Variation coefficient of stone density and renal cortical thickness: the parameters evaluating non-contrast computed tomography imaging for predict extracorporeal shock wave lithotripsy success.

The stone density (SD) is not the same in all parts of the stone due to the heterogeneous nature of the stone and the shock wave (SW) passes through tissues of many different densities until it reaches the stone. These factors affect the success of Extracorporeal Shock Wave Lithotripsy (ESWL). We aimed to evaluate the effect of the Variation Coefficient of Stone Density (VCSD) and Renal Cortical Tickness (RCT) on the success of ESWL. Between 2020 and 2023, 510 patients who underwent ESWL were divided into 2 groups treatment success (n:304) and treatment failure (n:206). Non-Contrast Computed Tomography (NCCT) imaging values of hydronephrosis degree of the kidney, stone location, stone volume (SV), stone-skin distance (SSD), SD, Standard deviation of Stone Density (SDSD), VCSD, RCT, Soft-Tissue Thickness (STT), Muscle Thickness (MT) were analyzed. VCSD value was obtained by dividing SDSD by SD. Along the SW, tissues were divided into three components: kidney (renal cortex), muscle and other soft tissues. RCT, MT and SSD were measured at three different angles (0°, 45°, and 90°) and these 3 lengths were averaged. In univariate analysis, Body Mass Index (BMI), SV, SD, VCSD, SSD, RCT and STT were demonstrated to affect ESWL success. In multivariate analysis, low BMI, SV, SD, RCT and large VCSD were significant independent predictors of ESWL success. Among these parameters, VCSD had the highest prediction accuracy, followed by SD, SV, RCT and BMI, respectively. This study demonstrated that VCSD value and RCT are predictive parameters in determining the treatment of patients with urinary calculi and selecting suitable ESWL candidates.

The Predictive Factors of Renal Loss After Iatrogenic Ureteral Avulsion in the Medicolegal Perspective.

Objectives: As an effective and minimally invasive technique, ureteroscopy has some potential intraoperative complications. Ureteral avulsion is among these complications, although rare. This study aimed to determine factors predicting nephrectomy by considering ureteral avulsion from a medicolegal perspective for the 1st time in the literature. Methods: A total of 33 patients with ureteral avulsion during ureteroscopic surgery, who presented to various hospitals in Turkey between September 2004 and April 2019 and whose cases were being reviewed at the Institution of Forensic Medicine with regard to malpractice, were evaluated retrospectively. The patients who underwent nephrectomy after ureteral avulsion were evaluated as Group 1, and those who underwent reconstructive surgery as Group 2. Results: The mean age of the patients was 39.5±12.1 years. Seventeen (51.5%) patients had partial and 16 (48.4%) had complete ureteral avulsion. Nephrectomy was performed in 14 (42.4%) patients, and ureteral reconstruction in 19 (57.5%) patients. It was determined that the patients in Group 1 had more proximal stones and a higher degree of hydronephrosis compared to Group 2. Complete avulsion developed in 71.4% of the patients in Group 1 and in 31.6% of those in Group 2. After avulsion, 78.6% of the patients in Group 1 were treated in a state hospital, and 63.2% of those in Group 2 were treated in a tertiary referral hospital. The increase in the degree of hydronephrosis, presence of complete avulsion, and intervention at a state hospital were determined as independent predictive factors for nephrectomy. Conclusion: This is the first study with the largest cohort in the literature to medicolegally evaluate ureteral avulsion and determine predictive factors for nephrectomy. Although each patient should be treated with different methods in the presence of ureteral avulsion, our study aimed to provide a common approach to this catastrophic complication.

Prediction of infective complications after retrograde intra renal surgery using Machine learning.

BACKGROUND: To compare the models obtained with classical statistical methods and machine learning (ML) algorithms to predict postoperative infective complications (PICs) after retrograde intrarenal surgery (RIRS). MATERIAL AND METHODS: Patients who underwent RIRS between January 2014 and December 2020 were retrospectively screened. Patients who did not develop PICs were classified as Group 1 and patients who developed as Group 2. RESULTS: Three-hundred and twenty-two patients were included in the study; 279 patients (86.6%) who did not develop PICs were classified as Group 1, and 43 patients (13.3%) who developed PICs were classified as Group 2. In multivariate analysis, the presence of diabetes mellitus, preoperative nephrostomy, and stone density were determined to be factors that significantly predicted the development of PICs. The area under the curve (AUC) of the model obtained by classical Cox regression analysis was 0.785, and the sensitivity and specificity were 74% and 67%, respectively. With the Random Forest, K- Nearest Neighbour, and Logistic Regression methods, the AUC was calculated as 0.956, 0.903, and 0.849, respectively. RF's sensitivity and specificity were calculated as 87% and 92%, respectively. CONCLUSION: With ML, more reliable and predictive models can be created than with classical statistical methods.

