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Background: Biochemical recurrence (BCR) can be seen in the early or late period after radical prostatectomy (RP). Various models have been developed to predict BCR. Objective: In our study we evaluated accuracy of four pre-operative models (GP score, PRIX, D’Amico risk classification, CAPRA) in predicting BCR after RP in Turkish patients. Methods: Age, preoperative total prostate specific antigen (PSA) values, clinical stages, total number of cores taken in biopsy, number of positive cores, preoperative biopsy Gleason score (GS), follow-up time and presence of BCR after RP were recorded. BCR was defined as a total PSA value > 0.2 ng / dl twice consecutively after RP. Classifications or scoring was performed according to pre-operative models. The 1, 3 and 5 year (yr) BCR-free rates of the patients were determined for each model. Also the accuracy of four predictive models for predicting 1, 3 and 5-yr BCR was evaluated. Results: For all pre-operative models there was statistically significant difference between risk groups in BCR free rates at 1, 3 and 5-yr after RP (p

Objective:To investigate the results of a modified open partial nephrectomy technique by using cyanoacrylate glue after the parenchymal restoration sutures without performing tissue reapproximation and to compare complications between risk groups according to the preoperative aspects and dimensions used for an anatomical (PADUA) classification in 50 patients.Metarials and Methods:We performed open partial nephrectomy by using cyanoacrylate glue in 50 patients with a localized tumor and normal contralateral kidney between 2005 and 2012 with a mean follow-up of 40 months. All patients were evaluated by routine biochemical analyses and imaging modalities such as abdominal tomography and magnetic resonance when needed. PADUA scores were assessed according to the computed tomography images.Results:The mean blood loss was higher and the duration of surgery and ischemia was longer in high-risk group than in low-risk group. The difference was statistically significant (p=0.001, p=0.004, and p=0.0009, respectively. Intraoperative collecting system restoration was performed in 3 (9.9%) low-risk and 10 (50%) high-risk patients. Collecting system fistulization or chronic renal failure was not observed in any patient.Conclusion:Application of cyanoacrylate adhesive in nephron-sparing surgery is safe and effective in patients with a low PADUA risk score. Further randomized and controlled studies in a large series of patients will provide more conclusive results.

Background A total of 78 patients aged 11 to 17 years were diagnosed with congenital ventral penile curvature and underwent surgery with the dorsal plication technique between 2005 and 2014. Aim To investigate the long-term outcomes of 72 patients who underwent dorsal penile plication for the treatment of congenital ventral penile curvature without hypospadias. Methods In all cases, the intervascular space between the deep dorsal vein and dorsal artery was dissected, and tunical plication was carried out with non-absorbable 3-0 polyamide sutures and the complication and satisfaction rates of the patients were determined in the postoperative seventh year. Outcomes At the final postoperative follow-up, the patients’ satisfaction with the operation was found to be 95.8%. RESULTS Shortening of the penis (0.5-1 cm) in five cases, recurrence with less than a 20-degree curvature in two cases, palpable sutures in two cases was observed and no patients reported erectile dysfunction. Strengths & Limitations The limitations of our study can be considered as the absence of pharmacological erection in the preoperative evaluation, failure to evaluate penile length at the last postoperative follow-up due to the continued development of the penis, inability to evaluate erectile function at the beginning, postoperative erectile capacity being assessed in only some of the operated cases, all operations being performed by a single surgeon in the same center, and the absence of standardized questionnaires for postoperative satisfaction or adverse events. CONCLUSION According to the results of this study, dorsal plication is a relatively simple method with a low risk and high success rate for the treatment of congenital ventral penile curvatures.

Ischaemic priapism is the most common form of priapism and requires urgent treatment. In this study, we evaluated the effectiveness of the caverno-dorsal vein shunt on resolution of ischaemic priapism and on the post-operative long-term erectile function in patients presenting with priapism. The study included 10 patients admitted to our hospital for priapism between 2010 and 2018. The median age of the patients was 31 (24-66) years. The median priapism time was 13.5 (7-38) hours. The blood gas measurements were taken from the corpus cavernosum, and the drainage of the corpus cavernosum was performed as an emergency intervention. Then, the corpus cavernosum was irrigated with 0.01% adrenaline 5 times in 20-min intervals. The caverno-dorsal vein shunt procedure was performed in cases without regression of priapism. Two months after, the operation shunt was closed. Detumescence occurred in all patients. Eight of 10 patients maintained their erectile function. In 2 patients, severe erectile dysfunction occurred at post-operative 2 months following a priapism attack and penile prosthesis implantation was performed in these 2 patients. Our study showed that caverno-dorsal vein shunt procedure is effective in providing detumescence and maintaining potency in cases with ischaemic priapism. In our opinion, caverno-dorsal vein shunt can be considered as the first treatment of choice for refractory low-flow priapism.

