Neodymium:YAG visual laser ablation of the prostate: 7 years of experience with 230 patients.

PURPOSE: We evaluated the short and long-term outcome of neodymium:YAG visual laser ablation prostatectomy for treatment of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 230 patients with symptomatic BPH underwent visual laser ablation prostatectomy. Evaluation measures included the American Urological Association symptom score, maximum urinary flow rate, post-void residual urine volume and morbidity. RESULTS: Median followup was 36 months (range 6 to 79). Of the patients 220, 196, 180, and 167 were available at 6 months, 1, 2 and 3 years, respectively. Moreover, 98 patients were followed for a minimum 5 years. At 6 months maximum urinary flow rate increased from 6.7 to 17.9 ml. per second, post-void residual urine volume decreased from 159 to 52 ml. and the American Urological Association symptom score was reduced from 22 to 7.2. Improvement in the evaluation parameters also continued at 5 years. Early complications consisted of prostatitis, urinary retention, and bleeding in 6 (2.6%), 3 (1.4%) and 1 (0.4%) patient, respectively. Irritative symptoms persisting greater than 4 weeks were seen in 28 (12.2%) patients. Late complications were bladder neck contracture, urethral stricture, and urinary retention in 3 (1.4%), 2 (0.9%) and 2 (0.9%) patients, respectively. Of the 153 sexually active men 5 noticed erectile impotence at 6 months. There were 20 (12.0%) patients who reported retrograde ejaculation. The reoperation rate was 5.5%. CONCLUSIONS: Our results further confirmed that visual laser ablation prostatectomy is a safe and effective treatment for BPH. It has minimal morbidity and durable therapeutic effects. However, the major disadvantage is postoperative irritative voiding symptoms.     

Impact of lockdown COVID-19 on metabolic control in type 2 diabetes mellitus and healthy people

AimsThe impact of prolonged COVID-19 lockdown on metabolic control in type 2 diabetes patients and healthy individuals has not exactly been known. We aimed to evaluate the change in body weight and metabolic control in type 2 diabetic and non-diabetic healthy subjects during the prolonged lockdown period.MethodsDiabetic (n = 85), and age-and sex-matched non-diabetic subjects (n = 55) were included in this prospective study. Body mass index and metabolic parameters were compared between before and 6th months of lockdown. Changes in values were evaluated using the difference before and after lockdown.ResultsAge (54.81 ± 10.53 vs. 52.61 ± 4.88 years), gender (female, 68.2% vs. 56.4%) and, BMI (33.44 ± 6.48 vs. 31.63 ± 3.57 kg/m²) were similar between groups (p > 0.05). Before and after lockdown, BMI increased both in non-diabetic (0.54 ± 0.95 kg) and diabetic groups (1.91 ± 5.48 kg) (p > 0.05). Increase in HbA1c was more in diabetic than in non-diabetic groups (0.71 ± 1.35 vs. 0.02 ± 0.19%, p = 0.002). Glucose, LDL-C, and TG increased in diabetic (39.69 ± 74.69, 7.60 ± 34.33, and 58.21 ± 133.54 mg/dl, p < 0.05) whereas non significantly decreased in non-diabetic group (?0.51 ± 4.40, ?3.52 ± 14.53, and ?6.47 ± 41.77 mg/dl, respectively. After adjusting BMI, increase in blood glucose (p = 0.021), HbA1c (p = 0.018), and TG (p = 0.041) levels were more in diabetic than non-diabetic group. Duration of diabetes was an independent predictor of the change in HbA1c (OR: 1.2, 95% CI = 1.1–1.8, p = 0.032).ConclusionsBody weight gain was observed in type 2 diabetic patients and healthy subjects. This is the first study to show that prolonged lockdown COVID-19 pandemic worsened glucose regulation and increased TG level in diabetes mellitus independent of weight gain.     

Melanocortin 3 receptor gene polymorphism is associated with polycystic ovary syndrome in Turkish population

Polycystic ovary syndrome (PCOS) is a frequent complex disorder with an ill-defined etiology. Genetic factors seem rather effective at the occurrence of the disease, however, the evidence of established various studies results are unsatisfied. We aimed to make a contribution to the genetic baseline of the disease by investigating melanocortin 3 receptor gene polymorphism in affected patients. 101 PCOS patients and 162 age-matched healthy volunteered control subjects recruited to the study. PCOS patients classified according to their BMI class and insulin resistance situation. Anthropometric measurements, physical examination results, laboratory findings, and hormone levels were recorded for each participant and analysis of two SNPs on the MC3R gene; rs3746619 and rs3827103 were performed. Although no significant difference was observed in rs3827103 polymorphism between PCOS patients and controls; rs3746619 polymorphism was determined associated with PCOS in the heritage of dominant (AA + AC) and co-dominant (AA) genotypes. Two polymorphisms did not found related to obesity and insulin resistance in PCOS subgroups analysis. MC3R gene rs 3746619 polymorphism was found associated with PCOS in the Turkish population and may make a contribution to the genetic baseline of the disease.     

