Procalcitonin as an early indicator of urosepsis following prostate biopsy

BACKGROUND

To investigate the usefulness of serum procalcitonin (PCT) in the early diagnosis of urinary tract infection (UTI) and urosepsis following transrectal prostate biopsy.

METHODS

In this prospective observational study, 227 patients who underwent transrectal ultrasound-guided prostate biopsy were evaluated. The relationship between urosepsis and age, serum PCT, C-reactive protein, prostate-specific antigen (PSA), prostate volume, PSA density and pathologic results following biopsy was assessed. Serum PCT level was measured in all patients immediately before the biopsy and at the post-biopsy day 2.

RESULTS

Of the 227 patients, 11 (4.8%) developed UTI with positive urine culture without urosepsis and 5 (2.2%) developed urosepsis within 30 days after biopsy. The concentration of PCT was within the normal range before the biopsy. Procalcitonin concentration at post-biopsy day 2 was significantly higher in patients who developed urosepsis (1.91 ± 2.99 ng/ml vs. 0.05 ± 0.08 ng/ml; p = .004) compared with non-UTI patients. Only elevated PCT level at post-biopsy day 2 was a statistically significant independent predictor of post-biopsy urosepsis. The area under the ROC curve for the prediction of urosepsis was 0.976 (95%CI: 0.941-1.000) and a cut-off 0.095 ng/ml in the level of PCT at post-biopsy day 2 yielded a sensitivity of 100% and specificity of 93.8% in detecting urosepsis following biopsy.

CONCLUSIONS

Procalcitonin appears to be a useful early biomarker to predict the urosepsis following prostate biopsy. Patients with elevated PCT value should be closely monitored after the biopsy.

Factors affecting fluoroscopy time during percutaneous nephrolithotomy: Impact of stone volume distribution in renal collecting system

Purpose:

To identify the factors increased fluoroscopy time during percutaneous nephrolithotomy and investigate the relationship between the 3D segmentation volume ratio of stone to renal collecting system and fluoroscopy time.

Materials and Methods:

Data from 102 patients who underwent percutaneous nephrolithotomy were analyzed retrospectively. Volume segmentation of both the renal collecting system and stones were obtained from 3D segmentation software with the images on CT data. Analyzed stone volume (ASV), renal collecting system volume (RCSV) measured and the ASV-to-RCSV ratio was calculated. Several parameters were evaluated for their predictive ability with regard to fluoroscopy time.

Results:

The stone-free rate was 55.9% after the percutaneous nephrolithotomy. Complications occurred in 31(30.4%) patients. The mean fluoroscopy time was 199.4±151.1 seconds. The fluoroscopy time was significantly associated with the ASV-to-RCSV ratio (p<0.001, r=0.614). The single tract was used in 77 (75.5%) cases while multiple tracts were used in 25 (24.5%) cases. Fluoroscopy time was significantly associated with multiple access (p<0.001, r=0.689). On univariate linear regression analysis, longer fluoroscopy time was related with increased stone size, increased stone volume, increased number of access, increased calyx number with stone, increased ASV-to-RCSV, increased operative time and decreased stone essence. On multivariate linear regression analysis, the number of access and the ASV-to-RCSV were independent predictors of fluoroscopy time during percutaneous nephrolithotomy.

Conclusions:

The distribution of the stone burden volume in the pelvicalyceal system is a significant predictor for prolonged fluoroscopy time during percutaneous nephrolithotomy. Measures to decrease FT could be beneficial in patients with a high ASV-to-RCSV ratio for precise preoperative planning.

The role of inflammatory parameters (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-eosinophil ratio) in patients with Peyronie's disease

OBJECTIVES

The aim of the study was to investigate the ability of the systemic inflammatory parameters to predict the discrimination of the phases of Peyronie's disease (PD).

MATERIALS AND METHODS

Demographic, clinical, and laboratory data from 156 patients with PD were analyzed. A complete blood count (CBC) was obtained for every patient, and the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-eosinophil ratio (MER) were calculated for every men. Subsequently, patients were divided into two groups based upon the phase of the disease.

