Effects of butein on renal ischemia/reperfusion injury: An experimental study.

OBJECTIVES: Renal ischemia/reperfusion (I/R) injury is a common cause of acute kidney injury. The aim of this study was to investigate the effect of butein on renal I/R injury. MATERIALS AND METHODS: Twenty-seven rats were randomly allocated to three groups (n = 9): a sham group, a renal I/Runtreated (control) group, and a renal I/R-butein group. The sham group underwent only opening and closing of the peritoneum. In the control group, an experimental I/R model was created and 1 cc isotonic saline was applied to the peritoneum. In the butein group, the experimental I/R model was created and 1 mg/kg butein was administered intraperitoneally 15 minutes before the beginning of ischemia. The left kidneys of the rats were histopathologically examined for tissue damage caused by I/R. RESULTS: Histopathological examination of the tissue damage revealed that all kidneys in the sham group were normal. By contrast, 2 in the control group (22.2%) had small focal damaged areas, 1 (11.1%) had < 10% cortical damage, 5 (55.6%) had 10-25% cortical damage, and 1 (11.1%) had 25-75% cortical damage. The butein group had 1 (11.1%) normal kidney, 2 (22.2%) with small focal damaged areas, 4 (44.4%) with < 10% cortical damage, and 2 (22.2%) with 10-25% cortical damage. Tissue damage was significantly lower in the sham group than in the control and butein groups (p < 0.01). No statistically significant differences were observed in the histopathology of the control and butein groups (p > 0.05). CONCLUSIONS: Intraperitoneal administration of butein had no significant effect on renal tissue injury.

Surgical and functional outcomes of radical retropubic prostatectomy after biopsy-related acute prostatitis.

INTRODUCTION: The present study sought to evaluate the intraoperative, postoperative, oncologic, and functional results of radical prostatectomy (RP) after previous prostatitis. MATERIAL AND METHODS: We retrospectively reviewed available data of 320 patients undergoing open radical prostatectomy between 2010 and 2016. From this group, 23 (7.2%) had previous transrectal prostate biopsy-related acute prostatitis history. The perioperative and postoperative data were statistically compared between Group 1 (with previous prostatitis) and Group 2 (without previous prostatitis). The variables that were evaluated included demographic characteristics, perioperative complications, functional and oncological outcomes. RESULTS: In Group 1, the operative time, hospitalization and bladder catheterization time was statistically increased by 40 min, 1.9 days, and 2.5 days, respectively (p <0.001, p <0.001, p = 0.02). The positive margin rate was not significantly different between the two groups (p = 0 .64). The rate of complications with Clavien >2 increased in Group 1 (G1 26% vs. G2 12%) (p = 0.02). Neurovascular bundle preservation ratio was statistically higher in Group 2 (G1 46.5% vs. G2 76.9%) (p = 0.02). The functional results were similar for both groups 12 months after surgery. CONCLUSIONS: Previously, transrectal prostate biopsy-related acute prostatitis history was associated with a higher operative time, hospitalization and bladder catheterization time, and perioperative complications during RP. According to our study, although the neurovascular bundle preservation is technically more difficult, potency and urinary continence rate was not affected by previous prostatitis history. However, further studies are still required to confirm these results.

Serum levels of prostate specific antigen are elevated after colonoscopy.

The risks of prostate cancer and colorectal carcinoma increase with age. So, colonoscopy and measurement of serum prostate specific antigen (PSA) may be performed during a short term in a given patient. We aimed to evaluate whether colonoscopy affects serum PSA levels and to evaluate the relationship between prostate volume and elevation in serum PSA levels after colonoscopy. This study included 44 consecutive male patients, who underwent colonoscopy. The mean age of the patients was 56.05±9.27 years. The mean time required for colonoscopy was 30 min. Serum PSA levels were measured 48-72 hours before colonoscopy, immediately after performing laxative enema, and at 24-48th hour, the 7th day, and the 14th day after colonoscopy in each patient. The serum PSA level was elevated after enema and at 24-48th hour and 7th day after colonoscopy from the baseline (p<0.05), and declined to the baseline by 14th day. When the cut off value of 20 cm3 for normal prostate volume was taken into account, the serum PSA levels were significantly higher at the 24-48th hour and the 7th day in patients with larger prostate volume (>20 cm3) than those with normal prostate volume (p=0.013 and p=0.009). These results suggest that PSA is easily released by manipulations from the larger prostate. In conclusion, serum PSA levels were elevated during 7 days after colonoscopy. Before performing invasive procedures, patients with high serum PSA levels should be asked whether colonoscopy was performed prior to the measurement.

