Disease management in a patient diagnosed with COVID-19 disease during induction intravesical BCG therapy: A case report and review of the literature.

OBJECTIVE: To discuss the patient diagnosed with COVID-19 disease while receiving intravesical induction bacillus Calmette-Guérin (BCG) treatment for non-muscle-invasive bladder cancer, its management in the light of the literature. PATIENT AND METHODS: A 52-year-old male patient, who received intravesical BCG treatment for high-grade pT1 papillary urothelial carcinoma, presented 12 h after taking the fourth dose of induction therapy 38.2° fever and chills. The patient's reverse transcriptase-polymerase chain reaction test was positive, and Thorax CT imaging showed a few ground-glass pneumonic infiltrations in bilateral lung bases consistent with COVID-19 disease. RESULTS: Although international urology associations have current recommendations regarding the pandemic process, only one study has made specific recommendations regarding the patient group diagnosed with COVID-19 while receiving intravesical BCG treatment. According to this recommendation, we interrupted our patient's BCG treatment for 3 weeks and then completed the treatment for 6 weeks. A maintenance treatment not exceeding 1 year was planned. CONCLUSION: This group of patients' recommendation is to delay BCG therapy for at least 3 weeks after initial symptoms to allow for complete recovery. Although the administration schedule varies, maintenance therapy is recommended for no more than 1 year.

The role of the resistive index in predicting testicular atrophy after orchiopexy in unilateral undescended testis.

PURPOSE: One of the most important complications of undescended testis (UDT) surgery is testicular atrophy (TA). We aimed to investigate the factors associated with TA in children who underwent orchiopexy for unilateral UDT. METHODS: The data of 215 patients aged < 15 years who underwent orchiopexy for unilateral UDT between November 2019 and September 2022 were analyzed retrospectively. Clinical, radiological, surgical, and follow-up findings were recorded. RESULTS: TA was observed in 29 (13.5%) patients. Mean resistive index (RI) values were 0.44 ± 0.06, 0.54 ± 0.09 and 0.69 ± 0.1 in low, middle and high testicular locations, respectively, and intratesticular RI increased significantly as the testis location raised (p < 0.001). After orchiopexy, the mean testis volume ratio (TVR) increased significantly (0.63 ± 0.13 vs. 0.77 ± 0.15, p < 0.001). Besides, the mean RI values decreased significantly in the postoperative follow-up (0.53 ± 0.12 vs. 0.47 ± 0.13, p < 0.001). In multivariate regression analysis, testicular high location (OR 4.332, 95% CI 2.244-6.578, p = 0.002), deferens-epididymal anomaly (OR 3.134, 95% CI 1.345-7.146, p = 0.021), TVR ≤ 0.5 (OR 5.679, 95% CI 2.953-12.892, p < 0.001) and RI ≥ 0.6 (OR 7.158, 95% CI 3.936-14.569, p < 0.001) were independent predictive factors for TA after orchiopexy. CONCLUSION: Higher testis location, deferens-epididymis anomaly, preoperative TVR and RI were independent predictive factors for TA after orchiopexy in unilateral UDT. The results of the study will help surgeons to predict TA before orchiopexy.

Comparative analysis of ureteroscopic laser lithotripsy and extracorporeal shock wave lithotripsy in the treatment of childhood proximal ureteral stones.

PURPOSE: This study aims to make a comparative analysis of the superiority of ESWL and URS in proximal ureteral stones in children. METHODS: A total of 155 patients under the age of 15 were included in the study. The patients were divided into two groups as Group 1 (n = 80, ESWL) and Group 2 (n = 75, URS) according to the type of procedure performed. The patients in both groups were evaluated in terms of age, gender, lateralization, stone size, stone volüme, stone density, and preoperative hydronephrosis. In addition, both methods used were compared in terms of success rate, time, cost, hospitalization and complications. RESULTS: The mean age were 7.4 ± 2.1 in Group-1 and 8.1 ± 1.8 in Group-2. Demographic, clinical and laboratory data of both groups were similar. The hospitalization time, procedure time, success rate and cost were significantly higher in Group-2. The complication rate was significantly higher in Group-2 (p < 0.001). There was a significant negative correlation between ESWL success and stone volume (ρ - 0.375, p = 0.001) and stone density (ρ - 0.283, p = 0.011). CONCLUSION: ESWL can be performed as the first line treatment of proximal ureteral stones in children due to its daily use, low cost, short procedure time and low complication rate. Increasing stone volume and density reduces the success of ESWL.