Comparison of oncological and functional outcomes of perineoscopic radical prostatectomy and robot-assisted radical prostatectomy.

The aim of this study is to compare the functional, oncological, and complication outcomes of perineoscopic radical prostatectomy (PeRP) and robot-assisted radical prostatectomy (RARP) operations. Patients who underwent radical prostatectomy (RP) between October 2018 and June 2020 for localized prostate cancer (N0, < T3) were retrospectively screened. After the exclusion criteria, 56 patients who underwent PeRP and 67 patients who underwent RARP remained in the study. Demographic, perioperative, and postoperative data were collected. In functional outcomes, continence and potency status were compared at 1, 3, 6, and 12 months. The mean age of the patients was 61.3 ± 5.9 years in the PeRP group and 62.2 ± 5.7 years in the RARP group. No statistically significant differences were present between preoperative and postoperative values. Among the perioperative findings, the mean operation time was 90.4 ± 11.2 min for the PeRP group and 114.6 ± 14.7 min for the RARP group. The operation time was shorter in the PeRP group. The average hospital stay was 2 ± 0.6 days in the PeRP group and 2.3 ± 0.5 days in the RARP group. It was significantly shorter in the PeRP group. There is no statistically significant difference between the two groups in the oncological and functional results. PeRP is a surgical procedure safe in low-risk patients with medium-risk prostate cancer (PCa) who do not require lymph-node dissection. Moreover, PeRP minimizes the difficulties of perineal surgery.

A Critical Analysis of the Magnetic Resonance Imaging Lesion Diameter Threshold for Adverse Pathology Features.

To investigate the relationship between lesion size determined using multiparametric magnetic resonance imaging (mpMRI) and histopathological findings of specimens obtained after mpMRI fusion biopsy and radical prostatectomy (RP). We retrospectively analysed 290 patients with PCa who underwent an MRI fusion biopsy. We measured the diameter of suspicious tumour lesions on diffusion-weighted mpMRI and stratified the cohort into two groups. Group A included patients with a suspicious tumour lesion 10 mm and Group B included those with a suspicious tumour lesion > 10 mm. In Group B, the PI-RADS score determined in mpMRI was higher than Group A, and there was a statistically significant difference between the two groups in terms of clinical T-stage. The PCa detection rate and the number of positive cores were statistically significantly higher in Group B than in Group A. In addition, there was a statistically significant difference between the two groups in relation to the biopsy, the International Society of Urological Pathology (ISUP) grade values, and the presence of clinically significant PCa. In Group B, pathological T-stage and extraprostatic extension (EPE) and surgical margin (SM) positivity were found to be higher among the patients who underwent RP. In the multivariate analysis, the mpMRI lesion size being > 10 mm was found to be an independent predictive factor for SM and EPE positivity. The clinical results of this study support the modification of the lesion size threshold as 10 mm for use in the differentiation of PI-RADS scores 4 and 5.

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

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

The effect of single or multiple arteries in the donor kidney on renal transplant surgical outcomes.

BACKGROUND: As the number of end-stage renal disease (ESRD) patients is increasing, but there are not enough living donors, it is necessary to broaden the criteria for candidates who can undergo donor nephrectomy. Thanks to surgeons' increasing experience with laparoscopic donor nephrectomy (LND), multiple renal artery grafts, previously considered a relative contraindication to donor nephrectomy, have become candidates for LDN. We aimed to compare the outcomes of donors and recipients with single artery and with multiple arteries in LDN. METHODS: A total of 214 patients were included in the study. Patients were divided into two groups according to the number of donor arteries: donors with one artery (group 1) and donors with multiple arteries (group 2). The number of donor arteries, operative time, warm ischemia time (WIT), cold ischemia time (CIT), arterial anastomosis time, venous anastomosis time, the extent of bleeding, and preoperative complications were recorded to evaluate the preoperative data. RESULTS: The mean operation time in group 1 was 90.3 ± 11.8 min, while in group 2, it was 102.1 ± 5.5 min (p = 0.000). WIT group 1 was 90.9 ± 4.3 s and group 2 100.6 ± 2.1 s (p = 0.000). Arterial anastomosis time was 12.25 ± 3.8 in group 1 and 22.5 ± 4.5 in group 2 (p = 0.000). No statistically significant difference was found between the two groups in other parameters. CONLUSION: Increasing the number of donor arteries in renal transplantation (RT) operations prolonged the operation time on both the donor and recipient sides. Still, it had no negative impact on complications or graft function in the postoperative period.

