Zafer Demirer

Testis-Sparing Surgery in Small Testicular Masses Not Suspected to Be Malignant

UNLABELLED Fifteen patients with small testicular masses not suspected to be malignant were included in the study, and permanent and frozen section analyses were evaluated. As a result frozen analysis, preoperative externalization of the suspected malignancy with a physical examination, ultrasonographic evaluation, and serum tumor marker analysis were concluded as key points for accurate decision making between TSS and radical orchiectomy. BACKGROUND We aimed to determine the safety, efficacy, and the concordance of permanent and frozen section analysis (FSA) of testis-sparing surgery (TSS) in patients who had small testicular masses that were not suspected to be malignant. PATIENTS AND METHODS Fifteen patients who underwent TSS were included in the study. TSS was performed for the patients who had testicular lesions <25 mm and testicular lesion volume <30% of the whole testis. All patients had normal serum tumor marker levels and ultrasonographic evaluation did not indicate malignancy. Surgery was performed via an inguinal approach with temporary cord occlusion and FSA of the lesions. Benign findings allowed for TSS, and cancer prompted total orchiectomy. RESULTS The mean patient age was 25.33 (range, 20-36) years. The predominant complaint was swelling (9 patients). The mean lesion diameter was 16 mm (range, 5-26 mm). Fourteen of all cases (93%) had benign pathology and underwent TSS. Only 1 patient, whose FSA revealed malignant formation, underwent radical orchiectomy. Final pathology of this patient was seminoma. Complete histopathologic concordance was observed between the results of frozen and permanent sections. TSS was performed with no intra- or postoperative complications. After a mean follow-up of 23 months (range, 6-44 months) all patients, except 3 who were lost to follow-up, were free of disease. CONCLUSION The main key points for accurate decision-making between TSS and radical orchiectomy are intraoperative FSA and preoperative externalization of possible suspected malignancy with physical examination, ultrasonographic evaluation, and serum tumor marker analysis.

Inhibition of inducible nitric oxide synthase prevents shock wave therapy induced renal injury.

Abstract Objectives: Shock wave lithotripsy treatment (SWT) is not completely free from side effects; one of the accused mechanisms for renal injury during SWT is oxygen- and nitrogen-derived free radical productions. Therefore, we aimed to evaluate the effect of inhibition of nitric oxide (NO) production by N-[3(aminomethyl) benzyl) acetamidine] (1400W), highly selective inducible nitric oxide synthase (iNOS) inhibitor, at SWT-induced kidney damage. Materials and methods: Twenty-four rats those underwent right nephrectomy procedure were divided equally into three groups as control, SWT, and SWT + 1400W. 1400W was administered at a dose of 10 mg/kg at 2 h prior to SWT procedure and at the beginning of SWT procedure via intraperitoneal route and continued daily for consecutive 3 days. At the end of the fourth day, animals were killed via decapitation and trunk blood and the left kidneys were taken for biochemical and histopathologic evaluation. Results: SWT caused renal tubular damage and increased lipid peroxidation and antioxidant enzyme activities and SWT also significantly increased nitro-oxidative products. Inhibition of iNOS via administration of 1400W ameliorated renal injury and decreased tissue lipid peroxidation (malondialdehyde), superoxide dismutase, glutathione peroxidase and nitrite/nitrate levels (NOx). In addition, it was seen that histolopathological changes were attenuated in the SWT + 1400W group when compared to SWT group. Conclusion: SWT-induced renal injury might be due to excessive production of oxygen free radicals and NO production. Inhibition of iNOS attenuates renal injury following SWT treatment. It can be concluded that iNOS inhibitors or peroxynitrite scavengers might be used to protect the kidneys against SWT-induced morphological and functional injuries.

Persistent Mullerian duct syndrome with transverse testicular ectopia and seminoma.

