Urology Journal

Purpose: To discern the positive and negative attributes of the various treatment modalities for benign prostatic hyperplasia. Materials and Methods: A comprehensive literature review is presented for endoscopic treatment of the bladder outlet obstruction with an emphasis on current randomized controlled trials available comparing these treatment modalities. Results: Transurethral resection of the prostate remains the gold standard when assessing alternative treatment options available for benign prostatic hyperplasia. Holmium laser enucleation of the prostate demonstrates equivalent efficacy with a more favorable risk profile. Photoselective

vaporization, transurethral needle ablation, and transurethral microwave therapy have demonstrated safety and short-term efficacy; however, data on long-term efficacy are currently lacking. Conclusion: The current endoscopic methods may offer favorable safety and efficacy for the treatment of the bladder outlet obstruction. However, further research is needed to establish long-term efficacy for many of the currently available treatment options.

Purpose: To assess the beneficial effect of different fractions of Cynodon dactylon (C. dactylon) on ethylene glycol-induced kidney calculi in rats. Materials and Methods: Male Wistar rats were randomly divided into control, ethylene glycol, curative, and preventive groups. The control group received tap drinking water for 35 days. Ethylene glycol, curative, and preventive groups received 1% ethylene glycol for induction of calcium oxalate (CaOx) calculus formation. Preventive and curative subjects also received different fractions of C. dactylon extract in drinking water at 12.8 mg/kg, since day 0 and day 14, respectively. After 35 days, the kidneys were removed and examined for histopathological findings and counting the CaOx deposits in 50 microscopic fields. Results: In curative protocol, treatment of rats with C. dactylon N-butanol fraction and N-butanol phase remnant significantly reduced the number of the kidney CaOx deposits compared to ethylene glycol group. In preventive protocol, treatment of rats with C. dactylon ethyl acetate fraction significantly decreased the number of CaOx deposits compared to ethylene glycol group. Conclusion: Fractions of C. dactylon showed a beneficial effect on preventing and eliminating CaOx deposition in the rat kidney. These results provide a scientific rational for preventive and treatment roles of C. dactylon in human kidney stone disease.

Purpose: To evaluate the ultrastructural features of the urinary stones removed with endoscopic stone surgery, using micro computed tomography (micro-CT). Materials and Methods: Patients who had endoscopic surgery for renal or ureteral stones removal were included in this study. After surgery, the stones were classified into three groups and investigated with Skyscan 1174 micro-CT. Group I underwent percutaneous nephrolithotomy (PNL) with ultrasonic lithotripsy; group II had ureteroscopic stone surgery (USS) with pneumatic lithotripsy; and group III (the control group) had stone removal with USS or PNL without lithotripsy. Stone homogeneity, voids, and the internal structure of the stones were evaluated. Chi-square test was used to evaluate the difference statistically. P values less than .05 were considered statistically significant. Results: A total of 24 "calcium oxalate monohydrate" stones from 24 patients were scanned with micro-CT. Stones treated with ultrasonic lithotripsy (group I) were more fragile, fragmented, and cracked than those treated with the pneumatic lithotripsy (group II; P = .01). Stones in group II were more homogeneous and smooth than those in group I and resembled those of the control group (P = .02). Homogeneous, non-fragile stones and heterogeneous, fragile calculi were seen in all groups. Conclusion: The stone fragility could be confirmed by micro-CT investigation. Ultrasonic lithotripters increase the stone fragility, which is demonstrated with increased heterogeneity by micro-CT.

