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Double J (DJ) ureteral stents are frequently used as a natural consequence of common use of endoscopic procedures. Even though use of these stents is practical and safe, undesired problems such as urinary tract infection, kidney dysfunction may develop in case of their long stay in the body. DJ stents staying for a long time in the body due to forgotten by urologist and frequently by the patients or due to carelessness of the patients which may cause serious medical and legal problems. Herein, we reported two cases with DJ stent placed 4 and 2 years ago after open kidney stone operation and encrusted as they were forgotten. These 2 cases were treated by application of ESWL, endoscopic laser cystolithotripsy, suprapubic percutaneous cystolithotripsy, ureteroscopic lithotripsy and percutaneous nephrolithotomy methods consecutively. In conclusion, cases with DJ stents should be informed and warned strictly to avoid rare but serious problems due to delay or forget of these stents. We think that with an algorithm including the consecutive treatment alternatives management of encrusted DJ stents might be more successful. J Clin Exp Invest 2012; 3(2): 263-266, DJ stentler endoskopik uygulamaların yaygınlaşmasıyla beraber sıklıkla kullanılmaktadır. Bu stentler güvenli ve pratik olmalarının yanında vücutta normalden uzun süre kalırlarsa üriner sistem enfeksiyonu, böbrek fonksiyon kaybı gibi yan etkilere sahiptir. Bazen ürologlar çoğu kez de hastalar tarafından unutulan veya hastanın ilgisizliği nedeniyle vücutta uzun süre kalan double J stentler günümüzde halen sorun olmaya devam etmektedir Bu yazıda, biri 4 yıl önce ve diğeri 2 yıl önce açık böbrek taşı ameliyatı sırasında yerleştirilen ve sonrasında unutulup taşlaşan DJ stentli iki hastanın uygulanan ESWL, endoskopi sistolitotripsi, perkütan sistolitotripsi ve perkütan nefrolitotripsinin kombine kullanımıyla taşsız hale getirilmeleri tartışıldı ve ilgili yayınlar gözden geçirildi. Biz DJ stent yerleştirilen hastaların takiplerinde hastaların daha sıkı uyarılmalarının ve daha çok bilgilendirmelerinin gerekli olduğuna inanıyoruz. Bunun için gerekirse iletişim imkanlarından da yararlanılmalıdır. Enkruste veya taşlaşmış DJ stentlerle mücadele etmek için birçok seçeneğin olduğu ve belli bir algoritma ile bu seçeneklerin kullanılarak hastaların taşsız hale getirilebileceği düşüncesindeyiz.

Ovotesticular disorder of sex development (OTDSD) is a rare condition and defined as the presence of ovarian and testicular tissue in the same individual. Most of patients with OTDSD have female internal genital organs. In this report, we present a case in which, we demonstrated prostate tissue using endoscopic and radiologic methods in a 46-XX, sex determining region of the Y chromosome negative male phenotypic patient, with no female internal genitalia. Existence of prostate in an XX male without SRY is rarely seen and reveals a complete male phenotype. This finding is critical to figure out what happens in embryonal period.

Objectives 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. Methods Testosterone (0.1-300 μM) 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 μM), voltage-dependent inward rectifier K + channel inhibitor barium chloride (30 μM) and voltage-sensitive K + channel inhibitor 4-aminopyridine (1 mM). Results Testosterone (0.1-300 μM) 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 μM. 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). Conclusions 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.

To find answers about preventing the colonic mucosal regrowth after seromuscular enterocystoplasty and the dissection pane, we performed an experimental study in dogs. We also report our experience with mucosal regrowth and bladder function after augmentation colocystoplasty.This study comprised 10 adult healthy female mongrel dogs. We performed this animal experiment in 2 stages. At stage 1 we constructed a low capacity bladder. Stage 2 was performed 6 months after stage 1. At the end of detrusorectomy a 15 cm. segment of sigmoid colon was detubularized. The animals were randomly divided into 2 groups. In the 5 group 1 dogs de-epithelialization was performed with needle point cautery at a low cut setting, and the mucosa, muscularis mucosa and submucosa were resected, leaving the fibers of the muscularis externa exposed. In the 5 group 2 dogs de-epithelialization was performed by the peeling technique, in which the dissection plane was developed between the mucosa and muscularis mucosa, and the muscularis mucosa and submucosa remained on the colonic muscle. The de-epithelialized patch of bowel was shaped as a cup patch and anastomosed to the edges of the detrusor muscle over the bulging urothelium. The animals were sacrificed at 12 months of followup. All bladders were inspected macroscopically for regrowth of the colonic mucosa. Multiple sections of the augmentation patches were obtained and processed routinely for histological evaluation to determine what happened to the urothelium.We noted good urodynamic results in all dogs and there was no statistical difference in the groups in regard to bladder capacity. Mucosal regrowth did not develop in either group.When dissection is performed successfully whether or not the submucosa is removed, there is no observed regrowth or loss of bladder capacity in either technique.

