Efficiency of the estimation of physiologic ability and surgical stress (E-PASS) score in predicting postoperative complications after robot-assisted radical prostatectomy.

BACKGROUND: Robot-Assisted Radical Prostatectomy (RARP) is increasingly becoming the standard surgical treatment for prostate cancer. While some risk factors for postoperative complications of RARP have been identified, no scoring model that incorporates both preoperative physical status of the patient and intraoperative risk factors has been developed. The Estimation of Physiologic Ability and Surgical Stress (E-PASS) score was initially described to predict postoperative complications after gastrointestinal surgical procedures. This study aims to assess the effectiveness of the E-PASS score in predicting postoperative complications of RARP. METHODS: A retrospective evaluation was conducted on 204 patients who underwent RARP between 2019 and 2022. Demographic data, parameters indicating patients' preoperative physical condition, and intraoperative risk factors were analyzed. The E-PASS score and subscores were calculated for each patient. RESULTS: Of the patients, 164 (80.4%) were discharged without any postoperative complications (Group 1), and 40 (19.6%) experienced various degrees of complications (Group 2). Patients in Group 2 had higher rates of previous abdominal surgery, elevated Eastern Cooperative Oncology Group (ECOG) performance scores, longer surgical durations, and higher E-PASS scores. To assess the effectiveness of the Comprehensive Risk Score (CRS) as a predictive factor for postoperative complications, a receiver operating characteristic (ROC) curve was constructed with a 95% confidence interval (CI), and a cut-off value was established. The cut-off value for CRS was determined to be -0.0345 (area under the curve [AUC]=0.783, CI: 0.713-0.853; p<0.001). Patients with a CRS higher than the cut-off value had a 16.4 times higher rate of postoperative complications after RARP (95% CI: 5.58-48.5). CONCLUSION: The E-PASS scoring model successfully predicts postoperative complications in patients undergoing RARP by using preoperative data about the physical status of the patient and surgical risk factors. The E-PASS score and its subscores could be utilized as objective criteria to determine the risk of postoperative complications before and immediately after surgery.

Patients with testicular cancer receiving adjuvant chemotherapy: Compliance with follow-up in the first three years.

PURPOSE: The aim of this study was to investigate the compliance with follow-up in patients receiving adjuvant chemotherapy (ACT) for testicular cancer at two academic hospitals. MATERIALS AND METHODS: The study analyzed 104 patients with testicular tumors who had undergone surgery at least a year before and received ACT between March 2017 to March 2022. The mean follow-up was 29.2±16.2 (12-73) months. Patients were classified as fully compliant (100% compliance), moderately compliant (50-99%), poorly compliant (1-49%), and non-compliant (no attendance) according to their compliance with the follow-up schedule. RESULTS: At the end of the first year, 76% of patients were fully compliant. By the end of the second year, this number dropped to 50%. Furthermore, 25% of patients were identified as non-compliant in the second year and only 4.3% in the third year. When comparing patients who were compliant and non-compliant at first- and second-year follow-up, no statistically significant difference was found according to age, tumor size, disease stage, or ACT regimen (P=0.938, P=0.784, P=0.867, and P=0.282, respectively). CONCLUSION: This study showed that full compliance with follow-up gradually decreased over the years and that the factors examined were not able to predict this decrease. Prospective studies can help design individualized education and follow-up programs, considering each patient's tumor stage.

Job satisfaction, depression severity and quality of life ratings of perioperative nurses in robotic-assisted and laparoscopic surgery.

