Granulomatous hepatitis following intravesical bacillus Calmette-Guerin therapy.

Although intravesical bacillus Calmette-Guerin (BCG) administration is an effective method in the treatment of superficial urinary bladder carcinoma, some complications may arise such as a granulomatous reaction either in the urinary tract or, in rare cases, outside the urinary tract. We report in this paper a case of granulomatous hepatitis following intravesical BCG administration.

Prevalence of nocturnal enuresis and accompanying factors in children aged 7-11 years in Turkey.

There has been limited epidemiological research about nocturnal enuresis in Turkey. The objectives of this study were to ascertain the prevalence of nocturnal enuresis and the epidemiological factors associated with this in Turkish children aged 7-11 y, living in Manisa. Included in the study were 2000 children from various primary schools in Manisa. Parents were asked to fill out our specially designed questionnaire. In all, questionnaires for 1703 children were completed and returned to the department (871F, 51.1%; 832M, 48.9%). The prevalence of nocturnal enuresis for females was 10.6%, for males it was 16.9% and the overall prevalence was 13.7%. The prevalence of nocturnal enuresis decreased with age. Enuresis nocturna was found to be more common in children with a family history of bedwetting (76.5%). Deep sleeping, poor toilet habits and low educational level of the family were associated with enuresis. Consanguineous marriage did not influence the incidence of enuresis nocturna. There was no difference between enuretics and nonenuretics with reference to breastfeeding, being firstborn or being right- or left-handed. In our opinion, enuresis is an important problem for both families and children in Turkey for which specific guidelines should be developed. Various methods have been tried in the treatment of enuresis because of its multi-factorial aetiology. Child, family and physician co-operating together achieve the best help to both child and family.

The effects of extensive vas mobilization on testicular histology during orchiopexy.

We were aware that extensive mobilization of vas deferens during orchiopexy could cause secondary infertility due to testicular damage and/or functional obstruction of the vas deferens. We decided to perform this experimental study in order to document the effects of this procedure on the testis. Thirty adult fertility-proven New Zealand white rabbits were randomly divided into 3 groups. Ten rabbits underwent extensive mobilization of the vas deferens and the other 10 rabbits had vasectomy on the left side. The remaining 10 rabbits were explored on the left side only and were considered sham controls. Four weeks later all rabbits underwent bilateral orchiectomy. Mean seminiferous tubular diameters and Johnsen's testicular biopsy scores were noted. Comparison of the three groups showed that vas mobilization and vasectomies cause no effect on the viability of testis, however, significant testicular histological changes, which were different from the controls and contralateral testis, were observed. We concluded that during any surgical intervention involving the inguinal canal, vascular and neural supports of the vas deferens should be preserved as much as possible in order to avoid iatrogenic damages to the testis.

Effect of long-term alcohol abuse on male sexual function and serum gonadal hormone levels.

PURPOSE: The relationship between chronic alcohol abuse and male sexual dysfunction and pituitary gonadal function abnormalities remains uncertain. The purpose of this study was to assess the effect of chronic alcoholism on sexual functions and serum hormone levels. MATERIALS AND METHODS: Forty-five chronically alcoholic men and a control group of thirty healthy non-alcoholic volunteers were enrolled in the study. Each of the men in the study and control group were interviewed according to a sexual dysfunction questionnaire by an urologist. Blood samples were collected for evaluation of hormone levels. Sera were stored at -70 degrees C for analysis. RESULTS: The sexual desire and erection scores of alcoholic men were not statistically different from those of the control group. Fourteen out of the 45 alcoholic men complained of loss of erection during sexual activity. No significant difference in hormone levels between groups was found except for FSH. CONCLUSION: In the absence of hepatic and gonadal failure in chronically alcoholic men, there is no significant difference in serum hormonal levels, sexual dysfunction form, and sexual functions between alcoholics and normal healthy non-alcoholic men.

Effects of extracorporeal shockwave lithotripsy at different stages of pregnancy in the rabbit.

Although SWL is now the most common treatment modality for urinary tract stone disease, it is not regarded as a safe method for pregnant patients because of its potential harmful effects on fetus. Using a rabbit model, we investigated whether SWL might cause fetal injury when administered at various developmental stages. Two groups of pregnant rabbits were given 1000 shockwaves either early or late in the gestational period. Time-matched controls did not receive shockwaves. After spontaneous labor, all newborn rabbits were counted, weighted, and measured, and specimens were taken from organs and examined histopathologically. The numbers, weights, and diameters of the newborns in each group were similar. There was no notable histopathologic finding in the heart and brain specimens of any of the newborns, whereas noticeable congestion and multiple focal intraparanchymal microhemorrhages were found in lungs, livers, and kidneys of the animals that had been exposed to shockwaves early in gestation. In conclusion, this study shows that SWL is not a safe treatment in early pregnancy.

