Serum testosterone levels, testis volume, and the risk of prostate cancer: are these factors related?

Amaç: Literatürde serum serbest ve total testosteron düzeyleri ve prostat kanseri arasındaki ilişki hakkında kesin olmayan sonuçlar bildirilmiştir. Biz kendi hasta grubumuzda total ve serbest serum testosteron düzey- leri, testis hacmi ve prostat kanseri arasındaki ilişkiyi araştırdık. Gereç ve yöntemler: Alt üriner sistem semptomları ile üroloji polikliniğine başvuran 102 hastada serum total ve serbest testosteron düzeyleri ve serum PSA değerleri kayıt edildi. Anormal rektal muayene bulgusu ve/veya >4.0ng/mL serum PSA düzeyi nedeni ile bütün hastalara transrektal ultrasonografi (US) rehber- liğinde prostat biyopsisi yapıldı. Bütün transrektal ve testis US incelemeleri ve biyopsileri aynı radyolog tarafından yapıldı. Testis uzunluğu, genişliği ve yüksekliği transvers ve longitudinal gri skala görüntülerde ölçüldü ve testis hacmi hesaplandı. Bulgular: Prostat biyopsisi yapılan 102 hastanın 32sinde prostat kanseri saptandı (%31.3) (prostat kanseri grubu). Geri kalan hastalar benign histopatolojik bulgulara sahipti (prostat kansersiz grup). Prostat kanseri ve benign histoloji grupları yaş, total ve serbest testosteron, PSA değerleri ve testis hacmi açısından karşı- laştırıldı. Prostat kanseri olan hastaların ortalama yaşı daha büyük bulundu (p= 0.04). Serum PSA, serbest testosteron ya da total testosteron ve testis hacmi açısından iki grup arasında anlamlı fark yoktu (p>0.05). İkili lojistic regresyon analizi ne serbest ne de total testosteronun prostat kanseri için belirteç olmadığını göstermiştir (sırasıyla p= 0.315 ve 0.213). Sadece yaş prostat kanseri gelişimi açısından anlamlı bir faktör olarak bulunmuştur (p= 0.02). Sonuç: Çalışmamızda total, serbest serum testosteron düzeyleri, testis hacmi ve prostat kanseri riski arasın- da bir ilişki gösterilememiştir. Dolayısıyla prostat kanserini ön görmek için serum testosteron düzeylerine bakmak PSA taramasına katkı sağlıyor gibi görünmemektedir.Objective: Inconclusive results have been published in the literature regarding the relationship between free and total serum testosterone levels and prostate cancer. We investigated the relationship between total and free serum testosterone levels, testes volume, and prostate cancer in our patient population. Material and methods: Total and free serum testosterone levels and serum PSA levels were recorded for 102 consecutive patients. All of the patients underwent transrectal ultrasonography-guided prostate biopsy due to an abnormal digital rectal examination finding and/or a serum PSA level of >4.0 ng/mL. All of the transrectal and testis US examinations and prostate biopsies were performed by the same radiologist. The testis length, width, and height were measured from transverse and longitudinal gray scale images, and the testis volume was calculated. Results: Prostate cancer was detected in 32 of 102 patients (31.3%) who underwent prostate biopsy (prostate cancer group). The remaining patients had benign histopathological findings (prostate cancer-free group). The prostate cancer and benign histology groups were compared for age, total and free testosterone, PSA values, and testis volume. The patients with prostate cancer were found to have a higher mean age (p= 0.04). There were no significant differences in serum PSA levels, free or total testosterone levels, or testis volumes between the two groups (p>0.05). A binary logistic regression analysis showed that neither free nor total testosterone was a predictor of prostate cancer (p= 0.315 and p= 0.213, respectively). Only age was found to be a significant risk factor for the development of prostate cancer (p= 0.02). Conclusion: Our study failed to show a relationship between total or free serum testosterone levels, testis volume, and the risk of prostate cancer. Therefore, monitoring serum testosterone levels for prostate cancer prediction does not appear to add an advantage over PSA screening

Comparison of lithotripsy methods during mini-PNL: is there a role for ballistic lithotripsy in the era of high-power lasers