Objective: This study investigated the role of preoperative ureteral stent placement in reducing the risk of ureteral injury, an intraoperative complication of radical retropubic prostatectomy (RRP), and its contribution to the surgeon’s comfort. Materials and Methods: Open RRP was performed in 66 patients diagnosed with localized prostate cancer in our clinic between 2010 and 2015. The patients were divided into two groups; group 1 (n=34) underwent surgery without ureteral stent placement and group 2 (n=32) had surgery following the placement of a ureteral stent. The cases were preoperatively evaluated by suprapubic and transrectal ultrasonography. Perioperative and postoperative complications of all cases were determined. Both groups were assessed in terms of ureteral injury, operative time, and surgeon’s comfort. Results: The mean age of the patients in group 1 and group 2 was 61.12±5.92 (50-72) years and 63.58±6.2 (51-75) years, respectively. The mean prostate volume was 76.8±2.41 and 72.4±3.53 cc in groups 1 and 2, respectively. The mean operative time was 143.9±3.06 minutes in group 1 and 136.8±2.83 minutes in group 2. Partial ureteral injury occurred in three patients in group 1 and was repaired intraoperatively. Of these patients, two had previously undergone radiotherapy for prostate cancer and it was difficult to perform prostate dissection intraoperatively. The remaining patient had a history of transurethral resection of the prostate. No ureteral injury was observed in any of the patients in group 2. Conclusion: Preoperative ureteral stent placement in selected patients can facilitate ureteral dissection and reduce ureteral injury risk.

Introduction Urethral pain syndrome is a subgroup of chronic pelvic pain syndromes and comprises a relatively challenging patient group in urological practice. Several different treatments have been used for the management of the condition from a mostly empirical basis. In this article, we present the results of a small cohort of young male patients treated with sertraline and gabapentin therapy. Material and methods The data of 52 patients was retrospectively evaluated and 31 patients' data was included in this study. Clinical symptom scores, including International Prostate Symptoms Score, Hamilton Anxiety Rating Scale, Visual Analog Scale for Pain, Quality of Life due to Lower Urinary Tract Symptoms, and Urinary, Psychosocial, Organ Specific, Infection, Neurologic/Systemic, Tenderness of Skeletal Muscles (UPOINT) classifications were retrospectively analyzed from the patient records and charts. Results We observed improvement in clinical scores involving anxiety, lower urinary tract symptoms, quality of life, and pain. Statistical analysis revealed significant amelioration of the symptoms with gaba- pentin and sertraline treatment in our cohort. Conclusions Gabapentin and sertraline treatment may be considered in the second step management of urethral pain syndrome. To draw an evidence-based recommendation, prospective and comparative studies should be conducted in the future.

This study aimed to investigate the long-term outcomes of the surgical combination of revascularization and penile corrective techniques after having obtained promising preliminary results from a previous study. Between 2008 and 2015, the combined treatment was undertaken for 60 patients with Peyronie's disease and erectile dysfunction. A preoperative urological evaluation was performed with penile color Doppler ultrasonography, electromyography of the corpus cavernosum and cavernosometry. All the patients completed 15-item and 5-item IIEFs preoperatively and at postoperative follow-up. The mean age of the patients was 53.78 ± 6.48 years ranging from 47 to 63. The mean follow-up period was 48 (14-68) months. The degree of penile angulation was40 in all the patients. Urethra dissection was required in five patients. Penile disassembly was performed on one patient due to distal complex corporeal deformity. None of the patients reported complications after surgery. The mean total IIEF score was reported to be 25.4 ± 2.8 before the operation and 52.23 ± 1.2 at the end of the follow-up (p 0.05). The mean IIEF-5 score was 7.3 ± 1.3 preoperatively and 20.9 ± 1.9 at the end of follow-up (p 0.05). The results of IIEF-15 for erectile function demonstrated that 32 patients had a cutoff value of26, indicating no ED. Although all patients had complete penile straightening, 7 (11.66%) reported shortening of the penis but was not dissatisfied with the treatment. The number of patients satisfied with the outcomes of the operation was 53. The statistically significant improvement and satisfactory results achieved with the IIEF questionnaires suggest that the proposed combined treatment could be an alternative to penile prosthesis in highly selected patients with Peyronie's disease, particularly those with erectile dysfunction; however, more studies are needed to confirm these results.

The aim of this study was to investigate for the first time the surgical results of combining complex corrective techniques with penile revascularization in patients with Peyronie’s disease having ED and consider the technique as an alternative to penile prosthesis implantation. Between 2008 and 2011 penile revascularization surgery along with penile corrective techniques was performed in nine patients with Peyronie’s disease having ED. A preoperative urological evaluation was performed with penile color doppler ultrasonography, electromyography of the corpus cavernosum and cavernosometry. The degree of penile angulation was >40° in all patients. All the patients were asked to answer a 15-item questionnaire—the ‘International Index of Erectile Function’ (IIEF-15)—and a 5-item version of the IIEF (IIEF-5) preoperatively and during the postoperative follow-up. The operation was deemed an improvement or a failure according to the scores on the IIEF-5. The mean age of the patients was 51.4±4.2 years. The mean follow-up period was 18 months. None of the patients reported complications after surgery. Complete penile straightening was achieved in all patients. However, two (22.2%) patients reported penile shortening but did not express any dissatisfaction in this regard. All patients were satisfied with the final surgical results. The mean IIEF-5 score was 9.8±3.1 before the operation and it was reported to be 22.03±2.4 at the end of the follow-up period (P

