Mehmet Kalkan

Association of Insulin Resistance with Overactive Bladder in Female Patients

Purpose Metabolic syndrome and obesity have been advocated to be risk factors for the development of overactive bladder (OAB). Additionally, insulin resistance is the underlying mechanism of metabolic syndrome. We aimed to investigate the association of insulin resistance with overactive bladder in female patients. Methods We prospectively conducted the study in our urology department. Female patients aged between 30 and 76 years old applied to our policlinics with or without OAB symptoms were enrolled. One hundred and twenty-two patients with OAB and 62 age-matched controls without OAB were included into the study. Fasting serum insulin, glucose, high-density lipoprotein (HDL-c), and triglycerides levels were measured. Insulin resistance value was obtained via the homeostasis model assessment of insulin resistance (HOMA-IR) calculator. The chi-square and Mann-Whitney U tests were used to compare differences in variables. Results Serum insulin level was found higher in female patients with OAB (11.5±6.2 µU/mL) relative to controls (6.4±2.1 µU/mL), statistically significant (P=0.036). In addition, HOMA-IR was significantly found higher in the OAB group, 2.86 (0.76 to 17.04) in comparison to controls, 1.32 (0.67 to 224), P=0.018. High-density lipoprotein cholesterol levels (HDL-c) were significantly found lower in females with OAB. Conclusions Insulin resistance can be associated to overactive bladder and may play significant role in pathogenesis.

Intrarenal Surgery vs Percutaneous Nephrolithotomy in the Management of Lower Pole Stones Greater than 2 cm.

Purpose To compare the efficacy of RIRS and PNL in lower pole stones ≥2 cm. Materials and and Methods: A total of 109 patients who underwent PNL or RIRS for solitary lower pole stone between April 2009 and December 2012, were retrospectively analyzed. Lower pole stone was diagnosed with CT scan. Stone size was assessed as the longest axis of the stone. All patients were informed about the advantages, disadvantages and probable complications of both PNL and RIRS before the selection of the procedure. Patients decided the surgery type by themselves without being under any influences and written informed consent was obtained from all patients prior to the surgery. Patients were divided into two groups according to the patients’ preference of surgery type. Group 1 consisted of 77 patients who underwent PNL and Group 2 consisted of 32 patients treated with RIRS. Stone free statuses, postoperative complications, operative time and hospitalization time were compared in both groups. Results There was no statistical significance between the two groups in mean age, stone size, stone laterality, mean follow-up periods and mean operative times. In PNL group, stone-free rate was 96.1% at first session and 100% after the additional procedure. In Group 2, stone-free rate was 90.6% at the first procedure and 100% after the additional procedure. The final stone-free rates and operative times were similar in both groups. Conclusions RIRS should be an effective treatment alternative to PNL in lower pole stones larger than 2 cm, especially in selected patients.

Findings concerning testis, vas deference, and epididymis in adult cases with nonpalpable testes

In this study, we aimed to state the relationship between testis, epididymis and vas deference, in adult cases with nonpalpable testis. Between January 1996 and December 2009, we evaluated 154 adult cases with nonpalpable testes. Mean age was 23 years (20-27 years). Explorations were performed by open inguinal incision, laparoscopy, and by inguinal incision and laparoscopy together on 22, 131 and 1 patient, respectively. Of all the unilateral cases, 32 were accepted as vanishing testis. In five of these cases, vas deference was ending inside the abdomen, and in the others, it was ending inside the scrotum. In the remaining 99 unilateral and 22 bilateral cases, 143 testes were found in total. Testes were found in the inguinal canal as atrophic in one case, at the right renal pedicle level with dysmorphic testis in one case, and anterior to the internal ring between the bladder and the common iliac vessels at a smaller than normal size in 119 cases. One (0.69%) case did not have epididymis. While epididymis was attached to the testis only at the head and tail locations in 88 (61.53%) cases, it was totally attached to the testis in 54 (37.76%) cases. There is an obviously high incidence rate of testis and vas deference anomalies, where epididymis is the most frequent one. In cases with abdominal testes, this rate is highest for high localised abdominal testes.

Non-alcoholic fatty liver disease is associated with benign prostate hyperplasia in men and with overactive bladder in women.

Abstract Objective. Metabolic syndrome plays a significant role in the development of benign prostate hyperplasia (BPH) and overactive bladder (OAB). Non-alcoholic fatty liver disease (NAFLD) is accepted as the hepatic component of metabolic syndrome. This study investigated the association of NAFLD with BPH and OAB. Material and methods. In total, 702 men with BPH and 529 women with and without OAB were recruited into the study in a cross-sectional risk factor analysis. All male and female patients were separated into two groups, with or without NAFLD. An overnight fasting blood profile was obtained and whole abdominal ultrasound was performed by a blinded radiologist in each patient to measure hepatic steatosis. Results. NAFLD was diagnosed in 387 (55.8%) of 702 men with BPH. Statistically significantly higher prostate volumes were found in men with NAFLD in comparison to without (p = 0.018). The female population included 207 women with NAFLD and 322 women without. OAB was found in 75.8% and 52.4% of women with and without NAFLD (p = 0.022). Conclusions. NAFLD is associated with BPH in men and with OAB in women. These findings confirm the hypothesis that BPH is an aspect of the metabolic syndrome and support the hypothesis that OAB is an aspect of the metabolic syndrome.

