Search

Purpose: The effects of metformin on prostate volume and prostate-specific antigen (PSA) were investigated.

Amaç: Soğuk, mesane fonksiyonunda değişik şekillerde hasara neden olabilen stres indükleyici bir faktördür. Bu çalışmada kortikosteroid ve antihistaminik tedavisinin akut ve kronik olarak indüklenmiş soğuk stres üzerine etkilerini araştırmak amaçlanmıştır.Gereç ve Yöntemler: 42 adet dişi sıçanrastgele yedi gruba ayrılmıştır. Gruplar şu şekildedir;Kontrol grubu, Akut soğuk stress (ACS) grubu; ACS+ kortikosteroid (CORT) grubu; ACS+CORT+antihistaminik grubu; Kronik soğuk stress (CCS) grubu; CSS CORT grubu; CSS+CORT+antihistaminik grubu. Bu uygulamalardan sonraki 15. günde, genel anestezi altında sıçanlara sistektomi uygulandı ve mesaneleri çıkarıldı. Çıkarılan dokular %10 nötral tamponlu formalin içerisinde fikse edilip takip edildikten sonra hematoksilen eozin ve Toluidin mavisi ile boyandı.Bulgular: Mast hücre sayısına göre yapılan değerlendirmede, kontrol grubuna kıyasla en yüksek değer CCS grubunda gözlenmiştir. En düşük değer CCS + CORT grubunda elde edilmiştir. CCS grupları arasındaki karşılaştırmaya göre, lamina propriadaki en yüksek polimorfonükleer lökosit (PNL) değerleri CCS grubunda görülürken, CORT ve CORT+Antihistaminik tedavilerinin, lamina propriadaki PNL değerlerini önemli ölçüde azalttığı gözlendi. Epiteldeki PNL sayıları ACS ve CCS gruplarında yüksek iken, CORT ve/veya antihistaminik ile tedavi edilen ACS ve CCS gruplarındaki sonuçların kontrol grubundakilerle benzer olduğu ortaya çıkmıştır. CORT’a ek olarak antihistaminik enjeksiyonun, CCS'deki epitelde bulunan lenfosit sayısını, sadece CORT'dan daha verimli bir şekilde azalttığı görüldü.Sonuç: Mevcut çalışma, kortikosteroid tedavisinin, enflamatuar hücre infiltrasyonunu ve mast hücre sayısını azalttığını ortaya koymuştur. Özellikle kronik soğuk stresde daha belirgin bir iyileşme olduğu gözlenmektedir., Objective: Cold is a stress-inducing factor that can cause changes in bladder function in various ways. The present study is intended to investigate the effects of corticosteroid and antihistaminic treatment on acutely and chronically induced cold stress.Material and Methods: Forty-two female rats were randomly divided into seven groups as follows: Control group; Acute cold-stress (ACS) group; ACS+ corticosteroid (CORT) group; ACS+CORT + Antihistaminic group; Cronic cold-stres (CCS) group; CSS+CORT group; CSS+CORT+Antihistaminic group. On the 15th day after these treatments, bladders of the rats were harvested for histopathological examinations under general anesthesia and fixed with 10% neutral buffered formaline. Hematoxylin and eosin and toluidine blue stainings were performed.Results: The comparison based on mast cell count yielded the highest value in the CCS group in comparison to the control group. The lowest value was harvested in the CCS + CORT group. The comparison between the CCS groups revealed the highest polymorphonuclear leucocyte (PNL) values in the lamina propria in the CCS group, whereas the CORT and CORT + Antihistaminic treatments were found to have significantly decreased the PNL values in the lamina propria. While the PNL counts in the epithelium were high in the ACS and CCS groups, the results in the ACS and CCS groups that were treated with CORT and/or antihistaminic were revealed to be similar with those in the control group. It was discovered that antihistaminic injection in addition to CORT decreased the lymphocyte counts in epithelium in CCS more efficiently than CORT alone did.Conclusion: The present research revealed that corticosteroid treatment reduced inflammatory cell infiltration and decreased mast cell count. A more evident amelioration was observed particularly in chronic cold stress.

Introduction We examined the effect of seasonal variation on sexual behavior and its relationship with testosterone levels. The existence of the inhibiting effect of cold stress on sexual behavior and testosterone levels was our hypothesis. Material and methods A total of 80 cases, aged between 20 and 35 years old, were enrolled. Blood samples for testosterone, FSH, LH, and prolactin were obtained twice from each participant at the same time of day (before 10 am). The first samples were taken in January and February, the months which have the average lowest heat days (-15.9°C and -14.6°C, respectively) in our region. The second samples were taken in July and August, which has the average highest heat days (25.4°C and 26.1°C, respectively) in our region. Two times IIEFs (International Index of Erectil Function) were fulfilled at the same day of taking blood samples. The frequency of sexual thoughts and ejaculation were questioned by asking “How many times did you imagine having sex?’’ and “How many times did you ejaculate in a week?”. The body mass index of the participants in the study was calculated in the winter and in the summer. Results There were significant differences in terms of IIEF scores, frequency of sexual thoughts and ejaculations, BMI (Body mass index), and both testosterone and FSH levels between the winter and summer measurements. We did not find any significant differences with regards to prolactin and LH levels. Conclusions Although testosterone levels are within normal limits in both seasons, its level in cold months is less than in hot months. Testosterone levels can change according to the season. The impact of cold seasons in particular should be taken into account when evaluating testosterone levels and sexual status, as well as the other influences (social, cultural).

Introduction In this animal study, we reviewed the histomorphological findings in rabbit kidneys after a high number of high-energy shock wave applications and observed if there were any cumulative effects after repeated sessions. Material and methods We formed 2 groups, each consisting of 8 rabbits. Group 1 received 1 session and group 2 received 3 sessions of ESWL with a 7 day interval between sessions, consisting of 3500 beats to the left kidney and 5500 beats to the right kidney per session. The specimens of kidneys were examined histomorphologically after bilateral nephrectomy was performed. For statistical analysis, 4 groups of specimens were formed. The first and second groups received 1 session, 3500 and 5500 beats, respectively. The third and fourth groups received 3 sessions, at 3500 and 5500 beats per each session, respectively. The sections were evaluated under a light microscope to determine subcapsular thickening; subcapsular, intratubular and parenchymal hemorrhage; subcapsular, intersitital, perivascular and proximal ureteral fibrosis; paranchymal necrosis; tubular epithelial vacuolization; tubular atrophy; glomerular destruction and calcification. Results In histopathological examinations capsular thickening, subcapsular hematoma, tubuloepithelial vacuolisation, glomerular destruction, parenchymal hemorrhage, interstitial fibrosis, and perivascular fibrosis were observed in all groups. In statistical analysis, on the basis of perivascular fibrosis and tubular atrophy, there was a beats per session dependent increase of both. Conclusions The detrimental effects from ESWL are dose dependent but not cumulative for up to 3 sessions. Histopathological experimental animal studies will aid in understanding local and maybe, by means of these local effects, systemic effects.