The aim of this study was to determine the surgical success and complication rates of mixed type of mesh materials compared with Prolene mesh in sling surgery over a 4-year follow-up period.Between 2005 and 2007, broad-based double-forced sling operations were performed in 144 women with stress incontinence using three different types of mesh material. Group I consisted of 48 patients in whom Vypro® mesh (Ethicon, USA) was used; group II of 48 patients in whom Ultrapro® mesh (Ethicon) and group III of 48 patients in whom Prolene® light mesh (Ethicon) was used. The patients' data and the success of the operation were evaluated based on the 24 h pad test, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scoring and Korman questionnaire analysis.The ICIQ-SF score, the number of pads used and the results of 24 h pad test were statistically lower in group II at postoperative month 48 (p0.05). The rate of postoperative complications was lower in Group II than in the other groups (p0.05). The continence rates of groups I, II and III were 84.7%, 91.6% and 85.1%, respectively, in the 48th postoperative month.Ultrapro mesh can be used in sling surgery owing to its higher success rates, and lower vaginal and urethral extrusion and de novo urgency rates, which have also been shown in clinical studies.

Summary The aim of this study was to investigate and compare histological characteristics of spermatic veins in patients with and without varicocele. Between February 2009 and July 2009, spermatic veins were obtained from 13 patients with varicocele. Microsurgical subinguinal low ligation was performed in all patients. Spermatic veins of patients without varicocele were obtained from 12 patients who underwent radical nephrectomy. Histologically, sections of veins were stained with haematoxylin and eosin. Mean tunica adventitia thickness size of the spermatic veins was 0.35 ± 0.08 mm and 0.22 ± 0.1 mm respectively in patients with varicocele and control group (P = 0.001). Similarly, mean tunica media thickness size of the spermatic veins was 0.25 ± 0.05 mm and 0.09 ± 0.04 mm respectively in patients with varicocele and control group (P 0.05). No significant differences were detected between the tunica adventitia and tunica media thicknesses of patients with varicocele and sperm parameters (P > 0.05). Our study demonstrated that tunica adventitia and tunica media thicknesses seem to be increased in patients with varicocele compared with normal subjects.

Summary We investigated the effects of quercetin on pathological findings on testicular ischaemia–reperfusion (I/R) injury in rats. Twenty-four male Wistar albino rats were randomly assigned into four groups: Group 1, control (n = 5); Group 2, sham (n = 4); Group 3, I/R (n = 8); and Group 4, I/R + quercetin (n = 7). Bilateral testicular artery and vein were occluded for 1 h, followed by reperfusion in I/R and I/R + quercetin animals. Quercetin (20 mg kg−1 per day) was administrated once daily by gavage to Group 1 and Group 4, respectively, after reperfusion. At the end of the study, bilateral orchiectomies were performed for histopathologic examination. The tissue damage was evaluated with light microscopy. Normal inter-stitium and seminiferous tubules were observed in control group. In the sham group, rats were seen minimal oedema around the seminiferous tubules and congested vascular structures. In Group 3, oedema, vascular congestion and haemorrhage between seminiferous tubules were observed. In Group 4, histopathologic features were markedly less than Group 3 (P = 0.03). Our study demonstrated that quercetin seems to have a protective effect on testis histopathology in rats with testicular I/R.

Summary We evaluated and compared serum oxidative and antioxidative parameters of patients with erectile dysfunction (ED) and control subjects. Twenty married male patients with ED for at least 12 months (Group 1) and 20 volunteer healthy, sexually active, married and age-matched men (Group 2) were included in the study. Group 1 and 2 were compared concerning serum mean total antioxidant capacity (TAC), total oxidant status (TOS), paraoxonase1 (PON1), arylesterase, total thiol and oxidative stress index (OSI). Mean patient age was 47.9 ± 8.1 and 44.4 ± 10.6, respectively, in Group 1 and 2. Serum TAC levels were 1.7 ± 0.5 and 2.3 ± 0.3, respectively, in Group 1 and 2 (P = 0.002). Serum TOS levels were 21.8 ± 20.5 and 11.7 ± 2.2, respectively, in Group 1 and 2 (P = 0.035). Serum PON1 levels were 69.8 ± 13.1 and 164.9 ± 56.5, respectively, in Group 1 and 2 (P

