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Circumcision is possibly the most frequently performed elective surgical procedure in men. It can simply be described as the excision of the preputium. There have been several studies about the association between circumcision and urinary tract infections (UTI). Many studies have demonstrated that the frequency of UTI increase in uncircumcised males, especially in the first year of life. This review discusses the embryology of the preputium, epidemiology, indications, complications and benefits of circumcision, as well as operation and anesthesiology techniques. It especially examines the association between UTI and circumcision and the importance of circumcision in congenital urinary system anomalies. In addition, this review examines the associations between circumcision and sexually transmitted diseases, including HIV, and the protective role of circumcision on penile cancer.

Chemotherapeutic agents are not very effective in treating advanced endometrial cancers (ECs). Recent studies have demonstrated the immune evasion mechanism of tumors and possible remedies. Programmed cell death protein 1 (PD-1), programmed death ligand 1 (PD-L1), and programmed death ligand 2 (PD-L2) are immunomodulator molecules that have been the focus of research in lung cancer, melanoma, and renal cell cancer. However, there are few studies concerning EC. This retrospective study aimed to determine PD-1, PD-L1, and PD-L2 expression immunohistochemically in EC, and to study their correlation with clinicopathologic tumor characteristics. This study comprised 127 patients with EC. Anti PD-1, PD-L1, and PD-L2 antibodies were examined immunohistochemically on sections obtained from tissue microarray paraffin blocks. No staining with PD-1 in tumor cells was seen; however, we found positive staining in tumor cells at 36.2% with PD-L1 and 64.4% with PD-L2, and at 61.6% with PD-1, 36.2% with PD-L1, and 93.2% with PD-L2 in immune cells. When comparing staining and clinicopathologic findings, most of the PD-L1 negative tumors (both in tumor and immune cells) were FIGO Stage I, which was significantly higher than stage II-III-IV tumors (P<0.05). There was a statistically significant association between the FIGO grade and the PD-L1 score in immune cells (P=0.009), and between staining of PD-1, PD-L1, and PD-L2 and age (P=0.004, 0.013, and 0.043, respectively). Interaction between PD-1, PD-L1, and PD-L2 may be a potential target for immunotherapy in elderly and advanced stage EC patients.

Objective: The aim of this study is to evaluate sexual functions and quality life of patients who are followed-up for non-muscle invasive bladder cancer (NMIBC)., Material and Methods: Between March 2015-June 2016, 50 patients underwent cystoscopy for NMIBC. At the end of the 1 st year follow-up patients were assessed for sexual functions using 5-item version of the International Sexual Function Index (IIEF-5) for male and the Female Sexual Function Index(FSFI) for female; for quality of life (QoL) by the European Organisation for Research and Treatment of Cancer-Non-Muscle Invasiv Bladder Cancer Quality of Life Questionnaire (EORTC QLQ-NMIBC24) and for emotional status by Beck depression inventory., Results: There were 44 male and 6 female patients with the mean age of 57.6±11.5 years. Twenty patients received intravesical treatment after transurethral resection of bladder tumour. The mean Beck (10.7±9.5) IIEF-5 (15.6±5.9), FSFI (19.2±10.9), and the EORTC-QLQ NMBIC 24 (38.2±7.7) scores of the patients were determined as indicated. Among the patients, 42 (84%) of them were not feeling bad about their bladder tumors and 37 (74%) were not worrying about their daily lives. Moreover, 12 (24%) patients were not interested with sexuality, while 27 (54%) of them did not feel comfortable about sexual sincerity. Interestingly, 27 patients receiving intravesical treatment were concerned that the treatment they received for prevention of recurrence and progression of bladder tumor infect their partners during sexual intercourse., Conclusion: NMIBC affects patients' sexual functions and QoL negatively. Therefore during the follow-up of these patients, it is important to inform these patients accurately about their treatments to be applied and predicted complications in the follow up period.

