A new alternative approach to management of acute phase Peyronie's disease: low intensity extracorporeal shockwave therapy and platelet-rich plasma.

BACKGROUND: The aim of this study was to investigate the efficacy, safety, and outcomes of the combination of low intensity external shock wave therapy (Li-ESWT) and platelet-rich plasma (PRP) therapy in acute phase Peyronie's disease (PD). METHODS: The datas of patients admitted with acute phase Peyronie's between January 2014 and January 2022 were reviewed retrospectively. In total, we included total 159 patients who used combination of vitamin E 600 mg/day plus colchicine 1.5 mg/day plus oral daily 5 mg tadalafil (N.=77) in group 1 and received Li-ESWT+PRP combination therapy plus oral daily 5 mg tadalafil (N.=82) in group 2. We noted characteristics of fibrous plaques, pain status, penile curvature degree, and erectile function parameters. All patients were visited at the 3rd and 12th months after the treatment. RESULTS: Preoperative demographic characteristics were similar in the two groups. There was a statistically significant improvement in the mean plaque size, penile curvature degree, IIEF-5 and VAS scores in the intervention group after the treatment. Ecchymosis and hematoma were not observed at the injection site and Li-ESWT application areas in the intervention group. No local or systemic drug reactions were noted in either group. CONCLUSIONS: Combination of Li-ESWT and PRP are highly effective and safety to early treatment in the acute phase PD.

Correlation of resistive index of prostatic capsular artery to clinical symptoms in men with chronic prostatitis/chronic pelvic pain syndrome.

OBJECTIVES: To evaluate the relation between resistive index (RI) of prostatic capsular arteries by transrectal Doppler ultrasonography in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and its correlation with lower urinary tract symptoms, erectile dysfunction and premature ejaculation parameters of CP/CPPS. METHODS: In total, we included 68 patients presenting with chronic prostatitis/chronic pelvic pain syndrome. We formed two groups, as Group 1 of 35 patients with a RI ≥ 0.7 and Group 2 of 33 patients with RI < 0.7. All patients were assessed with International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5), premature ejaculation diagnostic tool (PEDT) and National Institutes of Health Chronic Prostatitis Symptom Index (CPSI). In addition, the RI of the prostate capsular artery was measured in all patients using Doppler ultrasound. Statistical analyses were performed with SPSS version 18. A p value < .05 was considered significant. RESULTS: Demographic characteristics were similar in the two groups. IPSS was 11.3 ± 6 in Group 1 and 9.7 ± 5.3 in Group 2. IIEF-5 was 18.6 ± 2 in Group 1 and 20.4 ± 2.3 in Group 2. PEDT was 12.4 ± 5.6 in Group 1 and 11.2 ± 4 in Group 2. CPSI (total) was 19.3 ± 12.3 in Group 1 and 10.6 ± 7.7 in Group 2. There was significant statistical difference in IPSS, IIEF-5, and CPSI between the two groups (p < .001, p < .001, p < .001 respectively). However, we found no significant difference in PEDT between the two groups (p = .19). CONCLUSIONS: There is a significant correlation between the lower urinary tract symptoms and erectile dysfunction parameters and the RI of the prostatic capsular artery in CP/CPPS and RI is an effective and noninvasive method to assess the severity of the disease.

Papillary Urothelial Carcinoma Arising from Ureterocele: Is it a Rare Occurrence?

Various hydronephrotic, dysplastic or clinical pathologies can accompany ureterocele, which is a cystic dilatation of the intravesical part of the submucosal ureter. However, the development of cancer in the ureterocele is highly unusual. Hematuria is the most common sign, although imaging can also indicate alterations in the wall of the ureterocele. Unfortunately, there is no current guideline for the management of papillary urothelial carcinoma arising from ureterocele. Non-muscle-invasive bladder cancer treatment and follow-up protocols are classically applied. However, the anatomical structure of the ureterocele differs from that of normal bladder tissue. It is unclear whether this difference represents a risk in terms of deep tissue tumour invasion. In addition, tumour cells may migrate to the upper urinary tract due to urinary reflux developing following tumour resection. The management of papillary urothelial carcinoma arising from ureterocele must therefore be specific to that condition. However, this depends on an increase in the number of patients reported in the literature. Our review of the literature revealed very few reports. The present study is therefore particularly valuable from that perspective and describes the clinical management of a patient developing papillary urothelial carcinoma in ureterocele. Key Words: Ureterocele, Bladder, Hematuria, Urothelial carcinoma.

A clinical trial comparing BiVap (Richard Wolf®) saline vaporization of the prostate vs. TwisterTM Diode Laser System in the treatment of benign prostatic obstruction between prostate volume 90 to 150†ml.