Persistent Mullerian duct syndrome (PMDS) is a rare form of the 46 XY disorders of sexual differentiation, characterized by the presence of a uterus and fallopian tubes due to the failure of Mullerian duct regression in genotypically normal males. More than 150 cases have been recorded, most of them in adults. In most cases, the PMDS is discovered during surgery for inguinal hernia or cryptorchidism, or by the presence of transverse testicular ectopia (TTE). The presence of PMDS with TTE is even more uncommon. In TTE, both testes descend through the same inguinal canal into the same scrotal sac. Patients with TTE present with symptoms of unilateral cryptorchidism and a contralateral inguinal hernia. For patients with inguinal hernia and cryptorchidism associated with TTE, PMDS should be kept in mind, and radiologic evaluation such as ultrasonography or magnetic resonance imaging of the genitourinary system and karyotyping are recommended. Whereas radiologic evaluation could be helpful in the diagnosis of TTE, it cannot diagnose the malignancy itself. The case explained in this report will offer urologists additional useful treatment strategies for patients with inguinal hernia and cryptorchidism.

Medical ozone therapy reduces shock wave therapy-induced renal injury

Abstract Objectives: Extracorporeal shock wave (ESW) lithotripsy is the preferred treatment modality for uncomplicated kidney stones. More recently free oxygen radical production following ESW application has been considered to be crucial in shock wave-induced renal damage. It has been shown that ozone therapy (OT) has ameliorative and preventive effects against various pathological conditions due to increased nitro-oxidative stress. In current study, we aimed to evaluate the efficacy of OT against ESW-induced renal injury. Methods: Twenty-four male Sprague–Dawley rats were divided into three groups: sham-operated, ESW, and ESW + OT groups. All groups except sham-operated group were subjected to ESW procedure. ESW + OT group received 1 mg/kg/day of oxygen/ozone mixture intraperitoneally at 2 h before ESW, and OT was continued once a day for consecutive three days. The animals were killed at the 4th day, and kidney tissue and blood samples were harvested for biochemical and histopathologic analysis. Results: Serum ALT and AST levels, serum neopterin, tissue nitrite/nitrate levels, and tissue oxidative stress parameters were increased in the ESW group and almost came close to control values in the treatment group (p < 0.05, ESW vs. ESW + OT). Histopathological injury scores were significantly lower in treatment group than the ESW group (p < 0.05, ESW vs. ESW + OT). Immunohistochemical iNOS staining scores in ESW group were higher than those of sham-operated group (p < 0.05, ESW vs. sham-operated), iNOS staining scores in OT group were significantly lower than the ESW group (p < 0.05, ESW + OT vs. ESW). Conclusion: OT ameliorates nitro-oxidative stress and reduces the severity of pathological changes in the experimental ESW-induced renal injury of rat model.

Affective Temperament Profiles of Overactive Bladder Patients

We have read the article “Affective Temperament Profiles of Overactive Bladder Patients” presented by Saribacak et al. with great interest (1). This study assesses the potential relationship between the overactive bladder (OB) disease profile of individuals with temperament. The authors reported that there might be a relationship between OB syndrome, which presents as serotonergic dysfunction, and anxious temperament.

RE: ultrasonic Measurement of Testicular Tumors and the Correlation with pathologic Specimen Sizes

We read with great interest the article “The value of testicular ultrasound in the prediction of the type and size of testicular tumors” by Shtricker et al. (1). They aimed to assess the correlation between ultrasound (US) findings and testicular tumor type and size. The authors concluded that the testis US findings underestimated the size in 25% of the malignant testicular lesions and 16% of the cases were proven to be benign. Thus they recommended putting into practice frozen sections for borderline cases. This study gives substantial information on this clinically relevant condition. The awareness of this diagnostic finding and its clinical results may increase the accuracy of preoperative management of the patients with testicular lesions. Thanks to the authors for this contribution. Several medical subspecialties manage their treatments with respect to anatomic measurements. The reproducibility and accuracy of the measurements are especially crucial in radiology as important clinical decisions are often based on the assumption that radiologic measurements are accurate and any measurement differences on follow-up imagings represent a real change in size. Favorably, measurements of the tumors on images should be accurate, reproducible, and practiced in a standardized method with low rates of intra-and interobserver variability. Even so, there a lot of factors, which may affect the consistency of the measurement, including patientdependent factors, technical factors and radiologist-dependent factors (2,3). World Health Organization criteria (WHO) (4) and the Response Evaluation Criteria in Solid Tumors (RECIST) (5) are two widely accepted guidelines of measurement methods to obtain standardized results (6). WHO criteria recommend the measurement method on the basis of an approximation of cross-sectional area (bidimensional measurement), whereas RECIST suggests to measure only the tumor’s greatest diameter (unidimensional measurement) on a transverse plane (7). Shtricker et al. have designed this study as a multicenter study (1). This design may increase the variabilities in the tumor measurement. However, the authors did not mention any measurement method for standardization in the study. A lot of published studies based on the variability and reproducibility of tumor measurements define their measurement methods and they generally use WHO or RECIST criteria. Therefore a measurement variability might occur due to lack of measurement standardization. Vol. 42 (1): 172-173, January February, 2016

