Glans Diameter and Meatus Localization Are the Sole Predictors of Primary Distal Hypospadias Surgery Complications: A Multivariate Analysis of Single Surgeon Series.

INTRODUCTION: Tubularized incised plate urethroplasty (TIPU) surgery is among the most successful techniques for distal hypospadias. Our objective was the investigation of complication rates and their predictors. METHODS: Between 2010 and 2021, 150 patients with distal hypospadias were operated on consecutively by a single surgeon using the TIPU technique. The primary outcome was the complication rates including fistula, meatal stenosis, and glans dehiscence. Secondary outcomes were predictor factors of complications. RESULTS: The average glans diameter was 13.9 ± 0.10 mm and 57.0% of the patients had a glans diameter greater than 14 mm. Single-layer and double-layer urethroplasty were used in 55.3% (n = 83) and 44.7% (n = 67) of patients, respectively. Overall complication rate was 23.3% (n = 35), which included fistula (3.3%, n = 5), glans dehiscence (12.7%, n = 19), and meatal stenosis (8.6%, n = 13). Glandular meatus localization (OR = 58.8, p = 0.001) and smaller glans diameter (OR = 0.39, p = 0.001) were significant predictors in the multivariate analysis of overall complications. For fistula complications, only short operation time (OR = 0.83, p = 0.03) was found as a significant predictor. Glans width (<14 mm) was the only significant predictor of both glans dehiscence (OR = 3.4, p = 0.03) and stenosis (OR = 5.67, p = 0.013) complication. CONCLUSION: TIPU technique for distal hypospadias has notable success and acceptable complication rates. Dartos augmented single-layer urethral closure seems adequate for complication prevention. Preoperative assessment of the glans width and meatus site is advised to predict complication rates.

The use of supine PNL technique for a tubeless procedure and shorter hospital stay: A comparison of supine and prone PNL procedures in 361 cases. / El uso de la técnica de NLP en decúbito supino para un procedimiento sin cámara y una estancia hospitalaria más corta: una comparación de los procedimientos de NLP en decúbito supino y prono en 361 casos.

OBJECTIVE: To compare the efficacy and safety of prone and supine percutaneous nephrolithotomy (P/SPNL) with special emphasis on tubeless (T) and totally tubeless (TT) surgery. MATERIAL AND METHODS: This retrospective, single-surgeon, consecutive series comparison study involved 361 consecutive patients who under went PNL operations in either the prone or Galdakao-modified Valdivia supine positions between September 2016 and March 2020. Indication for surgery was a stone diameter greater than 2 cm. The two groups were compared in terms of preoperative demographics, stone parameters, and perioperative data. RESULTS: The groups were similar in terms of preoperative demographics, while the blood transfusion rate was insignificantly higher in PPNL (7% vs 3.3%, p=0.165). Mean operative time (58.0±20.6 vs 54.1±15.9 min., respectively, p=0.165), fluoroscopy time (p=0.895), and Clavien complication rates (p=0.87) were similar. SPNL exhibited a significantly (p<0.001) higher rate of T operations (23, 37.7%) than PPNL (46, 15.3%). TT cases were also higher with SPNL (14% vs 29.5%,p=0.003). Urine leakage (p=0.085) and post-operative JJ stent placement (p=0.180) rates were statistically similar between the two groups. Length of hospital stay was approximately one day shorter for T cases in both groups (PPNL: 1.37±0.80 vs 2.26±1.28 days, p=0.001; SPNL: 1.65±0.83 vs 2.76±2.27 days, p=0.028). Stone free rates were 91.3% and 88.5% for PPNL and SPNL, respectively (p=0.488). CONCLUSION: SPNL has proved to be as safe and effective as its prone counter part, with similar stone-free and complication rates. T and TT-PNL seem more viable with SPNL, which will increase patient comfort and allow shorter hospitalization times.