Objectives To evaluate prospectively the success of scrotal incision orchiopexy (Bianchi technique) with or without inguinal hernia in patients with an undescended testis within the inguinal canal or beyond the external inguinal ring. Methods A total of 72 orchiopexies were performed in 56 patients with a primary undescended testis. The testicular position and size were assessed again at 1 year of follow-up. Results A total of 56 patients had bilateral (n = 14), right (n = 26), and left (n = 18) primary undescended testes. Scrotal orchiopexy was attempted in 72 testes and was successful in 68; the remaining 4 patients required conversion to traditional inguinal orchiopexy because of inadequate mobilization. In 34 children (43 testes), the testis was distal to the external inguinal ring (group 1). Scrotal orchiopexy was performed successfully in 42 testes in this group, and only 1 patient required conversion to a traditional inguinal incision. The average operating time was 18 minutes. In 22 children (29 testes), the testis was located within the inguinal canal (group 2); 3 cases required conversion to traditional inguinal orchiopexy. The average operative time was 25 minutes in group 2. All patients had satisfactory scrotal placement with at least one follow-up examination. Conclusions A scrotal incision for a palpable primary testis is well tolerated, cosmetically pleasing, and associated with a short operative time.

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. 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. 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. 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.

Aims: We retrospectively review patients who underwent ureteral implantation with a psoas hitch during obstetric or gynecologic operations and describe a new modification. Methods: 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. Results: 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. Conclusions: Modified psoas hitch ureteral reimplantation is an effective and safe way of reconstruction for treating defects in ureteral length.

Aim: To present the results of a new modification of dismembered pyeloplasty performed to prevent the occurrence of secondary obstruction. Methods: Modified dismembered pyeloplasty was performed in 35 children (age range 3 months to 16 years) who had unilateral ureteropelvic junction obstruction. In postoperative follow-up, presence of hydronephrosis on ultrasonography, differential renal function (DRF) and renal drainage half-time on technetium-99m diethylenetriaminepentaacetic acid (DTPA) renography were recorded and compared with preoperative data. Results: Mean anteroposterior renal pelvic diameter, mean preoperative DRF and radioisotope clearance half-time on DTPA renography of the affected kidneys were 61.4 mm, 38.6% and 34.3 min in children with prenatal hydronephrosis, and 67.5 mm, 37.6% and 39.4 min in children that presented with symptoms, respectively. After surgery, mean anteroposterior renal pelvic diameter, mean DRF and radioisotope clearance half-time on DTPA renography of the affected kidneys were 10.9 mm, 45.9% and 11.9 min in children with prenatal hydronephrosis, and 20 mm, 41.9% and 15.2 min in children that presented with symptoms, respectively. No failure was observed in any patient at an average follow-up of 26 months (range 1–5 years). Conclusions: Open dismembered pyeloplasty is the treatment of choice for intrinsic ureteropelvic junction obstruction. The modification of dismembered pyeloplasty that we performed is an alternative for the prevention of secondary obstruction.

Achievement of spontaneous tumescence after penile implant surgery has already been reported. However, regular spontaneous full, rigid erection upon sexual arousal that is adequate for vaginal penetration and tumescence for satisfactory sexual performance is an extremely rare condition in men with three-piece hydraulic implants. Similarly, prolonged erection is not expected in such implant cases even with the use of erectogenic agents. We report this interesting phenomenon confirmed by magnetic resonance imaging technique in a patient with inflatable device.

OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

Objective To use a new vasovasostomy technique for reversal of vasectomy. Design Case report. Setting Clinical and academic research environment. Patient A patient who had undergone vasectomy. Intervention We used 4/0 prolene as a guide during anastomosis for reversal of vasectomy. Main Outcome Measure Semen analysis. Result(s) Three months after the operation, the spermiogram showed the sperm count, the percentage of normal morphologic sperm, progressive motility, and vitality as 9 million/L, 70%, 33%, and 60%, respectively. Six months later, the spermiogram was repeated and the following results were obtained: the sperm count, the percentage of normal morphologic sperm, progressive motility, and vitality as 14 million/L, 65%, 40%, and 65%, respectively. Conclusion(s) This new technique is cost-effective, easy, cheap, and less time-consuming, and has a high success rate.

Introduction: In this study, our aim was to evaluate the effectiveness of the mucosal flap barrier (MFB) upon the incompetent ureteral orifice of an experimentally produced rabbit reflux model. The rabbit reflux model was done in the first stage of the study. This method is a new and original procedure which is different from Bischoff’s and Witherington’s osteoplasty techniques. Materials and Methods: We performed the mucosal flap procedure in eight 2–2.5 kg male New Zealand rabbits with experimentally produced refluxing ureters. The first stage of our study was to create refluxing ureters. Due to the upward and inward ‘J’ fishhook course of the intravesical ureter of rabbits, we performed two deep 12- and 4-o’clock incisions by suturing the edges of the intravesical ureter apart with catgut sutures. Additionally, to stop the tilting action of the trigonum during micturition, we performed two parallel incisions between the ureteral meatus. These parallel incisions were the authors’ modifications for the rabbit reflux model and which gives long-lasting reflux for the rabbit. We checked the reflux at the end of the 3rd month and performed our new MFB antireflux procedure. This mucosal flap made a cover on the incompetent ureteral orifice. This technique is completely different from the osteoplasty techniques described by Bischoff and Witherington. Results: Four months after the MFB application, we performed intravenous urography, cystometry and cinefluorography. There was no obstruction or reflux. Two rabbits were sacrificed at the 4th month. Both flaps were fully intact without any fixation at the medial side causing obstruction. At present, 3 rabbits are still alive. We did cinefluorography and cystometry at the 15th month and there was no obstruction or reflux. We are trying to keep them alive till the end of their natural lifespan. Conclusions: During the formation of the rabbit reflux model, we observed that spontaneous reflux even at high intravesical pressures did not have high percentages as previously mentioned in the literature. But it is possible and enough to produce an experimental reflux model by using meatotomy and interureteric incisions. Moreover, in rabbits with vesicoureteral regurgitation produced by ureteral meatotomy and interureteral incisions, reflux can be eliminated the MFB procedure. This method is an easy procedure for small bladders or dilated ureters after any kind of open reimplantation applications and it could be used by pneumovesical applications in the future.

Gonococcal infection of a penile prosthesis is a rare presentation of a common disease. Here we report two cases of penile prosthesis extrusion due to gonococcal infection.

This study was performed to investigate the effect of propylthiouracil (PTU) on rat testis, and to compare the results of the different treatment regimens of levothyroxine and zinc. Twenty sexually mature Wistar albino rats were subjected to PTU for 14 days intraperitoneally to make them hypothyroidic. The effect of PTU on testicular function was assessed histopathologically after unilateral orchiectomy on day 15, and treatment was evaluated by measuring serum thyroid-stimulating hormone (TSH), T3, T4, and zinc levels on days 0, 7, and 15. The rats were then divided into five groups which were given levothyroxine and/or zinc treatment for 15 days. Orchiectomies were repeated on day 30, and specimens were evaluated histopathologically. Although serum T3, T4 and zinc levels decreased, serum TSH levels increased in PTU-treated rats, and the difference to the control group was statistically significant (P < 0.001). Maturation arrest of spermatogenesis, a reduced number of Sertoli and Leydig cells, a decreased tubular diameter, interstitial oedema, and thickening of basal membrane were observed in hypothyroidic testicles. After treatment, testicular histology and spermatogenesis gradually recovered in all groups with hypothyroidism, but maximum improvement was achieved in the levothyroxine + zinc sulphate replacement group, indicating a possible role of zinc in testicular function.

