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Öğe Analysis of Suprapubic and Transrectal Measurements in Assessment of Prostate Dimensions and Volume Is Transrectal Ultrasonography Really Necessary for Prostate Measurements?(UROL & NEPHROL RES CTR-UNRC, 2009) Ozden, Eriz; Gogus, Cagatay; Kilic, Ozcan; Yaman, Onder; Oezdiler, ErolIntroduction: The objective of this study was to evaluate the correlation of suprapubic ultrasonography and transrectal ultrasonography in measurements of prostate dimension and volume. Materials and Methods: One hundred consecutive patients with lower urinary tract symptoms were examined by suprapubic and transrectal ultrasonography modalities in a same session. Measurements of the 3 dimensions of the prostate (anteroposterior, transverse, and craniocaudal) and its volume performed by suprapubic ultrasonography were compared with the corresponding measurements by transrectal ultrasonography in order to determine the correlation of the measurements. Prostate volumes were calculated using the ellipsoid formula. Data were further analyzed in subgroups according to prostate volumes smaller or larger than 50 mL, measured by suprapubic ultrasonography. Results: The mean prostate volume of the 100 patients, measured by suprapubic and transrectal ultrasonography were 65.9 +/- 35.8 mL and 62.5 +/- 32.0 mL, respectively (r = 0.94; P < .001). The craniocaudal diameters had the strongest correlation among dimension measurements (r = 0.89; P < .001). Suprapubic and transrectal ultrasonography measurements also showed significant correlations for both prostates smaller or larger than 50 mL. Eighty-five percent of the patients had both volume measurements under or above this limit. Conclusion: There was strong correlation between suprapubic and transrectal ultrasonography measurements of the prostate sizes, including both for volume or specific dimension measurements.Öğe Benign prostatic hyperplasia and prostate cancer differentiation via platelet to lymphocyte ratio(IOS PRESS, 2015) Kaynar, Mehmet; Yildirim, Mehmet Erol; Gul, Murat; Kilic, Ozcan; Ceylan, Kadir; Goktas, SerdarBACKGROUND: The aim of the current study is to evaluate NLR and PLR inflammation markers in PCa and BPH. METHODS: Clinical and pathological data such as age, prostate volume, PSA, NLR, and PLR levels of 201 patients were retrospectively reviewed. Pathological sample results of these patients were categorized either as benign or malign. The benign group consisted of chronic prostatitis and BPH and the malign group of PCa. The PSA levels were divided into three categories as PSA: 0-4 ng/ml, PSA: 4-10 ng/ml, and 10 ng/ml and above. RESULTS: In the benign category, the mean PLR values for PSA: 0-4 ng/ml is 131.8 +/- 31.2, for PSA: 4-10 ng/ml 124.7 +/- 83.9 and 10 ng/ml and above 124 +/- 53 in chronic prostatitis group and in the BPH group for PSA: 4-10 ng/ml 120.3 +/- 45.1, for PSA: 4-10 ng/ml 126 +/- 54,2, and 10 ng/ml and above 191.4 +/- 176.1. In the malign category, the mean PLR values of PCa patients is for PSA: 0-4 ng/ml 122.8 +/- 43.8, for PSA: 4-10 ng/ml 123 +/- 43.8, and above 10 ng/ml 179.1 +/- 94. Related to the variables of age, NLR, and mean prostate volume, there were no statistically significant differences. Statistically significant differences were observed in the mean PLR values only if the PSA level was 10 ng/ml and above (p: 0.044) in the BPH and PCa groups. The correlation of the PCa Gleason score and PSA, NLR and PLR parameters in the malign category revealed no statistically significant differences (P > 0.05). CONCLUSION: Effective malign and benign differentiation of prostate pathologies based on noninvasive inflammation biomarkers such NLR and PLR necessitate clinical studies with larger patient series.Öğe Cystocele repair with trocarless mesh system:3 year result(WILEY, 2018) Yildiz, Guner; Kilic, Ozcan; Akand, Murad[Abstract not Available]Öğe Does lower-pole caliceal anatomy predict stone clearance after shock wave lithotripsy for primary lower-pole nephrolithiasis?