To compare the outcomes of flexible ureterorenoscopy (F-URS) with extracorporeal shock wave lithotripsy (ESWL) for the treatment of upper or mid calyx kidney stones of 10 to 20 mm. A total of 174 patients with radioopaque solitary upper or mid calyx stones who underwent ESWL or F-URS with holmium:YAG laser were enrolled in this study. Each group treated with ESWL and F-URS for upper or mid calyx kidney stones were retrospectively compared in terms of retreatment and stone free rates, and complications. 87% (n = 94) of patients who underwent ESWL therapy was stone free at the end of 3rd month. This rate was 92% (n = 61) for patients of F-URS group (p = 0.270 p 0.05). Retreatment was required in 12.9% of patients (n = 14) who underwent ESWL and these patients were referred to F-URS procedure after 3rd month radiologic investigations. The retreatment rate of cases who were operated with F-URS was 7.5% (n = 5) (p = 0.270 p 0.05). Ureteral perforation (Clavien grade 3B) was occured in 3 patients (4.5%) who underwent F-URS. Fever (Clavien grade 1) was noted in 7 and 5 patients from ESWL and F-URS group, respectively (6.4% vs 7.5%) (p = 0.78 p 0.05). F-URS and ESWL have similar outcomes for the treatment of upper or mid calyx renal stones of 10-20 mm. ESWL has the superiority of minimal invasiveness and avoiding of general anethesia. F-URS should be kept as the second teratment alternative for patients with upper or mid caliceal stones of 10-20 mm and reserved for cases with failure in ESWL.

Isolated brain stem tuberculoma: a case report and review of the literature Approximately 5 to 10% of tuberculosis cases involve brain and central nervous system. Tuberculosis involving central nervous system (CNS) due to haematogenous spread is not a rare entity. CNS manifestations may be meningitis, solitary tuberculomas, abscess, infarct or milier parenchymal disease. In this case report, we discuss a 17-year- old female with isolated pontin tuberculoma and comorbidity of genital tuberculosis and review the literature.

Distal üreter tașlarının tedavisinde; üreterorenoskopik litotripsi (ÜRS) ve vücut dıșı șok dalga litotripsinin (ESWL) etkinliklerini karșılaștırması landı.YÖNTEMTek distal üreter tașı olan hastaların dosyaları geriye dönük incelendi. Hastalar uygulanan tedavi seçeneklerine göre ESWL ve ÜRS gruplarına ayrıldı. Gruplar; tedavi bașarısı ve komplikasyon oranları açısından karșılaștırıldı.BULGULARESWL ve ÜRS gruplarında sırasıyla 112 ve 108 hasta yer aldı. Yaș, taș boyutu ve cinsiyet değișkenleri gruplar arasında farklılık göstermedi. Ortalama taș boyutu 10,8 mm’di. Operasyon sonrası tașsız hasta oranı, ÜRS grubunda %89,8 ve ESWL grubunda%59,8’di. Gruplar arası fark istatistiksel olarak anlamlıydı (p, AIMTo compare the effi ciency of ureterorenoscopic lithotripsy (URS) and extracorporeal shock wave lithotripsy (ESWL) in the treatment of distal ureteral stones.METHODSThe data of all patients with a single distal ureter stone were investigated, retrospectively. The patients were divided into two groups according to the management options as ESWL and URS. The success and complication rates of the groups were compared.RESULTSThere were 112 and 108 patients in ESWL and URS groups, respectively. Patients’ age, stone size and gender were similar in both groups. The average stone size was 10.8 mm. Postoperative success rate defined as the removal of all the stones was higher in URS group (89.8%) than ESWL group (59.8%), and the difference was significant (p

1980’lerin sonundan itibaren, prostata özgü antijenin (prostate specific antigen, PSA) klinikte kullanılmaya bașlanmasıyla prostat kanseri hastalarının kaderi dramatik olarak değiști. Günümüzde daha fazla sayıda erkek lokalize, küçük, daha az agresif ve ölümcülolmayan prostat kanseri tanısı almaktadır. Klinik olarak lokalize prostat kanserinin tedavisinde, günümüzde radikal prostatektominin yanı sıra, prostatın kriyo–cerrahi ile ablasyonu, brakiterapi ve yüksek yoğunluk odaklı ultrasonografi de alternatif tedavi seçenekleri olarak kabul edilmektedir.Bu derlemede, birincil sonuç olarak lokalize prostat kanserinde fokal tedavi alternatiflerinin bașarısı ve komplikasyon oranları belirlemeyi ladık. Derlemenin ikincil sonucu ise bu ișlemler için uygun olan aday hastaların tanımlanmasıydı.“Prostat kanserinin fokal tedavi alternatifleri”, “yüksek yoğunluk odaklı ultrasonografi ve prostat kanserinin kriyocerrahisi” ve “prostat kanserinin radyofrekans ablasyonu” tanımlamalarıyla Medline taraması yaptık. Toplamda 1173 makale değerlendirildi ve bunlardan içerik olarak uygun bulunan 45 tanesi derlemede kullanıldı.Konuyla ilgili kontrollü çalıșma yoktu. Amerikan Üroloji Derneği kılavuzları, prostatın kriyocerrahi ablasyonunu tedavi edici bir yöntem olarak kabul etmektedir; ancak cerrahi ve cerrahi dıșı alternatiflerle kıyaslandığında, daha az morbidite ve olasılıkla aynı tedavietkinliğine sahip minimal invasiv bir yöntem olarak geliștirilmesine rağmen yüksek yoğunluk odaklı ultrasonografi ise hala deneysel olarak kabul edilmektedir.Girișim yapılmadan düzenli takip edilme kriterlerini yakalayan ancak aktif tedavi șansını kaçırma hissiyle anksiyete yașayan hastalarda, fokal tedaviler iyi alternatifler olabilir. Ancak, fokal tedavi seçeneği düșük ve orta dereceli riski olan hastalar için saklanmalıdır.Radyolojik ve klinik evre sırasıyla T2b ve T2a’nın altında olmalıdır. Ek olarak, adaylar alternatiflerin deneysel olduğu ve zaman içinde tedavi seçeneğinin değiștirilmesine ihtiyaçları olabileceği yönünde bilgilendirilmelidirler. Yakın gelecekte fokal tedavi alternatifleri daha gerçekçi tedavi seçeneklerine dönüșebilirler, ancak kanıta dayalı veri sağlamak için iyi desenlenmiș, çok merkezli randomize prospektif çalıșmalara ihtiyaç vardır., The destiny of prostate cancer patients has been dramatically changed since the introduction of prostate specifi c antigen (PSA) into clinical use in late 1980s. Currently more men are diagnosed with localized, small, less aggressive and non-lethal prostatic carcinoma. Besides radical prostatectomy, cryosurgical ablation of the prostate, brachytherapy and high-intensity focused ultrasound have been accepted as alternative treatment options in clinically localized prostatic carcinoma.In this review, we aimed to evaluate the success and complication rates of alternative focal treatment options as the primary outcome. The secondary outcome of this review was to define the candidate patients eligible for these procedures.We searched the Medline using specifi ed expressions including “focal treatment alternatives of prostatic carcinoma”, “high-intensity focused ultrasound and cryosurgery of prostatic carcinoma” and “radiofrequency ablation of prostatic carcinoma”. A total of1173 papers related to the focal treatment options were analyzed and only 45 of them related to the subject were included.There wasn’t a controlled trial dealing with the topic. American Urologic Association guidelines have accepted cryosurgical ablation of the prostate as a therapeutic option; however the high-intensity focused ultrasound is still considered as an experimental treatment option, although it has been developed as a minimally invasive procedure with reduced morbidity and potentially with the same therapeutic efficacy in comparison with the surgical or non surgical options.For patients meeting the variable criteria for regular follow up visits without intervention but experiencing anxiety with the feeling of losing active treatment options, focal therapies may be ideal alternatives. However, focal therapy options should be spared for patientswith low to moderate risks. The radiologic and clinical stages should be below T2b and T2a, respectively. In addition, all candidates should be informed that the alternatives are considered as experimental and they may need an alternative treatment option in time.Focal therapy alternatives may be more realistic treatment options in the near future; however, well designed multicenter prospective randomized trials are required to provide evidence based data.

