Analysis of the Causes of Newborn Priapism: A Retrospective Clinical Study.

Priapism is a rare condition in the newborn. The aim of this study was to investigate the demographic, etiologic and clinical features of neonatal priapism. We retrospectively analysed the data of 11 patients diagnosed with neonatal priapism in the neonatal intensive care unit between 2000 and 2019. Priapism was defined as an erection in the neonatal period, lasting more than 4 hours. Etiological examinations revealed polycythemia in one (9.09%) patient, D-dimer elevation in three patients, and heterozygous methyltetrahydrofolate 667 gene mutations in one patient. Other patients were considered idiopathic. Detumescence was achieved in all 11 (100%) patients during the follow-up period. The median hospitalization duration was 6 (IQR [4, 8]; range, 2-9) days. The median follow-up duration was 38 (IQR [30, 42]; range, 13-94) months for patients followed-up in our hospital after discharge. Neonatal priapism is a rare condition. Successful treatment results can be achieved with conservative methods. Data acquired from our study showed that diseases with a tendency to hypercoagulation belong to the etiology by damaging penile microcirculation and make the response to conservative treatment more challenging.

Value of neutrophil-to-lymphocyte ratio in predicting surgical intervention for hydronephrosis during pregnancy.

BACKGROUND: We aimed to examine the hematological parameters of pregnant patients with ureteral stones that require intervention. METHODS: Medical data of patients presenting to urology department between October 2018 and December 2020 were retrospectively analyzed. Patients with flank pain associated with hydronephrosis were included in the study and divided into two groups according to whether an intervention was performed or not (Group-1, Group-2). Ureterorenoscopy (URS) or ureteral stent placement was performed as intervention. Demographic data, complete blood count (CBC), urine analysis, and ultrasonographic findings were collected. Gestational age (week), number of pregnancies, maternal age (years), Anteroposterior pelvis diameter (mm), VAS (Visual Analog Scale) (range 1-10) and mean platelet volume (MPV) were collected from the patient file. Inflammatory markers including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were computed. RESULTS: About 35 patients were included in Group-1 and 52 patients in Group-2. Ureterorenoscopy was performed in 21/35 (60%) patients, and ureteral stents were placed in 14/35 (40%) patients. None of the patients experienced complications. There was no statistical difference between these two groups in terms of maternal age, gestational age, number of pregnancies, pelvis diameter, PLR, and MPV. VAS and NLR were statistically higher in group-1 (p < 0.05). According to the Receiver operating characteristic curve analysis performed for the prediction of ureteral stone presence, the best cut-off point for the NLR 4.153 (sensitivity 80%, specificity 80.6%, area under curve (AUC): 0.824). CONCLUSIONS: We think that NLR can be used to determine the group that needs to be intervented due to ureteral stones in patients with symptomatic hydronephrosis during pregnancy.

Fluoroscopy-free RIRS on the second session after ureteral stent placement.

AIM: Fluoroscopy is used in some stages of the conventional Retrograde Intrarenal Surgery (RIRS) procedure and is beneficial. On the other hand, radiation exposure is its most obvious disadvantage. As a subgroup, we aimed to show that fluoroscopy-free technique is safe and effective in patients who underwent RIRS after passive dilatation. MATERIALS AND METHODS: Between October 2018 and April 2020, 54 cases of second session RIRS of renal stones performed by a single surgeon were retrospectively evaluated. Patients' demographic characteristics (age, gender), stone features (laterality, size, number, volume, and location), mean operative time, and, perioperative and postoperative complications, as well as the stone-free rate (SFR), were all retrospectively evaluated. The results were classified as stone free, clinical insignificant residual fragments (CIRF), and presence of residual stones. Complications were graded using the Clavien-Dindo classification system. We used a modified surgical technique. RESULTS: All of complications were minor. There were no major complications (Clavien grade III-IV). The stone-free rate was 70.3% (38/54) on the first day after surgery and 83.3% (45/54) 1 month afterward, respectively. If we accept the absence of residual stone as success, we can say that it is about 91% successful in the first month. CONCLUSION: This technique has a high stone-free success rate and a low complication rate without the use of radiation. For surgeons experienced in endourology, we can say that the fluoroscopy-free technique is safe and effective in secondary-session RIRS cases which passive dilatation was performed by inserting a ureteral catheter before.

The presence of chronic inflammation in positive prostate biopsy is associated with upgrading in radical prostatectomy.

