Güven Sevin

Ileal orthotopic neobladder (modified Hautmann) via a shorter detubularized ileal segment: experience and results.

To evaluate the clinical, urodynamic, functional, radiological and metabolic results of the ileal (modified Hautmann) orthotopic neobladder over 10 years of experience.

Staging error in the bladder tumor: the correlation between stage of TUR and cystectomy.

Objectives:Because tumor stage is very important in determining therapy, accurate sraging of bladder cancer must be estimated. For this aim, we examined the stage of TUR and compared it with the stage of cystectomy.Materials and methods:From 1992 to 1999, operations were performed on 127 patients with local invasive bladder cancer. Eight cases (74 male, 6 femle) underwent complete TUR of the tumor and then radical cystectomy. There was no residual macroscopic tumor after TUR in the bladder. The pathological staging of TUR and cystectomy were estimated and compared in these 80 cases. All pathologies were evaluated by the same pathology center.Results:There was correlation in only 20 patients (25%; 15 were T1, 5 were T2) while there was global error and discordance in 60 patients (75%). All of these 60 cases were overstaging in cystectomy specimens and downstaging was not found in any case. Fifty per cent of 10 T1 tumors were T1, while 50% were T3a;21.4% of T2 tumors were T2, 35.7% were T3a and 42.8% were T3b.Conclusions:The staging error of TUR in the bladder tumor may cause severe mistakes on deciding about radical surgery. However, although there was no understaging, which is more risky for false cystectomy indication, urologists must be careful about overstage/understage in the staging of TUR.

Antegrade extraperitoneal approach to radical cystectomy and ileal neobladder.

Background: We describe a new operative technique for the surgical treatment of bladder cancer.

Echo-Colour Doppler Ultrasonography in the Diagnosis of Varicocele

The relationship between varicocele and infertility has long been defined. About a third of the male patients undergoing evaluation for infertility present with a varicocele. Sixty male patients between 17 and 35 years of age (mean 25.6) were examined with a colour-doppler flow imaging system. The diameters of the veins in the pampiniform plexus were measured by gray-scale sonography.Our findings were classified with regard to venous diameter, the existence or non-existence of reflux, the circumstances under which these findings were recorded (e.g. during normal respiration and standing position or during Valsalva manoeuvre and supine position). Finally our results suggest that: (a) the clinical significance of the presence of dilated veins or reflux during increased intraabdominal pressure and under similar circumstances should be regarded with caution; (b) positive findings during normal inspirium are highly significant (grades III and IV).

Bone mineral content and related biochemical variables in patients with ileal bladder substitution and colonic Indiana pouch

OBJECTIVES To evaluate the effects of ileal bladder substitution or colonic Indiana pouch on skeletal bone density and various biochemical parameters related to bone metabolism. PATIENTS AND METHODS In 27 patients with urinary diversion and 14 controls with benign urologic disease, bone mineral density (BMD), assessed by dual-photon absorptiometry; serum electrolyte, creatinine, alkaline phosphatase and parathyroid hormone levels were determined, and capillary blood gas analysed. BMD was measured in the lumbar spine and the femur neck. The mean time since surgery was 33.6+/-10.1 months in 17 patients with an ileal bladder substitution and 56+/-9.1 months in 10 patients with a colonic Indiana pouch (p=0.001). RESULTS Although BMD did not change in the colonic Indiana pouch group, it was reduced in the patients with ileal bladder substitution compared to control group. The mean pH value was not statistically significant different in the both groups from the control group (p>0.2). The mean base excess value reduced in the substitution group (p<0.01). While alkaline phosphatase levels increased in both groups compared to control group (p<0.05), the mean parathyroid hormone level decreased only in the patients with ileal bladder substitution (p<0.05). The other biochemical parameters were similar in patients and control subjects. There was a statistically significant correlation between the base excess values and BMD values of the patients in both groups. CONCLUSION Although there is decreased BMD in patients with an ileal bladder substitute, there is no change in BMD in the patients with Indiana pouch. Alkaline phosphatase levels increased in both patient groups indicating increased bone turnover.

