Urology Journal

Recently, occurrence of urinary tract endometriosis (UTE) is more frequently diagnosed. According to literature, it refers to approximately 0.3 to even 12% of all women with endometriosis. The pathogenesis of UTE has not been clearly explained so far. The actually proposed hypotheses include embryonic, migration, transplantation, and iatrogenic theory. Most frequently UTE affects bladder, less often ureters and kidneys. One-third of patients remains asymptomatic or exhibits only minor manifestations. In symptomatic patients main complaints include dysuria, urinary urgency, and/or frequency, painful micturition, and burning sensation in the urethra and discomfort in the retropubic area. Treatment of UTE is challenging and can be pharmacological, surgical or can be a combination of both methods. In this paper we present a review of the literature concerning the UTE, its diagnosis and treatment.

Purpose: We retrospectively compared laparoscopic transperitoneal and retroperitoneal approaches for the decor­tication of simple renal cysts with respect to safety, postoperative pain, and clinical results.

Materials and Methods: The study included 40 patients (28 males and 12 females) with symptomatic simple renal cysts and who underwent laparoscopic cyst decortication, and they were evaluated retrospectively. Patients' age, gender, disease-specific history, comorbid disease and family history, in general and urological and phys­ical examination findings were recorded. Patients prior to surgery were evaluated by urinalysis, serum creati­nine level, blood count, urinary tract ultrasonography, and unenhanced and contrast-enhanced abdominal com­puted tomography. Patients were informed about laparoscopic surgery and their written informed consent was taken. For those who preferred the laparoscopic approach, the placement of the cyst, history of prior surgery and obesity were evaluated. All patients filled out the visual analog scale (VAS) to evaluate postoperative pain.

Results: The mean age of the patients were 54.65 ± 5.26 years in the retroperitoneal group and 56.0 ± 4.66 years in the transperitoneal group. For all patients the indication for surgery included right or left flank pain. The mean operative time for the transperitoneal approach was 51.5 min., and that for the retroperitoneal approach was 44.75 min. This difference was statistically significant between the two groups (P < .05). According to VAS scale, the retroperitoneal scoring method was found to be lower than the transperitoneal scoring method. All patients were discharged on the first postoperative day, and the drains were taken out. None of the patients had complications. At the end of six months, no clinical and radiological recurrence was detected in any patient.

Conclusion: We consider the retroperitoneal approach to be the first-choice because of its shorter operation time and particularly low level of postoperative pain.

Purpose: This study was conducted to compare safety, efficacy and cosmetic outcome between standard laparoscopic live donor nephrectomy (sLDN) and mini-laparoscopic donor nephrectomy (mLDN) in a randomized clinical trial.

Materials and Methods: From March 2012 to June 2013, 100 consecutive kidney donors were randomly assigned to two equal groups for laparoscopic donor nephrectomy.

mLDN: Six to eight centimeters Pfannenstiel incision was made slightly above pubis symphysis and 11 millimeters trocar was fixed through exposed fascia using open technique. Five mm port was placed under direct vision at the umbilicus for camera insertion and two 3.5 mm ports were placed in subxiphoid and paraumbilical area.

sLDN: Ten mm port was placed at umbilicus using open access technique for camera insertion. Five mm trocar for grasping and 11 mm trocar for vascular clipping were placed at subxiphoid and paraumbilical areas under direct vision, respectively. The second 5 mm trocar was placed in suprapubic area. Cosmetic appearance was assessed three months after surgery by using the Patient Scar Assessment Questionnaire (PSAQ).

Results: Demographic data of the patients was not significantly different between two groups. Total operative time and ischemic time was nearly similar in both groups (104 ± 21 vs. 114 ± 24 min; P = .327 and 4.03 vs. 4.07 min; P = .592). There were no cases of conversion to open surgery. Mean hospital stay was similar between the two groups [2.1 (2-5) vs. 2.4 (2-5) days; P = .346]. Kidney graft function assessed by serum creatinine val­ues (mg/dL) of recipients, was equivalent in both groups (1.58 vs. 1.86: P = .206). Mean appearance score (34 vs. 29) and consciousness score (22 vs. 18) in PSAQ showed significantly better results in the mLDN group.

