Glans penis and prepuce colonisation of yeast fungi in a paediatric population: pre- and postcircumcision results.

The members of the genera Candida and Malassezia comprise opportunistic yeast with a natural habitat on the skin of humans and warm-blooded animals. This study aimed to compare the prevalence of these yeast fungi in samples from the glans penis and prepuce 3-5 min prior to circumcision and after 1-month follow-up by mycological examination. A total of 77 children aged between 0.01 and 13.0 years (mean age 5.8 +/- 3.4) were included in the study. Impression preparations were made on modified Dixon and Leeming-Notman agars without cycloheximide. The isolates were identified by morphological, biochemical and physiological characteristics. The frequency of yeast colonisation was found to be significantly decreased from 11.7% to 1.3% following circumcision (P = 0.008). The glans penis and prepuce were colonised with especially Candida albicans (50%) followed by Malassezia furfur (40%) and Malassezia sympodialis (10%). This study highlighted the potential medical benefits of circumcision as a significant factor decreasing the colonisation rate of yeast fungi. We suggest that circumcision, rather than age, plays an important part in the reduction of yeast fungi in genitalia.

Scrotal skin metastases of renal cell carcinoma: a case report.

A 52-year old male, with a history of radical nephrectomy due to renal cell carcinoma ten years ago, presented with a lesion on the scrotum which was diagnosed as a metastasis of renal cell carcinoma.

Comparison of fine-needle aspiration and open biopsy of testis in sperm retrieval and histopathologic diagnosis.

This study aimed to compare the diagnostic value of testicular fine-needle aspiration (FNA) with open biopsy in infertile males with azoospermia or severe oligozoospermia and to evaluate the reliability of testicular sperm extraction by FNA. A total of 76 testes of 40 patients, 34 with azoospermia, four oligozoospermia and two patients who underwent orchidectomy as a result of cancer of prostate were included. Detailed clinical and laboratory examinations were performed and two semen analyses were obtained from each patient. A 20-ml 26 gauge 13-mm needle was used for FNA and smears were stained with May-Grunwald-Giemsa and Papanicolaou stain. An open biopsy was performed in each patient after FNA and the samples were stained with haematoxylen-eosin. Smears and histological stains were examined and compared under light microscopy by the same pathologist. In 69 of the 76 testes (90%) FNA cytology results agreed with the histology. In four testes, the aspirate was unsatisfactory and in three testes, spermatocytic arrest was found cytologically while subsequent biopsies revealed diffuse fibrosis. In 15 of 16 patients (93.7%) with normal and hypospermatogenesis, spermatozoa had been extracted by FNA. Spermatozoa could not be obtained after neither FNA nor open biopsy in the remaining 24 patients. Testicular FNA in infertile males is a simple, reliable and minimally invasive diagnostic tool. It is as effective as open biopsy for testicular sperm extraction and good results can be achieved in experienced hands.

Laparoscopic renal biopsy in bilateral pelvic kidney with chronic glomerulonephritis.

Percutaneous needle biopsy under the guidance of ultrasound or computerized tomography is the most valuable method in the diagnosis of parenchymal kidney diseases. However, sometimes it can be difficult to perform in the presence of certain anomalies, anatomic variations, or medical problems. In the presence of bilateral pelvic kidney, which is a rare anomaly, laparoscopy can be used to obtain biopsy. Biopsy of kidney was planned in a 26-year-old woman who presented with a history of hypertension for 7 years and proteinuria with the diagnosis of nephrotic syndrome. For the biopsy, the laparoscopic approach was chosen since the patient had bilateral pelvic kidneys. Under general anesthesia, using three port sites, the right kidney was reached, which was located more anterior than the left one. Three biopsy specimens for histologic evaluation were taken with a Tru-Cut biopsy needle. No complications were encountered during or after the operation. The patient was ceased from urological follow-up after performing an ultrasound on the first postoperative day. This is the first case of pelvic kidney with chronic glomerulonephritis reported in the literature in which the histologic diagnosis was made with the help of laparoscopy. Laparoscopic kidney biopsy is a minimally invasive technique that can be done in cases with anatomic variations, making percutaneous needle biopsy impossible.

A giant renal calculus treated without nephrectomy.

The case of a patient with a giant renal calculus weighing 770 g in a solitary functioning kidney is reported. A 57-year-old man presented with right lumbar pain and macroscopic hematuria, and a giant stone was diagnosed in his right kidney. Nine days after a percutaneous nephrostomy placement, the patient underwent selective right renal angiography and transcatheter superselective embolization due to a sudden gross hematuria observed from both the nephrostomy tube and urethra. Embolization was successful. Right anatrophic nephrolithotomy was performed after stabilization of the patient. There were no complications during the recovery period. The case reported here is significant not only because it is the 7th biggest and the heaviest stone in the literature but also because it is the first giant stone reported to be in a solitary functioning kidney and treated without nephrectomy.

Morbidity of flank incision in 100 renal donors.

