Soner Coban

High Power Diode Laser Vaporization of the Prostate: Preliminary Results for Benign Prostatic Hyperplasia

PURPOSE Vaporization techniques using lasers have gained wide acceptance for benign prostatic hyperplasia as an alternative to transurethral prostate resection. The high power, 980 nm wavelength diode laser is a new promising alternative with a more rapid ablation rate and excellent hemostatic properties, as shown in ex vivo and in vivo animal models. We prospectively evaluated vaporization efficiency of the high power, 980 nm diode laser for bladder outlet obstruction due to benign prostatic hyperplasia. MATERIALS AND METHODS A total of 47 consecutive patients were included in the study. Inclusion criteria were maximal flow rate 12 ml per second or less with voided volume 150 ml or greater, International Prostate Symptom Score 12 or greater and quality of life score 3 or greater. Patients with a history of neurogenic voiding dysfunction, chronic prostatitis, or prostate or bladder cancer were excluded from analysis. Preoperative maximal flow rate, post-void residual urine, International Prostate Symptom Score, quality of life, International Index of Erectile Function-5, prostate specific antigen and prostate volume were compared with values at 3 and 6 months. Complications were assessed. RESULTS Month 3 assessment revealed that the mean +/- SD International Prostate Symptom Score decreased significantly from 21.93 +/- 4.88 to 10.31 +/- 3.79 (p = 0.0001). The mean maximal flow rate increased significantly from 8.87 +/- 2.18 to 17.51 +/- 4.09 ml per second (p = 0.0001). Quality of life score changed considerably compared to baseline. All of these values showed slight improvement at month 6. There was no deterioration in erectile function according to the International Index of Erectile Function-5 short form. Post-void residual urine decreased significantly. Prostate volume and prostate specific antigen reductions were also significant. The most common postoperative complications were retrograde ejaculation (13 of 41 patients or 31.7%) and irritative symptoms (11 of 47 or 23.4%), which subsided in the maximal flow rate at 2 weeks. Recatheterization was necessary in 2 patients due to urinary retention after catheter removal. Two patients had temporary combined urge and stress incontinence for 2 weeks. Late bleeding in 1 patient 4 weeks postoperatively necessitated catheterization and irrigation. CONCLUSIONS The high power diode laser provided significant improvements in International Prostate Symptom Score and the maximal flow rate with low morbidity. Thus, these results of prostate vaporization with the high power diode laser, representing what is to our knowledge the first clinical study in the literature, are encouraging.

Age and total and free prostate-specific antigen levels for predicting prostate volume in patients with benign prostatic hyperplasia

Abstract Objectives: To investigate the predictive values of free prostate-specific antigen (fPSA), total PSA (tPSA) and age on the prostate volume. Methods: The data of 2148 patients with lower urinary tract symptoms were analyzed retrospectively. The patients who had transrectal ultrasonography guided 10 core biopsies owing to the findings obtained on digital rectal examination and presence of high PSA levels (PSA = 2.5–10 ng/dl), and proven to have BPH histopathologically were included in the study. Age, tPSA, fPSA and the prostate volumes (PV) of the patients were noted. Results: One thousand patients that fulfilled the inclusion criteria were included in the study. The PV of the patients were significantly correlated with age, tPSA and fPSA (p < 0.001 and r = 0.307, p < 0.001 and r = 0.382, p < 0.001 and r = 0.296, respectively). On linear regression model, fPSA was found as a stronger predictive for PV (AUC = 0.75, p < 0.001) when compared to age (AUC = 0.64, p < 0.001), and tPSA (AUC = 0.69, p = 0.013). Conclusions: Although tPSA is an important prognostic factor for predicting PV, the predictive value of fPSA is higher. PV can easily be predicted by using age, and serum tPSA and fPSA levels.

