Evaluation of black grape pomace, a fruit juice by-product, in shalgam juice production: Effect on phenolic compounds, anthocyanins, resveratrol, tannin, and in vitro antioxidant activity.

The aims of this research were to investigate the usability of black grape pomace in the production of shalgam juice, which is a traditional fermented Turkish beverage, to transform the pomace into the high value-added product and to enrich the shalgam juice with phenolic compounds. Black grape pomace and black carrot were used as the sources of polyphenols and five different formulations were obtained according to the amounts of black carrot and black grape pomace. During the fermentation, the samples were taken at different periods and analyzed for anthocyanins, phenolic compounds, antioxidant activity, and tannin content. Gentisic, caffeic, ferulic, coumaric, and chlorogenic acids, catechin, glucosides of kaemferol and isorhamnetin, resveratrol, rutin, cyanidin-3-xylosylglucosylgalactoside, cyanidin-3-xylosylgalactoside, cyanidin-3-xylosylglucosylgalactoside acylated with sinapic acid, ferulic acid, or coumaric acid, and glucosides of cyanidin, petunidin, and malvidin were identified in the shalgam juices that contained both black grape pomace and black carrot in their formulation. Some of these polyphenols were not detected detect in the shalgam juices that were produced from only the black carrot or black grape pomace. During the fermentation, a decrease in the amount of anthocyanins originated from black carrots and an increase in the amount of anthocyanins orginated from black grape pomace were determined. Black grape pomace addition to the formulation before the fermentation caused an increase in the amount of tannin in the shalgam juice samples. Consequently, it is thought that black grape pomace can be fruitfully evaluated in shalgam juice production and can be enhanced by polyphenolic profile of shalgam juice.

The effect of the use of tranexamic acid in percutaneous nephrolithotomy on blood loss and surgical visual clarity: a prospective, randomized, controlled and double-blind study.

Tranexamic acid, once a randomly used antifibrinolytic agent, has been in standard protocols for many specific surgeries. Studies are still needed to standardize the dose and route of tranexamic acid administration, examine its possible contributions in urological surgery, and establish a protocol for its use. To contribute to this goal, we designed a prospective, randomized, double-blind study on 75 patients with 1 control and 2 study groups (n = 25) who underwent percutaneous nephrolithotomy. Group Tranexamic acid received 10 mg/kg intravenous tranexamic acid preoperatively. And Group Irrigation received the same amount in the initial irrigation fluid. Primarily, we observed the total amount of blood transfusion and the changes in hemoglobin and hematocrit values during 2 postoperative days. Distinctively, we intraoperatively monitored hemoglobin continuously as a saturation hemoglobin value to assess the timing of the effect of tranexamic acid. Secondarily, we questioned surgical visual clarity with a standard visual score to reveal its contribution to surgical practicality, operative time, and residual fragment quantity. Our results revealed a significant difference in the reduction of hemoglobin and hematocrit change and blood transfusion in both tranexamic acid groups concerning control, especially on the second day (p = 0.003, p = 0.002, p = 0.001). Likewise, surgical visual scores were significantly better in both tranexamic acid groups (p = 0.018). In conclusion, intravenous or local administration of tranexamic acid at a dose of 10 mg/kg will be sufficient to maintain perioperative stability in hemoglobin values, use fewer blood products and provide a better visual advantage for the surgeon intraoperatively.The trial registration number is NCT05947435, and the date of registration is 07/07/2023, retrospectively registered.

Mineral composition, the profile of phenolic compounds, organic acids, sugar and in vitro antioxidant capacity, and antimicrobial activity of organic extracts of Juniperus drupacea fruits.

