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ABSTRACT: To evaluate the ability and the utility of diffusion-weighted (DW) magnetic resonance imaging (MRI) with high and low b values to visualize benign and malignant renal lesions, and to determine which b value (b=100, 600, or 1000s/mm(2)) was most useful in differentiating benign from malignant renal lesions.
Fifty-eight patients with 67 renal lesions and 50 normal contralateral kidneys (as control) were enrolled in the study. DW imaging was performed with b values of 100, 600, and 1000s/mm(2). Results of the histopathological evaluation were compared with the DW MRI results. Apparent diffusion coefficient (ADC) values, and the sensitivity and specificity for differentiating malignant renal lesions from benign renal lesions were calculated for each b value.
The mean ADC values of normal renal parenchyma with b=100, 600, and 1000s/mm(2) values were (3.14±0.54)×10(-3), (2.52±0.30)×10(-3), and (2.16±0.43)×10(-3)mm(2)/s, respectively. The mean ADC values of benign renal lesions (n=35) with b=100, 600, and 1000s/mm(2) values were (2.88±0.88)×10(-3), (2.58±0.91)×10(-3), and (2.10±0.93)×10(-3)mm(2)/s, respectively. The mean ADC values of malignant renal lesions (n=32) with b=100, 600, and 1000 values were (2.74±0.58)×10(-3), (2.09±0.63)×10(-3), and (1.66±0.51)×10(-3)mm(2)/s, respectively. Using DW imaging malignant renal lesions could be differentiated from benign renal lesions, and also angiomyolipomas and oncocytomas could be differentiated from renal cell carcinoma.
DW MRI with quantitative ADC measurements can be useful in the differentiation of benign and malignant renal lesions. High b values (b=600 and 1000s/mm(2)) had the best specificity and sensitivity.
Clinical radiology 02/2011; 66(5):420-5. · 1.65 Impact Factor
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ABSTRACT: Although screw breakage or loosening are rarely encountered, they were reported to occur after instability of the internal fixation.
A man with a history of traumatic pelvic fracture 6 months ago presented to our clinic with inability to void. An anterior urethral meatotomy was made and a calcified but intact screw was removed from the urethra.
Screw migration with urological manifestations are extremely rare and usually include bladder migration with a subsequent voiding of the screw. We present a case in which internal urethrotomy for posterior urethral stricture caused erosion of a bone screw into the urethra which was subsequently removed by anterior meatotomy.
Irish Journal of Medical Science 11/2008; 179(3):443-5. · 0.58 Impact Factor
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ABSTRACT: Several studies have suggested that male infertility and testicular cancer may have common aetiological factors. Scrotal ultrasonography (US) has an important role in the diagnosis of testicular tumours when not palpable by physical examination. In this study, we present two infertile men referred to our clinic. Patients were evaluated by a detailed physical examination, semen analyses and hormonal assessment. Both patients underwent scrotal US examination. Semen analysis of the patients revealed oligoasthenospermia in both patients. Scrotal US revealed hypoechoic masses in the left and right testes of both patients, which were nonpalpable by physical examination. Scrotal exploration and subsequent orchidectomy were performed. Histopathological examination revealed mixed germ cell tumour and Sertoli-Leydig cell tumour in case 1 and case 2 respectively. With these cases, we discussed the role of scrotal US in the routine diagnostic evaluation of infertile men.
Andrologia 03/2008; 40(1):58-61. · 1.55 Impact Factor
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ABSTRACT: The aim of the present study was to determine the incidence of bacteraemia after urodynamic study (UDS) in patients with lower urinary tract symptoms, and to evaluate the role of bacteraemia as a morbidity factor related to UDS. A total of 57 patients (mean age: 52.8 years, range: 8-76 years) were evaluated by UDS. Prophylactic antibiotics were not administered to any of the patients before the procedure. Before UDS, urine cultures were examined for the presence of infection of the urinary tract (UTI). Venous blood was taken before and just after performing UDS. There was no bacterial growth in blood cultures of any patients before the UDS. Of the 57 patients, two had bacteriuria before study. After UDS, bacteraemia was determined in four (7%) out of 55 patients. The two patients with a bacteriuria before the procedure also had positive blood cultures. Infectious complications are the most important morbidity factors related to the UDS. Despite the use of strict aseptic techniques, bacteraemia may occur in patients undergoing UDS. The results of the present study may help when counselling patients who are to undergo UDS.