INTRODUCTION: To evaluate the efficacy, safety and postoperative outcomes of the BiVap and Twister systems with benign prostatic obstruction (BPO) in prostate volüm between 90-150 ml. METHODS: In total, we included 131 patients treated with BiVap system (n = 68) and Twister system (n = 63). Postoperative complications including urinary tract infection, transient hematuria, severe dysuria and fever >38° C, urinary incontinence and urethral stricture were also noted. All patients were evaluated at the postoperative 1st, 3rd, 6th and 12th month and preoperative and postoperative values of IPSS score, QoL score, total PSA, IIEF 15, PVR, Qmax and Qave were compared. RESULTS: Preoperative demographic characteristics were similar in the 2 groups. There was observed significant improvement for IPSS, Qmax, Qave, PVR, and QoL score by the postoperative first month compared to the preoperative values in both groups. Maximum improvement in the IPSS, Qmax, Qave, QoL score and PVR were achieved at postoperative 6, 3, 12, 3 and 12th months respectively in group 1. In group 2 maximum improvement in the same parameters were achieved at postoperative 6, 3, 6, 6 and 12th months, respectively. CONCLUSIONS: BiVap and Twister systems are safe, effective, and useful technique, which can be used in the surgical treatment of BPO between 90-150 ml.

Is Access Sheath Essential for Safety and Effective Retrograde Intrarenal Stone Surgery?

OBJECTIVE: To evaluate the results of retrograde intrarenal surgery (RIRS) with flexible ureteroscope (f-URS), using ureteral access sheath and without the sheath. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Kesan State Hospital, Edirne, Turkey, between February 2019 and May 2020. METHODOLOGY: Patients treated with RIRS for renal and proximal ureteral stone were evaluated. Two groups were formed that used ureteral access sheath or not. Operation and fluoroscopy times, postoperative complications and stone-free rates were compared. RESULTS: Group 1 consisted of 51 patients were operated with, using ureteral access sheath; and Group 2 having 62 patients, were operated without using ureteral access sheath. The mean volume of the stones was 1135 mm3 (73-7491 mm3) in the group without access sheath and 1273 mm3 (251-3635 mm3) in the group with access sheath. The mean operation time was 55 minutes (20-115 min) in the group without access sheath, and 70 minutes (30-125 min) in the group with access sheath. Postoperative febrile UTI was found in 5 (8%) of the patients without access sheath, and in 4 (8%) of the patients with access sheath (p=0.733). The stone-free rate of the patients with radiological controls was 58 (93%) in the group without access sheath and 46 (90%) in the group with access sheath (p=0.306). Fluoroscopy timings were 2.7 seconds (0-8 sec) in the group without access sheath and 8.4 seconds (2-20 sec) in the group with access sheath (p=0.001). CONCLUSION: UAS usage has no marked impact on SFR, complication rate and operation time. RIRS can be performed safely and effectively without using UAS. Key Words: Flexible ureteroscope, ITO score, Ureteral access sheath, Intrarenal stones.

Penile rehabilitation with low-intensity extracorporeal shock wave therapy in patients after prostate cancer surgery. Early physiological changes and postoperative follow-up outcomes.

INTRODUCTION: To investigate the efficacy, safety and postoperative outcomes of using tadalafil and low-intensity extracorporeal shock wave therapy (Li-ESWT) on penile rehabilitation and preventing urinary incontinence after radical prostatectomy. METHODS: In total, we included 66 patients who used only tadalafil (n = 32) in group 1 and used tadalafil and treated by Li-ESWT (n = 34) in group 2. We noted International Index of Erectile Function (IIEF) 5, daily incontinence pad measurements at preoperative, postoperative 3rd, 6th and 12th months respectively. We also evaluated penis blood flow and neovascularisation by penile doppler ultrasonography at postoperative 3rd and 12th months for all patients. Statistical analyses were performed with SPSS version 18. A P-value < .05 was considered significant. RESULTS: Preoperative demographic characteristics were similar in the two groups. There was a statistically significant improvement in IIEF-5, which started at the 6th month and continued increasingly at the 12th month in group 2 compared with group 1. Also, there was a significant decrease in incontinence rate in group 2 compared with group 1 in the sixth month. CONCLUSIONS: Combined use of tadalafil and Li-ESWT is highly effective and safe for the treatment of erectile dysfunction and for the prevention of urinary incontinence after prostate cancer surgery.

Clinical comparison of two minimal invasive techniques in the treatment of benign prostatic enlargement over 90 ml: BIVAP (Richard Wolf®) saline vaporization of the prostate vs. bipolar plasmakinetic TURP. / Comparación clínica de dos técnicas mínimamente invasivas en el tratamiento del agrandamiento de la próstata benigno en más de 90 ml: vaporización salina de la próstata BiVap (Richard Wolf®) frente a la RTUP plasmakinética bipolar.

