Histological and morphological development of the prepuce from birth to prepubertal age.

PURPOSE: To study the histological changes of the preputial tissue from birth to prepubertal age in order to define unnoticed morphological changes. MATERIALS AND METHODS: Prepuce samples were obtained from 79 healthy boys who underwent routine ritual circumcision. Specimens were divided into six groups according to the boys' age: newborn, 0-1 year of age, 2-3 years of age, 4-5 years of age, 6-7 years of age, and 8-9 years of age. Histologic analysis of the specimens was performed by H&E, Masson's trichrome, Verhoeff-Von Gieson, immunohistochemical staining. RESULTS: Microscopic examinations showed that average epithelial thickness increased after the neonatal period (p=0.001). When collagen fiber density was evaluated, no significant differences between groups were found (p=0.083). When the elastic fibers in the dermis were evaluated, it was determined that the number and thickness of elastic fibers increased with age. Immunohistochemical examinations showed that the number of peripheral nerves marked with S100 was lower in the neonatal period than at other ages (p=0.048). When the vessels marked with CD105 antibody were counted, there was no significant difference between the groups (p=0.078). CONCLUSIONS: This is the first study to examine the age-related structure of connective tissue elements in the foreskin. Our results showed that the prepuce's prepubertal maturation process is continuous, and the first 2 years of life are appropriate not only in relation to the physiological effects of age but also the optimum structural changes for wound healing, such as vessel diameter, epithelium thickness, peripheral nerve count.

Does structured withdrawal of desmopressin improve relapse rates in patients with monosymptomatic enuresis?

PURPOSE: Relapse after cessation of desmopressin is an important problem in treating patients with enuresis. Structured withdrawal of desmopressin tablets has been shown to decrease relapse rates. However, scientific data are lacking on the structured withdrawal of the fast melting oral formulation of desmopressin. We compared relapse rates of structured withdrawal using placebo and direct cessation in a population of patients with enuresis who were desmopressin responders. MATERIALS AND METHODS: Patients diagnosed with enuresis and responding to desmopressin from 13 different centers were involved in the study. Patients were randomized into 4 groups. Two different structured withdrawal strategies were compared to placebo and direct withdrawal. Sample size was estimated as 240 (60 patients in each group), with a power of 0.80 and an effect size of 30%. Randomization was performed using NCSS statistical software (NCSS, Kaysville, Utah) from a single center. The relapse rates of the groups were compared using chi-square testing. Logistic regression analysis was performed to define the independent factors having an effect on relapse rates. RESULTS: Desmopressin treatment was initiated in 421 patients, and 259 patients were eligible for randomization. Relapse rates were 39 (1%) and 42 (4%) for the structured withdrawal groups, which were significantly less than for direct withdrawal (55, 3%) and placebo (53, 1%). Logistic regression analysis revealed that initial effective dose of 240 µcg, greater number of wet nights before treatment and nonstructured withdrawal were associated with higher relapse rates. CONCLUSIONS: We found that structured withdrawal with the fast melting oral formulation of desmopressin results in decreased relapse rates. Application of a structured withdrawal program was also an independent factor associated with reduced relapse rates, together with lower initial effective dose and number of wet nights per week. Relapse after cessation of desmopressin is an important problem, and in this study structured withdrawal was observed to be associated with decreased relapse rates compared to placebo and direct withdrawal.

Advances in the management of enuresis.

There are still many undiscovered facts about enuresis, even though it is a very old "symptom". It is a significant health problem with a high prevalence among children and a lower prevalence in adulthood. Many treatment guidelines have been proposed for the management of this problem. The improvement of diagnostic tools, and also treatment modalities, have had a significant impact on success rates; however, the long-term success rates need to be higher, especially in resistant cases. In this report, we summarize the advances made in the diagnosis and treatment of enuresis.

Evaluation of functional lower urinary tract dysfunction in children: are the physicians complying with the current guidelines?

