Publications by authors named "Ayhan Dalkilic"

14 Publications

  • Page 1 of 1

The learning curve of sting method for endoscopic injection treatment of vesicoureteral reflux.

Int Braz J Urol 2018 Nov-Dec;44(6):1200-1206

Department of Pediatric Urology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

Objective: To identify how many endoscopic injection (EI) procedures, STING method, must be performed before reaching an ideal success rate when simulation training has not been received.

Materials And Methods: The EI procedures performed by two pediatric urology fellows were investigated. The study excluded patients without primary VUR and those with previous EI or ureteroneocystostomy, lower urinary tract dysfunction, and/or duplicate ureters. The EIs used dextranomer hyaluronate and the STING method, as described by O'Donnell and Puri. Groups number was determined by multiple statistical trials. Statistically significance differences were achieved with one combination that had 35 EI procedures each and with 3 different combination of patients, having 12, 24, and 36 patients, respectively. Therefore, groups were established 12 patients. The first fellow performed 54 EIs, and the second performed 51. Therefore, each of the first fellow's three groups contained 18 EI procedures, and each of the second fellow's 17.

Results: The study included 72 patients and 105 ureter units. When the data from both fellows were combined, each of the three groups contained 35 procedures. For the first fellow, the success rates in the first, second, and third groups were 38.3%, 66.6%, and 83.3% (p = 0.02), respectively, and for the second fellow, the success rates were 41.2%, 64.7%, and 82.3% (p = 0.045), respectively. The increased success rates for both fellows were very similar.

Conclusions: An acceptable rate of success for EI may be reached after about 20 procedures and a high success rate after about 35-40 procedures.
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http://dx.doi.org/10.1590/S1677-5538.IBJU.2017.0465DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6442187PMC
February 2019

A Comparison of EORTC And CUETO Risk Tables in Terms of the Prediction of Recurrence and Progression in All Non-Muscle-Invasive Bladder Cancer Patients.

Urol J 2019 02 21;16(1):37-43. Epub 2019 Feb 21.

Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey.

Purpose: To compare the prediction accuracy of the European Organization for Research and Treatment of Cancer (EORTC) and the Spanish Urology Association for Oncological Treatment (CUETO) risk tables in all non-muscle invasive bladder cancer patients.

Material And Methods: Recurrence and progression-free survival of all patients were assessed according to the EORTC and the CUETO risk tables for each patient and the concordance index was used to indicate discriminative ability. Statistical analyses were performed, at 1 and 5 years, to the whole group and separately to those treated or not treated with bacillus Calmette-Guerin (BCG) .

Results: The study included 400 patients. One-year BCG maintenance therapy was applied to 181 patients (45.3%). The recurrence rate was higher than in CUETO, and similar to EORTC. The EORTC was determined to provide better discrimination than CUETO in the whole patient group and in those treated or not treated with BCG. The concordance indices for these groups were 0.777, 0.705; 0.773, 0.669; and 0.823, 0.758, respectively . The progression rate was similar in this study to the rate defined in both risk tables. The discrimination power was similarin EORTC and CUETO for all the groups. The concordance indices were 0.801, 0.881; 0.915, 0.930; and 0.832, 0.806, respectively.

Conclusion: The EORTC has more power than CUETO to discriminate each recurrence risk group and both risk tables can successfully discriminate progression risk groups in all patients.
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http://dx.doi.org/10.22037/uj.v0i0.4091DOI Listing
February 2019

Lower urinary tract dysfunction in pediatric patients after ureteroneocystostomy due to vesicoureteral reflux: Long-term follow-up.

Low Urin Tract Symptoms 2019 Apr 11;11(2):O48-O52. Epub 2018 Jan 11.

Urology Department, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.

Objective: The aim of the present study was to evaluate long-term lower urinary tract dysfunction (LUTD) in pediatric patients who underwent ureteroneocystostomy due to vesicoureteral reflux.

