Does smoking change the efficacy of combination therapy with vitamin E and colchicines in patients with early-stage Peyronie's disease?

This study was conducted to find out if smoking has an effect on the results of combination therapy with vitamin E and colchicines in patients with early-stage Peyronie's disease (PD). A total of 58 potent patients suffering from early-stage PD were included in the study (mean age 47.3 years, range 25-73 y). The time from onset of the disease was <6 months and no patient had ED. The patients with severe fibrotic or calcified plaques were not included in the study. Of the patients, 36 were smokers (Group 1) and 22 were non-smokers (Group 2). All the patients received vitamin E (800 IU daily) and colchicines (1 mg daily) for 6 months. Follow-up ranged from 5 to 13 months (mean 10.3 m). The combination therapy was effective and well tolerated in both groups. There were no significant differences between the two groups according to age, disease duration, related disease (diabetes, hypertension, hypercholesterolemia, and hypertriglyceridemia), plaque sizes, and plaque numbers. The resolution in pain and increase in penile curvature and plaque size were similar rates in both groups (p > 0.05), while decrease in penile curvature and plaque size were higher in Group 2 (p < 0.05). No patient discounted the therapy due to side effects. The oral combination therapy with vitamin E and colchicines appears to be an effective procedure in patients with early-stage PD and smoking may have worsening effects on the treatment results.

Induction of spermatogenesis by inguinal varicocele repair in azoospermic men.

13 infertile patients who had complete azoospermia and clinical varicocele underwent inguinal varicocele repair. Semen analyses were obtained starting 3 months after varicocele repair. Bilateral varicocele repair in 2 men and unilateral in 11 men were performed. Induction of spermatogenesis was achieved in 3 (23%) patients. Two of them had hypospermatogenesis and one had maturation arrest at spermatid stage. No pregnancies by natural intercourse resulted. Although one couple used fresh ejaculate for intracytoplasmic sperm injection, the result was unsuccessful. All men with Sertoli cell-only and early maturation arrest remained azoospermic after surgery. No association between successful outcome and patient age, sex hormone analysis, varicocele grade, testicular volume, unilateral or bilateral varicocele repair were apparent. Varicocele repair can result in the induction of spermatogenesis for men with hypospermatogenesis and late maturation arrest. No other related factor could be detected.

Is dorsale penile vein ligation (dpvl) still a treatment option in veno-occlusive dysfunction?

PURPOSE: To determine the long-term results of the DPVL for the treatment of venous impotence. PATIENTS AND METHODS: The long term results of DPVL in 134 patients were interviewed. The mean age was 39.2 (range 21-72). Power color doppler imaging, pharmacocavernography/dynamic cavernosometry were performed. Postoperatively, all the patients were controlled in the 6th month, first year and, if possible, once a year. The mean follow-up was 54.8 (14-76) months. Postoperative outcomes were classified into three groups: complete spontaneous erection (CR), response to pharmacotherapy (PR) or no satisfactory improvement (NR). RESULTS: The short-term success in the 6th month according to above mentioned was 38.8%, 18.6% and 42.5%; and in the first year was 19.4%, 14.9% and 65.6% respectively. The result in 35 patients whose follow-up was at least 5 years (mean 67 months) was 11.4%, 14.3% and 74.3% respectively. Positive prognostic factors were preoperative age <40, duration of erectile dysfunction <2 years, non-smoker patients, non neurogenic disease and distal disease. With all these parameters present, long-term success (CR, PR) rose from 33.6% to 55.9% (P < 0.001). CONCLUSIONS: Long-term success for unselected patients undergoing DPVL is disappointing; however, careful patient selection significantly improves long-term results.

Is dorsale penile vein ligation (DPVL) still a treatment option in veno-occlusive dysfunction?

