Hayrettin Şahin

Diagnosis of urethral strictures: Is retrograde urethrography still necessary?

Different methods are available in the diagnosis and treatment of urethral strictures. True diagnosis is necessary for choosing the most suitable method of treatment and to inform the patient about the method, complications, recurrence rate and costs. In this study we aimed to compare the efficiency complications and reproducibility of retrograde urethrography with urethroscopy. The retrograde urethrographic (RGU) and urethroscopic findings of 38 male patients were evaluated. Thirty had the same findings with either technique. In 8 patients the RGU was misdiagnosing (p<0.01). In conclusion, it has been shown that the results of RGU are misleading when it is not combined with urethroscopy and we think that it must not be a routine method in the diagnosis of urethral strictures.

Coagulation parameters in the patients with Fournier's Gangrene.

Aim: In this prospective study, we aimed to determine the coagulation parameters in the patients with Fournier’s gangrene. Methods: The study group is consisted of 12 consecutive Fournier’s gangrene patients (11 men and 1 woman) and control group is consisted of patients with Periurethral abscess (n=2), Scrotal abscess (n=4) and Epididimorchitis (n=4). Fibrinogen, protein C, protein S,␣antithrombin III, lupus anticoagulant, cardiolipin IgG and IgM, prothrombin time-international normalized ratio, activated partial thromboplastin time, platelet count, proaccelerin, antihemophilic globulin (FVIII), albumin, and calcium were evaluated in all subjects. Tissue specimens were taken from Fournier’s gangrene patients. These specimens were tested for arterial and venous thrombosis using light microscopy. Results: All of the patients with Fournier’s gangrene had both arterial and venous thrombosis in tissue specimens. The levels of fibrinogen and FVIII were high, the level of protein C was low in 12 patients. Lupus Anticoagulant was positive 11 of 12 patients. Conclusions: According to our findings, we think that some coagulation parameters (FVIII, Lupus anticoagulant, protein C, fibrinogen) may be diagnostic for Fournier’s gangrene.

Comparison of the efficacy of single or double intravesical epirubicin instillation in the early postoperative period to prevent recurrences in non-muscle-invasive urothelial carcinoma of the bladder: prospective, randomized multicenter study.

Objectives: To investigate the efficacy of single or double epirubicin instillation during the early postoperative period (EPP) in intermediate-risk non-muscle-invasive urothelial cancer. Methods: Patients with primary and solitary or multiple (3 or less) Ta (grade 2–3) or T1 (grade 1–2) tumors were enrolled. Patients were randomized to receive either a single dose of 100 mg epirubicin instillation within 6 h or a second 100 mg epirubicin instillation during the 12th–18th hours after a complete TUR-BT. At the end of the 60-month follow-up period, the available data were statistically analyzed. The end-points of the study were determined as disease-free survival, progression and recurrence rates, time to recurrence, and time to progression. Results: A total of 299 patients from 24 institutions were randomized between January 2002 and June 2004. There were 143 patients from 18 institutions who met the eligibility criteria. The follow-up and disease-free survival periods were 16.9 months and 16 months, respectively. There was no statistical difference in the demographic properties and the end-points between the groups. Conclusions: A single dose of intravesical 100 mg epirubicin chemotherapy during the early postoperative period for primary intermediate-risk non-muscle-invasive urothelial cancer achieved 16 months of mean disease-free survival. A second intravesical epirubicin instillation did not provide any significant benefit.

The effects of cellular telephone use on serum PSA levels in men

Background: The increasing use of cellulartelephones is known to have harmful effects onhuman health. The aim of this prospective studywas to determine whether cellular telephone useaffected serum PSA levels in men. Methods: Participants included 20 menwith ages ranging from 22 to 65 years who hadnever previously used cellular telephones.Blood samples were taken prior to and 30 daysafter the beginning of cellular telephone use.Serum was separated from the blood samples andstored in a deep freezer until the end of thestudy, at which time serum free and total PSAlevels were determined by tandemradioimmunoassay. The results werestatistically analyzed by the Wilcoxon PairedSigned Rank Test. Results: Average free and total PSAvalues were 2.070 ng/ml and 0.500 ng/ml beforethe study, and 2.0 ng/ml and 0.505 ng/ml at theend of the study, respectively. No significantdifference was determined between the initialand final values (p > 0.05). Conclusions: The results indicatethat cellular telephone use does notsignificantly affect PSA values in the shortterm. Nevertheless, we think that there is aneed for longer-term studies on this subject.

The effects of GnRH analogues and antiandrogenes in preventing the gonadotoxic effects of COPP chemotherapy

Background: In this study we aimed to discuss whether thegonadal suppression is effective or not in preventing the gonadal toxiceffects of some chemotherapeutics.Methods: Forty Sprague-Dawley adult male rats were randomised into4 groups, each consisting of 10. No drugs were given to the first group. Thesecond group received GnRH agonist and antiandrogen, the third groupreceived COPP chemotherapy protocol and the last group received COPPtogether with GnRH agonist and antiandrogen. Ninety days after drugapplication we sacrificed all rats. Total body weight, testicular weight andtesticular size measurements were all recorded. All testicular tissues wereexamined histologically for the ratio of active seminiferous tubules.Results: There was no difference in total body weight. The weight andmeasurements of testicular tissues were decreased in-group 3 and 4 whencompared with 1 and 2. The amount of active seminiferous tubules wassignificantly less in the third group.Conclusions: As a conclusion we think that gonadal suppressionapplied during chemotherapy regimen could decrease the testicular toxiceffects of chemotherapeutic but more clinical investigations needed forroutine application.

The importance of visual erotic stimulation in the differential diagnosis of erectile impotence.

