Role of Oxidative Stress in Male Reproductive Dysfunctions with Reference to Phthalate Compounds

Sapna Sedha, Sunil Kumar, Shruti Shukla

Urology Journal, Vol. 12 No. 5 (2015), 16 November 2015, Page 2304-2316

Purpose: A wide variety of environmental chemicals/xenobiotics including phthalates have been shown to cause oxidative stress targeting the endocrine system and cause reproductive anomalies. The present review describes various issues by oxidative stress causing male reproductive dysfunctions. Here in this review, the importance and role of phthalate compounds in male reproductive dysfunction has been well documented.

Materials and Methods: One class of environmental endocrine disruptors is phthalates. Phthalate compounds are mostly used as plasticizers, which increase the flexibility, durability, longevity, and etc. of the plastics. Large-scale use of plastic products in our daily life as well as thousands of workers engaged in the manufacture of plastic and plastic products and recycling plastic industry are potentially exposed to these chemicals. Further, general population as well as vulnerable groups i.e. children and pregnant women are also exposed to these chemicals. Phthalates are among wide variety of environmental toxicants capable of compromising male fertility by inducing a state of oxidative stress in the testes. They may also generate reactive oxygen species (ROS) that may affect various physiological and reproductive functions.

Results: The available data points out that phthalate compounds may also induce oxidative stress in the male reproductive organs mainly testis and epididymis. They impair spermatogenic process by inducing oxidative stress and apoptosis in germ cells or target sertoli cells and thereby hamper spermatogenesis. They also impair the Leydig cell function by inducing ROS, thereby decreasing the levels of steroidogenic enzymes.

Conclusion: Thus in utero and postnatal exposure to phthalate compounds might lead to decreased sperm count and various other reproductive anomalies in the young male.



Factors Influencing Complications of Percutaneous Nephrolithotomy: A Single-Center Study

Sedat Oner, Muhammed Masuk Okumus, Murat Demirbas, Efe Onen, Mustafa Murat Aydos, Mehmet Hakan Ustun, Metin Kilic, Sinan Avci

Urology Journal, Vol. 12 No. 5 (2015), 16 November 2015, Page 2317-2323

Purpose: Percutaneous nephrolithotomy (PNL) is a minimally invasive procedure used for successful treatment of renal calculi. However, it is associated with various complications. We assessed the complications and their potential influencing factors in patients who had undergone PNL.

Materials and Methods: In total, 1750 patients who had undergone PNL from November 2003 to June 2011 were evaluated retrospectively. PNL complications and possible contributing risk factors (age, sex, serum creatinine level, previous operations, hydronephrosis, calculi size, localization, opacity, surgeon's experience, accessed calyxes, number of accesses, and costal entries) were determined. Receiver operating characteristic (ROC) analysis was used to investigate the cutoff values of the data. Ideal cutoff value was determined by Youden's J statistic. All the demographic and clinical variables were examined using backward stepwise logistical regression analysis. Continuous variables were categorized with logistic regression analysis according to the cutoff values.

Results: Complications occurred in 396 (24.4%) patients who had undergone PNL. Hemorrhage requiring blood transfusion occurred in 221 (12.6%) patients, hemorrhage requiring arterial embolization occurred in 7 (0.4%) patients, perirenal hematoma occurred in 17 (0.97%) patients, hemo-pneumothorax occurred in 32 (1.8%) patients, and colon perforation occurred in 4 (0.22%) patients. Three patients (0.06%) died of severe urosepsis, and one patient (0.02%) died of severe bleeding. The calculus size, localization, access site, number of accesses, presence of staghorn stones, surgeon's experience, and duration of the operation significantly affected the complication risk.

Conclusion: Our retrospective evaluation of this large patient series reveals that, PNL is a very effective treatment modality for kidney stones. However, although rare, serious complications including death can occur.



Core Length: An Alternative Method for Increasing Cancer Detection Rate in Patients with Prostate Cancer

Omer Gokhan Doluoglu, Cem Nedim Yuceturk, Muzaffer Eroglu, Berat Cem Ozgur, Arif Demirbas, Tolga Karakan, Selen Bozkurt, Berkan Resorlu

Urology Journal, Vol. 12 No. 5 (2015), 16 November 2015, Page 2324-2328

Purpose: We determine whether the lengths of benign and malignant cores affect cancer detection rates in patients with prostate cancer (PCa).

