Predictive Factors for Requirement of Ureteral J Stenting in Ureteroscopic Treatment of Distal Ureteral Stones.

BACKGROUND: We aimed to investigate the factors predicting the need for ureteral J stent placement in the treatment of distal ureteral stones by ureteroscopy (URS). METHODS: Between January 2007 and June 2018, 550 consecutive patients who underwent URS with the diagnosis of distal ureteral stone disease were evaluated in a single center. The patients were divided into two groups as; group 1 who received a ureteral J stent, and group 2 without ureteral J stent. The two groups were compared in terms of possible preoperative, perioperative and postoperative risk factors. RESULTS: History of systemic disease, stone disease and extracorporeal shock wave lithotripsy (SWL) were significantly higher in group 1 (P<0.001, P=0.009, P=0.016). The operation time was longer in group 1 (P<0.001). The rate of impacted stones was higher in group 1 (61.7% vs 15.6%; P<0.001). In multivariate analysis, co-morbidities, previous SWL history, presence of impacted ureteral stone and prolongation of the operation time were found to be statistically significant in predicting ureteral J stent placement. CONCLUSION: In the treatment of distal ureteral stones by URS, not only perioperative complications, prolongation of the operation time, and the presence of residual stones but also preoperative factors, such as systemic disease, and impacted ureteral stones should be considered as predictive factors in assessing the need for a ureteral J stent and to avoid unnecessary stent procedures.

Comparison of Two Single-Incision Mini-Slings for the Treatment of Incontinence.

INTRODUCTION: This study aimed to compare the safety and efficacy of 2 single-incision mini-sling (SIMS) systems with different designs of anchoring mechanism. METHODS: The records of patients who have been operated for the treatment of female stress urinary incontinence (SUI) with 2 different SIMS systems were retrospectively evaluated. Patient characteristics, physical examination results, and quality of life (QoL) questionnaires were used to evaluate the patients. Primary efficacy endpoints were the cure and failure rates. Secondary efficacy endpoints were complications and differences in QoL questionnaires. RESULTS: Eighty-three patients from group 1 (Ophira SIMS system) and 77 patients from group 2 (Gallini SIMS system) were evaluated. There was no significant difference between the 2 groups regarding patient characteristics. The objective cure rates were found to be 83.1 and 79.2% in group 1 and group 2, respectively (p = 0.09). Mesh-related complications, such as anchor displacement, bladder erosion, vaginal erosion, and groin pain, were more common in group 1. No severe complications were observed. For both groups, a significant improvement in all scores of QoL questionnaires was observed after surgery; however, the differences between 2 groups were not significant. CONCLUSIONS: The present study showed that the treatment of female SUI with 2 different SIMS systems had similar efficacy, complication rates, and scores in QoL questionnaires.

Can the Hounsfield unit predict the success of medical expulsive therapy using silodosin in 4- to 10-mm distal ureteral stones?

OBJECTIVE: We aimed to investigate the predictive ability of the Hounsfield unit (HU) on non-contrast computed tomography (NCCT) for the success of medical expulsive therapy (MET) using silodosin in distal ureteric stones of 4-10 mm. METHODOLOGY: The data of patients who underwent MET were retrospectively screened. The patients were divided into two groups as Groups 1 and 2 depending on the presence or absence of stone expulsion, respectively. In addition to HU calculated using the NCCT images, state of the collecting systems, daily fluid intake, number of emergency department visits, and number of pain attacks were compared. RESULTS: A total of 88 patients were included in the study. Sixty-four patients (72.7%) expelled the stone after MET while the treatment was not successful in 24 patients (27.3%). The stone area was significantly larger in Group 2 (28.4 ± 15.7 mm2 vs 46.8 ± 16.1 mm2 ; P < .001). NCCT-HU was calculated as 542.5 ± 256.8 for Group 1 and 873.1 ± 335.2 for Group 2, indicating a significant difference (P < .001). The mean number of pain attacks was 1.5 ± 1.2 in Group 1 and 2.2 ± 1.4 in Group 2 (P = .048). The number of visits to the emergency department significantly differed between Groups 1 and 2 (1.1 ± 1.0 and 1.8 ± 1.3, respectively; P = .010). CONCLUSIONS: In this study, HU and stone area values calculated on NCCT were found to be effective factors in predicting the treatment success for MET. Therefore, we consider that it would be useful to consider these parameters in the selection of an appropriate treatment for distal ureteric stones.

