Objective: The aim of this study is to evaluate the effect of ejaculation on serum total, free and complex prostate-specific antigen (PSA) levels and their effect on biopsy decisions. Material and methods:Our study includes 47 men older than 45 years with symptomatic benign prostatic hyperplasia (BPH). Patients' PSA levels were under 2.5 ng/mL, and there were no known conditions to preclude ejaculation. Eight patients with similar demographic, and clinical characteristics were chosen as a control group. With three days of sexual abstinence, blood samples were drawn for the measurement of baseline PSA levels, and then the patients were told to ejaculate. One, 5, 24 and 72 hours after ejaculation, serum total, free and complexed PSA levels were measured. Serum PSA sampling was performed at the same intervals in the control group without ejaculation. Results:The mean age of the patients was 59.13±1.38 years in the study group, and 63.75±3.13 years in the control group. The mean international prostate symptom scores (IPSS) were 11.78±1.12 and 11.63±3.32 in the study, and the control groups, respectively. The mean baseline total, free, and complexed PSA values were 1.07±0.09, 0.31±0.03, and 0.71±0.08 ng/mL, respectively. In the study group, total PSA value was found to be 1.29±0.12 ng/mL (p=0.008) at first hour after ejaculation, and this change was statistically significant when compared with baseline values. Mean total PSA level rose up to 1.28±0.13 ng/mL (p= 0.05) by the 5 th hour after ejaculation, but this change was not statistically significant relative to the baseline values. Mean free PSA level rose after the first hour postejaculation to 0.37±0.04 ng/mL (p= 0.01) and after the fifth hour postejaculation to 0.37±0.04 ng/mL (p= 0.002), and these changes were statistically significant relative to the baseline values. There were no statistically significant changes at the other sampled times as for the total, free or complexed PSA serum levels. When all three values were considered individually, in only 2.12% of the patients, biopsy decisions could be affected by the elevation in PSA levels. Conclusion:When the PSA value is borderline with respect to biopsy decisions, the effect of ejaculation on serum PSA levels may be clinically important. In these patients, ejaculation must be questioned, and repeated. PSA levels should be evaluated 24 hours after ejaculation. There were no statistically significant changes in the levels of complex PSA values. Further studies are needed to clarify the relationship between complexed PSA and ejaculation.

ARTICLE INFO ______________________________________________________________ ______________________Purpose: Aim of this study is to examine the effectiveness of dextranomer/hyaluronic acid copolymer and polyacrylate polyalcohol copolymer in endoscopic treatment of vesicoureteral reflux disease in adult patients with and without chronic renal failure. Materials and Methods: Thirty two patients (12 female, 20 male) with a total of 50 renal units were treated for vesicoureteral reflux. There were 26 (81%) chronic renal failure patients. The success of treatment was evaluated by voiding cystouretrography at 3rd and 12th months after subureteric injection. The persistence of reflux was considered as failure. Patients were divided into two groups according to injected material. Age, sex, grade of reflux and treatment results were recorded and evaluated.Results: Reflux was scored as grade 1 in seven (14%), grade 2 in 16 (32%), grade 3 in 21 (42%) and grade 4 in six (12%) renal units. There was not patient with grade 5 reflux. Fourteen renal units (28%) were treated with dextranomer/hyaluronic acid copolymer (group 1) and 36 renal units (72%) were treated with polyacrylate polyalcohol copolymer (group 2). The overall treatment success was achieved at 40 renal units (80%). The treatment was successful at 11 renal units (79%) in group 1 and 29 renal units (81%) in group 2 (p = 0.71). There was not statistically significant difference between two groups with patients with chronic renal failure in terms of treatment success (p = 1.00). Conclusions:The effectiveness of two bulking agents was similar in treatment of vesicoureteral reflux disease in adult patients and patients with chronic renal failure.

ÖzetMesanenin küçük hücreli karsinomu, yüksek sistemik metastaz insidansı ile klinik olarak saldırgan bir davranış ile karakterize nadir bir antitedir. Tüm primer mesane tümörlerinin yaklaşık %0.5 kadarını oluşturur. Mesanenin küçük hücreli kanseri tanısı alan 48 yaşındaki erkek olgu literatür bilgileri eşliğinde sunuldu.

ÖzetAmaç: Bu çalışmada mesane ürotelyal kanseri nedeniyle radikal sistoprostatektomi yapılan hastalarda prostat adenokarsinom sıklığını araştırmayı ve prostat kanseri saptanan olguların histopatolojik özelliklerini ortaya koymayı amaçladık. Gereç ve Yöntem:Ocak 2005 ile Haziran 2011 yılları arasında mesane ürotelyal kanseri nedeniyle radikal sistoprostatektomi yapılan ve ameliyat öncesi prostat kanseri tanısı olmayan 157 erkek hasta çalışmaya alındı. Hastaların patolojileri geriye dö-nük olarak değerlendirildi. Üriner diversiyon olarak 125 hastaya ileal konduit, 28 hastaya ortotopik ileal mesane ve dört hastaya üreterokütanostomi tekniği uygulandı. Bulgular: Radikal sistoprostatektomi uygulanan 157 hastanın 26'sında (%16.5) prostat kanseri saptandı. Prostat kanseri saptanan hastaları ortalama yaşı 67.3 yıl, saptanmayanların ise 61 yıl idi. Ortalama PSA değerleri prostat kanseri saptanan ve saptanmayan hastalarda sırası ile 2.9±0.35 ng/dl ve 2.7±0.41 ng/dl idi. Prostat kanseri saptanan hastaların Gleason skoru bir hastada 2+2, bir hastada 4+3 ve 24 hastada 3+3 olarak bulundu. Bu hastaların mesane kanseri patolojik evresi ise 10 hastada T4N2, bir hastada T4N1, dört hastada T3N1, sekiz hastada T2N0, bir hastada T1N0 ve iki hastada T0N0 olarak bulundu.Sonuç: Çalışmamızda radikal sistoprostatektomi uygulanan hastalarda rastlantısal prostat kanseri saptanma sıklığı %16.5 olarak bulunmuş olup bu nedenle hastaların patolojilerinin dikkatli ve detaylı değerlendirilmesi gerektiğini düşünmekteyiz.Anahtar sözcükler: Rastlantısal prostat adenokarsinomu; sistoprostatektomi; ürotelyal mesane karsinomu. SummaryBackground: The aim of this study is to evaluate the incidence of prostate adenocarcinoma in patients who underwent radical cystoprostatectomy for urotelial carcinoma, and present the histopathological features of these patients.

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