Female Urethral Malignant Melanoma With Vesical Invasion: A Case Report

We report a 75-year-old female with a primary urethral malignant melanoma. A mass protruding from inside the urethra was detected on physical examination. Abdominopelvic magnetic resonance imaging revealed a mass extending from the urethra with dimensions of 4 × 2 cm, and periurethral heterogenous fatty planes consistent with infiltration. The histopathologic examination was consistent with HMB45(+) malignant melanoma. We performed cystourethrectomy and bilateral inguinal and pelvic lymphadenectomy in one session. The pathology report revealed primary malignant melanoma of the urethra invading the inferior bladder wall. The patient received no adjuvant therapy because of cardiopulmonary morbidities and the presence of multiple pulmonary metastases. The patient eventually died 13 months after surgery

A Rare Renal Epithelial Tumor: Mucinous Cystadenocarcinoma Case Report and Review of the Literature

Primary renal mucinous cystadenocarcinoma is a very rare lesion of kidney which originates from the metaplasia of the renal pelvic uroepithelium. Only one case with primary mucinous cystadenocarcinoma has been reported in the English literature. We report second case of mucinous cystadenocarcinoma which was radiologically classified as type-IIF Bosniak cyst in peripheral localization. We aimed to present this extreme and unusual entity with its radiological, surgical, and pathologic aspects under the light of literature

Does pelvic injury trigger erectile dysfunction in men?

WOS: 000442089500008PubMed ID: 26764545Purpose: Pelvic ring fractures constitute 3%-8% of all fractures of the skeletal system and are generally related with high energy trauma. Sexual dysfunction following pelvic fracture has a high incidence, and affects the male patients both physically and psychologically. In this study, we aimed to investigate the impact and frequencies of comorbidities such as erectile dysfunction (ED) with adverse sociocultural and psychological consequences for the patient who had a pelvic ring fracture. Methods: This study included 26 men who corresponded to the inclusion criteria and agreed to participate our study. Results: According to fracture types, most of our cases were Tile type A1 and type A2. Severe and moderate ED were detected in 46.1% (12/26) of these patients via the International Index of Erectile Function-5 questionnaire. Conclusion: ED develops following pelvic fractures, especially in Tile type B and C pelvic fractures

Cavernosal Smooth Muscle Function After Experimental Ischemic Priapism

Objective: We aimed to investigate the role of apoptosis and its effects on cavernosal smoothmuscle (CSM) function after ischemic priapism (IP) in a rat model. Materials and Methods: Twelve adult Sprague-Dawley rats were assigned into two groups: The priapism and control groups. In all rats, erections were obtained by the vacuum method; however, in the priapism group, erections were maintained with a rubber band for 4 h to mimic priapism. After 14 days following this procedure, penile excision was performed and cavernosal tissues were investigated pharmacologically and histopathologically. Isometric tension changes due to several contractile and relaxant pharmacological agents were investigated with/without nitric oxide synthase (NOS) and guanylate cyclase (GC) inhibition. Results: Isometric contraction and relaxation responses due to the agents applied did not differ between the groups. However, with NOS and GC inhibition, the cavernosal tissues relaxed less in the priapism group than in the controls (p<0.05). Histopathological evaluation of the tissues revealed that the average apoptosis rates were greater in the priapism group than in the controls in both the CSM (60.3% vs. 31.8%) and cavernosal epithelia (40.2% vs. 7%). Conclusion: IP induction caused fibrosis by the apoptotic process in rat CSM. After IP, apoptosis in endothelial tissue was more evident than that in smooth muscle tissue in the corpus cavernosum. IP is likely to affect the NO pathway, resulting in a decrease in the NO-dependent relaxation in the cavernosal tissue

Intravesical Migration and Calcification of Intrauterin Device: A Case Report and Review of the Literature

Intrauterine device (IUD) is widely used for the long duration of protection, cost-effectiveness and for being a reversible contraceptive method as well as having low complication rates. Despite low complication rates, various IUD-related complications, such as spontaneous aborts, bleeding, infection, and uterine perforation may occur. Although perforation of the uterus by an IUD is not uncommon, bladder perforation is a rare complication. A regular follow-up of patients with IUDs for the complications and training of clinicians for insertion and removal are mandatory to provide better and safe family planning services. Here, we report a case of a patient with uterine perforation with a calcified IUD migration into the the bladder

Better Comfort for Both Patient and Doctor: Prospective Randomized Study about Flexible and Rigid Cystoscopy

Objective Cystoscopy is the gold standard method for the diagnosis and follow-up of non-muscle invasive bladder cancer (NMIBC). Since cystoscopy was performed under local anesthesia in office condition, patients’ discomfort and pain during the procedure gained importance. Consequently, flexible cystoscopy (FC) has been used since 1970s to improve the patient comfort. In this study, we compared both flexible and rigid cystoscope in terms of patients and doctors comfort. Besides, we evaluated the effect of the type of cystoscopy for patients with benign prostatic hyperplasia (BPH). Materials and Methods We evaluated male patients with NMIBC. We excluded patients with urethral stricture, active hematuria and those who underwent diagnostic cystoscopy or first local cystoscopy for the first time. The patients were sequentially randomized to flexible (group 1) or rigid cystoscopy (group 2) groups. Pain, hematuria, disuria, and the postoperative necessity for medication were noted. In addition, doctor comfort during procedure was scored. Results When we compared both groups after the cystoscopy, patient and physician comfort in group 1 was statistically significantly superior to that in group 2 (p<0.001). Besides, flexible cystoscopy provided better results in terms of postoperative hematuria, pain, and need of medication of patients. When we included only patients with BPH, group 1 also provided better results. Conclusion Although flexible cystoscopy is costly, its higher comfort, and lesser postoperative morbidity may make it cost-effective, cumulatively. On the other hand, FC may also be favorable for older patients with BPH

Radikal prostatektomi esnasında rektal yaralanma: Kolostomi kaçınılmaz son mu?

