Factors Influencing Bladder Perforation during Transurethral Resection of Bladder Cancer: A Comprehensive Analysis.

BACKGROUND: Bladder perforation (BP) is one of the important complications during transurethral resection of bladder tumour (TURBT). Additionally, multiple factors can contribute to BP. Here, we investigated the rates of BP, specifically in variant histology of bladder cancer (BC), and examined the clinical follow-up of relevant patients. METHODS: Of the 797 patients who underwent TURBT between 2015 and 2023, they were divided into two groups according to BP during the operation. Group 1 (n = 744) consisted of patients without BP, whereas Group 2 (n = 53) consisted of patients with BP. Demographic, operative, postoperative and follow-up data were investigated and analysed. Groups were examined in terms of causes of BP. Significance was set at p < 0.05. RESULTS: A significantly higher rate of BP was found in patients operated with bipolar energy (p = 0.027) than in their counterparts. In multivariable analysis, the presence of the obturator reflex during TURBT was significantly associated with an increased risk of BP (p < 0.001). We observed a statistically significant increase in the rate of BP in patients with a history of previous intravesical Bacillus Calmette-Guérin (BCG) therapy (p = 0.023). Variant histology was reported in 32 patients (4%). However, we could not find any statistically significant relationship between the development of BP and the variant histology of BC (p = 0.641). CONCLUSIONS: Multiple factors can affect BP during TURBT. Understanding the factors associated with BP is crucial for improving patient safety and outcomes. According to the results of the present study, the energy source, the presence of obturator reflex during TURBT and intravesical BCG therapy may increase BP. Nevertheless, the presence of variant histology was not significantly associated with BP.

The Controlling Nutritional Status (CONUT) Score as a Predictor of Local Recurrence in Patients Underwent Partial Nephrectomy Alongside the R.E.N.A.L. Nephrometry Score.

PURPOSE: This study aims to assess the utility of the CONUT (Controlling Nutritional Status) Score and R.E.N.A.L. (Renal Nephrometry Score) Score in predicting tumor recurrence in patients with kidney cancer. Additionally, we investigated which parameters contributed to these scores. MATERIALS AND METHODS: In total, 115 patients that underwent partial nephrectomy between January 2015 and August 2023 at a single tertiary center were enrolled. After the exclusion criteria, data from 88 patients were analyzed. Age, gender, body mass index (BMI), comorbidities (hypertension, diabetes), smoking status, tumor characteristics, CONUT Scores, and R.E.N.A.L. scores were retrospectively recorded. Statistical analyses were performed, and significant p was p<0.05. RESULTS: The presence of diabetes and hypertension showed a statistically significant association with tumor recurrence (p=0.033 and p=0.003, respectively). A high BMI significantly increased the risk of recurrence (p < 0.05). There was a strong positive relationship between the high tumor stage and positive surgical margins with recurrence (p<0.001). Patients with high R.E.N.A.L. Scores and high CONUT Scores had a higher risk of recurrence (42.1% and 8.7%, respectively), and this difference was statistically significant (p<0.001). CONCLUSION: CONUT and R.E.N.A.L. scores may be used to predict tumor recurrence after partial nephrectomy. Additionally, diabetes, hypertension, high BMI, and positive surgical margin rate might affect surgical success rate for recurrences. Clinicians should consider all these parameters and coring systems to gather more successful results after partial nephrectomy.

Investigation of the causes of BCG refractory in patients treated with intracavitary BCG as secondary treatment in superficial bladder tumors with transurethral resection.

BACKGROUND: Non-muscle invasive bladder cancers (NMIBC) tend to recur and progress over time. Bacillus Calmette-Guerin (BCG) is an effective therapy for the treatment of NMIBC in that it reduces both recurrence and progression rates. The present study investigates the causes of BCG failure, with emphasis on those attributable to application errors by the practitioner and/or patient. METHODS: The demographic and histopathological characteristics of 115 patients who underwent TUR-B for primary bladder tumors and who underwent intracavitary BCG in the postoperative period in the Urology Clinic of the Izmir Katip Çelebi University Atatürk Training and Research Hospital between January 2014 and January 2019, were analyzed retrospectively. BCG-refractory patients were compared with non-BCG refractory patients after BCG administration. RESULTS: The extent of the tumor, and the involvement of the tumor in the bladder trigone and/or the bladder neck were found to increase significantly the likelihood of BCG refractory. When the micturition times of both groups were compared after instillation, the differences between the groups were found to be statistically significant. In the BCG-refractory patient group, the micturition time after instillation was shorter due to the tumor involvement in the trigone/bladder neck. CONCLUSION: Some modifiable factors originating from the patient and the tumoral characteristics were found to have an effect on BCG failure. It was further determined that the time until micturition after BCG administration is an important parameter to be considered in the prevention of application deficiencies. We believe these factors should be subjected to careful consideration during patient selection and follow-up.