Could Penile Mondor's Disease Worsen Symptoms in Patients with Erectile Dysfunction?

BACKGROUND: To determine the impact of Penile Mondor's disease (PMD) in patients with erectile dysfunction (ED). METHODS: Forty-seven patients diagnosed with PMD were included in the study and analyzed prospectively. The patients were divided into two groups according to the presence of ED at admission. The patients with ED were named Group 1, and those without ED were named Group 2. The International Index of Erectile Function (IIEF-5) and Beck Anxiety Inventory (BAI) forms at admission, 3rd, and 6th months were compared. RESULTS: There were 21 (44.6%) patients in Group 1 and 26 (55.4%) patients in Group 2. The mean patient ages in Group 1 and Group 2 were 38.1 ± 7.5 and 26.9 ± 10.3 years, respectively (p < 0.001). The mean admission IIEF-5 score was 19.52 ± 1.21 in Group 1 and 22.92 ± 1.23 in Group 2. After treatment, the mean IIEF-5 scores in Group 1 were 19.24 ± 1.14 and 19.09 ± 1.09 at the 3rd and 6th months, respectively. The mean IIEF-5 scores in Group 2 was 22.77 ± 0.99 and 22.96 ± 1.08 at 3rd and 6th months, respectively. In Group 1, the 6th-month IIEF-5 score was lower than the initial score (p = 0.026). In Group 1, the mean BAI score at 6 months increased compared to admission (6.0 ± 1.27 vs 5.43 ± 1.43, p = 0.015). CONCLUSION: PMD can worsen symptoms in men with ED who have a low IIEF5 score. The anxiety of recurrence of PMD during sexual intercourse may have caused this situation, or this may also be due to the natural progression of ED.

Is there an association between urine biochemical parameters on admission and the severity OF COVID-19?

AIM: To determine the importance of urinary biochemical parameters on the severity of coronavirus disease-2019 (COVID-19). METHODS: One hundred and thirty-three patients who were diagnosed with COVID-19 were retrospectively included. Groups were formed according to the severity of their disease (moderate [n = 85], severe [n = 29] and critical = [n = 19]), and an additional control group was created from healthy individuals (n = 50). We investigated the correlation between urine biochemical parameters and the severity of the disease. RESULTS: Erythrocyturia, proteinuria and glucosuria rates were significantly higher in patients than in the controls. In patients, the median urine specific gravity (SG) was lower (P < .001), and the median potential of hydrogen (pH) value was higher compared with the controls (P < .001). In correlation analyses, there were strong positive correlations between disease severity and age (r = 0.545, P < .001), RR (r = 0.838, P < .001) and proteinuria (r = 0.462, P < .001), while there was a strong negative correlation with SpO2 (r = -0.839, P = .001). On multivariate analysis, age (OR: 1.06, 95% CI 1.03-1.10, P = .035), respiratory rate ≥30 breaths/min (OR: 4.72, 95% CI 1.26-6.24, P < .0031), SpO2  ≤ 93% (OR: 3.82, 95% CI 1.18-5.82, P = .001) and proteinuria (OR: 1.13, 95%CI 1.02-2.1, P = .023) were independent predictive factors for disease severity. CONCLUSION: Proteinuria in routine urine analysis, which is one of the parameters that can be easily applied in the application, may be related to the severity of the COVID-19 disease.

Flank Pain as a Symptom of COVID-19.

