Mehmet İlker Gökçe

Tadalafil rehabilitation therapy preserves penile size after bilateral nerve sparing radical retropubic prostatectomy

OBJECTIVE To evaluate the change in penile size r bilateral nerve sparing retropubic radical prostatectomy (BNSRRP) and possible effect of Tadalafil. MATERIALS AND METHODS A total of 65 patients underwent BNSRRP and they were evaluated prospectively for a whole year of follow-up. The patients were randomized to control without rehabilitation (Group 1) or Tadalafil rehabilitation group (Group 2). The patients were evaluated at months 3, 6 and 12 postoperatively for erectile function, penile measurements (flaccid penile length, penile length at maximum erection, penile circumference at flaccid status, and penile circumference at maximum erection), penile abnormalities and general health status. Statistical analysis was performed by Chi-Square test and significance was defined as p value < 0.05. RESULTS In Group 1 there was significant decrease in penile measurements at month 3 compared to preoperative measurements. There was decrease in all parameters at month 6 compared to month 3 but only the decrease in penile length at maximum erection was significant. There were no significant differences between postoperative months 6 and 12 for all measurements. In Group 2 there was a tendency to decrease in all measurements at month 3 compared to baseline. There was no significant difference for penile measurements between postoperative 3rd and 6th months and between 6th month and the first year. CONCLUSION Although further large sampled trials are needed to describe the possible positive effect of tadalafil or other PDE5-I s on penile size after BNSRRP, tadalafil rehabilitation is effective in preserving penile size especially in the early postoperative period after BNSRRP.

Effectiveness of Antibiotics Given to Asymptomatic Men for an Increased Prostate Specific Antigen

PURPOSE Although there is controversy surrounding this subject, some urologists in daily practice often prescribe antibiotics before biopsy to men with a newly increased prostate specific antigen. We evaluated the effects of antibiotics on serum total prostate specific antigen, free prostate specific antigen, percent free prostate specific antigen and prostate specific antigen density in men with prostate specific antigen between 4 and 10 ng/ml and normal digital rectal examination. We also investigated the incidence of prostate cancer after antibiotic treatment by performing prostate biopsies in all patients regardless of posttreatment prostate specific antigen. MATERIALS AND METHODS Between May 2006 and April 2008 a total of 100 men with total prostate specific antigen between 4 and 10 ng/ml were enrolled in this study. In addition to total prostate specific antigen, free prostate specific antigen, percent free prostate specific antigen and prostate specific antigen density values were evaluated for all of the patients. Patients with pathological digital rectal examination and urinalysis were excluded from the study. All patients received 400 mg ofloxcacin daily for 20 days. After treatment the patients were reevaluated. Regardless of the total prostate specific antigen value after therapy transrectal ultrasound guided prostate biopsy was performed. RESULTS Overall 23 men (23%) had histologically proven prostate cancer on biopsy. Mean total prostate specific antigen, free prostate specific antigen and prostate specific antigen density decreased after treatment in patients with and without prostate cancer. However, these reductions within these parameters were not significantly different between patients with and without prostate cancer. Only percent free prostate specific antigen change after treatment was found to be significantly different between patients with and without prostate cancer (p = 0.015). In 17 of the 100 men total prostate specific antigen after treatment was less than 4 ng/ml and of these 5 (29.4%) had prostate cancer on biopsy. CONCLUSIONS Although antibiotic therapy will decrease serum total prostate specific antigen, it will not decrease the risk of prostate cancer even if the prostate specific antigen decreases to less than 4 ng/ml. Therefore, prescribing antibiotics for asymptomatic men with a newly increased prostate specific antigen may not be an appropriate method of management.

Comparison of radical and partial nephrectomy in terms of renal function: A retrospective cohort study

Abstract Objective. This study aimed to evaluate kidney function following radical or partial nephrectomy and to evaluate the role of two common chronic diseases, hypertension (HT) and diabetes mellitus (DM), on glomerular filtration rate (GFR) in the long term. Material and methods. Data on 488 patients who underwent surgery for renal tumours between 1994 and 2008 were investigated. Patient characteristics and estimated GFR, history of DM or HT, tumour size and new-onset decrease in GFR were recorded. Multivariable Cox proportional hazards regression was used to investigate whether the two types of operation were associated with chronic kidney failure after surgery, and the outcome was adjusted for age, gender, HT, DM and tumour size. p Values less than 0.05 was regarded as significant. Results. Seventeen patients (18.9%) in group 1 and 176 (68%) in group 2 developed new onset of GFR < 60 ml/min/1.73 m2. Three patients (2.9%) in group 1 and 137 (37.2%) in group 2 developed new onset of GFR < 45 ml/min/1.73 m2 (p < 0.05). HT was associated with new-onset chronic renal failure in the radical nephrectomy group (hazard ratio 1.39, 95% confidence interval 1.028–1.890). Conclusion. After surgical treatment of renal masses, patients are at risk for development of chronic renal failure. A decrease in GFR was detected in both partial and radical nephrectomy, the latter associated with increased risk, especially in hypertensive patients. Routine praxis of radical nephrectomy should be overviewed.

