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Introduction To determine the factors affecting the success of distal hypospadias repair in adults. Material and methods Medical records of adult patients who underwent distal hypospadias repair in our clinic were reviewed. Patient's age, external urethral meatus location, hypospadias status, anesthesia type, diversion type, nelaton diameter and surgeons were recorded as factors affecting surgery success. Only patients, operated with tubularisation incised plate urethroplasty (TIPU) technique, were included. Results were classified as successful, stricture, fistula and slough. We compared the factors affecting the success. SPSS 16.0 were used for statistical assessment and logistic regression analysis was used to determine success. p Results One hundred and eight patients underwent distal hypospadias repair in our clinic. Mean age was 21.44 ± 2.0. 38 patients had distal penile, 67 patients had subcoronal, 2 patients had coronal and 1 patient had glandular hypospadias. Eighty eight patients had primary, 12 secondary, 5 tertiary and 3 cripple hypospadias. Seventy eight patients underwent TIPU under local anesthesia, and 30 patients underwent under spinal anesthesia. Suprapubic catheter was used in 92 patients and transurethral catheter was used in 16 patients. Sixteen different surgeons performed the operations. Seventy operations were successful. Three stricture, 24 fistula, and 11 slough were determined. Overall success rate was 64.81%. Patient's age, external urethral meatus location, anesthesia type, diversion type, nelaton diameter and the surgeon difference did not affected surgical outcomes. Only hypospadias status (primary/redo) affected the success (p = 0.037). Conclusion The only factor affecting surgical outcomes of distal hypospadias repair in adults seems to be hypospadias status. It might be due to the lack of second layer in the redo operations.

Objectives Our aim was to examine correlation between Post-void residual urine (PVR) after uroflowmetry and random PVR. Methods Male patients reporting to the Urology outpatient clinic with LUTS were selected. Patients' age, prostate volume, bladder capacity, voided volume, maximum flow rate, average flow rate, random PVR and PVR after uroflowmetry were recorded. We evaluated the correlations between these parameters. Also we assessed if there was a difference between random PVR and PVR after uroflowmetry. We divided PVR after uroflowmetry and random PVR into three groups: Group 1: 0–50 mL, Group 2: 51–100 mL and Group 3: >100 mL. Also we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2: >400 mL. We compared these groups to determine whether a significant difference. Results Seventy-seven patients applying to the urology outpatient clinic were assessed between 2013 and 2014. PVR after uroflowmetry was significantly higher than random PVR (P 400 mL, PVR after uroflowmetry was different, but random PVR was similar (P

OBJECTIVE To compare two different doses of lidocaine used for periprostatic nerve block on pain perception during transrectal ultrasound (TRUS) guided prostate biopsy. MATERIAL AND METHODS A total of 288 patients with elevated prostate specific antigen (PSA) levels and/or abnormal digital rectal examination who underwent TRUS-guided prostate biopsy were included in the study. The patients were divided into 3 groups: Group 1 (n=103) prostate biopsy were performed after administering perianal intrarectal application of 10 mL 2% lidocaine gel, Group 2 (n=98) 2 mL of 2% lidocaine injection on each side following rectal installation of lidocaine gel and Group 3 (n=87) 4 mL of 2% lidocaine injection on each side after rectal instillation of lidocaine gel. Patients' pain scores during biopsy procedure were reported using visual analogue score (VAS). Independent sample t test, ANOVA test and Tukey test were used for statistical evaluation. RESULTS The mean age, prostate volume and PSA level were 65.6±8.4 years, 58.2±34.8 mL, and 11.8±3.4 ng/mL respectively. There were no statistically significant differences in baseline characteristics between the groups. The mean VAS scores were 2.4±1.8 in Group 1, 2.5±1.9 in Group 2 and 1.6±1.6 in Group 3. Patients in Group 3, reported significant pain reduction compared with patients in Groups 1 and 2 (p=0.002, and 0.001, respectively). However, there was no statistically significant difference in VAS scores between Groups 1 and 2 (p=0.815). CONCLUSION According to our results we recommend the use of perianal intrarectal lidocain gel application, and periprostatic nerve block with injection of 4 ml 2% lidocaine per side combination in TRUS-guided prostate biopsies. Further large-scale randomized control studies are needed to validate these finding.

