Ovotesticular disorder of sex development with a prostatic gland and review of literature.

Ovotesticular disorder of sex development (OTDSD) is a rare condition and defined as the presence of ovarian and testicular tissue in the same individual. Most of patients with OTDSD have female internal genital organs. In this report, we present a case in which, we demonstrated prostate tissue using endoscopic and radiologic methods in a 46-XX, sex determining region of the Y chromosome negative male phenotypic patient, with no female internal genitalia. Existence of prostate in an XX male without SRY is rarely seen and reveals a complete male phenotype. This finding is critical to figure out what happens in embryonal period.

A new modification of dismembered pyeloplasty for primary ureteropelvic junction obstruction.

AIM: To present the results of a new modification of dismembered pyeloplasty performed to prevent the occurrence of secondary obstruction. METHODS: Modified dismembered pyeloplasty was performed in 35 children (age range 3 months to 16 years) who had unilateral ureteropelvic junction obstruction. In postoperative follow-up, presence of hydronephrosis on ultrasonography, differential renal function (DRF) and renal drainage half-time on technetium-99m diethylenetriaminepentaacetic acid (DTPA) renography were recorded and compared with preoperative data. RESULTS: Mean anteroposterior renal pelvic diameter, mean preoperative DRF and radioisotope clearance half-time on DTPA renography of the affected kidneys were 61.4 mm, 38.6% and 34.3 min in children with prenatal hydronephrosis, and 67.5 mm, 37.6% and 39.4 min in children that presented with symptoms, respectively. After surgery, mean anteroposterior renal pelvic diameter, mean DRF and radioisotope clearance half-time on DTPA renography of the affected kidneys were 10.9 mm, 45.9% and 11.9 min in children with prenatal hydronephrosis, and 20 mm, 41.9% and 15.2 min in children that presented with symptoms, respectively. No failure was observed in any patient at an average follow-up of 26 months (range 1-5 years). CONCLUSIONS: Open dismembered pyeloplasty is the treatment of choice for intrinsic ureteropelvic junction obstruction. The modification of dismembered pyeloplasty that we performed is an alternative for the prevention of secondary obstruction.

Spontaneous and prolonged drug-induced erection in a patient with inflatable penile implant.

Achievement of spontaneous tumescence after penile implant surgery has already been reported. However, regular spontaneous full, rigid erection upon sexual arousal that is adequate for vaginal penetration and tumescence for satisfactory sexual performance is an extremely rare condition in men with three-piece hydraulic implants. Similarly, prolonged erection is not expected in such implant cases even with the use of erectogenic agents. We report this interesting phenomenon confirmed by magnetic resonance imaging technique in a patient with inflatable device.

Polycystic horseshoe kidney.

Horseshoe kidney is a renal fusion anomaly during embryogenesis. The reported incidence of horseshoe kidney varies from 1 in 400 to 1 in 1,800 live births (commonly quoted 1 per 400) [Wilson and Azmy 1986]. Adult polycystic kidney disease is a hereditary disorder with autosomal-dominant transmission. Its incidence is approximately one in every 1,000-5,000 cases [Levine et al. 1997]. Polycystic horseshoe kidney is a very rare occurrence with incidence ranges of 1 in 134,000 to 1 in 8,000,000 cases [Brum et al. 1997]. We add another case to the literature.

Prevention of colonic mucosal regrowth after seromuscular enterocystoplasty.

PURPOSE: To find answers about preventing the colonic mucosal regrowth after seromuscular enterocystoplasty and the dissection pane, we performed an experimental study in dogs. We also report our experience with mucosal regrowth and bladder function after augmentation colocystoplasty. MATERIALS AND METHODS: This study comprised 10 adult healthy female mongrel dogs. We performed this animal experiment in 2 stages. At stage 1 we constructed a low capacity bladder. Stage 2 was performed 6 months after stage 1. At the end of detrusorectomy a 15 cm. segment of sigmoid colon was detubularized. The animals were randomly divided into 2 groups. In the 5 group 1 dogs de-epithelialization was performed with needle point cautery at a low cut setting, and the mucosa, muscularis mucosa and submucosa were resected, leaving the fibers of the muscularis externa exposed. In the 5 group 2 dogs de-epithelialization was performed by the peeling technique, in which the dissection plane was developed between the mucosa and muscularis mucosa, and the muscularis mucosa and submucosa remained on the colonic muscle. The de-epithelialized patch of bowel was shaped as a cup patch and anastomosed to the edges of the detrusor muscle over the bulging urothelium. The animals were sacrificed at 12 months of followup. All bladders were inspected macroscopically for regrowth of the colonic mucosa. Multiple sections of the augmentation patches were obtained and processed routinely for histological evaluation to determine what happened to the urothelium. RESULTS: We noted good urodynamic results in all dogs and there was no statistical difference in the groups in regard to bladder capacity. Mucosal regrowth did not develop in either group. CONCLUSIONS: When dissection is performed successfully whether or not the submucosa is removed, there is no observed regrowth or loss of bladder capacity in either technique.

