Propofol reduces nitric oxide-induced apoptosis in testicular ischemia-reperfusion injury by downregulating the expression of inducible nitric oxide synthase.

BACKGROUND: The aim of the present study was to investigate the underlying mechanisms in the preventive effects of intravenous anesthetics on testicular ischemia-reperfusion injury. METHODS: Forty male Wistar Albino rats were randomly assigned to four groups of 10 rats each. Anesthesia was induced and maintained with thiopental in groups 1 and 2 and with propofol in groups 3 and 4. Groups 2 and 4 received left testicular ischemia (torsion) for 1 h and reperfusion (detorsion) for 24 h. Groups 1 and 3 (control groups) had no testicular torsion and detorsion. At 24 h of reperfusion, animals were killed and ipsilateral testes were removed for determination of tissue nitric oxide (NO) levels and immunohistochemical evaluation of endothelial nitric oxide synthase (eNOS), inducible NOS (iNOS), and apoptosis protease-activating factor 1 (APAF-1). RESULTS: Between groups 1 and 3, there were no differences in tissue NO levels and eNOS, iNOS, and APAF-1 expressions. iNOS and APAF-1 expressions were markedly increased in group 2, but these parameters were at the mild to moderate level in group 4 at 24 h of reperfusion. Also, elevated expression of iNOS was accompanied by a high NO production in group 2 compared with group 4. Although eNOS expressions were increased in both the groups (groups 2 and 4), there were no significant differences between these groups. CONCLUSIONS: Propofol as an anesthetic agent may attenuate germ cell-specific apoptosis and decrease NO biosynthases through downregulation of iNOS expression in an animal model of testicular torsion and detorsion.

The preventive effects of thiopental and propofol on testicular ischemia-reperfusion injury.

BACKGROUND: Testicular torsion is a urological emergency that requires immediate surgical intervention to prevent testicular damage. The aim of the study was to investigate the preventive effects of thiopental and propofol as anesthetics on testicular ischemia-reperfusion injury. METHODS: Forty male Wistar Albino rats were randomly assigned to four groups of 10 rats each. During 5 h, anesthesia was induced and maintained with thiopental in groups 1 and 2 and with propofol in groups 3 and 4. Groups 2 and 4 received left testicular ischemia (torsion) during 1 h and reperfusion (detorsion) during 4 h. Groups 1 and 3 (control groups) had no testicular torsion and detorsion. At the end of 5 h, animals were killed and both ipsilateral and contralateral testes were removed for histopathologic examination and measurement of tissue MDA (malondialdehyde) and NO (nitric oxide) levels. RESULTS: In the contralateral testes of all the groups, MDA and NO measurements were not different from ipsilateral testes of the control groups. Between the groups 1 and 3, there were no differences in MDA and NO levels. Although torsion/detorsion of testes in group 4 caused significantly increased levels of tissue MDA and NO values compared with group 3, ischemia-reperfusion in group 2 caused a further increase in these levels compared with group 4. The ipsilateral testes in the control groups did not show any morphological changes. Testicular torsion/detorsion in rats with thiopental anesthesia (group 2) caused significantly greater histopathologic injury levels than rats with propofol anesthesia (group 4). CONCLUSION: Our results suggest that propofol as an anesthetic agent may prevent testicular damage by scavenging reactive oxygen and nitrogen species and inhibiting lipid peroxidation in an animal model of testicular torsion and detorsion.

Which procedure should be chosen as a salvage operation in anterior hypospadias cases, meatal-based or onlay island flap? A comparative analysis.