OBJECTIVES: The aim of this study is to evaluate the efficacy, safety and postoperative outcomes of the recently developing endoscopic techniques of Bi-Vap (Richard Wolf®) saline vaporization of the prostate and bipolar plasmakinetic TURP in BPE over 90 ml. METHODS: In total, we included 147 patients treated with BiVap (Richard Wolf®) saline vaporization of the prostate (n=75) and bipolar plasmakinetic TURP(n=72). The inclusion criteria were Qmax ≤10 mL/s,IPSS ≥16, and prostate volume over 90 ml. Operation, hospitalization and catheter removal time were noted. Postoperative complications including urinary tract infection, transient hematuria, severe dysuria, and fever >38°C, urinary incontinence and urethral stricture were also noted. All patients were evaluated at the postoperative month 3. Preoperative and postoperative values of IPSS score, QoL score, IIEF-5, PVR, Qmax and Qave were compared. Statistical analyses were performed using SPSS 18.0 program and statistical significance was set at p<0.05. RESULTS: The groups were similar with respect to preoperative age, height, weight, creatinine, PSA, prostate volume, IPSS score, Qmax, Qave, QoL score, PVR and IIEF-5 values. The mean operation time was significantly higher (<0.001) removal were significantly lower (0.001) compared to group 1. The groups were similar regarding at postoperative month 3 IPSS score, Qmax, Qave,QoL score, PVR and IIEF-5 values. The only exception was the rate of severe dysuria, which was significant lyhigher in group 2. CONCLUSION: Both BiVap (Richard Wolf®) saline vaporization of the prostate and bipolar plasmakinetic TURP are safe and highly effective minimal invasive techniques, which can be used in the surgical treatment of BPE over 90 ml. Although the longer operation time and higher rate of postoperative irritative symptoms, Bi-Vap (Richard Wolf®) saline vaporization of the prostate seems to be a potential alternative to other techniques with shorter length of stay and time to catheter removal.

El objetivo de este estudio es evaluar la eficacia, la seguridad y los resultados postoperatorios de las técnicas endoscópicas recientemente desarrolladas de la vaporización de solución salina Bi-Vap (Richard Wolf®) de la próstata y la RTUP plasmakinética bipolar en BPE de más de 90 ml. MÉTODOS: En total, se incluyeron 147 pacientes tratados con vaporización salina BiVap (Richard Wolf®)de la próstata (n=75) y RTUP plasmakinética bipolar (n=72). Los criterios de inclusión fueron de Qmax ≤10mL/s, IPSS ≥16 y volumen de próstata por encima de 90 ml. Se anotó el tiempo de operación, hospitalización y retiro del catéter. También se observaron complicaciones postoperatorias que incluyen infección del tracto urinario, hematuria transitoria, disuria severa y fiebre >38° C, incontinencia urinaria y estenosis uretral. Todos los pacientes fueron evaluados en el tercer mes postoperatorio y se compararon los valores preoperatorios y postoperatorios de la puntuación IPSS, la puntuación de calidad de vida, IIEF-5, PVR, Qmax yQave. Los análisis estadísticos se realizaron utilizando el programa SPSS 18.0 y la significación estadística se estableció en p<0,05.RESULTADOS: Los grupos fueron similares con respectoa la edad preoperatoria, altura, peso, creatinina, PSA,volumen prostático, puntuación IPSS, Qmax, Qave, puntuación QoL, valores de PVR e IIEF-5. El tiempo medio de operación fue significativamente mayor (<0,001) y el tiempo de hospitalización y el tiempo de extracción del catéter fueron significativamente más bajos (<0,001) el grupo 2 en comparación con el grupo 1. Los grupos fueron similares con respecto a la puntuación IPSS postoperatoria del 3er mes, Qmax, Qave, puntuación QoL, valores de PVR y IIEF-5. La única excepción fue la tasa de disuria severa, que fue significativamente mayor en el grupo 2. CONCLUSIONES: Tanto la vaporización con solución salina BiVap (Richard Wolf®) de la próstata como la RTUP plasmakinética bipolar son técnicas mínimamente invasivas seguras y altamente eficaces, que se pueden utilizar en el tratamiento quirúrgico de BPE en más de 90 ml. Aunque el tiempo de operación más largo y la mayor tasa de síntomas irritativos postoperatorios, la vaporización salina de la próstata con BiVap (RichardWolf®) parece ser una alternativa potencial a otras técnicas con una hospitalización más corta y un tiempo menor de extracción del catéter.