Materials and Methods: We evaluated retrospectively 512 patients in our clinic who had undergone 12 core transrectal ultrasound (TRUS)-guided prostate biopsies. The cores were divided into two groups: one with cancer (group 1) and one without cancer (group 2). We also classified Gleason scores as poorly differentiated (scores of 7-10) and moderately differentiated (scores of 5-6); these scores were compared with each other in terms of the core length. The core lengths of the groups were compared using a Student's t-test. A P value of less than .05 was considered to be statistically significant.

Results: Of the 512 patients, 76 (15%) had PCa. In total, we evaluated 912 cores of prostate biopsy samples from the 76 patients. Since 92 cores included insufficient tissue and rectal mucosa, we were not able to evaluate them. The remaining 820 cores were divided into two groups. Cancer was detected in 302 cores; 518 cores were benign in nature. The average core length in group 1 was 11.9 ± 4.4 mm, and the average core length in group 2 was 11.1 ± 5.1 mm (P = .015). The core lengths of poorly differentiated and moderately differentiated cancers were similar: 12.3 ± 4.2 mm and 11.7 ± 4.5 mm, respectively (P = .25).

Conclusion: Increasing cancer detection rates in cores may be related to core length in TRUS-guided prostate biopsies in PCa patients.


Diagnostic Yield and Complications Using a 20 Gauge Prostate Biopsy Needle versus a Standard 18 Gauge Needle: A Randomized Controlled Study

jianlong wang, Ben Wan, Chao Li, Jianye Wang, Weixin Zhao, Qiang Fu, Kaile Zhang

Urology Journal, Vol. 12 No. 5 (2015), 16 November 2015, Page 2329-2333

Purpose: To compare and evaluate whether a 20 gauge (20G) biopsy needle maintains a similar detection rate as that of the commonly used 18G needle for transrectal ultrasound-guided prostate biopsy (TRUSPB) aimed at assessing prostate cancer (PCa) and decreasing pain and complications.

Materials and Methods: A total of 122 cases with indications of PCa were randomly allocated into two groups for this randomized controlled study. TRUSPB was performed randomly using either an 18G or 20G needle for core biopsies (62 cases with 18G and 60 cases with 20G). Detection rate, pain, and complications were assessed after the procedure.

Results: The cancer detection rate in the 18G group (40.3%) did not differ from that in the 20G group (35.0%). However, the number of patients with pain was significantly lower in 20G group (P < 0.05). The number of patients with self-limiting hematuria decreased in both groups after the biopsy procedure (18G: 38 cases; 20G: 16 cases; P < .0001). Hematochezia occurred in 11 cases (9 cases [14.5%] in the 18G group; 2 cases [3.4%] in the 20G group). The number of patients with infection, dysuria, and urinary retention tended to be lower in 20G group.

Conclusion: Use of a 20G needle for TRUSPB yielded a comparable cancer detection rate to that of an 18G needle and led to less local injury, pain, and complications. A larger and more sensitive study is needed to verify our results.



Objective: To evaluate the results of novel modifications on tension- free vaginal tape (TVT) for the treatment of women with stress urinary incontinence (SUI).

Materials and Methods: Sixteen female patients (average age 49.29 years, range: 31-78) who underwent anti-incontinence surgery to correct their SUI in the period between June 2010 and August 2014 were included in the study. In situ anterior vaginal wall sling was prepared, and monofilament polypropylene tape passed below the in situ-sling and standard TVT procedure was performed. Both ends of the mesh in the suprapubic region were labeled with Vicryl sutures and left outside the wound. The middle of the mesh in the vaginal region were labeled with similar suture and left outside the vagina. Foley catheter was removed on the third postoperative day. The average period of follow-up was 8 months (range: 5-17).

Results: All patients benefited from the surgery; 15 (94%) of them completely cured and one patient clinically improved. Urinary retention was observed in one patient where the tension of the tape was reduced using adjustment sutures. No vaginal mesh erosion was detected during the gynecological examination postoperatively. No significant post-voiding residue was detected after catheter removal.