Objective To determine the overall long-term success of penile revascularization surgery in the treatment of vasculogenic erectile dysfunction (ED) and also to investigate the effect of risk factors on the results of a modified Furlow-Fisher technique. Patients and methods Between 1999 and 2010, 125 men with a mean (sd, range) age of 43.2 (11.3, 23-69) years underwent penile revascularization surgery. In all, 110 men completed the long-term follow-up with a mean follow-up of 73.2 months. Diagnostic evaluations, penile colour Doppler ultrasonography, corpus cavernosum electromyography, and cavernosometry, were performed in all the men before surgery. The efficacy of the surgery was assessed as improvement or failure according to the change in the five-item version of the International Index of Erectile Function (IIEF-5). A ≥5 point increase in the IIEF-5 score during the latest patient visit after surgery compared with that before surgery was regarded as improvement (surgical success). Results The mean (SD) IIEF-5 score was 7.3 (3.2) before surgery and at the end of the follow-up period it was 16.8 (3.1). The success rates were 81.8% at 3 months, 77.2% at 1 year, 70% at 2 years, 66.3% at 3 years and 63.6% at 5 years after surgery in the men who achieved a no-ED threshold score of >26 in the IIEF-15. The success rate was the highest in the men with no risk factors (92.8%). Seven patients (6.36%) showed signs of glans hypervascularization as a major complication. Conclusions Penile revascularization surgery has not been widely used by urologists probably due to the technical difficulties and the use of phosphodiesterase type 5 inhibitors. However, with reported high rates of noncompliance or failure of oral pharmacotherapy it seems likely that this surgery will become more popular in the near future.

We investigated the effects of Antep pistachio on International Index of Erectile Function (IIEF) scores, penile color Doppler ultrasound (PCDU) parameters and serum lipid levels in patients with ED. A total of 17 married male patients with ED for at least 12 months were included in this prospective study. Patients were put on a 100 g pistachio nuts diet for 3 weeks. IIEF and PCDU were evaluated before and after the pistachio diet. In addition, plasma total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride were measured before and after dietary modifications from all subjects. Mean IIEF-15 score was 36 ± 7.5 before the diet and 54.2 ± 4.9 after the diet (P=0.001). Similarly, an increase in all five domains of IIEF was observed after the diet (P0.05). Mean peak systolic velocity values before and after the pistachio diet were 35.5 ± 15.2 and 43.3 ± 12.4 cm s(-1), respectively (P=0.018). After the pistachio diet, TC and LDL levels decreased significantly, whereas HDL level increased (P=0.008, 0.007 and 0.001, respectively). We demonstrated that a pistachio diet improved IIEF scores and PCDU parameters without any associated side effects in patients with ED. Furthermore, the lipid parameters showed statistically significant improvements after this diet.

Summary In this study, we investigated whether electromyography of corpus cavernosum (CC-EMG) results vary with age and whether CC-EMG could be a parameter to predict ageing of cavernous smooth muscle. Recordings of electrical activity of corpus cavernosum (EACC) were retrospectively investigated in 134 patients with erectile dysfunction. Penile colour Doppler ultrasonography and cavernosometry were also performed for all of the patients. The total number and duration of EACC and amplitudes between positive and negative peaks were compared between the flask state for 10 min and after intracavernosal papaverine injection. The mean age of the 47 patients in group 1 was 35.2 ± 6.3 years (range, 23–44), the mean age of the 45 patients in group 2 was 51.1 ± 3.1 years (range, 45–56) and the mean age of the 42 patients in group 3 was 61.8 ± 4.6 years (range, 57–77). Total IIEF-5 score was 7.6 ± 2.1 in group 1, 7.9 ± 2.4 in group 2 and 7.9 ± 2.1 in group 3. There were no statistically significant differences among the groups regarding electrical potential frequencies, durations and amplitudes of electromyographic recordings. Conclusion: We do not think that CC-EMG findings could be used efficiently as a predictor of ageing.

The aim of this study was to evaluate acellular porcine pericardium (APP) and compared the results with those obtained from venous grafts in the surgical management of Peyronie's disease (PD). An APP (Group 1) and an autologous saphenous vein graft (Group 2) were used in 27 and 26 patients, respectively for Peyronie's correction. The patients' age, body mass index (BMI), operation time, duration of follow-up, preoperative and postoperative IIEF-5 scores, plaque size and loss of sensation were evaluated in both groups. There were no differences between the two groups in terms of age, BMI, follow-up period, and preoperative and postoperative IIEF-5 scores. The postoperative IIEF-5 scores were higher than the preoperative IIEF-5 scores in both groups. The operation time was significantly longer in Group 2 than in Group 1. The duration of sensation loss was shorter in Group 1 compared to Group 2. Penile shortening was similar in both groups.

