Ozgur Yaycioglu

Public awareness of testicular cancer and self-examination in Turkey: A multicenter study of Turkish Urooncology Society

BACKGROUND Testicular self-examination is the easiest and cheapest way to scan testicular cancer. However, the public awareness about testicular self-examination is very low. We aimed to investigate the public awareness of Turkish people about testicular cancer and testicular self-examination. METHODS We performed a survey consisting of 10 questions concerning testicular cancer and testicular self-examination in 799 students in the first year of 12 different medical schools. Aiming for a common method of data collection, the questionnaires were administered to the students during a class just before the lesson started. The whole data from all of the centers were pooled in a common data-base file. RESULTS Eighty-nine (11.1%) of the participants reported that they had knowledge about testicular cancer, but only 11 (1.4%) of them answered all the questions about testicular cancer correctly. Eight (1%) of the participants reported that they had been performing testicular self-examination routinely once a month. Four (0.5%) of them were both well informed about testicular cancer and had been performing testicular self-examination once a month as suggested. CONCLUSION The present study showed that awareness on testicular cancer and testicular self-examination is very low and suggests a need for efforts in Turkey to increase public awareness and education.

Intraoperative Floppy Iris Syndrome: Facts for the Urologist

Intraoperative floppy iris syndrome (IFIS) consists of a triad of flaccid and billowing iris, iris prolapse through the surgical incisions, and progressive pupil constriction. IFIS increases the risk for complications during cataract surgery. It was first described in patients on tamsulosin treatment but can also be seen in patients on other non-subtype specific alpha(1)-adrenergic receptor (alpha(1)AR) antagonists. Urologists who are initiating treatment with alpha(1)AR antagonists should inform their patients that these drugs may increase the difficulty of cataract surgery, but once the ophthalmologists are forewarned, necessary safety measures can be taken to achieve good surgical results.

Sperm retrieval and live birth rates in presumed Sertoli-cell-only syndrome in testis biopsy: a single centre experience

We aimed to investigate sperm retrieval rates (SRR) by testicular sperm extraction (TESE), factors affecting SRR, and fertilization rate (FR), implantation rate (IR), clinical pregnancy rate (CPR) and live birth rate (LBR) in patients with presumed Sertoli‐cell‐only syndrome in testis biopsy (SCOS). We retrospectively evaluated files of 134 patients with SCOS who underwent TESE. Group I were patients in whom spermatozoa were retrieved and Group II were patients in whom no spermatozoa could be retrieved. SRR, Follicle stimulating hormone (FSH), Luteinizing hormone (LH), and testosterone levels, and the volume of testicles were compared between groups. In addition, FR, IR, CPR and LBR were determined. Sperm retrieval was achieved in 37 (27.6%) patients (Group I), and the remaining 97 (72.4%) patients made Group II. There were no significant differences in age, infertility time, testicular volume, serum FSH, LH and testosterone levels between Groups I and II (p > 0.05). Intracytoplasmic sperm injection (ICSI) was performed in 36 patients. FR, IR, and CPR were 60.86 ± 23.03, 36.53 ± 41.78 and 51.3% respectively. Cycle and patient based LBRs were 37.8 and 45.1% respectively. SRR in SCOS is lower than patients with non‐obstructive azoospermia (NOA) in general. No parameters to predict spermatozoa retrieval were determined. In patients with SCOS, ICSI achieves similar live birth rate to other patients with NOA.

A Preoperative Prognostic Model Predicting Recurrence-free Survival for Patients With Kidney Cancer

OBJECTIVE To develop a preoperative prognostic model in order to predict recurrence-free survival in patients with nonmetastatic kidney cancer. METHODS A multi-institutional data base of 1889 patients who underwent surgical resection between 1987 and 2007 for kidney cancer was retrospectively analyzed. Preoperative variables were defined as age, gender, presentation, size, presence of radiological lymph nodes and clinical stage. Univariate and multivariate analyses of the variables were performed using the Cox proportional hazards regression model. A model was developed with preoperative variables as predictors of recurrence after nephrectomy. Internal validation was performed by Harrells concordance index. RESULTS The median follow-up was 23.6 months (1-222 months). During the follow-up, 258 patients (13.7%) developed cancer recurrence. The median follow-up for patients who did not develop recurrence was 25 months. The median time from surgery to recurrence was 13 months. The 5-year freedom from recurrence probability was 78.6%. All variables except age were associated with freedom from recurrence in multivariate analyses (P < 0.05). Age was marginally significant in the univariate analysis. All variables were included in the predictive model. The calculated c-index was 0.747. CONCLUSIONS This preoperative model utilizes easy to obtain clinical variables and predicts the likelihood of development of recurrent disease in patients with kidney tumors.

The effects of systemic alpha-1 adrenergic antagonists on pupil diameter in rats.

