Preoperative neutrophil-to-lymphocyte ratio (NLR) may be predictive of pathologic stage in patients with bladder cancer larger than 3 cm.

OBJECTIVE: Bladder cancer (BCa) is the most common malignancy of the urinary tract. In this study, we aimed to evaluate the ability of preoperative neutrophil-to-lymphocyte ratio (NLR) to predict pathologic stage of at the time of first transurethral resection of bladder tumor (TUR-BT) in patients with BCa larger than 3 cm. PATIENTS AND METHODS: Records of consecutive patients undergoing TUR-BT for BCa with a diameter >3 cm were reviewed. A total of 222 patients were eligible for analysis, and were divided into two groups: 162 patients in non-muscle-invasive BCa (NMIBC) group and 60 patients in muscle-invasive BCa (MIBC) group. Differences in preoperative blood parameters and NLR were evaluated between groups with an unequal variance t-test. RESULTS: In the NMIBC group, 59 patients had low-grade and 103 high-grade papillary urothelial carcinomas. 60 patients had T2 stage carcinoma. The mean age of the patients was 71.8 and 75.7 years, and mean NLR was 3.44 ± 2.03 and 4.6 ± 2.8 in NMIBC and MIBC groups, respectively. In terms of NLR, there was a statistically significant difference between the NMIBC and MIBC groups (p = 0.005). CONCLUSIONS: Our results showed that NLR might act as a significant predictive biomarker on the staging of BCa. Also, NLR could be used as a cost-effective, simple, common usable biomarker in urology clinic practice.

The effects of estradiol on cardiac muscle electrophysiology in orchiectomized rat model: a new insight to side effects caused by castration.

OBJCTIVE: Although the testosterone has a protective effect on heart, patients having maximal androgen blockade due to prostate cancer resembles endothelial dysfunction and cardiac problems when compared to normal population. We aimed to test the effect of 17 beta estradiol on the orchiectomized male rat heart electrophysiology and ion channel expression levels. MATERIALS AND METHODS: This study was conducted on 27 male rats with 4 groups (healthy, orchiectomized, orchiectomized+17 beta estradiol treated and orchiectomized+vehicle treated). Action potentials and contractions were recorded simultaneously, while expressions of the calcium and potassium ion channels were measured. RESULTS: Testosterone depletion for 4 weeks has caused a significant prolongation in the action potential durations and decrease in maximal contraction force as well as a deceleration. While this depletion suppressed expression of potassium channels, it increased the expression of calcium ion channels. Application of estradiol on the other hand, except for the calcium ion channel expression, had no positive effect on the tested parameters. CONCLUSIONS: Testosterone has a markedly important and protective effect on male cardiac muscle preparations while estrogen does not have any. It is predicted that testosterone has showed this effect by means of modulation of some key points of excitation-contraction pairing of cardiac muscle.

Evaluation of laparoscopic transperitoneal adrenalectomy: is it feasible for large masses?

AIM: The aim of this paper was to determine whether laparoscopic adrenalectomy (LA) is a safe and effective treatment for the management of large adrenal tumors. METHODS: We retrospectively evaluated the data of patients who underwent LA at our institution between September 2002 and September 2012. Seventy-six transperitoneal LA were performed by the same surgical team. Patients with invasive tumors to adjacent organs or distant metastasis were excluded from the study. All patients were operated using the 450 oblique position as transperitoneal approach. RESULTS: The mean age of the patients was 48.3 years (range 20-68 years). The mean tumor size was 5.37 cm (range 2-15 cm). Sixteen patients had tumor size over 8 cm. The mean tumor weight was 31.2 gr (range 2-156 g). The lesions were localized on the right side in 42 (55%) patients and on the left side in 34 (45%) patients. The mean intraoperative blood loss was 114 mL (range 20-400 mL) and the mean operative time was 112 min (range 55-300 min). Six patients (7%) required conversion to open procedure. The mean hospitalization time was 2.5 days (range 1-4 days). Five patients (6%) had post-operative minor complications. There were no incidents of capsular invasion or adverse cardiovascular events. CONCLUSION: LA is safe and feasible for both malign and benign adrenal lesions. Good preoperative assessment, surgical skills, team work and adherence to anatomical and surgical principles are the key to success for large adrenal masses.