The COVID-19 disease is spreading rapidly worldwide, and no vaccine or very effective drug has been found yet. However, the transmission rate of the disease can be reduced by taking precautions. Therefore, it is essential to detect the patients early to prevent the spread of the disease.1,2 We report a case of 26-year-old male patient who was admitted to our urology outpatient clinic with the complaint of flank pain and had incidental findings of COVID-19 in the lung bases on abdominal CT.

Predictive values of blood urea nitrogen/creatinine ratio and other routine blood parameters on disease severity and survival of COVID-19 patients.

We aimed to examine independent predictive factors for the severity and survival of COVID-19 disease, from routine blood parameters, especially the blood urea nitrogen (BUN)/creatinine (Cr) ratio. A total of 139 patients with COVID-19 were investigated at Siirt State Hospital. According to the disease severity, the patients were categorized as three groups (moderate: 85, severe: 54, and critical: 20). Then, patients were divided into two groups: nonsevere (moderate) and severe (severe and critical). Demographic, clinical data, and routine blood parameters were analyzed. In multivariate model adjusted for potential confounders BUN/Cr ratio (odds ratio [OR] = 1.70; 95% confidence interval [CI]: 1.20-2.40; P = .002) and neutrophil to lymphocyte ratio (NLR) (OR = 2.21; 95% CI: 1.20-4.30; P < .001) were independent predictive factors for disease severity. In multivariate Cox proportional hazard model BUN/Cr ratio (hazard ratio [HR] = 1.02; 95% CI: 1.01-1.05; P = .030), and NLR (HR = 1.17; 95% CI: 1.06-1.30; P = .020) were independent predictors for survival of COVID-19 disease. The optimal thresholds of the BUN/Cr ratio at 33.5 and 51.7 had the superior possibility for severe disease and mortality, area under the curve (AUC) were 0.98 and 0.95, respectively. The optimal thresholds of NLR at 3.27 and 5.72 had a superior possibility for severe disease and mortality, AUC were 0.87 and 0.85, respectively. BUN/Cr and NLR are independent predictors for COVID-19 patient severity and survival. Routine evaluation of BUN/Cr and NLR can help identify high-risk cases with COVID-19.

Can preoperative gonadotropin and testosterone levels predict the success of varicocelectomy?

We examined the effects of preoperative hormonal values on varicocelectomy success. A total of 136 patients who underwent varicocelectomy for infertility in our clinic were analysed retrospectively. Improvement in semen quality was defined as >50% increase in post-operative total motile sperm count (TMSC) in those with preoperative TMSC >5 million and at least 100% increase in those with <5 million. The patients were divided into two groups as benefiting from the treatment (Group A) and no benefits (Group B). The best cut-off value for follicle-stimulating hormone (FSH) and the luteinising hormone/testosterone ratio (LTR) that can predict varicocelectomy success were 7.01 and 0.016 with an area under the curve of 0.844 and 0.856 respectively. The highest sensitivities and specificities of FSH and LTR were 0.845 and 0.788 and 0.821 and 0.846 respectively. Binary logistic regression analysis showed FSH (odds ratio [OR]: 3.7; p < .001) and LTR (OR: 5.2; p < .001) as independent predictive factors in predicting varicocelectomy success. Our study demonstrated that low FSH (7.01 IU/L) and LTR (<.016) can be a useful preoperative predictive tool to help identify men who benefit most from varicocelectomy in infertile patients with varicocele.

Our Retroperitoneal Cystic Echinococcosis Surgery Experiences at Mehmet Akif Inan Training and Research Hospital in Sanliurfa

Objective: This study aimed to discuss the place of surgical technique in patients who were operated for retroperitoneal hydatid cyst at our clinic, in the light of current literature. Methods: Data from seven patients who were operated for retroperitoneal hydatid cyst between May 2012 and May 2019 were retrospectively collected and evaluated. Results: Two patients were operated for isolated retroperitoneal hydatid cyst, one for liver hydatid cyst accompanying renal hydatid cyst and four patients were operated only for renal hydatid cyst. Recurrence was not observed in the follow-up. Conclusion: In our study, emphasis was laid on the fact that cysts can be treated successfully by using total, subtotal and partial cystectomy methods based on the organ and tissue neighbourhood.

