Sperm retrieval and live birth rates in presumed Sertoli-cell-only syndrome in testis biopsy: a single centre experience.

We aimed to investigate sperm retrieval rates (SRR) by testicular sperm extraction (TESE), factors affecting SRR, and fertilization rate (FR), implantation rate (IR), clinical pregnancy rate (CPR) and live birth rate (LBR) in patients with presumed Sertoli-cell-only syndrome in testis biopsy (SCOS). We retrospectively evaluated files of 134 patients with SCOS who underwent TESE. Group I were patients in whom spermatozoa were retrieved and Group II were patients in whom no spermatozoa could be retrieved. SRR, Follicle stimulating hormone (FSH), Luteinizing hormone (LH), and testosterone levels, and the volume of testicles were compared between groups. In addition, FR, IR, CPR and LBR were determined. Sperm retrieval was achieved in 37 (27.6%) patients (Group I), and the remaining 97 (72.4%) patients made Group II. There were no significant differences in age, infertility time, testicular volume, serum FSH, LH and testosterone levels between Groups I and II (p > 0.05). Intracytoplasmic sperm injection (ICSI) was performed in 36 patients. FR, IR, and CPR were 60.86 ± 23.03, 36.53 ± 41.78 and 51.3% respectively. Cycle and patient based LBRs were 37.8 and 45.1% respectively. SRR in SCOS is lower than patients with non-obstructive azoospermia (NOA) in general. No parameters to predict spermatozoa retrieval were determined. In patients with SCOS, ICSI achieves similar live birth rate to other patients with NOA.

The association between intron 4 VNTR, E298A and IVF 23+10 G/T polymorphisms of ecNOS gene and sildenafil responsiveness in patients with erectile dysfunction.

The objective of the study was to determine the association between intron 4 variable number of tandem repeats (VNTR), E298A and IVF 23+10 G/T polymorphisms of ec-NOS gene and sildenafil responsiveness in patients with erectile dysfunction (ED). Ninety-six patients who were evaluated for ED between November 2003 and June 2004 and 167 healthy individuals representing the normal population as controls were included in the present study. The patients were evaluated by medical history, five-item version of International Index of Erectile Function, serum glucose, testosterone levels and lipid profiles. Sixty-seven patients received four consecutive doses of sildenafil from 25 to 100 mg according to the response. The ec-NOS gene intron 4 VNTR, E298A and IVF 23+10 G/T polymorphisms were evaluated in the isolated DNA blood samples obtained from the patient group with ED (n=96), from the group received sildenafil (n=67) and from the healthy group (n=167). Genotype distributions of ec-NOS gene intron 4, E298A and IVF 23+10 G/T polymorphisms in the patient group were similar to those in the healthy group. The frequency of the ec-NOS gene intron 4 genotype were found as bb=41.7%, ab=50% and aa=8.3% in the sildenafil responders and bb=93.5% and ba=6.5% in the sildenafil non-responders. This finding was statistically significant. Statistical analysis of ec-NOS gene E298A and IVF 23+10 G/T polymorphisms did not reveal any significant difference between sildenafil responders and non-responders. These findings may indicate that 'a' allele of ec-NOS gene intron 4 VNTR polymorphism associates with a better sildenafil response.

Ureteroscopic treatment of proximal ureter stones with the aid of an antegrade occlusion balloon catheter.

PURPOSE: To define the role of an antegrade occlusion balloon catheter in preventing migration of proximal ureteral stones to the dilated proximal ureter during endoscopic treatment. MATERIAL AND METHODS: An occlusion balloon catheter was used in 8 of 21 patients with proximal ureteral stones who underwent ureterorenoscopy. Five of the eight patients had solitary kidneys admitting with anuria and had percutaneous nephrostomy. In the other three patients, percutaneous nephrostomy and occlusion balloon catheters were placed a day before the procedure, since these patients had total obstruction and massive dilatation of the proximal ureter and renal collecting system. The balloons of occlusion catheters were inflated with 1 ml of sterile saline proximal to the stones just before ureterorenoscopy. RESULTS: All stones could be reached by ureterorenoscopy and treated successfully with the aid of an ultrasonic lithotripter, and no stone migration to the upper dilated collecting system was observed. Just after the operation, while the patient was still lying on the operation table, the occlusion catheter was removed. The nephrostomy catheter was removed a day later. All patients were totally stone-free after the procedures. CONCLUSION: Occlusion balloon catheters increase the ureteroscopic treatment success rate in proximal ureter stones. This should be kept in mind especially when dilatation of the proximal collecting system is prominent and in cases with unsuccessful previous intervention with a retrograde stone cone catheter.

