Urology Journal

Purpose: To evaluate different urinary factors contributing to idiopathic calcium stone disease for determining appropriate medical treatments. Materials and Methods: Two 24-hour urine samples were collected

from 106 male recurrent idiopathic calcium stone formers and another 109 randomly selected men as the control group matching for age. Results: Cases had significantly higher mean urine oxalate, calcium, uric acid, and chloride in comparison with the healthy controls (P < .001). After necessary adjustment, only mean urine levels of oxalate and uric acid were higher in stone formers than those in controls. The mean value of supersaturation for calcium oxalate was significantly higher in patients than the controls (P = .001); whereas supersaturation for calcium phosphate and uric acid did not reach statistical significe (P = .675 and P = .675, respectively). Hyperoxaluria and hypercalciuria were among the most frequent abnormalities. After categorizing urine parameter values into four quartiles, the risk of stone formation was found to increase as the urine calcium, oxalate, uric acid, chloride, and citrate rise. In contrast, the risk of stone formation decreased with the increase of urine potassium. Conclusion: Oxalate seems to play the most important role as urinary stone risk factor in our population followed by calcium and uric acid. In addition to the risk factors, it seems that supersaturation as the sum of all risk factors probably has a high predictive value.

Purpose: To investigate the preferences and practice patterns of urooncologic surgeons in Turkey on bowel preparation and peri-operative management for radical cystectomy. Materials and Methods: This study was conducted by Turkish Urooncology Association as a multicenter survey. Participants were asked to fill in questionnaires dispensed at annual oncologic meeting or using internet access to the website of Urooncology Association. The questionnaire consisted of multiple choice or open-ended questions related to frequency of cystectomy, surgical technique and type of diversion, bowel preparation protocol, nasogastric tube applications, antibiotic prophylaxis, and deep vein thrombosis prophylaxis. Collected data from the survey were presented descriptively. Results: Forty-four questionnaires from 44 surgeons of different centers were evaluated. All participants answered that they always perform bowel preparation before cystectomy. Four participants reported that they had an experience of cystectomy without bowel preparation. Bowel preparation methods included long conservative methods, short enema protocols, and Golytely, but there were significant differences in application of each method. Of participants, 88.6% perform diversion by themselves whereas others ask help from a general surgeon. Antibiotic prophylaxis is preferred mostly by 2 agents using third-generation cephalosporins and metronidazole for a period of 5 days or more in the majority. Type, duration, and dosage of deep vein thrombosis prophylaxis differed among participants. Conclusion: There are significant individual differences in peri-operative management of radical cystectomy, which render deficient and sometimes inadequate patient care. There is a need to establish standard protocols for bowel preparation and adequate peri-operative management for radical cystectomy.

Purpose: To evaluate if 18 fluorodeoxyglucose positron emission tomography (18FDG-PET) scan could identify post-chemotherapy retroperitoneal lymph node (RPLN) involvement in advanced germ cell tumors of the testis. Materials and Methods: Between January 2005 and January 2009, 16 patients with advanced germ cell tumors of the testis underwent RPLN dissection (RPLND) following chemotherapy. Before RPLND, abdominal computed tomography (CT), magnetic resonance imaging (MRI), and 18FDG-PET were performed in all the patients. Findings on 18FDG-PET were compared with pathological evaluation of the removed lymphatic tissue. Results: Both abdominal CT and MRI demonstrated retroperitoneal masses in all the patients following chemotherapy. Although PET did not demonstrate any activity in 8 patients, tumor was detected histopathologically. In 1 patient, 18FDG-PET demonstrated activity; however, no tumor was detected on pathology. Of the remaining 7 patients, 18FDG-PET findings were concordant with the histopathological findings. No activity was detected in 2 patients with no tumors whereas all 5 patients harboring viable tumor cells showed positive 18FDG-PET activity. In our study, sensitivity and specificity of 18FDG-PET in detecting RPLN involvement were detected to be 39% and 67%, respectively. Conclusion: 18FDG-PET imaging does not seem to be a reliable method in detecting RPLN involvement in advanced germ cell tumors of the testis

following chemotherapy. Therefore, we neither recommend routine use of 18FDG-PET scanning nor decide the treatment work-up by solely relying on the 18FDG-PET findings in this patient group.

Purpose: To evaluate the feasibility of laparoscopic simple prostatectomy for large volume prostates.