Clinical comparison of two minimal invasive techniques in the treatment of benign prostatic enlargement over 90 ml: BIVAP (Richard Wolf(R)) saline vaporization of the prostate vs. bipolar plasmakinetic TURP / Comparación clínica de dos técnicas mínimamente invasivas en el tratamiento del agrandamiento de la próstata benigno en más de 90 ml: vaporización salina de la próstata BiVap (Richard Wolf(R)) frente a la RTUP plasmakinética bipolar

OBJECTIVES: The aim of this study is to evaluate the efficacy, safety and postoperative outcomes of the recently developing endoscopic techniques of Bi-Vap (Richard Wolf(R)) saline vaporization of the prostate and bipolar plasmakinetic TURP in BPE over 90 ml. METHODS: In total, we included 147 patients treated with BiVap (Richard Wolf(R)) saline vaporization of the prostate (n = 75) and bipolar plasmakinetic TURP (n = 72). The inclusion criteria were Qmax ≤ 10 mL/s,IPSS ≥ 16, and prostate volume over 90 ml. Operation, hospitalization and catheter removal time were noted. Postoperative complications including urinary tract infection, transient hematuria, severe dysuria, and fever >38°C, urinary incontinence and urethral stricture were also noted. All patients were evaluated at the postoperative month 3. Preoperative and postoperative values of IPSS score, QoL score, IIEF-5, PVR, Qmax and Qave were compared. Statistical analyses were performed using SPSS 18.0 program and statistical significance was set at p < 0.05. RESULTS: The groups were similar with respect to preoperative age, height, weight, creatinine, PSA, prostate volume, IPSS score, Qmax, Qave, QoL score, PVR and IIEF-5 values. The mean operation time was significantly higher (< 0.001) removal were significantly lower (0.001) compared to group 1. The groups were similar regarding at postoperative month 3 IPSS score, Qmax, Qave,QoL score, PVR and IIEF-5 values. The only exception was the rate of severe dysuria, which was significant lyhigher in group 2. CONCLUSION: Both BiVap (Richard Wolf(R)) saline vaporization of the prostate and bipolar plasmakinetic TURP are safe and highly effective minimal invasive techniques, which can be used in the surgical treatment of BPE over 90 ml. Although the longer operation time and higher rate of postoperative irritative symptoms, Bi-Vap (Richard Wolf(R)) saline vaporization of the prostate seems to be a potential alternative to other techniques with shorter length of stay and time to catheter removal

OBJETIVO: El objetivo de este estudio es evaluar la eficacia, la seguridad y los resultados postoperatorios de las técnicas endoscópicas recientemente desarrolladas de la vaporización de solución salina Bi-Vap (Richard Wolf(R)) de la próstata y la RTUP plasmakinética bipolar en BPE de más de 90 ml. MÉTODOS: En total, se incluyeron 147 pacientes tratados con vaporización salina BiVap (Richard Wolf(R)) de la próstata (n = 75) y RTUP plasmakinética bipolar (n = 72). Los criterios de inclusión fueron de Qmax ≤ 10mL/s, IPSS ≥ 16 y volumen de próstata por encima de 90 ml. Se anotó el tiempo de operación, hospitalización y retiro del catéter. También se observaron complicaciones postoperatorias que incluyen infección del tracto urinario, hematuria transitoria, disuria severa y fiebre > 38° C, incontinencia urinaria y estenosis uretral. Todos los pacientes fueron evaluados en el tercer mes postoperatorio y se compararon los valores preoperatorios y postoperatorios de la puntuación IPSS, la puntuación de calidad de vida, IIEF-5, PVR, Qmax yQave. Los análisis estadísticos se realizaron utilizando el programa SPSS 18.0 y la significación estadística se estableció en p < 0,05. RESULTADOS: Los grupos fueron similares con respectoa la edad preoperatoria, altura, peso, creatinina, PSA, volumen prostático, puntuación IPSS, Qmax, Qave, puntuación QoL, valores de PVR e IIEF-5. El tiempo medio de operación fue significativamente mayor (< 0,001) y el tiempo de hospitalización y el tiempo de extracción del catéter fueron significativamente más bajos (< 0,001) el grupo 2 en comparación con el grupo 1. Los grupos fueron similares con respecto a la puntuación IPSS postoperatoria del 3er mes, Qmax, Qave, puntuación QoL, valores de PVR y IIEF-5. La única excepción fue la tasa de disuria severa, que fue significativamente mayor en el grupo 2. CONCLUSIONES: Tanto la vaporización con solución salina BiVap (Richard Wolf(R)) de la próstata como la RTUP plasmakinética bipolar son técnicas mínimamente invasivas seguras y altamente eficaces, que se pueden utilizar en el tratamiento quirúrgico de BPE en más de 90 ml. Aunque el tiempo de operación más largo y la mayor tasa de síntomas irritativos postoperatorios, la vaporización salina de la próstata con BiVap (RichardWolf(R)) parece ser una alternativa potencial a otras técnicas con una hospitalización más corta y un tiempo menor de extracción del catéter

Does using alprazolam during outpatient flexible cystoscopy decrease anxiety and pain?

