Urology

Premature ejaculation (PE) is the most common sexual problem experienced by men, and it affects 20%-30% of them. Pulsed radiofrequency (PRF) neuromodulation has been shown to be an effective treatment for a wide range of pain conditions. We used PRF to treat PE by desensitizing dorsal penile nerves in patients resistant to conventional treatments. Fifteen patients with a lifelong history of PE, defined as an intravaginal ejaculatory latency time (IELT) of ,1 minute that occurred in more than 90% of acts of intercourse and was resistant to conventional treatments, were enrolled in this study. Patients with erectile dysfunction were excluded. The mean age of the patients was 39 6 9 years. Before and 3 weeks after the treatment, IELT and sexual satisfaction score (SSS; for patients and their partners) were obtained. The mean IELTs before and 3 weeks after procedure were 18.5 6 17.9 and 139.9 6 55.1 seconds, respectively. Side effects did not occur. Mean SSSs of patients before and after treatment were 1.3 6 0.3 and 4.6 6 0.5, and mean SSSs of partners before and after treatment were 1.3 6 0.4 and 4.4 6 0.5, respectively. In all cases, IELT and SSS were significantly increased (P , .05). None of the patients or their wives reported any treatment failure during the follow-up period. The mean follow-up time was 8.3 6 1.9 months. It is early to conclude that this new treatment modality might be used widely for the treatment of PE; however, because it is an innovative modality, placebo-controlled studies (eg, sham procedure), with larger numbers of patients and including assessment of penile sensitivity (eg, biothesiometry), are needed.

Nephrolithiasis management within an ectopic kidney presents a challenge to the urologists. Several treatment modalities are possible in this group of patients. Although percutaneous nephrolithotomy (PNL) is an accepted treatment modality in anatomically normal kidneys, ectopic pelvic kidneys require a different and more complicated approach for PNL. We recently treated a 24-year-old patient with calculus and an encrusted J–J stent

Purpose: The miniaturized percutaneous nephrolithotomy (mPNL) can be performed by using a very wide range of different access sheaths (14-22 Fr). It has been well known that tract size is one of the main parameters affecting the complication rates in PNL. We aimed to compare 21 Fr with 16.5 Fr mPNL tract sizes in adult patients. Materials and Methods: From May 2013 to April 2018, 604 patients with kidney stone underwent mPNL in our department. The study was designed as retrospective and match-pair analysis was the preferred method for the formation of groups. The 21 Fr mPNL cases were matched with 16.5 Fr mPNL cases at a 1:1 ratio, according to the patients' age, gender, body mass index, American Society of Anesthesiologists (ASA) score, stone characteristics (stone size, opacity and localization) and hydronephrosis. Patients with solitary kidney, renal anomalies, musculoskeletal abnormalities, and pediatric patients (< 18 years old) were excluded from the study. Both groups (21 Fr and 16.5 Fr) were compared in terms of demographics, stone characteristics, operative data and post-operative outcomes. Results: A total of 260 patients were included in the study (130; 21 Fr mPNL group and 130; 16.5 Fr mPNL group). The operation time was significantly shorter in 21 Fr group (21 Fr; 85.2 ± 37.5, 16.5 Fr; 101.7 ± 37.7 minutes, p = 0.001). Complete stone clearance rates were 76.9% and 62.3% in 21 Fr and 16.5 Fr mPNL, respectively (p = 0.01). There was no significant difference between the groups in terms of overall operative and post-operative complications. However, in subgroups analysis, post-operative fever was higher in 16,5 Fr mPNL (4 patients in 16.5 Fr, no patients in 21 Fr group, p = 0.044); steinstrasse, renal colic and post-operative JJ stent requirement rates were higher in 21 Fr mPNL procedure (p: 0.018, p: 0.031 and p: 0.046, respectively). The hospitalization time was significantly higher in 21 Fr (p = 0.01). Conclusion: Although 21 Fr mPNL procedure has advantages such as better success rates and shorter operation time, some post-operative complications (steinstrasse, renal colic, post-operative JJ stent requirement) are against of 21 Fr mPNL when compared with 16.5 Fr mPNL procedure. Further randomized prospective studies with larger patient volume are needed to confirm these results.

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.

Objective: The differential diagnosis of kidney tumors, especially those with eosinophilic cytoplasms, can be problematic due to overlapping morphologic features. CD138 is primarily a plasma cell marker but is known to be expressed in the proximal renal tubular epithelium as well. This study aims to investigate the possible contribution of CD138 expression in the differential diagnosis of kidney tumors with eosinophilic cytoplasm. Material and Method: The case series consisted of 15 chromophobe (ChRCC), 5 eosinophilic variant (EoRCC), 10 clear cell (CCRCC) and 9 papillary (PRCC) renal cell carcinomas, and 13 oncocytomas. Sections obtained from representative paraffin blocks were stained against CD138 antibody. Results: All CCRCC and PRCC showed membranous CD138 expression. In some of the other eosinophilic renal tumors, cytoplasmic CD138 labeling in varying degrees was detected. In CCRCC cases, CD138 expression was especially observed in low grade areas and areas showing cystic and pseudopapillary growth patterns. A similar pattern of cytoplasmic staining was seen in 3 of the EoRCC and the most of the PRCC cases (6/9). Conclusion: Our findings suggest that CD138 may contribute to the differential diagnosis of renal tumors because of the membranous staining pattern in CCRCC and EoRCC cases and the cytoplasmic staining in CHRCC and oncocytoma cases. Its contributory role may be improved by combined usage with markers like Cytokeratin 7 and RCC marker.

