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Objective: To examine whether voided volume (VV) could change the uroflow patterns and result in children with lower urinary tract dysfunction (LUTD)., Methods: Between January 2009 and May 2010, the children with LUTD were enrolled in this study. Uroflowmetry (UF) combined with electromyography (EMG) was performed two times and was reviewed independently by two urologists. UF-EMG curves were classified as bell, staccato, intermittent, plateau, and tower. Patients' expected bladder capacity (EBC) and VV were recorded. Patients were divided into four groups according to their VV and EBC. Group 1, VV <50% of EBC; group 2, VV between 50 and 100% of EBC; group 3, VV between 100 and 125% of EBC; group 4, VV >125% of EBC., Results: A total of 143 patients underwent UF-EMG at least two times and 382 results were obtained. Groups 1, 2, 3 and 4 consisted of 27, 60, 27 and 29 children, respectively. The percentages of normal, intermittent, plateau voiding patterns were 58.5, 12.8, 7.1% in group 1; 79.8, 5.4, 1.8% in group 2; 59.2, 8.5, 2.8% in group 3; and 37.2, 5.1, 2.6% in group 4, respectively. The percentages of staccato and tower pattern were 1.4, 20% in group 1; 9.1, 3.6% in group 2; 30, 0% in group 3; and 55.1, 0% in group 4, respectively. The rate of tower shape curve decreased as voided volume increased, but the rate of staccato curve increased as voided volume increased., Conclusions: In case of exceeding the EBC, the test should be repeated with normal VV when UF results are being evaluated., (© 2015 Wiley Publishing Asia Pty Ltd.)

Context:: Prostatic cysts are uncommon. These cysts are usually asymptomatic and are diagnosed incidentally during ultrasonographic examination. On rare occasions, they may cause drastic symptoms., Case Report:: We report on a case of severely symptomatic anteriorly located prostatic cyst arising from the bladder neck in a 30-year-old man presenting with lower urinary tract symptoms, without clinical evidence of benign prostatic hyperplasia. Transrectal ultrasonography (TRUS), computed tomography (CT) and cystourethroscopy demonstrated a projecting prostatic cyst that occupied the bladder neck at the precise twelve o'clock position. It was acting as a ball-valve, such that it obstructed the bladder outlet. Transurethral unroofing of the cyst was performed and the patient's obstructive symptoms were successfully resolved. Histopathological examination indicated a retention cyst., Conclusions:: It should be borne in mind that midline prostate cysts can be a reason for bladder outlet obstruction in a young male. Such patients may have tremendous improvement in symptoms through transurethral unroofing of the cyst wall.

Objectives: Extracorporeal shock wave (ESW) lithotripsy is the preferred treatment modality for uncomplicated kidney stones. More recently free oxygen radical production following ESW application has been considered to be crucial in shock wave-induced renal damage. It has been shown that ozone therapy (OT) has ameliorative and preventive effects against various pathological conditions due to increased nitro-oxidative stress. In current study, we aimed to evaluate the efficacy of OT against ESW-induced renal injury., Methods: Twenty-four male Sprague-Dawley rats were divided into three groups: sham-operated, ESW, and ESW + OT groups. All groups except sham-operated group were subjected to ESW procedure. ESW + OT group received 1 mg/kg/day of oxygen/ozone mixture intraperitoneally at 2 h before ESW, and OT was continued once a day for consecutive three days. The animals were killed at the 4th day, and kidney tissue and blood samples were harvested for biochemical and histopathologic analysis., Results: Serum ALT and AST levels, serum neopterin, tissue nitrite/nitrate levels, and tissue oxidative stress parameters were increased in the ESW group and almost came close to control values in the treatment group (p < 0.05, ESW vs. ESW + OT). Histopathological injury scores were significantly lower in treatment group than the ESW group (p < 0.05, ESW vs. ESW + OT). Immunohistochemical iNOS staining scores in ESW group were higher than those of sham-operated group (p < 0.05, ESW vs. sham-operated), iNOS staining scores in OT group were significantly lower than the ESW group (p < 0.05, ESW + OT vs. ESW)., Conclusion: OT ameliorates nitro-oxidative stress and reduces the severity of pathological changes in the experimental ESW-induced renal injury of rat model.