OBJECTIVES: To evaluate the effect of pre-operative alprazolam medication on anxiety and pain in flexible cystoscopy for bladder cancer follow-up. METHODS: A total of 86 male patients who had flexible cystoscopy for bladder cancer follow-up at 6th and 9th months were included in the study. A visual analog scale (VAS) pain score and the State-Trait Anxiety Inventory (STAI) were used. The 6th (VAS-1)and 9th (VAS-2) month pain scores and 6th month STAI score (STAI-1) and, 9th month STAI score before (STAI-2a) and after alprazolam (0.5 mg) intake (STAI-2b) were compared. RESULTS: The mean age was 66.49±12.45 years. Patients were grouped by age≤65 (Group-1) and age≥66 (Group-2). Mean VAS score for VAS-1 and VAS-2 were 2.66±0.96 and 2.44±1.05, respectively (p=0.007). The mean VAS-1 and VAS-2 scores in Group 1 were 3.0±1.05 and 2.73±1.18, respectively (p=0.009). The mean VAS-1 and VAS-2 scores in Group 2 were 2.36±0.77 and 2.17±0.86 respectively (p=0.031). The differences between mean anxiety scores were all statistically significant. All STAI (1, 2a, and 2b) and VAS (1 and 2) scores in Group-1 were statistically significantly higher than Group-2. Increasing STAI score is associated with a statistically significant increase in the VAS scores in the 0.50 and 0.75 quantiles (p=0.021 and p=0.039, respectively). CONCLUSIONS: Using alprazolam before flexible cystoscopy reduces both anxiety (STAI-1 vs STAI-2b) and pain (VAS-1 vs VAS-2). Previous cystoscopy experience reduces anxiety (STAI-2a vs. STAI-2b). Elderly patients have less anxiety and pain scores than younger patients in flexible cystoscopy.

Does using alprazolam during outpatient flexible cystoscopy decrease anxiety and pain? / ¿Disminuye el Alprazolam la ansiedad y el dolor durante la cistoscopia flexible ambulatoria?

OBJECTIVES: To evaluate the effect of pre-operative alprazolam medication on anxiety and pain in flexible cystoscopy for bladder cancer follow-up. METHODS: A total of 86 male patients who had flexible cystoscopy for bladder cancer follow-up at 6th and 9th months were included in the study. A visual analog scale (VAS) pain score and the State-Trait Anxiety Inventory (STAI) were used. The 6th (VAS-1) and 9th (VAS-2) month pain scores and 6th month STAI score (STAI-1) and, 9th month STAI score before (STAI-2a) and after alprazolam (0.5 mg) intake (STAI-2b) were compared. RESULTS: The mean age was 66.49±12.45 years. Patients were grouped by age≤65 (Group-1) and age≥66 (Group-2). Mean VAS score for VAS-1 and VAS-2 were 2.66±0.96 and 2.44±1.05, respectively (p = 0.007). The mean VAS-1 and VAS-2 scores in Group 1 were 3.0±1.05 and 2.73±1.18, respectively (p = 0.009). The mean VAS-1 and VAS-2 scores in Group 2 were 2.36±0.77 and 2.17±0.86 respectively (p = 0.031). The differences between mean anxiety scores were all statistically significant. All STAI (1, 2a, and 2b) and VAS (1 and 2) scores in Group-1 were statistically significantly higher than Group-2. Increasing STAI score is associated with a statistically significant increase in the VAS scores in the 0.50 and 0.75 quantiles (p = 0.021 and p = 0.039, respectively). CONCLUSIONS: Using alprazolam before flexible cystoscopy reduces both anxiety (STAI-1 vs STAI-2b) and pain (VAS-1 vs VAS-2). Previous cystoscopy experience reduces anxiety (STAI-2a vs. STAI-2b). Elderly patients have less anxiety and pain scores than younger patients in flexible cystoscopy