Objective: Our aim was to evaluate and determine the frequency of Transmembrane protease, serine 2 (TMPRSS2)-ERG fusion in Turkish patients with clinically localized prostate cancer by using immunohistochemistry and reveal its relationship with clinicopathologic variables. Material and methods: Radical prostatectomy specimens of 99 patients, who underwent radical retropubic prostatectomy for localized cancer, between January 2002 and December 2011 were analyzed in the study. To detect ERG fusions, monoclonal ERG antibodyclone ID: EPR3864 (Epitomics, San Diego, CA, USA) and monoclonal anti-ERG antibody (9FY) (BiocareMedical, LLC, USA) were used. The immunistochemical expression of ERG protein was assessed as positive or negative regardless of stain intensity. Patients’ age, total and primary Gleason scores, PSA levels, prostate volumes, tumor volumes, tumor stages and perineural invasion status were analysed retrospectively. Total fusion rate and correlation between the variables and fusion were evaluated. Results: Mean age, prostate volume, tumor volume, PSA value of 99 patients were 62.02 years (±5.93), 50.02 cc (±20.67), 3.19 cc (±4.16), and 9.34 ng/mL (±3.37) respectively. TMPRSS2-ERG fusion was seen in 46 (46.5%) of 99 patients. When the variables analysed with independent samples t test to predict fusion (+) status, none of them was found to be statistically significant. When evaluated by logistic regression analysis for (+) or (-) status, only tumor stage was found to be statistically significantly correlated with fusion (p=0.049). Conclusion: The incidence of TMPRSS-ERG fusion in patients with localised prostate cancer in our study with Turkish population was found as 46.5%. Only tumor stage correlated with TMPRSS2-ERG fusion.

Objective To analyze the contribution of multiparametric MRI and PCA3 assay, pre- decision of initial biopsy in PSA level between 3-10 ng/mL patients with normal digital rectal examination(DRE). Materials and Methods PSA level 3-10 ng/mL ,patients, with normal DRE results and no previous prostate biopsy history, were included in this study. Each patient underwent multiparametric MRI one week before biopsy. Urine sample taking for PCA3 examination preceded the biopsy. Systematic and targeted biopsies were conducted. Patients with high PSA levels were seperated into two groups as: high PCA3 scored and low PCA3 scored. Then each group was divided into two sub-groups as: MRI lesion positive and negative. Tumor incidence, positive predictive values(PPV) and negative predictive values(NPV) were calculated. Results 53 patients were included between February 2013 and March 2014.Mean age 61.22 ± 1.06. Mean PSA value 5.13 ± 0.19 ng / mL. Mean PCA3 score 98.01 ± 23.13 and mean prostate size was 48.96 ± 2.67 grams. Fourty nine patients had both PCA3 score and multiparametric MRI. The PCA3’s PPV value was 58.33%. If multiparametric MRI lesions are added to high PCA3 scores , the PPV appears to elevate to 91.66%. NPV of PCA3 was 96%. NPV was 95% when there was no lesion in the multiparametric MRI with low PCA3 scores. Sensitivity was 91.66% , specificity was 95% respectively. Conclusion Adding multimetric MRI can also support biopsy decision for patients with high PCA3 value. When PCA3 value is low, patients can be survailled without any need to take a MRI.

Objective Radical prostatectomy may have a significant impact on quality of life (QoL) because of erectile dysfunction, depression and incontinence. In this study, the mood and QoL of patients who underwent radical prostatectomy due to localized prostate Ca and were non-relapsed at least 12 months after operation were evaluated. Materials and methods We evaluated 35 patients who underwent radical prostatectomy operation between 2000 and 2011 and showed no reduction during 12 months observation. IIEF, Beck Depression test, and EORTC 3.0 quality of life were given and scored. In this study, the effects of erectile dysfunction according to Beck depression test and QoL scores and correlation between the mood and QoL are evaluated. Results In our study, ED groups categorized as mild, moderate and severe had no correlation with Beck depression scores ( p = 0.874). But only the patients with severe and moderate erectile dysfunction had moderate and severe depression scores. Negative correlation was determined ( p = 0.013) when Beck Depression scores with IIEF scores without categorizing ED groups. Correspondingly, negative correlation was determined ( p = 0.048) between QoL and IIEF scores, whereas positive correlation was determined ( r = 0.756 and p Conclusions We observed that an increase of erectile dysfunction elevated depression symptoms and resulted in bad quality of life. During tumor control, it is important to use methods that do not affect QoL.

Introduction Our aim was to assess our TIP urethroplasty results in adults with local anaesthesia. Materials and methods Medical records of adult patients who underwent TIP urethroplasty due to distal hypospadias in our clinic between April 2006 and May 2013 were reviewed. Patient's age, external urethral location, preoperative calibration size of urethra, primary or secondary or more, circumsized or uncircumsized conditions were recorded. The records were categorized as circumcised–uncircumcised, urethral stent calibration 16 Fr and above or 14 Fr and below, primer or seconder and above, special group or the others. SPSS 16.0 were used for statistical assessment and chi-square test was used to determine success. p Results 51 patients underwent distal hipospadias repair under local anaesthesia in our clinic between April 2006 and May 2013. Mean age was 21.3. 24 patients had coronal, 26 patients had subcoronal, 1 patient had glanuler hypospadias. 40 patients were primary, 7 secondary, 4 tertiary. 38 patients were circumsized. 13 patients were uncircumsized. Mean preoperative calibration was 14.8 Fr, mean urethral stent calibre was 15, 1 Fr, mean stent duration time was 5.9 day. Suprapubic catheter was used for drainage at 48 patients. 22(52.3%) were successful, 20(47.6%) were unsuccessful of 42 patients with follow up. 13 patients that had fistula underwent fistula repair after 3 months later under local anaesthesia. 2 patients had stricture and they underwent meatotomy and dilatation. On one patient, second TIP urethoplasty operation was performed because the first operation was unsuccessful. Operation was very successful and it upgraded our over all success to 90.4%. An optimal group as primary, uncircumcised, 16 Fr neourethra was formed and were compared with the other groups. Success rate between optimal group and others was not different statistically. Conclusion Our success rate was similar to literature. This survey reveals that distal hypospadias repair can be performed under local anaesthesia.

