis of the urothelium during its excretion by the urine. Infectious causes of HC in immunocomprimesed patients are adenovirus, BK polyoma-virus (BK), JC virus, and Cytomegalovirus (CMV). The present article attempts to make a review of literature for the treatment of intractable HC and report three cases with HC.

Oxidative stress parameters in patients with prostate cancer, benign prostatic hyperplasia and asymptomatic inflammatory prostatitis: A prospective controlled study

BACKGROUND The imbalance between oxidant and reductant mechanisms creates a nidus for the etiopathogenesis of several diseases. In this study, we aimed to compare the oxidative stress (OS) parameters in patients who were diagnosed with prostate cancer (pCa), benign prostatic hyperplasia (BPH) or asymptomatic inflammatory prostatitis (AIP), according to the histopathologic examination of transrectal ultrasonographic prostate biopsy and transurethral prostate resection specimens. OBJECTIVES In this study, we aimed to compare oxidative stress between histologically proven prostate cancer, hyperplasia and prostatitis. MATERIAL AND METHODS According to histopathologic examinations, 97 patients were divided into 3 study groups: group 1: pCa (n = 30), group 2: BPH (n = 41), and group 3: AIP (n = 26). Finally, 30 patients were enrolled in a control group. MDA levels, CuZn-SOD, Se-GPx, CAT activities, and trace element levels were evaluated. RESULTS A statistically significant difference between prostate cancer and other groups were documented in terms of MDA activity. Contrary to AIP, a statistically significant difference has also been encountered between BPH and the control group. Decreased CuZn-SOD enzyme levels were found in PCa and BPH patients without statistical significance. Increased CAT activity was also documented in PCa, BPH and AIP patients. No significant difference in GPX activity was documented between the groups, except BPH and control group. Trace element levels were low in the patients with prostate cancer and BPH when compared with the control group. CONCLUSIONS Despite the data regarding OS in PCa patients, there is a paucity of data regarding BPH and especially AIP patients. Our study revealed obvious oxidative stress in BPH and PCa patients as opposed to AIP. Assessing the oxidative stress in these patients may assist in the future prevention, diagnosis and also treatment. However, the question whether the presence of OS-related parameters and drugs could be used for the diagnosis or management of prostatic diseases, needs to be addressed in future larger and better studies with a more rational basis.

Concised Form for Lower Urinary Tract Dysfunction Symptom Scale in Children

INTRODUCTION Symptom Scales (SS) are questionnaires for evaluating and following up of special illnesses. SS used for the diagnosis and follow-up of Lower Urinary Tract Dysfunction (LUTD) in children is called LUTD Symptom Scale (LUTDSS). AIM Aim of the present study was to identify the questions which are more important for the diagnosis of LUTD in children and create a simpler SS. MATERIALS AND METHODS From January 2005 to March 2015, 631 children between the age 5 and 15 were enrolled in this study. Eleven children with active urinary tract infections were excluded from the study. Two hundred sixty three children from the nursery and secondary school saying that they have no urinary complaints and having LUTDSS <9 were designed as control group. Three hundred fifty seven children with LUTDSS score ≥9 were thought as having LUTD and diagnoses were verified with 3-day bladder diaries and 2-time Uroflow-EMG-PVR tests. The answered questions of LUTDSS in patient and control group were compared. RESULTS Children with daytime incontinence (first question of questionnaire) were 47.7 (4.8-510) times (p=0.01), children with enuresis (third question) were 59.53 (6.2-961) times (p=0.001), children with pause while urinating (eighth question) were 28.7 (4.4-2090) times (p=0.001), children with urgency (tenth question) were 54.7 (29.3-604) times (p=0.039) more likely to have LUTD than the children not having these complaints. The area under ROC curve created by using 1,3,8, and 10 questions was calculated 86.4%. CONCLUSION The diagnosis and control of LUTD can be made by using only 1., 3., 8. and 10. questions, and these 4 questions could form simpler SS for LUTD in children.

