Clinical practice in vesicoureteral reflux with respect to EAU guidelines: A multicenter study.

PURPOSE: We designed a multicenter, retrospective study to investigate the current trends in initial management of reflux with respect to European Association of Urology (EAU) Guidelines in Urology clinics of our country. MATERIALS AND METHODS: The study group consisted of 1988 renal units (RU) of 1345 patients treated surgically due to vesicoureteral reflux (VUR) (between years 2003 and 2017) in nine different institutions. Patients were divided into two groups according to time of initial treatment and also grouped according to risk factors by "EAU guidelines on VUR." RESULTS: In this series, 1426 RUs were treated initially conservatively and 562 RUs were initially treated with surgery. In initially surgically treated group, success rates of surgery decreased significantly in low and moderate risk groups after 2013 (P = .046, P = .0001, respectively), while success rates were not significantly different in high risk group (P = .46). While 26.6% of patients in low risk group were initially surgically treated before 2013, this rate has increased to 34.6% after 2013, but the difference was not statistically significant (P = .096). However, performing surgery as the initial treatment approach increased significantly in both moderate and high risk groups (P = .000 and P = .0001, respectively) after 2013. Overall success rates of endoscopic treatments and ureteroneocystostomy (UNC) operations were 65% and 92.9% before 2013 and 60% and 78.5% after 2013, respectively. Thus, the overall success rate for surgery was 72.6%. There was significant difference between success rates of UNC operations before and after 2013 (P = .000), while the difference was not significant in the injection group (P = .076). CONCLUSION: Current trends in management of reflux in our country do not yet follow the EAU guidelines on VUR in low and moderate risk groups despite these reliable and accepted guidelines were expected to influence our daily approach.

Investigating the relationships between quality of life, fatigue and leisure time physical activity in prostate cancer patients.

OBJECTIVES: The aim of this study was to investigate the relationship between the parameters of fatigue, quality of life and leisure time physical activity in prostate cancer (PCa) patients. This is the first study in the literature to report interaction between these parameters from the perspective of physiotherapy and rehabilitation. MATERIALS AND METHODS: Fifty-eight out-patients were enrolled in this study. In an oncologic rehabilitation unit, Functional Assessment of Chronic Illness Therapy-Fatigue Questionnaire (FACIT-F), Functional Assessment of Cancer Therapy-Prostate Questionnaire (FACT-P) and Godin Leisure Time Exercise Questionnaire (GLTEQ) were utilized to evaluate fatigue, quality of life and physical activity, respectively. Frequencies and the relationships between the results of the parameters were analyzed. RESULTS: The average age of patients was 67.68 ± 7.54 years. Mean scores of FACIT-F [42.94 ± 8.25] and FACT-P [118.81 ± 13.39] were determined. The median score of GLTEQ was 14 (0-70). There were positive correlations between FACIT-F and FACT-P (r= 0.633, p< 0.001); GLTEQ and FACT-P (r= 0.275, p< 0.05) and; FACIT-F and GLTEQ (r= 0.297, p< 0.05). CONCLUSION: Increased fatigue and decreased leisure time physical activity level may affect quality of life negatively. Moreover, it was observed that decreasing leisure time physical activity level affects fatigue negatively. Accordingly, physiotherapists with PCa patients may focus on developing physical activity levels in various ways to address the multidimensional problems of fatigue and quality of life.

The impact of radiological anatomy in clearance of lower caliceal stones after shock wave lithotripsy.

The goal of this study was to determine the factors affecting stone clearance after extracorporeal shock wave lithotripsy (ESWL) for lower caliceal stones. Lower pole stone clearance was investigated in 128 (80 males, 48 females) patients treated with ESWL during 1998-2003 in our clinic. Renal anatomy was determined on standard intravenous urogram. The lower infundibulopelvic angle (LIPA) was measured as the angle between the vertical pelvis axis and the vertical axis of lower infundibulum (Sampaio's method). The mean age of the patients was 42.8 +/- 12.4 (19-77) years. The mean stone diameter and burden were found to be 1.28 +/- 0.58 (0.5-3.5) cm and 1.2 +/- 1 (0-7) cm(2) respectively. The stone-free rate was 62.5% and ESWL was unsuccessful in 16 (12.5%) patients. Thirty-two (25%) patients had residual fragments < or =4 mm retained in lower calices after lithotripsy. The stone clearance was found to be unrelated to stone burden and diameter (P = 0.17 and P = 0.14, respectively). However, there was a significant difference between mean lower pole infundibulum length (P = 0.001), infundibulum width (P = 0.001) and LIPA (P = 0.0001) between stone-free patients and patients with residual fragments. Multivariate logistic regression analysis accepting stone-free as the favourable result also confirmed that LIPA, lower pole infundibulum length and width were factors that significantly affected the outcome. Lower pole anatomy has a significant influence on clearance of fragments after ESWL.