Juniperus drupacea fruit is widely used in traditional and complementary medicine in Turkey for the treatment of different diseases in various forms such as molasses and tar. This study was carried out to evaluate the phenolic compounds, organic acid, sugar, and macro- and micromineral distributions of methanol and water extracts of J. drupace fruit, as well as their antioxidant and antimicrobial potential. For this purpose, total phenolic content by spectrophotometer, phenolics, organic acids, and sugars distributions by HPLC in extracts of J. drupacea fruits, and macro- and micromineral element content by ICP-AES in fruit were determined. 2,2-diphenyl-l-picrylhydrazyl assay (DPPH assay) was used to evaluate in vitro antioxidant activity in extracts. The antimicrobial potential of J. drupacea fruit methanol extract against some gram-positive and gram-negative pathogenic bacteria was evaluated using disk diffusion and minimum inhibitory concentration (MIC) methods. The potassium macroelement and the iron microelement were found at high content in J. drupacea fruit. The total phenolic content in the methanol extracts was higher than the water extracts. Among the individual phenolic compounds, catechin, a flavonoid that was the highest in both extractions, was determined as 300.49 µg/g in methanol extract and 314.88 µg/g in water extract. DPPH scavenging activity was higher in methanol extracts. While the methanol extract of J. drupacea had no-inhibitory effect on the gram-negative bacteria tested, it exhibited a strong inhibition on the gram-positive bacteria Listeria innocua, Listeria monocytogenes, Staphylococcus carnosus, and Enterococcus faecalis.

Six-Minute Walk Test: How to do Guide for Performing a Reliable Test, Interpretation, and Prognostication in Pulmonary Hypertension.

Six-minute walk test (6MWT) is the most widely used exercise capacity measurement worldwide in patients with pulmonary hypertension (PH). Although cardiopulmonary exercise testing (CPET) is the gold standard for the assessment of exercise capacity in cardiovascular diseases; the limited accessibility of the device, the need for experience in interpreting the results, and the difficulties in performing CPET in advanced PH have aroused the interest in the application of easier methods for the measurement of exercise capacity. Since then, accumulated data proved that; 6-minutes walking distance (6MWD) can be used to determine exercise capacity and is highly correlated with maximum oxygen consumption (peak VO2) detected by CPET in patients with heart failure and/or PH. Moreover, 6MWT is very easy and practical to apply in all PH subgroups. This review is focused on the application of a reliable 6MWT and the interpretation of the results in patients with PH.

Evaluation of Nurses' Vaccine Hesitancy, Psychological Resilience, and Anxiety Levels During COVID-19 Pandemic.

OBJECTIVE: This study aimed to evaluate the vaccine hesitancy, psychological resilience, and anxiety levels of nurses during the COVID-19 pandemic. MATERIALS AND METHODS: This cross-sectional study was conducted with 676 nurses working at the survey time. Sociodemographic features, the status of hesitancy against the COVID-19 vaccine, the Coronavirus Anxiety Scale, and the Brief Resilience Scale were used in the questionnaire form to collect the data. RESULTS: Most participants (68.6%; n=464) stated they were hesitant about the COVID-19 vaccine. A sig- nificantly higher rate of hesitancy was detected in the age group of 20-39 years, those who did not have COVID-19 vaccine, and those who did not think the COVID-19 vaccine is protective (P < .05). It was determined that 6.8% (n=46) of the nurses had COVID-19 anxiety. A significantly higher rate of anxiety was detected in the age group of 40 years and older, those working in the emergency department, and those working in the COVID-19 unit during the pandemic period (P < .05). The median Brief Resilience Scale score of nurses is 19(6). A negative, weak, and significant relationship was found between the Brief Resilience Scale and Coronavirus Anxiety Scale scores (P = .001). CONCLUSION: During the pandemic, higher rates of anxiety were detected in healthcare personnel and those working in COVID-19 units. It was also found that as the level of anxiety increased, the level of psychological resilience decreased. To reduce the anxiety level and strengthen the psychological resilience of nurses, the cornerstones of the health system, fast, effective, and curative interventions should be made.

Effect of the COVID-19 Pandemic on the Psychological Health of Patients Who Underwent Liver Transplantation Due to Hepatocellular Carcinoma.

