Mehmet Kamuran Bircan

Diagnosis of urethral strictures: Is retrograde urethrography still necessary?

Different methods are available in the diagnosis and treatment of urethral strictures. True diagnosis is necessary for choosing the most suitable method of treatment and to inform the patient about the method, complications, recurrence rate and costs. In this study we aimed to compare the efficiency complications and reproducibility of retrograde urethrography with urethroscopy. The retrograde urethrographic (RGU) and urethroscopic findings of 38 male patients were evaluated. Thirty had the same findings with either technique. In 8 patients the RGU was misdiagnosing (p<0.01). In conclusion, it has been shown that the results of RGU are misleading when it is not combined with urethroscopy and we think that it must not be a routine method in the diagnosis of urethral strictures.

Retrospective analysis of 135 renal trauma cases

Background: We review our trauma cases over the last 11 years and discuss our diagnosis and treatment modalities.

Coagulation parameters in the patients with Fournier's Gangrene.

Aim: In this prospective study, we aimed to determine the coagulation parameters in the patients with Fournier’s gangrene. Methods: The study group is consisted of 12 consecutive Fournier’s gangrene patients (11 men and 1 woman) and control group is consisted of patients with Periurethral abscess (n=2), Scrotal abscess (n=4) and Epididimorchitis (n=4). Fibrinogen, protein C, protein S,␣antithrombin III, lupus anticoagulant, cardiolipin IgG and IgM, prothrombin time-international normalized ratio, activated partial thromboplastin time, platelet count, proaccelerin, antihemophilic globulin (FVIII), albumin, and calcium were evaluated in all subjects. Tissue specimens were taken from Fournier’s gangrene patients. These specimens were tested for arterial and venous thrombosis using light microscopy. Results: All of the patients with Fournier’s gangrene had both arterial and venous thrombosis in tissue specimens. The levels of fibrinogen and FVIII were high, the level of protein C was low in 12 patients. Lupus Anticoagulant was positive 11 of 12 patients. Conclusions: According to our findings, we think that some coagulation parameters (FVIII, Lupus anticoagulant, protein C, fibrinogen) may be diagnostic for Fournier’s gangrene.

Gunshot Injuries of the Ureter: One Centre’s 15-Year Experience

Abstract Purpose: Ureteral injury is a rare condition. It is difficult to identify the best diagnostic methods and treatment. We report our experience with penetrating ureteral injuries secondary to gunshot wounds. The methods of diagnosis and treatment options of these cases are described and discussed. Materials and Methods: A retrospective review of ureteral injuries due to penetrating trauma between January 1990 and December 2005, in the Urology and General Surgery departments of our hospital. Ureteral injures were graded according to the AAST-OIS. We evaluated mechanism of injury, initial urinalysis, radiologic and operative procedure, associated injuries, and postoperative complications. Results: A total of twenty-one (sixteen male, five female) cases of gunshot ureteral injuries were evaluated retrospectively. The median patient age was 27.85 years (16–48 years). All patients had signs and symptoms of an acute abdomen and only nine patients were evaluated radiologically. Haematuria was absent in 71.4% of patients (15 of 21). All patients had associated injuries and were evaluated from grade I to V. Grade I had none, grade II had 1 (4.76%), grade III had 3 (14.29%), grade IV had 14 (66.6%), grade V had 3 (14.29%). Ureteral stent or nephrostomy tubes were used in all primarily repaired patients. Two patients developed urinary leakage, which resolved spontaneously. Conclusions: Ureteral injury should always be borne in mind and, when suspected, the surgeon should dissect and visualize the ureter during exploration. Adequate debridment, and ureteral stenting or nephrostomy drainage are good techniques for successful treatment.

Cerebrospinal fluid prostate specific antigen (CSF PSA) in prostate cancer patients with lower spine metastasis.

Aim: In this prospective study, our aim was to investigate the CSF PSA levels and CSF/Serum PSA ratios in patients with prostate cancer with lower spine metastasis. Methods: The study involved patients with prostate cancer (n = 15), benign prostatic hyperplasia (n = 17) and non-prostatic disease (n = 9). Serum and CSF were obtained prior to spinal anesthesia for urological surgery. Total PSA levels in the serum and CSF were measured by electrochemiluminescence immunoassay. The results were tested statistically using the Mann–Whitney U test. Results: The mean serum PSA levels were 20.36 ng/ml in the prostate cancer patients, 5.37 ng/ml in the BPH patients and 0.76 ng/ml non-prostatic disease. The mean CSF PSA levels in groups were 0.127, 0.051 and 0.027 ng/ml, respectively. The mean CSF PSA/serum PSA ratios in groups were 0.007, 0.018 and 0.042, respectively. This result is statistically significant (P < 0.001).Conclusions: Although mean serum PSA and CSF PSA levels in the patients with cancer of the prostate and lower spine metastasis are higher than those in the others, the mean CSF PSA/serum PSA ratio is lower. However, clinical usefulness of CSF PSA value and CSF PSA/ Serum PSA ratio can be limited because CSF PSA values are usually very low, and CSF PSA/Serum PSA ratio of 4 prostate cancer patients are as high as 1 BPH patient.