We compared the outcome of flip-flap procedure (Mathieu procedure) with onlay island urethroplasty after previously failed repairs in anterior hypospadias cases. Charts of patients who underwent salvage flip-flap ( n=58) and onlay procedure ( n=24) were reviewed. Age range was 3-19 years (mean: 9+/-4.1) and 2-30 years (10.3+/-5.2) in the onlay and Mathieu groups, respectively ( p>0.05). In the onlay group, the flap was prepared from penile skin and preputial tissue in 5 and 19 cases, respectively. The meatal-based flap was laterally directed in 7 cases in the Mathieu group. The mean number of prior operations was greater in the onlay group when compared with the Mathieu group (1.85+/-1.53 vs. 1.41+/-0.65, respectively) although the difference was not statistically significant (Student's- t test, p>0.05). A total of 14 out of 58 (24.1%) and 6 out of 24 (25%) cases resulted in fistula formation in the Mathieu and island flap groups, respectively. Comparison of the rates of fistula formation did not reach statistical significance (Pearson chi(2), p=0.934). Skin dehiscence in one case and burying of the penis in another patient due to inadequacy of skin for coverage, occurred as complications in the onlay group. Splitting of the glans in 1, dehiscence of skin in 1 patient and complete breakdown of the neourethra in 1 case were the complications encountered in the Mathieu group. Both Mathieu and onlay island procedures have similar success rates as a salvage operation in anterior hypospadias cases if proper patient selection is done. The onlay procedure has been more commonly performed after a failed Mathieu procedure and the reverse rarely occurs.

Calyceal fornix rupture during cystography.

We report the first case of calyceal fornix rupture due to cystography in the literature. We recommend that instillation of all the contrast material should be attentively traced by the fluoroscope during cystography.

Outcome of pull-in procedure in children with severe post-disruption posterior urethral strictures.

A total of 17 children aged 5 to 15 years with the diagnosis of posttraumatic posterior urethral stricture were operated upon using a pull-in procedure during the last 9 years. Among the diagnostic tools, synchronous inspection of both the anterior and posterior urethra by cystoscopy yielded the most valuable information. A success rate of 70% was achieved with the procedure plus postoperative re-catheterization. A pedunculated tube prepared from the scrotal skin cured 2 patients after a series of failed operations. Difficult voiding occurring after removal of the stent due to an inappropriate pressure gradient created between the bladder neck and urethra usually benefits from short-term catheterization. Mild chordee was present in 1 patient. Ejaculation and erection were present in 3 children who reached puberty.

Retrovesical echinococcal cyst causing renal failure and nocturnal enuresis in a child.

Although retrovesical hydatid cysts are observed in adulthood albeit very rarely, to our knowledge there is no case reported in childhood. In the current case, a huge retrovesical hydatid cyst caused obstructive uropathy, polydipsia, and secondary nocturnal enuresis in a child. Because the retrovesical hydatid cyst was firmly adherent to the neighboring structures, partial cystectomy could be performed. Perioperative and postoperative complications did not occur, and the symptoms relieved in the early postoperative period.

A rare cause of cystic testicular mass in an infant--cystic dysplasia of the testis.

In this article, a 6-month-old infant with cystic dysplasia of the testis (CDT) is presented. Although different genitourinary abnormalities associated with CDT have been reported, this is the first case of the association of CDT with penoscrotal hypospadias, unilateral undescended testicle, bilateral scrotal hernia, small and hypocompliant bladder and urethral obstruction. Orchiectomy was carried out for the treatment of this rare cause of testicular cystic mass.

An unusual cause of urinary retention: a primary retrovesical echinococcal cyst.

We present a patient with symptoms of frequency, a mild decrease in urinary stream, and urinary retention due to a huge hydatid cyst located in the retrovesical region. Chest radiography and abdominal computed tomography did not reveal any other site of hydatid disease involvement. Since the cyst was in intimate contact with the seminal vesicles and the vasa deferentia, part of the hydatid sac wall adherent to these structures was left behind during the surgical excision. The patient was free of voiding symptoms, and no other episode of urinary retention had occurred at 6 months of follow-up. Pelvic computed tomography did not reveal recurrence of hydatid disease at 6 months postoperatively.

Isolated renal and retroperitoneal hydatid cysts.

