POWER DOPPLER ULTRASOUND MAPPING IN NONOBSTRUCTIVE AZOOSPERMIC PATIENTS PRIOR TO TESTICULAR SPERM EXTRACTION

This study was conducted to localize the testicular regions, which have better blood circulation by power Doppler ultrasonography in patients with nonobstructive azoospermia before testicular sperm extraction (TESE), and to investigate whether these vascularized areas have a high sperm retrieval rate or not. We evaluated 110 testes of 55 cases that were diagnosed as nonobstructive azoospermia. The mean age of the study group was 33 years (range 26 to 42). Patients with Y chromosome microdeletions, karyotype and hormonal abnormalities (except elevated FSH levels) were excluded from the study. In all cases, testes were evaluated by power Doppler ultrasonography before testicular sperm extraction. Testis was divided vertically into five equal parts and the area with maximum vascularity was determined subjectively. During testicular sperm extraction, starting from best-perfused areas, biopsies were done. If no motile or sufficient amount of sperm was found, TESE procedure was tried on the contralateral testis. TESE were performed from 82 testes and for the regions that show good and poor vascularity. The sperm finding rate was 38% and 14%, respectively (OR = 3.55)(p = 0.001). Power Doppler ultrasound mapping of the testis in nonobstructive azoospermic cases is a reliable and informative method to assess spermatogenic foci. It is a noninvasive technique that minimizes the unnecessary removal of hormone producing tissue and gives chance to end the TESE earlier than currently practiced procedures.

IS VARICOCELE A PROGNOSTIC FACTOR FOR DETERMINING SPERM RETRIEVAL RATE BEFORE TESTICULAR SPERM EXTRACTION?

66 nonobstructive azoospermic mean with normal genetic analysis composed of 32 (48%) patients with and 34 (52%) patients without varicocele were evaluated for the rate of sperm extraction five months after the varicocelectomy. Sperm retrieval was successful in 22 of 32 patients (68%) who had been operated because of varicocele and in 13 of 34 patients (38.2%) who had no varicocele (OR = 3.55) (CI: 1.15-11.27) (p = 0.025). Overall, sperm extraction was successful in 35 of 66 patients (53%). Repair of varicocele in non-obstructive azoospermic patients may return spermatogenesis to normal in spermatogenic focuses. So, the present of varicocele and its treatment might be considered as a prognostic factor for sperm retrieval in these patients.

Is There an Impact of Postoperative Urethral and Periurethral Anatomical Features in Post-Radical Retropubic Prostatectomy Incontinence?

OBJECTIVES

To determine the anatomical changes in urethral and periurethral tissues after radical retropubic prostatectomy (RRP) by magnetic resonance imaging (MRI) and correlate these changes to continence.

MATERIALS AND METHODS

14 patients with grade 2-5 incontinence and 16 continent (grade 1) patients who had undergone non-nerve-sparing RRP for clinically localized prostatic carcinoma were evaluated. The sphincteric urethral length, transverse and craniocaudal diameters of both levator ani muscles and the volume of periurethral fibrosis were determined by abdominopelvic MRI. Continent (group 1) and incontinent (group 2) groups were compared in terms of sphincteric urethral length, transverse and craniocaudal diameters of levator ani muscles, volume of periurethral fibrosis, prostate volume, age and pathological stage.

RESULTS

Among all the evaluated parameters, a statistically significant correlation was found only between the volume of periurethral fibrosis and the number of postoperative operations for urethral strictures in the incontinent group (p = 0.013, r = 0.859).

CONCLUSIONS

Our results suggest that the postoperative sphincteric urethral length is not the sole factor in regaining continence after RRP as mentioned in the literature.

Urinary incontinence after pelvic trauma: a case report

Stress and Urge urinary incontinence may develop after a pelvic trauma especially after pelvic bone fractures. Incontinence may persist even though any type of bladder neck suspension is performed if malunion occurs between fracture ends. In stress and urge urinary incontinence developed after pelvic trauma, patients should also be evaluated for malunion of fractures which may lead to bone spurs and during any type of bladder neck suspension these should also be removed.

