Kenan Karademir

Hypospadias in adults

Abstract Objectives To review the follow-up data and complications of adult patients who underwent hypospadias surgery. Methods The records of 88 male patients with an average age of 21.9 years (range 20 to 27) who were operated on for hypospadias from 1996 to 2001 were reviewed in two groups: primary cases and all others (at least one unsuccessful attempt to correct the hypospadias). The primary cases consisted of 48 anterior, 9 middle, and 2 proximal hypospadias; the second group consisted of 16 urethrocutaneal fistula, 8 hypospadias, and 5 cripple cases. Results The complication rate was 10.1% for the first group and 27.5% for the second group. After the second intervention in groups 1 and 2, the overall success rate was 100% and 89.6%, respectively. Conclusions Adult hypospadias is repaired with the techniques used in pediatric cases. However, the postoperative complication rate is higher, and these patients more often require multiple interventions.

Evaluation of the role of varicocelectomy including external spermatic vein ligation in patients with scrotal pain

Abstract  Objectives: The aim of the present study was to assess and compare pre‐ and postoperative scrotal pain in patients with varicocele who underwent varicocelectomy with different approaches.

A peripheric neuromodulation technique for curing detrusor overactivity: Stoller afferent neurostimulation

Objective To perform Stoller afferent neurostimulation (SANS) with and without a low-dose anticholinergic (oxybutynin hydrochloride) in patients with detrusor overactivity and compare the results obtained with the two therapeutic approaches. Material and methods A total of 43 patients with symptoms of detrusor overactivity (frequency, urgency, urge incontinence) underwent urodynamic studies (UDS). Those in whom UDS revealed phasic detrusor overactivity were evaluated using a quality of life questionnaire and voiding diaries. Patients were randomized into two groups: Group 1 received SANS alone; Group 2 received SANS combined with a low-dose anticholinergic (5 mg of oral oxybutynin hydrochloride). Both groups were re-evaluated following 8 weeks of therapy. Results There were 21 patients in Group 1 and 22 in Group 2. The treatment response rate was 61.6% and 83.2% in Groups 1 and 2, respectively. In both groups, the best symptomatic improvements were obtained in patients with urge incontinence. The percentage decreases in the mean number of symptoms of frequency and urgency were 36.7% and 46.1%, respectively in Group 1 and 44.2% and 61.1%, respectively in Group 2. However, there were no statistically significant differences in the effects on frequency and urgency between the two groups. The anticholinergic drug was well tolerated by all patients in Group 2. One patient reported local tenderness, and a small hematoma developed in another following SANS therapy. Conclusion SANS is an easy and inexpensive therapeutic method with low morbidity in patients with an overactive bladder. Combination with a low-dose anticholinergic increases the success rate without causing any significant side-effects.

Intravesical Heparin and Peripheral Neuromodulation on Interstitial Cystitis

Introduction: We wanted to evaluate the therapeutic effect of intravesical heparin and peripheral neuromodulation on patients with interstitial cystitis. Materials and Methods: From March 2002 to August 2003, 8 female and 2 male subjects conform to the NIDDK criteria and not responsive to the previous conventional treatments were included in the study. Wisconsin pain scores, maximal cystometric capacities, and night and day voiding frequencies were determined and these studies were repeated in the 2nd and 12th months of the treatment with 10,000 units intravesical heparin and peripheral neuromodulation. Frequency of the treatment was once a week during first 8 weeks, once in 2 weeks in the following 8 weeks, and once in 3 weeks four times. Then, it was decreased to once a month. Results: The mean follow-up period was 13 months (12–16 months). Day and night voiding frequency were significantly better in the 2nd and 12th months, when compared to pretreatment values. The Wisconsin pain scores were 62.5 ± 13.9% and 62.8 ± 15.2% in the 2nd and the 12th months, respectively. The average increase in the maximum cystometric capacity was 54.8 ± 27.4% and 52.5 ± 31.6% in the 2nd and the 12th months, respectively. Conclusions: Intravesical heparin and peripheral neuromodulation combination seems to be an alternative for patients with interstitial cystitis not responsive to other treatments.

Penile metastasis of prostatic adenocarcinoma

Prostatic carcinoma metastasizing to the penis is rare. A case of adenocarcinoma of the prostate with metastases to the penile shaft and glans penis is presented.

Histopathologic changes in the mucosa of ileal orthotopic neobladder: Findings in 24 patients followed up for 5 years

OBJECTIVE To evaluate changes occurring in the mucosa of the neobladder over a period of 60 months in 24 patients with orthotopic ileal neobladder. MATERIALS AND METHODS A total of 36 male patients have undergone radical cystoprostatectomy and received an orthotopic ileal neobladder in our hospital during the last 10 years; 24 of these patients, all of whom completed a follow-up period of 60 months, are included in this study. All cases underwent a biopsy of the ileal mucosa at the time of surgery and their neobladder mucosa was then biopsied at 6, 12, 24, 36 and 60 months. The specimens were stained with hematoxylin-eosin in order to examine the changes in the thickness of the mucosa and its villi. Sections were also stained with Alcian blue and periodic acid-Schiff in order to determine the number of goblet cells. A morphometric scoring system was created to quantify the change in villi size. RESULTS The mean thickness of the ileal mucosa at the initial biopsy was 270.9 +/- 35.9 microm and displayed a continuous decrease at all of the subsequent biopsies. The number of luminal goblet cells increased during follow-up. Villus atrophy was found to be a continuous process during follow-up. No dysplasia or malignancy was detected in any of the biopsies. CONCLUSION During a follow-up period of 5 years, there were no neoplastic changes in our patients, but instead a protective response of the mucosa to its new environment was observed.

