Facile Analytical Methods to Determine the Purity of Titanium Tetrachloride.

We propose a simple method to investigate both the qualitative and quantitative properties of titanium tetrachloride. The selection and concentration of the employed solvent were found to be very important in the analysis of highly reactive titanium tetrachloride (TiCl4). Herein, we employed various concentrations of an acid solution to serve as a stabilizing medium. Qualitative analysis was performed via Fourier transform-infrared spectroscopy (FT-IR) and scanning electron microscope-energy dispersive spectroscopy (SEM-EDS). Additionally, the quantitative analysis was performed via inductively coupled plasma optical emission spectroscopy (ICP-OES). We concluded that both the qualitative and quantitative properties of titanium tetrachloride could be easily measured using a specific acidic solvent as a medium.

Proper mesh placement using the outer cylinder of a ballpoint pen in the transobturator adjustable tape sling procedure for female stress urinary incontinence.

PURPOSE: The transobturator adjustable tape (TOA) sling operation is an effective procedure that allows for correction of postoperative incontinence or obstruction through adjustment of the mesh tension. During the operation, the outer cylinder of a ballpoint pen was used for proper mesh placement with less dissection. We evaluated the efficacy and safety of the TOA sling operation with the use of the outer cylinder of a ballpoint pen. MATERIALS AND METHODS: A total of 127 consecutive women with stress urinary incontinence underwent the TOA sling operation with the use of the outer cylinder of a ballpoint pen. The preoperative evaluations included a stress cough test, urodynamic study, and questionnaires related to quality of life. The mesh tension was adjusted 1 day after the operation. Postoperative evaluation was done at 1 month and included a stress cough test, uroflowmetry, questionnaires, and asking about satisfaction. At 1 year, we evaluated the patients with a stress cough test and by asking about their satisfaction with the procedure. RESULTS: The overall cure rate was 95.3% at 1 month and 96.8% at the 1-year follow-up. Postoperative adjustment of the mesh tension was done for 22 patients (17.3%). Eight patients needed increased tension for remaining stress urinary incontinence, and 14 patients needed reduced tension for urinary obstruction. The maximal flow rate was decreased significantly. However, the residual urine volume was not increased significantly. The total score on the questionnaires increased significantly. CONCLUSIONS: Results were excellent compared with outcomes of the traditional TOA sling procedure. Proper mesh placement by use of the outer cylinder of a ballpoint pen with less dissection and tension adjustment could improve the success rate of the TOA sling operation.

Relationship of sex hormones and nocturia in lower urinary tract symptoms induced by benign prostatic hyperplasia.

OBJECTIVE: The study sought to clarify the relationship between sex hormone levels and lower urinary tract symptoms (LUTS) in patients with benign prostate hyperplasia. METHODS: Between 2007 and 2010, serum total testosterone (TT), free testosterone, and estradiol were prospectively measured in patients who were transferred to our university hospital. The 924 subjects were divided into two groups. Group I (n = 646) were treated with an alpha blocker only and group II (n = 278) were treated with an alpha blocker + a 5-alpha reductase inhibitor over 3 months before their visit. Clinical conditions were assessed by digital rectal examination, prostate-specific antigen, International Prostate Symptom Score (IPSS), transrectal ultrasonography and maximum urinary flow rate and postvoid residual urine. RESULTS: The mean age was 69.65 ± 6.56 years. The total IPSS and subscore (storage symptom) was significantly associated with age (p < 0.001/p < 0.05) and the TT level (p < 0.05/p < 0.05). TT level was significantly decreased in patients with ≥ 4 episodes of nocturia. The TT level was significantly related to the presence of severe LUTS (p < 0.05). CONCLUSIONS: Endogenous testosterone may have a beneficial effect on lower urinary tract function and that a high frequency of nocturia may induce testosterone deficiency.

Preoperative factors influencing postoperative results after vasovasostomy.