Diagnosis and treatment of ejaculatory duct obstruction in male infertility.

OBJECTIVE: To discuss the diagnosis and treatment of ejaculatory duct obstruction in male infertility. PATIENTS AND METHODS: Twenty-four males were treated for ejaculatory duct obstruction between 1994 and 1998 in our clinic. Patients' age varied between 20 and 40 (mean=29). Ejaculatory duct obstruction was considered in patients with low to normal ejaculate volume, azoospermia or oligospermia, decreased motility, normal serum gonadotropin and testosterone levels, absent or low fructose in the ejaculate and evidence of obstruction on transrectal ultrasonography. The definitive diagnosis was made by the absence of efflux of methylene blue injected through the vas during cytoscopy. All the patients were subjected to transurethral resection of ejaculatory ducts and spermograms before and 3 months after resection were compared. RESULTS: Before transurethral resection mean sperm count was 1.66x10(6)/ml compared to 25.4x10(6)/ml postoperatively. The difference was statistically significant (p=0.001). After the operation, 58.3% of the cases had improvement in sperm motility, and 62.5% had increased ejaculate volume. No significant complications occurred, and in only 1 (4.17%) patient, there was persistent hematuria. After a mean follow-up period of 9 (6-18) months, 6 (25%) pregnancies were noted. CONCLUSION: Although transurethral resection is an effective method for the treatment of ejaculatory duct obstruction, the pregnancy rate is low, which could be related to the hazardous effects of urinary reflux into ejaculatory ducts or functional abnormalities of seminal vesicles.

Ureterocystoplasty in bilaterally functional kidneys.

OBJECTIVE: Traditional augmentation cystoplasty using gastrointestinal segments is known to be associated with metabolic abnormalities and alterations in the bladder causing potential carcinogenesis. In this respect alternative techniques have been searched preferably lined by urothelium. We performed ureterocystoplasty in 7 patients with a diagnosis of neurogenic bladder and investigated the clinical and functional aspects. PATIENTS AND METHODS: Between 1995 and 1999, ureterocystoplasty was performed using both ureters in 4 male and 3 female children with bilaterally functional kidneys. Patients' ages varied between 1 and 7 (mean 4.7) years. Before the operation all the children were incontinent, had a small-capacity noncompliant bladder, and high-grade (IV-V, International Classification System) reflux on voiding cystouretrography (VCU). Technetium-99m DTPA renal scintigraphy was also performed in all children to evaluate renal function before and after the operation. RESULTS: Before the operation the mean end-filling intravesical pressure was 45.6 (35-60) cm H(2)O which decreased to 18.9 cm H(2)O 3 months postoperatively. The mean bladder capacity 3 months after ureterocystoplasty was found to be 279.3 (250-330) ml. All the children were continent and VCU showed the absence of reflux. There was mild to moderate improvement in renal function after surgery in both kidneys on technetium-99m DTPA renal scintigraphy. Three (43%) patients could void spontaneously with abdominal straining, whereas 4 (57%) children could empty their bladders by clean intermittent catheterization. A double-J stent was inserted in 1 (14%) patient because of a rise in serum creatinine after the removal of the ureteral catheter. Patients were followed for a mean period of 30 (8-50) months and all the children remained continent. The bladder capacity and end-filling pressure measurements were also stable. CONCLUSION: Ureterocystoplasty was found to be an effective method for bladder augmentation in bilaterally functional kidneys with an acceptable complication rate

Is there significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithotripsy?

OBJECTIVE: To determine whether there is a significance of the choice of prone versus supine position in the treatment of proximal ureter stones with extracorporeal shock wave lithothripsy (ESWL). METHODS: Ninety-six patients with proximal ureter stones underwent ESWL. The procedure was performed in the supine position in 48 of them (group 1) and in the prone position in the other 48 patients (group 2). Stone-free rates, repeat ESWL rates, shocks per patient and shocks per session were compared in both groups. RESULTS: The mean session number per patients was 1.64+/-0.75 in group 1 and 1. 33+/-0.59 in group 2 (p = 0.224). The stone-free rates 3 months after ESWL were 88.3% in group 1 and 90.6% in group 2. The difference between the results was statistically insignificant (p<0.05). Therefore, these two parameters were similar in both groups. On the other hand, the number of shocks per session was 4,863.54+/-2, 114.85 in group 1 and 3,704.16+/-1,726.75 in group 2. This difference was statistically significant (p = 0.011). The patients tolerated the supine position better in general. Patients in the prone position experienced discomfort on inspiration and expiration and pain localized to the lumbar vertebrae. CONCLUSION: These results suggest that the supine position decreases the number of shocks per session in the treatment of proximal ureter stones with ESWL and this will be cost-effective.