OBJETIVOS: Evaluar el efecto del alprazolam preoperatorio sobre la ansiedad y el dolor durante la cistoscopia flexible en el seguimiento del cáncer vesical. Métodos Se incluyeron 86 pacientes varones en seguimiento con cistoscopia flexible por cáncer vesical a los 6 y 9 meses. Se utilizaron una escala visual analógica (EVA) para el dolor y el Formulario STAI (State-trait anxiety Inventory) de ansiedad. Se compararon los resultados de dolor al 6º (EVA1) y 9º mes (EVA2) y los resultados del formulario STAI al 6º (STAI 1) y 9º mes, antes (STAI 2a) y después de la toma de alprazolam (STAI 2b). RESULTADOS: La edad media fue de 66,49±12,45 años. Los pacientes se agruparon por edad ≤ 65 años (Grupo 1) y ≥ 66 (Grupo 2). Las puntuaciones de la EVA 1 y EVA 2 fueron 2,66±0,96 y 2,44±1,05, respectivamente (p = 0,007). La media de las puntuaciones EVA 1 y EVA 2 en el grupo 1 fueron 3,0±1,05 y 2,73±1,18, respectivamente (p = 0,009). La media de las puntuaciones EVA 1 y EVA 2 en el grupo 2 fueron 2,36±0,77 y 2,17±0,86, respectivamente (p = 0,031). Las diferencias entre las puntuaciones medias de ansiedad fueron todas significativas. Todas las STAI (1, 2a y 2b) y EVA (1 y 2) en el grupo 1 fueron superiores a las del grupo 2, con diferencias estadísticamente significativas.Una puntuación del STAI creciente se asocia con un aumento significativo de las puntuaciones de la EVA en los cuartiles 0,50 y 0,75 (p = 0,021 y p = 0,039, respectivamente). CONCLUSIONES: La utilización de alprazolam antes de la cistoscopia flexible reduce tanto la ansiedad (STAI-1 vs STAI-2b) como el dolor (EVA-1 vs EVA-2). La experiencia de cistoscopia previa reduce la ansiedad (STAI-2a vs. STAI-2b). Los pacientes ancianos tienen valores más bajos de ansiedad y dolor en la cistoscopia flexible que los pacientes jóvenes

Unenhanced computed tomography findings of renal papillae in patients with a ureteral stone.

PURPOSE: In some patients with a ureteral stone without uretero-hydronephrosis, it is difficult to determine the location of the stone. The objective of the present study was to investigate the changes in renal papillae using unenhanced computerized tomography (uCT) and determine the side of calculi using the renal papillary findings in patients with a ureteral stone. METHODS: uCT data from 81 patients were retrospectively reviewed for this study. The inclusion criteria were unilateral ureteral calculi, no renal calculi and no hydronephrosis. For each patient, three measurements of CT attenuation of 0.05 cm2 area were made in the tip of the interested renal papillae, both stone side and non-stone side. Student's t test was used for statistical analysis. RESULTS: Forty-one right-sided and 40 left- sided isolated unilateral ureteral calculi patients were evaluated by uCT exam. The average attenuations of the tip of the papillae in stone side and non-stone side were 34.1 Hounsfield units (HU) and 30.6 HU, respectively. There was a statistically significant difference between stone and non-stone sides (p< 0.05). CONCLUSION: During routine practical uCT applications, it can be difficult to distinguish phleboliths, ureteral stone or the existence of non-opaque ureteral stone, so papillae density measurements can be a practical method to identify the existence of ureter stone and its location (side).

Recent management of urinary stone disease in a pediatric population.

The incidence of stone disease has been increasing and the risk of recurrent stone formation is high in a pediatric population. It is crucial to use the most effective method with the primary goal of complete stone removal to prevent recurrence from residual fragments. While extracorporeal shock wave lithotripsy (ESWL) is still considered first line therapy in many clinics for urinary tract stones in children, endoscopic techniques are widely preferred due to miniaturization of instruments and evolution of surgical techniques. The standard procedures to treat urinary stone disease in children are the same as those used in an adult population. These include ESWL, ureterorenoscopy, percutaneous nephrolithotomy (standard PCNL or mini-perc), laparoscopic and open surgery. ESWL is currently the procedure of choice for treating most upper urinary tract calculi in a pediatric population. In recent years, endourological management of pediatric urinary stone disease is preferred in many centers with increasing experience in endourological techniques and decreasing sizes of surgical equipment. The management of pediatric stone disease has evolved with improvements in the technique and a decrease in the size of surgical instruments. Recently, endoscopic methods have been safely and effectively used in children with minor complications. In this review, we aim to summarize the recent management of urolithiasis in children.

Does the use of smaller Amplatz sheath size reduce complication rates in percutaneous nephrolithotomy?

PURPOSE: To evaluate the effect of Amplatz sheath size used in percutaneous nephrolithotomy (PCNL) on postoperative outcomes, bleeding and renal impairment rates. MATERIALS AND METHODS: We retrospectively evaluated the records of 91 patients who had undergone PCNL. We divided the patients into 2 groups according to Amplatz sheath size (22 and 30 French [F]) used in the PCNL procedure. Groups were retrospectively compared in terms of pre- and postoperative hemoglobin and renal function, mean nephrostomy time, mean nephrostomy tube diameter, mean operative time, mean hospi­talization time and mean scopy time. RESULTS: Mean operative time, mean preoperative hemoglobin and serum creatinine values were similar in 2 groups. The mean stone diameter of patients in group 1 (22F) and group 2 (30F) were 38.47 ± 11.51 mm and 37.69 ± 12.33 mm, respectively. Pre- and postoperative hemoglobin (Hb) levels were 14.52 ± 1.5 g/dL and 13.51 ± 1.4 g/dL, respectively in group 1. Pre- and postoperative Hb level were 14.23 ± 1.6 g/dL and 10.73 ± 1.7 g/dL, respectively in group 2. There was a significant difference between the two groups in terms of mean scopy time (P = .023), postoperative Hb (P = .027), postoperative creatinine (P = .032), mean nephrostomy duration (P = .019), mean nephrostomy diameter (P = .028) and hospitalization time (P = .034). There was significant difference between the two groups in bleeding requiring blood transfusion (P = .023) and residual stone (P = .035). CONCLUSION: The smaller the Amplatz sheath used in PCNL, the lower kidney hemorrhage and renal function impairment happens.

