Superselective vesical artery embolization versus intravesical formalin for intractable hematuria in patients with bladder cancer.

OBJECTIVE: Intractable hematuria is a leading critical problem occurring in patients with advanced stage bladder cancer (BCa) that are not suitable for radical cystectomy. The present study, for the first time in the literature, aimed to compare the effectiveness of intravesical formalin (IF) and superselective vesical artery embolization (SVAE) in the management of intractable and life-threatening hematuria in BCa patients. METHODS: The retrospective study included 40 BCa patients who underwent SVAE or IF treatment due to intractable hematuria after failure of other methods. Patients were divided into two groups based on the procedures administered: SVEA Group (n = 24) and IF Group (n = 16). RESULTS: The success rate at first-line therapy was 50% (12/24) in SVAE Group and 82% (13/16) in IF Group (p = 0.046). Based on the success rates at first- and second-line therapies, the overall success rate in SVAE Group was 75% and this rate was similar to that of IF Group (p = 0.439). Complication rate was significantly higher in IF patients than in SVAE patients (37.5% vs. 8.3; p = 0.024), whereas duration of postoperative hospital stay was significantly longer in SVAE Group (15.8 vs. 6 days; p = 0.041). CONCLUSION: The advantages of IF appear to include shorter postoperative hospital stays and higher success rates at a single session, while the advantages of SVAE seem to include non-requirement of spinal/general anesthesia, easy repeatability, and low complication rates. In the management of patients with intractable hematuria, patients' general condition, comorbidities, and anesthesia-related risks should be taken into consideration.

Superselective vesical artery embolization versus intravesical formalin for intractable hematuria in patients with bladder cancer. / Embolización vesical supraselectiva versus formalina intravesical para la hematuria intratable en pacientes con cáncer de vejiga.

OBJECTIVE: Intractable hematuria is a leading critical problem occurring in patients with advanced stage bladder cancer (BCa) that are not suitable for radical cystectomy. The present study, for the first time in the literature, aimed to compare the effectiveness of intravesical formalin (IF) and superselective vesical artery embolization (SVAE) in the management of intractable and life-threatening hematuria in BCa patients. METHODS: The retrospective study included 40 BCa patients who underwent SVAE or IF treatment due to intractable hematuria after failure of other methods. Patients were divided into two groups based on the procedures administered: SVEA Group (n=24) and IF Group (n=16). RESULTS: The success rate at first-line therapy was 50% (12/24) in SVAE Group and 82% (13/16) in IF Group (p=0.046). Based on the success rates at first- and second-line therapies, the overall success rate in SVAE Group was 75% and this rate was similar to that of IF Group (p=0.439). Complication rate was significantly higher in IF patients than in SVAE patients (37.5% vs. 8.3; p=0.024), whereas duration of postoperative hospital stay was significantly longer in SVAE Group (15.8 vs. 6 days; p=0.041). CONCLUSION: The advantages of IF appear to include shorter postoperative hospital stays and higher success rates at a single session, while the advantages of SVAE seem to include non-requirement of spinal/general anesthesia, easy repeatability, and low complication rates. In the management of patients with intractable hematuria, patients' general condition, comorbidities, and anesthesia-related risks should be taken into consideration.

Obturator nerve block and transurethral surgery for bladder cancer.

AIM: The obturator nerve may be accidentally stimulated during transurethral resection of lateral bladder wall tumors, causing adductor spasms. In this study, we evaluated the results of obturator nerve block (ONB) produced via a blind anatomical approach. METHODS: Between April 2004 and April 2006, 114 patients with bladder tumors located on the lateral bladder wall had undergone transurethral resection of the bladder tumor (TUR-BT) at our clinic. Sixty-three patients with adductor spasms received local anesthetic ONB; no adductor spasms were observed in the remaining 51 patients. ONB was obtained with 10 mL of 1% prilocaine infiltrated through a 22 G spinal needle using a blind anatomical approach. RESULTS: Two of the 63 patients were excluded from the study due to bladder wall perforations caused by adductor spasms. Successful ONB was performed unilaterally in 61 patients. Muscle spasms were absent in 59 of the 61 patients (97%). In 2 patients receiving spinal anesthesia, and in whom total resection of bladder tumors was performed, adductor muscle spasms were seen during deep resection of the tumor bed, which prevented surgery from proceeding further. CONCLUSION: ONB for the prevention of adductor spasms is a useful technique for the prevention of deep and uncontrolled cuts in the dorso-lateral part of the bladder wall during TUR-BT. The blind anatomical approach is a simple and easy procedure, with a high success rate.

Does pleurodesis for pleural effusions give bright ideas about the agents for hydrocele sclerotherapy?

OBJECTIVE: Evaluation of the effectiveness of rifampicin and some agents used in the pleurodesis of pleural effusions, such as autologous blood and purified mineral talc. PATIENTS AND METHODS: A total of 56 hydroceles were treated by sclerotherapy, in a random fashion, using purified mineral talc, rifampicin and autologous blood as sclerosant agents. The control group of patients were handled with aspiration only. RESULTS: The cohort of patients in the blood group had a success rate comparable to the control group (p > 0.05). the rifampicin group did better than both control and blood groups (p < 0.05) but not better than the talc group (p < 0.01). Success rate was highest in the talc group of patients who needed no re-sclerotherapy procedures. CONCLUSION: Purified mineral talc was shown to be potentially the best sclerosant for the sclerotherapy of hydroceles and epididymal cysts.