Comparison of the efficacy of silodosin and a terpene combination in the medical expulsive therapy of distal ureteral stones.

OBJECTIVE: We aimed to compare the efficacy of silodosin and a terpene combination in the treatment of distal ureteral stones. METHODOLOGY: The data of the patients admitted to the urology policlinic with renal colic, diagnosed with distal ureteral stones, and followed up with medical expulsive therapy between December 2017 and June 2018 were retrospectively reviewed. The patients were divided into two groups: Group 1 comprised 72 patients that received 8 mg/day silodosin and Group 2 consisted of 51 patients that were given three capsules of a terpene combination daily. The groups were compared in terms of the patients' demographic characteristics, medical history, localisation of the present stone, renal collecting system status, daily fluid intake, number of emergency service visits, number of additional analgesic applications needed, number of pain attacks, number of days off work, stone expulsion rate and time to stone expulsion. RESULTS: Of the total 123 patients, 98 (79.7%) were stone-free. The stone-free rate was 75.0% in Group 1 and 86.3% in Group 2, with no statistical difference between the two groups. However, the number of visits to the emergency service because of pain, number of additional analgesic applications required, number of days off work, and time to stone expulsion were statistically significantly lower in Group 2 than in Group 1. CONCLUSIONS: The treatment of distal ureteral stones with silodosin is as effective as the terpene combination. However, the terpene combination is more effective than silodosin in managing pain and accelerating stone expulsion.

The use of computed tomography as the first imaging modality in patients with renal colic and microscopic haematuria.

OBJECTIVE: We aimed to evaluate the use of computed tomography (CT) as the first imaging modality in patients with renal colic and microscopic haematuria. METHODOLOGY: The patients that presented to the emergency service of six health centers with renal colic between January 2017 and January 2018 and were found to have microscopic hematuria on urinalysis were retrospectively evaluated. Only patients for whom non-contrast CT was used as the first imaging modality were included in the study. Patients were divided into two groups according to the stone presence (stone +, stone -) and the groups were compared in terms of demographics and clinical characteristics of patients. RESULTS: A total of 834 patients were included in the study and 711 (85.3%) were diagnosed with urolithiasis. CT also revealed additional pathology in 26 (3.1%) patients. The male patients had a significantly higher rate of stones than female patients (89.5% vs 75.2%; P < .001) and the BMI values were also significantly higher in the male patients compared with the females (27.0 ± 2.1 vs 25.0 ± 4.0, P < .001). Right renal colic was more common in female patients and the rate of left renal colic was significantly higher in male patients. The male patients diagnosed with stone disease required treatment at a higher rate than the female patients (P = .005). CONCLUSIONS: Because of its high sensitivity and specificity values in the diagnosis of stone disease, easy applicability and fast results, CT can be safely used as the first imaging modality for the diagnosis of renal colic and microscopic haematuria.

Five-Year Efficacy of Transobturator Tape Treatment and Quality of Life in Women with Stress Urinary Incontinence.

BACKGROUND: We aimed to assess the results of first- and fifth-year outcomes and the effect on quality of life (QoL) of transobturator tape (TOT) treatment in patients with stress urinary incontinence (SUI). METHODS: The patients who underwent TOT surgery between January 2008 and June 2013 were screened retrospectively. The QoL was evaluated with Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory-Short Form (UDI-6). The subjective evaluation of patients in terms of incontinence outcome was classified as worsened (UDI-6 and IIQ-7 if pre-operative < postoperative), improved (UDI-6 and IIQ-7 if pre-operative > postoperative), or cured (UDI-6 and IIQ-7 postoperative <10). The first-year and fifth-year success rates were compared between the IIQ-7 and UDI-6 results. RESULTS: A total of 109 patients were included in the study. There was a significant improvement (P<0.001) in the patients' UDI-6 and IIQ-7 scores when the preoperative and postoperative first-year results were compared. Comparing the postoperative first-year and fifth-year total UDI-6 and IIQ-7 scores, a significant improvement was observed and the patients' complaints were significantly reduced (P<0.001). The results of the IIQ-7 and UDI-6 questionnaire revealed that the TOT surgery success rate was 93.3% at the end of the first year and 88.7% at the end of the fifth year. CONCLUSION: The postoperative first-year and fifth-year data reveal that TOT surgery has a high success rate and positive effects on QoL. Low complication rates and the ease of application make TOT a good alternative to other treatment modalities in surgical treatment of SUI.

