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© 2022 Wiley-VCH GmbH.The aim of this study was to evaluate the data currently available on predictors of sperm retrieval (SR) in infertile men with Klinefelter syndrome (KS). The data of infertile patients with KS who were evaluated for primary infertility in the andrology outpatient clinics of six centres were retrospectively reviewed. SR, fertilization and pregnancy rates were evaluated. While SR was achieved with microscopic testicular sperm extraction (mTESE) in 57.7% of the cases, the positive pregnancy rate was 22%. While mosaicism was significantly associated with achieving pregnancy, it was not significant for SR (p = 0.002 and p = 0.136 respectively). However, receiving medical treatment prior to mTESE was a positive factor for both achieving pregnancy (p = 0.010) and successful SR (p = 0.032). Unsurprisingly, fertilization rate was a variable that increased the pregnancy rate (p = 0.001). In addition, total testosterone value correlated with SR (p < 0.001). For patients with KS, pregnancy can be achieved by obtaining sperm through mTESE, especially in those with mosaic karyotype, normal partner fertility, a high fertilization rate and who receive appropriate medical treatment before mTESE.

Aims In children with Down syndrome (DS) which causes cognitive impairment and intellectual disability (ID), dysfunctional voiding is proposed to be more common than in the normal population. In this study, we aimed to compare the voiding symptoms of DS children with a control group by validated questionnaires. Methods Thirty-seven DS children without any previous urological complaints and 59 non-DS healthy children as control group was included in the study. Overactive bladder symptoms and dysfunctional voiding were evaluated with validated Overactive Bladder Questionnaire (OAB-V8) and Dysfunctional Voiding Symptom Score (DVSS) questionnaire, respectively. Data were arranged, descriptive and comparative statistical analysis were performed. Results Demographic data of the two groups were similar except age of completing toilet training being higher in DS group. Total OAB-V8 and DVSS scores were significantly higher in the DS group. The mean scores of questions regarding voiding frequency, urgency and urgency incontinence in OAB-V8 were significantly higher in the DS group. The mean daytime incontinence, urgency, urgency incontinence, and quality of life scores in the DVSS were also significantly higher in the DS group. Conclusions DS children have more frequent dysfunctional voiding than the normal population. ID of these children may prevent the expression of these symptoms. Awareness and early detection of these symptoms are crucial to prevent devastating complications such as renal failure. Therefore, validated questionnaires are simple, useful, and noninvasive methods.

WOS: 000502637300002, PubMed: 30817282, Objective: There is no clear consensus on which patients and how many of microscopic testicular sperm extraction (mTESE) procedures will be successful. in this study, we aimed to evaluate the sperm retrieval rates and factors affecting these rates in men who underwent repeat mTESEs. Material and methods: A total of 346 patients who underwent mTESE for sperm retrieval were included in the study. Patients were divided into groups according to the number of mTESE operations. Patients' karyotype, follicle-stimulating hormone (FSH) and testosterone levels, varicocele presence, and testis volumes were recorded from patient files. the sperm retrieval rates were compared between groups, and predicting factors for successful sperm retrieval were evaluated. Results: Microscopic TESE was applied for the first time in 244 patients, 1-2 times in 73 patients, and 3-4 times in 29 patients. There was a significant difference between groups in preoperative FSH values and postoperative testicular histopathology (p=0.004 and p

Aim: The aim of this study is to evaluate the epidemiological, treatment modality and survival characteristics of 4792 patients with Prostate Cancer(PC) who were treated at Ege University Hospital (EUH).Methods and Materials: The data were recorded using the CANREG programme. WHO (World Health Organization) and SEER (Surveillance, Epidemiolgy, and End Results) system were considered for classification and survival analysis. Chi-square test, General Linear Model and Kaplan-Meier survival analysis were done. Log Rank (Mantel-Cox), Breslow (Generalized Wilcoxon) and Tarone-Ware models were used for Kaplan-Meier survival analyses. p value, Amaç: Ege Üniversitesi (EÜ) Hastanesinde 1992-2017 arası kanser tanı ve tedavisi yapılan prostat kanseri (PK) tanılı 4792 hastanın epidemiyolojik özellikleri, tedavi modaliteleri ve sağkalım özelliklerinin tanımlanması amaçlanmıştır.Gereç ve Yöntem: EÜ Kanserle Savaş Araştırma ve Uygulama Merkezi tarafından toplanan PK verileri CANREG özel bilgisayar programına kaydedilmiş, DSÖ (Dünya Sağlık Örgütü) ve SEER (Surveillance, Epidemiolgy, and End Results) sistemleri temelinde gruplanarak analizler yapılmıştır. İstatistiksel analizlerde Kikare, General Linear Model, Kaplan Meier sağkalım analizleri uygulanmıştır. Kaplan-Meier Sağkalım analizinde Log Rank(Mantel-Cox), Breslow(Generalized Wilcoxon) ve Tarone-Ware istatistikleri kullanılmıştır. İstatistiksel analizlerde p

Background Although few studies have reported fertility outcomes, no study has reported risk factors that might predict sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism in a large series. Objectives To investigate fertility outcomes and predictors for successful sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction (mTESE). Materials and methods This retrospective observational study included 327 azoospermic men with a history of cryptorchidism who underwent mTESE. Fertility outcomes including sperm retrieval, fertilization rate, number of transferred embryos, pregnancy, miscarriage, and live birth rates were recorded. Results Sperm retrieval was observed in 172 (52.6%) of the patients. the mean fertilization, pregnancy, and live birth rates were 55.2%+/- 20.5, 53.5%, and 44.8%, respectively. the sperm retrieval rate was significantly higher at the orchidopexy age of 9.5 years (42.1%) (P = .000). Patients with total testicular volume of >= 13.75 mL had significantly higher sperm retrieval rate (65.2%) than the patients with total testicular volume of < 13.75 mL (45.5%) (P = .001). Patients with total testosterone level of >= 300.5 ng/dL had significantly higher sperm retrieval rate (65.6%) than the patients with total testosterone level of < 300.5 ng/dL (40.3%) (P = .000). Patients with follicle-stimulating hormone (FSH) level of 17.25 mIU/mL (44.4%) (P = .000). Younger male and female ages, and higher fertilization rates were the parameters that might predict pregnancy. Conclusions Infertile azoospermic men with a history of cryptorchidism have high sperm retrieval rate with mTESE. Patients who had orchidopexy at the age of = 13.75 mL with total testosterone level of > 300.5 ng/dL and FSH level of

We aimed to correlate the predisposing demographic and clinical factors for erectile dysfunction (ED) in young men and treatment response in these men with data from older men. the patients were divided into two groups: = 40 years (group II, n = 73). ED was evaluated with the International Index of Erectile Function-5 (IIEF-5) questionnaire, and Beck's Depression Inventory (BDI) questionnaire was used to evaluate mood status. the number of patients with morning rigidity and normal libido was higher in group I (70.7% vs. 16.4%, p = .039 and 72% vs. 37%, p = .047). the increase in scores other than IIEF-Orgasmic Function and Sexual Desire domain scores after treatment was higher in the first group (p = .029, p = .035 and p < .001 respectively). in multivariate analysis, the factors predicting the low IIEF-Erectile Function domain score in young men were testosterone level and BDI score (p = .026 and p = .034). Although psychogenic factors contribute significantly to the aetiology of ED, hormone profile is more preserved in young men than in older men.

Objective: To investigate the gene expression profile of CSCs and to explore the key pathways and specific molecular signatures involved in the characteristic of CSCs. Materials and methods: CD133+ /CD44+ CSCs and bulk population (non-CSCs) were isolated from DU-145 cells using fluorescence-activated cell sorting (FACS). We used Illumina HumanHT-12 v4 Expression to investigate gene expression profiling of CSCs and non-CSCs. Protein–protein interaction (PPI) network analysis was performed using the STRING database. Biomarkers selected based on gene expression profiling were visually analyzed using immunofluorescence staining method. An image analysis program, ImageJ®, was used for the analysis of fluorescence intensity. Results: In microarray analysis, we found that many ribosomal proteins and translation initiation factors that constitute the mTOR complex were highly expressed. PPI analysis using the 33 genes demonstrated that there was a close interaction between ribosome biogenesis, translation, and mTOR signaling. The fluorescence amount of mTOR and MLST8 were higher in CSCs compared to non-CSCs. Conclusions: The increase in a number of genes associated with ribosome biogenesis, translation, and mTOR signaling may be important to evaluate prognosis and determine treatment approach for prostate cancer (PCa). A better understanding of the molecular pathways associated with CSCs may be promising to develop targeted therapies to prolong survival in PCa. © 2019, Federación de Sociedades Españolas de Oncología (FESEO).

Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm's potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause.