A new testis prosthesis material: polymethylmethacrylate.

Introduction: Silicone has been the standard prosthesis material for the last three decades but new materials are being searched because of the known disadvantages of silicone such as migration and high cost. We wanted to test in rats whether or not polymethylmethacrylate could be an alternative to silicone. Materials and Medhods: We prepared polymethylmethacrylate and silicone testis prostheses which were similar to testis size of rats. Eleven rats were implanted with polymethylmethacrylate, 11 others were implanted with a silicone prosthesis and sham operation was performed in 10 rats. Three months later the scrotums of the animals were removed with the prosthesis for a quantitative analysis of the chronic inflammation and fibrotic reaction and to measure the thickness of the capsule. Result: Rejection and infection were not observed in any of the prosthesis-implanted rats. Both prosthesis groups displayed increased vascularization, hemosiderin accumulation and fibrotic and hyalinized tissue formation that replaced the muscle. Chronic inflammation was measured and found to be higher in the polymethylmethacrylate group and the difference was not found to be significant. The average thicknesses of the capsules around the polymethylmethacrylate and silicone groups were found to be 58.4 and 46.8 µm, respectively, and that difference was not significant again. Conclusions: In the short term polymethylmethacrylate was equally well tolerated, but the low cost of polymethylmethacrylate made it more advantageous.

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.

Medical ozone therapy reduces shock wave therapy-induced renal injury

Abstract Objectives: Extracorporeal shock wave (ESW) lithotripsy is the preferred treatment modality for uncomplicated kidney stones. More recently free oxygen radical production following ESW application has been considered to be crucial in shock wave-induced renal damage. It has been shown that ozone therapy (OT) has ameliorative and preventive effects against various pathological conditions due to increased nitro-oxidative stress. In current study, we aimed to evaluate the efficacy of OT against ESW-induced renal injury. Methods: Twenty-four male Sprague–Dawley rats were divided into three groups: sham-operated, ESW, and ESW + OT groups. All groups except sham-operated group were subjected to ESW procedure. ESW + OT group received 1 mg/kg/day of oxygen/ozone mixture intraperitoneally at 2 h before ESW, and OT was continued once a day for consecutive three days. The animals were killed at the 4th day, and kidney tissue and blood samples were harvested for biochemical and histopathologic analysis. Results: Serum ALT and AST levels, serum neopterin, tissue nitrite/nitrate levels, and tissue oxidative stress parameters were increased in the ESW group and almost came close to control values in the treatment group (p < 0.05, ESW vs. ESW + OT). Histopathological injury scores were significantly lower in treatment group than the ESW group (p < 0.05, ESW vs. ESW + OT). Immunohistochemical iNOS staining scores in ESW group were higher than those of sham-operated group (p < 0.05, ESW vs. sham-operated), iNOS staining scores in OT group were significantly lower than the ESW group (p < 0.05, ESW + OT vs. ESW). Conclusion: OT ameliorates nitro-oxidative stress and reduces the severity of pathological changes in the experimental ESW-induced renal injury of rat model.

The Smooth Muscle Ratio at the Renal Pelvis in Adults: Does It Predict Surgical Outcome?

Introduction: Patients with ureteropelvic junction obstruction occasionally remain undiagnosed until adulthood. There are no objective criteria to predict the results of pyeloplasty in adult patients. We have evaluated the results of pyeloplasty in adult patients and investigated whether these results are correlated with the histopathology of the surgical specimen. Materials and Methods: Histological sections from 26 patients with ureteropelvic junction obstruction were analyzed. Their mean age was 25.1 years. Diethylenetriamine-pentaacetic acid scans were used to determine the degree of renal obstruction and postoperative healing. Improvement in diuretic renography was defined as a greater than 20% decrease in the half-time of the preoperative value. To examine smooth muscle and collagen tissue, sections were stained using Masson’s trichrome. Smooth muscle ratio was identified by color image analysis. Results: 18 patients (69.2%) fulfilled the criteria of healing. Patients with an improved scan had a mean smooth muscle percent (SMP) of 1.85 ± 0.87 while subjects with no significant change in their diuretic scans had a mean SMP of 0.36 ± 0.03 (p = 0.001). There was a strong correlation between the SMP and the improvement. Conclusions: Adult pyeloplasty was found successful in about 70% of the cases. The SMP of the renal pelvis seems to be helpful in predicting the surgical outcome.