OBJETIVO: Comparar la eficacia y seguridad de la nefrolitotomía percutánea en decúbito prono y supino (P/SPNL) con especial énfasis en la cirugía tubeless (T) y totalmente tubeless (TT).MATERIAL Y MÉTODOS: Este estudio comparativo retrospectivo, de un solo cirujano, de series consecutivas, involucró a 361 pacientes consecutivos que se sometieron a operaciones de NLP en decúbito prono o en decúbito supino Valdivia modificado por Galdakao entre septiembre de 2016 y marzo de 2020. La indicación para la cirugía fue un diámetro de cálculo mayor de 2cm. Los dos grupos se compararon en términos de datos demográficos preoperatorios, parámetros de cálculos y datos perioperatorios. RESULTADOS: Los grupos fueron similares en términos de demografía preoperatoria, mientras que la tasa de transfusión de sangre fue insignificantemente mayor en PPNL (7% vs 3,3%, p=0,165). El tiempo operatorio medio (58,0 ± 20,6 vs 54,1 ± 15,9 min., respectivamente , p=0,165), el tiempo de fluoroscopia (p=0,895) y las tasas de complicaciones de Clavien (p=0,87) fueron similares. SPNL exhibió una tasa significativamente más alta (p<0,001) de operaciones T (23, 37,7%) que PPNL (46, 15,3%). Los casos de TT también fueron mayorescon SPNL (14% vs 29,5%, p=0,003). Las tasasde pérdida de orina (p=0,085) y colocación de stentJJ postoperatorio (p=0,180) fueron estadísticamente similares entre los dos grupos. La duración de la estancia hospitalaria fue aproximadamente un día más corta para los casos T en ambos grupos (PPNL: 1,37 ± 0,80vs 2,26 ± 1,28 días, p=0,001; NPSP: 1,65 ± 0,83 vs 2,76 ± 2,27 días, p=0,028). Las tasas de ausencia de cálculos fueron 91,3% y 88,5% para PPNL y SPNL ,respectivamente (p=0,488).CONCLUSIÓN: La NLPS ha demostrado ser tan segura y eficaz como su contraparte en decúbito prono, con tasas similares de complicaciones y ausencia de cálculos. T y TT-PNL parecen más viables con SPNL, lo que aumentará la comodidad del paciente y permitirá tiempos de hospitalización más cortos.

Hypergonadotropic Hypogonadism: Management of Infertility.

BACKGROUND: Medical treatments are used either alone or in combination with assisted reproductive techniques for the treatment of infertile patients with hypergonadotropic hypogonadism. A wide range of treatment options such as gonadotropins, aromatase inhibitors (AIs), selective estrogen receptor modulators (SERMs) and their combination are available as options. OBJECTIVE: The aim of this review was to evaluate treatment options for infertile men with hypergonadotropic hypogonadism. METHODS: A literature search of MEDLINE (1980-2019) was conducted using the terms 'hypogonadism', 'male infertility', 'gonadotropins', 'SERMs' and 'AIs'. Pathologies leading to hypergonadotropic hypogonadism and treatment modalities such as gonadotropins, SERMs, AIs and surgical treatment were discussed. RESULTS: FSH increases spontaneous pregnancy rates but the level of evidence was proven to be low for live birth rates. AIs are valid treatment options for patients with low T/E2 ratio as they significantly increase sperm concentrations. SERMs are recommended for infertile males with a sperm concentration between 10-20 million. Varicocele was reported to increase testosterone levels of hypogonadic infertile males. CONCLUSION: Medical treatment modalities such as gonadotropins, SERMs, AIs and a combination of these therapies has been showed to have some effect in improvement of fertility but is not mainstream of the treatment.

A Population-Based Study of Peyronie's Disease in Turkey: Prevalence and Related Comorbidities.

INTRODUCTION: Peyronie's disease (PD) prevalence varies between 0.39% and 20% and studies on PD prevalence are limited. AIM: This study aims to determine the prevalence of PD in males aged ≥30 years in Turkey and to evaluate etiological factors associated with it. METHODS: The study was conducted in 12 regions of Turkey according to the Eurostat Nomenclature of Territorial Units for Statistics 1 classification and included 1,208 patients. Survey questionnaires including questions about demographic features and basic health status as well as about diagnosis and etiology of PD were put forth to the volunteers who agreed to participate in the study. Diagnosis of probable PD was established by evaluating the questionnaires. Patients with a diagnosis of congenital penile curvature were excluded from the group with PD. Chi-square test, Fisher's exact test, and Mann-Whitney U test were used. MAIN OUTCOME MEASURE: The primary outcome analyzed in this article was the prevalence rate of PD in Turkey and the associated comorbidities. RESULTS: The prevalence of PD was determined as 5.3%. The rates of participants with PD were found to be the highest in the 50-59 years group (27%) and in the North-East Region (20%). Compared with participants without PD, participants with PD were older (median: 52 interquartile range [41-64] vs 45 [37-55]; P < .001) and the rates of smokers (73% vs 60.9%; P = .036) and those having diabetes mellitus (17.5% vs 9.2%; P = .045), hypertension (14.3% vs 6.9%; P = .041), and heart failure were higher (7.9% vs 2.5%; P = .027). Male with PD symptoms preferred their partners on top during sexual intercourse (15.2% vs 34.1%; P < .001). This is the first study to evaluate premature ejaculation prevalence and related comorbidities with face-to-face interviews. CONCLUSION: The prevalence of PD was 5.3% in Turkey. Besides advanced age, smoking, position of sexual intercourse, and presence of comorbidities especially diabetes mellitus, hypertension, and heart failure were the factors associated with PD prevalence. Kadioglu A, Dincer M, Salabas E, et al. A Population-Based Study of Peyronie's Disease in Turkey: Prevalence and Related Comorbidities. Sex Med 2020;8:679-685.