AMAÇ: Robot-yardımlı (RYRP) ve retropubik (RRP) radikal prostatektominin fonksiyonel sonuçlarını karşılaştıran çok sayıda çalışma olmasına rağmen, yüksek-riskli hasta grubu gibi seçilmiş bir hasta grubunda karşılaştıran çalışma sayısı kısıtlıdır. Bu çalışmada, yüksek-riskli prostat kanserli (PK) hastalarda bu iki yöntemin ereksiyon sonuçlarının karşılaştırılması amaçlandı. GEREÇ ve YÖNTEM: Yüksek-riskli PK nedeniyle RRP uygulanan 84 hasta ve RYRP uygulanan 60 hasta çalışmaya dahil edildi. Hastaların demografik verileri, perioperatif veriler, hastaya ve hastalığa özgü faktörler, preoperatif ve postoperatif 3. ay Uluslararası Erektil Fonksiyon İndeksi (IIEF) skorları, hasta dosyalarından retrospektif olarak kaydedildi. Çalışmanın birincil amacı, iki yöntem arasında erektil fonksiyondaki değişimin karşılaştırılmasıydı; ikincil amacı ise iki yöntem arasındaki perioperatif verilerin ve onkolojik sonuçların karşılaştırılmasıydı. İstatistiksel anlamlılık için 0,05’den küçük p değerleri kabul edildi BULGULAR: İki grubun demografik ve histopatolojik verileri benzerdi. İki grupta da postoperatif 3. ayda bakılan IIEF skorunda belirgin azalma mevcuttu (birinci grupta -10,42±2,72 ve ikinci grupta -9,82±1,86 puan, p=0,330). Bununla uyumlu şekilde her iki grupta da orta ve ileri düzeyde erektil disfonksiyonu olan hasta oranında artış mevcuttu ancak bu oranlar arasında anlamlı bir farklılık yoktu. Her iki grupta da hastaların yaklaşık yarısında potens korunmuştu. Ayrıca, operasyon süresi RRP lehine bulunurken (p=0,024), postoperatif kateterizasyon süresi ve tahmini kan kaybı, RYRP lehine bulundu (sırasıyla, p=0,019 ve p=0,036). SONUÇ: Radikal prostatektomi, yüksek-riskli PK hastalarında düşük komplikasyon oranları ve erken dönem kabul edilebilir potens oranlarıyla güvenle uygulanabilir. Açık ve robotik teknik arasında yüksek-riskli PK hastalarında erken dönem erektil fonksiyonların korunmasında önemli bir fark saptanmamıştır, OBJECTIVE: the number of studies comparing the functional results of robot-assisted (RARP) and retropubic (RRP) radical prostatectomy, in a high-risk group of patients, is limited. in this study, we compared the erectile function results of these two methods in patients with high-risk prostate cancer (PCa). MATERIAL and METHODS: Eighty-four patients who underwent RRP and 60 patients who underwent RARP for high-risk PCa were included in this study. Demographic data, perioperative data, patient and disease specific factors, preoperative and postoperative 3rd month International Index of Erectile Function (IIEF) scores were recorded retrospectively from hospital registration system. the primary aim of the study was to compare the change in erectile function between two methods; the secondary aim was to compare the perioperative data and oncologic results between the two methods. P values less than 0.05 were accepted for statistical significance. RESULTS: Demographic and pathological data of the two groups were similar. There was a significant decrease in the IIEF score in the postoperative 3rd month in both groups (-10.42±2.72 in the first group and-9.82±1.86 in the second group, p=0.330). Consistent with this finding, there was an increase in the number of patients with intermediate and advanced erectile dysfunction in both groups, but there was no significant difference between these groups. in both groups, the potency was preserved in approximately half of the patients. in addition, the mean operation time was found in favor of RRP (p=0.024), while mean postoperative catheterization time and estimated blood loss were found in favor of RARP (p=0.019 and p=0.036, respectively). CONCLUSION: Radical prostatectomy can be performed safely in patients with high-risk PCa with low complication rates and acceptable early potency rates. There was no significant difference between the open and the robotic technique for the preservation of short-term erectile function.

Spermatogenez, birçok hormonal ve parakrin faktörle düzenlenen, dinamik bir süreçtir. Bu süreç, otokrin, parakrin ve endokrin etkenlerin güdümünde ve aşamalı bir süreçtir ve gonadotropinlerin etkisi altındadır. Hareketli spermatozoanın meydana geldiği spermiyogenez ise, spermatogenezin nihai basamağıdır. Bu basamakta, Sertoli hücrelerinin önemli bir düzenleyicisi olduğu, hücre-iskeleti yapısı önemlidir. Sertoli hücreleri, germ hücrelerinin gelişimi için destekleyici ortamı sağlarlar ve dinamik bir hücre iskeletine sahiptirler. Gonadotropinler, testosteron, östrojen ve büyüme hormonunun spermatogenezde önemli rolleri vardır ve bunların yokluğunda önemli defektler görülebilmektedir. İnfertilite, yaygın görülen ve çiftlerde önemli psikososyal problemlere neden olan bir problemdir. Azoospermi, erkek faktörünün yaklaşık %10’undan sorumludur ve bu durumda hormonal tedavinin başarısı sınırlıdır. Bu tedavilerle hedeflenen sonuç, immatür germ hücrelerini, oositi döllemeye yetkin olgun hücreler haline getirmektir. Bu kapsamda, gonadotropinlerin etki mekanizmalarının ve Leydig-Sertoli hücreleri ve germ hücreleri arasındaki etkileşimin aydınlatılması, kritik öneme sahiptir. Spermatogenez basamaklarında rol oynayan lokal ve sistemik faktörlerin daha iyi anlaşılmasıyla ve genetik bazlı farklılıkların ortaya çıkartılmasıyla immatür germ hücrelerinin olgun hücreler haline getirilmesi yoluyla infertilite tedavisinde yeni ufuklar açılabilir., Spermatogenesis is a dynamic process which is managed with various hormonal and paracrine factors. Spermatogenesis is a stepwise process guided by autocrine, paracrine and endocrine factors and is under the influence of gonadotropins. the spermiogenesis, in which the motil spermatozoa occur, is the final step of spermatogenesis. in this step, the cell-skeleton structure, in which the Sertoli cells are important regulators, is fundamental. Sertoli cells provide a supportive environment for the development of germ cells and have a dynamic cytoskeleton. Gonadotropins, testosterone, estrogen and growth hormone have important roles in spermatogenesis and considerable defects may be considered in the absence of these. Infertility is a common problem that causes significant psychosocial challenges in couples. Azoospermia is responsible for approximately 10% of the male factor and the success of hormonal therapy is limited in this case. the targeted result with these treatments is to transform immature germ cells into mature cells capable of fertilizing oocytes. in this context, the mechanisms of action of gonadotropins and the clarification of the interaction between LeydigSertoli cells and germ cells are critical. With the better understanding of local and systemic factors involved in the spermatogenesis steps and by revealing genetic-based differences, new horizons may be opened in infertility treatment by transforming immature germ cells into mature cells.

Amaç: Bu çalışmada, kliniğimizde, Fourni- er Gangreni nedeniyle cerrahi debridman sonrası Vakum Yardımlı Kapama (VYK) ve konvansiyonel rivanollü pansuman (RP) tedavisi uygulanan hastaların sonuçlarını karşılaştırmayı amaçladık.Gereç ve Yöntemler: Kliniğimizde Fournier gangreni nedeniyle tedavi edilen 96 hasta, çalışmaya dahil edildi. Hastalar iki gruba ayrıldı; debridman sonrası VYK uygulananlar (Grup A, n=56) ve konvansiyonel RP uygulananlar (Grup B, n=40). Hastaların demografik verileri, hastanede kalış süreleri, ikincil debridman gereklilikleri, nekroz alanı ve lokasyonu, yara iyileşme süreleri, üretral striktür öyküsü, peroperatif kolostomi gereksinimi, perkütan sistostomi gereksinimi, orşiektomi gerekliliği, septik şok varlığı, Fournier gangreni etyolojisi, mortalite oranı ve Fournier Gangreni Şiddet İndeks Skoru karşılaştırıldı. İstatistiksel analizler için Bağımsız Gruplar t-test, Mann-Whitney U test, ki-kare test and Fisher’s exact test kullanıldı. İstatistiksel anlamlılık için 0.05’den küçük p değeri kabul edildi.Bulgular: VYK uygulanan grupta, hospitalizasyon süresi ve yara iyileşme süresi daha kısaydı (p=0.018 ve p=0.026) ve ikincil debridman gereken hasta sayısı da daha azdı (p=0.011). Multivaryat regresyon analizinde, nekroz alanının büyüklüğü, yara iyileşme süresi, peroperatif kolostomi gereksinimi, septik şok varlığı ve Fournier Gangreni Şiddet İndeks Skoru, mortalite oranını anlamlı olarak etkileyen bağımsız değişkenlerdi.Sonuç: Fournier gangreni, alternatif tedavi yöntemlerine rağmen, önemli oranda mortalite nedeni olabilen bir hastalıktır. VYK, daha kısa hospitalizasyon süresi ve daha hızlı iyileşme süresi sağlaması nedeniyle, önemli bir postoperatif tedavi ve yara-bakım yöntemidir., Objective: In this study, we aimed to com- pare the outcomes of patients who underwent Vacuum Assisted Closure (VAC) and conventional rivanol dressing (RD) treatment after surgical debridement due to Fournier Gangrene in our clinic.Materials and Methods: Ninety-six patients treated at our clinic for Fournier Gangrene were included in the study. The patients were divided into two groups; VAC applied patients (Group A, n = 56) and conventional RD applied patients (Group B, n = 40) after debridement. Patient’s demographic data, duration of hospital stay, secondary debridement requirements, necrosis area, and location, wound healing times, urethral stricture history, perioperative colostomy requirement, percutaneous cystostomy requirement, orchiectomy need, septic shock presence, etiology of Fournier Gangrene, mortality rate and Fournier Gangrene Severity Index Score were compared. Independent Groups t-test, Mann-Whitney U test, chi-square test and Fish- er’s exact test were used for statistical analysis. A p value of less than 0.05 was considered for statistical significance.Results: The duration of hospitalization (days) and wound healing time were shorter (p = 0.018 and p = 0.026) and the number of pa- tients requiring secondary debridement was less (p = 0.011) in the VAC applied group. In the multivariate regression analysis, the size of the necrosis area, wound healing time, perioperative colostomy requirement, the presence of septic shock and Fournier Gangrene Severity Index Score were independent variables that significantly affected the mortality rate.Conclusions: Fournier Gangrene is a disease that may be a significant cause of mortality despite the alternative treatment methods. VAC is an important postoperative treatment and wound-care method, with a shorter hospitalization period and faster recovery time.