Materials and Methods: Between October 2007 and July 2009, laparoscopic simple prostatectomy was performed on 16 patients with the prostates over 80 mL. All the patients were operated with transvesical method. Peri-operative and 3rd postoperative month data were recorded and evaluated. Results: The mean prostate volume was 147 mL (range, 80 to 200 mL). The mean operation time, blood loss, duration of hospitalization, and duration of drain placement was 133 minutes (range, 75 to 210 minutes), 134 cc (range, 50 to 300 cc), 3.9 days (range, 2 to 7 days), and 2.1 days (range, 2 to 3 days), respectively. Only one patient required blood transfusion due to postoperative bleeding and clot obstruction in the catheter lumen. Postoperative infection

was not seen and recatheterization was not needed in any of the patients. All the patients’ pathology reports were noted as benign. Pre-operative and postoperative International Prostate Symptom Score were 9.2 and 25.4,

respectively. Maximum urinary flow rate was 4.0 mL/sec pre-operatively, but 24.7 mL/sec postoperatively.

Conclusion: Laparoscopic simple prostatectomy is a feasible method with low morbidity and improved postoperative outcomes.

Purpose: To study the general health and quality of life in patients with sexual dysfunctions. Materials and Methods: One hundred and thirty-seven patients with diagnosis of a known sexual dysfunction (SD) were studied. A healthy group of 111 individuals matched for sex, education, and marital status were also

selected as a control group. Both groups completed two questionnaires: General Health Questionnaire-28 (GHQ-28) and Personal Wellbeing Index– Adult (PWI-A). To analyze data, descriptive methods as well as student t test for independent groups were used. Results: The mean scores for individuals suffering from SD were more than the control group in total GHQ scale and all its subscales. The mean scores in total PWI-A scale and most of its subscales for individuals suffering from SD were lower than the control group. Since the obtained t values (4.16 to 5.22) for all the comparisons done between the mean scores in GHQ for the two groups were higher than t value in the ‘t table’ for df = 206 at α = 0.01 (2.58), differences obtained were significant. Since obtained t values (-2.03 to 4.65) for total quality of life and health, achievements, personal relationship, safety, and feeling part of community dimensions were higher than t value in the ‘t table’ for df = 206 at α = 0.05 and α = 0.01 (1.96 and 2.58, respectively), differences obtained except for standard of living and future security were significant. Conclusion: Somatic, social, and mental measures for people having sexual

dysfunctions (patient group) were lower than the control group.

Purpose: To investigate the success rate of internal urethrotomy when combined with corticosteroid injection in urethral scar tissue for treatment of urethral stricture. Materials and Methods: We performed a double-blind, randomized, placebo-controlled study on 70 patients with urethral stricture, who underwent internal urethrotomy from June 2003 to July 2008. Patients were randomized into 2 groups; the experimental group (34 patients) who received triamcinolone acetonide injection and the control group (36 patients) that received an injection of sterile water after internal urethrotomy. Postoperative results were compared between two groups. Results: In the experimental group, 1 (2.94%), 3 (8.82%), and 2 (5.8%) patients developed infection, bleeding, and extravasation, respectively, and recurrence was noted in 12 patients. In the control group, infection, bleeding, and extravasation occurred in 2 (5.55%), 3 (8.33%), and 2 (5.55%) patients, respectively, and stricture recurred in 15 patients. There were no significant differences in stricture location as well as its etiology between the two groups (P = .672 and P = .936, respectively). Complication and recurrence rates in experimental group were lower than the control group, but the difference was not statistically significant (P = .847 and P = .584, respectively). However, time to recurrence decreased significantly in experimental group (8.08 ± 5.55 versus 3.6 ± 1.59 months) (P < .05). In our study, we did not find any complications that could be attributed to the triamcinolone acetonide injections. Conclusion: It seems that steroid injection after internal urethrotomy is a safe method, which may delay the recurrence of urethral stricture.

 

Purpose: To evaluate renal colic frequency in different seasons and around full moon. Materials and Methods: A total of 1481 patients with renal colic were studied retrospectively addressing days of a month both in solar and lunar calendar. Results: The mean age of the patients was 57 ± 13 years. Total admissions

in summer was 613; of which 288 (41%), 199 (39%), and 126 (43%) were in years 2002, 2003, and 2004, respectively. The highest frequencies in solar calendar were on days 2 (56), 20 (63), and 27 (59) and the lowest were on days 6 (36), 22 (38), 26 (34), and 31 (31). We did not find any statistically significant association according to solar calendar (P = .3). In lunar calendar, most of the admissions were on day 15 (69) and the lowest rates were on days 1 (25) and 30 (26), which was statistically significant (P = .04). Conclusion: Renal colic frequency is not correlated with solar calendar, but its highest frequency in lunar calendar is in the middle of the month period. Although we found a correlation between full moon effect and renal tide, but

this is a new window for further studies.

