Acute kidney injury following supine mini-PNL versus retrograde intrarenal surgery in patients with renal stones < 3 cm: a prospective comparative study

Background: The purpose of the current study was to prospectively compare mini-PNL and RIRS for development of acute kidney injury (AKI), success, and complication rates in a cohort of patients with kidney stones less than 3 cm. Methods: In this prospective study, data of 60 consecutive patients underwent mini-PNL (n=31) or RIRS (n=29) was investigated. Urinary NGAL levels were measured preoperatively and at postoperative 6th hour to evaluate AKI. Success and complication rates were also compared. Results: The mean stone size was signifcantly higher in the mini-PNL group (24.6 mm vs. 18.2 mm, p=0.02). The mean postoperative NGAL levels were 45.6±12.4 and 48.1±13.6 for the mini-PNL and RIRS groups, respectively. The increase was statistically signifcant for both groups (p: 0.01). The diference between the two groups for mean postoperative NGAL measurements was not statistically signifcant (p=0.47). The SFR was signifcantly higher in the miniPNL group (96.7% vs. 79.3%, p=0.04). The complication rates were similar for the two groups (p=0.99). The mean duration of operation was 48.2±22.5 min in the mini-PNL group and 62.6±18.1 min in the RIRS group (p=0.03). The median duration of hospitalization was 1 day for both groups. Conclusions: In patients with renal stones<3 cm in diameter, mini-PNL in supine position provides higher SFR and shorter operative times with similar rates of complications and AKI when compared with RIRS. Mini-PNL should be considered as the primary treatment option together with RIRS for renal stones and should not be ruled out for being a more invasive option

Erectile function in SRY positive 46,XX males with normal phenotype

Introduction The 46,XX male syndrome is a rare disorder of sex development and has two different forms, depending on the sex-determining region's presence on the Y chromosome (SRY) gene. The SRY positive 46,XX males are usually diagnosed during infertility workup. We evaluated the erectile function of 46,XX SRY positive males and compared it with healthy males. Material and methods Ten patients with azoospermia and 46,XX SRY positive disorder who referred to a urology clinic with infertility were analyzed retrospectively. Controls were chosen from healthy males at similar ages. The physical examination was performed, and serum hormones were obtained at admission. The clinical assessment of erectile dysfunction was evaluated by the International Index of Erectile Function (IIEF) questionnaire. Results There was no statistically significant difference between the two groups in terms of age, serum prolactin, luteinizing hormone (LH) levels and IIEF scores (P >0.05). In 46,XX males, serum follicle-stimulating hormone (FSH) levels were significantly higher, and total testosterone levels and testicular volumes were found to be significantly lower when compared to controls (p <0.001, p <0.05, p <0.01, respectively). Conclusions This study indicates that these males' erectile function is similar to those of 46,XY males

Does mean platelet volume (MPV) have a role in evaluation of erectile dysfunction and its severity?

Purpose: The mean platelet volume (MPV) has important role in the pathophysiology of vascular diseases as a marker of the platelet activity. To investigate the association between mean platelet volume and erectile dysfunction (ED) and to search whether this marker can be used for diagnosis of ED. Materials and methods: Of the 312 patients with ED of various degrees, 122 patients without ED (IIEF-5>21) were included in this prospective study. Severity of ED was determined according to IIEF-5 questionnaire. MPV, fasting serum glucose, cholesterol, low density lipoprotein (LDL) and serum testosterone levels are also recorded. The mean platelet volume was calculated by the Coulter counter technique and sexual function was determined by International Index of Erectile Function erectile function domain (IIEF-5). Results: The mean age of patients was 58.4 years. The mean MPV value of patients with ED was significantly higher compared to the non-ED patients (8.91 vs. 8.22, p=0.0001). The severity of ED was shown to have a positive strong correlation with MPV values (r=0.719, p=0.001). Mean serum triglyceride, glucose, total cholesterol and LDL cholesterol levels were noted higher in patients with ED. MPV values were found to be significantly higher in patients with ED. Conclusion: MPV level shows significant correlation with severity of ED. This cheap laboratory test can have potential to be a marker of ED. Further prospective larger studies with vascular wall thickness measurements should be conducted

Is a contrast study really necessary prior to ureteroscopy?

