Does transrectal ultrasonography-guided biopsy of the prostate lead to possible further metastasis via circulating tumor cells?

Background/aim: We evaluate whether transrectal ultrasonography (TRUS)-guided prostate biopsy might lead to spillage of tumor cells into peripheral blood as a result of disruption of the epithelial barrier and ultimately result in metastasis. Materials and methods: Eighty-eight patients underwent TRUS-guided prostate needle biopsy due to prostate-specific antigen (PSA) increase or abnormal digital rectal examination at the Samsun Research and Training Hospital (Samsun, Turkey) between April 2016 and September 2018. Approximately 10 mL of whole blood was collected from patients before, 1 week after, and 1 month after biopsy. Samples were analyzed for CD117 positivity and prostate-specific membrane antigen (PSMA) levels using flow cytometry. Patients with pathologically determined prostate cancer and without CD117 positivity before biopsy were included in the study. The study group thus consisted of 55 patients. Results: Subjects' PSA levels ranged from 2.3 to 40.0 ng/mL (median: 7.9 ng/mL), and their Gleason score was a median of 7 (range: 5­9). PSMA levels ranged between 9.3 ng/mL and 118.5 ng/mL and CD117 antigen levels between 0 and 5. We detected no CD117- positive cells in blood samples collected 7 days or 1 month after biopsy. Conclusion: We detected no circulating tumor cells in the peripheral circulation following biopsy. Prostate needle biopsy seems to be a safe method in terms of spillage of tumor cells into blood circulation as a possible cause of further metastasis.

Effects of varicocele on testicles: Value of strain elastography: A prospective controlled study.

The aim of this study was to evaluate the structural changes in testicles of the patients with varicocele by strain elastography (SE) and to identify the relationship between semen analysis and hormone levels considering SE results. The patients were separated into two groups as varicocele and control, according to their physical examination and the scrotal colour duplex ultrasonography results. All patients underwent examination by hormonal profile, semen analysis, colour duplex ultrasonography and sonoelastography. Testicular volume, resistive index (RI) of intratesticular arterial flow, strain rate and varicocele measurements were recorded. The left testicle strain ratios (SR) median value was 0.18 (0.15-0.26) in the varicocele group and 0.25 (0.19-0.28) in the control group (p < 0.001). The median RI value was 0.59 (0.52-0.64) in the varicocele group and 0.52 (0.5-0.59) in the control group (p < 0.001). No difference was found considering volume between the right and left testicles in either group. These results showed that elastography could be useful to detect the damage caused by varicocele on testicles in early period. However, studies with more patients would help to increase elastography's value and reliability.

The effect of migraine and tension-type headaches on female sexual functions: A prospective, cross-sectional, controlled study.

OBJECTIVE: We aimed to investigate the effects of migraine and tension-type headaches (TTH) on female sexual function. MATERIAL AND METHODS: In this prospective study, sexually active females; 45 who were suffering from migraines, 47 who were TTH patients as diagnosed by a neurology clinic, and 50 who were healthy women that served as the control group were included. Sexual functions of the cases were evaluated through the Female Sexual Function Index (FSFI) with Turkish validation and the results were compared among the groups. RESULTS: There was no significant difference between the ages and body mass index (BMI) of the migraine, TTH, and control groups. Although there was no significant difference between the FSFI scores of women with migraines and TTH, the FSFI scores of these two groups were found to be statistically significantly lower than that of the control group (16.77±4.27, 17.56±3.47, 26.81±3.19) (p<0.001). When all subgroup scales of FSFI scores were examined, both migraine and TTH groups were found to be significantly lower than the control group (p<0.001). CONCLUSION: This study shows that migraines and TTH disrupt the quality of life for patients and cause female sexual dysfunction. Therefore, it is important that patients with neurologic disorders are also evaluated for sexual dysfunction.

Effect of Intra-abdominal Pressure Rise on Hematological Parameters in Laparoscopic Urologic Surgery.