BACKGROUND: The primary aim of this study was to compare liver transplant (LT) recipients with and without hepatocellular carcinoma (HCC) in terms of COVID-19-related depression, anxiety, and stress. METHOD: A total of 504 LT recipients with (HCC group; n = 252) and without HCC (non-HCC group; n = 252) were included in the present case-control study. Depression Anxiety Stress Scales (DASS-21) and Coronavirus Anxiety Scale (CAS) were used to evaluate the depression, stress, and anxiety levels of LT patients. DASS-21 total and CAS-SF scores were determined as the primary outcomes of the study. Poisson regression and negative binomial regression models were used to predict the DASS and CAS scores. The incidence rate ratio (IRR) was used as a coefficient. Both groups were also compared in terms of awareness of the COVID-19 vaccine. RESULTS: Poisson regression and negative binomial regression analyses for DASS-21 total and CAS-SF scales showed that the negative binomial regression method was the appropriate model for both scales. According to this model, it was determined that the following independent variables increased the DASS-21 total score: non-HCC (IRR: 1.26; p = 0.031), female gender (IRR: 1.29; p = 0.036), presence of chronic disease (IRR: 1.65; p < 0.001), exposure to COVID-19 (IRR: 1.63; p < 0.001), and nonvaccination (IRR: 1.50; p = 0.002). On the other hand, it was determined that the following independent variables increased the CAS score: female gender (IRR:1.75; p = 0.014) and exposure to COVID-19 (IRR: 1.51; p = 0.048). Significant differences were found between the HCC and non-HCC groups in terms of median DASS-21 total (p < 0.001) and CAS-SF (p = 0.002) scores. Cronbach's alpha internal consistency coefficients of DASS-21 total and CAS-SF scales were calculated to be 0.823 and 0.783, respectively. CONCLUSION: This study showed that the variables including patients without HCC, female gender, having a chronic disease, being exposed to COVID-19, and not being vaccinated against COVID-19 increased anxiety, depression, and stress. High internal consistency coefficients obtained from both scales indicate that these results are reliable.

An Eight-year, Single-center Experience on Ultrasound Assisted Thrombolysis with Moderate-dose, Slow-infusion Regimen in Pulmonary Embolism.

BACKGROUND: There is limited data on moderate-dose with slow-infusion thrombolytic regimen by ultrasound-asssisted-thrombolysis (USAT) in patients with acute pulmonary embolism (PE). AIMS: In this study, our eight-year experience on USAT with moderate-dose, slow-infusion tissue-type plasminogen activator (t-PA) regimen in patients with PE at intermediate-high- and high-risk was presented, and short-, and long-term effectiveness and safety outcomes were evaluated. METHODS: Our study is based on the retrospective evaluation of 225 patients with PE having multiple comorbidities who underwent USAT. RESULTS: High- and intermediate-high-risk were noted in 14.7% and in 85.3% of patients, respectively. Mean t-PA dosage was 35.4±13.3 mg, and the infusion duration was 26.6±7.7 h. Measures of pulmonary artery (PA) obstruction and right ventricle (RV) dysfunction were improved within days (p<0.0001 for all). During the hospital stay, major and minor bleeding and mortality rates were 6.2%, 12.4%, and 6.2%, respectively. Bleeding and unresolved PE accounted for 50% and 42.8% of in-hospital mortality, respectively. Age, rate, and duration of t-PA were not associated with in-hospital major bleeding and mortality. Oxygen saturation exceeded 90% in 91.2% of patients at discharge. During follow-up of median 962 (610-1894) days, high-risk status related to 30-day mortality, whereas age >65 years was associated with long-term mortality. CONCLUSION: Our real-life experience with USAT with moderate-dose, slow-infusion t-PA regimen in patients with PE at high-and intermediate-high risk demonstrated clinically relevant improvements in PA obstructive burden and RV dysfunction. Age, rate or infusion duration of t-PA was not related to major bleeding or mortality risk, whereas unresolved obstruction remained as a lethal issue.