OBJECTIVE: To elucidate whether the diagnostic and treatment approaches of the physicians for functional lower urinary tract dysfunction (LUTD) in children is complying with the current guidelines. MATERIAL AND METHODS: We have conducted an internet-based national survey for the physicians from different departments randomly sampled from the database of Turkish Paediatric Urology Society. Participants were asked to answer two-page questionnaire consisting of 4 main sections: "demography," "working conditions," "daily practice," and "scientific knowledge." Kruskal Wallis and multiple logistic regression were used for statistical analyses. RESULTS: Of the 117 departments a total of 93 have completed the survey (n: 58 urology; n: 35 paediatric nephrology). Routine use of a questionnaire with validated symptom scoring system was found to be 13.9%. Of the participants, only 38.7% were asking all of the patients to fill the bladder diary. During treatment, only 24.7% were applying standard urotherapy for every patient. Almost half of the clinicians (45.1%) believed that they were personally insufficient during the evaluation of those children. Finally, 86% reported that children with LUTD were not adequately approached. CONCLUSIONS: Evaluation of LUTD in children is not complying with the current guidelines. General approach for those children needs to be revisited by the clinicians.

Factors affecting complication rates of ureteroscopic lithotripsy in children: results of multi-institutional retrospective analysis by Pediatric Stone Disease Study Group of Turkish Pediatric Urology Society.

PURPOSE: We evaluated factors affecting complication rates of ureteroscopy for pediatric ureteral calculi. MATERIALS AND METHODS: We retrospectively evaluated 642 children who underwent ureteroscopy at 16 Turkish centers between 2000 and 2010. Semirigid ureteroscopy was used with various calibers to treat 670 ureteral units in 660 sessions. Complications were evaluated according to the Satava and Clavien classification systems. Univariate and multivariate analyses were done to determine predictive factors affecting complication rates. RESULTS: A total of 367 females and 265 males were studied. Mean±SD patient age was 90.2±51.4 months (range 4 to 204). Mean±SD stone size, operative time and postoperative hospital stay were 8.9±4.7 mm, 45.8±23.8 minutes and 1.8±2.8 days, respectively. At a mean±SD followup of 13.3±17.6 months 92.8% of patients were stone-free and efficacy quotient was 90.3%. Complications, which occurred in 8.4% of patients (54 of 642), were intraoperative in 25 (Satava grade I to II in 22), early postoperative in 25 (Clavien grade I to II in 23) and late postoperative in 4 (all grade III). While operative time, age, institutional experience, orifice dilation, stenting and stone burden were statistically significant on univariate analysis, multivariate analysis revealed that operative time was the only statistically significant parameter affecting the complication rate. CONCLUSIONS: Semirigid ureteroscopy is effective, with a 90% stone-free rate and efficacy quotient. Most complications are low grade and self-limiting. Our results confirm that prolonged operative time is an independent predictor of complications, and should be considered when choosing and performing the treatment modality.

An alternative method for determining daily bladder perception.

OBJECTIVES: To avoid the unphysiologic nature of cystometry, we searched a new tool for evaluating bladder perceptions. METHODS: The study group consisted of 25 (14 girls and 11 boys) primary monosymptomatic enuretic children with a mean age of 11 (range 8-16). Four children were excluded due to neuromuscular dysfunctions of the bladder, which was demonstrated with the help of cystometry. All children filled a voiding chart 3 times daily to record the duration elapsed till normal desire (ND(daily)) and strong desire (SD(daily)). During cystometry, the amounts of infused medium (cystometric ND(ml) and cystometric SD(ml)) and the duration (cystometric ND(sec) and cystometric SD(sec)), till ND and SD were perceived and recorded. RESULTS: Mean cystometric ND(ml) was 209.9 +/- 107.2 and ND(sec), 318.1 +/- 135.5, whereas mean cystometric SD(ml) was 273.0 +/- 103.1 and SD(sec), 415.7 +/- 136.8. To evaluate the reliability of elapsed time instead of milliliters, as a parameter, cystometric ND/SD values were calculated and a strong correlation was found between the 2 (ND/SD(sec) = 0.77 +/- 0.19 and ND/SD(ml) = 0.77 +/- 0.19, r = 0.9795, P = .000). Although there was a strong correlation between 3 ND(daily) (r = 0.9576, P = .000), between 3 SD(daily) (r = 0.9706, P = .000), and 3 ND/SD(daily) (r = 0.8706, P = .000), no significant correlation was determined between mean ND(daily) and cystometric ND(sec) (r = 0.3410, P = .2032), and also between mean SD(daily) and cystometric SD(sec) (r = 0.2740, P = .2402). CONCLUSIONS: Daily durations of sensations do not correlate with those perceived during cystometry. However, as the results of 3 consecutive daily recordings have a strong correlation, comparison of the reliability of these methods is still needed.

