¿Cuándo se debe realizar la fijación testicular contralateral en pacientes pospuberales con torsión testicular? Estudio comparativo / When should contralateral testicular fixation be performed in postpubertal patients with testicular torsion: A comparative study

Objetivo En este estudio nos propusimos averiguar cuál es el momento óptimo para realizar la fijación testicular contralateral evaluando nuestros resultados de diez años en pacientes pospuberales con torsión testicular bajo un enfoque centrado en el paciente. Métodos Los pacientes pospuberales con diagnóstico de torsión testicular en un hospital terciario entre enero de 2012 y septiembre de 2022 se dividieron en dos grupos según los criterios del «enfoque centrado en el paciente» que adoptamos en nuestro centro. En el grupo1 se fijó el testículo contralateral en el mismo acto quirúrgico y en el grupo2 la fijación se realizó de forma diferida. Ambos grupos fueron examinados retrospectivamente, analizados estadísticamente y comparados. Resultados Un total de 41 pacientes se incluyeron en el estudio. En 19 (46,3%) de ellos se realizó fijación en el mismo acto, y en 22 (53,7%) se efectuó la fijación testicular contralateral de forma electiva. Se observó dehiscencia precoz de la herida en un paciente de cada grupo (4,5% grupo1 frente al 5,3% grupo2). En el periodo postoperatorio no se detectó atrofia ni torsión testicular contralateral en ningún grupo del estudio durante el seguimiento de 1año. Conclusión No existe ningún algoritmo para determinar el momento óptimo en que debe realizarse la fijación testicular contralateral en pacientes pospuberales con torsión testicular. Mediante enfoques centrados en el paciente, en los que se da prioridad a las características clínicas del paciente para determinar cuándo realizar la fijación testicular contralateral, se pueden obtener resultados que demuestran su eficacia y su seguridad (AU)

Objective In this study, we aimed to describe the timing of contralateral testicular fixation with our ten year results in postpubertal patients with testicular torsion with a patient-based approach. Methods Postpubertal patients diagnosed with testicular torsion in a tertiary hospital between January-2012 and September-2022 were divided into two groups according to the «patient-based approach» criteria we adopted in our clinic. Group1 in whom the contralateral teste was fixed in the same surgical act and group2 in whom the fixation was deferred. Both groups, were retrospectively examined, statistically analyzed and compared. Results A total of 41 patients were included in the study. Among those, 19 (46.3%) were fixed in the same act, and 22 (53.7%) underwent postponed elective contralateral testicular fixation. Early term wound dehiscence was observed in one patient in each group (4.5% group1 vs. 5.3% group2). In the postoperative period, no contralateral testicular atrophy or torsion was detected in the study groups during 1-year follow-up. Conclusion There is no algorithm for when contralateral testicular fixation should be performed in postpubertal patients with testicular torsion. Patient-based approaches, in which the clinical characteristics of the patient are prioritized in determining the timing of contralateral testicular fixation, can produce more effective and safe results (AU)

When should contralateral testicular fixation be performed in postpubertal patients with testicular torsion: A comparative study.

OBJECTIVE: In this study, we aimed to describe the timing of contralateral testicular fixation with our ten year results in postpubertal patients with testicular torsion with a patient-based approach. METHODS: Postpubertal patients diagnosed with testicular torsion in a tertiary hospital between January-2012 and September-2022 were divided into 2 groups according to the "patient-based approach" criteria we adopted in our clinic. Group 1 in whom the contralateral teste was fixed in the same surgical act and group 2 in whom the fixation was deferred. Both groups, were retrospectively examined, statistically analyzed and compared. RESULTS: A total of 41 patients were included in the study. Among those, 19 (46.3%) were fixed in the same act, and 22 (53.7%) underwent postponed elective contralateral testicular fixation. Early term wound dehiscence was observed in one patient in each group (4.5% Group 1 vs. 5.3% Group 2). In the postoperative period, no contralateral testicular atrophy or torsion was detected in the study groups during 1-year follow-up. CONCLUSION: There is no algorithm for when contralateral testicular fixation should be performed in postpubertal patients with testicular torsion. Patient-based approaches, in which the clinical characteristics of the patient are prioritized in determining the timing of contralateral testicular fixation, can produce more effective and safe results.

The effects of different doses of caudal morphine with levobupivacaine on postoperative vomiting and quality of analgesia after circumcision.