Intravesical epirubicin in the prophylaxis of superficial bladder cancer

Forty-five patients who underwent transurethral resection (TUR) for Ta-Tl superficial bladder cancer were included in the study. Fourteen patients who had TUR alone were assigned to the control group. Epirubicin therapy was started two weeks after complete TUR of the tumour. Epirubicin in a dose of 50 mg diluted in 50 ml saline was instilled weekly for 8 weeks in the epirubicin group. The mean follow-up was 24 months. Although recurrence rate was higher in the control group (64.2% versus 32.2%), it was not found to be statistically significant (p=0.0914, chi-square test). Tumour-free intervals in patients with recurrent disease were significantly longer in the epirubicin group (p<0.05, Mann-Whitney U-test). In conclusion: intravesical epirubicin therapy, which both reduces recurrence rate and prolongs time to recurrence, was found to be effective in the prophylaxis of superficial bladder cancer.     

Predisposing factors and treatment outcome in Fournier's gangrene. Analysis of 28 cases

OBJECTIVES: To evaluate the etiologic factors and the effects of surgical debridement and adjunctive therapies on morbidity and mortality of Fournier's gangrene. METHODS: 27 males, 1 female, a total of 28 patients with a mean age of 58 years treated for Fournier's gangrene were evaluated retrospectively. RESULTS: Predisposing factors including diabetes, alcohol abuse, paraplegia and renal insufficiency were identifiable in 54% of the patients. Etiologic origin of the gangrene was urogenital, cutaneous and anorectal in 43, 25 and 11% of the patients, respectively. The pathology was limited to genitalia in 10, extending to perineum in 8, the umbilicus in 7 and even up to the axilla in 3 patients. Suprapubic cystostomy and colostomy were necessary in 18 and 2 cases, respectively. We used hyperbaric oxygen therapy in 2 and honey in 6 patients to accelerate wound healing. A repeat debridement was necessary in 39% of the cases. Plastic surgery and grafting were done in 14 patients. Our mortality rate was 7%. CONCLUSION: Early recognition of the pathology and aggressive surgical debridement are the mainstay of the management of Fournier's gangrene. Additional strategies to improve wound healing and increase patient survival are also needed.     

Vitamin D Replacement Improves Tear Osmolarity in Patients with Vitamin D Deficiency

Background: Vitamin D deficiency is a common health problem worldwide. Many parts of the human eye, including the epithelium of the cornea, lens, ciliary body, and retinal pigment epithelium, as well as the corneal endothelium, ganglion cell layer, and retinal photoreceptors, contain vitamin D receptor (VDR). Dry eye is also a common health problem. An adequate tear film is required for maintaining health and function of the eye. Tear hyperosmolarity is considered to be the cause of ocular surface inflammation, symptoms, and tissue damage. It is well-documented that vitamin D has an anti-inflammatory action. We aimed to investigate the effect of vitamin D replacement on tear osmolarity in patients with vitamin D deficiency. Methods: A total of 44 patients (38 females, six males, mean age:43.5 ± 12.8 years) with vitamin D deficiency currently managed by the Endocrinology and Metabolism Department of Diskapi Training and Research Hospital in Turkey were enrolled in the study. Patients were given 50,000 units of 25(OH)D₃ intramuscularly, once weekly, over a period of eight weeks. All of the patients underwent tear function osmolarity (TFO) measurement initially and eight weeks after vitamin D replacement. Demographic, anthropometric, and biochemistry data of patients were recorded. Results: The mean TFO was significantly decreased (313.7 ± 17.3 mOsm/L; 302.7 ± 14.2 mOsm/L, p<0.001) at the end of the second month; 25(OH)D₃ concentrations increased from 8.3 ± 3.5 ng/mL to 68.8 ± 22.3 ng/mL (p<0.001). The mean levels of hsCRP, FPG, P were 2.5 ± 2.5 mg/L, 5.09 ± 0.48 mmol/L, 1.06 ± 0.16 mmol/L initially, and 3.8 ± 5.9 mg/L, 5.11 ± 0.68 mg/dL, 1.09 ± 0.16 mmol/L after vitamin D replacement, respectively (p>0.05). The mean Ca level was 2.37 ± 0.07 mmol/L initially and 2.35 ± 0.07 mmol/L after vitamin D replacement (p<0.05). The change of TFO was negatively correlated with the variation of 25(OH)D₃ before and after replacement in patients with dry eye disease (r=–0.390, p=0.049). Conclusions: As a consequence of the presence of VDR and 1α-hydroxylase in different parts of the eye, vitamin D replacement improves tear hyperosmolarity that is considered to be induced by ocular surface inflammation.     

Celiac crisis in an adult type 1 diabetes mellitus patient presented with diarrhea,weight loss and hypoglycemic attacks

Type 1 diabetes mellitus (T1DM) is an autoimmune disease, characterized by loss of the insulin-producing β cells of the islets of Langerhans in the pancreas, causing insulin deficiency. Celiac disease has been seen in 3 to 8 % of T1DM patients. Celiac crisis, an acute severe onset of celiac disease, is a rare and life-threatening manifestation. We report a 50-year-old man with type 1 diabetes mellitus who arrived at our service with a 2-month history of watery diarrhea associated with hypoglycemic attacks, abdominal pain, and weight loss of 13 kg. The diagnosis of celiac crisis was made based on diarrhea leading to dehydration, severe metabolic and electrolyte abnormalities, and subsequent improvement after introduction of a gluten-free diet.