Erectile dysfunction rates and requests for treatment in patients attending outpatient urology clinics and those accompanying them.

Background: Erectile dysfunction is a common sexual function disorder in men. The aim of the present study was to determine the rates of erectile dysfunction and requests for treatment in male patients refered to our outpatient urology clinics and those accompanying them who were older than 20 years. Methods: The study comprised 2 groups: group 1 included male patients older than 20 years whom attend to the outpatient urology clinics, and group 2 included their companies whom were older than 20 years. Subjects were asked whether they had erectile dysfunction or not, if so whether they had been treated or not, if not then why, and whether they desired treatment or not at present. Results: Erectile dysfunction was determined in 224 subjects (13.9%) in group 1, and 57 (8.5%) in group 2. It was found that approximately one half (49.1%) of patients with erectile dysfunction did not complaint about this. The main reasons for this were failure to perceive sexual dysfunction as a problem, and shame. Of 281 men who determined to have erectile dysfunction, 71 indicated that they desired treatment. In those who did not desire treatment, the main reasons were failure to perceive it as a problem, and shame. Conclusions: These findings show that the doctor has a great responsibility in determining erectile dysfunction. Therefore discussions of sexual health should be made a routine part of doctor-patient discussions, and patients, especially those over 50, should be asked whether they have a complaint of erectile dysfunction.

Premature ejaculation rates and treatment needs in males aged 20 years and over attending urology outpatient clinic

Aim: The purpose of this study was the assessment of the rates of premature ejaculation and desires for treatment in male patients 20 years and over attending urology outpatient clinic. Methods: All subjects included in the study were asked whether they had a complaint of premature ejaculation; if so, whether they had sought a doctor’s assistance; if not, why they had not; why they did not mention their complaint during the first visit; whether they desired treatment; and if not, why they did not. Results: A total of 1608 subjects were questioned. Premature ejaculation was present in 333 (20.7%). Premature ejaculation was the primary complaint of 33 of those attending the urology outpatient clinic. The most common reasons for not seeking a doctor’s assistance were failure to see the condition as a problem, and embarrassment. Fifty four (16.2%) of these patients did not desire treatment. The most common reason for not desiring treatment was regarding it as unnecessary at present, and old age. Conclusion: The questioning of all men aged 20 and over attending urology outpatient clinic concerning premature ejaculation will greatly increase diagnoses and treatments.

The effects of cellular telephone use on serum PSA levels in men

Background: The increasing use of cellulartelephones is known to have harmful effects onhuman health. The aim of this prospective studywas to determine whether cellular telephone useaffected serum PSA levels in men. Methods: Participants included 20 menwith ages ranging from 22 to 65 years who hadnever previously used cellular telephones.Blood samples were taken prior to and 30 daysafter the beginning of cellular telephone use.Serum was separated from the blood samples andstored in a deep freezer until the end of thestudy, at which time serum free and total PSAlevels were determined by tandemradioimmunoassay. The results werestatistically analyzed by the Wilcoxon PairedSigned Rank Test. Results: Average free and total PSAvalues were 2.070 ng/ml and 0.500 ng/ml beforethe study, and 2.0 ng/ml and 0.505 ng/ml at theend of the study, respectively. No significantdifference was determined between the initialand final values (p > 0.05). Conclusions: The results indicatethat cellular telephone use does notsignificantly affect PSA values in the shortterm. Nevertheless, we think that there is aneed for longer-term studies on this subject.

The effects of GnRH analogues and antiandrogenes in preventing the gonadotoxic effects of COPP chemotherapy

Background: In this study we aimed to discuss whether thegonadal suppression is effective or not in preventing the gonadal toxiceffects of some chemotherapeutics.Methods: Forty Sprague-Dawley adult male rats were randomised into4 groups, each consisting of 10. No drugs were given to the first group. Thesecond group received GnRH agonist and antiandrogen, the third groupreceived COPP chemotherapy protocol and the last group received COPPtogether with GnRH agonist and antiandrogen. Ninety days after drugapplication we sacrificed all rats. Total body weight, testicular weight andtesticular size measurements were all recorded. All testicular tissues wereexamined histologically for the ratio of active seminiferous tubules.Results: There was no difference in total body weight. The weight andmeasurements of testicular tissues were decreased in-group 3 and 4 whencompared with 1 and 2. The amount of active seminiferous tubules wassignificantly less in the third group.Conclusions: As a conclusion we think that gonadal suppressionapplied during chemotherapy regimen could decrease the testicular toxiceffects of chemotherapeutic but more clinical investigations needed forroutine application.

The importance of visual erotic stimulation in the differential diagnosis of erectile impotence.

In this study we aimed to determine the importance of visual erotic stimulation (VES) alone, and in combination with intracavernosal papaverine injection (ICPE) in the differential diagnosis of erectile impotence. Sixty-four patients with erection porblems were investigated betwen June 1992 and January 1994.VES could be the first investigative method in the differential diagnosis of erectile impotence. This will help us in some groups of patients with psychogenic impotence to avoid the application and complications of ICPE. In patients with insufficient erections with VES alone, ICPE must be combined with VES in order to detect the causes of psychogenic erectile impotence more correctly.