Pelvicalyceal stone load: a factor affecting the outcome of extracorporeal shockwave lithotripsy for renal pelvic calculi

OBJECTIVES

To determine the effect of variations in pelvicalyceal volume on the results of extracorporeal shock wave lithotripsy (ESWL) and the relationship of stone load to estimated pelvicalyceal volume in patients with renal pelvic stones.

PATIENTS AND METHODS

In all, 204 patients with renal pelvic stones were treated primarily by ESWL. Exclusion criteria were radiolucent stones, dilatation of the renal collecting system, JJ stent insertion before ESWL and an inadequate follow-up. The surface area of the stones and the renal collecting system were measured using a grid of 1 mm2 divisions. The pelvicalyceal volume was calculated as 0.6 (area)1.27. To evaluate the treatment results a pelvicalyceal stone load (PSL) index, describing the relationship of stone load to total estimated pelvicalyceal volume, was defined as stone volume/renal collecting system volume.

RESULTS

The mean (range) pelvicalyceal volume of the patients was 13.24 (4.12-28.47) mm3 and the mean PSL index was 26.2%. The cumulative success rates according to the PSL decreased from 97% to 90% with increasing PSL, but remained at > 95% in patients with a PSL index of < 50%. In all, 184 sessions were applied and the session/patient ratio increased from 1.41 to 3.0 with increasing PSL. Complications were acute pyelonephritis in three and steinstrasse in five patients.

CONCLUSION

The PSL index appears to be a more accurate and reproducible method for predicting the outcome of ESWL, and has the advantage of considering the effect of pelvicalyceal anatomy.

Magnetic resonance imaging and morphometric histologic analysis of prostate tissue composition in predicting the clinical outcome of terazosin therapy in benign prostatic hyperplasia

PURPOSE

To determine whether magnetic resonance imaging (MRI) or quantitative color-imaged morphometric analysis (MA) of the prostate gland are related to the clinical response to terazosin.

METHODS

Thirty-six male patients with symptomatic benign prostatic hyperplasia (BPH) with a serum prostate-specific antigen level of 4-10 ng/mL underwent MRI with body coil, transrectal prostate ultrasonography and biopsy prior to terazosin therapy. For MRI-determined stromal and non-stromal BPH, the ratio of the signal intensity of the inner gland to the obturator internus muscle was evaluated. Histologic sections were stained with hematoxylin and eosin. The MA of the specimens was performed by Samba 2000. Results of the two techniques were interpreted according to the terazosin therapy results.

RESULTS

The mean stromal percentage was 60.5 +/- 18.0%. No statistically significant relationship was found between the clinical outcome of terazosin and the MRI findings. The MA results showed a significant relationship between the percentage of stroma and the percent change of the peak urinary flow rate, but not with the percent change of the international prostate symptom score after terazosin therapy (P < 0.05).

CONCLUSION

Magnetic resonance imaging alone is not sufficient in predicting the response to terazosin therapy. Morphometric analysis of BPH tissue composition can be used in predicting the clinical outcome of terazosin therapy but it is suitable only in patients for whom prostatic biopsy is necessary in order to rule out prostate cancer.

The value of percent free prostate specific antigen, prostate specific antigen density of the whole prostate and of the transition zone in Turkish men

INTRODUCTION

This study was undertaken to evaluate the value of percent free prostate specific antigen (PSA), PSA density of the whole prostate (PSAD) and of the transition zone (TZPSAD) in reducing unnecessary biopsies in Turkish men with serum PSA levels between 2.5 and 20 ng/mL.

MATERIALS AND METHODS

A total of 105 patients referred for early prostate cancer detection or lower urinary tract symptoms participated in the study. All patients had serum total PSA level, PSAD, total prostate volume, and rectal examination, 43 patients had serum free PSA level, and 65 patients had TZPSAD. Using transrectal ultrasound, sextant biopsy and two additional transitional zone biopsies were performed. The value of percent PSA, PSAD, and TZPSAD in reducing unnecessary biopsies was evaluated.