Abstract Background For renal stones > 20 mm, percutaneous nephrolithotomy (PNL) offers the best stone clearance rates with acceptable complication rates. This study aimed to compare the efficiency of high-power holmium YAG laser and ballistic lithotripsy during mini-PNL. Methods Data from 880 patients who underwent mini-PNL for renal stones was investigated retrospectively. The study utilized propensity score matching to create two groups: laser lithotripsy (n = 440) and ballistic lithotripsy (n = 440). The groups were matched based on stone size, Guy’s stone score, and stone density. The main objectives of the study were to assess the stone-free rate (SFR), duration of surgery, and complication rates. Results The average age of the population was 51.4 ± 7.1 years, with a mean stone size of 28.6 ± 8.3 mm and a mean stone density of 1205 ± 159 HU. There were no significant differences between the groups. The SFRs of the laser lithotripsy and ballistic lithotripsy were 92.5% and 90.2%, respectively (p = 0.23). The laser lithotripsy group had a notably shorter surgery time (40.1 ± 6.3 min) compared to the ballistic lithotripsy group (55.6 ± 9.9 min) (p = 0.03). Complication rates were similar (p = 0.67). Conclusions Our study shows that a high-power holmium YAG laser provides quicker operation time compared to ballistic lithotripsy. However, ballistic lithotripsy is still an effective and safe option for stone fragmentation during mini-PNL. In places where a high-power holmium YAG laser is not available, ballistic lithotripters are still a safe, effective, and affordable option for mini-PNL

Significance of the interval between first and second transurethral resection on recurrence and progression rates in patients with high-risk non-muscle-invasive bladder cancer treated with maintenance intravesical Bacillus Calmette-Guerin

Objective

Effect of Age on Outcome of High-Risk Non-Muscle-Invasive Bladder Cancer Patients Treated with Second Transurethral Resection and Maintenance Bacillus Calmette-Guerin Therapy

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Evaluation of the optimal duration for retrograde intrarenal stone surgery to prevent postoperative complications

Objective To evaluate retrograde intrarenal surgery (RIRS) outcomes and to determine the effect of operative time on complications of RIRS. Methods Patients undergoing RIRS for renal stones were evaluated. These patients were divided into two groups according to the operation time (Group 160 minutes). Peroperative outcomes such as fluoroscopy time, stone-free rates, complications and duration of hospitalization were compared. Results Group 1 consisted of 264 patients and Group 2 consisted of 297 patients. SFR rates, duration of hospitalization, and postoperative urinary tract infection rates were similar in both groups. Fluoroscopy time was 7.8 +/- 7.3 (0-49) sec in group 1 and 13.1 +/- 9.8 (0-81) sec in group 2. Complications according to modified Clavien-Dindo classification system (MCDCS) were 13 and 32 patients (Grade 1), 31 and 63 patients (Grade 2), 1 and 1 patient (Grade 3) in group 1 and 2, respectively. There was statistical difference between the two groups in terms of duration of fluoroscopy time and the MCDCS. Although duration of hospitalization and UTI rates were higher in group 2, no statistical significance was observed among groups. Conclusion Limiting the operation time to 60 minutes in RIRS seems to be important in reducing postoperative complications

Attitudes of urologists on metabolic evaluation for urolithiasis: outcomes of a global survey from 57 countries

Although stone disease is an important health problem with high incidence and recurrence rates, it is a preventable disease. Attitudes and practices of urologists regarding the prevention of recurrence continue to be a subject of debate. In this context, an online survey study was conducted involving 305 urologists from 57 different countries. The first 7 questions collected demographic data about the urologists and the remaining 23 questions were about the recurrence and metabolic evaluation, medical treatment, and follow-up of urinary stone disease. Most urologists (85.2%) thought that metabolic examination was important. Approximately one-third of the participants (34.1%) performed 24-hour urine analysis and stone analysis was ordered by 87.5% of the urologists. Metabolic analysis was performed for all patients by 14.7% of the participants. For pediatric patients this rate was 68.5%, and for adults with recurrence the rate was 81.6%. Reasons cited by the urologists for not performing metabolic analysis included not feeling confident doing so (18.3%), having limited facilities in their hospital (26.5%), having an excessive daily workload (31.8%), patient-related factors (27.5%), and referring patients to other departments for metabolic evaluation (20.9%). Although majority of the responding urologists do consider the metabolic analysis as vital important, they seemed not to be willing to perform these tests with the same degree of enthusiasm in their daily practice. Our results show that urologists need support in performing and interpreting 24-hour urine analysis, improving their knowledge levels, and communicating with patients. Urology residency training should focus more on the prevention of urinary stone recurrence in addition to the surgical training