Üreter taşları acilde sık rastlanan bir durumdur. Tedavide obstrüksiyonu acil gidermek için double-J kateter konabilir. Double-J kateter takılırken ya da üreterorenoskopik litotripsi yapılırken taş ya da parçaları retrograd böbreğe migrasyon olabilir. Ancak spontan retrograd migrasyon nadir bir durumdur. Bu makalede üreter taşına bağlı obstrüktüf üropati ve enfeksiyon gelişen hastaya acil double-J kater koyma işleminden sonra taşın spontan böbreğe retrograd migrasyonundan bahsettik. Benign prostat hiperplazisinin bu olasılığı artırabileceği sonucuna vardık., Renal colic due to ureteral stones is a common medical situation in the emergency. Double j ureteral stent insertion may lead relief of obstruction. Stones or fragments may migrate to the kidney via retrograde way during insertion of double j stent or ureterorenoscopic lithotripsy. Besides this, spontaneous retrograde migration is an unusual phenomenon. In this article, we reported a case with spontaneous retrograde migration of a ureteral stone which was secondary to the insertion of double j stent for relief of obstructive uropathy and infection. We revealed that benign prostatic hyperplasia (BPH) might increase this probability.

AMAÇ: Hastane şartlarında uzman doktorların yaptığı sünnetlerin komplikasyon oranlarının saptanmasıdır.YÖNTEMLER: 2004-2012 yılları arasında Kars Devlet Hastanesi, Kafkas Üniversitesi Tıp Fakültesi Hastanesi, Kars Özel Bioanaliz Polikliniği ve Kars Özel Şifa Polikliniğinde 0-19 yaşları arasındaki 2220 hastaya Üroloji ve Genel Cerrahi Uzmanları tarafından dorsal-ventral slit ve eksizyon tekniği uygulanarak sünnet yapıldı. Sünnet sonrası oluşan komplikasyonlar retrospektif olarak değerlendirilmiştir.BULGULAR: Çalışmamızda komplikasyon oranı %3.3 olup, kanama %1.65 oranı ile ilk sırayı alırken, sırasıyla enfeksiyon %1.2, yetersiz sünnet % 0.25, anesteziye bağlı komplikasyonlar %0.20 olara saptanmıştır. Ayrıca bir hastada inklizyon kisti oluşmuştur.SONUÇ: Sünnet cerrahi bir işlem olup, hastane şartlarında ve işin uzmanı hekimler tarafından yapıldığında ciddi komplikasyonlar büyük oranda azalmaktadır., OBJECTIVE: Our aim is to evaluate the complication rates of circumcisions performed by specialists in the hospitals.METHODS: 2220 patients with the ages ranging between 0 and 19 years old were circumcised by urologists and general surgeons in Kars State Hospital, Kafkas University Faculty of Medicine, Kars Private Bioanaliz and Şifa outpatient clinics between June 2004 and September 2012. Dorsal ventral slit and excision technique was preferred for all patients. The procedures were performed in hospitals with obeying the surgical sterilization rules.RESULTS: The overall complication rate was 3.3%; bleeding was the most common one with a rate of 1.65%, infection in 1.2%, inadequate excision in 0.25% and complications related with anesthesia in 0.2%. Bleeding complications were not serious and only 11 cases (0.49%) required re-intervention under local anesthesia, of these, hemorhagic diatesis was found in 4. İnfection that threatened the life of the patient was not observed.CONCLUSION: Circumcision is a surgical modality. It had rules to be obeyed like the other surgical modalities and a technique. Serious complications are very rare, if deferred to these rules and performed by specialists in the hospitals’ conditions. We advise to investigate the patients for hemorhagic diatesis prior to circumcision. Key words: circumcision, complications

Aşırı aktif mesane (AAM) hayat kalitesi üzerine belirgin etkisi olan yaygın bir tıbbi durumdur. Tedavi yaklaşımı davranışsal ve farmakolojiktir. İlk farmakolojik tedavi alternatifi tolerabilitesi, etkinliği ve uzun dönem komplians gibi sınırlayıcı faktörleri olan antikolinerjik ajanlardır. AAM’ nin patofizyolojisinin anlaşılması ve farmakolojik tedavideki alternatif ajan arayışı, bu durumun tedavisi için yeni moleküllerin geliştirilmesini sağlamıştır. Bu moleküllerin antikolinerjik ilaçlarla benzer etkileri olup, yan etkilerinden kaçınmaktadırlar., Overactive bladder (OAB) is a prevalent condition that has a significant impact on quality of life. The usual treatment approach is both behavioral and pharmacological. The first-line pharmacological treatment commonly utilizes anticholinergic agents, which may be limited by their tolerability, efficacy, and long-term compliance. Developments in elucidating the pathophysiology of OAB and alternative targets for pharmacological therapy have led to newer agents being developed to manage this condition. These agents which have alternate mechanism of action and avoid the anticholinergic side effects.

Bireyler yaşam tarzlarını modifiye ve kontrol ederek, fertilite potansiyellerini bir dereceye kadar arttırabilir veya muhafaza edebilirler. Yaşam tarzlarının modifikasyonu, üreme sağlığı ve fertilite potansiyelini arttıracak veya bozacak çeşitli faktörlere maruziyeti belirleyebilir. Bu makalede, yaşam tarzı seçimlerine göre değişebilecek modifiye edilebilir bazı faktörleri ve onların üreme sağlığına olan etkilerini güncel tıbbi literatür eşliğinde sunuyoruz., Individuals have roles in preserving or increasing their fertility potential to a degree by controlling and modifying their life styles. Life styles modification may determine exposure to various factors that may improve or disprove reproductive health and fertility potential. Herein, we try to present some modifiable factors varies according to the life style preferences and their effects on reproductive health in the light of current medical literature.

AMAÇ: İnfertil erkeklerde varikoselin cerrahi olarak düzeltilmesinden sonraki geç dönemde spermiogram değerlerine ve fertiliteye katkısını belirlemek için hastalar retrospektif olarak araştırıldı.YÖNTEMLER: Çalışmamızda Ocak 2004-Haziran 2012 yılları arasında Kars Devlet Hastanesi ve Kars Kafkas Üniversitesi Tıp Fakültesi'nde infertilite nedeniyle ameliyat yöntemine bakılmaksızın varikoselektomi yapılan ve kayıtlarına ulaşılan 240 hasta retrospektif olarak tarandı. Spermiogram ve doppler USG incelemesi olan ve tıbbi kayıtlarına ulaşılan 148 hasta çalışmaya dahil edildi. 46 hastanın medikal kayıtlarına ulaşılamadı, onlar da telefonla aranarak fertilizasyon durumları soruldu ve yeni bir semen analizi yaptırmak üzere kliniğimize davet edildi. Varikoselektomi yapılıp eşi gebe kalan ancak düşükle sonlanan çiftler fertil olarak kabul edildi.BULGULAR: Hastaların ameliyat yaşları 19-38 arasında olup, yaş ortalamaları 29.3 olarak hesaplandı. Preoperatif semen analizinde, hastaların %70.6' sında (n: 131) oligospermi, %22.4' ünde (n: 43) oligoastenospermi ve %7' sinde (n: 14) oligoastenoteratozoospermi mevcuttu. Hastaların 125’ inin (%64.7) postoperatif spermiogram tetkiklerinde, WHO kriterlerine göre sperm konsantrasyonu, motilitesi veya morfolojisinin en az birinde artış saptandı. 80 çiftte (%41.1) varikoselektomi sonrasında ek bir tedavi ve yardımcı üreme tekniği kullanılmadan gebelik gerçekleştiği öğrenildi.SONUÇ: Biz çalışmamızda, infertil hastaların sperm parametrelerinde ve spontan gebelik oranında artış saptadık. Varikoseli olan infertil hastalara varikoselektomiyi tavsiye etmekteyiz., OBJECTIVE: In our study, we retrospectively analysed the effect of surgical varicocele repair on sperm analysis and fertility status of infertile patients in the late period.METHODS: We retrospectively searched the records of 240 patients who underwent surgical varicocele repair between January 2004 and June 2012 in Kars State Hospital and Kafkas University Faculty of Medicine. 148 patients with obtained full medical records, sperm analysis and doppler ultrasonography were included in the study. We could not reach the postoperative data of 46 patients and they were asked current status of fertility on the phone and invited to our department for new semen analysis. Couples whose pregnancies resulted with abortions after varicocele repair were accepted as fertile.RESULTS: The mean age of the patients was 29.3 years ranging between 19 and 38 years old. Preoperative sperm analysis showed oligospermia, oligoasthenospermia and oligoasthenoteratozoospermia in 70.6%, 22.4% and 7% of cases, respectively. Postoperative semen anlaysis revealed improvements in at least one of sperm concentration, motility and morphology in 125 patients according to the WHO criteria and 80 of couples had spontaneous fertilization after varicocelectomy without any requirement of assisted reproductive techniques.CONCLUSION: Our study showed increase in parameters of semen analyses and spontaneous pregnancies in patients after varicocelectomy. We advise varicocelectomy to the infertile cases with varicoceles.

