Prospective Investigation on the Paternity Intention and Affecting Factors in 84 Post-treatment Testicular Cancer Patients.

PURPOSE: to investigate the factors affecting post-treatment paternity intention in patients followed up after the diagnosis of testicular cancer and to make recommendations for the early postoperative period based on the identified factors. MATERIALS AND METHODS: This prospective descriptive study included total 185 patients who presented to our outpatient clinic between February 2000 and July 2020 who had radical orchiectomy due to suspected testicular cancer based on physical examination and other assessments. Contact information was found for 88 of 185 patients, and accordingly, the patients were reached by one-to-one phone calls. Upon literature review, a questionnaire consisting of 10 previously validated items was developed by the researchers. The patients were compared by separating them into two groups composed of patients with (Group 1) and without (Group 2) paternity intention. RESULTS: A total of 84 patients participated in the study, and the participation rate was 95.5%. It was found that 19 of 32 (38%) patients with paternity intention already had children. Only 21 (40%) of 52 patients without paternity intention were married. The mean age was 26.65 (18-39) years in Group 1, while it was 28.73 (19-45) years in Group 2. Tumor volume and serum tumor markers were higher in Group 2 than in Group 1. Parameters such as testicular side in which the tumor was located, smoking status, undescended testis history, and postsurgical chemotherapy history were not statistically significant difference between the two groups. CONCLUSION: The major findings included that the young aged, unmarried, and serious testicular cancer (Tumor volume and serum tumor markers were higher) can be affecting factors for testicular cancer patients' paternity intention. Early psychological counseling about paternity may be useful for testicular cancer patients.

Contribution of pre-varicocelectomy color Doppler ultrasonography finding to surgery and its correlation with semen parameters.

BACKGROUND: This study aimed to determine the contribution of color Doppler ultrasonography (CDUS) performed before varicocelectomy to the success of surgical treatment and to evaluate the correlation between CDUS findings and semen parameters. METHODS: A total of 84 patients diagnosed with grade 3 left varicocele in our clinic between 2016 and 2018 were evaluated. The patients in whom the decision for varicocelectomy was based on only physical examination (PE) findings and abnormal semen analysis (SA) were defined as Group 1, while the patients undergoing varicocelectomy based on PE, CDUS and SA findings were defined as Group 2. The patients diagnosed with varicocele based on PE and CDUS findings who were included in a followup protocol due to normal semen parameters were defined as Group 3. RESULTS: In Group 1, there was a total of 28 patients and the mean number of ligated internal spermatic veins was 4.53 (range, 2-10). In Group 2, there was a total of 30 patients and the number of ligated internal spermatic veins was 3.76 (range, 1-8). No statistically significant difference was found between Group 1 and 2 in terms of the number of internal spermatic veins ligated during varicocelectomy. No statistically significant correlation was found between semen parameters and the number of veins ligated during varicocelectomy in Group 1 and 2 and between semen parameters and CDUS findings group 2 and 3. CONCLUSIONS: In patients with primary grade 3 varicocele, diagnosed by physical examination there is no need for additional imaging in primary cases.

Factors Affecting Success of Semi-rigid Ureterorenoscopy in Proximal Ureter Stone Treatment.

OBJECTIVE: To evaluate the factors affecting the success of semi-rigid ureteroscopy in proximal ureter stones. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Urology, Nevsehir State Hospital, Turkey between March 2017 and October 2019. METHODOLOGY: Patients, who underwent a semi-rigid ureteroscopic lithotripsy (URSL) operation for proximal ureteral stones, were evaluated retrospectively in terms of gender, age, stone side, stone size, stone density, the type of lithotripsy, placement of the stone cone, the type of anesthesia and postoperative stone-free rates, which were recorded. The diameter of the ureter with the stones and the distances of the stones to the ureteropelvic junction (UPJ) were measured. Patients who had stone-free status after the URSL were labelled as group I. Patients whose stones were pushed back during URSL were labelled as group II. RESULTS: The distance of the stone to the UPJ was statistically significantly higher in group I (p=0.006). The rate of using stone cone in patients in group I was statistically significantly higher than in patients in group II (p=0.001). The rate of stones in the middle ureter in group I was statistically higher than group II (p<0.001). The rate of using laser lithotriptor in group I was statistically higher than group II (p=0.007). CONCLUSION: Semi-rigid URSL is a useful technique in the proximal ureter stones.  The distance of the stone to the UPJ affects the success; and using laser lithotripsy and stone cone increases the success. Key Words: Ureteral stone, Ureterorenoscopy, Laser lithotriphsy, Pnomotic lithotripsy.

MAGPI under local anaesthesia without catheter as an alternative to standard TIP procedure in distal hypospadias repair.

To evaluate the surgical outcomes of meatal advancement and glanuloplasty incorporation (MAGPI) and tubularised incised plate (TIP) urethroplasty. We retrospectively reviewed the patient records who had hypospadias repairing surgery between March 2017 and March 2020 in terms of age, meatal position, operative and anaesthesia techniques and surgical outcomes. Hypospadias repair was performed in 85 patients. TIP urethroplasty was performed in 17 patients where MAGPI was performed in 63 patients. Preoperative meatal stenosis was present in 10. Coronal glanular and subcoronal hypospadias were present in 65 and 15 patients respectively. Mean operative time was 41.3 ± 28 min. The mean duration of the catheter was 7.56 days. A significant chordee was present in 35 patients where 45 patients had no chordee. The overall success rate was 93.75%. MAGPI ended up with an unfavourable result in 1 and TIP urethroplasty in 4. Postoperative urethral stenosis was seen in 1. Of those who ended up with an unfavourable result, 4 were with subglandular hypospadias. Urethral catheter required in 4 of those who failed, whereas 1 had no catheter following surgery. Therefore, MAGPI is a useful method in selected glandular and subglandular hypospadias repair with favourable surgical outcomes including no stent requirement.

