Minimally invasive connective water vapor energy method for benign prostatic hyperplasia.

The Rezum system has emerged as a promising treatment option for benign prostatic hyperplasia (BPH) by employing endoscopic removal of prostate tissue. This meta-analysis aimed to evaluate the benefits and drawbacks of Rezum therapy in recent studies. A systematic literature search was conducted in EMBASE, PubMed, and the Cochrane Library databases until December 2021, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search utilized keywords such as water vapor thermal therapy, Rezum, convective water vapor thermal therapy, and convective radiofrequency water vapor thermal therapy. A total of 21 studies were included in the analysis, comprising 5 prospective randomized studies, 2 case series, 2 randomized controlled trials, 1 crossover study, and 11 retrospective studies. The collective sample involved 2090 patients with a mean follow-up period of 14.42 ± 18.08 (1-72) months and a mean age of 68.12 ± 4.79 years. Significant improvements were reported in the International Prostate Symptom Score (IPSS), quality of life (QoL), maximal flow rate (Qmax), postvoid residual urine volume (PVR), prostate volume (PV), and International Erectile Index Function (IIEF) values. Unlike other BPH treatments that often require general or regional anesthesia, the connective water vapor energy system can be administered with sedo-analgesia and local anesthesia, potentially leading to improved sexual function scores. Considering the relief of symptoms, Rezum therapy may serve as a viable alternative to transurethral surgery for patients with prostate volumes ranging from <30 to >80 cc.

Efficacy of Pentosan Polysulfate Treatment in Patients with Interstitial Cystitis/Bladder Pain Syndrome.

Objectives: Pentosan Polysulfate (PPS) is the only oral treatment for interstitial cystitis (IC)-bladder pain syndrome (BPS) approved by the World Health Organization. Self-evaluation scales can provide more objective results on pre- and post-treatment satisfaction. The aim of this study was to investigate the effect of pentosan polysulfate treatment on symptoms in IC-BPS patients. Methods: This study included 37 adult male and female patients with IC-BPS who reported pain, urinary urgency, polyurea, and nocturia without urinary tract infection for a minimum of six months prior to the study and were taking 300 mg/day oral pentosan polysulfate. Pre- and post-treatment symptoms, Interstitial Cystitis Symptom Index (ICSI) Scores, quality of life (QoL) scores (1-4), and satisfaction conditions were examined. Results: Following the application of inclusion and exclusion criteria, mean age of 37 suitable patients was 46.0±11.9 years and 27% (10 individuals) of the patients were male. Pre-treatment, ICSI scores, and measures of satisfaction degree and QoL increased significantly after the treatment (p<0.001). Adverse reaction was detected in two patients (5.4%) among the patients treated with pentosan polysulfate. Conclusions: Oral pentosan polysulfate for the treatment of interstitial cystitis/bladder pain syndrome treatment could achieve recovery in symptoms, increase Interstitial Cystitis Symptom Index score and improve quality of life and patient satisfaction.

[Miliary Pulmonary Tuberculosis After Intravesical BCG Instillation in a Patient with High-Grade Bladder Cancer]. / Intravezikal BCG Uygulamasi Sonrasi Olusan Miliyer Akciger Tüberkülozu Olgusu.