PURPOSE: To determine the long-term results of the DPVL for the treatment of venous impotence. PATIENTS AND METHODS: The long-term results of DPVL in 134 patients were interviewed. The mean age was 39.2 (range 21-72). Power color doppler imaging, pharmacocavernography/dynamic cavernosometry were performed. Postoperatively, all the patients were controlled in the 6th month, first year and, if possible, once a year. The mean follow-up was 54.8 (14-76) months. Postoperative outcomes were classified into 3 groups: complete spontaneous erection (CR), response to pharmacotherapy (PR) or no satisfactory improvement (NR). RESULTS: The short-term success in the 6th month according to above mentioned was 38.8%, 18.6% and 42.5%; and in the first year was 19.4%, 14.9% and 65.6% respectively. The result in 35 patients whose follow-up was at least 5 years (mean 67 months) was 11.4%, 14.3% and 74.3% respectively. Positive prognostic factors were preoperative age <40, duration of erectile dysfunction <2 y, non-smoker patients, non neurogenic disease and distal disease. With all these parameters present, long-term success (CR, PR) rose from 33.6% to 55.9% (p < 0.001). CONCLUSIONS: Long-term success for unselected patients undergoing DPVL is disappointing; however, careful patient selection significantly improves long-term results.

Risk factors for penile prosthetic infection.

OBJECTIVES: To determine the risk factors for penile prosthesis infection. METHODS: The records of 135 penile prosthesis implantation in 127 patients were reviewed. Of the 135 prothesis, 115 were malleable, 12 were self-contained and 8 were inflatable. Of these procedures, 111 were primary, 9 were primary with reconstructions and 15 were secondary. Mean follow-up was 47 months (minimum 6 months). All of the reconstructions were penile plications or plaque excisions for Peyronie's disease. RESULTS: The ratio of penile prosthesis infection was 8.89%. Secondary implantation, paraplegia, non-controlled diabetes mellitus (p < 0.001) and surgeon's inexperience (p < 0.05) were detected as the risk factors for penile prosthesis infection. But age, smoking, alcohol consumption, obesity, atherosclerosis, presence of diabetes mellitus (DM), history of penile surgery, simple penile reconstruction, type of the erectile dysfunction (ED), type of the penile prostheses and incision and were not found as the risk factors (p > 0.05). CONCLUSIONS: Paraplegie, non-controlled diabetes mellitus, secondary implantation and surgeon's inexperience appear to be the risk factors for penile prosthesis infection. In secondary implantation, longer operation time is detected as a factor increasing the risk of penile prosthesis infection. For these patients, careful preoperative preparation, more attention to perioperative antisepsis and postoperative follow-up are required. Since it has been determined that surgical experiences decrease the complication rate, these patients should be operated by experienced surgeons.

Objective penile vascular response to intraurethral prostaglandin E2 (dinoprostone).

PURPOSE: Intraurethral prostaglandin E2 (PGE2) administration is a noninvasive treatment modality for erectile dysfunction. The purpose of this study was to evaluate the objective effects of this agent by measuring peak systolic velocities of cavernosal arteries after intraurethral PGE2 administration and comparing with the results obtained with an intraurethral placebo gel and intracavernous papaverine injection. MATERIALS AND METHODS: The study group consisted of 22 consecutive impotent volunteers with a mean age of 46 years who had normal penile arterial responses as determined by penile arterial responses on papaverine-stimulated penile duplex ultrasonography. The peak systolic velocity in cavernosal arteries was recorded after intracavernous injection of 60 mg of papaverine. All patients received 1 mg of intraurethral PGE2 gel and placebo at 15-day intervals. The peak systolic velocities were recorded after each treatment. RESULTS: Mean peak systolic velocity achieved by intraurethral administration of PGE2 gel (25 +/- 8 cm/s) was less than that achieved by intracavernous papaverine (40 +/- 6 cm/s) but higher than that obtained by placebo (15 +/- 4 cm/s). Twelve patients had erections, while 9 had partial and 1 had no erection with intraurethral PGE2. Placebo did not cause any erections. No serious side effects were observed. CONCLUSION: Intraurethral administration of PGE2 appears to be an effective and simple method for increasing penile arterial flow and can be used during penile Doppler ultrasonography to stimulate the penile arterial system.