Open, laparoscopic and robot-assisted laparoscopic radical prostatectomy: comparative analysis of operative and pathologic outcomes for three techniques with a single surgeon's experience.

OBJECTIVE: To compare outcomes of open (O-), laparoscopic (L-) and robot-assisted laparoscopic (RAL-) radical prostatectomy (RP) performed by the same surgeon. PATIENTS AND METHODS: From May 1999 to April 2012, 484 RPs were performed by a single surgeon. Patients' data including age, body-mass index, serum prostate specific antigen (PSA) level, Gleason score of prostate biopsy and prostatectomy specimen, preoperative prostate and specimen volumes, clinical and pathologic stages, operation time, estimated blood loss (EBL), catheterization time, blood transfusion rate were recorded. Prospectively collected data was evaluated retrospectively by statistical analyses. RESULTS: Of 484 radical prostatectomies, ORP (50), LRP (308) and RALRP (79) done by the same surgeon were included into study. Mean ages were 63.8, 62.7 and 60.3 years for ORP, LRP and RALRP respectively. Operation times for ORP, LRP and RALRP were 255, 208 and 242 minutes. EBL and hospitalization time were 602, 526, 234 mL, and 9.1, 3.2, 3.2 days for ORP, LRP and RALRP, respectively. While a significant advantage was found for EBL and complication rates in RALRP and for operation time in LRP, significant disadvantages were found in terms of catheterization time, hospitalization time, decrease in hemoglobin and blood transfusion in ORP. However, preoperative prostate volume and serum PSA level, oncologic outcomes and positive surgical margins were nearly similar in all operative techniques. CONCLUSIONS: Minimally invasive techniques such as LRP and RALRP are promising techniques with comparable outcomes with ORP. Shorter catheterization time, less blood loss and fewer complication rates can be provided by RALRP.

Effect of sildenafil on platelet function and platelet cGMP of patients with erectile dysfunction.

To investigate the effect of sildenafil on platelet function and cyclic guanosine monophosphate (cGMP) levels in patients with erectile dysfunction, we evaluated the association between erectile function and platelet responses after administration of 100 mg sildenafil. Erectile responses were monitored after 8 daily doses of the drug. Adenosine diphosphate (ADP) and collagen-induced platelet aggregation and simultaneous adenosine triphosphate (ATP) release and cGMP levels were determined before and after sildenafil therapy. Basal levels for platelet aggregation, ATP release and cGMP were compared with age-matched controls. There was no difference among basal levels of platelet responses between patients and controls, except for ADP-induced platelet aggregation (P = 0.04). It was significantly higher in the patient group. Analysis of the responses to sildenafil revealed that for the patients who showed a positive erectile response, there was a significant increase in platelet cGMP (P = 0.028) and a decrease in ADP-induced platelet aggregation (P = 0.04). However, for those who showed a negative or poor erectile response, there was no change in platelet cGMP levels and platelet functions. Sildenafil did not affect collagen-induced platelet responses although cGMP levels of the responders increased. It is concluded that sildenafil increases platelet cGMP in the patients with positive erectile response. Therefore, it has been speculated that platelet cGMP may be used as an index for erectile response.

Indications for intraoperative frozen section in robot assisted radical prostatectomy: a pilot study.

INTRODUCTION: To evaluate indications for intraoperative frozen section (IFS) during robot assisted laparoscopic radical prostatectomy (RALRP) in our series. PATIENTS AND METHODS: Prospectively documented 80 patients with prostate cancer (PCa) who underwent RALRP were evaluated between June 2010 and July 2012. Patients were divided into 2 groups according to whether systematically IFS was performed or not. Group 1 (n=66) consisted of patients on whom systematic IFS was performed, Group 2 (n=14) consisted of patients on whom IFS was not performed. All recorded data evaluated and statistical analyses were performed for determining indications and predictive factors for IFS during RALRP. All patients were operated by single surgeon and IFS, pathological assessments were performed by experienced uro-pathologist. Statistical significant p value was p < 0.05. RESULTS: Mean follow-up was 15±6 (25-4) months. Pre-operative prostate volume in trans- rectal ultrasonography (TRUS) was statistically higher in Group 1 than Group 2 (p = 0.037). The other parameters were statistically similar in both groups. According to outcomes of our study IFS was a dependent factor for positive surgical margin. Additionally, the cut off value of prostate volume in TRUS for IFS was 55.5 cc for IFS. CONCLUSIONS: Preoperative measured prostate volume in TRUS may be an indicator of IFS. Therefore, more accurate information may be given to patients with prostate cancer (Pca) before RALRP by using preoperative prostate volume in TRUS.

