Türker Köksal

Urologic Complications of Extravesical Ureteroneocystostomy in Renal Transplantation from Living Related Donors

Introduction: Reconstruction of the urinary system during renal transplantation is usually performed with antirefluxive ureteroneocystostomy techniques and extravesical methods are usually preferred. Material and Methods: Between 1983 and 1997, 241 renal transplantations from living donors were performed at our institution. A variation of the Lich-Gregoir technique was used as the ureteroneocystostomy method in all cases. Results: A total of 12 (4.9%) urologic complications were observed. Urinary fistula developed in 5 (2%) cases and were explored surgically during the early postoperative period. Postoperative vesicoureteral reflux (VUR) to the transplanted kidney was identified in 7 (2.9%) cases. Either endoscopic or surgical interventions resolved VUR in 4 cases while the other 3 did not need further treatment. No ureteral stenosis was observed. There was no loss of graft due to urologic complications. Conclusions: Urologic complications after renal transplantation are reported to be about 7% and ischemia is blamed as the major contributing factor. Preparation of the native ureter during donor nephrectomy and preservation of distal periureteral fatty tissue, anastomosis technique variations in vascular anatomy, rejections and medications are the major factors determining the ischemia.

Is Sildenafil Citrate an Alternative Agent in the Evaluation of Penile Vascular System with Color Doppler Ultrasound

Introduction: The ideal diagnosis and therapeutic agent for erectile dysfunction (ED) would be an oral drug taken prior to color Doppler ultrasound (CDU) examination and sexual intercourse. In the present study we have investigated if the efficacy of oral sildenafil is optimal in the diagnosis of underlying pathology of ED. Material and Methods: The study group comprised of 41 patients with ED. Firstly, all patients underwent CDU examinations after the combined intracavernosal injection of 60 mg of papaverine and sexual stimulation (CIS). Secondly, these patients were examined after taking 50 mg of oral sildenafil citrate combined with self-manual and visual sexual stimulation. Results: The differences of peak systolic velocity values were statistically significant between CIS and sildenafil (right: 40.7 ± 2.9 vs. 28.7 ± 3.3; left: 41.2 ± 3.3 vs. 25.7 ± 2.4; p < 0.001) in patients with normal penile vascular system. However, end-diastolic velocity and resistance index values were not significant between the same groups. In addition, there were not significant differences for peak systolic and end-diastolic blood flow velocities and resistances index with CIS and sildenafil in cases with vasculogenic ED. Conclusions: Sildenafil citrate plus visual sexual stimulation is not reliable as CIS to make accurate interpretation of penile vascular status using CDU. On the other hand, in some cases suspected of psychogenic ED after detailed sexual history, sildenafil might be tried as an initial step of the functional evaluation with CDU in order to prevent prolonged erection risk with intracavernosal injection of vasoactive agents.

The restorative effect of a selective cyclooxygenase-2 inhibitor on urothelial cell–cell interactions after partial bladder outlet obstruction in rats

To determine the changes in cyclooxygenase‐2 (COX‐2), E‐cadherin and α‐catenin expression after partial bladder outlet obstruction (PBOO), and whether a selective COX‐2 inhibitor (celecoxib) might inhibit COX‐2 expression and have beneficial effects on urothelial cell‐to–cell interactions in rats subjected to PBOO.

Apoptotic and Proliferative Index after Alpha-1-Adrenoceptor Antagonist and/or Finasteride Treatment in Benign Prostatic Hyperplasia

Introduction: The induction of apoptosis has emerged as a potential target for optimization of the medical management of benign prostatic hyperplasia (BPH), recently. The influence of α1-adrenoceptor antagonist (α1-ARA), 5-α reductase inhibitor and their combination on prostatic cell apoptotic and proliferative indices of benign hyperplastic prostate gland were investigated. Material and Methods: A total of 49 male patients with BPH (mean age: 66.5 years) treated with α1-ARA and/or finasteride were retrospectively evaluated. Patients treated with α1-ARA (doxazosin n = 12 and terazosin n = 10), finasteride (n = 9) and combination of finasteride and α1-ARA (n = 9) were enrolled in the study. Primary antibodies were Ki-67 and proliferating cell nuclear antigen for the evaluation of proliferation in prostate stromal and epithelial cells. In situ apoptotic DNA fragmentation was evaluated using TUNEL assay. Results: All treatment groups had no significant changes in the rate of prostate stromal and epithelial cell proliferation. Epithelial apoptotic index (AI) was not statistically significant for finasteride vs. α1- ARA, α1-ARA vs. finasteride + α1-ARA and finasteride + α1-ARA vs. finasteride groups. While α1-ARA was more effective than finasteride on stromal apoptosis, α1-ARA-induced stromal apoptosis was not significantly different from α1-ARA plus finasteirde treatment. Conclusion: Not only androgen variabilities but also alterations in sympathetic neurotransmission with age could have important implications for pathophysiological prostate growth. The combination of finasteride and α1-ARA is not superior to α1-ARA therapy with their similar epithelial and stromal apoptotic effects with unaffected cell proliferation.

Penile scintigraphy with 99mTc-human immunoglobulin G: a novel method for distinguishing the unstable and stable phases of Peyronie's disease

Objective  To investigate the value of penile scintigraphy using 99mTc‐human immunoglobulin G (IgG) to differentiate the unstable (acute) and stable (chronic) phases of Peyronies disease (PD).