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ABSTRACT: PURPOSE: The main objectives of this retrospective cohort study were to evaluate reproductive endocrine and semen profiles before and after simple orchiectomy in patients with unilateral postpubertal cryptorchidism and to investigate the relationship between hormone levels and histopathology of the removed testis. METHODS: We evaluated 40 adult males who were admitted to our clinic, between 2001 and 2007, with unilateral undescended testis. Right orchiectomy was performed in 27 patients and left orchiectomy in 13. Semen analysis, serum inhibin B, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone levels were examined in before and 3 months after orchiectomy. Orchiectomy materials were evaluated histopathologically. RESULTS: Semen parameters, as well as testosterone and LH levels, did not change in any histopathological subgroups in the postoperative follow-up. In patients with maturation arrest, mean serum inhibin B level statistically significantly decreased from 160.9 to 83.5 pg/ml, and mean FSH level significantly increased from 4.8 to 7.6 mIU/ml after orchiectomy (p value, 0.008 and 0.008, respectively). Though, the levels were still within the normal range of the two hormones. CONCLUSIONS: Simple orchiectomy does not have any effect on semen parameters and testosterone level in patients with postpubertal cryptorchidism. The change in inhibin B and FSH levels after orchiectomy in patients with maturation arrest is not clinically significant.
International Urology and Nephrology 08/2012; · 1.47 Impact Factor
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ABSTRACT: To investigate the relation of testosterone-induced relaxation with smooth muscle K+ channels in human internal spermatic veins. Testosterone induces relaxation in human isolated internal spermatic veins, and this effect decreases in high-grade varicocele (recently reported).
The responses of isolated internal spermatic veins from patients with varicocele were recorded isometrically using a force displacement transducer. After contracting the venous rings with 45 mM KCl, relaxation with testosterone (0.1-300 μM) was recorded in the absence or presence of large conductance calcium-activated K+ channel and the voltage-sensitive K+ channel inhibitor tetraethylammonium, adenosine triphosphate-sensitive K+ channel inhibitor glibenclamide, voltage-dependent inward rectifier K+ channel inhibitor barium chloride, and voltage-sensitive K+ channel inhibitor 4-aminopyridine.
Testosterone induced relaxation in human isolated internal spermatic veins in the absence of inhibitors (maximal effect 52.88±6.72, n=24). Although tetraethylammonium, barium chloride, and 4-aminopyridine did not alter the testosterone-induced relaxant responses, GLI inhibited these responses.
These results have demonstrated that testosterone induces relaxation in human isolated internal spermatic veins of patients with varicocele by way of adenosine triphosphate-sensitive K+ channels.
Urology 05/2011; 78(1):233.e1-5. · 2.43 Impact Factor
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ABSTRACT: We evaluated the effectiveness of pulsed radiofrequency (PRF) denervation of spermatic cord for the treatment of chronic orchialgia. Five patients diagnosed with chronic orchialgia were evaluated with a thorough medical and psychiatric history, physical examination, and scrotal Doppler ultrasound, urinary system x-ray film, and urine analyses. One of the patients had bilateral chronic orchialgia. All of the patients had pain for a period of at least 3 months, and multiple conservative therapies failed to alleviate the pain. The patients, who had temporary pain relief after undergoing outpatient diagnostic cord block, were determined to be candidates for PRF denervation. PRF denervation of spermatic cord was performed for 6 testicular units. Visual analog scores were noted before and after the procedure. There were no pathologic conditions that indicated chronic orchialgia in any of the patients. No complications, including testicular atrophy or hypoesthesia of the scrotal or penile skin, occurred after the procedure. Mean visual analog scores before and after the procedure were 9 and 1, respectively. None of the patients needed any analgesics after the procedure or during the follow-up period. Mean follow-up period was 20 ± 2.5 weeks. No recurrence was noted, and none of the patients needed additional therapy. This is a limited case report on the short-term use of PRF. Randomized, placebo-controlled, and long follow-up period studies are needed to better assess the efficacy of this procedure for chronic orchalgia.
Journal of Andrology 03/2011; 33(1):22-6. · 2.97 Impact Factor
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ABSTRACT: Pelvic kidney is the most common type of renal ectopia. These abnormally positioned kidneys are often clinically asymptomatic. However, they are prone to urinary infection, stone formation and trauma. Admitted patients often complain of lower abdominal pain and urinary infection. Pelvic kidneys may also lead to misdiagnosis when it is associated with hydronephrosis or large cystic structures. Thus, it is rather difficult to pinpoint the origin of the problem. We reported here different clinical presentations of our two patients with pelvic kidneys.