WOS: 000376566800015Aim: Radical prostatectomy (RP) is the gold standard treatment method for localized prostate cancer, because of its high oncological success. Iatrogenic rectal injury (IRI) during RP is rarely seen, but it may causes serious complications because of the close anatomic relationship between the prostate and rectum. Aim is to present our series about management of IRI without colostomy. Material and Method: Between June 1999 and June 2013, radical retropubic prostatectomy (RRP) was performed to 372 patients by a single surgeon. 10 cases (% 2,6) were complicated by a rectal injury during RRP. Instant rectal closure was performed in 3 layers without a diverting colostomy, at the time of surgery. Omental vascular flap was placed between rectum and vesicourethral anastomosis. Results: The clinical stages of IRI cases were T1c, T2a and T2c in 2, 3 and 5 patients, respectively. Their preoperative Gleason scores were 6, 7 and 8 in 3, 5 and 2 patient, respectively. None of the 10 had undergone previous prostatic or rectal surgery, or received preoperative radiotherapy or hormonal therapy. Discussion: Instant diagnosis and rectal wall closures by three layers are essential for successful repair. Our technique seems as a safe, minimal invasive and highly effective option for the management of IRI.Amaç: Lokalize prostat kanserinde, radikal prostatektomi yüksek onkolojik başarısı nedeniyle altın standart tedavi metodudur. Radikal prostatektomi sırasında iyatrojenik rektal yaralanma (İRY) nadiren görülür fakat bu durum prostat ve rektumun anatomik yakın ilişkisinden dolayı ciddi komplikasyonlara sebep olabilir. Amacımız kolostomisiz tedavi ettiğimiz iyatrojenik rektal yaralanma serimizi sunmaktır. Gereç ve Yöntem: Haziran 1999 ve Haziran 2013 yılları arasında aynı cerrah tarafından retropubik radikal prostatektomi (RRP) uygulandı. RRP sırasında 10 vakada (%2,6) rektal yaralanma oldu. Cerrahi esnasında fark edilir edilmez kolostomi diversiyonu uygulanmaksızın üç tabaka halinde rektal açıklık kapatıldı. Omental damarlı flep rektum ve vezikoüretral anastomoz arasına yerleştirildi. Bulgular: İyatrojenik rektal yaralanma gerçekleşen vakaların klinik evresi sırasıyla 2 hastada T1c, 3 hastada T2a ve 5 hastada ise T2c idi. Operasyon öncesi Gleason skorları ise sırasıyla 3 hastada 6, 5 hastada 7 ve 2 hastada ise 8 idi. Rektal yaralanma olan 10 hastanın hiçbiri daha önce prostat veya rektum cerrahisi geçirmemiş ve operasyon öncesi radyoterapi ve hormon tedavisi almamıştı. Tartışma: Erken tanı ve rektum duvarının üç tabaka halinde kapatılması başarılı bir tamirin esasını oluşturur. Uyguladığımız yöntem rektal yaralanma tedavisinde güvenilir minimal invaziv ve oldukça etkili bir tedavi seçeneği gibi görünmektedir

Our experience in chordee without hypospadias: Results of 102 cases

Purpose: We present long-term surgical experience of 102 chordee without hypospadias cases. Materials and Methods: This retrospective study included 102 chordee without hypospadias cases who were surgically treated between 1999 and 2012. Range of patients' age was from 1 month to 31 years. Seventy-two patients were adult, and 30 were children. Mean duration of follow up was 49.3 months. The patients were categorized into 4 groups including skin tethering (group 1), fibrotic dartos and Buck's fasciae (group 2), corporeal disproportion (group 3) and urethral tethering (group 4) with the aid of intraoperative artificial erection, according to the structural defect. Results: Forty patients (group 1) were successfully treated with penile degloving. Except 3 (10%) of 31 (group 2) cases, extensive resection of the fibrotic dartos and Buck's fascia was needed to straighten the penis. Corporeal disproportion was identified in 27 patients of whom 2 cases (7%) had complications. One of them developed urethrocutaneous fistula, and he was treated with buccal mucosal graft urethroplasty successfully. In other one, chordee persisted after two years, and we had to do Nesbit wedge resection after tunica albuginea plication to achieve penile straightening at the same session; otherwise we avoid tunica albuginea excision or incision. Overall 96 (94%) of 102 patients were successfully treated at first operation. Conclusion: We concluded that tunica albuginea plication is very effective for both prepubertal and postpubertal period and also in management of recurrence. We believe that, in experienced hands, early surgical correction can be done successfully in this condition

The role of institutional environment driving firms' attention to forward-looking aspirations

When are firms’ search behaviors regulated by their future performance expectations below their future performance targets (forward-looking determinant of search behavior) versus their performance below their historical or social aspirations (backward-looking determinant of search behavior)? Firms’ search behaviors are influenced both by their forward- and backward-looking determinants, yet we do not know much about the contingencies that make firms more/less attentive to the forward-looking versus backward-looking search determinants. Our fundamental argument is that firms’ resource dependence on distinct environmental actors in different institutional settings makes their search more attentive to forward- or backward-looking search determinants. We specifically argue that although capital market demands in market-based financial systems make firms’ search forward-looking, demands and pressures of banks in bank-based financial systems make their search activities backward-looking. Our findings suggest that although the impact of future performance expectations below targets on firms’ search activities is intensified in market-based financial systems, firms’ search activities are more influenced by their performance decline below aspirations in bank-based financial systems. We discuss implications for theory and practice