Does varicocele correction lead to normalization of preoperatively elevated mean platelet volume levels

INTRODUCTION There are several studies on the relationship between increased mean platelet volume (MPV) and varicocele. We investigated the relationship between preoperative and 6-month postoperative MPV values in patients whose varicocele was corrected with surgery. METHODS A total of 282 patients underwent surgery at our urology clinic between December 2011 and December 2013 for primary varicocele. We retrospectively examined the records of 61 patients who came to the 6-month postoperative follow-up. The preoperative varicocele diagnosis was made with physical examination findings and supported with colour Doppler ultrasonography. RESULTS The varicocele was grade I in 12 patients, grade II in 34 patients and grade III in 11 patients. When the preoperative and 6-month postoperative haemoglobin (Hb), MPV, mean corpuscular volume, platelet, and platelet distribution width (PDW) values were compared, there was a significant decrease in MPV (p = 0.019), and a significant increase in Hb (p < 0.001). A noticeable increase was also present in PDW, but it was not statistically significant (p = 0.058). CONCLUSION We found that MPV increased in patients with varicocele and tended to decrease again after the varicocele was surgically corrected. However, we feel larger prospective series are needed.

A Giant Case of Pyonephrosis Resulting from Nephrolithiasis

Pyonephrosis is an uncommon disease that is associated with suppurative destruction of the renal parenchyma in adults. Upper urinary tract infection and obstruction play a role in its etiology. Immunosuppression from medications (steroids), diseases (diabetes mellitus, AIDS), and anatomic variations (pelvic kidney, horseshoe kidney) may also be risk factors for pyonephrosis. Fever, shivering, and flank pain are frequent clinical symptoms. On physical examination, a palpable abdominal mass may be associated with the hydronephrotic kidney. Septic shock and death can occur if the disorder is not treated with urgent surgery. After the acute phase, most patients are treated with nephrectomy. In this paper, we share the etiology, clinical features, diagnosis and treatment of pyonephrosis using the background of a case with giant pyonephrosis developing due to a kidney stone, the most common cause of upper urinary tract obstruction.

Comparison of the effectiveness of IPSS and VPSS without any help in LUTS patients: a prospective study

Abstract Aim: To compare the correlation of visual prostate symptom score (VPSS) and international prostate symptom score (IPSS). To investigate the effect of educational level and age in the responses to VPSS and IPSS. Method: Three hundred and nine patients who gave consent and applied via LUTS to our institution were included in this study. They were requested to fill IPSS and VPSS. The patients were divided into two groups as middle-aged and elderly with a cutoff point of 65 years. They were divided into six groups based on educational level. SPSS was used for the statistical evaluation. Results: The mean age of the patients was 61.5 ± 8.9 years. The correlation was found between IPSS and VPSS (p < .05). Education was found not to contribute for answering IPSS and VPSS (p = .332 and .138, respectively). No difference was found between the middle-aged and elderly groups in terms of the rates of inability to answer IPSS and VPSS (p = .177 and .681, respectively). Conclusions: There is a correlation between VPSS and IPSS. VPSS can be used as an auxiliary or alternative tool instead of IPSS in evaluating LUTS; however, has no superiority to IPSS in elderly group. Currently, the best option to exclude bias in illiterate group is VPSS.

Cholesterol granuloma of the paratesticular tissue: A case report.

A 38-year-old man was admitted to our clinic with an enlarging right scrotal mass that had been present for 7 years. Right radical inguinal orchiectomy was performed and a histopathological diagnosis confirmed a very rare case of cholesterol granuloma of the paratesticular tissue. It can be very difficult to preoperatively distinguish testicular tumours from cholesterol granulomas of the testis or epididymis. Cholesterol granuloma should be kept in mind in patients with large and non-tender scrotal masses.