Urologia 10/2010; 77(3):212-5.
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ABSTRACT: Posterior urethral valve (PUV) is a congenital obstructive defect of the male urethra with an incidence of 1/8,000 to 1/25,000 live births. PUV is the most common cause of lower urinary tract obstruction in neonates. The diagnosis of PUV is usually made early, and PUV cases have rarely been detected in adults.
Here we report the case of a 35 years old man presented with obstructive urinary symptoms. In spite of bladder neck rejection uroflowmetry pointed out infravesical obstruction with max. flow rate 9 ml/s and average flow rate 6 ml/s in uroflowmetry. During cystoscopy mild bladder trabeculation and resected bladder neck were seen. While the cystoscope was taken off, PUV were obtained.
Since PUV is a rare condition in adults and the diagnosis of PUVs is also difficult in these groups we must consider this situation during evaluation of adult patients with obstructive symptoms especially during cystourethroscopy.
German medical science : GMS e-journal 01/2010; 8:Doc08.
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ABSTRACT: Urethral duplication is a rare congenital anomaly of the lower urinary system and has varied presentation. According to the Effmann classification, type IIA2-Y urethral duplication is characterized by the duplicated urethra originating from the bladder neck and opening into either the rectum or the perineum. The accessory urethra is normal and functional and the normally positioned dorsal urethra is hypoplastic and stenotic in unusual form of Y-type duplication. We present a new case with unusual form of Y-type duplication and discuss its treatment.
German medical science : GMS e-journal 01/2010; 8:Doc33.
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ABSTRACT: We retrospectively review patients who underwent ureteral implantation with a psoas hitch during obstetric or gynecologic operations and describe a new modification.
Between December 1997 and May 2005, 20 patients between 26 and 56 years underwent ureteral reimplantation by using the nonrefluxing, extravesical Lich-Gregoir onlay technique with psoas hitch at our institution by the same reconstructive surgery team. Additionally, we used a urethral catheter balloon as a landmark for the bladder mucosa and fixed the bladder to the psoas tendon by using the balloon. We performed 14 ureteral reimplantations during the surgery as intraoperative reconstruction. In 6 patients, delayed reconstruction of the ureter was performed a few days following the previous operation.
For intraoperative and delayed reconstructions, the mean operation time for ureteral reimplantation was 24 and 75 min. We took out the urethral catheter on the second operative day and the anastomotic drain on the third. The average hospital stay was 5.7 days. No cases of chronic flank pain, recurrent pyelonephritis, persistent severe hydronephrosis or compromised renal function occurred. No patient required reoperation.
Modified psoas hitch ureteral reimplantation is an effective and safe way of reconstruction for treating defects in ureteral length.
Urologia Internationalis 01/2010; 85(3):257-60. · 0.99 Impact Factor
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ABSTRACT: Urethral stents usually provide initial, dramatic relief from obstructive voiding symptoms. However, complications such as recurrent urinary tract infections, stent migration, encrustation and recurrent urethral strictures are not rare, and stents should be removed when complications occur. Urethral stent removal is associated with potential risks of urethral injury, bleeding and external sphincter trauma. Hyperbaric oxygen therapy (HBO) accelerates wound healing by increasing tissue microcirculation, decreasing capillary pressure and resolving tissue edema. Although HBO has been used in various urologic applications, there is no report of HBO therapy being used to treat isolated urethral injuries. Here we present a case of urethral stripping caused by endoscopic stent removal, and its conservative treatment with HBO therapy.
The Kaohsiung journal of medical sciences 07/2009; 25(6):334-7. · 0.61 Impact Factor
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ABSTRACT: To investigate the effect of testosterone on contractile tone of endothelium-denuded human corpus cavernosum strips. Human studies designed to examine a possible relaxant effect of testosterone on corpus cavernosal circulation are lacking.
Testosterone (0.1-300 microM) was added cumulatively to organ baths after precontraction of isolated human corpus cavernosum strips (n = 5) with KCl (45 mM). Testosterone-induced responses were tested in the presence of nonselective, large, conductance Ca(2+)-activated and voltage-sensitive K(+) channel inhibitor tetraethylammonium (1 mM), adenosine triphosphate-sensitive K(+) channel inhibitor glibenclamide (10 microM), voltage-dependent inward rectifier K(+) channel inhibitor barium chloride (30 microM) and voltage-sensitive K(+) channel inhibitor 4-aminopyridine (1 mM).
