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INTRODUCTION Refractory overactive bladder (OAB) in children can be treated with second line modalities such as as biofeedback, transcutaneous electrical stimulation (TENS), and botulinum toxin. In this study, we aimed to investigate the efficacy of biofeedback-assisted pelvic floor muscle therapy (PFMT) on symptoms, bladder capacity, uroflowmetry, and pelvic floor muscle activity (PFMA) in children with resistant OAB or dysfunctional voiding (DV) with associated seconder bladder overactivity (DV/SBO). MATERIALS AND METHODS A total of 24 children with resistant OAB were included in the study. Patients were divided into two groups as: group-1 pure OAB and group-2 DV/SBO. Children were evaluated with voiding diary, uroflowmetry-EMG, PFMA before and after treatment. All patients were treated with PFMT. RESULTS Urgency cured or improved in 12 of 17 (71%) of children in group-1 and in six of seven (86%) children in group-2 (P

OBJECTIVE: We have reviewed the data of the patients in order to evaluate the effectiveness of our ureterocystoplasty technique in augmentation cystoplasty operation. MATERIAL AND METHODS: Data of a total of 16 patients with bilateral functional kidneys who had undergone augmentation ureterocystoplasty between January 1995 and June 2018 which were retrieved during the retrospective archive scanning were included in the study. Ultrasonography (USG), serum blood urea nitrogen and creatinine values and Technetium-99 DTPA (Tc-99 DTPA) scan were used to evaluate the renal function of the patients. Intravenous pyelography (IVP) and USG were used to evaluate the ureters before surgery. Magnetic resonance (MR) urographies were performed in our center. RESULTS: Of the total 16 patients, 10 were male and 6 were female, while ages ranged from 1 to 24 years. Among 16 patients, the most common cause of neurogenic bladder etiology was meningomyelocele. In the urodynamic studies performed before the operation, it was determined that the bladder capacities of the patients were between 40–180 mL and the bladder compliances were 1.0–4.0 cc/cmH(2)O. At postoperative 3(rd) months, it was determined that the bladder capacities of the patients were between 180–330 mL and the bladder compliances were between 6.0–24.0 cc/cmH(2)O. CONCLUSION: Augmentation ureterocystoplasty seems to be an appropriate technique in which successful results are obtained with appropriate patient selection. Besides, complications that may occur due to use of ileal segment are avoided.

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

We researched the survival of bone marrow-derived mesenchymal stem cells (MSCs) and the results of MSCs' injected into decompensated bladders in a rabbit model.Partial bladder neck obstruction (PBNO) and subsequent decompensation of the bladder was achieved by wrapping the bladder neck with autologous rectus fascia. In the first aspect of the experiment 18 rabbits underwent MSC injection into the decompensated bladder to prove the survivability of injected MSCs. For this purpose MSCs were isolated, transfected with Green Fluorescent Protein (GFP), and injected into the detrusor layer. Once viability was assessed in the first phase, an additional 10 rabbits underwent PBNO in the second phase. Five of these animals underwent subsequent MSC injection (group 3, stem cell) and 5 did not (group 2, obstruction). Both groups were compared to 5 controls (group 1). Urodynamics were performed in all groups. After the animals were sacrificed the groups were compared via morphometric analysis, contractile response to carbachol and KCl, and muscarinic receptor type analysis.On morphometric analysis, collagenous area rates were 43, 53 and 37% in group 1, 2 and 3, respectively. There was no statistically significant difference between groups in terms of bladder weight, bladder capacity and vesical pressure. The contractile effects of KCl and muscarinic agonist carbachol were significantly higher in groups 1 and 3 than group 2. The response to carbachol was antagonized by muscarinic M(1) and M(3) receptor antagonist pirenzepine and abolished by muscarinic M(3) receptor antagonist 4-DAMP in all groups.The injection of MSCs decreased the collagenous area, increased detrusor contractility. Functional M(3) receptors were also expressed in MSCs-injected bladder smooth muscle as well as in control group.

Double J (DJ) ureteral stents are frequently used as a natural consequence of common use of endoscopic procedures. Even though use of these stents is practical and safe, undesired problems such as urinary tract infection, kidney dysfunction may develop in case of their long stay in the body. DJ stents staying for a long time in the body due to forgotten by urologist and frequently by the patients or due to carelessness of the patients which may cause serious medical and legal problems. Herein, we reported two cases with DJ stent placed 4 and 2 years ago after open kidney stone operation and encrusted as they were forgotten. These 2 cases were treated by application of ESWL, endoscopic laser cystolithotripsy, suprapubic percutaneous cystolithotripsy, ureteroscopic lithotripsy and percutaneous nephrolithotomy methods consecutively. In conclusion, cases with DJ stents should be informed and warned strictly to avoid rare but serious problems due to delay or forget of these stents. We think that with an algorithm including the consecutive treatment alternatives management of encrusted DJ stents might be more successful. J Clin Exp Invest 2012; 3(2): 263-266, DJ stentler endoskopik uygulamaların yaygınlaşmasıyla beraber sıklıkla kullanılmaktadır. Bu stentler güvenli ve pratik olmalarının yanında vücutta normalden uzun süre kalırlarsa üriner sistem enfeksiyonu, böbrek fonksiyon kaybı gibi yan etkilere sahiptir. Bazen ürologlar çoğu kez de hastalar tarafından unutulan veya hastanın ilgisizliği nedeniyle vücutta uzun süre kalan double J stentler günümüzde halen sorun olmaya devam etmektedir Bu yazıda, biri 4 yıl önce ve diğeri 2 yıl önce açık böbrek taşı ameliyatı sırasında yerleştirilen ve sonrasında unutulup taşlaşan DJ stentli iki hastanın uygulanan ESWL, endoskopi sistolitotripsi, perkütan sistolitotripsi ve perkütan nefrolitotripsinin kombine kullanımıyla taşsız hale getirilmeleri tartışıldı ve ilgili yayınlar gözden geçirildi. Biz DJ stent yerleştirilen hastaların takiplerinde hastaların daha sıkı uyarılmalarının ve daha çok bilgilendirmelerinin gerekli olduğuna inanıyoruz. Bunun için gerekirse iletişim imkanlarından da yararlanılmalıdır. Enkruste veya taşlaşmış DJ stentlerle mücadele etmek için birçok seçeneğin olduğu ve belli bir algoritma ile bu seçeneklerin kullanılarak hastaların taşsız hale getirilebileceği düşüncesindeyiz.