Intravesical administration of Bacillus Calmette-Guerin (BCG) vaccine is used in the treatment of superficial bladder cancer. In clinical practice, intravesical BCG immunotherapy after transurethral tumor resection is a highly effective treatment option in preventing tumor recurrence and progression in medium and high risk superficial bladder tumors. Since patients are given live tuberculosis (TB) bacillus, serious side effects such as pneumonia, sepsis and even death can be seen. Lung involvement occurs in less than 1% of patients and most commonly presents as interstitial pneumonia or miliary TB. Miliary TB is difficult to diagnose and is usually based on high clinical suspicion, as Mycobacterium bovis is not isolated in most cases. Treatment is not completely standardized. However, in severe cases, a combination of antituberculosis drugs and corticosteroids is recommended. In this report, a case of miliary tuberculosis, a very rare complication after instillation of BCG into the bladder in a patient with a diagnosis of superficial bladder cancer, was presented. A 73-year-old male patient diagnosed with bladder tumor underwent transurethral resection of bladder tumor, and then weekly intravesical injection of BCG-MEDAC for six weeks had no adverse effects. Three weeks of intravesical BCG supplementation was planned for the patient who had no signs of recurrence when checked three months later by cystoscopy. Two hours after the first dose, the patient, who applied to the emergency department with the complaint of chills and shivering, was hospitalized for further follow-up and treatment. Afterwards, repeat cultures were taken from the patient whose fever continued on the seventh day of treatment with broad-spectrum antibiotics (meropenem and teicoplanin). In addition, when abdominal and thorax computed tomography (CT) were performed, multiple miliary nodular lesions were detected in both lungs and were evaluated in favor of miliary TB. With these findings, the patient was started on miliary TB therapy [isoniazid (INH), rifampicin (RIF), ethambutol (EMB) and streptomycin (STM)] targeting Mycobacterium bovis, since it was an infection that developed after BCG injection. In the third week of the treatment, the patient's fever was under control, and he was discharged on the 25th day of his hospitalization because of significant improvement in infection markers [C-reactive protein(CRP)-procalcitonin]. At the end of two months, there was clear regression of pulmonary abnormalities on control thorax CT. In conclusion, miliary TB developing after intravesical BCG instillation is a very rare condition, the cause of which is not fully understood, the etiology of fever can be easily missed, and the diagnosis is difficult. In addition, this case is presented to draw attention to a critical disease that requires long treatment and follow-up and requires attention.

Investigation of the effectiveness of magnetic field therapy in women with urinary incontinence: Literature review.

OBJECTIVE: Magnetic stimulation (MS) provides a novel strategy for the treatment of urinary incontinence (UI), although its efficacy remains uncertain. This systematic review both evaluated the effects of MS treatment on UI and investigated its impacts on female patients' life quality. METHODS: A review of the literature that was conducted in EMBASE, PubMed, Google Scholar, and the Cochrane Library (2016-2021) with the search terms; Incontinence of stress OR urge of urination OR Urinary incontinence mixed type. The search was carried out for all randomised controlled trials (RCTs) in English. A manual search has also been conducted for the reference lists of the studies found. Seven studies, with a total of 523 patients (475 patients with SUI), 12 urge urinary incontinence. The study included patients with (UUI) and 36 patients with mixed urinary incontinence (MUI). A total of 10 male patients were excluded from the study. In the included studies, The International Incontinence Questionnaire-Short Form was used to investigate the effects of MS therapy on UI symptoms (ICIQ-SF). RESULTS: According to the literature review, MS is an effective therapy option for female patients with UI. Still, to establish the efficacy of MS in this area, more large-scale, high-quality RCTs with extended follow-up periods that use consistent stimulation modalities and evaluate comparable outcomes are needed. CONCLUSION: MS treatment leads to an improvement in the symptoms of UI, in addition to an associated Improved quality of life for patients, without any reported side effects, while the longer-term treatment outcomes must be determined by long-term trials.

A case of a high-flow priapism treated with superselective transcatheter embolization.

High-flow priapism is a rare condition characterized by prolonged and painless erection. It is defined as contusion or thrombosis of the cavernous body of the penis usually secondary to blunt trauma. Due to the rarity of the disease, there is no well-defined consensus about treatment. Conservative treatment is often applied with non-steroidal anti-inflammatory drug. We present a case of 58-year-old man with proximal partial priapism that developed secondary to blunt trauma to the penis. The patient did not benefit from non-steroidal anti-inflammatory drug therapy and then was successfully treated with selective embolization.