The Consistent Effectiveness and Safety of Macitentan Therapies Across Idiopathic and Congenital Heart Disease-Associated PulmonaryArterial Hypertension: A Single-Center Experience.

BACKGROUND: In this single-center study, we evaluated efficacy and safety issues and predictors of survival in patients with idiopathic and congenital heart disease-associated pulmonary arterial hypertension who were under macitentan therapies. METHOD: Our study retrospectively evaluated 221 patients with pulmonary arterial hypertension enrolled in our single-center study, and mono, dual, and triple macitentan therapies were noted in 30, 115, and 76 patients, respectively. The longitudinal changes in clinical, neurohumoral, and echocardiographic measures of pulmonary arterial hypertension were evaluated. The Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management, Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management 2.0, and Registry to Evaluate Early and Long- Term Pulmonary Arterial Hypertension Disease Management Lite 2 scores at baseline, Swedish PAH Registry, Comparative Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension registry, and French Pulmonary Hypertension Network registry risk status both at baseline and first control were assessed. RESULT: The median follow-up period was 1068 [415-2245] days. Macitentan was associated with significant improvements in functional class, 6-minute walk distance, N-terminal pro-brain natriuretic peptide (NT-proBNP), and echocardiographic measures without any deterioration of hemoglobin or hepatic enzymes. The low-risk scores with each model at baseline and/or first control are related to significantly better survival. Age, gender, and log-NT-proBNP in time-fixed and idiopathic pulmonary arterial hypertension, and log-NT-proBNP in time-dependent Cox proportional hazard regression analyses were independent predictors of mortality. CONCLUSION: Mono- or sequential combination macitentan therapies were associated with sustained benefits in functional class, 6-minute walk distance, NT-proBNP, and echocardiographic measures in patients with idiopathic pulmonary arterial hypertension and congenital heart disease-associated pulmonary arterial hypertension, and low-risk scores at baseline and/or first controls can be translated to better survival.

Evaluation of Vaccine Hesitancy and Anxiety Levels among Hospital Cleaning Staff and Caregivers during COVID-19 Pandemic.

It is important to vaccinate individuals working in the field of health who are more at risk compared to society during the pandemic period. The aim of this study was to evaluate the vaccine hesitancy and anxiety levels of hospital cleaning staff and caregivers during the COVID-19 pandemic. This descriptive type cross-sectional study was conducted with 460 hospital cleaning staff and caregivers. Demographic and social characteristics form, Coronavirus Anxiety Scale (CAS), and Vaccine Hesitancy Scale (VHS) adapted to the pandemic were used in the questionnaire form used to collect the data of the study. It was determined that the rates of hesitation against the COVID-19 vaccine and childhood vaccine were 42.2% (n = 194) and 10.9% (n = 50), respectively. Less than half of the participants (44.6%) believe that the COVID-19 vaccine is protective. COVID-19 anxiety (CAS score ≥ 9 point) was detected in 19.6% of participants and statistically significant differences were found between patients with (n = 90) and without (n = 370) anxiety regarding gender (p < 0.001), working unit (p = 0.002), vaccination status (p = 0.023) and history of psychological disease (p = 0.023). It has been shown that the VHS-total scores of those who are not vaccinated, those who are hesitant about vaccination, those who do not think that the vaccine is protective, and those who state that there is no need for a legal obligation in vaccination are higher. When participants were asked about the most anxious situation during the COVID-19 period, the highest response rate was 62.4% for my parents' exposure to COVID-19. The most anxious situation among participants is their parents' exposure to COVID-19. Although participants are highly vaccinated, they have serious hesitancy about the COVID-19 vaccine. This study also showed that there was a parallel relationship between COVID-19 anxiety and vaccine hesitancy.

Suicidal Ideation, Self-esteem, and Hopelessness in Patients With Pulmonary Arterial Hypertension.