Objectives: We aimed to evaluate the circumcision status and complications, and the value of penile visibility index in predicting circumcision complications among elementary school children. Patients and Methods: Elementary school students were evaluated with physical exam in terms of circumcision complications. Visible penile length/stretched penile length ratio was calculated for each subject and recorded as penile visibility index (PVI). Data were assessed with SPSS 15.0 software. Results: Average age was 9.04 (5 - 14) years. Circumcision complications were detected in 84 of 361 circumcised subjects (23.2%). There was no relationship between age at circumcision and complications (p > 0.05). Concealed penis was detected in 3.6% of all subjects. Mean PVI was significantly different between cases with and without glanular adhesion, and between cases with and without residual prepuce. On the overall, mean PVI in complication and no complication groups were 0.52 and 0.59 respectively, and the difference was statistically significant (p

Inflatable penile prosthesis (IPP) implantation is a successful method for treatment of erectile dysfunction. IPP placements have rare complications. In this paper, we present a highly unusual case of an inguinal hernia as a short-term complication of a 3-piece IPP implantation. The patient was a 55-year-old man with erectile dysfunction due to diabetes mellitus. He presented 3 weeks after implantation with a strong cough. On exploration, the reservoir was seen in direct inguinal hernia sac. After removing the reservoir from the sac, the hernia was repaired with mesh and the reservoir was placed in the space of Retzius again. The patient is symptom free at follow-up.

OBJECTIVE: Active surveillance has become a management option for low-risk prostate cancer patients, while keeping the curative treatment option available. In this study, we evaluated the our results of active surveillance for localized prostate cancer patients. MATERIAL AND METHODS: Patients diagnosed with localized prostate cancer who chose an active surveillance protocol were followed with PSA measurements, digital rectal examinations, and TRUS-guided biopsies. The patients' data and rebiopsy results were evaluated. The results were compared with the results of the patients who had definitive treatment. RESULTS: Forty-one patients on active surveillance and 34 patients with at least one rebiopsy were included in the study. Twenty-seven patients who had more than one rebiopsy were followed for an average of 27.7 (12-78) months. Twelve patients (44.4%) had undergone definitive treatment including radical prostatectomy (n=9), and radiotherapy (n=3). There were 17 patients under surveillance after a second biopsy, and 9 (33%) of them had a third biopsy. Among these 9 patients, 7 patients were kept under surveillance, and 2 (7%) them had a fourth biopsy. Active surveillance of 15 out of 17 patients who have not undergone definitive treatment is still ongoing. CONCLUSION: Active surveillance is a treatment option refrains low-risk prostate cancer patients from the complications of an early or unnecessary definitive treatment and related reduction in the quality of their lives. while keeping the curative treatment option available. Active surveillance can be applied safely with the appropriate patient selection, regular examinations and tests.

Objective To evaluate the clinical and histopathological results of adult unilateral cryptorchidism patients. Material and methods Data from adult unilateral cryptorchidism patients that underwent orchiectomy in our clinic between between January 2004 and March 2013 were retrospectively evaluated. Patients were divided into three groups as intra-abdominal, inguinal canal and superficial inguinal region according to the location of the undescended testes. Patients were also grouped according to their testicular volume ( 12 cc). Histopathology results of orchiectomy specimens were classified as follows: 1. Sertoli cells only, testicular atrophy and vanished testis (anorchia) 2. Hypospermatogenesis, and 3. Maturation arrest. Patients were grouped as normospermia, azoospermia and oligo/astheno/teratospermia groups according to semen analysis results. Correlations between testicular localization, testicular size, semen analysis and pathology results were evaluated. Incidental tumor detection rates were also calculated. Results Two hundred and forty-four adult unilateral cryptorchidism patients underwent orchiectomy in our clinic. There was no a significant relationship between location of the testis and testicular pathology results (p=0.707). Most common semen analysis results was normospermia in patients with high testicular volume group however azoospermia and oligoasthenospermia observed commonly in patients with low testicular volume group. There was a significant relationship between testicular volume and semen analysis results (p=0.023). No significant relationship was observed between semen analysis and pathological results (p=0.929). After an evaluation of all factors with possible effects on the semen analysis results, only testicular volume (p=0.036) was found to have a significant impact. Only one case (0.4%) was incidentally diagnosed seminoma after a review of 233 patients with available histopathological results on record. Conclusion Adult unilateral cryptorchidism has a minimal effect on male fertility or even this effect can be overlooked. Low detection rates of incidental germ cell tumors also make an orchiectomy decision questionable in such cases.

