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A differential diagnosis of testicular torsion and epididymitis has serious importance for testicular health. In emergency conditions, if testicular torsion goes unnoticed and epididymo-orchitis is diagnosed, organ loss may occur. This study aimed to evaluate the usefulness of haematologic parameters for the diagnosis of both testicular torsion and epididymo-orchitis and for differential diagnosis of these two diseases. Patients were divided into three groups as those undergoing surgery for testicular torsion, those receiving medical treatment for epididymitis and a healthy control group. All patients had complete blood counts taken with determinations of mean platelet volume (MPV), platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR) and leucocyte counts. These were then compared between groups. Leucocyte, MPV and NLR values were higher in both the epididymitis and torsion groups compared to the controls (p < .001). Platelet counts and PLR were significantly higher in the epididymitis group compared to the other two groups (p < .001). Leucocyte, MPV and NLR values may be used in the diagnosis of epididymitis and testicular torsion. Platelet counts and PLR appear to be useful in differentiating epididymitis from testicular torsion. However, there is a need for prospective studies with larger numbers of patients.

Objective: In this study we aimed to evaluate prognostic factors for the survival of patients with Fournier's gangrene (FG), and overview different validated scoring systems for outcome prediction. Material and methods:We retrospectively analyzed the data of 39 patients treated for FG in our clinic. Data were collected on medical history, symptoms, physical examination findings, vital signs, laboratory parameters at admission and at the end of treatment, timing and extent of surgical debridement, and the antibiotic treatment used. The Fournier's Gangrene Severity Index (FGSI) and Charlson Comorbidity Index (CCI) were used to predict outcome. The data were analyzed in relation with the survival of the patients. Mann-Whitney U test, chi -square test, Wilcoxon signed rank test, and Cox regression analysis were used for the statistical analysis.Results: Of 39 patients analyzed, 8 (20.5%) died and 31 (79.5%) survived. The median FGSI score on admission was 2 (0-9) for the survivors and 6 (2-14) for the non-survivors (p=0.004). The median CCI scores of the survivors and non-survivors were 2 (0-10) and 6.5 (5-11), respectively (p=0.001). Except for urea, albumin and hematocrit levels, no significant differences were found between survivors and non-survivors for other laboratory parameters on admission. Lower albumin levels and advanced age were found to be associated with mortality. Conclusion:High blood urea, low albumin, and low hematocrit levels were associated with poor prognosis. High CCI and FGSI scores could be associated with a poor prognosis in patients with FG.

Stents and catheters are widely used in urology. In this study, the frequency of double J (DJ) stent colonization and stent-associated bacteriuria was investigated. Between June 2011 and June 2012, 130 patients (17-72 years old) who underwent DJ stenting were enrolled in the study. Surgeries prior to stenting included stone extraction/lithotripsy, endopyelotomy, and diagnostic ureteroscopy. Prior to stenting, sterile urine samples were obtained, and urinary cultures were performed upon removal of the DJ stents, the second procedure. DJ stent cultures were also performed. Sixty-three stents were inserted into the right ureter and 67 into the left ureter of the patients. Cultures showed bacterial colonization in 10 (7.7%) cases. There was no significant association between positive stent culture and patient age, sex, or stent laterality. The rate of colonization was 2.2%, 2.9%, and 25% when indwelling time was less than 4 weeks, 4-6 weeks, and more than 6 weeks, respectively. In the present study, the rate of infection associated with a DJ stent and urinary infection was not very high. However, bacterial colonization increases significantly with indwelling time of the stent, and sterile culture of urine does not rule out colonization of the stent. Bacteriological investigation showed very low rates of colonization within 6 weeks after the insertion of stents, indicating that ureteral stents can be used safely within that time period.