A novel surgical technique for extraperitoneal radical prostatectomy with using 3 trocars: Results after 154 cases. / Una novedosa técnica para la prostatectomía radical extraperitoneal con 3 trocares: resultados después de 154 casos.

OBJECTIVES: Recently laparoscopic radical prostatectomy (LRP) is a minimally invasive surgical option for prostate cancer (PCa) treatment in the lack of robot. To eliminate numbers of trocars and to modify surgical technique can make the LRP procedure easier. We aimed to introduce our novel approach on LRP by using just only 3 trocars and to compare conventional extraperitoneal LRP (eLRP) with 3 trocars eLRP. METHODS: Of the 223 PCa patients undergone eLRP were divided into 2 groups as Group 1 (n=69) consisted of conventional eLRP, Group 2 (n=154) consisted of consecutive 3 trocars eLRP. Demographic, operative, postoperative, and short-term follow-up data including functional results were analysed. RESULTS: Mean follow-up was 10.9±5.1 months. Preoperative and demographic parameters were comparable between the groups. Mean operative time, intraoperative used carbon dioxide (CO2) gas, and hospital stay were significantly shorter in Group 2 (for all parameters p<0.001). Haemoglobin decrease was also less in Group 2 without statistical significance. Oncologic and functional results were similar. There was no major complication in Group 2. CONCLUSIONS: According to our results 3 trocars eLRP can be performed safely and effectively in experienced hands. Haemorrhage, operative time, CO2 usage, and hospital stay could be shortened with our novel approach.

OBJETIVOS:  Recientemente, la prostatectomía radical laparoscópica (PRL) es una opción mínimamente invasiva para el tratamiento del cáncer de próstata (CaP) cuando no existe la robótica. Eliminar el numero de trocares y modificar la técnica quirúrgica, puede hacer la PRL un procedimiento fácil. Nuestro objetivo es introducir nuestra nueva técnica para la PRL utilizando solo 3 trocares y compararla con la PRL tradicional. MÉTODOS: De los 223 pacientes con cáncer de próstata que recibieron una PRL extraperitoneal se dividieron en 2 grupos: Grupo 1 (n=69) consistió en la PRL convencional; Grupo 2 (n=154) PRL con 3 trocares. Datos demográficos, quirúrgicos, postoperatorios, seguimiento y resultados funcionales fueron analizados. RESULTADOS: La mediana de seguimiento fue de 10,9±5,1meses. Las variables preoperatorias y demográficas fueron comparables entre ambos grupos. El tiempo medio de cirugía, el uso intraoperatorio de CO2 y la estancia hospitalaria fueron menores en el Grupo 2 (para todos los parámetros pde hemoglobina fue menor también en el grupo 2 sin significación estadística. Los resultados funcionales y oncológicos fueron similares. No hubo complicaciones mayores en el Grupo 2. CONCLUSIONES: De acuerdo con nuestros resultados la PRL extraperitoneal con 3 trocares se puede realizar de forma segura y efectiva en manos expertas. El sangrado intraoperatorio, tiempo quirúrgico y el uso de CO2 se pueden acortar con el uso de esta técnica.

A novel surgical technique for extraperitoneal radical prostatectomy with using 3 trocars: results after 154 cases / Una novedosa técnica para la prostatectomía radical extraperitoneal con 3 trocares: resultados después de 154 casos