Journal of Hospital Infection 08/2004; 57(3):241-4. · 3.39 Impact Factor
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ABSTRACT: Our aim was to examine the effects of melatonin on the testicular tissue of adult rats with experimentally-induced left varicocele, and to determine the relationship between melatonin and apoptosis regular proteins in the anti-oxidant defence system. Forty adult male Wistar rats were divided equally into four groups. A sham operation was performed on the rats in group I, and experimental left varicocele was created in groups II, III and IV. Melatonin was administered intraperitoneally at doses of 5 mg/kg and 10 mg/kg to rats in groups III and IV, respectively. An immunohistochemical analysis of the left testicular tissue was performed to evaluate the expression of Bax and Bcl-2, while tissue malondialdehyde (MDA) and antioxidant enzyme activities were assessed in homogenates to determine the role of the oxygen defence system. The immunohistochemical analysis revealed an increased ratio of pro-apoptotic protein Bax in groups II and III, whereas no significant activity was observed in the sham operated rats ( P<0.05). Similarly, the tissue MDA level increased and a significantly decreased level of antioxidant enzymes was observed in these groups ( P<0.05). Although rats in group IV showed a slightly increased ratio of the pro-apoptotic marker Bax, there was no significant difference between groups I and IV. Similarly, group IV showed decreased levels of MDA and increased levels of anti-oxidant enzyme activity with decreased Bax expression. The close relationship between pro-apoptotic/anti-apoptotic markers, reactive oxygen species and antioxidant agents provided a useful in vivo model for studying the pathophysiology of varicocele and evaluating the role of antioxidants in the prevention testicular damage.
Urological Research 06/2004; 32(3):204-8. · 1.23 Impact Factor
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ABSTRACT: We report a case of Buerger's disease in a 70-year-old man which involved the penile arterial system and subsequently led to penile amputation.
Scandinavian Journal of Urology and Nephrology 02/2004; 38(2):188-9. · 0.99 Impact Factor
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ABSTRACT: Although prostate specific antigen (PSA) is widely used in the discrimination of benign prostatic hyperplasia (BPH) and prostate cancer, its diagnostic value is controversial due to an appreciable false positive rate. In the present study, we compared a recently introduced assay method, equimolar PSA measurement, to non-equimolar PSA measurement and also determined the diagnostic value of percent free PSA with changing total PSA (tPSA) measurements. Between April 1999 and December 2001, the sera of 61 patients with BPH and 41 with prostate cancer were examined. Total PSA and free PSA was determined using the Immulite 2000 assay system, whereas equimolar tPSA measurement was performed using Bayer PSA Q for the Chiron ACS 180 system. Comparative analysis of the two different assays revealed better diagnostic sensitivity and specificity values for equimolar tPSA measurement, which in turn would have led to 10% of the patients avoiding an unnecessary biopsy. Additionally, percent free PSA with the changing denominator of tPSA assays showed that the free PSA/equimolar tPSA ratio was the best tumor marker among the studied forms of PSA. It was concluded that equimolar tPSA measurement using recombinant Fab fragments is superior to the classical measurements with monoclonal antibodies, and that the use of percent free PSA with the equimolarly measured tPSA has better sensitivity and specificity in the discrimination of benign and malignant diseases of the prostate.
World Journal of Urology 06/2003; 21(1):43-7. · 2.41 Impact Factor
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ABSTRACT: To investigate the level of malondialdehyde (MDA), a direct indicator of lipid peroxidation-induced injury by reactive oxygen species (ROS), in testicular biopsy specimens from infertile patients.
Levels of MDA were measured in testicular biopsy specimens from 29 consequent-randomized infertile men, aged 29.58+/-4.76 (21 to approximately 45) years. All patients were evaluated by a complete medical and reproductive history, physical examination, semen analysis (at least two), serum follicle-stimulating hormone and free testosterone levels, testicular biopsy and contact imprint. Scrotal colour Doppler ultrasonography was used to confirm suspected varicocele. The testicular MDA level was measured using the thiobarbituric acid test and the results were expressed per unit tissue weight.