The rapid introduction of technological developments into healthcare systems adds another layer of complexity to the already demanding jobs of nurses, particularly for those working in perioperative care. In the present study, our primary aim is job satisfaction, whereas the secondary outcomes are psychological well-being and quality of life (QoL) ratings of perioperative nurses who take part in robotic-assisted and pure laparoscopic surgery. A total of 101 perioperative nurses in six different centers were included in the study. Fifty-one of the nurses were working in robotic-assisted laparoscopic surgery and 50 of them were working in pure laparoscopic surgery. All participants responded to Minnesota Job Satisfaction Questionnaire (MJSQ), Beck Depression Inventory (BDI) and SF-36 QoL Measurement Survey. The two groups did not differ in their total MJSQ, BDI and SF-36 QoL scores (pMJSQ:0.066, pBDI:0.329, pSF-36-QoL:0.136). In addition, there were no differences between the two groups in their intrinsic job satisfaction and extrinsic job satisfaction sub-scores (pintrinsic: 0.473, pextrinsic:0.121). Overall, 18.9% of the nurses reported having moderate to extreme depressive symptoms and most of them (87.1%) had low to moderate levels of job satisfaction. Finally, QoL ratings was generally at moderate levels. Perioperative nurses who work in robotic-assisted laparoscopic surgery do not differ from those working in pure laparoscopic surgery in terms of their job satisfaction, psychological well-being, and QoL ratings. In addition, across groups' psychological well-being, job satisfaction, and QoL ratings were not particularly high, suggesting that more attention needs to be paid to improving the work conditions of perioperative nurses.

Can the Mayo Adhesive Probability Score Predict Perioperative Outcomes in Laparoscopic Total and Partial Adrenalectomy?

Objective: This study aimed to determine whether the Mayo adhesive probability (MAP) score could predict perioperative outcomes in transperitoneal laparoscopic total adrenalectomy (LTA) and laparoscopic partial adrenalectomy (LPA). Materials and Methods: The clinical data of 139 patients who underwent transperitoneal LTA (n = 116) or LPA (n = 23) between March 2013 and September 2022 were retrospectively analyzed. According to the images obtained from preoperative contrast-enhanced computed tomography or magnetic resonance imaging, the patients were divided into two groups: the low MAP score group (0-1 points) and the high MAP score group (2-5 points). General clinical features and perioperative outcomes were compared between the groups. Results: In patients with a high MAP score, the mean body mass index (BMI) (p: 0.005), tumor size (p: 0.005), operative time (p: 0.002), estimated blood loss (EBL) (p: 0.001), and complication rate (p: 0.013) were significantly higher compared with those with a low MAP score. The comparison of the patients between the LTA and LPA subgroups revealed that operative time and EBL were significantly higher in both subgroups among the patients with a high MAP score. Moreover, the complication rate in the LTA subgroup was significantly higher in the high MAP score group compared with the other group. The Multivariate analyses revealed that a high MAP score was a risk factor for prolonged operative time (Odds Ratio [OR]: 3.081, 95% Confidence Interval [CI]: 1.284-7.398, p: 0.012), increased EBL (OR: 2.495, 95% CI: 1.114-5.588, p: 0.026), and complications (OR: 6.085, 95% CI: 1.532-24.171, p: 0.01) Conclusions: Patients with a high MAP score had a prolonged operative time, increased EBL, and a higher complication rate compared with those with a low MAP score. In addition, we found that a high MAP score was an independent risk factor for perioperative parameters and complications in patients who underwent LTA and LPA.

Selection for antimicrobial prophylaxis in emergency and elective transurethral procedures: Susceptibility pattern in Türkiye.

BACKGROUND: In this study, we aimed to determine the most appropriate antimicrobial agents for prophylactic antibiotic use during emergency and elective transurethral procedures. METHODS: The study was conducted in five hospitals located in five different geographical regions of Türkiye. The microorganism cultured in urine before emergency and elective transurethral procedures in these centers between March 2021 and March 2022 were reviewed retrospectively from the hospital records. Demographic data (age and gender) of the patients, comorbid disorders, previous urological procedures, anomalies of the urogenital tract, use of urethral catheters (permanent or clean intermittent catheterization), cultured microorganisms, and antibiotic susceptibilities were noted. The patients hospitalized or had antibiotics for any reason in the previous 1 month were excluded from the study. RESULTS: A total of 1450 patients, 742 men (51.2%) and 708 women (48.8%), were included in the study. The mean age of the patients was 55.3±19.36 (1-98) years. Diabetes mellitus was evident in 271 (18.7%) patients. The five most common microorgan-isms cultured in urine, in order of frequency, were: ESBL (-) Escherichia coli in 418 (28.8%), ESBL (+) E. coli in 309 (21.3%), Klebsiella pneumonia in 183 (12.6%), Enterococcus faecalis in 124 (8.6%), and Pseudomonas aeruginosa in 89 (6.1%). The susceptibility rates to antimicrobial agents recommended for prophylaxis by the American Urology Association and the European Association of Urology guidelines were found as follows: cefepime 87.1%, ampicillin+sulbactam 84%, TMP-SMX 71.6%, amoxicillin+clavulanate 63.5%, cefoxitin 59%, ceftazidime 58.6%, cefuroxime 43.5%, ceftriaxone 43%, and cefixime 38.4%. CONCLUSION: We found that currently recommended antimicrobials provide poor coverage for the most common pathogens isolated. Urologists should consider patient-based antibiotic prophylaxis in endoscopic urethral procedures, follow appropriate proto-cols, and consider local antibiotic resistance.