Bu derlemede, fosfodiesteraz inhibitörlerinin (PDEİ) semen parametreleri üzerindeki etkilerinin değerlendirilmesi amaçlanmıştır. Literatürde, erektil disfonksiyon tedavisi için yaygın kullanılan PDEİ’nin semen parametreleri üzerinde de önemli etkileri olduğunu gösteren çok sayıda çalışma mevcuttur ve PDEİ bu etkilerini farklı yolaklar üzerinden göstermektedir. Deneysel çalışmalarda, genital sistemin birçok farklı organında PDE ekspresyonu gösterilmiştir. Bu ajanların uygulama dozu ve süresi de etkinlik için belirleyicidir. Örneğin, bir uzun etkili oral PDEİ olan tadalafilin terapötik dozda kullanımının semen parametrelerinde olumlu etkileri olduğu, ancak yüksek dozda uzun süre kullanımının olumsuz etkileri olduğu bildirilmiştir. PDEİ’ler, testiste, özellikle lamina propriada yol açtıkları histopatolojik değişikliklerle spermatogenez üzerinde etki gösterebilir. PDEİ’lerinin sperm motilitesi üzerinde de etkileri olabilir ve bu etkiler, pentoksifilin gibi non-spesifik PDEİ’ler ile de görülebilir; otokrin ve parakrin mekanizmalarla Leydig hücreleri üzerinden testosteron sentezi üzerinde de etki gösterebilir; androjen-bağlayıcı protein üzerinden Sertoli hücrelerine etki ederek sekretuar fonksiyonları arttırabilir. Semen hacmi, motil spermatozoa yüzdesi, sperm konsantrasyonu ve sperm morfolojisi, kronik PDEİ kullanımı ile birlikte artmaktadır. Sonuçta, oral PDEİ’lerin, uygun kullanıldığında, infertil erkeklerin semen parametrelerine olumlu etki yapmaları beklenmektedir, In this review, it is aimed to evaluate the effects of phosphodiesterase inhibitors (PDEI) on semen parameters. There are numerous studies in the literature that show that PDEIs, which are widely-used for the treatment of erectile dysfunction, have also important effects on semen parameters and they exhibit these effects by different pathways. In experimental studies, PDE expressions have been demonstrated in various organs of the genital system. The dose and the duration of these agents also determines their effectiveness. For example, it has been reported that the use of a long-acting oral PDEI, tadalafil, has positive effects on semen parameters in a therapeutic dose, but has a negative impact on long-term use at high doses. PDEIs may have effects on spermatogenesis, caused by histopathological changes in the testes especially those in the lamina propria. PDEIs may also have effects on sperm motility, and these effects may also be seen with non-specific PDEIs such as pentoxifylline. They may also act on testosterone synthesis via Leydig cells with autocrine and paracrine mechanisms. They may increase secretory functions by acting on Sertoli cells through androgen-binding protein. Semen volume, motile spermatozoa percentage, sperm concentration, and sperm morphology increase with the use of chronic PDEI. In conclusion, the oral PDEIs, when used appropriately, are expected to make a positive impact on semen parameters of infertile men.

Conventional semen analysis solely is not completely adequate to predict pregnancy outcomes. Therefore, advanced sperm function tests have been developed and introduced to clinical practice. These tests use different methods and techniques to evaluate different stages of fertilization steps. In this review, we reported some commonly used sperm function tests: sperm penetration assay, sperm-zona pellucida binding test (hemizona assay), acrosomal reaction test, hyaluronan binding test, hypo-osmotic swelling test, magnetic-activated cell sorting and zeta sperm selection. We discussed the literature concerning these tests, the utilization techniques and also purpose and mechanism of each test. We emphasized the importance of sperm function tests in predicting in vitro fertilization and pregnancy outcomes and in the management of infertile couples and also the limitations of these tests. Along with improvements in molecular biology techniques, we believe that more applicative and beneficial tests will be developed in the near future.

AMAÇ: Penil plikasyon tekniği, konjenital penil kurvatür hastalığı tedavisinde kullanılan önemli bir tekniktir. Hastalarımızda bu tekniğinin başarısını ve sonuçlarını analiz etmeyi amaçladık.GEREÇ VE YÖNTEM: Penil plikasyon tekniğiyle opere edilen 50 hastanın verileri retrospektif analiz edildi. Hastalara telefon yoluyla ulaşıldı ve kontrole çağrıldı. Hastaların işlemden genel memnuniyetleri, komplikasyon oranı, hastanede yatış süresi, kurvatür dereceleri, erektil fonksiyonları, ele gelen sertlik hissi sorgulandı.BULGULAR: Olguların ortalama yaşı 29,75'di (22-48). Ortalama kurvatür derecesi 40,1°'ydi. Hastalarda en sık ventral kurvatür saptandı. En sık saptanan kurvatür derecesi 45°'ydi (%54). 40 hasta (%80) postoperatif birinci gün eksterne edildi. On hastada (%20) ele gelen lezyon hissi mevcuttu. Otuz altı hasta (%72) işlemden genel olarak memnun olduğunu belirtti. Altı hastada minör komplikasyonlar görüldü, hiçbirisi girişim gerektirmedi. On hastada (%20) rezidü 5° kurvatür saptandı, ancak hiçbirisi ikincil cerrahi gerektirmedi. Dört hasta, ele gelen lezyon hissi olduğunu (%8) ve üç hasta, peniste hissizlik olduğunu (%6) bildirdi. Kırk dört hasta, erektil fonksiyonlarında bozulma olmadığını (%88) belirtti.SONUÇ: Plikasyon tekniği, konjenital penil kurvatür tedavisinde yüksek hasta memnuniyeti ve düşük komplikasyon oranıyla uygulanan bir yöntemdir. Hastaların operasyondan beklentileri preoperatif dönemde iyi irdelenmeli ve hastaların imkansız beklentiler içerisinde olmaları önlenmelidir. Polyester sütürlerin kullanılmasıyla, ele gelen sertlik hissi azalmıştır, OBJECTIVE: Penile plication technique is a fundamental technique used in the treatment of congenital penile curvature disease. We aimed to analyze the success rate and results of this technique in our patients.MATERIAL AND METHODS: We performed retrospective analysis of 50 patients who underwent penile plication. We reached the patients via telephone and called them for control. Patients’ overall satisfaction associated with the procedure, complication rate, hospitalization time, the degree of curvature, erectile function and feeling of palpable lesion were questioned.RESULTS: The mean age of the cases was 29.75 (22–48). The mean curvature degree was 40.1. Ventral was the most common curvature direction. The most common curvature degree was 45°. Forty patients (80%) were discharged on the first postoperative day. There was feeling of palpable lesion in 10 patients (20%). Thirty-six patients (% 72) declared that they were generally satisfied with the procedure. Minor complications were seen in 6 patients, none required intervention. Residual 5° curvature was detected in 10 patients (20%), but no secondary surgery was required. Four patients reported feeling of palpable lesion (8%) and 3 patients had penile numbness (6%). Fortyfour patients (88%) reported no deterioration in erectile function.CONCLUSION: Plication technique is a frequently performed method in the treatment of congenital penile curvature with a low complication rate and high patient satisfaction. Urologists must pay attention to patients’ expectations from the surgery during the preoperative period and patients must be avoided from having impossible expectations. The use of polyester sutures has reduced the feeling of palpable lesion

In this study, it was aimed to investigate apoptosis in renal injury and the effect of lisinopril in rat model, which constitute unilateral ureteral obstruction. The retroperitoneal ureter was ligated with a 4.0 silk for the experimental model of ureteral obstruction in Wistar albino rats. Untreated group (n = 20) received no treatment. For the lisinopril-treated group (n = 20), 20 mg/kg/day of drug was given orally. Ultrastructural differences were analyzed using electron microscopic technique; apoptotic distribution was analyzed using the TUNEL method. After electron microscopic evaluation, on the 4th and 14th day in the untreated group, edema in the glomeruli, loss of microvillus and apoptotic cells in proximal tubule cells and sclerosis in the glomeruli were detected. On the 4th day in the lisinopril-treated group, the kidney was ultrastructurally normal and a less number of apoptotic cells were only observed on the 14th day. On light microscopic examination on the 4th and 14th day in the untreated group, while the glomeruli were normal in structure, the boundary of the proximal tubule was disrupted and some picnotic cells in both the proximal and collecting tubules were observed. In both 4th and 14th day of the lisinopril-treated group, kidney showed normal structure, although in some places picnotic cells in the collecting tubules were observed. In conclusion, lisinopril was effective and it may prevent early renal damage in the direct obstruction model.

The electromyographic properties of the cremaster muscle (CM) are quite different from other skeletal muscles. It shows excessive spontaneous discharges, and the motor unit shape and firing frequency of the CM muscle differ from that of limb muscles. In this study, CM of six adult cadavers and six orchiectomy specimens were used to reveal the detailed histology of the muscle and provide an anatomophysiological explanation for these unusual electromyographic properties. Routine histochemical stains revealed the CM was composed of several distinct bundles of smooth and striated muscle fibers within connective tissue. The smooth muscle fibers that were more profuse than previously known and were not arranged in layers, but widely dispersed between striated muscle fibers. Bielschowsky silver staining technique, anti-neurofilament and anti-synaptophysin immunostaining showed the presence of multiple motor end-plates observed as a series of small dots or lines running along the striated muscle fibers and several nerve endings on a single muscle fiber. Myosin immunostaining confirmed the CM is a slow-twitch muscle, and alpha-actin smooth muscle immunostaining confirmed the presence of a large number of smooth muscle fibers. There were also small multipolar neurons forming nerve plexuses between smooth muscle fibers. Anti-GFAP immunostaining confirmed the presence of glial cells similar to astrocytes. In conclusion, the findings of this detailed anatomical study showed the CM, widely known as a striated muscle, contains a large number of smooth muscle fibers, and the spontaneous electromyographic discharges are due to the presence of multiple motor end-plates and dense innervation.

Objective To describe the effects of epididymal and vasal ligation, in an experimental rat model, by using connexin 43 and occludin immunohistochemistry as well as transmission electron microscopy. Design Comparative and controlled experimental research study. Setting University animal research and histology laboratories in Turkey. Animal(s) Wistar male rats in experimental and control groups. Intervention(s) The control group underwent sham operation (n = 7). The first experimental group (n = 7) underwent unilateral epididymal ligation, whereas the second experimental group (n = 7) underwent unilateral vasal ligation to induce experimental epididymal and vasal obstruction models, respectively. All animals were then killed at 90 days. Main Outcome Measure(s) Immunohistochemical expression of connexin 43 and occludin for testicular tissues was determined after epididymal and vasal obstruction models. Ultrastructural morphological changes were examined by electron microscopy. Result(s) Results of the semiquantitative analysis revealed that expressions of both occludin and connexin 43 in the rat testis were decreased in the experimental groups compared with in the sham-operated group. However, changes after vasal ligation were more prominent. Ultrastructural examination confirmed decreased intercellular communication as well as increased cellular degeneration among the ipsilateral and contralateral testicular tissues. Conclusion(s) Immunohistochemical expression of occludin and connexin 43 were decreased in the testis after vasal and epididymal ligation when compared with the sham-operated group. Ultrastructural changes indicating cell degeneration were more prominent after vasal ligation.

