Melih Culha

Comparison of Testicular Volumes before and after Varicocelectomy

We attempted to determine the testicular volume changes in patients with unilateral varicocele, before and after varicocelectomy. Testicular volume differences were correlated for each group of varicocele grade. 123 men with a unilateral left varicocele were presented for surgery: 36 had grade I, 49 had grade II, and 38 had grade III varicoceles. A Prader orchidometer was used for testicular volume determination before and after varicocelectomy in each patient. Both left and right testicular volumes were compared. After the repair of grade I varicoceles, an improvement in testicular volumes was noticed, but the difference was not statistically significant (p > 0.05). Both right and left testicular volumes increased significantly after operation in patients with grades II and III varicoceles (p < 0.001). Right testicular volume improved more than left in most of the patients. Men with large varicocele had significantly decreased testicular volumes than men with small varicocele before operation. So testicular growth arrest was more significant in patients with large varicocele and postoperative results indicated a more dramatic improvement.

Diphallus with Urethral Duplications

We report a case of glandular diphallus with incomplete urethral duplication associated with rotation anomaly in the right kidney, complete ureteral duplication and ectopic ureteral orifice in the left. The bladder was single with good sphincter control.At operation, the hypoplastic glans was resected and the urethra opening into this glans was anastomosed side by side with the other urethra.Diphallus and incomplete urethral duplication are discussed in the light of evidence in the literature.

Effect of Cardiac Resynchronization Therapy on Libido and Erectile Dysfunction

Chronic heart failure (HF) is a common, complex clinical syndrome characterized by dyspnea, fatigue and exercise intolerance. HF patients experience decreased libido and erectile dysfunction (ED). The effects of cardiac resynchronization therapy (CRT) on libido and erectile function have not been previously evaluated. We aimed to investigate the effects of CRT on libido and ED.

Coexisting papillary and clear renal cell carcinoma in the same kidney.

Renal cell carcinoma (RCC) is the most common solid lesion of the kidney. Bilateral synchronous benign and malignant renal tumors have been defined in some reports. However, unilateral concordance of malignant renal tumors is very rare and there are only a few cases that had synchronous different subtypes of malignant renal tumors arising within the same kidney. Herein, we describe a 67-year-old male patient who had clear cell RCC and papillary RCC in his right kidney that were successfully treated with radical nephrectomy. We also reviewed the pertinent literature.

Management of Buried Penis in Adults

Buried penis is rarely managed in adults. Two patients with buried penis were treated at 18 and 20 years of age. An autolog split-thickness graft was used for covering the dermal defect of the penis. Results were successful without any evidence of postoperative complications.

Patient-Partner Satisfaction with Intracavernous Medication Supported with Oral Agents in Selected Cases of Peyronie's Disease

We attempted to find the most adequate treatment option for some selected cases of Peyronies disease. Between 1993 and 1996, 38 patients with Peyronies disease and erectile dysfunction were treated with intracavernous medication, supported with oral colchicine and vitamin E. None of the cases had severe angulation of penis and intolerable pain during erection. Quality of sexual life was assessed by CWRU questionnaire. After ten-month follow-up we found improvement in all parameters, in CWRU. The symptoms of 24 cases diminished. The 21 partners examined were also satisfied with the therapy. We conclude that intracavernous medication combined with oral agents is a useful alternative treatment in selected cases of Peyronies disease.