Poster: "ECR 2011 / C-0036 / Feasibility of MR urography in patients with urinary diversion " by: " B. Battal , M. Kocaoglu, E. Aydur, M. Dayanc, A. T. Ilica; Ankara/TR"

Aims To examine whether obstruction changes the expression of prostaglandins (PGs) in bladder, intravesical low-dose aspirin could be used as a new route of drug administration, this way of administration influences PGs' expression, and contractile function of the bladder is protected after treatment. Methods Eighteen rabbits were divided into three groups. Sham-operated group (group 1) included 6 rabbits. Twelve rabbits were partially obstructed for 70 days. Six of these 12 rabbits not receiving any treatment constituted obstructed group (group 2). The remaining six rabbits received 2 mg/kg/day aspirin (group 3). One rabbit in each group was evaluated on 1st, 7th, 14th, 28th, 42nd, and 70th days following obstructive surgery. After scarification, the percentage of collagenous area and concentrations of PGE2 and PGF2-alpha were measured. Contractile responses to field stimulation (EFS), carbachol, and potassium chloride (KCl) were determined. Results Wet tissue PGE2 and PGF2-alpha levels were higher in obstructed group than the other groups. Aspirin decreased the percentage of collagenous area in group 3 compared to the group 2, but this difference was not statistically significant. The strips from aspirin groups resulted in better contractile response to cholinergic stimulation with KCl, but this difference was not statistically significant between the obstructed and aspirin groups. Similarly, carbachol did not elicit significantly greater concentration-dependent contraction in strips from obstructed group compared to those from aspirin groups. Maximum responses to EFS were not significant in aspirin group compared to those from obstructed group. Conclusions Intravesical aspirin may have protective effect on partially obstructed bladder. Neurourol. Urodynam. Neurourol. Urodynam. 30: 1646–1651, 2011. © 2011 Wiley Periodicals, Inc.

Ovotesticular disorder of sex development (OTDSD) is a rare condition and defined as the presence of ovarian and testicular tissue in the same individual. Most of patients with OTDSD have female internal genital organs. In this report, we present a case in which, we demonstrated prostate tissue using endoscopic and radiologic methods in a 46-XX, sex determining region of the Y chromosome negative male phenotypic patient, with no female internal genitalia. Existence of prostate in an XX male without SRY is rarely seen and reveals a complete male phenotype. This finding is critical to figure out what happens in embryonal period.

Objectives To investigate the effect of testosterone on contractile tone of endothelium-denuded human corpus cavernosum strips. Human studies designed to examine a possible relaxant effect of testosterone on corpus cavernosal circulation are lacking. Methods Testosterone (0.1-300 μM) was added cumulatively to organ baths after precontraction of isolated human corpus cavernosum strips (n = 5) with KCl (45 mM). Testosterone-induced responses were tested in the presence of nonselective, large, conductance Ca 2+ -activated and voltage-sensitive K + channel inhibitor tetraethylammonium (1 mM), adenosine triphosphate-sensitive K + channel inhibitor glibenclamide (10 μM), voltage-dependent inward rectifier K + channel inhibitor barium chloride (30 μM) and voltage-sensitive K + channel inhibitor 4-aminopyridine (1 mM). Results Testosterone (0.1-300 μM) produced relaxation in human corpus cavernosum (maximum relaxation 65.4% ± 3.3% of KCl-induced contraction) that reached a maximum at a concentration of 300 μM. Testosterone-induced relaxation was significantly attenuated by glibenclamide, but it was not affected by the other K + channel inhibitors (tetraethylammonium, barium chloride, or 4-aminopyridine). Conclusions Testosterone might induce relaxation in human isolated corpora cavernosa strips by activation of smooth muscle adenosine triphosphate-sensitive K + channels. This finding suggests that testosterone, in addition to its known endothelial action, might regulate erectile function locally by its action on the smooth muscle of the human corpus cavernosum.

OBJECTIVES Inhibin B reveals Sertoli cell activity. After our previous findings of an increase in inhibin B succeeding classic inguinal orchiopexy, we sought to determine the changes in endocrine parameters after scrotal orchiopexy in patients with cryptorchidism and to compare these findings with the results of classic orchiopexy. METHODS A total of 50 boys with an undescended testis, 32 unilateral and 18 bilateral, were included in the present study. Scrotal orchiopexy was performed in all of them. Before and 6 months after orchiopexy, the serum basal inhibin B and other serum hormonal levels were measured in all patients. RESULTS The mean serum basal inhibin B levels had significantly increased and the other reproductive hormonal levels had not changed at 6 months after successful scrotal orchiopexy in our 50 patients (P = 0.016). Within the subgroups, the increase in inhibin B levels was significant in only those 2-9 years old with a unilateral undescended testis. The increase in inhibin B in those 10-12 years old with unilateral or bilateral undescended testis resulted from the start of puberty. No significant difference was found in terms of an increase in inhibin B after classic and scrotal orchiopexy. CONCLUSIONS The measurement of inhibin B levels could be used as a follow-up parameter after orchiopexy. The serum inhibin B level increases after scrotal incision orchiopexy just as after classic inguinal orchiopexy. The increased level of inhibin B might indicate that the orchiopexy has been beneficial.

