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Functional disorders of the glymphatic system and Aquaporin-4 (AQP-4) channels take part in the pathophysiology of neurodegenerative disease. The aim of this study was to describe the distribution of AQP-4 channels in the prefrontal cortex and hippocampus in a mouse model of NMDA receptor blocking agent-induced schizophrenia-like behavior model. NMDA receptor antagonist MK-801 was used to produce the experimental schizophrenia model. MK-801 injections were administered for eleven days to Balb/c mice intraperitoneally. Beginning from the sixth day of injection, the spatial learning and memory of the mice were tested by the Morris water maze (MWM) task. A group of mice was injected with MK-801 for ten days without the MWM task. Hippocampus and prefrontal specimens were collected from this group. Tissue samples were stained immunohistochemically and AQP-4 channels were examined by electron microscope. Time to find the platform was significantly longer at MK-801 injected group than the control group at the MWM task. Also, time spent at the target quadrant by the MK-801 group was shorter compared to the control group. AQP-4 expression increased significantly at MK-801 group glial cells, neuronal perikaryon, perineuronal and pericapillary spaces. In the MK-801 group, there was remarkable damage in neurons and glial cells. Increased AQP-4 channel expression and neurodegeneration at the MK-801 group induced with schizophrenia-like behavior model. MK-801 induced NMDA receptor blockade causes a decline in cognitive and memory functions. Increased AQP-4 expression at the prefrontal cortex and hippocampus to elicit and transport products of synaptic neurotransmitters and end metabolites is suggested.

Introduction Residual stone fragments remain a challenging topic for urologists following retrograde intrarenal surgery (RIRS). This study investigates the effectiveness of second-look flexible ureterorenoscopy (URS) to achieve a true stone-free status and decrease stone-related events. Material and Method A total of 176 consecutive patients treated with RIRS for kidney stones were included in the study. Patients were divided into two groups, group 1 receiving the standard of care (n=51) and group 2 receiving second-look flexible URS (n=125). In all cases, one or more calyceal stones of 1 to 4 mm were extracted with a basket at the time of stent removal. Unless earlier intervention was necessary, patients were followed up every six months to determine if they had experienced SREs. Results The mean follow-up time for the whole group was 21±11.1 months. The mean number of stones in group 1 and group 2 was 1.25±0.11 and 1.56±0.19, respectively. Postoperative stone-free rate after RIRS for group 1 and group 2 were 37.25% (n=19/51) and 40.8% (n=51/125), respectively. The SFR improved to 93.6% (n=117/125) in group 2. Multivariable analysis showed that type of intervention, stone size, and body mass index were independent prognostic factors for SREs. When group 2 was taken as a reference, the odds ratio for SREs was 8.48 (95% CI: 2.95–24.42) in group 1. Conclusion This study found that second-look flexible URS increased the SFRs and diminished the number of SREs. We propose performing second-look flexible URS following RIRS in the presence or suspicion of RSFs to provide better treatment results, less radiation exposure, and greater patient satisfaction. Key Words Retrograde Intrarenal Surgery, Flexible Ureteroscopy, Stone-free Rate, Residual stone Fragments, Stone-Related Event, Second-look Flexible Ureteroscopy.

Objective The incidence of prostate adenocarcinoma (PCa) is increased with the use of prostate-specific antigen (PSA). In the current study, we aimed to investigate the impact of 5- alpha- reductase inhibitors (5-ARI) on pathological progression in patients followed by active surveillance (AS). Material and methods Records of 69 patients with localized prostate cancer under AS (PSA ≤15 ng/mL, PSAD ≤0.20, ≤cT2c, Gleason sum ≤3+3, the number of cancer positive cores ≤3) were evaluated retrospectively. Patients were followed-up with quarterly PSA testing and semiannual digital rectal examination during the first 2 years, and semiannual PSA testing thereafter. Repeat biopsies were done annually and whenever indicated by clinical findings. Pathological progression was defined as increasing Gleason grade, number of cancer-positive cores, and/or increasing percentage of cancer in any core. Results Patients using (29/69: 42%) and not using (40/69: 58%) 5-ARI were followed for a median of 39 (IQR: 23-45) and 23.5 (IQR: 17-37.5) months, respectively. Pathological progression was observed in 32% (22/69) of the patients at a median of 25 (IQR: 18-39) months. Pathological progression was observed in 34.5% (10/29) and 30% (12/40) of the patients using and not using 5-ARI, respectively (Log-rank p=0.4151). Definitive treatment was done in 31% (9/29) and 47.5% (19/40) of the patients using and not using 5-ARI, respectively. Patients who did not use 5-ARI received definitive treatment earlier than 5-ARI users (Log-rank p=0.0342). On multivariate analysis, more than 2 cancer-positive cores (HR: 11.62) and age (HR: 0.94) were independently associated with pathological progression (p

