Özkan Polat

Management of Fournier's Gangrene: Review of 45 Cases

PurposeFourniers gangrene is a fatal synergistic infectious disease with necrotizing fasciitis of the perineum and abdominal wall along with the scrotum and penis in men and the vulva in women.MethodsThe clinical and operative records of 45 patients with Fourniers gangrene during a 14-year period were analyzed.ResultsThe etiology of the infection was identified in 39 patients. The most common causes were colorectal diseases and urogenital diseases. Four patients died with an overall mortality of 8.8%. The mortality rate was higher in patients with diabetes mellitus, but it was not statistically different. The age, duration of the symptoms, and the presence of rectal abscess were not found to be significant factors regarding mortality rate.ConclusionsSurgery with extensive debridement of all necrotic tissue is the main stay of treatment.

Iatrogenic injuries to ureter, bladder and urethra during abdominal and pelvic operations

Abdominal and pelvic operations at Departments of Obstetrics and Gynaecology, and General Surgery play an important role in ureteral, bladder and rarely urethral injuries.Fifty-nine patients with iatrogenic ureteral, bladder and urethral injuries were treated at the Department of Urology, Atatürk University Research Hospital, between 1985 and 1995. These injuries were urinary vaginal fistulas in 43 patients (vesicovaginal 33, ureterovaginal 7, urethrovaginal 2 and vesicovaginal plus urethrovaginal 1), ureteric ligation in 9, bladder laceration in 7. These injuries were treated by different methods. All patients were followed up by intravenous urography (IVU) and urine culture three months later.It must be borne in mind that iatrogenic urinary tract injuries are not rare. Bladder and ureteral catheterization must be performed to prevent these complications.

Transitional Cell Carcinoma of the Bladder in Patients under 40 Years of Age

A review of our records between 1993 and 1998 identified 25 patients with transitional cell carcinoma of the bladder who were less than 40 years old, 22 males and 3 females. The youngest patient was 19 years old. At the time of diagnosis 16 patients had superficial (Ta/T1) and 9 had invasive disease. Twenty-four patients were followed up for a period of 3–71 months (mean: 19.2 months). The recurrence rate for patients with superficial disease was 12.5%, and the progression rate for patients with invasive disease was 77.7%.We concluded that the patients under 30 years of age presented with lower grade and lower stage disease than those over 30. Transitional cell carcinoma of the bladder in young adults has a natural history similar to that seen in older patients. Accordingly, all patients, regardless of age, should be treated as aggressively as necessary on the basis of the stage and the grade of the tumour.

PEYRONIE'S DISEASE : INTRALESIONAL TREATMENT WITH INTERFERON ALPHA-2A*AND EVALUATION OF THE RESULTS BY MAGNETIC RESONANCE IMAGING

In this clinical study, to determine the therapeutic efficacy of interferon (IFN) treatment for Peyronies disease, we applied interferon alpha-2A (IFN alpha-2A) intralesionally in the treatment of Peyronie plaques in 15 patients and results were evaluated by magnetic resonance imaging (MRI).Patients whose plaque sizes were 0.5 and 1 cm responded better to the treatment. There was about a 90% lessening in the sizes of the plaques of 1.5 cm, 83.3% of 2 cm, as the ones which were 0.5 cm and 1 cm disappeared completely after treatment.As a conclusion, the treatment of Peyronies disease with IFN alpha-2A is effective and side effects are minimum.

Seminal plasma nitric oxide concentration in oligo- and/or asthenozoospermic subjects with/without varicocele.

There is an inverse correlation between seminal plasma nitric oxide (NO) concentration and sperm parameters (motility and concentration) in patients with varicocele. This study investigated whether this occurs in patients with oligo- and/or asthenozoospermia due to causes other than varicocele. A total of 69 (19 with varicocele and oligo- and/or asthenozoospermia [group 1], 30 from oligo- and/or asthenozoospermic ones without varicocele [group 2], and 20 from healthy subjects [control group]) semen samples were analyzed. While group 1 had a significantly higher NO concentration in the seminal plasma compared to both the control group and group 2, there was no significant difference between group 2 and the control group ( p >.05). In group 1, but not in the other groups, there was an inverse correlation between the seminal plasma NO concentration and sperm motility and concentration. NO production could be specifically related to the varicocele, since NO production in oligo- and/or asthenozoospermia cases without varicocele is not increased.

Squamous metaplasia of the bladder: findings in 14 patients and review of the literature.

We have documented the data of squamous metaplasia of the bladder in 14 patients who had undergone cystoscopies for different reasons. In two biopsies, there were marked keratinization and cellular atypia. One of these two subjects was diagnosed as squamous carcinoma of the prostate and transitional cell carcinoma of the bladder. The lesions of 8 female patients were on the trigone and evaluated as normal anatomical variants due to hormonal changes. Three of them were remarkable because of recurrent urinary infections. Apart from the two male patients with squamous cell carcinoma of the prostate the two male patients with current squamous metaplasia have been following up. In this study, we have also reviewed the relationship between squamous metaplasia, infection and malignancy.