Aşırı aktif mesane (AAM) hayat kalitesi üzerine belirgin etkisi olan yaygın bir tıbbi durumdur. Tedavi yaklaşımı davranışsal ve farmakolojiktir. İlk farmakolojik tedavi alternatifi tolerabilitesi, etkinliği ve uzun dönem komplians gibi sınırlayıcı faktörleri olan antikolinerjik ajanlardır. AAM' nin patofizyolojisinin anlaşılması ve farmakolojik tedavideki alternatif ajan arayışı, bu durumun tedavisi için yeni moleküllerin geliştirilmesini sağlamıştır. Bu moleküllerin antikolinerjik ilaçlarla benzer etkileri olup, yan etkilerinden kaçınmaktadırlar., Overactive bladder (OAB) is a prevalent condition that has a significant impact on quality of life. The usual treatment approach is both behavioral and pharmacological. The first-line pharmacological treatment commonly utilizes anticholinergic agents, which may be limited by their tolerability, efficacy, and long-term compliance. Developments in elucidating the pathophysiology of OAB and alternative targets for pharmacological therapy have led to newer agents being developed to manage this condition. These agents which have alternate mechanism of action and avoid the anticholinergic side effects.

ÖZET GİRİŞ: Soğuk etkisinin mesane işlevini ve detrusor kontraktilitesini etkilediği bilinmekle birlikte bu etkileşimde rol oynayan fizyolojik mekanizma yeterince araştırılmamış ve anlaşılmamıştır. Klinik olarak soğuk etkisinin genellikle işemeyi uyarıcı etkisinin sıklıkla gözlenmesine rağmen özellikle pelvik ağrı sendromu ve aşırı aktif mesane sendromunun soğuk ile ilişkisi hakkında yeterince bilgi yoktur. Klinik gözlemlerde, soğuk bu klinik tablolardaki semptomları artırıcı etki gösterebilmektedir. 1957 yılından itibaren, mesane soğuk refleksinin bulunmasıyla bu konuya ilgi artmış ve çeşitli araştırıcılar tarafından bu refleksin afferent ve efferent yollan ayrıca merkezi ve çevresel yollan anlaşılmaya çalışılmıştır. Bununla birlikte tekrarlayıcı buzlu su testi uygulamalan detrusor kasılımım uyarmak amacıyla, medüller şok fazımn tedavisinde bir rehabilitasyon metodu olarak kullanılmış ve bu testin bazı hipo- veya arefleksi durumunda etkili olduğu bildirilmiştir. Vücut soğuması genellikle artmış bir diürezle ilişkilidir. Mesane soğuk refleksi ile düşük ısıya maruz kalma esnasında artmış ani sıkışma hissi arasındaki ilişki aydınlatılamamıştır. Hayvan deneylerinde derinin soğutulmasıyla detrusor cevabım kolaylaştırmak veya uyarmak konusunda başanlı olunamamıştır. Bu durum deri soğuk reseptörlerinin, mesane soğuk refleksine (MSR) giriş yapamadığını düşündürmektedir. Mesanenin ısı algılamasmdaki görüşler değişiktir. Birçok araştıncı mesane mukozasının sıcak ve soğuk sıvı aynmını yapabildiği konusunda hemfikirken diğerleri mesanede termal duyumsama olmadığını rapor etmiştir. Daha sonrakiler ise ısı algılamasının mesanedeki reseptörler tarafından değil, sadece üretral reseptörler tarafından algılanabildiğini rapor etmişlerdir. Bu tezin amacı sıçanlarda akut ve kronik soğuk stresin mesane düz kası kasılımı üzerine etkisini ve soğuk strese bağlı oluşan histomorfolojik değişiklikleri araştırmaktır. Bu tez çalışmasından elde edilecek bilgiler, henüz açıklanamamış soğuk ve mesane uyanmıarasındaki ilişkiye ışık tutabilecek ve aşın aktif mesane sendromu ve ağrılı mesane sendromu gibi hastalıkların etiolojisinde soğuk etkisinin olası rolüne işaret edebilecektir. 111GEREÇ VE YÖNTEM: Her biri 6 adet erişkin erkek Sprague-Dawley sıçanlardan oluşan 3 grup oluşturuldu. İlk grup olan kontrol grubu soğuk strese maruz bırakılmadı ve organ banyosu çalışmaları için feda edilmelerine kadar oda sıcaklığında beslendi. Akut soğuk stres (ASS) grubu olan ikinci grupta sıçanlar, 8 saat süre ile +4° C derecede tutulduktan hemen sonra mesaneleri çıkarılarak feda edildiler. Kronik soğuk stres (KSS) grubu olan üçüncü grupta ise sıçanlar 21 gün süreyle, her gün +4° C derecede, 4 saat tutulduktan sonra mesaneleri çıkarılıp feda edildiler. Her mesaneden iki adet elde edilen mesane şeritleri, dört kanallı organ banyosunda izometrik gerilime getirildi. Kasılma çalışmaları dinlenme geriliminde, gevşeme çalışmaları ise (10`5 M) karbakolle önceden gerilmiş dokularda gerçekleştirildi. Karbakol (10`9 - 10`4 M arasında doz yanıtı) ve elektriksel alan uyarımı (EAU) (1, 5, 15, 40 Hz, 10 V, lms, 15 saniye) ile kasılma ve izoproterenol (10`9 - 10`4 M arasında doz yanıtı) ve EAU'ya gevşeme yanıtları test edildi. Doku ağırlığına göre normalize edilen verilerin istatistiksel değerlendirmesi 'SPSS 10.0 for Windows' tıbbi istatistik programı kullanılarak, 'one way ANOVA' ile ve grafikler ise 'Jandel scientific, Sigma Plot 3.0' programı kullanılarak yapıldı. İstatistiksel anlam p=0,05 sınırında kabul edildi. BULGULAR: 120 mM K ile elde edilen maksimum kasılma yanıtları kontrol grubunda, ASS ve KSS gruplarına oranla istatistiksel olarak yüksek bulundu. Gerek karbakol gerekse de EAU ile elde edilen kuru ve yaş ağırlıklara göre normalize edilen kasılma yanıtları kontrol grubunda ASS ve KSS gruplarına göre yine istatistiksel olarak yüksek bulundu. Elde edilen kasılma yanıtları mesane şeritlerinin ağırlığından bağımsız olarak maksimum kasılma güçlerine göre normalize edildiğinde ise karbakol yanıtları, kontrol grubu ve KSS grubunda, ASS grubuna göre istatistiksel olarak yüksek bulunurken EAU ile elde edilen kasılma yanıtlarında gruplar arasında istatistiksel fark saptanmadı. Gevşeme çalışmalarında gruplar arasında maksimum gevşeme yanıtlan açısından fark izlenmedi. İzoproteranole karşı oluşan gevşeme yanıtlarında, kuru ve yaş ağırlıklara ve maksimum gevşemeye göre normalize edilen değerler karşılaştırıldığında, gruplar arasında istatistiksel olarak fark saptanmadı. EAU ile elde edilen kasılma yanıtlarında ise doku ağırlıklarına göre normalize edilen değerlerde gruplar arasında fark bulunmazken maksimum gevşemeye göre normalize edilen değerlerde, ASS ve KSS gruplarında kontrol grubuna göre istatistiksel olarak daha az gevşeme saptandı. IVHematoksilen & Eozin ve PAS (Periodic Asid Schiff) ile gerçekleştirilen histolojik çalışmalarda kontrol grubunda ürotelyum ve lamina proprianın morfolojisinin düzgün, GAG (glikozaminoglikan) tabakasının sürekli olduğu saptandı. ASS ve KSS uygulanan gruplarda, ürotelyumun yer yer dejenere olduğu görülürken, lamina propriada inflamatuar hücre infiltrasyonu ve bazı bölgelerde GAG tabakasının sürekliliğinin bozulduğu bulundu. Ayrıca, KSS uygulanan grupta yer yer mast hücreleri görüldü. ASS ve KSS uygulanmış gruplardaki bulgular benzerlik göstermekle beraber, ASS uygulanmış gruptaki mukozal hasarın daha yoğun düzeyde olduğu saptandı. SONUÇ: Bu çalışmada dışardan vücut soğutulmasıyla oluşturulan akut ve kronik soğuk stresin, mesane düz kas kasılımı ve gevşemesi üzerine olan etkisi gösterilmiştir. Buna göre akut veya kronik soğuk stres mesane