Testosterone (0.1-300 microM) produced relaxation in human corpus cavernosum (maximum relaxation 65.4% +/- 3.3% of KCl-induced contraction) that reached a maximum at a concentration of 300 microM. Testosterone-induced relaxation was significantly attenuated by glibenclamide, but it was not affected by the other K(+) channel inhibitors (tetraethylammonium, barium chloride, or 4-aminopyridine).
Testosterone might induce relaxation in human isolated corpora cavernosa strips by activation of smooth muscle adenosine triphosphate-sensitive K(+) channels. This finding suggests that testosterone, in addition to its known endothelial action, might regulate erectile function locally by its action on the smooth muscle of the human corpus cavernosum.
Urology 05/2009; 74(1):229-32. · 2.43 Impact Factor
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ABSTRACT: A 21-year-old man presented with an enlarged giant hemangioma on glans penis which also causes an erectile dysfunction (ED) that partially responded to the intracavernous injection stimulation test. Although the findings in magnetic resonance imaging (MRI) indicated a glandular hemangioma, penile colored Doppler ultrasound revealed an invaded cavernausal hemangioma to the glans. Surgical excision was avoided according to the broad extension of the gland lesion. Holmium laser coagulation was applied to the lesion due to the cosmetically concerns. However, the cosmetic results after holmium laser application was not impressive as expected without an improvement in intracavernous injection stimulation test. In conclusion, holmium laser application should not be used to the hemangiomas of glans penis related to the corpus cavernosum, but further studies are needed to reveal the effects of holmium laser application in small hemangiomas restricted to the glans penis.
Asian Journal of Andrology 10/2008; 10(5):819-21. · 1.52 Impact Factor
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ABSTRACT: Several animal and human studies in vivo and in vitro indicate that testosterone has vasodilatory effects on different vessels. However, the effect of testosterone on the internal spermatic vein is not clear. In addition, the role of testosterone in the pathophysiology of varicocele is not established. We investigated the effect of testosterone on the internal spermatic vein in vitro in patients with varicocele and analyzed its relation to varicocele grade.
Isolated internal spermatic veins were collected from patients who underwent varicocelectomy and orchiectomy. The preparations (3 to 4 mm rings) were mounted in an organ bath containing 10 ml Krebs-Henseleit solution on an L-shaped brace for tension measurement along the former circumferential axis. Changes in venous tension in the presence of testosterone (0.1 to 300 microM) were recorded isometrically by a force displacement transducer.
Cumulative concentrations of testosterone (0.1 to 300 microM) elicited concentration dependent relaxation of 45 mM KCl induced active tone in the internal spermatic vein (mean +/- SEM 60.97% +/- 5.05% of the KCl induced contraction). Relaxation to testosterone (1 to 300 microM) was significantly higher in 5 cases of grades 0 and 1 varicocele than in 15 of grades 2 and 3 varicocele (maximum relaxation response 78.58% +/- 8.25% vs 55.10% +/- 5.3% of the KCl induced contraction).
To our knowledge the current report is the first to describe testosterone induced relaxation of the human internal spermatic vein. The vasodilatory effect of testosterone on the human internal spermatic vein decreases in high grade varicoceles.
The Journal of urology 09/2008; 180(2):772-6. · 4.02 Impact Factor
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ABSTRACT: Inhibin B reveals Sertoli cell activity. After our previous findings of an increase in inhibin B succeeding classic inguinal orchiopexy, we sought to determine the changes in endocrine parameters after scrotal orchiopexy in patients with cryptorchidism and to compare these findings with the results of classic orchiopexy.
A total of 50 boys with an undescended testis, 32 unilateral and 18 bilateral, were included in the present study. Scrotal orchiopexy was performed in all of them. Before and 6 months after orchiopexy, the serum basal inhibin B and other serum hormonal levels were measured in all patients.
The mean serum basal inhibin B levels had significantly increased and the other reproductive hormonal levels had not changed at 6 months after successful scrotal orchiopexy in our 50 patients (P = 0.016). Within the subgroups, the increase in inhibin B levels was significant in only those 2-9 years old with a unilateral undescended testis. The increase in inhibin B in those 10-12 years old with unilateral or bilateral undescended testis resulted from the start of puberty. No significant difference was found in terms of an increase in inhibin B after classic and scrotal orchiopexy.
