Mustafa Aldemir

The randomized comparison of two different endoscopic techniques in the management of large bladder stones: transurethral use of nephroscope or cystoscope?

PURPOSE Endoscopic treatment of large bladder stones via cystoscope is still bothersome, and open cystolithotomy is the preferred method in many centers. To gain more insight into the endoscopic bladder stone management, we aimed to compare the transurethral use of nephroscope and cystoscope randomly. PATIENTS AND METHODS Forty-three male patients with bladder stones were randomized into two groups, to perform nephroscopic (group 1, n = 22) and cystoscopic (group 2, n = 21) stone fragmentation procedures transurethrally. Combined pneumatic/ultrasonic lithotripsy device was used in both groups to fragment the bladder stones. RESULTS The mean stone size in group 1 and group 2 was 3.6 +/- 1.3 cm and 3.5 +/- 1.6 cm, respectively (p > 0.05). Stone fragments were removed completely in all of the patients, and the mean operation time was calculated as 48.2 +/- 13.2 minutes in group 1 and 68.1 +/- 22.7 minutes in group 2, with no intraoperative complications (p < 0.01). None of the patients developed urethral stricture disease in the early (postoperative third month) follow-up. Three patients with previously known urethral stricture disease have shown to have the same disease in the late (postoperative 14.4 +/- 5.1 months) follow-up. CONCLUSION Treatment of large bladder stones by transurethrally placed nephroscope is a fast and effective treatment modality compared to endoscopic treatment via cystoscope. Nephroscope allows for use of larger forceps and facilitates collection of large stone fragments through its 24F sheath. It also prevents multiple entries to the urethra and hence avoids possible urethral injury. Combined pneumatic/ultrasonic lithotripsy device, with its aspiration quality, enables the surgeon to gain a better endoscopic view during both procedures.

Pistachio diet improves erectile function parameters and serum lipid profiles in patients with erectile dysfunction.

We investigated the effects of Antep pistachio on International Index of Erectile Function (IIEF) scores, penile color Doppler ultrasound (PCDU) parameters and serum lipid levels in patients with ED. A total of 17 married male patients with ED for at least 12 months were included in this prospective study. Patients were put on a 100 g pistachio nuts diet for 3 weeks. IIEF and PCDU were evaluated before and after the pistachio diet. In addition, plasma total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride were measured before and after dietary modifications from all subjects. Mean IIEF-15 score was 36±7.5 before the diet and 54.2±4.9 after the diet (P=0.001). Similarly, an increase in all five domains of IIEF was observed after the diet (P<0.05). Mean peak systolic velocity values before and after the pistachio diet were 35.5±15.2 and 43.3±12.4 cm s–1, respectively (P=0.018). After the pistachio diet, TC and LDL levels decreased significantly, whereas HDL level increased (P=0.008, 0.007 and 0.001, respectively). We demonstrated that a pistachio diet improved IIEF scores and PCDU parameters without any associated side effects in patients with ED. Furthermore, the lipid parameters showed statistically significant improvements after this diet.

Penile revascularization in vasculogenic erectile dysfunction (ED): long-term follow-up.

Study Type – Therapy (case series)

Quercetin has a protective role on histopathological findings on testicular ischaemia–reperfusion injury in rats

We investigated the effects of quercetin on pathological findings on testicular ischaemia–reperfusion (I/R) injury in rats. Twenty‐four male Wistar albino rats were randomly assigned into four groups: Group 1, control (n = 5); Group 2, sham (n = 4); Group 3, I/R (n = 8); and Group 4, I/R + quercetin (n = 7). Bilateral testicular artery and vein were occluded for 1 h, followed by reperfusion in I/R and I/R + quercetin animals. Quercetin (20 mg kg−1 per day) was administrated once daily by gavage to Group 1 and Group 4, respectively, after reperfusion. At the end of the study, bilateral orchiectomies were performed for histopathologic examination. The tissue damage was evaluated with light microscopy. Normal inter‐stitium and seminiferous tubules were observed in control group. In the sham group, rats were seen minimal oedema around the seminiferous tubules and congested vascular structures. In Group 3, oedema, vascular congestion and haemorrhage between seminiferous tubules were observed. In Group 4, histopathologic features were markedly less than Group 3 (P = 0.03). Our study demonstrated that quercetin seems to have a protective effect on testis histopathology in rats with testicular I/R.