Clinical comparision of intravesical hyaluronic acid and hyaluronic acid-chondroitin sulphate therapy for patients with bladder pain syndrome/interstitital cystitis.

INTRODUCTION Patients with a history of bladder pain syndrome/interstitial cystitis (BPS/IC) and who responded poorly or unsatisfactorily with previous treatment were compared taking intravesical hyaluronic acid (HA) or hyaluronic acid-chondroitin sulphate (HA-CS). METHODS Patients were treated with intravesical instillation with 50 mL sterile sodium hyalurinic acid (Hyacyst, Syner-Med, Surrey, UK) (n = 32) and sodium hyaluronate 1.6% sodium chondroitin sulphate 2% (Ialuril, Aspire Pharma, UK) (n = 33). Intravesical instillations were performed weekly in first month, every 15 days in the second month and monthly in third and fourth months, for a total of 8 doses. Patients were evaluated using a visual analog pain scale (VAS), interstitial cystitis symptom index (ICSI), interstitial cystitis problem index (ICPI), voiding diary for frequency/nocturia, cystometric bladder capacity and voided volume at the beginning and at 6 months. All patients had a potassium sensitivity test (PST) initially. Wilcoxon and Mann-Whitney U tests were used for statistical analysis. RESULTS In total, 53 patients met the study criteria. There were 30 patients in the HA-CS group (mean age: 48.47) and 23 patients in the HA group (mean age: 49.61) (p > 0.05). The initial PST was positive in 71.7% patients (38/53) overall with no difference between groups (p > 0.05). Responses for VAS, ICCS, ICPS, 24-hour frequency/nocturia statistically improved in both groups at 6 months. There was no significant difference in symptomatic improvement (p > 0.05). Eight patients had mild adverse events. CONCLUSION HA and HA/CS instillation can be effective in BPS/IC patients who do not respond to conservative treatment. An important limitation of our study is that the HA dosage of the 2 treatment arms were different. It would be more appropriate with same HA dosage in both groups; however, there was no commercially available glycosaminoglycan (GAG) substance with same HA dosage for single and combination therapy. Large, long-term randomized studies are required to determine if there is a difference between these treatments.

The value of perioperative mitomycin C instillation in improving subsequent bacillus calmette-guerin instillation efficacy in intermediate and high-risk patients with non-muscle invasıve bladder cancer: a prospective randomized study

PURPOSE We evaluated the efficacy of perioperative mitomycin C (MMC) instillation to improve subsequent bacillus Calmette-Guérin (BCG) instillation efficacy in intermediate and high risk patients with non-muscle invasive bladder cancer (NMIBC). MATERIALS AND METHODS From November 2004 to May 2006, 51 patients with intermediate or high risk NMIBC were enrolled in this prospective randomized trial. In group A, patients were treated with perioperative MMC (40 mg MMC in 40 mL saline was administered within 6 hours of surgery) followed by delayed (at least 15 days from surgery) BCG instillations (once a week for 6 weeks, 5 x 108 colony-forming units in 50 mL saline). Patients in group B were treated with delayed BCG instillations alone. The primary end points were recurrence-free interval and recurrence rate. RESULTS There were 25 and 26 patients in groups A and B, respectively. Median follow-up was 41.3 months (range 8 to 64) in group A and 40.9 months (range 6 to 68) in group B. Recurrence rate was 36 % (9 of 25) and 19.3 % (5 of 26) in group A and B, respectively (p = 0.052). Median time to the first recurrence was 8 months in group A and 7 months in group B (p = 0.12). CONCLUSIONS The present study showed no statistically significant difference in terms of recurrence rate and median time to first recurrence between intermediate or high-risk patients with NMIBC who were treated with early single dose instillation of MMC plus delayed BCG and those who were treated with only BCG.

Significance of the interval between first and second transurethral resection on recurrence and progression rates in patients with high‐risk non‐muscle‐invasive bladder cancer treated with maintenance intravesical Bacillus Calmette‐Guérin

To evaluate the effect of the interval between the initial and second transurethral resection (TUR) on the outcome of patients with high‐risk non‐muscle‐invasive bladder cancer (NMIBC) treated with maintenance intravesical Bacillus Calmette‐Guérin (BCG) therapy.

