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OBJECTIVE To demonstrate the predictive effect of PSA derivatives and time markers that is prostate-specific antigen (PSA) doubling time (PSADT) and PSA velocity (PSAV) on survival in men with hormone-refractory prostate cancer (HRPCa). STUDY DESIGN Descriptive, analytical study. PLACE AND DURATION OF STUDY Department of Urology, Erciyes University, Faculty of Medicine, Kayseri, Turkey, between 2012 and 2020. METHODOLOGY One hundred patients, who were treated with prostate cancer, were subjected. The PSA values were noted, nadir PSA values were detected, times to nadir PSA, HRPCa, and follow-up times were recorded. PSADT and PSAV were calculated. The relationships between the groups were analyzed. Kaplan-Meier curves were used to estimate overall survival between the groups. RESULTS The patients were grouped according to the mean PSADT, median PSAV, median nadir PSA, and mean time to HRPCA. The survival of those with high PSADT, low PSAV and low nadir PSA were found to be significantly longer (p=0.006, p

Objective The aim of this prospective study was to evaluate the early results of transrectal prostate biopsies performed under the guidance of multiparametric prostate magnetic resonance imaging (mpMRI) in biopsy naive patients. Material and methods Biopsy naive patients who had prostate-specific antigen level 4-10 ng/mL and/or abnormal digital rectal examination findings and provided informed consent were examined using mpMRI. The study included 80 patients with an MRI-defined lesion with a Prostate Imaging and Reporting and Data System (PIRADS) score of ≥3. All mpMRIs were reported by the same uro-radiologist according to PIRADS version 2. An MRI-targeted biopsy was performed by an ultrasonography system with rigid fusion registration software. The first two to five core biopsies per MRI-defined lesions were obtained, and then a standard random 12-core biopsy was performed. Transrectal biopsies were performed under local anesthesia or sedoanalgesia. Results Of the 80 patients, 29 (36.3%) were found to have cancer using the conventional 12-core biopsy, but only 20 (25%) were found to have prostate cancer using the MRI-targeted prostate biopsy. Combining the two biopsy methods (conventional+MRI-targeted), cancer detection rate increased to 43.8% (35/80 patients). The cancer detection rate using the combined method was statistically higher than that using the conventional biopsy method (p=0.03). Using the conventional biopsy method, 960 core biopsies were collected from 80 patients. Of the 960 core biopsies, 111 (11.6%) were found to be cancer. Further, 101 suspected lesions were detected using mpMRI in 80 patients. In addition, 397 core biopsies were obtained from these lesions. Of the 397 core biopsies, 62 (15.6%) were reported as prostate cancer. The core positivity rate of MR-targeted biopsy was statistically higher than that of conventional biopsy (p=0.04). Conclusion The preliminary results of MRI-targeted prostate biopsy combined with conventional biopsy suggested that the combined biopsy method was crucial in prostate cancer diagnosis especially in patients with prostate cancer suspicion and no biopsy history. However, larger sample prospective studies are needed to validate the effectiveness of MRI-targeted biopsy and combined biopsy methods.

Objective:Bacillus Calmette-Guérin (BCG) limited availability, cost, and allergic response in some patients limit its use, leading to the search for alternative agents. We aimed to present the outcomes of intermediate- and high-risk non-muscle invasive bladder cancers treated with bladder wall thermochemotherapy (BWT) system via a single-arm prospective study.Materials and Methods:Overall, 44 patients were enrolled and subjected to a treatment with mitomycin-C and BWT for 6 weeks, followed by a monthly maintenance for up to 1 year. The recurrence rate, progression rate, recurrence-free survival, progression-free survival, and side effects were evaluated.Results:In the intermediate- and high-risk groups, the median follow-up duration was 14 and 17 months; recurrence rates were 28.6% and 23.3%; progression rates were 7.1% and 23.3%; the recurrence free survival at the 24th month were 78.6% and 80.0% and the progression free survival at the 24th month were 92.6% and 76.7%, respectively. All the patients suffered from dysuria lasting for 2-3 days; five of the 442 BWT application developed allergic reactions requiring treatments with oral agents.Conclusion:BWT showed comparable recurrence and progression rates, but seemed safer than BCG when our findings were compared to those of published studies. It could be an alternative for individuals who are not suitable for BCG or in a case of BCG unavailability.

Objective:It is aimed to present the long-term oncologic and nephrological follow-up results in patients who underwent radical cystectomy and ureterocutaneostomy (RC+UC) due to localized muscle-invasive bladder cancer (MIBC).Materials and Methods:A total of 83 patients diagnosed with localized MIBC (age ≥70 years or an American Society of Anesthesiologists score ≥3), who underwent RC+UC between January 1995 and June 2013, were evaluated retrospectively. Patients who died due to postoperative early surgical complications and patients with a preoperative glomerular filtration rate (GFR)