Splenogonadal fusion (SGF) is a rare congenital anomaly in boys and girls. It commonly presents as a testicular mass treated with an unnecessary orchiectomy. We present 3 cases of SGF diagnosed in adulthood and discuss the published literature focusing on several aspects of this rarity. These cases of SGF of both types presented with the usual complaints. In our first case, orchiectomy was performed since the left testis was hypoplastic and testicular neoplasm could not be ruled out. The testicles could be preserved in the latter 2 cases. The second case is the continuous-type SGF associated with contralateral testicular aplasia and, to our knowledge, this is the first reported case of continuous SGF associated with testicular aplasia. Knowledge of this entity may help prevent unnecessary orchiectomy.

The approach for the intravesical suspicious lesions or stones in the preadolescent children especially in boys is still a challenging problem. Open surgery, percutaneous suprapubic endoscopy or transurethral endoscopic approaches are the treatments of choice in children. However, there is a group in children between the ages of 10 and 12 years, which can be named as grey zone population; the length of the instruments is insufficient for transurethral intervention such as endoscopic stone extraction, transurethral bladder tumor resection especially for the lesion at the posterior bladder wall in this group. The aim of this study is to describe a new technique using laparoscopic instruments for percutaneous bladder stone and tumoral lesion and determines the efficacy of this procedure. Satisfactory results have been obtained in patients with these pathologies. In selected cases, operation time, urethral and mucosal damage, hospital stay, and cost can be decreased to a minimum with this simple technique.

We studied the effects of biofeedback treatment on voiding and urodynamic parameters in children with voiding dysfunction.We prospectively studied 188 children between June 1998 and November 2003. Biofeedback was performed with a urodynamics processor that enables simultaneous recording of urine flow and electromyography, and visual display of flow/electromyography activity. At the beginning of the study this treatment was performed once weekly. After patients understood the concept and performed homework regularly sessions were scheduled at 3 to 4-week intervals and continued for 6 months. All children were evaluated at 6 months and again at 2 years after completing biofeedback training.The number of the children completing biofeedback was 168 (89.4%). Improvement was obtained in all parameters, ranging from 59.2% to 87.8% at 6 months. Maximum improvement was acquired with flattened voiding in 65 of 74 children (87.8%), whereas the least improvement was acquired with daytime wetting in 58 of 98 children (59.2%). These improvements continued at 2-year followup, and ranged from 53.1% to 87.3%. While the rate of improvement for nocturnal enuresis, staccato voiding, detrusor-sphincter dyssynergia, vesicoureteral reflux and urinary tract infection had increased, the remaining parameters had decreased at 2-year followup.Biofeedback training is a simple, effective and well tolerated treatment modality in children for various parameters resulting from bladder dysfunction. Motivation and willingness to participate in biofeedback treatment are important selection criteria.

An 11-year-old boy with a neurogenic bladder had a Tc-99m MAG3 dynamic renal scan to evaluate the split renal function. The left kidney could not be visualized on perfusion imaging and early static studies but started to concentrate radionuclide at the 6th minute. At first glance, the scintigraphic appearance implied delayed concentration and stasis in the excretion phase. However, further evaluation of the images and the renogram curve suggested intrarenal reflux (IRR) resulting from reciprocal changes in the bladder and kidney curves. Because it is not a usual finding to see IRR in the early concentration phase when the bladder is relatively empty, there was further evaluation with renal parenchymal scintigraphy. The left kidney was nonfunctioning on a Tc-99m DMSA scan, suggesting IRR as the most probable diagnosis. Voiding cystourethrography also confirmed left IRR and hydronephrosis was demonstrated later. This case illustrates the potential misinterpretation of a Tc-99m MAG3 dynamic renal scan in the presence of nonfunctioning renal tissue and IRR. However, a careful review of the renogram pattern established the correct diagnosis, obviating the need for further investigation.

To examine whether voided volume (VV) could change the uroflow patterns and result in children with lower urinary tract dysfunction (LUTD).Between January 2009 and May 2010, the children with LUTD were enrolled in this study. Uroflowmetry (UF) combined with electromyography (EMG) was performed two times and was reviewed independently by two urologists. UF-EMG curves were classified as bell, staccato, intermittent, plateau, and tower. Patients' expected bladder capacity (EBC) and VV were recorded. Patients were divided into four groups according to their VV and EBC. Group 1, VV50% of EBC; group 2, VV between 50 and 100% of EBC; group 3, VV between 100 and 125% of EBC; group 4, VV125% of EBC.A total of 143 patients underwent UF-EMG at least two times and 382 results were obtained. Groups 1, 2, 3 and 4 consisted of 27, 60, 27 and 29 children, respectively. The percentages of normal, intermittent, plateau voiding patterns were 58.5, 12.8, 7.1% in group 1; 79.8, 5.4, 1.8% in group 2; 59.2, 8.5, 2.8% in group 3; and 37.2, 5.1, 2.6% in group 4, respectively. The percentages of staccato and tower pattern were 1.4, 20% in group 1; 9.1, 3.6% in group 2; 30, 0% in group 3; and 55.1, 0% in group 4, respectively. The rate of tower shape curve decreased as voided volume increased, but the rate of staccato curve increased as voided volume increased.In case of exceeding the EBC, the test should be repeated with normal VV when UF results are being evaluated.