düz kasında kasılma yanıtlarım zayıflatmaktadır. Ayrıca, mesane düz kasının nörojenik uyarıya gevşeme yanıtı da soğuk stres ile azalmaktadır. Bu hayvan modelinde soğuk stres mesane epiteli ve lamina propriada histopatolojik değişikliklere yol açmıştır. Soğuk stresin sıçan mesanesindeki bu etkilerinin oluşmasında rol oynayan hücresel mekanizmaların ve aynı patofizyolojik nedenlerin insanda çeşitli mesane hastalıklarının etioloj isindeki olası rolünün araştırılması gereklidir. SUMMARY INTRODUCTION AND OBJECTIVES Although the effect of cold stress on bladder function is commonly observed there is not enough investigation about the physiological mechanism involved in this relation. Clinically, cold usually provokes micturition, however, the possible etiological role of cold stress in overactive bladder syndrome and pelvic pain syndrome has not been thoroughly investigated. According to common clinical observation the cold stress increases the symptoms of these syndromes. As of 1957, the attention to this matter has been increased by means of discovery of the bladder cold reflex and the afferent and efferent or central or peripheric pathways of this reflex have been investigated by the various investigators. The use of the ice water test as a rehabilitation method to reduce the medullary shock phase was effective in patients with detrusor hypo- or areflexia and helped in restoring normal detrusor contractility. Body cooling is usually associated with an increased diuresis. The relationship between the bladder cooling reflex and the commonly experienced increase in urgency during exposure to low temperature is unclear. In animal experiments the investigators have failed to evoke or facilitate a detrusor response by cooling of the skin, which may suggest that cutaneous cold receptors do not provide an input to the bladder cooling reflex. The ideas about the thermal sensation of the bladder are various. Most investigators have concluded that the bladder mucosa can distinguish between hot and cold fluids but others have reported an absence of thermal sensation in bladder. These latter authors have postulated that thermal sensation is perceived exclusively by urethral receptors and not by receptors in the bladder mucosa. The aim of this study is to investigate the effect of acute and chronic cold stres on the contractility and the histomorphology of rat bladder. We believe that the results of this study will be help us to understand the effect of cold on bladder function and also the possible role of the cold stress in the etiology of various bladder diseases such as over active bladder and painful bladder syndrome. VIMATERIALS AND METHODS We divided the animals into 3 groups each including 6 male Sprague-Dawley rats. The control group was not exposed to cold stress and fed at the room temperature until their bladders were removed under anesthesia and processed for organ bath and histological studies. The rats in the acute cold stress (ACS) group were exposed to acute cold stress at the +4° C degrees for 8 hours. Immediately thereafter their bladders were removed for the same purpose. The rats in the chronic cold stress (CCS) group were exposed to chronic cold stress at +4° C degrees for 4 hours every day for 21 days and thereafter they underwent bladder removal under anesthesia. All animals were sacrified after bladder removal. Two bladder strips were obtained from each bladder and incubated in a four chamber organ bath and stretched to isometric tension. Contraction studies were performed at baseline isometric tension and relaxation studies were performed on pre-contracted tissues by 10`5 M carbachol. In contraction studies, the contraction responses of tissues to carbachol (İO^-IO`4 M cumulative dose response stimulation) and electrical field stimulation (EFS) (1, 5, 15, 40 Hz, 10 V, 1 ms, 15 sec) were measured. In relaxation studies, the relaxation responses of pre contracted tissues to isoproterenol (İO^-IO`4 M, cumulative dose response stimulation) and EFS were measured. All contraction and relaxation results were normalized according to tissue weight and as well as according to maximum contraction or relaxation. Statistical analysis was performed by `one way ANOVA` using `SPSS 10.0 for Windows` and graphics were performed on `Jandel Scientific, Sigma Plot 3.0` program. Statistical significance was determined at p=O.05 level. RESULTS Maximum contraction responses obtained with 120 mM K in the control group were significantly higher compared with the ACS and CCS groups. Carbachol and EFS-induced contractions in the control group were significantly higher than the ACS and CCS groups when normalized according to the weight of bladder strips. However, when normalized according to maximum contractility, carbachol contractions in the control group and CCS group were significantly higher than the ACS group and also, there were no statistically significant difference between groups in the EFS-induced contractions. In relaxation studies, maximum relaxation responses were similar between groups. There was no statistical difference between groups in terms of the relaxation responses to VIIisoproterenol normalized according to tissue weight and maximum relaxation response. EFS- induced relaxation was also similar between groups when results were normalized according to weight. However, EFS-induced relaxation was found to be significantly higher in the control group compared to ACS and CCS groups when data was normalized according to maximal relaxation response. Histological studies on H&E and PAS stained slides revealed normal urothelium with an intact GAG layer and normal lamina propria. In ACS and CCS groups, urothelium was damaged in some parts along with GAG layer and lamina propria was infiltrated by inflammatory cells. Urothelial damage in ACS group seemed to be more severe compared with the CCS group and mast cell infiltration was only observed in the CCS group CONCLUSION In this study, we have shown the effect of acute and chronic cold stress in rats on the function of the bladder in vitro and bladder histology. Our results have revealed that acute or chronic cold stress decreases the contractile responses of bladder tissue in vitro. On the other hand, EFS-induced relaxation is also decreased by acute or chronic cold stress. These changes in the isometric tension studies are found to be associated with urothelial damage and inflammatory reaction in lamina propria. The cellular pathways involved in this process need to be clarified by further studies. Understanding the precise mechanism behind the effect of cold stress on bladder physiology and morphology may help us to better understand the pathophysiology of various bladder diseases in humans. Vlll 53