Our aim was to examine correlation between Post-void residual urine (PVR) after uroflowmetry and random PVR.Male patients reporting to the Urology outpatient clinic with LUTS were selected. Patients' age, prostate volume, bladder capacity, voided volume, maximum flow rate, average flow rate, random PVR and PVR after uroflowmetry were recorded. We evaluated the correlations between these parameters. Also we assessed if there was a difference between random PVR and PVR after uroflowmetry. We divided PVR after uroflowmetry and random PVR into three groups: Group 1: 0-50 mL, Group 2: 51-100 mL and Group 3:100 mL. Also we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2:400 mL. We compared these groups to determine whether a significant difference.Seventy-seven patients applying to the urology outpatient clinic were assessed between 2013 and 2014. PVR after uroflowmetry was significantly higher than random PVR (P 0.001). When we divided PVR after uroflowmetry and random PVR into three groups there was a significant difference between the groups (P = 0.02). When we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2:400 mL, PVR after uroflowmetry was different, but random PVR was similar (P 0.001, P = 0.72).PVR after uroflowmetry seems to be incorrectly high in patients whose bladder capacity is above 400 mL.

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

The aim of the study is to investigate whether there is an effect of adult circumcision on ejaculation parameters and to research the relationship between intravaginal ejaculation latency time (IELT) and premature ejaculation diagnostic tool (PEDT). Adults who underwent voluntary circumcision between September 2010 and November 2011 were enrolled in this prospective study. The IELT before and 3 months following circumcision was recorded. Also, PEDT was filled out before and 3 months after circumcision. During statistical evaluation, the comparison of situations before and after circumcision was made using IELT averages and PEDT total scores. Furthermore, the correlation between changes in IELT and PEDT has also been evaluated. A total of 30 volunteers (mean age 21.25±0.44) were enrolled in the study. The volunteers' mean and median IELT before were 104.36±66.21 and 88 (26-307) seconds, whereas mean and median IELT after circumcision were 123.56±54.44 and 107.5 (67-300) seconds, respectively. The increase after circumcision was statistically significant (P=0.001). The mean and median PEDT score were 4.26±2.91 and 3 (1-12) before, and 2.63±1.82 and 2 (0-7) after circumcision. Improvement was statistically significant (P

To evaluate the discrepancy between tumor sizes determined from preoperative computed tomography (CT) and surgical specimens and its clinical implications.The charts of 86 patients who underwent surgical resection of a renal mass between 1995 and 2007 were reviewed retrospectively. Tumor size was determined both from preoperative CT and pathologic specimen. Histopathologic evaluation was done. Wilcoxon test was used to compare the mean radiographic tumor size on CT with the mean pathologic size. P0.05 was considered as the threshold for statistical significance.The median age was 59 (21-84). Clinical stage was T1a in 13, T1b in 47, and ≥ T2 in 26; pathologic stage was T1a in 12, T1b in 45, and ≥ T2 in 29 patients. Histological subtype was clear cell, papillary, chromophobe, sarcomatoid, and oncocytic in 72, 7, 5, 1, and 1 patients, respectively. Mean radiographic and pathologic size was 6.33 and 6.43 cm, respectively (p = 0.342). On the average, radiographic measurement underestimated pathologic size by 1 mm. When subgroups of patients according to tumor size were formed as4, 4-7, and7 cm, mean radiographic size was 2.79, 5.44, and 9.57 cm, mean pathologic size was 3.47, 5.62, and 9.26 cm, respectively. In subgroups of4, 4-7, and7 cm; radiographic measurement underestimated pathologic size by 0.68 (p = 0.018) and 0.18 cm (p = 0.470) and overestimated by 0.31 cm (p = 0.454), respectively.Overall discrepancy between radiographic and pathologic tumor sizes was 1 mm. No significant stage shift due to measurement error was detected. Our findings suggest that CT is an accurate method with which to estimate renal tumor size preoperatively.

Objectives To determine the rate of renal fragmentation resulting from blast effects and perform microscopic examination of renal arteries after gunshot wounds resulting from a high-velocity bullet. Methods A total of 194 patients with gunshot wounds due to blast effects underwent surgical exploration. Of the 194 patients, 35 (18%) had 37 renal unit injuries (2 patients had bilateral renal injury). Of the 37 renal units, 32 were treated with nephrectomy and 5 with renoraphy. During surgical exploration, 7 patients were found to have renal fragmentation resulting from blast effects. The distance between the bullet direction in the body and the renal parenchyma was evaluated. Also, the histologic changes in the renal artery were examined microscopically. Results Although the renal injury rate from abdominal gunshot wounds due to high-velocity bullets was 18%, the renal fragmentation rate due to blast effect was 0.36%. The mean distance between the bullet direction in the body and the renal parenchyma in patients with renal fragmentation was 2.2 cm (range 1 to 5). Two patients had intimal lacerations and one had minimal thrombosis. Conclusions Renal fragmentation from the blast effect in these patients was closely related to the distance between the bullet direction in the body and the renal parenchyma. The possibility was greater for close-range (less than 50 m) gunshots. We believe that the histologic changes in the renal artery are not very important in the patients.

