Diagnostic value of serum ghrelin levels in prostate cancer.

PURPOSE: Expression of recently identified growth hormone-releasing peptide, ghrelin, and its receptor has been demonstrated in prostate cancer (PCA) cell lines. It was also shown that ghrelin has increased cell proliferation in vitro when added to PCA cell lines. The aim of this study was to evaluate the diagnostic value of serum ghrelin levels in detection of PCA. MATERIAL AND METHOD: 30 patients with PCA and 50 patients with benign prostate hyperplasia (BPH) were enrolled in the study. The serum ghrelin levels of PCA and BPH patients were compared. The correlations between ghrelin and age groups, body mass index, total prostate-specific antigen (PSA) levels, free/total PSA ratio, Gleason score, and prostate volume were also studied. RESULTS: There were no statistically significant differences between the two groups and parameters mentioned above in terms of serum ghrelin levels (p > 0.05). CONCLUSION: Although ghrelin has been shown to induce PCA cell proliferation by in vitro studies, its role in the diagnosis of PCA was not demonstrated in our clinical study. Insufficient secretion of ghrelin into serum or the effect of other sources of ghrelin to serum ghrelin levels could be responsible for this discrepancy.

Stone formation on surgical staple in the bladder: a long-term complication of laparoscopic colposuspension.

We present a case of a bladder stone that developed around a surgical staple after laparoscopic colposuspension. The patient had undergone laparoscopic colposuspension for stress urinary incontinence at another institution 6 years ago. The hernia mesh and a tacker had been used as a surgical stapler. The stone and staple were retrieved endoscopically. To our knowledge, this is the first case of such a complication after laparoscopic colposuspension with a stapling device.

Values for free/total prostate-specific antigen ratio as a function of age: necessity of reference validation in a Turkish population.

BACKGROUND: The aim of this study was to evaluate age-related changes in free/total prostate-specific antigen (f/t PSA) ratio, focusing on the avoidance of unnecessary prostate biopsies. METHODS: A total of 898 men aged 30-88 years without a history of prostate surgery and disease were enrolled into the study. Serum tPSA, fPSA and f/t PSA ratios were determined for the study population and for different age categories. All males who had suspicious digital rectal examination and tPSA >4 ng/mL underwent transrectal ultrasonography-guided prostate biopsy. Receiver operating characteristic (ROC) curves for each group were generated by plotting the sensitivity vs. 1-specificity for the f/t PSA ratio. The sensitivity and specificity were obtained using different f/t PSA ratio cutoffs for different age groups. RESULTS: Prostate cancer was detected in 63 patients (7%). Age-specific cutoffs were determined according to likelihood ratios at the levels of 10%, 15% and 15% f/t PSA ratio for ages 50-59, 60-69 and >/=70 years, respectively. However, a single cutoff of 10% is recommended across all age ranges (positive likelihood ratio 2.36). ROC curves demonstrated that the area under the curve (AUC) was significant for all patients with initial PSA of 4-10 ng/mL (AUC 0.703-0.796), except for the >/=70-year age group (AUC 0.549). CONCLUSIONS: The current study showed that the use of f/t PSA ratio in patients with PSA levels of 4-10 ng/mL should enhance the specificity of PSA screening and decrease the number of unnecessary biopsies. f/t PSA levels may show dissimilarities according to age and ethnicity, so further studies are warranted to identify this relationship.

Correlations between the ICIQ-SF score and urodynamic findings.