OBJECTIVES: Recently laparoscopic radical prostatectomy (LRP) is a minimally invasive surgical option for prostate cancer (PCa) treatment in the lack of robot. To eliminate numbers of trocars and to modify surgical technique can make the LRP procedure easier. We aimed to introduce our novel approach on LRP by using just only 3 trocars and to compare conventional extraperitoneal LRP (eLRP) with 3 trocars eLRP. METHODS: Of the 223 PCa patients undergone eLRP were divided into 2 groups as Group 1 (n = 69) consisted of conventional eLRP, Group 2 (n = 154) consisted of consecutive 3 trocars eLRP. Demographic, operative, postoperative, and short-term follow-up data including functional results were analysed. RESULTS: Mean follow-up was 10.9 ± 5.1 months. Preoperative and demographic parameters were comparable between the groups. Mean operative time, intraoperative used carbon dioxide (CO2) gas, and hospital stay were significantly shorter in Group 2 (for all parameters p < 0.001). Haemoglobin decrease was also less in Group 2 without statistical significance. Oncologic and functional results were similar. There was no major complication in Group 2. CONCLUSIONS: According to our results 3 trocars eLRP can be performed safely and effectively in experienced hands. Haemorrhage, operative time, CO2 usage, and hospital stay could be shortened with our novel approach

OBJETIVOS: Recientemente, la prostatectomía radical laparoscópica (PRL) es una opción mínimamente invasiva para el tratamiento del cáncer de próstata (CaP) cuando no existe la robótica. Eliminar el número de trocares y modificar la técnica quirúrgica, puede hacer la PRL un procedimiento fácil. Nuestro objetivo es introducir nuestra nueva técnica para la PRL utilizando solo 3 trocares y compararla con la PRL tradicional. MÉTODOS: De los 223 pacientes con cáncer de próstata que recibieron una PRL extraperitoneal se dividieron en 2 grupos: Grupo 1 (n = 69) consistió en la PRL convencional; Grupo 2 (n = 154) PRL con 3 trocares. Datos demográficos, quirúrgicos, postoperatorios, seguimiento y resultados funcionales fueron analizados. RESULTADOS: La mediana de seguimiento fue de 10,9 ± 5,1meses. Las variables preoperatorias y demográficas fueron comparables entre ambos grupos. El tiempo medio de cirugía, el uso intraoperatorio de CO2 y la estancia hospitalaria fueron menores en el Grupo 2 (para todos los parámetros pde hemoglobina fue menor también en el grupo 2 sin significación estadística. Los resultados funcionales y oncológicos fueron similares. No hubo complicaciones mayores en el Grupo 2. CONCLUSIONES: De acuerdo con nuestros resultados la PRL extraperitoneal con 3 trocares se puede realizar de forma segura y efectiva en manos expertas. El sangrado intraoperatorio, tiempo quirúrgico y el uso de CO2 se pueden acortar con el uso de esta técnica

The examination of the nephroprotective effect of montelukast sodium and N-acetylcysteine in renal ischemia with dimercaptosuccinic acid imaging in a placebo-controlled rat model.

PURPOSE: To determine the nephroprotective effect of NAC and Montelukast Sodium administration against the development of renal damage associated with long warm renal ischemia. METHODS: Twenty-seven rats were randomly divided into 3 study groups, which received NAC, montelukast and placebo, and 3 rats were included in the sham-treated control group. Medications were given 3 days before the procedure. DMSA renal scintigraphy was performed before and after surgery. The right renal pedicle was occluded for 45 min to induce ischemia and then subjected to reperfusion for 6 h (I/R groups). RESULTS: On pathological examination, the mean pathological scores of the montelukast and NAC groups were significantly lower than those of the placebo group. (p <0.05). In biochemical examination, significant differences were found in all parameter levels between the placebo group and the montelukast and NAC groups. (p <0.05) When postoperative DMSA renal scintigraphy measurements and renal function levels were compared, significant differences were found between the montelukast and NAC groups and the placebo and sham groups. CONCLUSION: The administration of NAC and montelukast sodium was seen to have a nephroprotective effect against the development of renal damage associated with warm renal ischemia.

Current status of uro-oncology training during urology residency and the need for fellowship programs: An international questionnaire study.