Objectives: The aim of the present study was to assess and compare pre- and postoperative scrotal pain in patients with varicocele who underwent varicocelectomy with different approaches. Methods: The study included 144 consecutive patients with left-sided varicocele who had left scrotal pain for more than 3 months. All patients underwent varicocele ligation using either a subinguinal or inguinal approach with or without external spermatic vein ligation. We asked the patients to complete an ‘Assesment Questionnaire for Scrotal Pain’ both before and after the surgery. Results: The surgery was successful in 101 (83.4%) of the 121 patients available for follow up. Seventy-four (61.1%) patients reported the complete resolution of pain while 27 patients (22.3%) reported partial resolution. Symptoms worsened in a single case and pain persisted postoperatively in 19 cases (15.7%). There were no statistically significant differences in the characteristics of the pain and grade of varicocele between postoperative groups. A significant difference was observed in postoperative success between patients who had external spermatic vein ligation and those who did not, regardless of the surgical approach (inguinal or subinguinal). All patients who reported complete or partial resolution of pain stated that they would recommend surgery to relatives with the same problem. Conclusions: Varicocelectomy using either inguinal or subinguinal approaches is an effective and reasonable treatment option in this patient group and should include external spermatic vein ligation for a satisfactory outcome.

To perform Stoller afferent neurostimulation (SANS) with and without a low-dose anticholinergic (oxybutynin hydrochloride) in patients with detrusor overactivity and compare the results obtained with the two therapeutic approaches.A total of 43 patients with symptoms of detrusor overactivity (frequency, urgency, urge incontinence) underwent urodynamic studies (UDS). Those in whom UDS revealed phasic detrusor overactivity were evaluated using a quality of life questionnaire and voiding diaries. Patients were randomized into two groups: Group 1 received SANS alone; Group 2 received SANS combined with a low-dose anticholinergic (5 mg of oral oxybutynin hydrochloride). Both groups were re-evaluated following 8 weeks of therapy.There were 21 patients in Group 1 and 22 in Group 2. The treatment response rate was 61.6% and 83.2% in Groups 1 and 2, respectively. In both groups, the best symptomatic improvements were obtained in patients with urge incontinence. The percentage decreases in the mean number of symptoms of frequency and urgency were 36.7% and 46.1%, respectively in Group 1 and 44.2% and 61.1%, respectively in Group 2. However, there were no statistically significant differences in the effects on frequency and urgency between the two groups. The anticholinergic drug was well tolerated by all patients in Group 2. One patient reported local tenderness, and a small hematoma developed in another following SANS therapy.SANS is an easy and inexpensive therapeutic method with low morbidity in patients with an overactive bladder. Combination with a low-dose anticholinergic increases the success rate without causing any significant side-effects.

Objectives To evaluate the effects of adult circumcision on sexual function in men circumcised only for religious or cosmetic reasons. Methods The study group consisted of 42 male patients with a median age of 22.3 years (range 19 to 28) referred for circumcision from June 2002 to January 2003. Of the 42 men, 39 desired circumcision for religious reasons. Before circumcision, their sexual performance was evaluated using the Brief Male Sexual Function Inventory (BMSFI) and ejaculatory latency time. The BMSFI evaluation and ejaculatory latency time measurements were repeated after a postoperative interval of at least 12 weeks. The scores in the five main sections of the BMSFI and the ejaculatory latency times before and after circumcision were analyzed. Results The differences in the mean BMSFI scores were not statistically significant in any of the five sections. However, the mean ejaculatory latency time was significantly longer after circumcision ( P = 0.02). Conclusions Adult circumcision does not adversely affect sexual function. The increase in the ejaculatory latency time can be considered an advantage rather than a complication.

Introduction: Patients with ureteropelvic junction obstruction occasionally remain undiagnosed until adulthood. There are no objective criteria to predict the results of pyeloplasty in adult patients. We have evaluated the results of pyeloplasty in adult patients and investigated whether these results are correlated with the histopathology of the surgical specimen. Materials and Methods: Histological sections from 26 patients with ureteropelvic junction obstruction were analyzed. Their mean age was 25.1 years. Diethylenetriamine-pentaacetic acid scans were used to determine the degree of renal obstruction and postoperative healing. Improvement in diuretic renography was defined as a greater than 20% decrease in the half-time of the preoperative value. To examine smooth muscle and collagen tissue, sections were stained using Masson’s trichrome. Smooth muscle ratio was identified by color image analysis. Results: 18 patients (69.2%) fulfilled the criteria of healing. Patients with an improved scan had a mean smooth muscle percent (SMP) of 1.85 ± 0.87 while subjects with no significant change in their diuretic scans had a mean SMP of 0.36 ± 0.03 (p = 0.001). There was a strong correlation between the SMP and the improvement. Conclusions: Adult pyeloplasty was found successful in about 70% of the cases. The SMP of the renal pelvis seems to be helpful in predicting the surgical outcome.

