Rare Fibroepithelial Polyp Extending Along the Ureter: A Case Report

Background: Fibroepithelial polyps of the urinary tract are rare tumors, and their occurrence in the upper urinary tract is highly unusual. Case Report: This study reports a 9-year-old boy who presented to our clinic with complaints of unilateral flank pain and macroscopic hematuria. The direct urinary system graph did not show stone formation; therefore, magnetic resonance urography was performed. This revealed a filling defect in the left proximal ureter. On cystoscopy, a polyp was seen in the orifice of the left ureter, extending along the ureter. The polyp was resected by laser ablation and removed from the ureter. Histopathologic examination revealed a fibroepithelial polyp comprising fibrovascular stroma covered with transitional epithelium. Conclusion: Although extremely rare, a fibroepithelial polyp should be considered in the differential diagnosis when a young patient presents with flank pain and macroscopic hematuria. Endoscopic procedures may be the treatment of choice for polyps located in the upper ureter

A Case Report: Fournier’S Gangrene in a Patient With Type-1 Diabetes Mellitus

DergiPark: 379024tmsjAims: Fournier’s gangrene is a necrotizing fasciitis of the perinea and genital areas. Scrotal Fournier’s gangrene,while being rare, is an urological emergency and requires urgent surgery. In this case report, we aimed to investigate a patient with Fournier’s Gangrene (FG), caused by a cut to scrotu

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The protective effect of quantum light therapy on testis ischemia reperfusion

Bu çalışmada amaç testis torsiyonuna bağlı gelişen iskemi reperfüzyon hasarında quantum ışın terapisinin koruyucu rolü olup olmadığını ortaya koymak idi. Bu amaçla her biri 8 rattan oluşan toplam 6 grup kuruldu. Bu gruplar şöyledir. Grup I kontrol grubudur Grup II, testis iskemi-reperfüzyonu uygulanan gruptur. Grup III’te 4 hafta boyunca, haftada 3 kez, 5 dakika 5 Hz kuantum ışın tedavisi uygulanmıştır. Grup IV’ te 4 hafta boyunca, haftada 3 kez, 5 dakika 5 Hz kuantum ışın tedavisi uygulandıktan sonra testis iskemi-reperfüzyonu uygulanmıştır. Grup V’te 4 hafta boyunca, haftada 3 kez, 5 dakika 50 Hz kuantum ışın tedavisi uygulanmıştır. Grup VI’da ise 4 hafta boyunca, haftada 3 kez, 5 dakika 50 Hz kuantum ışın tedavisi uygulandıktan sonra testis iskemi-reperfüzyonu uygulanmıştır. Gerekli işlemler yapıldıktan sonra sol testisler alınıp dokular histopatolojik olarak incelenmiştir. İstatiksel analiz sonucu testis iskemi reperfüzyon modeli oluşturulup quantum tedavisi uygulanan ratlarda 50 Hz şiddetinde quantum tedavisi uygulanan ratlarda, seminifer tübül çapları, epitel kalınlıkları ve johnsen skorlarının 5 Hz şiddetinde kuantum tedavisi uygulanan ve kontrol grubundaki ratlara göre anlamlı derecede daha iyi sonuçlar verdiği bulunmuştur.The purpose of this study is to demonstrate the protective effect of quantum light therapy on testis ischemia reperfusion injury due to testicular torsion. For this aim we form 6 groups each has 8 rats. Group I is the control group. Group II is performed testicular ischemia and reperfusion. In group III rats are applied 5 Hz quantum light therapy for 5 minutes during 4 weeks, three times a week. In Group IV rats are applied 5 Hz quantum light therapy for 5 minutes durıng 4 weeks three times a week and then testicular ishemia reperfusion is demostrated. In Group V rats are applıed 50 Hz quantum lıght therapy for 5 minutes durıng 4 weeks, three times a week. In Group VI rats are applied 50 Hz quantum light therapy for 5 minutes during 4 weeks, three times a week and then testicular ishemia reperfusion is demostrated. Afterwards orchiectomy is performed for left testis for each rat and testicular tissues are investigated histopathologically. After statistical analysis the results in the rats that are applied 50 Hz quantum lıght therapy has positive effect of reducing testicular ınjury

Predictive and prognostic impact of preoperative complete blood count based systemic inflammatory markers in testicular cancer

Purpose: To determine the utility of preoperative complete blood count (CBC) based systemic inflammatory markers in the prediction of testicular cancer and its prognosis. Material and Methods: Between 2008-2017 the data of all testicular tumor patients undergoing radical orchiectomy were retrospectively analyzed. Patient baseseline characteristics (age, tumor stage, tumor markers, etc.) and results of routine preoperative blood tests including mean platelet volume (MPV), red cell distribution width (RDW), lymphocyte ratio (LR) and neutrophil ratio (NR) were retrieved. In addition, neutrophil to lymphocyte ratio (NLR) was calculated. Results: Mean age of the tumor and control group was 36.0 +/- 15 and 30.50 +/- 11 years, respectively. Mean RDW, NR and NLR were significantly higher in the tumor group with p values<0.001; whereas LR and MPV were significantly higher in the control group (p<0.001). Receiver Operating Characteristic (ROC) analyses of LR, NR, RDW, MPV, and NLR are shown in Table-3. The cut off values for RDW and NR were found as 13,7 (Area under the curve (AUC): 0.687, sensitivity = 42.2%, specificity = 84.8%) and 55.3 (AUC:0.693, sensitivity 72.2%, specificity 62%), respectively. Area under the curve for NLR in tumor group was 0.711, with a threshold value of 1.78 and sensitivity=81.8% and specificity= 55.4% (AUC:0.711/sig<0.001) that together with RDW exhibited the best differential diagnosis potential which could be used as an adjuvant tool in the prediction of testicular tumor and its prognosis. Conclusion: Several systemic inflammatory markers, which are obtained by routinely performed cost-effective blood tests, could demonstrate incremental predictive and prognostic information adjuvant to preoperativly achieved testiscular tumor markers

Penile curvature after Peyronie's disease surgery: What are the risk factors?