To evaluate the effect of pre-operative alprazolam medication on anxiety and pain in flexible cystoscopy for bladder cancer follow-up.A total of 86 male patients who had flexible cystoscopy for bladder cancer follow-up at 6th and 9th months were included in the study. A visual analog scale (VAS) pain score and the State-Trait Anxiety Inventory (STAI) were used. The 6th (VAS-1)and 9th (VAS-2) month pain scores and 6th month STAI score (STAI-1) and, 9th month STAI score before (STAI-2a) and after alprazolam (0.5 mg) intake (STAI-2b) were compared.The mean age was 66.49±12.45 years. Patients were grouped by age≤65 (Group-1) and age≥66 (Group-2). Mean VAS score for VAS-1 and VAS-2 were 2.66±0.96 and 2.44±1.05, respectively (p=0.007). The mean VAS-1 and VAS-2 scores in Group 1 were 3.0±1.05 and 2.73±1.18, respectively (p=0.009). The mean VAS-1 and VAS-2 scores in Group 2 were 2.36±0.77 and 2.17±0.86 respectively (p=0.031). The differences between mean anxiety scores were all statistically significant. All STAI (1, 2a, and 2b) and VAS (1 and 2) scores in Group-1 were statistically significantly higher than Group-2. Increasing STAI score is associated with a statistically significant increase in the VAS scores in the 0.50 and 0.75 quantiles (p=0.021 and p=0.039, respectively).Using alprazolam before flexible cystoscopy reduces both anxiety (STAI-1 vs STAI-2b) and pain (VAS-1 vs VAS-2). Previous cystoscopy experience reduces anxiety (STAI-2a vs. STAI-2b). Elderly patients have less anxiety and pain scores than younger patients in flexible cystoscopy.

Introduction Human papillomavirus (HPV) is one of the most common sexually transmitted infections and is the cause of several different diseases in men and women. Although little is known about HPV infection in men, they are also in the risk group of HPV infection and play an important role in transmitting the virus to women. Aim To define the efficacy of the HPV vaccine through cross-immunization and its role in clearance of HPV infection, and to assess infection-associated factors in men. Methods This prospective randomized clinical study enrolled 171 evaluable men with genital warts between June 2009 and October 2013. After the initial treatment intervention, 91 patients were randomly assigned to receive HPV vaccine in three doses. Eighty patients were in the control (unvaccinated) group. One hundred-eleven men were single and 60 men were married. Patients who had previous treatment for pre-existing warts and medical disorders that needed chronic treatment or immunosuppression were not included in the randomization. Also 29 men with follow-up less than 12 months and incomplete vaccination were not included. Main Outcome Measures The patients were assessed regarding age, condom use, marital status, number of visible genital warts, and smoking status. Post-treatment follow-up was monthly up to 12th month. Results Mean age was 34±7.6. One hundred fifteen patients were smokers. For the recurrence of warts, age, smoking, vaccination status were insignificant and marital status was significant in the univariable analysis; only marital status preserved significance (HR: 2.0 CI:1.29–3.12 P =0.002) in the multivariable analysis including vaccination status, marital status, and smoking. Conclusion Among the investigated factors vaccination status was not but marital status significantly influenced wart recurrence. Married men had more recurrences in our population. Larger multicenter randomized clinical trials are lacking and seriously required to investigate the therapeutic effect of current quadrivalent HPV vaccine in genital warts. Coskuner ER, Ozkan TA, Karakose A, Dillioglugil O, and Cevik I. Impact of the quadrivalent HPV vaccine on disease recurrence in men exposed to HPV infection: A randomized study. J Sex Med 2014;11:2785–2791.