Four patients (3 male, 1 female) with isolated renal and 1 female patient with isolated retroperitoneal cysts were reviewed. The mean age of the patients was 46 (25-64). The most common presenting symptom was pain. Two cases were discovered incidentally by the observance of renal calcification on abdominal x-ray. Indirect hemagglutination test was positive in all cases but eosinophilia was present only in 1 (20%) case. Nephrectomy was performed to 1 patient who presented with hydaturia and had a large communicating cyst involving most of the kidney. Total cystectomy was performed in other renal cysts. Total cystectomy with wide excision of the involved muscle was performed to the retroperitoneal hydatid cyst. Patients were followed by an average of 23.8 (9-50) months with indirect hemagglutination test and USG. No evidence for recurrence was found up to date.

Simplification of laparoscopic extraperitoneal colposuspension: results of two-port technique.

PURPOSE: The aims of the present prospective study were to apply a new simplification for Laparoscopic Burch Colposuspension and to assess the postoperative results of this treatment modality for stress urinary incontinence. MATERIALS AND METHODS: Twenty-four patients underwent simplified laparoscopic procedure via two ports, utilising endoscopic tacker and two stripes of prolene mesh. Patients were evaluated for operative time, duration of urethral catheter, length of hospital stay, complications and continence status. RESULTS: The technique was successful in 21 patients after 24 months follow-up. Average operative time was 39 minutes. The lengths of urethral catheterisation and hospital stay were 22 and 45 hours, respectively. One operative complication and three postoperative recurrences were recorded. CONCLUSION: Laparoscopic bladder neck suspension continues to develop as the instruments and techniques are improved. In carefully evaluated patients, it provides safe and minimally invasive procedure. We report the results of a new technique to simplify and speed up a laparoscopic extraperitoneal colposuspension.

Lessons from 197 Mathieu hypospadias repairs performed at a single institution.

Over a 15-year period, 197 Mathieu hypospadias repairs were performed at our institution. The present study reports our experience with this operation with an analysis of factors associated with unfavorable results. Cosmetic results were either excellent or satisfactory in all but 4 cases (2%). Overall, 42 patients (21%) voided with a fistula. A history of a previous operation, flap length, type and structure of the suture, suturing technique, existence of chordee and torsion, and circumcision status were analyzed as prognostic factors. Fifteen years were divided into three equal time intervals, and the success rates of these intervals were also compared. The length of the flap, (< vs >/=20 mm), suture structure (monofilament versus multifilament), and suture type (6-0 vs 5-0) were found to be factors with a significant influence on success rates (P < 0.05). The fistula rates of the three 5-year intervals were 52%, 28%, and 11%, respectively. The difference between time periods was also significant (P < 0.01). On multivariate analysis, only the difference between time intervals remained significant. The present analysis suggests that experience could be considered the most important factor affecting the success rate of hypospadias surgery. We recommend not changing the type of operation so often that not enough experience can be gained. The best results can be achieved in the most experienced hands.

A new application of laparoscopic instruments in percutaneous bladder stone removal.

The aim of this study is to describe a new technique using laparoscopic instruments for percutaneous bladder stone management and determine the efficacy of this procedure. The technique is based on percutaneous removal of the bladder stone(s) by using laparoscopic instruments under video-cystoscopic visualization. Laparoscopic large grasper or butterfly net like sac were used to extract bladder stones in six patients who were candidates of open cystolithotomy. Satisfactory results have been obtained in patients with solitary bladder stones that have diameters up to 3 cm or multiple stones. In selected cases, operation time, urethral and mucosal damage, hospital stay, and cost can be decreased to a minimum with this simple technique. It may be an alternative method to previously reported percutaneous bladder calculi management modality, in which percutaneous nephrolithotomy devices have been utilized.

13 years' experience of penile fracture.

Thirty-two cases of penile fracture in 1983-1996 were retrospectively reviewed and the patients were recalled for assessment of current status. The time from injury to repair ranged from 8 to 31 hours. The tear in the tunica albuginea was repaired with absorbable interrupted sutures. All patients were discharged on the day after operation. Skin loss required dermal grafting one month postoperatively in one patient. Erectile function returned within 2 days and coitus was achieved on average 13 days after the repair. Two patients had slight penile curvature which did not impede coitus. At long-term follow-up all patients reported satisfactory function.

Role of Tile classification in predicting urethral injuries in pediatric pelvic fractures.