PURPOSE: The purpose of this study is to evaluate the preoperative factors that influenced postoperative sperm concentration after vasovasostomy. MATERIALS AND METHODS: We retrospectively reviewed 97 consecutive single-layer vasovasostomy procedures performed by a single surgeon between March 2003 and September 2010. The patients were stratified into three groups based on sperm concentration at 1 month follow-up: group I-azoospermia, group II-oligospermia, and group III-normal. We evaluated the preoperative factors that may have influenced sperm concentration at postoperative 1 month. Patients with serial semen analysis were divided into four groups according to the change in postoperative sperm concentration at the 6-month visit: group II-N-from oligospermia to normal, group II-O-from oligospermia to oligospermia, group III-O-from normal to oligospermia, group III-N-from normal to normal. We compared the pregnancy rate among the four groups. RESULTS: The mean obstructive interval was 9.69 years in group I, 6.02 years in group II, and 7.82 years in group III. There were significant differences found among the groups (p=0.035). There was significantly different change in sperm concentration, sperm motility, and sperm morphology between each of the groups. A total of 32 patients underwent serial semen analyses at 1 month, 3 months, and 6 months after vasovasostomy. There was no significant difference in patient age, obstructive interval, or follicle-stimulating hormone among the groups. The natural pregnancy rate in group II-O was lower than that in group II-N, and in group III-O was lower than that in group III-N. However, there was no significant difference among each of the groups. CONCLUSIONS: The sperm concentration after vasovasostomy was significantly related to the obstructive interval between vasectomy and reversal.

Unusual presentation of bilateral adrenocortical carcinoma mimicking adrenal metastasis.

A 75-year-old female visited our hospital with bilateral adrenal masses that were detected incidentally during lumbar spine magnetic resonance imaging (MRI) for the evaluation of radiating flank pain. Consecutive computed tomography and MRI revealed bilateral adrenal masses with no evidence of lymph node enlargement or local invasion; 2[(18)F]fluoro-2-deoxyglucose (FDG)-positron emission tomography showed an intense FDG accumulation in both adrenal glands without abnormal FDG uptake in extra-adrenal regions. The laboratory test results were within normal ranges. We performed a bilateral adrenalectomy. The pathologic diagnosis of both adrenal masses was consistent with adrenocortical carcinoma. The patient recovered well with no complications.

Clinical significance of immediate urine cytology after transurethral resection of bladder tumor in patients with non-muscle invasive bladder cancer.

OBJECTIVES: To assess the clinical significance of immediate urine cytology (IUC) after transurethral resection of bladder tumor (TURBT) for non-muscle invasive bladder cancer (NMIBC). METHODS: We reviewed the records of 174 patients who underwent IUC after TURBT for NMIBC. IUC was obtained just before Foley catheter removal after TURBT. The relationship between IUC and tumor stage, grade, size and multiplicity, as well as preoperative urine cytology and immediate intravesical epirubicin therapy, were assessed. The relationship between a positive IUC and cancer recurrence was also assessed. Multivariate Cox proportional hazards regression analysis was carried out, including IUC, tumor stage, tumor grade, tumor size, tumor multiplicity, preoperative urine cytology and immediate intravesical epirubicin therapy. RESULTS: IUC was positive in 76 patients (43.7%) and negative in 98 patients (56.3%). In the positive IUC group, tumor stage and grade were higher (P = 0.001, <0.001), tumor size was larger (P = 0.001), tumor multiplicity was higher (P = 0.002) and positive preoperative cytology was more likely (P = 0.006) than in the negative IUC group. In the positive IUC group, the cancer recurrence rate was 72.3% and that of the negative IUC group was 30.6% (P < 0.001). In a multivariate Cox proportional hazards regression analysis, positive IUC (HR 1.83, P = 0.019), tumor size (HR 1.72, P = 0.045), tumor multiplicity (HR 3.63, P = 0.015), preoperative urine cytology (HR 1.23, P = 0.043) and immediate intravesical epirubicin therapy (HR 0.171, P = 0.001) were independent prognostic factors for cancer recurrence. CONCLUSION: These data suggest that IUC after TURBT for NMIBC can be an independent prognostic factor to predict cancer recurrence.

An unusual success with simultaneous urethral repair and reimplantation of penile prosthesis in a patient with urethral stricture induced by rotated tubing.

