Hasan Soydan

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.

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.

Lithiasis in Varicocele Veins: “Varicolithiasis”

A 20-year-old man presented with chronic left scrotal pain and discomfort, especially in the upright position. On physical examination the testes and epididymes were normal on palpation but were remarkable for a grade III left varicocele. Multiple solid “bead string” lesions were also palpated in the varicocele veins. The lesions were opaque on x-ray (fig. 1). Gray scale and color Doppler sonography using a 5 MHz. linear phased array transducer revealed a 6.5 mm. left spermatic vein with multiple calcifications and acoustic shadowing. Roentgenographic examination and ultrasonography of the kidneys, ureters and bladder were normal. Metabolic evaluation included serum electrolyte, creatinine, calcium, phosphorus and uric acid tests. Hemogram, urinalysis and urine culture were performed, and 24-hour urine samples were collected and analyzed for calcium, uric acid, creatinine, oxalate, sodium and citrate. In addition, urinary pH and volume were measured and were found to be normal. History, clinical examination and colony counts were also obtained to exclude genitourinary infections. Exploration of the left spermatic cord and testis showed a normal vas and testis but mobile solid lesions were palpated in the varicocele veins (fig. 2). The varicocele vein segment was then excised and the solid lesions appeared as stones. Stone analysis demonstrated whitlockite calcium phosphate. However, histolopathological examination of the varicocele veins revealed thrombosed large vessels with perivascular fibrosis and interstitial edema.

Subinguinal Varicocelectomy Under Spinal Anesthesia in a Fahr's SyndromePatient with Non-Obstructive Azoospermia

Previously, Fahr’s syndrome diagnosed 21 year-old male patient, consulted to urology outpatient clinic suffering from left scrotal pain. Physical examinations and Doppler tests results indicated left grade III varicocele. Left subinguinal varicocelectomy was performed safely under spinal anesthesia. This is the first and unique case showing co-existence of Fahr’s syndrome and varicocele and also the first spinal anesthesia procedure in a Fahr’s syndrome patient. In this report we tried to show that varicocelectomy can be performed under spinal anesthesia safely on Fahr’s syndrome patients.

Clinical and histopathological results of the adult patients with unilateral cryptorchidism.

OBJECTIVE To evaluate the clinical and histopathological results of adult unilateral cryptorchidism patients. MATERIAL AND METHODS Data from adult unilateral cryptorchidism patients that underwent orchiectomy in our clinic between between January 2004 and March 2013 were retrospectively evaluated. Patients were divided into three groups as intra-abdominal, inguinal canal and superficial inguinal region according to the location of the undescended testes. Patients were also grouped according to their testicular volume (<4 cc, 4.1-12 cc, and >12 cc). Histopathology results of orchiectomy specimens were classified as follows: 1. Sertoli cells only, testicular atrophy and vanished testis (anorchia) 2. Hypospermatogenesis, and 3. Maturation arrest. Patients were grouped as normospermia, azoospermia and oligo/astheno/teratospermia groups according to semen analysis results. Correlations between testicular localization, testicular size, semen analysis and pathology results were evaluated. Incidental tumor detection rates were also calculated. RESULTS Two hundred and forty-four adult unilateral cryptorchidism patients underwent orchiectomy in our clinic. There was no a significant relationship between location of the testis and testicular pathology results (p=0.707). Most common semen analysis results was normospermia in patients with high testicular volume group however azoospermia and oligoasthenospermia observed commonly in patients with low testicular volume group. There was a significant relationship between testicular volume and semen analysis results (p=0.023). No significant relationship was observed between semen analysis and pathological results (p=0.929). After an evaluation of all factors with possible effects on the semen analysis results, only testicular volume (p=0.036) was found to have a significant impact. Only one case (0.4%) was incidentally diagnosed seminoma after a review of 233 patients with available histopathological results on record. CONCLUSION Adult unilateral cryptorchidism has a minimal effect on male fertility or even this effect can be overlooked. Low detection rates of incidental germ cell tumors also make an orchiectomy decision questionable in such cases.