Efficacy of dretler stone cone in the treatment of ureteral stones with pneumatic lithotripsy.

INTRODUCTION: Ureteroscopic pneumatic lithotripsy has been used to treat ureteral calculi for more than 10 years. Owing to its low price and high degree of effectiveness, it has become the most popular ureteroscopic lithotripsy device in use worldwide. The major limitation of the technique is the occurrence of proximal fragment migration during intracorporeal lithotripsy. The Dretler Stone Cone is a new device developed to prevent stone migration during ureteroscopic lithotripsy. The aim of this study was to assess the efficacy and safety of this device during ureteroscopic pneumatic lithotripsy. PATIENTS AND METHODS: Twenty-three consecutive patients having ureteral stones were treated with a 10-Fr semirigid ureteroscope, a Stone Cone Nitinol Retrieval Device, and a pneumatic lithotriptor. In all patients Stone Cones were placed under visual guidance through the working channel of the ureteroscope. Outcomes of this device were then compared with the outcomes of 23 previous patients with stones of similar sizes and locations who had undergone ureteroscopic pneumatic lithotripsy prior to the Stone Cone being available at our clinic. RESULTS: All patients in the study group were stone-free after the procedure. No stone fragments were noted to migrate to proximal segments. CONCLUSIONS: The Dretler Stone Cone effectively prevents proximal stone migration and facilitates stone fragmentation during pneumatic lithotripsy with no risk of ureteral injury. It has only a small extra cost.

Ocular side-effects of tolterodine and oxybutynin, a single-blind prospective randomized trial.

AIM: To evaluate the effects of tolterodine and oxybutynin on visual accommodation, pupillary diameter, intraocular pressure and tear secretion in women with overactive bladder. METHODS: One hundred and four eyes from 52 consecutive female patients (age range: 22-60 years) with a urodynamic diagnosis of overactive bladder were prospectively investigated. Patients with a history of ocular disease or surgery were excluded. The subjects were randomly assigned to one of two groups: Group I received 2 mg tolterodine bid and Group II received 5 mg oxybutynin tid. All patients were evaluated at baseline (day 0) and after 1 month of treatment (day 28) by an ophthalmologist who was blinded to the medication. At each time point, a complete ophthalmic examination was performed and accommodation amplitude (AA), and pupillary diameter (PD) in dim and bright light were recorded. As well, tear secretion was assessed based on tear film break-up time and Schirmer I-test results. Statistical comparisons were made using the chi-square test, Student's t-test and Mann-Whitney U-test, as appropriate. RESULTS: Twenty-eight patients (56 eyes) received tolterodine and 24 patients (48 eyes) received oxybutynin. The mean ages of the two groups were similar (P = 0.523). After 4 weeks of treatment, AA was significantly lower in the oxybutynin treated group (P = 0.003, 95% CI 0.15, 0.62) whereas there was no significant change in AA in the tolterodine treated group (P = 0.155, 95% CI -0.042, 0.86). At day 28, PD in dim light was significantly larger in the tolterodine treated group (P = 0.031, 95% CI -0.82, -0.06), whereas no significant change in PD in dim light was noted in the oxybutynin treated group (P = 0.330, 95% CI -0.38, 0.18). Neither group showed a significant change in PD in bright light values on day 28 (P > 0.05 for both). In each group, the differences from day 0 to day 28 for intraocular pressure, and Schirmer-I results were insignificant (P > 0.05 for all). Both groups had significantly shorter tear film break-up time after 1 month of therapy (P = 0.014 (95% CI 0.47, 3.81) and P = 0.02 (95% CI 1.14, 4.61) for the tolterodine and oxybutynin treated groups, respectively). CONCLUSION: Four weeks of standard-dose oxybutynin treatment in women with overactive bladder decreases AA significantly, whereas the same duration of standard-dose tolterodine does not have this effect. However, tolterodine seemed to affect PD in dim light. One month of treatment with either of these anticholinergic drugs shortens tear film break-up time significantly. Concerning ocular side-effects, tolterodine seems to offer an advantage over oxybutynin because it does not affect AA, however, the shorter tear film break-up time with both agents suggests potential problems for patients who already have dry eye.

Efficacy and safety of sildenafil citrate in hemodialysis patients.

