[Isolation and identification of Mycobacterium tuberculosis from the urine samples by conventional and molecular methods]. / Konvansiyonel ve moleküler yöntemler ile idrar örneklerinden Mycobacterium tuberculosis izolasyonu ve tanimlanmasi.

Genitourinary tuberculosis presents a challenge in diagnosis and treatment due to variations in clinical and radiological signs, insufficient patient history and difficulty in the isolation of the bacilli. The aim of this study was to isolate and identify Mycobacterium tuberculosis from the urine samples obtained from patients with suspected urinary tuberculosis admitted to our hospital by using Ehrlich-Ziehl-Neelsen (EZN), culture and polymerase chain reaction-restriction analysis (PCR-RFLP) methods. A total of 1004 urine samples collected from 437 patients who were admitted to our hospital between January 2004-July 2006, were inoculated on Löwenstein-Jensen (LJ) and/or BACTEC 12B (Becton Dickinson, USA) after decontamination and, direct preparations stained with EZN method were evaluated microscopically. M. tuberculosis complex (MTC) and mycobacteria other than tuberculosis (MOTT) were differentiated by nitro-alpha-acetylamino-beta-hydroxypropiophenone (NAP) test and the susceptibility testing for the MTC strains to primary antituberculosis drugs were performed by BACTEC 460 TB (Becton Dickinson, USA) system. PCR-RFLP method was performed for the identification of Mycobacterium spp. Twenty-two (5%) patients have yielded positive results by at least one of the conventional methods (EZN, LJ and/or BACTEC). Fifteen samples were positive for acido-resistant bacilli (ARB) by EZN method, and 17 samples were positive for mycobacterial growth in the cultures. Ten of 22 patients were found positive by both of the methods, while seven were culture positive but ARB negative and five were culture negative but ARB positive. These five patients received BCG treatment because of the presence of bladder tumor. Twelve (70.5%) of 17 strains isolated from culture were identified as MTC, while five (29.4%) were identified as M. fortuitum. Of 12 MTC isolates, eight (66.7%) were found susceptible to all of the antituberculosis agents, while one was found resistant to isoniazide (INH) and ethambutole (ETB), one was resistant to INH and rifampicin (RIF), and two were resistant to only INH. It is concluded that, in order to identify mycobacteria and to perform antituberculous susceptibility tests, cultivation of mycobacteria is a prerequisite.

Is there a relation between irritable Bowel syndrome and urinary stone disease?

Our aim was to investigate the role of renal colic, a clinical condition characterized by excruciating pain, in the etiopathogenesis of irritable bowel syndrome (IBS). Two groups of patients were enrolled in the study. Group I consisted of 59 patients (33 male and 26 female) with a median age of 41.9 (18 to 58) years. The patients in group I were admitted to our clinic with urinary stone disease and with a medical history of acute renal colic. Group II consisted of 55 patients (25 male and 30 female) with a median age of 40.1 (18 to 56) years, complaining of urologic abnormalities other than stone disease. IBS was diagnosed using Rome criteria. Metabolic analysis for stone disease was performed on patients in group I. The incidence of five metabolic abnormalities--low urine volume, hypercalciuria, hyperoxaluria, hyperuricosuria and hypocitraturia--in patients with and without irritable bowel disease was investigated. IBS was found in 16 of the 59 patients (27.1%) in group I and in 6 of the 55 patients (10.9%) in group II. The difference was statistically significant (P < 0.05). Relative risk of developing IBS was 2.48 times higher in patients with urinary stone disease than in those without stone disease. There was no statistically significant difference in the metabolic analysis of patients with and without IBS in group I. IBS causes great suffering. Urinary stone disease should be considered as an etiological factor during management of IBS patients. In the presence of gastrointestinal symptoms, a patient with a medical history of acute renal colic might be referred to a gastroenterologist.

General anesthesia does not affect the serum complexed and free prostate specific antigen levels.