Objectives: The purpose of this study was to determine prognostic factors affecting semen parameters in patients with varicocele during the postadolescent period., Methods: This study was approved by the Institutional Review Board. Between May 2013 and May 2015, we prospectively obtained demographic and sonographic data from postadolescent patients with varicocele. Potential risk factors affecting semen parameters, including age at diagnosis, height, weight, body mass index, varicocele laterality, varicocele grade, left testicular volume, right testicular volume, total testicular volume, testicular atrophy index, testicular volume differential, right and left maximum vein diameters, peak retrograde flow velocity, reflux flow volume, and reflux grade in both supine and standing positions, were recorded., Results: The left peak retrograde flow velocity, reflux flow volume, and reflux grade in the supine and standing positions, left testicular volume, right testicular volume, total testicular volume, and follicle-stimulating hormone level were found to be associated with abnormal semen parameters (P < .05). By multivariate analysis, the follicle-stimulating hormone level was associated with the sperm concentration and morphologic characteristics, and the left peak retrograde flow velocity in the standing position was associated with deterioration of sperm motility and morphologic characteristics. Additionally, the left reflux grade in the standing position was associated with the sperm concentration, and the left testis volume was associated with motility., Conclusions: The left peak retrograde flow velocity and reflux grade in the standing position were significantly associated with all semen analysis parameters. This finding supports the use of testicular duplex Doppler sonography as a noninvasive tool for evaluation of testicular function in patients with varicocele and helps clinicians determine patients' fertility status., (© 2016 by the American Institute of Ultrasound in Medicine.)

Unlabelled: Fifteen patients with small testicular masses not suspected to be malignant were included in the study, and permanent and frozen section analyses were evaluated. As a result frozen analysis, preoperative externalization of the suspected malignancy with a physical examination, ultrasonographic evaluation, and serum tumor marker analysis were concluded as key points for accurate decision making between TSS and radical orchiectomy., Background: We aimed to determine the safety, efficacy, and the concordance of permanent and frozen section analysis (FSA) of testis-sparing surgery (TSS) in patients who had small testicular masses that were not suspected to be malignant., Patients and Methods: Fifteen patients who underwent TSS were included in the study. TSS was performed for the patients who had testicular lesions <25 mm and testicular lesion volume <30% of the whole testis. All patients had normal serum tumor marker levels and ultrasonographic evaluation did not indicate malignancy. Surgery was performed via an inguinal approach with temporary cord occlusion and FSA of the lesions. Benign findings allowed for TSS, and cancer prompted total orchiectomy., Results: The mean patient age was 25.33 (range, 20-36) years. The predominant complaint was swelling (9 patients). The mean lesion diameter was 16 mm (range, 5-26 mm). Fourteen of all cases (93%) had benign pathology and underwent TSS. Only 1 patient, whose FSA revealed malignant formation, underwent radical orchiectomy. Final pathology of this patient was seminoma. Complete histopathologic concordance was observed between the results of frozen and permanent sections. TSS was performed with no intra- or postoperative complications. After a mean follow-up of 23 months (range, 6-44 months) all patients, except 3 who were lost to follow-up, were free of disease., Conclusion: The main key points for accurate decision-making between TSS and radical orchiectomy are intraoperative FSA and preoperative externalization of possible suspected malignancy with physical examination, ultrasonographic evaluation, and serum tumor marker analysis., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Context and Objective: Lasers are widely used in treating symptomatic benign prostatic hyperplasia. In current practice, potassium titanyl phosphate (KTP) lasers are the most common type of laser systems used. The aim here was to evaluate the rapid effect of high-power laser systems after application of hypericin., Design and Setting: Experimental animal study conducted in the Department of Urology, Gülhane Military Medical Academy, Ankara, Turkey, in 2012., Methods: Sixteen rats were randomized into four groups: 120 W KTP laser + hypericin; 120 W KTP laser alone; 80 W KTP laser + hypericin; and 80 W KTP laser alone. Hypericin was given intraperitoneally two hours prior to laser applications. The laser incisions were made through the quadriceps muscle of the rats. The depth and the width of the laser incisions were evaluated histologically and recorded., Results: To standardize the effects of the laser, we used the ratio of depth to width. These new values showed us the depth of the laser application per unit width. The new values acquired were evaluated statistically. Mean depth/width values were 231.6, 173.6, 214.1 and 178.9 in groups 1, 2, 3 and 4, respectively. The most notable result was that higher degrees of tissue penetration were achieved in the groups with hypericin (P < 0.05)., Conclusions: The encouraging results from our preliminary study demonstrated that hypericin may improve the effects of KTP laser applications.