Erectile dysfunction (ED) is more frequent among end-stage renal failure patients than the normal population. Sildenafil citrate has been successfully used for the symptomatic treatment of erectile dysfunction. The aim of this study was to determine the efficacy and safety of sildenafil citrate in the treatment of ED in patients on hemodialysis. Fifty-five hemodialysis patients above 18 years suffering from ED with steady sexual partners were included in the study. The first five and fifteenth questions of the International Index of Erectile Function were employed to evaluate ED in the patient group. A Single 50-mg sildenafil citrate tablet was prescribed for each patient. The patients were encouraged to take it on the day after hemodialysis and 1 hour before sexual intercourse. The erectile function of the patients after the treatment was re-evaluated in the same manner by International Index of Erectile Function. The ages of the patients ranged between 30 and 73 years (mean 50.6 +/- 10.9). The overall response rate was 74.5% (38/51). Side effects were nausea (n = 2), palpitation (n = 2), flushing (n = 1), and angina (n = 1). Sildenafil citrate (50 mg) was observed to be safe and effective for treatment of hemodialysis patients with careful evaluation and proper patient selection.

Renal transplantation experience following endoscopic treatment of vesicoureteral reflux.

The most efficacious treatment for end-stage renal disease is renal transplantation. Because high-grade vesicoureteral reflux forecasts potential future complications, the patients studied were subjected to bilateral nephroureterectomy before transplantation. The aim of this study was to investigate the posttransplantation results of a subureteral injection performed before transplantation to treat high-grade vesicoureteral reflux in end-stage renal disease patients. Renal transplantation was performed on 14 of 52 end-stage renal disease patients that had undergone prior subureteral injection. Subureteral injection had been performed in 24 refluxing renal units of these 14 patients. Ten patients had bilateral and 4 patients unilateral reflux. The treatment criterion was reflux of at least grade III; however, when low-grade reflux was present in the contralateral renal unit, it was also treated during the same session. Success was determined as no (complete) or decrease to grade I (partial) reflux. The patient ages ranged between 13 and 46 years (mean 29.3 years). The reflux resolved in 20 of 24 renal units (83%) and was reduced to grade I in 3 of the others (12%), namely resulting in a total response rate of 95%. Except for 1 patient who was lost to follow-up, the other recipients were observed for 6 to 47 months (mean 23 months). Only 1 patient experienced symptomatic urinary tract infection or asymptomatic bacteriuria after renal transplantation. Acute rejection occurred in 5 and chronic rejection in 3 patients. In conclusion, subureteral injection instead of nephroureterectomy seems to be an efficient and minimally invasive alternative for renal transplant recipients with high-grade vesicoureteral reflux.

Covered metallic ureteral stent in the management of malignant ureteral obstruction: preliminary results.

OBJECTIVES: To evaluate the effectiveness of ureteral Dacron-covered metallic stents in the management of malignant ureteral obstruction. METHODS: Covered metallic stents were placed unilaterally using a percutaneous approach in an antegrade fashion into nine ureters of 8 patients with bilateral malignant ureteral obstruction. The contralateral kidneys were drained by percutaneous nephrostomy in 7 patients. The primary diagnoses were rectal cancer in 5 patients and cervical, bladder, and prostate cancers in the remaining cases. RESULTS: Covered metallic stents could be successfully placed in all patients. Only one of nine ureters was stented with a double J-stent. In a mean follow-up of 9 months (range 1 to 14), 7 of 8 patients died because of their primary disease. During the follow-up period, none of the stents were obstructed, displaced, or infected. CONCLUSIONS: Dacron-covered metallic stents appear to be successful in the treatment of patients with malignant ureteral obstruction. The preliminary outcome encourages and justifies the application of this drainage method.

Percutaneous sclerotherapy of a giant benign renal cyst with alcohol.

We report a case of giant, benign renal cyst that was treated with percutaneous aspiration and sclerotherapy using 95% alcohol. A seven French catheter was inserted into the cyst under ultrasonographic and fluoroscopic guidance, and was then left in place to drain the cyst contents. Approximately 4 l of fluid was drained the first day. The following day, a gravity sinogram was obtained, which showed there were no connections between the cyst and the collecting system. The alcohol treatment involved repeated injections of decreasing amounts of alcohol, with volumes selected in accordance with follow-up sinograms. The patient's symptoms resolved and cyst drainage stopped after 3 successive days of therapy. Totally 600 ml alcohol has given. Follow-up ultrasound (US) and computed tomography (CT) studies showed no recurrent disease; with only a small remnant of the cyst wall. We encountered no major complications during follow-up.