Two percent of the bladder non-muscle-invasive (NMI) transitional cell carcinomas (TCC) are associated with upper urinary tract (UUT) TCC. We evaluated the role of nuclear matrix protein-22 (NMP-22) (BladderChek) test in the diagnosis of lower urinary tract and UUT-TCC.From March 2009 to June 2011, 122 patients with bladder NMI-TCC underwent 205 control cystoscopy. A total of 95 (78 men and 17 women, mean age 60.7 years, range, 27-88) patients who were followed regularly with NMP-22 test and with follow-up cystoscopies (145 episodes; min. 1-max. 5) were included in this study. For routine monitoring of the UUT, IVU or CT urography was used once a year for high grades (HG), and once in every other year for low grades (LG). The sensitivity and specificity of NMP-22 were evaluated by ROC curves, and sensitivity, specificity, and positive and negative predictive values were calculated. Chi-square test was used for the differences between the subgroups.Cystoscopy and NMP-22 results of the patients included in the study revealed the sensitivity (44.4%) of the test was very low and the specificity (98.4%) was quite high (p0.001). Among the 10 cystoscopies where NMP-22 was negative, but cystoscopy was positive for tumor, 8 had LG and 2 had HG TCC. NMP-22 was never positive in low-grade tumors, in other words, all of the NMP-22-positive 8 tumors were high grade. On the other hand, in 20% (2/10) of the cases, NMP-22 can be negative although the tumor was high grade. Two (2.1%) HG UUT-TCC were detected in 95 patients. These 2 patients were within the 125 cystoscopies (75 patients) where both NMP-22 and cystoscopy were negative for tumor.Nuclear matrix protein-22 cannot detect LG TCC. However, it detects overwhelming majority of HG TCC. For this reason, positive NMP-22 test largely indicates HG TCC. NMP-22 is also not reliable in UUT-TCC, even in HG tumors.

In the great majority of the cases, transrectal ultrasound guided prostate biopsy (TRUS-Bx) is the definitive step in the diagnosis of prostate cancer (CaP). Although this procedure is well tolerated by most patients, it can result in considerable discomfort that can effectively be overcome with local injection anesthesia. In this study, we evaluated the effect of the size (i.e., circumference) of the transrectal probe on pain during TRUS-Bx.One hundred and seventy eligible patients who had elevated total prostate specific antigen (tPSA) and/or abnormal digital rectal examination (DRE) were included in this study. Patients (pts.) were divided into three TRUS-Bx groups; Group I: 60 pts. underwent TRUS-Bx with newer B-K Type 8808 probe (circumference 58 mm) under injectable periprostatic anesthesia, Group II: 60 pts. underwent TRUS-Bx with B-K Type 8551 probe (circumference 74 mm) under injectable periprostatic anesthesia, and Group III: 50 pts. underwent TRUS-Bx with B-K Type 8551 probe (circumference 74 mm) without local anesthesia. Periprostatic injection anesthesia was performed with 10 cc, 1% lidocaine (5 cc on each side) 10 min before TRUS-Bx. Pain was assessed using a 10-point modified visual analog scale (VAS) 15 min after the biopsy procedure.Three groups were homogeneous with respect to age and tPSA, and no statistically significant difference was observed in terms of mean biopsy duration between the 3 groups. Most of the patients experienced no pain to slight pain in Groups I and II, but 66% of the patients had more than moderate pain (VAS ≥ 5) in Group III with mean VAS score statistically higher than the other two groups (Group I vs. III, P = 0.0001; Group II vs. III, P = 0.0001). Mean VAS score was not statistically different between Group I and II (P = 0.126). No statistically significant difference in VAS pain perception was observed between different age categories within the Group I, II, and III.In the absence of injectable local anesthesia, larger probe (74 mm) results in much higher VAS pain perception than same size and smaller (58 mm) probe used under injectable local anesthesia. However, under injectable local anesthesia, the size (circumference) of the transrectal probe (58 mm vs. 74 mm) does not result in any different pain perception during TRUS-Bx.

Ureteral stent placement after ureteroscopic lithotripsy has some advantages and disadvantages. In this randomized study, the necessity of ureteral stent placement after uncomplicated ureteroscopy for impacted ureteral stones was assessed.Between 2005 and 2007, 60 evaluable patients were equally randomized to groups with and without stents. Patients underwent ureteroscopic pneumatic lithotripsy for ureteral stones. The operation was completed with or without stent placement according to the randomization order. Excretory urography was performed 3 months after the procedure. All stents were cystoscopically removed at the third postoperative week. Sociodemographic and clinical variables (age, sex, stone location, stone size, operative time, hospital stay, narcotic and nonnarcotic analgesic use), and postoperative complications (fever, pain delaying discharge, emergency department visit, urinary retention, stent-related irritative symptoms) were evaluated.Mean stone size was not significantly different in both groups. Mean operative time was significantly longer in the stent group: 30.5 +/- 9.6 vs 43.7 +/- 11.6 minutes. On the operation day and until postoperative day (POD) 5, narcotic (P = 0.004) and nonnarcotic analgesic (P = not significant) use was more frequent in the no-stent group. At POD 5 and later, although narcotic and nonnarcotic analgesic use were frequently necessary in the stent group, both were almost unnecessary in the no-stent patients. Stent-related irritative symptoms were overwhelmingly higher (10% vs 93%) in the stent group. Discharge was delayed (23% vs 10%) and unplanned emergency department visits (20% vs 10%) were exercised almost two times more commonly in the no-stent group. Stone-free rates were identical (n = 29/30; 97%) in both groups.Routine placement of a ureteral stent is not mandatory in patients without complications after ureteroscopic lithotripsy for impacted ureteral stones. Stent placement can be argued and agreed with the patients preoperatively in the light of the data presented above.