Ultrasonography-guided penile block for adult penile surgery

To the Editor, Although penile nerve block (PNB) both blind and ultrasound (US)-guided has been established for clinical use, studies have focused more on children than adults. The analgesic effect of US-guided PNB in adult patients undergoing penile surgery has yet to be demonstrated. We report here its advantages in a randomized, blinded, clinical study. After ethics committee permission (KOU KAEK 2013/ 117) and informed written consent, we enrolled 40 adult patients (20-60 yr, American Society of Anesthesiologists physical status I-II) scheduled for elective penile surgery (malleable prosthesis implant). Patients were randomized (sequentially numbered, opaque, sealed envelopes) to either spinal anesthesia ? PNB (PNB) or spinal anesthesia alone (control) groups (20 patients per group). In a pilot study on ‘‘spinal only’’ patients, the mean (SD) 24 hr postoperative morphine consumption was 28 (8) mg. For 90% power and an alpha error of 0.05, the sample size needed to detect a 30% difference was 18 subjects per group. With the patient in the lateral decubitus position, spinal anesthesia (25 G Quincke; B. Braun, Melsungen Germany) consisting of hyperbaric bupivacaine 10 mg with fentanyl 25 lg was used. Penile nerve block was subsequently performed using a high-frequency linear probe placed vertically over the pubic symphysis at the base of the penile shaft. Sagittal views identified the penile shaft, corpus cavernosum, inferior ramus of the pubic bone, and Scarpa’s fascia. Using an out-of-plane approach under real-time US guidance, the block needle (Ultraplex, 22G; B. Braun, Melsungen, Germany) was advanced until it perforated Scarpa’s fascia with a ‘‘pop.’’ Then, 20 mL of 0.25% bupivacaine was injected in fractionated doses, with intermittent aspiration. For all patients, postoperative analgesia was provided with patient-controlled analgesia (morphine 1 mg bolus, eight-minute lockout, maximum 6 mg hr). A pain nurse blinded to the anesthesia care performed postoperative follow-up. Pain (dynamic) was assessed at one, six, 12, and 24 hr postoperatively using a visual analogue scale (VAS), where 0 = no pain and 10 = worst imaginable pain. The presence of nausea and vomiting were recorded at the same time intervals. Patient-controlled analgesia morphine consumption and the incidence of nausea and vomiting during the first 24-hr postoperative period were also recorded. The Mann-Whitney U-test was used for comparison of VAS scores and morphine consumption between the two groups. The incidence of nausea and vomiting was compared using Fisher’s exact test. Anesthesia for both groups provided sufficient analgesia for the mean (SD) duration of surgery [PNB, 114 (45) min; control, 108 (38) min). The VAS scores and postoperative morphine consumption, however, were lower in the PNB group than in the control group at every time interval Y. Gürkan, MD A. Kuş, MD Department of Anesthesia, Kocaeli University Hospital, Kocaeli, Turkey

Inflammatory Myofibroblastic Tumor of the Bladder

DOI: 10.4328/JCAM.656 Received: 24.03.2011 Accepted: 01.04.2011 Printed: 01.05.2013 J Clin Anal Med 2013;4(3): 239-40 Corresponding Author: Ali Saribacak, Yerkoy Devlet Hastanesi Uroloji Klinigi Yerkoy, Yozgat, Turkiye. T.: +90 3545162470 (4031) GSM: +905327086077 F.:+90 3545166147 E-Mail:saribacak@gmail.com Ozet Mesanenin inflamatuar miyofibroblastik tumoru (IMT) nadir gorulmekle birlikte embriyonel rabdomyosarkom ve leiomyosarkomdan ayrimi radikal girisimlerden kacinilmasi acisindan onemlidir. Bu yazida, 32 yasinda makroskopik hematuri ile basvuran ve IMT tanisi konulan bir hastanin ilginc sistoskopik gorunumu ve tedavisi sunulmustur.

Natural Course of Tunica Albuginea Fibrosis and Antifibrotic Effect of Intralesional Verapamil Injec

1 Levend Özkan1, Ali Sarıbacak2, Tayyar Alp Özkan1, Hasan Yılmaz1, Kürşat Yıldız3, Melih Çulha1 1Üroloji Anabilim Dalı, Kocaeli Üniversitesi Tıp Fakültesi, Kocaeli, 2Üroloji Kliniği, Yerköy Devlet Hastanesi, Yozgat, 3Patoloji Anabilim Dalı, Kocaeli Üniversitesi Tıp Fakültesi, Kocaeli, Türkiye Penil Fraktürün Konservatif Tedavisi / Conservative Treatment of Penile Fracture Natural Course of Tunica Albuginea Fibrosis and Antifibrotic Effect of Intralesional Verapamil Injection in Rabbits with Penile Fracture Model