Ozgu Aydogdu

Erratum to “Does Urinary Bladder Shape Affect Urinary Flow Rate in Men with Lower Urinary Tract Symptoms?”

In the paper titled “Does Urinary Bladder Shape Affect Urinary Flow Rate in Men with Lower Urinary Tract Symptoms?” we should add an author who has contributed to our study for the images: Murat Cinar, Department of Biomedical Engineering, Faculty of Engineering and Architecture, Izmir Katip Celebi University, 35620 Izmir, Turkey. In addition we should here correct the affiliation of one of the authors named Omer Karal and the postal code in the affiliation of the author Mahmut Pekedis.

Effectiveness of Doxazosin in Treatment of Distal Ureteral Stones in Children

PURPOSE We evaluated the effectiveness of doxazosin in children with distal ureteral stones in terms of stone expulsion rates and time to expulsion. MATERIALS AND METHODS A total of 39 patients 2 to 14 years old with lower ureteral stones smaller than 10 mm were enrolled and randomly divided into 2 groups. Group 1 consisted of 20 controls receiving ibuprofen for pain and group 2 consisted of 19 patients receiving doxazosin. Doxazosin dose was approximately 0.03 mg/kg daily. All patients were evaluated with x-ray, ultrasound or spiral computerized tomography. Stone expulsion rates and time to expulsion between the groups were compared. Mean followup was 19 days. Effects of doxazosin were also evaluated by comparing subgroups with stones smaller than 5 mm and 5 to 10 mm. Results were also evaluated with special emphasis on gender and age. RESULTS Expulsion was observed in 14 patients (70%) in group 1 and 16 (84%) in group 2 (p >0.05). Mean expulsion times for groups 1 and 2 were 6.1 and 5.9 days, respectively (p >0.05). Although fewer pain episodes were observed in the treatment group, this finding could not be evaluated objectively. None of the patients experienced any adverse effects. CONCLUSIONS Administration of 0.03 mg/kg doxazosin daily in children to treat distal ureteral stones up to 10 mm is not superior to analgesic alone. This result is not affected by gender, stone size or patient age. However, additional randomized controlled studies, especially including larger stone volumes, and different doses of doxazosin and other alpha-blockers, might highlight the usefulness of alpha-blockers for ureteral stones in children.

Tadalafil rehabilitation therapy preserves penile size after bilateral nerve sparing radical retropubic prostatectomy

OBJECTIVE To evaluate the change in penile size r bilateral nerve sparing retropubic radical prostatectomy (BNSRRP) and possible effect of Tadalafil. MATERIALS AND METHODS A total of 65 patients underwent BNSRRP and they were evaluated prospectively for a whole year of follow-up. The patients were randomized to control without rehabilitation (Group 1) or Tadalafil rehabilitation group (Group 2). The patients were evaluated at months 3, 6 and 12 postoperatively for erectile function, penile measurements (flaccid penile length, penile length at maximum erection, penile circumference at flaccid status, and penile circumference at maximum erection), penile abnormalities and general health status. Statistical analysis was performed by Chi-Square test and significance was defined as p value < 0.05. RESULTS In Group 1 there was significant decrease in penile measurements at month 3 compared to preoperative measurements. There was decrease in all parameters at month 6 compared to month 3 but only the decrease in penile length at maximum erection was significant. There were no significant differences between postoperative months 6 and 12 for all measurements. In Group 2 there was a tendency to decrease in all measurements at month 3 compared to baseline. There was no significant difference for penile measurements between postoperative 3rd and 6th months and between 6th month and the first year. CONCLUSION Although further large sampled trials are needed to describe the possible positive effect of tadalafil or other PDE5-I s on penile size after BNSRRP, tadalafil rehabilitation is effective in preserving penile size especially in the early postoperative period after BNSRRP.

Lower urinary tract conditions in children with attention deficit hyperactivity disorder: correlation of symptoms based on validated scoring systems.