The application of appendiceal Mitrofanoff principle to Stanford pouch.

OBJECTIVE: The present paper reports the functional aspects of a novel continent cutaneous reservoir. PATIENTS AND METHODS: A continent cutaneous reservoir was constructed by the application of appendiceal Mitrofanoff principle to Stanford pouch in four male and three female patients between 1995-1998 in our clinic. The mean age of the patients was 45.6 years (7-67 years) and the etiological factor was carcinoma of the bladder in four, interstitial cystitis in one and extrophy-epispadias complex in two cases. Patients were followed with arterial blood gas determination, serum biochemistry, urinalysis and urine culture at postoperative 3 weeks and by 3-month intervals thereafter. Additionally, pouch graphy, abdominal ultrasonography and urodynamic tests were performed every 6 months. RESULTS: After the operation all the patients were continent. Stoma was transferred from the umbilicus to the right lower quadrant in one case (14.3%) because of difficulty in catheterisation. Pouch graphy at postoperative 6 months revealed low-grade vesicoureteral reflux in two (28.6%) patients and one (14.3%) of them required suppressive antibiotic therapy because of pyelonephritis episodes. Another patient developed hyperchloremic metabolic acidosis and needed oral alkaline supplementation. The mean pouch capacity measured at postoperative 6 months was 423 (350-550) ml and the mean end-filling pressure was found as 21 (18-25) cmH2O. After a mean follow-up period of 37 (18-45) months all the patients remained continent and stable. CONCLUSION: The continent cutaneous reservoir presented herein is our alternative to orthotopic neobladder in female patients undergoing radical cystectomy. It also provided continence as well as good quality of life in patients with extrophy-epispadias complex and male patients after radical cystectomy and urethrectomy.

Isolated renal and retroperitoneal hydatid cysts.

Four patients (3 male, 1 female) with isolated renal and 1 female patient with isolated retroperitoneal cysts were reviewed. The mean age of the patients was 46 (25-64). The most common presenting symptom was pain. Two cases were discovered incidentally by the observance of renal calcification on abdominal x-ray. Indirect hemagglutination test was positive in all cases but eosinophilia was present only in 1 (20%) case. Nephrectomy was performed to 1 patient who presented with hydaturia and had a large communicating cyst involving most of the kidney. Total cystectomy was performed in other renal cysts. Total cystectomy with wide excision of the involved muscle was performed to the retroperitoneal hydatid cyst. Patients were followed by an average of 23.8 (9-50) months with indirect hemagglutination test and USG. No evidence for recurrence was found up to date.

Clinical, urodynamic and endoscopic characteristics of the stanford pouch ileal neobladder constructed with absorbable staples.

PURPOSE: The clinical, urodynamic and endoscopic aspects of the Stanford pouch ileal neobladder formed with absorbable staples were investigated. METHODS: A Stanford pouch ileal neobladder was formed using absorbable staples after radical cystoprostatectomy in 30 male patients with the diagnosis of muscle invasive carcinoma of the bladder between 1995 and 1998. The mean age of the patients was 62 (range 41-70) years. Patients were followed with arterial blood gas, serum biochemistry, pouch cystography, urodynamic tests and endoscopy. RESULTS: Five (16.7%) patients had early postoperative complications and three were related to the neobladder. One year postoperatively, low grade (I, II) vesicoureteral reflux was present in five (16.7%) cases. The mean preoperative and 6 months postoperative serum creatinine levels were 1.07+/-0.3 mg/dL and 1.2+/-0.4 mg/dL, respectively, but the difference was not statistically significant (P=0.1). Six months postoperatively the mean serum chloride level was 109+/-4.5 (range 100-113) mmol/L and the mean arterial blood pH was 7.37+/-0.2 (range 7.3-7.4). Two (6.7%) patients required oral alkaline supplementation because of high chloride levels. All the patients except one were continent throughout the day after 1 year. However, nocturnal enuresis was present in 25 (83.3%) cases. The pouch capacity was increased gradually up to 12 months postoperatively and the mean pouch capacity 12 months postoperatively was 460+/-95.8mL. Micturition occurred spontaneously in most patients while some needed abdominal straining. None of the patients had a residual urine of more than 60 mL. The mean maximum flow rate 6 months postoperatively was 9.8 (range 5.4-15.0) mL/s. After 6 months the stapled edge was noticed as a nodular line. One year postoperatively only a white scar could be observed at the suture line. CONCLUSION: The Stanford pouch ileal neobladder constructed using absorbable staples was able to provide a good capacity low pressure reservoir with a low rate of complications.