AIMS: The primary aim of this prospective study was to examine the correlations between "The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF)" score and urodynamic findings in patients with urge incontinence. In addition, we aimed to observe the alterations of these parameters with antimuscarinic therapy. METHODS: Between January and December 2005, patients referred to our department with urge incontinence were examined. After taking a detailed clinical history, physical examination, and urinalysis, each patient was asked to complete an ICIQ-SF questionnaire. We carried out subtracted cystometry according to a fixed protocol on all patients. Patients who were defined as detrusor overactivity incontinent were given antimuscarinic therapy for 3 months. Following treatment, filling cystometry and ICIQ-SF scoring were repeated in all patients. All pre- and post-treatment data of 18 male and 42 female patients were transferred to the SPSS 11.0 for Windows program, and statistical analyses were performed. RESULTS: The patients' ages ranged from 28 to 70 (mean 49.8) years. We found statistically significant differences between the pre- and post-treatment parameters (mean ICIQ-SF score, first sensation, cystometric capacity, maximum detrusor pressure, compliance; P<0.01). We found negative correlation between pre-treatment mean ICIQ-SF score and first sensation (correlation coefficient -0.266, P<0.05) and positive correlation between pre-treatment mean ICIQ-SF score and maximum detrusor pressure (correlation coefficient 0.4, P<0.01). CONCLUSIONS: ICIQ-SF scoring is a practical and reliable method for baseline and post-treatment evaluation of patients with urge incontinence. Significant correlation exists between ICIQ-SF score and urodynamic parameters.

Successful repair of a bladder herniation after old traumatic pubic symphysis diastasis using bone graft and hernia mesh.

Bladder herniation associated with pubic symphysis diastasis is a very rare condition. We report a case with bladder herniation after traumatic pubic symphysis disruption. The patient was treated with open reduction of the bladder and definitive internal fixation of the pubis. We used a bone allograft for closure of the diastasis and a prolene mesh graft for supporting the abdominal wall. We obtained a successful outcome during a 12-month follow-up period.

Partial nephrectomy using a monopolar radiofrequency device: an animal model.

OBJECTIVES: To compare the use of radiofrequency (RF) and electrocautery in partial nephrectomy without renal artery clamping for bleeding and tissue destruction. METHODS: Sixteen adult rabbits were randomized into two groups. Partial nephrectomy using a monopolar RF device without renal artery clamping was performed in 8 rabbits (RF group) and partial nephrectomy using electrocautery was performed in the rest (cautery group). Four rabbits in each group (rabbits 1, 3, 5, and 7) were kept for follow-up, and the operated kidneys of the rest were removed for histopathologic evaluation. The tissue samples were placed in 10% formalin solution and sent to the pathology laboratory. The groups were compared in terms of bleeding and tissue destruction. RESULTS: The mean blood loss was 3.6 +/- 1.2 mL in the RF group and 8.3 +/- 2.7 mL in the control group (P = 0.003). A rabbit in the control group died on postoperative day 3 because of bleeding. Others were followed up for 3 months postoperatively. The amount of thermal destruction was comparable between the two groups. Varying degrees of thermal destruction were observed at the cutting margins in both groups. No difference was found between the two groups in terms of the deepness of thermal injury (1 to 2 mm). CONCLUSIONS: The findings of our experimental study showed that the use of the RF electrode in partial nephrectomy without renal artery clamping resulted in less intraoperative bleeding without differences in terms of tissue destruction.

A prospective randomized study for comparing bipolar plasmakinetic resection of the prostate with standard TURP.

OBJECTIVES: To compare clinical results of plasmakinetic (PK) resection vs. standard monopolar resection of the prostate, i.e. transurethral resection of the prostate (TURP). MATERIALS AND METHODS: 48 patients were included in this study between January 2003 and October 2003. They were randomized into two groups (TURP:PK) with a ratio of 1:1. PK resections (n = 24) were carried out by using PlasmaKinetic Tissue Management System (Gyrus Medical Ltd, Cardiff, UK) and PlasmaSect electrodes. TURPs (n = 24) were done by using a 26-Fr continuous-flow resectoscope and Karl Storz 27040 electrodes. Patients were assessed for safety and efficacy by measuring the IPSS and maximum flow rates at 1, 3, 6 and 12 months and residual urine measurement at 3, 6 and 12 months and transrectal ultrasonography at 6 months. RESULTS: The patients' ages ranged from 50 to 82 (mean 64 +/- 10) years. Groups were similar for operation time, bleeding score, resected tissue, catheterization time and irrigated volume. Mean serum Na levels at the end of the operation were 141.7 +/- 5.1 in the TURP group and 145.2 +/- 4.4 in the PK group (p = 0.013). The IPSS, QOL score and Q(max) had improved significantly in the postoperative period without any differences in either group. CONCLUSIONS: The main advantage of PK resection seems to be decreasing the risk of TUR syndrome, thus, larger prostates could be treated without a time limitation, theoretically. However, this technique brings no advantages in terms of intra- and postoperative bleeding, hospital stay, operation time and late complications.