(KARGER, 2007) Talas, Halit; Kilic, Ozcan; Tangal, Semih; Safak, MutAim: In order to have an idea about the success rates after extracorporeal shock wave lithotripsy ( SWL) in patients with lower- pole stones, we reviewed the caliceal anatomy of the patients treated in our clinic. Patients and Methods: One hundred and ninety- eight patients having at least a 3- month follow- up period, with a single stone located in the lower pole, were included. Lower infundibulopelvic angle ( LIP- A), infundibular width, and infundibular length were measured from standard intravenous urograms taken before initial ESWL. Results: One hundred and thirty patients ( 65%) were male, and 68 patients ( 35%) were female. We found no impact of age, sex, and affected side on the results of ESWL. The overall stone- free rate was 61.1% after 3 months of followup. The stone- free rates were 47.8 and 81.4% in patients with an acute ( <70 degrees) and an obtuse (>= 70 degrees) LIP- A, respectively ( p = 0.007). Taking the infundibular width into consideration, the stone- free rates were 85.4 and 43.2% for favorable and unfavorable angles and widths ( p = 0.003). However, infundibular length and stone sizes were not found to have important effects on a stone- free status ( p = 0.546 and p = 0.283). Conclusion: We conclude that LIP- A (>= 70 degrees) has the greatest impact on the clearance of residual fragments produced by SWL.Öğe The effect of bladder sensation on uroflowmetry parameters in healthy young men(WILEY, 2016) Kaynar, Mehmet; Kucur, Mustafa; Kilic, Ozcan; Akand, Murat; Gul, Murat; Goktas, SerdarAimsTo investigate the effect of the bladder sensation grade on uroflowmetry parameters. MethodsFifty healthy volunteering young men were enrolled in the present study. In total, three uroflowmetry evaluations were made. Q(max), Q(ave), VV, and PVR urine was obtained three times in three described bladder sensation grades, nearly at the same time of the day. ResultsThe mean age of the participants in the present study is 29.083.8 years. The mean Q(max) values of the volunteers were 17.4 +/- 4.8ml/s, 24.1 +/- 6.0ml/s, and 29.6 +/- 6.5ml/s in the first, second, and third, voiding desire grades, respectively. The mean Q(ave) values were 9.9 +/- 2.1ml/s, 12.9 +/- 2.9ml/s, and 15.9 +/- 4.0ml/s for each of the voiding desire grades mentioned. A statistically significant difference was obvious for all three bladder sensation grades in terms of Q(max) and Q(ave) values (P=0.000). However, no statistically significant difference was seen regarding the PVR urine volumes. The mean voided volume in the first, second and third uroflowmetry were 140 +/- 42ml, 245 +/- 64ml, and 449 +/- 105ml, respectively. The highest Q(max) and Q(ave) values were obtained when the desire to void was urgent. ConclusionsThe findings of the study show that, uroflowmetry evaluations are to be made if the patients have a strong desire to void. Only thus the highest Q(max) values can be obtained; yet, the degree of perceived bladder sensation does not have a statistically significant impact on PVR quantity. Neurourol. Urodynam. 35:622-624, 2016. (c) 2015 Wiley Periodicals, Inc.Öğe Eosinophilic Cystitis: A Rare Cause of Nocturnal Enuresis in Children(KOWSAR PUBL, 2016) Kilic, Ozcan; Akand, Murat; Gul, Murat; Karabagli, Pinar; Goktas, SerdarIntroduction: Eosinophilic cystitis (EC) is a rare and poorly understood inflammatory condition, characterized by eosinophilic infiltration of all layers of the bladder wall, which mimics bladder tumors. EC may present with symptoms such as increased urination frequency, dysuria, gross/microscopic hematuria, suprapubic pain and urinary retention. Case Presentation: We present a 17-year-old male patient, who was continent night and day in his childhood, and was admitted to our clinic for complaints of hematuria and nocturnal enuresis for the past six months. His history and physical examination were unremarkable, and routine hematological and biochemical tests were normal. Cystoscopy revealed a 4 x 3 cm erythematous, polypoidal, solid lesion on the bladder dome. Histopathological examination of the lesion revealed transitional epithelium with stromaledema, where diffuse, dense infiltration of lamina propria by eosinophils and lymphocytes was also seen. According to these findings, a histopathological diagnosis of EC was made, and the patient was treated with corticosteroids, antimicrobial agents and antihistamines. His symptoms dramatically improved and nocturnal enuresis also recovered after treatment. Conclusions: Although it is a rare entity, EC should be kept in mind in the differential diagnosis of patients presenting with dysuria, hematuria and any kind of acquired voiding dysfunction, including frequency, pollakiuria and incontinence.