This study aimed to investigate the protective effect of tadalafil on reactive oxygen species induced by a hyperoxia model in rats, both in terms of enzymes such as superoxide dismutase (SOD) and nitric oxide (NO), and its pathological effects on the corpus cavernosum. Overall, 24 rats were divided into three groups. The control group (eight rats) was not exposed to any intervention. The second group (eight rats), was exposed to hyperoxia in a hyperoxia cabinet for 8 h a day for 10 days. The third group (eight rats) was exposed to hyperoxia the same as in the second group, tadalafil at a dose of 10 mg/kg was given orally as a dissolved form in water in the amount of 10-12 ml/100 g/day to the rats placed in separate cages having removed from the hyperoxia cabin. SOD levels differ enough to create a difference, but there was no significant difference in terms of NO levels. The SOD level was highest in hyperoxia conditions and lowest in the group given tadalafil. While corpus cavernosum hyperemia was found to be higher statistically in the experimental groups than in the control group, we found that the severity of hyperemia was less in the group given tadalafil. The corpus cavernosum was found to be statistically more dilated in the experimental groups than in the control group. We determined that hyperoxia status increased the level of SOD and this level decreased with tadalafil administration, which would make a statistical difference.

espanolOBJETIVOS: El objetivo es determinar si la ureterolitectomia laparoscopica (UL) es una buena alternativa a la ureterorenoscopia flexible con litotricia (URSF) a traves de la comparacion de ambas tecnicas en lo que a coste y efectividad radica. METODOS: Analizamos 79 pacientes con litiasis ureterales proximales de mas de 1,5 cm que recibieron URSF o UL en relacion a coste-efectividad. Los datos recogidos incluyeron edad, IMC, tamano de la litiasis, tiempo de la cirugia, tiempo de hospitalizacion, complicaciones y tasa libres de litiasis a los 15 dias y 3 meses de la cirugia. Auditamos los costes de las URSF y UL y se compararon en relacion a coste-efectividad. RESULTADOS: No hubo diferencias estadisticamente significativas entre los grupos en relacion a la edad, IMC, tamano de la litiasis, tasa libre de litiasis a los 3 meses y complicaciones (p>0,05). Los tiempos quirurgicos fueron estadisticamente menores en URSF en comparacion a UL (61,5±24,3 min y 140,9±49,1 min, respectivamente, (pz0,05). La tasa libre de litiasis a los 15 dias fue mas baja en el grupo de URSF que UL (31 (81,6%) y 41 (100%), respectivamente, p Aunque la diferencia estadistica desaparece a los 3 meses (p>0,05). El coste medio de URSF y UL fue de $194,2 ± 12,4 y $ 179,2 ± 58,5, respectivamente (p CONCLUSION: URSF es igualmente efectiva que UL en terminos de tasa libre de litiasis. Los costes de URSF es mas alto que UL. URSF es la primera opcion en el tratamiento de litiasis de mas de 1 cm en ureter proximal. En caso de experiencia laparoscopica de alto nivel, UL puede sustituir a URSF, especialmente en casos dificiles. EnglishOBJECTIVES: We aimed to understand whether laparoscopic ureterolithotomy (LU) is a good alternative to flexible ureterorenoscopic lithotripsy (FURS) by comparing these techniques concerning cost-effectiveness. METHODS: We analysed 79 patients with upper ureteral stones larger than 1.5 cm underwent FURS or LU concerning cost-effectiveness analysis. The data including age, body mass index (BMI), stone size, operation time, hospitalisation time, complications and stone-free rates of 15th day and 3rd months. We audited the costs of FURS and LU and compared them concerning cost-effectiveness. Arch. Esp. Urol. 2021; 74 (6): 592-598 https://doi.org/10.37554/en-20201213-3423-7 ORIGINAL ARTICLE Keywords: Flexible ureterorenoscopy. Laparoscopic ureterolitotomy. Cost-effectiveness. Lithotripsy. RESULTS: There was not any statistically significant difference between the two groups with regard to age, BMI, stone size, stone-free rates at the 3rd month, and complication rates, (p>0.05). The operation times were statistically lower in the FURS than in the LU (61.5±24.3 min and 140.9±49.1 min, respectively, p However, this statistical difference disappears at 3 months (p>0.05). The mean costs of FURS and LU were $194.2±12.4 and $179.2±58.5, respectively (p CONCLUSION: FURS is equally effective to LU in terms of stone-free rates. The cost of FURS is higher statistically than LU. FURS is shown as the first choice for the upper ureteral stones larger than 10 mm in size, if the laparoscopic experience is in high-level situations in that clinic, LU may be a suitable alternative to FURS, especially for challenging cases

Introduction: We investigated the survival of a flexible ureterorenoscope (FURS) in regard to the total stone area (TSA) and total usage time (TUT) to determine the cutoff values for its survival. Materials and Methods: Data were obtained from 1326 patients who underwent flexible ureterorenoscopy. The stone area and the usage time of the FURS were obtained in each case. The data from each FURS were considered as a group. The TSA was calculated as the sum of the stones for which only one FURS broke, and the TUT was calculated as the sum of the time of use within the body in all cases during the tool's survival. Data from 13 groups of 1258 patients were analyzed in regard to the TSA and TUT. Results: We found a positive correlation of the case number with the TSA and TUT. The Pearson correlation coefficients were 0.983 and 0.937 for the TSA and TUT, respectively (p < 0.05). The mean case number, TSA, and TUT where only one FURS was used were 97.38 +/- 31.34, 11,886 +/- 4567.93 mm(2), and 5160 +/- 1570.52 minutes, respectively. The area under the curve (AUC) of the receiver operating characteristic curve of the FURS survival for the TSA was 91.7% (95% confidence interval [CI]: 0.76-1.07). The best cutoff value for the FURS survival was 6838 mm(2), with a sensitivity of 91%. The results for the AUC and the best cutoff value in regard to the TUT for using only one FURS were 66.7% (95% CI: 0.4-0.93) and 4617 minutes, respectively, with a sensitivity of 66%. If the cutoff value is taken as the average value of the TSA and TUT, the sensitivity rate drops to similar to 58% and 50%, respectively. Conclusion: FURS can be safely used when the stone area and TUT are about 9158 mm(2) and 4617 minutes, respectively, with a sensitivity of 66%.

Objectives: To investigate the operation time (OT) and ureteral access sheath (UAS) usage with the infection rates and to determine a cut-off value for OT. Methods: We retrospectively analysed the data of the patients who underwent flexible ureterorenoscopy (FURS) for renal stones larger than 20 mm between 2010 and 2019. The investigated parameters were OT, UAS using, and infection status. The data were analysed by forming two groups according to whether the OT was less than 60 minutes and more, whether the UAS was used and whether an infection occurred. In addition, independent risk factors that may affect postoperative urinary infection development were also investigated by logistic regression analysis. And, a Receiver Operating Characteristic (ROC) curve analysis was applied to determine a cut-off value in OT terms, where infection rates increase more. Results: A total of 575 patients were enrolled in the study. The rates of the usage of UAS and infection were greater statistically in the group for longer than 60 minutes. OT was longer statistically in the infection group than in the group without infection (94.1 ± 14.2 and 68.01 ± 23.1, for groups 1 and 2, respectively, P

Objective: To evaluate the efficacy and outcomes of PlasmaKinetic™ urethrotomy against cold knife direct vision internal urethrotomy in terms of recurrence rates. Patients and Methods: A total of 136 male patients with urethral strictures were enrolled into the study. The patients were allocated to cold knife or PlasmaKinetic urethrotomy groups sequentially by using computer-generated numbers. Group A (PlasmaKinetic) and group B (cold knife) included 70 and 66 patients, respectively. All patients were reevaluated at the 3rd, 9th and 18th month postoperatively with uroflowmetry. Results: Group A patients had a postoperative 3rd-month maximum flow rate value of 16.09 ml/s, whereas this same parameter was 15.15 ml/s in group B (p < 0.05). The urethral stricture recurrence rate up to the 9-month period was statistically significant for group A (14%) compared with group B (30%). When we compared the recurrence rates of these groups from postoperative day 1 up to the 18th month, the results were 37% for group A and 33% for group B (p > 0.05). Conclusion: PlasmaKinetic urethrotomy provides a better recurrence-free rate during the early period compared with conventional cold knife therapy. Nevertheless, the outcome of the stricture did not change and fibrotic tissue reformed between the 9th and the 18th month.