OBJECTIVE: This study aimed to evaluate the opinions of urologists from different countries about uro-oncology education, fellowship programs, and approaches to different urological malignancies at different stages using a questionnaire. MATERIAL AND METHODS: A total of 207 urologists from 22 countries were sent a questionnaire containing 18 items by email. The questions were related to urologic oncology training provided during residency, acceptance of uro-oncology as a sub-branch, the necessity of certification for treatment and follow-up, fellowship program preferences, adequateness of the programs, and approach differences to the different stages of urological malignancies among the urologists from different countries. RESULTS: In total, 111 (53.62%) urologists who completed the questionnaire were enrolled in the study, and 40.54% of the urologists reported that the uro-oncology training during the residency period was not sufficient. Furthermore, 79.27% of the urologists reported opinions about acceptance of uro-oncology as a sub-branch. The ratio of urologists who undertake the treatment of patients with muscle-invasive bladder cancer (radical surgery and urinary diversion) and prostate cancer (radical prostatectomy, definitive radiation therapy, experimental local treatment, and hormonal therapy) is 27.92% and 37.83%, respectively. The urologists reported that they perform nephron-sparing surgery (NSS), radical nephrectomy (RN), and laparoscopic NSS/RN treatments in patients with localized renal cancer at the rates of 61.26%, 47.74%, and 25.22%, respectively. CONCLUSION: Uro-oncology training during the residency period seems to be inadequate in most of the countries, and a high number of the urologists tend to avoid high-volume operations and systemic treatments of uro-oncologic malignancies.

Histopathologic Evaluation of the Effects of Intraurethral Platelet Rich Plasma in Urethral Trauma Experimentally Induced in Rat Model.

OBJECTIVE: To determine the efficacy of platelet rich plasma applied early initialization after urethral trauma for preventing inflammation and spongiofibrosis. MATERIALS AND METHODS: Twenty-three rats were randomized and divided into 3 groups, with 10 rats in 2 groups. Only sham group had 3 rats. The urethras of all rats were traumatized with a pediatric urethrotome knife at 6- and 12-o'clock. For 15 days, group I was given platelet rich plasma (PRP) once a day without urethral injury (sham group), group II (n = 10) was not given any medical treatment only urethral injury group (UI-PRP), group III (n = 10) was given PRP once a day intraurethrally as instillation using a 22 ga catheter sheath with urethral injury (UI+PRP). On day 15, the penises of the rats were degloved to perform penectomy. RESULTS: A significant difference was detected in all parameters when the sham, UI-PRP, UI+PRP groups were compared (respectively, P = .001, / <.001, / .008 / .007) and a significant difference was observed among mucosal inflammation, fibrosis, and edema parameters when UI-PRP and UI+PRP groups were compared. (Respectively; P <.001, / <.001 / .006). CONCLUSION: In this study, it was shown that intraurethral PRP applied after urethral trauma significantly decreased mucosal inflammation, spongiofibrosis, and edema. Depending on the results we acquired in this study, we think that PRP may be a promising option in urethral stricture treatment.

Comparison of Long-Term Automated Retinal Layer Segmentation Analysis of the Macula between Silicone Oil and Gas Tamponade after Vitrectomy for Rhegmatogenous Retinal Detachment.

PURPOSE: To identify long-term changes in individual retinal layer thickness using automated retinal layer segmentation analysis on high-resolution spectral-domain optical coherence tomography (SD-OCT) scans of eyes with macula-off rhegmatogenous retinal detachment (RRD) treated with vitreoretinal surgery (VRS) and gas or silicone oil tamponade and having single-operation success. METHODS: A total of 58 patients operated on by VRS for RRD and followed up for 12 months were imaged by SD-OCT. The patients with retinal diseases such as an epiretinal membrane or cystic macular edema in the operated and fellow eyes were excluded. The thicknesses of the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), photoreceptor layer, and retinal pigment epithelium were compared to those of the fellow eyes after the 12-month follow-up. Thickness changes in individual layers were quantitatively analyzed in the operated and fellow eyes and correlated with the type of tamponade used in the surgery. RESULTS: Spectralis OCT automated segmentation software was used for the retinal layer analysis. There were 22 females and 36 males. Their mean age was 60.7 ± 11.2 years. The mean central macular thickness was 214.3 ± 29.5 µm in the operated and 229.7 ± 21.7 µm in the fellow eyes (p = 0.008). There was a statistically significant difference between the operated and the healthy fellow eyes in the following layers: the RNFL (p = 0.017), GCL (p = 0.02), INL (p = 0.005), and ONL (p = 0.008) in the central foveal area; the RNFL (p < 0.001), INL (p = 0.017), and ONL (p = 0.022) in the perifoveal ring; and the RNFL (p < 0.001), IPL (p = 0.042), INL (p = 0.001), and OPL (p = 0.001) in the peripheral ring. The logMAR best corrected visual acuities were 2.51 ± 0.68 and 2.69 ± 0.62 at baseline and 0.60 ± 0.38 and 0.50 ± 0.38 at month 12 in the silicone oil tamponade (n = 28) and the gas tamponade (n = 30) group (p = 0.52 and p = 0.21, respectively). The foveal GCL, OPL, and ONL and the perifoveal GCL and IPL were statistically significantly thinner in the silicone oil tamponade group (p = 0.01, p = 0.046, p = 0.024, p = 0.006, and p = 0.011, respectively). CONCLUSIONS: Significant changes were observed in the retinal layers after VRS for RRD. Individual retinal layers seem to be affected 1 year after VRS for RRD. The type of tamponade can influence the thickness of the retinal layers. The thickness of the retinal layers was significantly preserved in eyes treated with gas tamponade when compared to those treated with silicone oil tamponade in the long term. Further studies are needed to validate our results.

