Hasan Salih Sağlam

Testosterone Levels and Sexual Function Disorders in Depressive Female Patients: Effects of Antidepressant Treatment

INTRODUCTION Women suffer from depression more frequently than men, which indicates that sex hormones might be involved in the etiology of this disease. AIMS The purpose of this study was to assess the relationship between testosterone and depression pathophysiology in depressive women along with sexual function. We also investigated whether antidepressant treatment causes any change in levels of this hormone or in sexual function. METHODS Premenopausal female patients aged 25-46 years (n = 52) with diagnosed major depression were included in this study as the patient group, and 25- to 46-year-old premenopausal women without depression (n = 30) were included as the control group. MAIN OUTCOME MEASURES Serum testosterone and sex hormone-binding globulin (SHBG) levels were measured twice, before and after the antidepressant treatment. Bioavailable testosterone (cBT) levels were calculated using the assay results for total testosterone (TT), SHBG, and albumin according to the formulas of Vermeulen et al. Depression severity was measured using the 17-item Hamilton Depression Rating Scale, and sexual function was evaluated with the Arizona Sexual Experience Scale. RESULTS The mean TT and cBT levels significantly increased in the patient group after the antidepressant treatment (P < 0.001). Pre-treatment TT and cBT levels were significantly lower in the patient group than in the control group (P < 0.001). Similar results were obtained for post-treatment serum TT and cBT levels in the patient and control groups (P > 0.05). There were no significant differences among the groups in terms of SHBG level. CONCLUSION The low testosterone levels in depressed women compared with women in the control group and the elevated levels post-pharmacotherapy suggest that testosterone may be involved in depression.

Fasting Blood Glucose and Lipid Profile Alterations following Twelve-Month Androgen Deprivation Therapy in Men with Prostate Cancer

Purpose. In this retrospective study, we aimed to investigate the effects of androgen deprivation therapy (ADT) on blood glucose and blood cholesterol levels over a 12-month period. Materials and Methods. Between January 2010 and June 2012, the data of 44 patients with prostate cancer who were receiving ADT were collected from a hospital database. Patients with additional malignancy or diabetes and those who had been prescribed and were currently taking cholesterol-lowering medication were excluded from the study. Data (including fasting blood glucose levels and a cholesterol profile) were collected and analysed statistically. A P value <0.05 was considered statistically significant. Results. Twelve months after the initiation of ADT, fasting blood glucose (FBG), total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglyceride (TG) levels changed. FBG, TC, LDL cholesterol, and TG increased significantly (P = 0.009, 0.000, 0.000, and 0.000, resp.), while HDL cholesterol decreased (P = 0.000). Conclusion. ADT may increase FBG, TC, LDL cholesterol, and TG but decrease HDL cholesterol by the end of a year of treatment. Therefore, close followup may be needed as a consequence of one-year ADT regarding metabolic alterations.

Tranexamic acid decreases blood loss during transurethral resection of the prostate (TUR -P)

Introduction Postoperative blood loss after prostate surgery is thought to be associated with an increase in urinary fibrinolytic activity. Tranexamic acid (TXA) is both a potent inhibitor of plasminogen and urokinase activators and a low molecular weight substance that is excreted unchanged in the urinary tract and can be administered both orally and intravenously. We investigated the effect of TXA on the amount of blood loss during transurethral resection of the prostate (TURP). Materials and methods Forty patients with registry numbers ending in even numbers were allocated to the treatment group; those ending in odd numbers were used as controls and received no treatment. The treatment group received 10 mg/kg TXA by intravenous infusion during the first half hour of the operation, while the control group of patients received no medication. Serum hemoglobin was measured before and after surgery. The volume and hemoglobin concentration of the irrigation fluid, resected prostate weight, and duration of resection were recorded. Results The mean loss of hemoglobin per gram of resected prostate tissue was 1.25 g in the TXA group and 2.84 g in the control group. Total hemoglobin loss in the irrigating fluid and hemoglobin loss per 1 gram of prostate tissue was lower in the group of patients given TXA than in the control group (p = 0.018 and p <0.001). Conclusion Reduced bleeding during TURP as a result of TXA treatment may lead to better surgical conditions and, as a consequence, shorter operative times and lower irrigating fluid volumes.

