¿Evita la antibioterapia biopsias de próstata en pacientes con valores elevados de PSA? / Does Antibiotherapy Prevent Unnecessary Prostate Biopsies in Patients With High PSA Values?

Introducción: Investigamos si la antibioterapia tiene algún papel en el PSA total (tPSA), PSA libre (fPSA) y fPSA/tPSA en pacientes con PSA superior a 2,5ng/ml. También si tiene alguna relación con la tasa de diagnóstico de cáncer de próstata. Material y métodos: Un total de 108 pacientes mayores de 50 años con síntomas del tracto urinario inferior y PSA>2,5ng/ml fueron incluidos en este estudio. Se dio antibioterapia a todos los casos durante tres semanas. Luego se tomó biopsias con guía ultrasonográfica a todos los pacientes. Antes y después de la antibioterapia se les aplicó los cuestionarios International Prostate Sypmtom Score (IPSS) y National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) y se comparó los valores de tPSA, fPSA y fPSA/tPSA en sangre. Resultados: Las variaciones de tPSA, fPSA y fPSA/tPSA antes y después de la antibioterapia no mostraron diferencias estadísticamente significativas (p>0,05). Cuando excluimos el adenocarcinoma de próstata se hallaron diferencias estadísticamente significativas en las puntuaciones del IPSS y NIH-CPSI en todos los casos. Conclusiones: La administración de antibioterapia a pacientes con niveles de PSA superiores a los valores de corte no produjo un cambio significativo en la decisión de realizar biopsias de próstata con aguja. Se debería considerar realizar biopsias de próstata sin antibioterapia previa en los pacientes con PSA elevado cuando no exista una sospecha de prostatitis (AU)

Introduction: We investigated if antibiotherapy has any role on total PSA (tPSA), free PSA (fPSA) and fPSA/tPSA ratio in patients with tPSA higher than 2.5 ng/ml. We also analyzed if it has any relation with prostate cancer diagnosis rate. Material and Methods: A total 108 patients older than 50 years of age with lower urinary system sypmtoms and tPSA >2.5ng/ml were included in this study. Antibiotherapy was given to all the cases for three weeks. After that, transrectal ultrasound-guided prostate biopsies were taken from all the patients. Before and after antibiotherapy, "The International Prostate Symptom Score" (IPSS) and "National Institutes of Health Chronic Prostatitis Symptom Index" (NIH-CPSI) questinories are performed and serum tPSA, fPSA and fPSA/tPSA values were obtained. Results: TPSA, fPSA and fPSA/tPSA ratio alterations prior to and after antibiotherapy did not show any statistically significant difference (p>0.05). When prostate adenocarcinoma was excluded, an statistically significant decrease was found in IPSS and NIH-CPSI scores for all cases. Conclusions: Antibiotherapy given to patients with PSA levels higher than threshold value has not led to significant change in prostate needle biopsy decision. Prostate biopsy should be considered without trying antibiotherapy in patients with high PSA values if a suspicion of prostatitis does not exist (AU)

[Does antibiotherapy prevent unnecessary prostate biopsies in patients with high PSA values?]. / ¿Evita la antibioterapia biopsias de próstata en pacientes con valores elevados de PSA?

INTRODUCTION: We investigated if antibiotherapy has any role on total PSA (tPSA), free PSA (fPSA) and fPSA/tPSA ratio in patients with tPSA higher than 2.5ng/ml. We also analyzed if it has any relation with prostate cancer diagnosis rate. MATERIAL AND METHODS: A total 108 patients older than 50 years of age with lower urinary system sypmtoms and tPSA >2.5ng/ml were included in this study. Antibiotherapy was given to all the cases for three weeks. After that, transrectal ultrasound-guided prostate biopsies were taken from all the patients. Before and after antibiotherapy, "The International Prostate Symptom Score" (IPSS) and "National Institutes of Health Chronic Prostatitis Symptom Index" (NIH-CPSI) questinories are performed and serum tPSA, fPSA and fPSA/tPSA values were obtained. RESULTS: TPSA, fPSA and fPSA/tPSA ratio alterations prior to and after antibiotherapy did not show any statistically significant difference (p>0.05). When prostate adenocarcinoma was excluded, an statistically significant decrease was found in IPSS and NIH-CPSI scores for all cases. CONCLUSIONS: Antibiotherapy given to patients with PSA levels higher than threshold value has not led to significant change in prostate needle biopsy decision. Prostate biopsy should be considered without trying antibiotherapy in patients with high PSA values if a suspicion of prostatitis does not exist.

[Major urologic surgical procedures in locally advanced colorectal cancers]. / Procedimientos quirúrgicos urológicos mayores en el cáncer colorrectal localmente avanzado.