Retained surgical gauze is a rare but known problem in patients who have medical history of surgery. Suspicion and evaluation of this rare condition is sometimes very difficult for the clinician because retained surgical sponges can be totally asymptomatic or can hide themselves perfectly in the plain abdominal films. For this reason clinican should excersize high rate of suspicion, should not solely depend upon plain films and should consider more sophisticated examinations like ultrasonography (US) or computerized tomography for the appropriate management of these retained sponges. We present here a very unusual and late presentation of surgically retained gauze which gave a false appearance of a kidney with decreased functional activitity in the excretory urography (EU) 32 years after nephrectomy.

Objectives To evaluate, in a prospective study, the benefit of adding local periapical prostatic anesthesia to routine periprostatic infiltration to the prostate-seminal vesicle junction in a randomized fashion. Transrectal ultrasound-guided biopsy is the reference standard in the diagnosis of prostate cancer. Although well tolerated by most patients, it can be associated with discomfort. Methods A total of 120 consecutive evaluable patients with an elevated total prostate-specific antigen (tPSA) level, increased tPSA velocity, and/or abnormal digital rectal examination findings were enrolled. The patients were randomized into two groups. Group 1 received periprostatic infiltration of 6 mL 1% lidocaine. Group 2 received periprostatic and apical infiltration: 4 mL 1% lidocaine at the prostate-seminal vesicle junction and 2-mL infiltration at the prostatic apex 15 minutes before transrectal ultrasound-guided biopsy. Pain was assessed using a 10-point modified visual analog scale. Results The mean patient age was 63.7 ± 1.2 years and 64.2 ± 1.1 years, the mean tPSA level was 12.1 ± 1.5 ng/mL and 13.6 ± 2.7 ng/mL, the mean biopsy duration was 6.2 ± 2.5 minutes and 6.1 ± 2.2 minutes, and the mean visual analog scale pain score was 1.26 ± 0.1 and 1.23 ± 0.1 for groups 1 and 2, respectively. No statistically significant difference was observed with respect to age, tPSA level, mean biopsy duration, or pain score between the two groups. Conclusions Periprostatic lidocaine infiltration provides local anesthesia that results in improved visual analog scale pain scores. Additional apical infiltration did not improve patient discomfort further. However, comparative evidence has indicated that increasing the time elapsed between the anesthetic infiltration and the biopsy procedure may further improve pain control.