Is prophylactic breast radiotherapy necessary in all patients with prostate cancer and gynecomastia and/or breast pain?

PURPOSE: We investigated the efficacy of prophylactic radiotherapy for gynecomastia/breast pain induced by 150 mg bicalutamide in a prospective, randomized, multi-institutional trial. MATERIALS AND METHODS: After definitive treatment for localized prostate cancer 125 patients were randomized to 12 Gy radiotherapy before bicalutamide as prophylactic radiotherapy (53) or bicalutamide only for nonprophylactic radiotherapy (72). The incidence of gynecomastia, breast pain and tenderness, and discomfort perceived by the patients was assessed by physical examination and direct questioning at 3, 6 and 12 months of followup. RESULTS: At the end of 12 months the gynecomastia rate was 15.8% in the prophylactic group and 50.8% in the nonprophylactic group (p <0.001). On patient evaluation the breast enlargement rate was 34.4%. The severity of breast pain and tenderness was not different between the groups. The breast pain rate was 36.4% and 49.2% by 12 months in the prophylactic and nonprophylactic groups, and the rate of patients who felt discomfort from gynecomastia was 11.4% and 29.5%, respectively. CONCLUSIONS: In this prospective study the incidence of gynecomastia was not as high as previously believed. Although prophylactic breast irradiation seemed to decrease the gynecomastia rate in patients on 150 mg bicalutamide, our study proves that not all patients need prophylaxis since only 52% were significantly bothered by gynecomastia. Thus, individual assessment is needed to select patients who need prophylactic radiation while on 150 mg bicalutamide.

Post-prostatic massage examination for prediction of asymptomatic prostatitis in needle biopsies: a prospective study.

PURPOSE: Although asymptomatic prostatitis is the most common noncancer diagnosis as demonstrated histologically by biopsies, screening and identification before biopsy remain unclear. In this study we prospectively evaluate the efficacy of examination of post-prostatic massage urine for prediction of asymptomatic prostatitis in biopsies. MATERIALS AND METHODS: A total of 161 consecutive men 50 to 80 years old with serum prostate specific antigen 4.1 to 10.0 ng/ml, normal digital rectal examination, no evidence of clinical prostatitis or urinary tract infection, who underwent 8 or 10-core prostate biopsies under transrectal ultrasonography guidance were included in the study. Immediate pre-biopsy leukocyte count in post-prostatic massage urine was determined per high power field (400 x). We selected 5, 7 and 10 leukocytes per high power field as cutoffs, and urine was examined for prediction of histological prostatitis. RESULTS: Histological diagnosis was prostatitis, benign prostatic hyperplasia and prostate cancer in 66 (41.0%), 63 (39.1%) and 32 (19.9%) patients, respectively. The mean number of leukocytes and percentage of positive post-prostatic massage urine microscopy for all cutoffs were significantly higher in subjects with prostatitis than in those without prostatitis (p <0.0001). Histological prostatitis was predicted most accurately by the 5 leukocyte cutoff (sensitivity 68.2%, specificity 82.1% and area under the receiver operating characteristics curve 0.75). CONCLUSIONS: In asymptomatic men with mild increases of prostate specific antigen histological evidence of prostatic inflammation is common. The leukocyte count in post-prostatic massage urine appears to be useful for screening of this condition before biopsy. Our data suggest that 10 leukocytes per high power field in post-prostatic massage urine, the usually applied cutoff, may be too high for the definition of prostatic inflammation.

Short term effects of GnRH agonists on plasma fibrinolytic balance in patients with advanced prostate cancer.