OBJECTIVE: To determine the potential utility of hematological parameters in the diagnosis of intra-abdominal hypertension (IAH). STUDY DESIGN: Cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Health Sciences University, Samsun Training and Research Hospital, Samsun, Turkey, from January 2016 to July 2017. METHODOLOGY: Forty-two patients who underwent transperitoneal laparoscopic urologic surgery were included. Blood samples were obtained during periods of pre-insufflation, insufflation, and desufflation to determine the effects of increased intraabdominal pressure (IAP) on hematological parameters, respectively. RESULTS: Leukocyte and neutrophil median values changed with time (p<0.001). The median pre-insufflation, insufflation, and desufflation values for leukocytes were 6.3 fL (4.2-7.8 fL), 7.2 fL (4.4-9.9 fL), and 8.1 fL (4.9-13.5 fL), respectively. In the pre-insufflation period, the median value for neutrophils was 3.7 x 103 µL (2.0-6.2 x 103 µL), increasing 5.1 x 103 µL (2.1-9.7 x 103 µL) during insufflation and 6.1 × 103 µL (3.1-10.0 x 103 µL) during desufflation. The median values obtained in pre-insufflation period were significantly lower than those recorded in the other periods. There was no difference between the median values obtained during insufflation and those obtained during desufflation. The mean platelet volume (MPV) values during pre-insufflation, insufflation, and desufflation were 8.2 fL (6.3-9.6 fL), 8.8 (6.2-10.3 fL), and 8.1 (6.6-10.6 fL), respectively. There was a statistically significant increase in MPV values during high IAP (p<0.001). CONCLUSION: The rise in MPV during IAP rise indicated that this parameter may be used to detect IAH.

The use of diclofenac sodium in urological practice: A structural and neurochemical based review.

Diclofenac sodium (DS) is a non-steroidal anti-inflammatory drug with antipyretic and analgesic effects. It is mainly found in the form of sodium salt. The mechanism of action of DS operates by way of cyclooxygenase (COX) inhibition. The physiological effect of this substance derives from a decrease in prostaglandin production. DS is a benzeneacetic acid derivative with anti-inflammatory properties. As a non-steroidal anti-inflammatory drug (NSAID), DS binds to both forms of COX (COX-1 and COX-2) and inhibits the conversion of arachidonic acid into pro-inflammatory prostaglandins by means of chelation. At the same time, this agent is also able to inhibit tumor angiogenesis, in which COX-2 is involved. DS is effective in overcoming pain and inflammation when it inhibits COX-2, but gastrointestinal side effects appear when it inhibits COX-1. In this review, we have focused on chemical structure and pharmacokinetic properties and renal effects of DS in light of current knowledge. Additionally, use of diclofenac nanoparticles were also discussed.

Preputial bacterial colonisation in uncircumcised male children: Is it related to phimosis?

OBJECTIVE: To evaluate the presence of uropathogens in the periurethral skin and the effect of phimosis on bacterial colonisation. METHODS: The observational cohort study was conducted in Samsun Research and Training Hospital, Samsun, Turkey from June to December, 2014, and comprised patients undergoing circumcision. Before circumcision, all children were examined in the operating room and the presence of phimosis was recorded. All patients had circumcision performed by the same surgical team under general anaesthesia. Before the procedure, samples were taken from preputial skin of all patients by swab before cleansing with polyvidone-iodine. The samples were inoculated on 5% sheep blood agar and eosin-methylene blue agar. RESULTS: The median age of the 117 children was 5 years (range: 1-12). Of the total, 19(16.2%) children had complete phimosis, and 72(61.5%) had partial phimosis. In all,91(77.7%) children had phimosis and 26(22.3%) had no phimosis. Of the 91 patients with different degrees of phimosis, 52(57.1%) had clinically significant uropathogenic bacterial colonisation >100,000 colony-forming units per millilitre [cfu/ml]). Of the 26 patients without phimosis, 13(50%) had clinically significant colonisation. Thus, there was no effect of the presence of phimosis on bacteria colonisation (p=0.655). CONCLUSIONS: Important uropathogens colonise the preputium in uncircumcised male children. There was no effect of phimosis on colonisation.

Pathological Investigation of Childhood Foreskin: Are Lichen Sclerosus and Phimosis Common?

OBJECTIVE: To evaluate histopathological results of foreskin removed during circumcision in the pediatric age group and the relationship between these and the degree of phimosis. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Urology, Samsun Training and Research Hospital, Samsun, Turkey, from June to December 2014. METHODOLOGY: Male children undergoing planned circumcision were examined for the presence and degree of phimosis which was recorded before the operation. After circumcision, the preputial skin was dermatopathologically investigated. Pathological investigation carefully evaluated findings such as acute inflammation, chronic inflammation, increased pigmentation and atrophy in addition to findings of Lichen Sclerosus (LS) in all specimens. The pathological findings obtained were classified by degree of phimosis and evaluated. RESULTS: The average age of the 140 children was 6.58 ±2.35 years. While 61 (43.6%) children did not have phimosis, 79 (56.4%) patients had different degrees of phimosis. Classic LS was not identified in any patient. In a total of 14 (10%) children, early period findings of LS were discovered. The frequency of LS with phimosis was 12.6%, without phimosis was 6.5% (p=0.39). The incidence of histopathologically normal skin in non-phimosis and phimosis groups was 37.7% and 22.7%, respectively. In total, 41 (29.3%) of the 140 cases had totally normal foreskin. CONCLUSION: Important dermatoses such as LS may be observed in foreskin with or without phimosis. The presence of phimosis may be an aggravating factor in the incidence of these dermatoses.

