Yılmaz Aksoy

ORIGINAL RESEARCH—SURGERY: Seventeen Years' Experience of Penile Fracture: Conservative vs. Surgical Treatment

INTRODUCTION Penile fracture is the rupture of the tunica of one or both corpora cavernosa due to direct blunt trauma to the erected penis. Partial or complete rupture of the urethra or injury to the deep dorsal vein may accompany penile fracture. AIM To compare conservative and surgical treatment modalities in terms of duration of hospitalization, early and late complications such as penile nodule and curvature, erectile dysfunction, and painful erection. MAIN OUTCOME MEASURES Treatment results and complications in two groups were evaluated with history and physical examination, and International Index of Erectile Function-5 Questionnaire was used for erectile function assessment. Methods. The charts of 42 men diagnosed with penile fracture were retrospectively reviewed, and two treatment modalities were compared: conservative (Group I) and surgical (Group II). Results. Between 1991 and 2008, a total of 42 patients with penile fracture were followed in our clinic for a mean of 18 months (range: 6-30 months). Five men who refused surgical treatment were treated conservatively, and the other 37 patients underwent surgical treatment. In Group II, the most common complication was painful erection (in 4 of 37 patients, 10.8 %), whereas in Group I, 80 % (4/5 patients) suffered complications such as wound infection, painful erection, penile nodule and curvature, and erectile dysfunction. Conclusion. Diagnosis of penile fracture can be based on history and physical examination; diagnostic tests such as ultrasonography and magnetic resonance imaging are generally not required. Fractures must be repaired either immediately or delayed. Because management with emergency surgical repair is the most effective approach, with the lowest complication rate, surgical treatment should be preferred compared to a conservative approach.

Diagnostic performance of diffusion-weighted MRI in the detection of nonpalpable undescended testes: comparison with conventional MRI and surgical findings.

OBJECTIVE The aim of this feasibility study was to evaluate the role of diffusion-weighted MRI in the evaluation of nonpalpable undescended testes. MATERIALS AND METHODS Thirty-six boys with undescended testes underwent preoperative abdominal and pelvic MRI to identify the location of the testes. MRI included free-breathing diffusion-weighted imaging (DWI) with b values of 50, 400, and 800 s/mm(2), a T1-weighted turbo spin-echo sequence, and a T2-weighted fat-suppressed turbo spin-echo sequence. After laparoscopic examinations, two observers independently reviewed the preoperative images. The DW images alone were reviewed first, followed by the conventional MR images alone and the conventional MR and the DW images together. The laparoscopic and MRI findings were compared. Sensitivity, specificity, and accuracy in the identification of nonpalpable undescended testes were calculated for DWI, conventional MRI, and the combination of DWI and conventional MRI. RESULTS The combination of DWI and conventional MRI was the most sensitive and most accurate technique. Observer 1 found 31 undescended testes, and observer 2, 30 testes with this technique. Sensitivity was 0.91 and 0.88 for observers 1 and 2, and accuracy was 0.92 and 0.86. With DWI alone, observer 1 located 30 testes, and observer 2, 28 testes (sensitivity, 0.88 and 0.82; accuracy, 0.86 and 0.81). Using conventional MRI alone, both observers located 29 testes (sensitivity, 0.85; accuracy, 0.86 and 0.84). The accuracy of locating testes was superior with the combination of DWI and conventional MRI for both observers (accuracy, 0.92 and 0.86). An intraabdominal atrophic testis managed by laparoscopic orchiectomy was found by neither observer with DWI or with conventional MRI. CONCLUSION Use of DWI with a high b value yields information that complements conventional MRI findings, improving identification and location of nonpalpable undescended testes. We recommend the use of conventional MRI in addition to DWI to increase the preoperative sensitivity and accuracy of identifying and locating nonpalpable testes.

The relationship between varicocele and semen nitric oxide concentrations

Abstract We investigated the relationship between seminal plasma nitric oxide (NO) concentrations and conventional semen parameters in patients with varicocele. Semen samples were obtained from infertile patients with varicocele (n=55) and from normal controls (n=48). The mean NO concentration in the seminal plasma of patients with varicocele was significantly higher than that of the controls (P < 0.01). A significant negative correlation was noted between NO and sperm motility (r=−0.29, P=0.003), NO and sperm concentration (r=−0.26, P=0.008) and NO and normal morphology (normal %) (r=−0.25, P=0.01). It was concluded that increased NO production may influence sperm production, motility and morphology in patients with varicocele.

ORIGINAL RESEARCHORIGINAL RESEARCH—SURGERY: Seventeen Years' Experience of Penile Fracture: Conservative vs. Surgical Treatment

INTRODUCTION Penile fracture is the rupture of the tunica of one or both corpora cavernosa due to direct blunt trauma to the erected penis. Partial or complete rupture of the urethra or injury to the deep dorsal vein may accompany penile fracture. AIM To compare conservative and surgical treatment modalities in terms of duration of hospitalization, early and late complications such as penile nodule and curvature, erectile dysfunction, and painful erection. MAIN OUTCOME MEASURES Treatment results and complications in two groups were evaluated with history and physical examination, and International Index of Erectile Function-5 Questionnaire was used for erectile function assessment. Methods. The charts of 42 men diagnosed with penile fracture were retrospectively reviewed, and two treatment modalities were compared: conservative (Group I) and surgical (Group II). Results. Between 1991 and 2008, a total of 42 patients with penile fracture were followed in our clinic for a mean of 18 months (range: 6-30 months). Five men who refused surgical treatment were treated conservatively, and the other 37 patients underwent surgical treatment. In Group II, the most common complication was painful erection (in 4 of 37 patients, 10.8 %), whereas in Group I, 80 % (4/5 patients) suffered complications such as wound infection, painful erection, penile nodule and curvature, and erectile dysfunction. Conclusion. Diagnosis of penile fracture can be based on history and physical examination; diagnostic tests such as ultrasonography and magnetic resonance imaging are generally not required. Fractures must be repaired either immediately or delayed. Because management with emergency surgical repair is the most effective approach, with the lowest complication rate, surgical treatment should be preferred compared to a conservative approach.