Objective: The aim of this study is to examine the usefulness of preoperative neutrophile-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratios to predict pathological upstaging of invasive bladder cancer who underwent radical cystectomy., Material and Methods: A total of 126 patients who underwent radical cystectomy at our clinic between January 2006 and March 2015 were retrospectively analysed. One hundred and twelve patients with organ-confined invasive bladder tumors (T2) detected at histopathological examination of transuretral resection material were included in the study. Upstaging was seen at histopathological examination of radical cystectomy specimens of 42 patients. We compared preoperative neutrophile-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio between upstaged and not-upstaged groups., Results: There were no statistically significant correlation between age, time to radical cystectomy, gender, lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio ratios and carcinoma in situ in upstaged and non-upstaged groups. Statistical analyses showed that preoperative neutrophile-to-lymphocyte ratio was higher in upstaged patients (p=0.009). In multivariate analysis preoperative neutrophile-to-lymphocyte ratio and positive surgical margin were significantly higher in upstaged group., Conclusion: In organ-confined muscle invasive bladder cancer neutrophile-to-lymphocyte ratio seems to be an acceptable parameter to predict locally advanced disease., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Objective: We investigated the prognostic value of preoperative neutrophil-to-lymphocyte ratio (NLR) on germ cell testicular tumors (GCT)., Material and Methods: The data of 53 patients who underwent inguinal orchiectomy were analyzed retrospectively. NLR was calculated from the preoperative complete blood cell counts. Receiver operating characteristic (ROC) analysis was performed to find the threshold values for NLR. Correlations between cancer-specific survival (CSS) and progression-free survival (PFS) and NLR were evaluated., Results: The mean follow-up time was 23.55±18.06 months. The mean level of NLR was 3.08±1.81. Optimal threshold values of NLR was calculated as 3.55 for PFS (area under curve, AUC: 0.55) and 3.0 for CSS (AUC: 0.66). For patients with a NLR of <3.55 and NLR of ≥3.55, mean times-to-progression were 55.71 months (95% CI, 51.27-60.14) and 51.95 months (95% CI, 38.02-65.87, p=0.152), respectively. As well as, for patients with a NLR of <3.0 and NLR of ≥3.0, mean times-to-cancer specific death were 54.72 months (95% CI, 49.05-60.38) and 49.43 months (95% CI, 37.64-61.22, p=0.119), respectively., Conclusion: Preoperative NLR is not a useful tool to predict the prognosis of patients with GCT., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Objective: We updated our data on penile fractures and investigated the significance of the time interval from the incident of the fracture until the operation on the erectile functions and long-term complications., Material and Methods: Between January 2001 and June 2014, 64 patients were operated on with a preoperative diagnosis of penile fracture. We could evaluate 54 of these patients. The patients were classified into 3 groups according to the time interval from the time of fracture until surgery. The validated Turkish version of the erectile components of International Index of Erectile Function (IIEF) was answered by every patient 3 times after the surgery; before the incident of fracture, at first postoperative year, and at the time of the study (IIEF-5 and question #15 were used). The complications were noted and an erectile function index score was calculated for every patient., Results: Mean follow up period was 44.9 (±2.8) months for all patients There was no statistically significant difference between the 3 groups in terms of the erectile components of IIEF questionnaire scores for the time periods and for individual patients in each separate group. Complications for all groups were also similar., Conclusion: In consideration of long-term results, neither serious deformities nor erectile dysfunction occur as a consequence of a delay in surgery performed within the first 24 hours in patients without urethral involvement., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

The mononuclear title cadmium complex, [Cd(C 10 H 14 N 2 O) 2 (C 8 H 4 NO 2 ) 2 (H 2 O) 2 ], is centrosymmetric and contains two water mol-ecules, two 4-cyanobenzoate (CB) ligands and two di-ethyl-nicotinamide (DENA) ligands. All the ligands are coordinated to the Cd II atom in a monodentate mode. The four nearest O atoms around the Cd II atom form a slightly distorted square-planar arrangement, with the distorted octa-hedral coordination sphere being completed by the two pyridine N atoms of the DENA ligands at distances of 2.3336 (13) Å. The dihedral angle between the carboxyl-ate group and the adjacent benzene ring is 8.75 (16)°, while the benzene and pyridine rings are oriented at a dihedral angle of 57.83 (5)°. The water mol-ecules exhibit both intra-molecular [to the non-coordinating carboxyl-ate O atom, enclosing an S (6) hydrogen-bonding motif, where O⋯O = 2.670 (2) Å] and inter-molecular [to the amide carbonyl O atom, enclosing an R 2 2 (16) ring motif, where O⋯O = 2.781 (2) Å] O-H⋯O hydrogen bonds. The latter lead to the formation of supra-molecular chains propagating along [110].