Objective: To investigate the frequency of suicidal ideation and its correlation with other clinical variables in patients with pulmonary arterial hypertension.Methods: Fifty patients with pulmonary arterial hypertension who presented to the cardiology department between 2018 and 2019 and 50 healthy controls were included in the study. A sociodemographic and clinical data form was completed by both the patients and controls, and the Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), Rosenberg Self-Esteem Scale (RSE), and Suicide Probability Scale (SPS) were administered. SPSS version 22 software was used in the statistical analysis.Results: The mean ± SD systolic pulmonary pressure of the patients was 47.48 ± 18.86 and the pulmonary artery pressure was 33.32 ± 19.69. BHS, BDI, and SPS total scores were statistically significantly higher in the patient group compared to the control group (P < .001, P = .001, P = .026, respectively). RSE scores were also higher in the patient group compared to the control group (P = .017).Conclusions: It is important to identify pulmonary arterial hypertension patients with intense feelings of hopelessness and depressive symptoms and to provide psychiatric treatment and psychotherapeutic interventions to improve their self-esteem.

A seven-year single-center experience on AngioJet rheolytic thrombectomy in patients with pulmonary embolism at high risk and intermediate-high risk.

BACKGROUND AND AIM: Angiojet Rheolytic thrombectomy (ART) has been utilized as a catheter-based treatment in acute pulmonary embolism (PE). In this study based on our seven-year experience on ART in patients with PE, we evaluated efficacy and safety outcomes of ART. METHODS: Our study is based on retrospective evaluation of 56 patients with high- and intermediate-high-risk PE, age (62 years; interquartile-range (IQR): 50-73) who underwent ART. RESULTS: High- and intermediate-high-risk were noted in 21.4 % and in 78.6 % of patients, respectively. ART duration was 304(IQR: 246-468) seconds. Measures of obstruction, right to left ventricle diameter ratio (RV/LV ratio), right to left atrial diameter ratio and pulmonary arterial pressures were improved (p<0.001 for all). During hospital stay, acute renal failure, major and minor bleeding, and mortality rates were 37.5%, 7.1%, 12.5%, and 8.9%, respectively. Aging related to post-procedural nephropathy while high-risk status was associated with in-hospital mortality (p=0.006) and long-term mortality. CONCLUSIONS: The ART resulted in significant and clinically relevant improvements in the pulmonary arterial thrombotic burden, RV strain and hemodynamics in patients with PE at high- and intermediate-high-risk. Aging increased the risk of post-procedural nephropathy whereas baseline high-risk status predicted in-hospital and long-term mortality.

Flexible ureterorenoscopy and laser lithotripsy with regional anesthesia vs general anesthesia: A prospective randomized study

ABSTRACT Purpose To compare the effect of general anesthesia (GA) and regional anesthesia (RA) on f-URS outcomes and surgeon comfort. Material and Methods The study was conducted between June 2017 to January 2018 and data collection was applied in a prospective, randomized fashion. 120 patients participated in the study and were divided into RA group (n=56) and GA group (n=64). Demographic, operative and post-operative parameters of patients were analysed. The end point of this study was the effect of two anesthesia regimens on the comfort of the surgeon, and the comparability of feasibility and safety against perioperative complications. Results The study including 120 randomized patients, 14 patients were excluded from the study and completed with 106 patients (45 in RA group and 61 in GA group). No difference was detected between the two groups in terms of preoperative data. During the monitorization of operative vital signs, 3 patients in RA group experienced bradycardia, and this finding was significant when compared with GA group (p=0.041). Additionally, 2 patients in RA group experienced mucosal tears and 1 patient experienced hemorrhage during the operation, but no complications were observed in the GA group (p=0.041). Postoperative surgeon comfort evaluation revealed statistically significant results in favor of GA group (p=0.001). Conclusions Both GA and RA are equally effective and safe anesthesia methods for f-URS procedures. However, RA group showed significantly increased likelihood of bradycardia and mucosal injury during surgery, and significantly decreased surgeon comfort during surgery.

Flexible ureterorenoscopy and laser lithotripsy with regional anesthesia vs general anesthesia: A prospective randomized study.

