M. Cemil Uygur

Factors affecting outcome of one-stage anterior hypospadias repair: analysis of 422 cases.

Abstract The repair of hypospadias is among the most difficult problems in urology, as it demands the construction of a well-functioning urethra and a good cosmetic appearance. We performed a retrospective analysis of 422 cases subjected to one-stage anterior hypospadias repair between 1982 and 1999 in our clinic and investigated the effects of factors like degree of hypospadias, surgical technique, and the surgeons experience on outcome. The operations used were MAGPI (91), urethral advancement (10), Mathieu (260), modified Allen-Spence (50), onlay island flap (5), and double-faced island flap (6) procedures. The early complication rate was 18%, while the final success rate following secondary interventions was 95%. The complications included fistula formation in 49 cases (12%), flap necrosis in 12 (3%), meatal problems in 12 (3%), residual chordee in 4 (1%), and urethral stricture in 1 (<1%). Complication rates were significantly higher if the meatus was proximal or there was severe chordee and in the first 6 years of the study. The flap procedures were associated with a higher complication rate. It is concluded that one-stage procedures are successful in the repair of anterior hypospadias in experienced hands with proper patient selection.

Effect of transurethral indwelling catheter on serum prostate-specific antigen level in benign prostatic hyperplasia

OBJECTIVES The purpose of this prospective study was to determine the influence of indwelling transurethral catheters on the serum prostate-specific antigen (PSA) levels in patients with benign prostatic hyperplasia (BPH). We compared the PSA values of preoperatively catheterized and noncatheterized patients. METHODS Ninety patients undergoing a prostatectomy for benign disease were included. The indwelling catheter (IC) group and noncatheterized (NC) group each consisted of 45 patients. A total of 83 patients who did not have prostate carcinoma were analyzed by means of PSA, PSA density (PSAD), and pathologic presentations. Prostate pathologies that might elevate PSA values were excluded to demonstrate the correlation of PSA levels and standard urethral catheterization. RESULTS A statistically significant relationship was determined between an indwelling urethral catheter and an elevated serum PSA value. The average PSA level of the IC group was 2.6 times that of the NC group. CONCLUSIONS PSA, PSAD, and age-adjusted PSA levels were elevated above normal ranges in patients with BPH who had an indwelling urethral catheter.

Serum concentrations of sex hormones in men with severe lower urinary tract symptoms and benign prostatic hyperplasia.

Objective: To find out the impact ofage-related changes in serum concentrations ofsex hormones on the development of severe lowerurinary tract symptoms and benign prostatichyperplasia (BPH).Patients and methods: The study groupconsisted of 61 consecutive patients subjectedto prostatectomy for BPH between 2000–2001 inour clinic. Forty-five randomly assigned, ageand socioeconomically matched cases without any lower urinary tract symptoms were taken asthe control group. Both clinical BPH andcontrol groups were divided to 3 age groups(namely 50–59, 60–69 and ≥70 years) andage-related changes in serum concentrations ofsex hormones were investigated.Results: Prostate adenoma weight was foundto be increased significantly (p = 0.02) withadvancing age in clinical BPH group. There wasno difference between serum concentrations ofmeasured sex hormones between small and largeprostates except for serum estradiol levels,which were found to be significantly higher inpatients who had an adenoma weight of >50 g(p = 0.047). Similar results were obtained inboth clinical BPH and control groups withrespect to age-related changes in serumconcentrations of sex hormones. Briefly therewas an age-related decrease in serum freetestosterone levels and increase in serumestradiol, prolactin and gonadotropin levels.Serum free testosterone concentration wassignificantly higher in the control group forages 60–69 (p = 0.015) while total testosteronewas higher in BPH patients for patients olderthan 70 years of age(p = 0.027). No othersignificant change was documented between 2groups. An age-dependent increase in serumE/freeT ratio was documented in both clinicalBPH and control patients whereas serum freeT/Tratio was decreased in the BPH group withadvancing age (p = 0.008).Conclusion: The decrease in serum freetestosterone concentrations with a relativerise in serum estradiol levels with advancingage might be an important factor in thedevelopment of BPH. However it is likely thatserum concentrations of sex hormones playlittle impact on the clinical severity ofBPH.

