Alper Eken

Objective: To evaluate the safety and efficacy of the 180-W GreenLight XPS laser system for the treatment of benign prostatic hyperplasia in patients taking oral anticoagulants. Methods: All consecutive patients admitted for lower urinary tract symptoms associated with benign prostatic hyperplasia from November 2012 to October 2016 and who underwent photoselective vaporization of the prostate with the 180-W GreenLight XPS laser were included in the study. The perioperative outcomes examined were the operating time, laser time, energy usage, and duration of postoperative catheterization. Functional parameters (International Prostate Symptom Score, maximum urinary flow rate, and post-void residual urine volume), prostate volume, and serum prostate-specific antigen concentration were examined at baseline and 3 months. Perioperative complications, if any, were noted. Results: All functional parameters (International Prostate Symptom Score, maximum urinary flow rate, and post-void residual urine volume) significantly improved from baseline to 3 months. A small number of patients experienced at least one minor adverse event. There was no difference in the rate of adverse events between patients who were and were not taking anticoagulants. Conclusions: Photoselective vaporization with a 180-W laser is an efficacious and safe treatment for benign prostatic hyperplasia, even in patients taking anticoagulant medications.

The aim of this study was to evaluate the predictive value of preoperative hormonal levels and pathology, as well as the outcome of microsurgical testicular sperm extraction in patients with non‐obstructive azoospermia (NOA), presenting to our clinic for treatment of infertility. The records of 145 men with NOA who underwent microdissection testicular sperm extraction (micro‐TESE) between March 2013 and November 2016 were studied. The patient's age, testicular volume, hormonal profile for follicle‐stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (TT), and testicular pathology were recorded. The sperm retrieval, the clinical pregnancy and live birth delivery rates were noted. Our testicular sperm retrieval rate was 65.5%. There was no statistical difference in age, testicular volume, or hormonal levels in the TESE‐positive and negative groups. Hypospermatogenesis was found in testicular histopathology in 57 of 117 patients (48.7%) who underwent testicular biopsy. Sertoli Cell‐Only (SCO) syndrome was seen in 20.5%, Germ Cell Maturation Arrest (MA) in 16.3%, and Atrophy‐hyalinization in 14.5%. Seven men had Klinefelter's syndrome (KS), four of whom were TESE‐positive. There were no adverse effects of the procedure except for infection at the incision site in one patient. Single intracytoplasmic sperm injection (ICSI) cycles were performed in 92 couples leading to 41 clinical pregnancies and 26 live birth deliveries. Micro‐TESE is a safe procedure in experienced hands and provides infertile men with NOA an opportunity to father children. However unselected candidates with NOA should be counselled at the outset that only 17.9% will eventually become biological fathers.

Purpose: This study evaluated the safety and efficacy of photoselective vaporization of prostate using the 120 W High Performance System for management of symptomatic benign prostatic hyperplasia (BPH). Methods: We prospectively obtained data from 229 patients between January 2009 and December 2012. We evaluated the serum prostate specific antigen level, International Prostate Symptom Score (IPSS), prostate volume; maximum urine flow rate (Q _max ); and postvoid residual urine volume (PVR) in the patients at presentation and on follow-up at 1, 6, 12, and 24 months. The mean duration of the surgery, energy used, hospital stay, and intra- and postoperative complications were assessed. Results: The mean age of the patients was 71.2 ± 9.6 years, and the mean preoperative size of the prostate was 59.41 ± 28.1 mL. The mean duration of the surgery was 47.35 ± 16.14 min, and the mean energy use was 184.39 ± 101.3 kJ. The mean time to removal of the urinary catheter was 21.45 ± 11.06 h, while the mean duration of hospital stay was 24.82 ± 11.5 h. The IPSS declined and mean Q _max increased by over twofold within the first month. The PVR also declined significantly in all groups up to 6 months after the surgery and increased slightly thereafter. Urinary urgency and incontinence occurred in two patients, while four patients developed urinary strictures. Between 12 and 24 months after the surgery, four patients underwent repeat surgery. Conclusions: Our findings show that photoselective vaporization is safe and effective for the management of BPH and resulted in few complications. It yielded improvements in all parameters that were sustained even up to 2 years after the surgery.