This study aimed to evaluate the effect of preoperative imaging techniques on the success and complication rates of ureteroscopy. We performed a retrospective analysis of 736 patients (455 males and 281 females), with a mean age of 45.5±15.2 years (range, 1–88 years), who underwent rigid ureteroscopic procedures for removal of ureteral stones. Patients were divided into 4 groups according to the type of imaging modality used: group I, intravenous urography (n=116); group II, computed tomography (n=381); group III, computed tomography and intravenous urography (n=91), and group IV, ultrasonography and abdominal plain film (n=148). Patients’ demographics, stone size and location, prior shock wave lithotripsy, lithotripsy technique, operation time, success rate, and rate of intraoperative complications were compared among the groups. There were no significant differences in success and complication rates among the groups. The stone-free rate after primary ureteroscopy was 87.1% in group I, 88.2% in group II, 96.7% in group III, and 89.9% in group IV (P=0.093). The overall incidence of intraoperative complications was 11.8%. According to the modified Satava classification system, 6.1% of patients had grade 1, 5.1% had grade 2, and 0.54% had grade 3 complications. Intraoperative complications developed in 12.1% of patients in group I, 12.6% of patients in group II, 7.7% of patients in group III, and 12.2% of patients in group IV (P=0.625). Our findings clearly demonstrate that ureteroscopic treatment of ureteral stones can be safely and effectively performed with no use of contrast study imaging, except in doubtful cases of anatomical abnormalities

The impact of vitamin E supplementation on semen parameters and pregnancy rates after varicocelectomy: a randomised controlled study

In this study, we aimed to investigate the impact of vitamin E supplementation on semen parameters and pregnancy after varicocelectomy. Forty-five infertile male patients who were diagnosed with varicocele and underwent subinguinal varicocelectomy were included in the study. After performing subinguinal varicocelectomy, the patients were randomised into two groups: 22 receiving vitamin E for 12 months, and 23 as the control group without receiving any supplementation. The pre-operative parameters of semen analyses and pregnancy rates of both groups were compared with those of post-operative parameters. There were no statistically significant differences between the groups in terms of sperm count and motile sperm percentage, in pre-operative, post-operative 3rd month, post-operative 6th month and post-operative 12th month periods. Repeated-measures anova was performed, and sperm count, percentage of change in sperm count, motile sperm count and percentage of change in motile sperm count of the groups were compared. The administration of vitamin E increased all of these parameters; however, they were not found to be statistically significant. In conclusion, vitamin E supplementation might improve the sperm parameters after varicocelectomy; however, further studies including larger number of samples are needed to make a proper decision on vitamin E supplementation after varicocelectomy

What is the optimum lithotripsy method for high density stones during mini-PNL? Laser, ballistic or combination of both

Percutaneous nephrolithotomy (PNL) is the primary treatment option for renal stones > 20 mm in diameter. Mini-PNL gained popularity with its minimally invasive nature. The aim of this study was to compare the efficiency of ballistic and laser lithotripsy with the combined use of both techniques. Data of 312 patients underwent mini-PNL for renal stones with Hounsfield Unit > 1000 was investigated retrospectively. We identified 104 patients underwent combined ballistic and laser lithotripsy. Propensity score technique was used to create the laser and ballistic lithotripsy groups. Groups were matched on stone size, stone density, and Guy's stone score. Primary end point of the study was to compare the stone free rate (SFR), complication rates, and duration of surgery. Mean age of the population was 49.4 +/- 6.1, stone size was 24.6 +/- 6.3 mm, and stone density was 1215 +/- 89 HU. The groups were similar for age, stone size, stone density, and Guy's stone score. The SFR and the complication rates of the 3 groups were similar (p = 0.67). The duration of the surgery was shorter in the combined group (46.1 +/- 6.3 min) compared to the laser lithotripsy (54.5 +/- 6.6 min) and ballistic lithotripsy (57.2 +/- 6.9 min) groups. Both laser and ballistic lithotripsy are effective methods for stone fragmentation during mini-PNL. Combined use of both methods has the potential to improve the fragmentation rates and diminish the operative times in case of high density stones