Methods: The present retrospective study was performed on 61 patients. Patients were divided into 3 groups: Group 1 (n = 26), did not have LUTD; Group 2 (n = 23), had LUTD; and Group 3 (n = 12), was not toilet trained preoperatively. Patients were reassessed regarding de novo LUTD or the persistence of LUTD at least 7 years after the ureteroneocystostomy.

Results: Mean patient age was 7 years (range 1-15) when ureteroneocystostomy was performed and the surgery was associated with a 92% success rate. The mean follow-up period was 10 years (range 7-12 years). Postoperative LUTD was present in 6 (23%), 12 (52%), and 1 (8.3%) patients in Groups 1, 2, and 3, respectively. The presence of LUTD before surgery and bilateral repair in the same setting were predictive risk factors for the presence of LUTD during the long-term follow-up. LUTD occurred at higher rate in Group 2 than in Groups 1 and 3 (52% vs. 23% and 8.3%, respectively; P = .015). The presence of de novo LUTD was significant in Group 1 compared with the presence of preoperative and postoperative LUTD (P = .031, Wilcoxon analysis).

Conclusions: LUTD may not resolve after a ureteroneocystostomy, and additional therapy could be necessary. Due to the probability of damage to the ureterovesical nerve and/or disturbed bladder dynamics, de novo LUTD may occur in patients with bilateral high-grade reflux without LUTD before a ureteroneocystostomy.
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http://dx.doi.org/10.1111/luts.12213DOI Listing
April 2019

Applicability of the EORTC risk tables to predict outcomes in non-muscle-invasive bladder cancer in Turkish patients.

Turk J Urol 2017 Mar 6;43(1):48-54. Epub 2017 Jan 6.

Clinic of Urology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.

Objective: To evaluate the consistency of the results of patients who were treated for non-muscle-invasive bladder cancer (NMIBC) in our clinic with the European Organization for Research and Treatment of Cancer (EORTC) risk table.

Material And Methods: Data were retrospectively analyzed from 452 patients who had undergone transurethral resection of bladder tumor (TUR-BT) between the years 2002, and 2010 for primary or recurrent NMIBC. Our study had a retrospective design but based on prospective cohort study. Patients were staged according to the 2002 Tumor Node Metastasis (TNM) classification and the 1973 World Health Organization grading system. Recurrence was defined as non-muscle-invasive or muscle-invasive and progression as muscle-invasive tumor determined based on following cystoscopy and TUR-BT results, and confirmed by histopathologic analysis. Patients in the current study were classified into four groups according to the EORTC risk tables. Time to first recurrence and progression was determined for each risk group.

Results: Of the 452 patients, 348 were enrolled in this study. The overall mean follow-up period was 55.25 months of all patients. Of 348 patients, 130 (37.4%) and 258 patients (74.1%) had recurrence after treatment at the 1 and 5 year follow-up period, respectively. While 35 (10.1%) and 99 patients (28.4%) progressed to muscle-invasive cancer at the 1 and 5 year follow-up period, respectively. In the multivariate analysis, grade, number, size of the tumor size, and concomitant carcinoma in situ were found to be statistically significant for disease progression and recurrence.

Conclusion: When EORTC risk tables were comparatively evaluated in our patient population, we can say that EORTC tables predict nearly accurately the clinical course of patients with NMIBC.
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http://dx.doi.org/10.5152/tud.2016.77603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330268PMC
March 2017

The importance of active surveillance, and immediate re-biopsy in low-risk prostate cancer: The largest series from Turkey.

Turk J Urol 2016 Sep;42(3):140-4

Clinic of Urology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.

Objective: To evaluate long-term outcomes of active surveillance (AS) applied in low-risk prostate cancer patients, and the impact of re-biopsy results on the prediction of progression.