OBJECTIVE: This study aimed to determine the predictive effect of the presence of chronic prostatitis associated with prostate cancer (PCa) in prostate biopsy on Gleason score upgrade (GSU) in radical prostatectomy (RP) specimens. MATERIALS AND METHODS: The data of 295 patients who underwent open or robotic RP with a diagnosis of localized PCa following biopsy were retrospectively analyzed. Patients were divided into two groups with and without GSU following RP. Predictive factors affecting GSU on biopsy were determined. The impact of chronic prostatitis associated with prostate cancer on GSU was examined via logistic regression analysis. RESULTS: Out of 224 patients with Gleason 3+3 scores on biopsy, 145 (64.7%) had Gleason upgrade, and 79 (35.2%) had no upgrade. Whilst comparing the two groups with and without Gleason upgrade in terms of patient age, prostate-specific antigen (PSA) value, PSA density (PSAD), prostate volume (PV), neutrophil/lymphocyte (N/L) ratio, number of positive cores, percentage of positive cores, and Prostate Imaging Reporting and Data System version 2 score, no statistically significant difference was detected. The presence of chronic prostatitis associated with PCa was higher in the patient cohort with GSU in contrast to the other group (p < 0.001). According to the univariate logistic regression analysis, the presence of chronic prostatitis was identified to be an independent marker for GSU. CONCLUSIONS: Pathologists and urologists should be careful regarding the possibility of a more aggressive tumor in the presence of chronic inflammation associated with PCa because inflammation within PCa was revealed to be linked with GSU after RP.

External validation of the T.O.HO. score and derivation of the modified T.O.HO. score for predicting stone-free status after flexible ureteroscopy in ureteral and renal stones.

OBJECTIVE: The T.O.HO. scoring system was developed to predict stone-free status after flexible ureterenoscopy (fURS) lithotripsy applied for ureter and renal stones. This study aimed to perform the external validation of the T.O.HO. score in the Turkish population and propose a modification for this system. MATERIAL METHODS: Patients who underwent fURS for kidney and ureteral stones between January 2017 and January 2020 were retrospectively analysed. The patient and stone characteristics and perioperative findings were noted. The T.O.HO. score was externally validated and compared with the STONE score. Stone-free parameters were evaluated with the multivariate analysis. Based on the results of this analysis, the T.O.HO. score was modified and internally validated. RESULTS: A total of 621 patients were included in the study. The stone-free rate was determined as 79.8% (496/621) after fURS. The regression analysis showed that stone area had better predictive power than stone diameter (P = .025). Lower pole (reference), middle pole [odds ratio (OR) = 0.492 P = .016] and middle ureteral (OR = 0.227, P = .024) localisations, stone density (OR = 1.001, P < .001), and stone volume (OR = 1.008, P < .001) were determined as independent predictive markers for stone-free status. Based on the effect size of the stone surface area in the nomogram, stone volume was divided into five categories, at 1-point intervals. The AUC values of the T.O.HO., STONE, and modified T.O.HO. score in predicting stone-free status were calculated as 0.758, 0.634, and 0.821, respectively. The modified T.O.HO. created by adding stone volume was statistically significantly superior to the original version (ROC curve comparison, P < .001). CONCLUSION: The T.O.HO. score effectively predicted stone-free status after fURS. However, modified T.O.HO. SS showed the best predictive performance compared with original T.O.HO. SS.

A perfect storm: Open surgical approach to iatrogenic abdominal aortic injury developed during percutaneous nephrostomy.

Percutaneous nephrostomy catheter insertion allows the diagnosis and treatment of many pathologies from kidney failure to infection and obstruction. Vascular injuries are considered one of the complications of percutaneous interventions and are rarely seen after percutaneous nephrostomy catheter insertion. Herein, we report the first case of the successful surgical treatment of iatrogenic abdominal aortic injury after percutaneous nephrostomy catheter insertion in a 78-year-old female patient who developed hydroureteronephrosis and acute renal failure due to obstructive ureteral stone in the right proximal ureter.

Female Urethroplasty With Dorsal Onlay Labia Minora Graft: Technical Details and Initial Results.

