Effects of ACE I/D polymorphism on prostate cancer risk, tumor grade and metastatis.

UNLABELLED: The aim was to substantiate the putative significance of angiotensin-converting enzyme (ACE) (insertion/deletion) I/D polymorphism on prostate cancer risk, BTPSA-A TPSA (before treatment-after treatment prostate-specific antigen) levels and tumor development. MATERIALS AND METHODS: 48 prostate cancer patients and 51 healthy volunteers were included. The ACE I/D genotypes were determined by PCR (polymerase chain reaction) and RFLP (restriction fragment length polymorphism) techniques. RESULTS: The DD genotype may have detrimental and the II genotype may have protective effect on prostate cancer (p = 0.03). The highest before treatment PSA (BTPSA) values were found in the patient group having the DD genotype (p = 0.017). PSA-AT levels were higher in homozygous mutant DD than homozygous II and the decrease in PSA-AT level was found to be statistically significant in each genotype (p = 0.000). Patients with the D allele showed a higher prevalence of late stage prostate carcinoma when compared to the patients with II genotype (p = 0.022) and the detrimental effects of the D allele, both in lymph node metastases and distant metastasis were observed. CONCLUSION: The risk of prostate cancer development, the PSA level and tumor metastasis may be associated with genetic variation in the ACE I/D genotypes which may be used as an important biomarker for further studies.

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.

Primary retroperitoneal hydatid cyst with unusual clinical manifestation.

Although hydatid disease may affect any organ of the body, there are only a limited number of cases where the primary lesion is in the retroperitoneal region. Since the clinical and laboratory findings are nonspecific, the correct preoperative diagnosis may be difficult. A primary retroperitoneal hydatid cyst that was given a preoperative diagnosis of adrenal mass and treated by adrenalectomy and partial nephrectomy is presented and discussed with the relevant literature.

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.

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.