Effect of trospium chloride therapy on intraocular pressure and tear secretion in overactive bladder patients

Abstract Purpose: To investigate the effect of trospium chloride, which has an anticholinergic effect, used in overactive bladder (OAB) treatment on the intraocular pressure (IOP) and tear secretion after 12 weeks of treatment. Materials and methods: This prospective study was performed at a single center between October 2014 and January 2016. A detailed history was obtained from the female OAB patients at the eye outpatient department. After checking the exclusion criteria, oral trospium chloride 30 mg bd was started. The patients were followed-up in terms of drug effectiveness and ophthalmic and other side effects at the 4th and 12th weeks. All procedures were repeated at both of these time-points. Results: The mean age of the patients was 48.98 ± 11.98 years (range 19–75). The data of 80 OAB patients were evaluated in the study. Trospium chloride did not cause any significant change in the OAB patients regarding their 4th week and 12th week IOP measurements (p = 0.251, p = 0.340, respectively). It was found to decrease tear secretion significantly at both time-points (p = 0.020, p = 0.001, respectively). Trospium chloride treatment of one patient (1.25%) was discontinued due to dry eye. Conclusions: Trospium chloride decreases the symptoms in female OAB patients. Trospium chloride can be safely used in female OAB patients with normal IOP and no comorbidity as regards IOP changes as it did not cause a significant change in IOP in these patients. Pre-treatment and post-treatment dry eye symptoms of OAB patients about to start using trospium chloride should be queried beforehand as it can cause a statistically significant decrease in tear secretion. We concluded that it would be appropriate to refer the patients to an ophthalmologist before starting the drug if relevant symptoms are present.

Transperitoneal laparoscopic nephrectomy of non-functional horseshoe kidney that could not be identified preoperatively in a child

Horseshoe kidney is the most common congenital fusion anomaly. Ureters being stuck between the isthmus and the intestines cause urinary stasis and lead to more common development of urinary tract infection and urolithiasis compared to a normal kidney. If not treated, kidney function may be gradually lost. Although the condition is usually diagnosed with ultrasound screening, the diagnosis may be overlooked in patients with a non-functional kidney due to the lack of renal vascularization. We aim to present a 6 years old boy who have non-functioning kidney which is a part of undiagnosed horseshoe kidney. We emphasize that horseshoe kidney should be suspected when live renal parenchyma tissue passing the midline is observed during laparoscopic nephrectomy of a non-functional kidney that could not be preoperatively diagnosed as a horseshoe kidney in this presentation.

Rare late metastasis of testis seminoma to the bladder

A 45-year-old male presented to our clinic with complaining of hematuria for a month. The investigations showed a 59 × 24-mm myxoid mass on the right lateral bladder wall and this was removed with transurethral resection. The histopathology evaluation result was seminoma (classic type). The medical history revealed that the patient had undergone inguinal orchiectomy for a testis tumour 10 years before and the diagnosis was classic type seminoma. He received chemotherapy following the orchiectomy, but had not gone for follow-up after the first year. There was no other metastasis and he was put on the iphosphamide, etoposide, cisplatin (IPE) protocol. The patient has been disease-free for the last 5 months and the tumour markers and cystoscopy were normal. Testis tumours can rarely cause other organ metastases in the late stage even if curative surgery and chemo-radiotherapy were initially administered. Proper follow-up is crucial. It is also necessary to query the tumour history when a tumour in any organ is considered.

Erectile dysfunction scores are lower in type 2 diabetes mellitus but not correlate with carotis intima media ticknes or coronary arter disease

ED skores are lower in type 2 diabetes mellitus but not correlate with carotis intima media ticknes or coronary arter disease. ED is not suitable for describing cardiovascular risk in type 2 diabetic patients • Patient and control groups were similar in terms of percentage patients with concomitant hyperlipidemia (51.5 and 39.6%), and CAD (33.8 and 22.9%) • CIMT measurement (mm) and hypertension (42.6 and 25.0%), revealed significantly higher values for patients with type 2 diabetes mellitus than controls (p=0.020). • ED was determined in 75.0% of diabetic patients and in 60.4% of controls with identification of severe ED in 29.4% of overall patient population and 39.2% of patients with ED, whereas only in 10.4% of controls. • ED scores was significantly lower in patients than controls (14.3(7.3) vs. 18.2(6.3), p=0.004) with significantly higher percentage of patients than controls in the category of severe dysfunction (29.4 vs. 10.4%, p=0.014). • No significant relation of hypertension, hyperlipidemia, CAD and CIMT to ED was noted.