Serum prostat spesifik antijen yüksekliği nedeniyle ampirik antibiyotik tedavisi verilen ve verilmeyen hastalardaki prostat biyopsi sonuçlarının değerlendirilmesi

Amaç: Antibiyotik kullanılıp kullanılmamasının total prostat spesifik antijen (PSA) düzeyi ve serbest/total (s/t) PSA oranına etkisi ve bu değişimlerin prostat biyopsi sonuçlarına olan yansımalarının değerlendirilmesi. Materyal ve Metod: Kliniğimizde 2004 ile 2016 yılları arasında yaşa göre PSA değeri normalden yüksek olan ve prostat biyopsisi yapılan 1,062 hasta retrospektif olarak değerlendirildi. Rektal muayenede bulgusu olan veya 5-alfa redüktaz inhibitörü kullanan hastalar çalışma dışında tutuldu. Bu olgulardan, kontrol PSA değerleri olan veya PSA düzeyleri 4 ile 10 ng/mL arasında olduğu için antibiyotik tedavisi öncesinde ve sonrasında s/t PSA oranı elde edilmiş bulunan toplam 303 hasta çalışmaya dahil edildi. Toplam 214 hastaya ortanca 4 hafta (2-8 hafta) süren antibiyotik tedavisi sonrasında, kalan 89 olguya antibiyotik verilmeksizin ortalama 1 ay sonraki kontrol PSA düzeylerindeki yükseklik nedeniyle biyopsi yapılmıştı. Her iki grupta da PSA ve s/tPSA oran değişimleri için %5 ve %10 sınır (cut off) değerler alınarak karşılaştırmalar yapıldı. Bulgular: Hastaların ortanca yaşı 63 yıl (45-86 yıl) idi. Antibiyotik verilen grupta (n= 214) her iki sınır değer için (%5 ve %10) anlamlı PSA düşüşü izlenmedi. Antibiyotik verilmeyen hastalarda (n= 89) ise her iki sınır değeri için kontrol PSA değerlerinde anlamlı artış saptandı (%5 sınır değer için p< 0.001, %10 sınır değer için p< 0.001). Antibiyotik alan ve almayan olgular birlikte değerlendirildiğinde (n= 303) PSA’daki azalma ve artışlar antibiyotik kullanılan grupta her iki sınır değer için de anlamlı olarak yüksek bulundu (%5 sınır değer için p< 0.001 ve p< 0.001; %10 sınır değer için p= 0.001 ve p= 0.001). Serbest/total PSA oran değişimleri açısından her iki sınır değer için antibiyotik verilip verilmemesinin anlamlı bir fark oluşturmadığı izlendi. Antibiyotik verilsin veya verilmesin total PSA değişimleri ile patoloji sonuçları arasında arasında anlamlı ilişki saptanmadı. Ancak antibiyotik verilen ve s/t PSA oranında değişim izlenen olgularda her iki sınır değer için patoloji sonuçları ile anlamlı ilişki gözlendi. Bu oranın azaldığı olgularda prostat kanseri, arttığı olgularda ise benign patolojiler daha yüksek oranda saptandı (%5 sınır değer için p değerleri sırasıyla p= 0.004 ve p= 0.014; %10 sınır değer için p değerleri sırasıyla p= 0.014 ve p= 0.026). Yine antibiyotik alan ve almayan olgular birlikte değerlendirildiğinde de oran değişimleri ile patoloji sonuçları arasında anlamlı farklılık saptanmadı. Sonuç: Rektal muayenesi normal, yaşa göre yüksek PSA değeri olan hastalarda önce antibiyotik verilerek ya da herhangi bir ilaç verilmeksizin makul bir süre sonra kontrol PSA değerine bakılarak prostat biyopsisine karar vermek sıklıkla başvurulan durumlardır. Biyopsi kararı verilmesinde s/t PSA oran değişimlerinin, özellikle antibiyotik kullanan olgularda total PSA'dan daha fazla yol gösterici olabileceği anlaşılmaktadır. Objectives: To evaluate the impact of antibiotic treatment on total prostate specific antigen (PSA) levels and free/total (f/t) PSA ratio and the relevance of these changes to prostate biopsy results. Materials and Methods: We retrospectively evaluated 1,062 patients with elevated ageadjusted serum PSA levels who underwent prostate biopsy between 2004 and 2016. Patients with abnormal digital rectal examination findings and/or treated with 5-alpha-reductase inhibitors were excluded. A total of 303 cases with followup PSA levels and f/t PSA ratio determinations because of total PSA values between 4 and 10 ng/mL before and after antibiotherapy were included into this study. There were 214 patients with persistent elevated serum PSA levels after a mean duration of 4-week (range; 2-8) antibiotic treatment followed by prostate biopsy (treatment group) and 89 patients who had prostate biopsy after a mean followup of 1 month without antibiotherapy (control group). The groups were compared with regard to both 5% and 10% cut off changes in serum PSA levels and f/t PSA ratios. Results: The mean age of patients were 63 years (range; 45-86). In the treatment group (n= 214), PSA level decrease remained insignificant at both cut off values. In the control group (n= 89), there was a significant rise in subsequent PSA levels at both cut off values (for 5% cut off value p< 0.001; for 10% cut off value p< 0.001). When the treatment and control groups were taken together (n= 303) changes at PSA levels, either rise or decrease, were significantly higher in the treatment group for both cut off values (for 5% cut off value p< 0.001, p< 0.001; for 10% cut off value p= 0.001, p= 0.001). Antibiotic treatment had insignificant impact on f/t PSA ratio changes at both cut off values. Again, antibiotic treatment had no impact on the relation between serum PSA levels and biopsy results at both cut off values. On the other hand, f/t PSA ratio changes at both cut off values with relevance to antibiotic treatment were found to be related with histopathologic results. While increase in f/t PSA ratio was more related with benign biopsies, decrease in f/t PSA ratio was more related with cancer (for 5% cut off value p= 0.004, p= 0.014; for 10% cut off value p= 0.014, p= 0.026). When both groups were taken together the impact of f/t PSA ratio changes on biopsy results remained insignificant. Conclusion: Obtaining a second PSA level after a followup period with or without empirical antibiotic use before biopsy appears to be a frequent clinical approach in patients with elevated age-specific PSA levels despite normal findings on digital rectal examination. Changes at f/t PSA ratio rather than total PSA only, particularly in antibiotic treated cases appear to be more useful in decision making for biopsy