Retrospective study of systemic immune-inflammation index in muscle invasive bladder cancer: initial results of single centre.

PURPOSES: We aimed to evaluate the prognostic value of the preoperative systemic immune-inflammation index (SII) in patients who underwent radical cystectomy due to muscle invasive bladder cancer (MIBC). METHODS: We researched our cystectomy database between April 2006 and December 2018. Demographic data, operation and postoperative data were recorded. There were 191 MIBC patients who underwent radical cystectomy. After detailed analyses, preoperative SII was calculated by the formula as "(neutrophil) × (platelet)/(lymphocyte)". Cancer-specific survival (CSS) and overall survival (OS) were examined. The prognostic value of SII was analysed with univariate and multivariate Cox proportional hazards regression models. Receiver operating characteristic (ROC) was used to determine the optimum SII. Significant P was P < 0.05. RESULTS: The mean follow-up was 37 ± 6.7 months. The mean age of patients was 62.1 ± 9 years. The optimal cutoff value of SII was determined as 843 in ROC curve (area under the curve: 0.9; P < 0.001). The CSS and OS were significantly poor in patients with higher SII level (respectively; P < 0.001, P = 0.04). Gender, lymph node involvement, pathologic stage, grade and SII were statistically significant in multivariate Cox proportional hazards regression model for CSS. CONCLUSIONS: Preoperative elevated SII could be an independent prognostic factor in MIBC patients who underwent radical cystectomy. If SII > 843, CSS might be poor. Our results should be confirmed with randomised-controlled prospectively designed future studies with large cohorts.

The examination of the nephroprotective effect of montelukast sodium and N-acetylcysteine in renal ischemia with dimercaptosuccinic acid imaging in a placebo-controlled rat model

Abstract Purpose To determine the nephroprotective effect of NAC and Montelukast Sodium administration against the development of renal damage associated with long warm renal ischemia. Methods Twenty-seven rats were randomly divided into 3 study groups, which received NAC, montelukast and placebo, and 3 rats were included in the sham-treated control group. Medications were given 3 days before the procedure. DMSA renal scintigraphy was performed before and after surgery. The right renal pedicle was occluded for 45 min to induce ischemia and then subjected to reperfusion for 6 h (I/R groups). Results On pathological examination, the mean pathological scores of the montelukast and NAC groups were significantly lower than those of the placebo group. (p <0.05). In biochemical examination, significant differences were found in all parameter levels between the placebo group and the montelukast and NAC groups. (p <0.05) When postoperative DMSA renal scintigraphy measurements and renal function levels were compared, significant differences were found between the montelukast and NAC groups and the placebo and sham groups. Conclusion The administration of NAC and montelukast sodium was seen to have a nephroprotective effect against the development of renal damage associated with warm renal ischemia.

Impact of increased aspartate aminotransferase to alanine aminotransferase (De Ritis) ratio in prognosis of testicular cancer.

