Gurhan Gunaydin

Is It Possible to Predict Sepsis, the Most Serious Complication in Prostate Biopsy?

Objective: Prostate biopsy for the diagnosis of prostate cancer by transrectal ultrasonography (TRUS) is a common procedure used in daily urology practice with a low complication rate and easy applicability. In this study, the precipitating factors and prophylaxis for sepsis, the worst complication of the procedure, were assessed. Patients and Methods: 2,023 patients with suspected prostate cancer who underwent biopsy by TRUS in one center were assessed retrospectively. The relationship between sepsis and age, serum total prostate-specific antigen (PSA) level, PSA density, prostate volume, number of biopsies, number of repeated biopsies, accompanying diagnosis of prostatitis, presence of urethral catheter, and presence of diabetes mellitus was assessed. Data were analyzed using the t test and logistic regression analysis. Results: Of the 2,023 patients, 62 (3.06%) developed sepsis within 5 days after biopsy. There was no significant relationship between the biopsy and the above parameters using the logistic regression analysis. Using the t test, it was found that the number of biopsy cores (p < 0.001), presence of urethral catheter (p < 0.0001), and presence of diabetes mellitus (p < 0.0001) were predictive factors for sepsis. Conclusion: Sepsis is a rare but life-threatening complication after prostate biopsy by TRUS. Although preoperative prophylactic oral antibiotics and enema before biopsy have proven to be effective in decreasing urinary tract infection rates, patients with urethral catheter, diabetes mellitus or those to undergo biopsy from more sites than ten cores should be closely monitored after biopsy.

Results of Extracorporeal Shock Wave Lithotripsy in the Pediatric Age Group

Objective: In this study we aimed to show the efficacy of extracorporeal shock wave lithotripsy (ESWL) for urinary stone disease in the pediatric age group and to evaluate the complications encountered after the treatment. Methods: 67 children with 109 stones underwent ESWL, using a Dornier MPL 9000 lithotriptor. Styrofoam boards were used to protect the lungs. KUB and chest radiographs were taken on the day after treatment. If stone-free status was achieved, the patient was followed with ultrasonography and urine analysis every 6 months for 2 years. If fragments <4 mm were present, follow-up was repeated every 3 months. Results: Stone size ranged from 0.5 to 3.5 cm. 71 renoureteral units underwent a total of 129 ESWL sessions. Retreatment was required in 28 patients. The mean number of sessions per unit was 1.8. A stone-free status was achieved in 60 renoureteral units. The overall success rate was 88.6%. The composition of the stone was mixed calcium oxalate and phosphate in the majority of the patients. Auxiliary procedures used were push-back, ureteroscopic stone removal, and open surgery. Hematuria, colics and fever over 38°C were the complications encountered after the treatment. Conclusions: ESWL is the first-line treatment for renal and upper ureteral calculi. However, larger stones which will require several ESWL sessions and consecutively increased number of shock waves are best treated with percutaneous nephrolithotomy plus ESWL. Patients with congenital anomalies necessitating surgical reconstruction are the best candidates for operation.

Doxazosin: a new cytotoxic agent for prostate cancer?

Objective To determine the sensitivity of drug‐resistant prostate cancer cell lines to doxazosin‐mediated cell death, and the effects of combining doxazosin and chemotherapeutic agents on these cell lines.

Reliability of frozen section examination of obturator lymph nodes and impact on lymph node dissection borders during radical cystectomy: results of a prospective multicentre study by the Turkish Society of Urooncology

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b

Pro-inflammatory cytokine response of the fluid contents of spermatoceles and epididymal cysts.

Summary. The aim of the study was to determine the cellular contents and concentrations of interleukin 6 (IL‐6), interleukin 8 (IL‐8) and tumour necrosis factor alpha (TNF‐α) in fluids of patients with spermatocele or epididymal cyst. Twenty‐five symptomatic patients, 14 with epididymal cysts and 11 with spermatoceles, were included in the study. Fluids were obtained during surgical excision of the cysts and cytological smears were stained with May–Gruenwald–Giemsa to establish cell components. The concentrations of IL‐6, IL‐8 and TNF‐α were measured by chemiluminescent immunometric assay. Cytological analysis of the fluids demonstrated various sperm forms ranging from immature germ cells to degenerated spermatozoa without inflammatory cells such as neutrophils and macrophages. The concentrations (mean± SEM, pg/mg protein) of IL‐6, IL‐8 and TNF‐α were 13.52 ± 1.40, 22.20 ± 2.43, 3.51 ± 1.43 in spermatocele fluids and 5.76 ± 0.48, 11.57 ± 1.89, 2.53 ± 0.41 in epididymal cyst fluids. Both IL‐6 and IL‐8 concentrations in the spermatocele group were higher than in the epididymal cyst group (P < 0.0001). There were no differences in TNF‐α concentrations between the groups (P > 0.05). These findings indicate that local production of pro‐inflammatory cytokines is involved in cyst formation. The presence of immunologic activation in these fluids advocates a policy of selective surgical intervention in patients with spermatocele or epididymal cyst.