Evaluation of serum oxidative and antioxidative status in patients with erectile dysfunction

We evaluated and compared serum oxidative and antioxidative parameters of patients with erectile dysfunction (ED) and control subjects. Twenty married male patients with ED for at least 12 months (Group 1) and 20 volunteer healthy, sexually active, married and age‐matched men (Group 2) were included in the study. Group 1 and 2 were compared concerning serum mean total antioxidant capacity (TAC), total oxidant status (TOS), paraoxonase1 (PON1), arylesterase, total thiol and oxidative stress index (OSI). Mean patient age was 47.9 ± 8.1 and 44.4 ± 10.6, respectively, in Group 1 and 2. Serum TAC levels were 1.7 ± 0.5 and 2.3 ± 0.3, respectively, in Group 1 and 2 (P = 0.002). Serum TOS levels were 21.8 ± 20.5 and 11.7 ± 2.2, respectively, in Group 1 and 2 (P = 0.035). Serum PON1 levels were 69.8 ± 13.1 and 164.9 ± 56.5, respectively, in Group 1 and 2 (P < 0.001). Serum arylesterase levels were 336 ± 12 and 370.4 ± 47.9, respectively, in Group 1 and 2 (P = 0.003). Serum total thiol levels were 733.1 ± 253 and 885.5 ± 95.3, respectively, in Group 1 and 2 (P = 0.016). Serum OSI was 0.14 ± 0.17 and 0.05 ± 0.11, respectively, in Group 1 and 2 (P = 0.021). Mean blood platelet count was significantly higher in Group 1 (P = 0.001). A positive correlation between platelets and oxidative state and a negative correlation between platelets and antioxidative state were found. Oxidative stress was detected to be increased, whereas antioxidative parameters were detected to be decreased in patients with ED.

Evaluation of blood platelet count and function in patients with erectile dysfunction

We evaluated and compared blood total platelet count, mean platelet volume (MPV) and platelet distribution width (PDW) values of patients with erectile dysfunction (ED) and control subjects. A total 57 male patients (mean age 49.7 ± 12 years) with ED and 59 control men (mean age 49.7 ± 10.7 years) were included in the study. All patients were evaluated using medical history with International Index of Erectile Function (IIEF) scores, physical examination and routine blood analysis. Total blood count, including white blood cell (WBC), total platelet counts, MPV and PDW parameters, were recorded in both groups. MPV values were detected to be significantly higher in patients with ED than control group: 10.7 ± 1 and 9.72 ± 1.5, respectively (P = 0.001). Similarly, PDW values were significantly higher in patients with ED than control group: 14.6 ± 2.8 and 12.9 ± 1.9, respectively (P = 0.001). However, mean platelet and mean WBC counts were similar in both groups (P = 0.45). We demonstrated that MPV and PDW values significantly increased in patients with ED compared with the control group. According to these findings, platelet function might play an important role in patients with ED that warrants further research.

Comparison of arterial blood supply to the testicles in the preoperative and early postoperative period in patients undergoing subinguinal varicocelectomy