Objectives To review the follow-up data and complications of adult patients who underwent hypospadias surgery. Methods The records of 88 male patients with an average age of 21.9 years (range 20 to 27) who were operated on for hypospadias from 1996 to 2001 were reviewed in two groups: primary cases and all others (at least one unsuccessful attempt to correct the hypospadias). The primary cases consisted of 48 anterior, 9 middle, and 2 proximal hypospadias; the second group consisted of 16 urethrocutaneal fistula, 8 hypospadias, and 5 cripple cases. Results The complication rate was 10.1% for the first group and 27.5% for the second group. After the second intervention in groups 1 and 2, the overall success rate was 100% and 89.6%, respectively. Conclusions Adult hypospadias is repaired with the techniques used in pediatric cases. However, the postoperative complication rate is higher, and these patients more often require multiple interventions.

Aim: To determine whether there is a change in sexual satisfaction and self-esteem in adult patients with monosymptomatic enuresis. Methods: This study was a prospective questionnaire analysis. 35 adult age individuals still suffering from monosymptomatic enuresis filled out 5-item Arizona Sexual Experiences (ASEX) scale and the 10-item Self-Esteem Scale (SES). Same query forms were filled out by 23 similar aged healthy control group and the results were compared. A value of P

Objective To evaluate changes occurring in the mucosa of the neobladder over a period of 60 months in 24 patients with orthotopic ileal neobladder. Materials and methods A total of 36 male patients have undergone radical cystoprostatectomy and received an orthotopic ileal neobladder in our hospital during the last 10 years; 24 of these patients, all of whom completed a follow-up period of 60 months, are included in this study. All cases underwent a biopsy of the ileal mucosa at the time of surgery and their neobladder mucosa was then biopsied at 6, 12, 24, 36 and 60 months. The specimens were stained with hematoxylin-eosin in order to examine the changes in the thickness of the mucosa and its villi. Sections were also stained with Alcian blue and periodic acid-Schiff in order to determine the number of goblet cells. A morphometric scoring system was created to quantify the change in villi size. Results The mean thickness of the ileal mucosa at the initial biopsy was 270.9 +/- 35.9 microm and displayed a continuous decrease at all of the subsequent biopsies. The number of luminal goblet cells increased during follow-up. Villus atrophy was found to be a continuous process during follow-up. No dysplasia or malignancy was detected in any of the biopsies. Conclusion During a follow-up period of 5 years, there were no neoplastic changes in our patients, but instead a protective response of the mucosa to its new environment was observed.

The histopathological report of the biopsy material retrieved from hyperemic areas of the bladder during control cystoscopy of a 70-year-old man who had a bladder cancer diagnosis three years previously, indicated the presence of a carcinoma in situ (CIS). Intravesical immunotherapy treatment was initiated. After severe symptoms of dysuria emerging during intravesical immunotherapy with BCG, the immunotherapy treatment dosage was lowered. His treatment was then discontinued due to the progression of symptoms. A biopsy was performed due to higher prostate spesific antigen (PSA) and digital rectal examination abnormalities which indicated granulomatous prostatitis. An antituberculosis treatment was initiated because the PPD test result was 25 mm and the QuantiFERON test was positive. After one month, the patient’s PSA levels were reduced, and his clinical status improved. The symptoms of severe dysuria, sterile pyuria, abnormal digital rectal examination findings and high PSA levels during intravesical BCG treatment should remind us diagnosis of granulomatous prostatitis. It should not be forgotten that diagnosis of granulomatous prostatitis was established histopathologically, and the patient benefited from medical treatment.

Circumcision is generally considered a simple, rapid operation with medical benefits which accrue throughout life. The influence of circumcision on sexual satisfaction has always been argued. In this study, the assessment of the pudendal evoked potentials (PEP) in adults before and at least 12 weeks after circumcision was done. Healthy males aged between 18-27 years, who were willing to undergo circumcision were included in the study. Before and after circumcision, sexual performance was evaluated with the Brief Male Sexual Function Inventory (BMSFI), consisting of sexual drive, erection, ejaculation, problem assessment, and overall satisfaction sections. Forty-three adult males were enrolled in the study. Mean PEP latency was 41.97 +/- 0.25 (39.90-44.50) ms and 44.73 +/- 0.33 (40.90-47.60) ms before and after circumcision, respectively. Mean difference between pre- and postoperative PEP values was 2.76 ms which was statistically significant (p0.001). Mean ejaculatory latency time was significantly longer after circumcision (p0.001). In the light of our findings, we conclude that circumcision may contribute to sexual satisfaction by prolonging PEP latency but further studies are warranted also regarding the other dimensions of circumcision.

