The presence of hydronephrosıs ın stagıng bladder cancer: an omınous sıgn

Objective: We investigated whether the presence of unilateral or bilateral upper tract obstruction could accurately predict advanced cancer stage. Methods: Six hundred and ten patients with bladder cancer entered into the tumor registries of our institutions between January 1990 and December 1994. The median patient age was 64 years (range 35 to 80). A total 75 (12%) patients had unilateral or bilateral hydronephrosis on an IVP at the time of initial diagnosis of the bladder cancer. Preoperative screening included physical examination, chest radiograph, complete blood count, blood urea nitrogen, creatinin, electrolyte analysis and IVP. Furthermore, patients were usually evaluated by bone scan and computerized tomography (CT). The diagnosis of transitional cell carcinoma was made by cystoscopy and transurethral resection of the tumor. Staging transurethral resection was done in all cases. Results: During a 5-year period 75 of 610 patients with carcinoma of the bladder had ureteral obstruction on excretory urography at the time of the initial diagnosis. Preoperative IVP revealed unilateral and bilateral hydronephrosis in 55 (73%) and 20 (27%) patients, respectively. Pathological staging revealed predominantly pT1 lesions for patients with unilateral obstruction. There were 30 (55%) patients with pT1, 10 (18%) with pT2, and 15 (27%) with pT3. Pathological staging revealed predominantly pT2 lesions for patients with bilateral obstruction. Pathological stage was pT2 in 10 (50%) cases, pT3 in 5 (25%), and pT4 in 5 (25%). Conclusion: IVP can be used in staging because hydronephrosis may Indicate the presence of a muscle-invasive bladder cancer, especially, bilateral hydronephrosis was strongly associated with advanced stage disease

Does the Positive Intracavernous Papaverine Test Always Indicate a Normal Penile Vascular System?

Objective: A positive intracavernous papaverine test has been presumed to determine normal erectile hemodynamics. Recently, positive erectile responses to intracorporeal injection tests were reported in patients with penile arterial insufficiency. Methods: This hypothesis was assessed by obtaining hemodynamic data using color Doppler ultrasonography in 417 patients with erectile dysfunction aged between 20 and 73 years (mean 43.06 +/- 13.66). A normal penile vascular system was found in 95 patients (22.79%), veno-occlusive dysfunction in 76 (18.22%), arteriogenic erectile dysfunction (ED) in 113 (27.10%) and mixed-type ED in 133 (31.89%). Results: A positive erection response was achieved in 176 patients with combined intracavernosal injection of 60 mg papaverine and self-manual genital stimulation (CIS) test, while a negative response was observed in the remaining 241 (57.79%). Color Doppler ultrasonography combined with pharmacological erection has proved a normal penile vascular system in 94 (53.41%) and penile arterial insufficiency in 82 (46.59%) patients of those who gave a positive response to the CIS test. Also, a positive CIS test response was observed in all patients with unilateral arterial insufficiency (n = 31) and in 51 patients (62.19%) out of 82 with bilateral arterial insufficiency. Conclusion: A positive intracavernous papaverine test indicates veno-occlusive dysfunction competence but does not necessarily signify a normal penile arterial system. The CIS test should be combined with color Doppler ultrasonography in order to determine the vascular component of ED, since the differentiation is not possible between slight penile arterial insufficiency and psychogenic or neurogenic impotence with the CIS test

The presence of hydronephrosıs ın stagıng bladder cancer: an omınous sıgn

Objective: We investigated whether the presence of unilateral or bilateral upper tract obstruction could accurately predict advanced cancer stage. Methods: Six hundred and ten patients with bladder cancer entered into the tumor registries of our institutions between January 1990 and December 1994. The median patient age was 64 years (range 35 to 80). A total 75 (12%) patients had unilateral or bilateral hydronephrosis on an IVP at the time of initial diagnosis of the bladder cancer. Preoperative screening included physical examination, chest radiograph, complete blood count, blood urea nitrogen, creatinin, electrolyte analysis and IVP. Furthermore, patients were usually evaluated by bone scan and computerized tomography (CT). The diagnosis of transitional cell carcinoma was made by cystoscopy and transurethral resection of the tumor. Staging transurethral resection was done in all cases. Results: During a 5-year period 75 of 610 patients with carcinoma of the bladder had ureteral obstruction on excretory urography at the time of the initial diagnosis. Preoperative IVP revealed unilateral and bilateral hydronephrosis in 55 (73%) and 20 (27%) patients, respectively. Pathological staging revealed predominantly pT1 lesions for patients with unilateral obstruction. There were 30 (55%) patients with pT1, 10 (18%) with pT2, and 15 (27%) with pT3. Pathological staging revealed predominantly pT2 lesions for patients with bilateral obstruction. Pathological stage was pT2 in 10 (50%) cases, pT3 in 5 (25%), and pT4 in 5 (25%). Conclusion: IVP can be used in staging because hydronephrosis may Indicate the presence of a muscle-invasive bladder cancer, especially, bilateral hydronephrosis was strongly associated with advanced stage disease