In the title complex, [Zn(C 8 H 4 NO 2 ) 2 (C 10 H 14 N 2 O) 2 (H 2 O) 2 ], the Zn II cation, located on an inversion centre, is coordinated by two water mol-ecules, two 4-cyano-benzoate (CB) anions and two di-ethyl-nicotinamide (DENA) ligands in a distorted N 2 O 4 octa-hedral geometry. In the mol-ecule, the dihedral angle between the planar carboxyl-ate group and the adjacent benzene ring is 9.50 (14)°, while the benzene and pyridine rings are oriented at a dihedral angle of 56.99 (5)°. The water mol-ecules exhibit both an intra-molecular hydrogen bond [to the non-coordinating carboxyl-ate O atom, enclosing an S (6) hydrogen-bonding motif, where O⋯O = 2.6419 (19) Å] and an inter-molecular hydrogen bond [to the amide carbonyl O atom, enclosing an R 2 2 (16) ring motif, where O⋯O = 2.827 (2) Å]; the latter lead to the formation of supra-molecular chains propagating along the [110] direction.

The asymmetric unit of the title polymeric compound, [Cu(C8H4NO2)2(C10H14N2O)(H2O)] n , contains one Cu(II) atom, one coordinating water mol-ecule, two 4-cyano-benzoate (CB) ligands and one coordinating N,N-di-ethyl-nicotinamide (DENA) mol-ecule. The DENA ligand acts as a bis-monodentate ligand, while the CB anions are monodentate. Two O atoms of the CB ligands, one O atom of the water mol-ecule and the pyridine N atom of the DENA ligand form a slightly distorted square-planar arrangement around the Cu(II) atom which is completed to a square-pyramidal coordination by the apically placed O atom of the DENA ligand, with a Cu-O distance of 2.4303 (15) Å. In the two CB anions, the carboxyl-ate groups are twisted relative to the attached benzene rings by 2.19 (12) and 3.87 (15)°, while the benzene rings are oriented at a dihedral angle of 5.52 (8)°. The DENA ligands bridge adjacent Cu(2+) ions, forming polymeric coordination chains running along the b axis. In the crystal, strong water-carboxyl-ate O-H⋯O hydrogen bonds link adjacent chains into layers parallel to (10-1) and weak C-H⋯O hydrogen bonds further stabilize the crystal structure. The cyano group C and N atoms of one of the CB ligands are disordered over two sets of sites with equal occupancies.

Objective: To propose a new minimal invasive surgical technique using a microdebrider (shaver) to excavate the fibrosed corpora cavernosa for penile prosthesis implantation in patients with severe fibrosis., Material and Methods: Two patients with severe corporeal fibrosis were implanted with a penile prosthesis using this technique. In the first patient, fibrosis was due to neglected idiopathic ischemic priapism and the second patient had his prosthesis extruded because of erosion in another center. Both patients were counseled about the procedure and the possible complications related to the experimental nature of the technique. A written informed consent was obtained from both patients. Excavation of the corpora was performed using microdebrider in both patients., Results: Both operations were performed successfully without any intraoperative complications, including urethral injury or perforation of the tunica. The mean operation time was 57 min. The postoperative period was uneventful without any infection, migration, erosion, or mechanical failure. The penile length was increased nearly 2 cm in both patients, and the penile girth was increased around 30% in the patient who underwent inflatable penile prosthesis implantation., Conclusion: The microdebrider potentially provides an important advance in patients with severe corporeal fibrosis to excavate the fibrosed corpora cavernosa for penile prosthesis implantation. The main advantages include fast, safe, and effective excavation of fibrous corpora cavernosa adequate for a satisfactory penile prosthesis implantation.

Objective: To evaluate the potential effect of bisphosphonates on bone mineral density (BMD) in patients who are treated with anti-androgen drugs and radiotherapy for metastatic prostate cancer., Materials and Methods: The data of 31 patients with metastatic prostate cancer who were treated with anti-androgen drugs and radiotherapy during a 1-year period were retrospectively reviewed. Patients were divided in 2 groups, in which 17 patients in group 1 were treated with zoledronic acid (4 mg/month, intravenous) and 14 patients in group 2 who did not receive zoledronic acid. BMD was measured before the treatment and at the end of the 1st year by dual energy X-ray absorptiometry. Statistical analyses were performed with the T test., Results: Mean age of the patients was 71.42 ± 6.7(range 59-85) years. A significant increase was noted for pelvic bone, femoral neck, and lumbar vertebrae t scores when pretreatment and 1st year measurements were compared in group 1 (p < 0.05). In group 2 a significant decrease was noted for pelvic bone and femoral neck t scores at the end of the 1st year (p < 0.05). A significant increase was noted for pelvic bone and femoral neck follow-up in BMD values at the end of the 1st year compared to initial measurements in group 1. A significant decrease was noted for lumbar vertebrae follow-up in BMD values at the end of the 1st year when compared to initial values in group 2., Conclusion: Zoledronic acid significantly increases BMD and delays unfavorable outcomes for bones in men who are treated with anti-androgen drugs and radiotherapy for metastatic prostate cancer.