Evaluation of a New Ultrasound Measurement Tool for the Diagnosis of Dysfunctional Voiding in Pediatric Population: Full/Empty Bladder Wall Thickness Ratio

OBJECTIVE To investigate the roles of bladder wall thickness (BWT) measurement and full/empty (F/E) BWT measurement ratio in the diagnosis of dysfunctional voiding in pediatric population. METHODS Totally, 324 patients were involved in this prospective study, and group 1 consisted of healthy children (n=198), and group 2 consisted of patients with dysfunctional voiding (n=126). BWT measurements were done at the anterior, posterior, and lateral walls, and F/E BWT ratios were calculated. Two groups were compared for BWT measurement, and receiver operating characteristic analysis was performed to find out a cutoff value for BWT and F/E BWT ratios. RESULTS Mean age of group 1 was 6.4 years and that of group 2 was 6.5 years. BWT measurements were higher in the empty state compared with full state and in boys compared with girls. However, BWT ratios did not show significant difference between male and female patients. F/E BWT ratios were found to be higher in group 2 compared with group 1 (P=.02). In receiver operating characteristic analysis, a cutoff value of 0.324 (sensitivity 66.67% and specificity 79.80%) and 0.295 (sensitivity 83.33% and specificity 64.14%) was found for anterior and posterior F/E BWT rates, respectively. CONCLUSION Ultrasonographic measurement of BWT and calculation of F/E BWT ratio may serve as a noninvasive tool for evaluating lower urinary tract symptoms in children. Further studies including larger number of patients would be of great interest.

The prognostic significance of preoperative leukocytosis and neutrophil-to-lymphocyte ratio in patients who underwent radical cystectomy for bladder cancer

INTRODUCTION We evaluated the prognostic effects of hematologic parameters of preoperative leukocytosis and neutrophil-to-lymphocyte ratio (NLR) in patients who underwent radical cystectomy for bladder cancer. METHODS We retrospectively reviewed the medical records of 363 patients who underwent radical cystectomy for bladder cancer between January 1990 and June 2013. In total, 286 patients were included in the study. Age, gender, pathologic stage, lymph node involvement, preoperative hydronephrosis, histologic sub-type, surgical margin status, and lymphovascular invasion were recorded for each patient. Univariate and multivariate analysis were performed to determine the prognostic value of the preoperative clinical and laboratory parameters on disease-specific survival (DSS). Additionally, the correlation between leukocytosis and other factors were evaluated. RESULTS According to the univariate analysis preoperative leukocytosis and NLR were detected as negative prognostic factors on DSS. Preoperative leukocytosis, NLR, stage, lymph node involvement, histologic subtype, grade and age were independent prognostic factors for DSS, on multivariate analysis. Patients with leukocytosis had higher stage, grade and lymphovascular invasion. CONCLUSIONS Inexpensive, reproducible, and readily available peripheral blood count components of white blood cell count and NLR were independent prognostic factors, which can stratify DSS risks in bladder cancer patients who underwent radical cystectomy.

How significant is upgrade in Gleason score between prostate biopsy and radical prostatectomy pathology while discussing less invasive treatment options

Abstract Objective.This study aimed to assess the oncological outcomes of patients experiencing an upgrade from their initial biopsy pathology, and to determine whether these tumours have characteristics resembling their initial biopsy Gleason score (GS) or final radical prostatectomy (RP) GS. Material and methods. Data on 632 patients undergoing open retropubic RP between January 1994 and May 2011 at Ankara University were investigated retrospectively. Data included age, preoperative prostate-specific antigen (PSA), clinical stage, biopsy GS, prostate volume, RP specimen GS, surgical margin positivity, pathological T stage and biochemical recurrence. Biochemical recurrence of GS concordant and upgraded tumours was compared. Results.GS concordance was found in 378 cases (59.8%) and GS upgrading was observed in 183 patients (28.9%). GS upgraded tumours were found to have higher biochemical recurrence rates than their corresponding concomitant GS group. Multivariate analysis revealed that serum PSA level, pathological T stage and GS upgrading were independent prognostic factors for biochemical recurrence. Age and prostate volume were not found to be independent prognostic factors. Conclusion. Upgrade in biopsy GS is a predictor for aggressive tumours with a higher risk for biochemical recurrence than concordant tumours. It may be observed in about a quarter of patients. As it was not possible to identify correctly those patients who may experience an upgrade in GS, patients who are candidates for less invasive treatment options must be informed about the risk of upgrading and the possibility of a worse clinical course.

Functional Outcomes and Long-term Durability of Artificial Urinary Sphincter Application: Review of 56 Patients With Long-term Follow-up

Purpose To evaluate the long-term outcomes of artificial urinary sphincter (AUS) implantation and to report the complication rates, including mechanical failure, erosion, and infection. Materials and Methods From June 1990 to May 2011, AUS (AMS 800) implantations were performed in 56 adult males by one surgeon. Various demographic and preoperative variables, surgical variables, and postoperative outcomes, including success and complication rates with a median follow-up of 96 months, were recorded retrospectively. Results The mean age of the patients at the time of AUS implantation was 61.8 (±14.2) years. During the follow-up period, the total complication rate was 41.1% (23 patients). The incidence of complications was significantly lower during the follow-up period after 48 months (p<0.05). Kaplan-Meier analysis revealed that 5- and 10-year failure-free rates were 50.3% and 45.2%, respectively. Conclusions Long-term durability and functional outcomes are achievable for the AMS 800, but there are appreciable complication rates for erosion, mechanical failure, and infection of up to 30%.