Introduction: We compare and evaluate the safety, efficacy, and short-term outcomes of the new GreenLight XPS 180W (GL-XPS) laser system with the former generation GreenLight HPS 120W (GL-HPS) system for the treatment of benign prostatic hyperplasia (BPH) in a prospective nonrandomized single-centre study.Methods: From May 2012 to June 2013, 161 consecutive patients with lower urinary tract symptoms secondary to BPH were included: 88 patients were treated with the GL-HPS system and 73 were treated with the GL-XPS system. The perioperative variables International Prostate Symptom Score (IPSS), quality of life (QOL), and maximum flow rate (Qmax) were recorded at baseline, at one month and 6 months. Serum prostate-specific antigen (PSA) was assessed at baseline.Results: The mean age was 70.2 years in the GL-HPS group and 68.6 years in the GL-XPS group. Prostate volumes were 62.3 mL and 61.3 mL, respectively. Both groups showed significant postoperative improvement in the IPSS, QOL, Qmax variables compared to baseline levels. There were no significant differences in improvement in IPSS and QOL between groups. However, both operating and catheterization times were shorter in patients in the GL-XPS group. The overall postoperative complication rate was similar in both groups.Conclusion: Both GreenLight systems provide safe, effective tissue vaporization with significant clinical relief of BPH obstruction. The GL-XPS system appears more favourable with regard to reduced operating and hospitalization time, suggesting more cost-effective and efficient tissue removal.

Formed in 1959, the Singapore Medical Association (SMA) is the national medical organisation representing the majority of medical practitioners in both the public and private sectors

Öz Üreteral DJ stentler uzun yıllardır üroloji pratiğinde sıklıkla kullanılmaktadır. Artan kullanıma bağlı olarak stentle ilgili komplikasyonlarda da artış izlenmiştir ve unutulan üreteral stentler ciddi bir klinik sorun olarak karşımıza çıkabilmektedir. Bu komplikasyonlardan en sık rastladıklarımız erken dönemde ağrı ve irritatif semptomlardır. Geç dönemde ise unutulan stentlerin etrafındaki bakteriyel kolonizasyon ve biofilm tabakası taş oluşumuna zemin hazırlamaktadır. Unutulan DJ stentin tedavisi stentin lokalizasyonu, etrafında taş oluşumu gibi birçok faktöre bağlı olarak değişebilmektedir. Makalemizde unutulan iki farklı DJ stente bağlı olarak oluşan taş tedavisine klinik yaklaşımımız literatür eşliğinde tartışılması amaçlanmıştır.

Perivascular epithelioid cell tumours (PEComas) are a family of rare mesenchymal tumours arising in various anatomic locations. PEComas are defined by the presence of perivascular epithelioid cells that coexpress muscle and melanotic markers, especially HMB-45. They have unpredictable biological behaviour and are mostly benign, but some tumours can become unresectable or metastatic. Surgical resection, when possible, is the best treatment option. Radiation therapy, cytotoxic chemotherapy or immunotherapy have been reported as treatment options, either alone or in combination therapy. Prostatic PEComa is extremely rare, with only 1 malignant case reported. We report the first case of prostatic PEComa, which was benign and treated with transurethral resection.

Penile emergencies are rare but when they do occur, prompt diagnosis and treatment are warranted. Emergent conditions of the male genitalia are mainly traumatic, vascular or infectious. Penile emergencies are usually caused by trauma to the penis, during sexual intercourse or manipulation of an erect penis during masturbation. One of the traumatic vascular penile emergencies is superficial penile dorsal vein rupture. This is a rare condition, with just a few reported cases. It is usually taken into differential diagnosis with the other acute penile injuries that present, such as acute penile edema or ecchymosis. We report a case of 59-year-old male with a superficial penile dorsal vein rupture which occurred during manipulation of the erect penis.