Onur Kaygisiz

The protective effect of L-arginine, tadalafil, and their combination in rat testes after ischemia and reperfusion injury

INTRODUCTION Nitric oxide (NO) plays an important role in the ischemia and reperfusion process. In this study, we aimed to examine the effect of L-arginine, tadalafil, and their combination for prevention of the ischemia reperfusion injury after testis torsion in rats. METHODS A total of 40 adult, male Sprague-Dawley rats were allocated into five groups. Three hours of left testicular torsion was performed in each group, excluding the control group. While the ischemia reperfusion (I/R) group had no treatment, I/R + Arg group received L-arginine, I/R + Td group received tadalafil and I/R + Arg + Td group received tadalafil and L-arginine 30 minutes before the detorsion. Then the left testis was untwisted for four hours of reperfusion. After bilateral orchiectomy, lipid peroxidation (LPx) and glutathione (GSH) activities were examined in testicular tissue. Spermatogenesis was evaluated with Johnsens score. RESULTS LPx levels of the I/R group were found to be significantly higher than for groups that received drugs for both testes (p<0.001). GSH levels of the combination group were higher than I/R group in ipsilateral testis (p<0.01) and it was significantly higher than other groups for contralateral testis (p<0.001 for I/R group, p<0.01 for I/R + Arg, p<0.05 for I/R + Td). Mean Johnsens score of the I/R group was found to be significantly lower than treatment groups in ipsilateral testis (p<0.001 for I/R + Arg + Td group, p<0.01 for other treatment goups) and contralateral testis (p<0.001). The mean Johnsen score of the combination group was significantly higher than that of other treatment groups in ipsilateral testis (p<0.05) and it was significantly higher than in the I/R + Td group in the contralateral testis (p<0.05). CONCLUSIONS L-arginine, tadalafil, and combination of these two molecules showed protective effect against ischemia/reperfusion injury for both testes after unilateral testis torsion.

Can pain during digital rectal examination help us to decide the necessity and the method of anesthesia for transrectal ultrasound guided prostate needle biopsy

OBJECTIVE Transrectal ultrasound (TRUS) guided prostate biopsy is well tolerated by patients but the lack of an effective marker to predict pain prevents us from determining pre-procedurally which patient group needs local anesthesia for biopsy and probe pain. Thus in this study, we investigated predictor factors for prostate biopsy and probe insertion pain. MATERIALS AND METHODS 71 patients who were undergoing prostate biopsy without anesthesia were included in the study retrospectively. Pain had been assessed with visual analogue scale (VAS 0-10). Digital rectal examination (DRE) pain was analyzed for biopsy and probe insertion pain. RESULTS DRE pain was related to both probe pain and biopsy pain. CONCLUSION Although level of pain during DRE determines patients in need of local anesthesia, since the number of patients with moderate-severe pain is rather big, it seems efficient in determining the patients in need of additional anesthesia due to probe pain.

T2E (TMPRSS2-ERG) fusion transcripts are associated with higher levels of AMACR mRNA and a subsequent prostate cancer diagnosis in patients with atypical small acinar proliferation

Genetic rearrangements involving androgen-regulated transmembrane protease serine 2 (TMPRSS2) and genes from the ETS transcription factor family, most commonly ERG and ETV1, result in alteration that responsible for oncogenic activity in prostate cancer (PC). The aims of the present study were to: 1) investigate the frequency of these fusion transcripts in prostate tissue samples obtained from patients diagnosed with atypical small acinar proliferation (ASAP), 2) determine any clinical significance of T2E expression at the RNA level in predicting PC detection in subsequent biopsies, and 3) evaluate expression of the PC marker, alpha-methylacyl-CoA racemase (AMACR), according to T2E status by real-time quantitative reverse transcription PCR (RT-qPCR). T2E transcripts were detected in 31.7% (n=20) of the patients examined, and this was significantly associated with subsequent detection of PC in ASAP patients with a prostate specific antigen (PSA) level of 4-10ng/ml (p=0.045). AMACR expression was also significantly higher in the patients who were diagnosed with PC in subsequent biopsies than in the patients who were not diagnosed with PC (p=0.034) and in T2E-positive ASAP patients (p=0.002) compared to T2E-negative ASAP patients. Although these results need to be further clinically validated, we suggest that the presence of T2E transcript, in association with higher AMACR expression, is an indicator of PC risk from a T2E-positive focus or an unsampled malignant gland adjacent to a T2E-positive site in ASAP lesions.