To assess the results of shockwave lithotripsy (SWL) for renal calculi in upper, middle, and lower calices according to the stone burden.A series of 52 female and 66 male patients with a mean age of 47.8 years and isolated single caliceal stones who underwent SWL monotherapy were enrolled. Stone burden, stone location, number of sessions/shockwaves, and auxiliary procedures were noted for each patient. Stones were located in the upper, middle, and lower calices of 35, 43, and 40, patients respectively, with mean stone burdens of 81.4 mm2, 75.2 mm2, and 96.3 mm2, respectively. Patients were evaluated with intravenous urography, plain film, or ultrasonography. Success was determined 3 months after the last session. Re-treatment rates were calculated. The effect of anatomic factors on the success of treatment for lower-caliceal stones also was determined.The mean stone burden, median number of treatment sessions, and mean number of shockwaves were 84.2 mm2, 2, and 4344, respectively. The auxiliary procedure rate was 16.1%, and the re-treatment rate was 71.2%. Failure was noted in 26 patients (22%). The stone-free rates for stones in the upper, middle, and lower calices were 82.8%, 83.4%, and 67.5%, respectively (P = 0.14). The stone-free rates for stones100 mm2 and 100 to 200 mm2 were 91.2% and 65.5%, respectively (P = 0.001). The efficiency quotient was 49.8, 44.8, and 32.5 for upper-, middle-, and lower-caliceal stones, respectively. Infundibular length (P = 0.006) and infundibular width (P + 0.036) were significant in determining the stone-free rate after treatment of lower-caliceal stones.We recommend SWL as the first choice for treatment of stones200 mm2 in the upper and middle calices. Extracorporeal lithotripsy is one of the options for lower-caliceal stones200 mm2 but has high re-treatment and auxiliary-procedure rates in these cases.

Objective To examine the histopathological effects of diabetes on spermatogenesis and to detect the proliferation of germ cells with proliferative cell nuclear antigen (PCNA). Design Controlled experimental study. Setting The animal laboratory of the Experimental Surgery Center of Ege University, Izmir, Turkey. Animal(s) Ten nondiabetic (control) and 20 diabetic adult male albino rats. Intervention(s) The rats were IP injected with 40 mg/kg streptozotocin for 5 days to create a diabetic condition that was confirmed by testing blood glucose levels 5–7 days after the first injection. Main outcome measure(s) Mean testicular diameter, mean semniferous tubuli diameter (MSTD), and PCNA index. Result(s) Six weeks after the streptozotocin injection, both the mean testicular and the seminiferous tubuli diameters were significantly decreased in diabetic rats compared with the control group. Conclusion(s) The effects of diabetes on spermatogenesis can be clearly detected as a decrease in testicular diameter, MSTD, and PCNA index.

We aimed to analyse the relationship between sperm parameters and International Index of Erectile Function (IIEF) score, the Female Sexual Function Index (FSFI) score, the testosterone (T) level in infertile men and between FSFI score and partners' fertility. Patients were divided into three groups; (group 1: azoospermia [n = 57], group 2: sperm count15 million [n = 41], group 3: sperm count15 million [n = 81]). Patients and their partners filled the IIEF and FSFI forms. The normality of the tests was analysed with Kolmogorov-Smirnov and Shapiro-Wilk tests. Spearman's rho test, a nonparametric test, was used to correlate the data. A value of p .05 was considered statistically significant. There was a positive correlation between the sperm count, other sperm parameters, morphology and motility and IIEF score, FSFI score and T (p = .037, .028 and .041 respectively). We found a positive correlation between IIEF score and FSFI score (p = .182). Infertile partners' FSFI score was lower than fertile partners' scores (p = .023). Male infertility causes severe sexual dysfunction in couples, and female sexual dysfunction increases in parallel to that of men. Male sexual function also tends to decrease with low sperm count. While the clinician evaluates infertile couples, psychological and sexual functions should also be evaluated and patients should not be deprived of appropriate treatment.

Objective To determine the neurophysiological and vascular factors in diabetic impotence, particularly the role of autonomic neuropathy on venous leakage and erectile impotence. Patients and methods Thirty-four diabetic men with impotence were investigated using various neurophysiological and radiological methods. The results were compared with those from patients with idiopathic penile venous leakage for autonomic neuropathy, especially for spontaneous cavernosal activity (SCA). Results Of the neurophysiological tests, the SCA was most frequently abnormal, with the loss of normal periodic oscillations. Penile venous leakage, either alone or with arterial insufficiency, was the most frequent vascular problem (67%) in patients with diabetic impotence, in whom the SCA was absent in most (83%). Conversely, the SCA was normal in all impotent patients with idiopathic venous leakage. Conclusion Venous leakage in diabetic patients is probably produced by autonomic dysfunction of the penile vascular innervation or degeneration of penile smooth muscles, because the SCA was absent more often in these patients.

Objective To define the histopathological changes occurring as a result of open and percutaneous needle testicular biopsy in adult rats. Materials and methods Percutaneous needle and open testicular biopsies were taken from 35 male albino rats (120–140 days old). Nine of the rats were killed 10 days after the biopsy, eight after 30 days and the other eight 60 days after the biopsy. A control group of six rats underwent orchidectomy with no preceding testicular biopsy. Results Significant tubulitis and obstructive findings were detected 10 days after needle biopsy (P

Leydig cell tumors of the testis are rare, mostly presenting as a testicular mass or as endocrinological symptoms. Here, three patients who were admitted for investigation of primary infertility and one patient presenting with a testicular mass are reported. The histological features were reviewed and an immunohistochemical study was done using a panel of antibodies against cytokeratin, vimentin, inhibin A, S-100, Ki-67, follicle-stimulating hormone, luteinizing hormone, prolactin, p53, bcl-2, and c-erbB2. The latter case (lost during follow up of metastatic disease) demonstrated massive tumor necrosis, extension through the tunica albuginea, and a high mitotic activity and MIB-1 score. Only this malignant case was bcl-2 positive. Of the two oncogenic markers studied, none of the cases were positive for c-erb2, while p53 was positive in more than 50% of cells in the malignant case and in one case of infertility with a large tumor, hemorrhage, focal necrosis and atypical cytological features. We recommend the evaluation of infertile men for Leydig cell tumors, and we believe that a panel of antibodies, including Ki-67, p53 and bcl-2, used for immunohistochemical analysis could be of diagnostic value in the identification of malignant and borderline cases of Leydig cell tumor.

Objective To determine the histopathological changes in both the ipsilateral and contralateral testes of prepubertal and adult male rats 60 days after creating different obstructive models. Material and methods Thirty-six prepubertal and 32 adult albino male rats were examined in three different obstructive models of the right testis. In group 1 the spermatic cord was ligated, in group 2 the ligation was between the caput epididymis and testis, and in group 3 the vas deferens was ligated. Sixty days after ligation both testes were removed and evaluated for testis diameter, mean seminiferous tubule diameter (MSTD), and degenerative, obstructive and inflammatory changes. Results The diameter of the obstructed right testis and MSTD were significantly greater in prepubertal rats but there was no apparent difference in adult rats. For obstructive changes, sloughing of germ cells in the prepubertal rats and germ cell absence in adult rats were significantly more common in group 3. The contralateral testis diameter and MSTD of group 3 was significantly greater only in prepubertal rats. Statistically significant values of obstructive change, e.g. sloughing of germ cells and apical vacuolation in Sertoli cells, were apparent in prepubertal rats, but tubular ectasis was the only statistically significant criterion of obstruction in adult rats. Conclusion The testes are more susceptible to obstruction of the vas deferens in prepubertal than in adults rats, resulting in increased hydrostatic pressure and oedema of both the ipsilateral and contralateral testes, which might be caused by collateral circulation and rat testicular microcirculation, with a rhythmic pattern of arteriolar dilatation and constriction (vasomotion). Although the presence of oedema and high hydrostatic pressure was not prominent in adults, formation of spermatic granulomas and absence or sloughing of germ cells in the obstructed and contralateral testes reflect the early effects of vas ligation on spermatogenesis in adulthood.

Objective To evaluate, in patients with unobstructive azoospermia, the heterogeneity of spermatogenesis within the testes and thus whether there is any region of advanced spermatogenesis. Patients and methods Seventy infertile men (mean age 34 years, sd 5.01) with no varicoceles or testicular atrophy had bilateral open testicular biopsies taken from six different sites. For each biopsy specimen the number of seminiferous tubules and of tubules with sperm maturation were counted (by light microscopy at × 400). The ratio of tubules with active spermatogenesis to the total number was calculated for each biopsy sample. Results The mean (sd) right and left testicular volumes were 19.82 (7.8) and 18.84 (7.89) mL, respectively; the patients' follicle-stimulating hormone level was 8.34 (1.17) IU/mL. On sextant biopsy spermatozoa were detected in 42 of the 70 patients (60%). The mean (sd) ratio of tubules with spermatozoa was 5.23 (0.8)% for the right and 5.37 (0.76)% for the left testes. There was no statistically significant difference in the ratio of seminiferous tubules positive for spermatozoa at the different biopsy sites in either the right or left testis. Spermatozoa were identified in only one to three biopsy sites in almost half of those with maturation arrest; this ratio increased to 74% in patients diagnosed as having Sertoli-cell-only syndrome with focal spermatogenesis. Conclusion There is no region of the testis that is rich or advanced in spermatogenesis in patients with unobstructive azoospermia. Without multiple testicular biopsy it is possible to miss advanced spermatogenesis in some unobstructed patients. The sextant testis biopsy is a reliable method for detecting the presence and exact location of seminiferous tubules with spermatozoa in patients with unobstructive azoospermia.