PURPOSE We investigated whether certain voiding problems have a higher incidence in patients with attention deficit disorder with hyperactivity compared to age matched controls. MATERIALS AND METHODS We used the Conners Parent Rating Scale-revised for attention deficit disorder with hyperactivity and lower urinary tract symptom score to evaluate voiding problems. A total of 62 children with attention deficit disorder and 124 healthy controls were enrolled. We evaluated uroflowmetry patterns in both groups. Residual urine volumes and Bristol stool scale were noted. We examined the correlation between total Conners Parent Rating Scale-revised and lower urinary tract symptom score in patients with attention deficit disorder. Additionally we analyzed each index of the Conners Parent Rating Scale-revised separately in terms of correlation with symptom subgroups for lower urinary tract symptom scores. RESULTS Mean ± SD total lower urinary tract symptom score was 11.1 ± 2.9 in patients with attention deficit disorder with hyperactivity and 3.2 ± 1.3 in controls, a difference that was statistically significantly (p <0.001). With the exception of constipation, mean scores of all lower urinary tract symptom subindices were significantly higher in patients with attention deficit disorder compared to controls. Symptoms evaluated in lower urinary tract symptom score were mostly correlated with attention deficit disorder index of the Conners Parent Rating Scale-revised. If a child with attention deficit disorder has a high index in the Conners Parent Rating Scale-revised, he or she is more likely to have urgency. Also, if a child with attention deficit disorder has a high hyperactivity subscale score, he or she is more likely to have enuresis. CONCLUSIONS Voiding problems are more common in children with attention deficit disorder with hyperactivity than in age matched controls. Urgency and enuresis are the outstanding problems in children with attention deficit disorder. Simultaneous use of the Conners Parent Rating Scale-revised and lower urinary tract symptom score questionnaire should be encouraged in patients with attention deficit disorder to allow a structured and quantitative evaluation of these overlapping problems.

Minimally invasive surgical treatment for large impacted upper ureteral stones: Ureteroscopic lithotripsy or percutaneous nephrolithotomy?

INTRODUCTION The management of patients with large impacted upper ureteral stones is difficult; there is no standard treatment. We compared the outcomes of percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotripsy (UL) to treat large (≥1.5 cm), impacted, upper ureteral stones. METHODS In total, 86 patients with large impacted upper ureteral stones were included in this study. Of these patients 41 underwent UL and 45 underwent PCNL. The inclusion criteria were: longest diameter of stone ≥1.5 cm, the localization of stone between the lower border of L4 spine and ureteropelvic junction and impacted stone. RESULTS In the UL group, we were unable to reach the stone in 3 patients because of ureteral stricture and edema despite balloon dilation. Of these 3 patients, we were unable to optimally visualize the stone in 2 patients due to bleeding and mucosal injury following balloon dilation. The stricture was too firm and could not be passed in the third patient. Also in the UL group, 15 patients had stones or big fragments which migrated into the renal collecting system. In the PCNL group, 21 patients had concurrent renal stones <1 cm and stones were successfully removed in all patients. No statistically significant difference was found between groups in terms of operation time. Mean hospital stay was significantly shorter in the UL group. Success rates were 82.3% in the UL group and 97.6% in the PCNL group (p = 0.001). CONCLUSION The recent study confirms that PCNL is a safe and effective minimally invasive procedure with acceptable complication rates in the treatment of patients with large, impacted upper ureteral stones.

Near Infrared Spectroscopy to Diagnose Experimental Testicular Torsion: Comparison With Doppler Ultrasound and Immunohistochemical Correlation of Tissue Oxygenation and Viability