BACKGROUND: Gonadotropin releasing hormone (GnRH) agonists are the cornerstone of metastatic prostate cancer treatment. Cardiovascular effects of GnRH agonists are unclear. In this study, we investigated the short term effects of GnRH agonists on plasma fibrinolytic parameters in patients with metastatic prostate cancer. METHODS: Eleven patients (mean age 69.3 +/- 6.5) with metastatic prostate cancer and a clinical indication for GnRH agonist therapy were selected. Plasma plasminogen activator inhibitor (PAI-1) antigen (Ag), tissue plasminogen activator (t-PA) Ag and thrombin-activatable fibrinolysis inhibitor (TAFI) activity levels were measured at baseline and at 4 weeks after the first dose of GnRH agonist, Goserelin Acetate (Zoladex, subcutaneous administration, 10.8 mg). RESULTS: Serum prostate specific antigen (PSA) levels significantly decreased from 36.6 +/- 19.3 to 1.1 +/- 0.3 ng/ml after Goserelin acetate treatment (P = 0.005). Significant changes occurred in the fibrinolytic parameters. GnRH agonists decreased plasma t-PA Ag levels (16.3 +/- 4.9 vs. 12.2 +/- 2.8 ng/ml, P = 0.047) and increased PAI-1/t-PA molar ratio (4.8 +/- 3.6 vs. 6.6 +/- 3.4, P = 0.16), on the other hand, plasma PAI-1 Ag (59.0 +/- 48.5 vs. 56.4 +/- 30.5 ng/ml, P = 0.8), and TAFI levels (130.6 +/- 9.5 vs. 124.2 +/- 26.5% activity, P = 0.3) did not change significantly. CONCLUSION: This study provides evidence that GnRH agonists may inhibit fibrinolytic system by decreasing t-PA levels.

Short-term catheterization after TIP repair in distal hypospadias: who are the best candidates?

Over the last decade, tubularized incised plate (TIP) urethroplasty has become the first choice of surgical technique in patients with distal hypospadias. Despite the excellent cosmetic and functional results, prolonged catheterization (7-14 days) remains the main disadvantage of the TIP repair. In this study, we investigated the outcomes of the short-term catheterization in children with distal hypospadias in order to elucidate any relationship between the length of catheterization and the patients' age, meatal localization and postoperative complication rates. The charts of 183 patients who underwent TIP repair for distal hypospadias in two different centers were reviewed retrospectively. Patients were grouped based on their catheter removal time (before 24 h vs. after 24 h) and the toilet status of children (toilet-trained vs. in-diaper). Children who had at least 6 months of follow-up and regular office visits were included in the study group, and the results were compared to the literature as well as the subgroups were also evaluated in terms of complications and catheterization period. A total of 128 patients with 40.4 months of the mean age (6-180 months) and 22.7 months of the follow-up (6-49 months) were included in the study. For the group 1 patients (n = 99) in whom the urethral catheter was removed before 24 h, the mean age and follow-up were 33.4 months (6-150 months) and 22.3 months (6-48 months), respectively. The catheters of group 2 patients (n = 29) were removed after 24 h, and their mean age and follow-up were 64.4 months (6-180 months) and 24.2 months (6-49 months), respectively. The group 2 patients were significantly older than those of group 1 (P < 0.05). The complications, such as fistula, meatal stenosis, tube dehiscence and buried penis, were seen in 11.1% of the group 1 and 13.8% of the group 2 (11.7% in overall), showing no statistically significant difference. On the other hand, 44% of the patients (n = 56) were toilet-trained at time of surgery. Although the mean age (79 months vs. 10.4 months) and the catheter removal time (64.3% vs. 87.5% before 24 h) of this group were significantly longer than the patients in diaper (P < 0.05), no significant difference was determined in terms of complication (14.2% vs. 9.7%). TIP repair with short-term catheterization has similar outcomes to the patients who conventionally carry their stent 7-14 days. The meatal position and the toileting status of the patients are not important in the use and length of catheterization.

Intermediate-term functional and cosmetic results of the Snodgrass procedure in distal and midpenile hypospadias.

We have evaluated the long-term functional and cosmetic results of the Snodgrass technique in the treatment of anterior and midpenile hypospadias. A total of 70 patients who presented in the period between 1997 and 2002 underwent the Snodgrass procedure for the treatment of hypospadias. Patients who had been operated on 2 or more years previously were recalled for evaluation. Of the 31 cases identified, 19 (61%) were contacted and came for reevaluation. Genital examination and urinary flow measurements were made. Maximum urinary flow rates and voided urine volumes were assessed using the nomograms described by Toguri et al. The mean age of the patients was 6 years (range 2-12) at the time of surgery and 8 years (range 4-17) at the time of evaluation, and the mean follow-up period was 3.1 years (range 2-5). Two patients had had at least one previous surgery, and 17 were primary patients. The hypospadiac meatus was anterior in 16 patients and midpenile in three. Although some patients had urinary spraying due to skin irregularity in the meatus during voiding, 18 patients had normal peak urinary flow rate (Qmax) corresponding to their age group. Only one patient in the equivocally obstructed group had meatal stenosis, which was corrected with meatotomy. All patients had a cosmetic view of a vertical slit tip of the glans. Tubularized incised plate urethroplasty (TIPU) is a successful technique with good functional and cosmetic long-term results in distal hypospadias.