How does gender affect ureaplasma and mycoplasma growth and antimicrobial susceptibility rates?

BACKGROUND: The aim of this study was to assess the presence of M. hominis and U. urealyticum agents, their distribution between male and female, and differences in antibiotic susceptibility in samples sent from Hisar Intercontinental Hospital's various clinics with the preliminary diagnosis of genitourinary system infection. METHODS: The Mycoplasma IES test was used to identify M. hominis and U. urealyticum, and to determine antibiotic susceptibility results, in samples taken from patients. The findings of mycoplasma and ureaplasma culture testing samples requested between 2014 and 2021 were evaluated retrospectively from our records. RESULTS: M. hominis was found to be positive in 7.37% of the examinations, U. urealyticum was found to be positive in 34.98% of the examinations, and either of them were found to be positive in 22.01% of the examinations. The growth rate of M. hominis and/or U. urealyticum was determined to be 24.95% in females and 10.13% in males, with the growth rate in females being greater and statistically significant (p < 0.001). According to the antibiotic susceptibility test results, clarithromycin (R 17.91%) was the most susceptible antibiotic overall for both microorganisms, while clindamycin (R 90.28%) was the most resistant. Depending on the sex, clarithromycin (R 18.40%) was found to be the most susceptible antibiotic in females, and levofloxacin (R 10.87%) to be the most susceptible in males. CONCLUSION: Given the presence of M. hominis and U. urealyticum infections, especially in the presence of risky conditions such as pregnancy, laboratory tests for the diagnosis of these agents should be used in such studies since no urogenital infections were detected in the routine cultures of the patients followed up with the suspicion of urogenital infection. Gender differences should also be considered as a parameter in the preference of antibiotics.

How well do ESWL nomograms predict treatment success in pediatric patients?

OBJECTIVE: To study was to identify the variables that influence the outcomes of pediatric SWL patients in our clinic and to compare our findings to previously published nomograms. METHODS: All children who underwent SWL at a single center between 2005 and 2020 were included in this retrospective study. Depending upon the age and mental state of the children, SWL procedures were performed with or without anesthesia. Data from the hospital information system were obtained on patient characteristics, metabolic evaluation, imaging, SWL details, and post-procedure results, and their correlation with the Onal and Dogan nomograms was evaluated. RESULTS: The present study included 112 pediatric patients in total. The average age was 8.22 ± 4.9 (83.3 ± 58.1 months, 4 months-16 years), and the median stone size was 9.5 ± 3.2 mm (4-20 mm). Even though there was quite a significant positive correlation between age and the number of shots and the intensity of shots (intensity and number of shots increased with increasing age), there was no statistical difference in the number of sessions and stone-free rates. The number of shots and sessions was significantly lower in patients with hydronephrosis (N = 70) than in those without (N = 42) (p < 0.001). When the stone-free rates of patients without and with hydronephrosis were compared, it was discovered that they were 69.05% and 92.86%, respectively, which was statistically significant (p < 0.01). CONCLUSIONS: It is believed that the nomograms developed for SWL in pediatric patients should be reviewed, and larger, prospective studies should be conducted.

Could "Retrograde Intrarenal Surgery" be Used as an Efficient Technique in the Treatment of Calyceal Diverticula Stones.