The efficacy of udenafil in end-stage renal disease patients undergoing hemodialysis.

INTRODUCTION: Erectile dysfunction (ED) is frequently observed in end-stage renal disease (ESRD) patients on hemodialysis (HD) compared to non-uremic patients. This situation causes severe psychogenic problems in patients and disrupts the quality of life. Different phosphodiesterase type 5 (PDE-5) inhibitors have been used, and efficacies revealed, for the treatment of ED in HD patients; however, there are no studies related to udenafil use or results for HD patients. This study retrospectively evaluated the efficacy and reliability of udenafil for HD patients. MATERIALS AND METHODS: The laboratory findings, side effects after treatment, and International Index of Erectile Function (IIEF) scores before and after treatment were compared and evaluated for HD patients who applied to our urology clinic with ED complaints and were treated with udenafil. RESULTS: The results showed that in the HD patient group with ED, apart from ED, there were severe rates of other sexual dysfunction. In our patient group, there was a statistically significant improvement in all scores for erectile function (p = 0.033), orgasmic function (p < 0.001), sexual desire (p < 0.001), relationship satisfaction (p < 0.001), and general satisfaction (p < 0.001) after treatment. The reported side effects were headache in one patient and dyspepsia in one patient. CONCLUSION: We concluded that udenafil is an effective and reliable treatment approach for HD patients; however, our results require support from prospective randomized crossover studies with sildenafil.

Incidence of bacterial colonisation after indwelling of double-J ureteral stent.

OBJECTIVE: To determine the bacterial colonisation after double-J stent use and the risk factors for bacteriuria linked to the stent. MATERIALS AND METHODS: A total of 102 patients (61 men and 41 women, mean age 47.5 ± 14.16) were examined. The stents were removed under aseptic conditions, and a urine culture was obtained before the removal of the stents. After the stents were removed, the upper, central and lower sections were separated, and washing water was sent through the stent. RESULTS: Bacterial colonisation was found in 29.4% (30 of 102) of the stents. The most frequently observed microorganisms were determined as staphylococcus, coagulase negative (8 of 30) and E. coli (5 of 30). The washing fluid used to clean the interior of the catheter produced pathogens in 8 patients (7.8%), and these pathogens were observed to be the same microorganisms that colonised the outside of the stent. There was no statistical difference between the patients with colonisation and those without in terms of age, gender, duration of stenting and reason for stent insertion. CONCLUSIONS: Though stent colonisation does not always entail symptomatic urinary tract infections, as shown in our study, the pathogens in the urine culture are the same as those colonising the stent, confirming the reality that colonisation is the main factor in these events. Additionally, according to our study, significant colonisation may be found in the first 3 weeks, contrary to the literature, causing us to consider that urinary tract infections may develop even in the early period.

Pediatric extracorporeal shock wave lithotripsy: multi-institutional results.

AIM: To evaluate the efficacy, auxiliary procedures and complications of pediatric extracorporeal shock wave lithotripsy (ESWL) performed with electrohydraulic lithotripters. METHODS: Children with urolithiasis, aged between 0 and 15, were retrospectively evaluated. ESWL was performed by using two different electrohydraulic lithotripters, Elmed Multimed Classic (Elmed Medical Systems, Ankara, Turkey) and E-1000 (EMD Medical Systems, Ankara, Turkey), between January 2008 and December 2012 in four different referral centers in Turkey. RESULTS: 85.5% of patients were stone-free at 3 months. Further ESWL treatment was needed in 33.7% of the cases (one session, n = 55; two sessions, n = 15; three sessions, n = 13). Steinstrasse occurred in 10 patients but 8 of them cleared completely during the follow-up period. Urinary tract infection was detected in 3 (3.9%), fever in 3 (3.9%) and a small subcapsular hematoma in one (1.3%) patient, respectively. When the stones were divided into two groups as those with diameters <10 mm and ≥10 mm, it was found that the stone-free rate was associated with stone diameter, and that the smaller diameters had higher but statistically insignificant stone-free rates (P = 0.196). CONCLUSION: ESWL yields favorable results with low rates of complication and auxiliary procedures in selected pediatric patients.

