M. C. Uygur

A novel surveillance protocol for stage I nonseminomatous germ cell testicular tumours.

To report the results of a novel surveillance policy for stage I nonseminomatous germ cell tumours (NSGCTs).

Combined use of prostate-specific antigen derivatives decreases the number of unnecessary biopsies to detect prostate cancer

The authors evaluated the prostate cancer detection rate in Turkish patients with prostate-specific antigen (PSA) levels of 4 ng/ml to 10 ng/ml and who had normal digital rectal examination (DRE) findings. They also aimed to evaluate the value of PSA density and percent free PSA in minimizing unnecessary prostate biopsies for these PSA ranges. This prospective study included 134 consecutive men referred for early prostate cancer detection or lower urinary tract symptoms. All men underwent transrectal ultrasound with systematic sextant needle biopsies. The ability of PSA density and percent free PSA to improve the power of PSA in the detection of prostate cancer was evaluated with statistical analyses as well as receiver operating characteristics curves. Among the 134 men, 124 (92.5%) had a benign histology and 10 (7.5%) had cancer diagnosed on the initial biopsies. Despite the disappointing results in regard to the sensitivity and specificity of PSA derivatives alone, the combination of PSA density and percent free PSA significantly increased the area under the curve compared with the use of each test alone. To increase the specificity of PSA in this patient population, the authors recommend combining two PSA derivatives in deciding whether to perform a biopsy. In a PSA range of 4 ng/ml to 10 ng/ml and with normal DRE, a percent free PSA < 21% and a PSA density > 0.18 yields highest specificity with 90% sensitivity.

A solitary and synchronous metastasis of renal cell carcinoma to the bladder.

We report a case of renal cell carcinoma with solitary metastasis to the bladder which occurred and was treated synchronously. The mode of spread and possible treatment modalities are discussed with relevant information from the literature.

Long-Term Treatnent of Nocturnal Enuresis withi Desmopressin Intranasal Spray

The purpose of this study was to determine the efficacy and safety of long-term treatment of nocturnal enuresis with desmopressin intranasal spray. Sixty-five children with primary nocturnal enuresis with a mean age of 11.3 years (range 7-17) underwent a 2-week observation period followed by dose titration period of 1 week. Those children completely dry with desmopressin entered a randomized, placebo-controlled, double-blind phase lasting 2 weeks, followed by a 6-month open treatment. The enuretic status of the children was documented for 2 weeks after the treatment was stopped. Eleven children had no change from baseline wetting with desmopressin. Thirty-two children receiving 20 mg and 9 children with 40 mg desmopressin were completely dry. Thirteen children were wet 1-2 nights per week, which was better than in the pretreatment period. During the 6-month open-treatment period, the effect of desmopressin was found to be stable. No side effects or adverse reactions were encountered. Two weeks after the treatment was stopped, 25 children were still completely dry (38% of the initial study population, 50% of the responders). The cure rate appeared to continue beyond 18 months after discontinuation of the treatment.

Repeated transurethral resection and intravesical BCG for extensive superficial bladder tumors.

PURPOSE We report our experience with repeat transurethral resection (TUR) in a group of patients with superficial bladder tumors in whom complete resection in one session was impossible because of the extensive tumor burden. PATIENTS AND METHODS Only the patients with such extensive (>10 g of resected tissue) tumors that we were unable to perform complete TUR initially were included in the present study. The patients underwent repeat TUR(s) 4 weeks after the previous one until complete resection of the tumor was achieved. After complete TUR, if the pathology examination confirmed superficial disease, the patients received intracavitery immunotherapy and were followed up thereafter. If pathology examination documented muscle-invasive disease, cystectomy was suggested. RESULTS Of the 43 patients undergoing repeat TUR, 15 needed a second and 5 needed a third session to achieve complete resection. Of the patients, 28 (65%) had stage T1 and 15 (35%) has stage Ta tumor. Eight patients (19%) otherwise regarded as having superficial tumor were found to have muscle-invasive disease following repeat TURs. The mean follow-up of the remaining 35 patients with superficial disease was 34 months (range 1-126 months). Four of the patients with superficial disease progressed to T2 tumor. However, 16 patients achieved a state of complete response with no tumor recurrences during a mean of 38 months (range 4-126 month). The present protocol achieved bladder sparing in a total of 22 (63%) of the 35 patients with superficial disease. CONCLUSIONS From the presented series, we suggest that one can use the combination of repeat TUR and intravesical immunotherapy in the management of bulky superficial bladder tumors in an effort to preserve the bladder.

Gynecomastia following Chemotherapy for Testicular Cancer

A 22-year-old man received 4 cycles of bleomycin, etoposide and cisplatin combination chemotherapy for clinical stage IIA embryonal cell carcinoma of the right testis. The treatment resulted in complete remission. Five months following cessation of the chemotherapy first on the left and then 2 weeks later on the right side painful gynecomastia developed. His hormonal values are all normal with no evidence of recurrence of the cancer. Gynecomastia on both sides resolved in 8 months spontaneously without any treatment. He is still in clinical remission 14 months after completion of the chemotherapy. We should be aware that gynecomastia following cytotoxic chemotherapy in a young man does not necessarily mean the return of the cancer.

Enuresis nocturna: New concepts in pathophysiology

Although nocturnal enuresis was first described centuries ago, there is still a lot unknown about its pathophysiology. The functional bladder capacities, diurnal vasopressin levels, urine osmolalities and urine output of enuretic and normal children were compared. We have concluded that enuretics have normal bladder capacities insufficient for increased nocturnal urine volumes because of loss of diurnal variation in serum vasopressin levels and related decrease in urinary osmolalities.

Prognostic factors and the role of neprectomy in metastatic renal cell carcinoma

The objective of this study was to evaluate the prognostic factors and role of nephrectomy in metastatic renal cell carcinoma. We reviewed 62 cases of metastatic renal cell carcinoma (RCC) at presentation to document the factors influencing the survival and to evaluate the role of nephrectomy. Sex and age of the patients, size of the primary tumour, site and number of the metastases, nephrectomy, cell type and grade of the tumour and type of the medical treatment were analyzed as prognostic factors. The age and sex of the patients, cell type and type of the medical treatment did not appear to be significant predictors of prognosis. However, improved survival was correlated with tumours ≤7 cm in diameter, low grade tumours, metastasis limited to single organ and removal of the primary tumour. When these parameters were analyzed in a combined manner patients who had undergone nephrectomy showed consistently longer survival. We suggest that nephrectomy should be considered in all patients with metastatic RCC, as long as the morbidity of the operation is predicted to be acceptable.

Is routine stenting necessary in pyeloplasty

Although the evaluation of surgical procedures for the repair of ureteropelvic junction obstruction continues, open pyeloplasty is still the gold standard in the management of pediatric cases. The use of stents in open pyeloplasty is subject to discussion among pediatric urologists. To clarify this question on the basis of our experience, we retrospectively reviewed our 28 stented and 15 unstented pediatric pyeloplasty operations in terms of hospital stay, early and late complications, and success rates. While there were no differences between both groups in terms of early and late complications and success rates, hospital stay favored the unstented cases. We have concluded that routine stenting in pyeloplasty is not necessary unless a perfect anastomosis is accomplished.