Do the values of prostate specific antigen obtained from fresh and dried urine reflect the serum measurements

AIM To investigate if free PSA (fPSA) and total PSA (tPSA) values obtained from simultaneously collected urine, fresh and dried on filter paper, reflect the serum free and total PSA. MATERIALS AND METHODS The sera and 20 cc first voided urine from 33 consecutive men aged between 40 and 84 (mean 61 ± 12), were collected in the morning and delivered to the laboratory. Three different aliquots of 100 microgram urine were taken with automatic pipette and dropped on 3 certain areas of a filter paper and allowed to dry for each patient. On each paper, borders of dried urine were marked. PSA values were obtained from the sera and fresh urine samples and recorded. Later on particular days dried urine samples were dissolved and eventually PSA values were derived and recorded again. The results were compared to each other. Correlations were evaluated by using an SPSS statistics program. RESULTS Serum PSA values correlated weakly (r < 0.24) with fresh and dried urine PSA values. While PSA in fresh and dried urine samples showed strong correlation (0.5 < r < 0.74), a very strong correlation (r > 0.75) among PSA values of dried urine samples of 1-day, 7- and 28-days, were seen. CONCLUSIONS We conclude that PSA values obtained from fresh and dried urine could not reflect serum PSA values. But, because dried urine on a filter paper can be stable for years, it could be used for forensic purposes.

A novel technique for anterior vaginal wall prolapse repair: anterior vaginal wall darn.

Aim. The aim of this study is to introduce a new technique, anterior vaginal wall darn (AVWD), which has not been used before to repair the anterior vaginal wall prolapse, a common problem among women. Materials and Methods. Forty-five women suffering from anterior vaginal wall prolapse were operated on with a new technique. The anterior vaginal wall was detached by sharp and blunt dissection via an incision beginning from the 1 cm proximal aspect of the external meatus extending to the vaginal apex, and the space between the tissues that attach the lateral walls of the vagina to the arcus tendineus fascia pelvis (ATFP) was then darned. Preoperation and early postoperation evaluations of the patients were conducted and summarized. Results. Data were collected six months after operation. Cough stress test (CST), Pelvic Organ Prolapse Quantification (POP-Q) evaluation, Incontinence Impact Questionnaire (IIQ-7), and Urogenital Distress Inventory (UDI-6) scores indicated recovery. According to the early postoperation results, all patients were satisfied with the operation. No vaginal mucosal erosion or any other complications were detected. Conclusion. In this initial series, our short-term results suggested that patients with grade II-III anterior vaginal wall prolapsus might be treated successfully with the AVWD method.

Prilocaine Irrigation for Pain Relief After Transurethral Resection of the Prostate

PURPOSE This study aimed to examine the effect of postoperative addition of a local anesthetic agent to irrigation fluid on the alleviation or prevention of pain after transurethral resection of the prostate (TURP). PATIENTS AND METHODS This prospective, double blind, placebo-controlled study included 50 patients aged 50 to 87 years. The patients were randomized into two groups. As each patient began to experience postoperative pain after spinal anesthesia wore off, 30 mL of 2% prilocaine was injected into the irrigation solution bags, and the bladder was irrigated (prilocaine group). The irrigation solution used in the control group was prilocaine-free. Visual analog scale (VAS) scoring was used to assess the severity of pain. Bladder irrigation in all patients was discontinued 1 day postsurgery. RESULTS There was not a statistical difference in surgical parameters between the two groups. All patients in the prilocaine group were satisfied with the analgesic efficacy of prilocaine, except for two (8%). The mean number of irrigation solution bags (3000 mL) used for each patient in the prilocaine group was 7.04 ± 1.2. Prilocaine-related side effects were not observed. Conversely, pain developed in all but two patients in the control group. The mean number of irrigation solution bags used for each patient in the control group was 7.6 ± 1.8. Mean VAS pain score was 0.35 ± 0.12 and 5.10 ± 3.26 in the prilocaine and control groups, respectively (P<0.001). CONCLUSION Prilocaine solution safely alleviated postoperative pain in the patients who underwent TURP. The use of continuous bladder irrigation with a diluted prilocaine solution consistently decreased the need for parenteral analgesics.

