Evaluation of Sexual Function in Patients with Lower Lumbar Disc Herniation: A Comparison of Pre- and Postoperative Status.

BACKGROUND: Neuroregulation of sexual functions requires coordination of parasympathetic, sympathetic, and somatosensory neuronal pathways. The nerves formed by the lower lumbar plexus provide the innervation of the urogenital organs. Lower lumbar disc hernias (LDHs) might impair the neuroregulation of sexual functions by compressing the neural structures. This prospective study aims to evaluate the effect of lower LDHs on libido and sexual dysfunctions. METHODS: A total of 61 sexually active patients diagnosed with single-level LDH who underwent unilateral microdiscectomy were included in the study. The patients' healthy sex partners were included in study as controls. The International Sexual Function Index-5 (IIEF-5) and Female Sexual Function Index (FSFI) were used for sexual assessment of male and female participants, respectively. Visual Analog Scale (VAS) was used for pain assessment. RESULTS: According to the FSFI scores, all 20 female patients had preoperative sexual dysfunction, which improved in 15 (75%) patients after surgery (p < 0.001). According to the IIEF-5 score for men, 38 of 41 male patients had preoperative sexual dysfunction, which improved in 26 (68.4%) patients postoperatively (p < 0.001). CONCLUSION: The preoperative sexual dysfunctions of LDH patients improved significantly after the microdiscectomy.

Can the Mayo Adhesive Probability Score Predict Perioperative Outcomes in Laparoscopic Total and Partial Adrenalectomy?

Objective: This study aimed to determine whether the Mayo adhesive probability (MAP) score could predict perioperative outcomes in transperitoneal laparoscopic total adrenalectomy (LTA) and laparoscopic partial adrenalectomy (LPA). Materials and Methods: The clinical data of 139 patients who underwent transperitoneal LTA (n = 116) or LPA (n = 23) between March 2013 and September 2022 were retrospectively analyzed. According to the images obtained from preoperative contrast-enhanced computed tomography or magnetic resonance imaging, the patients were divided into two groups: the low MAP score group (0-1 points) and the high MAP score group (2-5 points). General clinical features and perioperative outcomes were compared between the groups. Results: In patients with a high MAP score, the mean body mass index (BMI) (p: 0.005), tumor size (p: 0.005), operative time (p: 0.002), estimated blood loss (EBL) (p: 0.001), and complication rate (p: 0.013) were significantly higher compared with those with a low MAP score. The comparison of the patients between the LTA and LPA subgroups revealed that operative time and EBL were significantly higher in both subgroups among the patients with a high MAP score. Moreover, the complication rate in the LTA subgroup was significantly higher in the high MAP score group compared with the other group. The Multivariate analyses revealed that a high MAP score was a risk factor for prolonged operative time (Odds Ratio [OR]: 3.081, 95% Confidence Interval [CI]: 1.284-7.398, p: 0.012), increased EBL (OR: 2.495, 95% CI: 1.114-5.588, p: 0.026), and complications (OR: 6.085, 95% CI: 1.532-24.171, p: 0.01) Conclusions: Patients with a high MAP score had a prolonged operative time, increased EBL, and a higher complication rate compared with those with a low MAP score. In addition, we found that a high MAP score was an independent risk factor for perioperative parameters and complications in patients who underwent LTA and LPA.

The Impact of Ureteral Access Sheath Size on Perioperative Parameters and Postoperative Ureteral Stricture in Retrograde Intrarenal Surgery.

Objective: To investigate the effect of the diameter of ureteral access sheath (UAS) used during retrograde intrarenal surgery (RIRS) on operative parameters, perioperative ureteral injury, and ureteral stricture development. Materials and Methods: The study was designed as a prospective randomized controlled trial and included 320 patients who underwent RIRS. The patients were divided into two groups according to the diameter of UAS (9.5F/11.5F [Group 1] and 12F/14F [Group 2]) placed during the operation. At the end of the operation, ureteral injury was checked visually using semirigid ureterorenoscopy and classified according to the ureter injury scale. In the postoperative first year, the control CT urography images were used to observe newly developing ureteral dilatation. Results: There was no statistical difference between the two groups in terms of patient and stone characteristics, operative time, postoperative stone-free rate, and postoperative infection development parameters. In Group 1, 30 (18.8%) of the patients had low-grade and 8 (5%) of the patients had high-grade ureteral injury, while in Group 2, 44 (27.5%) had low-grade and 19 (11.9%) had high-grade ureteral injury (p = 0.013). In the postoperative period, ureteral stricture was found in 5 (1.6%) patients, of whom 4 (2.5%) were in Group 2 and 1 (0.6%) (p = 0.371). Conclusion: The results of our study showed that the use of a 12F/14F UAS in patients who are not previously stented increases the risk of high-grade ureteral injuries; however, despite this increase there is no difference in ureteral stricture formation.