The measurement of inhibin B levels could be used as a follow-up parameter after orchiopexy. The serum inhibin B level increases after scrotal incision orchiopexy just as after classic inguinal orchiopexy. The increased level of inhibin B might indicate that the orchiopexy has been beneficial.
Urology 07/2008; 72(3):525-9. · 2.43 Impact Factor
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ABSTRACT: Retroperitoneal lymph node dissection (RPLND) for testicular cancer is an important treatment modality for patients with stage I or IIA disease. Several urologists have previously reported the feasibility and usefulness of laparoscopic RPLND for such patients. The aim of this experimental pilot-feasibility study was to investigate whether visualization of retroperitoneal lymph nodes with patent blue violet (PBV) dye application is a feasible and an effective method during laparoscopic RPLND in a pig model.
Four 12-month-old white male pigs were included in the study. After PBV dye injection into the spermatic funicular and intratesticular parenchyma, the color changes in the retroperitoneal region were examined during transperitoneal laparoscopic visualization of the retroperitoneum. The time interval between the injection and the staining of lymphatic structures was measured for each intervention. Blue-stained retroperitoneal nodal tissues were dissected and removed by the laparoscopic approach and histologic examination was performed.
After PBV dye injection, intense staining of the ipsilateral retroperitoneal lymphatic vessels and nodes was seen. Distribution of the PBV and the color changes of the retroperitoneal lymphatic structures were examined under laparoscopic vision in all pigs. All blue-stained retroperitoneal nodular tissues were removed laparoscopically and examined histologically. Histopathologic examination noted all specimens as lymph nodes with no toxic effects of PBV dye.
We demonstrated that spermatic funicular injection of PVB dye is an effective and accurate method for retroperitoneal lymph node visualization in pigs. The use of this technique in combination with a laparoscopic approach makes RPLND easier and more effective.
Journal of Endourology 06/2008; 22(5):999-1004. · 1.85 Impact Factor
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ABSTRACT: Splenogonadal fusion (SGF) is a rare congenital anomaly in boys and girls. It commonly presents as a testicular mass treated with an unnecessary orchiectomy. We present 3 cases of SGF diagnosed in adulthood and discuss the published literature focusing on several aspects of this rarity. These cases of SGF of both types presented with the usual complaints. In our first case, orchiectomy was performed since the left testis was hypoplastic and testicular neoplasm could not be ruled out. The testicles could be preserved in the latter 2 cases. The second case is the continuous-type SGF associated with contralateral testicular aplasia and, to our knowledge, this is the first reported case of continuous SGF associated with testicular aplasia. Knowledge of this entity may help prevent unnecessary orchiectomy.
Urologia Internationalis 02/2008; 81(3):360-3. · 0.99 Impact Factor
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ABSTRACT: To perform a prospective study to evaluate the success of scrotal incision orchiopexy in children with a palpable undescended testis within the inguinal canal or beyond the external inguinal ring with or without inguinal hernia.
A total 204 scrotal orchiopexies were performed in 166 patients with a primary undescended testis. These children were followed up for an average of 29.4 months to document the testicular position and size.
The scrotal orchiopexy technique was successful in 192 testes; the remaining 12 testes required conversion to traditional inguinal orchiopexy because of inadequate mobilization. Of 108 children (128 testes) in whom the testis was distal to the external inguinal ring, this technique was successful in 104 (124 testes). The success rate was 96.9% (124 testes of 128), and only 4 patients (four testes) required conversion to a traditional inguinal incision. The average operative time was 15 minutes in this group. In the other group with 58 children (76 testes) with a testicular location within the inguinal canal, conversion to the traditional inguinal orchiopexy was performed in 8 patients (eight testes). The success rate in this group was 89.5% (68 of 76 testes). The average operative time was 21 minutes in these patients, and follow-up ranged from 16 to 68 months (average 29.4). All testes were satisfactorily positioned in the scrotum, and no testicular atrophy developed.
The results of our study have shown that scrotal orchiopexy is simple, safe, and effective in selected cases compared with the standard two-incision approach in the treatment of the palpable undescended testis.
