Seyfettin Ciftci

Perineural invasion in prostate biopsy specimens is associated with increased bone metastasis in prostate cancer

We aimed to evaluate the relationship between perineural invasion (PNI) and bone metastasis in prostate cancer (PCa).

Urinary nerve growth factor and a variable solifenacin dosage in patients with an overactive bladder

Introduction and hypothesisWe evaluated changes in urinary nerve growth factor (NGF) and NGF/creatinine (NGF/Cr) levels after increasing the dosage of solifenacin in overactive bladder patients.MethodsThe study groups included 59 overactive bladder (OAB) patients and 20 healthy subjects as controls. We measured NGF at baseline for the patients and controls, and used the Overactive Bladder Awareness Tool (OAB-V8) to evaluate urinary symptoms. All patients received a treatment of solifenacin 5 mg for 6 weeks. The responders to treatment served as group 1 and nonresponders received solifenacin 10 mg for an additional 6 weeks. Responders and nonresponders to the 10-mg treatment were defined as groups 2 and 3 respectively. NGF was measured after each treatment using the ELISA method and normalized by the urinary creatinine levels (NGF/Cr).ResultsThere were 21, 22 and 16 patients in groups 1, 2, and 3 respectively. At baseline, the NGF and NGF/Cr levels were higher in groups 1, 2, and 3 compared with the controls. After the solifenacin 5 mg treatment, the NGF and NGF/Cr levels of group 1 individuals decreased to those of the control level. After increasing the dosage of solifenacin to 10 mg in group 2, the NGF and NGF/Cr levels decreased to normal levels. In group 3 (patients who did not responded to any treatment), these levels remained unchanged.ConclusionsOur results suggest that urinary NGF could be a potential biomarker for monitoring the treatment of symptoms in OAB patients who are treated with solifenacin.

Varicocele Repair Improves Testicular Histology in Men with Nonobstructive Azoospermia.

Objective. To determine the histopathological differences after varicocele repair in testicular tissue in males with nonobstructive azoospermia. Methods. Between 2009 and 2014, 45 men with complete azoospermia and palpable varicocele, presenting with primary infertility of at least 1 year, undergoing varicocele repair at our institution were selected for the study. A standard systematic testicular 6-core Tru-Cut biopsy was performed during varicocele repair. Other biopsies were obtained from each testicle of all patients at the time of microscopic sperm extraction procedure. Results. Nineteen patients were selected for the study. Testicular biopsy specimens were classified as Sertoli cell only on preoperative histopathological analysis in 14 patients. After varicocele repair, focal spermatogenesis (n = 3) and late maturation arrest (n = 2) were found in these patients. Average Johnsen score was significantly increased after varicocelectomy (P = 0.003). Motile sperm was found in one patient on postoperative semen analyses and in 10 more patients in the microscopic sperm extraction procedure. Preoperative high serum follicle stimulating hormone level and venous reflux were significantly and negatively correlated with the increase in average Johnsen score (P < 0.05). Conclusions. Our findings suggest significant improvement in testicular histology after varicocele repair.

Coexisting papillary and clear renal cell carcinoma in the same kidney.

Renal cell carcinoma (RCC) is the most common solid lesion of the kidney. Bilateral synchronous benign and malignant renal tumors have been defined in some reports. However, unilateral concordance of malignant renal tumors is very rare and there are only a few cases that had synchronous different subtypes of malignant renal tumors arising within the same kidney. Herein, we describe a 67-year-old male patient who had clear cell RCC and papillary RCC in his right kidney that were successfully treated with radical nephrectomy. We also reviewed the pertinent literature.

Percentage of free prostate-specific antigen (PSA) is a useful method in deciding to perform prostate biopsy with higher core numbers in patients with low PSA cut-off values

The aim of this study was to evaluate the predictive role of percentage of free prostate‐specific antigen (%fPSA) cut‐points in prostate cancer (PCa) detection in patients with total PSA (tPSA) levels between 2.5 ng/mL and 10.0 ng/mL. In total, 1321 consecutive initial transrectal ultrasound (TRUS)‐guided 12‐core biopsies performed between 2005 and 2011 were evaluated retrospectively. Benign pathologies, high‐grade prostatic intraepithelial neoplasia, and atypical small acinary proliferations were categorized as noncancerous (benign), and prostate adenocarcinomas were categorized as cancerous (malignant). The patients were categorized according to: Catalonas published %fPSA categories (<10%, 10–15%, 15–20%, 20–25%, or > 25%); digital rectal examination (DRE) results [benign (negative) or suspicious of malignancy (positive)]. There was a significant relationship between the %fPSA cut‐points and detection of PCa in DRE‐negative patients. The presence of a 10% cut‐point increased the probability of PCa threefold. The %fPSA was significantly more related to PCa than the tPSA value in receiver operating characteristic (ROC) curve analyses (p = 0.001). Based on our findings, a lower %fPSA, especially <10%, is an important parameter when deciding whether to perform a biopsy on patients with a tPSA between 2.5 ng/mL and 10 ng/mL.

Intravesical Migration of Missed Intrauterine Device Associated with Stone Formation: A Case Report and Review of the Literature

Intrauterine device is the most widely used method of reversible contraception. It may cause various complications including perforation of uterus. In this case, 44-year-old woman was presented with lower urinary tract symptoms after six years of insertion. Patient has no remarkable physical or laboratory finding but abdominal ultrasound revealed a 27 mm hyperechogenicity, suggestive of foreign body or calculus on the posterior bladder wall which was removed endoscopically. This case highlights the need of immediate and periodic evaluation of women with intrauterine device to avoid missing serious complications.

Laser-induced breakdown spectroscopy is a reliable method for urinary stone analysis.