Value of the newly developed pelvic dimension index/prostate volume ratio in predicting positive surgical margin in prostate cancer.

PURPOSE: To evaluate the diagnostic performance of pelvimetric measurements, in particular the pelvic dimension index (PDI)/prostate volume (PV) ratio (PDI/PV), in predicting positive surgical margin (PSM) in prostate cancer (PC). MATERIALS AND METHODS: 127 patients who had pre-operative pelvic imaging were included in this study. Demographic and clinical data were recorded. Apical depth (AD), interspinous distance (ISD), intertuberous distance (ITD), bony femoral width (BFW), soft-tissue width (SW), symphysis angle (SA), anteroposterior diameter of the pelvic inlet (API), anteroposterior diameter of the pelvic mid-plane (APM), anteroposterior diameter of the pelvic outlet (APO), pelvic depth (PD), bony width index (BWI), soft tissue width index (SWI), pelvic cavity index (PCI), PDI and PV were measured on MRI or CT. Using PDI and PV, we developed a new parameter of "PDI to PV ratio" (PDI/PV). Logistic regression analysis was used to determine the predictive potential of variables in detection of PSM. RESULTS: The AD, PV, SA and total prostate specific antigen (PSA) were significantly higher in PSM( +), while PDI, BWI, SWI, API, PDI/PV and PD were significantly lower in PSM( +) (p < 0.05). In multivariate analysis, PDI/PV ratio and clinical stage were all significant predictor of PSM, where PDI/PV ratio was the strongest predictor, followed by clinical stage. CONCLUSION: Pelvimetric measurements indicating deep location of the prostatic apex rather than pelvic width are more effective in predicting PSM. Prediction of PSM with pelvimetric measurements, in particular PDI/PV ratio, may be helpful for surgical planning in preoperative period.

Can HALP score, a new prognostic tool, take the place of traditional scoring systems in Fournier's gangrene?

PURPOSE: Fournier's Gangrene (FG) is a fatal condition, therefore prognosis prediction is a crucial step before treatment planning. We aimed to investigate the predictive value of Hemoglobin, Albumin, Lymphocyte and Platelet (HALP) score which is frequently employed in vascular disorders and malignancies, on disease severity and survival in FG patients and to compare HALP score with well-known scoring systems on this aspect. MATERIALS AND METHODS: Eighty-seven men who had surgical debridement for FG between December 2006 and January 2022 were included in this study. Their symptoms, physical examination findings, laboratory tests, medical histories, vital signs, extent and timing of the surgical debridement and antimicrobial therapies were noted. The HALP score, Age-adjusted Charlson Comorbidity Index (ACCI) and Fournier's Gangrene Severity Index (FGSI) were evaluated for their predictive values for survival. RESULTS: FG patients were grouped as survivors (Group 1, n = 71) and non-survivors (Group 2, n = 16) and the results were compared. The mean ages of survivors (59 ± 12.55 years) and non-survivors (64.5 ± 14.6 years) were similar (p = 0.114). The median size of necrotized body surface area was 3% in Group 1 and 4.8% in Group 2 (p = 0.013). On admission, hemoglobin, albumin and serum urea levels and white blood cell counts were significantly different in two study groups. Two study groups were similar for HALP scores. However, ACCI and FGSI scores were greater significantly in non-survivors. CONCLUSIONS: Our results indicated that HALP score does not predict a survival successfully in FG. However, FGSI and ACCI are successful outcome predictors in FG.

