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Double J (DJ) stents serve as a therapeutic option to relieve obstruction. However, incrustation can be an important cause of dysfunction of these stents. We investigated the relationship between incrustation of DJ stents and indwelling time using a grading system for luminal occlusion. The medical records of 42 patients with urolithiasis related to DJ stent incrustation were retrospectively reviewed. All polyurethane DJ stents were examined for severity of incrustation with a grading system based on the occlusion of stent lumen. For the level of grades 3 groups of patients were compared: group 1 included 14 patients whose stents were removed a month after insertion; group 2 included 16 patients whose stents were removed 45 days after insertion; group 3 included 12 patients whose stents were removed 3 months after insertion. The incrustation of 42 DJ stents was graded from 1 to 3 depending on the occlusion of the DJ stent. Mean age of patients was 39.6±6.71 years and median indwelling time was 50 days. The groups were similar regarding age, sex, and side of DJ stent. In comparison, the grade of incrustation in group 3 was higher than the grades in group 1 and group 2 (p=0.001). Incrustation is one of the most important complications of DJ stents, and was related to indwelling time. Therefore, close follow-up and frequent DJ stent changes are very important in patients with urolithiasis.

Kadihasanoglu, Mustafa/0000-0001-5109-5319 WOS:000453452300056 PubMed: 30539881 Paratesticular rhabdomyosarcoma (RMS) is a rare nongerm cell intrascrotal malignant tumor in children and young adult/teens resulting from the mesenchymal tissues of the tunica vaginalis, epididymis, spermatic cord, and testis. RMS accounts for approximately 7% of all genitourinary tract RMSs and 12% of all pediatric scrotal neoplasms. Patients usually present with a painless unilateral scrotal mass. We report a 16-year-old boy with a paratesticular RMS mimicking epididymal cyst. To our knowledge, this is the first case reported in the literature presenting as an epididymal cyst.

toktas, mahmut gokhan/0000-0001-9845-5481; Kadihasanoglu, Mustafa/0000-0001-5109-5319; WOS:000390100700002 Objective: To present the initial experience with micro-percutaneous nephrolithotomy (micro-PNL) in patients with kidney stones. Methods: Medical records of 66 patients with kidney stones who underwent micro-PNL between December 2012 and March 2015 were retrospectively reviewed. The demographic data; stone side, location and size; operation and fluoroscopy time; intraoperative and postoperative complications; preoperative and postoperative hemoglobin levels and hematocrit; and operation success of the patient were evaluated. Results: The mean age of the patients was 46.62 +/- 13.94 years, and their mean body mass index was 25.77 +/- 2.62 kg/m(2). The mean stone size was 186.7 +/- 34.23 mm(2). The mean operation and fluoroscopy times were 80.46 +/- 43.67 min and 10.78 +/- 7.14 min, respectively. The mean hemoglobin drop was 0.86 g/dL. Twenty-four intraoperative and 17 postoperative complications were observed. An overall success rate of 95% (including clinically insignificant residual fragments) was achieved. Conclusion: Micro-PNL is a feasible, safe, and effective minimally invasive treatment modality for patients with small kidney stones.

Kadihasanoglu, Mustafa/0000-0001-5109-5319 WOS:000408624600018 PubMed: 27709642 Priapism is a rare but severe urological emergency of erection of penis in the absence of physical and psychological sexual stimulation. Priapism is often idiopathic and is commonly associated with medications and underlying medical or traumatic causes. In this report, we present a case of a 70-year-old White Caucasian man who developed priapism after the administration of ondansetron, which is a selective serotonin type-3 (5-HT3) receptor antagonist. This case is unique, because, to date, there are only two presented cases in literature. The objective of this case report is to highlight the importance of recognising the possibility of priapism with ondansetron because this condition is not commonly seen in clinical practice to be associated with ondansetron and may go unrecognised. Also, potential pathophysiological mechanisms involved in the development of ondansetron-induced priapism are presented.

