Ferhat Ates

Evaluation of the role of varicocelectomy including external spermatic vein ligation in patients with scrotal pain

Abstract  Objectives: The aim of the present study was to assess and compare pre‐ and postoperative scrotal pain in patients with varicocele who underwent varicocelectomy with different approaches.

CYP1A1 (Ile462Val), CYP1B1 (Ala119Ser and Val432Leu), GSTM1 (null), and GSTT1 (null) polymorphisms and bladder cancer risk in a Turkish population.

We aimed to investigate bladder cancer risk with reference to polymorphic variants of cytochrome p450 (CYP) 1A1, CYP1B1, glutathione S-transferase (GST) M1, and GSTT1 genes in a case control study. Polymorphisms were examined in 114 bladder cancer patients and 114 age and sex-matched cancer-free subjects. Genotypes were determined using allele specific PCR for CYP1A1 and CYP1B1 genes, and by multiplex PCR and melting curve analysis for GSTM1 and GSTT1 genes. Our results revealed a statistically significant increased bladder cancer risk for GSTT1 null genotype carriers with an odds ratio of 3.06 (95% confidence interval=1.39-6.74, p=0.006). Differences of CYP1A1, CYP1B1 and GSTM1 genotype frequencies were not statistically significant between patients and controls. However, the specific combination of GSTM1 null, GSTT1 null, and CYP1B1 codon 119 risk allele carriers and specific combination of GSTM1 present, GSTT1 null, and CYP1B1 432 risk allele carriers exhibited increased cancer risk in the combined analysis. We did not observe any association between different genotype groups and prognostic tumor characteristics of bladder cancer. Our results indicate that inherited absence of GSTT1 gene may be associated with bladder cancer susceptibility, and specific combinations of GSTM1, GSTT1 and CYP1B1 gene polymorphisms may modify bladder cancer risk in the Turkish population, without any association being observed for CYP1A1 gene polymorphism and bladder cancer risk.

Association between the androgen levels and erectile function, cognitive functions and hypogonadism symptoms in aging males

Purpose: Aging in men is characterized by a moderate decrease in plasma testosterone (T) levels. However, the association between partial androgen deficiency of the aging male and clinical symptoms and the ideal screening test are controversial. In this study, we investigated the association between the androgen levels and erectile function, cognitive functions and hypogonadism symptoms in aging males. Materials and methods: We investigated the association between total (TT), calculated free (FT) and bioavailable (BT) testosterone, and various clinical and laboratory parameters in 103 healthy males, 50–80 years old. Biochemical assessment was done after overnight fasting. Questionnaires were used to test for hypogonadism symptoms, erectile and cognitive functions. Results: TT levels were not correlated with aging in this study. However, FT and BT were found to decrease with age due to rising sex hormone binding globulin. TT levels were strongly correlated with FT and BT levels (respectively p = 0.0001, p = 0.0001). TT, FT and BT were only correlated with cognitive functions (p = 0.012, p = 0.004, p = 0.02 respectively). There was no correlation between TT, FT and BT levels and erectile function and hypogonadism symptoms. Conclusion: T values in our study sample did not correlate with clinical signs and symptoms of hypogonadism. Thus, according to our data, symptoms in the aging male should not be indiscriminately assigned to a decrease in TT, FT or BT levels.

Testis-Sparing Surgery in Small Testicular Masses Not Suspected to Be Malignant

UNLABELLED Fifteen patients with small testicular masses not suspected to be malignant were included in the study, and permanent and frozen section analyses were evaluated. As a result frozen analysis, preoperative externalization of the suspected malignancy with a physical examination, ultrasonographic evaluation, and serum tumor marker analysis were concluded as key points for accurate decision making between TSS and radical orchiectomy. BACKGROUND We aimed to determine the safety, efficacy, and the concordance of permanent and frozen section analysis (FSA) of testis-sparing surgery (TSS) in patients who had small testicular masses that were not suspected to be malignant. PATIENTS AND METHODS Fifteen patients who underwent TSS were included in the study. TSS was performed for the patients who had testicular lesions <25 mm and testicular lesion volume <30% of the whole testis. All patients had normal serum tumor marker levels and ultrasonographic evaluation did not indicate malignancy. Surgery was performed via an inguinal approach with temporary cord occlusion and FSA of the lesions. Benign findings allowed for TSS, and cancer prompted total orchiectomy. RESULTS The mean patient age was 25.33 (range, 20-36) years. The predominant complaint was swelling (9 patients). The mean lesion diameter was 16 mm (range, 5-26 mm). Fourteen of all cases (93%) had benign pathology and underwent TSS. Only 1 patient, whose FSA revealed malignant formation, underwent radical orchiectomy. Final pathology of this patient was seminoma. Complete histopathologic concordance was observed between the results of frozen and permanent sections. TSS was performed with no intra- or postoperative complications. After a mean follow-up of 23 months (range, 6-44 months) all patients, except 3 who were lost to follow-up, were free of disease. CONCLUSION The main key points for accurate decision-making between TSS and radical orchiectomy are intraoperative FSA and preoperative externalization of possible suspected malignancy with physical examination, ultrasonographic evaluation, and serum tumor marker analysis.

