Murat Kosan

Effect of periprostatic nerve blockade before transrectal ultrasound‐guided prostate biopsy on patient comfort: A randomized placebo controlled study

Background: In the present study, we assessed the efficacy and morbidity of periprostatic local anesthesia before transrectal ultrasound (TRUS)‐guided biopsy of the prostate.

Effect of Sildenafil Citrate on Penile Weight and Physiology of Cavernous Smooth Muscle in a Post–radical Prostatectomy Model of Erectile Dysfunction in Rats

OBJECTIVES To evaluate the gross morphometric changes and in vitro responses of the corpus cavernosus of rats treated with sildenafil citrate after cavernous neurotomy. METHODS The animals were divided into 3 groups. Group 1 consisted of sham-operated rats (n = 16); group 2 consisted of rats that underwent bilateral cavernous neurotomy (BCN) (n = 16); and group 3 consisted of rats that underwent unilateral cavernous neurotomy (UCN) (n = 16). Each group of rats was further classified into 2 subgroups according to whether or not they received sildenafil treatment. The rats were killed on postoperative day 14, and penectomy was performed. Apoptosis was assessed by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL), and organ-bath studies were evaluated by Phenylephrine (Phe), acetylcholine (Ach), sodium nitroprusside (SNP), and electrical field stimulation (EFS) responses. RESULTS Penile weight in the BCN group was significantly lower than that of sham-treated group. UCN allowed much more preservation of penile weight compared with that in the sham-treated group. Sildenafil citrate treatment had positive effects on penile weight of both BCN (P = .003) and UCN (P = .004) groups. BCN increased smooth muscle apoptosis when compared with the sham or UCN group. Sildenafil citrate had a positive effect on the apoptotic index. In the BCN group, responses to Phe, Ach, SNP, and EFS decreased significantly, and sildenafil treatment corrected the responses to Phe, Ach, and SNP. CONCLUSIONS Our experimental study results support that early and daily sildenafil citrate treatment has a protective affect on the adrenergic and cholinergic systems, which play a role in erectile function.

Effect of urothelium on bladder contractility in diabetic rats

Aim: It is known that physiopathological changes in diabetes affect the function of the bladder. In this study, we aimed to demonstrate the possible effects of diabetes on the urothelium during this physiopathological process.

Effect of transurethral resection on serum free/total prostate-specific antigen levels in patients with benign prostatic hyperplasia.

OBJECTIVES Transurethral resection of the prostate (TURP) can cause elevation of total serum prostate-specific antigen (PSA). However, the effect of these procedures on free PSA and percent free PSA is still unknown. The aim of this study was to investigate the effect of TURP on serum total PSA, free PSA, and free/total (f/t) PSA ratio in patients with benign prostatic hyperplasia (BPH) and to determine the reliability of f/t PSA ratio after such interventions. METHODS Fifty-three patients with BPH who underwent TURP because of severe bladder outlet obstruction symptoms were included in this study. All patients underwent digital rectal examination and transrectal ultrasound (TRUS), and routine hematologic (complete blood count) and serum biochemical tests, urine analysis, and a peak urinary flow test were performed. Serum total PSA and free PSA levels were determined 1 hour before and 24 hours after TURP by using enzyme immunometric assay. Preoperative and postoperative free and total PSA and f/t PSA ratio were statistically compared. RESULTS Although postoperative total PSA and free PSA increased significantly compared with preoperative values (P <0.001 and P = 0.024, respectively), the difference between preoperative and postoperative f/t PSA ratios was not statistically significant (P = 0.103). CONCLUSIONS Finding no significant change in f/t PSA ratio, although there is a significant increase in the serum levels of total and free PSA, suggests to us that f/t PSA ratio may be a more reliable parameter in the early period after such interventions as TURP.

Skin-to-Stone Distance Has No Impact on Outcomes of Percutaneous Nephrolithotomy

Objective: Skin-to-stone distance (SSD) is a stronger factor than body mass index in predicting the success of shock wave lithotripsy. We aimed to evaluate the impact of SSD on outcomes of percutaneous nephrolithotomy (PCNL). Materials and Methods: The medical records of 1,280 patients who had undergone PCNL between April 2007 and February 2012 were evaluated retrospectively. 192 patients who had had preoperative non-contrasted computed tomography and single renal access were included the study. According to this median SSD value, patients were divided into two groups: group 1 (SSD ≤94 mm) (n = 92) and group 2 (SSD >94 mm) (n = 90). The groups were compared according to operative and postoperative parameters. Results: We found no significant differences between the two groups with regard to stone-free rate, operation time, fluoroscopy time, hospitalization time, visual analog score of pain, stone burden, transfusion rates and complication rates. On the other hand, the mean body mass index of group 1 was significantly lower than that of group 2 (p < 0.05). Conclusions: In this retrospective review of patients undergoing PCNL, we found that SSD has no impact on operative and postoperative outcomes. These results were in accordance with the safety of PCNL in obese patients.