Conclusion: This technique gives feasible option to adjust the tension of the mesh in the early post-operative period in case of urinary retention. Presence of intervening in situ sling reduces the risk of vaginal erosions. Long-term success is expected because dislocation of the mid-urethral sling is less likely.



Comparison of Sexual Functions in Pregnant and Non-Pregnant Women

Mustafa Aydin, Neval Cayonu, Mustafa Kadihasanoglu, Lokman Irkilata, Mustafa Kemal Atilla, Muammer Kendirci

Urology Journal, Vol. 12 No. 5 (2015), 16 November 2015, Page 2339-2344

Purpose: The physiology and anatomy of pregnant women change during pregnancy. Pregnancy is an anatomically and physiologically amended process experienced by women and as a result of these changes, sexual life of pregnant women alters during pregnancy. We aimed to compare sexual functions of pregnant and non-pregnant women.
Materials and Methods: Sexually active 246 pregnant women were included into this cross-sectional controlled study. A total of 210 non-pregnant women were served as control. Both groups were compared in terms of age, gestational age, presence of urinary incontinence, body mass index, and obstetrical history. Sexual functions of the women were evaluated with Female Sexual Function Index (FSFI). Data were analyzed using chi-square, Mann-Whitney U, Fisher's Exact, Shapiro Wilk, Kruskal Wallis and Dunnett's tests where appropriate. The P
values < .05 were considered statistically significant.
Results: Mean age in both groups were comparable (P = .053). Median total FSFI scores in the pregnant women were significantly lower than those non-pregnant (18.9 vs. 22.7; P < .05). Additionally, the subgroup analyses of the FSFI scores were found that, total FSFI score is significantly lower in the pregnant group compared to non-pregnant group (P < .05). Furthermore, rate of sexual dysfunction in pregnant women was significantly higher than those non-pregnant women (91.08% vs. 67.61%, P = .0001). However, in pregnant women, no meaningful difference in rate of sexual dysfunction was found according to the trimesters (P = .632). Moreover, gravidity and parity exhibited negative impacts on the sexual functions. But number of abortions did not affect sexual function.
Conclusion: These data demonstrate that pregnancy significantly diminishes sexual function in women. We believe that, couples need to be counseled regarding the impact of pregnancy on sexual functions.

Erectile Dysfunction Is Positively Correlated with Mean Platelet Volume and Platelet Count, but Not with Eosinophil Count in Peripheral Blood

Alper Otunctemur, Muammer Bozkurt, Huseyin Besiroglu, Emre Can Polat, Levent Ozcan, Emin Ozbek

Urology Journal, Vol. 12 No. 5 (2015), 16 November 2015, Page 2347-2352

Purpose: Increased eosinophil count (EC), mean platelet volume (MPV), and platelet count (PC) are important in vascular disorders which are main factors resulting in endothelial dysfunction. We aimed to investigate the association between MPV, and EC, with erectile dysfunction (ED).

Materials and Methods: Two hundred thirty participants (130 patients with ED, and 100 healthy controls) were enrolled in this study. A detailed psychosexual history obtained, and physical, and laboratory examination were performed. International Index of Erectile Function (IIEF)-5 questionnaire was used to evaluate the erectile status objectively. IIEF-5 score was applied to all patients, and IIEF-5 score under 22 was considered as ED. The MPV, PC, and EC were compared between the two groups.

Results: The mean age of the patients with ED and control group was 55.62 ± 8.90 years and 54.19 ± 4.10 years, respectively. MPV and PC levels were significantly higher in ED group (8.51± 1.00 fL and 8.16 ± 0.94 fL; 244.59 ± 57.3 cells/µL and 230.17 ± 48.44 cells/µL, respectively (P < .05). EC and white blood cell count were not significantly different between study and control groups.

Conclusions: In our study a relationship was found between elevated MPV, and PC with ED. MPV and PC may be used as a biomarker in patients with ED.