Cross-Sectional Analysis of Penile Length in Males 13 to 15 Years Old According to Pubertal Development Stages

PURPOSE Genital development is affected by pubertal process to a great extent, and puberty is a complex phenomenon that is influenced by multiple factors resulting in individual differences. We studied penile length and its relationship to pubertal stage in boys 13 to 15 years old. MATERIALS AND METHODS Healthy boys who were candidates for military high school were evaluated between June and July 2011. Age, residence and body mass index were recorded. Stretched penile length was measured. Pubic hair was assessed according to Tanner and Marshall staging. Genital puberty stage was defined by measurement of testicular volume with Prader orchidometer. Relationship of penile length to age, residence, pubertal stages and body mass index was evaluated statistically. RESULTS A total of 1,539 boys were included in the study. Mean ages and number of patients according to genital stage were as follows. Mean age was 14 years for genital stage 1 (5 patients), 13.9 years (range 13 to 15) for stage 2 (194), 14.07 years (13 to 15) for stage 3 (965) and 14.11 years (13 to 15) for stage 4 (375). Linear regression analysis revealed a significant effect of body mass index, genital stage and pubic hair stage on penile length (p <0.001) but no significant effect of age or residence. Mean penile length was significantly different among different age groups and among pubertal stages. However, mean penile lengths of different age groups within the same pubertal stage were similar. CONCLUSIONS Penile length during puberty should be evaluated individually according to the current pubertal stage. Our study offers a reliable reference table of penile length for pubertal age group.

Postshockwave Lithotripsy Outcome Evaluation in Ureteral Stones: Comparison Between Noncontrast Computed Tomography and Plain Abdominal Radiography

BACKGROUND AND PURPOSE There are no definite data indicating which modality to use to assess the efficacy of shockwave lithotripsy (SWL). Usually, plain abdominal radiography (PAR) is recommended in percutaneous nephrolithotomy (PCNL) afterward and in the follow-up of asymptomatic stones, whereas noncontrast CT (NCCT) is recommended in cases of residual fragments. We compared the efficacies of PAR and NCCT in terms of assessing the outcome of SWL treatment for radiopaque ureteral stones. PATIENTS AND METHODS Those patients with renal colic and a radiopaque ureteral stone of 5 to 20 mm that was detected on PAR were included in the study; body mass index (BMI) values were calculated and recorded. Patients whose PAR revealed opacities suspicious for ureteral stones were evaluated with NCCT at 3-mm slices. Stone status was assessed with PAR and NCCT on post-SWL day 3. Detection of no stone, a residual fragment of ≤ 4 mm, and a residual fragment of >4 mm was defined as success, clinically insignificant residual fragments, and failure, respectively. RESULTS On post-SWL day 3, both PAR and NCCT revealed stones in 31 patients, and no stones were seen in either modality in 29 patients. NCCT revealed stones whereas PAR had negative results for stones in two patients. These patients had upper ureteral stones of 7.5 mm (6-9 mm) before SWL. Mean stone size on NCCT after SWL was 2.5 mm (1-4 mm). Mean BMI of these two patients was 27.72, and mean BMI of the patients with upper ureteral stones that were revealed by both PAR and NCCT was 27.68; these two values were statistically similar. CONCLUSION PAR is capable of detecting clinically significant residual fragments, and patients can be followed up with PAR alone after SWL treatment for radiopaque ureteral stones. This approach both decreases the cost and prevents excessive radiation exposure.

A rare cause of urethral obstruction: verumontanum attachment.

A 52-year-old man presented with obstructive urinary symptoms, including weakness of urinary stream, hesitancy, intermittency and the sensation of incomplete bladder emptying many years in duration. Medical history revealed no urogenital trauma or urethral instrumentation. However, a urogenital infection, probably urethritis, due to prostatitis 5 years ago had not been treated with any drugs. Urinalysis and serum prostate specific antigen were normal. International Prostate Symptom Score was 23. The patient had severe symptoms. Maximum flow rate was 9 ml. per second. On cystoscopy a verumontanum attachment causing urethral obstruction was observed at 12 o’clock (see figure). A resectoscope was inserted into the urethra and the attachment was separated using loop without resection. Benign prostatic obstruction was evident but the urethral lumen was not fully obstructed. Transurethral resection was performed and a urethral catheter was placed.

Correlation Between Residual Volume of Male Patients After Uroflowmetry and Random Residual Volume

Our aim was to examine correlation between Post‐void residual urine (PVR) after uroflowmetry and random PVR.