Procarbazine (P) is an effective chemotherapeutic drug especially used in lymphoma treatment; however testicular toxicity is a limiting factor. Various ways of treatment were tried to preserve testicular function including hormonal treatment, antioxidant treatment, and sperm cryopreservation but resulted with low rates of satisfaction. Procarbazine is a well known agent causing sterility even in the first doses of chemotherapy. Antioxidants such as N acetylcysteine and ascorbate have been used for protective purposes and were very successful. Melatonin (M) is another powerful antioxidant and we aimed to use M for the protection of P induced testicular toxicity in this study. Procarbazine was given peroral by gavage once a week at a dose of 62.5 mg/kg/week for 4 weeks (total dose: 250 mg/kg) (P group) and in procarbazine + melatonin (PM) group, 10 mg/kg melatonin was intraperitoneally administered daily for five days a week for 4 weeks (total 20 days). The experiment ended at day 90. In the P and PM groups the testicle width, length, and weight, sperm A and sperm AB properties (Sperm A: sperms straight line progressive, Sperm B: sperms straight slow progressive, Sperm AB: Sperm A + Sperm B), spermatogonia, Sertoli cells, seminiferous tubule, and germinative layer thickness were lowered as compared with the control group. However, there were no significant differences between the P and PM groups in regard to these parameters. Melatonin preserved Sertoli cell and spermatogonia function. The testosterone and follicle-stimulating hormone (FSH) levels were also preserved. Melatonin significantly decreased malondialdehyde (MDA) levels and preserved the antioxidant enzyme levels such as glutathione peroxidase (GPx) and nitrite nitrate (NO2-/NO3-). Melatonin may protect testicular functions in P treated patients and is open to consideration during chemotherapy since it appears to be without any side effects.

Objectives: Extracorporeal shock wave lithotripsy (ESW) induces renal damage by excessive production of free oxygen radicals. Free Oxygen radicals cause cellular injury by inducing nicks in DNA. The enzyme poly(adenosine diphosphate-ribose) polymerase (PARP) involved in the process of repair of DNA in damaged cells. However, its activation in damaged cells can lead to adenosine triphosphate depletion and death. Thus, we designed a study to evaluate the efficacy of 3-aminobenzamide (3-AB), a PARP inhibitor, against extracorporeal shock wave induced renal injury., Methods: Twenty-four Sprague-Dawley rats were divided into three groups: control, ESW, ESW + 3-AB groups. All groups except control group were subjected to ESW procedure. ESW + 3-AB group received 20 mg/kg/day 3-aminobenzamide intraperitoneally at 2 h before ESW and continued once a day for consecutive 3 days. The surviving animals were sacrificed at the 4th day and their kidneys were harvested for biochemical and histopathologic analysis. Blood samples from animals were also obtained., Results: Serum ALT and AST levels, serum neopterin and tissue oxidative stress parameters were increased in the ESW group and almost came to control values in the treatment group (p < 0.05, ESW vs. ESW + 3-AB). Histopathological injury score were significantly lower in treatment group than the ESW group (p < 0.05, ESW vs. ESW + 3-AB)., Conclusion: Our data showed that PARP inhibition protected renal tissue against ESW induced renal injury. These findings suggest that it would be possible to improve the outcome of ESW induced renal injury by using PARP inhibitors as a preventive therapy.

