What We Know About Penile Mondor's Disease.

INTRODUCTION: Penile Mondor's Disease (PMD) is a rare illness that causes thrombophlebitis in the superficial veins of the penis that is manifested by transient pain and swelling. PMD often is associated with trauma to the penis, prolonged or vigorous sexual intercourse, and has been linked to genetics. OBJECTIVES: Our aim is to review the current literature on PMD. METHODS: A comprehensive literature search of English and Turkish publications on PMD was found through PubMed and Web of Science using various keywords. It is a systematic review. RESULTS: PMD might be an uncommon, harmless condition that normalizes with moderate therapy or potentially clinical therapy. Its pathogenesis has not yet been completely explained; however, different etiological variables are known. The current studies on PMD are summarized. CONCLUSION: Analyses are frequently made with a fair history and actual assessment. In any case, education on the illness is needed. Furthermore, the identification should be supported by ultrasonography. In a greater part of the patients, results are acquired with 2 months of clinical treatment. In exceptionally uncommon cases, careful thrombectomy or expulsion of the superficial vein is required. Özkan B, Coskuner ER. What We Know About Penile Mondor's Disease. Sex Med Rev 2022;10:396-401.

Predictive Factors and Intracytoplasmic Sperm Injection Results for Sperm Retrieval by Microdissection Testicular Sperm Extraction (micro-TESE) in Patients with Klinefelter Syndrome.

OBJECTIVE: To determine the predictive factors for successful retrieval of sperm from testicles before microdissection-testicular sperm extraction (micro-TESE) in patients with Klinefelter syndrome (KS) in order to counsel these patients regarding the likelihood of findings sperm. MATERIALS AND METHODS: The study is a retrospective analysis of the records of 67 men with KS between April 2016 and August 2020. Serum luteinizing hormone, follicle stimulating hormone, testosterone, prolactin, and estradiol levels were investigated. Testicular volumes were measured by ultrasonography. TESE was noted as positive or negative. RESULTS: There were 32 (47.8%) micro-TESE-negative patients and 35 (52.2%) m-TESE positive patients. The age of the micro-TESE-negative (34.9 ± 5.1 years) patient group was significantly higher than the micro-TESE-positive (32.3 ± 4.7 years) group (P = .035).The left testicular volume values were significantly higher in the micro-TESE-positive group (P = .019). Follicle stimulating hormone, luteinizing hormone, and prolactin levels were higher in m-TESE-negative patients compared to micro-TESE-positive patients, and testosterone levels and testicular volume were lower in micro-TESE-negative patients compared to micro-TESE-positive patients. However, these differences were not significant. As a result of intracytoplasmic sperm injection (ICSI) performed on 31 couples, 20 pregnancies and 16 live births were obtained (51.06%). CONCLUSION: Among the parameters examined in this study, the age of the patient with KS may be predictive for micro-TESE success. Counseling should be given that some patients with KS may have a child via micro-TESE-ICSI.

Premature Ejaculation and Endocrine Disorders: A Literature Review.

Premature ejaculation (PE) is the most common male sexual dysfunction, with 30% of men experiencing PE worldwide. According to the generally accepted classification, there are two types of PE: lifetime PE and acquired PE. Various biological and psychological causes are known to be involved in the etiology of PE. However, due to the incomplete definition and etiopathogenesis of PE, there is no effective treatment. Although clinical and animal studies indicate that hormones play a role in controlling the ejaculation process, the precise endocrine mechanisms are unclear. In addition, little is known about the role of endocrine disorders in PE etiology. However, there is evidence that diabetes mellitus (DM), obesity, metabolic syndrome (MetS), thyroid gland disorders, pituitary gland disorders, and vitamin D deficiency affect the prevalence of PE. Moreover, it has been reported that the prevalence of PE decreases with treatment of these endocrine disorders. In this review, the relationship between PE and DM, MetS, obesity, vitamin D deficiency, and thyroid and pituitary gland disorders is summarized.

Reno-protective effects of Phosphodiesterase 5 inhibitors.