Purpose: To report a novel technique for arteriovenous fistula (AVF) closure in side-to-side fistulas. Materials and Methods: One hundred and sixty-two patients with sideto- side AVFs, who were candidates for AVF closure, were randomly divided into two groups: group A (84 patients) who underwent AVF ligature and group B (78 patients) who underwent AVF closure using transvenous endovenorrhaphy technique. Both procedures were conducted by the same surgical team. The patients were followed up for 6 months.

Results: Of 124 patients with proximal AVFs, 65 (52%) subjects underwent ligation and 59 (42%) transvenous endovenorrhaphy. Of 38 patients with distal AVFs, half underwent ligation and for the remainder, transvenous endovenorrhaphy was done. Failure of AVF closure was detected in 28 (17%) patients; 25 (89.28%) were in group A and 3 (10.71%) were in group B. All of these recurrences were successfully treated by transvenous endovenorrhaphy technique. Conclusion: We claim that significant lower failure rate of transvenous endovenorrhaphy makes it the technique of choice, especially for side-to-side AVFs.

Purpose: To study the prevalence of duplex system and double ureter in cadavers and intravenous pyelograms in Indian population. Materials and Methods: Fifty cadavers were dissected and 50 intravenous

pyelograms were examined on both (right and left) sides for the presence of duplex system and double ureter.

Results: One male cadaver aged 43 years showed complete double ureter and duplex system on the right side and incomplete double ureter and duplex system on the left side. Another male cadaver aged 56 years showed incomplete double ureter and duplex system only on the right side. An intravenous pyelogram of a 43-year-old man showed incomplete double ureter along with duplex system on the right side. Conclusion: Developmental anomalies of the kidney, ureter, and urinary bladder should be kept in mind and promptly detected before the manifestations of aforementioned complications increase the morbidity of the affected individuals.

Purpose: To discuss the issue of screening for prostate cancer in elderly individuals. The impact of life expectancy on the choice of treatment in both patients and health care providers has been investigated as well. Materials and Methods: We identified studies published from 1990 onwards by searching the MEDLINE database of the National Library of Medicine. Initial search terms were “localized prostate cancer” and “early stage prostate cancer” combined with “elderly patients, life expectancy, palliative, curative, quality of life, watchful waiting, radical prostatectomy, brachytherapy, and external beam radiotherapy”. Results: Despite the decrease in prostate carcinoma-specific mortality, the use of prostate-specific antigen (PSA) has been shown to increase the prostate cancer detection rate with a shift to detection at earlier and less invasive pathological stages, overriding concerns about over-diagnosis and over treating. However, PSA screening is mainly offered to younger individuals, and older patients are more likely to have progressive disease and high-risk prostate cancer at diagnosis. Given that PSA screening diagnoses mainly curable, early prostate cancer, screening decision could be offered to otherwise healthy elderly patients who are likely to benefit from aggressive treatment. Conclusion: Prostate-specific antigen screening is not officially recommended and most scientific associations promote shared decision making. While PSA screening decision is currently based on physician’s judgment, it is clear that a strict age cut-off of 75 years reduces over-screening, but also prohibits screening in healthy older men with a long life expectancy.

Purpose: To discuss the methodological considerations of a standard and applicable randomized clinical trial (RCT). Materials and Methods: Using a predefined strategy, we conducted systematic computerized search of the MEDLINE (1966 to 2011) and EMBASE (1980 to 2011) databases to identify all English language educational articles discussing the RCT methodological aspects. Full text versions of identified studies were reviewed in blinded fashion for key methodological and statistical characteristics. Results: Randomized clinical trials in surgery are the highest level of the primary research evidence in evidence-based medicine. There is increasing demand for implementation of RCTs in urological daily practice. Conclusion: Randomized clinical trials’ report should be absolutely clear, simple, and easy to understand with well-defined internal and external validity. Efforts should be made to design high quality RCTs in urology. There are substantial needs for urologists to their knowledge about RCT.