Öğe First experience with a new form of orthotopic ileal neobladder (Leuven N-Pouch) following radical cystectomy(AVES, 2019) Akand, Murat; Kilic, Ozcan; Bocu, Kadir; Harmankaya, Ismail; Aydogan, Muhammed FurkanBladder cancer is the most common malignancy of the urinary tract. Radical cystectomy with pelvic lymph node dissection and a urinary diversion (UD) is the gold standard treatment of non-metastatic muscle-invasive bladder cancer (MIBC). Although ileal conduit is the standard and most commonly performed type of UD, more number of centers have recently started to perform orthotopic ileal neobladder (OIN). A novel OIN has been described in 2005 as the so-called "Leuven N-pouch", which combines the features of the commonly used Hautmann and Studer neobladders. Herein, we report our first experience with a case of Leuven N-pouch in our department, which was performed for a male patient with MIBC.Öğe Hemostatic Efficacy and Histopathological Effects of Ankaferd Blood Stopper in an Experimental Rat Model of Cyclophosphamide-induced Hemorrhagic Cystitis(ELSEVIER SCIENCE INC, 2016) Kilic, Ozcan; Akand, Murat; Karabagli, Pinar; Piskin, Mehmet MesutOBJECTIVE To evaluate the hemostatic efficacy and histopathological effects of Ankaferd Blood Stopper (ABS) in an experimental rat model of cyclophosphamide-induced (CYP) hemorrhagic cystitis (HC). MATERIALS AND METHODS Forty male Sprague-Dawley rats were included in the study. Firstly, 10 rats were divided equally into 2 groups where the first group was administered only an intraperitoneal (i.p.) injection of normal saline to constitute the negative control group (CON). The remaining 5 rats were administered only a single i.p. injection of CYP (without any further treatment) for induction of HC to constitute the positive control group (HC). Subsequently, the remaining 30 rats, which also received i.p. CYP for induction of HC, were divided into 3 groups to which intravesical saline (SAL group), epinephrine (EPN group), and ABS (ANK group) were administered for 3 consecutive days. Ten days after the third instillation, cystectomy was performed for histopathological examination. Specimens were evaluated for presence of congestion, edema, necrosis, ulceration, and regenerated epithelium, and scores were given for each parameter according to the severity. RESULTS No statistically significant difference was observed for congestion, edema, necrosis, and ulceration between HC-SAL, and also between CON-ANK groups (all P values > .05). There was a significant difference for total scores between EPN and ANK groups (P = .009). There was statistically significant difference for regenerating epithelium between CON-EPN, CON-ANK, HCANK, and SAL-ANK groups. CONCLUSION Intravesical administration of ABS is at least as efficacious as EPN in terms of congestion, edema, necrosis, and ulceration. Moreover, ABS can be considered as a better option in inducing regenerating epithelium than EPN. (C) 2016 Elsevier Inc.Öğe Histomorphological Differences of Spermatic Cords regarding Subinguinal versus Inguinal Levels: A Cadaveric Study(KARGER, 2009) Tuccar, Eray; Yaman, Onder; Erdemli, Esra; Zeyrek, Tugba; Esmer, Ali Firat; Kilic, Ozcan; Avunduk, Mustafa CihatAim: Varicocele is a common disorder among male population and is the most common cause of secondary infertility. Microsurgical inguinal or subinguinal operations are the preferred approaches but the two differ in technical difficulty. Therefore, we examined the histomorphological differences of spermatic cords at both subinguinal and inguinal levels in this cadaveric study. Methods: Spermatic cords from 9 adult male cadavers were examined at both the inguinal and subinguinal levels using a light microscope with an image analysis program in the anatomy and histology laboratories of Ankara University Medical School between July 15, 2006 and February 15, 2007. Results: In terms of number and wall thickness, we did not observe any significant histomorphological differences in spermatic cord veins and arteries between the subinguinal and inguinal