Effect of stanford pouch and ileal conduit urinary diversions on bone mineral density and metabolism

After urinary-intestinal diversions metabolic complications may occur in long term follow up. We aimed to evaluate bone metabolism changes in urinary diverted patients. Nineteen patients with urinary diversions (11 Stanford pouch and 8 ileal conduit) performed with diagnosis of locally invasive bladder cancer and 19 age-sex matched healthy subjects were enrolled in the study. Bone mineral density (BMD), arterial blood pH, bicarbonate and base excess as well as bone mineralisation parameters at urine and serum were evaluated for all groups. For statistical evaluation, nonparametric comparisons between groups were used. Comparison of ileal conduit and control groups displayed higher alkaline phosphatase and parathormone levels in the patient group though the difference was not significant. The mean BMD values of ileal conduit group were osteopenic, revealing a significant difference with the control group. Statistically significant differences between alkaline phosphatase, parathormone levels of Stanford pouch and control groups were apparent whereas BMD values were not significantly different. When the two patient groups were compared with each other, no difference in BMD or bone metabolism parameter values could be observed. Patients with urinary diversions are under risk of bone demineralisation and must be followed by BMDs, arterial blood analysis and bone mineral metabolism parameters.

Remission of Idiopathic Retroperitoneal Fibrosis after Sequential Therapy with Corticosteroids and Tamoxifen

The most favored therapy for idiopathic retroperitoneal fibrosis is the surgical relief of ureteral obstruction and use of corticosteroids to prevent recurrence. Although effective, long-term corticosteroid treatment could be associated with serious side effects. We would like to present a case of idiopathic retroperitoneal fibrosis treated successfully with intraperitonealization of the ureters and sequential therapy with steroids and tamoxifen to minimize the side effects.

Combination of Transcutaneous Electrical Nerve Stimulation and Ondansetron in Preventing Cisplatin-Induced Emesis

Objective: To find out whether the combination of transcutaneous electrical nerve stimulation (TENS) and ondansetron had an increased antiemetic effect. Materials and Methods: Fourteen testis and 11 bladder cancer patients were scheduled for 4 cycles of bleomycin-etoposide-cisplatin (BEP) or methotrexate-vinblastine-etoposide-cisplatin (MVEC) combination chemotherapy, respectively. At each cycle the whole cisplatin dose was given in 1 day that is 100 mg/m2/day in the BEP and 70 mg/m2/day in the MVEC protocols. Ondansetron was given at a dose of 12 mg/day and TENS was applied by commercially available ‘Relief Band’(Maven Labs, Inc., Citrus Heights, Calif., USA). The first 3 cycles of each case were blindly randomized to one of the following regimens; TENS vs. ondansetron vs. a combination of both. The regimens were applied during the administration of cisplatin and the patients were asked to report their nausea according to a scale between 0 to 10. Also for each regimen the number of emetic attacks experienced during the administration of cisplatin was recorded by the same observer. Then the scores of each regimen were compared. Results: The mean nausea scores for regimens TENS, ondansetron and TENS + ondansetron were found to be 5.12 ± 2.54, 3.0 ± 1.71 and 0.8 ± 0.96, respectively. Ondansetron was better than TENS in preventing nausea (p = 0.000). However the combination of TENS and ondansetron resulted in a significant decrease in nausea scores when compared to TENS alone (p = 0.000) or ondansetron alone (p = 0.000). The mean number of emetic attacks for the TENS, ondansetron and TENS + ondansetron regimens were 3.16 ± 1.84, 1.64 ± 1.44 and 0.56 ± 0.82, respectively. A statistically significant difference was present between the number of emetic attacks observed with the TENS + ondansetron combination and TENS alone (p = 0.000) or ondansetron alone (p = 0.001). Ondansetron was again better than TENS in preventing emetic attacks (p = 0.001). Conclusion: The use of TENS as an adjunct to ondansetron therapy has provided significant benefit in preventing nausea and emetic attacks caused by cisplatin.

Splenogonadal fusion: Report of a case

Abstract  A 15‐year‐old male patient was admitted to our hospital with a left undescended testis. He also suffered from congenital limb defects. Ultrasonography revealed atrophic testicular tissue in the left groin, approximately 2‐cm in size. Upon left inguinal exploration, atrophic testicular tissue was found and an orchidectomy was performed. Histopathological examination revealed splenogonadal fusion, which has a known association with congenital limb defects.