Penile curvature after Peyronie's disease surgery: What are the risk factors?

Surgery is the golden standard for the treatment of patients with Peyronie's disease in chronic phase (12-18 months). Learning risk factors for post-surgical curvature (>20°) would aid both surgeon and patient in their decision-making process. The aim of this study was to investigate the risk factors for residual/recurrent curvatures. The clinical data of the patients, who underwent reconstructive surgery for PD between 1997 and 2016, were retrospectively reviewed. Follow-ups were performed via physical examination, surveys and phone calls. For shortening surgery (Nesbit/plication), initial bi-planar curvature was proved to be a predictor of post-operative curvature (p = .05). Lateral and ventral curvatures were associated with higher recurrence rates in patients who underwent grafting surgery (p = .01). In terms of baseline comorbidities, only diabetes mellitus had an association with curvature nonrecurrence for both shortening and lengthening surgeries (p < .05). Grafting surgery may be suggested to patients who had bi-planar curvatures instead of Nesbit surgery. Nesbit plication surgery may be preferred for patients with lateral and ventral curvatures instead of grafting surgery. Higher cavernosal blood pressures and more nocturnal erections of nondiabetic young patients might impede plication sutures and grafts and therefore increase penile curvature recurrence.

Effects of Ankylosing Spondylitis on Erectile Function.

OBJECTIVES: Ankylosing spondylitis (AS), which is a chronic rheumatologic disorder, may be associated with erectile dysfunction (ED). This study aims to investigate the incidence of erectile dysfunction in patients with AS with a control group and to investigate the risk factors for ED. METHODS: All demographic data were recorded. Participants in both groups filled in the IIEF-5 (International Index of Erectile Function), Beck Depression Index (BDI) and Beck Anxiety Index (BAI) questionnaires, whereas patients with AS additionally filled in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrological Index (BASMI) and Ankylosing Spondylitis Quality of Life (ASQoL) questionnaires. Patients were compared concerning erectile function and predictive factors. Fifty patients with the AS diagnosis and fifty healthy males were included in this study. RESULTS: ED of all degrees was present in 38% and 30% of males in the AS group and control group, respectively, with no statistical difference. However, the mean IIEF-EF domain score of the AS group (22.3±7.0) was significantly lower than the control group (25.7±4.3) (p=0.004). In addition, BDI and BAI scores were significantly higher in the AS group. When we have divided patients in the AS group into two, according to the presence or absence of the ED, the mean IIEF-EF domain score of patients with ED was lower than AS patients without ED. No difference was detected in both groups concerning age and the duration of the disease. Patients who had ED in the AS group had significantly higher scores in BASDAI, BASFI, depression and anxiety; however, no significant difference was detected among groups regarding BASMI scores.Mean IIEF score was lower in patients with AS, and this had a negative correlation with BASDAI, BASFI, ASQoL, BDI and BAI scores. CONCLUSION: Erectile function scores were slightly lower in the AS group than the control group in our study. ED risk factors were shown as disease activity and psychological status.

The relationship between erectile dysfunction and the Atherogenic Index of Plasma.