The kidneys are vital organs that play an important role in removing waste materials from the blood, electrolyte balance, blood pressure regulation, and red blood cell genesis. Kidney disease can be caused by various factors, including diabetes, ischemia/reperfusion injury, and nephrotoxic agents. Inflammation and oxidative stress play a key role in the progression and pathogenesis of kidney diseases. Acute kidney injury (AKI) and chronic kidney disease (CKD) are important health problems worldwide, as they are associated with a long-term hospital stay, and increased morbidity and mortality in high-risk patients. Current standard therapeutic options are not sufficient to delay or stop the loss of kidney function. Therefore, it is necessary to develop new therapeutic options. Phosphodiesterase 5 inhibitors (PDE5Is) are a currently available class of drugs that are used to treat erectile dysfunction and pulmonary hypertension in humans. However, recent evidence suggests that PDE5Is have beneficial renoprotective effects via a variety of mechanisms. In this review, the benefits of PDE5 inhibitors in clinical conditions associated with kidney disease, such as diabetic nephropathy, ischemia-reperfusion injury, and acute and chronic kidney injury, are summarized.

Sexual Problems of Men With Androgenic Alopecia Treated With 5-Alpha Reductase Inhibitors.

INTRODUCTION: 5-Alpha reductase inhibitors (5-ARIs) are widely used in the treatment of benign prostatic hyperplasia (BPH) and androgenic alopecia (AGA). AIM: To examine all available data on the effects of 5-ARIs on sexual functioning in AGA treatment and to assess whether 5-ARIs increase the risk of sexual dysfunction. METHODS: A literature review of publications at PubMed related to the subject was used. MAIN OUTCOME MEASURE: We assessed erectile dysfunction, ejaculation impairment, and decreased libido. RESULTS: 5-ARIs may cause side effects such as erectile dysfunction, ejaculation problems, and decreased libido in patients. Their long-term impact and precise mechanism have not been clarified. Data from studies on 5-ARIs are important for drug selection and patient counseling. More training and awareness is needed for clinicians and patients to recover many patients from sexual adverse effects. CONCLUSION: 5-ARIs used in the treatment of AGA have well-defined side effects, which can negatively affect sexual life. It is unknown and unpredictable which men using these drugs may be subject to these side effects and when these effects may appear. Studies have been insufficient to provide a clear answer to this question. Coskuner ER, Ozkan B, Culha MG. Sexual Problems of Men With Androgenic Alopecia Treated With 5-Alpha Reductase Inhibitors. Sex Med Rev 2019;7:277-282.

Post-SSRI Sexual Dysfunction: Preclinical to Clinical. Is It Fact or Fiction?

INTRODUCTION: Selective serotonin reuptake inhibitors (SSRIs) are a widely used class of drug for various psychiatric disorders during the lifespan, including pregnancy, lactation, childhood, and adolescence. Deterioration in sexual functioning is a major and serious adverse effect of SSRIs. There is emerging evidence that SSRIs can have long-lasting effects on sexuality. AIM: To summarize the long-lasting effects of SSRIs on sexuality, starting with animal models and continuing with the clinical experience of different investigators. METHOD: A literature review of relevant publications in PubMed. MAIN OUTCOME MEASURES: To assess the long-lasting effects of SSRIs on sexuality. RESULTS: Although the persistent effects of SSRIs on sexuality have been little studied in humans, animal studies suggest that SSRIs might cause permanent sexual dysfunction after ending SSRI exposure at a young age but not in adulthood in rats. There are no prospective randomized controlled trials in humans and the present evidence is derived from case reports, incidental research findings, and experiences of some internet communities. CONCLUSION: There is some preclinical evidence from animal studies for enduring SSRI-induced sexual dysfunction, but the available clinical information could prevent a clear decision about the existence of post-SSRI sexual dysfunction, its pathophysiology, and its management. We need more research to fill in the gaps in our knowledge. Coskuner ER, Culha MG, Ozkan B, Kaleagasi EO. Post-SSRI Sexual Dysfunction: Preclinical to Clinical. Is It Fact or Fiction? Sex Med Rev 2018;6:217-223.