Hydatid disease of the urinary tract: Review of the management of 9 cases

The aim of this study is to review 9 cases with urinary tract hydatid disease in terms of symptoms, findings, laboratory tests, radiological findings and treatment modalities.There were 7 males and 2 females with a mean age of 33.6 years (range from 7 to 67 years). In 6 patients hydatid cyst was located in the kidney (1 involved the liver), in 2 the cysts were in the paravesical and retrovesical region (1 coexisted bladder tumor) and 1 the cyst was located adrenal gland. The investigations included urinalysis, eosinophil count, Casoni skin test, indirect haemagglutination test (IHA), transabdominal ultrasonography (TAUS), intravenous urography (IVU) and computed tomography (CT). All patients underwent various surgical procedures and were followed-up for an average of 3 years (range: 1 month to 5 years) period in terms of complications and recurrence rates.The most common symptom was lumbar or abdominal pain. Eosinophilia was seen in 4 patients (44.4%), IHA positivity in 3 patients (33.3%) and Casoni skin test were positive in 3 patients (33.3%). The most diagnostic method of radiological investigations was abdominal pelvic CT (100%). After surgical treatment, in mean a 3 year (range: 1 month to 5 years) follow-up period, no complication and recurrence were seen.Hydatid disease of the urinary tract is relatively uncommon and is likely to cause considerable diagnostic difficulties for clinicians and radiologists; therefore, it should be born in mind in the differential diagnosis of space-occupying lesions of the urinary tract.

Effects of Doxazosin in Men with Benign Prostatic Hyperplasia: Urodynamic Assessment

AbstractObjective: In this study, a randomized and placebo controlled trial, we aimed to study the effectiveness and safety of doxazosin based upon urodynamic parameters, especially pressure/flow studies, in men with benign prostatic hyperplasia (BPH). Materials and methods: A total of 57 men (29 doxazosin, 28 placebo) 48–82 years of age with BPH were enrolled. Yet, 8 of 29 in the doxazosin group and 10 of 28 in the placebo group were excluded due to side effects of doxazosin and intolerability of urodynamic assessment of free uroflow, postvoiding residual-urine volume (PVR) and pressure/flow studies. Results: There were improvements in all urodynamic parameters (Free Qmax: 30.4% and 28%, PVR: 14 ml and 12 ml, invasive Qmax: 29.3% and 26.2%, Pdet at Qmax: −32.7% and −30%, Pdet-max: −29% and −27.7% at end of the 1st and 6th months whereas placebo effects were worsening in all urodynamic parameters. Conclusions: We suggest that doxazosin is an important treatment option for patients with BPH, and efficacy of doxazosin should be evaluated with objective, quantitative urodynamic studies not with subjective symptom scores. But additional costs and invasiveness of urodynamic studies restrict their common usefulness.

Clinical Management of Hydatid Disease of the Urinary Tract

This study reviews urinary hydatid disease in seven males and three females (mean age, 32.1 ± 17.7 years; range, 7–67 years). Cysts were located in the kidney in six cases (one also involved the liver), the paravesical and retrovesical region in two cases (one coexisted with a bladder tumour), the adrenal gland (one case) and in the right parapelvic region (one case). Investigations included urinalysis, eosinophil count, Casoni skin test, indirect haemagglutination test (IHA), abdominal ultrasonography, intravenous urography and computed tomography (CT). All patients underwent surgery and were followed for an average of 5.6 years. Lumbar or abdominal pain was the most common symptom. Eosinophilia was seen in five patients (50%), IHA positivity occurred in four patients (40%) and the Casoni skin test was positive in four patients (40%). Abdominal CT was the most useful diagnostic method of radiological investigation (100%). No complications or recurrences were seen on follow-up. Urinary hydatid disease is uncommon and is likely to cause considerable diagnostic difficulties, and should therefore be considered in the differential diagnosis of space-occupying lesions of the urinary tract.

Pharmacotherapy of benign prostatic hyperplasia: inhibitor of 5 alpha-reductase.

We studied the effects of 5 alpha-reductase inhibitor (finasteride) in the treatment of benign prostatic hyperplasia (BPH). This study is a randomized controlled trial. Sixty-two patients were treated with 5 alpha-reductase (finasteride 5 mg/day) and 61 patients (control group) with placebo for one year. Prostatic volume, maximal urine flow rate, AUA symptom scoring, residual urine volume and prostate-specific antigen (PSA) levels were evaluated at 3, 6, 9 and 12 months.In the first 6 months prostatic volume decreased rapidly (20.5%), in the second 6 months it decreased slowly and reached the maximal rate (23.3%). Maximal urine flow rate increased in the second 6 months. AUA symptom scores decreased first at 3 months and were 4.6 points lower at the end of the 12th month. There were no significant changes in residual volume. The 5 alpha-reductase inhibitor caused a 50% decrease in PSA levels, like in other studies.Becuase of the prolonged use of the drug, treatment with 5 alpha-reductase inhibitor is not tolerated by many patients and being expensive its future in the pharmacotherapy of BPH is unclear.