Transüretral Prostat Rezeksiyonu Sonrası Medikal Tedaviye Devam Durumunun Öngörülmesinde Preoperatif Prostat Boyutu Belirleyici midir

GIRIŞ ve AMAC: Benign prostat hiperplazisi (BPH) nedeniyle TURP uygulanan hastalarin kucuk de olsa bir bolumunde postoperatif alt uriner sistem semptomlari (AUSS) devam etmekte ve bu hastalarda medikal tedaviye devam edilmektedir. Biz de calismamizda, TURP uygulanan hastalarda prostat boyutu ile postoperatif ek girisim oranlari ve AUSS nedeniyle medikal tedaviye devam edilme oranlari arasinda iliski olup olmadigini arastirdik. YONTEM ve GERECLER: Preoperatif prostat boyutlarina gore hastalar Grup 1 (prostat hacmi ≥80 ml) ve Grup 2 (prostat hacmi <80 ml) olarak iki gruba ayrildi. Gruplar; preoperatif PSA degerleri ve prostat volumu, eslik eden ko-morbiditeler, postoperatif ek sistoskopi ve sistometri yapilip yapilmadigi, postoperatif medikal tedavi kullanimi acisindan karsilastirildi. BULGULAR: Calismaya toplam 87 hasta dahil edildi. Grup 1’deki 26 hastada prostat boyutu ≥80 ml iken, grup 2’deki 61 hastada prostat boyutu <80 ml idi. 87 hastanin 19’una (%22), postoperatif donemde AUSS’nin devam etmesi nedeniyle, sistoskopi veya sistometri yapildi ya da medikal tedavi yeniden baslandi. Istatistiksel olarak anlamli olmasa da, 80 ml altinda prostat hacmi olup, TURP uygulanan hastalarda, postoperatif AUSS’nin daha sik goruldugu gozlendi. TARTIŞMA ve SONUC: Her ne kadar TURP sonrasi iseme bozukluklarini ve risk faktorlerini belirlemek icin prospektif ve genis serili calismalara ihtiyac olsa da, elde ettigimiz veriler buyuk prostatlarda TURP’nin cerrahi sonuclarinin daha yuz guldurucu olabilecegine isaret etmektedir. Turkce Kisa Baslik: Prostat Hacmi ve Tedaviye Devam Durumu

The outcome of percutaneous nephrolithotomy on ≥50 mm staghorn and multiple calyceal stones

Objective To determine the success rate of percutaneous nephrolithotomy (PNL) in kidney stones over 50 milimeters. Material and methods Twenty-four patients with a renal stone size of >50 mm between January 2007 and December 2016 were enrolled. Stone-free and complication rates were investigated. Results Twenty-one (87.5%) patients were male and 3 (12.5%) were female. Fifteen (62.5%) stones were located in the right, and 9 (37.5%) in the left kidney. Twenty-one (87.5%) patients were operated using single-access, and three (12.5%) patients were double-access. Thirteen (54%) patients were found to have no stone after operation and 11 (46%) patients had residual stones. Extracorporal shock wave lithotripsy was applied to 5 of 11 patients with residual stones, while flexible ureteroscopy was applied to 6 of them. After additional treatments, 8 (33.5%) patients were observed to be stone free. The stone-free rate was 87.5%. The mean operation time was 135.43 (85-240) minutes. Hemoglobin levels before and after operation were 14.8 (12-16.7) and 12.6 (9.3-15.5), respectively (p=0.001). The hospital stay was 6.04 (4-8) days. Complications were observed in four patients (16.6%). Conclusion PNL has high stone-free rate on staghorn type large stones compared with multiple calyceal scattered large stones.

Our experiences with robot- assisted laparoscopic surgery in pediatric patients: the first case series from Turkey

