Evaluation and comparison of S.T.O.N.E. and Guy's scoring systems for predicting percutaneous nephrolithotomy outcomes in supine position.

BACKGROUND: Percutaneous nephrolithotomy (PCNL) was applied in the prone position until recently. But also, in recent years supine positions was applied in patients with kidney stones. Predicting how much renal stones can be cleared after surgery and possibility of complications is an important question for both surgeons and patients. Therefore different scoring systems are used to evaluate outcomes of PCNL before surgery. PATIENTS AND METHODS: Between 2018 and 2020, 80 patients with renal stone who underwent PCNL in the supine position were evaluated preoperatively by S.T.O.N.E. and Guy's scoring systems (GSS). The predictions of both scoring systems for stone-free and complication rates in patients who underwent PCNL in the supine position were evaluated. Also, these scoring systems were compared among themselves for reliability. RESULT: In both scoring systems, there was a statistically significant difference between postoperative stone-free (SF) and residual stone (RS) of patients and in predicting the likelihood of complications in patients. No statistically significant difference was found between the two scoring systems in predicting the stone-free rate. CONCLUSION: Our findings revealed that S.T.O.N.E. nephrolithometry and Guy's score systems can be used effectively to predict stone-free rate, complications, and operation duration in supine position PCNL for renal stones.

Can stone migration be predicted preoperatively in ureteroscopic lithotripsy?

OBJECTIVE: In our study, we aimed to evaluate the parameters that are effective in predicting the possibility of stone migration during ureteroscopic lithotripsy. PATIENTS AND METHOD: We divided our patients two group whom we applied ureteroscopic lithotripsy. Patients who migrated stones during ureteroscopic manipulation to the 1st group, and the patients who did not migrate stones to the second group were included. We measured the proximal ureter diameters of the patients in both groups on their computed tomography. We compared these values statistically. In addition, we determined a cut-off value for the ureter diameter to predict the possibility of stone migration. RESULT: Especially, ureter diameters of patients with middle and lower ureter stones showed significant differences between groups. Also, stone sizes differed significantly between groups. CONCLUSION: We concluded that the possibility of stone migration is high in patients with a ureter diameter higher than 7.45 mm in the middle and lower ureteric stones. Also, we believe that stone diameter and the surgeon's experience are effective factors in stone migration.

Can we use neutrophil to lymphocyte ratio in the diagnosis and prediction of extracapsular extension in localized prostate cancer?

PURPOSE: We investigated role of neutrophil-to-lymphocyte ratio (NLR) in the diagnosis and prediction of extracapsular extension (ECE) in clinically localized prostate cancer (PCa). MATERIALS AND METHODS: A total of 396 patients with clinically localized PCa who underwent open radical retropubic prostatectomy (RRP), and 260 patients with benign prostatic hyperplasia (BPH) who underwent suprapubic prostatectomy were included in the study. Preoperative NLR, prostate specific antigen (PSA), prostate specific antigen density (PSAD), free PSA, prostate volume (PV), free/total PSA (f/t PSA) in both groups, and relation of NLR with PSA, Gleason Score (GS), and pathologic stage in PCa group were investigated. Records of patients were analyzed retrospectively. RESULTS: NLR, free PSA, f/t PSA, and PV were statistically higher in BHP, and PSAD was higher in PCa group. In PCa group, NLR was found to be higher in patients with PSA >10 ng/ml compared to those with less than ⩽10 ng/ml. NLR increases as the preoperative GS increases, and it was higher in pT3 patients than pT2 patients. NLR was statistically higher in those patients with positive lymph nodes than those without after RRP (p = 0.029). CONCLUSION: NLR is not a sufficient biomarker in differentiating clinically localized PCa from BPH. NLR increases as preoperative GS and pathologic stage increases. Lymph node involved patients after RRP have statistically higher NLR. NLR can be an indicator of ECE and lymph-node involvement in clinically localized PCa.

The effect of Mirabegron and Duloxetine combination in mixed-type urinary incontinence treatment.