Case report: Further upward migration of a misplaced double-j ureteral stent

A 45-year-old man was referred to our hospital for the removal of a misplaced double-J ureteral stent. The lower end of the stent shortly after insertion was at the level of sacroiliac joint. However one week later the stent was further migrated upwards to the level of 4th lumbar vertebra. Immediate ureterorenoscopy was performed to prevent further migration of the stent to the renal pelvis and the stent was removed by the grasping forceps under direct vision successfully.

Are clinical characteristics of familial benign prostatic hyperplasia different than in sporadic cases

Objective: Familial benign prostatic hyperplasia (BPH) is a recently popularised entity with yet uncertain clinical and pathological features. In the present study we investigated whether there was any difference between clinical characteristics of familial and sporadic BPH in a series of 148 surgically treated BPH patients. Materials and Methods: A retrospective analysis was performed in 148 patients subjected to transvesical or transurethral prostatectomy to determine the clinical features of familial BPH. Patients were categorised as having familial BPH when 3 or more (including the patient) first-degree family members gave a history of BPH. Accordingly 23 cases who fit this criterion were accepted as having familial BPH and the rest of the cases were taken as the control group. The two groups were compared with respect to age, International Prostate Symptom Score (IPSS), quality of life score, prostate specific antigen (PSA), maximum urinary flow rate and the weight of the surgical prostate specimen. Results: The mean age, IPSS, quality of life score, total PSA, maximum urinary flow rate and the weight of the surgical prostate specimen were found as 65.13 ± 5.51 years, 23.13 ± 4.82, 4.78 ± 0.95, 6.0 ± 4.1 ng/ml, 6.9 ± 2.7 ml/s and 62.96 ± 38.76 g, respectively, in the familial BPH group whereas the same parameters were measured as 68.13 ± 7.68 years, 24.74 ± 3.73, 4.52 ± 0.85, 5.93 ± 4.75 ng/ml, 4.6 ± 1.71 ml/s and 70.87 ± 53.21 g, respectively. No significant difference was present between familial and sporadic BPH cases in any of the studied parameters. Conclusion: The clinical features of familial BPH did not differ significantly from those of sporadic BPH.

Effects of combined androgen blockade on bone metabolism and density in men with locally advanced prostate cancer.

Objective: To investigate whether combined androgen blockade (CAB) produces any adverse effects on bone metabolism and mineral density in patients with locally advanced prostate cancer.Materials and methods: The study group consisted of 17 stage T4 prostate cancer patients treated with CAB and had no evidence of bone metastasis on bone scintigraphy. The mean duration of CAB and final total prostate specific antigen (PSA) level at the time of study were found at 28.5 ± 15.9 (6–58) months and 0.39 ± 0.5 (0.1–2) ngml, respectively. Twenty age and socioeconomically matched benign prostate hyperplasia (BPH) patients were taken as the control group. Both groups were compared with regard to lumbar bone mineral density (LBD), femur bone mineral density (FBD) and serum parameters of bone metabolism namely calcium (Ca), phosphate (P), magnesium (Mg) and alkaline phosphatase (ALP). Bone mineral density was measured with dual energy x-ray absorptiometry.Results: The mean FBD, LBD and serum Ca, P, Mg and ALP measurement of the patients treated with CAB were 0.85 ± 0.1 g/cm2, 1.16 ± 0.2 g/cm2, 9.1 ± 0.3 mg/dl, 3.6 ± 0.6 mg/dl, 1.95 ± 0.14 mg/dl, 187.5 ± 61 mg/dl, respectively. No significant difference was found between patients subjected to CAB and the age matched controls in any of the studied parameters namely age, FBD, LBD, Ca, Mg and ALP except serum phosphate. Serum phosphate levels were significantly (p =0.001) higher in patients treated with CAB suggesting a minor effect of CAB on bone metabolism.Conclusion: No convincing evidence was found about the detrimental effect of CAB on bone mineral density and metabolism in a highly selected group of patients with advanced prostate cancer without bone metastases.