The objective of this study was to audit the costs of retrograde intrarenal surgery (RIRS) and micropercutaneous nephrolithotomy (microperc) and compare them in terms of cost-effectiveness. We performed a retrospective analysis of 63 patients who underwent microperc and 48 patients who underwent RIRS. The cases, performed between first use and first repair, were used for this initial study. The costs associated with performing RIRS and microperc, including the costs of devices, disposables, hospitalization, and additional required treatments, were audited. The main perioperative and postoperative parameters were collected, including operation time, JJ stent requirements, used disposables, stone-free rates, and complications. Statistical analyses of the means of continuous variables were performed using Student’s t test and the Mann–Whitney U test. Categorical variables were analyzed using Chi-squared tests. The mean cost of RIRS was $917.13 ± 73.62 and the mean cost of microperc was $831.58 ± 79.51; this difference was statistically significant (p < 0.001). The mean operation time of the RIRS group was significantly shorter than the microperc group (55.62 ± 19.62 min and 98.50 ± 29.64 min, respectively, p < 0.001). The assessment of required additional treatment showed that it was significantly higher in the RIRS group than the microperc group (p = 0.02). The stone-free rate for RIRS was 66.6 and 80.9 % for microperc; this difference was not statistically significant (p = 0.12). In our series, the use of microperc is less expensive than RIRS due to additional required treatments and ancillary equipment in RIRS. RIRS is more effective than microperc in terms of operation time and more effective use of operation rooms.

Introduction: We compared the cost-effectiveness of laparoscopic simple prostatectomy (LSP) vs open prostatectomy (OP). Patients and Methods: A total of 73 men treated for benign prostatic hyperplasia were enrolled for OP and LSP in groups 1 and 2, respectively. The findings were recorded perioperative, including operation time (OT), blood lost, transfusion rate, conversion to the open surgery, and the complications according to the Clavien Classification. The postoperative findings, including catheterization and drainage time, the amount of analgesic used, hospitalization time, postoperative complications, international prostate symptom score (IPSS) and International Index of Erectile Function (IIEF) scores, the extracted prostate weight, the uroflowmeter, as well as postvoiding residual (PVR) and quality of life (QoL) score at the postoperative third month, were analyzed. The cost of both techniques was also compared statistically. Results: No statistical differences were found in the preoperative parameters, including age, IPSS and QoL score, maximum flow rate (Q(max)), PVR, IIEF score, and prostate volumes, as measured by transabdominal ultrasonography. No statistical differences were established in terms of the OT and the weight of the extracted prostate. No differences were established with regard to complications according to Clavien's classification in groups. However, the bleeding rate was significantly lower in group 2. The drainage, catheterization, and hospitalization times and the amount of analgesics were significantly lower in the second group. The postoperative third month findings were not different statistically. Only the Q(max) values were significantly greater in group 2. While there was only a $52 difference between groups with regard to operation cost, this difference was significantly different. Conclusion: The use of LSP for the prostates over 80 g is more effective than the OP in terms of OT, bleeding amount, transfusion rates, catheterization time, drain removal time, hospitalization time, consumed analgesic amount, and Q(max) values. On the other hand, the mean cost of the LSP is higher than OP. Better effectiveness comes with higher cost.

Gastrointestinal injuries that occur during or after laparoscopic and robot-assisted surgery are serious side effects that affect patient outcome. In this review, we attempt to highlight the identification, incidence and management of gastrointestinal and visceral complications of laparoscopic and robot-assisted surgery. A search of Medline and PubMed databases was performed using the following terms: gastrointestinal complications of laparoscopy, laparoscopic, kidney and robotic surgery. A total of 1,072 papers related to the subject were analyzed. Forty-six of these papers were included in the present review. These papers reported high numbers of participants and had a high level of evidence. Gastrointestinal complications during laparoscopic and robot-assisted surgery are rare, but similar, and can occur at any time between access and closure. Despite their infrequency, these complications can result in mortality. The early recognition and management of gastrointestinal complications is very important. Unrecognized or delayed identification of gastrointestinal complications may cause sepsis and death.

Introduction: In this study, we describe a new approach called the double-layer on and prepucial flap technique in order to prevent fistula or fissure development. Material and Method: Twenty-seven patients with subcoronal hypospadias were enrolled. The prepared prepucial flap was divided into two equal parts. A double-layer flap was formed and used for reinforcing of the neourethra. Uroflowmetric analysis was used for evaluating the urethral stricture at the end of the first year. A blinded urologist and the patients' themselves evaluated the aesthetic appearance. Results: The mean age was 12.17 ± 2.79. All cases were primary. All evaluated parameters were at the end of the first year. Only three (3/27, 11.1%) of the patients had minimal external mea stricture that managed with urethral dilatation. None of them had any fistula, fissure, or dehiscence as well as infection and hematoma. The mean Qmax value was 17 ml/s and the Qave value was 9 ml/s. The mean scores with standard deviations with regard to the appearance of the patients' penis before and after operations were 3.08 ± 0.77 and 8.25 ± 0.73, respectively and this difference was statistically significant (p < 0.001). Conclusion: The double-layer dartos flap technique is a candidate to be the least risky technique to prevent complications as well as to increase the aesthetic appearance up to satisfactory levels.

Introduction: We investigated the monopolar and bipolar energy effects on prostate and correlated the results with the type of pathology, thus determining the relationship between tissue damage and the PSA level. Material and Methods: One hundred and twenty four patients underwent TURP and according to the energy source, 2 groups were designed as monopolar (Group 1) and bipolar energy (Group 2). Hemoglobin and free and total PSA were measured preoperatively and 6 hours postoperatively, and differences were calculated. The weight of resected tissue and operation time were also recorded. Two groups were also formed later according to the pathology as chronic prostatitis (CP) and BPH. The findings were analyzed. Results: There were no statistical differences between the groups in terms of age; prostate volumes; resected tissue; operation times; pre- and postoperative Hb, total-free PSA, IPSS, PVR, and quality of life scores; or postoperative maximum flow rates. Changes in total-free PSA (25.7 and 10.8 ng/dl for PSA; 13.2 and 5.76 ng/dl for free PSA for Groups 1 and 2, respectively) were significantly different between Groups 1 and 2. There was a statistical difference in total PSA between the groups among CP patients (28.18 and 11.73 ng/dl for Groups 1 and 2, respectively). But no statistical difference existed among BPH patients. The change in Hb differed based on pathological results. Conclusion: Bipolar TURP is less invasive than monopolar TURP on the basis of postoperative PSA levels. In addition, bleeding during TURP is affected not by the kind of energy, but by the pathology.

Introduction: We prospectively analyzed parental anxiety and outcomes of the SmartClamp circumcision and the classic surgical dissection technique.Methods: A total of 250 boys underwent circumcision between 2009 and 2012 at Kars State Hospital and Kafkas University Faculty of Medicine in Turkey. The initial 125 children were circumcised by conventional dissection method and the remaining children were operated on with a SmartClamp device. Children in both groups were compared in terms of bleeding, infection, penile edema, operative time, cosmetic result, length of the inner mucosal layer, and parental anxiety. We used a State-Trait Anxiety Inventory (STAI) form to gauge how the circumcision affected parental anxiety. This form was completed by parents on postoperative day 2.Results: There were no statistically significant differences among the 2 groups in terms of age, bleeding, infection, and cosmetic displeasure (p > 0.05). The STAI scores of the parents from the SmartClamp group were statistically higher than that of the other group (p < 0.001). Penile edema was more common in the SmartClamp group (p = 0.039). However, the mean operative time was statistically shorter (p < 0.001) and the inner mucosal length was significantly longer in the SmartClamp group (p < 0.001).Conclusion: Circumcision with the SmartClamp device was faster. Cosmetic results and complication rates were similar. Unfortunately, this technique seemed to entail the disadvantages of longer mucosal length, penile edema, and higher parental anxiety. Urologists should keep these points in mind when choosing a technique.

