Osman Inci

Value of Dynamic Contrast-Enhanced MRI and Correlation with Tumor Angiogenesis in Bladder Cancer

OBJECTIVE The aim of this study was to investigate dynamic contrast-enhanced MRI (DCE-MRI) for the noninvasive measurement of bladder cancer angiogenesis by correlation with microvessel density, histologic grade, and tumor staging, and to predict the outcome of local recurrence. MATERIALS AND METHODS Twenty-four patients with bladder cancer were examined using DCE-MRI. Hemodynamic parameters obtained by DCE-MRI included peak time enhancement in the first minute (E(max/1)) after contrast administration, second minute (E(max/2)), third minute (E(max/3)), fourth minute (E(max/4)), and fifth minute (E(max/5)), and the steepest slope. Microvessel density was identified by immunostaining of endothelial cells using FVIII-related antigen. The Mann-Whitney U test, multivariate discriminant analysis, Spearmans correlation coefficient, and analysis of variance were used for statistical analysis. RESULTS Correlation was seen between DCE-MRI parameters (E(max/1) and steepest slope) and microvessel density (p < 0.05). E(max/1) and steepest slope were found to have a statistically significant correlation with histologic grade (p < 0.05 and p < 0.01, respectively). A significant difference was seen between groups of patients with and without local recurrence with regard to two of the DCE-MRI parameters (p < 0.05 for E(max/1) and E(max/2)). CONCLUSION The contrast enhancement patterns on DCE-MRI are influenced by tumor angiogenesis, as reflected by elevated microvessel density expression. Therefore, they are valuable indicators for assessing tumor angiogenic activity and tumor neovascularization in bladder cancers.

The Role of Arginine, Indomethacin and Kallikrein in the Treatment of Oligoasthenospermia

We have treated 45 patients with various degrees of oligospermia and asthenospermia with arginine, indomethacin and kallikrein. Fifteen patients have received the amino acid L-arginine hydrochloride, 15 the antiinflammatory agent indomethacin, while 15 others the enzyme kallikrein. These drugs have been administered for at least 3 months to encompass a complete cycle of spermatogenesis.As a result, treatment with these drugs has increased sperm count and motility to some extent. Three pregnancies (20%) have been obtained by arginine and one pregnancy (6.6%) by indomethacin. Though arginine offers some hope for the future, improvement of the fertilizing capacity with these drugs is still controversial.

Giant prostatic urethral calculus associated with urethrocutaneous fistula

Abstract  Urethral stones in men are rare clinical entity and most of them migrate from the urinary bladder. Urethral stones are rarely formed primarily in the urethra and are usually associated with urethral strictures or diverticula. We report a 41‐year‐old man with giant prostatic urethral stone (5.9 × 3.2 × 2.8 cm) associated with a urethrocutaneous fistula. The etiological factors, pathogenesis, clinical presentation, complications and management of giant urethral calculi are reviewed.

Bilateral synchronous granulomatous orchitis: gray-scale and colour Doppler sonographic findings.

A 60-year-old man presented with impotence ultrasonography demonstrated bilateral irregular hypoechoic infiltration of testes and normal epididymis. Colour Doppler sonography showed only peripheral but no intralesional flow. Since the lesion was presumed as malignancy bilateral high inguinal orchiectomy was performed and bilateral idiopathic granulomatous orchitis was diagnosed. It was concluded that granulomatous orchitis should be considered in the differential diagnosis of diffuse testicular hypoechoic involvement which showed only peripheral low-resistance flow on colour Doppler sonography, in the proper clinical setting. Although this may be a helpful sign in the differential diagnosis of diffuse testicular infiltrations, high inguinal exploration remains mandatory.

'Multimodal' approach to management of prostate biopsy pain and effects on sexual function: efficacy of levobupivacaine adjuvant to diclofenac sodium - a prospective randomized trial.