The aim of this study was to determine the duration that antibiotherapy should have in order to make total prostate-specific antigen (tPSA) levels decrease to normal ranges in patients without prostatitis symptoms but with total PSA levels around 4.01-9.9 ng/dL.A total of 129 male patients were enrolled and divided into either study group (N.=102) or control group (N.=27). The study group received a 21-day treatment with ofloxacin 400 mg/day, while the control group did not receive any treatment. tPSA and free PSA levels were measured on the 7th, 14th and 21st day, and at the 3rd, 6th, and 12th month of the study. tPSA levels and the number of patients whose tPSA levels decreased ≤4.0 ng/dL levels was recorded and analyzed for statistical significance.At 7, 14, and 21 days mean tPSA values were all lower than baseline values and the differences were statistically significant (P0.05). Of 102 patients 31, 38 and 36 patients had decreased tPSA levels at 7, 14, and 21 days, respectively. But when we compared 7th day mean tPSA levels with days 14 and 21, we found no statistical differences (P0.05). Sixty-six patients had persistently high tPSA levels and 64 of them underwent prostate biopsy. Prostate cancer was detected in 8 of them (12.5%).A seven-day course of antibiotherapy is enough to normalize PSA levels in gray-zone patients. If recurrence of PSA increase is seen during follow-up, antibiotherapy can be useful again in those patients who previously benefited from it, while it will prove unnecessary in those who did not have their tPSA level normalized by it.

To find answers about preventing the colonic mucosal regrowth after seromuscular enterocystoplasty and the dissection pane, we performed an experimental study in dogs. We also report our experience with mucosal regrowth and bladder function after augmentation colocystoplasty.This study comprised 10 adult healthy female mongrel dogs. We performed this animal experiment in 2 stages. At stage 1 we constructed a low capacity bladder. Stage 2 was performed 6 months after stage 1. At the end of detrusorectomy a 15 cm. segment of sigmoid colon was detubularized. The animals were randomly divided into 2 groups. In the 5 group 1 dogs de-epithelialization was performed with needle point cautery at a low cut setting, and the mucosa, muscularis mucosa and submucosa were resected, leaving the fibers of the muscularis externa exposed. In the 5 group 2 dogs de-epithelialization was performed by the peeling technique, in which the dissection plane was developed between the mucosa and muscularis mucosa, and the muscularis mucosa and submucosa remained on the colonic muscle. The de-epithelialized patch of bowel was shaped as a cup patch and anastomosed to the edges of the detrusor muscle over the bulging urothelium. The animals were sacrificed at 12 months of followup. All bladders were inspected macroscopically for regrowth of the colonic mucosa. Multiple sections of the augmentation patches were obtained and processed routinely for histological evaluation to determine what happened to the urothelium.We noted good urodynamic results in all dogs and there was no statistical difference in the groups in regard to bladder capacity. Mucosal regrowth did not develop in either group.When dissection is performed successfully whether or not the submucosa is removed, there is no observed regrowth or loss of bladder capacity in either technique.

Objectives To evaluate prospectively the success of scrotal incision orchiopexy (Bianchi technique) with or without inguinal hernia in patients with an undescended testis within the inguinal canal or beyond the external inguinal ring. Methods A total of 72 orchiopexies were performed in 56 patients with a primary undescended testis. The testicular position and size were assessed again at 1 year of follow-up. Results A total of 56 patients had bilateral (n = 14), right (n = 26), and left (n = 18) primary undescended testes. Scrotal orchiopexy was attempted in 72 testes and was successful in 68; the remaining 4 patients required conversion to traditional inguinal orchiopexy because of inadequate mobilization. In 34 children (43 testes), the testis was distal to the external inguinal ring (group 1). Scrotal orchiopexy was performed successfully in 42 testes in this group, and only 1 patient required conversion to a traditional inguinal incision. The average operating time was 18 minutes. In 22 children (29 testes), the testis was located within the inguinal canal (group 2); 3 cases required conversion to traditional inguinal orchiopexy. The average operative time was 25 minutes in group 2. All patients had satisfactory scrotal placement with at least one follow-up examination. Conclusions A scrotal incision for a palpable primary testis is well tolerated, cosmetically pleasing, and associated with a short operative time.

We describe a nephrogenic adenoma of the bladder in a 14-year-old girl with Turner's syndrome. The patient also had a past history of urological surgery for vesicoureteral reflux. In this case, the multifocal lesions were successfully treated by transurethral resection.