Background: The ideal tissue for complex urethral reconstruction has yet to be determined, especially in patients with deficient preputium. The use of bladder mucosa as a free graft could be an alternative in these problem cases. Methods: Bladder mucosa graft urethroplasty was performed on 14 patients with penoscrotal or scrotal hypospadias. The mean age of the patients was 18.7 (range 14–23) years. Ten cases were subjected to primary urethral reconstruction while four cases had previous hypospadias repair. Results: Complete urethral replacement by the bladder mucosa tube was performed in six patients. Meatal problems occurred in two (33.33%) patients and proximal fistula formed in one (16.67%) patient. A bladder mucosa graft was combined with preputial or tunica vaginalis grafts distally in eight cases, and one patient in the tunica vaginalis group developed fistula at the anastomosis of the bladder mucosa and tunica vaginalis grafts. The overall complication rate was 28.6%. Conclusions: Our initial results showed that bladder mucosa grafts can be used successfully for urethral reconstruction especially when combined with preputial or tunica vaginalis grafts distally.

Purpose: The treatment approach for enuresis is controversial due to the lack of consensus as to the exact causes of nocturnal enuresis. Despite various treatment modalities, pharmacotherapy still appears to be the common choice. The aim of this prospective study was the evaluation of the efficacy of combination therapy (imipramine and oxybutynin) in patients with enuresis nocturna. Patients and Methods: This prospective study was done with 77 monosymptomatic nocturnal enuretics between July 1996 and December 1998. Results: Even though there is no statistically significant difference between combination therapy (imipramine plus oxybutynin) and monotherapy, clinical data showed that combination therapy is more effective. Conclusions: We conclude that combination of imipramine with oxybutynin is a safe and new choice in the treatment of nocturnal enuresis.

The effect of anatomical factors such as lower infundibulopelvic angle (LIPA), lower infundibulum diameter (LID) and inferior calyceal length (ICL) on renal stone formation was investigated. These parameters were measured from noncalculous kidneys of 40 healthy kidney donors. The same parameters from 119 patients with single, unilateral, nonobstructive lower calyceal stone were also measured. LID and ICL were significantly higher in calculous kidneys when compared to the control group. On the other hand, the difference between the LIPA of the two groups was not significant. It is concluded that LID and ICL could be good indices in determining lower calyceal stone formation.

Two subtypes of priapism have been described based on the pathophysiologic mechanism. The more common type, termed stasis priapism, is characterized by a low flow state in which inadequate venous outflow creates an acidotic hypoxic environment leading to a painful prolonged erection. The other less common subtype, high flow priapism, is arteriogenic. We used embolization therapy in one case with long lasting stasis priapism and in the other with high flow priapism due to bilateral arteriosinusoidal fistulae in the penis. In both cases we used polyvinyl alcohol for embolization and sexual potency preservation. Priapism is the persistence of erection that does not result from sexual desire. Hauri et al. described two variants of priapism [4]. In high flow priapism (non-ischaemic) there is unregulated arterial inflow to the lacunar spaces due to a lacerated cavernous artery associated with previous perineal and penile trauma. In stasis priapism, the second type, the basis abnormality could be due to a more pronounced or prolonged blood entrapment inside the vascular spaces of the corpora cavernosa sustained by an unknown cause [2]. There are many treatment methods especially for low flow ischaemic variant [3]. We report two different kinds of priapism and embolization therapy in both of them with polyvinyl alcohol.

PURPOSE 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. MATERIAL AND METHODS We evaluated 23 adult male who admitted to our clinic, between 2005-2007 with unilateral undescended testis. Mean age was 23.36 (21-30). In 14 patients right orchiectomy, in 9 patients left orchiectomy was performed. Serum inhibin-B, Follicle-stimulating hormone (FSH), Luteinising Hormone (LH), testosterone levels, sperm analysis were examined in before and 1 month after orhiectomy. Orchiectomy materials were evaluated histopathologically. RESULTS Mean serum inhibin-B level decreased from 80.696pg/ml to 53.240pg/ml in post-operative period. Serum inhibin-B levels significantly decreased in 17 patients (>10 pg/ml). Mean FSH level increased from 8.929mIU/ml to 10.909 mIU/ml, in 18 patients significant increase was found. There were no changes in LH and total testosterone levels and spermiogram parameters. Histopathological evaluation revealed maturation arrest in 3 patients and Sertoli cell only (SCO) in 20 patients.The inhibin B level decrease was more prominent in the patients who had maturation arrest pathology. CONCLUSIONS Inhibin-B levels decrease and FSH levels increase after orchiectomy in adult undescended testis. Previous immunohistochemical studies shown that Leydig cells secretes inhibin-βB subunit in patients with SCO, so adult undescended testis has no contribution on fertility. Because of increased malignancy risk, best treatment option in unilateral undescended testis in adult patients is still orchiectomy.

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.