Torsion of the testis is a urological emergency most commonly occurring in adolescent boys. Hyperbaric oxygen treatment (HBOT) has been shown to alleviate reperfusion injury in experimental ischaemia of the testis. We report a 13-year-old boy who had prolonged right testicular ischaemia. Despite surgery, the colour of the testis remained poor. He underwent a post-operative course of 10 HBOT over 8 days, with restoration of blood flow on colour Doppler and reduction of oedema. At four-month followup, the testis appeared normal on ultrasonography. To the best of our knowledge, this is the first published case of torsion of the testis treated with HBOT.

Persistent Mullerian duct syndrome (PMDS) is a rare form of the 46 XY disorders of sexual differentiation, characterized by the presence of a uterus and fallopian tubes due to the failure of Mullerian duct regression in genotypically normal males. More than 150 cases have been recorded, most of them in adults. In most cases, the PMDS is discovered during surgery for inguinal hernia or cryptorchidism, or by the presence of transverse testicular ectopia (TTE). The presence of PMDS with TTE is even more uncommon. In TTE, both testes descend through the same inguinal canal into the same scrotal sac. Patients with TTE present with symptoms of unilateral cryptorchidism and a contralateral inguinal hernia. For patients with inguinal hernia and cryptorchidism associated with TTE, PMDS should be kept in mind, and radiologic evaluation such as ultrasonography or magnetic resonance imaging of the genitourinary system and karyotyping are recommended. Whereas radiologic evaluation could be helpful in the diagnosis of TTE, it cannot diagnose the malignancy itself. The case explained in this report will offer urologists additional useful treatment strategies for patients with inguinal hernia and cryptorchidism.

The aim of the study is to investigate whether there is an effect of adult circumcision on ejaculation parameters and to research the relationship between intravaginal ejaculation latency time (IELT) and premature ejaculation diagnostic tool (PEDT). Adults who underwent voluntary circumcision between September 2010 and November 2011 were enrolled in this prospective study. The IELT before and 3 months following circumcision was recorded. Also, PEDT was filled out before and 3 months after circumcision. During statistical evaluation, the comparison of situations before and after circumcision was made using IELT averages and PEDT total scores. Furthermore, the correlation between changes in IELT and PEDT has also been evaluated. A total of 30 volunteers (mean age 21.25±0.44) were enrolled in the study. The volunteers' mean and median IELT before were 104.36±66.21 and 88 (26-307) seconds, whereas mean and median IELT after circumcision were 123.56±54.44 and 107.5 (67-300) seconds, respectively. The increase after circumcision was statistically significant (P=0.001). The mean and median PEDT score were 4.26±2.91 and 3 (1-12) before, and 2.63±1.82 and 2 (0-7) after circumcision. Improvement was statistically significant (P<0.0001). No correlation could be found between ejaculation time and PEDT scores. Circumcision during adulthood does not adversely affect ejaculatory function; it may slightly improve. However, it could not be interpreted as a justification for circumcision in men with premature ejaculation (PE).