OBJECTIVE: Stress-type and urgency-type urinary incontinence are seen together in mixed-type urinary incontinence. Treatment is usually chosen according to the predominant type of incontinence. The aim of this study is to evaluate the effect of mirabegron and duloxetine combination in the treatment of mixed-type urinary incontinence. METHODS: The data of 88 mixed-type urinary incontinence patients who applied to the urology outpatient clinic between January 2018 and December 2019 were retrospectively analyzed. We applied mirabegron and duloxetine treatment to the patients. The International Consultation of Incontinence Questionnaire-Short Form, Overactive bladder symptom score questionnaire and daily pad count were statistically evaluated before and after the treatment. RESULTS: Statistically significant improvements were observed using the questionnaire forms and decreased daily pad usage after the eight-week treatment (p<0.001). Based on the clinical global effect scale, 62.50% of patients had a partial or complete response to treatment and also the use of daily pads were decreased from 3.7-0.89 on an average. CONCLUSION: Combination use of mirabegron and duloxetine in the treatment of mixed-type urinary incontinence improved symptom scores and decreased pad usage.

Relation of glycated hemoglobin and vitamin D deficiency with erectile dysfunction in patients with type 2 diabetes mellitus.

Erectile dysfunction (ED) is seen very often in the men with type 2 diabetes mellitus (DM). Due to the ability of vitamin D to reduce endothelial damage and oxidative stress, its role in preventing cardiovascular risk has been demonstrated in some studies. Since ED and cardiovascular disease have common pathogenic mechanisms, many studies have evaluated a possible relationship between vitamin D deficiency and ED. Total 120 patients with type 2 diabetes mellitus were evaluated in this study. Vitamin D and HbA1c values were statistically compared according to International Index of Erectile Dysfunction (IIEF-5) scores. 23.3% of 120 patients had mild, 38.3% had mild to moderate, 21.7% had moderate and 16.7% had severe ED. There was statistically difference in vitamin D levels of the patients according to IIEF-5 scores. Also, significant difference was found in HbA1c levels between the patients with severe ED and other groups. Cut-off point for vitamin D and HbA1c were determined according to IIEF-5 score in patients who were divided in to two groups (14.41 and 11.1). A statistically significant correlation was found between both cut-off points and IIEF-5 scores. Our study shows that patients with ED have a vitamin D deficiency and a poor glycemic control.

A Modified Partin Table to Better Predict Extracapsular Extension in Clinically Localized Prostate Cancer.

PURPOSE: Prediction of extracapsular extension (ECE) before radical prostatectomy in clinically localized prostate cancer (PCa) is very important for clinical practice. ECE affects our decision on treatment strategy. The aim of this study is to identify the predictors of ECE, determine cut-off values, and compare them with the accuracy of Partin Table parameters to improve tumor staging in clinical practice. MATERIALS AND METHODS: 374 patients with clinically localized PCa who underwent open radical retropubic prostatectomy (RRP) were included in this study. Gleason Score (GS), age, digital rectal examination (DRE), prostate specific antigen (PSA), prostate specific antigen density (PSAD), free PSA, Free/Total PSA, prostate volume (PV), number of cores involved, tumor length, and tumor percentage in maximum involved core in biopsy were investigated. RESULTS: PSAD, tumor percentage, and tumor length are predictive factors of ECE. The cut-off values of PSA, PSAD, maximum tumor length, and maximum tumor percentages in predicting ECE are: > 8.90 ng/mL, > 0.26 ng/mL2, >5mm, and >50%, respectively. The cut-off values for Partin extraprostatic extension (EPE) and organ confined (OC) disease are >29% and ≤ 64%, respectively. CONCLUSION: Partin tables could better predict extracapsular extension in clinically localized PCa if they include PSAD, tumor percentage, and tumor length. The cut-off values of these predictive factors can be beneficial in treatment strategies and in the decisions of lymphadenectomy and nerve-sparing surgery at radical prostatectomy.

Protective effect of liraglutide on experimental testicular ischaemia reperfusion in rats.