Management of testicular cancer with combined-modality treatment.

Thirty consecutive patients with germinal testis tumours were treated with combined-modality programme. Seven patients were entered in the surveillance protocol, 7 patients had irradiation of the paraaortic and ipsilateral pelvic lymph nodes, 16 patients were treated with four courses of chemotherapy. Of the patients 5 underwent surgical removal of residual masses. After the combined-modality treatment 27 (90%) patients had complete remission, 2 patients showed progression on therapy and the other had incomplete resection of residual masses. After a median follow-up period of 41.5 months, 27 (90%) remain continuously disease-free, 2 patients died and one patient is still alive with his enlarged mediastinal lymph nodes. The treatment policy stage by stage was defined by the current roles of surgery, irradiation and chemotherapy in our efforts.

Conservative management of advanced bladder cancer.

Between January 1991 and October 1993, 32 consecutive patients with documented primary bladder tumours invading muscle received 3 cycles of methotrexate, vinblastin, doxorubicin and cisplatin (MVAC). The disease was re-staged by bimanual examination with the patient under anaesthesia, CT scanning and transurethral biopsy or resection. Of the 32 patients 2 underwent total or partial cystectomy and 30 did not, because re-staging showed no residual tumour in 8 (25%), stage T1-2 in 12 (37.5%) and far-advanced tumour in 10 (31.2%). The median follow-up was 2.8 years. Twelve patients with stage T1-2 tumour have required TUR, and cystectomy has not been necessary. Two patients who underwent total/partial cystectomy were all downstaged pathologically. Of the 10 failures 5 patients died of disease and 5 are alive with metastatic disease. The overall survival rate was 84.3% (27 of 32) and was 96.8% for patients with a functioning bladder. The data suggested that this active regimen can clinically induce downstaging in a significant number of patients with primary muscle-infiltrating bladder tumours. Transurethral resection plus MVAC chemotherapy is important for increased curability in patients with advanced bladder cancer.

Relationship between histologic grading and serum prostate specific antigen in prostatic carcinoma.

Prostate specific antigen (PSA) is the most important tumour marker which, used routinely, proved to have a positive correlation with tumour volume and pathological stage. To evaluate the relationship between serum PSA and histologic grading of prostatic carcinoma, preoperative PSA determinations were made in 25 patients with prostatic cancer. Biopsy materials were evaluated and the Gleason scores were adjusted for histologic grading. The higher values of PSA were proportional to the Gleason scores of the primary prostatic biopsy.

NAG, GGT, creatinine, urea and creatinine clearance before and after ESWL.

N-acetyl-beta glucosaminidase (NAG) and gamma-glutamyltransferase (GGT) were measured in the urine and serum before, 24 hours and one week after extracorporeal shock wave lithotripsy in 25 patients. Although ESWL is the preferred method in the treatment of kidney stones, its effect on renal parenchymal cells has not been sufficiently elucidated. Since radiographic methods remain inadequate in the estimation and management of parenchymal damage, it is useful to establish the specific renal cell proteins in urine and serum, reflecting renal tubular cell destruction.

Acute experimental unilateral orchitis in the rabbit and its effect on fertility.

We examined the nature of contralateral damage following unilateral orchitis to see if an immunologically mediated mechanism was present. Experimentally induced orchitis in 18 white New Zealand rabbits were examined and compared to 20 in the control groups. Serum antisperm antibody presence and bilateral testicular biopsies (Johansen biopsy score, mean seminiferous tubule diameter) were examined and pregnancy rates were noted. Acute orchitis seemed to be a causative factor in production of antisperm antibody and the presence of antisperm antibody caused histologic changes in contralateral testicles and therefore impaired fertility.

Development of urethral stricture after transurethral prostatectomy: a retrospective study.

A total of 103 patients who were diagnosed to have benign prostatic hyperplasia (BPH) without preoperative urethral stricture and underwent transurethral prostatectomy (TURP) were evaluated retrospectively from patient charts. The incidence of urethral stricture development was calculated as 11.65% (12 out of 103 patients). Among the aetiologic factors analyzed, the most important ones appeared to be postoperative infection, age of the patient, duration of postoperative catheterization and histology of the disease, in the order of significance in the development of urethral stricture after TURP.

Zinc plasma levels in prostatic carcinoma and BPH.

Zinc in serum from patients with prostatic carcinoma and BPH before and after treatment was analyzed by atomic absorption spectrometry. There were significant differences between prostatic cancer and BPH. We also found distinct differences in the plasma content of zinc in patients with prostatic carcinoma before and after therapy. We conclude that the zinc concentration in serum may be a valuable index for the differential diagnosis and therapy of prostatic carcinoma.