The effects of menopause on the quality of life and longterm outcomes of transobturator tape treatment in women with stres urinary incontinence

ABSTRACT Purpose: We aimed to investigate the effects of menopause on long-term outcomes of transobturator tape (TOT) surgery. Materials and Methods: Patients who underwent TOT surgery were evaluated under two groups as postmenopausal and premenopausal. The International Consultation on Incontinence short-form questionnaire (ICIQ-SF), Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory-Short Form (UDI-6) questionnaires were completed by the patients at the 1st and 5th-year follow-up sessions. Patients with a postoperative UDI-6 and IIQ-7 score of <10 were considered as cured, those with lower postoperative scores compared to the preoperative period were regarded as improved, and the cases that had higher postoperative scores than preoperative values were interpreted as TOT failure. The TOT success rates were compared between the results obtained from UDI-6 and IIQ-7. Results: A total of 109 patients were included in the study (53 postmenopausal and 56 premenopausal). We contacted with 90 (48 premenopausal and 42 postmenopausal) women at 1st year control and 80 (44 premenopausal and 36 postmenopausal) women at 5th year control. There was a significant improvement in all of three questionnaires between the preoperative and post-operative 1st year control (ICIQ-SF: 15.5±2.5 vs. 1.8±4.3, p <0.001; IIQ-7: 68.9±9.8 vs. 2.75±15.2, p <0.001; UDI-6: 27.1±11.1 vs. 6.0±14.6, p <0.001) and the preoperative and post-operative 5th year control (ICIQ-SF: 15.5±2.5 vs. 3.1±5.3, p <0.001; IIQ-7: 68.9±9.8 vs. 9.6±26.7, p <0.001; UDI-6: 27.1±11.1 vs. 5.1±10.0, p <0.001). When we compared the premenopausal and postmenopausal patients in terms of recurrent urinary tract infection (UTI); 5 (12%) patients had recurrent UTI in postmenopausal group but no patients had recurrent UTI in premenopausal group at 1st year follow-up (p=0.039) and similarly the same 5 (13.9%) patients in follow-up had recurrent UTI in postmenopausal group but no patients had recurrent UTI in premenopausal group at 5th year follow-up (p=0.045). There were no significant differences between the premenopausal and postmenopausal patients in terms of TOT success rates at 1st and 5th year control, evaluated with UDI-6 (1st year: p=0.198 and 5th year: p=0.687) and IIQ-7 (1st year: p=0.489 and 5th year: p=0.608) questionnaires. Conclusions: Transobturator tape surgery is an effective and reliable method according to the long-term outcomes reported in this paper. In the current study, we determined that the TOT success rates were not affected by the presence of menopause.

The effects of menopause on the quality of life and long-term outcomes of transobturator tape treatment in women with stres urinary incontinence.