INTRODUCTION: Simultaneous urethral repair and reimplantation of penile prosthesis in a patient with urethral stricture induced by rotated tubing of a three piece penile prosthesis has not been reported yet. AIM: The aim of this study was to present our experience, which overcame severe urethral stricture induced by penile prosthesis implantation. MAIN OUTCOME MEASURE: Uroflowmetry, voding cystourethrogram, function of prosthesis, and complications. METHODS: We performed one-stage urethroplasty with pedicle island of penile skin and reimplantation of Titan penile prosthesis without abnormal rotation of the cylinder. RESULTS: The patient voided very well, and the prosthesis worked very well without complications. CONCLUSION: One-stage urethroplasty with pedicle island of penile skin and reimplantation of a three-piece penile prosthesis in simultaneous stage may be another choice to treat the long-segment urethral stricture occurred by three-piece penile prosthesis implantation.

Is warm temperature necessary to prevent urethral stricture in combined transurethral resection and vaporization of prostate?

OBJECTIVES: To compare the effect of warm and room temperature irrigation solution on the incidence of urethral stricture during combined transurethral resection and vaporization of the prostate (CTURVP). Urethral stricture after transurethral surgery of the prostate is a bothersome complication. Warm irrigation improves the blood flow and might decrease the incidence of urethral stricture compared with the use of room temperature irrigation, which decreases the blood flow in the urethral mucosa, resulting in ischemic injury. METHODS: The patients who underwent CTURVP were divided into those receiving only room temperature irrigation solution (group 1, 75 patients) or warm irrigation solution with a system maintaining the temperature of the ventral penile skin at about 36 degrees C continuously (group 2, 78 patients). At follow-up, 1, 3, and 6 months later, the International Prostate Symptom Score and peak urine flow rate were evaluated. RESULTS: The temperature of the ventral penile skin was 20 degrees C and 36 degrees C in groups 1 and 2, respectively. The rate of urethral stricture was 21.3% in group 1 and 6.3% in group 2 at the end of 6 months of follow-up (P = .002). CONCLUSIONS: The results of our study have shown that maintaining the temperature of the urethra with warm irrigation solution during CTURVP probably decreases the incidence of urethral stricture. The temperature in the urethra could be another important factor in stricture formation after CTURVP.

Effect of discontinuation of 5alpha-reductase inhibitors on prostate volume and symptoms in men with BPH: a prospective study.

OBJECTIVES: To investigate the change in prostate volume and symptoms after discontinuation of 5alpha-reductase inhibitors (5ARIs) in men with moderate to severe symptoms due to benign prostatic hyperplasia (BPH). METHODS: A total of 120 patients with BPH were enrolled from December 2004 to May 2008. The patients were randomized into 2 groups: group 1 received finasteride 5 mg plus alfuzocin 10 mg or tamsulosin 0.2 mg daily, and group 2 received dutasteride 0.5 mg plus alfuzocin 10 mg or tamsulosin 0.2 mg daily. All the patients received combination therapy for 1 year, followed by 1 year of alpha-blocker monotherapy. The prostate volume, International Prostate Symptom Score, and serum prostate-specific antigen level were determined at baseline and at 12 and 24 months after treatment. RESULTS: At 1 year after treatment, the prostate volume was reduced by 24.5% +/- 10.01% (P < .001) in group 1 and by 26.1% +/- 5.06% (P < .001) in group 2. One year after withdrawal of the 5ARIs, the prostate volume had increased by 20.7% +/- 14.1% (P < .001) and 18.6% +/- 7.4% (P < .001) in groups 1 and 2, respectively, compared with at the end of 1 year of treatment. Furthermore, the International Prostate Symptom Score had significantly deteriorated at 1 year after cessation of the 5ARIs in both groups compared with the values at the end of 1 year of combination therapy. CONCLUSIONS: Our data demonstrate that the discontinuation of 5ARIs during combination therapy induces prostate regrowth, as well as aggravation of symptoms in men with BPH. This result, therefore, suggests that the life-long use of 5ARIs should be considered for the prevention of BPH progression.