This study was performed to evaluate the effect of liraglutide on experimental testicular ischaemia reperfusion in rats in terms of biochemistry, histopathology and immunohistochemistry. A total of 28 male Wistar-Albino rats were divided randomly into 4 groups: control (7), sham (7), ischaemia-reperfusion (7) and ischaemia-reperfusion + liraglutide (7). Biochemically, Nitric Oxide, Malondialdehyde, Superoxide dismutase, Glutathione peroxidase and Catalase levels were measured in the testis. Apoptosis protease activating factor-1 and inducible nitric oxide synthase activity were evaluated immunohistochemically as well. Statistical analyses were made via the Kruskal-Wallis and Mann-Whitney U tests. In the reperfusion group, CAT and SOD values were increased (p > .05), NO and MDA values were decreased (p < .05) after administration of liraglutide. In addition, GPx values were significantly increased in ischaemia reperfusion + liraglutide administered group compared to reperfusion group (p < .05). Apaf-1 and iNOS activity were significantly decreased with the addition of liraglutide treatment to the ischaemia-reperfusion group (p < .05). First of all, we would like to say that liraglutide treatment is moderately preventive against I/R injury in testicular torsion. The anti-inflammatory, antioxidant and antiapoptotic properties of liraglutide are create a moderately protective effect as we show in this study.

The prognostic importance of neutrophil-to-lymphocyte ratio in testicular cancer.

PURPOSE: Testicular cancer is mostly seen in young men. We planned this study that neutrophil-lymphocyte ratio (NLR) would help us predict the prognosis of the patients, except known markers such as AFP, hCG, and LDH. PATIENTS AND METHOD: Between 2015 and 2020, we conducted our study on 152 patients undergoing radical orchiectomy in our clinic. We divided our patients into good, moderate, and poor prognostic groups. We also created a control group of healthy patients of similar ages. We evaluated the NLR results in preoperative peripheral blood statistically among these groups. RESULTS: We found a significant difference between the control group and the patient group, and between the good and moderate/poor prognostic groups for preoperative NLR. CONCLUSION: This study created the opinion that preoperative NLR will help us predict the prognosis of patients.

Functional, morphological and operative outcome after pyeloplasty in adult patients: Laparoscopic versus open.

OBJECTIVE: The aim of this study is determine and compare improvement of hydronephrosis, renal function, and operative outcome between laparoscopic and open pyeloplasty in adults. MATERIAL AND METHODS: Sixty-five adult patients with primary ureteropelvic junction obstruction (UPJO) underwent pyeloplasty between January 2014 and September 2020. Thirty-four patients had laparoscopic pyeloplasty (LP), 31 patients had open pyeloplasty (OP). In this retrospective study demographics, differential renal function (DRF), hydronephrosis, anteroposterior diameter of pelvis renalis (APD) and operative outcomes: operation time, blood loss, complications, hospital stay, etiology, analgesic requirement, complications, and success rates were compared between two groups. RESULTS: Improvement of APD is higher in OP group (p: 0.001). Improvement of DRF (p: 0.713) and hydronephrosis (p = 1.000), success (p: 0.407) and complication rate (p: 0.661) are comparable between two groups. Median hospital stay, postoperative analgesia requirement and blood loss was less in LP group, mean operative time was shorter in OP group (p: 0.001). CONCLUSION: Pain complaints are greatly reduced after pyeloplasty in adult patients but the drainage of kidney, DRF and hydronephrosis does not improve as much as desired. Improvement of APD is better and median operative time is less in OP, intraoperative blood loss, hospital stay, and analgesic requirement is less in LP group in our study.

Analysis of the YouTube videos on pelvic floor muscle exercise training in terms of their reliability and quality.