980-Nm Diode Laser Vaporization versus Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: Randomized Controlled Study

Mehmet Cetinkaya, Kadir Onem, Mehmet Murat Rifaioglu, Veli Yalcin

Urology Journal, Vol. 12 No. 5 (2015), 16 November 2015, Page 2355-2361

Purpose: We compared the effectiveness and complications of 980-nm diode laser vaporization and transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH).

Materials and Methods: In total, 72 consecutive patients with BPH entered the study. All patients underwent general and urological evaluations. The primary outcome was improvement in the International Prostate Symptom Score (IPSS). The secondary outcomes were IPSS quality of life (QoL), maximum urinary flow rate (Qmax), residual volume, and complications. Patients were allocated randomly to the TURP and laser groups. The Ceralas HPD120, a diode laser system emitting at a wavelength of 980 nm, was used for photoselective vaporization of the prostate (PVP). TURP was performed with a monopolar 26 French resectoscope. Preoperative and operative parameters and surgical outcomes were compared.

Results: In total, 36 patients in each group underwent PVP and TURP. The mean age ± standard deviation was 63.1 ± 9.1 years and 64.7 ± 10.2 years in the PVP and TURP groups, respectively. There were no statistically significant differences in age, prostate size, prostate-specific antigen concentration, Qmax, preoperative IPSS, or preoperative Qmax between the two groups. The operation duration was also similar between the groups (P = .36). The catheterization time was 1.45 ± 0.75 and 2.63 ± 0.49 days in the PVP and TURP groups, respectively (P < .01). The PVP group had a shorter hospital stay than the TURP group. The 3-month postoperative Qmax increased to 9.90 ± 3.61 and 6.59 ± 6.06 mL/s from baseline in the TURP and PVP groups, respectively; there was no difference in the increases between the groups (P = .08). The IPSS and IPSS-QoL were significantly improved with the operation (P < .01), and this improvement was similar in both groups P = .3 and P = .8, respectively . The complication rate was also similar between the two groups.

Conclusions: PVP with a diode laser is as safe and effective as TURP in the treatment of BPH, and the techniques have similar complication rates and functional results. PVP has the advantage of shorter hospitalization and catheter indwelling times and no need for discontinuation of anticoagulant therapy.


Use of Lidocaine 2% Gel Does Not Reduce Pain during Flexible Cystoscopy and Is Not Cost-Effective

Maria del Carmen Cano-Garcia, Rosario Casares-Perez, Miguel Arrabal-Martin, Sergio Merino-Salas, Miguel Angel Arrabal-Polo

Urology Journal, Vol. 12 No. 5 (2015), 16 November 2015, Page 2362-2365

Purpose: To compare the use of lubricant gel with lidocaine versus lubricant gel without anesthetic in flexible cystoscopy in terms of pain and tolerability.

Materials and Methods: In this observational non-randomized study, 72 patients were divided into two groups. Group 1 included 38 patients in whom lidocaine gel 2% was used and group 2 included 34 patients in whom lubricant gel without anesthetic was administered. The main variables analyzed were score in visual analogue scale (VAS) and score in Spanish Pain Questionnaire (SPQ). Student's t-test and Chi-square test were used to compare differences between 2 groups. The P values < .05% were considered statistically significant.

Results: Mean age of patients in group 1 was 64.50 ± 12.39 years and 67.79 ± 10.87 years in group 2 (P = .23). The distribution according to sex was 29 men and 9 women in group 1 and 25 men and 9 women in group 2 (P = .78). The total VAS score was 2.21 ± 2.05 in group 1 versus 1.59 ± 1.61 in group 2 (P = .16). In the SPQ, the current intensity value was 1.82 ± 0.86 in group 1 versus 1.53 ± 0.74 in group 2 (P = .14), and the total intensity value was 1.92 ± 1.86 in group 1 versus 1.03 ± 1.75 in group 2 (P = .04). The cost of gel with lidocaine is 1.25 euro and gel without anesthetic 0.22 euro.

Conclusion: The use of lidocaine gel does not produce benefit in terms of pain relief in flexible cystoscopy and also is costly.