OBJECTIVE Robotic surgery is a leading treatment option for minimally invasive surgery and has an increasing popularity in pediatric population, as well. In this article, we reported our case series of robot-assisted laparoscopic surgery in pediatric population. MATERIAL AND METHODS We retrospectively reviewed 29 consecutive pediatric patients who underwent robot- assisted procedures between May 2014 and October 2016. Patient demographics, hospitalization time, estimated blood loss, robotic time and total operative and peri-, and post-operative complications were evaluated. RESULTS A total of 24 ureter units (18 patients) with grade 1-5 vesicoureteral reflux in 13 female and 5 male, 1 male patient with vesicoureteral stenosis were underwent robot- assisted laparoscopic ureteral reimplantation (RALUR). All patients had complete resolution after surgery. Robot-assisted laparoscopic pyeloplasty (RALP) was performed in 6 patients with ureteropelvic junction obstruction. All patients had complete resolution after surgery. Completely intracorporeal robotic assisted laparoscopic augmentation ileocystoplasty (RLAIC) was applied to two patients with neurogenic bladder. The symptoms and preoperative hydronephrosis were regressed on the first month of follow-up. Robot-assisted laparoscopic reduction cystoplasty (RALRC) was performed in 14-year-old boy with a bladder diverticula and recurrent urinary tract infection. The last case was eleven- year-old female patient with non-functioning kidney. She had recurrent urinary tract infections and was treated with robotic assisted laparoscopic nephrectomy (RALN). CONCLUSION Robot-assisted laparoscopic surgery is safe and efficient in pediatric population. Although open surgery is still the gold standard for many pediatric diseases, inherent reconstructive advantages of robotic assisted laparoscopy have a chance to change this view.

MP56-17 THE HISTOPATHOLOGIC EFFECTS OF INTRACAVERNOSAL MITOMYCIN-C INJECTION IN A RAT PEYRONIE'S DISEASE MODEL

disease. Less than 1% used books or internet forums for information. Regarding treatments, 53.1% of men had tried at least one of surgery, medication, topical therapy, injection, vacuum or traction devices with 37.2% trying two or more therapies. In comparing therapies, 82.8% of those undergoing surgery reported improvement, compared to 60% on oral medication, 57.1% of injection therapies (note: prior to collagenase era), and 30.2% of vacuum / traction devices. A subset analysis of 49 patients who tried vacuum (43/49) or traction (6/49) devices was performed and demonstrated that 46.9% reported improved curvature and 8.2% improved length. No correlations were noted between subjective increase in penile length and the duration of vacuum or traction therapy. CONCLUSIONS: Among a cohort of PD men responding to a mail-in survey, medical websites were the most widely used source of information on PD, with nearly 30% of physicians perceived to lack an understanding of the disease. Almost half of PD patients choose not to pursue any kind of treatment. These results suggest a need for additional patient and provider education on the diagnosis and available therapies for PD therapies.

The histopathological effects of intracavernosal mitomycin-C injection in a rat Peyronie's disease model

INTRODUCTION We aimed to evaluate whether or not mitomycin-C (MMC) has an antifibrotic effect on transforming growth factor-beta (TGF-β)-induced Peyronies disease (PD) in a rat model. METHODS Eighteen 12-week-old male Sprague-Dawley rats were divided into three groups: Group 1=TGF-β1 (n=7); Group 2=TGF-β1+MMC (n=7); and Group 3=Sham group (0.25 ml bovine serum albumin injected) (n=4). All groups were sacrificed on the sixth week of the procedure and their penises were excised. All penis specimens were evaluated semi-quantitatively and quantitatively with histochemical, immunohistochemistry, and image analysis. RESULTS Both Group 1 and Group 2 had significantly higher fibrosis scores and lower elastic fibers in both outer surface of tunica albuginea (TA) and subsinusoidal area compared with Group 3. When compared with Group 1, the amount of collagen was significantly decreased in Group 2. Intracavernosal MMC injection (Group 2) ended up with lower elastic fibers when compared with Group 1. According to the quantitative analyses, when compared with Groups 1 and 3, lower dorsal, ventral, and trabecular thickening values were seen in Group 2. These parameters were only statistically significant when compared with Group 1, suggesting the antifibrotic effect of TGF-β1-induced fibrosis. Both Groups 1 and 2 showed lower decorin staining levels in subsinusoidal areas of tunica albuginea (SATA) and subsinusoidal areas of trabecular wall (SATW) when compared with Group 3. The statistically significant difference was only detected between Group 1 and Group 3. CONCLUSIONS Our study demonstrates the antifibrotic effects of MMC on PD. Further clinical studies are necessary to make inferences regarding its clinical use.