Frequency of Testicular Tumor in Patients with a Diagnosis of Infertility and Asymptomatic Male Applied to a University Hospital

Amaç: Testis tümörü genç erişkin erkeklerde en sık görülen kanserdir. İnmemiş testis, testis tümörü riskini artıran en önemli sebep olmakla birlikte birinci derece akrabalarda testis kanseri öyküsü, karşı testiste insitu germ hücre neoplazisi ve testiküler disgenezis sendromu etyolojide yer almaktadır. Bu çalışmadaki amaç erkek infertilitesi tanısı ile incelenen hastalarda testis tümörü sıklığını araştırmaktır. Hastalar ve Yöntem: Ağustos 2015 - Ağustos 2018 tarihleri arasında üroloji polikliniğine infertilite şikayeti ile başvuran veya kadın hastalıkları ve doğum kliniklerinden konsülte edilen erkek faktörü tanılı 954 erkek hastanın retrospektif değerlendirilmesi yapıldı. Hastaların anamnez, fizik muayene ve spermiogram bulguları kayıt edildi. Yapılan rutin fizik muayenelerinde testiküler kitle saptanan ve bu nedenle radikal orşiektomi yapılan hastaların verileri analiz edildi. Bulgular: İncelenen 954 erkek hastanın dördünde sağ, birinde ise sol testiküler kitle saptandı. Hastaların yaş ortalaması 31,6 (30-35) idi. Bu hastaların hiçbirinde inmemiş testis öyküsü mevcut değildi. Tüm hastaların tümör belirteçleri normal, yapılan bilgisayarlı tomografilerinde lenf nodu veya organ metastazı izlenmedi. Beş hastanın üçünde oligospermi , ikisinde azospermi mevcuttu. Yapılan inguinal orşiektomi operasyon patolojileri ise tüm hastalarda saf seminom olarak raporlandı. Sonuç: Özelllikle infertil erkek hastalarda testis muayenesi yapılırken artmış risk nedeniyle dikkatli olunmasının ve bu popülasyondaki bireylere kendi kendine yapılacakları testis muayenesinin erken tanıda önemli olduğu düşünülmektedir. Anahtar sözcükler: Testis tümörü, infertilite, seminomObjective: Testicular tumor is the most common cancer among the young adult men. Although the undescended testicle is the most common cause which increases the risk of testicular tumor, the testicular cancer diagnosis of any of the first degree relatives, in situ germ cell neoplasia of the other testicle and the testicular dysgenesis syndrome are also included in the etiology. The aim of this study is to investigate the frequency of testicular tumor in patients with infertility. Patient and Methods: 954 male patients, who presented to the urology polyclinic with a complaint of infertility or who were consulted from gynecology and obstetrics clinics with male infertility factor, between August 2015 and August 2018, were evaluated retrospectively. Medical records, physical examination and spermiogram findings were considered. The data of the patients who were diagnosed with testicular mass through physical examinations and underwent radical orchiectomy, were analyzed. Results: Of 954 evaluated male patients with a mean age of 31,6 (30-35) years, four had right testicular mass and one had left testicular mass. None of these patients had a medical record of undescended testicle. Tumor markers of all patients were normal and neither lymph node nor organ metastasis were observed through computerized tomography analysis. 3 of 5 patients had oligospermia and 2 had azoospermia. Pathologic diagnosis of inguinal orchiectomy materials were reported as pure seminoma in all patients. Conclusions: Especially in infertile male patients, when performing testicular examination it should be taken into consideration that there is an increased risk of testicular tumor. It is considered that informing individuals of this population about doing an examination of testicle is important in early diagnosis. Keywords: Testicular tumor, infertility, seminom

