The effect of local anesthesia types on erectile function in TRUS biopsy: A prospective study

Aim: To evaluate the effect of local anesthesia types on erectile function during transrectal ultrasound guided biopsy (TRUS-Bx).Material and Methods: Between February 2014 and February 2015, 50 men who underwent TRUS-Bx at our institution were included in this prospective study. The 50 patients were randomized and divided into two groups according to the type of anesthesia used. All patients were asked to indicate the level of pain experienced on a visual analogue scale (VAS) 10 min after the TRUS biopsy. All patients had to fill in the IIEF standardized questionnaire. Groups were evaluated in terms of pre-biopsy IEFF score (IIEF-1), post-biopsy 1st month IIEF score (IIEF-2) and post-biopsy 2nd month IIEF score (IIEF -3). Patient characteristics, mean VAS score and IIEF score were compared between the two groups.Results: The mean age,IIEF-1,tPSA level, prostate volume and VAS score were 60.86±0.95 years,18.68,6.81±0.54 ng/ml,51.10±3.82 cc and 3.5±0.26 in all patients, respectively. The difference in VAS scores between the groups was statistically significant (p<0.05). In Group 1 the IIEF-1, IIEF-2, and IIEF-3 were different from each other statistically. There was no statistically significant difference between IIEF-1 and IIEF-3 scores in group 2(p=0,136 z=-1,492).So it was observed that the initial IIEF scores were reached at the end of the second month in group 2 administered 12.5 g 2% lidocaine HCl jel.Conclusion: Our study indicates that although local periprostatic anesthesia by injecting 6 ml of 2% lidocaine provides more effective anesthesia for pain relief, intrarectal 12.5g 2% lidocaine HCl jel maintains less impact on erectile dysfunction for TRUS-Bx

Efficiency of Imaging Methods Prior to Percutaneous Nephrolithotomy

The most important step of percutaneous nephrolithotomy (PCNL) is planning the puncture site. A well selected puncture will facilitate nephroscopic navigation and stone clearance. The traditional methods for planning the puncture are intravenous urogram or retrograde pyelogram. Either of these imaging tools is adequate, but new tools such as 3D reconstructed tomography should be more accurate. Many recently developed imaging tools are promising, but no one is still ideal. The imaging techniques that we currently use have specific advantages and disadvantages. The purpose of this review is to summarise different imaging tools and their effectiveness prior to PCNL

Pathological staging of muscle invasive bladder cancer: is substaging of pT2 tumors really necessary?

OBJECTIVE: Compare clinical outcomes in patients having urothelial tumors invading less than one half of the depth of bladder muscle and greater than one half of bladder muscle and, to determine various clinical variables as predictive factors for survival. MATERIALS AND METHODS: According to our inclusion criteria, 57 patients among cases with T2 bladder tumor were selected. Thirty-five patients (61.4 %) had pT2a (Group-1) and 22 patients (38.6%) had pT2b (Group-2) muscle invasive tumors. Mean follow up time was 7.3 years for Group-1, and 6.1 years for Group-2. Multivariate analysis was performed in order to identify possible correlation of clinical variables like age, gender, grade of primary tumor, appearance of local and/ or distant metastasis with patient outcome. RESULTS: Five year recurrence-free and overall survival rates were 69.1% and 44.3% for patients with pT2a tumor, whereas these ratios were 66.1% and 43%, respectively for patients with pT2b tumor (p = 0.896; p = 0.975). Mean overall and progression-free survival times were 87.7 ± 13.8 and 116 ± 13.12 months for Group-1, while they were 73.8 ± 13.7 and 88.85 ± 12.55 months for Group-2, respectively. On both univariate and multivariate analysis, age was noticed as an independent predictive factor for survival. CONCLUSIONS: The depth of muscle invasion in bladder tumors has no prognostic significance. Recurrence of the disease either locally or at distant sites dramatically shortens patients' life. Being older than 60 years old during the time of radical surgery, is also a bad prognostic factor for overall and progression-free survival

Does varicocelectomy affect DNA fragmentation in infertile patients?

Introduction: The aims of this study were to investigate the effect of varicocelectomy on DNA fragmentation index and semen parameters in infertile patients before and after surgical repair of varicocele. Materials and Methods: In this prospective study, 72 men with at least 1-year history of infertility, varicocele and oligospermia were examined. Varicocele sperm samples were classified as normal or pathological according to the 2010 World Health Organization guidelines. The acridine orange test was used to assess the DNA fragmentation index (DFI) preoperatively and postoperatively. Results: DFI decreased significantly after varicocelectomy from 34.5% to 28.2% (P = 0.024). In addition all sperm parameters such as mean sperm count, sperm concentration, progressive motility and sperm morphology significantly increased from 19.5 × 10 6 to 30.7 × 10 6 , 5.4 × 10 6 /ml to 14.3 × 10 6 /ml, and 19.9% to 31.2% (P < 0.001) and 2.6% to 3.1% (P = 0.017). The study was limited by the loss to follow-up of some patients and unrecorded pregnancy outcome due to short follow-up. Conclusion: Varicocele causes DNA-damage in spermatozoa. We suggest that varicocelectomy improves sperm parameters and decreases DFI

Is there any association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer?

ABSTRACT Purpose We investigated the association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer. Materials and Methods The data of 440 patients who had undergone prostate biopsies due to high PSA levels and suspicious digital rectal examination findings were reviewed retrospectively. The patients were divided into two groups based on the presence of accompanying NIH IV prostatitis. The exclusion criteria were as follows: Gleason score>6, PSA level>20ng/mL, >2 positive cores, >50% cancerous tissue per biopsy, urinary tract infection, urological interventions at least 1 week previously (cystoscopy, urethral catheterization, or similar procedure), history of prostate biopsy, and history of androgen or 5-alpha reductase use. All patient's age, total PSA and free PSA levels, ratio of free to total PSA, PSA density and prostate volume were recorded. Results In total, 101 patients were included in the study. Histopathological examination revealed only PCa in 78 (77.2%) patients and PCa+NIH IV prostatitis in 23 (22.7%) patients. The median total PSA level was 7.4 (3.5–20.0) ng/mL in the PCa+NIH IV prostatitis group and 6.5 (0.6–20.0) ng/mL in the PCa group (p=0.67). The PSA level was≤10ng/mL in 60 (76.9%) patients in the PCa group and in 16 (69.6%) patients in the PCa+NIH IV prostatitis group (p=0.32). Conclusions Our study showed no statistically significant difference in PSA levels between patients with and without NIH IV prostatitis accompanying PCa

A Giant Ureteral Stone without Underlying Anatomic or Metabolic Abnormalities: A Case Report

A 28-year old man presented with left flank pain and dysuria. Plain abdominal film and computed tomography showed a left giant ureteral stone measuring 11.5 cm causing ureteral obstruction and other stones 2.5 cm in size in the lower pole of ipsilateral kidney and 7 mm in size in distal part of right ureter. A left ureterolithotomy was performed and then a double J stent was inserted into the ureter. The patient was discharged from the hospital 4 days postoperatively with no complications. Stone analysis was consistent with magnesium ammonium phosphate and calcium oxalate. Underlying anatomic or metabolic abnormalities were not detected. One month after surgery, right ureteral stone passed spontaneously, left renal stone moved to distal ureter, and it was removed by ureterolithotomy. Control intravenous urography and cystography demonstrated unobstructed bilateral ureter and the absence of vesicoureteral reflux