Bipolar plasma kinetic (BP) transurethral resection of prostate (TURP) has been proved to be a safe and effective treatment for benign prostatic enlargement (BPE). However, the role of bipolar TURP on large prostates over 100 g compared with open suprapubic prostatectomy (SP) in elderly patients (65 years) has not ever been studied before.A retrospective analysis of patients' medical records between 2007 and 2012 was performed. A total of 102 patients who underwent SP (n = 44) or BP-TURP [Gyrus Plasma Kinetic™ (Gyrus ACMI, USA)] (n = 58) for obstructive lower urinary tract symptoms due to BPE were included in this retrospective study. Inclusion criteria were age ≥65 years, prostate volume ≥100 g, International Prostate Symptom Score (IPSS) ≥18, and peak urinary flow rate (PFR) ≤15 ml/s. Exclusion criteria were urethral stricture, known history of neurogenic bladder due to neural disorders, previous prostate and/or urethral surgery, bladder stone, bladder cancer, and known prostate cancer. Operation time, hospitalization, and catheter removal times were noted. Patients were re-evaluated at postoperative 3rd and 12th months. Evaluated parameters were IPSS, quality of life (QoL), simplified International Index of Erectile Function-5 (IIEF-5), PFR, post-voiding residual urinary volume (PVR). Statistical significance was set at 0.05 and all tests were two-tailed.Preoperative IPSS, PVR, IIEF-5, QoL, and prostate volume were not statistically significantly different between two groups except for PFR. Mean follow-up for BP-TURP and SP groups were 15.0 ± 5.8 (R: 11-38), 22.1 ± 11.2 (R: 11-59) months, respectively (p0.001). When compared with SP, mean catheter removal time (p0.001) and median hospitalization time (p0.001) were significantly shorter in BP-TURP group. However, mean operative time was significantly (p0.001) longer than SP group and also median resected material weight was significantly lower in the BP-TURP group (p0.001). IPSS, QoL, PFR, PVR, and IIEF-5 scores at postoperative 3rd and 12th month were not significantly different between the two groups (p0.05). Thirty-three patients had perioperative complications according to the modified Clavien-Dindo system. Thirteen patients (22.4 %) in BP-TURP group and 20 patients (45.4 %) in SP group had complications. In 12th month follow-up visit, four patients presented with urethral stricture, three patients (5.1 %) were in BP-TURP group, and one patient (2.3 %) in SP group (p = 0.455). All strictures were treated with internal urethrotomy.BP-TURP is a safe and highly effective treatment modality for BPE in the elderly patients with prostate glands over 100 g. Clinical efficacy and postoperative 12th month's results were similar to SP. Larger studies with longer follow-up are needed in order to confirm our findings.

INTRODUCTION AND OBJECTIVES: Human papillomavirus (HPV) is one of the most common sexually transmitted infections. In 2009, FDA recommended HPV vaccine for the prevention of external genital lesions caused by HPV 6, 11, 16, or 18. There are conflicting results regarding cross protection from naturally occurring HPV infection. According to recent studies HPV vaccination can induce neutralizing antibodies across HPV species. Our purpose was to define the importance of immunization and its role in clearance of HPV infection and to assess infection-associated factors in men. METHODS: This prospective randomized trial enrolled 200 men with genital warts (GW), between June, 2009 and October, 2013. GW were diagnosed solely with their clinical features and their reaction to the aceto-white. Pathologic examination was performed in suspicious cases. Initial treatment was local excision with electrocautery or electrocautery alone in all patients. After the initial intervention, 200 patients were randomly assigned to receive a HPV vaccine in three doses (0, 2, 6 mos). Hundred patients were in the control (unvaccinated) group. All men were circumcised and reported only female sexual partners. Thirtynine men were excluded due to pre-existing medical disorders that needed chronic treatment or caused immunosuppression, follow-up (F/ U) less than 12 months and incomplete vaccination. Finally, 171 consecutive patients were included in study. There were 91 men in the vaccinated group and 80 men in the control group. One hundred-eleven were single and 60 men were married. The patients were assessed regarding age, marital status (MS), number of GW, physical examination and smoking status. Post-treatment F/U was monthly up to 6 months and one more at the 12th mo. GW recurrences were analyzed with Cox proportional hazards model. RESULTS: Mean age was 34 7.6. One hundred-fifteen (67.25%) patients were smokers. For the recurrence of GW, age, smoking, vaccination status (VS) were insignificant and MS was significant (p

Extracorporeal shockwave lithotripsy (SWL) remains the first-line treatment of urinary calculi. However, a number of studies have shown that adverse effects on the kidneys and the surrounding tissues may be encountered in short- and long-term follow-up. The aim of this study was to compare the effects of single-shot and twin-shot SWL techniques to identify the safest modality in terms of urinary enzyme excretion.In this prospective, investigator-blinded, randomized study, urinary enzymes, beta2-microglobulin, microalbumin, Na, K, Ca, and creatinine concentrations were analyzed in 59 consecutive patients. Measurements were performed in urine specimens collected immediately before and after the SWL procedure and also on the 3rd and 7th days after treatment, which was performed on a Dornier MFL-5000 lithotripter utilizing the twin-shot technique (Group 1; N = 30) or the single-shot technique (Group 2; N = 29) with 3000 shockwaves at 18 kV per treatment.Although there was no statistically significant difference in the results between the groups, urinary levels of microalbumin, alanine and aspartate aminotransferases, beta-2-microalbumin, gamma-glutamyltranspeptidase, Na, K, and Ca rose acutely after SWL, reaching maximum levels on the 3rd day, and returned to the baseline by the 7th day following the treatment in both groups.This study demonstrates that SWL performed by either a single-shot or twin-shot shockwave technique has a transient detrimental effect on renal function, as assessed by urine enzyme concentrations. It is recommended that the twin-shot shockwave technique be used in routine lithotripsy in consideration of the cost-effectiveness provided by the shorter treatment time.