PURPOSE: The aim of this study was to evaluate the content, reliability and quality of YouTube videos related to pelvic floor muscle exercise training. METHOD: This study was carried out on the descriptive model in order to evaluate the content, reliability and quality of the videos on YouTube related to pelvic floor muscle exercise training. "Pelvic floor muscle exercise" was searched on YouTube in English in March 2020, and a total of 107 videos were watched. Quality Criteria for Consumer Health Information (DISCERN) survey was used to analyze the videos in terms of their reliabilities, and Global Quality Score (GQS) was used to evaluate their qualities. RESULTS: When the contents of 59 videos included in the study were examined, it was determined that 52 of them contained useful information and 7 of them contained misleading information. Comprehensiveness mean scores, DISCERN mean scores and GQS means of the useful videos were found to be statistically higher than that of the moderate and misleading videos (p < 0.05).When videos were analyzed according to the publishing sources, 84.62% (44/52) of the useful videos and 85.71% (6/7) of misleading video were observed to be published by independent health information websites. No statistically significant difference was found between the overall comprehensiveness mean scores, DISCERN mean scores, GQS means and the features of the videos according to their publishing sources. CONCLUSION: In this study, it was observed that the vast majority of YouTube videos on pelvic floor muscle exercise training were useful videos; the vast majority of these videos were published by independent health information websites and contained moderately safe, accurate and quality information.

Our laparoscopic cystectomy experiences.

PURPOSE: We aimed to present our laparoscopic cystectomy experience and demonstrate that it is a feasible technique with safe oncologic principles. METHODS: Total 19 patients who underwent laparoscopic radical cystectomy and pelvic lymph node dissection (PLND) in our urology clinic (Okmeydani Training and Research Hospital) were retrospectively evaluated. Demographic data, operation technique and complications, tumour pathology and follow-up details of patients were recorded. RESULTS: Patients ranged from 40 to 73 years, with the average age of 60.8 and female/male rate was 2/17. The mean total operation time was 375 min (range 260-500). Mean hospitalisation time of patients was 10.3 days. The mean follow-up time was 11.2 months. CONCLUSION: Minimally invasive approaches in urology are becoming the first line treatment by the time. Due to the high costs and limited availability, robotic surgery is still not exactly widespread in the world. Our series showed that conventional laparoscopic cystectomy is an appropriate approach until robotic surgery becomes widespread.

Comprehensive examination of haematological parameters of patients operated due to testicular torsion.

We aimed to investigate the pre-operative predictive role of haematological parameters in patients with testicular torsion. The medical records of patients operated between January 2016 and November 2018 were retrospectively analysed. The demographic characteristics and complete blood count of the patients were recorded. We divided the patients who operated with testicular torsion into two groups: detorsion (Group 1) and orchiectomy (Group 2). A control group (Group 3) was created from healthy volunteers. All haematological parameters and other demographic data were compared between three groups. A total of 144 participants were included; Group 1, Group 2 and Group 3; 61, 27 and 56 respectively. The duration of symptoms and monocyte counts were found statistically significantly higher in patients undergoing orchiectomy than detorsion (p < .01). We found a significant difference in terms of neutrophil, lymphocyte, monocyte counts and neutrophil-lymphocyte ratio between patients with testicular torsion and controls. We also found that the monocytes count and symptom duration differed significantly between the detorsion group and the orchiectomy group. It is obvious that there is contradictory information according to the studies in the literature. We can say that the duration of symptoms and the number of monocytes are predictors of testicular viability.

The correlation between atherogenic indexes and erectile dysfunction.

Aside from the ordinary plasma lipid level measurements, the ratios based on individual plasma lipid levels such as atherogenic index of plasma (AIP), Castelli's risk index 1/2 (CRI-1/2), and atherogenic coefficient (AC) are the novel parameters to evaluate the patients with a high risk of CVD. In this study, we aim to evaluate the relationship between AIP, AC, and CRI-1/2 with increased risk of ED. Between April 2018 and February 2019, 253 patients, who were diagnosed as a vasculogenic ED in our clinic, were enrolled in the study. While the first group (n = 134) consisted of patients with moderate and mild ED (IIEF-EF: 17-30), the second group (n = 119) consisted of patients with severe ED. In addition to the mean values of lipid parameters; CRI-1 (total cholesterol/HDL), CRI-2 (LDL/HDL) AIP (log10(triglycerides/HDL), and AC (non-HDL/HDL) were calculated. The mean age was 44.02 ± 10.41 (24-70), and the mean BMI was 27.80 ± 4.12 (18.52 ± 41.97). However, CRI-1 and AIP values were found to be higher in the severe ED group compared to the mild ED group (CRI-1: 4.50 ± 1.47, 4.88 ± 1.30; p = .039; AIP: 0.489 ± 0.315, 0.617 ± 0.283; p = .007). Our results demonstrated that CR-1 and AIP have a positive correlation with the severity of ED. Moreover, we can suggest that patients with higher CR-1 and AIP values are likely to have more severe ED in the future.