Prediction of Response to Androgen Deprivation Therapy and Castration Resistance in Primary Metastatic Prostate Cancer

Purpose: We tried to establish the predictive factors influencing the initial response, as well as its duration, and time to castration resistance (CR) for primary advanced prostate cancer (PC) with bone metastasis. Methods: We evaluated all patients initially receiving androgen deprivation therapy (ADT) for primary advanced PC with bone metastasis. A total of 982 patients with complete medical records available for analysis from 18 centers were included in this study. Age, initial PSA, Gleason score (GS) and extent of bone involvement (EBI) were recorded in a database. Results: Among all the patients, 896 (91.2%) responded to ADT initially. Pretreatment PSA and EBI were significant predictors in the multivariate model. Among the 659 patients who progressed into a CR state, the mean duration of response was 22.4 months. There was a significant correlation between the CR state and nadir PSA (nPSA) level and time to nPSA. Pretreatment PSA, EBI, GS, highest tumor volume in biopsy cores (%), number of positive biopsy cores, percent positive biopsy cores and time to nPSA were proven to be significant to predict a nPSA. Pretreatment PSA, GS and EBI were statistically significant predictors of PSA normalization in multivariate analysis. The limitation of the study depends on the retrospective design and a model was developed for low standardization as a result of using multicenter data. The patients enrolled in this study were from a relatively long period of time (1989–2008). Conclusions: The results of this study indicate that it is possible to predict the initial response to ADT by pretreatment PSA levels and EBI, while the duration of response can be reflected by a multitude of clinical factors including nPSA, TTnPSA, percent positive cores, biopsy GS and EBI.

Free Nerve Ending Density on Skin Extracted by Circumcision and Its Relation to Premature Ejaculation

Many studies have shown that skin tissue extracted by circumcision can cause differences in sexual function, especially at the time of ejaculation. Sensitivity changes in penile skin and sexual satisfaction deriving from circumcision starting from premature ejaculation (PE) are discussed. Furthermore, most of these studies rely on questionnaires. Extracted free nerve endings (FNE) on the foreskin, which can detect temperature, mechanical stimuli (touch, pressure, stretch) or pain (nociception), have not been researched. Our aim is to determine FNEs in foreskin and the affects on sexual function, especially PE. This prospective study was done on adults who voluntarily applied to be circumcised between September 2010 and October 2011. The ejaculation latency times (ELT) before circumcision have been assessed, and a PE diagnostic tool (PEDT) form was filled out by the urologist according to the answers given by the volunteers. The proximal and distal ends of the foreskin were marked before circumcision, and the extracted foreskin was sent to the pathology department to determine FNEs. Twenty volunteers (average age 21.25 ± 0.44 years) were included in the study. The average ELT was 103.55 ± 68.39 seconds, and the average PE score was 4.35 ± 3.13. Proximal, middle, and distal tip nerve densities were compared. Proximal and distal (P = .003) and proximal and middle (P = .011) segments differed from each other, whereas middle and distal were similar (P = .119). There were not any correlations between PEDT scores and total nerve endings number (r = .018, P = .942). Also there were not any correlations between mean ELT and PEDT scores (r = .054, P = .822). The tissue extracted by circumcision has intensive FNEs, yet FNE intensity has no relation to PE.

Evaluation of the Impact of Shock Wave Lithotripsy on Kidneys Using a New Marker: How Do Neutrophil Gelatinese-associated Lypocalin Values Change After Shock Wave Lithotripsy?

OBJECTIVE To determine possible acute kidney injury with new marker neutrophil gelatinase-associated lipocalin (NGAL) in urine and to show the relationship between changes of this marker and conventional markers in patients undergoing shock wave lithotripsy (SWL). METHODS In patients with kidney stones, serum urea, creatinine, urine microalbumin, and NGAL levels were determined before SWL and at the first, second, and seventh days after SWL. In addition, patients who had undergone SWL were evaluated with Technetium-99m (Tc99m)-dimercaptosuccinic acid (DMSA) and Tc99m-diethylenetriaminepenta acetate renal scintigraphy 1 week before and 3 months after SWL. RESULTS AND LIMITATIONS Forty patients were included in the study. All patients had a single stone in the kidney with an average size of 9.25 mm (range 5-15). No statistical change was found in the levels of average serum urea and creatinine levels, urine microglobulin, and NGAL levels, which were measured before SWL and after SWL. No significant difference was identified in urine NGAL and microalbumin levels of the groups, which were separated by shock wave number and shock energy amount on the first, second, and seventh days after SWL. In the high-energy SWL group, 3 patients had a statistical decrease in their differential kidney function measured with Tc99m difference between differential function rates of the kidney before and after SWL (DMSA) after 3 months after SWL. CONCLUSION Our study found that, using both new and conventional parameters in the acute stage and 3 months later, SWL treatment does not cause acute kidney damage.