Objectives. To investigate the correlation of epidermal growth factor receptor (EGFR) expression and its ligands EGF and transforming growth factor-alpha (TGF-α) with disease outcome in a cohort of patients with superficial bladder cancer. Methods. Tumor samples of 21 patients with transitional cell carcinoma of the bladder were analyzed by immunohistochemistry for expression of EGFR, EGF, and TGF-α. Disease-related events were recorded during a routine clinical follow-up and analyzed for possible correlation with the expression status of the above-mentioned proteins. Results. All Stage pT1 transitional cell carcinomas expressed EGFR, and 10 of 21 (48%) tumors showed focal areas of strong EGF and/or TGF-α expression. Of these, 80% with EGF positivity (8 of 10) had recurrences, whereas only 9% of patients without EGF staining (1 of 11) did so. The same pattern was observed with TGF-α. A strong association was confirmed between EGF/TGF-α positivity and tumor recurrence (P

Objective To determine whether the free/total prostate-specific antigen (PSA) ratio can discriminate between patients with prostate cancer or benign prostatic hyperplasia (BPH). Patients and methods A prospective study was conducted using free and total PSA assays in patients who underwent transrectal-ultrasound guided biopsies indicated by a total serum PSA level of >4 ng/mL and/or a positive digital rectal examination. Sixty-nine men (median age 68 years, range 57–86) who presented to our out-patient department with symptoms of prostatism were included in the study. Blood samples were drawn from all patients before biopsy. Results Histopathological examination detected prostate cancer in 17 of 69 (25%) patients and 13 of these 17 patients had a free/total PSA ratio of

Objective Prostate-specific antigen (PSA) is widely used as a tumor marker in the early detection of prostate cancer. However, its value is limited by several factors such as not being specific for the cancer tissue, diurnal variations of the secretion, and changes in the serum levels observed following rectal manipulations. The effect of digital rectal examination (DRE) on serum PSA levels is still debatable. Methods A prospective study is conducted by utilizing the IRMA count (monoclonal) PSA assay in order to determine the effect of DRE on PSA serum levels. A total of 50 men (median age 61, range 42-75 years) who presented to our outpatient clinic for the first time with lower urinary tract outflow obstruction symptoms were included in this study. Further evaluation revealed prostate cancer in 5 patients (10%) and benign prostate hyperplasia in the others. Blood samples were drawn for a PSA assay from all patients prior to and 30 min and 24 h following DRE (PSA 1-3). Results The mean PSA values prior to and 30 min and 24 h following DRE were 4.09 +/- 0.67 range 0.2-19.47) ng/ml, 4.50 +/- 0.63 (0.15-17.75), and 4.28 +/- 0.68 (0.23-24.12) ng/ml, respectively. The median PSA levels for PSA 1, PSA 2, and PSA 3 were 2.49 +/- 4.74, 3.22 +/- 4.48, and 2.62 +/- 4.82 ng/ml, respectively. Although, there was a statistically significant increase in serum PSA levels 30 min after DRE, the clinical significance of this increase in PSA values with a mean difference of 0.4 ng/ml remains to be clarified. Conclusion Although the effect of DRE on PSA levels does not appear to be clinically significant, in order to prevent any confusion, it may be the best approach to perform DRE after obtaining serum for PSA analysis.

We applied the silver staining of nucleolar organizer regions (AgNOR) technique to the pretreatment biopsies of 50 cases of advanced prostate cancer. Three different counting methods were utilized in the enumeration of AgNORs. All methods yielded statistically significant differences of mean AgNOR counts of groups defined by high and low WHO, and by Gleason grades. However, there was overlap among groups, and further analysis of counts by grouping of patients according to their stage, response to treatment, and prognosis was not conclusive. Replicate counts were performed in 10 cases. While intraobserver reproducibility was high by all methods, only the second counting method yielded nonsignificant interobserver variability. There was a significant intratumoral heterogeneity of AgNOR scores. Lack of technical standardization, low reproducibility, and lack of correlation with prognosis limit the use of AgNOR counts in advanced carcinoma of the prostate. &1995 Wiley-Liss, Inc.