The relation between p53 overexpression and lymph node metastases in clinical stage t2 and t3a transitional cell bladder carcinoma.

Mutant p53 protein overexpression is generally associated with poorly differentiated invasive bladder tumors. The survival in such cases is also expected to be poor. The objective of the present study was to determine whether immunohistochemical staining for p53 was predictive of lymph node metastases in early muscle invasive transitional cell bladder cancer. Immunohistochemical staining for mutant p53 was performed on formalin fixed transurethral resection specimens of 31 patients who underwent radical cystectomy. Eleven tumors were grade II and 20 tumors were grade III. There were 16 stage T2 and 15 stage T3a tumors. Staining with p53 was categorised as positive if distinct nuclear staining was observed in > or = 20% of the cells. Results were compared according to grade, stage (T2 versus T3a) and lymph node metastases. Seventeen tumors (55%) were positive for mutant p53. Eleven cases had lymph node metastases which could not be assessed preoperatively. The distribution of p53 positive rate between grade II and grade III cases, and T2 and T3a tumors was not different. All the 11 patients with lymph node metastases had positive tumors for p53. We assume that p53 positive rate can be used to distinguish high risk patients for lymph node metastasis. Patients with stage T2 or T3a and p53 positive bladder cancer should be considered for early aggressive treatment options.

Effects of the 5 alpha-reductase inhibitor finasteride on serum levels of gonadal, adrenal, and hypophyseal hormones and its clinical significance: a prospective clinical study.

In the present study, we investigated the effects of a steroid 5 alpha-reductase inhibitor, finasteride, when given orally (5 mg/day), on the serum levels of gonadal, hypophyseal, and adrenal hormones and the clinical significance of these effects. Forty-eight patients with a mean age of 63 (range 49-81) were included in the study. All patients had symptoms of benign prostatic hyperplasia. Serum levels of testosterone, dihydrotestosterone, follicle-stimulating hormone (FSH) luteinizing hormone (LH), prolactin, aldosterone, cortisol, and dehydroepiandrosterone were determined before the study. The degree of symptoms in each patient and serum prostate specific antigen levels were determined together with uroflowmetric studies. Sexual status of the patients was also assessed with a self-administered questionnaire. All patients received finasteride, 5 mg/day, for 6 weeks. All of the above mentioned studies were repeated at month 3 and month 6. All of the patients had baseline hormonal values within the normal range. At month 3, the dihydrotestosterone level decreased by 60%, while the testosterone level increased by 15%. FSH and LH levels decreased by 24% and 16%, respectively. The changes in the serum levels of these hormones were further evident at month 6. No significant changes were noted in the serum levels of prolactin, aldosterone, cortisol, and dehydroepiandrosterone. Thirty-six patients (75%) were judged to be potent before the treatment. Finasteride caused erectile dysfunction in 8 patients (22%) by month 3 and in 12 (33%) by month 6. A substantial improvement was noted in symptoms of benign prostatic hyperplasia in all patients. The serum prostate specific antigen level decreased by 42% and 50% at month 3 and at month 6, respectively. Continued administration of finasteride, 5 mg/day alters the serum levels of testosterone, dihydrotestosterone, FSH, and LH significantly. Finasteride also causes sexual dysfunction in a substantial number of patients and should be offered with caution to patients who have an active sexual life.