OBJECTIVE: The objective of this study was to evaluate the functional results of dorsal onlay labia minora graft urethroplasty in the treatment of female urethral strictures. MATERIALS AND METHODS: Data were retrospectively examined for 13 patients who underwent augmentation urethroplasty through the dorsal approach using labia minora grafts between September 2017 and January 2019. Demographic, intraoperative, and postoperative data and follow-up conditions were recorded for all patients. RESULTS: The mean age of the patients was calculated as 48.2±7 years. The etiology of urethral strictures was found to be trauma in 2 patients, iatrogenic in 4 patients, and idiopathic causes in 7 patients. The mean urethral stricture length of the patients was 1.5±0.4 cm (range, 1-2.5 cm). The mean surgical duration was 95±11.4 minutes (range, 70-110 minutes). The mean postoperative American Urology Association symptom score, maximum urine flow rate, and postmictional residue values were statistically significantly different compared with preoperative data (P < 0.05). No peroperative and postoperative complications were detected in any patients. The mean follow-up duration of the patients was 19±5.3 months, and no recurrence of stricture was observed in any patients based on the cystourethroscopic examinations. All patients are being followed up in our clinic without any stricture recurrence or symptoms. CONCLUSIONS: The dorsal onlay labia minora graft urethroplasty technique in female urethral strictures is an efficient and applicable method with postoperative anatomic and functional results. Studies with longer follow-up periods and larger patient populations are required to present the success and reliability of this technique.

An Unexpected Complication After Extracorporeal Shock Wave Lithotripsy: Emphysematous Pyelitis.

Emphysematous urinary tract infections (UTI) are life-threatening conditions caused by gas-forming organisms. Emphysematous pyelitis (EP) is a rare, acute bacterial UTI characterized by gas formation only in the renal collecting system. Extracorporeal shock wave lithotripsy (ESWL) treatment was performed for 10-mm sized stone in the left renal pelvis in an 81-year-old female patient with no known comorbidities other than hypertension. In the 10th hour following ESWL treatment, the patient referred to the emergency department with fever and left flank pain. Gas was noticed in the left renal collecting system in non-contrast computed tomography (NCCT). A wide spectrum antibiotic was given to the patient due to EP diagnosis and a nephrostomy catheter was placed in the left renal pelvis. EP should be considered in the patient with fever and flank pain after ESWL and NCCT should be performed for further examination. Quick diagnosis, examination and treatment of these patients in the emergency department are important.

Evaluation of factors affecting sexual dysfunction in female patients with diabetes mellitus

ABSTRACT Objective Our objective in this study was to evaluate the factors predicting female sexual dysfunction (FSD) in patients with diabetes mellitus (DM). Subjects and methods The study included 149 women with DM. Sexual function was evaluated with the Female Sexual Function Index (FSFI) questionnaire, in which total scores under 26.55 characterized the occurrence of FSD (Group 1 > 26.55, Group 2 < 26.55). We recorded the patients' demographic, metabolic, and hormonal data. Ophthalmologic, neurologic, and renal complications were also evaluated. The antioxidant status of the patients in both groups was determined by measuring the activity of the enzymes paraoxonase-1 (PON-1) and arylesterase (ARE). Results Based on the FSFI scores, 60 patients were allocated to Group 1 (26.6 ± 12.3) and 89 to Group 2 (22.6 ± 9.5). Group 2 compared with Group 1 had significantly (p < 0.05) higher mean concentrations of glycated hemoglobin (HbA1c), glucose, triglycerides, and insulin, along with higher rates of metformin use, smoking, retinopathy, and nephropathy. The mean serum ARE concentrations were significantly lower in Group 2 compared with Group 1 (p = 0.000), but the mean serum PON-1 concentrations were similar between both groups (p = 0.218). On multivariable regression analysis, age, ARE activity, Beck Depression Inventory (BDI) score, and menopause were significant independent predictors of FSD (p < 0.05). Conclusions In this study, we evaluated the predictive factors determining FSD caused by DM. Despite the significant results found in our study, future randomized controlled studies with a long follow-up and a larger number of patients are required to determine how DM affects FSD.

Comparison of Two Different Scoring Systems in Encrusted Ureteral Stent Management: A Single-Center Experience.