Robotic-assisted partial nephrectomy without using ureteral stent: a single center experience.

OBJECTIVE: To share our results of robotic assisted partial nephrectomy (RAPN) we performed without using ureteral stent in a single center from Turkey. MATERIAL AND METHODS: Medical records of consecutive 45 patients (34 men and 11 women) who underwent RAPN for kidney lesions between March 2011 and December 2014 were retrieved, and evaluated. All the procedures were performed by a transperitoneal approach without using ureteral stent prior to surgery. Renal artery clamping was used in all cases and intraoperative ultrasonography was used in 2 cases. RESULTS: Patients undergoing RAPN had a mean tumor size of 4.42 cm (2-8) and a mean renal nephrometry score of 5.82 (4-11). The mean estimated blood loss was 250 mL (150-450 ml) and the mean operative time was 195 minutes (150-300). There was no statistical difference between the preoperative and postoperative serum creatinine levels at the first follow-up visit (0.9 vs. 0.95, p=0.087). Surgical margin positivity was not detected in any patient, and the mean surgical margin distance was calculated as 0.4 mm (0.2-10). In only 1 patient disease recurrence was detected at the 21(st) month of the the follow-up period, and no distant metastases was reported in our patients at a mean follow-up of 10 months (3-36 mos). Our complication rate was 11.1% and according to the Clavien system complications were as; grade 2 (3 patients), grade 3a (1 patient) and grade 3b (1 patient). CONCLUSION: With appropriately selected patients and adequate surgical experience, RAPN performed without using ureteral stent is a safe and feasible method for localized renal tumors.

Sexual dysfunction and depression among Turkish women with infertile husbands: the invisible part of the iceberg.

PURPOSE: To determine the effect of male infertility on the sexual functions and level of depression among Turkish women. METHODS: Fifty-six women with an infertile partner (exposed) and 48 women who conceived and gave birth without treatment (unexposed) were included in this study. The Female Sexual Function Index (FSFI) and Beck Depression Inventory (BDI) were used to determine sexual function and depression status. Statistical analyses were performed by independent samples t, Fischer's exact, and Mann-Whitney U tests. RESULTS: There were no significant differences in terms of demographic characteristics between groups except that unexposed women had received education for longer period of time (11.6 vs. 7.1 years, p = 0.001). Mean FSFI scores were 19.1 ± 5.5 for the exposed and 20.0 ± 3.4 for the unexposed group. The scores of sexual desire domain (3.4 ± 1.2 vs. 2.7 ± 1.2, p < 0.05), sexual dysfunction in the axis of lubrication (3.6 ± 1.4 vs. 4.0 ± 0.2, p = 0.039), and pain (4.1 ± 1.9 vs. 5.4 ± 0.8, p = 0.001) were found to be significantly higher in women with an infertile partner. According to BDI scores, these women were feeling more depressed (9.7 ± 7.3 vs. 1.4 ± 2.8, p = 0.001) than the unexposed group. CONCLUSION: Comparison of these groups indicated similar levels of sexual dysfunction. Nonetheless, we found that women with infertile partners experienced sexual problems related to lubrication and pain, even though they were in the initial stages of the treatment process for infertility. Exposed group had also higher level of depression than the unexposed group.

Depression and Sexual Dysfunction in Turkish Men Diagnosed With Infertility.