Effect of Preoperative Forced-Air Warming on Hypothermia in Elderly Patients Undergoing Transurethral Resection of the Prostate

Youn Yi Jo, Young Jin Chang, Yong Beom Kim, Sehwan Lee, Hyun Jeong Kwak

Urology Journal, Vol. 12 No. 5 (2015), 16 November 2015, Page 2366-2370

Purpose: Elderly patients under spinal anesthesia are vulnerable to hypothermia, leading to increased morbidity. The aim of this study was to investigate the effects of preoperative forced-air warming on perioperative hypothermia and shivering in elderly patients undergoing transurethral resection of the prostate (TURP) under spinal anesthesia.

Materials and Methods: Patients (> 65-year-old) scheduled for TURP under spinal anesthesia were randomly assigned to receive preoperative forced-air skin warming for 20 min (the pre-warmed group, n = 25) or not (control group, n = 25). Core temperatures were measured at 15-min intervals after spinal anesthesia, and intra- and post-operative shivering were also assessed.

Results: Incidences of intraoperative hypothermia (< 36ºC) in the pre-warmed and control groups were not significantly different (10/25 [40%] .vs 15/24 [62.5%], P = .259). However, severities of hypothermia were significantly different (P = .019). No patient in the pre-warmed group showed moderate or profound hypothermia, whereas of patients in control group 21% and 13% did so, respectively.

Conclusion: This study demonstrated that a brief period of preoperative forced-air warming did not completely prevent intraoperative hypothermia or shivering, but it could significantly reduce its severity in elderly male patients under spinal anesthesia.


Benign Prostatic Hyperplasia Treatment with New Physiotherapeutic Device

Simon Allen, Ivan Gerasimovich Aghajanyan

Urology Journal, Vol. 12 No. 5 (2015), 16 November 2015, Page 2371-2376

Purpose: Thermobalancing therapy, provided by Therapeutic Device, which contains a natural thermoelement, and is applied topically in the projection ofthe prostate,was aimed to improve blood circulation in the affected organ. We evaluated the effectiveness of new Therapeutic Device for the treatment of patients with benign prostatic hyperplasia (BPH).

Materials and Methods: We performed a clinical non-randomized controlled trial before and after 6-month treatment. Therapeutic Device was administered to 124 patients with BPH as mono-therapy. The dynamic of the patients' condition was assessed by the International Prostate Symptom Score (IPSS), ultrasound measurement of prostate volume (PV) and uroflowmetry. The control-group comprised 124 men who did not receive any treatment. The IPSS score, maximum flow rate (Qmax), and PV were compared between the groups.

Results: Baseline evaluation (pre-treatment) for both groups were comparable to each other with no clinically significant difference regarding age, IPSS score, Qmax and PV volume. Overall, thermobalancing therapy resulted in significant improvements from baseline to endpoint in IPSS (P = .001), IPSS storage and voiding subscores (both P = .001), and IPSS quality of life index (QoL) (P = .001) compared with control group. Moreover, comparison of parameters after 6 months treatment showed that thermobalancing therapy also improved the Qmax (P = .001), and PV (P = .001).

Conclusion: Two years clinical trial demonstrated that thermobalancing therapy administered for 6 months provides a marked improvement in patients presenting with symptomatic BPH not only on lower urinary tract symptoms (LUTS) but also in QoL and Qmax. Thus urologists should be aware about thermobalancing therapy as a non-invasive physiotherapeutic treatment option for treatment of BPH.



Brunn’s Cyst: A Rare Cause of Bladder Outlet Obstruction in a Young Man

Stephen Lalfakzuala Sailo, Laltanpuii Sailo

Urology Journal, Vol. 12 No. 5 (2015), 16 November 2015, Page 2381-2381

A 27-year-old man presented with obstructive voiding symptoms for eight years. He had a normal urinalysis and sterile urine culture. He had a low peak urine flow rate. Bladder ultrasound showed a 1.4 x1.2 cm cystic mass at the bladder neck and an intravenous urography revealed bilateral hydro-ureteronephrosis. On cystoscopic examination, a large cystic mass was noted at the bladder neck. Transurethral de-roofing and resection of the cystic mass was done using resection loop. The biopsy showed features of Brunn’s cyst. After the operation, the obstructive voiding symptoms subsided and he had a normal urine peak flow rate. Cystoscopy done three weeks after the operation revealed no residual lesion.