Erectile dysfunction following treatments of benign prostatic hyperplasia: a prospective study.

The effects of open prostatectomy, transurethral resection, transurethral vaporization, doxazosin and finasteride on sexual functions of men were investigated in a total of 305 patients with benign prostatic hyperplasia. The sexual functions of the patients were assessed with a questionnaire before treatment and 3 and 6 months after the treatment. A total of 212 (70%) patients were judged to be potent before the treatment. At 3 months, open prostatectomy and transurethral resection caused erectile dysfunction in 2 of 40 (5%) and 5 of 89 (6%) potent patients, respectively. At 6 months, one of the patients from the former and 2 of the patients from the latter groups who developed erectile dysfunction at 3 months stated improvement. Transurethral vaporization caused loss of erectile functions in 4 of 14 potent patients (29%) at the 3-month follow-up and, one of these patients recovered erectile functions at 6 months. Only one of the 33 patients (3%) using doxazosin stated that he lost his erectile functions both at 3 months and 6 months. At 3 months follow-up, finasteride caused loss of erectile functions in 8 of 36 potent patients (22%). Four of these patients underwent surgery (transurethral resection) after 3 months of finasteride use. At the 6-month follow-up, 4 more patients suffered from loss of erectile functions. We suggest that finasteride and transurethral vaporization have the greatest potential of impairing the sexual functions among the treatment options investigated in this study and that they must be carefully offered to the potent patients.

13 years' experience of penile fracture.

Thirty-two cases of penile fracture in 1983-1996 were retrospectively reviewed and the patients were recalled for assessment of current status. The time from injury to repair ranged from 8 to 31 hours. The tear in the tunica albuginea was repaired with absorbable interrupted sutures. All patients were discharged on the day after operation. Skin loss required dermal grafting one month postoperatively in one patient. Erectile function returned within 2 days and coitus was achieved on average 13 days after the repair. Two patients had slight penile curvature which did not impede coitus. At long-term follow-up all patients reported satisfactory function.

Malignant gonadal stromal tumor with bulky metastasis at diagnosis.

A 63-year-old man underwent inguinal orchiectomy for painless enlargement of the left testis. The diagnosis of malignant gonadal stromal tumor was made on the basis of morphology and immunohistochemical studies. At computed tomography there was bulky retroperitoneal metastasis. The patient then underwent retroperitoneal lymphadenectomy and received 6 courses of platinum-based chemotherapy at the end of which complete response was documented. However, at 18 months' follow-up, computed tomography revealed recurrent retroperitoneal metastasis. The patient was put on chemotherapy regimen again. But he developed pulmonary metastasis and died 28 months after the initial diagnosis. The clinical course of this patient suggests that malignant gonadal stromal tumor, if metastatic at diagnosis, may have a poor prognosis against most aggressive treatment approaches.

A novel continent cutaneous reservoir: application of appendiceal Mitrofanoff principle to Stanford pouch.

We describe our modification of Stanford pouch orthotopic bladder replacement both by formation of the pouch with absorbable staples (poly-GIA) and diverting it with the appendiceal Mitrofanoff conduit. This operation was performed on two patients with focal invasive bladder cancer--a male patient with bladder extrofia and a patient with a severely contracted bladder due to interstitial cystitis. No operative or postoperative complications were encountered. Follow-up after operation ranged between 6 and 16 months. The functional and cosmetic results of the operation were satisfactory. This operative modification may be considered for the patient requiring cystectomy who is not a candidate for orthotopic bladder replacement.

The correlation between prostate-specific antigen and age. Analysis of prostate-specific antigen values from 4,846 Turkish men with symptomatic benign prostatic hyperplasia.