OBJECTIVE: To investigate the effects of infertility on sexual functions and depression levels of Turkish men. METHODS: A total of 56 infertile men undergoing in vitro fertilization therapy and 48 fertile men, as the control group, were included in this prospective longitudinal study. The study data were collected using the International Index of Erectile Function 5 and 15 (IIEF-5 and IIEF-15), and the depression status of the interfile and control group participants was evaluated using Beck Depression Inventory. The data were analyzed using Statistical Package for Social Sciences (version 13.0) by chi-square and the Student t tests for statistical evaluations. RESULTS: Mild-to-moderate erectile dysfunction was detected in 85.9% of the patients in the infertile group and in all the control group participants according to IIEF-5 form, but this difference was not statistically significant. When the subparameters of erectile dysfunction were evaluated via IIEF-15, the infertile group's scores were observed to be significantly lower than those of the control group's in orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction domains. Based on Beck Depression Inventory, the current depression status of the infertile group was significantly worse than that of the control group. CONCLUSION: In this study, we determined that among Turkish men, being infertile did not cause significant impairment in erectile functions compared to the control group; however, it negatively affected subparameters of sexual functioning and we also determined that men who had infertility were feeling more depressed than the controls.

Role of anterior prostatic fat pad dissection for extended lymphadenectomy in prostate cancer: a non-randomized study of 100 patients.

PURPOSE: To determine the incidence and significance of lymph nodes found in anterior prostatic fat pad (APFP) and to evaluate the risk factors for the lymph node presence at the APFP according to preoperative and postoperative characteristics during the robot-assisted radical prostatectomy (RARP). METHODS: Between January 2011 and December 2014, 100 consecutive patients (47-77) with clinically localized prostate cancer underwent APFP excision during RARP at a single institute. Extended pelvic lymph node dissection was also performed to moderate- and high-risk patients (86 patients). Preoperative and postoperative findings were recorded, and descriptive analyses and multivariable analyses to predict the presence of lymph node within APFP were performed. RESULTS: Lymph nodes within APFP were detected in nine (9 %) patients. None of the patients had metastatic lymph node in APFP. Preoperatively, mean PSA levels (14.22 vs. 8.6, p = 0.0001), biopsy Gleason score (p = 0.002) and radical prostatectomy pathology Gleason score (p = 0.001) were higher in patients with lymph nodes at the APFP tissue. Pelvic lymph node metastases were detected in seven of 86 (8 %) patients. Of these seven patients, four (57 %) had lymph nodes at the anterior prostatic fatty pad (p = 0.0001). CONCLUSION: APFP dissection must be done regardless of the radical prostatectomy technique chosen. In our opinion, it is not necessary to do pathological examination of the APFP tissue routinely except for the patients with high preoperative PSA values, patients with high prostate biopsy Gleason scores and patients at high risk in order to save time and cost.

Penile Mondor disease and its effect on erectile function: results of 30 patients.

OBJECTIVE: To investigate the treatment outcomes among patients diagnosed with penile Mondor disease and to evaluate the effect of the disease on erectile function. METHODS: A total of 30 patients diagnosed with penile Mondor disease were enrolled in the study. All patients underwent physical examination and penile Doppler ultrasonography and filled in the International Index of Erectile Function (IIEF-5) questionnaire at regular intervals. Pharmacotherapy was started when penile Mondor disease was diagnosed. After the data were confirmed to be normally distributed using Kolmogorov-Smirnov test, the differences between the 3 IIEF-5 scores were evaluated using repeated measures analysis of variance and post hoc Bonferroni tests. RESULTS: The mean age of the patients was 34.3 years (range, 25-48 years). Ten patients had prolonged sexual intercourse, 4 had recent intestinal infection history, 2 had recent long-haul flights, 1 had sickle cell anemia, and 2 had penile trauma caused by sexual intercourse. Nine patients were considered idiopathic. Mean IIEF-5 scores at the baseline and at 1- and 2-month follow-ups were 20.87, 20.07, and 20.93, respectively. Although no significant difference was found between the baseline and the 2-month follow-up IIEF-5 scores, significant differences between the baseline and the 1-month (P = .004) and the 1- and 2-month follow-up IIEF-5 scores (P = .0001) were detected. CONCLUSION: Penile Mondor disease is a rare complication that can be successfully treated with medical therapy and conservative approach. Our series showed that penile Mondor's disease does not lead to permanent deformation of the penis or erectile dysfunction.

The role of the bipolar plasmakinetic TURP over 100 g prostate in the elderly patients.