Contact neodymium: YAG laser ablation of recurrent urethral strictures using a side-firing fiber.

PURPOSE: We evaluated the 2-year follow-up results of contact vaporization of recurrent urethral strictures using a side-firing Nd:YAG laser fiber. PATIENTS AND METHODS: A total of 21 male patients with recurrent benign urethral strictures 5 to 20 mm in length were treated with Nd:YAG laser in the contact mode using a side-firing probe. An initial urethrotomy was made at the 12 o'clock position by retrograde vaporization of the scarred tissue through the total length of the stricture with the aid of a metal guidewire. Then all the scarred tissue was gradually vaporized circumferentially until an adequate channel had been created and healthy normal tissue was visible. RESULTS: The mean operation time was 35 minutes (range 20-55 minutes). No significant bleeding or serious complication was seen in the perioperative or postoperative period. Hospital stay and catheterization time were 48 hours or less in all cases. The success rates at 6, 12, and 24 months were 76%, 67%, and 52%, respectively. The morbidity of the laser treatment was minimal. CONCLUSIONS: The contact Nd:YAG laser is a safe treatment modality for recurrent urethral strictures. In view of the moderately durable successful results, it may be considered a last attempt at a minimally invasive treatment before making the decision for open urethroplasty.

Nd:YAG laser ablation plus transurethral resection for large prostates in high-risk patients.

OBJECTIVES: To evaluate the outcome and morbidity rate of combined visual laser ablation of the prostate and transurethral resection of the prostate (TURP) in high-risk symptomatic patients with large prostates. METHODS: A total of 28 patients evaluated according to the American Society of Anesthesiologists (ASA) classification to have ASA grade 3 or greater and who had a prostate volume of 50 cm3 or greater, and peak urinary flow rate of less than 15 mL/s underwent visual laser ablation of the prostate plus TURP for severe lower urinary tract symptoms due to benign prostatic hyperplasia. The postoperative evaluation included the American Urological Association symptom score index, maximal urinary flow rate measurement, postvoid residual urine volume, and morbidity. RESULTS: The mean baseline prostate volume and duration of surgery was 85 cm3 (range 50 to 120) and 70 minutes (range 55 to 105), respectively. Surgery was performed under local and spinal anesthesia in 18 and 10 patients, respectively. No perioperative bleeding requiring transfusion or TURP syndrome developed. Urethral catheter drainage was continued for an average of 1.7 days. Only 1 patient developed irritative voiding symptoms. The postoperative follow-up period ranged from 6 to 21 months (median 11). Improvement in the evaluation parameters was noted in all cases. CONCLUSIONS: The results of our study show that visual laser ablation of the prostate plus TURP has the advantage of excellent homeostasis and lower morbidity in men with large prostates. When the patient's medical condition precludes TURP, this combination of techniques may be considered an option in such cases for symptomatic relief of obstructive urinary symptoms due to benign prostatic hyperplasia.

The effect of urethral catheterisation on serum prostate- specific antigen levels in male patients with acute urinary retention.

Urethral catheterisation is often used in acute urinary retention (AUR). In this study, we aimed to evaluate the effect of urethral catheterisation on serum prostate-specific antigen (PSA) levels in men with AUR. Our study subjects comprised 35 men with a mean age of 63.7 +/- 7.35 years (range 55 - 80) who presented with AUR at our department between March 1999 and June 2000. Patients were randomly divided into two groups; 18 patients underwent urethral catheterisation in the first group (catheterisation group), while 17 underwent suprapubic percutaneous cystostomy in the second group (cystostomy group). Serum PSA levels before manipulation, and 2 and 12 hours and 7 days after treatment were determined. The change in median PSA values after manipulation was statistically significant in the catheterisation group (p < 0.05), but not in the cystostomy group (p > 0.05). The change in serum PSA was not clinically important in any of the patients. These results suggested that urethral catheterisation did not cause a significant alteration in serum PSA in men with AUR retention.