RESULTS

Prostate carcinoma was detected in 25 of 105 patients (23.8%). Overall, areas under the ROC curves for percent free PSA, PSAD, and TZPSAD were 0.553, 0.595, and 0.550, respectively. In patients with a benign rectal examination, the value of percent free PSA slightly increased. On the other hand, in patients with prostate volume smaller than 50 cc, the value of percent free PSA and TZPSAD was encouraging. Areas under the ROC curves for percent free PSA, and TZPSAD were 0.615 and 0.642 respectively.

CONCLUSION

In Turkish men with intermediate serum PSA concentrations, percent free PSA, PSAD, and TZPSAD are poor predictors of biopsy outcome, whereas in the prostate smaller than 50 cc, percent free PSA and TZPSAD provide additional information. This may reflect ethnic differences between this population and those reported in other series.

What is the optimal treatment for lower ureteral stones larger than 1 cm?

PURPOSE

To compare the treatment options for lower ureteral stones larger than 1 cm.

METHODS

The records of 449 patients with lower ureteral calculi larger than 1 cm were reviewed retrospectively. Of these patients 342 (76.1%) were treated with extracorporeal shock wave lithotripsy (ESWL) (group 1), 66 (14.7%) with pneumatic lithotripsy (PL) (group 2) and 128 (28.5%) with ureterolithotomy (group 3). Eighty-seven (19.5%) patients underwent any of the two treatment modalities because of unsuccessful primary treatment.

RESULTS

The overall stone-free rates were 32.4, 90.9 and 95.3% for ESWL, PL and ureterolithotomy, respectively. These values were 84.4% for primary PL and 96.7% for primary ureterolithotomy. The re-treatment rate (46.4%) and secondary procedures were much more frequent in the ESWL group. There was no difference in the complication rates of the three groups.

CONCLUSIONS

Pneumatic lithotripsy with ureteroscopy seems to be an appropriate treatment for larger ureteral stones. While ESWL can be tried as a first treatment option because of its noninvasive nature, lower success and higher re-treatment rates limit its usefulness. Ureterolithotomy is still a reasonable alternative for these large or unfragmented stones.

Comparison of the nuclear matrix protein 22 with voided urine cytology and BTA stat test in the diagnosis of transitional cell carcinoma of the bladder

OBJECTIVE

To assess sensitivity, specificity, accuracy, positive predictive value and negative predictive value of nuclear matrix protein 22 (NMP22) test, BTA stat test and cytology in the urine of patients with a spectrum of urologic conditions, including bladder cancer.

METHODS

A total of 140 patients (40 with bladder cancer) provided a urine sample which was divided into appropriate aliquots for each of the tests cited above. The endoscopist, pathologist, cytologist and the person performing BTA stat test and NMP22 test were blinded as to the results of the other tests.

RESULTS

Receiver-operating characteristics curve interpretation determined that 12.0 U/ml was an optimal reference value for NMP22 to detect transitional cell carcinoma of the bladder in this patient group. Comparative results demonstrate a clear superiority of NMP22 and BTA stat tests in sensitivity in bladder cancer detection (p < 0.01), while cytology and NMP22 were better than BTA stat test in specificity (p < 0.05).

CONCLUSIONS

NMP22 and BTA stat test results represented significant improvement over urinary cytology for detection of transitional cell carcinoma. The sensitivities of NMP22 and BTA stat tests for detection of transitional cell carcinoma in this group of patients were as much as twice that of cytology. When the cutoff value of urinary NMP22 was set at 12.0 U/ml, NMP22 was more accurate than the other tests (p < 0.05).

Extracorporeal shockwave lithotripsy in anomalous kidneys

BACKGROUND AND OBJECTIVE

Extracorporeal shockwave lithotripsy (SWL) is accepted as first-line therapy for kidney stones. The aim of this study was to evaluate SWL therapy in patients with congenital urinary system anomalies.

PATIENTS AND METHODS

A total of 120 patients with congenital urinary system anomalies and kidney stones who underwent SWL treatment were evaluated. Of these patients, 44 (37%) had horseshoe kidneys, 22 (18%) had rotation anomalies, 13 (11%) had pelvic kidneys, and 41 (34%) had ureteral duplications. The mean stone size was 2.09+/-0.71 (range 0.8-4.6) cm2, and a total of 232 sessions (1.93 sessions/patient) were applied.