A 44-year-old woman, who had had left flank pain for the previous 3 months, was treated successfully for renal hydatid cyst disease by using an endoscopic technique with percutaneous access through an all seeing needle. Abdominal ultrasonography showed a Gharbi type III cyst in the lower pole of the left kidney. Computerised tomography of the abdomen revealed a bulky solid-cystic mass with calcified and well-defined wall and daughter cyst without contrast enhancement. The patient, who refused any renal operation, underwent a percutaneous intervention with access through an all seeing needle access. There were no intraoperative or early postoperative complications. To our knowledge, this is the first published report of this minimally invasive percutaneous access technique through an all seeing needle.

The aim of this study was to compare the efficacy and safety of alfuzosin (Alf) and tamsulosin (Tam) in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).One hundred men with benign prostatic hyperplasia (BPH) who were admitted to our urology department with lower urinary tract symptoms (LUTS) were enrolled in this randomized cross-over study. At enrollment, detailed medical history was recorded, and International Prostate Symptom Score (IPSS), digital rectal examination, urinary ultrasound, prostate specific antigen (PSA) level, and uroflowmetry were determined. BPH patients with IPSS greater than 8 and maximum urinary flow rate (Q(max)) lower than 15 ml/s were randomly divided into a Alf-Tam group (Alf for 8 weeks, followed by Tam for 8 weeks) or a Tam-Alf group (Tam for 8 weeks, followed by Alf for 8 weeks). There was no withdrawal period (washout) when switching drugs.In the first treatment period, each drug significantly improved IPSS and Q(max). In both the Alf-Tam and Tam-Alf groups, cross-over was effective in improving IPSS and Q(max). Alf and Tam significantly lowered IPSS and significantly increased Q(max) from baseline (P0.001). Neither drug affected serum PSA levels.Tam and Alf, which were used during different time frames in the same individuals, are associated with similarly favorable outcomes. When one alpha-blocker does not provide a desired effect in the treatment of BPH, switching to another alpha-blocker seems to be beneficial.

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 aimed to investigate whether high peripheral and cavernosal plasma levels of apolipoprotein-(a) [Lp (a)] is an indicator for vasculogenic erectile dysfunction. We determined Lp (a), total cholesterol (TC), triglyceride (TG) and high density lipoprotein (HDL) levels in peripheral and cavernosal blood in 39 patients with erectile dysfunction. Thirty-nine impotent patients have been divided into two groups: vasculogenic erectile dysfunction (VED) and nonvasculogenic 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 were compared in both groups. Lp (a) and TC levels were higher in both peripheral and cavernosal samples of VED group than in NVED group, with no differences between peripheral and cavernosal blood levels within the same groups. There were no significant changes in TG and HDL levels in either group. The detection of more than 31 mg/dl in Lp (a) level solely shows the vascular origin with a sensitivity and specificity of 95 and 82.3%, respectively. High Lp (a) levels can be considered an indicator of vasculogenic erectile dysfunction.

Cyproterone acetate was given as monotherapy to 18 patients with advanced prostatic carcinoma at a weekly dose of 300 mg. Progression was observed in all of the patients; median time to progression was 35 months and median survival time was 48 months. Partial response, stabilization, progression and exitus rates by years also showed favourable results, as compared with other forms of therapy in advanced prostatic carcinoma.

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.

Acute effects of extracorporeal shock wave lithotripsy (ESWL) with Siemens Lithostar on kidney and surrounding tissues were examined on 42 patients with unilateral kidney stones in the Department of Urology, Gazi University, Medical Faculty, Ankara, Turkiye. Radiological examinations were done and 24-h urine and blood samples were obtained a day before, the day after and 30 days after ESWL. Urinary excretion of proteins, glycosaminoglycan, and immunoglobulin G were significantly elevated the day after ESWL. Thirty days after excretion levels of these were statistically insignificant in regard to pretreatment levels. Creatinine clearance of the patients was significantly lowered the day after ESWL. One month later differences were insignificant. Excretory urography detected 12 (29%) kidneys with abnormalities the day after ESWL. Thirty days after only 3 (7%) of the kidneys had persistent abnormalities. The number of abnormalities with ultrasonography 24 h and 30 days after ESWL were 15 (36%) and 5 (12%) respectively. With CT-scanning kidney abnormalities 24 h after and 30 days after ESWL were 24 (57%) and 6 (14%) respectively. There was not any statistically significant difference between patients with either radiological or functional changes after ESWL and with patients without these changes in regard to patient age, sex, stone burden and shock wave number. In conclusion, electromagnetic lithotripsy induces acute renal morphologic and functional changes. Functional changes are transient and subside within a month but although decreasing either in size or number some morphologic changes persist during this period.