Objective: To examine the effect of warm and cold ischemia on functions of the operated kidney in cases with a normal contralateral kidney undergoing nephron sparing surgery. Methods: This study enrolled 40 patients with a normal contralateral kidney and without a renal function threatening risk factor, who were operated with NSS. The patients were randomized at admission. They were divided into 2 equal groups as warm and cold ischemia. An ice application for 10 minutes was done to cold ischemia group after clamping renal artery. Renal functions were evaluated with Technesium-99m-Dimercaptosuccinic Acid (DMSA) and serum creatinine at the preoperative and postoperative (day 1, day 15, month 6, and month 12) period. Statistical analysis was done with Mann Whitney U test, Wilcoxon Signed Rank test, and Fredman test. A p value below 0.05 was considered statistically significant. Results: There were no significant differences between the groups in terms of age, body mass index, ischemia time, tumor size, amount of hemorrhage, and procedure time. Both groups had a significantly higher DMSA uptake at the preoperative period compared with the postoperative period (postoperative day 1, day 15, month 6, and month 12) (p 0.001). However, both groups had similar DMSA uptake results at the postoperative period. Preoperative and postoperative creatinine levels were not significantly different from each other in both groups. Conclusion: Based on tumor localization, nephron sparing surgery without use of superficial cooling appears as a viable option for small renal masses.

Introduction: We evaluated the results and effects of radical nephrectomy followed by immunochemotherapy and embolization alone on the survival of patients with metastatic renal cell carcinoma. Patients and Methods: The study included 20 patients with histologically confirmed renal cell carcinoma. Ten patients were in the combined therapy group and the other 10 patients who were unable to undergo nephrectomy because of poor performance status or unresectable tumor were in the embolization group. Radical nephrectomy was performed on patients with good performance status (WHO criteria 0–1). Immunochemotherapy (interferon alpha 2a and 5-fluorouracil) was started within 1 month after surgery. A dose of 9 × 106 U/day interferon alpha 2a was subcutaneously administered 3 times a week. A dose of 750 mg/m2 5-fluorouracil was administered intravenously during 4 h in the first 5 days of treatment. 5-Fluorouracil therapy was converted to weekly intervals after the first 12 days. Combined therapy was continued for 3 months. Ethanol was used for transarterial embolization. The main renal arteries and parasitic arteries of the tumor were embolized. Results: There were no significant differences in age distribution, sex, affected side, tumor size and T stage between the groups. After completion of the combined therapy, 6 patients showed progression at the first control. Only 1 patient (10 %) had stable disease throughout the 10 months after combined therapy. One patient died of myocardial infarction on the 4th day in the embolization group. While progressive disease within the first 3 months was detected in 6 patients, the other 3 patients (30%) had stable disease for 14, 17 and 55 months, respectively. There was no complete response in any group and no patient was alive (died of renal cell carcinoma) at the time of the analysis of the study data. Whereas the median survival time was 11 months (1–80) (mean ± SE: 22.2 ± 9.1) in the combined group, this time was a median of 1 month (1–74) (mean ± SE: 17.5 ± 8.6) in the embolization group. There was no statistically significant difference in survival time between the groups (p > 0.05). Conclusion: In this preliminary report, the clinical findings in embolization-group patients were definitively worse than the nephrectomy plus immunochemotherapy-group patients. In spite of these differences, combination therapy using radical nephrectomy and immunochemotherapy could not show superiority to embolization alone, especially in terms of survival time.

Objective: Evaluation of the effectiveness of rifampicin and some agents used in the pleurodesis of pleural effusions, such as autologous blood and purified mineral talc.Patients and methods: A total of 56 hydroceles were treated by sclerotherapy, in a random fashion, using purified mineral talc, rifampicin and autologous blood as sclerosant agents. The control group of patients were handled with aspiration only.Results: The cohort of patients in the blood group had a success rate comparable to the control group (p > 0.05). the rifampicin group did better than both control and blood groups (p < 0.05) but not better than the talc group (p < 0.01). Success rate was highest in the talc group of patients who needed no re-sclerotherapy procedures.Conclusion: Purified mineral talc was shown to be potentially the best sclerosant for the sclerotherapy of hydroceles and epididymal cysts.

Fluoxetine, a selective serotonin re-uptake inhibitor, has been shown to increase the intravaginal latency of patients with premature ejaculation. We demonstrated the effects of fluoxetine on intravaginal latency, penile sensory threshold, and variables of sacral evoked response and cortical somatosensorial evoked potential in patients with premature ejaculation.Of 48 patients 40 who presented to our clinic with premature ejaculation met the study criteria, gave written or oral consent, and were divided randomly in a double-blind fashion into 2 groups of 20 patients. The study group received 20 mg. fluoxetine daily and the control group received placebo for 1 month. The patients were evaluated during visits before and after treatment for intravaginal latency, penile sensory threshold values, and the variables of sacral evoked response and cortical somatosensory evoked potential tests.Patient ages, intravaginal latencies, penile sensory threshold values, and amplitudes and latencies of sacral evoked response and cortical somatosensory evoked potential tests in both groups were not significantly different at the beginning of treatment (p0.05). At the end of treatment intravaginal latencies and penile sensory threshold values were increased in the study group compared to before treatment and the control group (p0.05). No change was observed in either group for the amplitudes and latencies of sacral evoked response and cortical somatosensory evoked potential tests (p0.05).These findings suggest that fluoxetine is effective treatment for premature ejaculation probably due to its effect of increasing the penile sensory threshold, without changing the amplitudes and latencies of sacral evoked response and cortical somatosensory evoked potential.