Comparison of bladder perceptions during cystometry in pediatric and adult patients.

OBJECTIVES: This study was designed to evaluate the reliability of bladder perception in children and compare it with that in adults. METHODS: A total of 30 children were included in the study. The average patient age was 11 years (range 7-16). In the first phase of the study, a catheter was fixed to the skin without introducing it through urethra. After the children were told that the test had begun, they were asked to report any sensations. In the second phase, although an 8F urodynamics catheter had been introduced, nothing was infused. In the third phase, regular filling cystometry was performed. The final phase of the study was performed using the same method as for the second phase. The intervals that elapsed until each sensation was perceived were recorded in seconds and were used to compare the perceptions. RESULTS: Of the 30 children, 4 were excluded because of sensation defects in the cystometric evaluation. In the first phase, none of the children reported any first sensation, first desire, normal desire, or strong desire. In the second phase, 3 of the children reported a first sensation and 2 reported a first desire. In the third phase, all 26 children reported sensations and the first sensation/normal desire percentage was 41% and the first desire/normal desire percentage was 52%. In the fourth phase, none of the children reported sensations. CONCLUSIONS: In our previous studies, we reported that an important percentage of adults perceived false sensations in the fake phases. The children had no significant perceptions in the fake phases (first, second, and fourth phases). Thus, the sensations reported by children during urodynamics studies are more reliable than those reported by adults.

Relationship between body mass index and pediatric urologic diagnoses.

OBJECTIVE: We had the clinical impression that children with certain urological diagnoses were thinner and others were heavier. We therefore reviewed body mass index (BMI) in children with a variety of urological diagnoses. MATERIALS AND METHODS: The data from all pediatric patients treated as outpatients in our office between 1 Jan and 30 Sept 2004 were analyzed retrospectively. The patients were counted only once, even if they came back to the office several times. They were grouped by the principal billing diagnosis, but groups of less than nine patients were excluded. BMI percentiles were determined based on data from the Centers for Disease Control and compared to diagnosis codes. RESULTS: The data from 1054 patients were analyzed: 53% were female, mean age was 8.0+/-3.7, mean BMI was 18.7+/-5.1 and mean BMI percentile was 64+/-31%. BMI varied significantly by diagnosis. Children with hernias and penile problems had the lowest BMI percentile and those with urinary infection and incontinence the highest, e.g. the mean BMI percentile was 46+/-31% for children with a hernia but 71+/-27% for those patients with nocturnal enuresis. CONCLUSIONS: The rate of obesity varied considerably based on pediatric urological diagnosis. Diet and personality may be part of the etiology for some urological disorders. It is possible that lifestyle changes may benefit urological patients who are obese.

Effect of maturation and aging on response of rabbit bladder to bilateral in vivo ischemia/reperfusion.