Penile Abscess Due to Intracavernosal Injection: A Case Report

Penile abscess is a rare clinical entity. We present the case of a 45-year-old paraplegic male who developed penile abscess due to self-administration of intracavernous papaverine injections for erectile dysfunction treatment. Penile magnetic resonance imaging revealed an abscess of 5x4.5 cm in size, located at the right side of the penis and the penile corpus deviated to the left side. Penile exploration, incision and drainage were performed and the patient was treated successfully with intravenous antibiotics. A penile prosthesis was implanted 6 months after the initial surgery

Evaluation of the Genetic Analysis Results in Infertile Patients with Non-Obstructive Azoospermia

Objective:To evaluate the genetic analysis results of patients who referred to our clinic infertility and whom semen analysis revealed non-obstructive azoospermia (NOA).Materials and Methods:Among 994 patients who underwent a microscopic testicular sperm extraction (micro-TESE) operation for NOA, 497 patients who were tested for karyotype analysis and 450 patients who were tested for chromosome Y microdeletion were included in our study. The rates of Klinefelter syndrome (KS) and Y chromosome microdeletion, sperm retrieval rates (SRR) in these genetic anomalies and the factors affecting them were investigated. Additionally, the association between the age, duration of infertility, testicular size, serum follicle stimulant hormone (FSH) and testosterone levels of patients and sperm extraction rates of micro-TESE operations were also evaluated.Results:The overall SRR of NOA patients who underwent micro-TESE was 47.5%. Among 104 patients with KS, sperm was successfully found after micro-TESE in 22 (21.2%). Fourteen patients were diagnosed with the Y chromosome microdeletion and sperm was successfully found in 4 (28.6%) of them; while the duration of infertility did not affect the SRR after micro-TESE (p=0.712); age, testicular volume serum FSH and testosterone levels had a significant effect on the SRR (p<0.005).Conclusion:In this study, the SRR of patients who have chromosome Y microdeletion or KS, was found to be lower than other studies in the literature. This difference could be derived from the genetically tested population’s structure, variance in the gene areas used for scanning and different demographic characteristics of different regions

Prevalence of Poor Sleep Quality and Its Determinants Among Men Suffering from Erectile Dysfunction

Objective:Recent findings implicate a higher prevalence of erectile dysfunction (ED) among men with sleep disorders. We investigated sleep quality among men with ED.Materials and Methods:A prospective study was conducted at 12 different andrology outpatient clinics among men with complaints of insufficient erections. The subjective quality of sleep was measured using the Pittsburgh Sleep Quality Inventory. Erectile function and its dimensions were measured using the International Index of Erectile Function (IIEF) questionnaire. The age-adjusted Charlson comorbidity index and Beck Depression Inventory were used to evaluate interrelations with comorbid disease severity and depression of the subjects consecutively in the study.Results:Among 431 eligible men, the median age of the participants and their erectile function scores in the IIEF were 51 [interquartile range (IQR)=43-59] and 16 (IQR=11-19), respectively. Poor sleep was observed in 192 of 431 (44.5%) subjects. Multivariable analysis revealed that younger age [odds ratio (OR)=0.95, p=0.01], lower body mass (OR=0.86, p=0.01), lower serum high-density lipoprotein cholesterol (OR=0.95, p=0.02), and higher severity of depression (OR=2.1, p=0.0001) were predictors of poor sleep quality among men with ED.Conclusion:Nearly half of the men with ED also suffer from poor sleep. Younger age, lean body mass, and severe depression were the main predictors of poor sleep quality among ED sufferers