Conclusion: Our experience in this study revealed that peri- and post-operative findings were comparable between sLDN and mLDN, but mLDN has significant better cosmetic appearance than standard laparoscopic approach.

Purpose: Nocturnal enuresis (NE) is a very common multifactorial pediatric disorder and in children with­out any other lower urinary tract symptoms is defined as monosymptomatic NE (MNE). Pharmacologi­cal, psychological/behavioral, and alternative interventions are commonly used and the first-line drug ther­apy for patients with MNE is desmopressin (dDAVP) but the response rate is less than 40-60% and the relapse rate is about 50-80% after treatment. Many studies show that some foods and beverages can promote diuresis or bladder irritability, which in some people can exacerbate bladder symptoms and NE. The pres­ent study aimed to compare the efficacy of combined specific dietary advices and dDAVP vs dDAVP alone.

Materials and Methods: We enrolled in the study 172 patients affected by MNE between January 2013 and May 2014, of these 35 were excluded. The inclusion criterion was primary MNE and exclusion criteria in­cluded non-MNE, secondary MNE and lactose intolerance. Children were treated with dDAVP at a dose of 120 μg a day and were randomized to receive dietary recommendations. They were asked to fill out a char­ter depicting their wet and dry nights for the period of treatment. Sixty-seven patients were randomly as­signed to receive dDAVP and dietary advices (group A) and 70 patients to receive dDAVP alone (group B).

Results: We included in our study 137 children, 102 (74.5%) male, and 35 (25.5%) female, aged be­tween 5 and 14 years. Our results show a higher response rate and a lower number of relapse in group A vs group B with 67.2% of responders in group A vs 58.6% in group B, after 3 months of ther­apy and 31.1% of relapse in group A vs 46.3% in group B one month, after the end of treatment.

Conclusion: Our results show the effectiveness of specific dietary advices in the manage­ment of primary MNE. However further studies are needed to determine whether the differ­ence between therapy with combined dietary recommendations and dDAVP vs dDAVP alone.

Purpose: To evaluate the effects of the presence of previous or synchronous non-muscle invasive bladder cancer (NMIBC) on the oncologic outcomes of radical nephroureterectomy in patients with upper tract urothelial carci­noma (UTUC).

Materials and Methods: In total, 505 patients with UTUC were enrolled from four different institutions. The clinicopathologic parameters of patients with and without previous or synchronous NMIBC were compared, and Kaplan-Meier estimates and multivariate Cox regression analyses were performed.

Results: The median follow-up period was 38.4 months. In all, 408 patients had primary UTUC, 45 (8.9%) had a history of NMIBC, 59 (11.7%) had concomitant bladder cancer, and seven (1.4%) had experienced both. Tumors in patients with associated NMIBC were more commonly multifocal (P = .001) and associ­ated with surgical margin positivity (P = .001). Kaplan-Meier estimates revealed that previous or synchro­nous NMIBC was significantly associated with bladder recurrence (P < .001) and locoregional recurrence/ distant metastasis (P = .008). A multivariate Cox regression model identified previous or synchronous NMIBC as an independent predictor of bladder recurrence (P < .001). However, the presence of previ­ous or synchronous NMIBC was not a prognostic indicator of locoregional recurrence/distant metastasis.

Conclusion: In patients with UTUC, previous or synchronous NMIBC was significantly associated with an increased risk of cancer recurrences in the bladder after radical nephroureterectomy. The present find­ings suggest that a close monitoring should be required for the patients with previous or concomitant NMIBC.