RESULTS

The overall stone-free rate after completion of the SWL treatments was 70% (84 patients). In horse shoe kidneys the stone-free rate was 68%, and sufficient fragmentation was achieved in another 21%. These values were 59% and 32%, respectively, for malrotated kidneys, 54% and 39% for pelvic kidneys, and 83% and 12% for ureteral duplications. The 10 patients in whom SWL treatment remained unsuccessful had horse-shoe kidneys (five cases), malrotated kidneys (two cases), pelvic kidney (one case), and ureteral duplication (two cases). Open surgery was performed in eight patients with renal anomalies, and ureteroendoscopic lithotripsy was performed in two patients with ureteral duplication.

CONCLUSION

Shockwave lithotripsy is an effective and reliable treatment method in patients with congenital urinary system anomalies, especially when the stones are <2 cm. Patients with ureteral duplication had the overall best stone-free rates. However, patients who have stones > or =3 cm in horseshoe or malrotated kidneys and duplex systems seem to be better candidates for percutaneous nephrolithotomy or open surgery.

Treatment of ureteral stones: comparison of extracorporeal shock wave lithotripsy and endourologic alternatives

AIM OF THE STUDY

The aim of the study is to compare the effectiveness of ESWL and ureteroscopic lithotripsy with pneumatic, ultrasonic and electrohydraulic modalities in patients with ureteral stones.

PATIENTS AND METHOD

In this study, 1,970 patients with ureteral stones were evaluated. ESWL and ureteroscopic lithotripsies were performed in 1,580 and 484 patients, respectively. The ESWL group was treated with a Siemens Lithostar plus. Ureteroscopic lithotripsy was performed with pneumatic lithotripsy (PL), ultrasonic lithotripsy (USL) and electrohydraulic lithotripsy (EHL) in 140 (28.9%), 311 (64.3%) and 33 (6.8%) patients, respectively. 94 patients underwent both because of unsuccessful ESWL therapy.

RESULTS

In the ESWL group, the stone-free rate was 49.9% and the fragmentation rate 71.0%. These values were: 95.0 and 97.1% for PL; 88.1 and 89.4% for USL; 90.9 and 93.9% for EHL, respectively. Ureteroscopic lithotripsy has been found more effective than ESWL in the treatment of middle and lower ureteral calculi (p < 0.001) and PL has the greatest success rate within these endoscopic groups.

CONCLUSION

ESWL therapy can be the first-line therapy in upper ureteral stones keeping the other modalities for unfragmented stones. However, ureteroscopic lithotripsy is the most effective treatment choice in lower ureteral stones no matter which kind of energy used and PL is the most effective and less complicated among the other types.

Nuclear p53 overexpression in bladder, prostate, and renal carcinomas

BACKGROUND

The aim of this study was to examine nuclear p53 overexpression in transitional cell carcinoma of the bladder, adenocarcinoma of the prostate, and renal cell carcinoma.

METHODS

Forty-four pathologic specimens from 39 bladder cancer patients, 41 prostatic adenocarcinoma, and 39 renal cell carcinoma specimens were analyzed immunohistochemically with D07 monoclonal antibody to detect the expression of the mutant p53 gene. Overexpression was said to occur when the number of positively-stained tumor nuclei were > or = 10% in each specimen. p53 overexpression was correlated with the clinical and histopathological features of these cancers.

RESULTS

Nuclear p53 overexpression occurred in 18.2% of transitional cell bladder cancer specimens, 12.2% of prostate cancer specimens, and 17.9% of renal cell cancer specimens. Statistical analyses showed that grade, vascular invasion, and necrosis in bladder cancer, a high Gleason score in prostate cancer, and the 1-year mortality rate in renal cancer were significantly related with p53 nuclear overexpression (P < 0.05).