The objective of this study was to compare the Atherogenic Index of Plasma (AIP) values as indicators of subclinical atherosclerosis among 124 patients with erectile dysfunction, which was thought to be vasculogenic and 126 control subjects who had no erectile dysfunction, and to compare cardiac performance values between both the groups using exercise stress tests (EST). Erectile function was assessed using the International Index of Erectile Function (IIEF-5) questionnaire form. AIP values were studied and compared between patients with ED (IIEF < 22) and those without ED (IIEF > 22) using the log10 TG/HDL-C formula. In addition, the correlation between the severity of ED and AIP was investigated according to IIEF-5 scoring. Metabolic equivalent (MET) values, maximal heart rates (max HR), and heart rate recovery (HRR) were evaluated with effort tests. AIP values were significantly higher in the ED group than in the control group (0.45 ± 0.27, and 0.37 ± 0.27; p = 0.015). According to IIEF-5 scoring, AIP values increased as ED scores decreased. In the EST, MET score and max HR values were significantly lower in the ED group (METs: 11.1 ± 2.2, and 11.6 ± 2.2; p = 0.045; Max HR: 162.8 ± 6.1, and 165 ± 8.7; p = 0.019). Although not statistically significant, HRR values were lower in the ED group. Higher AIP values were found in the ED group, and a positive correlation was established between AIP and the severity of ED. In addition, lower performance during the EST and lower HRR values, again in the ED group, confirms cardiac interaction with ED. These results indicate the importance of referral of patients with ED from urology clinics to cardiology units for risk determination and cardiac assessment, even if they areasymptomatic.

Evaluation of gonadotropin-replacement therapy in male patients with hypogonadotropic hypogonadism.

Hypogonadotropic hypogonadism (HH) is a rare disease in which medical treatment has a high success rate to achieve fertility. This study aimed to analyze the efficacy of hormone replacement therapy and determine predictive factors for successful spermatogenesis and spontaneous pregnancy in patients with idiopathic HH. A total of 112 patients with low testosterone (T), luteinizing hormone (LH) and follicle-stimulating hormone (FSH), and normal prolactin levels were diagnosed with HH and administered LH and FSH analogs as hormone replacement therapy. During treatment, 96 (85.7%) patients had sperm present in ejaculate samples. Among these patients, 72 were married and wanted a child. Of these 72 patients, 48 (66.7%) of couples had pregnancies from natural conception. After initiation of treatment, the mean time for the appearance of sperm in semen was 9.48 months. There were no significant differences between baseline FSH, T, and LH levels; however, older age, larger testicular size, and low rate of undescended testes were favorable factors for successful spermatogenesis. Larger testicular size and older age were also the main predictive factors for natural conception. We found that patients with undescended testes had a younger age, smaller testes, and lower T levels compared with patients exhibiting descended testes. The rate of sperm found in the ejaculate was not significantly decreased in patients with undescended compared with descended testis (73.7% vs 87.6%, P = 0.261). The medical approach for males with HH and azoospermia provides a successful treatment modality in regard to successful spermatogenesis and achievement of pregnancy.

Sexual function in women with Cushing's Syndrome: A controlled study.

OBJECTIVE: The aim of this study is to determine the severity of female sexual dysfunction (FSD), quality of life, and depression status in female patients with Cushing's syndrome (CS). MATERIAL AND METHODS: This study included 29 sexually active women with CS and 30 healthy age and body mass index matched women. The Female Sexual Function Index (FSFI) questionnaire, Beck Depression Inventory (BDI) and Short Form Health Survey (SF-36) were filled by each participant. Plasma levels of FSH, LH, PRL, cortisol, DHEA-S, 17-hydroxyprogesterone, androstenedione, free testosterone, total testosterone and estradiol were measured. RESULTS: Female sexual dysfunction was present in 88.9% of the women with CS and 24.1% of the control group. The CS group showed a lower total FSFI score [16.6 (IQR: 5-23)] compared to the healthy women [26.8 (IQR: 25.5-30.4) (p<0.001)]. The FSFI scores in the arousal, lubrication, orgasm, pain and satisfaction domains were all lower in the women with CS (p<0.001). Both summary scores of the SF-36 were reduced in women with Cushing's syndrome compared to the control group (p=0.001). The BDI scores of patients were significantly higher than those of the control subjects (p=0.007). In patients with CS, levels of LH, estradiol, and DHEA-S04 were significantly lower while cortisol (p<0.05), and 17 hydroxyprogestrone levels were higher than control subjects (p<0.05). CONCLUSION: This study showed that majority of the women with CS had FSD. This may be related to the inhibitory effect of cortisol on sex hormones.

Peyronie's disease surgery: Surgical outcomes of 268 cases.