OBJECTIVES: To evaluate the impact of maturation and aging on the effect of bilateral in vivo ischemia/reperfusion on bladder function. METHODS: Male rabbits were separated into three groups by age: immature, mature, and aged rabbits; and each group was subdivided into five subgroups. Each rabbit was subjected to 2 hours of bilateral ischemia. After ischemia, the rabbits in subgroup 1 were killed immediately; the other subgroups were allowed to recover for 1, 7, or 14 days. Separate control (sham-operated) subgroups were not subjected to ischemia. At the end of the experimental period, the bladder was excised, body and base separated, and two strips were prepared from each and mounted in individual baths. The contractile responses to field stimulation and carbachol, adenosine triphosphate, and potassium chloride were determined for the body. The responses to field stimulation alone were determined for the base. RESULTS: The rabbit body and bladder weights of the mature and aged rabbits were significantly greater than that of the young rabbits, but not different from each other. The mature rabbits were significantly more sensitive to ischemia/reperfusion than were the young rabbits. Finally, the aged rabbits were slightly more sensitive to ischemia/reperfusion than the mature rabbits. CONCLUSIONS: The results of our study have shown that the sensitivity of the bladder to ischemia/reperfusion injury increases with age. A very significant increase was found in the sensitivity between young and mature rabbits, with a significantly smaller increase in sensitivity between mature and old rabbits.

Association of elimination dysfunction and body mass index.

PURPOSE: The reported prevalence of mild and severe obesity among US children is 30% and 15%, respectively. Childhood obesity likely relates to alterations in diet that also may cause constipation. We investigated the relationship between obesity and various forms of elimination dysfunction. MATERIALS AND METHODS: The data of 251 patients who were diagnosed as having elimination dysfunction were analyzed retrospectively. Each patient's age, weight, height and diagnosis were evaluated and body mass index (BMI) was calculated. The percentile BMI was then analyzed based on diagnosis. BMI percentile> or =85% was defined as mild obesity and BMI percentile> or =95% was defined as severe obesity. The patients were divided into four groups based on diagnosis: constipation (n=70), enuresis+constipation (n=21), daytime incontinence (n=96) and nocturnal enuresis (n=64). RESULTS: The mean age of the patients was 9 years (range: 4-18 years). In the group with enuresis and constipation, 8/21 (38%) were mildly and 5/21 (24%) severely obese. Of patients with daytime incontinence, 36/70 (51%) were mildly and 22 (31%) severely obese, and of those with nocturnal enuresis alone, 35 (55%) were mildly and 20/64 (31%) severely obese. CONCLUSIONS: Of children with voiding dysfunction, 62-86% are also obese. This is almost double the rate in the normal population. These conditions may have a common etiology.

Is catheter cause of subjectivity in sensations perceived during filling cystometry?

OBJECTIVES: To investigate the impact of the catheter on perceptions of filling. In our previous study, we demonstrated that some patients perceived sensations despite a lack of filling during cystometry. METHODS: The study included 45 patients with lower urinary tract symptoms attributed to benign prostatic hyperplasia. The average patient age was 57.9 years (range 48 to 79). Patients were draped to keep them from seeing their penis and the filling bag, pump, and screen process. In the first phase, the catheter was fixed to the penile skin without introducing it through the urethra, and the patient was told the test had begun. At the end of the first phase, the bladder was emptied. Before the second phase, an 8F urodynamic catheter was introduced, but during the test, nothing was infused. During the third phase, filling cystometry was performed with a 50-mL/min pump speed. The bladder was emptied after all three phases. The times that elapsed until each sensation was perceived, in seconds, were used to compare the sensations. RESULTS: In the first phase, 21 patients reported a first sensation, 10 reported first desire, and 4 reported normal desire, despite a lack of catheterization. No statistically significant difference was found between the mean first sensation/first desire, first sensation/normal desire, first desire/normal desire ratios of the patients who perceived sensations in the three phases and the strong desire/normal desire ratios of the patients in the second and third phases (P >0.05 for all). CONCLUSIONS: Although the perceptions were reported in the first and second phases, the catheter could not be the sole cause of the subjectivity.

Effect of bladder ischaemia/reperfusion on superoxide dismutase activity and contraction.