Factors affecting length of stay in Fournier's gangrene: a retrospective analysis of 10 years' data.

BACKGROUND: We aimed to investigate the parameters that have an effect on the length of stay and mortality rates of patients with Fournier's gangrene. MATERIAL AND METHODS: A retrospective review was performed on 80 patients who presented to the emergency department and underwent emergency debridement with the diagnosis of Fournier's gangrene between 2008 and 2017. The demographic and clinical characteristics, length of stay, Fournier's Gangrene Severity Index score, cystostomy and colostomy requirement, additional treatment for wound healing and the mortality rates of the patients were evaluated. RESULTS: Of the 80 patients included in the study, 65 (81.2 %) were male and 15 (18.7 %) female. The most common comorbidity was diabetes mellitus. The mean time between onset of complaints and admission to hospital was 4.6 ±â€Š2.5 days. As a result of the statistical analyses, it was found that Fournier's Gangrene Severity Index score, hyperbaric oxygen therapy, negative pressure wound therapy and the presence of sepsis and colostomy were significantly positively correlated with length of stay. Also it was found that the Fournier's Gangrene Severity Index score, administration of negative pressure wound therapy and the presence of sepsis were correlated with mortality. CONCLUSION: Fournier's gangrene is a mortal disease and an emergency condition. With the improvements in Fournier's gangrene disease management, mortality rates are decreasing, but long-term hospital stay has become a new problem. Knowing the values predicting length of stay and mortality rates can allow for patient-based treatment and may be useful in treatment choice.

Supine Percutaneous Nephrolithotomy in a Patient with Solitary Lung: A Case Report and Literature Review.

Percutaneous nephrolithotomy (PNL) surgeries are performed with different patient positions, anesthesia methods and different-sized access sheaths in order to reduce the complication rates. Supine positioned PNL can be performed safely in the high-risk group patients with comorbidities. Herein, we present a patient who had a past surgical history of right pneumonectomy and underwent a supine PNL procedure under regional anesthesia for a staghorn renal stone in the right kidney.

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

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

Is neutrophile to lymphocyte ratio a predictor of gleason score upgrading according to risk classifications in patients with prostate cancer / ¿Es la proporción de neutrófilos a linfocitos un predictor de la puntuación de Gleason?upgrading según clasificaciones de riesgo en pacientes conCancer de prostata

Objectives: We aimed to determine theparameters that predict Gleason Score (GS) upgradingin patients undergoing robot-assisted laparoscopic radical prostatectomy (RARP) and especially the ability ofneutrophile to lymphocyte ratio (NLR) in predicting theupgrading.Methods: Patients who underwent RARP for prostatecancer in our clinic between January 2013 and January2018 were retrospectively analyzed. Patients’ demographic data, preoperative and postoperative parameters were all recorded in the database. NLR was calculated by dividing the absolute neutrophil count (NC)by the absolute lymphocyte count (LC). Patients were classified as low, moderate and high risk according tothe National Comprehensive Cancer Network (NCNN)Guidelines. Any increase in GS between biopsy resultsand radical prostatectomy specimens were consideredas an GS upgrading.Results: After applying the inclusion and exclusion criteria, a total of 571 patients, 205 patients without GSupgrading (Group 1) and 366 patients with GS upgrading (Group 2), were included. The mean preoperativePSA values and prostate volumes were 10.8 ± 8 ng/dL and 45 ± 18.8 ml, respectively. Group 2 had asignificantly high NC and NLR, significantly low plateletcount (PC) and LC, (p=0.0001, 0.0001, 0.001 and0.002, respectively). Group 2 was found to have significantly higher positive surgical margin (PSM), extraprostatic extension (EPE) and seminal vesical invasion(SVI) (p<0.001). There was no significant correlation between the parameters of NLR and PSM, EPE, SVI, andlymph node invasion (LNI). Binomial logistic regressionshowed patients with increased NLR had 1.68 timeshigher odds to exhibit an upgrade in GS in the post-surgical histopathological analysis.Conclusions: NLR calculated preoperatively is aneasy diagnostic method that can predict GS upgradingin patients scheduled for radical prostatectomy for prostate cancer.(AU)