Material And Methods: In our clinic, patients who had undergone AS for low-risk localized prostate cancer between the years 2005-2013 were included in the study. Our AS criteria are Gleason score ≤6, prostate-specific antigen (PSA) level <10 ng/mL, number of positive cores <3, maximum cancer involvement ratio <50% each core. Immediate re-biopsy (within 3 months) was performed to 65 patients who accepted AS. Finally, 43 patients who met re-biopsy criteria were included in the study. Prostate biopsy specimens were harvested from 12 cores under the guidance of transrectal ultrasound (TRUS). Re-biopsy was performed within 3 months (1-12 weeks). In re-biopsy, a total of 20 core biopsies were performed including the far lateral (6 cores) and transition zone (2 cores) in addition to standard 12 core biopsy. Our follow-up protocol is PSA measurement and digital rectal examination (DRE) every 3 months within the first 2 years, than every 6 months. Control biopsies was performed one year later and once upon every 3 years to patients whose PSA levels and DREs were normal at follow-up visits. More than 2 tumor invaded cores or 50% tumor in one core, and Gleason score exceeding 6 points were accepted as indications for definitive treatment. Patients were divided into two groups by re-biopsy results and compared according to the time to progression. We have done multivariate regression analysis to predict prognosis by using data on age, PSA level, and detection of tumor in re-biopsy specimens.

Results: Patients' median age was 61 years and PSA level was 5 (2.7-9) ng/mL. Tumor was detected in 22 (34%) patients at re-biopsy and they underwent definitive treatment. Additionally tumor was detected in 9 patients, but active surveillance was maintained because their pathologic results met active surveillance criteria. Median follow time was 42 (24-117) months. Definitive treatment was performed in 9 (21%) patients. PSA recurrence was not detected in none of 9 patients during 38 months of follow up. Only the presence of tumor in re-biopsy specimens was found predictor of disease progression in multivariate analysis.

Conclusion: We think that AS is safe method for low-risk localized prostate cancer patients, if it is performed in compliance with certain criteria and regular follow up, and early re-biopsy can be useful either during early period or long term follow-up.
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http://dx.doi.org/10.5152/tud.2016.47786DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5012439PMC
September 2016

Does maternal exposure during pregnancy to higher ambient temperature increase the risk of hypospadias?

J Pediatr Urol 2016 Dec 13;12(6):407.e1-407.e6. Epub 2016 Aug 13.

Department of Urology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.

Introduction: The association between ambient temperature that the mother is exposed to during pregnancy and hypospadias has not been investigated by the studies, although the recent studies showed the correlation between some congenital malformations (congenital heart disease, neural tube defect, etc.) and ambient temperature.

Objective: The aim was to investigate the relation between hypospadias and the ambient temperatures that the mother is exposed to during her pregnancy.

Methods: The data of patients with hypospadias that had their gestational periods in Ankara and Istanbul regions, and had other urological treatments (circumcision, urinary tract infection, pyeloplasty, nephrolithotomy, etc.) between January 2000 and November 2015 were analyzed retrospectively. The ambient temperature at 8-14 weeks of gestation was investigated for each patient by reviewing the data of the General Directorate of Meteorology, since this period was risky for development of hypospadias. The data including ambient temperature that the pregnant mother was exposed to, maternal age, parity, economical status, gestational age at birth, and birth weight were compared between two groups. The retrospective nature of the study may be a potential source for selection bias.

Results: The data of 1,709 children that had hypospadias repair and 4,946 children that had other urological treatments between 2000 and 2015 were retrospectively analyzed. There were no differences between the groups for maternal age, parity, economical status, gestational age at birth, and birth weight (Table). Analysis of exposed maximum and average ambient temperatures at 8-14 weeks of gestation revealed that July and August, hot periods in summer time, were more prevalent in the hypospadias group (p = 0.01). The average and maximum monthly ambient temperatures during summer increased the risk for hypospadias (OR, 1.32; 95% CI, 1.08-1.52; and OR, 1.22; 95% CI, 0.99-1.54, respectively.

Conclusions: In this paper, we evaluated the relation between hypospadias and the ambient temperatures that the mother is exposed during her pregnancy. The results of this study indicated that the high ambient temperatures the mother and fetus are exposed to at 8-14 weeks of gestation increased the risk of hypospadias in the offspring.
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http://dx.doi.org/10.1016/j.jpurol.2016.06.015DOI Listing
December 2016

The effect of ureteroscope size in the treatment of ureteral stone: 15-year experience of an endoscopist.