An investigation of the reliability of YouTube videos on undescended testis.

INTRODUCTION AND OBJECTIVE: There are thousands of patient information videos published on YouTube, the most watched video sharing platform; however, most of these videos contain incomplete or incorrect information. Interestingly, some videos with incomplete or incorrect information have a higher view rate. This study aimed to evaluate the quality of patient information videos on 'undescended testis' published on YouTube. MATERIAL AND METHOD: A search was conducted on YouTube using the keywords 'undescended testis' and 'cryptorchidism', and a total of 373 videos were found. Among these, 122 patient information videos presented in the English language were examined. Four different scoring systems were used to evaluate the quality of the videos: Patient Education Materials Assessment Tool for Audiovisual Materials, Global Quality Score, Journal of American Medical Association score, and modified DISCERN scoring system. Whether the videos contained accurate and sufficient information was evaluated using a scoring system developed based on the patient information booklet prepared by the European Association of Urology (EAU) on undescended testis. RESULTS: The median duration (sec), number of views and number of likes of the videos were 269 (11-2484), 589 (6-1.563561) and 7 (0-4.200), respectively. According to the EAU-patient information scoring (EAU-PIS), while 32 (26.2%) of the total 122 videos contained a good level of informativeness (score: 8-10), the view rate of these videos was only 4.1% among all videos. When the top 10 most watched videos were evaluated, their mean EAU-PIS was 5.9 ± 2.81, and these videos contained a moderate level of informativeness. On the positive side, 90% of all the videos recommended surgery as a treatment option. DISCUSSION: Although YouTube is a widely used video-sharing platform, it is also a website where people or institutions can easily upload non-standardized videos due to the absence of regulations. Therefore, although it is an easily accessible source of information, it has many gaps in terms of reliability. As shown in our study, the rate of videos with accurate information was very low. It would be beneficial for viewers to be aware of this and accept YouTube as a source where they can have a general idea about a subject in which they are interested rather than using it as a reference information site. In future, YouTube can become a reference source in the medical field, especially with the standardization of medical videos through the collaboration of various organizations.

What is the role of inflammatory markers in predicting spontaneous ureteral stone passage?

PURPOSE: To investigate the role of inflammatory markers in predicting the spontaneous passage of ureteral stones. METHODS: We retrospectively reviewed 279 patients with ureteral stones sized 4-10 mm that were managed conservatively. The patients were divided into two groups: Group 1 consisted of 137 patients who passed the stone spontaneously; Group 2 comprised 142 patients without spontaneous stone passage. The groups were compared using the Mann-Whitney U and chi-square tests. In addition, univariate and multivariate analyses were performed to identify the significance of the parameters. RESULTS: The mean age of the patients was 41.2 years. The patients in Group 1 had a significantly lower mean stone size, white blood cell count and neutrophil count. In addition, stone location, presence of hydronephrosis and history of urolithiasis were significantly different between the groups. Neutrophil percentage, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were insignificantly lower in Group 1. In a multivariate analysis, stone size, distal location and hydronephrosis status significantly predicted the spontaneous stone passage. However, inflammatory markers including white blood cell count, neutrophil count and neutrophil-to-lymphocyte ratio could not determine the likelihood of spontaneous stone passage. CONCLUSION: Our results suggest that inflammatory markers are no meaningful parameters for the prediction of spontaneous stone passage.

Comparison of the efficacy of desmopressin fast-melting formulation and enuretic alarm in the treatment of monosymptomatic nocturnal enuresis.