levels. Conclusion: We conclude that the subinguinal approach is not a harder technique than the inguinal approach concerning vessel dissection, but more studies must be made to compare subinguinal versus inguinal varicocelectomy. Copyright (C) 2009 S. Karger AG, BaselÖğe Intravenous paracetamol for relief of pain during transrectal-ultrasound-guided biopsy of the prostate: A prospective, randomized, double-blind, placebo-controlled study(ELSEVIER TAIWAN, 2015) Kilic, Ozcan; Akand, Murat; Kulaksizoglu, Haluk; Haliloglu, Ahmet H.; Tanidik, Seher; Piskin, Mehmet M.; Yurdakul, TalatTransrectal-ultrasound-guided prostate biopsy (TRUS-PBx) is the standard procedure for diagnosing prostate cancer. The procedure does cause some pain and discomfort; therefore, an adequate analgesia is necessary to ensure patient comfort, which can also facilitate good-quality results. This prospective, randomized, double-blinded, placebo-controlled study aimed to determine if intravenous (IV) paracetamol can reduce the severity of pain associated with TRUS-PBx. The study included 104 patients, scheduled to undergo TRUS-PBx with a suspicion of prostate cancer, that were prospectively randomized to receive either IV paracetamol (paracetamol group) or placebo (placebo group) 30 minutes prior to TRUS-PBx. All patients had 12 standardized biopsy samples taken. Pain was measured using a 10-point visual analog pain scale during probe insertion, during the biopsy procedure, and 1 hour postbiopsy. All biopsies were performed by the same urologist, whereas a different urologist administered the visual analog pain scale. There were not any significant differences in age, prostatespecific antigen level, or prostate volume between the two groups. The pain scores were significantly lower during probe insertion, biopsy procedure, and 1 hour postbiopsy in the paracetamol group than in the placebo group. In conclusion, the IV administration of paracetamol significantly reduced the severity of pain associated with TRUS- PBx. Copyright (C) 2015, Kaohsiung Medical University. Published by Elsevier Taiwan LLC. All rights reserved.Öğe Preliminary feasibility study of a new method of hypothermia in an experimental canine model(AVES, 2017) Sert, Ibrahim Unal; Akand, Murat; Kilic, Ozcan; Yavru, Nuri; Bulut, ErsanObjective: To build up a new microcontroller thermoelectric system to achieve renal hypothermia. Material and methods: Renal hypothermia system was tested under in vivo conditions in the kidneys of ten Mongrel dogs. Ambient temperature was evaluated using two different microcontrollers. In order to ensure hypothermia in the renal parenchyma, selection can be made among 4 modules and sensors which detect the temperature of the area. The temperature range of the system was adjusted between -50 degrees C and + 50 degrees C. Results: When single and double poles of the kidney were cooled, initial mean intraperitoneal temperature values were found 37.7 degrees C for rectum and 36.5 degrees C for renal cortex and medulla. After the temperature of the cooling module was set to 12 degrees C, the module was placed on the poles of the kidney. After fifteen minutes, temperature was 15.4 degrees C in the lower pole of the kidney, 28.1 degrees C in the cortex of the other side and 29.2 degrees C in the intramedullary region. The temperature was found to be 15 degrees C in the vicinity and 26.1 degrees C in the cortex across the module. After the system was stabilized, a very slight change was observed in the temperature. Conclusion: Hypothermia system developed ensured desired cooling of the targeted part of the kidney; however, it did not cause a change in the temperature of other parts of the kidney or general body temperature. Thus, it was possible to create a long-term study area for renal parenchymal surgery.