PURPOSE: To compare the effect of general anesthesia (GA) and regional anesthesia (RA) on f-URS outcomes and surgeon comfort. MATERIAL AND METHODS: The study was conducted between June 2017 to January 2018 and data collection was applied in a prospective, randomized fashion. 120 patients participated in the study and were divided into RA group (n=56) and GA group (n=64). Demographic, operative and post-operative parameters of patients were analysed. The end point of this study was the effect of two anesthesia regimens on the comfort of the surgeon, and the comparability of feasibility and safety against perioperative complications. RESULTS: The study including 120 randomized patients, 14 patients were excluded from the study and completed with 106 patients (45 in RA group and 61 in GA group). No difference was detected between the two groups in terms of preoperative data. During the monitorization of operative vital signs, 3 patients in RA group experienced bradycardia, and this finding was significant when compared with GA group (p=0.041). Additionally, 2 patients in RA group experienced mucosal tears and 1 patient experienced hemorrhage during the operation, but no complications were observed in the GA group (p=0.041). Postoperative surgeon comfort evaluation revealed statistically significant results in favor of GA group (p=0.001). CONCLUSIONS: Both GA and RA are equally effective and safe anesthesia methods for f-URS procedures. However, RA group showed significantly increased likelihood of bradycardia and mucosal injury during surgery, and significantly decreased surgeon comfort during surgery.

Modified autologous transobturator tape surgery - evaluation of short term results.

OBJECTIVES: The aim of this study is to evaluate the short-term outcomes of our modified autologous transobturator tape (aTOT) technique with rectus abdominis muscle fascial graft for the treatment of female stress urinary incontinence (SUI). MATERIAL AND METHODS: The data of 22 patients who underwent modified aTOT were recorded. Perioperative data regarding operative time, complications and postoperative visual analogue scores were noted. Patients were assessed 18 months after surgery. The primary endpoints of this study were the improvements in the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) subscores, one-hour pad test and cough stress test rates as an objective cure as well as the improvements in the PGI-I and ICIQ-FLUTS quality of life scores as a subjective cure. RESULTS: Mean age and the mean follow-up period were 51.7 ± 9.8 years and 20.1 ± 0.9 months, respectively. Urethral hypermobility and a positive cough stress test were detected in all the patients. Mean operative time was 43.8 ± 8.1 min. and the overall complication rate was 9%. Mean VAS scores at postoperative 24 hours were 2.6 ± 1.2. At the postoperative eighteenth month, no patient had a positive cough test and mean PGI-I score was 2 while two patients had moderate urinary incontinence according to the pad test. Pad test results, ICIQ subscores of voiding QoL, incontinence, incontinence QoL, total score and total QoL score at baseline and eighteen months after surgery were 76.9 ± 19.9, 9.6 ± 4.1, 15.5 ± 4.0, 39.5 ± 7.9, 27.9 ± 6.6, 68.4 ± 13.8 and 7.1 ± 2, 10.1 ± 2.4, 6.6 ± 2.1, 13.4 ± 4.5, 20.4 ± 4.8, 39.7 ± 9.2 respectively (p = 0.001, p = 0.004, p = 0.001, p = 0.001, p = 0.001, and p = 0.001, respectively) CONCLUSIONS: Modified aTOT is an effective and safe method with low morbidity for SUI treatment in short term.

Comparison of Miniaturized Percutaneous Nephrolithotomy and Standard Percutaneous Nephrolithotomy in Secondary Patients: A Randomized Prospective Study.