To compare the efficiency and spontaneous expulsion rates of tamsulosin and Rowatinex in patients with distal ureteral stones.Between March and July 2009, 90 patients with distal ureteral stones10 mm in size were included in the study. Patients were randomized in 3 groups: Group 1 (n = 31, those received 0.4 mg tamsulosin once daily), Group 2 (n = 30, those received 100 mg Rowatinex capsules 3 times a day), and Group 3 (n = 29, those received diclofenac 100 mg once daily). All patients were followed up for 10 days.Mean age of the patients was 42.4 ± 16.1 (range, 22-75), 46.5 ± 16.5 (range, 22-76), and 43.5 ± 16.6 (range, 18-71) years in Groups 1-3, respectively. On admission, 37.8% had hematuria and 78.9% had lower urinary tract symptoms (LUTS). No statistically significant differences were detected between the three groups regarding patient age, gender, mean stone size, stone location, stone site, additional analgesic requirement, number of ureteral colics during the treatment, and upper urinary tract dilation. The mean stone expulsion time was 3.5 days in Group 1, 6 days in Group 2, and 7 days in Group 3 (P = 0.02). Stone expulsion rate was significantly high in Group 1 compared to Group 2 (P = 0.002). Similarly, stone expulsion rate was significantly high in Group 1 compared to Group 3 (P = 0.001). Medical treatment with tamsulosin seems to be effective in patients with distal ureteral stones10 mm in size. However, use of Rowatinex does not seem to have any significant effect on clearance rate of distal ureteral calculi.

Introduction: This study aimed to investigate the surgical results of incision and vein grafting combined with two types of plication sutures, including Essed-Schroeder and longitudinal imbrication, to correct the cavernous sacculation in complex curvature resulting from Peyronie’s disease. Material and Methods: Between 2004 and 2008, 15 patients with complex curvature resulting from Peyronie’s disease were surgically treated. Essed-Schroeder plication and venous grafting were performed in 10 patients. Five of the 15 patients had cavernous sacculation, which was defined as albugineal elongation, except for the normally morphological cavernosal structure, which caused some degree of penile torsion beside the angulation. Surgery was used to establish sufficient cosmetic results by performing longitudinal imbrication on the cavernous sacculation on the same side as that of the Essed-Schroeder plication combined with venous grafting in these five patients. Results: Complete penile straightening was achieved in all the patients. Two patients (13.3%) reported penile shortening without showing dissatisfaction about it. One patient complained of anesthesia on part of the skin of the penile shaft. All the patients were satisfied with the final surgical results. Conclusions: A combination of the surgical methods might be necessary to correct the complex deformities due to Peyronie’s disease. Further studies with larger patient populations are needed to standardize these procedures.

PURPOSE Endoscopic treatment of large bladder stones via cystoscope is still bothersome, and open cystolithotomy is the preferred method in many centers. To gain more insight into the endoscopic bladder stone management, we aimed to compare the transurethral use of nephroscope and cystoscope randomly. PATIENTS AND METHODS Forty-three male patients with bladder stones were randomized into two groups, to perform nephroscopic (group 1, n = 22) and cystoscopic (group 2, n = 21) stone fragmentation procedures transurethrally. Combined pneumatic/ultrasonic lithotripsy device was used in both groups to fragment the bladder stones. RESULTS The mean stone size in group 1 and group 2 was 3.6 +/- 1.3 cm and 3.5 +/- 1.6 cm, respectively (p > 0.05). Stone fragments were removed completely in all of the patients, and the mean operation time was calculated as 48.2 +/- 13.2 minutes in group 1 and 68.1 +/- 22.7 minutes in group 2, with no intraoperative complications (p < 0.01). None of the patients developed urethral stricture disease in the early (postoperative third month) follow-up. Three patients with previously known urethral stricture disease have shown to have the same disease in the late (postoperative 14.4 +/- 5.1 months) follow-up. CONCLUSION Treatment of large bladder stones by transurethrally placed nephroscope is a fast and effective treatment modality compared to endoscopic treatment via cystoscope. Nephroscope allows for use of larger forceps and facilitates collection of large stone fragments through its 24F sheath. It also prevents multiple entries to the urethra and hence avoids possible urethral injury. Combined pneumatic/ultrasonic lithotripsy device, with its aspiration quality, enables the surgeon to gain a better endoscopic view during both procedures.

Arterialization operations of the penis are recommended for young patients with erectile dysfunction (ED). In this study, we investigated the efficiency of deep dorsal vein arterialization (DDVA) in carefully selected healthy elderly patientsAn initial extensive evaluation with corpus cavernosum electromyography, cavernosometry, and penile doppler ultrasonography was performed for 43 elderly patients with ED for whom the presence of risk factors (hypertension, diabetes, hyperlipidemia, smoking habit, psychiatric or neurologic disorders, liver or kidney failure, and history of major trauma) had been ruled out. All patients underwent to DDVA using the Furlow-Fisher technique. Surgical outcome was tested postoperatively by use of the fifteen-item International Index of Erectile Function questionnaire (IIEF-15). Surgical success was assumed if the score in the five-item version of the IIEF (IIEF-5) had increased by at least five points.Of the patients, 21 were detected to have caverno-occlusive disease, 13 had arteriogenic disease, and 9 had both caverno-occlusive and arteriogenic disease. The mean age of the patients was 59.7+/-4.6 years and the mean follow-up time was 22.1+/-7.1 months. The operation was successful in 26 cases (60.5%) according to IIEF-5. Total IIEF-15 score was increased from 19.2+/-5.0 to 28.5+/-9.4 (P0.05). Significant increases were observed in the erectile function, intercourse satisfaction, and overall satisfaction domains of IIEF-15. The preoperative degree of ED or the etiology of ED had no impact on the surgical results. Percent changes in the total IIEF-15 score and in its domains were no different between patients aged60 and those agedor=60.DDVA could successfully be performed for carefully selected elderly patients as long as the presence of risk factors for ED are ruled out.