A New Hemostatic Agent (Ankaferd Blood Stopper®) in Tubeless Percutaneous Nephrolithotomy: A Prospective Randomized Study

PURPOSE The present study evaluates the efficiency and reliability of a hemostatic agent ABS (Ankaferd Blood Stopper(®)) in tubeless percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS A total of 90 patients were divided into two subgroups. The first group had ABS applied during the intervention, whereas the control group underwent regular tubeless PCNL in this prospective randomized study. Age, stone size, operative time, postoperative hemoglobin change, renal parenchyma thickness, postoperative ureteral catheter removal time, access number, nephroscope time, blood transfusion rate, serum creatinine change, complication rate, visual analogue scale (VAS), and hospitalization time were compared between the two groups. RESULTS Preoperative and postoperative data obtained from both groups were compared. No statistically meaningful differences were found related to variables of mean age, stone size, access number, serum creatinine change, operative time, renal parenchyma thickness, VAS scores, and hospitalization period. Whereas the nephroscope time (minutes) was longer in the ABS group (Group 1 [G1]:3, 33±1, 72 vs G2:2, 62±1, 43, P=0.035), hemoglobin (Hb) decrease, and urine clarity time were statistically lower compared with the control group. Hb decrease was (mg/dL) (G1: 1.40±1.04 vs G2: 1.84±1.15, P=0.034), and urine clarity time was (hour) (G1: 9.60±5.50 vs G2: 11.95±4.71, P=0.012), respectively. Complications were encountered in three (6.6%) patients of the ABS group and in four (8.8%) of the control group. CONCLUSION ABS is an efficient and reliable hemostatic agent in tubeless PCNL. Comparative studies are needed, however, with other hemostatic agents that might be applied in tubeless PCNL.

Alteration in Contractile Responses in Human Detrusor Smooth Muscle from Obstructed Bladders with Overactivity

Introduction: In this study, we aimed to evaluate changes in contractile responses under in vitro conditions in detrusor overactivity (DO) in patients with bladder outflow obstruction (BOO). Materials and Methods: Detrusor strips obtained during open prostatectomy procedure from 16 patients with BOO related to benign prostate hyperplasia were evaluated under in vitro conditions. Patients were assigned to two groups as patients with (DO) and without (no DO) DO. Four detrusor strips were prepared from each bladder in dimensions of 2 × 10 mm, and were suspended in organ bath. Responses to carbachol (10–8 to 10–3M), electrical field stimulation (EFS) (0.5–32 Hz), single-dose adenosine 5′-triphosphate (ATP) (10–3M) and KCl (120 mM) were recorded to evaluate the contractile responses. EFS responses were repeated in the presence of NG-nitro-L-arginine methyl ester (L-NAME; 10 µM) and L-NAME + indomethacin. All responses were expressed as mg tension developed per mg of bladder tissue. Data obtained were compared using independent t test and one-way ANOVA test. Values of p < 0.05 were accepted as statistically significant. Results: Of the 16 patients on whom open prostatectomy was performed because of BOO, 8 of the patients were determined as no DO and 8 as DO. There were no differences between groups regarding age and residual urine. We found statistically significant differences between groups regarding dimensions of prostate, maximum bladder capacity and maximum bladder pressure. In the comparison of cumulative dose of carbachol, it was seen that responses were higher in the DO group, but the differences were not statistically significant. In EFS application, contractile responses were found to increase significantly in the DO group. No changes were observed between groups for ATP and KCl. EFS responses were found to be significantly higher in presence of L-NAME + indomethacin in the no DO group; however, no difference was seen in the DO group. Conclusions: Detrusor contractile responses to EFS increased in patients with BOO in presence of overactivity. These changes in contractile responses are observed possibly as a result of deterioration in neuromodulation, rather than as a result of changes in purinergic or cholinergic receptor sensation or level. We suggest that a noncholinergic-nonpurinergic mechanism can have some effect on these changes.

A large seminal vesicle cyst with contralateral renal agenesis

Seminal vesicle cysts (SVC) are rather rare disorders. Our case is the first in literature where contralateral renal agenesis was seen together with SVC and surgically managed. We believe that the occurrence of these two coinciding abnormalities is incidental.

Value of frozen sections of lymph nodes in pelvic lymphadenectomy in patients with invasive bladder tumor

Aim:  We examined the reliability of classical lymph node evaluation methods. We compared the results of preoperative computed tomography (CT) and perioperative frozen section examination of lymph nodes in patients on whom radical cystectomy was performed because of invasive bladder tumors.

Acetylsalicylic acid protects erectile function in diabetic rats

We aimed to evaluate the effect of acetylsalicylic acid (ASA) treatment on diabetes‐induced erectile dysfunction. Adult male Sprague–Dawley rats were divided into four groups as follows: (i) control (C), (ii) diabetic (D), (iii) ASA‐treated control (C+ASA) and (iv) ASA‐treated diabetic (D+ASA) groups. In groups 2 and 4, diabetes was induced by injection of 35 mg kg−1 streptozotocin. ASA (100 mg kg−1 day−1, orally) was administrated to rats in groups 3 and 4 for 8 weeks. Both intracavernosal pressure (ICP) and mean arterial blood pressure (MAP) were measured in in vivo studies. In organ bath, the relaxation responses to acetylcholine (ACh), electrical field stimulation (EFS) and sodium nitroprusside were tested in corpus cavernosum (CC) strips. The mRNA expression for neuronal nitric oxide synthase (nNOS) was calculated using reverse transcription polymerase chain reaction technique. In in vivo experiments, diabetic rats displayed reduced ICP/MAP values, which were normalised with ASA treatment. The relaxant response to high‐dose ACh and EFS at low frequencies (1–8 Hz) in CC strips from the D+ASA group were significantly higher when compared to the D group. Treatment with ASA normalised the raised mRNA expressions of nNOS in diabetic penile tissues. ASA may be involved in mRNA of protein synthesis of NO released from nonadrenergic and noncholinergic cavernosal nerve in diabetes.