CONCLUSION

Using the D07 monoclonal antibody, nuclear p53 overexpression is relatively uncommon in urologic malignancies, and moderately correlates with several histopathological and clinical features of urologic malignancies.

Correlation of nuclear p53 over-expression with clinical and histopathological features of transitional cell bladder cancer

Forty-four pathologic specimens of 39 bladder cancer patients were analyzed immunohistochemically with D07 monoclonal antibody to detect over-expression of mutant p53 gene. The findings were interpreted by correlating with patient age, sex, cigarette smoking, number and macroscopic appearance of tumour, histological tumour grade, muscular invasion, vascular invasion, necrosis and urothelial atypia or dysplasia. Mutant p53 gene was over-expressed in 8 (18.2%) specimens. Statistically significant correlation with grade, vascular invasion, necrosis and patient sex was found with p53 over-expression. Available follow-up data were insufficient to draw a conclusion about the prognostic role of p53 over-expression. Prospective studies with larger number of patients are needed to define the exact place of nuclear p53 over-expression in transitional cell bladder cancer.

Acute bioeffects of electromagnetic lithotripsy

Acute effects of extracorporeal shock wave lithotripsy (ESWL) with Siemens Lithostar on kidney and surrounding tissues were examined on 42 patients with unilateral kidney stones in the Department of Urology, Gazi University, Medical Faculty, Ankara, Türkiye. Radiological examinations were done and 24-h urine and blood samples were obtained a day before, the day after and 30 days after ESWL. Urinary excretion of proteins, glycosaminoglycan, and immunoglobulin G were significantly elevated the day after ESWL. Thirty days after excretion levels of these were statistically insignificant in regard to pretreatment levels. Creatinine clearance of the patients was significantly lowered the day after ESWL. One month later differences were insignificant. Excretory urography detected 12 (29%) kidneys with abnormalities the day after ESWL. Thirty days after only 3 (7%) of the kidneys had persistent abnormalities. The number of abnormalities with ultrasonography 24 h and 30 days after ESWL were 15 (36%) and 5 (12%) respectively. With CT-scanning kidney abnormalities 24 h after and 30 days after ESWL were 24 (57%) and 6 (14%) respectively. There was not any statistically significant difference between patients with either radiological or functional changes after ESWL and with patients without these changes in regard to patient age, sex, stone burden and shock wave number. In conclusion, electromagnetic lithotripsy induces acute renal morphologic and functional changes. Functional changes are transient and subside within a month but although decreasing either in size or number some morphologic changes persist during this period.

Multiple fibroepithelial polyps of the renal pelvis and calyces: a case report

Fibroepithelial polyp of the renal pelvis is an extremely rare entity. We report a case of multiple fibroepithelial polyps of the renal pelvis and calyces and discuss this rare and confusing condition with its clinical, radiological and pathological findings.

An unusual complication of extracorporeal shock wave lithotripsy: urinoma due to rupture of the renal pelvis

A case of a female patient with urinoma due to rupture of the renal pelvis after extracorporeal shock wave lithotripsy is described. Although temporary perirenal fluid accumulations after extracorporeal shock wave lithotripsy have been reported previously, possibly this is the first case presenting with an abdominal mass due to retroperitoneal urine collection.

Prognostic factors in superficial bladder cancer

A retrospective analysis of 91 patients with superficial transitional cell carcinoma (stages Ta and T1) is reported. In all of the patients transurethral resection was the treatment of choice. With the recurrence rate as the primary endpoint of interest it appeared that the number of tumours at presentation, invasion of the lamina propria, and histological grade were to be of prognostic importance. The frequency of tumour progression in our group was found to be 10 per cent. All of the patients who developed muscle invasion had lamina propria invasion at presentation.

Fracture of the penis and long-term results of surgical treatment

Twenty-five patients with fracture of the penis were treated surgically between 1968 and 1984. Long-term follow-up was obtained in 17. In no case were there any early post-operative complications. All patients stated that they were achieving normal, painless erections; two patients developed a slight penile curvature but this did not affect their sexual activities. We strongly recommend early surgical intervention because of these encouraging results. Urethral injury associated with the fracture did not occur in this series.