Objectives: We compared the Gleason scores obtained from sextant prostate biopsy and radical prostatectomy (RP) specimens in patients with localized prostate cancer. Patients and Methods: Sixty-one patients having a clinical diagnosis of localized prostate cancer underwent needle biopsy under transrectal ultrasonography (TRUS) and RP. Grading and staging were assigned based on Gleason scores and the TNM system, respectively. Results: Mean patient age was 65.5 ± 13.43 years and mean PSA level was 14.69 ± 3.95. Mean Gleason score for prostate biopsy and RP specimen were 5.85 ± 0.7 and 6.34 ± 1.44, respectively. With respect to clinical stage, there were 20 patients in stage 1 and 41 patients in stage 2 prostate cancer. Comparing the Gleason scores, the biopsy score was lower in 26 (42.26%) and higher than RP specimens in 7 (11.84%) cases, and there was agreement between the biopsy and RP specimens in 28 (45.9%) patients. The difference between the two Gleason scores was ± 1 for 18 patients (29.5%) and ± 2 or more for 17 patients (27.86%). Conclusion: In our study, high Gleason score biopsies with elevated PSA level (>10 ng/ml) were risk factors for extraprostatic extension, and we demonstrated that Gleason scores were significantly correlated with seminal vesicle and lymph node invasion (p < 0.05). The Gleason scores of biopsy and RP specimens agreed with 45.9% of TRUS-guided sextant prostate biopsies, and this ratio was 91.1% in moderately differentiated tumors

To compare retrospectively the recurrence rates of TUR alone versus different intravesical chemotherapy modalities in superficial bladder cancer cases, 187 patients with stage Ta and T1 bladder tumours were treated with transurethral resection followed by adjuvant intravesical chemotherapy with mitomycin, BCG or epirubicin or by transurethral resection alone. All patients in this study had historically proven transurethrally resectable primary, category Ta and T1 transitional cell carcinoma (TCC) of the bladder. Group I included transurethral resection alone, and the other groups included intravesical mitomycin-C(Group II), BCG (Group III) and epirubicin (Group IV) therapies after transurethral resection. 146 male and 41 female patients (78% male and 22% female patients) in this study were diagnosed as primary TCC bladder tumours. Only 52 of them were stage Ta and 135 of them were stage T1 bladder tumours. Examining the histological grade of the bladder tumours, 88 (47%) of the patients had grade I, 53 (28%) had grade IIa, 30 (16%) had grade IIb and remaining 16 (9%) had grade III bladder cancers. The recurrence rates were 25% for Group I, 23.8% for Group II, 26.2% for Group III and 22.7% for Group IV. These values were given with disregarding the grade and volume of the bladder tumours. For solitary, less than 3 cm low grade tumours (grade I, IIa) recurrence rates were 16% for Group I, 15.4% for Group II, 17.8% for Group III, 17.2% for Group IV (p> 0.05). As a result of this retrospective study, for patients with low grade, stage Ta and T1 tumours TUR alone may be the best treatment modality. Although intravesical chemotherapy is effective in decreasing short-term incidences of tumour recurrence, it has not decreased long-term incidences of tumour recurrence. The high cost and adverse side effects of intravesical chemotherapy should also be taken into consideration in superficial, single, low grade tumours of bladder.

To compare the anti-inflammatory effectiveness of corticotherapy and non-steroid anti-inflammatory drugs (NSAID), we examined 126 infertile men with infectious aetiology. Seventy-seven patients were on corticotherapy and antibiotherapy (thirty-eight patients on high-dose and thirty-nine patients on low-dose corticotherapy). Forty-nine patients had antibiotherapy and NSAID. According to our results in both the high- and low-dose groups sperm motility significantly improved, but in the high dose group more side effects were reported. In order to overcome the effects of infections on male infertility, we prefer corticotherapy instead of NSAID because it is more effective than NSAID.

The effects of valproate on male reproductive hormones have been studied in epileptic patients and animals, but the results are inconsistent because reproductive hormone abnormalities may be independent of the use of valproate and may be due to epilepsy itself. The aim of this study was to determine if there is an association between valproate and reproductive abnormalities in men with bipolar disorder or if the association is unique to men with epilepsy.The study included 39 male patients aged 18-50 years with a DSM-IV diagnosis of bipolar disorder (21 on lithium monotherapy and 18 on valproate monotherapy or valproate in combination with lithium therapy) and 15 male epilepsy patients on valproate monotherapy that were evaluated in terms of reproductive hormones.Duration of illness, duration of lithium and valproate therapy, daily dose and serum concentrations of lithium and valproate, duration of marriage, spouse's gravidity, the serum estradiol, luteinizing hormone, sex hormone-binding globulin, and free testosterone levels, and the free testosterone:luteinizing hormone ratio were not significantly different between the groups. Serum prolactin and follicle-stimulating hormone levels were significantly higher in the epilepsy patients than in the bipolar disorder patients on lithium monotherapy.The findings show that valproate did not have a negative effect on male reproductive hormones in the bipolar patients. The elevated prolactin and follicle-stimulating hormone levels observed in the epilepsy group should be attributed to epilepsy. To the best of our knowledge this is the first study to compare reproductive hormones in bipolar disorder and epilepsy patients on valproate therapy.

Amaç: Valproatın erkek üreme hormonları üzerine etkisi epilepsi hastalarında ve hayvanlarda çalışılmıştır. Sonuçlar çelişkilidir, çünkü üreme hormonlarındaki değişiklikler valproat kullanımından bağımsız olarak epilepsi hastalığıyla ilişkili olabilir. Bu çalışmanın amacı, valproat sağaltımıyla ilişkilendirilen üreme hormonlarındaki değişikliklerin bipolar bozukluk tanılı erkek hastalarda görülüp görülmediğini araştırmaktır. Yöntem: 18-50 yaş arası, DSM-IV’e göre bipolar bozukluk tanılı 39 erkek hasta (21’i sadece lityum, 18’i valproat ile birlikte lityum veya sadece valproat kullanan) ve sadece valproat kullanan idiyopatik jeneralize epilepsi tanılı 15 erkek hastanın üreme hormon değerleri karşılaştırıldı. Bulgular: Hastalık süreleri, ortalama lityum ve valproat kullanım süreleri, ortalama lityum ve valproat günlük doz ve serum düzeyleri, evlilik süresi ortalamaları, eşlerinin gebelik sayıları, serum östradiol, lüteinize edici hormon, seks hormon bağlayıcı globulin, serbest testosteron düzeyleri ve serbest testosteron/lüteinize edici hormon oranı açısından gruplar arasında anlamlı fark yoktu. Serum prolaktin ve folikül stimüle edici hormon düzeyleri epilepsi tanılı hasta grubunda lityum kullanan bipolar bozukluk tanılı hasta grubuna göre anlamlı olarak daha yüksekti. Sonuç: Bulgular, valproatın erkek üreme hormonları üzerine olumsuz etkisinin olmadığını göstermektedir. Epilepsi grubunda görülen prolaktin ve folikül stimüle edici hormon düzeylerindeki yükseklik epilepsi hastalığına atfedilebilir. Bu çalışma, literatürde valproat sağaltımının bipolar bozukluk ve epilepsi tanılı erkek hastalarda üreme hormonlarına etkisini karşılaştıran ilk çalışmadır., Objective: The effects of valproate on male reproductive hormones have been studied in epileptic patients and animals, but the results are inconsistent because reproductive hormone abnormalities may be independent of the use of valproate and may be due to epilepsy itself. The aim of this study was to determine if there is an association between valproate and reproductive abnormalities in men with bipolar disorder or if the association is unique to men with epilepsy. Materials and Method: The study included 39 male patients aged 18-50 years with a DSM-IV diagnosis of bipolar disorder (21 on lithium monotherapy and 18 on valproate monotherapy or valproate in combination with lithium therapy) and 15 male epilepsy patients on valproate monotherapy that were evaluated in terms of reproductive hormones. Results: Duration of illness, duration of lithium and valproate therapy, daily dose and serum concentrations of lithium and valproate, duration of marriage, spouse’s gravidity, the serum estradiol, luteinizing hormone, sex hormone-binding globulin, and free testosterone levels, and the free testosterone:luteinizing hormone ratio were not significantly different between the groups. Serum prolactin and follicle-stimulating hormone levels were significantly higher in the epilepsy patients than in the bipolar disorder patients on lithium monotherapy. Conclusion: The findings show that valproate did not have a negative effect on male reproductive hormones in the bipolar patients. The elevated prolactin and follicle-stimulating hormone levels observed in the epilepsy group should be attributed to epilepsy. To the best of our knowledge this is the first study to compare reproductive hormones in bipolar disorder and epilepsy patients on valproate therapy.

Objectives To evaluate the therapeutic effects of a selective endothelin type A receptor antagonist (ERA-A) on testis of streptozotocin (STZ)–induced diabetic rats. Methods Eighty rats were analyzed in 4 groups: healthy controls, diabetic rats, diabetic rats treated with ERA-A, and healthy rats treated with ERA-A. Diabetes was induced in 40 rats by a single intraperitoneal injection of STZ and followed for 2 months. A total of 20 diabetic and 20 healthy rats were also intravenously treated with ERA-A at days 7 and 15. The remaining untreated healthy rats served as controls. Blood glucose levels of ≥ 250 mg/dL were considered to indicate diabetes and were measured at the end of the second month. Formalin-fixed paraffin-embedded testis tissue sections were analyzed after staining with hematoxylin and eosin or specific antibodies for apoptotic markers. mRNA expressions of genes involved in the apoptotic pathway or spermatogenesis were evaluated by real-time reverse transcription–polymerase chain reaction. Results Major therapeutic effects of ERA-A could be achieved for damages caused by oxidative stress. Although a decrease in apoptotic cell death could be detected, no statistically meaningful results could be obtained for the duration of spermatogenesis. Conclusions ERA-A could prevent germ cell death by apoptosis and testicular damage in diabetic rats.