Combination therapy of imipramine with oxybutynin in children with enuresis nocturna.

PURPOSE: The treatment approach for enuresis is controversial due to the lack of consensus as to the exact causes of nocturnal enuresis. Despite various treatment modalities, pharmacotherapy still appears to be the common choice. The aim of this prospective study was the evaluation of the efficacy of combination therapy (imipramine and oxybutynin) in patients with enuresis nocturna. PATIENTS AND METHODS: This prospective study was done with 77 monosymptomatic nocturnal enuretics between July 1996 and December 1998. RESULTS: Even though there is no statistically significant difference between combination therapy (imipramine plus oxybutynin) and monotherapy, clinical data showed that combination therapy is more effective. CONCLUSIONS: We conclude that combination of imipramine with oxybutynin is a safe and new choice in the treatment of nocturnal enuresis.

Nephrogenic adenoma of the bladder after intravesical bacillus Calmette-Guérin treatment.

A 60-year-old female patient was subjected to transurethral resection of transitional cell carcinoma of the bladder and was given intravesical bacillus Calmette-Guérin treatment for 6 weeks. The control cytoscopy performed after 6 months revealed a polypoid lesion at the trigon and the lesion was resected. The pathological examination of the specimen showed no evidence of cancer but the presence of a metaplastic lesion that was nephrogenic adenoma.

Use of bladder mucosal graft for urethral reconstruction.

BACKGROUND: The ideal tissue for complex urethral reconstruction has yet to be determined, especially in patients with deficient preputium. The use of bladder mucosa as a free graft could be an alternative in these problem cases. METHODS: Bladder mucosa graft urethroplasty was performed on 14 patients with penoscrotal or scrotal hypospadias. The mean age of the patients was 18.7 (range 14-23) years. Ten cases were subjected to primary urethral reconstruction while four cases had previous hypospadias repair. RESULTS: Complete urethral replacement by the bladder mucosa tube was performed in six patients. Meatal problems occurred in two (33.33%) patients and proximal fistula formed in one (16.67%) patient. A bladder mucosa graft was combined with preputial or tunica vaginalis grafts distally in eight cases, and one patient in the tunica vaginalis group developed fistula at the anastomosis of the bladder mucosa and tunica vaginalis grafts. The overall complication rate was 28.6%. CONCLUSIONS: Our initial results showed that bladder mucosa grafts can be used successfully for urethral reconstruction especially when combined with preputial or tunica vaginalis grafts distally.

[Isolated ureteropelvic junction laceration following blunt body trauma]. / Künt vücut travmalarini takiben izole üreteropel vik bileske (UPJ) yaralanmalari.

The purpose of the study is to investigate the radiologic and clinical treatment methods following the rarely seen UPJ laceration due to blunt body trauma. In this study there are eight patients with isolated UPJ laceration, admitted to Gülhane Military Medicine Academy, Firat University Medical Faculty Urology department, and Elazig Military Hospital Urology Service. They are one child (12 years old) and 7 adults (6 male, 1 female) ranged 18-61 years old. Abdominal USG(Ultrasonography), IVP(Intravenous Pyelography), abdominal CT(Computed Tomography), and retrograde-antegrade pyelography were used for diagnosis. They were treated with percutaneous nephrostomy, double J stent implantation and reconstructive open surgical procedures. All patient were cured with the culmination of urinary extravasation and ureteropelvic patency.

[Missed ureteral injuries following surgical exploration with percutaneous nephrostomy and drainage treatment]. / Cerrahi eksplorasyon sonrasi gözden kaçirilan üreter yaralanmalarinda perkütan nefrostomi ve drenaj ile tedavi yaklasimi.

Twelve patients with missed ureteral injury and urinoma due to gunshot are evaluated following surgical exploration. All 12 had underwent surgical exploration at the other hospitals on admission. Fever, malaise, shocking chills, leucocytosis due to urinoma formation are the findings in the late postoperative period and CT (computer tomography) scan revealed urinoma. Intravenous urograms are nondiagnostic in 6 of patients and hematuria is detected in 6(%50) Percutaneous nephrostomy is emphasized as the first step of management for these lately diagnosed ureteral fistulas. Additionally, Urinoma is drained percutaneously. Hence we save the patients from a second operation following severe gunshot trauma. The presence of shock, intraoperative bleeding, colonic injury and blast effect of high velocity missile with delayed tissue necrosis are the cause of missed ureteral injury. At 8 patients, nephrostomy was the solution and total cure is achieved. Mean follow-up period after nephrostomy is 3 months. At 2, we perform psoas-hitch and ureteroneocystostomy, at one psoas-hitch, boary- flep and ureteroneocystostomy and at one ureteroureterostomy due to long ureteral obstruction on urinary fistula. As a conclusion, when treating missed ureteral injuries with urinary fistula and urinoma formation following complicated surgical intervention, percutaneous nephrostomy application and percutaneous drainage of urinoma may be the first step for management. Late surgical reconstitution is the second step when needed.