RESULTS

The mean age was 51.9 ± 9.6 in all study population. The mean duration between symptom onset and patient evaluation was 4.2 ± 3.2 months in acute phase group, while it was 32.7 ± 31.7 months in chronic phase group (p < 0.001). There were no significant differences between the groups according to comorbidities such as diabetes, hypertension, lipid abnormalities, ischemic heart disease, smoking, and alcohol consumption. There was a statistically significant difference in NLR and PLR between two groups (p = 0.008, p = 0.008, respectively). NLR and PLR were significantly correlated with discrimination status in univariate analysis (p = 0.003, p = 0.005, respectively). Multivariate regression analysis revealed that NLR was the only independent risk factor for discrimination of the phases of PD (p < 0.001). The ROC analysis revealed a cutoff value of 1.8 (AUC 0.712, p < 0.001; sensitivity 61.1%; specificity 75.0%) for the NLR.

CONCLUSION

Our study demonstrated that NLR could be helpful to differentiate the chronic phase from the acute phase in patients with PD. Therefore, NLR could be used as an objective biomarker to the management of the disease and choosing the appropriate treatment.

Are Platelet Indices such as Platelet Volume, Platelet Distribution Width, and Plateletcrit Associated with Peyronie Disease?

PURPOSE

Peyronie disease (PD) occurs as a result of recurrent microvascular injuries or trauma of the tunica albuginea, although its precise etiology is unknown. Mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT), which are parameters indicative of platelet activity, are considered to be functional markers of platelets involved in the pathophysiology of related inflammatory and vascular diseases. In this study, we aimed to examine the relationship between PD and platelet indices.

MATERIALS AND METHODS

We evaluated participants who presented to the andrology department of our institution between December 2015 and May 2018. Ninety-two men with PD and 80 healthy volunteers were included in this study. Participants who had received medical treatment affecting platelets or had any hematologic or systemic diseases were excluded from the study.

RESULTS

The mean age of men with PD was 53.8±10.2 years, and the mean age of the control group was 52.2±8.0 years (p=0.465). There were no significant differences in the mean IIEF-5 scores, platelet count, MPV, PDW, or PCT between the patients with and without PD (p<0.05).

CONCLUSIONS

No correlations were found between PD and platelet indices. Large-scale prospective cross-sectional studies are needed to elucidate the etiopathogenesis of PD.

Stone volume measuring methods: Should the CT based three-dimensional-reconstructed algorithm be proposed as the gold standard? What did the three-dimensional printed models show us?

OBJECTIVES

We researched to detect the optimal method for evaluating stone volume, by comparing the ellipsoid formula and 3D reconstructed volume to gold standard of water displacement volume using 3D printed models.

METHODS

We retrospectively analyzed out patient database and evaluated 27 patients who had percutaneous nephrolithotripsy. From the DICOM data of patient's preoperative CT images, stone structures were obtained using an image identification system. All DICOM files were saved in the stereolithography file format and a 3D printed model was created. True stone volume was found by water displacement method using this model and this volume compared with ellipsoid formula and 3D-reconstructed volume.

RESULTS

Stone volume on water displacement ranged from 0.38-29.8cm3 with a median of 17.5cm3, stone volume on ellipsoid formula ranged from 0.46-34.7cm3 with a median of 19.6cm3 and stone volume on CT based 3D-reconstructed ranged from 0.48-31.8cm3 with a median of 18.9cm3. There was a significant difference between ellipsoid formula and water displacement ( p <   0.0001 ); however, there was no difference between 3D-reconstructed volume and water displacement ( p = 0.051 ).

CONCLUSION

Stone volume calculation using CT based 3D-reconstructed algorithm improves the accuracy of stone volume estimation and this measurement is superior to ellipsoid formula.

Readability and understandability of andrology questionnaires

OBJECTIVE

Medical questionnaires, which enable collection, comparison and analysis of appropriate data as a means of written communication between a patient and a doctor, must be easily readable, and understandable. Here, we measure the readability and understandability of questionnaires used in andrology and examine the relationship between the educational status of the patients and the understandability of the forms.