The safety and effectiveness of percutaneous nephrolithotomy in solitary kidney aging male patients: our single-center experience.

OBJECTIVE: To assess the safety and effectiveness of percutaneous nephrolithotomy (PCNL) in aging male patients with a solitary kidney. METHODS: Among the patients undergoing PCNL between December 2009 and September 2014, 16 patients with solitary kidney (group 1) over the age of 40 were included in the analysis. Twenty patients with bilateral kidney patients (group 2) were included in the analysis, which constituted an age-matched control group. The patients' characteristics, stone characteristics, intraoperative and postoperative outcomes, including bleeding and transfusion rates, operative time, complications, hospital stay, stone-free rates (SFR) and renal function were evaluated. RESULTS: Mean age of the patients in groups 1 and 2 were 63.7 (range 48-73) and 64.8 (range 48-77). Mean stone size was 814 ± 390 mm2 in group 1, and 820 ± 405 mm2 in group 2 with no statistical significance (p = .35). The final SFR in the solitary kidney and bilateral kidney group was 87.5 and 90% (p = .07). Bleeding requiring transfusion, prolonged leakage from nephrostomy tract, mean operation time and access number were comparable between two groups (p > .05). However, the nephrostomy removal and hospital stay time were longer in the solitary kidney group (p < .05). The rate of perioperative DJ insertion was also higher in solitary kidney patients. A significant improvement was detected in creatinine and glomerular filtration rate levels in the sixth months after surgery in solitary kidney patients (p < .05). CONCLUSION: These results indicate that PCNL is a safe and effective method in aging male patients with a solitary kidney.

Percutaneous nephrolithotomy is safe and effective in aging male patients: a single center experience.

OBJECTIVE: To assess the safety and effectiveness of percutaneous nephrolithotomy in aging male patients. METHODS: Two hundred eighty-three male patients over the years of forty undergoing percutaneous nephrolithotomy between December 2009 and September 2014 were evaluated, retrospectively. The patients were stratified by four age groups [40-49 (group-1), 50-59 (group-2), 60-69 (group-3), ≥70 years (group-4)]. The groups were compared regarding stone size, mean operation time, mean access number, mean nephrostomy removal time, hospitalization duration, stone-free rate, and complications rate. The patients were also evaluated with regard to glomerular filtration rate levels preoperatively and in the sixth month after surgery. RESULTS: Mean stone size was 810 ± 490 mm2 in group-1, 840 ± 500 mm2 in group-2, 845 ± 480 mm2 in group-3, and 800 ± 460 mm2 in group-4 (p = .02). There was no statistical difference between the four groups in terms of mean operation time, access number, hemorrhage, nephrostomy removal time, and hospital stay duration (p > .05). After additional interventions; no significant difference was detected for final stone-free rates among the groups (p = .12). A significant improvement was detected in glomerular filtration rate levels in the sixth month after surgery in all groups (p < .05). CONCLUSION: These results indicate that percutaneous nephrolithotomy is a safe and effective method in aging male patients.

Dextranomer/Hyaluronic Acid Calcification Masquerading as Distal Ureteral Calculi in a Patient Previously Treated for Vesicoureteral Reflux.

Subureteral endoscopic injection is a safe and effective treatment for vesicoureteral reflux (VUR). Dextranomer/hyaluronic acid (Dx/HA) is the most commonly used bulking agent for the treatment of VUR. We report a confusing radiographic finding of calcified Dx/HA injection initially simulates distal ureteral stone in a female patient who has intermittent lumbar pain. Calcification of Dx/HA implants may mimic distal ureteral calculi; therefore, urologists should be aware of the potentially confusing radiographic images.