Mesrur Selcuk Silay

Photoselective Potassium Titanyl Phosphate (KTP) Laser Vaporization Versus Transurethral Resection of the Prostate for Prostates Larger Than 70 mL: A Short-Term Prospective Randomized Trial

OBJECTIVESnTo compare the short term outcomes of photoselective vaporization (PVP) and transurethral resection of the prostate (TURP) for glands larger than 70 mL in a prospective randomized trial.nnnMETHODSnSeventy-six consecutive patients with enlarged prostatic adenomas of 70 to 100 mL were randomly assigned for surgical treatment with TURP (n = 37) or PVP (n = 39). International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5) scores, maximum flow rates (Qmax), postvoid urine residues (PVR), and transrectal ultrasound (TRUS) volumes were recorded. Operative data, complications, catheter removal, and hospitalization periods were also recorded. Patients were reassessed at 3 and 6 months.nnnRESULTSnBaseline characteristics of both groups were similar. Mean preoperative TRUS volume was 88 +/- 9.2 mL in the TURP group and 86.1 +/- 8.8 mL in the PVP group. The procedure was significantly shorter for the TURP group (51 +/- 17.2 minutes versus 87 +/- 18.3 minutes, P <0.05), catheter removal (3.9 +/- 1.2 days and 1.7 +/- 0.8 days, P <0.05), and hospital stay (4.8 +/- 1.2 days versus 2 +/- 0.7 days, P <0.05) were shorter in the PVP group. A significant difference in IPSS, Qmax and PVR values was observed within the follow-up period in favor of the TURP. The percentage volume reduction was significantly higher in TURP group. Reoperation was necessary in 7 patients in PVP but none in TURP group.nnnCONCLUSIONSnAlthough PVP offers advantageous over TURP with regard to intraoperative and perioperative safety, early functional results of TURP are superior to PVP in patients with enlarged prostates larger than 70 mL.

Comparison of intravesical prostatic protrusion, prostate volume and serum prostatic-specific antigen in the evaluation of bladder outlet obstruction

Dear Editor I read the article by Lim KB et al. with great interest. However, there are some situations affecting the parameters of bladder outlet obstruction (BOO) and prostate-specific antigen (PSA) which are not excluded in this study. In the article, the exclusion criteria included previous lower urinary tract or pelvic surgery, previous pelvic trauma, radiation therapy, diabetic cystopathy or neurological bladder with voiding dysfunction. Although benign prostatic enlargement (BPH) is the most common cause of BOO in men, urethral stricture, bladder neck contracture, bladder neck dysfunction and striated sphincter dyssynergia may also cause BOO and lower urinary tract symptoms (LUTS) without concomitant BPH. It has been shown that 34% of all anterior urethral strictures are idiopathic with no history of infection, trauma or previous surgery so that the presence of urethral stricture in these patients cannot be excluded without further investigation. The other point is; it is well-known that urinary tract infections and prostatitis may also cause LUTS and may lead to false-positive PSA levels. Due to this knowledge, it is strongly recommended to check urinalysis in patients presenting with LUTS. As a result, I claim that these factors should be underlined and patients having the above given diseases must be a part of exclusion criteria to strengthen the outcomes of the study. References

Comparison of ureteroscopic procedures with rigid and semirigid ureteroscopes in pediatric population: does the caliber of instrument matter?

ObjectivesTo compare the results of two different ureteroscopes in pediatric ureteroscopy (URS) procedures.Patients and methodsSixty-five consecutive URS procedures in pediatric population (39 males, 26 females) were retrospectively evaluated. The subjects were divided in two groups according to the type of ureteroscope used: Group 1 (nxa0=xa032, Wolf 8F) and group 2 (nxa0=xa033, ACMI 6.9F). All the procedures performed in both groups were statistically compared regarding patient age, gender, lateralization, complication rates, whether the procedure was diagnostic or therapeutic, and whether a guide-wire was used. Additionally, in cases with ureteral stones, stone clearance rate and the necessity of a stone extractor were also compared between the groups. All data were statistically analyzed using chi-square and t tests, where appropriate. A p value less than 0.05 was considered as significant.ResultsMean age of the groups were comparable (9.44xa0±xa04.3 and 8.67xa0±xa03.9, pxa0=xa00.456). There was no statistically meaningful difference between the groups regarding patients’ gender, lateralization rates, whether the procedure was diagnostic or therapeutic, the need for a guide-wire use, and complication rates (pxa0>xa00.05). In cases with ureteral stones, both groups exhibited statistically comparable results in stone clearance rates and the use of a stone extractor (pxa0>xa00.05).ConclusionsData on this comparison demonstrated that both ureteroscopy devices in pediatric population can be used safely in URS procedures. Neither the diameter nor the rigidity is significantly affecting the outcomes and success rates ≤8F caliber.

Botulinum toxin-A injection may be beneficial in the treatment of life-long premature ejaculation

Although premature ejaculation (PE) is a very common male sexual dysfunction there is still no European Medicines Agency (EMEA) or Food and Drug Administration (FDA) approved pharmacological treatment developed for this disease. Ejaculation is a spinal cord reflex where bulbospongiosus and ischiocavernosus muscles play the primary roles. The latest articles provided us that, life-long PE is presumed to have an underlying neurobiological pathophysiology and thus medical therapy would be superior to psychotherapy. Therefore, we hypothesize that the inhibition of the stereotyped rhythmic contractions of these muscles via the injection of botulinum toxin type A, we may have a beneficial effect in treatment of life-long PE.

Montelukast prevents testes against ischemia-reperfusion injury through suppression of iNOS expression.

OBJECTIVEnTo elucidate the mechanism of a possible protective effect of montelukast against testicular ischemia/reperfusion (I/R) injury.nnnMATERIAL AND METHODSnFifty-one adult male Wistar-Albino rats were randomly assigned into 6 groups; sham + saline (S), sham + montelukast (M), I/R + S, I/R + S 30, I/R + M and I/R + M 30. Saline or montelukast (10 mg/kg) was intraperitoneally administered 30 minutes prior to (S 30, M 30) and during detorsion (I/R + S, I/R + M) in the I/R groups. The I/R groups underwent 2 hours of ischemia followed by 4 hours (early-term) of reperfusion in unilateral testes. Half of the rats underwent 24 hours (late-term) of reperfusion to investigate long-term effects. Testicular tissue samples were examined for biochemical and histopathological parameters. Germ cell apoptosis was evaluated using apoptosis-activating factor 1 (Apaf-1). Inducible nitric oxide synthase (iNOS) activity was analyzed in late-term reperfusion groups. Spermatogenic functions were assessed for each testis based on the Johnsen criteria.nnnRESULTSnUnilateral I/R caused a significant increase in serum TNF-α levels in the early-term group compared to the sham groups. Malondialdehyde levels and myeloperoxidase activity were found to be elevated in the I/R groups and accompanied with a significant decrease in glutathione levels when compared to the sham groups. I/R significantly increased iNOS activity and germ cell apoptosis compared to the sham groups. Montelukast treatment significantly reversed all of these parameters and achieved comparable results with the sham groups. Finally, spermatogenic indices were similar for the bilateral testes between all groups.nnnCONCLUSIONnMontelukast exerts protective effects against testicular I/R injury by inhibiting neutrophil activity, reversing the oxidative stress markers, decreasing iNOS activity and attenuating apoptosis.