OBJECTIVES: To correlate the effect of bilateral in-vivo bladder ischaemia/reperfusion on superoxide dismutase activity (SOD) and then to correlate this with contractile responses to various forms of stimulation. MATERIALS AND METHODS: Twenty mature male New Zealand White rabbits were divided into five equal groups: group 1 (controls); group 2, 2 h of in-vivo bilateral bladder ischaemia; and groups 3-5, 2 h of in-vivo ischaemia followed by 1, 7 or 14 days of reperfusion (recovery). At the end of the treatment period, bladder strips were incubated and placed in isolated baths for contractile studies. The contractile responses to field stimulation, carbachol (10 micromol/L), ATP and KCl were determined. The balance of the bladder body was separated into muscle and mucosa sections and analysed for SOD activity. RESULTS: There were few effects on contraction either directly after ischaemia or after 1 day of reperfusion. However, all contractile responses were significantly reduced at 7 and 14 days after ischaemia. SOD activity of the detrusor muscle was reduced significantly immediately after ischaemia and at 7 and 14 days of reperfusion. SOD activity of the mucosa was significantly greater than that of the muscle, and was significantly reduced by both ischaemia and all times of reperfusion. CONCLUSIONS: These studies show clearly that both ischaemia and reperfusion result in significantly lower activity of SOD, and in contractile dysfunctions, and that reperfusion results in greater decreases in both SOD activity and contractile responses than ischaemia alone.

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.

Diagnostic value of renal parenchymal density difference on unenhanced helical computed tomography scan in acutely obstructing ureteral stone disease.

OBJECTIVES: To evaluate the diagnostic value of the renal parenchymal density difference, detected using unenhanced helical computed tomography, as a secondary sign of acute obstruction due to a ureteral stone. METHODS: Fifty-five patients with acute flank pain, in whom a ureteral stone was detected on the symptomatic side using unenhanced helical computed tomography, and 22 control subjects with no urinary stone disease were included in this prospective study. Computed tomography was performed, starting from the upper poles of the kidneys down to the base of the urinary bladder. The renal parenchymal density was measured in the upper, middle, and lower portions of each kidney, and a mean value was calculated. The difference between the mean values of the two kidneys was used to predict the presence of an acutely obstructing ureteral stone. RESULTS: In 49 patients with a ureteral stone (89.1%), the difference between the parenchymal densities of the obstructed and nonobstructed kidneys was 5 Hounsfield units (HU) or greater and was lower on the obstructed side. In the remaining 6 patients (10.9%), the density difference was less than 5 HU but was still lower on the obstructed side. All subjects in the control group had a density difference of less than 5 HU. A renal parenchymal density difference of 5.0 HU or greater had 89.1% sensitivity, 100% specificity, 100% positive predictive value, 85.7% negative predictive value, and 93.4% accuracy in predicting the presence of an acute obstructing ureteral stone. CONCLUSIONS: These data suggest that the renal parenchymal density difference may be a valuable secondary sign of acute obstructing ureteral stone disease.

Can the outcome of transurethral resection of the prostate be predicted preoperatively?

OBJECTIVES: To establish a formula for predicting the outcome of transurethral resection of the prostate using noninvasive parameters of preoperative evaluation. METHODS: The data of 54 men with a mean age of 57 years (range 43 to 78) were retrospectively analyzed. The International Prostate Symptom Score, quality-of-life score of the International Prostate Symptom Score questionnaire, maximal flow rate (Qmax) recorded during uroflowmetry, age, prostate volume calculated by transrectal ultrasonography, postvoid residual urine volume, and results of pressure-flow studies were evaluated to find a formula that would predict the outcome of transurethral resection of the prostate. The patients were evaluated by uroflowmetry, postvoid residual urine volume determination, and International Prostate Symptom Score questionnaire at 3 months postoperatively. Four different success criteria were investigated with the calculated equations. RESULTS: According to the discriminant analysis, two new scores were calculated as S(1) = (0.169 x age) - (0.0075 x Qmax) and S2 = (0.168 x age) - (0.095 x Qmax) - (0.007 x detrusor pressure at Qmax). For the four success criteria, the optimal cutoff, obtained from the receiver operating characteristic curves of S(1) and S(2), was 8.83 and 9.21, respectively. A statistically significant difference was not found between S1 and S2. The S1 formula had a sensitivity between 71.8% and 85.2%, specificity between 71.4% and 86.7%, and positive predictive value between 72.2% and 92.9% for the four different criteria using two simple variables (Qmax of uroflowmetry and age). CONCLUSIONS: Because urodynamic parameters did not add benefit to the formula consisting of age and Qmax of uroflowmetry with considerable sensitivity and specificity, performing urodynamic studies might not be useful for predicting the outcome of transurethral resection of the prostate.