Introduction:The discrepancy between prostate biopsy and prostatectomy Gleason scores is common. We investigate the predictive value of prostate biopsy features for predicting Gleason score (GS) upgrading in patients with biopsy Gleason scores ≤6 who underwent radical retropubic prostatectomy (RRP). Our aim was to determine predictors of GS upgrading and to offer guidance to clinicians in determining the therapeutic option. Methods: We performed a retrospective study of patients who underwent RRP for clinically localized prostate cancer at 2 major centres between January 2007 and March 2013. All patients with either abnormal digital examination or elevated prostate-specific antigen at screening underwent transrectal ultrasound-guided prostate biopsy. Variables were evaluated among the patients with and without GS upgrading. Our study limitations include its retrospective design, the fact that all subjects were Turkish and the fact that we had a small sample size. Results: In total, 321 men had GS ≤6 on prostate biopsy. Of these, 190 (59.2%) had GS≤6 concordance and 131 (40.8%) had GS upgrading from ≤6 on biopsy to 7 or higher at the time of the prostatectomy. Independent predictors of pathological upgrading were prostate volume <40 cc (p < 0.001), maximum percent of cancer in any core (p = 0.011), and >1 core positive for cancer (p < 0.001). Conclusions: When obtaining an extended-core biopsy scheme, patients with small prostates (≤40 cc), greater than 1 core positive for cancer, and an increased burden of cancer are associated with increased risk of GS upgrading. Patients with GS ≤6 on biopsy with these pathological parameters should be carefully counselled on treatment decisions.

Bladder urothelial carcinoma is rare in young adults and occurs more commonly in older individuals. The aim of this study was to compare the clinical behavior, pathologic characteristics, and prognosis of urothelial carcinoma of urinary bladder in young versus older adults. A retrospective review of our records between 2007 and 2013 identified 56 patients (42 males and 14 females) with transitional cell carcinoma of the bladder who were less than 40 years old. Clinical and pathological parameters of patients who were less than 40 years of age were compared with those of a series of patients older than 40 years of age (the control group) during the same period. A survival analysis was performed using the Kaplan-Meier method and log-rank test, and Cox regression was performed to identify clinical parameters that affected the clinical outcomes. The mean age was 29.21 years (range, 5-40 years) for patients less than 40 years old and 61.66 years (range, 41-75) for those older than 40 years. The mean follow-up was 40.26 months (range, 12-65 months) for young patients and 42.57 months (range, 12-72 months) for the older patients. Young bladder cancer patients had smaller-sized tumors (less than 3 cm), less high-grade cancers, higher papillary urothelial neoplasms of low malignant potential, and low-grade tumors than patients older than 40 years. Multivariate logistic regression analysis predicted tumor recurrence in young patients with high-grade tumors [odds ratio (OR), 1.959; 95% confidence interval (CI), 1.235-2.965; p = 0.046] and tumors larger than 3 cm (OR, 1.772; 95% CI, 1.416-1.942; p = 0.032). The 5-year overall survival rate was 100% for young patients and 88.1% for older patients. No difference was observed in the recurrence-free (p = 0.321) and progression-free (p = 0.422) survival rates between the two groups. We concluded that although the clinical stage distribution, natural history, and outcomes of bladder urothelial cancer in young adults are similar to those in their older counterparts, clinicians must be aware that patients under 40 years of age presented with higher-grade and larger (>3 cm) tumors and are more likely to experience tumor recurrence.

This study indicates that intraperitoneal administration of sildenafil and udenafil efficiently suppresses radical production while decreasing histological changes after testicular ischemia-reperfusion injury.

Introduction:The aims of this study were to investigate the effect of varicocelectomy on DNA fragmentation index and semen parameters in infertile patients before and after surgical repair of varicocele.Materials and Methods:In this prospective study, 72 men with at least 1-year history of infertility, varicocele and oligospermia were examined. Varicocele sperm samples were classified as normal or pathological according to the 2010 World Health Organization guidelines. The acridine orange test was used to assess the DNA fragmentation index (DFI) preoperatively and postoperatively.Results:DFI decreased significantly after varicocelectomy from 34.5% to 28.2% (P = 0.024). In addition all sperm parameters such as mean sperm count, sperm concentration, progressive motility and sperm morphology significantly increased from 19.5 × 106 to 30.7 × 106, 5.4 × 106/ml to 14.3 × 106/ml, and 19.9% to 31.2% (P < 0.001) and 2.6% to 3.1% (P = 0.017). The study was limited by the loss to follow-up of some patients and unrecorded pregnancy outcome due to short follow-up.Conclusion:Varicocele causes DNA-damage in spermatozoa. We suggest that varicocelectomy improves sperm parameters and decreases DFI.