Objetivo: Determinamos los parámetros que predicen el grado de sobregradación deGleason en pacientes que recibieron prostatectomíaradical robótica asistida por laparoscopia (PRRL) yespecialmente la habilidad de la tasa de neutrófilos/linfocitos (NLR) a la hora de predecir la sobregradación.Métodos: Los pacientes que recibieron PRRL por cáncer de próstata en nuestra clínica entre enero 2013y enero de 2018 se analizaron retrospectivamente.Los datos demográficos, parámetros preoperatorios ypostoperatorios fueron reportados en la base de datos. NLR se calculo dividiendo el numero absoluto deneutrófilos (NC) por el numero absoluto de linfocitos(LC). Los pacientes se clasificaron como bajo, moderado y alto riesgo en la relación a las guías de NationalComprehensive Cancer Network (NCNN). Cualquieraumento en el grado de Gleason entre los resultadosde la biopsia y la prostatectomía radical fueron considerados como una sobregradación de grado deGleason.Resultados: Después de aplicar los criterios de inclusión y exclusión, un total de 571 pacientes, 205sin sobregradación de Gleason (Grupo 1) y 366 pacientes con sobregradación de Gleason (Grupo 2).La media de PSA preoperatorio y volúmenes prostáticos fueron de 10,8 ± 8 ng/dL y 45 ± 18,8 ml, respectivamente. El grupo 2 presentó un NC y NLR másalto, significativamente, bajos niveles de plaquetas yLC (p=0,0001, 0,0001, 0,001 y 0,002, respectivamente). El grupo 2 demostró tener niveles significativamente más altos de márgenes quirúrgicos (PSM),extensión extraprostatica (EPE) e invasión de vesículasseminales (SVI) (p<0,001). No se encontró una correlación significativa entre los parámetros de NLR yPSM, EPE, SVI, invasión ganglios linfáticos. El modelode regresión binomial logística demostró que los pacientes con un incremento de NLR tuvieron 1,68 másveces de tener una sobregradación de Gleason en elanálisis histopatológico postquirúrgico...(AU)

Machine learning algorithms can more efficiently predict biochemical recurrence after robot-assisted radical prostatectomy.

OBJECTIVES: To develop a model for predicting biochemical recurrence (BCR) in patients with long follow-up periods using clinical parameters and the machine learning (ML) methods. MATERIALS METHOD: Patients who underwent robot-assisted radical prostatectomy between January 2014 and December 2019 were retrospectively reviewed. Patients who did not have BCR were assigned to Group 1, while those diagnosed with BCR were assigned to Group 2. The patient's demographic data, preoperative and postoperative parameters were all recorded in the database. Three different ML algorithms were employed: random forest, K-nearest neighbour, and logistic regression. RESULTS: Three hundred and sixty-eight patients were included in this study. Among these patients, 295 (80.1%) did not have BCR (Group 1), while 73 (19.8%) had BCR (Group 2). The mean duration of follow-up and duration until the diagnosis of BCR was calculated as 35.2 ± 16.7 and 11.5 ± 11.3 months, respectively. The multivariate analysis revealed that NLR, PSAd, risk classification, PIRADS score, T stage, presence or absence of positive surgical margin, and seminal vesicle invasion were predictive for BCR. Classic Cox regression analysis had an area under the curve (AUC) of 0.915 with a sensitivity and specificity of 90.6% and 79.8%. The AUCs for receiver-operating characteristic curves for random forest, K nearest neighbour, and logistic regression were 0.95, 0.93, and 0.93, respectively. All ML models outperformed the conventional statistical regression model in the prediction of BCR after prostatectomy. CONCLUSION: The construction of more reliable and potent models will provide the clinicians and patients with advantages such as more accurate risk classification, prognosis estimation, early intervention, avoidance of unnecessary treatments, relatively lower morbidity and mortality. The ML methods are cheap, and their powers increase with increasing data input; we believe that their clinical use will increase over time.

Is neutrophile to lymphocyte ratio a predictor of Gleason score upgrading according to risk classifications in patients with prostate cancer.