OBJECTIVE: To assess the outcomes of the surgical techniques used in Peyronie's disease (PD) surgery. MATERIAL AND METHODS: Two hundred and sixty-eight patients received surgical treatment for PD. Fifty four and 144 patients underwent simple corporoplasties (shortening procedure, SP, group 1) or plaque incision and grafting surgery (lengthening surgery, LP, group 2), respectively, whereas 70 patients with erectile dysfunction underwent penile prosthesis implantation. RESULTS: Penile plication and Nesbit surgeries were performed in 5 (9%) and 42 (78%) patients out of total 54 patients. In the remaining 7 (13%) patients, Nesbit and plication suture combination was required for complete penile straightening. Mean curvature degree was 52.2±12.3 degrees. Follow up time was 36.1±29.4 months. No significant difference was demonstrated between the two groups in the baseline features and co-morbidities except age. In 144 patients who underwent plaque incision and grafting, mean age and PD onset duration were 54.1±9.2 years and 28.2±17.3 months respectively. Mean curvature degree was 58.4±18.9 degrees. Post-operative follow up time of the second group was 51.1±39.6 months. Additional plication suture was used in 48 patients (33%) patients. Degree of curvature improvement was 37.9±19.1 and 52.1±23.5 in SP and LP respectively (p=0.01). The initial anatomic success rates were 90.4% and 87.5% at their early post-operative follow-ups for group 1 and 2 respectively. These rates dropped to 82.7% and 83.6% at the long term follow-up (36 and 51 months) respectively (p=0.9). Although the average follow-up time of LP group was longer than SP group (52.1 mo vs. 37.0 mo), recurrence rates of these two groups were comparable. The combined functional and anatomical success of patients were demonstrated to be 79% and 75% in shortening and grafting surgery. Shortening surgery was not statistically superior to grafting surgery for patients in terms of having erection with or without the aid of PDE-5 inhibitors (94.4% vs. 88.2%, p=0.28). Shortening surgery makes a difference in the long term follow-up for patients who had erections without the aid of PDE-5 inhibitors (90.7% vs. 67.3%, p=0.02). CONCLUSION: Both SP and LP are successful in terms of penile straightening in the short and long-term follow-up. Curvature degree improvement is greater in LP. Patients who undergo LP surgery may suffer from ED in the long-term follow-ups. Greater percentage of patients who underwent LP require PDE-5 inhibitors usage for sexual intercourse. Despite stated shortcomings, combined success (anatomic and functional) is achieved in three out of four patients for both groups. Penile prosthesis implantation should be preferred for patients with ED and penile deformity.

Effect of low-energy shockwave therapy on angiogenic factors in the penile tissue of diabetic rats.

OBJECTIVE: The aim of this study is to investigate the effect of low-energy shock wave therapy (LESWT) on angiogenesis factors at penile tissue in a diabetic rat model. MATERIAL AND METHODS: A total of 30 male Sprague-Dawley rats which were allocated into three equal groups were included study. Group 1 (control group) included 10 male rats which did not receive any treatment were randomly chosen to serve as normal control. The remaining rats were injected intraperitoneally with 60 mg/kg of streptozotocin (STZ) to induce diabetes. Diabetic rats were divided into two equal group which constituted diabetic control, and LESWT treatment (DM+LESWT) group. Each rat in the DM+LESWT group received L-ESWT therapy. Endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF) mRNA expression levels of penile tissue were evaluated. RESULTS: Following STZ dosing eNOS level dropped in the diabetic control group relative to the control group. Statistically significant increase in eNOS levels were seen in the LESWT+DM group. Similarly, in the diabetic control group STZ treatment decreased VEGF levels, while in the LESWT+DM group VEGF nearly approached to baseline levels. However variations in VEGF levels were not statistically significant. CONCLUSION: Mechanism action of ESWT in the penile tissue seems to involve angiogenic factors.

Comparison of Two Different Methods Used for Semen Evaluation: Analysis of Semen Samples from 1,055 Men.