OBJECTIVE: To evaluate the efficacy of retrograde intrarenal surgery (RIRS) and holmium laser lithotripsy in the treatment of symptomatic renal calyceal diverticular (CD) stones. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: Department of Urology, Hisar Intercontinental Hospital, from 2008 and 2019. METHODOLOGY: Patients who underwent holmium laser lithotripsy with RIRS to manage symptomatic CD stones were evaluated retrospectively. Demographics, stone size, operation and hospital stay duration, the success of treatment and complications were noted. RESULT: Among the 30 treated patients, 13 patients were female and 17 were male. The mean age was 45.4 ± 11.9 (26-64), the stone diameter was 14.4 ± 4.1 mm, operation time was 70.47±35.7 (35-155) minutes, and mean length of hospital stay was 1.27±0.5 (1-3) days. In those patients who underwent RIRS, 26 (86.7%) were successfully treated while in 4 of 30 patients (13.3%) the procedure was not successful. Complications were observed in 10 (33.3%) patients. Clavien-I complications were demonstrated in 6 patients, Clavien III complications were demonstrated in 3 patients. One patient had urosepsis, 2 patients had ureteral laceration, and one patient with Clavien IV complication had perirenal hematoma. CONCLUSION: Laser lithotripsy therapy with RIRS is a safe and effective treatment for symptomatic calyceal diverticular stones and can be offered as the first-line treatment for calyceal diverticular stones. KEY WORDS: Calyceal diverticula, Stone disease, Flexible ureterorenoscopy, Holmium laser, RIRS.

Comparing Crystallized Phenol and Surgical Excision Treatments in Pilonidal Sinus Disease.

OBJECTIVE: To compare the results of commonly used treatments (Karydakis Flap method and crystallized phenol application) in the treatment of pilonidal sinus. STUDY DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Adana Seyhan State Hospital, Adana City Hospital, and Hisar Intercontinental Hospital Pediatric Surgery Clinic, from January 2016 to December 2020. METHODOLOGY: Patients who were treated for pilonidal Sinus and treated with surgical repair (karydakis flap method) and crystallized phenol method were included in the study. The efficacy and complications of both treatments were compared. RESULTS: Of the patients, 111 (34.7%) were treated with surgical repair, and 208 (65.3%) with the crystallized phenol method. Of the patients included in the study, 166 (52%) were male and 153 (48%) were female. The mean age was calculated as 15.5 (± 1.4). The mean hospital stay in the surgery group was 1.6 ± 0.4 days. The mean time to return to school was 2.8 ± 1.02 days in the phenol group and 12.3 ± 2.2 days in the Surgery group. Despite the third session of phenol application, recovery could not be achieved in 12 (5.7%) patients. Among those who had surgery, recurrence occurred in 7 (6.3%) patients and they had to be operated once more. CONCLUSION: Crystallized Phenol application can be applied in uncomplicated cases due to high success, low complication, rapid recovery, early return to daily activities. KEY WORDS: Crystallized phenol, Surgical treatment, Pilonidal sinus disease.

Urachal Actinomycosis Presenting with Recurrent Urinary Tract Infections in a Middle-aged Woman: A Rare Case Report.

The urachal cyst, a remnant of allantois sac during embryogenesis, is a rare condition in adulthood. Urachus is an embryologic remnant degenerating after birth. Abberrant obliteration of the urachus causes urachal abnormalities. The urachal cysts are almost always symptomatic when infected. The symptoms include fever, abdominal pain, tenderness, lower abdominal mass, nausea, vomiting, and dysuria. Ultrasonography, computerised tomography, and magnetic resonance imaging techniques may be insufficient for diagnosis. In most cases, staphylococcus species are isolated from cultures of urachal cysts. Other microorganisms such as Escherichia coli, Enterococcus faecium, Klebsiella pneumonia, and rarely actinomyces may be isolated. Actinomyces, an anaerobic gram-positive filamentous bacterium, is a rare cause of granulomatous disease. In this case report, a 56-year woman with urachal cyst infection with actinomyces is discussed according to current knowledge. Key Words: Urachal cyst, Urachus, Chronic cystitis, Actinomyces.

Comparison of hypochlorous acid and Povidone Iodine as a disinfectant in neonatal circumcision.