Turk J Urol 2016 Jun;42(2):64-9

Department of Urology, Ondokuz Mayıs University School of Medicine, Samsun, Turkey.

Objective: We aimed to investigate the ureter stone treatment results performed by using different- caliber semirigid ureteroscopes (URS).

Material And Methods: Adult patients who were treated for ureteral stones by a single endoscopist between January 2000 and March 2015 were analyzed. The patients were divided into 3 groups in accordance with the caliber of the ureteroscope used: 10/10.5 F Storz (Karl Storz, Tuttlingen, Germany) (January 2002-January 2005) URS was used in group 1, 8.9/9.8 F Storz (February 2005-December 2011) URS was used in group 2, and 6/7.5 FWolf (Richard Wolf, Knittlingen, Germany) (January 2012-March 2015) URS was used in group 3. Patients' age and gender, size and site of stones, stone-free rates (SFR), intra- and perioperative complication rates, and durations of surgery were compared among the groups. Intraoperative complications were classified according to modified Satava, and perioperative complications were classified according to modified Clavien classification systems.

Results: A total of 2461 patients treated for ureteral stones were analyzed. There were 583 patients in group 1 (10/10.5 F Storz), 1302 patients in group 2 (8.9/9.8 F Storz), and 576 patients in group 3 (6/7.5 F Wolf). SFR were 83.7%, 87.4%, and 92.2% in groups 1, 2, and 3, respectively (p=0.01). Duration of surgery was 30.34±10.36 min in group 1, 31.61±10.10 min in group 2, and 42.40±7.35 min in group 3 (p=0.01). The overall complication rates classified according to modified Satava classification were 10.8%, 7.6%, and 6.9% (p=0.01) while grade 3 modified Satava complication rates were 1.9%, 1.5%and 0.5% in groups 1, 2, and 3, respectively (p=0.01).

Conclusion: In this study, we found that more frequent use of a small- caliber URS resulted in a longer duration of surgery and an increased rate for JJ stent insertion, however it facilitated a safer and more successful ureteroscopy procedure.
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http://dx.doi.org/10.5152/tud.2016.84594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857919PMC
June 2016

Ureteroscopy in proximal ureteral stones after shock wave lithotripsy failure: Is it safe and efficient or dangerous?

Can Urol Assoc J 2015 Sep-Oct;9(9-10):E718-22. Epub 2015 Oct 13.

Department of Urology, 18 Mart University, Canakkale, Turkey.

Introduction: We assessed the effectiveness of ureteroscopy (URS) in proximal ureteral stones performed after shock wave lithotripsy (SWL) failure, and determined outcomes in terms of success rate, complications, and operation time.

Methods: We analyzed data of patients with previous unsuccessful SWL (Group I) and the ones that did not have SWL or URS before (Group II) for proximal ureteral stones between December 2007 and August 2014. Group I included 346 patients who underwent complementary URS and Group II 209 patients who underwent primary URS. Success rates, operation time and complications were compared between groups.

Results: Success rates of complementary and primary URS were 78.9% and 80.9%, respectively. The difference in success rates was not statistically significant between groups (p = 0.57). The complication rates of complementary URS was 12.1%, and 9.5% in primary URS (p = 0.49). No statistically significant differences were noted in terms of gender, age, stone size and side, or lithotripter type between groups. The mean operation time and need for balloon dilatation were higher in complementary URS group compared to the primary URS group, and the difference was statistically significant (p < 0.05).

Conclusions: Complementary URS may be used safely after SWL failure in proximal ureteral stones. Its success rate and morbidities are similar to primary URS, except for longer operation time and an increased need for balloon dilatation.
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http://dx.doi.org/10.5489/cuaj.2745DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4662429PMC
December 2015

Evaluation of Results of Diagnostic Ureteroscopy in Chronic Hemodialysis Patients.