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.

Telomerase activity in diagnosis of bladder cancer.

OBJECTIVE: Telomerase is an enzyme that can reconstitute the ends of chromosomes after cell division and thus circumvent the damage that occurs in normal adult somatic cells during successive mitotic cycles. Immortal cells have short but stable chromosomes and increased telomerase activity. Transitional cell carcinoma (TCC) has only a few useful markers of diagnostic or prognostic importance. The objectives of this study were to determine whether there was a correlation between telomerase activities and the grade or stage of TCC and whether the activity of the enzyme could serve as a biochemical marker of this tumor. MATERIAL AND METHODS: Telomerase activity was determined by examining, using a polymerase chain reaction-based assay designed using the telomeric repeat amplification protocol (TRAP), urine cell pellets obtained from 42 bladder cancer patients, 18 patients with primary hematuria, 19 patients with benign urologic disease, 14 patients with urologic malignancies other than TCC and 20 healthy volunteers. RESULTS: Telomerase activity was found in 24/31 patients with bladder tumors (77.4% sensitivity) and in 5/77 patients without tumors (93.5% specificity). No correlation was found between telomerase activity and the grade or stage of the tumor. Although none of the urine cell pellets obtained from the 20 healthy volunteers demonstrated telomerase activity, positive telomerase activity was found in two subjects in the benign urologic disease group and in three subjects in the other urologic malignancy group. It was demonstrated that gross hematuria was the cause of false-negative results in six of the nine patients (66.7%). but washing the pellets four times and diluting them before the TRAP assay solved this problem. CONCLUSION: These results indicate that telomerase activity may be a promising marker for TCC but the technical aspects of the technique must be improved before it is used in routine clinical practice as a standard method. False-negative results obtained using gross hematuric urine should be carefully reevaluated and cell pellets should be washed again and diluted before analysis.

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.

The free-to-total serum prostatic specific antigen ratio as a predictor of the pathological features of prostate cancer.

OBJECTIVES: Curative therapy and extended period of disease free survival for patients with prostate cancer is possible only if the radical prostatectomy is performed when the disease is organ confined. It has been shown that combined use of local clinical stage, Gleason score of transrectal needle biopsy and serum PSA can accurately predict the final pathological stage in men undergoing radical prostatectomy. Recently the free/total PSA (F/T PSA) has been shown to improve the specificity of serum PSA level in early detection prostate cancer. In this study the utility of F/T PSA ratio in prediction the final pathological features of the prostate cancer was investigated. METHODS: 52 patients who had undergone radical prostatectomy were included in this study with mean age of 63 (ranging from 49 to 73). According to the pathologic features of the tumors, patients were classified as organ confined in 37 (%71), specimen-confined in 39 (%75) and as with favorable pathology which was defined as organ confined or specimen confined with Gleason score lower than 7, 39 (%75) patients. RESULTS: Neither total PSA levels nor F/T PSA values correlate significantly with the pathological characteristics of the tumor. The logistic regression analysis showed that the biopsy Gleason score was the only variable that was able to predict the pathology of the tumor (p < 0,05). CONCLUSION: As a conclusion Gleason score of the needle biopsy specimen is the most predictive factor of the final pathological outcome. F/T PSA ratio did not provide additional information about predicting pathological stage.