Öğe Retrograde intrarenal surgery for renal stones - Part 1(AVES, 2017) Van Cleynenbreugel, Ben; Kilic, Ozcan; Akand, MuratThe main aim in the treatment of renal stones is to clearance of the stones completely with the least morbidity. Parallel to the improvements in technology during recent years, new flexible ureterorenoscopes and effective lithotripters such as holmium laser have been developed, thus retrograde intrarenal surgery (RIRS) has become an efficient and safe option in the management of urinary system stone disease with a gradually increasing popularity. Therewithal, innovations in auxiliary equipment such as guide-wires, ureteral access sheath and stone baskets have made this procedure more effective. With this modality, nowadays, the vast majority of renal stones can be treated successfully without need of open surgery or percutaneous nephrolithotomy. RIRS can be used as a primary treatment in patients with renal stones smaller than 2 cm, in cases with prior unsuccessful shock wave lithotripsy (SWL), infundibular stenosis, renoureteral malformation, musculoskeletal deformity, bleeding diathesis as well as obese patients. The efficiency of this procedure has been also proved in pediatric patients. In the first part of this detailed review for RIRS, history, indications and contraindications, preoperative preparation, antibiotic prophylaxis, anesthesia, surgical technique related to flexible ureteroscopes and auxiliary equipment being used, postoperative care and complications of this operation are discussed with up-to-date literature.Öğe Retrograde intrarenal surgery for renal stones - Part 2(AVES, 2017) Kilic, Ozcan; Akand, Murat; Van Cleynenbreugel, BenRetrograde intrarenal surgery (RIRS) has become an effective and safe treatment modality in the management of urinary system stone disease. Recent developments and innovations in the flexible ureterorenoscope and auxiliary equipment have made this procedure easier and more effective with increased success rates. RIRS can be used as a primary treatment in patients with renal stones smaller than 2 cm, prior unsuccessful shock wave lithotripsy, infundibular stenosis, renoureteral malformation, skeletal-muscular deformity, bleeding diathesis and obese patients. In the second part of this detailed review for RIRS, effect of stone composition on success rate, preoperative assessment of stone-free rate, the cost of this modality, education for RIRS, fluoroscopy use, the current role of RIRS in the treatment of various urolithiasis types and special conditions, and combined treatment methods are discussed with up-to-date literature.Öğe Role of dual-source dual-energy computed tomography versus X-ray crystallography in prediction of the stone composition: a retrospective non-randomized pilot study(SPRINGER, 2016) Akand, Murat; Koplay, Mustafa; Islamoglu, Necat; Gul, Murat; Kilic, Ozcan; Erdogdu, Merter BoraWe aimed to evaluate the accuracy of determining stone composition with dual-source (DS) dual-energy (DE) computed tomography (CT). A total of 142 patients, diagnosed with urolithiasis and had complete medical records, were included in the study. The number, dimensions, location and CT density of the stones, and dose-length products and effective radiation dose were recorded for every patient. Stone compositions determined with DECT by two radiologists separately were compared with crystallography method. Among 138 stones with a crystallographic result out of 187 stones evaluated, 58 calcium oxalate, 42 hydroxyapatite, 24 uric acid and 10 cystine stones were detected. DECT showed a sensitivity and negative predictive value of 68.67 and 67.5 % for calcium oxalate. Moreover, DECT was found to be very useful in predicting hydroxyapatite and cystine stones with a 100 % sensitivity and negative predictive value. Cohen kappa correlation test showed a substantial agreement (kappa = 0.682) between crystallographic analysis and prediction with DECT-analysis, which was statistically significant (p < 0.001). In this retrospective study, an unenhanced DECT was found to be accurate for in vivo determination of stone type, and thus it can be used easily without any extra burden to the patient or cost while providing additional information.