Impact of varicocele repair on semen parameters in infertile men: A systematic review and meta-analysis

Purpose: Despite the significant role of varicocele in the pathogenesis of male infertility, the impact of varicocele repair (VR) on conventional semen parameters remains controversial. Only a few systematic reviews and meta-analyses (SRMAs) have evaluated the impact of VR on sperm concentration, total motility, and progressive motility, mostly using a before-after analytic approach. No SRMA to date has evaluated the change in conventional semen parameters after VR compared to untreated controls. This study aimed to evaluate the effect of VR on conventional semen parameters in infertile patients with clinical varicocele compared to untreated controls. Materials and Methods: A literature search was performed using Scopus, PubMed, Embase, and Cochrane databases following the Population Intervention Comparison Outcome (PICOS) model (Population: infertile patients with clinical varicocele; Intervention: VR [any technique]; Comparison: infertile patients with clinical varicocele that were untreated; Outcome: sperm concentration, sperm total count, progressive sperm motility, total sperm motility, sperm morphology, and semen volume; Study type: randomized controlled trials and observational studies). Results: A total of 1,632 abstracts were initially assessed for eligibility. Sixteen studies were finally included with a total of 2,420 infertile men with clinical varicocele (1,424 patients treated with VR vs. 996 untreated controls). The analysis showed significantly improved post-operative semen parameters in patients compared to controls with regards to sperm concentration (standardized mean difference [SMD] 1.739; 95% CI 1.129 to 2.349; p<0.001; I2=97.6%), total sperm count (SMD 1.894; 95% CI 0.566 to 3.222; p<0.05; I2=97.8%), progressive sperm motility (SMD 3.301; 95% CI 2.164 to 4.437; p<0.01; I2=98.5%), total sperm motility (SMD 0.887; 95% CI 0.036 to 1.738; p=0.04; I2=97.3%) and normal sperm morphology (SMD 1.673; 95% CI 0.876 to 2.470; p<0.05; I2=98.5%). All the outcomes showed a high inter-study heterogeneity, but the sensitivity analysis showed that no study was sensitive enough to change these results. Publication bias was present only in the analysis of the sperm concentration and progressive motility. No significant difference was found for the semen volume (SMD 0.313; 95% CI -0.242 to 0.868; I2=89.7%). Conclusions: This study provides a high level of evidence in favor of a positive effect of VR to improve conventional semen parameters in infertile men with clinical varicocele. To the best of our knowledge, this is the first SRMA to compare changes in conventional semen parameters after VR with changes in parameters of a control group over the same period. This is in contrast to other SRMAs which have compared semen parameters before and after VR, without reference to a control group. Our findings strengthen the available evidence and have a potential to upgrade professional societies’ practice recommendations favoring VR to improve conventional semen parameters in infertile men

Impact of Varicocele Repair on Semen Parameters in Infertile Men: A Systematic Review and Meta-Analysis

Purpose:Despite the significant role of varicocele in the pathogenesis of male infertility, the impact of varicocele repair (VR) on conventional semen parameters remains controversial. Only a few systematic reviews and meta-analyses (SRMAs) have evaluated the impact of VR on sperm concentration, total motility, and progressive motility, mostly using a before-after analytic approach. No SRMA to date has evaluated the change in conventional semen parameters after VR compared to untreated controls. This study aimed to evaluate the effect of VR on conventional semen parameters in infertile patients with clinical varicocele compared to untreated controls.Materials and Methods:A literature search was performed using Scopus, PubMed, Embase, and Cochrane databases following the Population Intervention Comparison Outcome (PICOS) model (Population: infertile patients with clinical varicocele; Intervention: VR [any technique]; Comparison: infertile patients with clinical varicocele that were untreated; Outcome: sperm concentration, sperm total count, progressive sperm motility, total sperm motility, sperm morphology, and semen volume; Study type: randomized controlled trials and observational studies).Results:A total of 1,632 abstracts were initially assessed for eligibility. Sixteen studies were finally included with a total of 2,420 infertile men with clinical varicocele (1,424 patients treated with VR vs. 996 untreated controls). The analysis showed significantly improved post-operative semen parameters in patients compared to controls with regards to sperm concentration (standardized mean difference [SMD] 1.739; 95% CI 1.129 to 2.349; pConclusions:This study provides a high level of evidence in favor of a positive effect of VR to improve conventional semen parameters in infertile men with clinical varicocele. To the best of our knowledge, this is the first SRMA to compare changes in conventional semen parameters after VR with changes in parameters of a control group over the same period. This is in contrast to other SRMAs which have compared semen parameters before and after VR, without reference to a control group. Our findings strengthen the available evidence and have a potential to upgrade professional societies' practice recommendations favoring VR to improve conventional semen parameters in infertile men.</p