BACKGROUND AND PURPOSE: Bipolar plasma kinetic (BP) transurethral resection of prostate (TURP) has been proved to be a safe and effective treatment for benign prostatic enlargement (BPE). However, the role of bipolar TURP on large prostates over 100 g compared with open suprapubic prostatectomy (SP) in elderly patients (>65 years) has not ever been studied before. PATIENTS AND METHODS: A retrospective analysis of patients' medical records between 2007 and 2012 was performed. A total of 102 patients who underwent SP (n = 44) or BP-TURP [Gyrus Plasma Kinetic™ (Gyrus ACMI, USA)] (n = 58) for obstructive lower urinary tract symptoms due to BPE were included in this retrospective study. Inclusion criteria were age ≥65 years, prostate volume ≥100 g, International Prostate Symptom Score (IPSS) ≥18, and peak urinary flow rate (PFR) ≤15 ml/s. Exclusion criteria were urethral stricture, known history of neurogenic bladder due to neural disorders, previous prostate and/or urethral surgery, bladder stone, bladder cancer, and known prostate cancer. Operation time, hospitalization, and catheter removal times were noted. Patients were re-evaluated at postoperative 3rd and 12th months. Evaluated parameters were IPSS, quality of life (QoL), simplified International Index of Erectile Function-5 (IIEF-5), PFR, post-voiding residual urinary volume (PVR). Statistical significance was set at 0.05 and all tests were two-tailed. RESULTS: Preoperative IPSS, PVR, IIEF-5, QoL, and prostate volume were not statistically significantly different between two groups except for PFR. Mean follow-up for BP-TURP and SP groups were 15.0 ± 5.8 (R: 11-38), 22.1 ± 11.2 (R: 11-59) months, respectively (p < 0.001). When compared with SP, mean catheter removal time (p < 0.001) and median hospitalization time (p < 0.001) were significantly shorter in BP-TURP group. However, mean operative time was significantly (p < 0.001) longer than SP group and also median resected material weight was significantly lower in the BP-TURP group (p < 0.001). IPSS, QoL, PFR, PVR, and IIEF-5 scores at postoperative 3rd and 12th month were not significantly different between the two groups (p > 0.05). Thirty-three patients had perioperative complications according to the modified Clavien-Dindo system. Thirteen patients (22.4 %) in BP-TURP group and 20 patients (45.4 %) in SP group had complications. In 12th month follow-up visit, four patients presented with urethral stricture, three patients (5.1 %) were in BP-TURP group, and one patient (2.3 %) in SP group (p = 0.455). All strictures were treated with internal urethrotomy. CONCLUSIONS: BP-TURP is a safe and highly effective treatment modality for BPE in the elderly patients with prostate glands over 100 g. Clinical efficacy and postoperative 12th month's results were similar to SP. Larger studies with longer follow-up are needed in order to confirm our findings.

Impact of the quadrivalent HPV vaccine on disease recurrence in men exposed to HPV Infection: a randomized study.

INTRODUCTION: Human papillomavirus (HPV) is one of the most common sexually transmitted infections and is the cause of several different diseases in men and women. Although little is known about HPV infection in men, they are also in the risk group of HPV infection and play an important role in transmitting the virus to women. AIM: To define the efficacy of the HPV vaccine through cross-immunization and its role in clearance of HPV infection, and to assess infection-associated factors in men. METHODS: This prospective randomized clinical study enrolled 171 evaluable men with genital warts between June 2009 and October 2013. After the initial treatment intervention, 91 patients were randomly assigned to receive HPV vaccine in three doses. Eighty patients were in the control (unvaccinated) group. One hundred-eleven men were single and 60 men were married. Patients who had previous treatment for pre-existing warts and medical disorders that needed chronic treatment or immunosuppression were not included in the randomization. Also 29 men with follow-up less than 12 months and incomplete vaccination were not included. MAIN OUTCOME MEASURES: The patients were assessed regarding age, condom use, marital status, number of visible genital warts, and smoking status. Post-treatment follow-up was monthly up to 12th month. RESULTS: Mean age was 34 ± 7.6. One hundred fifteen patients were smokers. For the recurrence of warts, age, smoking, vaccination status were insignificant and marital status was significant in the univariable analysis; only marital status preserved significance (HR: 2.0 CI:1.29-3.12 P = 0.002) in the multivariable analysis including vaccination status, marital status, and smoking. CONCLUSION: Among the investigated factors vaccination status was not but marital status significantly influenced wart recurrence. Married men had more recurrences in our population. Larger multicenter randomized clinical trials are lacking and seriously required to investigate the therapeutic effect of current quadrivalent HPV vaccine in genital warts.