Prophylactic effects of systemic oral ephedrine in spinal anesthesia-induced hypotension during transurethral prostatectomy

Objective: We investigated the prophylactic effects of systemic oral ephedrine in spinal anesthesia-induced hypotension during transurethral prostatectomy. Material and Methods: Sixty American Society of Anesthesiologists Grade II and III patients scheduled for spinal anesthesia were randomized into one of two groups. Patients in Group I ( n r = r 30) received oral ephedrine 50 r mg in addition to premedication whilst those in Group II ( n r = r 30) received only premedication 30 r min before spinal anesthesia. Pre-infusion values were measured in order to obtain baseline readings after oral ephedrine administration in Group I and after premedication in Group II. Systolic arterial pressure (SAP) and heart rate (HR) were recorded before and after infusion, during and 5 r min after spinal anesthesia and intraoperatively. Hypotension was defined as SAP <100 r mmHg and <20% of baseline value. Hypotension was treated with 3 r mg ephedrine and bradycardia was corrected with atropine 0.5 r mg, given as an i.v. bolus. Results: SAP values were significantly lower in Group II during the spinal anesthesia, post-spinal and intraoperative periods ( p r < r 0.0001). Fifteen patients received ephedrine in Group II and seven in Group I. Supplemental ephedrine was used at doses of 3.42 r - r 0.97 r mg in Group I and 8.86 r - r 1.24 r mg in Group II. The incidence of hypotension was halved in Group I compared to Group II (23.33% vs 50%, p r = r 0.003). Six patients received atropine in Group II because of severe bradycardia. Mean HR values were lower in Group II than Group I during the spinal anesthesia, post-spinal and intraoperative periods. Conclusions: We conclude that a prophylactic oral dose of ephedrine 50 r mg is effective for minimizing and managing spinal anesthesia-induced hypotension during transurethral prostatectomy.

Immature Germ Cells in Semen and their Correlations with other Semen Parameters

AbstractPurpose: The significance of the presence of leukocytes and immature germ cells in semen and other parameters of semen is currently a subject of controversy. Materials and methods: Semen from 572 subfertile patients was analyzed according to WHO criteria and leukocytes as well as immature germ cells were assessed by identifying the round cells in semen by peroxidase staining. Microbiological investigation was carried out in cases with leukocyte counts of >1,000,000/ml. Results: It was found that as the concentration of spermatozoa decreased the rate of immature germ cells increased and this increase was accompanied by a decrease in motility and in the number of spermatozoa with normal morphology. As the sperm count increased, motility, number of spermatozoa with normal morphology and of immature germ cells also increased whereas an increase in sperm motility was accompanied by an increase in the percentage of spermatozoa with normal morphology. Microbiological investigations were negative in patients with semen leukocyte counts of >1,000,000/ml. Conclusions: Although it is possible to establish that the leukocyte and immature germ cell counts correlate with other parameters of semen, these correlations are not statistically significant. The most significant finding is that as the number of sperms decreases, the ratio of immature germ cells to total germ cells increases. While assessing immature germ cells instead of giving special attention to the number of immature germ cells in semen, the ratio of immature germ cells to total germ cells should be considered. The increase of leukocyte count in the semen of oligospermic patients may not always mean leukospermia.

Ileal orthotopic neobladder in women: the first experiences from Turkey and our modifications.