PURPOSE Near infrared spectroscopy measures tissue oxygenation even when there is complete cessation of blood flow. We evaluated near infrared spectroscopy to diagnose testicular torsion and blindly compared its accuracy with that of Doppler ultrasound. We also compared it by immunohistochemical evaluation of hypoxia and cell viability. MATERIAL AND METHODS Rats were randomized to 4 groups, including group 1-720-degree unilateral torsion, group 2-360-degree unilateral torsion, group 4-sham operation and group 4-720-degree unilateral torsion followed by surgical torsion reduction at minute 180. Near infrared spectroscopy and Doppler ultrasound were done blindly at minutes 0, 5, 30, 60, 180 and 400. All torsed and contralateral testicles were excised for pathological examination using hypoxia inducible factor-α for hypoxia and the TUNEL test for apoptosis. We compared all groups with the contralateral testis and the sham operated group. RESULTS All blinded, near infrared spectroscopy measurements correctly identified the torsed testis after minute 5. Median oxygen saturation in groups 1 and 2 was significantly different compared to that in the sham operated group after minute 5. In group 4 near infrared spectroscopy detected detorsion with the loss of a significant oxygen saturation difference between the affected and the contralateral testicle after detorsion. At minute 400 median oxygen saturation in group 4 was not statistically different compared to that in the sham operated group (p = 0.09) but it was significantly different compared to that in groups 1 and 2 (p <0.001). In each torsed testis oxygen saturation was at least 18.75% lower than in the contralateral testis. In groups 1 and 2 hypoxia inducible factor-α staining in torsed testicles was significantly greater than that in the contralateral organ and the sham operated group. In group 4 hypoxia inducible factor-α staining after detorsion was significantly decreased compared to that in groups 1 and 2. There was no significant difference in the apoptotic index between the experimental and the contralateral testis or the sham operated group. CONCLUSIONS Near infrared spectroscopy is as effective but quicker than Doppler ultrasound for detecting testicular torsion without a radiologist. Near infrared spectroscopy accurately reveals oxygen saturation, which is more vital than blood flow, on which Doppler ultrasound focuses.

Predictors of Surgical Outcome in Children With Vesicoureteral Reflux Associated With Paraureteral Diverticula

OBJECTIVES To retrospectively evaluate success rates of different surgical approaches in the treatment of paraureteral (Hutch) diverticula (PUD) associated with vesicoureteral reflux (VUR) and also to define preoperative objective criteria to predict the surgical outcome. METHODS Records of 51 patients who underwent surgical treatment for PUD were reviewed. Intravesical ureteroneocystostomy (UNC), subureteral injection, and extravesical UNC were performed in 23, 28, and 10 renal units, respectively. Records of patients were evaluated with particular emphasis on predictors of treatment outcome. Mean follow-up was 22.1 months (range, 3-46). Statistical significance was set at P <.05. RESULTS Overall success rates were 91%, 79%, and 80% for intravesical UNC, subureteral injection, and extravesical UNC, respectively (P >.05). The mean PUD index for patients who underwent endoscopic treatment was significantly lower (P <.05). In the endoscopic group, reflux was detected at the late-filling or voiding phase of voiding cystourethrography (P <.005). In patients, who were diagnosed with video urodynamics, reflux began at higher bladder pressures and volumes in the injection group (P <.005). UNC was more frequently used in patients with the orifice at the neck or dome (P <.005). CONCLUSIONS For injection in the lower PUD index, onset of reflux at late-filling or voiding phase on voiding cystourethrography, higher pressure and volume on video urodynamics, and C position orifice are positive predictive parameters for success. Bilateral reflux with high PUD index and grade 5 VUR are associated with failure of intravesical reimplantation. Presence of grade 5 VUR and an early onset of reflux outstand as negative predictive factors for unilateral extravesical UNC.

Pilot Feasibility Study of Transscrotal Near Infrared Spectroscopy in the Evaluation of Adult Acute Scrotum

PURPOSE We investigated the usefulness of transscrotal near infrared spectroscopy that measures testicular oxygen saturation (StO2%) in the diagnosis of testicular torsion vs other causes of the acute scrotum in adults. MATERIALS AND METHODS Between January and May 2009, 16 adult males presenting with acute scrotum underwent StO2% measurement of the affected and unaffected testis using near infrared spectroscopy followed by color Doppler ultrasound. If surgically explored, near infrared spectroscopy was performed at surgery and on postoperative day 1. Data were presented as means ± SD and/or normalized to the internal control. Cutoff value was generated for the StO2% difference between the affected testis and control side. RESULTS Sixteen males with acute scrotum of mean duration 12 hours were enrolled. Of 11 patients with abnormal Doppler undergoing surgical exploration, mean StO2% of the affected testis at presentation and at surgery decreased from 40.09 ± 2.66 (range 36 to 44) to 37.18 ± 3.31 (range 32 to 42), respectively, while StO2% of the unaffected testis remained 63.09 (range 55 to 69) both at presentation (SD 4.72) and at surgery (SD 4.98). Of the 11 surgically explored, 4 had orchiectomy and 7 patients underwent surgical detorsion. At presentation and at surgical exploration of the detorsed group, the mean normalized difference between the StO2% values of the affected and unaffected sides was -16.12 and -25.9, respectively. A cutoff value of -11.5 was measured for the StO2% difference between the affected testis and control side at presentation in patients who underwent surgery. CONCLUSIONS Near infrared spectroscopy identified all surgically confirmed cases of testicular torsion when affected testis StO2% was more than 11.5 units lower than the contralateral testis. In pilot testing, near infrared spectroscopy is a rapid, noninvasive, easy and safe method for the differential diagnosis of adult human testicular torsion.