Intracavernosal adrenalin injection in priapism

Prolonged erection is a rare problem in urology but it must be treated effectively. The most common etiological factor is intracavernosal vasoactive agent injection for diagnosis or treatment of erectile dysfunction. The aim of this study was to evaluate the efficacy of intracavernosal adrenalin injection alone in the treatment of priapism. Nineteen patients with prolonged erection were evaluated. Seventeen out of the 19 prolonged erections were due to intracavernosal vasoactive agent injection and the remaining two were idiopathic. In all cases 2 ml adrenalin (1/100 000) was injected in each cavernosal body. In the patients who did not respond to the first injection, repeated adrenalin injections were performed at 20 min intervals. Blood pressure and heart rate were monitored during the injections. Detumescence was achieved in ten (53%) patients after the first injection. Repeated adrenalin injections (2–5 injections) were required in nine patients and eight (42%) of them achieved detumescence. Only one (5%) patient who had 26-h prolonged erection could not achieve detumescence. There was no significant difference in blood pressure and heart rate during the monitoring of the patients when compared to the initial values. No standard treatment method has yet been described for prolonged erection. Repeated aspirations and irrigations for treatment of prolonged erection are problematical applications both for patients and urologist. Intracavernosal adrenalin injection alone can be used with high efficacy and safety for the treatment of prolonged erection especially in patients with a short duration of erection.

Extended Pelvic Lymph Node Dissection: Before or after Radical Cystectomy? A Multicenter Study of the Turkish Society of Urooncology

Purpose We aimed to ascertain the effects of performing extended pelvic lymph node dissection (PLND) on the duration of surgery, morbidity, and the number of lymph nodes removed when the dissection was performed before or after radical cystectomy (RC). Materials and Methods We used the database of our previous prospective multicenter study. A total of 118 patients underwent RC and extended PLND. Of the 118 patients, 48 (40.7%) underwent extended PLND before RC (group 1) and 70 (59.3%) underwent extended PLND after RC (group 2). The two groups were compared for extended PLND time, RC time, and total operation times, per operative morbidity, and the total numbers of lymph nodes removed. Results Clinical and pathologic characteristics were comparable in the two groups (p>0.05). The mean RC time and mean total operation times were significantly shorter in group 1 than in group 2 (p<0.001). The mean number of lymph nodes removed was 27.31±10.36 in group 1 and 30.87±8.3 in group 2 (p=0.041). Only at the presacral region was the mean number of lymph nodes removed significantly fewer in group 1 than in group 2 (p=0.001). Intraoperative and postoperative complications and drain withdrawal time were similar in both groups (p=0.058, p=0.391, p=0.613, respectively). Conclusions When extended PLND was performed before RC, the duration of RC and consequently the total duration of the operation were significantly shorter than when extended PLND was performed after RC. Practitioners may consider performing extended PLND before RC and rechecking the presacral area for additional lymph nodes after RC, particularly in elderly patients with high co-morbidity for whom the duration of surgery matters.

Biochemical Recurrence After Radical Prostatectomy: is the Disease or the Surgeon to Blame?

PURPOSE The PSA recurrence develops in 27 to 53% within ten years after radical prostatectomy (RP). We investigated the factors (disease grade and stage or the surgeons expertise,) more likely to influence biochemical recurrence in men post-radical prostatectomy for organ-confined prostate cancer by different surgeons in the same institution. MATERIALS AND METHODS A total of 510 patients that underwent radical prostatectomy were investigated retrospectively. Biochemical recurrence was defined as detection of a PSA level of ≥ 0.20 ng/mL by two subsequent measurements. The causes, which are likely to influence the development of PSA recurrence, were separated into two groups as those related to the disease and those related to the surgical technique. RESULTS Biochemical recurrence was detected in 23.5% (120 cases) of 510 cases. The parameters most likely to influence biochemical recurrence were: PSA level (p < 0.0001), T stage (p < 0.0001), the presence of extracapsular invasion prostate (p < 0.0001), Gleason scores (p = 0.042, p < 0.0001) and the presence of biopsy with perineural invasion (p = 0.03). The only surgical factor that demonstrated relevance was inadvertent capsular incision during the surgery that influenced the PSA recurrence (p < 0.0001). CONCLUSION The PSA recurrence was detected in 21.6% of patients who had been treated with radical prostatectomy within 5 years, which indicates that the parameters related to the disease and the patient have a pivotal role in the PSA recurrence.