To investigate the role of a new preoperative parameter, relaxation degree (RD), in the prediction of postoperative success after deep dorsal vein arterialization operations. Chart reviews and electromyographic recordings were evaluated in 52 patients on whom deep dorsal vein arterialization was carried out for pure caverno-occlusive dysfunction. The efficiacy of the operation was assessed as improvement or failure according to the five-item version of international index of erectile function (IIEF). RD was defined as the percentage decrease in cavernous electrical activity (CEA) after intracavernous papaverine injection. Preoperative RD measurements were statistically compared between the improvement and the failure groups. The mean age of patients was 34.2 ± 8.1 years (range 25–49) with a mean follow-up of 32 ± 8 months. Improvement was observed in 39 (75%) and failure in 13 (25%) patients. The mean RD values were 60% and 32% for surgical improvement and failure groups respectively (P

The aim of this study was to evaluate the surgical implantation techniques of AMS Spectra malleable penile prosthesis, its intraoperative and postoperative complications, and the rates of patient and partner satisfaction. Forty-six patients on whom AMS Spectra malleable penile prosthesis implantation was performed between 2009 and 2014 were retrospectively examined. Any complications seen intraoperatively and postoperatively were determined. International Index of Erectile Function (IIEF)-5, total IIEF erectile function domain scores were calculated preoperatively. IIEF-5, total IIEF erectile function domain and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) scores were calculated in the postoperative third, sixth and twelfth months. The mean age of the patients was 63.6±7.28 (38-80) years. The mean erectile dysfunction period was 4.29±2.51 years, and the mean follow-up period was 3.19±1.6 years. The mean IIEF-5 score was 5.86±0.92 before surgery, and it was 22.5±0.62 at the end of the follow-up. The mean total IIEF erectile function domain score was 6.02±1.09 before surgery, and it was 26.02±0.21 at the end of the follow-up. The mean EDITS score was 71.06±3.16 at the end of the follow-up. The mean EDITS score of the patients partners was 65.08±4.34 at the end of the follow-up. The overall satisfaction rates were 96.2% for the patients and 84.6% for the partners. As a result of this study, the AMS Spectra penile prosthesis implantation is an effective, reliable and economic method. It can be used in the treatment of erectile dysfunction in selected patient groups offering high patient and partner satisfaction rates.

To investigate the obstructive findings urodynamically in idiopathic detrusor overactivity and compare them (maximum flow rate 'Q max' detrusor pressure at maximum flow 'PQ max') with control group.Cystometric evaluation and pressure flow studies were performed in 25 women with symptoms of idiopathic detrusor overactivity and control group comprised 40 women with anatomic incontinence without cystocele. Patients with pelvic floor prolapse, motor urgency and poor compliance were excluded from the study. Q max less than 15 ml/s and PQ max more than 40 cm water were accepted as obstruction.After cystometric evaluation, obstruction was found in 36% of patients with idiopathic detrusor overactivity and 15% in control group. The range of maximum flow rate and PQ max values were 2-43.7 ml/s (mean 14.47 +/- 10.22) and 10-143 cm water (mean 58.97 +/- 35.13) in idiopathic urge syndrome group. These values were 6.6-51.8 ml/s (mean 23.24 +/- 12.43) and 9.7-61 cm water (mean 25.56 +/- 12.43) respectively in control group. Q max and PQ max parameters were compared statistically between the two groups. Idiopathic detrusor overactivity group had lower mean Q max and higher mean PQ max values than control group (P0.001) Table 1.Obstruction percentage was found to be more in idiopathic detrusor overactivity group than the control group.

Objectives: To evaluate the results andcomplications in 170 patients with symptomaticbenign hyperplasia who underwent laserprostatectomy focusing on six month and long-term results.Methods: A total of 170 patientsunderwent side firing Neodymium:Yag laserprostatectomy between January 1995 and February2001 of whom 152 and 82 were available after 6months and 3 years follow-up respectively.Evaluations were done by American UrologicalAssociation (AUA) symptom score, peak urinaryflow rate, residual volumes and immediate andlong-term complications were assessed.Results: Median patient follow-up periodwas 34.1 months (16–70). After 6 months the meanAUA score reduced from 20.2 to 8.2 and found as9.4 in patients who completed 3 yearsfollow-up. Post voiding urine volume decreasedfrom 110 ml to 46 ml at 6 months and found as60 ml after 3 years. Peak urinary flow rateincreased from 3.4 to 16.4 ml per second after6 months and found as 14.8 ml per second after3 years. The overall complications of 170patients in early period included urinaryretention after catheter removal in6 (3.52%), early bleeding in 2 (1.17%), latebleeding in 1 (0.58%). Late complicationsincluded urethral stricture requiring internalurethrotomy in 12 (7.8%), bladder neckcontracture in 4 (2.6%) and repeated laserprostatectomy after 2 years in 10 (5.88%)patients.Conclusion: Side firing Neodymium:Yaglaser prostatectomy offers a safe and effectivetreatment for bladder outlet obstruction due tobenign hyperplasia with minimal associatedmorbidity.