Öğe The role of vitamin E in the prevention of zoledronic acid-induced nephrotoxicity in rats: a light and electron microscopy study(TERMEDIA PUBLISHING HOUSE LTD, 2018) Sert, Ibrahim Unal; Kilic, Ozcan; Akand, Murat; Saglik, Lutfi; Avunduk, Mustafa Cihat; Erdemli, EsraIntroduction: Bisphosphonates are widely used in metastatic cancer such as prostate and breast cancer, and their nephrotoxic effects have been established previously. In this study we aimed to evaluate both the nephrotoxic effects of zoledronic acid (ZA) and the protective effects of vitamin E (Vit-E) on this process under light and electron microscopy. Material and methods: A total of 30 male Sprague-Dawley rats were divided into 3 groups. The first group constituted the control group. The second group was given i.v. ZA of 3 mg/kg once every 3 weeks for 12 weeks from the tail vein. The third group received the same dosage of ZA with an additional i.m. injection of 15 mg Vit-E every week for 12 weeks. Tissues were taken 4 days after the last dose of ZA for histopathological and ultrastructural evaluation. Paller score, tubular epithelial thickness and basal membrane thickness were calculated for each group. Results: For group 2, the p-values are all < 0.001 for Paller score, epitelial thickness, and basal membrane thickness. For group 3 (ZA + Vit. E), the p-values are < 0.001 for Paller score, 0.996 for epitelial thickness, and < 0.001 basal membrane thickness. Significant differences were also observed in ultrastructural changes for group 2. However, adding Vit-E to ZA administration reversed all the histopathological changes to some degree, with statistical significance. Conclusions: Administration of ZA had nephrotoxic effects on rat kidney observed under both light and electron microscopy. Concomitant administration of Vit-E significantly reduces toxic histopathological effects of ZA.Öğe Selective Low-Dose Spinal Anesthesia for Transrectal Prostate Biopsy: A Prospective and Randomized Study(MARY ANN LIEBERT, INC, 2015) Kucur, Mustafa; Goktas, Serdar; Kaynar, Mehmet; Apiliogullari, Seza; Kilic, Ozcan; Akand, Murat; Gul, MuratPurpose: To evaluate the use of spinal anesthesia by reducing anesthetic agent dose to provide better analgesia with minimal side effects without sacrificing the outpatient setting for prostate biopsy. In this study, efficacy and tolerability of selective low-dose spinal anesthesia versus intrarectal local anesthesia (IRLA) plus periprostatic nerve blockade (PPNB) were compared. Methods: Between September 2012 and April 2013, 100 patients, aged 40 to 80 years, prostate-specific antigen (PSA) 4ng/mL, abnormal digital rectal examinations, and enrolled for biopsy were included in the present study. Ensuring double blindness, pain was assessed using the visual analog scale (VAS). Anal sphincter relaxation, patient satisfaction with the anesthesia technique, and motor response were evaluated. Results: Differences between the two groups, considering age, American Society of Anesthesiologist score, total PSA, prostate volume, anesthesia duration, and cancer presence, were not statistically significant. Pain experienced during probe insertion, biopsy, and 30 minutes after biopsy was significantly lower in the low-dose spinal anesthesia group (P<0.0001). Anal sphincter relaxation degree was significantly higher in the spinal group (P<0.001). Patient procedure-related overall satisfaction level was significantly higher in the spinal anesthesia group (P<0.001). In the spinal anesthesia group, no motor blockade was observed. Between the two groups, no statistically significant difference was seen with regard to complications (P>0.05). Conclusion: Selective low-dose spinal anesthesia provides better pain relief than PPNB plus IRLA without sacrificing the day case setting in ambulatory practice. It is also associated with high patient satisfaction and willingness for a repeated biopsy without differences in procedure duration, tolerance, and complications.Öğe Spontaneous Nephrocutaneous Fistula With Tuberculous Autonephrectomy: A Case Report of a Delayed Diagnosis(KOWSAR PUBL, 2016) Akand, Murat; Kilic, Ozcan; Kucur, Mustafa; Kaynar, Mehmet; Goktas, SerdarIntroduction: Spontaneous nephrocutaneous fistula is a rare manifestation of renal disease that can occur due to various etiologies, such as renal calculus, chronic pyelonephritis, stricture of the ureteropelvic junction, and renal tuberculosis (TB). An autonephrectomy with a nephrocutaneous fistula due to renal tuberculosis can be diagnosed quite late if it is not suspected. Case Presentation: We report a case of a spontaneous nephrocutaneous fistula with tuberculous autonephrectomy. A 40-year-old white male with recurrent flank pain and intermittent purulent drainage from his right flank region for the previous 14 years was admitted to