The aim of this study was to evaluate whether there is a difference between gravimetrically and volumetrically measured semen samples and to assess the impact of semen volume, density, and sperm count on the discrepancy between gravimetric and volumetric methods. This study was designed in an andrology laboratory setting and performed on semen samples of 1,055 men receiving infertility treatment. Semen volume was calculated by gravimetric and volumetric methods. The total sperm count, semen density and sperm viability were also examined according to recent version of World Health Organization manual. The median values for gravimetric and volumetric measurements were 3.44 g and 2.96 ml respectively. The numeric difference in semen volume between 2 methods was 0.48. The mean density of samples was 1.01 ± 0.46 g/ml (range 0.90-2.0 g/ml). The numeric difference between 2 methods gets higher as semen volume increases (p < 0.001). Gravimetric and volumetric semen volume measurements were strongly correlated for all samples and for each subgroup of semen volume, semen density and sperm count, with minimum correlation coefficient of 0.895 (p < 0.001). In conclusion, the gravimetric measurement provides higher results than volumetric one and numeric differences between 2 methods increase as semen volume increases. However, further studies are needed to offer the use of gravimetrical method, which was thought to minimize laboratory errors, particularly for a high amount of semen samples.

The Case Report of Priapus and a Modern Approach to an Ancient Affliction.

INTRODUCTION: Priapism, taking its name from God Priapus, is total or partial erection lasting longer than 4 hours independent of sexual stimulus and can result in erectile dysfunction. There are three subtypes of priapism. AIM: To review the three subtypes of priapism, their pathophysiology, current treatment options, and complications. METHODS: The literature including priapism guidelines, review articles, and current trial studies was reviewed and the priapism type of God Priapus was investigated according to the mythology. MAIN OUTCOME MEASURES: All three types of priapism were reviewed for etiology, diagnosis, and management. Medical and surgical treatment options were reviewed in relation to the current literature. Special emphasis concerned current treatment strategies and controversial surgical topics. RESULTS: Ischemic priapism is the most common type, constituting 95% of all cases, and is an emergency. First-line treatments are blood aspiration and intracavernosal sympathomimetic drug injections. If these fail, then surgical shunt operations are recommended. A T-shunt combined with corporal tunneling is the currently popular option. Immediate penile prosthesis implantation is recommended for patients who present 48 to 72 hours after the onset of a priapism episode. High-flow priapism is caused by irregular arterial cavernosal blood flow, which usually occurs after a blunt perineal trauma. Antiandrogens and selective arterial embolization are the treatment options. Stuttering priapism is repetitive, self-limiting ischemic priapism and frequent in patients with sickle cell anemia. Ketoconazole is safe, cheap, and effective and appears to be a logical and suitable current treatment option to prevent further episodes, which is the primary treatment goal of stuttering priapism. CONCLUSION: Priapism is a relatively common condition but not well known by clinicians. The lack and delay of treatment result in irreversible complications such as erectile dysfunction. Each type of priapism should be diagnosed and treated correctly with caution.

Prospective evaluation of complications in laparoscopic urology at a mid-volume institution using standardized criteria: Experience of 1023 cases including learning curve in 9 years.

AIM: To evaluate the laparoscopic operations performed in our department according to the modified Clavien classification system of complications. MATERIALS AND METHODS: Between September, 2005 and February, 2014, a total of 1023 laparoscopic cases were performed. This period was divided into three terms (Terms 1, 2 and 3 consisting of 38, 32 and 32 months, respectively). According to the European Scoring System (ESS), easy (E), slightly difficult (SD), fairly difficult (FD), difficult (D), very difficult (VD) and extremely difficult (ED) cases were 35, 88, 170, 390, 203 and 137, respectively. The perioperative complications were evaluated based on the 3 time periods, with a specific emphasis on determining the learning curve according to the modified Clavien classification system of complications. RESULTS: A total of 236 (23.1%) complications were observed according to the modified Clavien classification. The minor (Clavien I-II) and major (Clavien III, IV and V) complication rates were 20.5% (n = 210) and 2.4% (n = 26), respectively. Clavien I was the most frequently encountered type of complication (n = 120, %11.7). No significant difference was observed among all 3 time periods regarding total complication rates. The D cases had the highest complication rate compared to E, SD, FD, VD and ED cases among all three terms. The total number of complications increased significantly with increasing grade of technical difficulty according to the ESS. CONCLUSION: Complications encountered in our laparoscopic surgery experience were predominantly minor, and the rate of complications was not significantly increased during the learning curve. The present data can provide guidance and manage expectations for surgeons introducing laparoscopy into their practice.

Neurovascular bundle dissection for Nesbit procedure in congenital penile curvature patients: medial or lateral?