INTRODUCTION: Extracorporeal Shock Wave Lithotripsy (ESWL) remains the preferred least invasive treatment for urinary tract stones. The main purpose of this study was to compare two treatment modalities for pain control during the ESWL procedure. MATERIAL AND METHODS: From 2013 to 2014, 220 patients received ESWL for kidney stones. Before the procedure, the weight and height were measured to determine the body mass index (BMI); in addition, oxygen saturation and the pulse of the patients, as well as pain level were determined. The pain control provided included two different methods: diclofenac sodium plus hyoscine-N-butyl bromide in the first group and pethidine plus diazepam in the second group. The pain level of the patients was determined using two different scales: the Wong-Baker and the Visual Analogue scales (VAS). At the end of three sessions, all patients were evaluated for the stone fragmentation rate by plain abdominal X-ray, and the findings were recorded and analyzed. RESULTS: A total of 220 patients were enrolled in this study. There were 91 patients in the first group (diclofenac sodium + hyoscine-N-butyl bromide) (male/female: 63/28) and 129 (male/female: 83/46) patients in the second group (pethidine HCL +diazepam). The mean age with SD according to each group was 42.03 (±16.43) and 42.56 (±14.23), respectively (p = 0.8). With regard to pain scores (using the Wong-Baker and VAS scales), the responses were significantly lower in the second group (p

The first-line management of metastatic prostate cancer is hormonal therapy. However, resistance to this treatment will emerge within an average of 24 months. Our purpose was to determine the course of metastatic prostate cancer under treatment. A total of 56 patients who were diagnosed with metastatic prostate cancer were enrolled. As initial management, 3 kinds of hormonal therapy consisting of bilateral orchiectomy (BSO) alone, BSO + anti-androgene (AA) and LH-RH + AA were applied. The patients were followed until the emergence of hormone resistance. Serum PSA levels at the time of first diagnosis, post-treatment nadir PSA levels, time to nadir PSA, time to hormonal resistance and PSA levels at hormonal resistance were assessed, retrospectively. The localization and number of metastases and the survival term from the beginning of the emergence of hormone resistance until death were investigated No significant differences could be established between the groups. The mean time to reach hormone refractory status was 30.3 months for the whole study group. The average term of survival was 42.7 months for the whole group. Distance metastases were found in 8 patients during follow-up. There were no statistical differences between the groups in terms of treatment modalities applied for metastatic prostate cancer. Patients with androgen independent prostate cancer demonstrated progression despite chemical or surgical castration, and had poor prognosis. Initial hormonal therapy failed after an average of 2 years in metastatic prostate cancer. Electronic supplementary material The online version of this article (doi:10.1186/2193-1801-3-725) contains supplementary material, which is available to authorized users.

Introduction Endometriosis can be defined as the presence of endometrial glandular and stromal tissue outside the uterus. Affected sites of endometriosis can even be the urinary tract. Here, we present the case of a 30-year-old woman with right ureteral endometriosis. This case was important due to the unusual localization and no signs of the disease except for hydroureteronephrosis. Case presentation A 30-year-old Caucasian woman with para 2 was admitted to our department for right side flank pain, dysuria and suprapubic pain. She had no complaints of vaginal discharge, bleeding or painful menstruation. Her menstrual cycles were normal and lasting for three to four days. She did not have a history of any surgical interventions. A physical examination revealed a right side costovertebral angle and suprapubic tenderness. Laboratory test results including a complete blood count, serum biochemical analysis, urine analysis and urine culture were normal. Urinary ultrasonography showed right side hydroureteronephrosis with renal cortical thinning. We suspected a right ureteral stone obstructing the ureter and a computed tomography scan was performed. The computed tomography scan revealed similar right side hydroureteronephrosis with obstruction of the ureter. No signs of stone were observed on the scan. Retrograde pyelography and diagnostic ureterorenoscopy were performed and they showed a focal stricture with a length of approximately 3cm at the distal ureteral part and secondary hydroureteronephrosis. Open partial ureterectomy and ureteroneocystostomy with Boari flap were performed. The pathologic specimen of her ureter demonstrated intrinsic endometriosis of the right ureter with endometrial glandular cells and stromal tissue. Conclusions Clinicians should suspect ureteral endometriosis in premenopausal women with unilateral or bilateral distal ureteral obstruction of uncertain cause. The main goals of the treatment should be preservation of renal function, relief of obstruction and prevention of recurrence.

Introduction: We evaluate the efficacy and outcomes of plasmakinetic vaporization (PKVP) and plasmakinetic resection (PKR) to treat benign prostatic hyperplasia (BPH).Methods: A total of 183 patients with BPH underwent plasmakinetic prostatic surgery between 2008 and 2012 at Kars State Hospital and Kafkas University Faculty of Medicine, Turkey. After clinical and preoperative evaluation, the patients were randomized to PKRP or PKVP groups sequentially by using computer-generated numbers. Group 1 included 96 patients treated with PKR. Group 2 included 87 patients treated with PKVP. Patients in both groups were compared in terms of hemoglobin drop, operation time, catheter duration, reobstruction, incontinence and recatheterization.Results: When we compared the maximum flow rates (Qmax values) at the 12th month, there was no statistical difference between 2 groups. Group 1 had a mean Qmax value of 17.92 ± 3.819 and Group 2 had a 18.15 ± 3.832 value (p > 0.05). There was a statistical difference between the groups in terms of hemoglobin drop, catheter duration and operation time. The mean catheter duration in Group 1 was 3.74 ± 1.049 days, and in Group 2 it was 2.64 ± 0.849 days (p < 0.05). Operation time was statistically longer in Group 2 (PKVP) and hemoglobin drop was statistically higher in Group 1 (PKR).Conclusion: PKVP for BPH is safe and effective. When compared with PKRP, it provides a significantly shorter catheter duration and less bleeding due to hemostasis control with similar IPSS and Qmax improvements after 1 year.

To evaluate the efficacy of cystoscopy, computed tomography (CT), transcavitary ultrasound (TCUS) and cytology, separately and in combination, for the diagnosis and evaluation of superficial bladder cancer. Initial cystoscopy and wash-out cytology were performed for 1548 patients. Of these, 206 with proven bladder tumors were included in this prospective study. CT and TCUS were performed for patients with bladder tumors without knowledge of their cystoscopy results. The lesions were classified as low- (pTa) and high- (pT1) risk superficial tumors according to multiplicity and size. Patients were divided into three categories according to their cystoscopically evaluated tumor size: ≤1 cm (88 patients, 42.7%), 1–3 cm (51 patients, 24.8%) and ≥3 cm (67 patients, 32.5%). TCUS identified 46 (22.3%) high-risk patients with/without invasion and 160 (77.7%) low-risk patients with no invasion. Overall, the sensitivity, specificity, positive predictive value and negative predictive value of TCUS for tumor detection were 77.4%, 60%, 94.7% and 22.2%, respectively. Cystoscopy remains the most widely used technique for the diagnosis of bladder cancer. The combined use of CT, TCUS and cytology detected 72% of cystoscopically proven tumors. Among the three, TCUS findings exhibited the strongest correlation with cystoscopy findings.