J Endourol 2016 Apr 17;30(4):371-4. Epub 2015 Dec 17.

2 Department of Urology, Sisli Hamidiye Etfal Training and Research Hospital , Istanbul, Turkey .

Objectives: To investigate the safety of diagnostic ureteroscopy (dURS) in chronic hemodialysis patients.

Methods: The data of chronic hemodialysis patients (group I) and the patients with normal estimated glomerular filtration rate (eGFR) (group II) who had dURS between 2004 and 2014 were analyzed retrospectively. eGFR, complications, and postoperative stent placement were noted in all patients. Continuous and categorical variables were compared between the groups. p < 0.05 was considered as statistically significant.

Results: Overall complication rate of group I was 10.5%, while this rate was 4.8% in group II (p = 0.16). No statistically significant differences were noted in terms of gender, age, or laterality between two groups. The mean duration of surgery and the rates of balloon dilatation and postoperative stent placement were higher in group I when compared with group II, and differences were statistically significant (p < 0.05).

Conclusions: In this study, we determined that dURS was a safe method in chronic hemodialysis patients. However, duration of surgery and the rates of balloon dilatation and postoperative stent placement were high in our study.
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http://dx.doi.org/10.1089/end.2015.0675DOI Listing
April 2016

Analysis of results of recurrence and progression rates of high-grade Ta bladder cancer and comparison with results of high-grade T1.

Urologia 2014 Oct-Dec;81(4):237-41. Epub 2014 May 22.

Ankara Training and Research Hospital, Ankara - Turkey.

Introduction: We aimed to evaluate the long-term recurrence and progression rates in a Turkish population with high-grade Ta and T1 bladder cancer and to determine malign potential of high-grade Ta bladder cancer.

Methods: 191 patients who had non-invasive bladder cancer were evaluated at a single institution between 2005 and 2010. Median follow-up was 55.6 months (13-108). Long-term follow-up results of recurrence and progression rates of high-grade Ta and T1 were analyzed and compared with each other.

Results: Of the 191 patients, 143 (74.9%) were high-grade T1 and 48 (25.1%) were high-grade Ta. Of the 143 patients who were high-grade T1, 39 (27.2%) responded to the induction BCG without recurrence. 33 (23%) patients had invasion deep into the muscle layer. 61 (42%) patients had recurred as high-grade T1. Of the 48 patients who were high-grade Ta, 15 (31%) responded to induction BCG without recurrence. 18 (37.5%) patients had recurrence as high-grade Ta. 12 (25%) patients had invasion deep into to the muscle layer. Of all the patients, 13 (7%) patients died of causes related to bladder cancer. In a multivariate analysis, concomitant CIS was statistically significant for the progression of high-grade Ta bladder cancer (p<0.005).

Conclusions: According to the data of the current study, the presence of concomitant CIS in patients with high-grade bladder cancers is associated with a higher risk of progression. There is a need for larger scale multi-institutional studies in order to support the hypothesis that high-grade Ta tumors should be considered as T1 tumors.
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http://dx.doi.org/10.5301/uro.5000072DOI Listing
December 2016

Effects of human Umbilical Cord Stem Cells and Granulocyte Colony- Stimulating Factor (G-CSF) on Carbon Tetrachloride-Induced Nephrotoxicity.

Nephrourol Mon 2012 20;4(3):545-50. Epub 2012 Jun 20.

Department of Nephrology, Sisli Etfal Research and Educational Hospital, Istanbul, Turkey.

Unlabelled:

Background: Recently, stem cells have been used to facilitate healing in animal models of renal failure induced by acute ischemic and nephrotoxic damage. Granulocyte colony-stimulating factor (G-CSF) has been reported to stimulate stem cell mobilization from bone marrow and these cells may contribute to renal repair.

Objectives: In the present study, the effects of G-CSF and stem cell administration as monotherapy or in combination, and the relation of these effects with the duration of therapy, have been investigated in an experimental rat model of carbon tetrachloride (CCl4)-induced nephrotoxicity.