As a causal factor in infertility, varicocele was identified in 17 (58.6 %) patients, and idiopathic infertility, testicular failure and obstruction in 4 (13.8 %) patients each. The testicular MDA level was 13.56 (6.01), 49.56 (24.04), 58.53 (48.07), and 32.64 (21.51), 32.72 (13.61), 23.07 (7.82), 42,12 (34.76) pmol/mg tissue in the normal spermatogenesis (control), late maturation arrest, Sertoli cell only (SCO) and hypospermatogenesis (mild, moderate, severe) groups, respectively. The elevation of MDA levels was significant in the testicular tissue from SCO and maturation arrest groups compared with the controls (P<0.05). In addition, the elevation in testicular MDA levels between the SCO and the moderate hypospermatogenesis, and the moderate hypospermatogenesis and the maturation arrest groups was significant (P<0.05).
Severe pathologic changes in the testicular tissue are associated with a high level of lipid peroxidation. These findings suggest that overproduction of ROS may play a role in the mechanism of testicular degeneration associated with infertility.
Asian Journal of Andrology 06/2003; 5(2):95-9. · 1.52 Impact Factor
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ABSTRACT: Autosomal dominant polycystic kidney disease (ADPKD) is a frequently occurring inherited condition with cysts in many organs including the kidneys. However, a combination of seminal vesicle cysts, cystic obstruction of ejaculatory duct and ADPKD is rarely encountered. The following case report presents an infertile ADPKD patient who had seminal vesicle cysts and ejaculatory duct cyst, and describes the treatment by transurethral resection of the ejaculatory duct.
Andrologia 04/2002; 32(2):91 - 93. · 1.55 Impact Factor
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ABSTRACT: Chronic non-bacterial prostatitis/chronic pelvic pain syndrome (CPPS) are frequently encountered clinical entities characterized by painful and irritative voiding symptoms often referable to the prostate. Diagnosis usually depends on the symptoms and treatment mainly consists of reassurance, anti-inflammatory medications and antibiotics in the absence of a documented infection. To have objective diagnostic criteria, we determined the possible roles and diagnostic efficacies of soluble cytokines interleukin-1beta (IL-1beta), tumor necrosis factor-alpha (TNF-alpha), IL-2R, IL-6 and IL-8 in the seminal plasma of patients with different forms of CPPS.
Seminal plasma was obtained from a total of 30 subjects who were evaluated in three groups. Each group comprised 10 patients having inflammatory CPPS, non-inflammatory CPPS and control subjects, respectively. The levels of IL-1beta, IL-2R, TNF-alpha, IL-6 and IL-8 were measured in seminal plasma using chemiluminescence.
The level of IL-2R in all three groups was below measurable values. Interleukin-1beta, TNF-alpha, IL-6 and IL-8 levels were elevated significantly in the two groups with CPPS compared with the control group (P < 0.05). Soluble cytokines showed a slight difference between patients with inflammatory CPPS and non-inflammatory CPPS, but this was not statistically significant (P > 0.05).
Although there are individual variables between the discrimination of inflammatory and non-inflammatory CPPS, cytokines are frequently present and elevated in the expressed prostatic secretions from men with CPPS. Our results indicate that several soluble cytokines can be used to identify this chronic and long-term disease.
International Journal of Urology 10/2001; 8(9):495-9. · 1.75 Impact Factor
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ABSTRACT: To describe the pathology-specific response to transurethral resection of ejaculatory ducts (TURED) in patients with complete or partial ejaculatory duct obstruction and to evaluate the role of TURED in light of powerful assisted reproductive technologies.
Retrospective clinical study.
University hospital.
Thirty-eight infertile men with obstruction of the ejaculatory ducts.
Diagnosis by transrectal ultrasonography or magnetic resonance imaging, and treatment with TURED.
Changes in semen variables, pregnancy outcomes, and complication rates were analyzed before and after surgery.
Improvement in semen variables was significantly better in patients with partial obstruction (94%) of ducts than in those with complete obstruction (59%) (P=.04). Cystic obstruction, especially midline and eccentric cysts, responded best to TURED. Before surgery, all patients were candidates for IVF/ICSI; after surgery, 32% of azoospermic men and 81% of oligospermic men conceived spontaneously or were referred for IUI instead of IVF/ICSI.
Ejaculatory duct obstruction due to cysts appears to respond best to TURED. In addition, TURED may decrease the need for IVF/ICSI as primary treatment in many cases. Finally, TURED may allow IVF/ICSI to be performed with ejaculated rather than surgically retrieved sperm.