Purpose: Imaging studies can show metastasis in testicular cancer (TCa); however, a test for risk of metastasis in TCa has not been described. The ratio of aspartate aminotransferase to alanine aminotransferase, also called the De Ritis ratio (DRR), is used for many other malignancies. We aimed to evaluate the association between preoperatively assessed DRR and prognosis in patients with TCa. Materials and Methods: One hundred twenty-eight patients with TCa were enrolled in a retrospective study between March 2007 and January 2017. Clinical, biochemical, and pathological data were recorded. Univariate and multivariate logistic regression analyses were used. The prognostic value of DRR and the threshold value were assessed by use of receiver operating characteristic curves. Significance was defined as p<0.05. Results: Mean follow-up was 37±9.7 months. There were 45 and 73 TCa patients with and without lymph node metastasis, respectively. Lung metastases and other solid organ metastases occurred in 14 and 4 patients, respectively. The optimal DRR threshold was 1.30 for both retroperitoneal lymph node involvement and metastasis. DRR was determined as an independent prognostic factor for retroperitoneal lymph node involvement and organ metastasis in univariate and multivariate analyses (p<0.001, p=0.006 and p=0.002, p=0.047, respectively). Conclusions: A preoperative DRR greater than 1.30 may be an independent risk factor for retroperitoneal lymph node involvement and organ metastases in patients with TCa.

Can tumor recurrence be reduced with plasma-kinetic vaporization of the area around the tumor in nonmuscle invasive bladder cancer?

Purpose: To investigate the effect on recurrence of vaporization of the tumor surroundings and suspicious areas with a plasma-kinetic (PK) system after transurethral resection (TUR) of nonmuscle invasive bladder cancer. Materials and Methods: The study included 121 patients with a primary superficial bladder tumor who were randomized as those who underwent TUR with the PK system (Group 1, n=62) and those who underwent TUR with the monopolar system (Group 2, n=59). The vaporization procedure was performed by suppressing the cutting option of the PK system for a period, which would accumulate energy sufficient to make swelling-waves on the mucosa very close to the area of the loop to be vaporized. Results: A total of 121 patients who met the study criteria were included for evaluation. Recurrence was determined in 21 patients in Group 1 (33.87%) and in 29 patients in Group 2 (49.15%) (p=0.088). Recurrence was close to the old resection site in 6 of 21 patients in Group 1, and in 13 patients in Group 2 (p=0.028); the difference was statistically significant. No statistically significant difference was determined between the two groups with respect to age, gender, number of tumor foci, rate or range of additional treatments applied, cigarette smoking rate, repeat TUR rate and rate of tumor en- countered in repeat TUR, T-stage, and tumor grade. Conclusions: The effect of vaporization on recurrence by the PK system may seem similar to the effect of standard TUR, the recurrence- lowering effect surrounding nonmuscle invasive bladder cancers is better.

Conjunctival Impression Cytology and Tear-Film Changes in Patients With Inflammatory Bowel Disease.

PURPOSE: To evaluate the ocular surface changes and tear-film functions in patients with inflammatory bowel disease (IBD). METHODS: The IBD group included 57 patients, and the control group included 29 healthy individuals. The Schirmer I test, tear breakup time (TBUT), corneal and conjunctiva fluorescent staining, and conjunctival impression cytology tests were performed to both groups. RESULTS: The rate of dry eye was 56.1% and 10.3% in the IBD and control groups, respectively, as assessed by the Schirmer I test (P<0.001). The rate of dry eye was 52.6% and 20.8% in the IBD and control groups, respectively through TBUT (P=0.004). The Ocular Surface Disease Index scores of the IBD group (15.25±7.31) were significantly higher than the control group (11.75±7.33) (P=0.039). According to the Oxford scheme, mild-to-moderate staining was 54.4% in the IBD group and 6.9% in the control group (P<0.001). Nelson Staging System showed that 69% of the IBD group had stage 2 or 3 impression cytology, whereas none of the control group had stage 2 or 3 impression cytology (P<0.001). Using the Schirmer I test, the rate of dry eye was 55.8% of the patients with IBD receiving 5-aminosalicylic acid (5-ASA) and 61.5% of the patients with IBD receiving both 5-ASA and azathioprine (P=0.485). CONCLUSIONS: Our study results showed that dry eye was 3 times higher in the IBD group than the control group. But, the duration of disease seems not to have effect on dry eye.

Comparision of Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery For The Treatment of Multicalyceal and Multiple Renal Stones.