Genitourinary tuberculosis (TB) is a common type of extrathoracic TB and can be found in isolation or associated with pulmonary TB. It contributes to 10-14% of extrapulmonary TB. Prostate TB is rare and usually found incidentally following transurethral resection of the prostate for treatment of benign prostatic obstruction as an isolated lesion in immunocompetant patient. The authors report a case of prostatic and pulmonary TB in animmunocompetant patient investigating for the positive positron emission tomography in lung and prostate. To our knowledge, this is the first case reported in the literature presenting with simultaneous hypermetabolic lesions in the prostate and lung.

Objective: In this study, the requirement of analgesia and the analgesic efficacy of a long-acting nonsteroidal antiinflammatory drug (NSAID), piroxicam, were investigated in patients with renal stone disease treated with extracorporeal shock wave lithotripsy (ESWL). Methods: This randomized, placebo-controlled study included 60 patients. Patients were divided into two groups randomly. A single dose of saline (2 ml) was given to the patients in group 1 (n = 20) and 2 ml of 40 mg piroxicam to the patients in group 2 (n = 40). All injections were administered into the gluteal muscle 45 min before ESWL. A verbal rating scale (VRS) was used to evaluate the pain. Groups were compared according to age, sex, weight, height, stone size, number of shock waves, duration of ESWL and VRS scores. Results: There was no statistically significant difference between both groups in demographic data, stone size, number of shock waves and duration of ESWL procedure (p > 0.05). However mean VRS scores were significantly lower in group 2 than in group 1 during and after the ESWL procedure. Conclusion: We considered that analgesic agents should be used to control the pain in second-generation lithotriptors. Piroxicam has clinically significant effects on the pain and also antiinflammatory effects, inhibits ureteric activity, and helps in stone passage.

Objective: We investigated free and total prostate-specific antigen (PSA) levels and free/total (f/t) ratio in the fasting saliva and compared them with the serum levels in normal individuals, in patients with benign prostatic hyperplasia (BPH) and prostate cancer. Our aim was to determine free and total PSA and f/t ratio in saliva and to improve and simplify the differentiation between BPH and prostate cancer by using saliva as an alternative to serum. Methods: Serum and fasting saliva concentrations of free and total PSA were measured in 35 men with BPH, 16 men with stage D prostate cancer, and 25 healthy men. Serum and fasting saliva samples were collected at the same time and were analyzed on the same day at our laboratory with microparticle enzyme immunoassay technology. Results: For the total of 76 men, there was a significant correlation between free and total PSA levels in each sample (r = 0.97 for serum and r = 0.44 for saliva, p

Hyperoxaluria is a well-known cause of renal stone disease and in vitro studies have shown that oxalate crystals have a stimulatory effect on apoptosis of renal tubular epithelial cells. Total and partial ureteral obstruction also have an accelerating effect on apoptosis of renal tubular epithelial cells. The aim of the present study was to investigate the apoptotic effect of unilateral ureteral obstruction in the presence of hyperoxaluria on the rat kidney. Twenty-eight male Wistar rats were divided into four groups, with seven rats in each. The groups were named G1 (control), G2 (hyperoxaluric), G3 (obstructive) and G4 (hyperoxaluric + obstructive). G2 and G4 rats were given 1% ethylene glycol (a precursor for oxalates) in their drinking water. G1 and G2 rats underwent sham operation, while left proximal ureteral ligation with a 5-zero silk suture was performed on G3 and G4 animals. The rats were sacrificed 2 weeks after the operation; left nephrectomy was then performed. We searched for the apoptotic cells by direct immuno-peroxidase detection of digoxigenin-labeled genomic DNA. The mean +/- SD values of the apoptotic cell count was 0.86+/-0.90 in G1 and 4.33+/-3.81 in G2. The values for G3 and G4 were 30.17+/-16.85 and 302.67+/-184.45, respectively. We found a statistically significant difference between all groups (P < 0.001). When compared with the control group (G1), the mean apoptotic cell count was fivefold that of G2 and 35- and 351-fold those of G3 and G4, respectively. Our study demonstrated that hyperoxaluria with complete ureteral obstruction induces an excessive level of apoptosis, which is responsible for renal damage, and that ureteral obstruction is a more important factor for apoptosis than hyperoxaluria. Considering these data, we also believe that research studies for medical preventive measures must be considered for patients with ureteral obstruction and/or hyperoxaluria.