PURPOSE: To report our single-center experience in encrusted ureteral stent management and to compare the utility of two different scoring systems, KUB (Kidney, Ureter, Bladder) versus FECal (forgotten, encrusted, calcified), in patient management. MATERIALS AND METHODS: We retrospectively analyzed the medical records of all patients who were found to have encrusted/retained ureteral stent and underwent various procedures to remove encrusted ureteral stent in our clinic between May 2014 and December 2018. Encrusted stent grading was performed using KUB and FECal grading systems. KUB system score is the sum of the stone burden scores of 3 different parts of an encrusted stent within the kidney, ureter and bladder determined using a scale from 1 to 5 according to the maximal diameter of encrustation. FECal grading system is based on the stone size, location and degree of stent encrustation and scored from Grade 1 to Grade 5. RESULTS: A total of 39 patients (29 males and 10 females) were included the study. The mean age of the patients was 46.4 ± 14.5 years, ranging from 13 to 71 years. The mean time from ureteral stent insertion to encrustation was 13.7 ± 26.4 months, varying between 2 and 120 months. The mean KUB score was 6.4 ± 2.4. According to FECal system, 53.8% of the patients were classified as Grade 1 and 15.4% as Grade 2. The encrusted ureteral stents of eight patients (20.5%) could be removed with the aid of a foreign body forceps inserted through a cystoscope. Fourteen patients (35.9%) underwent cystolithotripsy, seven (17.9%) underwent flexible ureterorenoscopy (URS), six (15.4%) underwent rigid URS, and three (7.7%) underwent combined percutaneous nephrolithotomy and URS beside stent removal. In multivariate regression analysis, largest encrustation diameter, FECal system grade and KUB score were found to be significant predictors of stone- and stent-free status (p<0.001 for all). Also, KUB score was found to be associated with the number of required procedures (r= .506, p= .001). CONCLUSION: KUB encrusted stent scoring system might be useful in predicting the number of required procedures to achieve stone- and stent-free status. Pure intracorporeal endourologic procedures, percutaneous interventions or open surgery might be preferred according to the patient's situation and the surgeon's experience and preference.

Postrenal Acute Renal Failure Due to Giant Fecaloma-related Bilateral Hydronephrosis: A Case Report and Brief Literature Review.

An 88-year-old woman presented to the emergency department with abdominal distention, fever, and constipation of about a week's duration. Laboratory tests showed impaired kidney function tests and fluid electrolyte values. Bilateral hydroureteronephrosis was observed on non-contrasted abdominal CT. Imaging revealed no intrinsic urological pathology (ureteral stones, etc.) that could lead to obstruction in the urinary system; however, excessively dilated and feces-loaded rectum and colon were observed. The patient was treated with conservative methods. Unfortunately, she passed away due to general condition disorder.

Evaluation of factors affecting sexual dysfunction in female patients with diabetes mellitus.

OBJECTIVE: Our objective in this study was to evaluate the factors predicting female sexual dysfunction (FSD) in patients with diabetes mellitus (DM). SUBJECTS AND METHODS: The study included 149 women with DM. Sexual function was evaluated with the Female Sexual Function Index (FSFI) questionnaire, in which total scores under 26.55 characterized the occurrence of FSD (Group 1 > 26.55, Group 2 < 26.55). We recorded the patients' demographic, metabolic, and hormonal data. Ophthalmologic, neurologic, and renal complications were also evaluated. The antioxidant status of the patients in both groups was determined by measuring the activity of the enzymes paraoxonase-1 (PON-1) and arylesterase (ARE). RESULTS: Based on the FSFI scores, 60 patients were allocated to Group 1 (26.6 ± 12.3) and 89 to Group 2 (22.6 ± 9.5). Group 2 compared with Group 1 had significantly (p < 0.05) higher mean concentrations of glycated hemoglobin (HbA1c), glucose, triglycerides, and insulin, along with higher rates of metformin use, smoking, retinopathy, and nephropathy. The mean serum ARE concentrations were significantly lower in Group 2 compared with Group 1 (p = 0.000), but the mean serum PON-1 concentrations were similar between both groups (p = 0.218). On multivariable regression analysis, age, ARE activity, Beck Depression Inventory (BDI) score, and menopause were significant independent predictors of FSD (p < 0.05). CONCLUSIONS: In this study, we evaluated the predictive factors determining FSD caused by DM. Despite the significant results found in our study, future randomized controlled studies with a long follow-up and a larger number of patients are required to determine how DM affects FSD.

Gasless robotic perineal radical prostatectomy: Experience of the first 12 cases. / Prostatectomía radical perineal robótica sin gas: experiencia en los primeros 12 casos.