The objective of this study was to compare the outcomes of the modified Nesbit procedure using different techniques for dissecting the neurovascular bundle (NVB) to correct ventral congenital penile curvatures (CPCs). The bundle was mobilized using the medial and lateral dissection technique in 21 (Group 1) and 13 (Group 2) patients, respectively. In the medial technique, Buck's fascia is opened at the dorsal side of the penis, the deep dorsal vein is removed at the most prominent site of the curvature and a diamond-shaped tunica albuginea (TA) is excised from the midline of the penis. In the lateral technique, the bundle is mobilized using a longitudinal lateral incision of the Buck's fascia above the urethra at the 5 and 7 o'clock positions via a bilateral approach. The localization and degree of curvature was evaluated using the combined intracavernous injection stimulation test or from the patients' photographs. The mean patient age and degree of curvature were similar between groups. The mean operation time was longer for Group 2 (P = 0.01). In Group 1, nine patients (42.8%) required one diamond excision, 10 (47.6%) required two diamond excisions and two (9.5%) required more than two excisions; in Group 2, six patients (46.2%) required two diamond excisions and seven patients (53.8%) required more than two diamond excisions (P = 0.019). The differences in penile shortening, penile straightening and numbness of the glans penis were not statistically significant. Medial dissection of the bundle for the modified Nesbit procedure reduces the number of diamond-shaped removals of TA and thus shortens operation time in comparison with its lateral counterpart.

Residual valve and stricture after posterior urethral valve ablation: how to evaluate?

OBJECTIVE: To investigate the clinical and radiological parameters of posterior urethral valve (PUV) patients with residual valve or strictures after primary valve ablation. PATIENTS AND METHODS: A total of 127 PUV patients were treated in our clinic between 1986 and 2009. We retrospectively reviewed the records of 101 patients, who had at least 1 year of follow-up data, regarding the presence of valve remnants or urethral strictures after PUV ablation. RESULTS: A total of 21 patients (20.8%) underwent repeat-urethroscopy and, of these, residual valve leaflets or stricture were detected in 10 patients (10/101, 9.9%). In 2 of these 10 (20%), the urethra had been found to be normal on the first voiding cystourethrogram following ablation. However, these two boys underwent re-urethroscopy due to persistent vesicoureteral reflux in one and persistent hydroureteronephrosis in the other, and valve remnants were detected. The remaining 8 cases had radiological signs consistent with persistent infravesical obstruction in the early period. Obstruction was due to urethral stricture and residual valve remnants in 2 and 6 cases, respectively. CONCLUSIONS: There was clinical suspicion of residual valve in about 20% of the cases and in half of these the urethra was found to be normal on urethroscopy. The possible presence of residual valve remnants after primary valve ablation should be confirmed by careful clinical, radiological and endoscopic evaluation.

Fetal urinoma and prenatal hydronephrosis: how is renal function affected?

OBJECTIVE: In our study, the functional prognosis of kidneys with prenatal urinomas were investigated. MATERIAL AND METHODS: Between 2006 and 2010, fetal urinomas were detected in 19 fetuses using prenatal ultrasonography (US), and the medical records were reviewed retrospectively. Of the 19 cases, the follow-up data were available for 10 fetuses. The gestational age at diagnosis, prognosis of urinomas, clinical course and renal functions were recorded. Postnatal renal functions were assessed with renal scintigraphy. RESULTS: Unilateral urinomas and increased parenchyma echogenicity in the ipsilateral kidney were detected in all of the fetuses. Of the 10 fetuses with follow-up data, the option of termination was offered in 6 cases of anhydramnios, including 3 cases with signs of infravesical obstruction (a possible posterior urethral valve (PUV) and poor prognostic factors and 3 cases with unilateral hydronephrosis and increased echogenicity in the contralateral kidney. Only one family agreed the termination. The other 5 fetuses died during the early postnatal period. The average postnatal follow-up period in the 4 surviving fetuses was 22.5 months (8-38 months). One patient with a PUV underwent ablation surgery during the early postnatal period. In the postnatal period, none of the 4 kidneys that were ipsilateral to the urinoma were functional on scintigraphic evaluation. The urinomas disappeared in 3 cases. Nephrectomy was performed in one case due to recurrent urinary tract infections. CONCLUSION: In our study, no function was detected in the ipsilateral kidney of surviving patients with urinomas. Upper urinary tract dilatation accompanied by a urinoma is a poor prognostic factor for renal function.