Comparison of international index of erectile function with nocturnal penile tumescence and rigidity testing in evaluation of erectile dysfunction.

We tried to compare the parameters of nocturnal penile tumescence and rigidity (NPTR) testing with erectile function (EF) domain score of International Index of Erectile Function (IIEF), which is used in diagnosis and determining the severity of erectile dysfunction (ED), and to assess the sufficiency of IIEF in the diagnosis of ED. A total of 90 men, mean age 46 years (24-75), presenting with ED to our clinic between January 2001 and March 2003 were included in the trial. All the men answered the standard IIEF (15 questions) forms and was divided into four groups as mild ED, moderate ED, severe ED and no ED according to the EF domain score that is obtained from 1st, 2nd, 3rd, 4th, 5th and 15th questions. Then NPTR testing with the RigiScan Plus monitoring device was performed for two consecutive nights on those men. The distribution of the six parameters of NPTR testing (number of erections, duration of erections, TAU base, RAU base, TAU tip, RAU tip) among the four groups and the correlation with IIEF-EF domain score were evaluated. Additionally, the distribution of the risk factors (diabetes mellitus, hypertension, atherosclerotic heart disease, dyslipidemia and smoking) was analyzed both among the four groups and in each group. According to IIEF-EF domain scores of 90 patients, 16 (18%) had severe ED, 21 (23%) moderate ED, 41 (46%) mild ED and 12 (13%) no ED. There was no statistically significant difference between the risk factors among the men in these groups (P > 0.05). When the IIEF-EF domain scores were compared with parameters of NPTR testing, no statistically significant difference was obtained among ED groups (mild, moderate, severe) (P > 0.05). However, we observed a statistically significant difference between three ED groups and no ED group (P < 0.05). If NPTR testing is considered as a gold standard test, sensitivity, specificity, positive predictive value and negative predictive value of IIEF-EF domain score in ED diagnosis are 100, 17.9, 29.4 and 100% respectively. In conclusion, we did not observe a clinical correlation between IIEF-EF domain scores and NPTR parameters in the whole population; however, we observed that if IIEF-EF domain scores were normal, NPTR parameters were also normal. In other words, we can say that if the initial IIEF-EF domain scores are normal, then we do not have to perform NPTR testing. This could be helpful to make a cost-effective diagnosis.

Effect of penile size on nocturnal erections: evaluation with NPTR testing with men having micropenis.

There has been conflicting opinions in the literature regarding sexual function in hypogonadal men with micropenis. In this study we aimed to evaluate erectile function in hypogonadal men with micropenis by nocturnal penile tumescence and rigidity testing (NPTR) and compared the results with young potent normal penile sized men. A total of 15 men (ages 17-30 y) defined having a micropenis with a stretched penile length of less than 9.3 cm were constituted the study group. Mean stretched penile length was 6.8+/-1.6 cm (range 3.6-7.8 cm). Karyotype analysis showed 46XY in all cases. Control group included 22 potent and normal penile sized men (23-29 y). All subjects completed three sessions of consecutive nights using the RigiScan Plus device. Comparison of the results of NPTR of control group with study group revealed that number and duration of erectile episodes (P < 0.001), duration of tip rigidity > 60% (P < 0.01), TAU tip and TAU base (P = 0.001), and RAU base (P = 0.01) were found to be significantly lower in men with micropenis. In conclusion, our study showed that men with micropenis are associated with decreased nocturnal erectile activity.