Murat Çakan

Risk factors for penile prosthetic infection.

Objectives: To determine the risk factorsfor penile prosthesis infection.Methods: The records of 135 penileprosthesis implantation in 127 patients werereviewed.Of the 135 prothesis, 115 were malleable, 12were self-contained and 8 were inflatable. Ofthese procedures, 111 were primary, 9 wereprimary with reconstructions and 15 weresecondary. Mean follow-up was 47 months(minimum 6 months). All of the reconstructionswere penile plications or plaque excisions forPeyronies disease. Results: The ratio of penile prosthesis infectionwas 8.89%. Secondary implantation, paraplegia, non-controlled diabetes mellitus(p < 0.001) and surgeons inexperience(p < 0.05) were detected as the risk factors for penileprosthesis infection. But age, smoking, alcohol consumption, obesity, atherosclerosis, presenceof diabetes mellitus (DM), history of penile surgery, simple penile reconstruction, type ofthe erectile dysfunction (ED), type of the penile prostheses and incision and were not found asthe risk factors (p > 0.05). Conclusions: Paraplegie, non-controlled diabetes mellitus,secondary implantation and surgeons inexperience appear to be the riskfactors for penile prosthesis infection. In secondary implantation, longer operation timeis detected as a factor increasing the risk of penile prosthesis infection. For these patients, careful preoperativepreparation, more attention to perioperative antisepsis andpostoperative follow-up are required. Since ithas been determined that surgical experiencesdecrease the complication rate, these patients should be operated by experienced surgeons.

Role of Testosterone/Estradiol Ratio in Predicting the Efficacy of Tamoxifen Citrate Treatment in Idiopathic Oligoasthenoteratozoospermic Men

Aim: It was the aim of this study to investigatethe effect ofalow testosterone/estradiol (T/E2) ratio and the normalization of this ratio by an aromatase inhibitor, anastrozole, on the treatment results of tamoxifen citrate (TAM) in idiopathic oligoasthenoteratozoospermic patients with a normal T/E2 ratio. Patients and Methods: 127 normogonadotropic men were included in this study. TAM (10 mg twice daily) was applied to 103 of the patients (group 1). The control group consisted of 25 patients who did not receive any treatment (group 2). After 3 months, TAM therapy was continued in 42 of the patients with a normal T/E2 ratio (group 1A). Of the remaining 61 patients with low ratios, 30 continued with TAM (group 1BTAM), while the remaining 31 patients underwent additional anastrozole therapy (1 mg/day) to TAM (group 1BANA). Results: In the 3rd month of the study, while the sperm concentration and motility were found significantly improved in group 1 (p < 0.05), they were significantly lower in groups 1BTAM and 1BANA than in group 1A (p < 0.01). In the 6th month of the study, the mean T/E2 ratio was normal in group 1A and group 1BANA, but was lower than normal ranges in group 1BTAM. The sperm concentration and motility significantly increased in groups 1A and 1BANA (p < 0.05). Conclusions: A significant decrease in the T/E2 ratio was seen in the majority of the patients during TAM treatment. Normalization of this ratio by addition of anastrozole to the treatment regimen improved the treatment outcomes. However, a placebo-controlled study is needed to confirm our results.

Is dorsale penile vein ligation (dpvl) still a treatment option in veno-occlusive dysfunction?

Purpose: To determine the long-term results of the DPVL for the treatment of venous impotence. Patients and methods: The long term results of DPVL in 134 patients were interviewed. The mean age was 39.2 (range 21--72). Power color doppler imaging, pharmacocavernography/dynamic cavernosometry were performed. Postoperatively, all the patients were controlled in the 6th month, first year and, if possible, once a year. The mean follow-up was 54.8 (14--76) months. Postoperative outcomes were classified into three groups: complete spontaneous erection (CR), response to pharmacotherapy (PR) or no satisfactory improvement (NR). Results: The short-term success in the 6th month according to above mentioned was 38.8%, 18.6% and 42.5%; and in the first year was 19.4%, 14.9% and 65.6% respectively. The result in 35 patients whose follow-up was at least 5 years (mean 67 months) was 11.4%, 14.3% and 74.3% respectively. Positive prognostic factors were preoperative age <40, duration of erectile dysfunction <2 years, non-smoker patients, non neurogenic disease and distal disease. With all these parameters present, long-term success (CR, PR) rose from 33.6% to 55.9% (P < 0.00l). Conclusions: Long-term success for unselected patients undergoing DPVL is disappointing; however, careful patient selection significantly improves long-term results.