OBJECTIVE: To analyze serum prostate-specific antigen (PSA) levels of men proven to have benign prostatic hyperplasia (BPH) and to document any correlation between PSA, age and resected or enucleated prostate tissue. PATIENTS AND METHODS: Serum PSA values, age and weight of specimens of 4,846 men who underwent prostatectomy in the Ankara region between January 1, 1991, and December 24, 1995, were reviewed retrospectively. RESULTS: Serum PSA values correlated directly with age (Pearson's r = 0.45, p < 0.00001). The mean PSA values of men in each decade of age differed significantly (p < 0.0001) from all other decades. However, the correlation between the weight of the prostatectomy specimen and age or PSA did not reach statistical significance. CONCLUSION: The effect of age on PSA is evident in men with symptoms of BPH. The existence of symptomatic BPH should also be considered together with age when interpreting PSA levels.

Conservative management of stage T2 or T3a bladder cancer with deep transurethral resection followed by four cycles of chemotherapy.

OBJECTIVE: To evaluate the efficacy of the conservative management of stage T2 and T3a bladder cancer with deep (radical) transurethral resection (TUR) followed by four cycles of chemotherapy with methotrexate, vinblastine, epirubicin and cisplatin (MVEC) and its impact on bladder preservation and tumour recurrences. PATIENTS AND METHODS: Between May 1990 and June 1995, 19 patients with stage T2 or T3a transitional cell carcinoma of the bladder who refused radical cystectomy entered the study. The patients were re-evaluated 4 weeks after completion of the treatment by cystoscopy, TUR of the tumour site and multiple deep bladder biopsies. The patients were maintained on periodic local and systemic surveillance with cystoscopy and deep biopsy every 3 months, and annual intravenous urography and computed tomography. RESULTS: Seventeen patients completed the treatment protocol; 13 patients were tumour-free at the first evaluation after treatment and six of these had tumour recurrences in the bladder during surveillance. Eleven patients retained their bladder in a functional state for a mean duration of 36 months (range 12-62+) and seven of them remain free of recurrence after a mean duration of 41 months (range 8-58+). CONCLUSION: Deep TUR of the bladder tumour followed by four cycles of MVEC chemotherapy is an effective alternative in the conservative management of patients with stage T2 and T3a bladder cancer. We suggest this protocol for patients who refuse or are unsuitable for surgery.

The efficacy of anti-serotoninergic agents in the treatment of erectile dysfunction.

We investigated 3 agents with antiserotoninergic activity (oral trazodone, ketanserin and mianserin) in a double-blind randomized placebo controlled design in terms of the effectiveness in erectile dysfunction. Positive response rates to 30 days of treatment were 65.2% with trazodone, 19.1% with ketanserin, 31.6% with mianserin and 13.6% with placebo. Response to trazodone treatment was significantly better than with placebo (p = 0.0004) and the other 2 agents (p = 0.03 and p = 0.002 for mianserin and ketanserin, respectively). The effectiveness of ketanserin and mianserin seemed to be greater than that of placebo but the differences did not reach statistical significance (p = 0.63 and p = 0.17, respectively).

Reconstruction of penoscrotal transposition.

OBJECTIVE: To assess the results of surgical correction of incomplete penoscrotal transposition and its impact on subsequent definitive urethroplasties and the final outcome. PATIENTS AND METHODS: The medical records of 22 patients who had undergone surgical correction for incomplete penoscrotal transposition at one centre in the last 8 years were evaluated retrospectively. The surgical technique is described and the outcome after correction is noted. RESULTS: All cases had severe hypospadias and approximately half had associated anomalies. No major complication occurred following surgery and the appearance of the external genitalia was satisfactory as judged both by the surgeons and patients. Operative scars did not constitute major handicaps for the subsequent urethroplasties. Sixteen patients have completed reconstructive surgery of whom 12 have glandular and four coronal meatuses. CONCLUSION: Reconstruction of penoscrotal transposition yielded satisfactory results in terms of cosmetic appearance and functional external genitalia, and is recommended before definitive urethroplasty.

Scrotal calcinosis.

Calcinosis is a rare benign lesion of the scrotum. A new case with scrotal calcinosis is presented and the relevant literature is reviewed.