INTRODUCTION: Neonatal circumcision is a procedure used worldwide which has very low rates of complication if conducted by a specialist. The present research aims to examine the wound healing effects of Hypochlorous Acid (HCOL) and Povidone Iodine (PI) used as a disinfectant prior to the procedure of circumcision and their antibacterial effectiveness. MATERIAL AND METHOD: The findings of sixty infants subjected to neonatal circumcision at the Hisar Intercontinental Hospital between January 2021 and June 2021 were prospectively recorded. Based on the disinfectant used, the patients were divided into two group: Group 1 including 28 patients for whom HCOL was used as an antiseptic solution, and Group 2 including 32 patients to whom PI was administered. RESULTS: Group 1 was formed of 28 patients while Group 2 included 32 patients. The mean ages of each group was 15.46 ± 10.58 (2-29) and 12.63 ± 10.00 (2-28) days, respectively. When the complications were examined individually, no significant difference was found between the groups. However, when all complications were analyzed collectively, it was determined that there was a significant difference, and the complication rate of Group 2 was greater (p = 0.037). In Group 2, the rate of edema and wound healing delay was significantly greater than that of Group 1 (p: 0.037 p: 0.036) (Table 1). CONCLUSION: It was determined that HCOL is reliable to be used as a disinfectant prior to neonatal circumcision.

The effects of stone density on surgical outcomes of retrograde intrarenal stone surgery.

OBJECTIVE: Several pre-operative parameters have been studied to estimate stone-free rate (SFR) following retrograde intrarenal surgery (RIRS) procedures. The objective of this study was to evaluate the effects of stone density on surgical outcomes of RIRS. METHODS: This retrospective study included 30 stone-free patients (Group SF) and 30 patients with residual fragments (Group RF). Patients' age and gender, laterality, non-contrast CT findings, including size and density of the kidney stones, infundibular pelvic angle (IPA), operational time, and post-operative pain were recorded and compared between the two groups. The stone density was measured by free hand region of interest (ROI) determination coincident with the stone borders and expressed as Hounsfield units (HUs). RESULTS: The rate of single stones was significantly higher in Group SF compared to Group RF (p < 0.001). The mean stone size was found as 11.93 ± 7.81 mm in Group SF and 16.27 ± 7.29 mm in Group RF with the difference being statistically significant (p < 0.001). The mean IPA was 53.87 degrees in Group SF and 50.33 degrees in Group RF. The mean density was measured as 748.17 ± 318.14 HU in Group SF and 945.90 ± 345.30 HU in Group RF. The mean stone density was statistically significantly higher in patients with residual fragments compared to the stone-free patients (p < 0.001). CONCLUSION: This study revealed that stone density as measured as HU affects the treatment outcomes with RIRS procedure and the mean density is significantly higher in patients with residual stone fragments. ADVANCES IN KNOWLEDGE: Studies about the effects of HUs on stone-free rate are limited in the literature. Stone density affects the treatment outcomes with RIRS procedure and the mean density is significantly higher in patients with residual stone fragments.

Cosmetic results of circumcision and scar wrinkling: Do we exaggerate in terms of hemostasis and sutures?

OBJECTIVE: To objective of this study was to investigate poor scar appearance of the circumcision line and scar wrinkling caused by the sutures placed during the circumcision in primary school age circumcised children. METHODS: A total of 455 children aged between 6 and 9 years, circumcised by four different specialists in our hospital between 2009 and 2018 were evaluated. Circumcisions performed due to balanitis, phimosis, secondary phimosis, and paraphimosis were excluded from the study. Only routine religious circumcisions performed on request of the family were included in the study. Children underwent a second procedure and those receiving treatment after the circumcision due to infection were excluded from the study. About 363 patients included the study. Patients were evaluated according to the Fitzpatrick skin type classification, independent observer scale, Stony Brook Scar Evaluation Scale, and Dunn-Bonferroni test. RESULTS: No statistically significant difference was found between distributions of scar wrinkling levels in children according to the circumcision (p > 0.05). There was a statistically significant difference between age of circumcision according to scare wrinkling levels (p = 0.001). According to the Dunn-Bonferroni test; the circumcision age was found to be significantly lower in children with severe scar wrinkling compared to the children with no or mild scar wrinkling (p = 0.001; p = 0.011). CONCLUSION: The tense, short-interval sutures placed away from the wound margin during circumcision in order to control subcutaneous bleeding lead to scar wrinkling and a poor cosmetic appearance. Knowing the risk factors leading to scar wrinkling and taking appropriate measures will provide acceptable cosmetic outcomes after the circumcision.