Urology 11/2007; 70(4):786-8; discussion 788-9. · 2.43 Impact Factor
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ABSTRACT: Shockwave lithotripsy (SWL) is the treatment of choice for most renal calculi because it is highly effective and relatively noninvasive. Although complications of SWL are relatively few, one that occurs more frequently is perirenal hematoma, usually diagnosed by radiologic procedures. We present an interesting case of scrotal ecchymosis as an unusual presentation of perirenal hematoma causing ipsilateral spermatic-vein thrombosis after SWL for a left renal stone. To our knowledge, this condition has not been reported previously.
Journal of Endourology 01/2007; 20(12):1002-4. · 1.85 Impact Factor
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ABSTRACT: There has been growing public concern on the effects of electromagnetic radiation (EMR) emitted by cellular phones on human health. Many studies have recently been published on this topic. However, possible consequences of the cellular phone usage on human sperm parameters have not been investigated adequately.
A total number of 27 males were enrolled in the study. The semen sample obtained from each participant was divided equally into two parts. One of the specimens was exposed to EMR emitted by an activated 900 MHz cellular phone, whereas the other was not. The concentration and motility of the specimens were compared to analyze the effects of EMR. Assessment of sperm movement in all specimens was performed using four criteria: (A) rapid progressive, (B) slow progressive, (C) nonprogressive, (D) no motility.
Statistically significant changes were observed in the rapid progressive, slow progressive and no-motility categories of sperm movement. EMR exposure caused a subtle decrease in the rapid progressive and slow progressive sperm movement. It also caused an increase in the no-motility category of sperm movement. There was no statistically significant difference in the sperm concentration between two groups.
These data suggest that EMR emitted by cellular phone influences human sperm motility. In addition to these acute adverse effects of EMR on sperm motility, long-term EMR exposure may lead to behavioral or structural changes of the male germ cell. These effects may be observed later in life, and they are to be investigated more seriously.
Archives of Medical Research 11/2006; 37(7):840-3. · 1.88 Impact Factor
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ABSTRACT: Seminal vesicle stones are extremely rare, and few cases have been reported. Treatment requires removal of the stone, generally through an open vesiculectomy. A 31-year-old man presented with perineal pain, painful ejaculation, and infertility of several years' duration. Multiple stones in the seminal vesicle duct system were diagnosed by radiologic examination. We treated the patient by seminal vesicle endoscopic stone removal, thereby obviating organ loss. The composition of the stones was whewellite. To our knowledge, this approach has not been previously reported, and our result may be encouraging for treatment of such pathologic conditions of the seminal vesicles.
Urology 04/2005; 65(3):591. · 2.43 Impact Factor
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ABSTRACT: Endolymphatic injection of several dyes have been previously studied to identify retroperitoneal lymphatic structure in animals and humans with malignant diseases. However, there have been no studies, to our knowledge, that demonstrate the utility of injecting patent blue dye into the testicular parenchyma to detect retroperitoneal lymphoid structure. The aim of this experimental study was to investigate whether intratesticular patent blue dye injection is feasible and is an accurate method for retroperitoneal lymph node mapping in rats.
Twenty male albino Wistar rats were included in the study and divided over two equal groups. The first group underwent patent blue violet (PBV) injection into the spermatic funiculus, while the second group underwent PBV injection into the testicular parenchyma. After the injection, the color changes in the retroperitoneal lymphatic structures and the urinary bladder were anticipated. The time interval between the injection and the staining of lymphatic structures and urinary bladder was measured for each intervention. Blue stained retroperitoneal nodal tissues were dissected and removed. These nodal tissues were examined histologically.
After PBV injection, intense staining of the ipsilateral spermatic cord lymphatics was seen and anticipated color changes in the retroperitoneal lymphatic structures and urinary bladder were evaluated visually. Both application routes of dye resulted in the same distribution of retroperitoneal lymph nodes in the same time frame. All retroperitoneal nodular tissues removed were noted histologically to be lymph nodes and were found to be consistent with the ipsilateral lumbar lymph and the ipsilateral suprarenal lymph nodes according to the staining order in both groups. No toxic effects were observed histologically. There were no statistically significant differences in the time intervals between the two groups.
We demonstrated that both funicular and intratesticular injections of patent blue dye are feasible and accurate methods for retroperitoneal lymph node mapping in rats. This shows that intralymphatic dye injection is not absolutely necessary to detect retroperitoneal lymphatic structures and may have applications beyond testis cancer.
Urologic Oncology 26(3):286-90. · 3.22 Impact Factor