Iatrogenic injuries to ureter, bladder and urethra during abdominal and pelvic operations

Abdominal and pelvic operations at Departments of Obstetrics and Gynaecology, and General Surgery play an important role in ureteral, bladder and rarely urethral injuries.Fifty-nine patients with iatrogenic ureteral, bladder and urethral injuries were treated at the Department of Urology, Atatürk University Research Hospital, between 1985 and 1995. These injuries were urinary vaginal fistulas in 43 patients (vesicovaginal 33, ureterovaginal 7, urethrovaginal 2 and vesicovaginal plus urethrovaginal 1), ureteric ligation in 9, bladder laceration in 7. These injuries were treated by different methods. All patients were followed up by intravenous urography (IVU) and urine culture three months later.It must be borne in mind that iatrogenic urinary tract injuries are not rare. Bladder and ureteral catheterization must be performed to prevent these complications.

Transitional Cell Carcinoma of the Bladder in Patients under 40 Years of Age

A review of our records between 1993 and 1998 identified 25 patients with transitional cell carcinoma of the bladder who were less than 40 years old, 22 males and 3 females. The youngest patient was 19 years old. At the time of diagnosis 16 patients had superficial (Ta/T1) and 9 had invasive disease. Twenty-four patients were followed up for a period of 3–71 months (mean: 19.2 months). The recurrence rate for patients with superficial disease was 12.5%, and the progression rate for patients with invasive disease was 77.7%.We concluded that the patients under 30 years of age presented with lower grade and lower stage disease than those over 30. Transitional cell carcinoma of the bladder in young adults has a natural history similar to that seen in older patients. Accordingly, all patients, regardless of age, should be treated as aggressively as necessary on the basis of the stage and the grade of the tumour.

Simultaneous determination of gemcitabine and its metabolite in human plasma by high-performance liquid chromatography

Gemcitabine (dFdC) is a pyrimidine antimetabolite with broad spectrum activity against tumors. In this paper, a normal-phase high-performance liquid chromatographic method was developed for the determination of the parent drug (dFdC) and its metabolite (dFdU) in human plasma. The described sample preparation procedure for determination of dFdC and dFdU is rapid, sensitive, reproducible and simple. The linear regression equations obtained by least square regression method, were area under the curve=0.0371 concentration (ng ml(-1))+192.53 and 1.05.10(-4) concentration (ng ml(-1))-1.2693 for dFdC and dFdU, respectively. The assay for dFdC and dFdU described in the present report has been applied to plasma samples from a bladder cancer patient.

Spontaneous Rupture of a Renal Angiosarcoma

Here we describe the clinical, radiologic, histopathological and immunohistochemical features of a rare spontaneous rupture of renal angiosarcoma detected in the left kidney of a 55-year-old male. Due to the rarity of this neoplasm (less than 15 cases have been reported), there is no unanimous concensus for therapy following radical nephrectomy. In our case there was no flank trauma and retroperitoneal haematoma around the left kidney was seen on computed tomography. The patient underwent left radical nephrectomy and died about 3 months after operation due to multiple bone and liver metastases. To our knowledge, this is the first report of spontaneous rupture of renal angiosarcoma and we suggest that it should be borne in mind that renal angiosarcoma may be a cause of retroperitoneal haematomas.

Seminal plasma nitric oxide concentration in oligo- and/or asthenozoospermic subjects with/without varicocele.

There is an inverse correlation between seminal plasma nitric oxide (NO) concentration and sperm parameters (motility and concentration) in patients with varicocele. This study investigated whether this occurs in patients with oligo- and/or asthenozoospermia due to causes other than varicocele. A total of 69 (19 with varicocele and oligo- and/or asthenozoospermia [group 1], 30 from oligo- and/or asthenozoospermic ones without varicocele [group 2], and 20 from healthy subjects [control group]) semen samples were analyzed. While group 1 had a significantly higher NO concentration in the seminal plasma compared to both the control group and group 2, there was no significant difference between group 2 and the control group ( p >.05). In group 1, but not in the other groups, there was an inverse correlation between the seminal plasma NO concentration and sperm motility and concentration. NO production could be specifically related to the varicocele, since NO production in oligo- and/or asthenozoospermia cases without varicocele is not increased.

Squamous metaplasia of the bladder: findings in 14 patients and review of the literature.

We have documented the data of squamous metaplasia of the bladder in 14 patients who had undergone cystoscopies for different reasons. In two biopsies, there were marked keratinization and cellular atypia. One of these two subjects was diagnosed as squamous carcinoma of the prostate and transitional cell carcinoma of the bladder. The lesions of 8 female patients were on the trigone and evaluated as normal anatomical variants due to hormonal changes. Three of them were remarkable because of recurrent urinary infections. Apart from the two male patients with squamous cell carcinoma of the prostate the two male patients with current squamous metaplasia have been following up. In this study, we have also reviewed the relationship between squamous metaplasia, infection and malignancy.