MATERIAL AND METHODS

Seven questionnaires (SHIM, AIPE, IIEF, MSHQ-EjD, PEDT, NIH-CPSI and IPSS) used to diagnose andological diseases were selected from the European Association of Urology guidelines. The number of syllables per word, the number of words in a sentence, and the average word and sentence lengths were calculated for each Turkish validated form. Readability scores were calculated, and closet tests were used to measure the understandability of the texts.

RESULTS

Three hundred and twenty-seven male volunteers participated in the study. Two hundred and sixteen of the participants (66%) had a high school or college education. The readability level of the seven forms was determined to be "Difficult" or "Very Difficult," and at least a high school education level was required to understand the forms. As education level and monthly income increased, the understandability of the forms increased; as the readability of the forms became more difficult, their understandability decreased (p<0.001).

CONCLUSION

The readability levels of questionnaires used in andrology are well above the reading level of Turkey. Health providers can help patients to fill out forms to increase doctor-patient communication.

Validation of the Turkish version of the Wisconsin stone-quality of life questionnaire

OBJECTIVE

We validated the Turkish version of the Wisconsin Stone-Quality of Life (WISQoL) questionnaire for male and female patients with kidney stones.

MATERIAL AND METHODS

The Turkish version of the WISQoL questionnaire was developed following a well-established multistep process. A total of 84 patients with kidney stones completed the Turkish WISQoL questionnaire, including the other validated questionnaires as The Short Form Health Survey (SF-36 v2) and Beck's Depression Inventory. Patients completed questionnaires before percutaneous nephrolithotomy (PNL) surgery as well as 2-4 weeks after surgery. Reliability was evaluated by internal consistency (tested by Cronbach's alfa) and test-retest reliability between week 2 and 4 (tested by Spearman correlation). Domain structures were examined by interdomain correlations using Spearman correlation coefficient. Convergent validity was assessed by correlating the scores of general health domain to the SF-36 v2, and the scores of emotional impact domain to the Beck's Depression Inventory questionnaire. Sensitivity to change was assessed by comparing scores before and after PNL surgery with the Wilcoxon signed rank test. Discriminant validity was evaluated by comparing the results of patients 2 and 4 weeks after surgery with Wilcoxon-rank sum tests.

RESULTS

The Turkish version of the WISQoL demonstrates good internal consistency (Cronbach's α=0.72-0.78) and test-retest reliability (p>0.05). Inter-domain associations within the WISQOL showed a substantial correlation between various WISQoL domains, indicating a high conceptual relationship between the domains. Also, the Turkish version of the WISQoL showed convergent validity with the corresponding validated questionnaires (Spearman's rho correlation coefficient=0.44-0.78). All domains of the WISQoL showed significant sensitivity to change (p≤0.001).

CONCLUSION

The Turkish version of the WISQoL is a generally reliable instrument that can be self-administered by Turkish patients with kidney stones in clinical and research settings. Further clinical studies in Turkish settings would be useful to provide powerful data on sensitivity to change.

The relationship between female sexual function index domains and premature ejaculation

PURPOSE

The aim of this prospective, observational study was to investigate the relationship between premature ejaculation (PE) and female sexual response cycle, using the female sexual function index (FSFI). The FSFI evaluates female sexual function in six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain.

METHODS

All men were considered to have PE if they fulfilled the criteria of the second Ad Hoc International Society for Sexual Medicine (ISSM) Committee. All men were also assessed by the Premature Ejaculation Diagnostic Tool (PEDT) and intravaginal ejaculatory latency time (IELT) using stopwatch which was held by the partner. All women completed the FSFI.

RESULTS

A total of 181 couples who had regular sexual intercourse with one partner for the past 6 months were enrolled the study. By the definition of ISSM Committee, there were 117 men with PE and 64 men without PE. Partners of men with PE had significantly lower total FSFI scores than did partners of men without PE (21.8 ± 3.5 for PE and 26.4 ± 3.1 for non-PE, p < 0.001). Moreover, all the domains of the FSFI scoring system were separately associated with PE. According to the mean FSFI scores, the 48.43% of women had sexual dysfunction in the non-PE group, and all women had sexual dysfunction in PE group.

CONCLUSION

PE is associated with female sexual dysfunction and all of the female sexual dysfunction domains, as determined by FSFI scores.

