Zafer Sinik

Antibiotic Prophylaxis for Transrectal Biopsy of the Prostate: A Prospective Randomized Study of the Prophylactic Use of Single Dose Oral Fluoroquinolone Versus Trimethoprim-Sulfamethoxazole

We investigated the efficacy of prophylactic use of single dose oral ofloxacin and trimethoprim-sulfamethoxazole regimens for transrectal prostate biopsy in 110 men. In the ofloxacin, trimethoprim-sulfamethoxazole and control groups, urinary infection was found in 2 (4.76%), 3 (6.66%) and 6 (26.08%) patients, respectively. Both of these antibiotic regimens produced a statistically significant reduction in urinary infection (p<0.02, p<0.05).Our study indicates that single dose fluoroquinolone or trimethoprimsulfamethoxazole prophylaxis seems to be effective, practical and economical.

Comparison of the Nuclear Matrix Protein 22 with Voided Urine Cytology and BTA stat Test in the Diagnosis of Transitional Cell Carcinoma of the Bladder

Objective: To assess sensitivity, specificity, accuracy, positive predictive value and negative predictive value of nuclear matrix protein 22 (NMP22) test, BTA stat test and cytology in the urine of patients with a spectrum of urologic conditions, including bladder cancer. Methods: A total of 140 patients (40 with bladder cancer) provided a urine sample which was divided into appropriate aliquots for each of the tests cited above. The endoscopist, pathologist, cytologist and the person performing BTA stat test and NMP22 test were blinded as to the results of the other tests. Results: Receiver-operating characteristics curve interpretation determined that 12.0 U/ml was an optimal reference value for NMP22 to detect transitional cell carcinoma of the bladder in this patient group. Comparative results demonstrate a clear superiority of NMP22 and BTA stat tests in sensitivity in bladder cancer detection (p < 0.01), while cytology and NMP22 were better than BTA stat test in specificity (p < 0.05). Conclusions: NMP22 and BTA stat test results represented significant improvement over urinary cytology for detection of transitional cell carcinoma. The sensitivities of NMP22 and BTA stat tests for detection of transitional cell carcinoma in this group of patients were as much as twice that of cytology. When the cutoff value of urinary NMP22 was set at 12.0 U/ml, NMP22 was more accurate than the other tests (p < 0.05).

Extracorporeal shockwave lithotripsy in anomalous kidneys

Traditionally, stones in anomalous kidneys have been removed by open or percutaneous surgery. Extracorporeal shockwave lithotripsy (SWL) with the Dornier MPL 9000 lithotripter was performed in seven patients with horseshoe kidneys, four with pelvic ectopic kidneys, and six with malrotated kidneys. Twelve patients (71%) needed repeated treatments. A total of 11 patients (65%) in all the groups were stone free, and four patients had asymptomatic residual fragments no more than 5 mm in diameter. In the remaining two patients, no sign of stone disintegration was observed, and they underwent open surgery. Extracorporeal lithotripsy is the treatment of choice for stones in horseshoe or malrotated kidneys but is not useful for stones in most pelvic kidneys.

Sertraline in the treatment of premature ejaculation: a double-blind placebo controlled study.

This study investigated the efficacy and the adverse effects of sertraline in the treatment of premature ejaculation (PE). Thirty-seven patients with PE were randomly assigned to receive either sertraline or a placebo. Of them 22 were given 50 mg of sertraline per day and the other 15 patients were given an identical placebo one per day. After 4 weeks, the latency to ejaculation in the sertraline group was found to be significantly longer than that of the placebo group (p<0.01). None of the patients discontinued therapy due to adverse effects. These results indicate that sertraline is an effective therapy for PE.

Extracorporeal Shock Wave Lithotripsy for Lower Caliceal Calculi

Objective: The aim of the study is to determine the effectiveness of extracorporeal shock wave lithotripsy (ESWL) therapy for isolated lower caliceal calculi. Patients and Methods: We analyzed 165 patients who were treated with the Siemens Lithostar Plus on an outpatient basis between March 1993 and August 1997. The age of patients ranged from 17 to 70 (mean 39.11) years. The stone size varied from 4 to 42 mm, and patients who had stones larger than 21 mm had a double-J stent inserted prior to treatment. Results: The overall stone-free rate at 3 months was 53.33%; whereas it was 61.79, 48.27, and 27.27% according to the stone size, ≤10, 11–20 and ≥21 mm, respectively. Complications were rare, including 2 pyelonephritis, 2 subcapsular hematoma formation, 24 renal colics and 8 stone streets, which were managed by ureteral stenting or additional ESWL and resulted in complete stone clearance. Conclusion: ESWL therapy is a reasonable and effective method for small lower caliceal stones, but due to its relatively low stone-free and high complication rates, percutaneous nephrolithotripsy or open surgery should be considered for stones larger than 21 mm.

What is the optimal treatment for lower ureteral stones larger than 1cm

Purpose : To compare the treatment options for lower ureteral stones larger than 1 cm.

An Unusual Cause of Urinothorax

Urinothorax is a rare complication of blunt renal trauma, ureteral instrumentation or ureteral surgery. A leakage from the urinary tract causes urinoma, a retroperitoneal collection of fluid, which can lead to urinothorax. We report a patient with solitary kidney who underwent extracorporeal shock wave lithotripsy (ESWL) for nephrolithiasis. Four days after ESWL, she had right-sided pleural effusion which demonstrated as urinothorax. Urinoma occurring after ESWL, as in our case, is a situation that has not been reported before as a cause of urinothorax. Urinothorax should be taken into consideration in patients with pleural effusion who recently underwent ESWL.

Elevation of serum and urinary carbohydrate antigen 19-9 in benign hydronephrosis

Objective: The aim of this study was to find out the predictive role of serum and urinary carbohydrate antigen 19‐9 levels in benign hydronephrosis and whether these levels are helpful for differentiation of complete or partial urinary obstruction.

Nuclear p53 Overexpression in Bladder, Prostate, and Renal Carcinomas

Background:

Correlation of nuclear p53 over-expression with clinical and histopathological features of transitional cell bladder cancer

Forty-four pathologic specimens of 39 bladder cancer patients were analyzed immunohistochemically with DO7 monoclonal antibody to detect over-expression of mutant p 53 gene. The findings were interpreted by correlating with patient age, sex, cigarette smoking, number and macroscopic appearance of tumour, histological tumour grade, muscular invasion, vascular invasion, necrosis and urothelial atypia or dysplasia. Mutant p53 gene was over-expressed in 8 (18.2%) specimens. Statistically significant correlation with grdde, vascular invasion, necrosis and patient sex was found with p53 over-expression. Available follow-up data were insufficient to draw a conclusion about the prognostic role of p53 over-expression. Prospective studies with larger number of patients are needed to define the exact place of nuclear p53 over-expression in transitional cell bladder cancer.