Results of Varicocelectomy in Patients with Isolated Teratozoospermia

Introduction: Isolated teratozoospermia is rarely encountered in patients with clinically palpable varicocele, and the consequences of varicocelectomy remain unclear in these cases. In the current study, we assessed the effect of varicocelectomy on sperm morphology in a series of patients with infertility. Materials and Methods: The data obtained from 52 primary subfertile men with isolated teratozoospermia and clinical palpable varicocele were reviewed retrospectively. Varicocelectomy was performed on 29 patients, and the remaining 23 patients did not undergo any treatment (control group). The differences in sperm morphology assessed by using Kruger’s strict criteria 3 months before and 12 months after varicocelectomy were taken into consideration for statistical analysis. Results: One patient who underwent varicocelectomy was excluded from the study due to varicocele recurrence. Thus, data obtained from the remaining 28 patients were evaluated. Following varicocelectomy, significant improvement was detected in the ratio of normal sperm forms (p < 0.001). While there was significant improvement in the ratio of sperm cells with head defects, tail defects and immature forms (p < 0.001), the ratio of sperm with acrosome and mid-piece defects was not changed (p > 0.05). While an overall spontaneous pregnancy was achieved in 5 of the 28 (17.8%) couples in the varicocelectomy group within 12 months after operation, neither improvement in sperm morphology nor pregnancy in the patients’ partners was detected in the control group. Conclusion: Varicocelectomy caused a significant improvement in sperm morphology, particularly in immature forms and forms with head and tail defects evaluated by Kruger’s classification.

Is visualising ureter before pyeloplasty necessary in adult patients

In this study, we aimed to detect whether or not visualising ureter and ureteropelvic junction (UPJ) preoperatively is necessary in adult patients who have primer UPJ obstruction. Between January 1995 to June 1999, 46 renal units in 45 patients with primer UPJ obstruction were evaluated. The patients were separated into 2 groups. In group 1, intravenous pyelography (IVP) and renal scintigraphy were performed to 17 renal units preoperatively. In group 2, in addition to these methods, either retrogradepyelography (RGP) or antegrade pyelography (AGP) were performed to 29renal units. Renal/bladder sonogram was used in patients with poor renal function in IVP or in renal scintigraphy. All the operations were performed through a flank incision. In group 2, additional information was gained for 8 (27.5%) of the renal units preoperatively. No additional information for this group found intraoperatively. In group 1, we found additionalinformation in 4 (23.53%) of the units intraoperatively. All the pathologiesin both groups were corrected intraoperatively. Double-J (D-J) stent wasused in 6 (35.29%) of the units in group 1 and 8 (27.58%) of the units in group 2 intraoperatively (p > 0.05). In group 2, 4 (13.79%) preoperative complications were seen due to RGP and they were treated either medicallyor conservatively. In the early postoperative period, a complication observed in 1 (5.88%) of the patients in group 1 and 1 of the patients in group 2 (3.44%) (p > 0.05). The first patient was treated with inserting D-Jand the latter one was treated conservatively. In the 3rd postoperative month, success rate was found to be 94.11% in group 1 and 96.55% in group 2 (p > 0.05). Additional pathologies in adult patients with primer UPJobstruction can be corrected intraoperatively through a flank incision.Therefore, imaging of ureter and UPJ may not be necessary in these patients.

Is There Any Additional Benefit of Venous Diameter and Retrograde Flow Volume as Measured by Ultrasonography to the Diagnosis of Suspected Low-Grade Varicoceles?