Comparison of holmium laser enucleation with bipolar transurethral enucleation of the prostate in patients with benign prostatic hyperplasia: Results of a multicentre study.

To assess the efficacy and morbidity of the holmium laser enucleation of the prostate and bipolar transurethral enucleation of the prostate in patients with benign prostatic hyperplasia. The study included 60 (55%) and 49 (45%) patients who underwent laser and bipolar enucleation of the prostate respectively. According to the perioperative data, except for length of hospital stay and enucleated prostate weight, all the remaining parameters were similar between the groups. There were significant differences between the preoperative and the postoperative third and 12th month voiding parameters in both groups. In the laser group, the maximum urine flow rate value was better than the bipolar group at the postoperative third and 12th months. However, we did not find any statistically significant difference between the groups in terms of the serum prostate-specific antigen level, International Prostate Symptom Score and postvoid residual urine volume at the postoperative third and 12th months. Our results show that both laser and bipolar techniques are effective minimally invasive surgical treatment options for men with benign prostatic hyperplasia. When compared to bipolar technique, laser technique provides shorter hospital stay, more prostatic tissue enucleation and better maximum urine flow rate values.

The Impact of Surgical Approaches for Isolated Acetabulum Fracture on Sexual Functions: A Prospective Study.

OBJECTIVES: To investigate the effects of surgical modalities for isolated acetabular fractures on the sexual functions of patients and their partners. DESIGN: Prospective. SETTING: Level I trauma centre. PATIENTS/PARTICIPANTS: Sixty-five patients who had undergone open reduction and internal fixation because of isolated acetabular fractures who were sexually active before, together with their partners. INTERVENTION: Patients operated on for isolated acetabular fractures were divided into 3 groups according to surgical approaches: the Kocher-Langenbeck approach (n = 36), ilioinguinal approach (n = 16), and modified Stoppa approach (n = 13). MAIN OUTCOME MEASUREMENTS: Sexual functions of patients and their partners were evaluated with the 5-item version of the International Index of Erectile Function score and Female Sexual Function Index score preoperatively and at the postoperative first year after the rehabilitation period. RESULTS: The mean age of the patients was 41.8 ± 13.0 (18-69) years. In male patients, the mean 5-item version of the International Index of Erectile Function score had changed from 24.3 to 20.0 at the postoperative first year and the decrease in sexual function scores was less with the Kocher-Langenbeck approach. In female patients, the Female Sexual Function Index scores had decreased statistically significantly from 24.9 to 18.3 at the postoperative first year, but there was no statistically significant difference between surgical groups. Both male and female patients' partners' sexual function scores were also decreased at the postoperative first year. CONCLUSIONS: As a result of our study, it was observed that the posterior approach is more advantageous than anterior approaches in preserving the sexual functions of male patients in acetabular fracture surgery. However, the surgical approach did not affect the sexual functions of female patients. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Does previous open or percutaneous renal stone surgery affect retrograde intrarenal surgery outcomes?

Background/aim: Open or percutaneous renal stone surgery can have an adverse effect on the collecting system of the kidney. We evaluated retrograde intrarenal surgery outcomes in patients with ≤30 mm renal stones who had open or percutaneous renal stone surgery history. Materials and methods: A total of 707 patients who underwent retrograde intrarenal surgery treatment were included in this study. Fifty-six patients had open or percutaneous renal stone surgery history (Group 1) and the remaining did not (Group 2, n = 651). The groups were compared in terms of age, stone size, stone-free rates, and complications. Results: The mean age of the patients was 51.16 ± 14.8 and 45.95 ± 14.6 years in Groups 1 and 2, respectively (p = 0.008). The mean stone size was 14.97 ± 6.1 mm and 16.47 ± 6.9 mm in Groups 1 and 2, respectively (p = 0.107). The stone-free rates were 71.4% and 84.1% in Group 1 and 2 respectively and it was significantly higher in Group 2 (p = 0.013). The overall rate of postoperative complications was higher in Group 1 (p = 0.019), but there was no difference between the two groups in terms of Clavien 1­2 and 3­4a complication rates. Conclusion: Our results showed that having a history of open or percutaneous renal stone surgery has a negative effect on the success and complication rates in retrograde intrarenal surgery. Therefore, patients should be well informed before this operation.

Laparoscopic partial adrenalectomy using near-infrared imaging: the initial experience.