Purpose: To study the simultaneous effects of prone position and anesthesia on intraocular pressure (IOP) and the time impact on post anesthesia visual loss development in percutaneous nephrolithotomy (PCNL). Materials and Methods: Twenty patients who were candidates for PCNL were recruited in this study. Intraocular pressure was measured in five occasions:

1. Base line; 2. Ten minutes after anesthesia (Supine-I); 3. Ten minutes after position change to prone (Prone-I); 4. At the end of the operation (Prone-II); and 5. Ten minutes after position change to supine (Supine-II). The data were analyzed by SPSS software using repeated measures ANOVA and paired t test. Results: The participants consisted of 17 (85%) men and 3 (15%) women, with the mean age of 44 years. The duration of the prone position was 79.75 ± 22.73 minutes. Intraocular pressure changed significantly in five positions (P = .000). It was lower in supine-I than baseline, higher in prone-I than base line and supine-I, lower in supine-II than prone-II, and highest in prone-II (P = .000). There was a linear relationship between IOP and prone position duration (r = 0.67; P = .001). Conclusion: Intraocular pressure dropped significantly after anesthesia and increased in prone position. There was a linear relationship between IOP rise and the prone position duration, doubled within two hours. Therefore, in PCNL carried out in prone position, it is recommended to observe safety measures and necessary precautions for IOP rise and possible post anesthesia visual loss, particularly in glaucoma.

Purpose: To evaluate the effect of the number of dissected lymph nodes (LNs) during radical cystectomy on survival outcomes. Materials and Methods: Medical files of 211 patients who underwent cystectomy between 1996 and 2009 were retrospectively evaluated. Seventy-four patients were included in the study and divided into two groups regarding the median number of retrieved LNs (median number = 13); 36 patients in the 1st and 38 in the 2nd group. Radical cystectomy, urinary diversion, and pelvic LN dissection were done in all the patients. When necessary, adjuvant chemotherapy was applied. Kaplan-Meier survival analysis was performed to compare survival outcomes of the groups. Results: Of 74 patients, 67 (90.5%) were men and 7 (9.5%) were women, with the mean age of 61.7 years (range, 39 to 83 years). Age distribution, pathologic stages, carcinoma in situ occurrence, adjuvant chemotherapy rates, LN involvement, and median follow-up period were similar in both groups. Mean dissected LNs number in the 1st and 2nd groups was 6.17 (range, 1 to 12) and 21.6 (range, 13 to 41), respectively. Five-year estimated overall survival rates were 24.5% and 60.5% (P = .002) while five-year estimated disease-specific survival rates were 43.7% and 74.4% (P = .049), respectively. Conclusion: Although exact guidelines are not described, it seems that dissection of high number of LNs during radical cystectomy is crucial.

Purpose: To diagnose the urothelial carcinoma of the bladder by measuring CA19-9 level in the urine. Materials and Methods: This study was conducted on 47 patients with histopathologically confirmed urothelial cancer and 50 control subjects. The urinary level of CA19-9 was measured in both groups by enzyme-linked immunosorbent assay after concentration of urine with Bio-Gel dry beads. Urine cytology was also done in both controls and patients. Results: The mean urinary level of CA19-9 was 194.59 ± 110.56 u/mL in patients and 11.67 ± 8.42 u/mL in controls (P = .0001). The mean urinary level of CA19-9 in patients with low-grade and high-grade bladder cancer was 206.56 ± 114.56 u/mL and 174.80 ± 94.06 u/mL, respectively (P = .56). Urine cytology by Papanicolaou stain was mostly negative. Conclusion: It can be concluded that CA19-9 may be a useful non-invasive test to diagnose the urothelial carcinoma of the bladder.

Purpose: To present the long-term results of failed vesicovaginal fistula repair using flap splitting techniques. Materials and Methods: Nine women with a previous failed vesicovaginal fistula repair, aged 18 to 69 years, underwent salvage vaginal reconstruction for damaged urethra or bladder, at a five-year interval lasting from 2003 to 2007. Fistulas were repaired using an interposed pediculated vaginal wall flap. Results: The repair was successful in all the patients, even in those with rectovesicovaginal fistula or a large vesicovaginal fistula with sphincter damage. Conclusion: Pediculated vaginal wall flap is an easily-prepared, well-vascularized tissue, which provides long-term favorable outcomes.