Predisposing factors and treatment outcome in Fournier's gangrene. Analysis of 28 cases.

OBJECTIVES: To evaluate the etiologic factors and the effects of surgical debridement and adjunctive therapies on morbidity and mortality of Fournier's gangrene. METHODS: 27 males, 1 female, a total of 28 patients with a mean age of 58 years treated for Fournier's gangrene were evaluated retrospectively. RESULTS: Predisposing factors including diabetes, alcohol abuse, paraplegia and renal insufficiency were identifiable in 54% of the patients. Etiologic origin of the gangrene was urogenital, cutaneous and anorectal in 43, 25 and 11% of the patients, respectively. The pathology was limited to genitalia in 10, extending to perineum in 8, the umbilicus in 7 and even up to the axilla in 3 patients. Suprapubic cystostomy and colostomy were necessary in 18 and 2 cases, respectively. We used hyperbaric oxygen therapy in 2 and honey in 6 patients to accelerate wound healing. A repeat debridement was necessary in 39% of the cases. Plastic surgery and grafting were done in 14 patients. Our mortality rate was 7%. CONCLUSION: Early recognition of the pathology and aggressive surgical debridement are the mainstay of the management of Fournier's gangrene. Additional strategies to improve wound healing and increase patient survival are also needed.

Evaluation and treatment of penile fractures: accuracy of clinical diagnosis and the value of corpus cavernosography.

OBJECTIVES: To assess the accuracy of clinical diagnosis and feasibility of treatment on the basis of cavernosographic findings in men with clinical features consistent with penile fracture. METHODS: Forty consecutive patients (mean age 32 years, range 18 to 65) who presented with a history of blunt penile trauma and clinical signs and symptoms indicating penile fracture during the past 11 years were included. The charts of the first 13 patients, who were seen between 1990 and 1994 and were treated surgically on the basis of the clinical findings, were reviewed retrospectively. In the next 27 patients, a prospective study was designed and treatment was determined according to their cavernosogram findings: 21 with evidence of corporal injury treated surgically and 6 with normal imaging treated conservatively. The follow-up ranged from 3 to 32 months (mean 14). RESULTS: The clinical diagnosis of penile fracture was accurate in 11 of 13 patients and was false in 2 (15%). In the prospective study, corporal injury as determined by cavernosography was confirmed surgically in all cases. The cosmetic and functional results were satisfactory in all, including the patients treated conservatively. No serious complication was reported. CONCLUSIONS: In men with blunt penile trauma, the clinical presentation can be misleading and may result in unnecessary surgery. The results also demonstrated that cavernosography is a useful investigation method and may be helpful in selecting the treatment approach in these cases.

Neodymium:YAG visual laser ablation of the prostate: 7 years of experience with 230 patients.

PURPOSE: We evaluated the short and long-term outcome of neodymium:YAG visual laser ablation prostatectomy for treatment of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 230 patients with symptomatic BPH underwent visual laser ablation prostatectomy. Evaluation measures included the American Urological Association symptom score, maximum urinary flow rate, post-void residual urine volume and morbidity. RESULTS: Median followup was 36 months (range 6 to 79). Of the patients 220, 196, 180, and 167 were available at 6 months, 1, 2 and 3 years, respectively. Moreover, 98 patients were followed for a minimum 5 years. At 6 months maximum urinary flow rate increased from 6.7 to 17.9 ml. per second, post-void residual urine volume decreased from 159 to 52 ml. and the American Urological Association symptom score was reduced from 22 to 7.2. Improvement in the evaluation parameters also continued at 5 years. Early complications consisted of prostatitis, urinary retention, and bleeding in 6 (2.6%), 3 (1.4%) and 1 (0.4%) patient, respectively. Irritative symptoms persisting greater than 4 weeks were seen in 28 (12.2%) patients. Late complications were bladder neck contracture, urethral stricture, and urinary retention in 3 (1.4%), 2 (0.9%) and 2 (0.9%) patients, respectively. Of the 153 sexually active men 5 noticed erectile impotence at 6 months. There were 20 (12.0%) patients who reported retrograde ejaculation. The reoperation rate was 5.5%. CONCLUSIONS: Our results further confirmed that visual laser ablation prostatectomy is a safe and effective treatment for BPH. It has minimal morbidity and durable therapeutic effects. However, the major disadvantage is postoperative irritative voiding symptoms.