Effect of hypothyroidism on the testes in mature rats and treatment with levothyroxine and zinc.

This study was performed to investigate the effect of propylthiouracil (PTU) on rat testis, and to compare the results of the different treatment regimens of levothyroxine and zinc. Twenty sexually mature Wistar albino rats were subjected to PTU for 14 days intraperitoneally to make them hypothyroidic. The effect of PTU on testicular function was assessed histopathologically after unilateral orchiectomy on day 15, and treatment was evaluated by measuring serum thyroid-stimulating hormone (TSH), T3, T4, and zinc levels on days 0, 7, and 15. The rats were then divided into five groups which were given levothyroxine and/or zinc treatment for 15 days. Orchiectomies were repeated on day 30, and specimens were evaluated histopathologically. Although serum T3, T4 and zinc levels decreased, serum TSH levels increased in PTU-treated rats, and the difference to the control group was statistically significant (P < 0.001). Maturation arrest of spermatogenesis, a reduced number of Sertoli and Leydig cells, a decreased tubular diameter, interstitial oedema, and thickening of basal membrane were observed in hypothyroidic testicles. After treatment, testicular histology and spermatogenesis gradually recovered in all groups with hypothyroidism, but maximum improvement was achieved in the levothyroxine + zinc sulphate replacement group, indicating a possible role of zinc in testicular function.

Effect of lower infundibulopelvic angle, lower infundibulum diameter and inferior calyceal length on stone formation.

The effect of anatomical factors such as lower infundibulopelvic angle (LIPA), lower infundibulum diameter (LID) and inferior calyceal length (ICL) on renal stone formation was investigated. These parameters were measured from noncalculous kidneys of 40 healthy kidney donors. The same parameters from 119 patients with single, unilateral, nonobstructive lower calyceal stone were also measured. LID and ICL were significantly higher in calculous kidneys when compared to the control group. On the other hand, the difference between the LIPA of the two groups was not significant. It is concluded that LID and ICL could be good indices in determining lower calyceal stone formation.

Effects of shock waves on the rat foetus.

Controversy exists concerning whether shock wave lithotripsy (SWL) is contraindicated during pregnancy (4, 5). The effects of shock waves on a variety of cells are well documented in both clinical and experimental studies, but their effect on the foetus remains unclear. In this study, we investigated the effects of SWL on the rat foetus. On the 8th, 11th, 14th and 17th days of pregnancy, 100, 250 or 500 shock waves were administered with a Multimed 2001 ELMED Systems Lithotriptor. In ongoing pregnancy, the effects of SWL on the foetus ranged from early mild effects to later moderate effects and fatal effects. There were no viable foetuses in the latest period of pregnancy in rats receiving 500 shocks waves. Histological changes were observed in the brain, lungs and subcutaneous tissue. Fusion and necrosis were found in many dead foetuses. Our study demonstrates that SWL causes foetal damage and death in the late period of pregnancy in rats.

Extratesticular epidermoid cyst with extension into the pelvis.

We report a case of simple epidermoid cyst of the scrotum with extension into the pelvis. Complete excision was performed transcrotally and the presence of epidermoid cyst confirmed by histopathological examination. Simple excision was sufficient for treatment of this very rare lesion. The patient is now in the follow-up period.

Embolization therapy in two subtypes of priapism.

Two subtypes of priapism have been described based on the pathophysiologic mechanism. The more common type, termed stasis priapism, is characterized by a low flow state in which inadequate venous outflow creates an acidotic hypoxic environment leading to a painful prolonged erection. The other less common subtype, high flow priapism, is arteriogenic. We used embolization therapy in one case with long lasting stasis priapism and in the other with high flow priapism due to bilateral arteriosinusoidal fistulae in the penis. In both cases we used polyvinyl alcohol for embolization and sexual potency preservation. Priapism is the persistence of erection that does not result from sexual desire. Hauri et al. described two variants of priapism. In high flow priapism (non-ischaemic) there is unregulated arterial inflow to the lacunar spaces due to a lacerated cavernous artery associated with previous perineal and penile trauma. In stasis priapism, the second type, the basic abnormality could be due to a more pronounced or prolonged blood entrapment inside the vascular spaces of the corpora cavernosa sustained by an unknown cause. There are many treatment methods especially for low flow ischaemic variant. We report two different kinds of priapism and embolization therapy in both of them with polyvinyl alcohol.