We aimed to investigate the role of urinary bladder shape which may potentially change with advancing age, increased waist circumference, pelvic ischemia, and loosening of the urachus on bladder emptying and UFR. We retrospectively investigated the medical records of 76 men. The patients were divided into two groups according to bladder shapes in MRI scan (cone and spheric shapes). There was a significant difference between the two groups in terms of IPSS, Qmax, Qave, and waist circumference. A positive correlation has been demonstrated between mean peak urinary flow rate measured with UFM and mean flow rate calculated using the CP. There was a significant difference between mean urinary flow rates calculated with CP of cone and sphere bladder shapes. The change in the bladder shape might be a possible factor for LUTS in men and LUTS may be improved if modifiable factors including increased waist circumference and loosening of the urachus are corrected.

Purpose: To evaluate the influence of perinephric fat infiltration and tumor size on survival of patients with renal cell carcinoma (RCC)., Materials and Methods: We have retrospectively reviewed the records of 338 consecutive patients with pT1-3aN0M0 RCC, including 275 pT1-2 and 63 pT3a tumors, who underwent open partial or radical nephrectomy between 1995 and 2008. Univariate and multivariate analyses were performed in order to evaluate the prognostic factors., Results: Median follow-up period was 36.07 months. Receiver Operating Characteristic curve analysis determined the optimal tumor size cutoff value as 7 cm (Area Under the Curve: 0.65 ± 0.047; 95% Confidence Interval: 0.558 to 0.741). Perinephric fat invasion and Fuhrman grade were independent prognostic factors for disease-specific survival (DSS). In patients with tumor size >7 cm, perinephric fat invasion affected DSS significantly. Tumor size (according to the cutoff value of 7 cm) significantly affected DSS in patients with pT3a disease. According to the TNM 2002 staging system, perinephric fat invasion did not have any significant effect on DSS in patients with tumor size smaller than 4 cm, unlike tumor size of 4 to 7 cm and >7 cm. pT3a tumors larger than 7 cm demonstrated the worst prognosis compared to other groups., Conclusion: Perinephric fat invasion was demonstrated as a significant prognostic factor for RCC patients with tumor size >4 cm. Consequently, evaluation of pT3a patients should take tumor size into consideration for better prognostic analysis.

Bladder augmentation has revolutionized the care of children with neurogenic bladder but it is associated with certain short- and long-term complications. Using the combination of gastric and ileal segments to balance effects of these segments might be a solution for complications. A total of 39 female Spraque-Dawley rats randomly divided into four groups: ileocystoplasty (11), gastrocystoplasty (9), ileogastrocystoplasty (11) and control (8). Serum/urine electrolytes and pH values, and serum creatinine levels and urine mucus concentration were measured. Kruskal-Wallis non-parametric variance analysis was performed to compare the groups and p < 0.05 was accepted as significant. Metabolic alkalosis with significantly lower urine pH was observed in gastrocystoplasty group. Gastroileal group showed similar results with the ileal group in all parameters. No stone formation was detected in the sham and gastric cystoplasty groups. Metaplastic and hyperplastic changes were observed in all segments surrounding urothelium. In conclusion, combination of gastric and ileal segments does not significantly reduce the rate of metabolic impairments, stone and mucus formation. Besides it is not associated with significant improvement in histological outcome since urine is still in contact with the gastrointestinal mucosa.

In this case report we describe a case of persistant Müllerian duct syndrome together with transverse testicular ectopia. These 2 entities are discussed to assess the relationship between them and the lack of necessity for magnetic resonance imaging in cases of undescended testes, and relevant literature is reviewed., (Copyright © 2010 Elsevier Inc. All rights reserved.)