Endoscopic treatment of complete bladder neck obstruction by transurethral Seldinger technique.

Bladder neck contracture is usually a complication of prostatectomy and the treatment of choice in such a condition should be endoscopic surgery. However, in a few patients the bladder neck may be completely obstructed preventing retrograde access into the bladder. A case is presented of complete bladder neck obstruction occurring after transurethral resection of prostate, which was treated after an access was provided by using transurethral Seldinger technique.

Objective penile vascular response to intraurethral prostaglandin E2 (dinoprostone).

PURPOSE: Intraurethral prostaglandin E2 (PGE2) administration is a noninvasive treatment modality for erectile dysfunction. The purpose of this study was to evaluate the objective effects of this agent by measuring peak systolic velocities of cavernosal arteries after intraurethral PGE2 administration and comparing with the results obtained with an intraurethral placebo gel and intracavernous papaverine injection. MATERIALS AND METHODS: The study group consisted of 22 consecutive impotent volunteers with a mean age of 46 years who had normal penile arterial responses as determined by penile arterial responses on papaverine-stimulated penile duplex ultrasonography. The peak systolic velocity in cavernosal arteries was recorded after intracavernous injection of 60 mg of papaverine. All patients received 1 mg of intraurethral PGE2 gel and placebo at 15-day intervals. The peak systolic velocities were recorded after each treatment. RESULTS: Mean peak systolic velocity achieved by intraurethral administration of PGE2 gel (25 +/- 8 cm/s) was less than that achieved by intracavernous papaverine (40 +/- 6 cm/s) but higher than that obtained by placebo (15 +/- 4 cm/s). Twelve patients had erections, while 9 had partial and 1 had no erection with intraurethral PGE2. Placebo did not cause any erections. No serious side effects were observed. CONCLUSION: Intraurethral administration of PGE2 appears to be an effective and simple method for increasing penile arterial flow and can be used during penile Doppler ultrasonography to stimulate the penile arterial system.

Neurofibroma of the bladder wall in von Recklinghausen's disease.

Neurofibromatosis, or von Recklinghausen's disease, is an autosomal dominant disease with multiple neurofibroma and café-au-lait spots. However, neurofibroma in the bladder wall is a rare condition in von Recklinghausen's disease. A 31-year-old man with neurogenic voiding dysfunction due to sacral meningocele and acute urinary retention with neurofibroma of the bladder wall is presented with detailed radiologic evaluation. Patients with von Recklinghausen's disease should be carefully evaluated if urological symptoms exist.

Practical approach to terminate urinary extravasation: percutaneous fistula tract embolization with N-butyl cyanoacrylate in a case with partial nephrectomy.

A 35-year-old woman who underwent partial nephrectomy had prolonged postsurgical urinary extravasation that led to a percutaneous fistula. A double-J catheter used as a ureteral stent during surgery was in place. A percutaneous pigtail nephrostomy was inserted on the 15th postoperative day but drainage continued. Antegrade pyelography demonstrated extravasation at the lower pole calyx. The double-J stent was removed on the 21st postoperative day, and a retrograde pyelogram showed no obstruction. Because drainage still was excessive on the 25th postoperative day, the fistula tract was embolized percutaneously with N-butyl cyanoacrylate, a tissue adhesive material. Drainage ceased immediately after the procedure, and control pyelography confirmed no extravasation. The patient was discharged on the 28th postoperative day. The patient had no additional complications at 36-month follow-up.

Bladder stones around a migrated and missed intrauterine contraceptive device.

Bladder stones occasionally develop because of foreign bodies in the bladder. Bladder stones in a 30-year-old woman were found to have formed around an intrauterine contraceptive device that had gone missing many years previously and had migrated into the bladder. Plain abdominal radiograms should be a part of the evaluation in patients with a history of an unretrieved intrauterine contraceptive device.

Anterior urethral valve as a cause of end-stage renal disease.

Although posterior urethral valves are predominant as a cause of obstructive uropathy in children, anterior urethral valves may also appear as the underlying etiologic factor in end-stage renal disease that results from obstruction. Two cases are presented of anterior urethral valve patients that were admitted with end-stage renal disease. The first case was successfully treated with diverticulectomy and urethral reconstruction in preparation for renal transplantation. The second case, however, had been on cystostomy drainage for 6 years and also had a contracted bladder. A more extensive lower urinary tract reconstruction was delayed. Children with poor stream and recurrent infections should be evaluated carefully and anterior urethral valve or diverticula should be considered in differential diagnosis of obstructive lesions.