Fertility and Sterility 08/2001; 76(1):138-42. · 3.56 Impact Factor
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ABSTRACT: To evaluate transrectal ultrasonography (US) and MR imaging findings of infertile patients with suspected complete or partial obstruction of the seminal duct system.
Two hundred and eighteen infertile patients with low ejaculate volume were evaluated by transrectal US. Endorectal MR imaging was performed on 62/218 patients. Prostatic cysts, ejaculatory duct (ED) dilatation (>2 mm in width), ED calculi or calcifications, seminal vesicle (SV) dilatation (a.p. diameter >15 mm), SV hypo/agenesis (a.p. diameter <7 mm), SV cysts (>5 mm), vasal agenesis and chronic prostatitis (coarse calcifications, heterogeneity in prostate) were considered significant findings for obstruction of the seminal duct system.
Pathologic findings were detected in 75% and 61% of patients with azoospermia on transrectal US and MR imaging, respectively. Transrectal US and MR imaging did not reveal any pathologies in 64.7% and 59.1% of patients with nonazoospermia, respectively. The incidences of hypoplastic/atrophic SV (12/48 vs. 5/170), SV agenesis (6/48 vs. 1/170), vasal agenesis (5/48 vs. 1/170) were significantly higher in the azoospermic subgroup (p<0.002).
US is a good method for initial evaluation of these patients especially in complete obstruction. Endorectal MR imaging should be reserved for selected patients in whom results of transrectal US are not conclusive.
Acta Radiologica 05/2000; 41(3):288-95. · 1.37 Impact Factor
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ABSTRACT: Autosomal dominant polycystic kidney disease (ADPKD) is a frequently occurring inherited condition with cysts in many organs including the kidneys. However, a combination of seminal vesicle cysts, cystic obstruction of ejaculatory duct and ADPKD is rarely encountered. The following case report presents an infertile ADPKD patient who had seminal vesicle cysts and ejaculatory duct cyst, and describes the treatment by transurethral resection of the ejaculatory duct.
Andrologia 04/2000; 32(2):91-3. · 1.55 Impact Factor
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ABSTRACT: To compare the sperm mixed-agglutination reaction (sMAR) with the peroxidase-labelled protein A method (POPA) in infertile patients with varicocele.
The study comprised 30 men with a history of varicocele-associated infertility and 30 fertile men (control group). Antisperm antibodies against spermatozoa in the semen and against progenitor spermatozoa in testicular tissue were detected using the two methods.
The tests were positive in 15 (50%) of patients with both the sMAR and the POPA methods, while no autoantibodies were detected in the control group. There were no significant differences between the methods. The sensitivity and specificity of both tests was approximately 93%, with no significant difference between them (P>0. 05).
Both methods may be used for detecting sperm autoantibodies in infertile patients with varicocele.
BJU International 12/1999; 84(7):835-8. · 2.84 Impact Factor
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ABSTRACT: To determine the effectiveness of seminal vesicle aspiration in the diagnosis and treatment of patients with ejaculatory duct obstruction.
Between March 1998 and February 1999, 10 infertile men with ejaculatory duct obstruction (EDO, mean age 32.7 years, range 25-47) and 10 fertile volunteers (mean age 33.2 years, range 25-42) underwent transrectal ultrasonography (TRUS) and TRUS-guided seminal vesicle aspiration. The volume of and presence of motile sperm in the aspirate was compared with the TRUS findings for both groups.
From TRUS of the patients with EDO, the mean (sd, range) transverse diameter of the right and left seminal vesicles were 1.97 (0.54, 0.8-2.6) cm and 1.93 (0.53, 0.9-2.6) cm; the corresponding values in the control group were 1.03 (0.15, 0.8-1.3) cm and 1.0 (0. 12, 0.8-1.4) cm, respectively (P<0.001). In all, 20 aspirate samples were obtained from the patients with EDO by bilateral seminal vesicle aspiration and only one (10%) had no sperm within the aspirate fluid. Of these 10 patients, two had immotile sperm and the remaining seven (14 samples) had a mean motile sperm count of 0.63 (0.45, 0.1-1.0)x106 /mL, whereas seven of eight men assessed in the control group had no motile sperm (one patient had immotile sperm within the aspirate fluid); this difference was significant (P<0.01).