The use of a laparoscopic bulldog clamp to control the dorsal vein complex during robot-assisted radical prostatectomy: a novel technique.

PURPOSE: To describe a novel technique to control dorsal vein complex (DVC) during robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS: We have been using a laparoscopic bulldog clamp to control DVC before apical dissection and urethral division. Data of 50 patients who underwent DVC control with laparoscopic bulldog clamp (group 1) were retrospectively compared with 50 consecutive patients in whom DVC was controlled with suture ligation (group 2). In the bulldog and suture groups, 30 and 31 patients underwent concomitant bilateral extended pelvic lymph node dissection (PLND), respectively. Operative and anastomosis time, estimated blood loss (EBL), apical surgical margin positivity, and early continence rates were evaluated. RESULTS: Patients in the bulldog group had significantly shorter operative time compared with patients in the suture group (146.8 vs 178.4 min, P=0.0005). Anastomosis time was significantly shorter in the bulldog group (12.3 vs 15.5 min, P=0.002). There was no difference in EBL between the groups (185 vs 184.2 mL). Immediate, postoperative first and third month continence rates were 62% vs 44%, 74% vs 60%, 90% vs 74% in groups 1 and 2, respectively. Although continence rates were better in favor of the bulldog group at each evaluation period, the difference did not reach statistical difference. None of the patients in both groups had apical surgical margin positivity. CONCLUSIONS: The use of a laparoscopic bulldog clamp to control DVC was associated with shorter operation and anastomosis time and a trend toward quicker recovery of continence. This technique provides clear vision during apical dissection and urethral division while potentially minimizing the external sphincteric trauma. Prospective randomized trials are needed for better evaluation of this technique.

Desire for penile girth enhancement and the effects of the self-injection of hyaluronic Acid gel.

Penile girth enhancement is a controversial subject but demands for enhancement are increasing steadily. Although various fillers have been widely used for soft tissue augmentation, there is no reliable material for this particular situation. Here we report a case of an acute hypersensitivity reaction in a man after his first self-injection of a filler material, which, he claimed, was hyaluronic acid gel for penile girth enhancement and glans penis augmentation.

The use of a bulldog clamp to control the dorsal vein complex during robot-assisted radical prostatectomy.

Optimal control of the dorsal venous complex (DVC) is a critical step in robot-assisted radical prostatectomy (RARP). If DVC is not controlled properly, bleeding may occur during the apical dissection. On the other hand, if it is controlled well, a bloodless field is attained and, thus, a precise apical dissection and urethral division is possible. Suture ligation is the most common technique used for dorsal vein control, while some authors recommend using an endovascular stapler. Recently, athermal division and selective suture ligation technique has been reported for DVC control. We describe a new technique: Use of a bulldog clamp to control the DVC during RARP. The control of the DVC with a bulldog clamp allows a bloodless field with precise apical dissection and provides preservation of maximum urethral length while avoiding sphincteral injury.

The Role of Partial Nephrectomy without Arterial Embolization in Giant Renal Angiomyolipoma.