The study aim was to investigate the effect of three different morphine doses added to levobupivacaine 0.125% for caudal analgesia after circumcision surgery in children, particularly in relation to the frequency of postoperative vomiting within the first 24 hours following surgery. Two hundred and forty patients aged 5 to 12 years undergoing circumcision were included in the study. Following induction, caudal 0.125% levobupivacaine 0.5 ml/kg was given after adding 7.5, 10 or 15 µg/kg morphine. The postoperative incidence of vomiting was 5%, 12.5% and 17.5% in the groups 7.5, 10 and 15 µg/kg morphine, respectively (P=0.012, 7.5 versus 15 µg/kg groups). Five percent of the 7.5 µg/kg group and none of the patients in the other groups required paracetamol within the first 12 hours, and there was a significantly greater need for rescue paracetamol over the 24 hours in the 7.5 group versus the 15 µg/kg group (P=0.013). Postoperative analgesic durations were long and did not differ between groups (1273±338, 1361±192 and 1426±48 minutes, respectively, P=0.08). In conclusion, because the incidence of vomiting is very low, the duration of postoperative analgesia is long and a dose of 7.5 µg/kg caudal morphine is much lower than doses previously reported to be associated with respiratory depression, this study supports the use of 7.5 µg/kg caudal morphine added to 0.125% levobupivacaine for circumcision surgery.

Caudal analgesia for prostate biopsy.

BACKGROUND: Although various local anesthesia techniques have been suggested to decrease pain and discomfort during a transrectal ultrasound (TRUS)-guided prostate biopsy, the best method has not yet been defined. The present prospective, double-blind, randomized study aims to investigate the clinical efficacy of 'walking' caudal block compared with an intrarectal lidocaine gel for this procedure. METHODS: One hundred patients were randomly assigned to two groups. In the lidocaine gel group, 10 ml of gel containing 2% lidocaine was given intrarectally. In the caudal group, 20 ml 0.1% bupivacaine with 75 microg fentanyl was injected. Pain scores, anal sphincter tone and patient satisfaction were evaluated. RESULTS: The pain scores were significantly lower in the caudal group at all stages. Verbal rating scores (scale 1-4) during probe insertion, probe maneuver and biopsies were 1 (0-2), 1 (0-2) and 1 (0-2) vs. 3 (0-5), 2 (1-3) and 4 (2-6), respectively (P value <0.0001 at all stages). The anal sphincter was more relaxed in the caudal group than in the gel group (P value <0.0001 in all categories). Highly satisfied patients were more frequently encountered in the caudal group, 34 (68%) vs. 8 (16%), P<0.0001, and unsatisfied patients were more frequently found in the gel group 1 (2%) vs. 12 (24%); P<0.001. All patients were able to walk without any assistance immediately after the procedures. CONCLUSION: 'Walking' caudal analgesia is an efficacious method for relieving the pain during TRUS-guided prostate biopsies in ambulatory practice.

Antiapoptotic effects of dehydroepiandrosterone on testicular torsion/detorsion in rats.

In the present study, we aimed to evaluate the effects of dehydroepiandrosterone (DHEA) on apoptosis of testicular germ cells after repair of testicular torsion in rats. Twenty-four adult male Sprague-Dawley rats were randomly divided into four groups, with six rats in each group: sham operation, torsion/detorsion (T/D), T/D + vehicle, and T/D + DHEA. Three hours before detorsion, 50 mg kg(-1) DHEA was given intraperitoneally to T/D + DHEA group. In all groups, bilateral orchiectomies were performed and both testicles were histologically examined, with apoptosis detected using the in situ DNA fragmentation [terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL)] system, with morphological damage detected using a four-level grading scale in each specimen. The testes of the sham group showed a normal histology. In T/D and T/D + vehicle groups, apoptotic spermatogonia and spermatocyte number were significantly higher than in the sham group (P < 0.01 for all). The T/D + DHEA group showed a reduction in apoptotic spermatocyte and spermatogonia number in seminiferous epithelia compared with T/D group (P < 0.01 for both). Apoptotic cell number of contralateral testes did not reveal any significant differences among these groups (P > 0.05). Specimens from T/D and T/D + vehicle had a significantly greater histological injury than sham and T/D + DHEA groups in the ipsilateral testes (P < 0.01 for both). Therefore, the results suggest that DHEA may be a protective agent for preventing apoptosis caused by testicular torsion.

Clinical management of hydatid disease of the urinary tract.

This study reviews urinary hydatid disease in seven males and three females (mean age, 32.1 +/- 17.7 years; range, 7-67 years). Cysts were located in the kidney in six cases (one also involved the liver), the paravesical and retrovesical region in two cases (one coexisted with a bladder tumour), the adrenal gland (one case) and in the right parapelvic region (one case). Investigations included urinalysis, eosinophil count, Casoni skin test, indirect haemagglutination test (IHA), abdominal ultrasonography, intravenous urography and computed tomography (CT). All patients underwent surgery and were followed for an average of 5.6 years. Lumbar or abdominal pain was the most common symptom. Eosinophilia was seen in five patients (50%), IHA positivity occurred in four patients (40%) and the Casoni skin test was positive in four patients (40%). Abdominal CT was the most useful diagnostic method of radiological investigation (100%). No complications or recurrences were seen on follow-up. Urinary hydatid disease is uncommon and is likely to cause considerable diagnostic difficulties, and should therefore be considered in the differential diagnosis of space-occupying lesions of the urinary tract.