Purpose: Polyoma virus hominis 1, better known as BK virus (BKV) infection might be a predisposing factor for prostate cancer (PCa). The aim of this study was to compare the frequency of BK virus infection in pathological specimens of patients with PCa compared to patients with benign prostatic hyperplasia.

Materials and Methods: From July 2011 to June 2012, paraffin-embedded tissue blocks of patients with PCa (60 specimens) and also with benign prostatic hyperplasia (60 specimens) were investigated. After DNA purification, existence of virus nucleic acid was assessed by polymerase chain reaction.

Results: Viral DNA was identified in 9 patients (15%) with BPH and 17 patients (28%) with PCa (P =.076). In patients with PCa, viral DNA was observed more often in those with lower total Gleason scores (P = .045).

Conclusion: The frequency of BK virus infection in PCa patients was higher than BPH patients. BK virus was more often observed in patients with lower Gleason scores. Less detection of BK virus DNA in overt cancer may prove the activity of the virus which paves the way for tumorigenic transformation at early stages of PCa.

Purpose: This study exploresthe factors affecting the willingness of dialysis patients' family members to become involved in living and deceased organ donation.

Materials and Methods: We utilize cross sectional data on 350 family members of dialysis patients collected through self-administered survey from June to October 2013. The factors affecting willingness to become deceased and living organ donors among respondents were identified by running logistic regressions.

Results: The findings reveal that ethnicity, education and role in family are significant factors explaining will­ingness for living donation, while ethnicity, knowledge of organ donation and donor age drive willingness for deceased donation. We also find that the reasons of respondents being unwilling to donate center on the lack of information and family objections for deceased donation, while being medically unfit, scared of surgery and family objections are the reasons for unwillingness to donate living organs.

Conclusion: In light of our findings,educational efforts are suggested to decrease the reluctance to become in­volved in living and deceased donation.

Purpose: This study aimed to investigate the effects of preoperative Valsalva leak point pressure (VLPP) on the outcomes of the single-incision midurethral sling procedure (Needleless® System) in female stress urinary incon­tinence (SUI).

Materials and Methods: We evaluated 112 patients who underwent midurethral sling placement for SUI using the Needleless® System. Patients were divided into two groups according to their preoperative VLPP values: VLPP >90 cmH2O (group 1) and VLPP 60-90 cmH2O (group 2). After the postoperative period, SUI status and satisfac­tion were compared between the two groups. Subjective cure was defined as the absence of any episodes of urinary incontinence associated with conditions that increase intra-abdominal pressure in daily life. Treatment satisfaction was analyzed according to patient responses as 'satisfied', 'neutral', and 'dissatisfied'. Postoperative other lower urinary tract symptoms except SUI were compared between the two groups too.

Results: There were no significant differences in age, body weight, and urodynamic parameters (except VLPP) between the two groups. The mean VLPPs were 105.9 ± 12.3 cmH2O (range, 93.6¬-118.2 cmH2O) in group 1 and 75.4 ± 10.5 cmH2O (range, 65-85.9 cmH2O) in group 2. The overall subjective cure rates were 65.0% in group 1 and 62.5% in group 2 (P = .744). The overall satisfaction rates were 58.8% in group 1 and 68.8% in group 2 (P = .600). Complication rates did not differ between the two groups.

Conclusion: When stratified as > 90 cmH2O or ≤ 90 cmH2O, preoperative VLPP did not affect Needleless® Sys­tem outcomes in female SUI patients.

Purpose: To determine whether testicular cryoablation caused histopathological orchiectomy, and to show its effects on serum total testosterone (t-testosterone) levels in rats.

Materials and Methods: A total of 12 Wistar albino male rats were used in this study. The animals were divided into two groups, as cryoablation (9 rats) and control (3 rats) groups. Bilateral cryoablation was performed in the cryoablation group. T-testosterone levels were measured in both groups before scrotal exploration. Bilateral or­chiectomy was performed in both groups 10 days after the cryoablation procedure. T-testosterone was measured immediately before orchiectomy. Mann-Whitney U test was used for intergroup comparisons.