Giant malignant fibrous histiocytoma of the testis

We present a case of malignant fibrous histiocytoma of the testis in a 59 year- old male who admitted to our hospital with left testicular painless mass presenting for two months. A scrotal ultrasound examination and magnetic resonance imaging revealed a 9 cm left testicular solid mass. Serum tumor markers were unremarkable. The patient underwent left radical orchiectomy. Histopathologic diagnosis was giant cell variant of malignant fibrous histiocytoma which composed of varying amounts of a mixture of spindled, rounded and osteoclastic type giant cells. Hemorrhagic and necrotic areas were seen between tumor nodules. In immunohystochemical staining, vimentin, CD68 were positive and SMA was focally positive. The patient then received adjuvant chemoterapy and currently, he has no sign of recurrence.

Superoxide Anion Production by the Spermatozoa of Men with Varicocele: Relationship with Varicocele Grade and Semen Parameters

Purpose

To investigate the pathophysiological role of superoxide anion and total reactive oxygen species (ROS) production by the spermatozoa of men with varicocele and its relationship with varicocele grade and semen parameters.

Materials and Methods

This prospective study included 34 men with grade II–III varicocele, regardless of their fertility status. The control group consisted of 13 healthy men. Semen characteristics were examined according to the 2010 World Health Organization criteria. The swim-up method was used for sperm preparation. Total ROS and superoxide anion production was assayed by luminol- and lucigenin-dependent chemiluminescence (CL), respectively.

Results

The men with varicocele had significantly higher total ROS and superoxide anion levels than the healthy control subjects (2.9±0.4 relative light unit (RLU) vs. 2.4±0.1 RLU, p=0.001 for luminol-dependent CL and 2.8±0.4 RLU vs. 2.3±0.2 RLU, p=0.002 for lucigenin-dependent CL). Cases of grade III varicocele had significantly higher superoxide anion and total ROS levels than grade II cases and control subjects (p<0.001). Superoxide anion and total ROS levels were negatively correlated with all semen parameters.

Conclusions

The superoxide anion levels produced by spermatozoa were significantly higher in varicocele patients than in control subjects. ROS production was related to increased varicocele grade, impaired semen concentration, and abnormal morphology in men with varicocele. Our findings suggest that superoxide anion overproduction may be an important step in the cascade of ROS-related damage to spermatozoa, resulting in impaired semen parameters in patients with varicocele.

Impact of poor glycemic control of type 2 diabetes mellitus on serum prostate-specific antigen concentrations in men

BACKGROUND

To evaluate the impact of poor glycemic control of type 2 diabetes mellitus (T2DM) on serum prostate-specific antigen (PSA) concentrations in men.

METHODS

We performed a prospective analysis of 215 consecutive patients affected by erectile dysfunction (ED). ED was evaluated using the IIEF-5 questionnaire and the poor glycemic control (PGC) of T2DM was assessed according to the HbA1c criteria (International Diabetes Federation). Patients were divided into PGC group (HbA1c ≥ 7%) and control group (CG) (HbA1c < 6%). Correlations between serum HbA1c levels and various variables were evaluated and multivariate logistic regression analyses were carried out to identify variables for PGC.

RESULTS

We compared 110 cases to 105 controls men ranging from 44 to 81 years of age, lower PSA concentrations were observed in men with PGC (PGC mean PSA: 0.9 ng/dl, CG mean PSA: 2.1 ng/dl, p < 0.001). Also mean prostate volume was 60% was smaller among men with PGC compared with men with CG (PGC mean prostate volume: 26 ml, CG prostate volume: 43 ml, p < 0.001). A strong negative correlation was found between serum HbA1c levels and serum PSA (p < 0.001 and r = -0.665) concentrations in men with PGC. We also found at the multivariate logistic regression model that PSA, prostate volume and peak systolic velocity were independent predictors of PGC.

CONCLUSION

Our results suggest that there is significant impact of PGC on serum PSA levels in T2DM. Poor glycemic control of type 2 diabetes was associated with lower serum PSA levels and smaller prostate volumes.