The aspiration of significant numbers of motile sperm from the seminal vesicles suggests the presence of distal obstructions of the ejaculatory duct and enables infertile couples to be candidates for assisted reproduction. However, there is a need for further research to determine the use of this technique in the diagnosis of partial EDO.
BJU International 12/1999; 84(9):1050-3. · 2.84 Impact Factor
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ABSTRACT: To analyse the effects of varicocelectomy on serum follicle-stimulating hormone (FSH), testosterone and free testosterone levels, and to investigate the interrelationships between seminal and hormonal variables.
The records were retrospectively evaluated for 78 infertile patients who underwent microsurgical inguinal varicocelectomy, with documented serum FSH, testosterone, free testosterone levels, sperm concentration and sperm motility before and after surgery. Left and bilateral varicoceles were detected in 40 and 38 patients, respectively. In addition, serum hormonal values of 10 fertile men in whom physical examinations and Doppler ultrasonography revealed no evidence of varicocele were recorded and used as a control group.
The mean (sd) serum FSH levels of all patients decreased from 15.21 (3.34) before surgery to 10.82 (2.93) mIU/mL afterward (P=0.01), and serum testosterone levels increased from 5.63 (1.40) to 8.37 (2.2) ng/mL (P=0.01), whereas free testosterone levels increased from 23.13 (3.19) to 32.83 (4.37) pg/mL (P<0.001). In contrast to the significant difference in sperm motility before and after surgery of all patients (P<0.01), the difference in sperm count was insignificant (P>0.05). Thirty-six patients with high serum FSH levels before surgery had significantly lower levels afterward (P=0.001). In this group, the sperm concentration and motility also increased, from 17.66 (4.35) to 20.76 (4.37) million/mL (P=0.05) and from 30.9 (4.4)% to 37.5 (4.34)%, respectively (P=0.01). In the remaining 42 patients who had normal preoperative serum FSH levels, there was a slight decrease after surgery (P=0.02). Their sperm concentration increased slightly (P=0. 04), and motility also increased (P=0.001). Sixty patients had a significantly higher testosterone level after surgery; in this group the sperm concentration and motility increased (P=0.01).
Varicocelectomy promotes Sertoli and Leydig cell function. The significant increase in serum free testosterone level results in a significant improvement in sperm concentration and motility.
BJU International 12/1999; 84(9):1046-9. · 2.84 Impact Factor
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BJU International 11/1999; 84(6):739-40. · 2.84 Impact Factor
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ABSTRACT: Distal ejaculatory duct obstruction (EDO) is a relatively rare but surgically treatable cause of male infertility. Transrectal ultrasonography (TRUS) has been commonly used in infertility evaluation in recent years. These pathologies are more common than expected and treated with transurethral resection of ejaculatory duct (TURED). Although TURED is the recommended routine procedure for all cases of EDO, it has complications, such as iatrogenic obstruction, in 4% of the cases. Herein, we evaluated a patient who had developed EDO secondary to TURED.
Archives of Andrology 51(3):221-3. · 0.89 Impact Factor
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ABSTRACT: We reviewed records from patients who underwent two different microsurgical varicocelectomy methods: 147 (high inguinal (MHIV) and 65 sub-inguinal (MSIV) microsurgery) to compare the therapeutic activity and complications. Patients who had 2 different microsurgical varicocelectomies were compared according to preoperative connected vein, number of designated arteries, postoperative semen and improvement degree in hormone parameters, increased ratio related with pregnancy and complications. The ratio of improvement of postoperative semen parameters in patients where MHIV and MSIV were performed was, 42% and 38% (p > 0.05). Pregnancy was achieved in MHIV at a ratio of 41% (34/82) and 33% (22/65) in MSIV (p > 0.05). There was no significant difference according to mean operation periods, the vein connected between the groups. The number of testicular arteries were significantly higher than the ones in MHIV (p < 0.01). However, as a postoperative complication, hydrocele was not seen in any of the patients, while relapses occurred in 1 MHIV and 2 MSIV patients. MHIV and MSIV techniques are effective methods to treat varicocele. However, the excess number of connected veins due to the anatomic feature of MSIV increases the possibility of relapses and the technical difficulty during surgical intervention.
Archives of Andrology 51(3):213-20. · 0.89 Impact Factor