Is there a correlation between intravaginal ejaculatory latency time and enuresis? An exploratory study

Introduction Premature ejaculation (PE) is the most common male sexual dysfunction. Monosymptomatic enuresis (ME) is nocturnal bed wetting, without any daytime symptoms. Recent clinical studies report an association between lifelong PE and ME. The purpose of this study was to compare the intravaginal ejaculatory time (IELT) between lifelong PE in men with and without ME. The goal was to determine if there is an association between the severity of ME and of IELT. Material and methods A total of 137 men with lifelong PE were included in this study. Subjects were asked if they had childhood ME. The characteristics and mean IELTs of patients with and without ME were compared using the students t–test, and the correlation between severity of ME and IELT was assessed with trend test. Results Of the 137 lifelong PE patients, 57 reported ME. There was a strong negative correlation in patients with ME between the severity of enuresis and IELT, with IELT being shorter in patients with severe ME. Conclusions A strong correlation between IELT and the severity of ME suggests a common underlying mechanism. Further studies are required to confirm these findings and elucidate the exact pathophysiology.

Comparison of Different Forms of Local Anesthetic in Cystoscopy: A Prospective Randomized Study

1 Mehmet Kalkan1, Sadi Turkan2, Abdullah Keretli3, Coskun Şahin1, Muhammet Fuat Ozcan4, Serkan Altinova4 1Sema Hastanesi, Uroloji Klinigi, Istanbul, 2Ozel Anadolu Hastanesi, Uroloji Klinigi, Kastamonu, 3Sema Hastanesi, Anestestezi ve Reanimasyon Klinigi, Istanbul, 4Ankara Ataturk Egitim ve Arastirma Hastanesi, Uroloji Klinigi, Ankara, Turkiye Lokal Anestezi ile Sistoskopi / Cystoscopy with Local Anaesthesia Comparison of Different Forms of Local Anesthetic in Cystoscopy: A Prospective Randomized Study

Paratesticular fibrous pseudotumors

Paratesticular fibrous pseudotumors (PFPs) are rare pathologies with quite wide and variable topographic-morphological features. It is difficult to distinguish PFPs from malignant masses. Treatment can be done by resection of the mass. We reported a young patient’s findings about this rare pathology.

Collective Circumcision Performed in Sudan: Evaluation in Terms of Early Complications and Alternative Practice

OBJECTIVEnTo present the results and complications of a collective circumcision application performed using a thermocautery device with the patient under local anesthesia in Sudan.nnnMATERIALS AND METHODSnA total of 5871 children aged 7 days to 17 years (mean 5.7 years) living in different regions of Sudan were circumcised from May 3 to 25, 2012. The circumcision procedures were performed by an experienced urologist and specialized healthcare officers with the patients under local anesthesia using a Thermo-Med TM 806 cautery device. The outcomes were evaluated in terms of early complications.nnnRESULTSnNone of the patients experienced bleeding that required surgical intervention. Mild hemorrhage developed in 3 cases but resolved with cauterization. One child developed tachycardia and syncope after the injection; however, no treatment was needed, and observation was sufficient. One patient developed a scrotal abscess, which was surgically treated. None of the patients developed complications from the local anesthetic agent.nnnCONCLUSIONnAlthough we are not in favor of collective circumcisions, our results have demonstrated that this type of circumcision can be performed safely with appropriate equipment and personnel in those regions in which circumcisions cannot be performed in a hospital setting for socioeconomic reasons.

A Bladder Wall Angiomyolipoma as a Manifestation of Tuberous Sclerosis: First Case Report

A 21-year-old female patient admitted to the emergency department complaining of left side pain. Hypovolemic shock, which was probably caused by retroperitoneal bleeding from left sided renal angiomyolipoma, was developed. Abdominal computed tomography showed multiple fat containing lesions in different, regions including right bladder wall, lower pole of left kidney, and right kidney. Some lesions compatible with tuberous sclerosis such as angiofibromas, Shagreen patches, myocardial, and brain hamartomas were also detected. Bladder wall mass showing intra- and extravesical extensions was seen at exploration. We removed the tumor completely preserving bladder trigone. Angiomyolipoma located at lower pole of left kidney was also removed. Diagnosis of bladder angiomyolipoma was confirmed by the immunohistochemical examination. Recurrent or residual mass was not detected at the three-months-follow-up. We report the first case of bladder angiomyolipoma confirmed by histopathologically as a tuberous sclerosis.

Repair of Adult Hypospadias Under Local Anesthesia: The Technique and Outcomes

DOI: 10.4328/JCAM.2068 Received: 28.09.2013 Accepted: 23.10.2013 Printed: 01.07.2015 J Clin Anal Med 2015;6(4): 410-3 Corresponding Author: Mehmet Kalkan, Fatih Üniversitesi Tıp Fakültesi Hastanesi, Sahil Yolu Sok. No: 16, 34844 Dragos, Maltepe, İstanbul, Turkey. T.: +905322650917 F.: +9