BACKGROUND: Primary monosymptomatic nocturnal enuresis (MNE) is a common pediatric condition and there are two firstline, evidence-based treatments available; desmopressin and the enuresis alarm. Although there are many studies comparing enuresis alarm and desmopressin treatments in the literature, most were conducted using old formulations of desmopressin. OBJECTIVE: To compare the efficacy of desmopressin MELT formulation and enuresis alarm therapy in patients with MNE. STUDY DESIGN: A total of 130 patients who had primary MNE were included in the study. The patients were divided into two groups using simple randomization; desmopressin MELT (Group 1, n = 66) and enuresis alarm (Group 2, n = 64). The patients were invited for a follow-up visit at the fourth, 12th and 24th weeks of treatment. Treatment response and compliance were evaluated using bed-wetting diary and ICSS criteria. RESULTS: The mean age of the patients Group 1 and 2 was 11.2 + 3.3 and 10.2 + 3.4 years, respectively (p = 0.104). Complete response rate was similar at 4th week (53% vs. 37.3%, p = 0.162) and at 12th week (68.4% vs. 68.2%, p = 0.257). The relapse rate was significantly higher in the desmopressin MELT group than in the enuresis alarm group (48.9% vs 20.5%, p = 0.007). At the end of the study ten patients were excluded from the study because of loss to follow-up and/or side effects. The overall complete response rate was significantly higher in the enuresis alarm group than in the desmopressin MELT group at the end of the study (41.3% vs 64.9%, p = 0.035). When the intention to treat analysis population was considered, similarly the complete response rate was significantly higher in the enuresis alarm group than in the desmopressin MELT group (40.9% vs 64.1%, p = 0.027). DISCUSSION: With regard to the management of children with MNE, our study revealed that desmopressin MELT and enuresis alarm both have high efficacy rates in primary MNE treatment both at 4th and 12th week. However, overall complete response rate was better in enuresis alarm treatment at 24th week. In addition, enuresis alarm treatment also presents as a more favorable relapse rate. CONCLUSIONS: Enuresis alarm presented a more permanent treatment response and a lower relapse rate than desmopressin MELT formulation.

Comparison of Monopolar and Bipolar Transurethral Resection of Non-Muscle Invasive Bladder Cancer.

OBJECTIVE: We aimed to compare the safety and efficacy of monopolar and bipolar transurethral resection (TUR) of bladder tumors (TURBTs). MATERIAL AND METHODS: A total of 240 patients who underwent TURBT were prospectively included in the study from May 2011 to May 2014. All patients with suspected bladder tumors were eligible for study inclusion. Those who refused consent and those undergoing routine restaging TURBT were excluded from analysis. Patients were divided on the basis of the monopolar arm and the bipolar arm. Study outcomes included the incidence of bladder perforation and obturator jerk, decrease in hemoglobin and sodium levels, rates of re-coagulation and blood transfusion, TUR syndrome, and operation time. RESULTS: The mean age of the patients was 62 ± 13.7 years. The incidence of obturator jerk and bladder perforation was greater in the bipolar arm. However, with a decrease in the hemoglobin and sodium levels, rates of re-coagulation and blood transfusion were greater in the monopolar arm. Statistical analysis did not show significant differences with regard to study outcomes between the groups. There was no case of TUR syndrome in the 2 arms. The residual tumors' rate was similar between the 2 groups. CONCLUSIONS: Our results showed that efficacy and safety of the monopolar and bipolar methods seems to be comparable in patients with bladder tumors.

Evaluation of the complications in transperitoneal laparoscopic renal and adrenal surgery with Clavien-Dindo classification.

OBJECTIVE: To evaluate our complications in renal and adrenal transperitoneal laparoscopic surgeries with Clavien-Dindo classification. MATERIAL AND METHODS: Two hundred and eight patients to whom renal and adrenal laparoscopic surgeries were performed between January 2008 and June 2015 were included the study. One hundred and twenty one (58.2%) patients were female and 87 (41.8%) of them were male. Laparoscopic procedures were performed as radical nephrectomy (n=49; 23.6%), simple nephrectomy (n=56; 26.9%), and partial nephrectomy (n=7; 3.4%), renal cyst decortication (n=27; 13%), pyelopasty (n=14; 6.7%) and adrenalectomy (n=55; 26.4%). Complications were classified according to Clavien-Dindo classification. RESULTS: The mean age of the patients was 48.01±14.9 years. The mean duration of hospital stay was 3.5±1.9 days. According to European Scoring System for Laparoscopic Operations the procedures were graded based on procedural difficulty as simple (n=27; 12.9%), difficult (n=172; 82.8%), and highly difficult (n=9; 4.3%). Complications were observed in 13 (6.3%) interventions. One of these occurred during very hard and 14 during difficult procedures. According to Clavien-Dindo Classification; Grades 1, 2, and 3 A complications developed in 3 (1.4%), 9 (4.3%), and 1(0.5%) patient, respectively. CONCLUSION: Laparoscopic surgery is an efficient procedure in well-chosen patients for renal and adrenal diseases with low complication rates.