Aim: We aimed to compare the efficacy and safety of mini-percutaneous nephrolithotomy (mPNL) and standard PNL (sPNL) in a group of patients who had a history of PNL and/or open renal surgery (secondary patients). Materials and Methods: The study included 148 patients who underwent secondary PNL between November 2016 and September 2018. The patients with kidney stone ≥2 cm were included in the study. Patients were randomly divided into two groups as mPNL and sPNL. For both groups, demographic data, stone characteristics, and operative and postoperative data were recorded prospectively. Data were analyzed at 95% confidence interval and considered significant when p value was <0.05. Results: A total of 148 (76 mPNL, 72 sPNL) patients with a history of PNL and/or open surgery were included in the study. The mean duration of operation was longer in mPNL (106.9 vs 91.2 minutes, p = 0.016). The mean duration of fluoroscopy in mPNL was shorter (4.4 vs 5.3 minutes, p = 0.021). The tubeless procedure was higher in the mPNL (21.1% vs 2.8%, p = 0.001). The hemoglobin drop was less in mPNL (0.7 vs 1.4 g/dL, p = 0.011). Duration of nephrostomy and hospitalization was longer in sPNL (p = 0.001 and p = 0.005, respectively). The success rate in the mPNL group was higher compared with the sPNL group; however, this difference was statistically insignificant (75.0% vs 72.2%, p = 0.558). Conclusion: mPNL is superior to sPNL in terms of hemoglobin drop, duration of fluoroscopy, applicability of a tubeless procedure, and duration of nephrostomy and hospitalization among secondary patients. Duration of operation was found to be longer for mPNL. Success rate was higher in the mPNL group, although not statistically significant.

Autologous transobturator midurethral sling.

OBJECTIVE: The aim of this study is to describe a novel transobturator midurethral sling surgery technique by using rectus abdominis fascia. MATERIAL AND METHODS: A 54-year-old woman complaining of urinary leakage during effort was diagnosed as pure stress urinary incontinence after detailed questioning, pelvic examination, uroflowmetry and measurement of residual urine volume. She was anxious about complications related to synthetic meshes. However, she was not interested in relatively morbid surgeries such as colposuspension and pubovaginal sling. Autologous transobturator midurethral sling was discussed with the patient. The patient approved the surgery and the surgery was planned. A 5 cm rectus fascia was harvested via suprapubic incision and non-absorbable stay sutures were placed on its' both edges. Anterior vaginal incision together with paravaginal dissection was performed, as in classical transobturator sling surgery. Groin puncture and blind dissection of adipose tissue was performed. C-shaped trocars were inserted, and advanced through groin punctures and brought up to midurethral incision by finger guidance. Stay sutures were transported via C-shaped trocars to the groin puncture in both sides. Graft was positioned on the midurethral part without any tension and stay sutures were tied to create a tissue bridge on obturator membrane. Incisions were closed and vaginal tampon was placed. Patient was discharged at the first postoperative day. RESULTS: At postoperative third and sixth months, patient was totally dry and did not have any voiding complaints. Small abdominal and vaginal incisions were clean, as well. CONCLUSION: Autologous transobturator midurethral sling surgery is a safe, effective and feasible surgical option for stress urinary incontinence in the era which mesh-related concerns are rising. Studies with larger volume and long-term follow up periods are needed.

Prediction of recurrence in non-muscle invasive bladder cancer patients. Do patient characteristics matter?

PURPOSE: To evaluate patients, diagnosed with non-muscle invasive bladder cancer, according to patient specific parameters including hemoglobin level, estimated glomerular filtration rate (eGFR), body mass index (BMI) and cigarette smoking and to identify if any of these parameters matters in terms of recurrence prediction. METHODS: 231 patients who have undergone transurethral resection of the bladder (TURB) between January 2015 and January 2018 and diagnosed with non-muscle invasive bladder cancer (NMIBC) were included. Patient demographic characteristics including age, sex, BMI and cigarette smoking were assessed. Hemoglobin, creatinine and eGFR values were recorded. Follow-up was performed according to the European Association of Urology (EAU) guidelines' recommendations. Recurrence and progression during follow-up were recorded. RESULTS: 231 patients were included in the study. Median patient BMI, Hb levels, and eGFR values were 26.51 kg/m2 (IQR 5.48), 14,2 g/dL (IQR 2.50), and 83.25 ml/min/1.73m2 (IQR 27.83), respectively. Among all patients, 105 (45%) were ex-smokers and 78 (33%) were current smokers, 41 had anemia (17.7%), 37 (16%) patients were obese; 104 (45%) had mildly impaired renal function and 34 (14.7%) had impaired renal function. During follow-up, 67 (29%) patients had disease recurrence and 21 (9.1%) had disease progression (9.1%). Univariate and multivariate analyses revealed significant relationship between recurrence and obesity, impaired renal function and cigarette smoking. CONCLUSIONS: Recurrence is a commonly encountered unfortunate consequence of NMIBC, and obesity, renal failure, history of smoking and anemia seem to increase the rate of recurrence among bladder cancer patients.