Predictive Factors for Spontaneous Stone Passage and the Potential Role of Serum C-Reactive Protein in Patients with 4 to 10 mm Distal Ureteral Stones: A Prospective Clinical Study.

PURPOSE We investigated possible predictive factors for spontaneous stone passage and the potential role of serum C-reactive protein and white blood count in patients with 4 to 10 mm distal ureteral stones. MATERIALS AND METHODS A total of 251 patients who presented with renal colic secondary to distal ureteral stone were included in study. Patients were grouped according to spontaneous stone passage. Serum C-reactive protein, white blood count and other possible factors were investigated for their potential predictive value for spontaneous stone passage at a followup of 5 weeks. Potential predictive factors for spontaneous stone passage were evaluated with univariate and multivariate analyses. ROC curve analysis was performed to find an optimal cutoff value for serum C-reactive protein according to spontaneous stone passage. Statistical significance was considered at p <0.05. RESULTS Spontaneous stone passage was observed in 135 patients (53.8%) in group 1 while 116 (46.2%) in group 2 did not expel the stone spontaneously. Median stone size was 5.7 mm. Stone size, serum C-reactive protein and white blood count were significantly higher in group 2 than in group 1. The number of patients with hydronephrosis and the number with spontaneous stone passage history were significantly lower in group 2 compared to group 1. The cutoff value of serum C-reactive protein provided by ROC analysis was 0.506 mg/l. Time to spontaneous stone passage was significantly higher in patients with serum C-reactive protein above the threshold and in patients with ureteral stones greater than 6 mm. CONCLUSIONS Stone size, previous spontaneous passage, hydronephrosis, serum C-reactive protein and white blood count can be used to predict spontaneous stone passage in patients with 4 to 10 mm distal ureteral stones. A serum C-reactive protein level of 0.506 mg/l can serve as a cutoff value to predict spontaneous stone passage.

The use of prophylactic single-dose fosfomycin in patients who undergo transrectal ultrasound-guided prostate biopsy: A prospective, randomized, and controlled clinical study

INTRODUCTION We aimed to demonstrate the efficacy, safety, and convenient use of fosfomycin trometamol in the preoperative antibiotic prophylaxis (PAP) of transrectal ultrasound-guided biopsy of the prostate (TRUSBP) in this prospective, randomized study. METHODS Between May 2014 and May 2015, a total of 300 patients who underwent TRUSBP were examined prospectively. Patients were randomized into two groups: group 1 consisted of 150 patients who were administered a single dose of 3 g oral fosfomycin as a PAP the night before the procedure; group 2 consisted of 150 patients who were administered 500 mg oral ciprofloxacin 60 min before the procedure as a PAP. Post-procedural febrile and afebrile infectious complications and pathological characteristics of the two groups were compared prospectively. RESULTS The mean age of the patients was 63.5±0.6 years in group 1 and 62.9±0.6 years in group 2. A total of two patients (1.3%) in group 1 and nine patients (6.0%) in group 2 experienced afebrile urinary tract infection (UTI). Afebrile UTI rate was significantly higher in group 2 (1.3% s. 6.0%, p=0,032). Febrile UTI was detected in two patients in group 2 and one patient in group 1. Urine cultures revealed 35.7% fluoroquinolone resistance. As a limitation, although the sample size was appropriate due to the power calculation, we believe that comprehensive studies including larger patient cohorts are needed to support our findings. CONCLUSIONS Due to its ease-of-use with only a single dose and lower rates of infectious complications (resistant and febrile UTIs), fosfomycin trometamol is a strong alternative for antibiotic prophylaxis in TRUSBP.