PURPOSE: We aimed to investigate the effects of menopause on long-term outcomes of transobturator tape (TOT) surgery. MATERIALS AND METHODS: Patients who underwent TOT surgery were evaluated under two groups as postmenopausal and premenopausal. The International Consultation on Incontinence short-form questionnaire (ICIQ-SF), Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory-Short Form (UDI-6) questionnaires were completed by the patients at the 1st and 5th-year follow-up sessions. Patients with a postoperative UDI-6 and IIQ-7 score of <10 were considered as cured, those with lower postoperative scores compared to the preoperative period were regarded as improved, and the cases that had higher postoperative scores than preoperative values were interpreted as TOT failure. The TOT success rates were compared between the results obtained from UDI-6 and IIQ-7. RESULTS: A total of 109 patients were included in the study (53 postmenopausal and 56 premenopausal). We contacted with 90 (48 premenopausal and 42 postmenopausal) women at 1st year control and 80 (44 premenopausal and 36 postmenopausal) women at 5th year control. There was a significant improvement in all of three questionnaires between the preoperative and post-operative 1st year control (ICIQ-SF: 15.5±2.5 vs. 1.8±4.3, p <0.001; IIQ-7: 68.9±9.8 vs. 2.75±15.2, p<0.001; UDI-6: 27.1±11.1 vs. 6.0±14.6, p<0.001) and the preoperative and post-operative 5th year control (ICIQ-SF: 15.5±2.5 vs. 3.1±5.3, p<0.001; IIQ-7: 68.9±9.8 vs. 9.6±26.7, p<0.001; UDI-6: 27.1±11.1 vs. 5.1±10.0, p<0.001). When we compared the premenopausal and postmenopausal patients in terms of recurrent urinary tract infection (UTI); 5 (12%) patients had recurrent UTI in postmenopausal group but no patients had recurrent UTI in premenopausal group at 1st year follow-up (p=0.039) and similarly the same 5 (13.9%) patients in follow-up had recurrent UTI in postmenopausal group but no patients had recurrent UTI in premenopausal group at 5th year follow-up (p=0.045). There were no significant differences between the premenopausal and postmenopausal patients in terms of TOT success rates at 1st and 5th year control, evaluated with UDI-6 (1st year: p=0.198 and 5th year: p=0.687) and IIQ-7 (1st year: p=0.489 and 5th year: p=0.608) questionnaires. CONCLUSIONS: Transobturator tape surgery is an effective and reliable method according to the long-term outcomes reported in this paper. In the current study, we determined that the TOT success rates were not affected by the presence of menopause.

Effect of smoking cessation on sexual functions in men aged 30 to 60 years.

PURPOSE: We aimed to evaluate the effects of smoking cessation on the sexual functions in men aged 30 to 60 years. MATERIALS AND METHODS: Male patients aged 30 to 60 years that presented to the smoking cessation polyclinic between July 2017 and December 2018 were prospectively included in the study. The amount of exposure to tobacco was evaluated in packyear. The patients filled the International Index of Erectile Function (IIEF) form before the cessation and six months after cessation of smoking. Patients were subgrouped according to age, education level and packs/year of smoking and this groups were compared in terms of IIEF total and all of the IIEF domains. RESULTS: The evaluations performed by grouping the patients according to age (30-39, 40-49 and 50-60 years) and education level (primary-middle school and high schooluniversity) revealed that the total IIEF scores obtained after smoking cessation were significantly higher compared to the baseline scores in all groups (p=0.007 for the 30-39 years group and p < 0.001 for the remaining groups). According to grouping by exposure to smoking (≤25, 26-50, 51-75, 76-100 and 101≥ packs/year), the total IIEF scores significantly increased after smoking cessation in all groups except 101≥ packs/year (p=0.051 for the 101≥ group and p < 0.001 for the remaining groups). CONCLUSIONS: Erectile function is directly proportional to the degree of exposure to smoking, and quitting smoking improves male sexual function in all age groups between 30-60 years of age regardless of pack-year and education level.

The impact of hyperbaric oxygen therapy on erectile functions and serum testosterone levels in patients with erectile dysfunction.

Objective: To evaluate the effects of hyperbaric oxygen therapy (HBOT) on erectile functions and serum testosterone levels in patients with erectile dysfunction (ED).Methods: The patients treated by HBOT for several diseases between July 2017-May 2018 and had erectile dysfunction were included in the study. All patients filled the International Index of Erectile Function (IIEF) questionnaire form; serum total testosterone (TT) and free testosterone (FT) levels were examined before the first day and after the last day of HBOT. The effects of demographic characteristics of patients on erectile functions were evaluated. Patients were categorized according to the risk factors. The IIEF scores, TT and FT levels of patients in first day and after last day of HBOT were compared.Results: Totally 43 patients were included in the study. The mean post-HBOT IIEF-EF score was significantly higher than the mean pre-HBOT IIEF-EF score of patients (25.4 ± 5.3 vs 20.6 ± 5.1; p < .001). There was no statistical difference between the pre-HBOT and post-HBOT serum TT and FT levels of patients (4.0 ± 2.3 ng/ml vs 4.1 ± 2.0 ng/ml, p = .797; 8.6 ± 3.8 pg/ml vs 8.9 ± 3.5 pg/ml, p = .658).Conclusions: HBOT improved the erectile functions in ED patients however we cannot detect any effect on testosterone levels in our study.