Could flank pain be an indicator of COVID-19 infection?

Background: We describe the incidental detection of patients infiltrates due to COVID-19 in lung basal sections in patients undergoing abdominal computed tomography (CT) with flank pain attending the urology outpatient clinic during the current pandemic. Methods: We retrospectively analysed 276 patients admitted to the Siirt Training and Research Hospital Urology outpatients clinic between 15 March 2020 and 9 August 2020 with a complaint of flank pain and undergoing non-contrast abdominal CT. A total of 10 patients with COVID-19 compatible findings in CT were defined as the study group. A control group was formed from 10 patients with only urological pathologies (kidney stones, ureteral stones, and hydronephrosis) without a COVID-19 compatible appearance on CT. Results: Ten (3.6 %) patients were identified with COVID-19 and pneumonic infiltrations in the basal regions of the lungs; diagnosis was made by cross-sectional abdominal CT. The visual analog scale (VAS) score of flank pain was significantly higher in the control group (p<0.001); these subjects had urological pathology and no evidence of COVID-19 in the basal regions of the lungs on abdominal CT. There were no signs of COVID-19 disease detected during the admissions procedure in the urology outpatient clinic, including fever, cough, and shortness of breath. Conclusion: During the COVID-19 pandemic, it is important to consider a diagnosis of COVID_19 in patients reporting non-severe flank pain if no urological pathology is evident on abdominal CT scans.

Sexual experiences between partners after penile prosthesis: Who is more satisfied?

Penile prosthesis implantation (PPI) is the final stage treatment in erectile dysfunction (ED). In this study, we planned to investigate the effect of PPI application on sexual functionality in the patients and their partners. After taking permission and consent for the study, from 20 male patients who were applied penile prosthesis due to ED between March 2013 and June 2018 and their partners, the couples were included in the study. Patients and partners filled in Arizona Sexual Experiences Scale (ASEX) form before PPI. After starting to use prosthesis, 20 patients and 19 partners were asked to fill in modified EDITS and ASEX form in the follow-ups in the sixth month. Average age was 54.35 years for the patients and 43.84 for the partners. Although post-PPI sexual satisfaction ratio was detected higher in female partners compared with the male patients, this difference was not statistically significant (p = .71). A significant recovery was also observed in total scale score, physiological stimulation, orgasm capacity and satisfaction scores in both groups after PPI. Penile prosthesis implantation is an operation providing high satisfaction for both the partner and the patient and is still one of the best options of ED.

Comparison of Non-Hilar Clamping Simple Enucleation and Enucleo-Resection of Exophytic Renal Tumors.

PURPOSE: To retrospectively evaluate our institutional experience with non-hilar-clamping simple enucleation (SE) and enucleoresection (ER) for the treatment of exophytic renal tumors regarding their oncological outcomes. MATERIALS AND METHODS: We retrospectively evaluated patients treated between 2006 and 2013 for clinical exophytic T1-T2a renal tumors using open nephron-sparing surgery. RESULTS: A total of 33 patients underwent SE and 39 underwent ER. The mean tumor size was 38.7 mm. None of the patients had positive surgical margins. No local recurrences were observed during the postoperative follow-up period (mean 40.7 ± 23.4 months); however, ipsilateral adrenal and contralateral kidney metastasis was detected in one of the patients. There was no statistically significant difference in the R.E.N.A.L Nephrometry Score, operative time, or intraoperative blood loss in the non-hilar-clamping SE and ER groups (P > .05). During the third postoperative month, the estimated glomerular filtration rate (eGFR) levels in the SE group were significantly reduced compared with the preoperative eGFR levels (P = .046). CONCLUSION: SE and ER with non-hilar clamping are safe, acceptable approaches for treating exophytic renal tumors.