Polyarteritis nodosa (PAN) may be systemic or isolated in distribution and may involve virtually any organ or tissue in the body. We report an unusual case of PAN with the clinical features of both penile and renal involvement in a 21-year-old man diagnosed incidentally by pathologic examination of the nephrectomized left kidney. Systemic and surgical therapeutic procedures were applied and his symptoms resolved within 6 weeks. Penile ulceration is a rare but serious manifestation of PAN that needs prompt and aggressive treatment.

Introduction: We wanted to evaluate the therapeutic effect of intravesical heparin and peripheral neuromodulation on patients with interstitial cystitis. Materials and Methods: From March 2002 to August 2003, 8 female and 2 male subjects conform to the NIDDK criteria and not responsive to the previous conventional treatments were included in the study. Wisconsin pain scores, maximal cystometric capacities, and night and day voiding frequencies were determined and these studies were repeated in the 2nd and 12th months of the treatment with 10,000 units intravesical heparin and peripheral neuromodulation. Frequency of the treatment was once a week during first 8 weeks, once in 2 weeks in the following 8 weeks, and once in 3 weeks four times. Then, it was decreased to once a month. Results: The mean follow-up period was 13 months (12–16 months). Day and night voiding frequency were significantly better in the 2nd and 12th months, when compared to pretreatment values. The Wisconsin pain scores were 62.5 ± 13.9% and 62.8 ± 15.2% in the 2nd and the 12th months, respectively. The average increase in the maximum cystometric capacity was 54.8 ± 27.4% and 52.5 ± 31.6% in the 2nd and the 12th months, respectively. Conclusions: Intravesical heparin and peripheral neuromodulation combination seems to be an alternative for patients with interstitial cystitis not responsive to other treatments.

Introduction: We evaluated the role of the seminal plasma PSA level in the prediction of the response to α-blocker treatment in patients with benign prostatic hyperplasia. Materials and Methods: 18 male patients with lower urinary tract symptoms were enrolled in the study. After their blood was sampled for PSA, ejaculates of all the subjects were obtained. Serum and seminal plasma PSA levels were calculated by Active PSA IRMA kit. Patients were given 4 mg/day doxazosin for a period of 6 weeks, following which their International Prostate Symptom Score (IPSS) evaluation was repeated. The correlation between serum PSA, seminal plasma PSA and PSA density levels and the percentage improvement in IPSS was investigated. Results: The mean serum PSA level, the mean PSA density and the mean seminal PSA level of the patients were 2.7 ± 1.2 ng/ml, 0.05 ± 0.02 ng/ml/cm3 and 0.7 ± 0.39 g/l, respectively. The percentage improvement in IPSS varied from 26.9 to 53.5%. Serum PSA and serum PSA density were not useful in the prediction of the response to α-blocker treatment, but the seminal PSA levels correlated with the percentage improvement in the IPSS (p = 0.017). Conclusions: Seminal plasma PSA has been found to be a better predictor of the response to α-blocker treatment when compared to serum PSA and PSA density.

Introduction: Silicone has been the standard prosthesis material for the last three decades but new materials are being searched because of the known disadvantages of silicone such as migration and high cost. We wanted to test in rats whether or not polymethylmethacrylate could be an alternative to silicone. Materials and Medhods: We prepared polymethylmethacrylate and silicone testis prostheses which were similar to testis size of rats. Eleven rats were implanted with polymethylmethacrylate, 11 others were implanted with a silicone prosthesis and sham operation was performed in 10 rats. Three months later the scrotums of the animals were removed with the prosthesis for a quantitative analysis of the chronic inflammation and fibrotic reaction and to measure the thickness of the capsule. Result: Rejection and infection were not observed in any of the prosthesis-implanted rats. Both prosthesis groups displayed increased vascularization, hemosiderin accumulation and fibrotic and hyalinized tissue formation that replaced the muscle. Chronic inflammation was measured and found to be higher in the polymethylmethacrylate group and the difference was not found to be significant. The average thicknesses of the capsules around the polymethylmethacrylate and silicone groups were found to be 58.4 and 46.8 µm, respectively, and that difference was not significant again. Conclusions: In the short term polymethylmethacrylate was equally well tolerated, but the low cost of polymethylmethacrylate made it more advantageous.

Prostatic carcinoma metastasizing to the penis is rare. A case of adenocarcinoma of the prostate with metastases to the penile shaft and glans penis is presented.