Effects of ethanol on intracorporeal structures of the rat.

OBJECTIVE: Previous studies demonstrated that acute in vitro exposure of corpus cavernosal tissue to ethanol decreased its response to field stimulation and pharmacological stimulation. In the present study we investigated the effects of chronic ethanol consumption on the ultrastructure of cavernosal smooth muscle cells, elastic fibres and collagen content. MATERIAL AND METHODS: Fourteen adult wistar rats were divided into a control group (n = 7, fed a standard diet and tap water) and an alcoholic group (n = 7, fed a standard diet and 5% (v/v) ethanol in drinking water and by increasing the ethanol concentration for every week, at the end of 6th week 30% (v/v) ethanol concentration was attained. Same dose was given until 12th week. At the end of 12th week blood samples were obtained and the ethanol concentrations were determined. The cavernosal tissues were obtained and immunohistochemical examinations were performed. RESULTS: Immunohistochemical analysis revealed that chronic ethanol exposure markedly decreased the content of smooth muscle cells, elastic fibres and collagen type 4. CONCLUSION: Our findings suggest that in this animal model chronic ethanol exposure decreases the percentage of staining for smooth muscle actin, elastin, and collagen type 4 which are the key structures fundamental for erection.

Effect of varicocelectomy on sperm creatine kinase, HspA2 chaperone protein (creatine kinase-M type), LDH, LDH-X, and lipid peroxidation product levels in infertile men with varicocele.

OBJECTIVES: To determine the total sperm creatine kinase, HspA2 chaperone protein (creatine kinase-M isoform), lactate dehydrogenase (LDH), LDH-X activities, and lipid peroxidation product (malondialdehyde [MDA]) levels in infertile men with varicocele and to examine the possible effect of varicocelectomy on these parameters. METHODS: Eighty-one men were enrolled in this study. The study population consisted of a control group (n = 25) and a varicocele group (n = 56). Of the 56 patients with varicocele, 26 underwent microsurgical subinguinal varicocelectomy at our institution between July 2002 and July 2003. The standard semen parameters (sperm concentration and motility and Kruger morphology) and total sperm creatine kinase, HspA2, LDH, and LDH-X activities, and MDA levels were assessed in the control and varicocele groups. The differences were compared between the two groups. The same parameters were repeated at 6 months postoperatively in the varicocelectomy group and the preoperative and postoperative results were compared. RESULTS: The sperm concentration was significantly lower in the varicocele group than in the control group (P = 0.01). The mean sperm HspA2 activities were significantly lower and the LDH activities and MDA levels were significantly greater in the varicocele group than in the control group (P = 0.005 and P = 0.001, P < 0.001, respectively). No statistically significant difference was found in the semen parameters in the varicocelectomy group preoperatively and postoperatively. Sperm HspA2 activities increased significantly after varicocelectomy compared with preoperatively (P < 0.001). CONCLUSIONS: Our data suggest that sperm HspA2 activities are lower and LDH activities and MDA levels are greater in infertile men with varicocele. These data also suggest that varicocelectomy increases HspA2 activities in these patients.

Nocturnal enuresis and allergy.

OBJECTIVE: To investigate whether an interaction exists between nocturnal enuresis and allergy. MATERIAL AND METHODS: Thirty-seven (20 boys, 17 girls) children with monosymptomatic nocturnal enuresis were recruited. We studied an allergy panel that included total IgE, 10 examples of inhalant-specific IgE, 10 examples of food-specific IgE, eosinophilic cationic protein (ECP) and Phadiotop. The same panel was studied in a control group of 18 children without monosymptomatic nocturnal enuresis. RESULTS: We did not determine statistically significant differences between the enuretic group and the control group in terms of levels of total IgE, the 10 examples of inhalant-specific IgE and Phadiotop. However, two (soybean and hazelnut) of the 10 food-specific IgE and ECP levels did differ significantly between the two groups. CONCLUSIONS: This first specific IgE study showed that there may be a relationship between nocturnal enuresis and soybean and hazelnut food allergens. Our findings may explain some cases of nocturnal enuresis. However, further studies are necessary to explain the underlying mechanisms and management of this disorder.