Evaluation of stone volume distribution in renal collecting system as a predictor of stone-free rate after percutaneous nephrolithotomy: a retrospective single-center study

We analyzed our stone-free rates of PNL with regard to stone burden and its ratio to the renal collecting system volume. Data of 164 patients who underwent PNL were analyzed retrospectively. Volume segmentation of renal collecting system and stones were done using 3D segmentation software with the images obtained from CT data. Analyzed stone volume (ASV) and renal collecting system volume (RCSV) were measured and the ASV-to-RCSV ratio was calculated after the creation of a 3D surface volume rendering of renal stones and the collecting system. Univariate and multivariate statistical analyses were performed to determine factors affecting stone-free rates; also we assessed the predictive accuracy of the ASV-to-RCSV ratio using the receiving operating curve (ROC) and AUC. The stone-free rate of PNL monotherapy was 53% (164 procedures).The ASV-to-RCSV ratio and calyx number with stones were the most influential predictors of stone-free status (OR 4.15, 95% CI 2.24-7.24, <0.001, OR 2.62, 95% CI 1.38-4.97, p < 0.001, respectively). Other factors associated with the stone-free rate were maximum stone size (p < 0.029), stone surface area (p < 0.010), and stone burden volume (p < 0.001). Predictive accuracy of the ASV-to-RCSV ratio was AUC 0.76. Stone burden volume distribution in the renal collecting system, which is calculated using the 3D volume segmentation method, is a significant determinant of the stone-free rate before PCNL surgery. It could be used as a single guide variable by the clinician before renal stone surgery to predict extra requirements for stone clearance.

Prostate-specific antigen reduction after empiric antibiotic treatment does not rule out biopsy in patients with lower urinary tract symptoms: prospective, controlled, single-center study

Background

To evaluate men, with lower urinary tract symptoms and newly elevated serum prostate specific antigen (PSA) to determine whether a three-week course of ciprofloxacin antibiotics lowers serum PSA levels and affects recommendations for prostate biopsy.

Methods

A prospective, controlled, single-center prospective trial of 177 men with a newly elevated PSA and lower urinary tract symptoms was conducted. Patients were randomized to three weeks of ciprofloxacin or observation. After three weeks, patients PSA levels and derivatives were repeated. At the end of 3 weeks, all patients underwent TRUS guided systematic 12-core prostate biopsies regardless of the final PSA value.

Results

Of 177 men who completed the study, 88 were in the treatment and 89 in the observation group. 46.5% of treatment and %18 of control groups patients PSA levels had decreased after 3 weeks and a significant PSA reduction was observed in the treatment group compare to control group (p: 0.035) but no significant prostate cancer detection rates were observed between the groups (p: 0.418). Also, in the treatment group prostate cancer detection rate was significantly higher in patients whom PSA levels were decreased (p: 0.011).

Conclusion

This study has shown that, use empirical antibiotic treatment decreased the PSA levels but did not have any effect on prostate cancer detection. In addition, prostate cancer detection rates were found to be higher in patients with reduced PSA levels after treatment. Therefore, it may not be safe to rule out biopsies in patients who achieve a satisfactory PSA response to antibiotics.

Are There Relationships between Seminal Parameters and the Neutrophil-to-Lymphocyte Ratio or the Platelet-to-Lymphocyte Ratio?

PURPOSE

The aim of this study was to evaluate the relationship of seminal parameters with the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR), which are inflammatory markers, in men with an abnormal semen analysis and men with normozoospermia.

MATERIALS AND METHODS

Fifty-seven men with abnormal semen analyses and 59 men with normozoospermia were included in this cross-sectional study. A complete blood count was recorded, and the NLR and PLR were calculated from the hematologic parameters.

RESULTS

The NLR was 1.84±0.78 in the normozoospermic group and 1.80±0.75 in the abnormal semen analysis group. The PLR was 95.32±35.47 in the normozoospermic group and 93.57±28.09 in the abnormal semen analysis group. No significant differences were found between the normozoospermic and the abnormal semen analysis group in the NLR (p=0.828) or the PLR (p=0.768). In addition, no seminal parameters were correlated with the NLR or the PLR (p>0.05).

CONCLUSIONS

We do not recommend using the NLR or the PLR as markers to screen for abnormal semen parameters or male infertility.