OBJECTIVE: The purpose of this study is to determine the morbidity of lumbotomy incision used in the last 100 living related donor nephrectomies retrospectively. METHODS: Since March 1991, 100 donor nephrectomies were made to living donors with lumbar incision. Incisions made in lateral decubitus position, subcostally or by an 11th or 12th rib resection. Left nephrectomy to 83, and right nephrectomy to 17 donors was performed. In 2 patients, there had been a peritoneal defect which was closed with primary sutures. In 19 patients 3 cm or shorter and in 5 patients longer than 3 cm of pleural entry had occurred. In all of the patients laceration was repaired without placement of a chest tube, however a chest tube had to be placed in 2 donors after obtaining a control chest x-ray postoperatively. RESULTS: All the patients mobilized and began to take orally in the first post-operative day. Wound infection, pneumonia and deep vein thrombosis had detected in none of the patients. The patients were discharged on the 4th and 5th postoperative day. During their control after 1 month from the operation it was found that all of them had returned to their daily life. In the postoperative period incisional hernia occurred in 7 patients which didn't need surgical repair and none of them complained of cosmetic problem. There was no any other late term complication was seen due to flank incision. CONCLUSION: Lumbotomy incision in donor nephrectomy, either a rib resection or supracostal approach, is reliable, provides excellent exposure for surgeon and has minimal morbidity.

The use of a removable stent in patients with prostate cancer and obstruction.

PURPOSE: A second generation temporary stent (ProstaCoil*) was inserted into the prostatic urethra of patients with obstruction due to prostate cancer to allow spontaneous voiding during hormonal therapy given to decrease the size of the prostatic mass. MATERIALS AND METHODS: The stent was inserted under fluoroscopic guidance using topical anesthesia in 27 patients (mean age 77 years) who presented with urinary retention due to advanced carcinoma of the prostate. All patients underwent operative or nonoperative hormonal therapy shortly after insertion of the stent. RESULTS: Followup of our patients was 3 to 48 months after stent removal and 15 void spontaneously. In 6 patients the stent was removed 9 to 19 months after insertion due to slow regression of the prostatic mass. Two of these patients required transurethral resection of the prostate and in 3 a new stent was inserted because of recurrent obstruction. two recently treated patients await stent removal and 3 died before removal of the stent. During followup no patient had urinary infection, either with the stent indwelling or after its removal. CONCLUSIONS: Temporary internal stenting of the prostate should be the treatment of choice for relieving obstruction during hormonal therapy given for prostate cancer.

Comparison between first-generation (fixed-caliber) and second-generation (self-expanding, large caliber) temporary prostatic stents.

In this study our aim was to compare a first-generation intraprostatic stent (Prostakath) with a second-generation one (ProstaCoil) in patients with prostatic obstruction. The comparison was made in terms of ease of insertion, need for repositioning, migration, infection, stone formation and length of time in place. One hundred and seventeen patients with an age range of 52-94 years were included in this study. Forty-nine of the patients were treated with gold-plated stainless-steel-made stent (Prostakath) inserted under sonographic and 68 of the patients were treated with a nitinol-made stent (ProstaCoil) inserted under fluoroscopic guidance. Indications for stent insertion were similar for both groups. We found that immediate correct positioning was 83% for the Prostakath and 100% for the ProstaCoil. In 42% of the cases the Prostakath necessitated later repositioning because of partial migration and in 12% of the cases removal because of complete migration into the bladder or the anterior urethra. No migration was observed with the ProstaCoil. In 10% of these cases the Prostakath could not be inserted because of the instability of the stent. Due to its larger caliber the second-generation stent caused more transient irritative symptoms. No difference was found in stent-induced infections (10% for all stents). Encrustations were found in 40% of the patients at 1 year with the Prostakath, but in 30% with the ProstaCoil at 2 years. Maximal indwelling time was 12 months with the Prostakath and 36 months with the ProstaCoil. We conclude that the second-generation stent was more advantageous because of its larger caliber allowing catheterization and endoscopic examinations, more flexibility and much longer indwelling time.

Objective and subjective comparison of transurethral resection, transurethral incision and balloon dilatation of the prostate. A prospective study.

Each of the treatment alternatives of benign prostatic hyperplasia (BPH) has its own advantages and disadvantages. The needs and the condition of the patient should be considered in choosing the proper treatment. After the treatment, patient satisfaction should also be considered because objective criteria do not always reflect the efficacy of the treatment. The long-term efficacy of the three alternative treatments of BPH (TURP, TUIP, TUBDP) were compared in a total of 60 men with obstructive symptoms. TUIP was found to be the method of treatment we recommended in young patients with a small and symptomatic adenoma, whereas TURP is still the 'gold standard'.

A new, large calibre, self-expanding and self-retaining temporary intraprostatic stent (ProstaCoil) in the treatment of prostatic obstruction.

OBJECTIVE: To determine the benefits of a new self-expanding and self-retaining large calibre temporary intraprostatic coil stent in patients with bladder outflow obstruction due to benign prostatic hypertrophy. PATIENTS AND METHODS: Sixty-five patients with bladder outflow obstruction have been studied with a follow-up period of 3-28 months (mean 16). RESULTS: Thirty patients became eligible for surgery and had their stent removed without difficulty 3-12 months after stent insertion. Only one stent was removed because of urgency and incontinence. Stent repositioning was required in five patients and 14 complained of temporary dysuria or perineal pain. Twenty-seven patients continue to pass urine through their stent without difficulty. CONCLUSION: Because of its large diameter and its temporary nature this new stent allows endoscopic examination of the bladder and has few side effects. This stent should be considered as an alternative to a urethral catheter or other temporary stents in patients who are unfit for surgery.

The incidence of congenital penile curvature.

To determine the incidence of congenital penile curvature a group of 500 consecutive male neonates at our institution were examined for this anomaly. In this group there were 3 cases of congenital penile curvature, for an incidence of 0.6%.