İnsan kök hücre çalışmaları sadece bilim adamlarının değil toplumun da ilgisini çeken, insan gelişim sürecine ait mekanizmaları aydınlatan ve tıbbi uygulamalarda değişiklikler yapacak çalışmalar olarak düşünülmektedir. Günümüzde kök hücre genitoüriner sistemi de içeren pek çok organda, rejeneratif tıp uygulamalarında kullanılmaktadır. Ancak kök hücre tedavisinin pratikte kullanımı embriyonik kök hücre araştırmalarına getirilen etik kısıtlamalar nedeniyle sınırlı kalmaktadır. Bilim adamları bunun yerine progenitör hücreler ve erişkin kök hücrelerinden oluşan diğer kök hücre kaynaklarına yönlenmektedirler. Bu kaynaklardan biri de erkek genital sistemine ait kök hücrelerdir. Germ hücreleri sahip olduğu genetik bilgiyi gelecek nesillere taşıyabilme yeteneğine sahip hücreler olarak tanımlanmaktadır. Memelilerde germ hücreleri erken embriyo döneminde ortaya çıkan primordial germ hücrelerinden köken alır. Erkeklerde bu hücreler mitozun G0/G1 fazında prospermatogonium olarak duraklarlar ancak prolifere olma yeteneklerini devam ettirirler. Doğum sonrası prospermatogoniumlar seminifer tübül bazal membranına göç eder ve spermatogonial kök hücreye diferansiye olurlar. Erişkin kök hücrelerinde olduğu gibi, spermatogonial kök hücreler de kendi kendini yenilerler ve faklılaşarak birden fazla terminal hücre tipine dönüşen “daughter” hücre oluşumunu sağlarlar. Spermatogonial kök hücre izolasyonu, in vitro kültürü ve pluripotent kök hücreden diferansiye edilmesi araştırmacılara hücrelerin biyolojik özelliklerini tanıma ve infertilite başta olmak üzere tedavide kullanımları ile ilgili çalışma olasılığı sağlayacaktır. Bu derlemede erkek genital sisteminde kök hücre kaynakları ve izolasyon yöntemleri gözden geçirilmiştir., Human stem cell research which attracts not only scientists’ but the public’s attention is considered to be able to identify the mechanism of human development, and to change the medical practices. Stem cells have been used for regenerative medicine applications in many organ systems, including the genitourinary system. The potential applications for stem cell therapy have, however, been restricted by the ethical issues associated with embryonic stem cell research. Instead, scientists have explored other cell sources, including progenitor and stem cells derived from adult tissues. Another source of the stem cells are the male genitourinary system. Germ cells are defined by their innate potential to transmit genetic information to the next generation through fertilization. In mammalian species, gametes are issued from primordial germ cells during early embryo development. In males, these cells arrest in G0/G1 of mitosis as a prospermatogonia, but retain a proliferative precursor potential. Following birth, prospermatogonia migrate to the basement membrane of the seminiferous tubule and differentiate into spermatogonial stem cells. Like adult stem cells, spermatogonial stem cells can both self-renew and provide daughter cells, which differentiate into one or more terminal cell types. Isolation, in vitro cultivation of spermatogonial stem cells and differentiation into pluripotent stem cells will allow researchers to study their biological characteristics and their applications in therapeutic approaches such as infertility. In this review, stem cell sources of male genital system and the isolation of these cells were scrutinized.

WOS: 000264178200008, PubMed ID: 19184395, In this study we aimed to evaluate the postnatally screened karyotype results in couples who were referred because of primary infertility between 2000 and 2006 in Izmir. The records of a total of 179 cases were evaluated retrospectively. A total of 21 cases (11.74%) showed chromosomal alteration. Thirteen (7.26%) were 47,XXY; three (1.68%) were pericentric inversion of chromosome 9; one (0.56%) 46,XY/45,XO; one (0.56%) 46,XY/47,XXY/48,XXXY; one (0.56%) 46,XY,t(X;1); one (0.56%) 46,XY/46,XY,del(Y)(q11.2) and one (0.56%) 46,XX. The rate of gonosomal chromosomal abnormalities was nearly three times higher in our region than the rate in the literature. Chromosomal analysis is strongly suggested particularly in those who suffer fertility problems.

We carried out a retrospective study to review the efficiency of grey-scale transrectal ultrasonography (TRUS) in detecting prostate cancer compared with the data in recent published work, including alternative imaging methods of the prostate gland. Our study group consisted of 830 patients who underwent TRUS-guided biopsy of the prostate between May 2000 and June 2004. The relation between abnormal TRUS findings and serum total prostate-specific antigen (tPSA) levels was evaluated in patients with prostate cancer who were divided into three different groups according to serum tPSA levels. Group I included patients with tPSA levels of 4-9.9 ng/mL, group II included tPSA levels of 10-19.9 ng/mL and group III included patients with tPSA levels of 20 ng/mL or more. In general, TRUS detected 185 (64%) of 291 cancers with a specificity of 89%, a PPV of 76% and an accuracy of 80%. TRUS findings enabled the correct identification of 22 (56%) of the 39 cancers in group I, 28 (30%) of the 93 cancers in group II and 135 (85%) of the 159 cancers in group III. In conclusion, TRUS alone has a limited potential to identify prostate cancer, especially in patients with tPSA levels lower than 20 ng/mL. Therefore, increased numbers of systematically placed biopsy cores must be taken or alternative imaging methods are required to direct TRUS-guided biopsy for improving prostate cancer detection.

Studies reporting the outcome of percutaneous nephrolithotomy (PCNL) in relation to stone burden and configuration are limited. We analyzed our stone-free and complication rates of PCNL with regard to stone surface area and configuration.Data of 234 patients who underwent PCNL were analyzed retrospectively. Patients were stratified into six groups according to stone burden and into four groups in relation to stone configuration. Groups were compared with respect to the number of tracts, success of therapy, complications, requirement for secondary procedures, drop in hematocrit, and blood transfusion requirement.The overall stone-free rate was 78.6% with a complication rate of 34.6%. Stone-free rates decreased with increasing stone size (P = 0.001) and with increasing caliceal component in complex stones (P = 0.01). The total number of complications rose with increasing stone surface area (P = 0.0001); however, stone distribution within the kidney did not affect the complication rate (P = 0.2). The mean operative time rose with increasing stone burden (P0.05) and increasing caliceal involvement by complex stones (P0.01). The need for multiple tracts also rose with increasing stone burden (P0.05).There is a decrease in the overall stone-free rate, as well as an increase in the complication rate, the secondary procedure rate, the mean operative time, and the need for multiple tracts, with increasing stone surface area with PCNL. With regard to stone configuration, there is a decrease in the stone-free rate, as well as an increase in the operative time, with increasing caliceal component in complex renal stones.

Objective We aimed to investigate electrophysiologically the intersegmental reflex circuit from sacral to lumbar cord segments in normopotent adult men, in patients with spinal cord injury and in patients with premature ejaculation. Methods Reflex EMG activity of the cremasteric (CM) and bulbocavernosus (BC) muscles was recorded simultaneously by needle electrodes during electrical stimulation of the upper lumbar and sacral dermatomes, respectively. Thirty-three healthy male volunteers, 16 patients with spinal cord injury (SCI) at the thoracic or cervical levels, and 26 men with premature ejaculation (PME) were included in the study. Results In controls, upper lumbar dermatomal stimulation (ULS) at the inner side of thigh only elicited a reflex response from the CM muscle and did not produce a regular response from the lower sacral myotomes such as in the BC muscle. However lower sacral dermatomal stimulation (LSS) at the dorsal nerve of penis consistently evoked reflex responses from both CM and BC muscles. These basic electrophysiological features were not different in patients with SCI. LSS did not elicit a reflex response from the CM muscle in about 39% of patients with PME, while the BC reflex was obtained from all patients with PME. Conclusions The neurophysiological pattern in BC and CM muscles during sacral or lumbar dermatomal stimulation reflects the sacrolumbar intersegmental reflex linkage that may be related to the ejaculatory process in men. The intersegmental sacrolumbar reflex circuit may be functionally disturbed in some patients with PME. Significance Interaction between the reflex activity of sacral to lumbar dermatomes could prove useful in defining electrophysiological mechanisms related to ejaculation in men.

Bu çalışmanın amacı, cinsel işlev bozukluğu nedeniyle farklı tiplerde penil protez yerleştirilen hastaların ameliyat sonrası verilerini özellikle yeniden ameliyat ile hasta ve eş memnuniyeti sonuçlarına odaklanarak analiz etmektir. Ocak 1989 ile Aralık 2006 yılları arasında bükülebilir veya şişirilebilir protez yerleştirilen 284 hastanın verileri retrospektif olarak değerlendirilmiştir. Bu süreçte 250 hastaya bükülebilir, 34 hastaya ise şişirilebilir penil protez yerleştirilmiştir. 97 hastaya AMS 600 bükülebilir protez, 6 hastaya AMS 650 bükülebilir protez, 143 hastaya Mentor bükülebilir protez, 4 hastaya Mentor Acuform protez, 21 hastaya AMS Dynaflex protez, 9 hastaya AMS Ultrex Plus protez ve 4 hastaya Mentor Alfa-1 protez yerleştirilmiştir. Hastaların çoğu (n=234) spinal anestezi altında ameliyat edilmiştir. Cerrahi yaklaşım olarak penoskrotal, infrapubik ve subkoronal yaklaşımlar kullanılmıştır. Toplam 156 hastadan ve 110 eşten ameliyatın memnuniyeti hakkında bilgi alınmıştır. Hastaların tamamında organik kökenli cinsel işlev bozukluğu saptanmıştır. Hastaların %58’inde vasküler kökenli cinsel işlev bozukluğu, %10.9’unda şeker, %11.3’ünde radikal pelvik cerrahi öyküsü, %8.8’sinde Peyronie hastalığı ve %10.9’unda diğer nedenler ortaya konmuştur. Ortalama hasta yaşı 64.3 yıl (31-74 yıl) ve izlem süresi 24 ay (3-68 ay) olarak saptanmıştır. 80 hastada (%28.2) penil ödem, penil veya skrotal hematom ve tedaviye yanıt veren enfeksiyon gibi minör istenmeyen yan etkiler izlenmiştir. Bununla birlikte, 19 hastada (%6.7) tekrar ameliyat gereksinimi doğmuştur. Bu hastalardan 14’ü kontrol edilemeyen enfeksiyon, 3 hasta mekanik hasar, 1 hasta yetersiz protez boyu ve 1 hasta kendiliğinden üretral protez erozyonu nedeniyle tekrar ameliyat edilmiştir. Görüşme yapılan grupta, bükülebilir penil protez kullanan 131 erkekten 92’si (%70.2) ve bu hastaların 90 eşinden 66’sı (%73.3); şişirilebilir penil protez kullanan 25 erkekten 22’si (%88) ve bu hastaların 20 eşinden 18’i (%90) protez cerrahisinden memnuniyetini bildirmiştir., Introduction: The aim of this study is to analyze the data of men with erectile dysfunction who had been inserted with various types of penile prosthesis; focusing on the examination of the re-operations and patient and partner satisfaction. Materials and Methods: Medical records of 284 men implanted with either malleable or inflatable penile prostheses from January 1989 to December 2006 were reviewed and retrospectively analyzed. During that period, 250 malleable and 34 inflatable penile prostheses were inserted. The AMS 600 Malleable prosthesis was inserted in 97 cases, the AMS 650 Malleable prosthesis in 6 cases, the Mentor Malleable prosthesis in 143 cases, the Mentor Acuform prosthesis in 4 cases, the AMS Dynaflex prosthesis in 21 cases, the AMS Ultrex Plus prosthesis in 9 cases and the Mentor Alpha-1 prosthesis in 4 cases. Most patients (n=234) received spinal anesthesia during their operations. Regarding the surgical approaches penoscrotal, infrapubic or subcoronal approaches were used. One hundred and fifty-six men and 110 partners were interviewed regarding the satisfaction of the operations. Results: All patients had a history consistent with an organic etiology of erectile dysfunction, including vascular disease in 58%, diabetes in 10.9%, radical pelvic surgery in 11.3%, Peyronie’s disease in 8.8% and others in 10.9%. The mean patient age was 64.3 years (range 31-74) and follow-up was 24 months (range 3-68). Eighty patients (28.2%) had transient minor complications such as penile edema, penile or scrotal hematoma or infections responsive to treatment. Besides, 19 patients (6.7%) had to be re-operated because of major complications such as: uncontrolled infection-14, mechanical failure-3, inadequate length-1 and spontaneous urethral prosthesis erosion-1. Overall, 92 (70.2%) of 131 men and 66 (73.3%) of 90 partners with malleable penile prosthesis and 22 (88%) of 25 men, and 18 (90%) of 20 partners with inflatable penile prosthesis were satisfied with the results of the penile prosthesis surgery concerning sexual relationship. Conclusion: Use of penile prostheses is a safe and efficient long term therapeutic option in patients with erectile dysfunction.

