Yuksel Yilmaz

The Efficacy of Fluoxetine in the Treatment of Premature Ejaculation: A Double-Blind Placebo Controlled Study

PURPOSE The efficacy of the selective serotonin re-uptake inhibitor fluoxetine in the treatment of premature ejaculation was examined. MATERIALS AND METHODS The study comprised 17 patients with premature ejaculation who presented to the urology clinic of our medical school. In this double-blind study the patients were randomized into treatment groups receiving 20 mg. fluoxetine daily for 1 week and 40 mg. daily afterward (group 1) or 1 capsule placebo daily for 1 week and 2 capsules daily afterward (group 2). The groups were evaluated according to the latent period of intravaginal ejaculation. RESULTS The latent period of intravaginal ejaculation in group 1 was significantly longer than that in group 2. Nausea, headache and insomnia were reported side effects. CONCLUSIONS Fluoxetine may be regarded as a safe and effective alternative in the treatment of premature ejaculation.

Severe complications of circumcision: An analysis of 48 cases

OBJECTIVE Circumcision is still the most commonly performed surgery in Islamic and Jewish societies. We report the findings of 48 cases referred for serious complications after circumcision that needed secondary surgical interventions. The aim of this study is to emphasize the important problem of circumcision complications. PATIENTS AND METHODS The 48 cases (mean age 14 years, range 5 months-24 years) with complications of circumcision were reviewed retrospectively. Circumcisions were performed at various medical centers or during religious ceremonies in environments other than health facilities. RESULTS The most commonly observed complication was preputio-glandular fusion, seen in 25 cases (52%). The other complications were: meatal stenosis in 11 (23%), urethral fistula in five (10.4%), partial glandular amputation in four (8%) and opening distal urethra in three (6%). Adhesion freeing and revision were performed in all cases of preputio-glandular fusion, patients with meatal stenosis underwent meatotomy, urethral fistulae were repaired by simple closure, partial glans amputations were patched with buccal mucosa, and patients with complete open distal urethra were repaired by Mathieu (one patient) and tubularized incised plate urethroplasty techniques. CONCLUSION Circumcision may be associated with many serious complications. To prevent these complications, the operation should be performed by educated and experienced personnel.

Virtual computed tomography cystoscopy in bladder pathologies

OBJECTIVE Assessed the usefulness of virtual cystoscopy performed with multidetector computed tomography (CT) in patients with different urinary bladder pathologies compared to the conventional cystoscopy. MATERIALS AND METHODS Eighteen patients with different bladder pathologies, which consisted of 11 tumors, 3 diverticula, 2 trabecular changes and 2 stones, were assessed with conventional cystoscopy and virtual CT cystoscopy. The results of virtual CT cystoscopy were compared with the findings of conventional cystoscopy. We determined the detection rate and positive predictive value of CT imaging based virtual cystoscopy in the diagnosis of urinary bladder lesions. RESULTS CT scanning was well tolerated by all patients, and no complications occurred. Images in 16 (88%) of the 18 virtual cystoscopic examinations were either of excellent or good quality. All tumors except one, 2 trabecular changes and 2 stones were characterized with similar findings in the both of methods. The masses ranged from 0.4 to 7.0 cm in diameter. While conventional cystoscopy could not evaluate interior part of the diverticulum, virtual CT cystoscopy could demonstrate clearly within it. There were no false-positive findings in our series. CONCLUSION Virtual CT cystoscopy is a promising technique to be used in the detection of bladder lesions. It should be considered especially at the evaluation of bladder diverticula. In the future, it may be possible or even advantageous to incorporate into the imaging algorithm for evaluation of bladder lesion.

Does Washing the Biopsy Needle with Povidone-Iodine Have an Effect on Infection Rates after Transrectal Prostate Needle Biopsy?