In this study we aimed to determine the importance of visual erotic stimulation (VES) alone, and in combination with intracavernosal papaverine injection (ICPE) in the differential diagnosis of erectile impotence. Sixty-four patients with erection porblems were investigated betwen June 1992 and January 1994.VES could be the first investigative method in the differential diagnosis of erectile impotence. This will help us in some groups of patients with psychogenic impotence to avoid the application and complications of ICPE. In patients with insufficient erections with VES alone, ICPE must be combined with VES in order to detect the causes of psychogenic erectile impotence more correctly.

Huge Renal Angiomyolipoma with Life-threatening Bleeding into Itself Spontaneously

Cite this article as: Çetinkaya M, Erdoğan Ö, Deliktaş H, Çelik Öİ, Şahin H. Huge Renal Angiomyolipoma with Life-threatening Bleeding into Itself Spontaneously. J Urol Surg 2018;5(2):116-119. ©Copyright 2018 by the Association of Urological Surgery / Journal of Urological Surgery published by Galenos Publishing House. Renal angiomyolipoma (R-AML) is one of the most common benign neoplasms of the kidney. It is usually asymptomatic and rarely becomes symptomatic. Management of R-AML is still controversial. Generally, follow-up is enough for the management of the disease but rarely, lifethreatening complications may develop. Here, we would like to present a case of huge R-AML with life-threatening bleeding with literature review.

Radical Prostatectomy and Lymphadenectomy in the High-Risk Prostate Cancer: Surgical Technique, Functional and Oncologic Outcomes

Prostat kanseri en sık görülen kanser olup erkeklerde kansere bağlı ölüm nedenleri arasında ikinci sıradadır. Amerika’da 2014 yılında 233,000 yeni olgu beklenmektedir (1). Klinik olarak prostat kanserini; lokalize, lokal ileri evre ve metastatik olmak üzere üç grupta inceleyebiliriz. Prostat kanserleri ayrıca biyolojik davranışları bakımından düşük, orta ve yüksek risk gruplarına ayrılmaktadır. Ancak, risk tanımlaması konusunda ne yazık ki tam bir fikir birliği sağlanamamıştır. Yüksek riskli hastalık için zaman zaman ‘klinik T3’, ‘lokal olarak ilerlemiş’, ‘kötü farklılaşmış’ gibi terimler kullanılsa da tek bir kriter bu hastalığı tanımlamak için yeterli değildir (2). Yüksek riskli prostat kanseri tanımı ile ilgili değişik kaynakların kriterleri Tablo 1’de özetlenmiştir. Risk gruplamasında en çok kullanılan D’Amico’nun sınıflamasıdır. Buna göre; prostat spesifik antijen (PSA) ≥20 ng/ml ya da Gleason Skoru (GS) 8-10 ya da klinik evre ≥T2c’den birine sahip olan hastalar yüksek riskli olarak kabul edilir (3). Risk grupları PSA ya da PSA kinetkleri, klinik evre ve biyopsi GS kullanılarak belirlenir. Ancak bu risk sınıflamalarında ve tanımlamalarında sorunlar olup fikir birliği yoktur. Bu sorunlar: 1. Klinik evrelemede Parmakla Rektal İnceleme (PRİ) ile %35,4 oranda doğru evreleme yapılamamakta ve genellikle daha yüksek evreleme söz konusu olmaktadır (10). Başlangıçta yüksek riskli olarak tanımlanan hastaların %21-63’ü Radikal prostatektomi (RP) sonrası patolojik olarak organa sınırlı bulunmuştur (11). Ayrıca PRİ, olguların %30-50’sinde ekstraprostatik yayılımı saptamada yetersizdir (12). Daha iyi bir evreleme yapabilmek için bazı çalışmalar yapılmış ya da yapılmaktadır. Difüzyon ağırlık Magnetik Rezonans Görüntüleme (MRG) ve magnetik rezonans spektroskopi gibi daha spesifik tanı yöntemleri kullanımı klinik evrelemeyi daha doğru yapmamızı sağlayabilir. Radical Prostatectomy and Lymphadenectomy in the High-Risk Prostate Cancer: Surgical Technique, Functional and Oncologic Outcomes

A retroperitoneal abscess with cutaneous fistula developed after stercoral fistula operation: a case report.

A 25-year-old male patient presented to our clinic with purulent discharge from the right lumbar area in May 1994. He had a gunshot wound and his ascending colon had been repaired primarily by tube caecostomy in May 1992. In November 1992 he had a stercoral fistula and following this he had a right hemicolectomy and ileotransversostomy and tube ileostomy with anal dilatation. One month postoperatively he had purulent discharge from the right lumbar area and was treated conservatively. The patient presented to our clinic after two years and on physical examination he had a fistula 1 cm in diameter with purulent discharge and had a median incision scar. An anterior right pararenal retroperitoneal abscess 3 • 7 cm large was detected by computed tomography (Fig. 1). His right retroperitoneal abscess was drained via a flank incision. Eight grape seeds were found in the pouch of the abscess (Fig. 2).

Acute Side Effects of Iopromide and Diatrizoate in Urography

Purpose: In a prospective study, we compared the acute (0–2 h) side effects of ionic and nonionic contrast media in 767 patients undergoing intravenous urography. Material and Methods: A nonionic contrast medium (iopromide) was compared to an ionic contrast medium (diatrizoate). Results: Side effects occurred in 25 patients (7.9%) receiving iopromide and in 104 patients (23.1%) receiving diatrizoate (p<0.01). the reactions in the iopromide group were mild in 11 patients, moderate in 5, and severe in 1. the reactions were 83, 19 and 2, respectively, in the diatrizoate group. the number of reactions that required treatment was equal in the two groups (p>0.05). Conclusion: At intravenous urography, iopromide induced fewer side effects compared to diatrizoate.