Bu çalışmada, Anlamlı yüksek mikst antiglobulin reaksiyon (MAR) değeri olan infertil erkek hastalardaki uygulanmış yardımcı üreme yöntemlerin (YÜY) sonuçlarının retrospektif analizini değerlendirmeyi amaçladık. Çalışma kapsamında 1995-2005 tarihleri arasında Ege Üniversitesi Aile Planlanması ve Kısırlık Araştırılma (Tüp Bebek) Merkezi’nde infertilite nedeniyle değerlendirilen yüksek MAR değerine sahip 69 infertil erkek hasta incelenmiştir. Hastaların tamamına çeşitli YÜY (İUİ, İVF, İCSİ) uygulanmıştır. Yüksek MAR düzeyinin YÜY’e olan etkisi analiz edilmiştir. Çalışmamıza alınan hastaların ortalama yaşı 35.5±3.9. Ortalama MAR değerleri %84±0.2. YÜY’den toplam 65 İUİ, 18 İCSİ ve 4 İVF uygulanmıştır. 21 hasta (%30.4) YÜY öncesi 3 ay süreyle kortikosteroid almışlardı. YÜY uygulanan 5 hastada İUİ (başarı: %6.1), 9 hastada İCSİ (başarı: %50) ve 1 hastada İVF (başarı: %25) sonucunda toplam 15 çiftte gebelik elde edilebilmişti. Bunlardan sadece altısı (%40) işlem öncesi kortikosteroid tedavisi almıştır, kortikoterapi alan hastaların sadece %28.5’ini oluşturuyordu. Gebelik oluşan çiftlerden %53.3’ünde erkek eş sigara kullanmaktayken, gebelik oluşmayan grupta sigara içme oranı %80 idi (p0.05). Yüksek MAR değeri olan hastalarda YÜY ile %22’ye varan gebelik oranlarına ulaşmak mümkün olmaktadır. YÜY öncesi kortikosteroid tedavisinin YÜY’ine olumlu bir etkisi görülmemektedir ve bu hastalara direkt İCSİ uygulanması önerilir. Sigara kullanımının YÜY’ine olumsuz etkisi vardır., Introduction: Retrospective analysis of the results of assisted reproductive techniques (ART) of infertile males with high mixed anti-globulin reactions (MAR). Materials and Methods: Data of 69 infertile male patients with high mixed anti-globulin reactions values (>15%) treated in Ege University IVF Centre between 1997 and 2005 were retrospectively evaluated. Various assisted reproductive techniques (ART): Intrauterine inseminations (IUI), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) were applied to all patients. The influences of high MAR values on ART were analyzed. Patients were also categorized with regards to smoking and receiving corticotherapy before treatment. SPSS 13.0 for Windows XP were used for statistical analysis. Results: Mean patients age was 35.5±3.9 years old. Mean MAR value was 84±0.2%. A total of 87 ART were applied (65 IUI, 18 ICSI and 4 IVF). Out of 69 patients 21 (30.4%) of them received corticosteroids before any ART for 3 months. ART were successful in 15 infertile couples: 5 IUI (success: 6.1%); 9 ICSI (success: 50%); 1 IVF (success: 25%) and unsuccessful in 54 infertile couples. We had 15 successful ART and only 6 of them (42.86%) were instructed corticotherapy before ART and this constituted 28.5% of patients receiving corticotherapy. We had 15 successful and 54 unsuccessful ART cycles out of 69 couples. Male partner had an anamnesis about smoking at 53% and 80% of couples with successful and unsuccessful ART cycles respectively and the difference was statistically significant (p0.05). Conclusion: It is possible to achieve as high as 22% success rates of pregnancy even in the presence of high MAR values. Corticotherapy did not influence ART results. Smoking has a negative effect ART results.

This study was conducted to evaluate postpubertal testicular and epididymal epithelial changes induced by unilateral epididymal and vasal obstruction in rats by measuring epithelium thickness of seminiferous tubuli (MSTet) and epithelium thickness of ductus epididymis (MDEet). Rats were randomly divided into 3 groups: group I underwent unilateral epididymal ligation; group II underwent unilateral vasal ligation and group III received sham operations. MDEet on the ipsilateral side of the epididymal ligation group significantly decreased compared to the contralateral side and sham group. For the contralateral side of the ligated vas, MDEet significantly decreased compared to the ipsilateral side and sham group. MSTet was less on the side of the operation than the contra lateral side and the sham group after both surgical procedures. The obstruction point of the male genital tract affect sperm parameters for clinical extraction or aspiration procedures.

We aimed to determine the changes of inducible nitric oxide synthase (iNOS) and endothelial nitric oxide synthase (eNOS) immunoreactivity and apoptosis after proximal and distal obstruction models on ipsilateral and contralateral testicular tissues. Male albino Wistar rats were randomly divided into three groups (n=30): a control group which underwent sham operations (n=10), a unilateral vasal ligation (n=10) and a unilateral epididymal ligation group (n=10). iNOS and eNOS distribution and apoptosis were studied in both ipsilateral and contralateral testes using quantitative immunohistochemistry. Nitric oxide synthase activity was significantly affected in ipsilateral and contralateral testes cells after vasal and epididymal ligation. eNOS immunoreactivity increased markedly after ipsilateral vasal ligation (ILVL). Degeneration-related changes were also associated with changes in apoptotic rate. Analysis using the terminal dUTP nick end-labeling TUNEL method revealed that apoptotic cell numbers significantly increased after ILVL. p53 and bcl-2 immunoreactivity increased in both experimental groups compared with the sham-operated group. Changes in iNOS and eNOS immunolocalisation were strongly associated with cell damage, because germ cell degeneration was more prominent in the ILVL group. Altered p53 immunolocalisation was also associated with cell degeneration, and a rise in bcl-2 immunoreactivity might be considered to reflect a protective mechanism in the testis. These cellular changes could enlighten understanding of the interaction between testicular functioning and damage.

Survey.To determine associations between sexual dysfunctions and electrophysiological examinations of the genital system in spinal cord injured patients.Ege University Hospital, Izmir, Turkey.In total, 25 patients (17 men, eight women) who were out of the spinal shock period were examined. Neurological levels were determined according to the American Spinal Injury Association (ASIA) impairment scale. Data about erection, ejaculation and vaginal lubrication were obtained via inquiry forms. Bulbocavernosus reflex (BCR), pudendal somatosensorial evoked potentials (pSEP) and perineal sympathetic skin responses (pSSR) were recorded by an electromyographer unaware of the sexual state or neurological level of the patient.BCRs could be obtained from all patients with lesion levels above the sacral centre. A significant association was found between reflex erection and BCR positivity, while psychogenic erection was shown to have a significant association with the preservation of pSSR in men. Despite the lack of statistical significance due to the small sample size of the women examined, a similar association with lubrication was observed. Ejaculation and orgasm were not shown to be significantly associated with any electrophysiological examination. However, ejaculation was preserved in all men with a lesion level below T12 and with positive pSSR. There was no significant relationship between pSEP and sexual functions. The relationship between the existence of sacral sensation and pSEP positivity was statistically significant.This study has proved that BCR and pSSR have an important role in the estimation of the remaining sexual function in spinal cord injured patients. STATEMENT ON ETHICS: We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