OBJECTIVE: To evaluate the outcomes of major urological procedures performed in patients with locally advanced colorectal cancer. MATERIAL AND METHODS: Data of 37 patients with locally advanced colorectal cancer who underwent major urological surgical procedures along with simultaneous cancer surgery between the years of 2005 and 2010 were retrospectively evaluated. RESULTS: The mean age was 58.3 years. Male/Female ratio was 2.7. 59% of the patients were primary, and 41% were recurrent cases of colorectal cancer. Bladder, ureters, urethra, kidneys and prostate were found as invaded in 19, 9, 5, 2 and 2 cases, respectively. The following single or combined procedures were performed; partial (n=11) or total (n=8; 2 combined with urethrocutaneostomy, 6 with ileal-conduit) cystectomy, urethroplasty (n=5), nephroureterectomy (n=2), radical nephrectomy (n=1), partial nephrectomy (n=1), ureteroneocystostomy (n=7), Boari's flap (n=4), transureteroureterostomy (n=3). Prolonged drainage was the most common surgical complication (27%). Urethrocutaneous fistula and total urinary incontinence were encountered in 1 and 1 patient, respectively. The incidence of hydronephrosis and elevated creatinine were 38% (preoperative 27%; postoperative 11%) and 24% (11% preoperative; 13% postoperative), respectively. Two deaths occurred in the first month of operations. Mean duration of follow up was 18(6-28) months for surviving 13 patients. Overall survival in 24 cases resulting in death was 21(1-42) months. CONCLUSIONS: Since the most important eventual effects of locally advanced colorectal cancer are on the kidneys from the urological point of view; the aim of an urologist, as a member of surgical team, should be preserving renal function in addition to helping complete removal of the tumor.

Dorsal vein rupture after practice of taqaandan, necrotising cavernositis, penile reconstruction, urethroplasty and penile prosthesis implantation.

Penile fracture is an uncommon and emergent urologic condition defined as traumatic rupture of the corpus cavernosum secondary to a blunt trauma of the erect penis. Tunica albuginea is thinned and stretched in the erect state, and a transverse tear in the corpus cavernosums may occur by a buckling force. However, penile dorsal vein tears may mimic penile fracture. Also, corporeal infection and purulent cavernositis are associated with trauma, cavernosography, priapism, intracavernosal injection therapy and penile prosthesis.

[Treatment of urogenital fistula in women]. / Tratamiento de la fístula urogenital en la mujer.

INTRODUCTION AND OBJECTIVES: We aimed to assess the results of the genitourinary fistula cases intervened in our center in a ten year period. PATIENTS AND METHODS: We evaluated the clinical data regarding genitourinary fistula from the medical records of 42 female patients who underwent surgery for this condition between May 2001 and June 2010. Age, previous medical history, diagnostic tools used, operative data and clinical outcomes of the patients were evaluated retrospectively. RESULTS: The mean age of patients was 51 years. Of 42 patients, 28 had vesicovaginal, 11 had ureterovaginal, and 3 had vesicouterine fistulas. Etiology of vesicovaginal fistula was surgical trauma in 71,5% and obstetric trauma in 28,5% of the patients. O'Connor technique was performed as a single procedure in 12 vesicovaginal fistula cases, and ureteroneocystostomy was added in 3. Transvesical repair was performed in 9, and transvaginal repair in 3 of the patients. All of 11 patients with ureterovaginal fistula were of iatrogenic origin; ureteroneocystostomy was performed in 6, and Boari flap was performed in 5 of these patients. Three vesicouterine fistulas were repaired primarily. Success rates in vesicovaginal, ureterovaginal and vesicouterine fistulas were 96, 100 and 100 percent, respectively. CONCLUSION: In experienced hands and according with the related basic surgical principles, operative treatment in genitourinary fistula represents an effective modality with high success rate.

Do ureteral catheterisation procedures affect sexual functions? A controlled prospective study.

The use of ureteral stents is a common procedure in urology practice. We investigated whether the use of double-J stent had an effect on sexual functions or not. One hundred and seventy-seven cases were included in the study. Unilateral double-J stent was placed during ureteral stone treatment in one hundred and eight of these cases. Sixty-nine cases were included as the control group. 'International Index of Erectile Function' (IIEF) and 'Female Sexual Function Index' (FSFI) questionaries were assessed before and 4 weeks after the intervention in all patients. When total IIEF and subdomains of IIEF scores of men and total FSFI and subdomains of FSFI scores of women whom double-J stent was placed were evaluated before and after the procedure, there was statistically significant reduction in patient's scores. In the control group, any statistically significant alteration in patient's score was not observed in men and women. Sexual functions are negatively affected in both women and men whom ureteral stents are placed. To reduce these problems specific to urinary system owing to stents, new treatment strategies and new studies that lead to improvements in the material and design of stents are required.

The effectiveness of sildenafil citrate in patients with erectile dysfunction and lower urinary system symptoms and the significance of asymptomatic inflammatory prostatitis.

We evaluated the effectiveness of sildenafil citrate on lower urinary system symptoms (LUTS) by using symptom score scales. We also evaluated whether or not the presence of asymptomatic inflammatory prostatitis had an effect on the alteration in the symptom scores. A total of 36 male patients were included in the study. For all the cases, 'International Prostate Symptom Score' (IPSS), 'National Health Institute Chronic Prostatitis Symptom Index' (NIH-CPSI) and 'International Index of Erectile Function' (IIEF-5) were investigated and the scores were calculated in the first visit. Sildenafil citrate was given for 30 days and at the second visit IPSS, NIH-CPSI and IIEF-5 scores were once more analyzed. Afterwards, the alterations of the scores between visits were statistically compared. Mean age of the 36 cases included in the study was 59.03±1.35. When the alterations in parameters of first visit and second visit were evaluated, we found a statistically significant increase in IIEF-5 and a statistically significant decrease in IPSS, IPSS-QOL (Quality of Life). In addition, when the cases were divided into two groups with and without asymptomatic inflammatory prostatitis, in the cases with asymptomatic inflammatory prostatitis, sildenafil citrate caused improvement only in ED, but had no effect on LUTS. Sildenafil citrate use in cases with LUTS and ED has an improving effect on LUTS as well as ED. However, in cases with asymptomatic inflammatory prostatitis, sildenafil citrate did not lead to an improvement in LUTS.