In an attempt to enhance the success of prostate-specific antigen (PSA) in the diagnosis and staging of prostate carcinoma (PCa) the concept of PSA density (PSAD) has been introduced by Benson et al. Likewise a study to investigate the role of PSAD in 53 patients with PCa and 47 patients with benign prostatic hyperplasia (BPH) has been done. PSADs seemed to increase directly proportional to the grade in PCa and differed significantly between patient groups with BPH and localized+metastatic PCa, BPH and localized PCa, and localized PCa and metastatic PCa. Although 0.6 level for PSAD seemed to be a rational cut-off level in our study, this issue needs to be studied in multiple centers involving an increased number of patients for resolution.

We describe a new technique that can easily be used as a tension-free practical alternative in closing the renal defects resulting after open partial nephrectomy (PN).A new technique (called "lipocorticoplasty") where "wrapped fatty tissue" was placed in the tumor crater to close the renal defects that occur following PN is reported in 10 consecutive patients who underwent PN between May 2006 and January 2009 (Group I). Patients were compared with equal number of consecutive patients who underwent standard open PN before January 2009 (Group II) in terms of operative time, bleeding, tumor size, drain removal time, postoperative length of stay (PLOS), complications, and functional and oncological follow-up. Postoperative follow-up included physical examination, laboratory tests, and radiological screening at 3-month intervals for the first year, at 6-month intervals for the second year, and annually thereafter.Mean tumor size (35.2 vs. 33.8 mm), operative time (156 vs. 165 min), bleeding (650 vs. 765 cc), drain removal time (2.8 vs. 2.5 POD), and PLOS (4.4 vs. 4.2 POD) were not statistically different between Group I and Group II, respectively. No intraoperative complications occurred. Postoperatively, transient complications without any permanent sequela were observed in 3 (1 in Group I and 2 in Group II) patients. Mean follow-up time was 16.1 months (7-26) in Group I and 19.1 months (8-36) in Group II. None of the patients had local or systemic recurrence at follow-up.Our new technique provides obvious benefits in local hemostasis, simplifies parenchymal suturing, obviates the need for coaptation of the edges of the tumor bed defect under tension, and minimizes nephron loss due to kinking and tearing of renal parenchyma in the closure of the renal defects following open renal tumor excision.

Objective To evaluate the efficacy of digital rectal examination (DRE), transrectal ultrasonography (TRUS), prostate-specific antigen (PSA) and PSA density (PSAD) in the diagnosis of prostate cancer (CaP). Patients and methods Retrospective data were analysed from a selected population of 159 patients (mean age 66.7 years, range 50–83), 56 with histologically diagnosed CaP and 103 with benign prostatic hyperplasia (BPH). Results Among the four methods, DRE was found to have accuracy, sensitivity and specificity rates of 79.9, 91 and 73.8% respectively. The most common clinical practice, the combination of PSA (> 4 ng/mL), DRE and TRUS, showed a higher accuracy, a similar specificity rate, but a lower sensitivity (84.2, 91.2 and 71.4%, respectively). Rates from the combination of PSAD (> 0.15 ng/mL/cm3) with DRE and TRUS were not significantly different from those obtained using the combination of PSA, DRE and TRUS. Conclusion PSAD alone or in combination did not improve the diagnostic value of PSA. We cannot claim DRE was the best method for the diagnosis of CaP, because this study group did not represent a true screening population. However, this study revealed that DRE should not be omitted from the physical examination of patients and, despite technological developments, it remains a major tool in the diagnosis of CaP.

Transrectal ultrasound (TRUS)-guided biopsy remains the mainstay of the diagnosis of prostate cancer. Although this diagnostic method is a safe procedure and well tolerated by most patients a significant number of patients report discomfort and pain during prostate biopsy. In order to define the best method of anesthesia, many studies, in which different methods were compared, have been performed. To determine the effectiveness of local injection anesthesia in TRUS-guided prostate biopsy, we designed and performed this prospective study in order to evaluate the utility of periprostatic nerve block for pain management. A total of 100 patients who had elevated total prostate-specific antigen (tPSA) and/or abnormal digital rectal examination (DRE) were included in this study. Half of the patients received periprostatic injection anesthesia (group I) and the remaining half received placebo (group II). Patients received 10 cm3 (5 cm3 each side) 1% lidocaine injected into the periprostatic nerve plexus under transrectal ultrasonic guidance. Pain during biopsy was assessed using a 10-point modified visual analog scale (VAS). In groups I and II, mean patient age was 66.8+2.5 and 65.6+11.5 y, mean tPSA was 7.87+/-3.6 and 11.3+/-1.7 ng/ml, mean biopsy duration was 6.5+/-2.5 and 6.6+/-2.2 min and mean pain score during TRUS-guided biopsy was 1.46+/-2.2 and 4.5+/-2.1, respectively. No statistically significant difference was observed with respect to age, tPSA and mean biopsy duration between these groups. Mean pain VAS score was statistically or significantly better (P=0.0001) in the lidocaine injection group (group I), and furthermore no patient had a VAS pain scoreor =5 in this group. Only minor and transient complications occurred in both groups. This study reinforces the usage of periprostatic nerve block as a standard method of pain management during TRUS-guided prostate biopsy, because it is simple, safe, uncostly and significantly effective without requiring additional time.