We assessed the analgesic efficacy of levobupivacaine when administered as an adjuvant to diclofenac sodium in prostate biopsy pain management and effects of prostate biopsy on sexual function. Ninety patients underwent transrectal ultrasound (TRUS)‐guided biopsy of the prostate and were randomly assigned to three groups: group D received diclofenac sodium suppository; Group L received periprostatic injection of levobupivacaine; group DL received diclofenac suppository and levobupivacaine in addition. Patients were asked to use a visual analogue scale score (VAS) questionnaire about pain after 10 core prostate biopsy. Sixty‐two patients reported to be prostate cancer‐free underwent further evaluation with the International Index of Erectile Function‐5 (IIEF‐5) questionnaire at 1 and 3 months after biopsy. Mean pain scores during prostate biopsy were significantly lower in group DL and were superior to the group L and group D (P < 0.001). Mean IIEF‐5 score prior to biopsies was significantly higher when compared with the mean IIEF‐5 score 1 month after biopsy (P < 0.0001). Mean IIEF‐5 scores 1 month after biopsy were significantly lower when compared with the mean IIEF‐5 scores 3 months after biopsy (P = 0.002). TRUS‐guided prostate biopsies have a statistically significant impact on short‐term erectile function, but this difference is not clinically significant; however, medium‐term erectile function is not affected both statistically and clinically.

The use of human dura mater as an interposition graft in the treatment of vesicovaginal fistula

Purpose: In this prospective study we aimed to describe our new technique; dehydrated human dura mater as an interposition graft in patients undergoing benign vesicovaginal fistula repair (VVF). Patients and methods: Eleven patients with benign VVFs aged 38–73 years were operated with dura mater interposition technique at our institution between July 1996 and February 2002. In all patients fistula were secondary to abdominal hysterectomies with benign diseases and two had undergone previous transvaginal surgery. Patients were operated 8–15 (mean 12) weeks after previous surgery. A suprapubic cystotomy was performed and the fistula was not excised. The bladder wall is widely dissected from underlying vagina. Dura-mater was placed over the vaginal suture line to close the fistulous tract, cytostomy was inserted and the bladder was closed. An 18 F Foley catheter was left in the bladder for 5 days. A successful repair is defined as no leakage by cystogram at 14 days postoperatively and completely dry by patient report. Results: An overall success rate of 100% was achieved in all patients. All patients remain dry at the follow – up which ranges from 7 to 60 (mean 26) mounts. Patients were discharged at 14 to 26 (mean 16) days postoperatively. No major complications or side effects were observed during the follow-up period. Conclusions: The use of human dura mater as an interposition graft in the treatment of vesicovaginal fistula is an alternative for VVF repairs because of its excellent tissue compability, stability, good elasticity and absorbability.

Case report: subcutaneous metastasis from small cell carcinoma of the prostate.

Pure primary small cell carcinoma of the prostate (SCCP) is an extremely rare entity. Natural history of this tumor is similar to that of the bronchogenic small cell carcinoma. Several theories of histogenesis have been proposed. Most widely accepted view is that SCCP arises from pluripotent stem cells of the prostate, which have the ability to differentiate into either epithelial or neuroendocrine type carcinomas. SCCP has an aggressive course, and a majority of patients have distant metastasis at presentation. Since it is a rare entity, no standard treatment regimen has been established. A case of primary pure SCCP with multiple subcutaneous metastases is presented.

Giant unilateral abdominoscrotal hydrocele in an adult: Case report

Abdominoscrotal hydrocele (ASH) is an apparently highly uncommon clinical entity especially in childhood. While hydrocele is among the commonest inguinal anomaly in adult, its extreme form ASH is infrequently reported form. ASH consists of two large sacs, both abdominal and scrotal, connecting with the inguinal canal. Surgical correction is mandatory. We present a 34-year-old man with giant ASH. He was treated with excision of hydrocele sac through an inguinal approach.

Failure of artificial insemination of husband's semen in the treatment of male infertility

In the management of infertility, in case semen quality is found insufficient and could not be improved by medical means, handling the available spermatozoa in the most beneficial way has been aimed. Thus, artificial insemination with low quality semen has become a therapeutic alternative. In this study homologous artificial insemination has been used to treat infertility caused by oligoasthenospermia. Eighteen couples have been treated for 58 cycles by intrauterine or paracervical insemination using cervical cups. During the same period 42 cycles with timed vaginal intercourse have been assessed. Though no pregnancies could be obtained following artificial insemination, one pregnancy occurred during no-treatment cycles.

A new cause of curvilinear renal calcification: calcified hydrocalycosis

Although many causes of curvilinear renal calcifications have been described, calcified hydrocalycosis mimicking hydatid cyst has not previously been reported. We report a case of hydrocalycosis which was appeared as a curvilinear calcified cystic lesion resulted from staghorn calculus associated with xanthogranolomatous pyelonephritis (XGPN) on intravenous pyelography (IVU) and computed tomography (CT).