Rashad Mammadov

Is It Possible to Predict Sepsis, the Most Serious Complication in Prostate Biopsy?

Objective: Prostate biopsy for the diagnosis of prostate cancer by transrectal ultrasonography (TRUS) is a common procedure used in daily urology practice with a low complication rate and easy applicability. In this study, the precipitating factors and prophylaxis for sepsis, the worst complication of the procedure, were assessed. Patients and Methods: 2,023 patients with suspected prostate cancer who underwent biopsy by TRUS in one center were assessed retrospectively. The relationship between sepsis and age, serum total prostate-specific antigen (PSA) level, PSA density, prostate volume, number of biopsies, number of repeated biopsies, accompanying diagnosis of prostatitis, presence of urethral catheter, and presence of diabetes mellitus was assessed. Data were analyzed using the t test and logistic regression analysis. Results: Of the 2,023 patients, 62 (3.06%) developed sepsis within 5 days after biopsy. There was no significant relationship between the biopsy and the above parameters using the logistic regression analysis. Using the t test, it was found that the number of biopsy cores (p < 0.001), presence of urethral catheter (p < 0.0001), and presence of diabetes mellitus (p < 0.0001) were predictive factors for sepsis. Conclusion: Sepsis is a rare but life-threatening complication after prostate biopsy by TRUS. Although preoperative prophylactic oral antibiotics and enema before biopsy have proven to be effective in decreasing urinary tract infection rates, patients with urethral catheter, diabetes mellitus or those to undergo biopsy from more sites than ten cores should be closely monitored after biopsy.

Relationship between Erectile Dysfunction and Silent Coronary Artery Disease: Detection with Multidetector Computed Tomography Coronary Angiography

Aim: Our aim was to determine the relationship between erectile dysfunction (ED) and silent coronary artery disease (CAD) by multidetector computed tomography (MDCT) coronary angiography. Methods: Thirty consecutive men with nonhormonal and nonpsychogenic ED and with no cardiac symptoms were evaluated. Medical history, physical examination and laboratory investigation were performed. The five-item brief form of the International Index of Erectile Function (IIEF-5) was performed for evaluation of ED. The Agatston score (AS) was determined from MDCT images under beta blockade to induce bradycardia. The MDCT coronary angiography findings were evaluated by two radiologists blinded to the clinical findings. Patients were classified into three categories (mild, moderate and severe ED) according to IIEF-5 scores and into five categories (very low, low, moderate, moderately high and high CAD risk) according to the AS. Results: Mean age was 58.3 ± 8.7 years (46-79). 6 patients had hypertriglyceridemia, 4 had hypercholesterolemia and 4 had hyperglycemia. All patients had normal early morning testosterone levels. Regarding IIEF-5 scores, none of them had mild ED, 14 had moderate ED and 16 had severe ED. Of the 14 patients with moderate ED, 21.4% had low and 28.5% had moderate CAD risk regarding AS. Of the 16 patients with severe ED, 25% had moderate, 31.2% had moderately high and 25% had high CAD risk regarding AS. Increasing age was a risk factor for high AS (p = 0.045). There was a significant correlation between AS and ED severity (p = 0.01). Conclusions: ED and CAD often coexist. MDCT coronary angiography can detect coronary lesions and allow appropriate medical intervention.

Could Serum Testosteron Level and Body Mass Index Predict Psa Relaps in Prostate Cancer Patients undergoing Radical Surgery

Purpose: It is well-known that indicators such as biopsy and prostatectomy Gleason score , clinical and pathological stage and preoperative PSA level can be utilized in predicting PSA recurrence in cases who underwent radical prostatectomy (RP) with the diagnosis of organ-confined prostate cancer. The purpose of this study was to investigate the predictability of postoperative PSA recurrence by serum total testosterone levels as well as body mass index (BMI). Materials and methods: Fourty-eight patients in whom RP was planned with the diagnosis of prostate-confined cancer were enrolled in this study. The data recorded included the patient’s preoperative testosterone levels and BMI as well as age, serum PSA level, clinical stage, Gleason score on biopsy, the presence of PIN and surgical margin positivity. After operation, the patients were kept under follow up according to the guidelines. During the follow-up, the analysis of the selected markers was performed using T-test, Mann-Whitney U test, Chi square test, Anova and Roc analysis in cases with documented PSA recurrence. Results: Serum total testosterone level, BMI, surgical margin positivity and Gleason score and preoperative PSA level are independent variables that affect PSA recurrence. On Roc analysis, a testosterone level of less than 2,81 ng/dL was found to be significant for the prediction of PSA recurrence (p=0.04). Conclusion: From this study, we concluded that, besides proven risk factors for PSA recurrence (Pre op. PSA level, Gleason score, surgical margin positivity and stage), preoperative low testosterone levels and high BMI can also be predictive.

Interstitial Cystitis: Practical Recommendations for Treatment

Interstitial cystitis remains a challenging condition to define and to manage. Practical tips in the diagnosis and treatment of interstitial cystitis are provided in the chapter based on the current evidence as well as the author’s own clinical experience.

Biochemical Recurrence After Radical Prostatectomy: is the Disease or the Surgeon to Blame?

PURPOSE The PSA recurrence develops in 27 to 53% within ten years after radical prostatectomy (RP). We investigated the factors (disease grade and stage or the surgeons expertise,) more likely to influence biochemical recurrence in men post-radical prostatectomy for organ-confined prostate cancer by different surgeons in the same institution. MATERIALS AND METHODS A total of 510 patients that underwent radical prostatectomy were investigated retrospectively. Biochemical recurrence was defined as detection of a PSA level of ≥ 0.20 ng/mL by two subsequent measurements. The causes, which are likely to influence the development of PSA recurrence, were separated into two groups as those related to the disease and those related to the surgical technique. RESULTS Biochemical recurrence was detected in 23.5% (120 cases) of 510 cases. The parameters most likely to influence biochemical recurrence were: PSA level (p < 0.0001), T stage (p < 0.0001), the presence of extracapsular invasion prostate (p < 0.0001), Gleason scores (p = 0.042, p < 0.0001) and the presence of biopsy with perineural invasion (p = 0.03). The only surgical factor that demonstrated relevance was inadvertent capsular incision during the surgery that influenced the PSA recurrence (p < 0.0001). CONCLUSION The PSA recurrence was detected in 21.6% of patients who had been treated with radical prostatectomy within 5 years, which indicates that the parameters related to the disease and the patient have a pivotal role in the PSA recurrence.