Association of Gleason score with PSA Values and Serum Testosterone Levels Measured Prior To Prostate Biopsy.

OBJECTIVE: To analyse the association of prostate cancer (PCa) Gleason score evaluated upon prostate biopsy with clinical PSA values, total and free testosterone (TT and FT, respectively) levels measured prior to biopsy. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Department of Urology, Sultan Abdulhamid Han Education and Research Hospital, from July to December 2019. METHODOLOGY: A total of 85 patients were included and classified into non-PCa (group 1) and PCa (group 2) groups according the results of prostate biopsy pathology. Age, digital rectal examination (DRE) findings; prostate volume (PV); free/total prostate specific antigen (PSA) ratio (f/tPSA); PSA density (PSA-D) and total PSA (tPSA), free PSA (fPSA), TT and FT levels of the two groups were evaluated. Associations of the ISUP grade of patients in group 2 with age, DRE findings for PCa; PV; PSA-D; f/tPSA and tPSA, fPSA, TT and FT levels were analysed. RESULTS: Mean patient age was 63.00 (57.50-70.00) years. Mean age, significant DRE findings for PCa, tPSA levels and PSA-D were significantly higher in group 2 (p <0.05), whereas PV was significantly higher in group 1 (p <0.05). The ISUP grade of patients in group 2 was significantly and positively correlated with age and tPSA levels (p <0.05). ISUP grade was significantly and positively correlated with significant DRE findings for PCa (p <0.05). However, ISUP grade was negatively correlated with PV and f/tPSA (p <0.05). No significant difference was observed between the two groups in terms of TT and FT levels (p >0.05). CONCLUSION: TT and FT levels evaluated before prostate biopsy did not provide any additional benefit in predicting Gleason score grade before biopsy. Key Words: Prostate biopsy, prostate cancer, ISUP grade, Gleason score, total testosterone, free testosterone.

The importance of PSA-Density in active surveillance for prostate cancer.

OBJECTIVE: In this study, we aimed to determine the predictive factor for additional treatment requirement in active surveillance (AS) for patients with low or very low-risk prostate cancer (PCa) and we investigated the effect of tumor burden by total core involvement rate in biopsy to predict of need for additional treatment. MATERIAL AND METHODS: 107 patients with PCa in AS between 2005 and 2018 have been evaluated retrospectively. Groups were divided into two groups according to the need for additional treatment. Group 1 received additional treatment, group 2 did not receive additional treatments and active surveillance was continued. Patient's total prostate-specific antigen (tPSA), prostate-specific antigen density (PSA-D), total core involvement count, quantity and rate at biopsy pathology results and follow-up period were recorded and compared in the two groups. RESULTS: The current cohort includes 107 patients. Mean age at diagnosis was 63.01years. Mean tPSA values at diagnosis were 6.09 ng/mL and 5.2 ng/mL in the group 1 and group 2, respectively. Mean follow-up period was 38.1 months (range, 12 to 134 months). Only PSA-D measurement significantly predicted need for additional treatment (p = 0.017). ROC analysis showed that the optimal threshold was 0.13 ng/mL/cc (sensitivity: 70.8%; specificity: 57.1%). Additional treatment requirement was not detected in patients with PSA-D cut-off level less than 0.07 ng/mL/cc. CONCLUSIONS: Total tumor burden of less than 5% is safe for patients with low or very low-risk PCa in AS. A 0.13 ng/mL/cc cut-off level of PSA-D can predict to need for additional treatment in patients managed by AS.

Perioperative Indices Predicting Fever Following Percutaneus Nephrolithotomy.

OBJECTIVE: To investigate 18 independent peroperative parameters that may have an effect on fever after percutaneous nephrolithotomy (PCNL). STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Departments of Urology, Nevsehir State Hospital, and Sultan Abdulhamid Han Education and Research Hospital, Turkey, from January 2016 to June 2019. METHODOLOGY: Two hundred and seventy-six patients, who underwent PCNL between 2016 and 2019 in two institutions, were evaluated retrospectively. Patients were divided as Group I and II, according to the absence or presence of fever after PCNL, then peroperative parameters were compared. RESULTS: There was no statistically significant difference between Group I and II in terms of age, gender, side of stone, ipsilateral open stone surgery or PCNL history, presence of renal anatomic anomaly, preoperative hydronephrosis grade, stone size in computed tomography (CT), stone Houndsfield Unit (HU) value, skin stone distance, duration of operation, postoperative D-J insertion rate and postoperative blood transfusion requirement (p >0.05). Guy' s Stone Score (GSS), number of calyceal access and duration of achieving limpid urine coming out of the nephrostomy tube were significantly higher in Group II (p <0.05). The rate of postoperative fever was statistically significantly higher in patients with middle calyceal (mid-calyceal) access, than patients with inferior calyceal access (p=0.05). CONCLUSION: High GSS, mid-calyceal access, the increase in the amount of mid-calyceal access, the longer duration of achieving limpid urine coming out of the nephrostomy tube were found to be related with fever after PCNL. Key Words: PCNL, Post-PCNL fever, Nephrolithiasis, Guy's stone score.