Bu çalışmamızda, BPH ve prostat kanseri tanılı hastalardaki PSA, serbest/toplam (s/t) PSA oranları ve PSA dansitelerini (PSA-D) karşılaştırmayı, prostat kanserli hastalardaki Gleason skorları ile PSA ilişkisini ortaya koymayı ve BPH’lı hastalarda yaşa bağlı PSA değişimlerini analiz etmeyi amaçladık. Ocak 2001-Aralık 2003 tarihleri arasında kliniğimizde BPH nedeniyle cerrahi uygulanan ve primer olarak prostat kanseri tanısı alan toplam 662 hastanın verileri geriye dönüşümlü olarak incelendi. BPH hastalarının yaş ortalaması 68.5 prostat kanserli hastalarının ise 66.9 idi. Prostat kanseri grubunda ortalama PSA değeri 32,3 ng/ml (0,4-165,6 ng/ml), BPH grubundakilerde ise 5,3 ng/ml (0,2-19,4 ng/ml) idi. PSA dansitesi hesaplanan prostat kanserli ve BPH’lı hastaların ortalama ve ortanca PSA-D değerleri sırasıyla 1,38 ve 0,54 ile 0,08 ve 0,06 idi. Kanserli grupta s/t oranlarının ortalaması 0.14 (0,01-0,72) ve ortancası 0,12, BPH grubundakilerin s/t PSA ortalaması 0,19 (0,01-0,70) ve ortancası 0,19 idi. BPH grubunun yaşa göre ortalama ve ortanca PSA değerleri 40-49 yaş grubunda 1,93 ve 2.0, 50-59 yaş grubunda 3.39 ve 2.25, 60-69 yaş grubunda 4.18 ve 3,0, 70 yaş üstünde 5,79 ve 4,50 olarak belirlendi. s/t PSA oranı ve PSA-D prostat kanseri ve BPH olgularında anlamlı farklılık göstermektedir. Gleason skorları PSA ile koreledir ve yaşa özgü PSA oranları geçerlidir., Introduction: Prostate cancer is one of the most important malignancies of male population because of its high morbidity and mortality. Early detection is important to obtain better treatment outcome. Prostate specific antigen (PSA) is a key marker for early detection of prostate cancer. The aim of this retrospective study is to compare prostate specific antigen (PSA) and free/total PSA (f/t PSA) ratios in patients with benign prostatic hyperplasia (BPH) and prostate cancer. In addition, PSA alterations’ correlation with Gleason score in prostate cancer patients and age-specific PSA levels in BPH patients were analysed. Materials and Methods: A total of 662 patients, who underwent surgical treatment for BPH or patients diagnosed with primary prostate cancer at Urology Department of Ege University between January 2001 and December of 2003, were recruited in the current study. All data were achieved from patient data archives retrospectively. Patients were analysed in 2 groups: BPH (543 patients) and prostate cancer (119 patients) patients. We compared PSA, f/t PSA ratios and PSA density (PSA-D) between 2 groups. We also reviewed the correlation between PSA levels and Gleason score in prostate cancer patients and age-specific PSA levels in BPH patients. Statistical analysis was done with SPSS 10.0. Results: 321 of 543 BPH cases underwent transurethral resection of prostate (TURP) and 222 BPH cases underwent suprapubic transvesical prostatectomy (SPTVP). 9 patients were diagnosed as prostate cancer pathologically who were considered as clinically BPH preoperatively. Median ages of the patients with BPH and prostate cancer are 68.5 and 66.9 years old, respectively. Median PSA in prostate cancer group was 32.3 ng/ml (0.4-165.6 ng/ml) and median PSA in BPH group was 5.3 ng/ml (0.2-19.4 ng/ml). 51 out of 543 BPH patients have PSA values more than 10 ng/ml (rate %9.3). f/t PSA ratios were available in 66 patients with prostate cancer. Median and mean f/t PSA ratios in this group were 0.14 (0.01-0.72) and 0.12, respectively. In BPH group, median and mean f/t PSA ratios were 0.19 (0.01-0.70) and 0.19, respectively. Mean PSA levels of prostate cancer patients with Gleason score of below 7.7 and above 7 were 22.7, 35.9, 32, respectively. Mean PSA levels stratified according to decades in BPH patients were 1.9 in 40-49 years old group, 3.4 in 50-59 years old group, 4.2 in 60-69 years old group, 5.8 in 70 years old and older group. Median and mean PSA density in prostate cancer (58 patients) cases were 1.38 and 0.54, respectively whereas median and mean PSA density in BPH (420) cases were 0.08 and 0.06, respectively. Conclusion: There is significant difference between prostate cancer and BPH patients with regards to f/t PSA and PSA-D values. In addition, PSA levels correlate well with Gleason scores in prostate patients. Agespecific PSA values are valid in BPH patients.

Amaç: Spinal kord yaralanmalı hastalarda cinsel fonksiyon bozukluklarının hasta bildirimleri ile ortaya konması ve nörolojik muayene bulgularıyla ilişkilerinin araştırılması. Gereç ve Yöntem: Çalışmaya spinal şok döneminden çıkmış, 30'u erkek, 13'ü kadın toplam 43 hasta alındı. Anket yoluyla hastaların yaralanma sonrası cinsel fonksiyonları hakkında ayrıntılı bilgi edinildi. Erektil fonksiyon; International Index of Erectile Function-5 (IIEF-5) ile, kadın cinsel fonksiyonu Female Sexual Function Index (FSFI) ile değerlendirildi. Nörolojik düzey American Spinal Injury Association (ASIA) protokolüne göre belirlendi. Bu seviyeler, cinsel fonksiyondan sorumlu spinal kord merkezlerinin yerleşimine göre T10 ve üzeri, T11-L2 arası, konus ve kauda olmak üzere 4 grupta sınıflanarak ereksiyon, ejakülasyon ve orgazmla ilgili bilgilerle nörolojik düzey arasındaki ilişkiler araştırıldı. Bulgular: Erkeklerde ortalama IIEF-5 skoru 7±6,69 idi. T10 ve üzerindeki seviyelerde refleks ereksiyonların %100 oranında korunduğu; konus-kauda lezyonlarında ise psikojen ereksiyonlar %100 oranında korunurken, refleks ereksiyonların olmadığı bulundu. Hastaların %43,3'ünde ejakülasyon korunmuştu. Ejakülasyon oranı T10 ve üzeri seviyelerde konus-kauda seviyelerine göre daha düşüktü. Konus-kauda lezyonu olan hastaların %83,3'ünde, bu düzeyin üzerindeki hastaların %54,5'inde orgazm mevcuttu. Kadınlarda ortalama FSFI skoru: 2,35±0,94 idi. Kadınlarda az sayıda hastada veri elde edebilmekle birlikte, konus-kauda lezyonu olan hastaların %83,3'ünde psikojen lubrikasyon korunurken, refleks lubrikasyonun olmadığı belirlendi. Bilgi edinilebilen hastalarda orgazm bozukluğu mevcuttu. Sonuç: Bu çalışma, spinal kord yaralanmalı hastalarda nörolojik düzeyin cinsel fonksiyonu düzenleyen merkezler esas alınarak sınıflanmasının geride kalan cinsel kapasitenin tahmininde önemli olduğunu göstermiştir., Objective: To determine sexual dysfunction and its association with neurological examination findings in spinal cord injured patients. Materials and Methods: Forty-three patients (30 men, 13 women) who were out of the spinal shock period were enrolled to the study. Information about the post-injury sexual functions was obtained via questionnaires. Erectile function was evaluated by International Index of Erectile Function-5 (IIEF-5), women sexual function was evaluated with Female Sexual Function Index (FSFI). Neurological level was determined according to American Spinal Injury Association (ASIA) impairment scale. These levels were classified into 4 groups, namely, T10 and above, T11-L2, conus, and cauda according to the alignment of the spinal cord centers responsible of sexual function. The relations between the data about erection, ejaculation, lubrication and orgasm, and neurological level were investigated. Results: Mean IIEF-5 score in men was 7±6.69. It was found that at levels of T10 and above; reflex erections were preserved with a 100% ratio. At conus-cauda lesions; while psychogenic erections were preserved with a 100% ratio, reflex erections were absent. In all patients with neurologic levels at or below T12, psychogenic erections were present. Ejaculation was present in 43.3% of men. Ejaculation rate was lower in T10 and above levels when compared with that in conus-cauda levels. Orgasm was present in 83.3% of the patients with conus-cauda lesions, and 54.5% of the patients with lesions above this level. Mean FSFI score in women was 2.35±0.94. Despite the lack of sufficient data in women, it was determined that in 83.3% of the patients with conus-cauda lesions, psychogenic lubrication was preserved while reflex lubrication was not. Orgasmic disorder was noteworthy in this limited sample of female patients. Conclusion: This study has demonstrated there is impairment in sexual dysfunction in both sex after spinal cord injury and that the classification of neurological level according to the spinal centers regulating sexual function in spinal cord injured patients has an imperative place in the estimation of the remaining sexual function.

Yayınlarda artan taş yükünün perkütan nefrolitotomi (PNL) tedavisinin başarısı ve istenmeyen yan etki oranlarına etkisini inceleyen çalışma sayısı oldukça azdır. Bu çalışmamızda, artan taş boyutunun PNL tedavisindeki başarı ve istenmeyen yan etki oranları üzerine olan etkisini inceledik. Retrospektif olarak 234 hastanın (234 PNL işlemi) verileri incelendi. Hastalar taş boyutuna göre iki gruba ayrıldı. Gruplar, taş boyutuna göre, tedavi başarısı, istenmeyen yan etki oranları, ek tedavi gereksinimleri, trakt sayısı, hematokrit düzeyindeki düşüş ve kan transfüzyonu gereksinimi açısından karşılaştırıldı. PNL için son taşsızlık oranı %87.1 ve istenmeyen yan etki oranı ise %34.6 olarak belirlendi. Artan taş boyutu ile taşsızlık oranları azalırken (p=0.001), istenmeyen yan etki oranlarının arttığı (p=0.0001) görüldü. Ortalama ameliyat süresi (p, Introduction: Studies reporting percutaneous nephrolithotomy (PNL) outcomes in relation to stone burden are very limited in the literature. We therefore examined our data to analyze our stone-free rates and complication rates of PNL with regards to stone surface area. Materials and Methods: Data of 234 patients who underwent 234 PNL procedures were retrospectively analyzed. Patients were stratified with respect to stone burden into two groups. Groups were compared with respect to the success of therapy, complications, requirement of secondary procedures, number of tracts, drop in hematocrit level and blood transfusion requirement in relation to stone burden. Results: The overall stone-free rate for PNL was 78.6% with a complication rate of 34.6%. Stone-free rates decreased with increasing stone burden (p=0.001). The total number of complications rose with increasing stone surface area (p=0.0001). The mean operative time increased with increasing stone burden (p