Benign phyllodes tumour of the prostate: An extremely rare entity.

Benign phyllodes tumour (BPT) of the prostate is a very rare neoplasm. It is composed of hyperplastic and neoplastic glandular stromal proliferation. Patients with BPT of the prostate generally present with lower urinary tract symptoms and hematuria. BPT of the prostate can potentially cause recurrent obstructive symptoms. Complete transurethral resection (TUR) and close postoperative follow-up is recommended. A 59-year-old man presented with dysuria and obstructive urinary symptoms. Flexible cystoscopy revealed prostatic hyperplasia and a polypoidal lesion originating from the right lateral lobe of the prostate. Magnetic resonance imaging revealed a 3 × 2.5-cm mass lesion in the right lateral lobe of the prostate. TUR of the prostate was performed and the pathological examination revealed benign prostatic hyperplasia and benign phyllodes tumour of the prostate.

A clinical study comparing BIVAP saline vaporization of the prostate with bipolar TURP in patients with prostate volume 30 to 80 mL: Early complications, physiological changes and postoperative follow-up outcomes.

INTRODUCTION: We compare BIVAP saline vaporization of the prostate with bipolar transurethral resection of the prostate (TURP) in the treatment of benign prostatic hyperplasia. METHODS: In total, we included 86 patients treated with BIVAP (n = 44) and bipolar TURP (n = 42). The inclusion criteria were maximum urinary flow rate (Qmax) ≤10 mL/s, International Prostate Symptom Score (IPSS) ≥16, and prostate volume measured with transrectal ultrasound scan between 30 and 80 mL. Serum electrolyte, hemoglobin, and hematocrit levels were determined preoperatively and postoperatively. All patients were evaluated at the postoperative first and third months and the IPSS score, post-void residual urinary volume (PVR), Qmax, and average urinary flow rate (Qave) were compared. Statistical analyses were performed using SPSS 16.0 program and statistical significance was set at p < 0.05. RESULTS: Preoperative demographic characteristics were similar in the 2 groups. The mean operation time was significantly higher (p = 0.02) and hospitalization time was significantly lower (p = 0.04) in the BIVAP group when compared to the bipolar TURP group. There was no significant difference between 2 groups in terms of preoperative and postoperative serum electrolyte, hemoglobin and hematocrit levels. Postoperative complication rates were similar in the 2 groups. The only exception was the rate of severe dysuria, which was significantly higher in the BIVAP group. No statistical difference was noted between the groups in terms of postoperative follow-up results. CONCLUSION: Bipolar TURP is a safe and highly effective technique which can be used in the surgical treatment of benign prostatic obstruction with minimal side effects. BIVAP saline vaporization of the prostate seems to be a potential alternative to bipolar TURP with shorter hospitalization time.

Impact of the quadrivalent HPV vaccine on disease recurrence in men exposed to HPV Infection: a randomized study.

INTRODUCTION: Human papillomavirus (HPV) is one of the most common sexually transmitted infections and is the cause of several different diseases in men and women. Although little is known about HPV infection in men, they are also in the risk group of HPV infection and play an important role in transmitting the virus to women. AIM: To define the efficacy of the HPV vaccine through cross-immunization and its role in clearance of HPV infection, and to assess infection-associated factors in men. METHODS: This prospective randomized clinical study enrolled 171 evaluable men with genital warts between June 2009 and October 2013. After the initial treatment intervention, 91 patients were randomly assigned to receive HPV vaccine in three doses. Eighty patients were in the control (unvaccinated) group. One hundred-eleven men were single and 60 men were married. Patients who had previous treatment for pre-existing warts and medical disorders that needed chronic treatment or immunosuppression were not included in the randomization. Also 29 men with follow-up less than 12 months and incomplete vaccination were not included. MAIN OUTCOME MEASURES: The patients were assessed regarding age, condom use, marital status, number of visible genital warts, and smoking status. Post-treatment follow-up was monthly up to 12th month. RESULTS: Mean age was 34 ± 7.6. One hundred fifteen patients were smokers. For the recurrence of warts, age, smoking, vaccination status were insignificant and marital status was significant in the univariable analysis; only marital status preserved significance (HR: 2.0 CI:1.29-3.12 P = 0.002) in the multivariable analysis including vaccination status, marital status, and smoking. CONCLUSION: Among the investigated factors vaccination status was not but marital status significantly influenced wart recurrence. Married men had more recurrences in our population. Larger multicenter randomized clinical trials are lacking and seriously required to investigate the therapeutic effect of current quadrivalent HPV vaccine in genital warts.