Purpose We sought to find out how testicular apoptosis is influenced by BHCG treatment in an experimental cryptorchidism model. Material and Methods Three main groups of 22 day-old healthy male Sprague-Dawley rats were formed (Sham-operated (SO), experimental cryptorchidism (EC), hormone treated EC groups (HT)). Each main group was also divided into early and late orchidectomy groups. HT group received 50 IU/kg BHCG daily for 7 days starting on first postoperative day. Eight and 30 days after EC surgery, all rats underwent left orchidectomy to reveal early and late changes in the testes. Apoptosis index (AI) was defined as the mean number of apoptotic cells per tubule. All groups were compared to each other, while each group was evaluated in terms of the differences between early and late periods. Results Study was carried out with 60 rats in 6 groups totally. AI was significantly greater in EC and HT groups than SO group in both early and late periods. AI in HT group was smaller than EC group; the difference was statistically significant in late period while it was not so in early period. AI was found to be significantly decreased with time in all 3 groups. Conclusions Testicular apoptosis was found to be increased in experimental cryptorchidism. In HT group, AI was smaller than that of EC. For this reason, we suggest that hormone treatment in EC may have an effect that prevents or decreases apoptosis in EC model.

Aim: Prostate-specific antigen (PSA) may elevate in case of prostate cancer, benign prostatic hyperplasia (BPH) as well as chronic prostatitis. In chronic prostatitis and BPH distinction PSA, free / total PSA ratio isn’t usefull. The aim of this study is to question the place of PSA density in the distinction of BPH and prostatitis. Materials and Methods: In our clinic BPH pre - diagnosed, data of transurethral resection of prostate (TUR-P) performed and histologically diagnosed as no chronic prostatitis observed (group 1), with TUR-P performed but chronic prostatitis diagnosed (group 2) patients were retrospectively analyzed. The age, PSA, biopsy history, prostate size and PSA density (PSAD = PSA level / prostate volume) of patients were recorded. Results: Chronic prostatitis was determined in 100 of 641 patients (15.6%). Biopsy before TUR-P was performed to 28 patients in the chronic prostatitis group, and 27 patients in BPH group (n=100) and in only 4 patients (14.3%) in the chronic prostatitis group pathological evidence of prostatitis was determined. PSA (p

Purpose To investigate the prevalance of constipation among children presenting with bedwetting. Material and Methods Charts of children applying with only bedwetting complaint were evaluated. Those with daytime voiding symptoms and urinary tract infections were excluded. Symptoms of voiding dysfunction were sought with detailed history. Parents were given questionnaires designed to reveal constipation according to Rome III criteria, and they were filled after at least one month of observation without any treatment. Diagnosis of constipation was made when direct graph revealed an intestinal fullness obscuring the rectal image and/or when the symptoms fulfilled the Rome III criteria. Results A total of 88 patients were evaluated (female:24, male:64, mean age: 8.65 yrs). Primary and secondary enuresis nocturna (EN) was diagnosed in 79 and 9 patients respectively. Constipation was diagnosed in 62% and 67% of the patients with primary and secondary EN respectively. Daytime irritative symptoms coexisted in 20.5% of the cases, and when these cases were excluded, constipation existed in 53.2% of the cases with primary monosymptomatic enuresis nocturna. This is a higher rate than the similar population according to the literature. Conclusions A significant rate of constipation coexist in patients presenting with bedwetting, and these cases should not be labelled as monosymptomatic nocturnal enuretics. This subgroup of patients should be identified as cases with elimination dysfunction and treated accordingly. Lack of daytime voiding symptoms do not exclude defecation disorders.

PURPOSE The causal relationship between circumcision and meatal strictures is controversial. We reviewed our data and assessed the roles of possible etiologic factors. MATERIAL AND METHODS Seventy six patients who underwent circumcision both for traditional and medical reasons at the department of Urology between 2004 and 2006 were included in the study. Meatal calibrations were achieved using lubricated polyethyhlene tubes by the same surgeon, such that the largest caliber tube that did not stretch the external meatus and fossa navicularis represented the meatal size. Postoperative meatal caliber was assessed at 1 to 3 months (mean:1.4) after the circumcision. Circumcision techniques were categorized with respect to the competence of phrenular artery. Circumferential incision was made at a more proximal level on the ventral aspect of the penis and no cautery to, or ligation of phrenular artery was performed in those who underwent phrenulum-sparing circumcisions. The influence of phrenulum sparing, diapers and preoperative gonadotropin treatment on the postoperative percent change in meatal calibration was assessed statistically. RESULTS Mean patient age was 35.4 months (range 1 to 102). Pre and postoperative mean meatal calibers were 10.53F and 10.11F respectively. Overall decrease in meatal caliber (3.98%) was statistically significant (p=0.0001). Preoperative gonadotropins, although statistically insignificant, seemed to have a protective effect. Phrenulum sparing did not prevent meatal downsizing (p=0.005). Having diapers seemed to be a greater risk factor for meatal strictures (p=0.001). CONCLUSIONS Decrease in meatal caliber as early as 1 to 3 months after circumcision is statistically significant, though clinical importance of this decrease is yet to be determined.