Simplification of laparoscopic extraperitoneal colposuspension: Results of two-port technique

Purpose: The aims of the present prospective study were to apply a new simplification for Laparoscopic Burch Colposuspension and to assess the postoperative results of this treatment modality for stress urinary incontinence.Materials and methods: Twenty-four patients underwent simplified laparoscopic procedure via two ports, utilising endoscopic tacker and two stripes of prolene mesh. Patients were evaluated for operative time,duration of urethral catheter, length of hospital stay, complications and continence status.Results: The technique was successful in 21 patients after 24 months follow-up. Average operative time was 39 minutes. The lengths of urethral catheterisation and hospital stay were 22 and 45 hours, respectively. One operative complication and three postoperative recurrences were recorded.Conclusion: Laparoscopic bladder neck suspension continues to develop as the instruments and techniques are improved. In carefully evaluated patients, it provides safe and minimally invasive procedure. We report the results of a new technique to simplify and speed up a laparoscopic extraperitoneal colposuspension. This revised version was published online in August 2006 with corrections to the Cover Date.     

Terazosin in the Treatment of Premature Ejaculation: A Short-term Follow-up

Aim: The aim of the present study was to evaluate the efficacy of terazosine in patients with premature ejaculation and lower urinary tract symptoms (LUTS), after excluding other sexual disorders and chronic prostatitis. Methods: A total of 90 patients with premature ejaculation and LUTS were enrolled to the study after excluding sexual disorders, prostatitis and benign prostatic hyperplasia. The patients were divided into two groups. Sixty patients in group 1 were treated with terazosine 5 mg daily for a month. Patients were followed monthly and questioned for their ejaculation problem. The results were classified as cure, improvement and ineffective. If patients showed improvement and ineffectiveness, the treatment was continued with 10 mg daily for the following month. Group 2 was included 30 patients, and placebo was applied for a month. At the end of this period, in patients who did not show any improvement, terazosine 10 mg was started. Results: In the treatment group, at the 1st month follow-up, 21 patients (35%) were cured, 20 (33.3%) showed improvement. In 19 (31.7%) patients, the treatment was ineffective. In group 2, 9 (30%) patients showed improvement and the rest had no-changes after one-month follow up. There was statistically significant difference between two groups (Pearson χ² test=0.000). Later, terazosine 10 mg was given to the patients in group 2 and to the patients who showed improvement or unsuccessful result with terazosine 5 mg. With terazosine 10 mg, 10 (14.5%) patients were cured, 29 (42.2%) patients were improved. Finally, terazosine treatment in patients with premature ejaculation was found to be effective in 60 patients (66.7%).Conclusion: Alpha blockers seem to be physiological medical agents in the treatment of premature ejaculation since ejaculation is under sympathetic control. Moreover, these agents are effective in lower urinary tract and they should be used in patients with premature ejaculation and lower urinary tract symptoms.     

Assessment of sapheno-femoral junction continence in patients with primary adolescent varicocoele

Background Although there is much evidence supporting a relationship between primary varicocoele and venous incompetence of the saphenofemoral junction in adults, there is no evidence for such a relationship during adolescence. Because of the effect of age and future occupation (standing upright for long periods) on the aetiology, pathogenesis and frequency of varicose veins of the lower extremity and incompetence of saphenofemoral junctions in adulthood, a comparison during adolescence is appropriate.Objective On the basis of a close physiopathological and haemodynamic relationship between primary varicose veins and primary varicocoele, we decided to evaluate the competence of the saphenofemoral junctions in a selected group of adolescents affected by primary varicocoele and compare these results with age-matched healthy adolescents.Materials and methods Twenty-five adolescents with primary varicocoele and 23 age-matched healthy controls were included in the study. In all cases physical examination and colour Doppler US was used to diagnose or exclude the presence of primary varicocoele and to evaluate the continence of the saphenofemoral junction.Results On the right side, 10 of 25 varicocoele patients and on the left side 11 of 25 varicocoele patients had incompetence of the saphenofemoral junction. For the control patients the incidence was 2/23 on the right side and 4/23 on the left side. The difference is statistically significant.Conclustions We demonstrated high concurrence of varicocoele and valvular incompetence of the saphenofemoral junction in a particular adolescent group. We suggest clinical examination and US assessment of the saphenofemoral junctions of adolescents affected by varicocoele in order to detect the early diagnosis of venous insufficiency of the lower limbs among these patients.     

Four analgesic techniques for shockwave lithotripsy: eutectic mixture local anesthetic is a good alternative

BACKGROUND AND PURPOSE: Various sedative and analgesic medication has been used for shockwave lithotripsy (SWL). The aim of this study was to evaluate the efficacy of different anesthesia modalities in these patients. PATIENTS AND METHODS: One hundred patients were randomly divided into four groups. The first (Group F) received fentanyl 1 microg/kg intravenously (IV), the second (Group D) received diclofenac sodium 1 mg/kg intramuscularly (IM), the third (Group T) received tramadol 1.5 mg/kg IM, and the fourth (Group E) was given 15 g of eutectic mixture local anesthetic (EMLA) cream containing lidocaine and prilocaine. After routine preoperative evaluation, all patients received midazolam 2 mg IV 5 minutes before lithotripsy for sedative premedication. In all groups, a supplemental 25-microg bolus of fentanyl was administered IV when patients complained of pain, moved, or grimaced in response to the shockwaves. Pain intensity was evaluated on a 0- to 100-mm visual analog scale (VAS). The level of sedation was determined using the Observer's Assessment of Alertness/Sedation (OAS/S). Side effects such as bradypnea, oxygen desaturation, bradycardia, pruritus, and nausea and vomiting were recorded. RESULTS: There were no statistically significant differences among the four groups with regard to VAS, OAS/S scores, or side effects. In Group F, the mean arterial pressure was decreased significantly at 10 and 20 minutes. The patients in this group also manifested a decrease of oxygen saturation at the first, tenth, and twentieth minutes and the end of SWL. CONCLUSION: Application of EMLA cream was as safe and effective as fentanyl, diclofenac, and tramadol, and reduction of the fentanyl dose during SWL was possible.     

Techniques of corporoplasty for penile curvature: Review of 18 patients

Penile curvature which can be acquired or combined with some congenital anomalies may cause trouble in sexual function or can affect the psychological status of the individual. Whatever the causes or the results are, this condition has been tried to be corrected for many years by many different techniques. Eighteen patients with penile curvature have been reviewed. Thirteen patients underwent Nesbit procedure, in 3 patients plication of the tunica albuginea was done and in 2 patients longitudinal incision and horizontal closure of the tunica albuginea were performed. In all cases the results were both functionally and cosmetically satisfying. The advantages and disadvantages of these techniques are discussed, with a review of the relevant literature. Presented at the XIIIth International Symposium of Operative Andrology, Budapest, 1993.     

Magnetic Resonance Imaging (MRI) in Penile Metastases of Extragenitourinary Cancers

Background: The aim of present study is to evaluate the efficacy of magnetic resonance imaging (MRI) in different types of penile metastases. Materials and methods: In this report, we present three cases of penile metastases that have been developed secondary to extragenitourinary malignancies. Two of them did not have any primary malignancy history.Results: Penile biopsies were performed in all patients and metastatic penile tumours were found due to extragenitourinary malignancies. Penile MRI was performed before biopsies. The findings of MRI were correlated with histopathologic diagnosis. Moreover, penile MRI was found to be more sensitive in the evaluation of the lesions than ultrasonography.Conclusion: MRI can be accepted as a reliable non-invasive method for the evaluation of the extent of penile metastases and involvement of tunica albuginea or urethral.