Did COVID-19 area change our urology practice: A retrospective analysis.

OBJECTIVE: This research aimed at evaluating the changing conditions and experiences of urological practice during the COVID-19 pandemic. METHODS: The data of all patients who were admitted to outpatient clinics at Hisar Intercontinental Hospital or the hospital's online patient portal system between March 11th and May 30th, 2020 were analyzed retrospectively. Of all patients, 545 in outpatient clinics and 25 in online portal system, (17%) were hospitalized for medical treatment, and 53 underwent surgery. There were 1032 patients admitted to Urology Clinics and 104 patients who underwent surgery in the same period of 2019. The pre-operative assessment of patients who were candidates of urological surgery included certain criteria for COVID-19. RESULTS: Of patients included in this study, the median age was 41 years (18-90). The mean hospital stay was 1 day (1-12), and the mean duration of operation was 25 min (3-250). Thirty-seven patients (69.8%) underwent general anesthesia, while only 11(20.8%) underwent combined spinal epidural anesthesia. Four patients (7.5%) required local and only one patient (1.9%) underwent sedo-analgesia. Complications were encountered in six patients (11.4%), urosepsis in two, pneumonia in one, and urinary tract infection in three patients. Compared to last year's numbers, the number of patients admitted to the hospital's outpatient clinic and that of hospitalized patients decreased by 47.2% and 49.1%, respectively. CONCLUSION: Emergent surgeries in urological practices can be performed safely under routine preoperative testing for COVID-19 and with the use of adequate protective equipment for both the surgical team and the patient.

Desmopressin versus desmopressin + oxybutynin in the treatment of children with nocturnal enuresis.

INTRODUCTION: Enuresis is identified as voluntary or involuntary leakage of urine for at least three consecutive months in the daytime and/or nighttime on clothes for children older than five. Monosymptomatic nocturnal enuresis (MNE) describes nighttime wetting without daytime leakage of urine in children with no pathology in the urinary system and it is 80% more common than enuresis. Desmopressin is the most common medical treatment for MNE. The aim of this study is to retrospectively compare the effectiveness of desmopressin as monotherapy and desmopressin + oxybutynin as a combination therapy in the treatment of nocturnal enuresis. MATERIAL AND METHOD: This study retrospectively evaluated 183 patients who applied to pediatrics, pediatrics surgery and urology clinics with the complaint of nocturnal enuresis and diagnosed with primary monosymptomatic nocturnal enuresis between January 2014 and December 2019. The patients were divided into two groups (91 patients) who only received desmopressin therapy (Group 1), and those (92 patients) who received desmopressin and oxybutynin combination therapy (Group 2). Response to treatment, compliance and recurrence ratios were determined in the evaluation. Complete response was accepted as 90-100% decrease in the number of nighttime wetting, partial response was accepted as 50-90% decrease in the number of nighttime wetting and those below 50% were regarded as non-response. The 1st, 3rd, and 6th months of control data of treatment effectiveness of both groups were evaluated and their responses to treatment and the side effects of drugs were examined. RESULTS: The mean age 183 patients of whom 103 were male and 80 were female was 10 (6-16) year. In the first month of control of Group 1, 71.4% had a complete cure, 8.8% had a partial cure and 19.8% had no response to treatment. In the third month of control of Group 1, 74.73% gave a complete response and were cured, 5.5% gave a partial response and 19.78% had no response. In the sixth month of Group 1, 70 patients were evaluated as complete response (79.5%), and 5 patients were evaluated as partial response (5.6%). In the first month of control of Group 2, 75% gave a complete response, 10.9% gave a partial response, 14.1% had no response to treatment. In the third month of control of Group 2, 86.9% gave a complete response, 6.52% gave a partial response, and 6.52% had no response. In the sixth month of the control of Group 2, the number of patients who did not come for control and could not be reached was 2, 83 patients out of 90 patients were evaluated as complete response (92.2%), 6 patients were evaluated as partial response (6.6%). CONCLUSION: Desmopressin is the only FDA approved pharmacologic treatment for nocturnal enuresis. Desmopressin reduces urine production and the anticholinergic agent allows the bladder to store more urine. Therefore, combined therapy can be recommended in the MNE treatment for specially selected cases.

