The significance of potassium chloride sensitivity test and urinary uronic acid level in the diagnosis of chronic pelvic pain syndrome.

OBJECTIVES: Noninvasive tests are needed for the diagnosis of chronic pelvic pain syndrome. We evaluated the significance of potassium chloride sensitivity test and urinary CTAB-precipitable uronate level in patients with chronic pelvic pain syndrome (CPPS). METHODS: We included 25 patients with interstitial cystitis (IC), and 30 patients with chronic prostatitis (CP) who applied to our outpatient clinic with the complaints of frequency, dysuria and pain on urination between the years 2003 and 2005. Thirty-five subjects were studied as healthy controls. All patients underwent cystoscopy, cystometry, voiding diary, sodium chloride, and potassium chloride filling tests. Visual analog scale (VAS) was used to determine pain scores. Patients with CP also underwent NaCl and KCl voiding tests. Urinary CTAB-precipitable uronate levels were obtained in all subjects. RESULTS: KCl test had a good sensitivity for IC. As for the patients with CP, KCl voiding test was useful, but KCl filling test was not. Urinary CTAB-precipitable uronate level was found to be significantly higher in patients with IC and CP than controls, and in patients with IC than in patients with CP. CONCLUSIONS: The results of our study suggest that KCl voiding test is a good candidate to be used in the diagnostic workup of patients with category III CP, and urinary CTAB-precipitable uronate level measurement may be a noninvasive diagnostic aid for IC and CP.

Comparing the therapeutic outcome of different alpha-blocker treatments for BPH in the same individuals.

OBJECTIVE: Alpha-blockers are the most widely used agents to treat lower urinary tract symptoms in males, and switching between alpha-blockers is a frequent management option when the desired effect could not be obtained. There is no data in the literature that reveal the outcome of treatments with different alpha-blockers within the same patient. We sought the answer to this question in a setting where the same individuals were treated with two different agents during different time frames. MATERIALS AND METHODS: Forty males with benign prostatic hyperplasia (BPH) applying to the Department of Urology with lower urinary tract symptoms (LUTS) were enrolled in the study consecutively. Patients were evaluated with detailed medical history, IPSS forms, digital rectal examination (DRE), urinary ultrasound, PSA, and uroflowmetry. The subjects received terazosin 5 mg daily for 3 months, and controlled release form of alfuzosin 10 mg daily for another 3 months, leaving a 1-month clearance period in between. The above-mentioned detailed evaluations were carried out before and after each alpha-blocker regimen. RESULTS: Mean age and PSA level was 63.3+/-1.6 years (45-80), and 2.1+/-0.4 ng/ml (0.16-6.3 ng/ml). IPSS and Qmax values before treatment with terazosin and alfuzosin were similar. Improvements in IPSS and Qmax values after treatments with both terazosin and alfuzosin were significant. There was no statistically significant difference between the drugs in terms of percent improvements in IPSS and Qmax with alpha-blocker treatment. No untoward effect except for transient dizziness in one case with terazosin treatment was encountered. CONCLUSION: Different alpha-blockers, which are used during different time frames in the same individuals, provide similar efficiency outcome. When the desired effect in the treatment for BPH could not be obtained with one alpha-blocker, there may not be any benefit in switching to another one.

An important issue in the management of elimination dysfunction in children: parental awareness of constipation.

The scale of parental awareness concerning children's bowel habits and its effects on voiding dysfunction were investigated. Parents of toilet-trained children older than 4 years were given questionnaires during the first interview and after follow-up of their children's bowel habits for symptoms and signs of constipation and urinary complaints. Diagnosis of constipation was made according to the Rome III criteria. Eighty-nine patients were included in the study. The number of constipated patients almost doubled after the observation period. Most of the urinary problems resolved upon treatment of constipation. History at first interview was misleading in 42% of the patients who would benefit from a simple treatment. Most of the parents were unaware of their children's bowel habits. Before proceeding with more complicated tests or treatment of voiding dysfunction, the symptoms and signs of constipation should be sought during a close parental observation period.

The smooth muscle ratio at the renal pelvis in adults: does it predict surgical outcome?