Introduction and Objectives: Transrectal ultrasound guided biopsy is an essential part in the diagnosis of prostate cancer. Although this procedure is well tolerated by most patients, sometimes it can result in some uneasiness. In this randomised double-blind placebo controlled study, we evaluated the effectiveness of intrarectal lidocaine during TRUS guided biopsy. Materials and Methods: 100 consecutive eligible patients who had elevated total prostate specific antigen (tPSA) and/or abnormal digital rectal examination (DRE) were included into this study. Patients were randomised into two groups. Group I received 20 cc of 2% intrarectal lidocaine 20 minutes before transrectal ultrasound guided biopsy and Group II received same amount of serum physiologic. Pain was assessed using a 10 point modified visual analog scale. Results: Mean patient age was 65.5±2.5 and 64.5±11.5 years, mean tPSA was 12.3±3.6 and 11.3±1.7 ng/ml, mean biopsy duration was 6.8±2.5 and 6.6±2.2 minutes, mean pain score during transrectal ultrasound guided biopsy was 4.8±2.2 and 4.4±2.1 in Groups I and II, respectively. No statistically significant difference was observed with respect to age, tPSA, mean biopsy duration and pain score between these groups. There was only one patient who could not tolerate the procedure at all, and he was paradoxically in the lidocaine group. Conclusion: The use of intrarectal lidocaine is not superior to placebo during transrectal prostate biopsy for pain control.

The management of patients with recurrent urethral strictures represents a challenge for the practicing urologist.We used holmium:yttrium-aluminum-garnet (Ho:YAG) laser in the management of recurrent urethral strictures in 13 patients. The energy level was set at 1.0 at a frequency of 10 pulses/sec. No treatment complications were observed. The mean preoperative maximum flow rate by uroflowmetric analysis was 3.8 mL/sec.Nine patients (69%) continue to do well with no symptoms at a median follow-up of 27 months with a mean maximum flow rate of 19 mL/sec. Of the four patients in whom treatment failed, three were retreated with the Ho:YAG laser. One of them was managed by insertion of a permanent urethral stent, another continues to do well without any further treatment, and the other is managed with dilation by self-catheterization. One of the four failures underwent open reconstructive urethroplasty after recurrence following his first treatment with the Ho:YAG laser.Our preliminary results suggest that Ho:YAG laser ablation of urethral strictures is safe and might be a reasonable alternative endoscopic treatment for recurrent urethral strictures.

Estimation of prostate gland volume with transrectal ultrasonography (TRUS) provides important information in the evaluation of benign and malignant prostate disease. We evaluated 119 patients with clinically benign prostatic hyperplasia (BPH) by TRUS. Sixty-eight of these underwent transurethral resection of the prostate (TUR-P), and 51 patients underwent open prostatectomy. In both groups the estimated weight correlated well with the removed prostatic weight (r = 0.643, p0.0001 in TUR-P and r = 0.729, p0.0001 in open prostatectomy). We found that TRUS is a valuable method for estimation of prostatic volume in patients with BPH.

Encrusted cystitis (EC) was first described as chronic cystitis with mucosal calcification in 1914 (1). It is a very rare chronic inflammatory disease presenting with dysuria, pelvic pain and gross hematuria. Voided urine contains mucus or calcified mucopurulent stone like particles. Urinalysis always reveals alkaline pH. It may be present in healthy individuals with no predisposing etiological factors (2-4). Etiologically, previous urological diseases, immunosuppression, urinary infection with urea splitting bacteria, or urological interventions resulting in bladder mucosa trauma may also be present (5, 6). In the present case report, we describe a novel treatment for EC with intravesical dimethyl sulfoxide.