Clam ileocystoplasty was performed in 18 patients with urge incontinence, total incontinence or enuresis with instable detrusor. Although the persistence of detrusor instability was observed in 33.33% of the patients, complete clinical cure was found in 72.23 and symptomatic improvement was 22.22%.

Purpose: We propose an alternative technique for intracavernous self-injection of sodium nitroprusside for erectile dysfunction by inserting a Medtronic ImPort* *Medtronic PS Medical/IPI, Minneapolis, Minnesota. catheter with a valved tip.Materials and Methods: A silicone catheter was implanted in 3 patients with psychogenic impotence. The reservoir, which is used for vasoactive agent injection, was implanted laterally to the anterosuperior iliac spine and the distal tip of the catheter was inserted into the corpora cavernosa via a subcutaneous tunnel. The injection technique was taught to the patient and the initial injection was performed 1 week later.Results: All patients and partners were satisfied with the technique and quality of erections at a mean followup of 14 months. There were no major local complications due to catheter implantation and no systemic complications due to sodium nitroprusside injection.Conclusions: An alternative technique for intracavernous pharmacotherapy of inserting ...

Purpose: We compared electrical activity of the corpus cavernosum after intracavernous papaverine and nitroprusside injections. Some aspects of the androgen modulator system in patients with veno-occlusive dysfunction are discussed.Materials and Methods: Electromyography of the corpus cavernosum was performed before and 1 day after intracavernous injection of 60 mg. papaverine and 400 microgram sodium nitroprusside in 22 patients with veno-occlusive dysfunction. Changes in duration and amplitude of electromyographic potentials were compared in groups with and without incoordination patterns.Results: The decreases in electrical amplitude and duration in 15 patients with a negative incoordination pattern, and increases in 7 with a positive pattern were more significant with intracavernous sodium nitroprusside than with papaverine injections.Conclusions: Electromyographic changes were more prominent with nitroprusside than with papaverine, which demonstrates the use of nitroprusside when performing c...

We determined arterial venous and sinusoidal factors in 20 patients with insulin dependent diabetes mellitus and erectile dysfunction by performing dynamic infusion cavernosometry (DIC), colour flow Doppler ultrasonography, penile biothesiometry and corpus cavernosum electromyography (CCE). DIC, colour flow Doppler ultrasonography and penile biothesiometry were done in standard fashion except for CCE. Paradoxical increase in the electrical activity of corpus cavernosum after intracavernous (IC) papaverine was called a discoordination that was due to cavernous smooth muscle contraction instead of relaxation. Arterial and accompanying pathologies were found in 10 (50%) patients. In 3 (15%) of them pure arterial pathology, in 6 (30%) patients arterial and veno-occlusive dysfunction (VOD) and in one patient arterial pathology with abnormal biothesiometry were found. VOD and accompanying pathologies were found in 12 (60%) patients. In 6 (30%) of them VOD and arterial, in 4 (20%) patients VOD and discoordination and in 2 (10%) patients VOD and abnormal biothesiometric values were present. A higher frequency and coexistence of VOD and discoordination pattern were observed. In conclusion, patients with diabetic impotence show a wide range pathophysiology of erection and the evaluation of these patients must include multistep techniques.

Dynamic infusion cavernosometry and cavernosography (DICC) were performed in 22 patients who were referred with symptoms of partial erection and transient erection and who were diagnosed as deep dorsal venous leakage by means of colour Doppler ultrasonography. We reached the diagnostic values for corporovenous leakage (CVL), also classified them and showed the veins that need to be ligated. With these advantages, DICC is a very cost-effective and safe technique that can be performed routinely in the diagnosis of corporovenous leakage.