Seminal plasma nitric oxide concentration in oligo- and/or asthenozoospermic subjects with/without varicocele.

There is an inverse correlation between seminal plasma nitric oxide (NO) concentration and sperm parameters (motility and concentration) in patients with varicocele. This study investigated whether this occurs in patients with oligo- and/or asthenozoospermia due to causes other than varicocele. A total of 69 (19 with varicocele and oligo- and/or asthenozoospermia [group 1], 30 from oligo- and/or asthenozoospermic ones without varicocele [group 2], and 20 from healthy subjects [control group]) semen samples were analyzed. While group 1 had a significantly higher NO concentration in the seminal plasma compared to both the control group and group 2, there was no significant difference between group 2 and the control group (p >.05). In group 1, but not in the other groups, there was an inverse correlation between the seminal plasma NO concentration and sperm motility and concentration. NO production could be specifically related to the varicocele, since NO production in oligo- and/or asthenozoospermia cases without varicocele is not increased.

Hydatid disease of the urinary tract: review of the management of 9 cases.

The aim of this study is to review 9 cases with urinary tract hydatid disease in terms of symptoms, findings, laboratory tests, radiological findings and treatment modalities. There were 7 males and 2 females with a mean age of 33.6 years (range from 7 to 67 years). In 6 patients hydatid cyst was located in the kidney (1 involved the liver), in 2 the cysts were in the paravesical and retrovesical region (1 coexisted bladder tumor) and 1 the cyst was located adrenal gland. The investigations included urinalysis, eosinophil count, Casoni skin test, indirect haemagglutination test (IHA), transabdominal ultrasonography (TAUS), intravenous urography (IVU) and computed tomography (CT). All patients underwent various surgical procedures and were followed-up for an average of 3 years (range: 1 month to 5 years) period in terms of complications and recurrence rates. The most common symptom was lumbar or abdominal pain. Eosinophilia was seen in 4 patients (44.4%), IHA positivity in 3 patients (33.3%) and Casoni skin test were positive in 3 patients (33.3%). The most diagnostic method of radiological investigations was abdominal pelvic CT (100%). After surgical treatment, in mean a 3 year (range: 1 month to 5 years) follow-up period, no complication and recurrence were seen. Hydatid disease of the urinary tract is relatively uncommon and is likely to cause considerable diagnostic difficulties for clinicians and radiologists: therefore, it should be born in mind in the differential diagnosis of space-occupying lesions of the urinary tract.

The relationship between varicocele and semen nitric oxide concentrations.

We investigated the relationship between seminal plasma nitric oxide (NO) concentrations and conventional semen parameters in patients with varicocele. Semen samples were obtained from infertile patients with varicocele (n = 55) and from normal controls (n = 48). The mean NO concentration in the seminal plasma of patients with varicocele was significantly higher than that of the controls (P < 0.01). A significant negative correlation was noted between NO and sperm motility (r = -0.29, P = 0.003), NO and sperm concentration (r = -0.26, P = 0.008) and NO and normal morphology (normal %) (r = -0.25, P = 0.01). It was concluded that increased NO production may influence sperm production, motility and morphology in patients with varicocele.

Transitional cell carcinoma of the bladder in patients under 40 years of age.

A review of our records between 1993 and 1998 identified 25 patients with transitional cell carcinoma of the bladder who were less than 40 years old, 22 males and 3 females. The youngest patient was 19 years old. At the time of diagnosis 16 patients had superficial (Ta/T1) and 9 had invasive disease. Twenty-four patients were followed up for a period of 3-71 months (mean: 19.2 months). The recurrence rate for patients with superficial disease was 12.5%, and the progression rate for patients with invasive disease was 77.7%. We concluded that the patients under 30 years of age presented with lower grade and lower stage disease than those over 30. Transitional cell carcinoma of the bladder in young adults has a natural history similar to that seen in older patients. Accordingly, all patients, regardless of age, should be treated as aggressively as necessary on the basis of the stage and the grade of the tumour.

Squamous metaplasia of the bladder: findings in 14 patients and review of the literature.

We have documented the data of squamous metaplasia of the bladder in 14 patients who had undergone cystoscopies for different reasons. In two biopsies, there were marked keratinization and cellular atypia. One of these two subjects was diagnosed as squamous carcinoma of the prostate and transitional cell carcinoma of the bladder. The lesions of 8 female patients were on the trigone and evaluated as normal anatomical variants due to hormonal changes. Three of them were remarkable because of recurrent urinary infections. Apart from the two male patients with squamous cell carcinoma of the prostate the two male patients with current squamous metaplasia have been following up. In this study, we have also reviewed the relationship between squamous metaplasia, infection and malignancy.