Penile Plication With or Without Degloving of the Penis Results in Similar Outcomes

Background Penile plication techniques with or without degloving offer a minimally invasive option for the treatment of penile curvature. Aim To review the outcomes of penile plication surgery and patient satisfaction with and without degloving of the penis. Methods We conducted a retrospective analysis of 52 patients who underwent penile plication for the treatment of Peyronie disease or congenital penile curvature. Outcomes Surgical success rates, complications, and patient satisfaction determined with the Treatment Benefit Scale were compared between groups. Results The overall surgical success rate was 92.3% at a mean follow-up of 18.84 ± 23.51 months. There were no intraoperative complications. In the degloving group, 42.6% of patients were greatly satisfied and 42.6% had better outcomes; in the without degloving group, 61.5% of patients were greatly satisfied and 30.8% had better outcomes. Comparison of outcomes was not statistically significant between groups. Clinical Implications The results of the present study indicate the two techniques can be used for penile plication. Conclusion With or without degloving, penile plication is safe and effective and provides high patient satisfaction. Kadirov R, Coskun B, Kaygisiz O, et al. Penile Plication With or Without Degloving of the Penis Results in Similar Outcomes. Sex Med 2017;5:e142–e147.

Comparison of Ureteroscopic Laser Lithotripsy with Laparoscopic Ureterolithotomy for Large Proximal and Mid-Ureter Stones

Objectives: To compare the effectiveness and complications of ureteroscopic laser lithotripsy with laparoscopic ureter laparoscopic ureterolithotomy in mid- or proximal portion of large ureteral stones. Material and Methods: We reviewed patients with large (>15 mm) ureteral stone and those who underwent ureteroscopic laser lithotripsy (URS group) or laparoscopic ureterolithotomy (LU group). The first attempt was considered successful in patients who had residual fragments smaller than 2 mm and no conversion of the primary procedure to another. Results: Sixty patients (URS group 29, LU group 31) met inclusion criteria. FURS was used as an adjunctive procedure in one patient for URS group and in two patients for LU group in the same season. LU had a higher success rate and the first-day stone-free rate when compared with URS. Number of procedures was also significantly higher in URS group. There was no difference in stone-free rates at the first and third months, and length of hospitalization and operation were higher in the LU group. Only two patients in the LU group and one patient in the URS group had major complications. Conclusions: Laparoscopy is an effective option of large proximal and mid-ureter stone treatment; however, URS provides similar stone-free rates at three months as a minimal invasive procedure.

Comparison of patient satisfaction rates for the malleable and two piece-inflatable penile prostheses

OBJECTIVE To compare patient/partner satisfaction with AMS 600-650 and AMS Ambicore penile implants (American Medical Systems, Minneapolis, USA) in patients with erectile dysfunction. MATERIAL AND METHODS The modified Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires at six months after implantation of 46 patients who underwent AMS 600-650 (n=23) or Ambicore placement (n=23) between 1/1/2008 and 1/1/2013 were analyzed. RESULTS The percentages of patients with AMS 600-650 who reported to be satisfied, very satisfied and neither satisfied nor dissatisfied with their prostheses were 34.78% (n=8), 30.43% (n=7) and 34.78% (n=8), respectively. For patients with AMS Ambicore, these percentages were 73.91% (n=17), 13.04% (n=3) and 13.04% (n=3), respectively. These overall satisfaction rates were significantly different between patients with AMS 600-650 and Ambicore (p=0.013). For patients with AMS 600-650, the percentages of patients who reported to be very likely, neither likely nor unlikely, or very unlikely to continue using their prosthesis were 30.43% (n=7), 34.78% (n=8), and 34.78% (n=8) while for patients with AMS Ambicore, these percentages were 65.21%, 21.33%, and 13.04%, respectively. These percentages were different between patients with AMS 600-650 and Ambicore (p=0.018). CONCLUSION The two-piece inflatable penile prosthesis was found to be more successful in overall satisfaction and more likely for continued use when compared to the malleable penile prosthesis.