Summary Introduction Dysfunctional voiding (DV) occurs in neurologically normal children who are not able to establish brain control on detrusor muscle contractions (DMCs). It is also reported to be the result of incorrect voiding habits during toilet training. Children contract pelvic floor muscles (PFMs) to suppress DMC and DV begins. Urinary nerve growth factor (uNGF) is necessary for the synthesis and regulation of neurotransmitters, development of dorsal root ganglia (sensory neurons), and development of sympathetic cells during embryonic and post-natal life. uNGF has also a role in the intracellular signal transduction in nerve cells towards the target organ. To our knowledge, no study has investigated the association between uNGF, biofeedback treatment and DV in children. Objectives The aim was to examine the potential effect of uNGF in the assessment of the effectiveness of biofeedback success in children with lower urinary tract disorders. Study design Fifty-two children with the suspicion of DV and 48 children from a primary school reporting no urinary complaints were enrolled in this study from October 2010 to April 2013 in the Urology Department. uNGF levels were compared. Results The mean uNGF/creatinine (Cr) level was 0.23 ± 0.26 in the control group and 0.96 ± 0.88 in the DV group (p Discussion To our knowledge this study is the first to show the correlations between uNGF levels and biofeedback therapy in children with DV. Tissue NGF in 12 patients with overactive bladder (OAB)/detrusor overactivity and 15 healthy women was previously compared and it was suggested that there was no correlation between bladder tissue NGF and OAB. uNGF levels in the bladder in patients with interstitial cystitis and idiopathic sensorial urgency were evaluated previously, and uNGF levels reported. Similar to these reports, most of the previous studies handled uNGF in patients with diseases such as interstitial cystitis, OAB, urinary tract infections, urolithiasis, spinal cord injury, and prostate cancer, and found significantly higher uNGF levels. These studies were generally in adults. A previous study about uNGF comprised 40 children with OAB, in contrast to other studies. According to this study, 40 children diagnosed with OAB were administered anti-muscarinic therapy (oxybutynin 0.3–0.5 mg/kg/day). It was reported that uNGF/Cr levels of the OAB group were higher than control group. In the current study, we evaluated the uNGF difference in DV and the effect of biofeedback treatment on uNGF levels. Conclusions uNGF levels were higher in children with DV and decreased after biofeedback therapy. uNGF levels could be used for the diagnosis and the assessment of biofeedback success in these children. Download : Download high-res image (105KB) Download : Download full-size image Figure . The mean uNGF/Cr levels in the DV group at the baseline, at the end of biofeedback therapy (6 and 12 months).

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

Objectives. Enterocystoplasty without bowel mucosa would be useful to preventmost complications related to the presence of bowel in the urinary tract. However, past attempts to remove the mucosa from intestinal segments have resulted in fibrosis and contraction of the patch. We designed this study to test the hypothesis that such contraction can be prevented by combining the principle of detrusorectomy and seromuscular colocystoplasty, covering the denuded urothelium with a de-epithelialized colonic segment, a procedure we named seromuscular colocystoplasty lined with urothelium (SCLU). Methods. SCLU was performed in 14 female mongrel dogs weighing 20 to 25 kg. We performed the procedure with and without preservation of the intestinal submucosa and in animals with intact and previously reduced bladders. We describe a new animal model of reduced bladder capacity. Bladder capacity and histology were evaluated 1 to 6 months after the procedure. Results. Twelve bladder specimens were available for analysis. In all cases, the seromuscularpatches remained viable and well vascularized. When the intestinal submucosa was not preserved in the patch, there was moderate contraction of the patch with subepithelial fibrosis and the bladder capacity was not preserved. In contrast, when the submucosa was preserved, there was no fibrosis and the capacity was preserved. In animals with previously reduced bladder capacity by either subtotal cystectomy or talc-induced fibrosis, SCLU effectively augmented bladder capacity Conclusions. The results suggest that the contraction of the intestinal patch in seromuscularenterocystoplasty can be avoided by the preservation of both the bladder urothelium and lamina propria, together with the submucosa and muscularis mucosa of the intestinal patch.

Aging in men is characterized by a moderate decrease in plasma testosterone (T) levels. However, the association between partial androgen deficiency of the aging male and clinical symptoms and the ideal screening test are controversial. In this study, we investigated the association between the androgen levels and erectile function, cognitive functions and hypogonadism symptoms in aging males.We investigated the association between total (TT), calculated free (FT) and bioavailable (BT) testosterone, and various clinical and laboratory parameters in 103 healthy males, 50-80 years old. Biochemical assessment was done after overnight fasting. Questionnaires were used to test for hypogonadism symptoms, erectile and cognitive functions.TT levels were not correlated with aging in this study. However, FT and BT were found to decrease with age due to rising sex hormone binding globulin. TT levels were strongly correlated with FT and BT levels (respectively p = 0.0001, p = 0.0001). TT, FT and BT were only correlated with cognitive functions (p = 0.012, p = 0.004, p = 0.02 respectively). There was no correlation between TT, FT and BT levels and erectile function and hypogonadism symptoms.T values in our study sample did not correlate with clinical signs and symptoms of hypogonadism. Thus, according to our data, symptoms in the aging male should not be indiscriminately assigned to a decrease in TT, FT or BT levels.

Systemic chemotherapy regimens with cisplatinum have been associated with several toxicities. Thus, a loco-regional therapy approach may greatly reduce the toxicity. For this purpose, we designed this experimental study to investigate whether local chemotherapeutic injection is superior to systemic cisplatinum injection for retroperitoneal lymph nodes. A total of 48 male Wistar rats were included to the study. Rats were divided into six groups. In the first three groups, systemic applications of cisplatinum, carboplatinum and oxaliplatin were performed, respectively. In the last three, local administration of cisplatinum, carboplatinum and oxaliplatin was performed, respectively. One hour after the chemotherapeutic agent applications, retroperitoneal lymph nodes were dissected and platinum concentrations were analyzed. When compared with systemic route, achieving higher platinum concentrations in the local chemotherapeutic application groups was the most spectacular result of the study. Serum platinum concentrations were also lower in the local application groups than systemic ones. When we compared local and systemic applications between three chemotherapeutic agents, the most significant concentration difference was seen in carboplatinum group. The results of this study demonstrate that intralymphatic delivery of cisplatinum, carboplatinum and oxaliplatin leads to higher drug concentrations in the retroperitoneal lymph nodes when compared with intravenous administration.