Comparison of Sexual Functions in Pregnant and Non-Pregnant Women.

PURPOSE: The physiology and anatomy of pregnant women change during pregnancy. Pregnancy is an anatomically and physiologically amended process experienced by women and as a result of these changes, sexual life of pregnant women alters during pregnancy. We aimed to compare sexual functions of pregnant and non-pregnant women. MATERIALS AND METHODS: Sexually active 246 pregnant women were included into this cross-sectional controlled study. A total of 210 non-pregnant women were served as control. Both groups were compared in terms of age, gestational age, presence of urinary incontinence, body mass index, and obstetrical history. Sexual functions of the women were evaluated with Female Sexual Function Index (FSFI). Data were analyzed using chi-square, Mann-Whitney U, Fisher's Exact, Shapiro Wilk, Kruskal Wallis and Dunnett's tests where appropriate. The Pvalues < .05 were considered statistically significant. RESULTS: Mean age in both groups were comparable (P = .053). Median total FSFI scores in the pregnant women were significantly lower than those non-pregnant (18.9 vs. 22.7; P < .05). Additionally, the subgroup analyses of the FSFI scores were found that, total FSFI score is significantly lower in the pregnant group compared to non-pregnant group (P < .05). Furthermore, rate of sexual dysfunction in pregnant women was significantly higher than those non-pregnant women (91.08% vs. 67.61%, P = .0001). However, in pregnant women, no meaningful difference in rate of sexual dysfunction was found according to the trimesters (P = .632). Moreover, gravidity and parity exhibited negative impacts on the sexual functions. But number of abortions did not affect sexual function. CONCLUSION: These data demonstrate that pregnancy significantly diminishes sexual function in women. We believe that, couples need to be counseled regarding the impact of pregnancy on sexual functions.

Extracorporeal shock wave lithotripsy in the primary treatment of encrusted ureteral stents.

Double pigtail (JJ) ureteral stents, are the most commonly used method of urinary diversion in the ureteral obstructions. Encrustations may occur as a result of prolonged exposure due to forgetting these stents in the body. Removing these materials might be an annoyance. Forty-four patients from three tertiary referral centres with forgotten JJ stents left in them between the years 2007 and 2014 were included in the study. Stents could not be removed by attempted cystoscopy. As an alternative approach, extracorporeal shock wave lithotripsy (ESWL) was the first choice since it is minimally invasive. The results of that treatment are presented along with the relevant demographic data. JJ stenting for urolithiasis was performed in 36 patients, after open surgery in five patients, and for oncological reasons in three patients. ESWL was applied to stents or to any suspicious region adjacent to the stent. In 29 of 44 patients, the stents were easily removed under cystoscopic procedures while in one patient the fragmented residual stent was spontaneously excreted. In eight patients, ureteroscopy was required; in five patients, percutaneous nephrolithotripsy was required; and in one patient, open surgery was required in order to remove stents. ESWL can be considered as a first-line treatment when a forgotten JJ stent is detected despite all precautions after any kind of urological intervention involving insertion of ureteral stents.

A comparison of efficacies of holmium YAG laser, and pneumatic lithotripsy in the endoscopic treatment of ureteral stones.

OBJECTIVE: We aimed to compare the effectiveness of holmium YAG laser and pneumatic lithotripsy in the treatment of ureteral stones. MATERIAL AND METHODS: A total of 216 patients who had established indications of ureteroscopy between November 2011 and June 2012 were included in this study. Patients' files were retrospectively reviewed by dividing cases as groups that underwent pneumatic (PL) or laser lithotripsy (LL) procedures. Age, sex, stone burden and localization, duration of follow-up, operative times were evaluated. Stone-free rates were evaluated by ureteroscopical examination, postoperative scout films and ultrasonography. RESULTS: Group PL consisted of 109 and group LL of 107 patients. Median age was 43.93±15.94 years in Group PL and 46.15±14.54 years in Group LL. Male to female ratio, stone burden and localization were similar for both groups. Overall success rate was 89.9% in Group PL and 87.9% in Group LL, respectively (p<0.791). With the aid of additional procedures, success rate was 100% for both groups at the end of the first month. Groups were not different as for operative time, rate of insertion of an ureteral catheter and its removal time. Hospitalization period was apparently somewhat shorter in Group LL (p=0.00). CONCLUSION: Pneumatic lithotripsy can be as efficacious as laser lithotripsy and be used safely in the endoscopic management of ureteral stone. In comparison of both methods, we detected no differences as to operative time, success of operation and the time to removal of the catheter, however, hospitalization period was shorter in Group LL.