Could be evaluated erectile response with simultaneously visual and sensory sexuel stimulation “Rigi-Scan and Sildenafil Citrate Test”

Amaç: Bu çalışmada erektil disfonksiyon (ED)’da, görsel ve duyusal seksüel uyarı (GDSU) testinin tanısal etkinliği ve tedavi öncesinde Sildenafil sitratın etkinliğini öngörebilmesi araştırıldı. Gereç ve Yöntem: ED şikayetleri ile 2005 ve 2006 yıllarında kliniğimize başvuran gönüllü, 13’ü diyabetik, 16’sı vasküler risk faktörü taşıyan toplam 52 hasta çalışmaya dahil edildi. Hastaların ortalama yaşı 55 (32- 73) idi. Ayrıntılı anamnez alındı, IIEF-5 formu doldurtuldu, gece ereksiyonlarının varlığı sorgulandı, hormon analizleri yapıldı. Hastalara 1 saat süreyle RigiScan-Plus takılarak, penil ereksiyonlar kayda alındı. GDSU testi 3 aşamada uygulandı, 1. aşamada hastalara medikal tedavi verilmeksizin, 2. aşamada 50mg Sildenafil sitrat, ve 3. aşamada ise 100mg Sildenafil sitrat verilerek test gerçekleştirildi. Herhangi bir aşamada yeterli ereksiyon sağlayan hastaların GDSU testi pozitif, hiçbir aşamada yeterli ereksiyon sağlayamayan hastaların GDSU testi negatif olarak değerlendirildi. Hastalara GDSU testi uygulandıktan sonra, intrakavernozal enjeksiyon testi (ICE), penil doppler ultrasonografi (PDU) ve nokturnal penil tümesans testi (NPT) uygulandı. Bulgular: GDSU testinde 5 hastada (%9,6) 1. ve 2. aşamada, 18 hastada (%34,6) sadece 2. aşamada ve 10 hastada (%19,2) da 3. aşamada yeterli ereksiyon sağlandı. Sonuçta 33 hastada (%63,5) GDSU testi pozitif, diğer 19 hastada (%36,5) GDSU testi negatif olarak değerlendirildi. GDSU testinin sadece NPT (p=0,028) ve ICE (p<0,001) ile benzer tanısal etkinliği olduğu saptandı.Purpose: In this study, in erectile dysfunction (ED), test of audio-visual sexual stimulation (AVSS) effectiveness of diagnostic and treatment prior to predict the efficacy of Sildenafil citrate was investigated. Material and method: Voluntarily admitted to our clinic with complaints of ED in 2005-2006, 13 diabetic, 16 with vascular risk factors of 52 patients were included the study. The mean age was 55 (32-73). Detailed history, IIEF-5 form, the presence of night erections were questioned, hormone analysis was performed. Penile erections were recorded, by attaching RigiScan-Plus to the patients for 1 hour. AVSS test was performed in 3 stages; 1st stage, without any medical treatment to the patients, 2nd stage, given 50mg of Sildenafil citrate and 3rd stage, was given 100mg of Sildenafil citrate. Patients who were providing adequate erection at any stage, the AVSS test positive, patients could not enough erection in any stage, the AVSS test negative were considered. After AVSS test applied to patients, the intracavernosal injection test (ICE), penile Doppler ultrasound (PDU) and nocturnal penile tumescence test (NPT) was performed. Results: Adequate erections were achieved, in 5 patients (9.6%) both 1st and 2nd stage, 18 patients (34.6%) only 2nd stage and 10 patients (19.2%) in 3rd stage in AVSS test. As a result 33 patients (63.5%) tested positive; other 19 patients (36.5%) were negative in AVSS test. Only, NPT (p=0.028) and ICE (p <0.001) were found to be similar to the diagnostic efficiency with the AVSS test. Conclusions: AVSS test is a more useful test than, those have difficult implementation and invasive testing such as NPT and ICE. AVSS test being performed simultaneously with the PDE-5 inhibitors is important to predict the effectiveness of treatment. AVSS is a noninvasive, reliable test, offering objective data and easy to apply