Undescended testis in adults are mostly atrophic and have higher malignancy potential, so orchiectomy is performed in these patients. We evaluated preoperative and postoperative sperm analysis, serum inhibin-B and other reproductive hormone levels, and examined histopathological findings in patients with unilateral adult undescended testis.

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 charcterized 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.Die Doppelung des Harnleiters ist eine seltene angeborene Störung der ableitenden Harnwege und hat unterschiedliche Einordnungen erfahren. Beim Typ II A-Y (Klassifikation von Effman) beginnt die Doppelung der Urethra am Blasenhals und mündet entweder im Rektum oder am Perineum. Der zusätzliche Harnleiter ist normal ausgebildet und funktional. Der normal positionierte dorsale Harnleiter ist hypoplastisch und in einer ungewöhnlichen Y-Form stenosiert. Hier wird ein neuer Fall von ungewöhnlicher Harnleiterdoppelung vom Y-Typ vorgestellt und die zugehörige Therapie diskutiert.

lthough ectopic kidney is a common abnormality, the displacement is usually downwards, towards, the pelvis, or medial. Upward displacement into the thoracic cavity is a much rarer finding, and most of the intrathoracic kidneys are found in males. About 50 cases have been reported in the literature. 1 A diaphragmatic hernia can be seen in 0.25% of cases. 2 In contrast to pelvic kidneys, intrathoracic kidneys are usually asymptomatic, and they are incidentally found on chest radiographs. In the ab

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.

Undescended testis in adults are mostly atrophic and have higher malignancy potential, so orchiectomy is performed in these patients. We evaluated preoperative and postoperative sperm analysis, serum inhibin-B and other reproductive hormone levels, and examined histopathological findings in patients with unilateral adult undescended testis.

Background: We present our experience in retroperitoneal interventions with 2 catheter mounted glove fingers through 2 access points. Methods: Patients were placed in the lateral decubitus position, and the retroperitoneum was accessed by blunt dissection through a 10-mm transverse skin incision on the posterior axillary line. Another incision was performed through the anterior axillary line, and the surgeon inserted his finger to dissect the muscle layers in the retroperitoneum to develop an initial space to place the glove finger balloon, which was attached to a 14-F Nelaton catheter. Results: This technique was performed on 32 patients. The mean operation time was 57.4 ± 26.7 minutes. A satisfactory retroperitoneal space for the operation was provided and both balloons inflated to 500 mL. No complications were observed. Conclusion: Retroperitoneal laparoscopy using 2 balloons is a safe, cheap, effective minimally invasive procedure, and we believe that the technique described above both decreases both the operation time and cost. [

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.

Objective: The differential diagnosis of kidney tumors, especially those with eosinophilic cytoplasms, can be problematic due to overlapping morphologic features. CD138 is primarily a plasma cell marker but is known to be expressed in the proximal renal tubular epithelium as well. This study aims to investigate the possible contribution of CD138 expression in the differential diagnosis of kidney tumors with eosinophilic cytoplasm. Material and Method: The case series consisted of 15 chromophobe (ChRCC), 5 eosinophilic variant (EoRCC), 10 clear cell (CCRCC) and 9 papillary (PRCC) renal cell carcinomas, and 13 oncocytomas. Sections obtained from representative paraffin blocks were stained against CD138 antibody. Results: All CCRCC and PRCC showed membranous CD138 expression. In some of the other eosinophilic renal tumors, cytoplasmic CD138 labeling in varying degrees was detected. In CCRCC cases, CD138 expression was especially observed in low grade areas and areas showing cystic and pseudopapillary growth patterns. A similar pattern of cytoplasmic staining was seen in 3 of the EoRCC and the most of the PRCC cases (6/9). Conclusion: Our findings suggest that CD138 may contribute to the differential diagnosis of renal tumors because of the membranous staining pattern in CCRCC and EoRCC cases and the cytoplasmic staining in CHRCC and oncocytoma cases. Its contributory role may be improved by combined usage with markers like Cytokeratin 7 and RCC marker.

lthough ectopic kidney is a common abnormality, the displacement is usually downwards, towards, the pelvis, or medial. Upward displacement into the thoracic cavity is a much rarer finding, and most of the intrathoracic kidneys are found in males. About 50 cases have been reported in the literature. 1 A diaphragmatic hernia can be seen in 0.25% of cases. 2 In contrast to pelvic kidneys, intrathoracic kidneys are usually asymptomatic, and they are incidentally found on chest radiographs. In the ab