Purpose: To investigate the effects of alpha-1 adrenergic blockers on pupil diameter (PD) in rats. Methods: Four groups, with 10 rats each, were designed to receive terazosin, tamsulosin, doxazosin, and no medication. Dilated pupil diameter (PD) measurements were performed 24 hr before, 24 hr after, and 30 days after the initiation of medication, and after 30 days of washout. The intergroup and intragroup differences in PD were evaluated using one-way ANOVA and Wilcoxon signed rank test, respectively. Results: In day 1, PD decreased in both eyes significantly only in tamsulosin and doxazosin groups, but these effects became insignificant at 30 days of treatment (p > 0.05). The control group showed no significant difference in PD (p > 0.05). PD values returned to baseline after the washout period in all groups. Conclusions: A significant reduction in PD occurred in two of the three groups with alpha-1 adrenergic blockers (tamsulosin and doxazosin), but this effect was not sustained at 30 days. Further functional and structural studies of the iris are needed to determine the clinical significance of these findings.

Management of complete ureteral obstructions with a transluminal puncture technique

INTRODUCTION The traditional delayed treatment of iatrogenic complete ureteral obstruction is open surgery. An easy endourological technique, transluminal re-canalization of the ureter by guide-wire puncture under fluoro-endoscopic control, which has been performed on 4 patients, is described. SURGICAL TECHNIQUE With the guidance of C-arm fluoroscopy, by moving the C-arm to different planes, the tip of the ureteroscope is directed to the correct plane to meet the obliterated proximal end of the ureter and under direct vision, transluminal puncture is performed using the stiff end of a 0.035-inch guide wire. Once the stiff end of the guide-wire is in the lumen of the proximal ureter, an ureteral catheter is introduced over the guide wire, the guide wire is then removed and reinserted through the ureteral catheter with its soft end leading and a double J catheter is inserted. Ureteral stricture, if later encountered, is treated with balloon dilatation. RESULTS Continuity of the ureter was restored in all 4 patients. The double J stents were removed 6 weeks later and a retrograde pyelography revealed resolution of the hydronephrosis without extravasation of urine. CONCLUSION Although a very satisfactory result was achieved in our cases, more cases are needed to show if it can be an alternative to conventional surgical repair. However, we believe that this minimally invasive technique can be used for short obliterated ureteral segments and neither delays nor does it preclude further management using open surgery.

Retroperitoneal recurrence of a stage 1 renal cell carcinoma 4 years following core biopsy and fine needle aspirationl: Possible needle tract seeding

Dear Dr. Bedrossian: I read with interest the Letter to the Editor entitled ‘‘Retroperitoneal Recurrence of a Stage 1 Renal Cell Carcinoma Four Years Following Core Biopsy and Fine Needle Aspiration: Possible Needle Tract Seeding’’ by Giorgadze et al. The authors report a case of an 83-year-old man who underwent CT-guided biopsy for a 3.5 cm left renal mass followed by radical nephrectomy. The biopsy technique involved fine needle aspiration (FNA) of the mass using a 22-gauge Chiba needle and concurrent core needle biopsy using a 20-gauge needle. Technical details such as the number of needle passage as well as the use of coaxial guide or cannula were not provided. The pathologic examination of the nephrectomy specimen showed a pT1a N0 M0, Fuhrman grade 3 papillary renal cell carcinoma. The patient developed a 15 cm left retroperitoneal mass extending behind the abdominal aorta and likely invading the left psoas muscle as well as retroperitoneal and retrocrural lymphadenopathy. There was no cutaneous or subcutaneous involvement. FNA and core needle biopsy of the mass were performed and the features of the specimens were consistent with recurrent papillary renal cell carcinoma. The authors speculate that as the primary tumor was confined to the kidney and had negative surgical margins, this recurrent tumor possibly presented needle tract seeding. They further suggest that the larger 20 gauge needle used for core biopsy caused needle tract seeding. Therefore, they conclude that when the adequacy of cellular material obtained via FNA is demonstrated, one should preferably omit core needle biopsy. I have some objections on the authors’ assumptions and conclusion. The evidence provided by the authors lets one only conclude that this is a case of local recurrence of renal cell carcinoma at the nephrectomy site. Any assumption on the cause of this recurrence is only a guess unsupported by scientific evidence. Even though the tumor was confined to the kidney with negative surgical margins, it showed high grade features. If we knew for sure that such tumors did not recur or metastasize, there would be no reason to follow them after nephrectomy. There is no way to exclude delayed lymph node metastasis. In addition, the recurrent mass did not involve skin or subcutaneous tissue on the needle’s tract. There have been no reports of needle tract seeding involving biopsy of renal cell carcinoma in the last 20 years, and core biopsy technique has been extensively used in this period. Therefore, I think one must present better evidence of tract seeding before making suggestions to omit taking core biopsies and be contented with FNA.

Simultaneous laceration of external iliac artery and vein complicating anterior vaginal wall sling operation for stress urinary incontinence.

Case reportWe report a case of simultaneous injury of right external iliac artery and vein by a needle carrier that was inserted from the suprapubic area down to the vaginal lumen during anterior vaginal wall sling procedure.DiscussionThe risk factors and measures to be taken to avoid this life threatening complication are discussed.