PURPOSE: Comparison of efficiency and reliability of percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS) in treatment of multicalyceal and multiple renal stones in the same renal unit. MATERIALS AND METHODS: Between 2011 and 2015, records of patients who underwent surgery for renal stone were retrospectively reviewed. Patients who had multiple stones located in different calices in the same renal unit were included. The patients that underwent PNL and RIRS were defined as Group I and Group II, respectively. Patient criteria (age,sex); the stone characteristics; time of procedure, fluoroscopy and hospitalization; stone-free and complication rates of groups were evaluated between the treatment groups. RESULT: There were no significant differences in terms of age, gender, BMI, laterality, number of stones, number of stone localization, hounsfield units and surface area characteristics of the stone between the PNL (n = 47) and RIRS (n = 35) groups (P = .558, P = .278, P = .375, P = 0.051, P = .053, P = .064, P = .642, P = .080, respectively). Stone free rate was 59.6% (n=28) in PNL, and 88.6% (n=31) in RIRS (P=.004). 1st or 2nd degree complications according to Modified Clavien Classification developed in 10 patients (21.3%) in Group I and 1 patient (2.9%) in Group II (P = .015). The 3A or 3B complications were similar in groups (P = .077). Time of procedure, fluoroscopy and hospitalization were significantly lower in Group II (P < .001, P < .001 and P < .001, respectively). CONCLUSION: RIRS is more effective and more reliable procedure than PNL with higher stone-free and lower complication rates in treatment of multicalyceal and multiple stone in the same renal unit.

Does Preoperative Use of Dutasteride Decrease Bleeding During Open Prostatectomy?

PURPOSE: To investigate whether use of dutasteride, a 5-alpha reductase inhibitor, for at least four weeks preoperatively affected the blood loss during open prostatectomy (OP). MATERIALS AND METHODS: Retrospective analysis was made of the data of 110 patients who had undergone OP. Group I comprised 50 patients that used dutasteride for 4 weeks preoperatively, and Group II comprised 60 patients that did not use the drug. The groups were compared in respect of age, total prostate specific antigen (TPSA) levels, prostate volumes, preoperative hemoglobin (Hgb) and hematocrit (Hct) levels, postoperative reduction of Hgb and Hct, percentage reduction in Hgb and Hct, and the administration of postoperative blood products. RESULTS: No differences were determined between the two groups in respect of prostate volumes, TPSA, preoperative Hgb and Hct levels (P = .813, P = .978, P = .422, P =.183, respectively). Postoperative Hgb reduction was 2.19 ± 1.36 g/dL in Group I, and 2.5 ± 1.47 g/dL in Group II (P = .260). Hgb reduction was calculated as 16.4 ± 9.7% in Group I and 17.6 ± 9.7% in Group II (P = .505). Reductions in Hct were 5.8 ± 3.7% in Group I, and 7.3 ± 4.4% in Group II, and percent reductions were 14.8 ± 9.4% in Group I and 17.3 ± 10.2% in Group II (P = .068, P = .182, respectively). CONCLUSION: The use of dutasteride before OP did not affect blood loss during surgery, therefore surgery should not be delayed for the administration of dutasteride to patients.

The Respiratory Induced Kidney Motion: Does It Really Effect the Shock Wave Lithotripsy?

PURPOSE: To investigate the effect of respiratory induced kidney mobility on success of shock wave lithotripsy (SWL) with an electrohydraulic lithotripter. MATERIALS AND METHODS: Between May 2013 and April 2015, 158 patients underwent SWL treatment for kidney stones with an electrohydraulic lithotripter. The exclusion criteria were presence of a known metabolic disease (such as cystinuria), non-opaque stones, need for focusing with ultrasonography, abnormal habitus, urinary tract abnormalities, and inability to tolerate SWL until the end of the procedure. Stones greater than 20 mm, and lower pole stones were also excluded. The movement of the kidneys were measured with fluoroscopy guidance. RESULTS: The procedure was successful in 66.7% of the males, and 56.9% of the females. The mean stone size was 11 ± 3 mm in the successful group, and it was 14 ± 4 mm in the unsuccessful group. The mean stone mobility rate was 32 ± 10 in the successful group and 40 ± 11 in the unsuccessful group. Multivariate analysis showed that stone size and kidney mobility affected the success rate significantly, however Hounsfield Unit (HU) did not. CONCLUSION: The current study shows the significant effect of kidney motion on the success of SWL. Further studies with different lithotripters are needed to determine the significance of kidney mobility.

Should manual detorsion be a routine part of treatment in testicular torsion?