Optimized imaging techniques for testicular masses: fast and with high accuracy

SummaryObjectiveThe purpose of this study is to determine the effectiveness of the diffusion-weighted magnetic resonance imaging (DWI) of the differentiation of benign and malignant testicular masses.MethodsFifteen male patients who admitted to our clinic with the diagnosis of testicular mass detected by ultrasound were enrolled to this study. The patients were between 20 and 61 years old (mean 25.7). Apparent diffusion coefficient (ADC) values were measured from ADC maps of lesion and normal testicular tissue. In addition, mean signal intensity (SI) measurements were obtained by using b: 1,000 of normal testicular tissue and lesion with three regions of interest (ROI). SI ratio values are obtained by dividing the value lesion SI to the normal testicular parenchyma SI. Histopathology of orchiectomy materials and ADC values and lesion SI rates were compared statistically.ResultsThere were no significant correlation (p = 0.97) between ADC values of benign and malign lesions and histopathological diagnosis in Student’s t test. There were statistically significant relationship with the histopathology of the lesion and the SI ratio in Student’s t test (p = 0.027).ConclusionsDWI is an effective method in differentiation of benign and malignant testicular masses. Important information can be obtained about nature of testis masses with quantitative measurements of the ADC and ratio of SI.ZusammenfassungZielDer Zweck dieser Studie ist es, die Wertigkeit der Diffusions-gewichteten Magnetresonanz Bildgebung (DMB) in der Differenzierung von benignen und malignen Hodentumoren zu erfassen.MethodikFünfzehn Männer, die an unsere Klinik mit im Ultraschall festgestellten Hodentumoren zugewiesen worden waren, wurden in die Studie aufgenommen. Das Alter der Patienten lag zwischen 20 und 61 Jahren (im Mittel 25,7). Apparente Diffusionskoeffizienten (ADK) wurden von Gebieten der Läsion und vom normalen Hodengewebe gemessen. Zusätzlich wurde Messungen der mittleren Signalintensität (SI) von Gebieten der Tumoren mit drei regions of interest (ROI) und vom normalen Hodengewebe durchgeführt. Die SI Quotienten wurden durch Division des SI Werte, die über der Läsion erhoben wurden, durch die im normalen Hodenparenchym gemessenen errechnet. Die Pathohistologie des Orchiektomie Materials wurden mit den ADK sowie mit den Tumor SI Quotienten statistisch verglichen.ErgebnisseIm Student’s t-Test bestand keine signifikante Beziehung (p = 0,97) zwischen den ADK Werten und den benignen, beziehungsweise den malignen Tumoren. Die Beziehung zwischen dem pathohistologischem Ergebnis und den SI Quotienten war im Student t-Test signifikant (p = 0,027).SchlussfolgerungenDie DMB ist eine Methode, die zur Differenzierung von malignen und benignen Hodentumoren gut geeignet ist. Wichtige Informationen über die Art des Hodentumors können mit quantitativen Messungen der ADK und den SI Quotienten gewonnen worden.

Prolidase enzyme activity in varicose venous walls related to sperm count in patients with varicocele

Abstract Objectives. To investigate peripheral, seminal and varicose venous wall prolidase enzyme activities and their relationships between sperm parameters in patients with varicocele. Design and methods. Prolidase enzyme activities were determined in blood, seminal fluid and varicose vein walls in patients with grade 3 varicocele. Sperm parameters were also measured and the relationships between prolidase enzyme and sperm parameters were assessed by statistical correlation analysis. Results. There was a significant and negative correlation between sperm counts and varicose venous wall prolidase enzyme activities (r = −0.618, p < 0.001) and a positive significant correlation between sperm counts and seminal fluid prolidase enzyme activities (r = 0.676, p < 0.001). None of the parameters were correlated with sperm motility indices. Conclusion. Varicose venous wall prolidase enzyme activity could be an important factor in progression of azoospermia and infertility in patients with varicocele.

Re: Daniela Marshall-Kehrel, Cornelia Feustel, Charlotta Persson de Geeter, et al. Treatment with Propiverine in Children Suffering from Nonneurogenic Overactive Bladder and Urinary Incontinence: Results of a Randomized Placebo-Controlled Phase 3 Clinical Trial. Eur Urol 2009;55:729–38

We read with interest the abovementioned article by Marschall-Kehrel et al [1] and thank the authors for this nice study. However, we would like to point out a couple of issues related to the subject. First, it is a well-known fact that making a diagnosis of constipation is often difficult, and parental history is misleading [2]. This is even more important when a medication that could potentially cause and/or worsen constipation is to be prescribed. Should a problem with bowel movements be overlooked, this could complicate the clinical picture or at least cause a delay in the recovery. Therefore, we are curious to know how the researchers made the diagnosis of constipation and what they would recommend on the subject for the practicing pediatric urologist. A second issue is the adverse effects of antimuscarinics on cognitive function, which has been studied in adults and in children taking oxybutynin and tolterodine [3–5]. We expected to find an input or a comment in such a phase 3 study on children receiving propiverine treatment. Finally, the formula for age-expected bladder capacity in Table 2 should be corrected as capacity (in ml) = (age + 2) 30, as defined by Koff [6]. We assume that this is nothing more than a printing error.