Abstract Objective. Varicocele, which is the abnormal dilatation of internal spermatic veins, is known as the most surgically correctable cause of male infertility. In the evaluation of testicular arterial and venous blood supply, the scrotal colour Doppler ultrasound (CDU) is a valuable diagnostic method. The aim of this study was to investigate how the testicular blood flow is affected after varicocelectomy, and the place of scrotal CDU in the follow-up after varicocelectomy. Material and methods. Thirty male patients who were diagnosed with left-sided varicocele were prospectively included in the study. Before the varicocelectomy, semen analyses were carried out, and peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI) were measured by CDU. In the third postoperative month, scrotal CDU and semen analysis were performed again and compared with the preoperative results. Results. The arterial flow parameters PSV and EDV increased significantly, and the resistance parameters RI and PI decreased significantly, compared with the preoperative values. Sperm concentration, progressive motility and normal morphology improved in the postoperative semen analysis compared with the preoperative results. The increases in all three parameters were statistically significant. No statistically significant difference in vascular parameters was seen between the patients with improved and unimproved semen analysis. Conclusions. As confirmed by the results of semen analysis and CDU, testicular blood flow increases after varicocelectomy, resulting in the recovery of the haemodynamics of the testicle. CDU, which is generally used for diagnosis in the varicocele, can also be a valuable method of determining treatment success after surgery.

Primary Mature Cystıc Teratoma Mimickıng an Adrenal Mass in an Adult Male Patient

Teratomas are bizarre neoplasms derived from embryonic tissues that are typically found only in the gonadal and sacrococcygeal regions of adults. Primary retroperitoneal teratomas are rare and present challenging management options. We report a case of a unilateral primary retroperitoneal mature cystic teratoma mimicking an adrenal mass in a 54-year-old male patient. Complete resection of the adrenal mass was performed by the flank approach by using the 11th rib resection. Because of the risk of malignancy, follow-up radiographic studies were performed to ensure the oncologic efficacy of resection. The patient has been free of recurrence for longer than 12 months.

The impact of vitamin E supplementation on semen parameters and pregnancy rates after varicocelectomy: a randomised controlled study

In this study, we aimed to investigate the impact of vitamin E supplementation on semen parameters and pregnancy after varicocelectomy. Forty‐five infertile male patients who were diagnosed with varicocele and underwent subinguinal varicocelectomy were included in the study. After performing subinguinal varicocelectomy, the patients were randomised into two groups: 22 receiving vitamin E for 12 months, and 23 as the control group without receiving any supplementation. The pre‐operative parameters of semen analyses and pregnancy rates of both groups were compared with those of post‐operative parameters. There were no statistically significant differences between the groups in terms of sperm count and motile sperm percentage, in pre‐operative, post‐operative 3rd month, post‐operative 6th month and post‐operative 12th month periods. Repeated‐measures anova was performed, and sperm count, percentage of change in sperm count, motile sperm count and percentage of change in motile sperm count of the groups were compared. The administration of vitamin E increased all of these parameters; however, they were not found to be statistically significant. In conclusion, vitamin E supplementation might improve the sperm parameters after varicocelectomy; however, further studies including larger number of samples are needed to make a proper decision on vitamin E supplementation after varicocelectomy.

Comparison of spermatic vein histology in patients with and without varicocele.

The aim of this study was to investigate and compare histological characteristics of spermatic veins in patients with and without varicocele. Between February 2009 and July 2009, spermatic veins were obtained from 13 patients with varicocele. Microsurgical subinguinal low ligation was performed in all patients. Spermatic veins of patients without varicocele were obtained from 12 patients who underwent radical nephrectomy. Histologically, sections of veins were stained with haematoxylin and eosin. Mean tunica adventitia thickness size of the spermatic veins was 0.35 ± 0.08 mm and 0.22 ± 0.1 mm respectively in patients with varicocele and control group (P = 0.001). Similarly, mean tunica media thickness size of the spermatic veins was 0.25 ± 0.05 mm and 0.09 ± 0.04 mm respectively in patients with varicocele and control group (P < 0.001). No significant differences were detected regarding the tunica adventitia and tunica media thicknesses when patients with grade 2 varicocele were compared with patients with grade 3 varicocele (P > 0.05). No significant differences were detected between the tunica adventitia and tunica media thicknesses of patients with varicocele and sperm parameters (P > 0.05). Our study demonstrated that tunica adventitia and tunica media thicknesses seem to be increased in patients with varicocele compared with normal subjects.