PRINCIPLES: Serum prostate-specific antigen (PSA) level is a widely used serum marker for diagnosis and management of prostate cancer. Although not well-defined, liver appears to be the most likely site of PSA metabolism. However, general anaesthesia usually changes hepatic blood flow, therefore it may affect the metabolism of PSA. In this study we investigated the affect of general anaesthesia on the serum total PSA, free PSA and free to total PSA levels. METHODS: 30 male patients who were hospitalised in the internal medicine clinic (non-surgery group) and 30 male patients who would undergo operation under general anaesthesia (15 for cholecystectomy and 15 for inguinal hernia repair) enrolled into the study. PSA measurement was done on the day of the hospitalisation (which was also the day of operation for surgery group), on the 24th hour following the first measurement and on the 21st day. Anaesthesia was standardized for all patients. RESULTS: There was no statistically significant difference in serum total PSA (p >0.05), free PSA levels (p >0.05) and free to total PSA ratio (p >0.05) between the surgery and non-surgery groups. There were statistically significant decreases in the 24th hour total PSA levels (13.8% in surgery group, p <0.05, and 13.1% in non-surgery group, p <0.05) and in the free PSA levels (4.0% in surgery group, p <0.05, and 8.2% in non-surgery group, p <0.05). There was no statistically significant difference in the free to total PSA ratios (p >0.05 and p >0.05, respectively). CONCLUSIONS: Anaesthesia does not affect PSA levels alone. However, hospitalisation decreases total and free PSA levels, although it does not have an affect on free to total PSA ratio.

How reliable are bladder perceptions during cystometry?

AIMS: Sensory input is important for bladder control in daily life. It has been reported that perceptions during cystometry are subjective. To help refine this subjectivity, objective and semi-objective tests (e.g., sensory thresholds of electrical stimulation) have been recommended by The International Continence Society. However, the reliability of such studies has not been established. This study was designed to evaluate the reliability of bladder perceptions during cystometry. METHODS: The study included 59 patients with urologic complaints. The average age of 40 male and 19 female patients was 58.1 years (range: 14-83). After insertion of an 8F double lumen catheter, patients were blinded to the pump and screen process. During Phase I nothing was infused. In Phase II, filling cystometry was performed with 50 ml/min pump speed and then the bladder was emptied. Phase III was performed with the same method used in Phase I. The time that each sensation was perceived, in seconds, was used to compare sensations. The bladder volume, at which sensations were perceived, was recorded at Phase II. RESULTS: Except for strong desire, there were no statistically significant differences between the mean times in seconds elapsed till sensations in Phases I and III, but they were different from those in Phase II. The time elapsed until strong desire was not different in each of the three phases. However, there was strong a correlation in the ratios of sensations to strong desire between Phase I and II (r = 1, P = 0.01), Phase I and III (r = 0.99, P = 0.01), and Phase II and III (r = 0.98, P = 0.01). CONCLUSIONS: Proprioception of the bladder filling during cystometry is subjective. This data shows that sensations noticed by the patient during filling cystometry may be related to stimuli other than bladder filling.

Voiding impairment after prostate biopsy: does tamsulosin treatment before biopsy decrease this morbidity?

OBJECTIVES: To evaluate the association of transrectal ultrasound (TRUS)-guided prostate biopsy with voiding impairment and to investigate whether tamsulosin treatment given before prostate biopsy could improve voiding impairment after the procedure. METHODS: The study included 66 consecutive patients who underwent TRUS-guided 12-core prostate biopsy and were prospectively randomized. Of the patients, 33 were treated with tamsulosin (0.4 mg daily) beginning the day before the biopsy procedure for 30 days. The remaining 33 patients underwent TRUS-guided prostate biopsy only with no tamsulosin treatment and served as the control group. The International Prostate Symptom Score (IPSS) and maximal flow rate (Qmax) were recorded in all patients before the procedure and on postbiopsy days 7 and 30. All patients were followed up and questioned about difficulty voiding and acute urinary retention after the procedure. RESULTS: No difference was found in the mean IPSS and Qmax before biopsy between the two groups (P >0.05). Acute urinary retention after the biopsy procedure developed in 1 patient in the tamsulosin group and 3 patients in the control group. The rate of voiding difficulty on postprocedure day 7 was significantly lower in the tamsulosin group (9.09%) than in the control group (42.42%), a statistically significant difference (P <0.001). In the tamsulosin group, the IPSS was significantly decreased on postbiopsy days 7 and 30 compared with the baseline value (P <0.05 and P <0.001, respectively), and Qmax was significantly elevated on postbiopsy day 30 (P <0.01). In the control group, the IPSS was significantly greater (P <0.05) and the Qmax was significantly lower (P <0.001) on postbiopsy day 7 compared with the baseline value. CONCLUSIONS: The results of our study show that TRUS-guided prostate biopsy leads to transient voiding impairment, and therefore, the alpha(1)-blocker tamsulosin before biopsy and for a brief interval afterward may decrease this morbidity.