Purpose:To evaluate the results of plaque incision and venous patch grafting to correct the dorsal curvature associated with Peyronie's disease.Materials and methods:18 patients with Peyronie's disease were treated surgically. All of the patients have dorsal penile curvature for more than one year causing intromission impossible or with some difficulty because of curvature. Median penile angulatio was 60° (range 45°–75°). A transverse incision about 2 cm long was made on the plaque where maximal site of curvature was identified. The saphenous vein harvested from the ankle region is opened longitudinally and its endothelial surface is placed and sutured in contact with the tunical defect.Results:Complete penile straightening was achieved in 16 (88.8%) cases and only two patients have residual curvature less than 30° permitting sexual intercourse. None of the patients returned to baseline preoperative angulation state in the follow up period. 3 patients (16.6%) reported penile shortening, but only one was concerned and showed dissatisfaction about it. 6 patients (33.3%) have transient changes in penile sensation that resolved within 4 months.Conclusions:Plaque incision and placement of saphenous vein patch graft offers a 94.4% satisfactory result in Peyronie's disease causing penile dorsal curvature.

Varicocele, which is the abnormal dilatation of internal spermatic veins, is known as the most surgically correctable cause of male infertility. In the evaluation of testicular arterial and venous blood supply, the scrotal colour Doppler ultrasound (CDU) is a valuable diagnostic method. The aim of this study was to investigate how the testicular blood flow is affected after varicocelectomy, and the place of scrotal CDU in the follow-up after varicocelectomy.Thirty male patients who were diagnosed with left-sided varicocele were prospectively included in the study. Before the varicocelectomy, semen analyses were carried out, and peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI) were measured by CDU. In the third postoperative month, scrotal CDU and semen analysis were performed again and compared with the preoperative results.The arterial flow parameters PSV and EDV increased significantly, and the resistance parameters RI and PI decreased significantly, compared with the preoperative values. Sperm concentration, progressive motility and normal morphology improved in the postoperative semen analysis compared with the preoperative results. The increases in all three parameters were statistically significant. No statistically significant difference in vascular parameters was seen between the patients with improved and unimproved semen analysis.As confirmed by the results of semen analysis and CDU, testicular blood flow increases after varicocelectomy, resulting in the recovery of the haemodynamics of the testicle. CDU, which is generally used for diagnosis in the varicocele, can also be a valuable method of determining treatment success after surgery.

Purpose: To investigate the clinical application of the new parameter'Relaxation Degree.Patients and methods: Chart reviews of 150 patients were evaluatedretrospectively of whom 96 had been diagnosed as pure cavernoocclusivedysfunction (COD) by using corpus cavernosum electromyography (CC-EMG) and cavernosometry and of whom 54 had been diagnosed as psychogenic erectile dysfunction by normal CC-EMG; cavernosometry and pulsedoppler scanning. Relaxation degree was defined as the percent decreasein the amplitudes of the electrical activity of corpus cavernosum (EACC).Results: Mean relaxation degree measurements were found as 66.5%,66.28% and 16% in minimal, moderate and severe COD groups respectively.This value was 80% in psychogenic erectile dysfunction group. Statisticalcomparisons were found significant between minimal and severe andmoderate and severe COD groups. All three organic erectile dysfunctiongroups were also compared with psychogenic erectile dysfunction groupwhere differences were found significant. If the normal relaxation degreewas accepted as more than 80%, COD could be diagnosed with 93% specifityand 98% sensitivity without performing cavernosometry.Conclusion: Relaxation degree parameter could be used in diagnosisof COD showing the percent relaxation ability of the cavernous smoothmuscle as a non invasive method when compared with cavernosometry.

To assess the efficacy of a modified technique in stress incontinence, that is vaginal wall sling reinforced with two layers of vaginal wall sutured inferiorly. 27 patients with Type II incontinence, 4 with Type III and 14 with mixed type who completed two years follow up were included into the study. Cure, improvement and failure rates were 84.4%, 8.9% and 6.7% respectively. Temporary retention is observed in 30 of the patients, vaginal stenosis and pelvic pain in 1 and suture granuloma in 5 of the patients. Reinforced insitu vaginal wall sling which gives additional support to urethral hammock inferiorly offers a better solution to both types of stress incontinence.