AIM: To evaluate the possible relationship between varicocele and chronic constipation. METHODS: Between April 2009 and May 2010, a total of 135 patients with varicocele or constipation and 120 healthy controls were evaluated. Patients were divided into two groups. In both groups detailed medical history was taken and all patients were examined physically by the same urologist and gastroenterologist. All of them were evaluated by color Doppler ultrasonography. All patients with constipation, except for the healthy controls of the second group, underwent a colonoscopy to identify the etiology of the constipation. In the first group, we determined the rate of chronic constipation in patients with varicocele and in the second group, the rate of varicocele in patients with chronic constipation. In both groups, the rate of the disease was compared with age-matched healthy controls. In the second group, the results of colonoscopies in the patients with chronic constipations were also evaluated. RESULTS: In the first group, mean age of the study and control groups were 22.9 ± 4.47 and 21.8 ± 7.21 years, respectively (P < 0.05). In the second group, mean age of the study and control groups were 52.8 ± 33.3 and 51.7 ± 54.3 years, respectively (P < 0.05). In the first group, chronic constipation was observed in 8 of the 69 patients with varicocele (11.6%) and 3 out of 60 in healthy controls (5%), respectively. In this regard, there was no statistical significance between varicocele patients and the healthy control (P = 0.37). In the second group, varicocele was observed in 16 of the 66 patients with chronic constipation (24.24%) and 12 out of 60 in healthy controls (20%) respectively. Similarly, there was no statistical significance between chronic constipation and healthy controls (P = 0.72). Internal/external hemorrhoids were detected in 4 of the 16 patients with chronic constipation and varicocele, in the second group. In the remaining 50 patients with chronic constipation 9 had internal/external hemorrhoids. In this regard, there was no statistical significance between chronic constipation and healthy controls (P = 0.80). CONCLUSION: Chronic constipation may not be a major predictive factor for the development of varicocele, but it may be a facilitator factor for varicocele.

reflexic neurogenic bladder with DSD (n 16) was markedly decreased compared with other types of neurogenic bladder. After oxybutynine treatment, bladder compliance was improved in all neurogenic bladder types (Table 1). The renal cortical lesion was aggravated in 3 children (18.8%) of the i®areflexia with high leak pressurei type, 1 (5.0%) of the i®hyperreflexia with DSDi type, and 2 (7.1%) of the i®hyperreflexia without DSDi type (Figure 1). CONCLUSIONS: Oral oxybutynin chloride treatment markedly improved the maximum cystometric capacity in all neurogenic bladder types although increases in maximum cystometric capacity/ estimated bladder capacity were limited. Patients with low compliance, areflexic neurogenic bladder with high leak pressure requires specific attention as this type has worse detrusor compliance.

We evaluated the effectiveness of pulsed radiofrequency (PRF) denervation of spermatic cord for the treatment of chronic orchialgia. Five patients diagnosed with chronic orchialgia were evaluated with a thorough medical and psychiatric history, physical examination, and scrotal Doppler ultrasound, urinary system x-ray film, and urine analyses. One of the patients had bilateral chronic orchialgia. All of the patients had pain for a period of at least 3 months, and multiple conservative therapies failed to alleviate the pain. The patients, who had temporary pain relief after undergoing outpatient diagnostic cord block, were determined to be candidates for PRF denervation. PRF denervation of spermatic cord was performed for 6 testicular units. Visual analog scores were noted before and after the procedure. There were no pathologic conditions that indicated chronic orchialgia in any of the patients. No complications, including testicular atrophy or hypoesthesia of the scrotal or penile skin, occurred after the procedure. Mean visual analog scores before and after the procedure were 9 and 1, respectively. None of the patients needed any analgesics after the procedure or during the follow-up period. Mean follow-up period was 20 ± 2.5 weeks. No recurrence was noted, and none of the patients needed additional therapy. This is a limited case report on the short-term use of PRF. Randomized, placebo-controlled, and long follow-up period studies are needed to better assess the efficacy of this procedure for chronic orchalgia.

To examine whether obstruction changes the expression of prostaglandins (PGs) in bladder, intravesical low-dose aspirin could be used as a new route of drug administration, this way of administration influences PGs' expression, and contractile function of the bladder is protected after treatment.Eighteen rabbits were divided into three groups. Sham-operated group (group 1) included 6 rabbits. Twelve rabbits were partially obstructed for 70 days. Six of these 12 rabbits not receiving any treatment constituted obstructed group (group 2). The remaining six rabbits received 2 mg/kg/day aspirin (group 3). One rabbit in each group was evaluated on 1st, 7th, 14th, 28th, 42nd, and 70th days following obstructive surgery. After scarification, the percentage of collagenous area and concentrations of PGE2 and PGF2-alpha were measured. Contractile responses to field stimulation (EFS), carbachol, and potassium chloride (KCl) were determined.Wet tissue PGE2 and PGF2-alpha levels were higher in obstructed group than the other groups. Aspirin decreased the percentage of collagenous area in group 3 compared to the group 2, but this difference was not statistically significant. The strips from aspirin groups resulted in better contractile response to cholinergic stimulation with KCl, but this difference was not statistically significant between the obstructed and aspirin groups. Similarly, carbachol did not elicit significantly greater concentration-dependent contraction in strips from obstructed group compared to those from aspirin groups. Maximum responses to EFS were not significant in aspirin group compared to those from obstructed group.Intravesical aspirin may have protective effect on partially obstructed bladder.

OBJECTIVE. The objective of this study was to evaluate whether administration of a diuretic agent in MR urography has an effect on renal length and to determine whether the increase in length can be used for the assessment of renal function.CONCLUSION. Renal length may change after diuretic injection, and these changes correlate with renal function.