Diagnosis of pediatric varicoceles by physical examination and ultrasonography and measurement of the testicular volume: using the prader orchidometer versus ultrasonography.

INTRODUCTION: The differentiation of unilateral versus bilateral varicoceles and testicular volume measurements are important in determining the need for adolescent varicocele surgery and also in following patients after varicocelectomy. The aim of this study was to prospectively compare the findings of physical examination and color Doppler ultrasonography in the diagnosis of pediatric varicoceles and to compare the findings using the Prader orchidometer and scrotal ultrasonography in the measurement of testicular volumes. PATIENTS AND METHODS: This study included 68 boys with varicoceles, ranging in age from 8 to 19 years. Varicoceles were diagnosed using both physical examination and scrotal color Doppler ultrasonography. The testicular volumes of 136 testicles were measured using the Prader orchidometer and scrotal ultrasonography. A difference of more than 10% or 2 ml in each testicular volume was considered significant. RESULTS: The mean age of the boys was 13.5 +/- 2.3 years. On physical examination, a left unilateral varicocele was diagnosed in 46 boys (67.6%). The other 22 boys (32.4%) had bilateral varicoceles. Color Doppler ultrasonography detected bilateral varicoceles in 4 of the 46 boys (8.7%) who were diagnosed by physical examination as having only left unilateral varicoceles (grade 3 in 3 patients and grade 2 in 1 patient). A different of more than 10% or 2 ml in testicular volume using the Prader orchidometer versus scrotal ultrasonography was detected in 3 out of 136 testicles (2.2%). The correlation between ultrasonography and Prader orchidometer results in the measurement of testicular volumes was statistically highly significantly consistent using the intraclass correlation test (r = 0.997 and p < 0.001 for the left testis; r = 0.998 and p < 0.001 for the right testis). CONCLUSIONS: Although the management of subclinical varicoceles remains controversial, these data show that color Doppler ultrasonography may be necessary in the diagnosis of bilateral varicoceles, especially in boys with high-grade left varicoceles. In contrast, scrotal ultrasonography, if considered the gold standard, did not show superiority over the Prader orchidometer in measuring testicular volumes.

Effect of administration mode (patient vs physician) and patient's educational level on the Turkish version of the International Prostate Symptom Score.

OBJECTIVES: To compare the effectiveness of the International Prostate Symptom Score (IPSS) when administered by the physician to when self-administered by the patient. The effect of the patient's educational level on the IPSS was also evaluated. METHODS: One hundred and seven previously untreated patients with symptomatic benign prostatic hyperplasia (BPH) completed the Turkish version of the International Prostate Symptom Score (Turkish I-PSS) and quality of life (QOL) questionnaires during a single office visit, first on their own and then with an interviewing physician. The patients were categorized into three groups according to their educational levels. Paired t-tests were performed to compare the total IPSS (tIPSS) and QOL results between the two testing modes. IPSS and QOL scores resulting from both modes were compared using a kappa test. Differences between the physician-assisted and self-administered scores among the different educational groups were further compared using a one-way anova test and Post Hoc Multiple Comparisons. To compare the objective effectiveness of tIPSS and QOL between the two testing modes, we selected the positive actual state, which was maximum urine flow (Qmax) of 15 mL/s or less and constructed receiver operating characteristics (ROC) curves for all patients. This estimation was constructed for each educational level. RESULTS: There were no statistical differences in IPSS and QOL values obtained by the patients or physicians (P > 0.05). The ROC areas for tIPSS were 0.94 and 0.93, and the ROC areas for QOL scores were 0.97 and 0.91 for information obtained by physicians and patients, respectively. When IPSS answers and QOL scores were evaluated separately, consistency was found across both modes of administration. However, there were lower levels of consistency in answers to IPSS questions 2, 5 and 6 (P = 0.59;0.42; 0.52, respectively). There was no significant difference among the aforementioned data in the educational groups. CONCLUSION: Although the total IPSS and QOL scores were not affected by the different modes of administration, we recommend that the physicians should evaluate answers to questions 2, 5 and 6 carefully. The present study demonstrates that the educational level did not affect the IPSS and QOL when administered either by the physician or the patient.