Surgery is the golden standard for the treatment of patients with Peyronie's disease in chronic phase (12-18 months). Learning risk factors for post-surgical curvature (>20 degrees) would aid both surgeon and patient in their decision-making process. The aim of this study was to investigate the risk factors for residual/recurrent curvatures. The clinical data of the patients, who underwent reconstructive surgery for PD between 1997 and 2016, were retrospectively reviewed. Follow-ups were performed via physical examination, surveys and phone calls. For shortening surgery (Nesbit/plication), initial bi-planar curvature was proved to be a predictor of post-operative curvature (p = .05). Lateral and ventral curvatures were associated with higher recurrence rates in patients who underwent grafting surgery (p = .01). In terms of baseline comorbidities, only diabetes mellitus had an association with curvature nonrecurrence for both shortening and lengthening surgeries (p < .05). Grafting surgery may be suggested to patients who had bi-planar curvatures instead of Nesbit surgery. Nesbit plication surgery may be preferred for patients with lateral and ventral curvatures instead of grafting surgery. Higher cavernosal blood pressures and more nocturnal erections of nondiabetic young patients might impede plication sutures and grafts and therefore increase penile curvature recurrence

Hypergonadotropic Hypogonadism: Management of Infertility

Background: Medical treatments are used either alone or in combination with assisted reproductive techniques for the treatment of infertile patients with hypergonadotropic hypogonadism. A wide range of treatment options such as gonadotropins, aromatase inhibitors (AIs), selective estrogen receptor modulators (SERMs) and their combination are available as options. Objective: The aim of this review was to evaluate treatment options for infertile men with hypergonadotropic hypogonadism. Methods: A literature search of MEDLINE (1980-2019) was conducted using the terms 'hypogonadism', 'male infertility', 'gonadotropins', 'SERMs' and 'AIs'. Pathologies leading to hypergonadotropic hypogonadism and treatment modalities such as gonadotropins, SERMs, AIs and surgical treatment were discussed. Results: FSH increases spontaneous pregnancy rates but the level of evidence was proven to be low for live birth rates. AIs are valid treatment options for patients with low T/E2 ratio as they significantly increase sperm concentrations. SERMs are recommended for infertile males with a sperm concentration between 10-20 million. Varicocele was reported to increase testosterone levels of hypogonadic infertile males. Conclusion: Medical treatment modalities such as gonadotropins, SERMs, AIs and a combination of these therapies has been showed to have some effect in improvement of fertility but is not mainstream of the treatment

Therapeutic Effects of Oligonol, Acupuncture, and Quantum Light Therapy in Chronic Nonbacterial Prostatitis

This research aimed to compare anti-inflammatory effects of oligonol, acupuncture, and quantum light therapy in rat models of estrogen-induced prostatitis. Adult male Wistar albino rats were grouped as follows: Group I, control (n = 10); Group II, chronic prostatitis (n = 10); Group III, oligonol (n = 10); Group IV, acupuncture (n = 10); Group V, quantum (n = 10); Group VI, oligonol plus quantum (n = 10); Group VII, acupuncture plus oligonol (n = 10); Group VIII, quantum plus acupuncture (n = 10); and Group IX, acupuncture plus quantum plus oligonol (n = 10). Chronic prostatitis (CP) was induced by the administration of 17-beta-estradiol (E2) and dihydrotestosterone (DHT). Oligonol was given for 6 weeks at a dose of 60 mg/day. Acupuncture needles were inserted at CV 3/4 and bilaterally B 32/35 points with 1-hour manual stimulation. Quantum therapy was administered in 5-minute sessions three times weekly for 6 weeks. Lateral lobes of prostates were dissected for histopathologic evaluation. Although all of the treatment modalities tested in this study showed anti-inflammatory effects in the treatment of CP in male rats, a synergistic effect was observed for oligonol plus quantum light combination. Monotherapy with oligonol showed a superior anti-inflammatory efficacy as compared to quantum light and acupuncture monotherapies

A rare complication of ESWL: Focal metastatic multiple organ abscesses in a horseshoe kidney

Extracorporeal shock wave lithotripsy (ESWL) is an effective treatment modality in the minimal invasive management of urinary system stone disease. Although the majority of the complications occuring after ESWL are minor (most common ones are gross haematuria, pain, perinephritic hematoma); bacteriuria may also occur in some cases which sometimes can lead to sepsis and even metastatic abscess formation in a very rare part of the cases treated. In this rare situation infection agent spreads quickly via hematogenous route and causes abscess formation in different parts of the body. Majority of such cases usually have an underlying systemic disease like diabetes mellitus (DM), malignancy, HIV or steroid use which lead to disruption of immune system functions. Abscess formation following ESWL is extremely rare and usually limited with some case reports published in the literature. Herein, we present a diabetic case with formation of multiple abscess foci in kidney, as well as in lungs and liver following ESWL. The patient was first admitted to our emergency department with high fever and respiratory distress and misdiagnosed as metastatic tumor foci based on radiologic findings. To the best of our knowledge, our case is the first one in the literature in whom simultanous abscess formation in multiple organ systems has been documented following an otherwise uneventful ESWL