Aims: We retrospectively review patients who underwent ureteral implantation with a psoas hitch during obstetric or gynecologic operations and describe a new modification. Methods: Between December 1997 and May 2005, 20 patients between 26 and 56 years underwent ureteral reimplantation by using the nonrefluxing, extravesical Lich-Gregoir onlay technique with psoas hitch at our institution by the same reconstructive surgery team. Additionally, we used a urethral catheter balloon as a landmark for the bladder mucosa and fixed the bladder to the psoas tendon by using the balloon. We performed 14 ureteral reimplantations during the surgery as intraoperative reconstruction. In 6 patients, delayed reconstruction of the ureter was performed a few days following the previous operation. Results: For intraoperative and delayed reconstructions, the mean operation time for ureteral reimplantation was 24 and 75 min. We took out the urethral catheter on the second operative day and the anastomotic drain on the third. The average hospital stay was 5.7 days. No cases of chronic flank pain, recurrent pyelonephritis, persistent severe hydronephrosis or compromised renal function occurred. No patient required reoperation. Conclusions: Modified psoas hitch ureteral reimplantation is an effective and safe way of reconstruction for treating defects in ureteral length.

Objectives To evaluate the effect of biofeedback therapy on the residual urine volume in children with dysfunctional voiding. Methods This prospective study was conducted in children with dysfunctional voiding associated with abnormal postvoid residual urine (PVR) from June 2002 to 2007. The children were divided randomly into 2 groups. Group 1 was treated with standard urotherapy combined with biofeedback therapy and group 2 was treated with only standard urotherapy. The outcomes of uroflow-electromyography pattern, urinary tract infection (UTI), and PVR were recorded before and at the end of sixth month of treatment. Results A total of 94 patients were enrolled in this study. Groups 1 and 2 consisted of 62 and 32 patients, respectively. The voiding pattern became normal in 80.6% (50/62) and 56.2% (18/32) of patients in groups 1 and 2, respectively. The PVR resolved in 40 of 62 (64.5%) patients in group 1 and in 11 of 32 (34.4%) children in group 2. Before the treatment, UTI was noted in 22.5% of patients (14/62) in group 1 and 21.8% of patients (7/32) in group 2. After the treatment, UTI was observed in 3.2% of patients (2/62) and in 9.3% (3/32) of patients in groups 1 and 2, respectively. Although both treatment modalities changed the voiding pattern, rate of febrile UTI, and PVR positively, these outcomes were better in a combination group. Conclusions The combination of standard urotherapy with the biofeedback therapy improved the results significantly.

Premature ejaculation (PE) is the most common sexual problem experienced by men, and it affects 20%-30% of them. Pulsed radiofrequency (PRF) neuromodulation has been shown to be an effective treatment for a wide range of pain conditions. We used PRF to treat PE by desensitizing dorsal penile nerves in patients resistant to conventional treatments. Fifteen patients with a lifelong history of PE, defined as an intravaginal ejaculatory latency time (IELT) of

Data concerning extracorporeal shock wave lithotripsy (SWL) management of small (or = 5 mm) asymptomatic renal caliceal stones are lacking in the literature. In this study, we aimed to determine the effectiveness of SWL in a special group of patients who had very small (or = 5 mm) asymptomatic renal caliceal stones. The group of patients consisted of pilots, gendarmes, and soldiers, such as commandos, for whom treatment was obligatory and who had to be stone free because of their military duties.We retrospectively examined SWL data and retrieved information for 84 patients with small asymptomatic renal caliceal stones. The SWL sessions were performed with a Siemens Lithostar lithotriptor. The mean age of the patients was 34 +/- 13 years. The mean stone size was 4.8 +/- 0.4 mm. The mean numbers of shockwaves and energy used were 2707 +/- 1742 and 18 +/- 2 kV, respectively. The location of stones were: 11 right upper calix, 10 right middle calix, 17 right lower calix, 13 left upper calix, 16 left middle calyx, and 17 left lower calix. Eighty-four patients underwent 101 SWL sessions. Only eight patients had second and three patients had third SWL treatments. SWL was performed five times for only one patient. All mean values were realized with an SPSS 10.0 statistical program.After the first, second, and third SWL sessions, the stone-free rate was calculated as 87%, 93% and 94%, respectively. Only five patients with lower renal caliceal stones were not stone free. The reported complications were macroscopic hematuria necessitating medical attention in four patients, skin ecchymosis in seven patients, severe colic pain in two patients, and urinary-tract infection in one patient. There was no need for hospitalization for these complications.SWL is effective and safe in patients with very small (or = 5 mm) asymptomatic renal caliceal stones in all locations.

Several animal and human studies in vivo and in vitro indicate that testosterone has vasodilatory effects on different vessels. However, the effect of testosterone on the internal spermatic vein is not clear. In addition, the role of testosterone in the pathophysiology of varicocele is not established. We investigated the effect of testosterone on the internal spermatic vein in vitro in patients with varicocele and analyzed its relation to varicocele grade.Isolated internal spermatic veins were collected from patients who underwent varicocelectomy and orchiectomy. The preparations (3 to 4 mm rings) were mounted in an organ bath containing 10 ml Krebs-Henseleit solution on an L-shaped brace for tension measurement along the former circumferential axis. Changes in venous tension in the presence of testosterone (0.1 to 300 microM) were recorded isometrically by a force displacement transducer.Cumulative concentrations of testosterone (0.1 to 300 microM) elicited concentration dependent relaxation of 45 mM KCl induced active tone in the internal spermatic vein (mean +/- SEM 60.97% +/- 5.05% of the KCl induced contraction). Relaxation to testosterone (1 to 300 microM) was significantly higher in 5 cases of grades 0 and 1 varicocele than in 15 of grades 2 and 3 varicocele (maximum relaxation response 78.58% +/- 8.25% vs 55.10% +/- 5.3% of the KCl induced contraction).To our knowledge the current report is the first to describe testosterone induced relaxation of the human internal spermatic vein. The vasodilatory effect of testosterone on the human internal spermatic vein decreases in high grade varicoceles.