The effect of varicocele repair on testicular volume in children and adolescents with varicocele.

PURPOSE: We investigated the effect of varicocele repair on testicular volume according to age in children and adolescents and review the long-term results of varicocele surgery. MATERIALS AND METHODS: The study included 39 boys 11 to 19 years old with clinical palpable varicocele who underwent varicocele surgery with at least 1 year of postoperative followup. Preoperative and postoperative testicular volumes were monitored and measured with an ellipsoid Prader orchidometer. Physical examination findings (testicular volumes and testicular consistency) in all boys, and serum hormone values and semen parameters in 16 adolescents were recorded and compared before and after surgery. RESULTS: Left unilateral varicocelectomy was done in 29 boys (74%) and bilateral varicocelectomy in 10 (26%). While no postoperative hematoma, infection or testicular atrophy was observed, 1 boy (2.5%) had varicocele recurrence and 2 boys (5.1%) had minimal hydroceles that required no intervention. Significant increases were observed in postoperative sperm concentration (p = 0.01), total motile sperm count (p = 0.009), testis volume (p = 0.000) and serum testosterone level (p = 0.014). All 15 boys with preoperative soft testis had normal testicular consistency postoperatively. Of the 19 boys with preoperative testicular atrophy 10 (53%) did regain normal testicular growth, while 9 (47%) retained testicular volume loss after surgery. When comparing preoperative to postoperative increase in testicular volume according to age in all boys, the mean was statistically significantly higher in boys younger than 14 years (left testis p = 0.037, right testis p = 0.000). CONCLUSIONS: Testicular consistency achieved normal firmness after varicocelectomy in all boys with preoperative soft testis. While there was catch-up growth in comparison to the contralateral testis, testicular consistency improved but testicular volumes may not increase significantly after varicocele repair at ages older than 14 years. However, in these adolescents postoperative semen parameters and serum hormone values may significantly improve regardless of testicular volume. Therefore, boys with varicocele and their families should be fully informed in light of these findings.

Immunohistological analysis of mast cell numbers in the intratumoral and peritumoral regions of prostate carcinoma compared to benign prostatic hyperplasia.

Recently, some studies reported the presence of mast cells in various malignancies and their role in tumor growth. The aim of the study was to determine the utility of mast cell numbers in evaluating benign and malignant prostate lesions, and to ascertain whether there are variations in the numbers of mast cells with the Gleason grade. The relationship between mast cell numbers and patient age was also investigated. Retrospectively, 104 prostate specimens were examined for the presence of mast cells. The study group consisted of 57 benign prostatic hyperplasias and 47 prostate carcinomas. The paraffin sections were stained with anti-human mast cell tryptase immunohistologically. The numbers of positively staining cells in five high-power fields were counted, and their mean was calculated. There was no relationship found between mast cell numbers and age statistically. The mean mast cell numbers of the intratumoral region were significantly different from those of the peritumoral region (p = 0.0001). While the difference between benign hyperplasia and the intratumoral region was found to be significant (p = 0.0001), no difference between hyperplasia and the peritumoral region was noted (p = 0.762). There was no statistical difference between Gleason score groups (p = 0.452), and there was no interaction between score groups and intraperitumoral regions (p = 0.355).