Materials And Methods: The fifty rats included in the study were distributed into 4 main groups, Group 1, 2, 3, and 4, and two subgroups for each group, except for Group 1. All rats received an intraperitoneal injection of CCl4. Then at 6 h, Groups 1, 2a, 3a, and 4a were administered saline, stem cells, G-CSF, and stem cell plus G-CSF, respectively. At 24 h, Groups 2b, 3b, and 4b were administered stem cells, G-CSF, and stem cell plus G-CSF, respectively. All animals were sacrificed 48 h after the CCl4 injections. Serum urea, creatinine, sodium, and potassium levels were measured from blood samples. Tissue α-glutathione S-transferase (GST) levels were also measured from renal tissues.

Results: Serum urea was reduced in all groups when compared to Group 1, but the decrease was statistically significant only in Group 3b (P = 0.04). Serum creatinine and sodium levels were similar in all groups (P > 0.05). Tissue GST levels were lower in all groups, but the reduction was significant only in Group 4a, which was administered stem cells + G-CSF at 6 h (P = 0.01). Tubular degeneration and/or tubular dilatation were the most common pathologic changes, and their incidence was similar in all groups (P > 0.05).

Conclusions: Although both stem cell and G-CSF monotherapy led to damage reduction, the effect was not significant. However, the reduced damage by the combined use of stem cells and G-CSF, particularly during the early period, was statistically significant.
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http://dx.doi.org/10.5812/numonthly.2979DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3614292PMC
April 2013

A case of seminal vesicle cyst associated with ipsilateral renal agenesis diagnosed during an investigation of urinary incontinence.

Turk J Urol 2013 Mar;39(1):53-5

Clinic of Urology, Şişli Etfal Training and Research Hospital, İstanbul, Turkey.

Seminal vesicle cysts are rare and usually associated with ipsilateral renal agenesis. The diagnosis of seminal vesicle cysts may be delayed or missed because of the non-specific symptoms of this condition. In this study, we aimed to discuss the diagnosis and treatment of a left seminal vesicle cyst that was associated ipsilateral agenesis in a 24-year-old patient who presented to our outpatient department with urinary incontinence. Ultrasonography and magnetic resonance imaging revealed a seminal vesicle cyst measuring 40×45 mm in diameter. Although the patient's symptoms were relieved with cyst aspiration via transrectal ultrasonography, the symptoms recurred 6 months later.
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http://dx.doi.org/10.5152/tud.2013.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548576PMC
March 2013

Early penile metastasis from primary bladder cancer as the first systemic manifestation: a case report.

Cases J 2009 Aug 14;2:7281. Epub 2009 Aug 14.

Department of 1st Urology, Sisli Etfal Research Hospital, Sişli, Istanbul, 34360 Turkey.

Metastatic involement of penis is an exceptionally rare condition. 77% of the metastases are originated from the pelvic region; prostate and bladder are the most frequent primary locations. Retrograde venous route, retrograde lymphatic route, arterial spread, direct extension, implantation and secondary to instrumentation are the mechanisms of metastasis. Approximately two thirds of all penile metastasis are detected at a mean time of 18 months after the detection of the primary tumor and the remaining one third is presented at the same time with primary tumor. Diagnosis is usually made by biopsy and also non invasive methods as MRI or colour-coded duplex ultrasonography. Treatment options in these patients are local excision, partial or complete penectomy, external beam radiation therapy and chemotheraphy. Despite these alternatives prognosis is usually poor.We present a case of urethelial carcinoma of the bladder and coincidental prostate adenocarcinoma with penile metastasis which is presented with priapism 6 months after radical cystectomy as the first systemic manifestation. We performed biopsy initially for staging and the patient underwent MRI showing the extension of the disease. The patient underwent radiotherapy of 56 gy and priapism partially resolved after the treatment. Chemotheraphy was also planned but the patient died 3 months following radiotheraphy.
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http://dx.doi.org/10.1186/1757-1626-0002-0000007281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827083PMC
August 2009