Aim: To present the results of a new modification of dismembered pyeloplasty performed to prevent the occurrence of secondary obstruction. Methods: Modified dismembered pyeloplasty was performed in 35 children (age range 3 months to 16 years) who had unilateral ureteropelvic junction obstruction. In postoperative follow-up, presence of hydronephrosis on ultrasonography, differential renal function (DRF) and renal drainage half-time on technetium-99m diethylenetriaminepentaacetic acid (DTPA) renography were recorded and compared with preoperative data. Results: Mean anteroposterior renal pelvic diameter, mean preoperative DRF and radioisotope clearance half-time on DTPA renography of the affected kidneys were 61.4 mm, 38.6% and 34.3 min in children with prenatal hydronephrosis, and 67.5 mm, 37.6% and 39.4 min in children that presented with symptoms, respectively. After surgery, mean anteroposterior renal pelvic diameter, mean DRF and radioisotope clearance half-time on DTPA renography of the affected kidneys were 10.9 mm, 45.9% and 11.9 min in children with prenatal hydronephrosis, and 20 mm, 41.9% and 15.2 min in children that presented with symptoms, respectively. No failure was observed in any patient at an average follow-up of 26 months (range 1–5 years). Conclusions: Open dismembered pyeloplasty is the treatment of choice for intrinsic ureteropelvic junction obstruction. The modification of dismembered pyeloplasty that we performed is an alternative for the prevention of secondary obstruction.

OBJECTIVES To perform a prospective study to evaluate the success of scrotal incision orchiopexy in children with a palpable undescended testis within the inguinal canal or beyond the external inguinal ring with or without inguinal hernia. METHODS A total 204 scrotal orchiopexies were performed in 166 patients with a primary undescended testis. These children were followed up for an average of 29.4 months to document the testicular position and size. RESULTS The scrotal orchiopexy technique was successful in 192 testes; the remaining 12 testes required conversion to traditional inguinal orchiopexy because of inadequate mobilization. Of 108 children (128 testes) in whom the testis was distal to the external inguinal ring, this technique was successful in 104 (124 testes). The success rate was 96.9% (124 testes of 128), and only 4 patients (four testes) required conversion to a traditional inguinal incision. The average operative time was 15 minutes in this group. In the other group with 58 children (76 testes) with a testicular location within the inguinal canal, conversion to the traditional inguinal orchiopexy was performed in 8 patients (eight testes). The success rate in this group was 89.5% (68 of 76 testes). The average operative time was 21 minutes in these patients, and follow-up ranged from 16 to 68 months (average 29.4). All testes were satisfactorily positioned in the scrotum, and no testicular atrophy developed. CONCLUSIONS The results of our study have shown that scrotal orchiopexy is simple, safe, and effective in selected cases compared with the standard two-incision approach in the treatment of the palpable undescended testis.

Purpose Anterior urethral valves (AUV) are rare entities generally described in case reports. They are an uncommon cause of lower urinary tract obstruction in children and can be difficult to diagnose. In the present study, we present our experience in four children with AUV along with a literature review. Materials and methods We retrospectively identified four children with AUV presented between 1998 and 2005 at age 4–9 years. Results Hematuria, urinary tract infection and weak voiding stream were the most common symptoms. Voiding cystourethrography (VCUG) confirmed the diagnosis of AUV. On cystourethroscopy, cusp-like valves in the anterior urethra were seen in all children. Transurethral endoscopic resection of the valves was carried out in three children using a pediatric resectoscope. In one child with a massive anterior urethral diverticulum, open resection of the valve, diverticulectomy and urethroplasty were performed. All patients were cured, none had complications as a result of surgery, and all reported a normal urinary stream at follow-up. Conclusions Children with poor stream and recurrent infections should be evaluated carefully and anterior urethral valves should be considered in differential diagnosis of obstructive lesions.

Objectives Spinning top urethra (STU) deformity arises secondary to detrusor instability, leading to an increase in the intravesical pressure against a closed sphincter. We retrospectively analyzed the effect of biofeedback treatment on STU in children with dysfunctional voiding. Methods A total of 121 patients with STU and voiding dysfunction were enrolled in this study. The patients divided into two groups. Group 1 (n = 49) were treated with simple bladder retraining with timed voiding, and group 2 (n = 72) were treated with biofeedback therapy. Voiding cystourethrography was performed 6 and 12 month later to determine the status of the STU after both therapies. Results The patient age range was 5 to 13 years (mean 8.1 ± 1.9) in group 1 and 5 to 13 years (mean 8.2 ± 1.7) in group 2. Group 1 consisted of 41 girls and 8 boys; group 2 consisted of 63 girls and 9 boys. Voiding cystourethrography revealed vesicoureteral reflux in 39 and 59 children in groups 1 and 2, respectively. The improvement rates of the biofeedback therapy in children with STU and vesicoureteral reflux were significantly greater than the children treated with timed voiding at 6 months and 1-year of follow-up. Conclusions For children admitted to urology clinics with urinary infection or complaints thought to be an unstable urinary bladder, proximal urethral dilation called STU is detected at a high frequency. It should be remembered that this situation can be related to vesicoureteral reflux and urinary bladder instability. Biofeedback training is a simple, effective, and well-tolerated treatment modality for these children.