INTRODUCTION: To present our initial clinical experience with laparoscopic partial adrenalectomy using indocyanine green dye with near-infrared fluorescence imaging. MATERIAL AND METHODS: A total of eight patients underwent transperitoneal laparoscopic partial adrenalectomy using indocyanine green dye with near-infrared fluorescence imaging in our clinic. After 5 mg intravenous indocyanine green dye administration, we resected the mass under the guidance of near-infrared fluorescence imaging and white light visualization in an effort to completely excise the mass while sparing uninvolved adrenal tissue. RESULTS: Seven patients underwent unilateral and one patient underwent bilateral laparoscopic partial adrenalectomy. The median tumor size was 43 mm. The surgery was successfully performed with negative margins in all patients. The tumors were hypofluorescent relative to normal adrenal tissue with indocyanine green dye with near-infrared fluorescence imaging in patients with Cushing's syndrome, aldosteronoma, and adrenal cyst. However, pheochromocytoma and angiomyolipoma were noted to be isoflourorescent and hyperfluorescent relative to normal adrenal parenchyma, respectively. CONCLUSIONS: Laparoscopic partial adrenalectomy using intraoperative indocyanine green dye with near-infrared fluorescence imaging seems to be safe and feasible. This technology may ultimately be helpful in resecting lesions with more precise surgical margins by identifying the vascular structure during laparoscopic partial adrenalectomy. Abbreviations: LTA: Laparoscopic total adrenalectomy; LPA:Laparoscopic partial adrenalectomy; ICG: Indocynanine green; NIRF: Near-infrared fluorescence; HPA: Hypothalamic-pituitary-adrenal.

Mixed epithelial and stromal tumor of the kidney treated with minimally invasive surgery.

Mixed epithelial and stromal tumor of the kidney (MESTK) is a rare kidney tumor that tends to occur in middle-aged and older women and is characterized by a distinctive histological appearance. Most of them were incidentally detected. A 26-year-old female patient was referred to in our clinic due to intermittent left lower back pain for 2 months and left renal mass. Abdominal computed tomography showed a cystic enhanced heterogenic left renal mass about 5 cm in the largest diameter was extending from the renal pelvis to the ureter and causing gross hydronephrosis of the left kidney. The mass treated with transperitoneal laparoscopic nephroureterectomy and bladder cuff resection. Histopathological evaluation revealed MESTK. In our patient, MESTK successfully and without any complication be treated by minimally invasive surgery. We believe that the fact that the tumor can mimic the urothelial-cell carcinoma of the kidney in radiological appearance, as seen in our case, should be taken into consideration.

Laparoscopic Partial versus Total Adrenalectomy in Nonhereditary Unilateral Adrenal Masses.

OBJECTIVE: To compare the surgical outcomes and clinical improvement 1 year after laparoscopic partial and total adrenalectomy for the treatment of patients with nonhereditary unilateral functional adrenal adenomas. MATERIAL AND METHODS: From March 2016 to January 2018, we performed 15 laparoscopic partial adrenalectomy (LPA; Group 1) and 25 laparoscopic total adrenalectomy (LTA; Group 2) procedures. The key points reside in adenoma identification, preservation of the remaining glandular parenchyma, and its blood supply with dissection in the space between the adenoma and the normal parenchyma. The operative and clinical outcomes were compered. RESULTS: The mean age of the patients was 45.1 (17-69) years and the median follow-up was 15 (12-26) months. Operative time, blood loss, and hospital stay were similar between the groups. No major perioperative and postoperative complications occurred. After surgery, all patients had resolution of their symptoms, with no patient in Group 1 requiring steroid replacement. However, a patient in Group 2 required steroid replacement therapy. On postoperative imaging, no residual and recurrent mass was detected. CONCLUSIONS: Our results showed that LPA is safe and feasible, and has similar therapeutic results compared with LTA in patients with a nonhereditary hormonally active unilateral adrenal mass. Furthermore, LPA can obviate the need for steroid replacement in these patients.

Safety and reliability of fluoroscopy-free technique in retrograde intrarenal surgery.

BACKGROUND: Traditional retrograde intrarenal surgery is performed under fluoroscopic guidance. In the present study, we assessed the efficacy and safety of retrograde intrarenal surgery without fluoroscopic guidance in selected patients with renal and proximal ureteral stone disease. METHODS: Between October 2013 and August 2016, a total of 350 patients who underwent retrograde intrarenal surgery for upper urinary tract stone disease were retrospectively analyzed. Ninety-five (Group 1) and 255 (Group 2) patients underwent retrograde intrarenal surgery with and without fluoroscopy guidance, respectively. We documented complications and success rates of the procedures retrospectively. RESULTS: The mean age of the patients was 45.3 years. The mean stone size was 14.5±5.5 (5-30) mm and 13.7±5.2 (4-30) mm in Group 1 and 2, respectively (P=0.197). The stone-free rates one month after surgery were 86.3% and 87% in Group 1 and 2, respectively (P=0.739). The overall incidence of intraoperative complication was 16.3%. In Group 1, incidence of intraoperative complication was 17.9% (N.=17) while in Group 2 incidence was 15.7% (N.=40) (P=0.620). The overall postoperative complication rate was 5.1%. Postoperative complications developed in seven patients (7.4%) in Group 1 and in 11 patients (4.3%) in Group 2 (P=0.250). CONCLUSIONS: Fluoroscopy-free retrograde intrarenal surgery seems to be technically feasible and safe for the treatment of renal and proximal ureteral stone disease in uncomplicated selected cases.