The lower urinary tract reconstruction with an ileal neobladder in woman is not very often but has been recently introduced centers. We report 8 female patients with ileal orthotopic neobladders after cystectomy. Patients and methods: Between 1995 to 1999, 7 female patients with organ confined invasive bladder cancer and 1 female patient with severely contracted bladder secondary to tuberculosis were operated. While standard radical cystectomy was done in 7 patients with bladder cancer, only simple cystectomy was performed in patient with contracted bladder. Detubularized ileal W-neobladder with antirefluxive ureteroileal reimplantation were used as a procedure and reservoirs are connected to the proximal urethra in all patients. Cystoscopy and biopsy was done routinly in the bladder neck and there were no tumour and CIS in any patient. Results: The mean age was 65.4 years (53–70) and the mean postoperative follow-up time was 31.8 months (6–48). There was no perioperative or early postoperative (first one month) mortality. Early postoperative complications included acute renal failure in 1 patient (12.5%), deep vein thrombosis in 1 patient (12.5%) and leakage from the pouch in 2 patients (25%). In one patient (12.5%), ileo-pouchal fistula was seen in sixth month and reoperated. Although there was not hypercontinence, one patient (12.5%) had totally incontinence. All other patients had normal micturition and no residual urine. Urethral recurrence was not seen in this postoperative follow-up period but pelvic recurrence and then distant metastases were found in one case (12.5%). Conclusions: The results of ileal orthtopic neobladder after radical or simple cystectomy in appropriate female patients are satisfactory. But certainly, we need the more experiences and studies about this subject.

Serum PSA and Age-Specific Reference Ranges in Patients with Prostatism Symptoms

Prostatic specific antigen (PSA), a tumour marker helpful in the diagnosis and follow-up of prostate cancer, may rise due to causes other than prostate cancer (i.e. BPH, acute prostatitis, etc.). Investigations in order to increase the sensitivity and specificity of PSA in prostate carcinoma are being carried out. Serum PSA levels of patients with prostatism with regard to age as well as these levels in the male population at risk but without clinical prostatic disease (those above the age of 40) should be well documented. The aim of this study is to find age-specific values and ranges of PSA in patients with prostatism symptoms.

Prospective evaluation of prostate specific antigen (PSA), PSA density, free-to-total PSA ratio and a new formula (prostate malignancy index) for detecting prostate cancer and preventing negative biopsies in patients with normal rectal examinations and intermediate PSA levels.

AbstractObjective: To improve the specificity and sensitivity of prostatic cancer detection, we prospectively evaluated total prostate specific antigen (PSA) level, PSA density, free-to-total PSA ratio and a new formula called prostate malignancy index (PMI) as a discriminator of prostate cancer in patients with intermediate PSA levels and normal digital rectal examinations. Materials and methods: Between November 1995 and October 1997, 95 patients who had serum PSA levels of 4.0 to 10.0 ng/ml with normal digital rectal examinations were prospectively evaluated. All patients underwent one or two times transrectal ultrasound guided prostate biopsies. Based on age specific reference range of PSA, PSA density and % free PSA ratio, PMI was calculated for each patient. The free and total serum PSA concentrations were determined by an Immulite assay system. (Diagnostic Product Corp., Los Angeles, California). Results: Overall 20 of 95 (21%) patients had prostate cancer. There were no significant differences in patient mean age and mean total PSA between those with benign and those with malignant biopsies (p>0.05). However, there were significant differences in mean PSAD, mean free-to-total PSA ratio and mean PMI (p<0.01, p<0.05, p<0.01, respectively). Benign condition specificities for PM index, percent free PSA, PSA density and total PSA at a 90% sensitivity for prostate cancer were 48%, 10.6%, 8% and 4%, respectively. Of 95 patients, 27 (28.4%) had a PMI of equal or more than 3.1, including 12 of 75 (16%) with negative biopsy and 15 of 20 (75%) with positive biopsy. Furthermore a cutoff MI 0.86 P correctly identified 24% of benign cases without missing any prostate cancer cases. The comparison of receiver operating characteristic (ROC) curve areas showed that PMI was better than total PSA (p<0.01). Although, the area under the ROC curve of % free PSA and PSAD were higher than the area of total PSA, these differences were not statistically significant (p>0.05). Conclusions: We concluded that the prostate malignancy index could be utilized to differentiate benign conditions from prostate cancer in patients with intermediate PSA levels and normal digital rectal examination. Also significant numbers of negative biopsies can be prevented in these patients.