our outpatient clinic. Fistulography and computerized tomography demonstrated a 51 x 60 mm area with a soft-tissue appearance that implied autonephrectomy of the right kidney, and a fistula tract with a 9 mm diameter between the skin and the retroperitoneal space. The patient was successfully treated with nephroureterectomy and excision of the fistulous tract, followed by antituberculous treatment. The pathological examination of the surgical specimen revealed chronic atrophic pyelonephritis, calcifications, and necrotizing granulomatous inflammation suggestive of TB. Conclusions: Urogenital TB is difficult to diagnose due to the lack of specific symptoms and signs. In the case of a nonfunctioning kidney without an obvious cause and a chronic spontaneous nephrocutaneous fistula, the possibility of associated renal TB should be kept in mind, especially in immunocompromised patients or in places where TB is a common health problem.Öğe Topical and Long-Acting Local Anesthetic for Prostate Biopsy: A Prospective Randomized Placebo-Controlled Study(KARGER, 2009) Yurdakul, Talat; Taspinar, Bulent; Kilic, Ozcan; Kilinc, Mehmet; Serarslan, AlparslanObjective: To determine the efficacy of intrarectal lidocaine gel alone and a combination of lidocaine gel with 2 different longer-acting local anesthetic (LA) agents that were injected into the periprostatic area before transrectal ultrasound-guided prostate biopsy. Patients and Methods: One hundred patients undergoing transrectal prostate biopsy were randomized into 4 groups of 25 patients each. Before the biopsy, group 1 received no local anesthesia, group 2 received 2% lidocaine gel intrarectally, group 3 received intrarectal lidocaine gel and 5 ml bupivacaine (0.25%) injected into periprostatic area, and group 4 received lidocaine gel intrarectally and a 5-ml ropivacaine injection (0.25%) in the same location as group 3. Pain levels during and after the biopsy were assessed by using a 10-point linear visual analog scale (VAS). Results: Patients in groups 3 and 4 had significantly lower VAS scores than those in groups 1 and 2, both during and 1 h after biopsy. There were no differences in the pain scores between groups 1 and 2. Conclusion: The combination of intrarectal lidocaine gel and periprostatic longer-acting LA agents significantly reduces the pain related to prostate biopsy, whereas intrarectal lidocaine gel administration alone does not reduce pain. Thus, administration of the periprostatic longer-acting LA agents alone is adequate. Copyright (C) 2009 S. Karger AG, BaselÖğe Transurethral resection of ejaculatory ducts in the treatment of complete ejaculatory duct obstruction(SPRINGER, 2008) Yurdakul, Talat; Gokce, Gurhan; Kilic, Ozcan; Piskin, M. M.Objectives To evaluate the value of transurethral resection of the ejaculatory duct (TURED) in the treatment of complete ejaculatory duct obstruction (EDO) as a treatable cause of male factor infertility. Materials and methods We retrospectively evaluated 12 azoospermic infertile men who were diagnosed as having complete EDO. The mean age of the patients was 32 years (range 24-40). Inclusion criteria were EDO in patients with azoospermia, normal serum levels of gonadotropins and testosterone and evidence of obstruction on transrectal ultrasonographic (TRUS) images. The definitive diagnosis was based on the absence of an efflux of methylene blue injected through the seminal vesicles during cystoscopy. All patients were treated by TURED. Results Before TURED, all patients were azoospermic and had been considered as candidates for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Following the operation, sperms were seen in the ejaculates of 11/12 patients. After a mean follow-up period of 12 (range 4-36) months, five (41.6%) pregnancies were noted (three spontaneous, one with intrauterine insemination and one with IVF/ICSI). Conclusion Transurethral resection was found to be a safe and somewhat effective approach for the treatment of EDO. After TURED, a significant improvement was achieved in semen parameters, and spontaneous pregnancy resulted in three cases. In addition, TURED can reduce the need for expensive procedures such as IVF/ICSI as this modality allows IVF/ICSI to be performed with ejaculated instead of surgically retrieved sperm.