Flouroscopy-free technique is safe and feasible in retrograde intrarenal surgery for renal stones

OBJECTIVE The aim of this study was to present outcomes of our patients who had undergone retrograde intrarenal surgery (RIRS) with fluoroscopy-free technique and evaluate the efficacy and safety of the technique. MATERIAL AND METHODS Between January 2013 and June 2015 the outcomes of 93 patients who had undergone RIRS with fluoroscopy-free technique were retrospectively evaluated. Our RIRS technique involved preoperative assessment of ureter by semi-rigid ureteroscope, inserting guidewire through semi-rigid ureteroscope, inserting ureteral access sheath over the guidewire with the visiual guidance of semi-rigid ureteroscope, passing flexible ureteroscope through the sheath, dusting the stone with holmium laser, rechecking the ureter with semi-rigid ureteroscope and inserting double J stent through semi-rigid ureteroscope. Low-dose computerized tomography scan was performed to all patients in postoperative first month and the results were classified as stone-free (absence of any fragment), clinically insignificant residual fragments (CIRF) (≤4 mm) and residual stone. RESULTS Study population consisted of 62 (66.6%) male and 31 (33.3%) female patients with a mean age of 47.8±14 (range 14-93) years. Mean stone size was 14.7±5 (7-32) mm. Median operative time was 72 (30-125) minutes. Stone-free rate was achieved in 65 (69.9%) patients while CIRF was achieved in 13 (13.9%) and residual stones were detected in 15 (16.1%) patients. Five patients (5.37%) had minor complications, including hematuria and fever. No major complications were observed. CONCLUSION Fluoroscopy-free technique is effective and safe technique in management of renal stone. Furthermore fluoroscopy-free technique can protect the surgeon from the negative effects of radiation.

Comparison of one-year results of transobturator tape method in the stress incontinence treatment according to body mass index.

OBJECTIVE The purpose of this study was to compare the 1-year results of patients on whom we used the transobturator tape method for the stress incontinence treatment according to body mass index (BMI). MATERIAL AND METHODS Patients diagnosed with stress incontinence and treated with the transobturator tape method were divided into three groups according to BMI. We recorded the results of preoperative urodynamic studies; durations of operation, catheterization, and hospitalization; and complications of patients. Patients were evaluated 1 year after the operation with respect to the objective/subjective success rates of the operation, patient satisfaction rates, and possible late complications. RESULTS The obese group was observed to have a significantly higher duration of operation than the normal and overweight groups (p<0.001). The objective and subjective success rates were not significantly different between the groups (p=0.567 and p=0.245, respectively). There was no statistical difference between the groups with respect to the satisfaction rates (p=0.245). There was no significant difference between all three groups with respect to both preoperative and postoperative complication rates (p=0.096). CONCLUSION The transobturator tape method for stress incontinence treatment has similar objective and subjective success rates, independent of BMI. In the obese patients, the operation time is longer than the others, but there is no difference with respect to the complication rates.

Relationship between development of urethral stricture after transurethral resection of prostate and glycemic control

Objectives: The purpose of this study is to investigate the association of glycemic control prior to TUR-P and postoperative urethral stricture development. Materials and Methods: Of the 168 patients with a diagnosis of urethral stricture, who underwent internal urethrotomy in our hospital were retrospectively analyzed for this study. 98 patients who underwent monopolar TUR-P in our hospital previously and were developed urethral stricture were divided into two groups as diabetic and nondiabetic. Based on their HbA1c concentrations, diabetics were allocated to two groups with good (HbA1c ≤6.5%) or poor (HbA1c > 6,5%) glycemic control. Time to internal urethrotomy and the other operative parameters were compared among groups. Results: Time to internal urethrotomy after TUR-P was significantly shorter in diabetic patients with poor glycemic control than Group 1 and Group 2 (P = 0,02, P = 0,012) but no significant difference was found between Group 1 and Group 2 (P = 0,368). There was no significant difference in the mean diagnosed and resected prostate wight among groups There was no significant difference in the mean resection time and the mean time to urethral catheter removal among groups. Conclusions: Especially in poor glycemic control patients, urethral stricture development was seen in the early period after TUR-P. For this reason, in the elective TUR-P scheduled poor glycemic controlled patients the operation should be done after glycemic control.

Intestinal perforation after radical cystectomy due to drain: case report.

The current standard treatment for nonmetastatic invasive bladder cancer is radical cystectomy with urinary diversion. Radical cystectomy surgery carries a serious potential risk of complications. In this case report, an intestinal perforation which was thought to be occurred due to a Foley catheter placed as a drain after the cystectomy is presented.