INTRODUCTION: Patients with ureteropelvic junction obstruction occasionally remain undiagnosed until adulthood. There are no objective criteria to predict the results of pyeloplasty in adult patients. We have evaluated the results of pyeloplasty in adult patients and investigated whether these results are correlated with the histopathology of the surgical specimen. MATERIALS AND METHODS: Histological sections from 26 patients with ureteropelvic junction obstruction were analyzed. Their mean age was 25.1 years. Diethylenetriamine-pentaacetic acid scans were used to determine the degree of renal obstruction and postoperative healing. Improvement in diuretic renography was defined as a greater than 20% decrease in the half-time of the preoperative value. To examine smooth muscle and collagen tissue, sections were stained using Masson's trichrome. Smooth muscle ratio was identified by color image analysis. RESULTS: 18 patients (69.2%) fulfilled the criteria of healing. Patients with an improved scan had a mean smooth muscle percent (SMP) of 1.85+/-0.87 while subjects with no significant change in their diuretic scans had a mean SMP of 0.36+/-0.03 (p=0.001). There was a strong correlation between the SMP and the improvement. CONCLUSIONS: Adult pyeloplasty was found successful in about 70% of the cases. The SMP of the renal pelvis seems to be helpful in predicting the surgical outcome.

Seminal plasma prostate-specific antigen level in benign prostatic hyperplasia.

INTRODUCTION: We evaluated the role of the seminal plasma PSA level in the prediction of the response to alpha-blocker treatment in patients with benign prostatic hyperplasia. MATERIALS AND METHODS: 18 male patients with lower urinary tract symptoms were enrolled in the study. After their blood was sampled for PSA, ejaculates of all the subjects were obtained. Serum and seminal plasma PSA levels were calculated by Active PSA IRMA kit. Patients were given 4 mg/day doxazosin for a period of 6 weeks, following which their International Prostate Symptom Score (IPSS) evaluation was repeated. The correlation between serum PSA, seminal plasma PSA and PSA density levels and the percentage improvement in IPSS was investigated. RESULTS: The mean serum PSA level, the mean PSA density and the mean seminal PSA level of the patients were 2.7 +/- 1.2 ng/ml, 0.05 +/- 0.02 ng/ml/cm(3) and 0.7 +/- 0.39 g/l, respectively. The percentage improvement in IPSS varied from 26.9 to 53.5%. Serum PSA and serum PSA density were not useful in the prediction of the response to alpha-blocker treatment, but the seminal PSA levels correlated with the percentage improvement in the IPSS (p = 0.017). CONCLUSIONS: Seminal plasma PSA has been found to be a better predictor of the response to alpha-blocker treatment when compared to serum PSA and PSA density.

Circumcision in adults: effect on sexual function.

OBJECTIVES: To evaluate the effects of adult circumcision on sexual function in men circumcised only for religious or cosmetic reasons. METHODS: The study group consisted of 42 male patients with a median age of 22.3 years (range 19 to 28) referred for circumcision from June 2002 to January 2003. Of the 42 men, 39 desired circumcision for religious reasons. Before circumcision, their sexual performance was evaluated using the Brief Male Sexual Function Inventory (BMSFI) and ejaculatory latency time. The BMSFI evaluation and ejaculatory latency time measurements were repeated after a postoperative interval of at least 12 weeks. The scores in the five main sections of the BMSFI and the ejaculatory latency times before and after circumcision were analyzed. RESULTS: The differences in the mean BMSFI scores were not statistically significant in any of the five sections. However, the mean ejaculatory latency time was significantly longer after circumcision (P = 0.02). CONCLUSIONS: Adult circumcision does not adversely affect sexual function. The increase in the ejaculatory latency time can be considered an advantage rather than a complication.

Histopathologic changes in the mucosa of ileal orthotopic neobladder--findings in 24 patients followed up for 5 years.

OBJECTIVE: To evaluate changes occurring in the mucosa of the neobladder over a period of 60 months in 24 patients with orthotopic ileal neobladder. MATERIALS AND METHODS: A total of 36 male patients have undergone radical cystoprostatectomy and received an orthotopic ileal neobladder in our hospital during the last 10 years; 24 of these patients, all of whom completed a follow-up period of 60 months, are included in this study. All cases underwent a biopsy of the ileal mucosa at the time of surgery and their neobladder mucosa was then biopsied at 6, 12, 24, 36 and 60 months. The specimens were stained with hematoxylin-eosin in order to examine the changes in the thickness of the mucosa and its villi. Sections were also stained with Alcian blue and periodic acid-Schiff in order to determine the number of goblet cells. A morphometric scoring system was created to quantify the change in villi size. RESULTS: The mean thickness of the ileal mucosa at the initial biopsy was 270.9 +/- 35.9 microm and displayed a continuous decrease at all of the subsequent biopsies. The number of luminal goblet cells increased during follow-up. Villus atrophy was found to be a continuous process during follow-up. No dysplasia or malignancy was detected in any of the biopsies. CONCLUSION: During a follow-up period of 5 years, there were no neoplastic changes in our patients, but instead a protective response of the mucosa to its new environment was observed.

Penile metastasis of prostatic adenocarcinoma.

Prostatic carcinoma metastasizing to the penis is rare. A case of adenocarcinoma of the prostate with metastases to the penile shaft and glans penis is presented.