The effects of fluoxetine on several neurophysiological variables in patients with premature ejaculation.

PURPOSE: Fluoxetine, a selective serotonin re-uptake inhibitor, has been shown to increase the intravaginal latency of patients with premature ejaculation. We demonstrated the effects of fluoxetine on intravaginal latency, penile sensory threshold, and variables of sacral evoked response and cortical somatosensorial evoked potential in patients with premature ejaculation. MATERIALS AND METHODS: Of 48 patients 40 who presented to our clinic with premature ejaculation met the study criteria, gave written or oral consent, and were divided randomly in a double-blind fashion into 2 groups of 20 patients. The study group received 20 mg. fluoxetine daily and the control group received placebo for 1 month. The patients were evaluated during visits before and after treatment for intravaginal latency, penile sensory threshold values, and the variables of sacral evoked response and cortical somatosensory evoked potential tests. RESULTS: Patient ages, intravaginal latencies, penile sensory threshold values, and amplitudes and latencies of sacral evoked response and cortical somatosensory evoked potential tests in both groups were not significantly different at the beginning of treatment (p >0.05). At the end of treatment intravaginal latencies and penile sensory threshold values were increased in the study group compared to before treatment and the control group (p <0.05). No change was observed in either group for the amplitudes and latencies of sacral evoked response and cortical somatosensory evoked potential tests (p >0.05). CONCLUSIONS: These findings suggest that fluoxetine is effective treatment for premature ejaculation probably due to its effect of increasing the penile sensory threshold, without changing the amplitudes and latencies of sacral evoked response and cortical somatosensory evoked potential.

The first case of periureteric hibernoma. Case report.

Hibernoma is a rare type of soft tissue neoplasm originating from brown fat tissue. The present case is the first periureteric hibernoma concentrically surrounding the ureter with a concomitant renal pelvis stone.

Sarcomatoid squamous cell carcinoma of the right renal pelvis with liver metastasis: case report.

We report on a man with sarcomatoid squamous cell carcinoma of the right kidney with liver metastases. Bilateral renal lithiasis and well differentiated squamous cell carcinomas of the right renal pelvis were also noted. This uncommon case is discussed and the literature is reviewed.

[Evaluation of 18 epididymo-orchitis cases]. / Epididimo-orsitli 18 olgunun degerlendirilmesi.

Eighteen patients with epididymo-orchitis were reviewed clinically, microbiologically and serologically. While there were positive urine culture in 5 patients before treatment, only one of them had positive culture in the epididymal aspirate. The epididymo-orchitis in two patients was the complications of the brucellosis. Ofloxacin or doxycycline was used in the treatment of 16 patients for 2-3 weeks and all, except one patient were recovered completely. The cases secondary to the brucellosis were treated with rifampicin plus doxycycline combination for 6 weeks. After treatment, no positive urine cultures were noted in all patients. As a result the epididymal aspiration to clarify etiological agent is not necessarily needed and empirical treatment may be generally curative.

Urethrocutaneous fistula due to a coil of hair.

Strangulation of the penis by a coil of hair is often an unrecognized clinical entity with severe potential complications. In this report, a five-year-old boy with urethrocutaneous fistula caused by the wrapping of a single strand of hair around the penis is presented.

Seminal parameters of ejaculates collected successively with sixty minute interval in infertile men: effect of combination of prazosin and terbutaline on these parameters.

Out of 37 infertile men, 33 who were able to give two ejaculates by masturbation successively with a sixty minute interval, were studied. There was no significant change in sperm density in the second ejaculation whereas seminal volume decreased (P less than 0.01) and sperm motility increased (P less than 0.05) significantly. After a seven-day treatment with combination of prazosin (alpha 1-blocker) and terbutaline (beta 2-stimulator), the same successive ejaculates were obtained from only 27 of these patients. In this case sperm density and motility changed insignificantly, whereas seminal volume again decreased (P less than 0.01) significantly. The changes in seminal parameters were not significant between the pre- and post-treatment second ones. In a short-term study there are not any alterations to observe. The favourable results with a long-term treatment, published by Japanese authors, require a confirmation by further studies.

The effects of caffeine and theophylline on the triple adenosine triphosphatase enzyme activities of spermatozoa from males with oligoasthenospermia.

The triple ATPase activities of washed spermatozoa of oligoasthenospermic men (but not of normals) were enhanced by the addition of caffeine and theophylline, which are known to have a stimulating effect on sperm motility. The biochemical mechanism of action of caffeine and theophylline on sperm homeostasis is discussed.

The effect of spermine, spermidine and kallikrein on the triple adenosine triphosphatase enzyme activity of spermatozoa in males with oligoasthenozoospermia.

Unknown factors in the seminal plasma of normal semen that affect the motility of spermatozoa have a positive effect on adenosine triphosphatase (ATPase) enzyme activity. In an attempt to produce such an effect, spermine, spermidine and kallikrein were added to the incubation media in which spermatozoal ATPase enzyme activity was determined. These seminal substances increased the triple ATPase enzyme activity of spermatozoa from oligoasthenozoospermic men. We propose that the ATPase enzyme activity of spermatozoa may indicate sperm motility as a biochemical test.