High-risk Oncogenic Human Papilloma Virus Infection of the Foreskin and Microbiology of Smegma in Prepubertal Boys.

OBJECTIVE: To evaluate the prevalence and genotypes of human papillomavirus (HPV) infection and microbiological status of the foreskin in asymptomatic prepubertal boys. METHODS: A total of 100 prepubertal healthy boys who underwent a standard circumcision procedure were included in the study. High-risk HPV status was determined by real-time polymerase chain reaction for the genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. The swabs were immediately sent to microbiology laboratory for culture and sensitivity tests. RESULTS: The median age at the time of surgery was 5.7 years (range, 2 months-9 years). High-risk HPV was detected in 9 foreskins (9%). Positive samples showed are HPV16 (n = 3), 31 (n = 2), 39 (n = 3), and 51 (n = 1). There were a total of 72 organism isolates: 54 gram-positive (75%) and 17 gram-negative (23.6%) bacteria and 1 (1.4%) Candida. The most commonly isolated gram-negative bacterium was Escherichia coli (41.2%), whereas the commonly isolated gram-positive bacterium was Enterecoccus sp. (57.4%). CONCLUSION: Our results showed that subclinical high-risk HPV infections are found in the foreskin, which could be a reservoir for HPV-associated diseases, and smegma seems not to be a risk factor for drug-resistant infection in children.

Can Bladder Wall Thickness Measurement Be Used for Detecting Bladder Outlet Obstruction?

OBJECTIVE: To investigate the relationship between bladder wall thickness (BWT) and uroflowmetric parameters and the International Prostate Symptoms Score (IPSS) in patients with lower urinary tract symptoms (LUTS). PATIENTS AND METHODS: A total of 236 male patients who had LUTS-related benign prostatic enlargement with serum prostate-specific antigen level ≤4 ng/mL were included in this study. Age and duration of LUTS and IPSS were recorded. BWT was measured using 7.5 mHz suprapubic ultrasonography before uroflowmetry and postvoid residual (PVR) was calculated thereafter. The relationship between BWT and poor indicators for bladder outlet obstruction (BOO) (IPSS >19, Qmax <15 mL/min, PVR >100 cm(3)) was investigated. RESULTS: The mean age was 62.5 ± 8.1 (39-77) years and the mean BWT was 3.8 ± 1.5 (1.4-8.7) mm. The mean IPSS, Qmax, PVR, and duration of LUTS were 17.7, 13.7 mL/min, 89.9, and 46.5 months, respectively. A positive correlation was found between BWT and IPSS, PVR and duration of LUTS, whereas a negative correlation was found between BWT and Qmax (P <.001). BWT increased when number of BOO parameters increased. BWT was 2.9 in patients without BOO parameters whereas BWT was 3.5, 4.1, and 4.5 mm in patients with any one, any two, and all parameters of BOO, respectively. CONCLUSION: BWT increased when number of BOO parameters increased. We believe that measurement of BWT is an easy, quick, and repeatable test to predict BOO severity.

Determination of the efficiency of 8 mg doxazosin XL treatment in patients with an inadequate response to 4 mg doxazosin XL treatment for benign prostatic hyperplasia.