Early Clinical Results of the Tolerability, Safety, and Efficacy of Autologous Platelet-Rich Plasma Administration in Erectile Dysfunction.

INTRODUCTION: Platelet-rich plasma (PRP) is useful in the treatment of different conditions and diseases as it contains concentrated levels of many growth factors. AIM: The aim of this study was to investigate the effectiveness of autologous PRP application in the treatment of erectile dysfunction (ED) in patients with metabolic syndrome. METHODS: In this prospective study conducted in June 2019, 31 patients with ED were included. The International Index of Erectile Function-Erectile Function domain (IIEF-EF) questionnaires were used to evaluate erectile function (EF). After administering the intracavernous autologous PRP 3 times with an interval of 15 days, IIEF-EFs were evaluated 1, 3, and 6 months later. MAIN OUTCOME MEASURE: IIEF in the 1st, 3rd, and 6th months and adverse events. RESULTS: While the mean IIEF-EF was 18 before the application, the mean IIEF-EF was 20 in the first, third, and sixth months after the procedure (P < .001). However, even though IIEF-EF values increased numerically, median value remained within the mild-moderate classification (scores between 17 and 21). Postprocedure sexual satisfaction scores were significantly higher than preprocedure values (8 vs 6, respectively; P = .002). In the first follow-up of a patient after the 3rd injection, a 4-mm diameter fibrotic plaque was observed on the ventral side in the middle of the penis shaft. CONCLUSION: In conclusion, our findings suggest that larger studies as well as placebo-controlled studies are needed to add PRP to the treatment protocol in ED. T Tas,Çakiroglu, E Arda, et al. Early Clinical Results of the Tolerability, Safety, and Efficacy of Autologous Platelet-Rich Plasma Administration in Erectile Dysfunction. Sex Med 2021;9:100313.

Effect of venous reflux time on testosterone and semen parameters of infertile males after microscopic varicocelectomy.

This study aimed to search whether there is a link between reflux flow and hormonal profile. Data of 250 patients were retrospectively investigated. Pre-operative and 6th month semen analyses of these patients' results were compared with pre-operative and post-operative 6th month serum levels of testosterone. Based on the venous flow on pre-operative Doppler ultrasonography, patients were divided into two groups. Patients with a venous flow ≤4 s were assigned to Group 1 and those with a venous flow >4 s to Group 2. Venous reflux time cut-off was calculated as 4 s using ROC curve according to the increase in testosterone level. When venous reflux time was selected as approximately 4.0 s, ROC had 79.8% sensitivity and 72.8 specificity. The probability of a post-operative increase in testosterone is high in patients with a venous reflux time longer than 4 s.

Reliability of thermocautery-assisted circumcision: retrospective analysis of circumcision performed voluntarily in countries of low socioeconomic status.