Objectives: Shock wave lithotripsy treatment (SWT) is not completely free from side effects; one of the accused mechanisms for renal injury during SWT is oxygen- and nitrogen-derived free radical productions. Therefore, we aimed to evaluate the effect of inhibition of nitric oxide (NO) production by N-[3(aminomethyl) benzyl) acetamidine] (1400W), highly selective inducible nitric oxide synthase (iNOS) inhibitor, at SWT-induced kidney damage., Materials and Methods: Twenty-four rats those underwent right nephrectomy procedure were divided equally into three groups as control, SWT, and SWT + 1400W. 1400W was administered at a dose of 10 mg/kg at 2 h prior to SWT procedure and at the beginning of SWT procedure via intraperitoneal route and continued daily for consecutive 3 days. At the end of the fourth day, animals were killed via decapitation and trunk blood and the left kidneys were taken for biochemical and histopathologic evaluation., Results: SWT caused renal tubular damage and increased lipid peroxidation and antioxidant enzyme activities and SWT also significantly increased nitro-oxidative products. Inhibition of iNOS via administration of 1400W ameliorated renal injury and decreased tissue lipid peroxidation (malondialdehyde), superoxide dismutase, glutathione peroxidase and nitrite/nitrate levels (NOx). In addition, it was seen that histolopathological changes were attenuated in the SWT + 1400W group when compared to SWT group., Conclusion: SWT-induced renal injury might be due to excessive production of oxygen free radicals and NO production. Inhibition of iNOS attenuates renal injury following SWT treatment. It can be concluded that iNOS inhibitors or peroxynitrite scavengers might be used to protect the kidneys against SWT-induced morphological and functional injuries.

The inguinal approach is used for the treatment of hydrocele in the pediatric population. Although studies on scrotal orchiopexy have mentioned hernia or hydrocele repair through the same scrotal incision as a part of an orchiopexy procedure, there are a few studies reporting the treatment of isolated communicating hydrocele through a scrotal incision. We retrospectively evaluated and compared the outcomes of inguinal and scrotal approaches for the treatment of communicating hydrocele in boys. The classical inguinal and scrotal approaches to the treatment of communicating hydrocele were performed on 46 and 30 testicular units (in 43 boys and 27 boys, respectively). The patients' charts were reviewed to assess the operative times as well as the immediate and long-term complications during follow-up periods. The patients' ages ranged from 1 year to 8 years (3.6 ± 2.0 years) in the inguinal group and from 1 year to 10 years (mean 4.6 ± 2.8 years) in the scrotal group. Operative time was significantly lower in the scrotal group (p < 0.0001). The early minor complication rate did not differ between the two groups. Furthermore, there were no major complications noted. None of the patients had hydrocele recurrence after a mean follow-up of 6 months. The advantages of the scrotal approach for the treatment of communicating hydrocele are as follows: it is well tolerated, simple, and cosmetically appealing, and it has a short operative time in comparison with the standard inguinal approach. The scrotal incision technique is an effective alternative in communicating hydrocele treatment., (Copyright © 2013. Published by Elsevier B.V.)

An overdose of acetaminophen (APAP) produces acute tubular necrosis. The aim of this study was to observe the effects of hyperbaric oxygen (HBO) only and combined with N-acetylcysteine (NAC) on inflammatory cytokines in kidney. Thirty-two male Sprague-Dawley rats were divided into four groups: sham, control (APAP), NAC, and NAC + HBO. In the APAP, NAC, and NAC + HBO groups, renal injury was induced by oral administration of 1 g/kg APAP. The NAC group received NAC (100 mg/kg/day). NAC + HBO group received NAC (100 mg/kg/day) intraperitoneally and HBO underwent at 2.8 ATA pressure with 100 % oxygen inhalation for 90 min every 12 h for 5 days. Rats in the sham group received distilled water only by gastric tube. All animals were killed on 6 days after APAP or distilled water administration. Creatinine, urea, neopterin, tumor necrosis factor-α (TNF-α), and interleukin (IL)-6 levels were measured in sera. There was a significant increase in serum creatinine and urea levels in the control group compared to the sham group (in both, p = 0.001). NAC and NAC + HBO significantly decreased serum neopterin, TNF-α, and IL-6 levels compared to control group. APAP administration caused tubular necrosis in the renal. NAC and NAC + HBO treatments significantly reduced APAP-induced renal damage. The results of this study showed that renal dysfunction in APAP toxicity was attenuated by the use of HBO and NAC treatments. The combination of NAC and HBO treatments might be recommended as an effective treatment modality for APAP-induced nephrotoxicity.