We aimed to evaluate the efficacy and the short- and long-term results of the modified four corner bladder neck suspension (FCBNS) procedure in the correction of type 2 stress urinary incontinence with moderate cystocele. We studied retrospectively 26 consecutive patients who underwent modified FCBNS procedure during a 2-year period at our institution. The modifications that were made were the distal sutures starting from the midurethra as a coil fashion of three centimetres to the bladder neck and its fixation to the pubic bone. Preoperative questionnaires, hospital and clinical records, and postoperative questionnaires were reviewed to assess comparative outcome among the patients. Patient follow-up ranged from 22 to 47 months (mean 33.5). The mean age at the time of surgery was 55.3 +/- 11.6, and mean parity was 3.2 +/- 1.3. Twenty-five of 26 women (96%) were cured after six months and 24 of 26 (92%) were cured after twenty-one months. Cystoceles were completely reduced. Complications occurred in 15% of the patients. The modified FCBNS is a useful and effective operation in treating anatomical stress urinary incontinence and an associated moderate cystocele since it elevates and supports midurethra as well in selected patients and it is associated with a low incidence of postoperative complications.

We attempted to identify the etiology of erectile dysfunction in 50 male patients with a mean age of 31.4 (25-42) years. The physical and neurological examinations, history, biochemistry and serum testosterone and prolactin levels were within normal limits. Pharmacopenile duplex ultrasonography, corpus cavernosum electromyography (CC-EMG) and cavernosometry were performed. Smooth muscle tone and the relaxation response after intracavernous papaverine and sodium nitroprusside injections were evaluated by CC-EMG. Autonomic dysfunction has been defined as increased electrical activities after visual sexual stimulation and lowered amplitudes despite normal smooth muscle content. Our definition is similar to this: paradoxically increased electrical activities after intracavernous injection. Caverno-occlusive dysfunction (COD) and accompanying pathologies were found in 38 patients (76%) with pure COD in 26 (52%), COD and arterial pathology in 2 (4%) and COD + autonomic dysfunction in 10 patients (20%). Amplitudes of cavernous electrical activity were low in 32 of 38 patients with COD. These high COD and autonomic dysfunction rates led us to examine these pathologies on molecular and electrophysiological bases.

We aimed to compare the electrical activity of corpus cavernosum before and after intracavernous papaverine injection and to determine the blood lipid profile in vascular and non-vascular erectile dysfunction, and also to assess whether vascular pathology and abnormal blood lipid levels impair cavernosal smooth-muscle relaxation. We determined total cholesterol (TC), triglyceride (TG) and high-density lipoprotein (HDL) levels in peripheral and cavernosal blood in 39 patients with erectile dysfunction. Electromyography of the corpus cavernosum was performed before and after an intracavernous injection with 60 mg of papaverine in all patients. Thirty-nine impotent patients have been divided into two groups: vasculogenic erectile dysfunction (VED) and non-vasculogenic erectile dysfunction (NVED), according to colour Doppler ultrasonic flowmetry, dynamic infusion cavernosometry and the pressure difference between the brachial arterial systolic pressure and cavernosal arterial systolic pressure measurements. Biochemical values and amplitude changes were compared in both groups. The TC level was higher in both peripheral and cavernosal samples of the VED group than in the NVED group (p = 0.000), with no differences between peripheral and cavernosal blood levels within the same groups (p > 0.05). There were no significant changes in TG and HDL levels in any of the groups (p > 0.05). The mean amplitude differences before and after papaverine injection (delta A) were found to be 2.05 +/- 0.78 microV in the VED group and 4.68 +/- 2.53 microV in the NVED group, showing that the relaxation response to papaverine was more significant in the NVED than in the VED group (p = 0.003). The moderate decreases in the amplitude of electrical activity of corpus cavernosum and the higher TC levels found in the VED group can be accepted as the parameters of impairment in the relaxation of corpus cavernosum, showing the role of hypercholesterolaemia and vascular pathologies in erectile dysfunction.

Purpose: To investigate the cavernosal electromyographic changes after deep dorsal vein arterialization. Patients and Methods: Corpus cavernosum electromyographies (CC-EMG) were done in 18 patients with patent anastomosis 1 year after the operation by using coaxial needle electrodes during the flaccid state and following intracavernous 60 mg papaverine injection. Results: Themean preoperative amplitude and relaxation degree measurements were found to be 77 ± 11 µV and 34 ± 8%, respectively. The same recordings 1 year after the operation were 140 ± 24 µV and 76 ± 11%, respectively. Comparisons of preoperative and postoperative values revealed statistically significant results (p < 0.0001). Conclusion: Smooth muscle restoration of cavernous tissue was proved by observing the postoperative increases in the amplitude and relaxation degree parameters of CC-EMG.

Giant prostatic urethral stones have been reported as a very rare entity, and the etiology of these stones is not clear. We report a case of a 40-year-old man with giant multiple prostatic urethral stones whereby the entire gland was replaced, and a big ureteral stone presented with voiding difficulty and recurrent urinary tract infections. In the literature, to our knowledge, this is the youngest case wherein giant prostatic urethral stones coexisted with a big ureteral stone. Many different-sized stones were observed endoscopically, some protruding into the urethra, and some filling different cavities on the prostate. Following cystoscopy, multiple giant prostatic stones weighing a total of 151 g were removed by the open retropubic route. We treated the big ureteral stone endoscopically.