Standard surgical approach of testissparing surgery for testicular tumour with benign or malignant tendency

tomy in select cases. These conditions are small testicular tumours, synchronous bilateral tumours, metachronous contralateral tumours, or tumour in solitary testis in patients for whom tumour volume is <30% of the testis volume and in whom preoperative testosterone levels are normal. 2

A rare case of penis agenesis (Aphallia) with associated multiple urogenital anomalies

The penis as a component of external genitalia, takes part in fertility, urinary and psychosexual structure of males with its complex character. We report a case of penis agenesis with associated left renal agenesis, left superior segment ureteral agenesis, prostate agenesis, left ureterocele, right vesicoureteral reflux and high urethrorectal communication above the rectal sphincter. The patient refused any surgical intervention because of his religious beliefs.

Efficacy of poly(adenosine diphosphate-ribose) polymerase inhibition in extracorporeal shock wave-induced renal injury

Abstract Objectives: Extracorporeal shock wave lithotripsy (ESW) induces renal damage by excessive production of free oxygen radicals. Free Oxygen radicals cause cellular injury by inducing nicks in DNA. The enzyme poly(adenosine diphosphate-ribose) polymerase (PARP) involved in the process of repair of DNA in damaged cells. However, its activation in damaged cells can lead to adenosine triphosphate depletion and death. Thus, we designed a study to evaluate the efficacy of 3-aminobenzamide (3-AB), a PARP inhibitor, against extracorporeal shock wave induced renal injury. Methods: Twenty-four Sprague-Dawley rats were divided into three groups: control, ESW, ESW + 3-AB groups. All groups except control group were subjected to ESW procedure. ESW + 3-AB group received 20 mg/kg/day 3-aminobenzamide intraperitoneally at 2 h before ESW and continued once a day for consecutive 3 days. The surviving animals were sacrificed at the 4th day and their kidneys were harvested for biochemical and histopathologic analysis. Blood samples from animals were also obtained. Results: Serum ALT and AST levels, serum neopterin and tissue oxidative stress parameters were increased in the ESW group and almost came to control values in the treatment group (p < 0.05, ESW vs. ESW + 3-AB). Histopathological injury score were significantly lower in treatment group than the ESW group (p < 0.05, ESW vs. ESW + 3-AB). Conclusion: Our data showed that PARP inhibition protected renal tissue against ESW induced renal injury. These findings suggest that it would be possible to improve the outcome of ESW induced renal injury by using PARP inhibitors as a preventive therapy.

The relationship between inflammation and mean platelet volume in varicocele pathophysiology

INTRODUCTION The mean platelet volume (MPV) is an extensively employed laboratory indicator related to platelet volume and function in inflammatory circumstances. The aim of this study was to assess the relationship between inflammation and mean platelet volume in varicocele pathophysiology. METHODS We conducted a recent study, which included 131 varicocele subjects and 82 healthy controls. The identification of varicocele was based on the results from both physical examination and color Doppler ultrasound. We analyzed some laboratory markers including haemogram tests in two groups. RESULTS There were no significant differences in the two groups in terms of baseline characteristics. MPV values were statistically higher in the varicocele group (9.73±0.86fL) than in the control group (9.03±0.70fL) (p<0.001). However, no significant relationship between MPV and varicocele grade was found. Furthermore, the receiver-operating characteristic curve analysis suggested the optimum MPV cut-off value for patients with varicocele as 9.05, with a sensitivity and specificity of 77% and 50%, respectively (p<0.001). CONCLUSION MPV can offer information on varicocele pathophysiology. Increased MPV levels in varicocele patients may be associated with inflammation.