Renal stone composition does not affect the outcome of percutaneous nephrolithotomy in children

PurposeWe sought to investigate the association between renal stone composition and percutaneous nephrolithotomy outcomes in pediatric patients and define the characterization of the stone composition.MethodsThe data of 1157 children who underwent percutaneous nephrolithotomy between 1991 and 2012 were retrieved from the multicenter database of the Turkish Pediatric Urology Society. The study population comprised 359 children (160 girls, 199 boys) with stone analyses. Patients were divided into five groups according to the stone composition [group 1: calcium oxalate; group 2: calcium phosphate; group 3: infection stones (magnesium ammonium phosphate, ammonium urate); group 4: cystine; group 5: uric acid, xanthine stones].ResultsPatient characteristics, perioperative, postoperative, and stone characteristics were compared considering the stone composition. There were no significant differences between the groups concerning age, sex, side involved, preoperative hematocrit levels, and solitary renal unit. Patients with cystine stones were more likely to have a history of stone treatment. Groups 2 and 5 had mostly solitary stones. However, group 3 had staghorn stone more often, and group 4 frequently had multiple stones. Overall stone-free rate (79.4%) was similar among the groups. Although stone composition was related to blood transfusion and prolonged operative and fluoroscopy screening times on univariate analysis, it was not a significant predictor of them on multivariate analysis.ConclusionsStone composition was not a predictor of outcomes of pediatric percutaneous nephrolithotomy. However, cystine and infection stones, which are larger and filled multiple calyxes due to the nature of stone forming, were more challenging cases that need multiple tracts.

RNA-based markers in biopsy cores with atypical small acinar proliferation: Predictive effect of T2E fusion positivity and MMP-2 upregulation for a subsequent prostate cancer diagnosis

Atypical small acinar proliferation (ASAP) is a precursor lesion of prostate cancer (PC), and PC develops from this suspicious focus or an unsampled malignant gland nearby. However, PC‐related molecular alterations that could guide the timing of repeat biopsies and help monitor PC risk in ASAP‐diagnosed patients have not been investigated. The purpose of this study was to first investigate the expression of seven different PC‐related RNAs that included serine 2 (TMPRSS2): erythroblastosis virus E26 oncogene homolog (ERG) gene (TMPRSS2‐ERG, T2E) fusion, alpha‐methylacyl‐CoA racemase (AMACR), kallikrein related peptidase 3 (KLK3), androgen receptor (AR), prostate cancer specific antigen 3 (PCA3), and matrix metalloproteinases (MMP)‐2 and 9.

Assessment of the Accuracy of the Multi Detector Computed Tomography in Defifining Renal Artery Before Laparoscopic Donor Nephrectomy Accuracy of Tomography for Renal Artery

70 enal transplantation is the most effective treatment option for end stage renal disease.1-3 As a consequence of the industrialized world more patients are being diagnosed with end stage renal disease predominantly due to diabetes and hypertension.4 Although the numbers of the patients in the waiting list for renal transplantation are increasing, kidney donation from deceased patients is not sufficient.5,6 Assessment of the Accuracy of the Multi Detector Computed Tomography in Defining Renal Artery Before Laparoscopic Donor Nephrectomy Accuracy of Tomography for Renal Artery

Effect of ADMA levels on severity of erectile dysfunction in chronic kidney disease and other risk factors

INTRODUCTION Hormonal, neurogenic, vasculogenic, and psychogenic impairments, as well as endothelial dysfunction may play a role in erectile dysfunction (ED) in patients with chronic kidney disease (CKD). Asymmetrical dimethylarginine (ADMA) is an inhibitor of nitric oxide, which is the key element of ED. ADMA levels are increased in CKD. We aimed to evaluate the effect of serum ADMA, prolactin, testosterone, and hemoglobin levels on erectile function of patients with CKD and control subjects. METHODS A total of 42 men with CKD and 25 age-matched controls were enrolled. The patients with CKD were categorized into group 1 and group 2 based on whether they had ED according to their response to International Index of Erectile Function questionnaire (IIEF-EFD). Group 3 was a control group. Serum ADMA, total testosterone prolactin, and hemoglobin levels of the patients were evaluated. RESULTS Serum ADMA, testosterone, and hemoglobin levels were similar between group 1 and 2, serum prolactin level was significantly high in group 1 than in group 2 or 3 (control group). There was no correlation between ADMA levels and IIEF-EFD scores of patients with CKD. CONCLUSIONS The results of this study suggest serum ADMA level is not related with ED in patients with CKD. Also, low testosterone and hemoglobin levels were not significant factors. High levels of serum prolactin are related with ED in patients with CKD.