Results: Baseline t-testosterone levels were 1.31 (0.78-2.45) ng/mL and 0.98 (0.91-2.05) ng/mL in the cryoab­lation and the control groups, respectively (P = .92). T-testosterone levels were 0.23 (0.07-1.12) ng/mL and 2.87 (0.63-3.06) ng/mL in the cryoablation and the control groups, respectively, in the blood samples obtained at the time of orchiectomy (P = .03). Histopathological examination of rat testes revealed varying degrees of paratestic­ular inflammation and necrosis in 13 of 18 testes in the cryoablation group. None of 6 testes showed necrosis in the control group.

Conclusion: Our study showed that histopathological orchiectomy could be obtained by cryoablation in rat testes.

Purpose: Controversy still exists as to whether testicular delivery during microsurgical subinguinal varicocelecto­my (MSV) provides benefit to the patient or not. This study specifically compared the therapeutic effect of MSV with and without testicular delivery for the treatment of varicocele in a cohort of infertile men.

Materials and Methods: We conducted a prospective, randomized, controlled study to evaluate the therapeutic efficacy of MSV with and without testicular delivery for the treatment of varicocele in infertile men. A total of 100 patients were specifically recruited using strict inclusion criteria to undergo MSV with testicular delivery (group1, n = 50) or MSV without testicular delivery (group 2, n = 50). All patients were followed-up at 3, 6 and 12 months following surgery. Semen parameters, pregnancy and recurrence rates, and complications were monitored.

Results: Mean surgical time for group 1 was significantly longer than group 2 (90.50 ± 15.60 min vs. 84.30 ± 15.58 min; P = .001). Sperm count and motility were significantly improved at the 12-month follow-up appoint­ment in both groups compared with pre-operative values, but were not significantly different at 3, 6, and 12 months when compared between the two treatment groups. The incidence of scrotal edema, and spermatic/testicular en­gorgement were higher in group 1 (both P = .001), although natural pregnancy rate was not significantly different between the two groups at the 12 month follow-up appointment (46% vs. 42%) (P = .817).

Conclusion: MSV with testicular delivery did not reduce the risk of recurrence and led to improved semen quality compared with MSV without testicular delivery. However, there was a higher risk of complication with this tech­nique, which must be borne in mind when considering the clinical implications of our dataset.

Purpose: The aim of this study was to evaluate the use of a dorsal island penile fasciocutaneous flap in the man­agement of resistant fossa navicularis strictures in circumcised West African men.

Materials and Methods:From January 2004 to December 2013 there were twenty-one patients with fossa navic­ularis strictures (FNS) with or without meatal stenosis who underwent urethroplasty using a previously described technique and a dorsal island penile fasciocutaneous flap. The average patient follow-up was 25.9 months.

Results: Urethral catheterization was the most common cause of FNS. All of the patients had successful urethral function and acceptable cosmetic results. One patient had partial dorsolateral skin necrosis that healed with con­servative measures. All patients, including the five patients with meatal stenosis,retained the natural shape of the external meatus and hada natural urine stream.

Conclusion:The penile cap technique uses a dorsal island fasciocutaneous flap and provides satisfactory function­al and cosmetic outcomes in the management of fossa navicularis and meatal strictures.

Purpose: Although many virulence factors have been defined for Helicobacter pylori (HP), vacuolating cytotoxin A (VacA) is known to be associated with apoptosis, the cag pathogenicity island protein (Cag-PAI),and growth factors. Both apoptosis and growth factors are thought to be related to the etiology of benign prostatic hyperpla­sia(BPH). Additionally, the relation between atherosclerosis-BPH and atherosclerosis-HP has also been reported in a limited number of studies. The aim of this pioneering study was to investigate the presence of HP in BPH patients who had undergone transurethral resection of prostate (TURP) and to discuss the potential pathophysiologic effects of HP on BPH.