Aims: To investigate the relation between the findings of physical examination and ultrasonography and to evaluate whether venous diameter (VD) and retrograde flow volume (RFV) have any additional benefit to the diagnosis of suspected low-grade varicoceles. Methods: Five hundred and fifty-two patients who applied to our outpatient clinic due to infertility were assessed by physical examination (PE) and B-mode and color Doppler ultrasonography (CDUS). The correlation of VD and RFV with clinical grade and with each other was investigated in cases diagnosed as unilateral left varicocele. Results: Unilateral left varicocele was detected in 184 (33.3%) of 552 patients: mean VD of the subjects was 3.17 ± 1.02 mm and mean RFV in 160 patients with a reflux was 24.01 ± 13.76 ml/min. There was a correlation of clinical grade both with VD and RFV (r = 0.669, p < 0.001 and r = 0.603, p < 0.001, respectively). Considering VD and RFV, there was a significant difference between grade (G)1–G2 and G2–G3 (p < 0.001, p < 0.001, respectively) except between subclinic-G1 varicocele groups (p = 0.626, p = 0.529, respectively). The best cut-off point predicting the palpable varicocele on physical examination was 3.1 mm (sensitivity 58.2%) for VD and 14.5 ml/min (sensitivity 83.8%) for RFV. Conclusions: Measurement of RFV is more sensitive than that of VD in predicting palpable varicocele. However, neither of them seem to have any additional benefit to PE in clarifying the diagnosis of suspected low-grade varicoceles.

Evaluation and reconstruction of an extremely rare genitourinary abnormality

Bladder duplication is characterized by both a widely variable anatomy and different modes of presentation [1, 2]. Complete duplication of the bladder, urethra, uterus and vagina without a hindgut anomaly in females is a very rare anomaly [3, 4]. In general, multiple-staged reconstructions are performed to improve and maintain both function as well as cosmetic appearance. We report here the diagnosis and outcome of one-staged surgical treatment of the complete bladder, urethra, uterus and vaginal duplication without hindgut anomaly in a 16-year-old girl.

Effect of Naloxone on Oxidative Stress and Testicular Injury due to Spermatic Vessel Ligation of Rat Testis

Aims: Two-stage Fowler-Stephens orchiopexy has been accompanied by testicular atrophy in some cases but neither of the mechanisms responsible for testicular injury are clear, nor is there an effective agent that might prevent this injury. In this study we aimed to investigate the long-term effects of naloxone, a morphine antagonist, on testicular histopathology and oxidative stress after spermatic vessel ligation (SVL) in rats. Methods: 32 prepubertal rats were randomly divided into four equal groups: group 1: control (only bilateral orchiectomies were performed); group 2: sham-operated group; group 3: SVL, and group 4: SVL+naloxone (1 mg/kg twice daily for 1 month). One month postoperatively, bilateral orchiectomies were performed to evaluate histopathologic findings and measurement of malondialdehyde (MDA) and nitric oxide (NO) levels. Results: Considering group 3, left SVL resulted in significant tissue damage in both testes, more severe in the ipsilateral testis. The SVL resulted in a significant increase in testicular MDA levels of both testes in this group (p < 0.05). While the ipsilateral testicular NO levels of groups 2 and 3 were significantly lower than of group 1 (p < 0.05), the contralateral testicular NO levels of all these groups were similar. After naloxone therapy, while there was no significant improvement in ipsilateral testicular histopathology (p > 0.05), the contralateral testicular histopathology improved significantly (p < 0.05). However, naloxone did not change either testicular MDA or NO levels. Conclusions: The SVL led to bilateral testicular injury, and oxidative stress may be a reason for this injury. Naloxone significantly improved contralateral testicular injury without showing any antioxidative effect.

Bilateral nephron-sparing surgery for giant bilateral renal angiomyolipomas associated with tuberous sclerosis complex Dev bilateral renal anjiyomyolipom ve tuberosklerozis kompleksli hastada bilat

R enal angiomyolipoma is a rare benign neoplasm (1-3% of all renal tumors) composed of varying amounts of mature adipose tissue, smooth muscle and thick-walled blood vessels. A 20% of all renal AMLs are associated with tuberous sclerosis. In patients with TSC, AML is usually multiple, bilateral and symptomatic natures. Patient’s symptoms and size of the lesion are the determinants for the choice of the treatment. In general, symptomatic or greater than 8 cm masses require intervention. Due to its benign nature, renal AMLs represents an ideal lesion for nephronsparing treatment by tumour enucleation, partial nephrectomy or selective arterial embolization (1,2). However, there are limited numbers data with regard to nephron sparing surgery of renal AMLs especially in bilateral cases with TSC. We report the treatment result of bilateral nephron-sparing surgery of a patient with giant bilateral renal AMLs and TSC.