Combined surgical and chemotherapy treatment for invasive primary urethral cancer: a case presentation

Abstract Background The European Association of Urology (EAU) defines primary urethral carcinoma (PUC) as a carcinoma that arises in the urethra without a previous diagnosis of carcinoma elsewhere in the urinary system. It is considered as a rare cancer, accounting for less than 1% of all malignant tumors and 5% of malignant tumors of the urinary system. The difficulty in diagnosis and its rarity can lead to delayed diagnosis and decreased survival. We think that a case report to be made in the literature for this rare disease with no consensus on treatment will contribute to disease management. Case presentation In this article, we describe the diagnosis and treatment process of a 75-year-old patient who was diagnosed with primary urethral cancer and had urethral discharge and difficulty in urination. The biopsy result from the suspected hyperemic area in the urethra in cystourethroscopy was primary urethral cancer. Urethrectomy followed by urethroplasty was performed on the patient's 2-cm primary urethral cancerous tissue. In the postoperative first month, an F-18 FDG whole-body PET scan for oncological evaluation showed increased pathological F-18 FDG uptake in the periphery of the mass in the penile urethra and indistinguishable boundaries from the prostatic urethra. After this, adjuvant gemcitabine and carboplatin therapy was planned by the oncology team. Conclusions Based on our outcome in this case, we believe that chemotherapy combined with surgery increases the chance of successful treatment in locally advanced urethral cancer

Variations in the Number of Patients Presenting With Andrological Problems During the Coronavirus Disease 2019 Pandemic and the Possible Reasons for These Variations: A Multicenter Study

Introduction: Coronavirus disease 2019 (COVID-19) pandemic caused unprecedented restrictions in outpatient services and surgical practices in urology as in other medical branches as well as in all areas of life

The relationship between premature ejaculation and the timing of pre-adult circumcision

We aimed to investigate the relationship between premature ejaculation and the age when men had been circumcised before adulthood. A total of 2,768 sexually active male patients aged between 18 and 65 years were included in this study. A multicentre study was conducted prospectively with the participation of 20 centres. A survey consisting of 12 questions prepared by the researchers, as well as the validated Turkish versions of the five-item Premature Ejaculation Diagnostic Tool, was administered to all participants. The study included 1,603 participants who met the inclusion criteria. There was no significant difference in the Premature Ejaculation Diagnostic Tool and self-reported ejaculation time between the participants who had been circumcised at different ages during childhood. Remembering circumcision experience with fear or anxiety did not increase the risk of sexual dysfunction compared to the participants who described their experience with happiness or with no particular emotion. There was no significant difference in Premature Ejaculation Diagnostic Tool scores or the self-reported ejaculation time of the participants circumcised at different ages. The age of childhood circumcision, having a fearful or anxious circumcision experience, does not affect the risk of premature ejaculation in adult life

Comprehensive Analysis of Global Research on Human Varicocele: A Scientometric Approach

Purpose: This study provides a comprehensive analysis of research trends on the etiology, mechanisms, potential risk factors, diagnosis, prognosis, surgical and non-surgical treatment of varicocele, and clinical outcomes before and after varicocele repair. Materials and Methods: Varicocele studies published between 1988 and 2020 were retrieved from the Scopus database on April 5, 2021. Original studies on human varicocele were included, irrespective of language. Retrieved articles were manually screened for inclusion in various sub-categories. Bibliometric data was subjected to scientometric analysis using descriptive statistics. Network, heat and geographic mapping were generated using relevant software. Results: In total, 1,943 original human studies on varicocele were published. These were predominantly from the northern hemisphere and developed countries, and published in journals from the United States and Germany. Network map analysis for countries showed several interconnected nodal points, with the USA being the largest, and Agarwal A. from Cleveland Clinic, USA, being a center point of worldwide varicocele research collaborations. Studies of adolescents were underrepresented compared with studies of adults. Studies on diagnostic and prognostic aspects of varicocele were more numerous than studies on varicocele prevalence, mechanistic studies and studies focusing on etiological and risk factors. Varicocele surgery was more investigated than non-surgical approaches. To evaluate the impact of varicocele and its treatment, researchers mainly analyzed basic semen parameters, although markers of seminal oxidative stress are being increasingly investigated in the last decade, while reproductive outcomes such as live birth rate were under-reported in the literature. Conclusions: This study analyzes the publication trends in original research on human varicocele spanning over the last three decades. Our analysis emphasizes areas for further exploration to better understand varicocele's impact on men's health and male fertility.Peer reviewe