OBJECTIVE: To present our results of first 12 patients on whom we performed gasless robotic perineal radical prostatectomy (r-PRP). METHODS: We performed gasless r-PRP on 12 patients between August 2018 and October 2018. Multiparametric magnetic resonance imaging was performed forall patients to exclude local advanced disease. Demographic characteristics, technical details, and intra and postoperative data were analyzed. RESULTS: The mean age of the patients was 62.6 ± 6years. The mean body mass index of the patients was 27 ± 4 kg/m2. Four patients had a history of major abdominal surgery. The mean preoperative prostate-specific antigen (PSA) was 7.4 ± 2.5 ng/mL. The mean prostate volume was 40 ± 10.2 cc. The mean perineal dissection time was 45.6 ± 5.8 minutes. The mean console time and total operative time were 117.8 ± 28.1 and 163.3 ± 30.7 minutes, respectively. The mean urethral catheter removal time was 9.2 ± 1.9 days. The immediate continence rate was 25% after the urethral catheter removal and the continence rate was 75% and 91.67% at the 3rd and 6th month follow-up, respectively. CONCLUSIONS: Gasless r-PRP is an efficient and safe method in prostate cancer surgery. However, prospective randomized and comparative studies are required with large patient series.

OBJETIVO: Presentar nuestros resultados en los primeros 12 pacientes en los que hemos realizado prostatectomía radical perineal robotica sin gas.MÉTODOS: Se realizó la prostatectomia radical robótica perineal sin gas en 12 casos entre agosto 2018 y octubre 2018. RNM multiparamétrica se realizó en todos los pacientes para excluir enfermedad avanzada local. Las características demográficas, detalles técnicos y datos intra e postoperatorios fueron analizados. RESULTADOS: La mediana de edad de los pacientes fue de 62,6 ± 6 años. El IMC medio fue de 27 ± 4 kg/m2, cuatro pacientes tenían historia de cirugía abdominal previa. EL PSA preoperatorio fue de 7,4 ± 2,5 ng/mL. El tamaño prostático medio fue de 40 ± 10,2 cc. El tiempo medio de disección perineal fue de 45,6 ± 5,8 minutos. El tiempo medio de consola y el tiempo quirúrgico total fueron de 117,8 ± 28,1 y 163,3 ± 30,7 minutos, respectivamente. El tiempo medio a la retirada de sonda fue de 9,2 ± 1,9 dias. La continencia inmediata fue de 25% después de la retirada de la sonda y la tasa de continencia fue de 75% y 92% al 3r y 6º mes de seguimiento, respectivamente. CONCLUSIONES: La prostatectomía radical robótica perineal sin gas es un procedimiento eficiente y seguro en la cirugía del cáncer de próstata. Aunque estudios prospectivos randomizados y estudios comparativos son necesarios con más series de pacientes.

The utility of De Ritis Ratio in predicting prognosis in testicular cancer.

OBJECTIVE: We aimed to investigate the possible association between testicular cancer prognosis and De Ritis ratio (AST/ALT). METHODS: The medical records of all patients who underwent radical inguinal orchiectomy at a single tertiary in Istanbul, Turkey between 2006 and 2017 were retrospectively analyzed. Investigated parameters included patients' demographics, complete blood count and blood biochemistry results, pathology results, treatment schemes, imaging results, and survival. De Ritis ratio was calculated as follows: AST/ALT. RESULTS: A total of 171 patients with a mean age of 32.6 ±â€Š10.1 years were included in the study. 73 patients had T1, 83 had T2, 13 had T3 and 2 had T4 disease. Rete testis invasion was detected in 74 patients (43.3 %) as well as lymphovascular invasion in 93 (54.4 %) and tunica albuginea invasion in 80 (46.8 %) patients. The cut-off value for AST/ALT was set at 1.35 [Area Under Curve (AUC): 0.791 with a sensitivity of 80 % and specificity of 73 %]. No statistically significance was observed between patients with and without elevated AST/ALT according to rete testis invasion, lymphovascular invasion, tunica albuginea invasion, and tunica vaginalis invasion (p = .25, p = .63, p = 1.0 and p = 1.0, respectively). 28.2 % of patients with seminoma had AST/ALT > 1.35 however 41.9 % of patients with non-seminoma pathology had AST/ALT > 1.35 (p = .078). Mean estimated survival time of patients with AST/ALT > 1.35 was higher than those with AST/ALT < 1.35, 91.8 versus 70.4 months, p < .001). As seen in Kaplan-Meier analysis elevated AST/ALT is associated with early-term mortality. CONCLUSION: De Ritis ratio was shown to be significantly associated with unfavorable prognosis. De Ritis ratio might serve as a prognostic biomarker in testicular tumor besides well-known tumor markers such as beta-human chorionic gonadotropin (hCG), alpha-fetoprotein (AFP) and lactate dehydrogenase (LDH).