Angiomyolipoma is a benign neoplasm composed of varying admixtures of blood vessels, smooth muscle cells, and adipose tissue. Because of an increased risk of spontaneous haemorrhage, surgical approach is needed greater than 4-8 cm size. We here report our partial nephrectomy experience in the 24 cm size giant angiomyolipoma. 26-year-old woman referred to our clinic with a 24 cm size angiomyolipoma in her lower pole of right kidney. The inferior vena cava was deviated to the left by the mass. All the blood tests were normal and we offered her the choices of partial nephrectomy or nephrectomy. Right subcostal approach was used. The patient underwent resection of the mass with a safety region of 1 cm. Frozen section evaluation was consistent with angiomyolipoma and free for surgical margin. Warm ischemia time was 35 min. and intraoperative bleeding volume was 200 cc. Postoperative 2nd day the drain was taken and hospital stay was 4 days. In literature we observed very rare angiomyolipoma cases with such a large dimension treated by partial nephrectomy without arterial embolization. If technically suitable partial nephrectomy is the main chioce in this kind of benign lesions in young patients.

In the cystoscopic follow-up of non-muscle-invasive transitional cell carcinoma, NMP-22 works for high grades, but unreliable in low grades and upper urinary tract tumors.

INTRODUCTION AND OBJECTIVES: Two percent of the bladder non-muscle-invasive (NMI) transitional cell carcinomas (TCC) are associated with upper urinary tract (UUT) TCC. We evaluated the role of nuclear matrix protein-22 (NMP-22) (BladderChek) test in the diagnosis of lower urinary tract and UUT-TCC. METHODS: From March 2009 to June 2011, 122 patients with bladder NMI-TCC underwent 205 control cystoscopy. A total of 95 (78 men and 17 women, mean age 60.7 years, range, 27-88) patients who were followed regularly with NMP-22 test and with follow-up cystoscopies (145 episodes; min. 1-max. 5) were included in this study. For routine monitoring of the UUT, IVU or CT urography was used once a year for high grades (HG), and once in every other year for low grades (LG). The sensitivity and specificity of NMP-22 were evaluated by ROC curves, and sensitivity, specificity, and positive and negative predictive values were calculated. Chi-square test was used for the differences between the subgroups. RESULTS: Cystoscopy and NMP-22 results of the patients included in the study revealed the sensitivity (44.4%) of the test was very low and the specificity (98.4%) was quite high (p < 0.001). Among the 10 cystoscopies where NMP-22 was negative, but cystoscopy was positive for tumor, 8 had LG and 2 had HG TCC. NMP-22 was never positive in low-grade tumors, in other words, all of the NMP-22-positive 8 tumors were high grade. On the other hand, in 20% (2/10) of the cases, NMP-22 can be negative although the tumor was high grade. Two (2.1%) HG UUT-TCC were detected in 95 patients. These 2 patients were within the 125 cystoscopies (75 patients) where both NMP-22 and cystoscopy were negative for tumor. CONCLUSIONS: Nuclear matrix protein-22 cannot detect LG TCC. However, it detects overwhelming majority of HG TCC. For this reason, positive NMP-22 test largely indicates HG TCC. NMP-22 is also not reliable in UUT-TCC, even in HG tumors.

Penile necrosis due to priapism developed after circumcision in a patient with protein S deficiency.

INTRODUCTION: Hypercoagulable state is a complex condition with an abnormal propensity for thrombosis. The consequences of it due to thrombosis of veins and arteries are the most common cause of sickness. AIM: The present study is a report of a case describing penis necrosis after circumcision and evaluation of hypercoagulable state as a reason of it. METHODS: l Nine-year-old boy referred from another hospital with the sequelae of the penile ischemia with discoloration of the penis after traditional circumcision. RESULTS: The ischemic event developed 3 weeks after circumcision. Priapism that was treated with needed glandulocavernous shunt initially developed following circumcision. All values of routine blood count and blood biochemical analysis were within normal limits. Further, hematologic studies revealed that there might be a hypercoagulable state as a result of lower protein S level. CONCLUSION: Circumcision is a common procedure frequently performed in many communities around the world. Although it is seen as an easy procedure and performed even by unauthorized medical stuff, it is not complication-free. Severe penile necrosis after circumcision should be treated on an individual basis, necessitating different techniques. Hypercoagulable state should be concerned and evaluated in such a complication. In short, circumcision has to be done by specialists who can handle such serious complications.