Relationship digit ratio with penil length and testis volume in children

Giriş: Androjenlerin uyarımı ile fonksiyonelreseptörlerin aktive olması erkek iç ve dışgenitallerin farklılaşmasında rol oynamaktadır.Homeobox (Hox) genleri embriyogenez sırasındael ve ayak parmakları gibi ekstremite gelişimi,genital tomurcuk farklılaşması, testis ve penisgelişimini düzenlemektedir. Bu gen mutasyonlarındahem parmakların hem de genital sisteminetkilendiği sendromlar bildirilmiştir. Yapılan çalışmalardaikinci ve dördüncü parmak uzunlukoranları ile prenatal testosteron seviyesinin ilişkili,yetişkin testosteron seviyeleri ile de ilişkisizolduğu gösterilmiştir.Bizim çalışmamızda amacımız 2 yaşınınüzerinde hastanemize sünnet için başvuran erkekçocuklarda 2-4 parmak oranı ile penil uzunlukve testiküler volüm arasında ilişkiyi değerlendirmektir.Materyal ve Metod: 2016-2017 yılları arasındasünnet için başvuran 125 erkek çocukçalışmaya alındı. Hipospadias, inmemiş testis,hidrosel, genital veya skrotal cerrahi öyküsü,endokrin hastalıkları bulunan çocuklar çalışmayadahil edilmedi. Tüm çocukların boy ve kilolarıölçülüp vücut kitle indeksleri, boy ve kilogelişim persentil yüzedeleri hesaplandı. Penisve parmak uzunlukları ile testiküler hacim değerlendirmeleriise preoperatif ameliyathanedegenel anestezi sonrası yapıldı. Penil ve parmakuzunluk ölçümleri sürmeli kumpas (verniercaliper)ile testis hacim değerlendirmesi ise praderorşidometrisi ile yapıldı.Bulgular: Çalışmaya alınan çocukların yaşortalaması 7,33±1,22 idi. Gevşek penil uzunlukile sağ 4. parmak uzunluğu, sağ 2/4 parmakoranı ve sol 2/4 parmak oranı ile anlamlı sonuçsaptandı (p=0,001). Gergin penil uzunluk ile sağ4. parmak uzunluğu, sağ 2/4 parmak oranı vesol 2/4 parmak oranı ile korele olduğu görüldü(p<0,05, p<0,05, p=0,001). Total testis hacmiile hem gevşek hem gergin penil uzunluk arasındada anlamlı bir korelasyon izlendi (p<0,05,p=0,001). Sonuç: Literatürde parmak uzunluğu ve oranları ile ilgili değişikhipotezlerle oluşturulmuş birçok çalışma mevcuttur. Ancak bizim çalışmamızdaliterature ile uyumlu sonuçların yanında kısmen de olsa farklısonuçlara ulaşılmıştır. 2/4 parmak oranının hem gevşek hem gergin peniluzunluk için bir gösterge olabilieceği düşünülmektedir.Objective: The activation of functional receptors via the stimulation of androgens has a role in the differentiation of male internal and external reproductive organs. Homeobox (Hox) genes regulate the development of limbs including fingers, genital bud differentiation and the development of testis and penis during embryogenesis. Syndromes in which both the fingers and the genital system are affected due to Hox gene smutations have been reported. Studies have shown that the second and fourth digit length ratios are related the level of prenatal testosterone but not adult testosterone levels. In the present study we eveluated the releation between the 2.-4. Digit length ratio and the penile length and the testicular volume among the patients over two years of age who visited our hospital for circumcision. Materials and Methods: 125 children who applied for circumcision between the years 2016 and 2017 was included in this study. Children with hypospadias, undescended testis, hydrocele, genital or scrotal surgery record and with endocrine disorders was excluded. Weights and lengths of all children were measured, body mass indexes and weight and length development percentiles were calculated. Penile and digit lengths were measured and testicular volumes were assessed preoperatively after general anesthesia in the operating room. Prader orchidometer was used for the assessment of testicular volumes whereas penile and digit lengths were measured by using vernier caliper. Results: The meanage of children included in this study is 7,33±1,22. Significant results were found between flask penile length and right 4th digit length, right 2/4 digit ratio and left 2/4 digit ratio (p=0,001). It was seen that the stretched penile length was correlated with right 4th digit length, right 2/4 digit ratio and left 2/4 digit ratio (p<0,05, p<0,05, p=0,001 respectively). There was also a significant correlation between total testicle volume and both flaccid and streched penile length (p<0,05, p=0,001 respectively). Conclusions: There are many studies in literature with various hypotheses about digit lengths and ratios. In our work, however, results that are in line with literature have been achieved, as well as partly different results. We believe that 2.-4. finger ratio can be an indicator for both flaccid and stretched penile length