OBJECTIVE: The objective of this study was to evaluate the reliability of thermocautery-assisted circumcision performed voluntarily in patients of poor countries. MATERIAL AND METHODS: Between 2016 and 2019, 32,000 children aged 7 days to 17 years were circumcised in multiple countries. The patients' urological examinations were done before the administration of local anaesthesia. Patients revealed to have undescended testicle, inguinal hernia, hypospadias, varicocele, penile rotation anomaly, epispadias and infection were not circumcised. All procedures were performed under local anaesthesia by using thermocautery. Afterwards, mucosa and skin were sutured using absorbable suture and the circumcised penis was dressed. Patients were instructed to remove the dressing after 3 days. RESULTS: Bleeding, requiring surgical intervention and drug reactions were not observed. The most observed complication was mucosal oedema, which occurred in approximately one-quarter of patients (26%, 8320/32,000) and continued for 3-5 days after the surgery. The most serious complication was a trapped penis, which occurred in 25 patients (0.078%). In six (0.018%) cases, meatal stenosis developed. Wound infection developed in only 10 (0.03%) cases, through the formation of an aseptic environment. Penile adhesion was seen in 35 cases (0.1%) and improved with anti-inflammatory treatment without any surgical intervention. CONCLUSION: Thermocautery-assisted circumcision can be used as an effective, safe and useful technique with few complications and rapid healing rates.

Comparison of Turkish Primary, Recurrent, and Non Stone-Forming Patients Using Hounsfield Unit Measurements: How Useful Is It?

INTRODUCTION: To investigate renal papillae attenuation value differences between controls and stone-forming (SF) patients and to evaluate the impact of mean Hounsfield unit (HU) measurements on the predictivity of stone development. MATERIALS AND METHODS: We compared papillae attenuation values in SF groups and a healthy stone-free control group. Metabolic evaluations were carried out on 88 primary and 98 recurrent SF patients, and 94 age-matched control patients were included. The papillae tip attenuation was measured using non-enhanced computed tomography scans in HU for an area with a mean size of 0.2 cm2. Inclusion criteria to the study were known stone composition (CaOx), unilaterality, and radiological examinations done in our center. RESULTS: In this study, 186 patients who met the criteria and 94 age-matched control patients were divided into 3 groups: the primary SF (Group 1), the recurrent SF group (Group 2), and the control group (Group 3). Metabolic variables which were compared between primary and recurrent SF did not show any significant difference, except urinary volume and phosphorus. The median (interquartile range) value of papillae HU density for the control group was 26.23 (3.84), for primary SF group it was 26.50 (11.25), and for recurrent SF group it was 29 (13). A significant difference in papilla HU levels for each group was found (p = 0.008). CONCLUSION: This study implied that HU values reflect the severity of the stone disease, although they could not discriminate controls from primary stone formers whose stone forming risk is lower compared to recurrent stone formers.

Do 'standard laparoscopic box trainers' represent real-life conditions during transperitoneal laparoscopical interventions of the upper tract?

BACKGROUND: The purpose of this study is to investigate the representativeness of the conventional laparoscopic standard box trainers in terms of real-life circumstances in transperitoneal laparoscopical interventions of the upper tract, using questionnaire inquiries with experienced surgeons. MATERIALS AND METHODS: The study was conducted with 44 laparoscopists, whose level of renal surgery experience was either high (primary surgeon in >100 cases), moderate (primary surgeon in >50 cases) or basic (primary surgeon in >20 cases). We used the box widely preferred in international training courses, which consists of a 10-mm 30° laparoscope, real endoscopic instruments, light source, monitor and chicken bone materials. Participants were asked whether they represent real-life situations while performing tasks by means of standard box trainers. RESULTS: The medians of 'restrained body posture of the surgeon', 'position of monitor', 'trocars entry slots', 'tissue distance and region' and 'limited field of movement and restricted working space' were analysed on their difference from the ideal value. All the variables were shown to be significantly different from the ideal value of 5 (p < 0.001). These results suggest that experienced surgeons in our study did not find the box simulation conditions similar to real surgery conditions. CONCLUSION: Conventional laparoscopic trainer box, which is currently being used, is far from representing for the real situation in transperitoneal laparoscopical interventions of the upper tract.