OBJECTIVES: We aimed to determine the parameters that predict Gleason Score (GS) upgrading in patients undergoing robot-assisted laparoscopic radical prostatectomy (RARP) and especially the ability of neutrophile to lymphocyte ratio (NLR) in predicting the upgrading. METHODS: Patients who underwent RARP for prostate cancer in our clinic between January 2013 and January 2018 were retrospectively analyzed. Patients' demographic data, preoperative and postoperative parameters were all recorded in the database. NLR was calculated by dividing the absolute neutrophil count (NC) by the absolute lymphocyte count (LC). Patients were classified as low, moderate and high risk according to the National Comprehensive Cancer Network (NCNN) Guidelines. Any increase in GS between biopsy results and radical prostatectomy specimens were consideredas an GS upgrading. RESULTS: After applying the inclusion and exclusion criteria, a total of 571 patients, 205 patients without GS upgrading (Group 1) and 366 patients with GS upgrading (Group 2), were included. The mean preoperative PSA values and prostate volumes were 10.8 ± 8 ng/dL and 45 ± 18.8 ml, respectively. Group 2 had a significantly high NC and NLR, significantly low platelet count (PC) and LC, (p=0.0001, 0.0001, 0.001 and0.002, respectively). Group 2 was found to have significantly higher positive surgical margin (PSM), extraprostatic extension (EPE) and seminal vesical invasion (SVI) (p<0.001). There was no significant correlation between the parameters of NLR and PSM, EPE, SVI, and lymph node invasion (LNI). Binomial logistic regression showed patients with increased NLR had 1.68 times higher odds to exhibit an upgrade in GS in the post-surgical histopathological analysis. CONCLUSIONS: NLR calculated preoperatively is an easy diagnostic method that can predict GS upgrading in patients scheduled for radical prostatectomy for prostate cancer.

OBJETIVOS: Determinamos los parámetros que predicen el grado de sobregradación de Gleason en pacientes que recibieron prostatectomía radical robótica asistida por laparoscopia (PRRL) y especialmente la habilidad de la tasa de neutrófilos/linfocitos (NLR) a la hora de predecir la sobregradación.MÉTODOS: Los pacientes que recibieron PRRL por cáncer de próstata en nuestra clínica entre enero 2013 y enero de 2018 se analizaron retrospectivamente. Los datos demográficos, parámetros preoperatorios y postoperatorios fueron reportados en la base de datos. NLR se calculo dividiendo el numero absoluto de neutrófilos (NC) por el numero absoluto de linfocitos (LC). Los pacientes se clasificaron como bajo, moderado y alto riesgo en la relación a las guías de National Comprehensive Cancer Network (NCNN). Cualquier aumento en el grado de Gleason entre los resultados de la biopsia y la prostatectomía radical fueron considerados como una sobregradación de grado deGleason. RESULTADOS: Después de aplicar los criterios de inclusión y exclusión, un total de 571 pacientes, 205 sin sobregradación de Gleason (Grupo 1) y 366 pacientes con sobregradación de Gleason (Grupo 2). La media de PSA preoperatorio y volúmenes prostáticos fueron de 10,8 ± 8 ng/dL y 45 ± 18,8 ml, respectivamente. El grupo 2 presentó un NC y NLR más alto, significativamente, bajos niveles de plaquetas y LC (p=0,0001, 0,0001, 0,001 y 0,002, respectivamente). El grupo 2 demostró tener niveles significativamente más altos de márgenes quirúrgicos (PSM), extensión extraprostatica (EPE) e invasión de vesículas seminales (SVI) (p<0,001). No se econtró una correlación significativa entre los parámetros de NLR y PSM, EPE, SVI, invasión ganglios linfáticos. El modelo de regresión binomial logística demostró que los pacientes con un incremento de NLR tuvieron 1,68 más veces de tener una sobregradación de Gleason en el análisis histopatológico postquirúrgico. CONCLUSIONES: El cálculo de NLR preoperatorio es un método fácil de diagnóstico que puede predecir la sobregradación de Gleason en pacientes que van a recibir una prostatectomía radical por cáncer de próstata.

Can robot-assisted kidney transplantation provide higher quality of life than open kidney transplantation during the early postoperative period?