Comparison of supine and prone miniaturized percutaneous nephrolithotomy in the treatment of lower pole, middle pole and renal pelvic stones: A matched pair analysis

ABSTRACT Purpose We aimed to compare the outcomes of supine and prone miniaturized percutaneous nephrolithotomy (m-PNL) in the treatment of lower pole, middle pole and renal pelvic stones. Materials and Methods 54 patients who performed supine m-PNL between January 2017 and March 2018 and 498 patients who performed prone m-PNL between April 2015 and January 2018 were included in the study. Of the 498 patients, 108 matching 1: 2 in terms of age, gender, body mass index, American Association of Anesthesiology score, stone size, stone localization and hydronephrosis according to the supine m-PNL group were selected as prone m-PNL group. The patients with solitary kidney, upper pole stone, urinary system anomaly or skeletal malformation and pediatric patients (<18 years old) were excluded from the study. The success was defined as 'complete stone clearance' and was determined according to the 1st month computed tomography. Results The operation time and fluoroscopy time in supine m-PNL was significantly shorter than prone m-PNL group (58.1±45.9 vs. 80.1±40.0 min and 3.0±1.7 min vs. 4.9±4.5 min, p=0.025 and p=0.01, respectively). When post-operative complications were compared according to the modified Clavien-Dindo classification, overall and subgroup complication rates were comparable between groups. There was no significant difference between the groups in terms of the success rates (supine m-PNL; 72.2%, prone m-PNL; 71.3%, p=0.902). Conclusions Supine m-PNL procedure is more advantageous in terms of operation time and fluoroscopy time in the treatment of lower pole, middle pole and renal pelvic stones.

Comparison of supine and prone miniaturized percutaneous nephrolithotomy in the treatment of lower pole, middle pole and renal pelvic stones: A matched pair analysis.

PURPOSE: We aimed to compare the outcomes of supine and prone miniaturized percutaneous nephrolithotomy (m-PNL) in the treatment of lower pole, middle pole and renal pelvic stones. MATERIALS AND METHODS: 54 patients who performed supine m-PNL between January 2017 and March 2018 and 498 patients who performed prone m-PNL between April 2015 and January 2018 were included in the study. Of the 498 patients, 108 matching 1: 2 in terms of age, gender, body mass index, American Association of Anesthesiology score, stone size, stone localization and hydronephrosis according to the supine m-PNL group were selected as prone m-PNL group. The patients with solitary kidney, upper pole stone, urinary system anomaly or skeletal malformation and pediatric patients (<18 years old) were excluded from the study. The success was defined as 'complete stone clearance' and was determined according to the 1st month computed tomography. RESULTS: The operation time and fluoroscopy time in supine m-PNL was significantly shorter than prone m-PNL group (58.1±45.9 vs. 80.1±40.0 min and 3.0±1.7 min vs. 4.9±4.5 min, p=0.025 and p=0.01, respectively). When post-operative complications were compared according to the modified Clavien-Dindo classification, overall and subgroup complication rates were comparable between groups. There was no significant difference between the groups in terms of the success rates (supine m-PNL; 72.2%, prone m-PNL; 71.3%, p=0.902). CONCLUSIONS: Supine m-PNL procedure is more advantageous in terms of operation time and fluoroscopy time in the treatment of lower pole, middle pole and renal pelvic stones.