OBJECTIVE We compared laser-induced breakdown spectroscopy (LIBS) with the traditionally used and recommended X-ray diffraction technique (XRD) for urinary stone analysis. MATERIAL AND METHODS In total, 65 patients with urinary calculi were enrolled in this prospective study. Stones were obtained after surgical or extracorporeal shockwave lithotripsy procedures. All stones were divided into two equal pieces. One sample was analyzed by XRD and the other by LIBS. The results were compared by the kappa (κ) and Spearmans correlation coefficient (rho) tests. RESULTS Using LIBS, 95 components were identified from 65 stones, while XRD identified 88 components. LIBS identified 40 stones with a single pure component, 20 stones with two different components, and 5 stones with three components. XRD demonstrated 42 stones with a single component, 22 stones with two different components, and only 1 stone with three different components. There was a strong relationship in the detection of stone types between LIBS and XRD for stones components (Spearman rho, 0.866; p<0.001). There was excellent agreement between the two techniques among 38 patients with pure stones (κ index, 0.910; Spearman rho, 0.916; p<0.001). CONCLUSION Our study indicates that LIBS is a valid and reliable technique for determining urinary stone composition. Moreover, it is a simple, low-cost, and nondestructive technique. LIBS can be safely used in routine daily practice if our results are supported by studies with larger numbers of patients.

Ultrasonography-guided penile block for adult penile surgery

To the Editor, Although penile nerve block (PNB) both blind and ultrasound (US)-guided has been established for clinical use, studies have focused more on children than adults. The analgesic effect of US-guided PNB in adult patients undergoing penile surgery has yet to be demonstrated. We report here its advantages in a randomized, blinded, clinical study. After ethics committee permission (KOU KAEK 2013/ 117) and informed written consent, we enrolled 40 adult patients (20-60 yr, American Society of Anesthesiologists physical status I-II) scheduled for elective penile surgery (malleable prosthesis implant). Patients were randomized (sequentially numbered, opaque, sealed envelopes) to either spinal anesthesia ? PNB (PNB) or spinal anesthesia alone (control) groups (20 patients per group). In a pilot study on ‘‘spinal only’’ patients, the mean (SD) 24 hr postoperative morphine consumption was 28 (8) mg. For 90% power and an alpha error of 0.05, the sample size needed to detect a 30% difference was 18 subjects per group. With the patient in the lateral decubitus position, spinal anesthesia (25 G Quincke; B. Braun, Melsungen Germany) consisting of hyperbaric bupivacaine 10 mg with fentanyl 25 lg was used. Penile nerve block was subsequently performed using a high-frequency linear probe placed vertically over the pubic symphysis at the base of the penile shaft. Sagittal views identified the penile shaft, corpus cavernosum, inferior ramus of the pubic bone, and Scarpa’s fascia. Using an out-of-plane approach under real-time US guidance, the block needle (Ultraplex, 22G; B. Braun, Melsungen, Germany) was advanced until it perforated Scarpa’s fascia with a ‘‘pop.’’ Then, 20 mL of 0.25% bupivacaine was injected in fractionated doses, with intermittent aspiration. For all patients, postoperative analgesia was provided with patient-controlled analgesia (morphine 1 mg bolus, eight-minute lockout, maximum 6 mg hr). A pain nurse blinded to the anesthesia care performed postoperative follow-up. Pain (dynamic) was assessed at one, six, 12, and 24 hr postoperatively using a visual analogue scale (VAS), where 0 = no pain and 10 = worst imaginable pain. The presence of nausea and vomiting were recorded at the same time intervals. Patient-controlled analgesia morphine consumption and the incidence of nausea and vomiting during the first 24-hr postoperative period were also recorded. The Mann-Whitney U-test was used for comparison of VAS scores and morphine consumption between the two groups. The incidence of nausea and vomiting was compared using Fisher’s exact test. Anesthesia for both groups provided sufficient analgesia for the mean (SD) duration of surgery [PNB, 114 (45) min; control, 108 (38) min). The VAS scores and postoperative morphine consumption, however, were lower in the PNB group than in the control group at every time interval Y. Gürkan, MD A. Kuş, MD Department of Anesthesia, Kocaeli University Hospital, Kocaeli, Turkey

Prostate volume predicts high grade prostate cancer both in digital rectal examination negative (ct1c) and positive (≥ct2) patients

INTRODUCTION We aimed to assess the relationship between prostate volume (PV) and high grade prostate carcinoma (HGPCa) in patients with benign and suspicious digital rectal examination (DRE) in our prostate biopsy cohort. MATERIALS AND METHODS Between 2009-2012, 759 consecutive initial transrectal systematic 12 cores prostate biopsies were included. PVs were calculated with transrectal ultrasound. Only prostate adenocarcinomas (PCa) were included into the study. For standardization, patients with missing data, and who have been exposed to any form of hormonal or radiation therapy were excluded. Patients were categorized with DRE (negative or positive) and Gleason sum [<7: low grade PCa(LGPCa), ≥7: HGPCa]. RESULTS Median PV was significantly lower in patients with HGPCa. There was a significantly increased risk of HGPCa with PV according to all groups in univariate logistic regression (LR). The significant relationship continued in multivariate LR with PSA and age. From the ROC curve analyses, again a significantly statistical concordance was found between the detection of HGPCa and PV (AUC:0.63, p<0.001), as well as between HGPCa and tPSA (AUC:0.73, p<0.001). tPSA and PV were also significantly concordant with HGPCa both in DRE negative and positive patients. CONCLUSIONS There is a significant relationship between HGPCa and decreasing PV. The continued significant relationship both in DRE negative and positive patients reinforces this relation.