Purpose: To determine the effect of washing the biopsy needle with povidone-iodine solution on infection rates after transrectal ultrasonography-guided prostate biopsy. Patients and Methods: 180 patients with transrectal prostate biopsy were included. Infection was excluded with midstream urine culture before biopsy, and patients were divided into two groups. In group 1 (n = 84), the needle was washed with povidone-iodine after each material reception during biopsy, and in group 2 (n = 96), it was not. At day 3 and 2 weeks after the biopsy, patients were checked. On day 3, midstream urine was cultured and patients were checked for fever, hematuria, rectal hemorrhagia, hematospermia and urinary retention. Also, the effect of rectal preparation on infection rate was evaluated. Results: There was no significant difference between the patients’ ages, PSA levels and prostate volumes. In total, 11 patients (6.1%; 4 from group 1 and 7 from group 2) developed infectious complications. There was no statistically significant difference between the groups. Fever, asymptomatic bacteriuria and urinary system infection rates were also not statistically different between the groups. The most frequent complication was hematuria with 83 cases (46.1%), but they did not need hospitalization and no patient had acute urinary obstruction. Conclusions: Washing the biopsy needle with povidone-iodine did not have an effect on the infection rates. Antibiotic prophylaxis and cleaning the biopsy equipment is adequate for low infection rates.

Undescended Testes in Adults: Clinical Significance of Resistive Index Values of the Testicular Artery Measured by Doppler Ultrasound as a Predictor of Testicular Histology

PURPOSE We evaluated the clinical significance of arterial impedance as a predictor of testicular histology in adults with undescended (inguinal) testes. MATERIALS AND METHODS We performed arterial impedance and testicular diameter measurements with the use of color Doppler ultrasonography on 22 adults with undescended testes. Arterial impedance of the contralateral descended testes served as controls. All patients later underwent inguinal orchiectomy and the testes were examined histologically. RESULTS Of the 22 undescended testes, 7 had arterial impedance values below 0.50, and the other 15 had values equal to or above 0.50. All testes with arterial impedance values below 0.50 had histologic scores between 2 and 3, whereas the others had scores of 3 and 8. Arterial impedance values and testicular volumes in the contralateral testes were significantly higher than the undescended testes. Although some of the testes with arterial impedance values above 0.50 had histologic score 3, testes with arterial impedance values below 0.50 never exceeded score 3. Volume differences of the undescended testes were not statistically significant. CONCLUSIONS Arterial impedance of an undescended testis may have a predictive value and provide more accurate information about its histology than the volume measurement itself.

Effect of Indapamide on Urinary Calcium Excretion in Patients with and without Urinary Stone Disease

BACKGROUND: Indapamide is an antihypertensive agent similar to thiazides, but with some different effects. Thiazide and thiazide-like diuretics are useful in preventing recurrent urinary stone formation due to their hypocalciuric effects. OBJECTIVE: To determine the hypocalciuric and other effects on certain laboratory parameters of indapamide 1.5 mg in different patient groups. METHODS: Four groups of patients recruited from urology and nephrology outpatient departments were experiencing non-hypercalciuric urinary stone disease (group 1), idiopathic hypercalciuria (group 2), urinary stone disease with hypercalciuria (group 3), and essential hypertension (group 4). In all patients, fasting serum uric acid, calcium, sodium, potassium, cholesterol, triglyceride, parathyroid hormone (PTH) values, and morning second-spot urine calcium and creatinine levels were assessed before and 8 weeks after treatment with indapamide. RESULTS: Urinary calcium excretion was reduced significantly in all groups: group 1 from 0.10 ± 0.02 to 0.07 ± 0.03 (mean ± SD; 30% reduction; p < 0.001), group 2 from 0.30 ± 0.15 to 0.15 ± 0.10 (50% reduction; p < 0.001), group 3 from 0.35 ± 0.15 to 0.20 ± 0.10 (43% reduction; p < 0.001), and group 4 from 0.10 ± 0.03 to 0.08 ± 0.02 (20% reduction; p < 0.0010). These results should be interpreted with caution since no control group was included in this study. Mean serum uric acid and triglyceride levels were significantly increased, and mean PTH and potassium levels and diastolic and systolic blood pressure were significantly decreased in all groups. Few temporary adverse effects, such as dizziness and fatigue, were noticed and none of them caused discontinuation of treatment. CONCLUSIONS: Indapamide 1.5 mg/day is effective in decreasing calciuria in patients with non-hypercalciuric urinary stone disease, idiopathic hypercalciuria, urinary stone disease with hypercalciuria, and essential hypertension. This could be achieved with few adverse effects similar to those of thiazides and indapamide 2.5 mg. Indapamide decreased the PTH levels in all groups. Long-term clinical benefits of these effects should be evaluated prospectively with further randomized studies.