Perineoscopic radical prostatectomy: A novel surgical technique for the treatment of prostate cancer.

OBJECTIVE: The objective of this article is to discuss the technical details of perineoscopic radical prostatectomy (perineoscopic-RP), which we performed for the first time as a surgical treatment for prostate cancer (PCa), and to present the outcomes of three patients who underwent this procedure. MATERIAL AND METHODS: Using a robotic scope as an optical system, we performed perineoscopic-RP in 3 patients in March 2018. Technical details of the procedure have been explained step-by-step in this article. Preoperative, perioperative, and postoperative data of all the patients was analyzed. RESULTS: Perineoscopic-RP was completed successfully without the need to convert to other approaches and/or techniques in all three patients. The patients were in a low-risk group for PCa. The mean time that elapsed to reach the prostate apex was 50±3.6 minutes, including the time required to install the optic and retractor system. The mean total operative time was 144.3±8.4 minutes. No intraoperative or postoperative complications were observed. Surgical margins were negative in all patients. Incontinence was observed in 2 patients after the removal of the Foley catheter. All patients achieved complete continence in the 3rd month during the follow-up. CONCLUSION: This technique, of which we presented the initial results in this article, can be successfully performed as a surgical intervention method for PCa. Prospective and comparative studies with larger patient series are required to place this method in routine practice.

Understanding the genital diseases of Ancient Anatolia in the light of the inscribed male genital offerings presented to gods.

In the ancient Greek and Roman world, many gods and goddesses were considered to possess healing powers, and there were their temples where they could heal those who prayed. For that reason, in the ancient times, people were going to healing temples of various gods and goddesses to recover from their illnesses or grievous injuries. Sick individuals at the temples were offering some written or unwritten votive reliefs indicating their illnesses, to the gods or goddesses to ask for healing or to express gratitude after finding a cure. Among these, votive stones containing written expressions and reliefs expressing the owner's health problem held an important position. In the research on this antiquity, four inscribed votives that had a male genital organ depicted on them and that were dedicated to Anatolian gods Theos Hypsistos and Sozon, and goddesses Phileis and Ollie, were found. In this article, we aimed to study the inscribed offerings that are still on display in museums and private collections discovered during the excavations in Anatolia hosting the ancient Greek and Roman civilizations simultaneously and their possible relations with the urogenital illnesses.

Gossypiboma: A Dramatic Result of Human Error, Case Report and Literature Review.

Gossypiboma refers to a retained foreign object that was forgotten in the body cavity during an operation. It is a rare surgical complication that most commonly occurs after intraperitoneal abdominal emergency surgical procedures, but may also occur after virtually any type of operation. Gossypiboma can be confused with neoplastic lesions and abscess. Clinical examination and radiological findings may sometimes mislead the physician. We intend to present our cases, which is thought to be a kidney tumour and bladder cancer but resulted gossypiboma which is a condition that is caused by a forgotten sponge during the operation and it can mimic the cancer. During the operation, the team must work in coordination and be careful. Unnecessary operations in such situation can significantly increase the patient's morbidity.

Splenic Injury During Percutaneous Nephrolithotomy: A Case Report of a Rare Complication.

Percutaneous nephrolithotomy has often been the preferred method for large and complex kidney stones. During percutaneous access to the collecting system, we encounter organ injuries due to anatomic neighborhoods. However, splenic injury is a relatively rare complication. We aimed to report how the complication process was managed conservatively in our case with transsplenic access. Then, a brief literature review on management strategy in similar conditions is highlighted.

Gasless robotic perineal radical prostatectomy: An initial experience.

Radical prostatectomy (RP) is the gold standard treatment method of localized prostate cancer. Today, this surgery is performed with open or minimally invasive methods. The history of open perineal RP (RPP) is very old, but it is not often preferred by urologists. The use of robot-assisted laparoscopic RP (RALP) is very frequently applied today. Robotic perineal RP (r-RPP) by using a Gel-Point and insufflating CO2 into the perineal region was first described in 2014. In this case report, we report a 68-year-old patient with localized prostate cancer in whom we successfully performed gasless r-RPP, and according to our knowledge, this is the first case of gasless r-RPP to be reported.