Impact of previous SWL on ureterorenoscopy outcomes and optimal timing for ureterorenoscopy after SWL failure in proximal ureteral stones.

PURPOSE: We aimed to evaluate the impact of previous unsuccessful shock wave lithotripsy (SWL) therapy on ureterorenoscopy (URS) outcomes in proximal ureteral stones and to define whether there is any optimal timing for safe URS after SWL. METHODS: The patients who underwent URS for proximal ureteral stones between the years 2015 and 2018 in eight centers were included. Patients were divided into two groups according to previous SWL history; group 1 consisted of patients without SWL before URS for the stone [SWL (-)] and group 2 consisted of patients with a previous SWL for the stone [SWL (+)]. Demographics, operation outcomes and stone characteristics were compared between these two groups. Regarding the complication and success rates, optimal timing for URS after SWL for the stone was calculated with receiver operator characteristics curve analysis. RESULTS: Totally 638 patients were included (group 1: 466 patients and group 2: 172 patients). The operation and hospitalization times, rate of ureteral stenting and complications were significantly higher in group 2. Stone free status was similar between the groups. Optimal timing for URS after SWL was calculated as 16.5 days (AUC = 0.657, p = 0.012) with a sensitivity of 68% and specificity of 72%, regarding the complication rates. Complication rates were significantly higher in patients who were operated before 16.5 days (27.7% vs 6.5%, p < 0.001). CONCLUSIONS: The optimal timing; 2-3 weeks delay of the URS procedure after unsuccessful SWL may decrease complication rates according to our results.

Predictive Factors of Ureterorenoscopy Outcomes in Proximal Ureteral Stones: A Multicenter Study of Aegean Study Group of the Society of Urological Surgery.

INTRODUCTION: We aimed to evaluate the predictive factors in a holistic manner for ureterorenoscopy (URS) outcomes in proximal ureteral stones by a multicenter study. MATERIALS AND METHODS: The data of patients who underwent URS for proximal ureteral stones between the years 2015 and 2018 in eight centers were recorded retrospectively. Patients were divided into two groups according to URS success: Group 1 consisted of patients with successful URS, and Group 2 consisted of patients with unsuccessful URS. The two groups were compared in terms of risk factors, stone, and clinical characteristics of patients. RESULTS: A total of 638 patients were included in the study. Group 1 consisted of 527 (82.6%) patients, and Group 2 consisted of 111 (17.4%) patients. In multivariate logistic analysis, the key risk factors for URS success was found to be age (OR = 0.980, 95% [CI] = 0.963-0.996, p = 0.018), stone area (OR = 0.993, 95% [CI] = 0.989-0.997, p = 0.002), and operation time (OR = 0.981, 95% [CI] = 0.968-0.994, p = 0.005). CONCLUSIONS: To make the treatment decision of proximal ureteral stones, it is necessary to examine several parameters including available equipment, stone, and patient characteristics. Physicians should keep these risk factors in mind in the decision of treatment options.

Can negative ureteroscopy be predicted in ureteral stone treatment?

INTRODUCTION: We aimed to evaluate factors predictive of negative ureteroscopy (URS) in ureteral stones. METHODS: Patients who underwent URS between January 2007 and June 2018 were included in the study. Patients were divided into two groups: group 1- positive URS (841 patients); and group 2 -negative URS (75 patients). These two groups were compared in terms of demographic data, stone characteristics, and postoperative outcomes. RESULTS: The mean age of the study patients was 44.5±15.1 years. The absence of collecting system dilatation due to the present stone was found to be a significant predictive factor for negative URS in univariate analysis, but there was no significant difference in multivariate analysis. In the multivariate analysis, low body mass index (BMI), no history of stone surgery, stone located in the distal ureter, small stone area, longer time between the last imaging procedure and URS, and medical expulsive therapy (MET) application were statistically significant in predicting negative URS. CONCLUSIONS: In this study, the parameters that significantly predicted negative URS were found to be low BMI, no history of stone surgery, distal localization of the stone, small stone area, longer time between the last imaging procedure and URS, and MET applied for the current stone. These parameters should be considered to avoid negative URS and patients should be informed of the possibility of negative URS prior to operation.