Effects of sildenafil citrate, acetylcholine, and sodium nitroprusside on the relaxation of rabbit cavernosal tissue in vitro

OBJECTIVES To investigate the effect of sildenafil together with the influence of sodium nitroprusside and acetylcholine and further discuss its mechanism of action in vitro. METHODS Isolated strips of rabbit corpus cavernosum were stimulated isometrically with phenylephrine. Graded relaxations were induced using increasing concentrations of acetylcholine, sodium nitroprusside, and sildenafil alone and in combination. RESULTS The agents all relaxed the rabbit corpus cavernosal strips in a dose-dependent manner. The inhibitory potentials of the test agents were ranked (from least inhibitory to most inhibitory) as follows: sildenafil, acetylcholine plus sildenafil, sodium nitroprusside, sodium nitroprusside plus sildenafil, acetylcholine. The presence of sodium nitroprusside in the medium reduced the median effective dose for the sildenafil-induced relaxation of the cavernosal tissue from 3.65 x 10(-5) M to 2.73 x 10(-7) M, and the presence of acetylcholine reduced it to 9.79 x 10(-6) M. CONCLUSIONS Sildenafil enhances the relaxing effect of both sodium nitroprusside and acetylcholine on the phenylephrine-induced contraction of rabbit cavernosal tissue.

Multicentral clinical evaluation of the aetiology of erectile dysfunction: A survey report

Patients with erectile dysfunction, who admitted to 4 different urological centres in Turkey were evaluated in terms of aetiological factors to establish the aetiology of erectile dysfunction in our population and compare it with the data derived from Western communities. After the history, physical examination, psychological evaluation and laboratory testing, a clinical diagnosis was established as primarily psychogenic, organic, or mixed aetiology. Mean patient age was 43.5 years (range 17 to 69), and 9 of the patients were unmarried. Of the patients 53 had vascular risk factors, and 10 reported a history of alcohol abuse. Eleven patients were using drugs that might interfere with the disorder. In this multicentral study of 115 impotent men, an organic cause was found in 43%, psychogenic in 47%, and mixed in 19%. Mean age of the overall patients was 43.48. When the ages of the patients with organic erectile dysfunction and those with psychogenic erectile dysfunction were compared, it was clearly seen that those with organic erectile dysfunction were much older (52.73 versus 33.02).

Diagnostic value of cytokeratin-18 as a tumor marker in bladder cancer

OBJECTIVES The aim of the study was to compare serum levels of cytokeratin-18 of patients with bladder cancer with those of the healthy controls, and to investigate the relation between cytokeratin level and the tumor stage. DESIGN AND METHODS Serum cytokeratin-18 levels of 38 patients with bladder cancer and of 25 healthy people were determined. Tumor stage was T(1) in 12 patients, T(2) in 9 patients, T(3) in 10 patients and T(4) in 7 patients. The serum cytokeratin-18 levels in these cases were analyzed with respect to the stage of the tumor. RESULTS Cytokeratin-18 level in the patient group was found to be significantly higher than that of the control group (p < 0.010) when the groups were totally compared. However, when the levels in patients with different tumor stages were compared with that of the controls, the difference was not significant in patients with stage 1 and 2 tumors (p > 0.05). Regarding the cut off value as 4.0 ng/mL, sensitivity and specificity for serum cytokeratin-18 were found to be 53% and 72% respectively. When sensitivity was calculated with respect to tumor stages, it was 8% for T(1,) 33% for T(2,) 90% for T(3) and 100% for T(4.) On the other hand, considering higher stage (T(3) and T(4)) tumors only, the sensitivity was calculated as 94%, but the sensitivity for lower stage (T(1) and T(2)) tumors was 19%. CONCLUSIONS It is clear that serum cytokeratin-18 level increases in patients with bladder cancer. However, it can only be useful as a tumor marker in the diagnosis of T(3) and higher staged tumors. This study indicated that cytokeratin-18 does not have any diagnostic value in lower stage bladder cancers.

Bazex syndrome: acrokeratosis paraneoplastica in association with simultaneous multiple genitourinary tumors.

We report a patient with Bazex (Bazex-Dupre-Christol) syndrome in association with multifocal basal cell carcinoma, epidermoid carcinoma of the lung, adenocarcinoma of the prostate, and possibly undifferentiated carcinoma of the bladder. To our knowledge, this is the first report of a patient with Bazex syndrome that consisted of four tumors, including two genitourinary tumors.