BACKGROUND: It was aimed to investigate the efficiency and reliability of the manual detorsion (MD) procedure in patients diagnosed with testicular torsion (TT). METHODS: A retrospective analysis was made of the data of 57 patients diagnosed with TT, comprising 20 patients with successful MD (Group I), 28 patients who underwent emergency orchiopexy (Group II), and 9 patients applied with orchiectomy (Group III). The groups were compared in respect of age, and duration of pain. The success rate of MD, the time of testicular fixation (TF), any problems encountered in follow-up, and follow-up times were analyzed in Group I. Data were analyzed with P-P pilot, Mann-Whitney U, Kruskal Wallis and Chi-square tests. A value of p < 0.05 was considered statistically significant. RESULTS: MD was successful and detorsion could be achieved in 20 of 26 patients. The groups were similar in respect of age (p = 0.217). The median duration of pain was 3 (1-8), 4 (1-72), and 48 (12-144) hours in Groups I, II, and III, respectively, and determined as similar in Groups I and II (p = 0.257), although a statistically significant difference was determined between the 3 groups (p < 0.001). TF was applied to Group I after median 10 (0-45) days, and no parenchymal disorder was determined in the median follow-up period of 21.5 (2-40) months. CONCLUSION: MD that can be easily and immediately performed after the diagnosis of TT decreases ischemia time. This seems to be an efficient and reliable procedure when applied together with elective orchiopexy, as a part of the treatment.

Factors Affecting Compliance to Intravitreal Anti-Vascular Endothelial Growth Factor Therapy in Patients with Age-Related Macular Degeneration.

OBJECTIVES: To determine factors influencing compliance in patients with neovascular age-related macular degeneration (n-AMD) undergoing intravitreal anti-vascular endothelial growth factor (VEGF) therapy. MATERIALS AND METHODS: The files of n-AMD patients recommended treatment with ranibizumab were reviewed retrospectively. The treatment regimen was 3 consecutive monthly injections followed by monthly follow-up with intravitreal injections as needed (pro re nata, PRN). Demographic and ocular characteristics were recorded. The patients were categorized into 2 groups: full compliance to treatment, or incomplete loading schedule and/or irregular maintenance treatment. All patients were interviewed by phone about factors affecting continuation of treatment. RESULTS: Mean age of the 314 patients (160 female, 154 male) included in the study was 71.6±9.1 years. A total of 246 patients (78.3%) could complete 3 consecutive injections at 1-month intervals after the start of treatment; 57 patients (18.2%) did not attend monthly follow-up during the 1-year follow-up period following the 3 consecutive monthly injections. Overall, 39.8% of the patients were not able to fully comply with the ranibizumab treatment by PRN regimen for 1 year. Better visual acuity at baseline, smaller lesion size, living closer to the hospital, higher education and sociocultural level, and better financial status were determined as factors affecting patient compliance. The most frequent reasons to discontinue treatment were fear of injection, disbelief in the benefit of the treatment, financial limitations, continuation of treatment at another center, and comorbid systemic diseases. CONCLUSION: Patient compliance and success rates of anti-VEGF therapy may be increased by determining the factors affecting patient compliance and raising awareness about n-AMD among patients and their relatives.

Complications and prostate cancer diagnosis rate of TRUS prostate biopsies using 16 and 18G needles by Clavien scoring.

AIM: We aimed to compare the 18 and 16-Gauge (G) needles used in transrectal ultrasonography (TRUS)-guided needle biopsy for cancer detection rates and complications using the Clavien Scoring System. MATERIALS AND METHODS: The 80 patients who were included in the study were randomized and divided into two groups. Group 1 (n = 36) had a TRUS-guided prostate biopsy with an 18G needle and Group 2 had a 16G needle (n = 44). The hematuria, bleeding assessment, and infection events were evaluated on a daily basis. These complications were graded according to the Clavien Scoring. RESULTS: In Group 1, only five (13%) patients were diagnosed with prostate cancer, and three patients were reported to have atypical small acinar proliferation (ASAP). In Group 2, 16 (36%) patients were diagnosed with prostate cancer and one patient was reported to have ASAP. The difference in the prostate cancer detection rate between the groups was statistically significant. According to the Clavien grading system, the complications were at the Grade 1 level in 25 people in Group 1 in 29 people in Group 2. Grade 2 level complications were not observed in either group. While one person was Grade 3 in Group 1, two people in Group 2 had this rate. There were no significant differences between the groups. CONCLUSIONS: We found that cancer detection rate increased by increasing the thickness of the needle used in TRUS-guided prostate biopsy without any increase in the complications.