Prevalence of stress urinary incontinence in both sexes at or after age 15 years: a cross-sectional study.

PURPOSE: We determine the prevalence of stress urinary incontinence among males and females at or after age 15 years in an education and research health district. MATERIALS AND METHODS: During a personal interview questionnaires were given to a total of 2,053 people at or after age 15 years in an education and research health district near Ankara, Turkey. In addition to the particular questions about stress incontinence, the medical history, including congenital or acquired diseases of clinical significance, operations and details relevant to positive findings were obtained. Groups with or without stress incontinence were compared in regard to age and sex, and parity in women. Subgroups that emerged as to the presence of nocturia and/or urgency incontinence were examined in regard to systemic diseases, operations, congenital anomalies and regular medications. RESULTS: A total of 229 people (11.1%) had stress incontinence, with a female predominance of 20.8% versus 1.0% (p <0.05). People 65 years old or older experienced stress incontinence 6.24 times more than those in the 15 to 24-year age group. In contrast, females had increasing stress incontinence prevalence by age as noted by relevant odds ratios. Stress incontinence prevalences among women in the 35 to 44 and 45 to 54-year age groups were about 39 and 35 times higher than those of men in the corresponding age groups. As expected the incontinence prevalences increased with the number of births in women. Nocturia was absent in 50.2% of all subjects, whereas 26.7% reported nocturia at all times and 23.0% had nocturia sometimes. Persistent nocturia was present in 21.1% of males and 32.1% of females. Persistent nocturia and urgency were apparently greater in patients with systemic diseases and/or those who had undergone surgery. Urgency incontinence was present in 9.7% of the entire population with a distinct female predominance of 16.3% versus 2.7%. CONCLUSIONS: Stress incontinence occurred in both sexes at or after age 15 years with a female predominance. The prevalence of stress incontinence increases with age and parity in women. Urgency and nocturia are more prevalent in people with systemic diseases and those who have undergone previous pelvic or neurosurgical operations.

Percutaneous management of ulcerative glandular hypervascularization after Virag-I operation.

A 42-year old man was admitted with glans ulcer, meatal stenosis, urinary retention and impotence. He had undergone a Virag-I operation because of impotence at another hospital 2 months earlier. The deep dorsal vein was isolated under local anesthesia and blocked by coils and embolized by n-butyl cyanoacrylate in a retrograde fashion. After 2 months, the glans had healed completely. The patient has no further urinary problem and is potent.

A case of incidentally detected Castleman's disease with retroperitoneal paravertebral localization.

Castleman's disease, or angiofollicular lymph node hyperplasia, is a fairly rare benign tumor of lymphoid origin. The expected localization is mediastinum and rarely retroperitoneum. An asymptomatic case is reported with multimodality imaging and postoperative findings. The lesion was detected incidentally on routine chest radiogram. Surgical exploration revealed a retroperitoneal mass and the mass was resected successfully through a thoracoabdominal flank incision. Castleman's disease should be included in the list of differential diagnosis of retroperitoneal masses which are mostly malignant tumors.

Embolization of the deep dorsal vein for the treatment of erectile impotence due to veno-occlusive dysfunction.

PURPOSE: We evaluate the effectiveness of deep dorsal vein embolization for the treatment of venous impotence. MATERIALS AND METHODS: A total of 32 impotent patients with veno-occlusive dysfunction underwent deep dorsal vein embolization. The condition was suspected based on findings of penile Doppler ultrasonography and cavernosometry. The diagnosis was confirmed with pharmacocavernosography that appeared to delineate venous leakage. During the procedure we isolated and cannulated the deep dorsal vein through a small dorsal penile incision with the patient under local anesthesia. We used a mixture of the tissue glue, N-butyl cyanoacrylate, and lipodol for embolization, with a total volume of 5 ml. injected antegrade into the previously catheterized dorsal vein under fluoroscopic control. As soon as we observed the occluded veins we performed repeat pharmacocavernosography. At 3-month followup patients were reassessed with history and cavernosometry. Followup ranged from 12 to 36 months (median 25). RESULTS: Of 32 patients 22 (68.7%) regained sexual activity, which was confirmed by cavernosometry. The remaining 10 patients (31.3%) experienced little if any clinical response, which correlated with cavernosometry. There were no significant side effects. CONCLUSIONS: Deep dorsal vein embolization for venogenic impotence is simple, effective and safe, and appears to be cost-effective. The results obtained in this limited number of patients are promising and justify trials in larger groups.