Effect of smoking cessation on sexual functions in men aged 30 to 60 years

ABSTRACT Purpose We aimed to evaluate the effects of smoking cessation on the sexual functions in men aged 30 to 60 years. Materials and Methods Male patients aged 30 to 60 years that presented to the smoking cessation polyclinic between July 2017 and December 2018 were prospectively included in the study. The amount of exposure to tobacco was evaluated in pack-year. The patients filled the International Index of Erectile Function (IIEF) form before the cessation and six months after cessation of smoking. Patients were subgrouped according to age, education level and packs/year of smoking and this groups were compared in terms of IIEF total and all of the IIEF domains. Results The evaluations performed by grouping the patients according to age (30-39, 40-49 and 50-60 years) and education level (primary-middle school and high school-university) revealed that the total IIEF scores obtained after smoking cessation were significantly higher compared to the baseline scores in all groups (p=0.007 for the 30-39 years group and p <0.001 for the remaining groups). According to grouping by exposure to smoking (≤25, 26-50, 51-75, 76-100 and 101≥ packs/year), the total IIEF scores significantly increased after smoking cessation in all groups except 101≥ packs/year (p=0.051 for the 101≥ group and p <0.001 for the remaining groups). Conclusions Erectile function is directly proportional to the degree of exposure to smoking, and quitting smoking improves male sexual function in all age groups between 30-60 years of age regardless of pack-year and education level.

Fournier gangrene due to Rhizobium Radiobacter.

Fournier's gangrene (FG) is a life-threatening, rapidly progressing acute necrotizing fasciitis of perianal, genitourinary and perineal areas. The most common isolated pathogens are E.coli, Streptococcus and Enterococcus in tissue and abscess cultures. However we present the first Rhizobium radiobacter FG in this case. A 47-year-old man presented with black necrotizing area with malodorous pus drainage in the bottom of the right hemiscrotum. Intravenous imipenem and Clindamycin were started prophylactically; all necrotizing tissues were debrided and right hemiscrotectomy was performed. Rhizobium radiobacter was isolated from tissue and abscess cultures. After successful treatment patient was discharged posteroperative 18th day. The combination therapy of early and totally surgical debridement of necrotic tissues and appropriate antibiotic use are adequate to control Rhizobium radiobacter infection in FG.

The Effect of Hyperbaric Oxygen Therapy on Erectile Functions: A Prospective Clinical Study.

INTRODUCTION: We aimed to evaluate the effects of hyperbaric oxygen therapy (HBOT) on erectile function in patients who had no cavernosal or urethral injury by using International Index of Erectile Function (IIEF) questionnaire. MATERIALS AND METHODS: The male patients who were treated by HBOT for several diseases between July 2017 and September 2017 were examined. All patients filled the IIEF questionnaire form before the first day and after the last day of HBOT and a questionnaire including demographic characteristics and medical history. The effects of demographic characteristics and risk factors on erectile function were evaluated, and the IIEF domain scores of patients in first day and last day of HBOT were compared. RESULTS: Totally, 50 patients were included in the study between July 2017 and September 2017 and the mean age was 59.38 ± 13.77. The mean post-HBOT IIEF-EF score of patients was significantly higher than the mean pre-HBOT IIEF-EF score of patients (15.74 ± 10.52 vs. 19.50 ± 10.91; p < 0.001). The mean post-HBOT IIEF scores of other domains including intercourse satisfaction, orgasmic function, sexual desire, and overall satisfaction were also significantly higher than pre-HBOT scores. CONCLUSIONS: HBOT may be a good alternative treatment or adjunctive treatment for erectile dysfunction.