Effects of doxazosin in men with benign prostatic hyperplasia: urodynamic assessment.

OBJECTIVE: In this study, a randomized and placebo controlled trial, we aimed to study the effectiveness and safety of doxazosin based upon urodynamic parameters, especially pressure/flow studies, in men with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 57 men (29 doxazosin, 28 placebo) 48-82 years of age with BPH were enrolled. Yet, 8 of 29 in the doxazosin group and 10 of 28 in the placebo group were excluded due to side effects of doxazosin and intolerability of urodynamic assessment of free uroflow, postvoiding residual urine volume (PVR) and pressure/flow studies. RESULTS: There were improvements in all urodynamic parameters (Free Qmax: 30.4% and 28%, PVR: 14 ml and 12 ml, invasive Qmax: 29.3% and 26.2%, Pdet at Qmax: -32.7% and -30%, Pdet-max: -29% and -27.7% at end of the 1st and 6th months whereas placebo effects were worsening in all urodynamic parameters. CONCLUSIONS: We suggest that doxazosin is an important treatment option for patients with BPH, and efficacy of doxazosin should be evaluated with objective, quantitative urodynamic studies not with subjective symptom scores. But additional costs and invasiveness of urodynamic studies restrict their common usefulness.

Fournier's gangrene: review of fifteen cases.

Fournier's gangrene is a synergistic necrotizing fasciitis of the perineum and abdominal wall along with the scrotum and penis in men and the vulva in women. The process was believed to be idiopathic in initial descriptions. Fifteen patients were treated for Fournier's gangrene between 1990 and 1995 in the Departments of General Surgery and Urology, School of Medicine, Atatürk University, Erzurum, Turkey. The most common causes were perianal sepsis and urogenital diseases. Escherichia coli and Staphylococcus aureus were identified most commonly in cultures of necrotic tissue. The mortality rate was 20 per cent despite aggressive surgical debridement and broad-spectrum antibiotics.

Iatrogenic injuries to ureter, bladder and urethra during abdominal and pelvic operations.

Abdominal and pelvic operations at Departments of Obstetrics and Gynaecology, and General Surgery play an important role in ureteral, bladder and rarely urethral injuries. Fifty-nine patients with iatrogenic ureteral, bladder and urethral injuries were treated at the Department of Urology, Atatürk University Research Hospital, between 1985 and 1995. These injuries were urinary vaginal fistulas in 43 patients (vesicovaginal 33, ureterovaginal 7, urethrovaginal 2 and vesicovaginal plus urethrovaginal 1), ureteric ligation in 9, bladder laceration in 7. These injuries were treated by different methods. All patients were followed up by intravenous urography (IVU) and urine culture three months later. It must be borne in mind that iatrogenic urinary tract injuries are not rare. Bladder and ureteral catheterization must be performed to prevent these complications.

Pharmacotherapy of benign prostatic hyperplasia: inhibitor of 5 alpha-reductase.

We studied the effects of 5 alpha-reductase inhibitor (finasteride) in the treatment of benign prostatic hyperplasia (BPH). This study is a randomized controlled trial. Sixty-two patients were treated with 5 alpha-reductase (finasteride 5 mg/day) and 61 patients (control group) with placebo for one year. Prostatic volume, maximal urine flow rate, AUA symptom scoring, residual urine volume and prostate-specific antigen (PSA) levels were evaluated at 3, 6, 9 and 12 months. In the first 6 months prostatic volume decreased rapidly (20.5%), in the second 6 months it decreased slowly and reached the maximal rate (23.3%). Maximal urine flow rate increased in the second 6 months. AUA symptom scores decreased first at 3 months and were 4.6 points lower at the end of the 12th month. There were no significant changes in residual volume. The 5 alpha-reductase inhibitor caused a 50% decrease in PSA levels, like in other studies. Because of the prolonged use of the drug, treatment with 5 alpha-reductase inhibitor is not tolerated by many patients and being expensive its future in the pharmacotherapy of BPH is unclear.

Peyronie's disease: intralesional treatment with interferon alpha-2A and evaluation of the results by magnetic resonance imaging.

In this clinical study, to determine the therapeutic efficacy of interferon (IFN) treatment for Peyronie's disease, we applied interferon alpha-2A (IFN alpha-2A) intralesionally in the treatment of Peyronie plaques in 15 patients and results were evaluated by magnetic resonance imaging (MRI). Patients whose plaque sizes were 0.5 and 1 cm responded better to the treatment. There was about a 90% lessening in the sizes of the plaques of 1.5 cm, 83.3% of 2 cm, as the ones which were 0.5 cm and 1 cm disappeared completely after treatment. As a conclusion, the treatment of Peyronie's disease with IFN alpha-2A is effective and side effects are minimum.