The effects of sildenafil on ocular blood flow.

PURPOSE: To investigate the effects of sildenafil, a popular new drug in the treatment of erectile dysfunction, on ocular blood flow. METHODS: This study was designed as a prospective, double-blind, placebo-controlled study. Twenty participants with erectile dysfunction were given a single oral dose of 100 mg sildenafil, while 10 participants with erectile dysfunction were given placebo. All the participants underwent routine systemic and ophthalmological examinations. Intraocular pressure, systolic and diastolic blood pressure and ocular blood flow (ophthalmic, central retinal, short posterior ciliary arteries) were measured in both eyes before and 1 hour after the dose of sildenafil or placebo. Ocular blood flow measurements were performed using colour Doppler ultrasonography. RESULTS: None of the parameters were significantly different between the groups before study drug intake. Although central retinal artery velocities were not changed, ophthalmic artery and short posterior ciliary artery peak systolic velocity, end-diastolic velocity, and mean velocity values were significantly increased 1 hour after drug intake in the sildenafil group compared to the placebo group (p < 0.05). CONCLUSION: Sildenafil causes a significant increase in blood flow in these arteries. A possible role of inhibition of phosphodiesterase-5 in vascular smooth muscles by sildenafil is implicated. Further studies are needed to investigate the effects of sildenafil on ocular blood flow in patients with senile macular degeneration, diabetic retinopathy and glaucoma.

Symptomatic renal metastasis 5 years after the management of a squamous cell carcinoma of the lung.

A case of solitary renal metastasis five years after the management of a primary squamous cell carcinoma of the lung is presented.

Relaxation incision and fascia lata grafting in the surgical correction of penile curvature in Peyronie's disease.

The purpose of this study was to evaluate the effects of treatment of curvature in Peyronie's disease with a relaxation incision and fascia lata grafting. Between 2000 and 2002, this technique was used for 12 patients with a 1-year history of plaque and curvature of more than 35 degrees. Penile degloving was performed with a circumferential incision. The tunica defect was closed with fascia lata grafting after a relaxation incision. For all patients, penile curvature was corrected and normal erections were achieved. No complication was observed in 9 to 24 months (mean, 10 months) of follow-up monitoring. The initial results suggested that tunica albuginea incision and fascia lata grafting could represent an alternative for the treatment of curvature in Peyronie's disease. Further studies are warranted.

A life-threatening hematochesia after transrectal ultrasound-guided prostate needle biopsy in a prostate cancer case presenting with lymphedema.

A 62-year-old male presenting with lymphedema at the left lower extremity was diagnosed as prostatic carcinoma by an ultrasound-guided needle biopsy. Six days after the biopsy procedure, he developed severe hematochesia. Colonoscopy revealed an oozing visible vessel at the anterior rectal wall, a few centimeters from the anus. Endoscopic hemostasis with %1 athexysclerol was applicated with success. Rebleeding with same severity as the first one occurred 48 hours after the first bleeding and endoscopic hemostasis was successful again. Follow-up was uneventful.

Fascia lata grafts for closure of secondary urethral fistulas.

OBJECTIVES: To evaluate the efficacy of fascia lata graft in the repair of secondary urethral fistulas. Urethral fistulas may result from a complication of hypospadias repair. The treatment of urethral fistulas is quite challenging. METHODS: This technique was used in 8 patients between 2000 and 2002. All patients had undergone hypospadias repair and had recurrent fistula formation. A 2 x 2-cm fascia lata graft was harvested from the lateral aspect of the thigh. After repair of the fistula, the fascia lata graft was placed between the urethra and skin. The mean age of the patients was 8 years (range 5 to 13). RESULTS: During 8 to 22 months (average 11) of follow-up, no recurrence of urethral fistula was observed. No complications occurred, and patients were completely satisfied with the results. CONCLUSIONS: The results of this study show that the fascia lata graft can be used for the closure of urethral fistula secondary to hypospadias repair. Additional studies are warranted.