Long-term results of permanent memotherm urethral stent in the treatment of recurrent bulbar urethral strictures.

PURPOSE: To evaluate the long term outcomes of permanent Memotherm urethral stent in the treatment of recurrent bulbar urethral stricture. MATERIALS AND METHODS: Twenty patients who underwent permanent Memotherm urethral stent implantation due to recurrent bulbar urethral stricture following previous unsuccessful surgical procedure from 1996 to 2002 were included in the study. Long-term outcomes of the patients were evaluated. RESULTS: The overall success rate was 87.5% at the end of the tenth year. There was discomfort in implantation area in eight patients about 1 month following the procedure. These patients were treated with alpha-blocker and anti-inflammatory drugs. Stone formation was observed at the urethral stent implantation area in two patients. Post-void dripping has been observed in 15 patients up to the postoperative 3rd month. Stress urinary incontinence was observed in a patient with a 1-year follow-up. Partial stent migration was observed in two patients. None of the patients experienced pain during erection. CONCLUSION: Memotherm urethral stent is a minimal invasive surgical procedure which can be safely and effectively used in patients with recurrent urethral stricture.

The stone formation in the Memotherm urethral stent implantation area: Is it a rare complication?

Recurrent urethral stricture is one of the biggest problems in urology. Urethral stents as an alternative treatment has been used since 1985. The stone formation in the Memotherm (Angiomed) urethral stent implantation area is a rare complication. We report the case of a 67-year-old man who had a stone in the Memotherm urethral stent implantation area 6 years after his urethral stent surgery.

Does urinary bladder shape affect urinary flow rate in men with lower urinary tract symptoms?

We aimed to investigate the role of urinary bladder shape which may potentially change with advancing age, increased waist circumference, pelvic ischemia, and loosening of the urachus on bladder emptying and UFR. We retrospectively investigated the medical records of 76 men. The patients were divided into two groups according to bladder shapes in MRI scan (cone and spheric shapes). There was a significant difference between the two groups in terms of IPSS, Qmax, Qave, and waist circumference. A positive correlation has been demonstrated between mean peak urinary flow rate measured with UFM and mean flow rate calculated using the CP. There was a significant difference between mean urinary flow rates calculated with CP of cone and sphere bladder shapes. The change in the bladder shape might be a possible factor for LUTS in men and LUTS may be improved if modifiable factors including increased waist circumference and loosening of the urachus are corrected.

Analysis of radiofrequency ablation of small renal tumors in patients at high anesthetic and surgical risk: urologist experience with follow-up results in the initial six months.

BACKGROUND: To evaluate the results of various types of radiofrequency ablation (RFA) treatment of renal tumors in patients with excessive anesthetic and surgical risk. MATERIALS AND METHODS: Data for RFA performed in in high risk patients were retrospectively evaluated. Other RFA applications in patients with no anesthetic and/or surgical risk were excluded. RFA was by ultrasound or CT guided percutaneous (USG/CT-PRFA) and retroperitoneally or transperitoneally laparoscopic (R/T-LRFA) techniques under general or local anethesia. Follow-up data of enhanced CT or MRI after 1, 3 and 6 months were analysed for twelve RFA applications. RESULTS: The RFA applications included 4 (40%) left-sided, 5 (50%) right-sided and 1 (10%) bilaterally RFA (simultaneously 1 right and 2 left). The localizations of tumors were 2 (16.6%) upper, 5 (41.6%) mid and 5 (41.6%) lower pole. The RFA applications included 9 (75%) USG-PRFA, 1 (8.3%) CT-PRFA, 1 (8.3%) T-LRFA and 1 (8.3%) R-LRFA. The mean age was 65.3 ± 8.5 (52-76) years. The mean tumor size was 29.6 ± 6.08 (15-40) mm. No complications related to the RFA were encountered in any of the cases. Failure (residual tumour) was determined in 8.3% (1/12) of USG-RFA application. The success rate was thus 91.7% (11/12). Other 1st, 3rd and 6th months follow-up data revealed no residua and recurrence. CONCLUSIONS: RFA application appears to be safe as a less invasive and effective treatment modality in selected cases of small renal tumors in individuals with excessive anesthetic and also surgical risk.