İlker Gökçe

Open prostatectomy is still a valid option for large prostates: a high-volume, single-center experience.

OBJECTIVES To evaluate, in a retrospective, single-center trial, our open prostatectomy outcomes and complications in the past 12 years to emphasize the feasibility of open prostatectomy for large prostates. METHODS A total of 1193 patients underwent open prostatectomy from 1995 to 2007. We retrospectively analyzed the data from 664 patients who had preoperative, operative, and postoperative data available. RESULTS The mean patient age was 67.5 years (range 52-86). The mean preoperative prostate-specific antigen value was 9.6 ng/mL (range 1.65-45.6). The mean prostatic weight was 88.7 g (range 45-324) and was significantly different for the 1995-2001 and 2002-2007 groups (73.6 vs 98.2 g, respectively). Of the 664 patients, 208 (31%) had had an indwelling catheter before surgery. The average International Prostate Symptom Score was 21.7 (range 13-32) preoperatively and 10.6 (range 8-18) postoperatively (P <.005). The average hospitalization was 6.74 days (range 4-14). Blood transfusion was required in 12.7% of the patients either intraoperatively or postoperatively. Postoperatively, 82 patients (12.3%) had urinary tract infections, 22 (3.2%) had bladder neck obstruction, 5 (0.7%) had urinary incontinence, and 15 (2.3%) had a ureteral meatus stricture. CONCLUSIONS Open prostatectomy is a feasible treatment option for patients with a large prostate and also for patients with additional bladder pathologic findings such as bladder calculi or diverticula for whom endoscopic treatment modalities are not appropriate. Consequently, open prostatectomy is still the primary option for patients with a prostate greater than 100 cm(3) and preserves its importance in urology practice, even in the presence of endoscopic innovations.

Do antibiotic prophylaxis and/or circumcision change periurethral uropathogen colonization and urinary tract infection rates in boys with VUR?

BACKGROUND To evaluate the effect of circumcision and/or antibiotic prophylaxis on periurethral flora and associated bacteriuria in male children with and without vesicoureteral reflux (VUR). PATIENTS AND METHODS The study included 91 boys with low-grade VUR and 106 healthy boys (control) without VUR. The boys with VUR were randomized as antibiotic prophylaxis only and antibiotic prophylaxis plus circumcision. The boys without VUR were randomized as circumcision group and followed-up group without circumcision. Periurethral swab and urine cultures were obtained from the participants at the beginning of the study, and at 1st, 3rd, 6th, 9th, and 12th month. The groups were compared in terms of positive periurethral and urine cultures. RESULTS The positive periurethral culture rate was significantly lower in the circumcised boys at all measurement times. The positive urine culture rate in the circumcised boys was lower than in the uncircumcised boys. Subgroup analysis based on age groups showed that age did not affect these statistical differences. CONCLUSION Circumcision decreases colonization of periurethral bacterial pathogenic flora. In boys with low-grade VUR, circumcision plus antibiotic prophylaxis prevented recurrent and febrile urinary tract infections.

Is There a Role of the Enhancement Degree of the Lesion on Computerized Tomography for the Characterization of Renal Tumors

PURPOSE We determined the role of tumor enhancement on dynamic enhanced computerized tomography for differentiating pathological characteristics. MATERIALS AND METHODS A total of 149 patients with renal tumor underwent dynamic enhanced computerized tomography at our university from June 2007 to November 2011. Tumors were treated surgically and pathological evaluation was done. Precontrast and postcontrast HU values, and the difference were recorded. Postcontrast HU evaluations were done at the nephrographic phase of the procedure. Tumor HU values were compared according to histological subtype, tumor grade and pathological stage. RESULTS Mean ± SD patient age was 57 ± 13 years and mean tumor size was 4.8 ± 2.7 cm. Postcontrast HU and contrast difference values were significantly lower in the malignant group. A cutoff HU value of 138 HU (mean AUC 0.893 ± 0.027, 95% CI 0.84-0.94) differentiated renal cell cancer from oncocytoma with 88% sensitivity and 87% specificity. Low and high grade cases demonstrated similar precontrast and postcontrast HU, and contrast difference values. These enhancement parameters were significantly lower for higher stage (pT2-3) renal cell cancer than for pT1. We detected higher postcontrast values (mean 62 ± 14 vs 56 ± 39 HU, p = 0.011) and contrast difference values (mean 92 ± 15 vs 82 ± 42 HU, p = 0.034) for high grade than for low grade renal cell cancer in patients with tumors 4 cm or less. CONCLUSIONS The degree of enhancement on computerized tomography helps differentiate tumor characteristics. These outcomes may help the clinician with prognostic evaluation and may augment the role of computerized tomography in therapeutic planning.

Serum testosterone levels, testis volume, and the risk of prostate cancer: are these factors related?

OBJECTIVE Inconclusive results have been published in the literature regarding the relationship between free and total serum testosterone levels and prostate cancer. We investigated the relationship between total and free serum testosterone levels, testes volume, and prostate cancer in our patient population. MATERIAL AND METHODS Total and free serum testosterone levels and serum PSA levels were recorded for 102 consecutive patients. All of the patients underwent transrectal ultrasonography-guided prostate biopsy due to an abnormal digital rectal examination finding and/or a serum PSA level of >4.0 ng/mL. All of the transrectal and testis US examinations and prostate biopsies were performed by the same radiologist. The testis length, width, and height were measured from transverse and longitudinal gray scale images, and the testis volume was calculated. RESULTS Prostate cancer was detected in 32 of 102 patients (31.3%) who underwent prostate biopsy (prostate cancer group). The remaining patients had benign histopathological findings (prostate cancer-free group). The prostate cancer and benign histology groups were compared for age, total and free testosterone, PSA values, and testis volume. The patients with prostate cancer were found to have a higher mean age (p=0.04). There were no significant differences in serum PSA levels, free or total testosterone levels, or testis volumes between the two groups (p>0.05). A binary logistic regression analysis showed that neither free nor total testosterone was a predictor of prostate cancer (p=0.315 and p=0.213, respectively). Only age was found to be a significant risk factor for the development of prostate cancer (p=0.02). CONCLUSION Our study failed to show a relationship between total or free serum testosterone levels, testis volume, and the risk of prostate cancer. Therefore, monitoring serum testosterone levels for prostate cancer prediction does not appear to add an advantage over PSA screening.

PD06-06 THE EFFECT OF NEUROVASCULAR BUNDLE PRESERVATION ON CHANGES IN PENIS LENGTHS AND ELASTICITY SCORES FOLLOWING RADICAL PROSTATECTOMY

RESULTS: 128 patients (40%) were found to have CaP in their biopsies: 61 patients (19%) had insignificant CaP and 67 patients (21%) had csCaP. 52 (78%) of 67 patients with missed csCaP had Gleason 3+41⁄47. 105 patients (32%) were in Active Surveillance at the time of their biopsies. Of these, 27 patients (26%) had csCaP with negative mpMRI. Logistic regression indicated that patients with high PCA3, high PSA density, a prior positive biopsy and smaller prostate volume are directly related to having csCaP in the presence of negative mpMRI (p<0.05). CONCLUSIONS: Despite recent advancement of MRI technology, negative mpMRI cannot rule out csCaP completely. 40% of men with negative mpMRI were diagnosed with CaP. Of these, 21% of men harbored csCaP. All clinical factors should be considered before eliminating a systematic biopsy because the MRI is unrevealing.