Urologic lesions accompanying pelvic fractures is a well-known entity, and reports on the correlation of pediatric pelvic fracture type with lower urinary tract injury are few in the literature. We have reviewed 27 records and x-ray films of male pediatric patients who required urologic intervention after trauma to see which type of fracture, classified according to Tile, has a higher predilection of urologic injury. Most of the fractures that were considered to be mechanically stable and mainly localized to the anterior pelvic arch had urologic lesions that were generally confined to the bulbomembranous urethra (48%).

The role of pentoxifylline in the treatment of erectile dysfunction due to borderline arterial insufficiency.

OBJECTIVE: To investigate the effects of pentoxifylline on penile blood flow and potency in patients with erectile dysfunction due to borderline arterial insufficiency. PATIENTS AND METHODS: Following a routine diagnostic evaluation, 36 patients with borderline arterial disease diagnosed using penile duplex ultrasonography were included in the study. Of these patients, 20 (mean age 54 years, range 40-66) received 1.2 g of pentoxifylline daily, divided into three doses orally, for 2 months and 16 (mean age 54 years, range 34-65) received a placebo. Peak systolic velocities (PSVs) before and after the treatment were compared with those in patients receiving a placebo. The clinical improvement in erectile function was also evaluated. RESULTS: Twelve of 20 patients receiving pentoxifylline had an increase in PSV at the end of the treatment period. The mean change in PSV achieved by pentoxifylline treatment (6.25 cm/s) was significantly higher than that achieved by the placebo (0.38 cm/s). Seven patients had a positive response (successful coitus achieved after treatment with pentoxifylline). No serious side-effects occurred. CONCLUSION: Pentoxifylline was well tolerated and could increase penile arterial inflow, shown objectively as an increase in PSV on penile duplex ultrasonography. These findings should encourage further studies of the efficacy of pentoxifylline in the treatment of impotence.

Techniques of corporoplasty for penile curvature: review of 18 patients.

Penile curvature which can be acquired or combined with some congenital anomalies may cause trouble in sexual function or can affect the psychological status of the individual. Whatever the causes or the results are, this condition has been tried to be corrected for many years by many different techniques. Eighteen patients with penile curvature have been reviewed. Thirteen patients underwent Nesbit procedure, in 3 patients plication of the tunica albuginea was done and in 2 patients longitudinal incision and horizontal closure of the tunica albuginea were performed. In all cases the results were both functionally and cosmetically satisfying. The advantages and disadvantages of these techniques are discussed, with a review of the relevant literature.

A prostaglandin synthesis inhibitor, diclofenac sodium in the treatment of primary nocturnal enuresis.

Various treatment modalities have been used in Primary Nocturnal Enuresis (PNE) and pharmacotherapy is widely accepted. Prostaglandins increase detrusor pressure, decrease urethral pressure and lead to sodium excretion. They also antagonize hydro-osmotic effect of vasopressin by competing with this hormone. According to these functions of prostaglandins it is suggested that inhibition of prostaglandin synthesis may have value in the management of PNE. We evaluated the efficacy or oral diclofenac sodium treatment in 78 patients. We conclude that diclofenac sodium, an inhibitor of prostaglandin synthesis, is a good alternative agent for nocturnal enuresis particularly as a supplementary treatment combined to Imipramine, with 60% complete response and 13.3% recurrence rate.

The efficacy of anti-serotoninergic agents in the treatment of erectile dysfunction.

We investigated 3 agents with antiserotoninergic activity (oral trazodone, ketanserin and mianserin) in a double-blind randomized placebo controlled design in terms of the effectiveness in erectile dysfunction. Positive response rates to 30 days of treatment were 65.2% with trazodone, 19.1% with ketanserin, 31.6% with mianserin and 13.6% with placebo. Response to trazodone treatment was significantly better than with placebo (p = 0.0004) and the other 2 agents (p = 0.03 and p = 0.002 for mianserin and ketanserin, respectively). The effectiveness of ketanserin and mianserin seemed to be greater than that of placebo but the differences did not reach statistical significance (p = 0.63 and p = 0.17, respectively).