Purpose: To determine the prevalence of self-reported erectile dysfunction (ED) among urological cases in Turkish men. Materials and Methods: Between January 2007 and January 2011, the diagnoses of 9780 men over 18 years old that presented to our urology polyclinic were reviewed. The 10 diseases with the highest frequency, the rate of the disease, and the intra-group ranking were determined in 18 to 39, ≥ 40-year-old, and in total. The rate of ED among urological cases was considered to be the self-reported ED prevalence. The findings were evaluated using the population-based (Turkey) ED prevalence found in the literature. Also, the prevalence of benign prostatic hyperplasia (BPH) was evaluated in the Turkish population. This evaluation compared the ED and BPH prevalence. Results: The prevalence of ED (self-reported ED) was 1.9%, 8.2%, and 4.8% in the age groups of 18 to 39, ≥ 40-years, and total, respectively. The intra-group ranking of ED was 8th, 3rd, and 8th in the aforementioned groups, respectively. The most frequent disease was BPH in total and ≥ 40-year-old groups. The ratio of patients with BPH to ED was 6.1 (BPH/ED: 2250/366). The prevalence of ED (self-reported ED) as well as BPH significantly increased with age (P < .001 and P < .001, respectively). Conclusion: The prevalence of ED in urological cases is relatively lower than expected. There is a discrepancy between the self-reported ED prevalence in urological cases and population-based ED prevalence.

Purpose: To evaluate the prevalence of peri-ictal urinary symptoms and their association with seizure type in patients with epilepsy. Materials and Methods: A total of 115 patients with epilepsy were recruited consecutively from neurology clinic between January 2006 and January 2008. Peri-ictal period was defined as the period ranging from 2 minutes prior to seizure attack up to 48 hours after it, and post-ictal period was the time up to 48 hours after regaining  consciousness. Peri-ictal urinary complaints were gathered with interview and data were analyzed using Pearson's Chi-square, Fisher's Exact test, and independent sample t test.

Results: The study population consisted of 57 (49.5%) men and 58 (50.4%) women, with the mean age of 26.83 ± 10.01 years. The frequency of at least one urinary symptom in studied patients was 39.1%. Incontinence, frequency, urgency, retention, and hesitancy were reported by 28 (24.3%), 14 (12.2%), 19 (16.5%), 10 (8.7%), and 8 (7%) patients, respectively. Women expressed more symptoms than men and a higher frequency of peri-ictal retention. Although overall urinary complaints were more frequent in patients with partial seizures, there was a higher frequency of urgency in patients with partial seizure (P = .037). Furthermore, apart from retention, there was no significant correlation between peri-ictal urinary symptoms and the patients' age. Conclusion: Our findings suggest that peri-ictal urologic dysfunction is a common problem among patients with epilepsy and post-ictal urinary retention might also be considered as a post-ictal deficit (Todd's deficit).

Purpose: To investigate the relationship between the accuracy of the answers provided by the patients to the International Prostate Symptom Score (IPSS) questionnaire and age and level of education. Materials and Methods: Two hundred and thirty-eight men were given self-administered IPSS questionnaires. After 48 to 96 hours, the IPSS form was completed again with the assistance of a physician. The relationship of the difference between the self-administered IPSS and forms completed with assistance with age and level of education was evaluated through Wilcoxon test. P values less than .05 were considered significant. Results: There was not a significant difference between the two IPSS among the high school or university graduates (P = .480). However, the difference was significant among the primary and secondary school graduates (P = .042 and P = 0.34, respectively). Of values obtained from self-administered IPSS forms and those completed with the assistance of a physician, there was a statistically significant difference in the group ≥ 60 years of age. Conclusion: Age ≥ 60 years and being primary or secondary school graduate are factors lowering the comprehension of the IPSS by the patients. Older patients and those with lower education could benefit from the assistance of a physician while completing this questionnaire.