PURPOSE: Purpose of this study is to investigate the quality of life (QoL) in patients with end-stage renal disease who underwent open or robot-assisted kidney transplantation (OKT and RAKT). MATERIALS AND METHODS: Patients who underwent OKT and RAKT at Bakirkoy Sadi Konuk Training and Research Hospital between June 2016 and December 2018 constituted the target population of this study. The patient group was divided into two groups as per the surgical technique (ie, open vs. robot-assisted). Demographic data, preoperative and postoperative data of all patients were collected prospectively. The QoL of the patients was assessed preoperatively and on the postoperative 30th day. RESULTS: Sixty-seven patients who underwent OKT and 60 patients who underwent RAKT were included. The mean patient age and BMI were calculated as 40.9 ± 11.6 years and 24.4 ± 2.9 kg/m2 , respectively. Patients in the RAKT group were significantly younger than the patients in the OKT group (P = .002). There were no significant differences between the two groups in terms of gender, BMI, ASA and the ratio of premptive patients. The mean preoperative hemoglobin level was significantly higher in the OKT group than the RAKT group (P = .003). While mean total ischemia time was shorter in the "open" group, intraoperative blood loss and incision length were shorter in the RAKT group. Duration of surgical drainage and hospital stay was shorter in the "robot-assisted" group. There was no significant difference between the groups in terms of SF-36 subparameters preoperatively. The physical component scores of the QoL questionnaire revealed that postoperative impairment of quality of life in the early postoperative period was more significant in the OKT than the RAKT. CONCLUSION: Patients who underwent RAKT have a higher QoL than the patients who were treated with OKT as per their self-reported QoL scores in the early postoperative period.

Testicular torsion in the medicolegal perspective: Why is the diagnosis missing?

BACKGROUND: By examining patients with testicular torsion (TT) that caused problems in medicolegal terms, the present study aims to define markers causing medical neglect or malpractice in similar conditions and perform a retrospective examination to characterize the medical aspects of patients with TT. METHODS: In this study, 53 patients who underwent orchiectomy for TT following interventions made between 2004 and 2019 in different hospitals of Turkey and had satisfactory clinical findings in their files based on medicolegal inspections were included. RESULTS: The median age of the patients was nine years. Twenty-three (43.4%) of the patients had TT on the left side, 29 (54.7%) had TT on the right side, and one (1,9%) patient had bilateral TT. It was noticed that 31 (58.5%) patients had epididymo-orchitis (EO), seven patients had (13.2%) urinary infection, five (9.4%) patients had a hydrocele, and four (7.5%) patients had renal colic, and the others had testicle contusion, gastroenteritis, inguinal hernia, and acute appendicitis as misdiagnoses. The mean time that passed between admission and TT diagnosis was detected as 59±11.2 hours. A statistically significant relation was detected between the branch of the physician who first evaluated the patients and the presence of performing scrotal examination and imaging during admission. The ratio of physical scrotal examinations by emergency service physicians was lower than with the urologists. Among the preliminary examiner allowed to be an advanced evaluation for the possibility of missing diagnosis by an independent specialist physicians, 25 (47.2%) were urologists, 22 (41.5%) were emergency service physicians, four (7.5%) were pediatricians, and two (3.8%) were radiologists. CONCLUSION: Physicians should perform the required evaluations for a suitable diagnosis and treatment by putting aside their medicolegal concerns and prevent the problems by giving priority to patient health. For the correct diagnosis and proper management of TT, it is necessary to increase the information levels of physicians, and patients should be explored urgently in the event of any clinical suspicion.

Perineoscopic vesicourethral reconstruction: A novel surgical technique for anastomotic stricture following radical prostatectomy.

OBJECTIVE: Vesicourethral anastomotic stenosis (VUAS) is frequently seen after prostate surgery because of various operative and postoperative factors. In this study, we aimed to present our results of perineoscopic bladder neck reconstruction, which is a new technique of the perineal approach in the treatment of patients with VUAS after prostate cancer surgery. MATERIAL AND METHODS: Sixteen consecutive patients who underwent perineoscopic bladder neck reconstruction in our clinic between July 2017 and March 2019 were included in the study. Demographic characteristics, surgical history, postoperative continence status, and additional treatment requirements were recorded. Perineoscopic surgery is defined as the visualization of the surgical site with instruments used in laparoscopy and the surgeon performing the entire operative procedure through the screen. RESULTS: The mean number of preoperative endoscopic bladder neck resections of the patients was 7±5.1, with a history of suprapubic cystostomy in 7 (43.7%) and radiotherapy in 5 (31.2%) patients before surgery. The mean surgical time was 126.2±13.1 min. The mean follow-up period was 13.2±6.8 months, and the success rate was 81.25%. During follow-up, two (12.5%) patients received perineoscopic re-do reconstruction because of stricture recurrence, and one (6.2%) patient was included in a urethral dilatation program. CONCLUSION: Improving visualization and ergonomics with the perineoscopic approach can increase the success rate of bladder neck reconstruction in comparison with the standard approach. In addition, the lack of need for expanded dissection (corporal separation, inferior pubectomy) reduces postoperative complication rates.

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

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

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

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