Serdar Goktas

A Novel Treatment Modality in Patients With Premature Ejaculation Resistant to Conventional Methods: The Neuromodulation of Dorsal Penile Nerves by Pulsed Radiofrequency

Premature ejaculation (PE) is the most common sexual problem experienced by men, and it affects 20%-30% of them. Pulsed radiofrequency (PRF) neuromodulation has been shown to be an effective treatment for a wide range of pain conditions. We used PRF to treat PE by desensitizing dorsal penile nerves in patients resistant to conventional treatments. Fifteen patients with a lifelong history of PE, defined as an intravaginal ejaculatory latency time (IELT) of <1 minute that occurred in more than 90% of acts of intercourse and was resistant to conventional treatments, were enrolled in this study. Patients with erectile dysfunction were excluded. The mean age of the patients was 39 +/- 9 years. Before and 3 weeks after the treatment, IELT and sexual satisfaction score (SSS; for patients and their partners) were obtained. The mean IELTs before and 3 weeks after procedure were 18.5 +/- 17.9 and 139.9 +/- 55.1 seconds, respectively. Side effects did not occur. Mean SSSs of patients before and after treatment were 1.3 +/- 0.3 and 4.6 +/- 0.5, and mean SSSs of partners before and after treatment were 1.3 +/- 0.4 and 4.4 +/- 0.5, respectively. In all cases, IELT and SSS were significantly increased (P < .05). None of the patients or their wives reported any treatment failure during the follow-up period. The mean follow-up time was 8.3 +/- 1.9 months. It is early to conclude that this new treatment modality might be used widely for the treatment of PE; however, because it is an innovative modality, placebo-controlled studies (eg, sham procedure), with larger numbers of patients and including assessment of penile sensitivity (eg, biothesiometry), are needed.

Is There Significance of the Choice of Prone versus Supine Position in the Treatment of Proximal Ureter Stones with Extracorporeal Shock Wave Lithotripsy

Objective: To determine whether there is a significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithothripsy (ESWL).Methods: Ninety–six patients with proximal ureter stones underwent ESWL. The procedure was performed in the supine position in 48 of them (group 1) and in the prone position in the other 48 patients (group 2). Stone–free rates, repeat ESWL rates, shocks per patient and shocks per session were compared in both groups.Results: The mean session number per patients was 1.64±0.75 in group 1 and 1.33±0.59 in group 2 (p = 0.224). The stone–free rates 3 months after ESWL were 88.3% in group 1 and 90.6% in group 2. The difference between the results was statistically insignificant (p<0.05). Therefore, these two parameters were similar in both groups. On the other hand, the number of shocks per session was 4,863.54±2,114.85 in group 1 and 3,704.16±1,726.75 in group 2. This difference was statistically significant (p = 0.011). The patients tolerated the supine position better in general. Patients in the prone position experienced discomfort on inspiration and expiration and pain localized to the lumbar vertebrae.Conclusion: These results suggest that the supine position decreases the number of shocks per session in the treatment of proximal ureter stones with ESWL and this will be cost–effective.

Proteasome inhibitor bortezomib increases radiation sensitivity in androgen independent human prostate cancer cells.

OBJECTIVES To investigate the effects of a strong proteasome inhibitor, bortezomib alone or in combination with radiotherapy on androgen-independent DU145 human prostate cancer cells. Proteasomes play important roles in cell cycle, proliferation, apoptosis, angiogenesis, and cellular resistance to chemotherapy and radiotherapy. METHODS Increasing concentrations of bortezomib alone or in combination with radiation were applied to DU145 cells and IC(50) values that inhibited cell growth by 50% were determined by 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyltetrazolium-bromide assay. Apoptosis was determined using annexin V staining by flow cytometry. mRNA levels of proapoptotic caspase-3 and antiapoptotic Bcl-2 genes were examined by reverse transcriptase polymerase chain reaction. RESULTS The IC(50) value of bortezomib was found to be 28 microm although 400- and 800-cGy radiation decreased the cell proliferation by 14% and 28%, respectively. In 400- and 800-cGy radiation applied DU145 cells, IC(50) value of bortezomib decreased to 23- and 12 microm, respectively. Exposure to 5 microm bortezomib for 48 hours caused apoptosis in 35% of the population whereas 800-cGy radiation resulted apoptosis in 14% of cells. However, 42% of DU145 cells that were exposed to 800 cGy and 5 microm bortezomib underwent apoptosis. Reverse transcriptase polymerase chain reaction results showed a significant decrease in mRNA levels of antiapoptotic Bcl-2 gene and an increase in proapoptotic caspase-3 gene expression in the combination group compared to control group. CONCLUSIONS Bortezomib increases radiation sensitivity in androgen-independent human DU145 prostate cancer cells through inhibition of Bcl-2 and induction of caspase-3 genes.

Accessory scrotum attached to a perineal lipoma in an adult male

Abstract Accessory scrotum is a condition in which a scrotum is located in the perineal region, in addition to the presence of normally located primary scrotum, testes and penis. The condition is extremely rare and the majority of reported cases have been diagnosed in infants. Herein, we present a case of accessory scrotum attached to a perineal lipoma in a 40‐year‐old man. The perineal mass was present at birth and grew very slowly over the years. There were no other congenital abnormalities or problems related to this anomaly. The case was easily managed by complete excision of the accessory scrotum and perineal lipoma. Gross and microscopic examination of the surgical specimen revealed an accessory scrotum attached to an encapsulated perineal lipoma. The present case demonstrates an adult prognosis of a patient born with this type of abnormality. To our knowledge, it is the first case of its kind to be reported in the literature.