OBJECTIVE: To compare the efficacy of 4 mg and 8 mg doxazosin XL treatments in patients with benign prostatic hyperplasia-related lower urinary tract symptoms and determine the efficiency of 8 mg in those patients with inadequate response to 4 mg. METHODS: A total of 162 patients were included in this study. Of the patients, 108 were randomized to receive 4 mg doxazosin XL (group 1), and 54 were randomized to receive 8 mg (group 2) treatments. After 1 month of treatment, 31 patients in group 1 whose quality of life (QoL) score was unchanged or had deteriorated were switched to 8 mg doxazosin XL treatment (group 1b). RESULTS: The mean age was 59.8 years. After 1 month of treatment, the mean alteration in the International Prostate Symptom Score was 3.9 and 5.2 (P = .028), for the maximum urinary flow rate (Q(max)), it was 3.0 and 3.6 mL/s (P = .206), and for the QoL score it was 1.3 and 1.7 (P = .038) in groups 1 and 2, respectively. For group 1b, during the period in which the patients were receiving 4 and 8 mg doxazosin XL treatments; the International Prostate Symptom Score changes were 1.3 and 3.6 (P <.001), the Q(max) changes were 1.6 and 3.2 mL/s (P <.019), and the QoL changes were 0.4 and 1.8 (P <.001) in groups 1 and 2, respectively. CONCLUSION: With no changes in side effects, 8 mg doxazosin XL treatment is an efficient choice for patients who did not have an adequate response to 4 mg doxazosin XL treatment.

Comparison of different scoring systems for outcome prediction in patients with Fournier's gangrene: experience with 50 patients.

OBJECTIVE: The aim of this study was to evaluate effective factors in the survival of patients with Fournier's gangrene (FG) and compare three different validated scoring systems for outcome prediction: Fournier's Gangrene Severity Index (FGSI), Uludag Fournier's Gangrene Severity Index (UFGSI) and age-adjusted Charlson Comorbidity Index (ACCI). MATERIAL AND METHODS: Fifty men who underwent surgery for FG between July 2005 and August 2012 were included in the study. Data were collected on medical history, symptoms, physical examination findings, vital signs, admission and final laboratory tests, timing and extent of surgical debridement, and antibiotic treatment used. The FGSI, UFGSI and ACCI were evaluated stratified by survival. Admission and final parameters were measured using the Mann-Whitney test. RESULTS: The results were evaluated for two groups: survivors (n = 43) and non-survivors (n = 7). Survivors were younger than non-survivors (median age 58 vs 68.5 years, p = 0.017). The median extent of body surface area involved in the necrotizing process in patients who survived and did not survive was 2.3% and 4.8%, respectively (p = 0.04). No significant differences in laboratory parameters were found between survivors and non-survivors at the time of admission, except for haemoglobin, haematocrit, serum urea and albumin levels. Only UFGSI, but not FGSI or ACCI, had any meaning or predictive value in disease severity or patients' survival. CONCLUSION: Only the UFGSI score could predict the disease severity and the patients' survival. The findings did not support previous findings that an UFGSI threshold of 9 is a predictor of mortality during initial evaluation.

Transperitoneal laparoscopic adrenalectomy: five years' experience with 35 patients.

OBJECTIVE: To present our laparoscopic surgery experience in the treatment of adrenal masses. MATERIAL AND METHODS: Between January 2008 and February 2013, a total of 35 patients (24 females, 11 males) underwent transperitoneal laparoscopic adrenalectomy to treat an adrenal mass. The patients underwent hormonal evaluation, chemical shift magnetic resonance imaging, or abdominal computed tomography. Twenty-seven patients (77.1%) had a hormone-active adrenal mass. RESULTS: Eighteen right, 16 left, and one bilateral transperitoneal laparoscopic adrenalectomies were performed. The mean age and body mass index of the patients were 47.4 years and 26.6 kg/m(2), respectively. The mean adrenal mass size, operation time, estimated blood loss, and hospitalization duration were 41.9 mm, 94.7 min, 30 cc, and 2.4 days, respectively. No minor or major complications were observed perioperatively or postoperatively. In one patient (2.8%), the laparoscopic approach was converted to open surgery due to severe bradycardia resulting from chronic obstructive pulmonary disease. Histopathological examinations revealed adrenocortical hyperplasia in 23 (66%) patients, benign pheochromocytoma in 8 (22.8%) patients, and periadrenal paraganglioma, adrenocortical carcinoma, myeloid metaplasia, and myelolipoma in one (2.8%) patient for each entity. CONCLUSION: Transperitoneal laparoscopic adrenalectomy is a safe and efficient minimally invasive treatment option with a low morbidity rate in the surgical treatment of adrenal masses.