Materials and Methods: A total of 113 cases who underwent TURP due to infravesical obstruction due to BPH were included in thestudy. Preoperatively, parameters including, age, height, body weight, body mass index (BMI), prostate specific antigen (PSA), prostate volume (PVo), maximum urinary flow rate (Qmax), fasting plasma insu­lin, and International Prostate Symptom Score (IPSS)values were evaluated. The presence of HP was investigated in the prostate specimens with real-time polymerase chain reaction (RT-PCR) method. Postoperatively, histo­pathological evidence of chronic prostatitis (hCP) was also analyzed.

Results: HP was detected in 1.8% (n=2) of the participants. Additionally, hCP was observed in 58.4% (n=66) of the 113 patients. The demographic and clinical parameters confirmed the presence of BPH disease.

Conclusion: Although BPH is a common disease, its physiologic etiology mechanisms are not clear. Based on our pilot study, despite its gastric location, we believe that HP should be considered in cases with clinical BPHbecause HP induces apoptosis and alterations in the equilibrium between apoptosis and local growth factorsin addition to its recently demonstrated extragastric effects mediated via the atherosclerotic pathway. Although our uncontrolled pioneer study was not designed to investigate the pathophysiologic mechanism, the isolation of HP from prostatic adenomasuggests the need for further well-designed studies on this topic.

Purpose: Abdominal trauma itself accounts for approximately 3% of all trauma cases. Among cases of multiple organ trauma, abdominal trauma accounts for 8-10% of cases. The frequency of genitourinary tract trauma is 10%. The renal trauma is 1-5% of all trauma cases. The aim of this study was to determine treatment's strategy according to analysis of renal trauma severity.

Materials and Methods: Since 2008, the Military Institute of Medicine, followed by the Trauma Center, treated 1119 trauma patients, of which 52 were renal trauma cases. In most cases, renal trauma was concomitant with multiple organ trauma.

Results: Of the 52 renal trauma cases, 35 (67%) were caused by transportation, 5 (10%) by falls, 8 (15%) by iat­rogenic factors, 2 (4%) by batteries, and 2 by idiopathic factors. In our study cohort, 31 cases (60%) experienced renal trauma concomitant with multiple organ trauma. Renal trauma involved injury to both kidneys in 9 (20%) patients, and to only 1 kidney in 34 (80%) patients.

Conclusion: The use of computed tomography scan in combination with strict observation of conservative treat­ment protocols and intravascular techniques results in effective treatment of renal trauma.

Purpose: Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a chronic pain condition and a com­mon problem in urology clinics. Although many different etiologies and mechanisms exist, the exact cause of the disease has been unknown. Central sensitization (CS) is defined as an augmentation of responsiveness of central cortical neurons to input from peripheral nociceptive structures. Somato-sensory evoked potentials (SEPs) is an electroneurophysiological method to assess cortical activity in somatosensory area of brain related to sensorial stimuli. We aimed to determine the presence of CS using the SEPs of dorsal penile nerve stimulation in patients with CP/CPPS.

Materials and Methods: Seventeen male patients diagnosed CP/CPPS and 17 male healthy controls were pro­spectively included in the study. For SEP study, electrical stimulus was applied with penile ring electrodes. Re­cording electrodes were placed as active to Cz' and reference electrode on Fz' ac-cording to the 10-20 Interna­tional System. Latency of N50 was defined as the second negative (up-ward) deflection of the W-shaped averaged cortical waveform.

Results: N50 latencies were significantly shortened in the patient group compared to the healthy con-trols (P < .001).

Conclusion: These results support the presence of central sensitization because of exaggerated trans-mission of pain sensation to the somatosensory cortex. Therefore, normalization of transmission might be an important step in treatment of pain in patients with CP/CPPS. This study can be counted as an important guiding on pathogenesis and treatment of disease.