A Novel Treatment of Chronic Orchialgia

We evaluated the effectiveness of pulsed radiofrequency (PRF) denervation of spermatic cord for the treatment of chronic orchialgia. Five patients diagnosed with chronic orchialgia were evaluated with a thorough medical and psychiatric history, physical examination, and scrotal Doppler ultrasound, urinary system x-ray film, and urine analyses. One of the patients had bilateral chronic orchialgia. All of the patients had pain for a period of at least 3 months, and multiple conservative therapies failed to alleviate the pain. The patients, who had temporary pain relief after undergoing outpatient diagnostic cord block, were determined to be candidates for PRF denervation. PRF denervation of spermatic cord was performed for 6 testicular units. Visual analog scores were noted before and after the procedure. There were no pathologic conditions that indicated chronic orchialgia in any of the patients. No complications, including testicular atrophy or hypoesthesia of the scrotal or penile skin, occurred after the procedure. Mean visual analog scores before and after the procedure were 9 and 1, respectively. None of the patients needed any analgesics after the procedure or during the follow-up period. Mean follow-up period was 20 ± 2.5 weeks. No recurrence was noted, and none of the patients needed additional therapy. This is a limited case report on the short-term use of PRF. Randomized, placebo-controlled, and long follow-up period studies are needed to better assess the efficacy of this procedure for chronic orchalgia.

Recovery of Abnormal Ejaculation by Intermittent Tamsulosin Treatment

PURPOSE We assessed the impact of intermittent tamsulosin treatment on abnormal ejaculation. MATERIALS AND METHODS This prospective study was performed between January 2001 and December 2004. It included 405 patients who were at least 50 years old with lower urinary tract symptoms. This study was divided into 2 phases. In phase 1 patients received a 0.4 mg tamsulosin capsule daily after breakfast for at least 3 months. The second phase of this study was performed in the 30 patients with abnormal ejaculation. In this phase these patients received 0.4 mg tamsulosin once daily every other day. Patients were assessed at study entry and at study week 6. RESULTS Abnormal ejaculation was reported as retrograde ejaculation by 18 patients, as decreased volume by 7 and as absent ejaculate by 5. Ejaculatory function recovered during intermittent tamsulosin treatment in 12 patients with retrograde ejaculation and in 7 with decreased volume or absent ejaculate. As a result, 19 of 30 patients (63.3%) with abnormal ejaculation recovered. A significant improvement in retrograde ejaculation was found after intermittent tamsulosin treatment (p = 0.02). Although there were improvements in decreased volume or absent ejaculate at week 6 of intermittent treatment, these differences were not statistically significant (p = 0.42 and 0.61, respectively). CONCLUSIONS The results of the current study, which to our knowledge is the first report of the effect of intermittent tamsulosin treatment on abnormal ejaculation, show that this treatment modality is well tolerated and provides comparable improvements for abnormal ejaculation.

Skin-to-Stone Distance Has No Impact on Outcomes of Percutaneous Nephrolithotomy

Objective: Skin-to-stone distance (SSD) is a stronger factor than body mass index in predicting the success of shock wave lithotripsy. We aimed to evaluate the impact of SSD on outcomes of percutaneous nephrolithotomy (PCNL). Materials and Methods: The medical records of 1,280 patients who had undergone PCNL between April 2007 and February 2012 were evaluated retrospectively. 192 patients who had had preoperative non-contrasted computed tomography and single renal access were included the study. According to this median SSD value, patients were divided into two groups: group 1 (SSD ≤94 mm) (n = 92) and group 2 (SSD >94 mm) (n = 90). The groups were compared according to operative and postoperative parameters. Results: We found no significant differences between the two groups with regard to stone-free rate, operation time, fluoroscopy time, hospitalization time, visual analog score of pain, stone burden, transfusion rates and complication rates. On the other hand, the mean body mass index of group 1 was significantly lower than that of group 2 (p < 0.05). Conclusions: In this retrospective review of patients undergoing PCNL, we found that SSD has no impact on operative and postoperative outcomes. These results were in accordance with the safety of PCNL in obese patients.

Intrarenal arterial stenosis in a patient with thromboangiitis obliterans

Abstract  Thromboangiitis obliterans (TAO) or Buerger’s disease is a clinical syndrome characterized by the development of segmental thrombotic occlusions of the medium and small arteries of the extremities. Exception of the peripheral arteries of the extremities in TAO is very rare. Reported herein is the first case of intrarenal branch involvement of the renal artery due to TAO.

Retrospective analysis of 74 cases of seminoma treated with radiotherapy

Background:  Standard post‐orchiectomy radiotherapy (RT) is accepted as a standard management option for stage I seminoma.

Analyses of 98 seminoma cases: A review article

Abstract98 Patients with seminoma were treated at Clinic of Radiation Oncology of Gülhane Military Medicine Academy between the years 1974–1995. All cases were undergone orchiectomy. The median age of the patients whom were staged respectively 76%, 17%, 7% according to AJCC system, stage I, stage II and stage III was 28 (20–58).While 87 patients were undergone only radiotherapy, 11 patients with advanced stage had taken chemotherapy with radiotherapy. In 52 months of median follow up duration, 5 year disease free survival rates were 98.6%, 93.3%, 25% and 94.5% for stage I, stage II, stage III and all stages respectively.As a result, we can propose that the seminoma is a disease with good results in oncology. In our view detailed staging and new treatment approaches in advanced disease will achieve better results in the future.