Introduction: Acetaminophen (APAP) is an analgesic and antipyretic agent. In overdoses, it is associated with nephrotoxicity. We examined the potential protective effects of N-acetylcysteine (NAC) and NAC + ozone therapy (OT) combination against APAP-induced nephrotoxicity., Materials and Methods: Thirty-two male Sprague-Dawley rats were divided into four groups: sham, control (APAP), NAC, and NAC + OT. In the APAP, NAC, and NAC + OT groups, kidney injury was induced by oral administration of 1 g/kg APAP. The NAC group received NAC (100 mg/kg/day). NAC + OT group received NAC (100 mg/kg/day) and ozone/oxygen mixture (0.7 mg/kg/day) intraperitoneally for 5 days immediately after APAP administration. All animals were killed at 5 days after APAP administration. Renal tissues and blood samples were obtained for biochemical and histopathological analyses. Neopterin, tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and IL-10 levels were measured in sera. Malondialdehyde (MDA) levels and glutathione peroxidase (GPx) activities were determined in renal homogenates., Results: NAC and NAC + OT significantly decreased MDA and TNF-α levels and increased IL-10 levels and GPx activities. Serum neopterin and IL-6 levels were not different among all groups. APAP administration caused tubular necrosis in the kidney. The degrees of renal necrosis of the APAP group were higher than the other groups. Renal injury in rats treated with combination of NAC and OT were found to be significantly less than the other groups., Conclusions: Our results showed that NAC and OT prevented renal injury in rats and reduced inflammation. These findings suggest that combination of NAC and OT might improve renal damages because of both oxidative stress and inflammation.

Purpose: The main objectives of this retrospective cohort study were to evaluate reproductive endocrine and semen profiles before and after simple orchiectomy in patients with unilateral postpubertal cryptorchidism and to investigate the relationship between hormone levels and histopathology of the removed testis., Methods: We evaluated 40 adult males who were admitted to our clinic, between 2001 and 2007, with unilateral undescended testis. Right orchiectomy was performed in 27 patients and left orchiectomy in 13. Semen analysis, serum inhibin B, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels were examined in before and 3 months after orchiectomy. Orchiectomy materials were evaluated histopathologically., Results: Semen parameters, as well as testosterone and LH levels, did not change in any histopathological subgroups in the postoperative follow-up. In patients with maturation arrest, mean serum inhibin B level statistically significantly decreased from 160.9 to 83.5 pg/ml, and mean FSH level significantly increased from 4.8 to 7.6 mIU/ml after orchiectomy (p value, 0.008 and 0.008, respectively). Though, the levels were still within the normal range of the two hormones., Conclusions: Simple orchiectomy does not have any effect on semen parameters and testosterone level in patients with postpubertal cryptorchidism. The change in inhibin B and FSH levels after orchiectomy in patients with maturation arrest is not clinically significant.

Objectives: Noninvasive tests are needed for the diagnosis of chronic pelvic pain syndrome. We evaluated the significance of potassium chloride sensitivity test and urinary CTAB-precipitable uronate level in patients with chronic pelvic pain syndrome (CPPS)., Methods: We included 25 patients with interstitial cystitis (IC), and 30 patients with chronic prostatitis (CP) who applied to our outpatient clinic with the complaints of frequency, dysuria and pain on urination between the years 2003 and 2005. Thirty-five subjects were studied as healthy controls. All patients underwent cystoscopy, cystometry, voiding diary, sodium chloride, and potassium chloride filling tests. Visual analog scale (VAS) was used to determine pain scores. Patients with CP also underwent NaCl and KCl voiding tests. Urinary CTAB-precipitable uronate levels were obtained in all subjects., Results: KCl test had a good sensitivity for IC. As for the patients with CP, KCl voiding test was useful, but KCl filling test was not. Urinary CTAB-precipitable uronate level was found to be significantly higher in patients with IC and CP than controls, and in patients with IC than in patients with CP., Conclusions: The results of our study suggest that KCl voiding test is a good candidate to be used in the diagnostic workup of patients with category III CP, and urinary CTAB-precipitable uronate level measurement may be a noninvasive diagnostic aid for IC and CP.