Low-cord orchidectomy for testicular cancer: what would be different?

INTRODUCTION: High cord radical orchidectomy (HRCO) is accepted as the standard surgical approach in testicular cancer, however low cord orchidectomy (LCRO) can reduce the morbidity of operation without worsening the oncological outcomes. METHODS: We retrospectively re-examined the specimens of men to determine the level of spermatic cord invasion (SCI). Men who had proximal SCI with negative surgical margins after HRCO were assumed to have de-novo residual tumour if LCRO was performed. Others were assumed as oncologically similar. We examined the relation between pre-operative variables and SCI and proximal SCI to determine whether prediction of proximal SCI is possible. RESULTS: 196 patients were included. 22 (11%) had SCI and ten (5%) had proximal SCI. Four patients with proximal SCI had positive surgical margins even after HRCO and didn't require additional local treatment. Six patients were assumed to have de-novo residual tumour if LCRO was performed. All six patients were metastatic and had systemic chemotherapy. High platelet count, tumour size, N stage, S stage and M stage were all significantly related with both SCI and proximal SCI (p < 0.05). CONCLUSION: Due to low probability of SCI, we think LCRO can safely be performed to reduce morbidity in Stage 1 patients. Although there is a risk for residual tumour in Stage 2-3 patients, currently there is no data that residual tumour would impair the success of systemic chemotherapy. Therefore we can not assume that these patients would be negatively affected. Pre-operative data can be useful to predict the presence of proximal SCI and select appropriate patients for LCRO.

Subtrigonal Inlay Patch Technique with Buccal Mucosa Graft for Recurrent Bladder Neck Contractures.

INTRODUCTION: We aimed to present a novel subtrigonal inlay patch (SIP) technique with buccal mucosa graft (BMG) for recurrent bladder neck contracture (BNC) via open approach. MATERIALS AND METHODS: Surgical approach for SIP technique is described in detail and outcomes of patients who have been operated with this technique for recurrent BNC were given. Briefly, bladder neck incision is performed after vertical cystotomy, fibrotic scar tissue is excised completely, and a BMG is patched at the end. RESULTS: All 3 patients were able to void in their first attempt after catheter removal. Follow-up durations were 14, 11, and 5 months for the patients and all 3 patients reported satisfactory voiding. No de novo urinary incontinence was reported by patients after catheter removal, and all were continent with no pad need on their last follow-up visit. None of the operated patients needed any intervention such as catheterization, dilatation, or internal urethrotomy for BNC on follow-up. CONCLUSION: The present study demonstrates the feasibility and promising results of SIP technique with open surgical approach. Further experience is mandatory with larger patient cohorts and longer follow-up.

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.

Effects of mirabegron on JJ stent-related symptoms: A multicentric study.

AIMS OF THE STUDY: To investigate the effect of mirabegron 50 mg/daily for JJ stent-related symptoms after ureteroscopic stone surgery. METHODS: Medical records of 145 patients who were given a single daily oral dose of 50 mg of mirabegron for relieving stent-related symptoms were retrospectively analysed. Demographic and clinical data and stone parameters were recorded. All participants completed the Turkish version of the Ureter Symptom Score Questionnaire (USSQ-T) on the postoperative 7th day, and again after at least 3 weeks, before JJ stent removal. The severity of stent-related symptoms was statistically compared before and after the mirabegron treatment. RESULTS: The mean urinary symptoms score decreased significantly from 30.87 ± 9.43 to 22.61 ± 6.78 (P < .0001), mean body pain score decreased significantly from 21.82 ± 11.22 to 14.03 ± 7.52 (P < .0001), mean work performance score decreased from 10.50 ± 8.61 to 7.02 ± 6.51 (P < .0001) and mean general health score decreased significantly from 15.43 ± 6.50 to 11.12 ± 3.70 (P < .0001). The mean sexual matters score significantly decreased from 3.88 ± 3.40 to 2.48 ± 2.03 (P < .0001), the additional problem score decreased from 9.31 ± 4.61 to 6.51 ± 2.83 (P < .0001) and the overall quality of life (QoL) score decreased from 5.18 ± 1.94 to 4.23 ± 1.71 after mirabegron use (P < .0001). CONCLUSION: Daily use of 50 g of mirabegron significantly improved stent-related symptoms, sexual matters and quality of life.

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.

Mechanisms and grading of nocturia: Results from a multicentre prospective study.

OBJECTIVE: To identify the pathophysiological mechanisms of nocturia and the correlation of these mechanisms with nocturia severity. METHODOLOGY: After approval by the local ethics committee, all patients with nocturia (≥1 nocturnal void/night) were included and filled the Overactive Bladder questionnaire, Nocturia Quality of Life, Incontinence Questionnaire - Male Lower Urinary Tract Symptoms (male), International Consultation on Incontinence Questionnaire - Female Lower Urinary Tract Symptoms (female) and 3-day frequency-volume chart. Patients were divided into three groups according to the severity of nocturia: group 1 consisted of patients with mild (1-2 voids/night), group 2 with moderate (3-4 voids/night) and group 3 with severe nocturia (>4 voids/night). Comparative analysis was performed between groups, and P < .05 was deemed as statistically significant. RESULTS: About 68.1%, 64.1% and 8.7% of the patients had nocturnal polyuria (NP), reduced bladder capacity and global polyuria, respectively. 42.7% of the patients had mixed nocturia. 6.1% of the patients did not comply with the aforementioned subtypes and defined as isolated nocturia. Regarding the severity of nocturia, 155 (41%) patients had mild, 167 (45%) patients had moderate and 57 (15%) patients had severe nocturia. Increased nocturia severity was related with decreased quality of life; higher age, urinary tract symptom scores, nocturnal urine volume, evening fluid consumption and beta-blocker medication rates. Increased nocturia severity was also associated with higher NP, global polyuria and reduced bladder capacity rates. CONCLUSIONS: Nocturia mechanisms may vary between mild and moderate to severe nocturia groups according to the present study. Nocturia grading with identification of subtypes may help for better standardisation of the diagnostic and treatment approaches as well as for the design of future clinical trials.

Nation-wide analysis of the impact of Covid-19 pandemic on daily urology practice in Turkey.

OBJECTIVE: To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic. METHODOLOGY: The centres participating in the study were divided into three groups as tertiary referral centres, state hospitals and private practice hospitals. The number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9-March-2020 and 31-May-2020. All these variables were recorded for the same time interval of 2019 as well. The weekly change of the workload of urology during pandemic period was evaluated, also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019. RESULTS: A total of 51 centres participated in the study. The number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the 3rd week of pandemics in state hospitals and tertiary referral centres; however, the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared, a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid-19 pandemic compared with normal life. CONCLUSIONS: Covid-19 pandemic significantly affected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non-deferrable surgeries by urologists in concordance with published clinical guidelines.

Easily accessible, up-to-date and standardised training model in Urology: E-Learning Residency training programme (ERTP).

OBJECTIVES: There is no standardised and up-to-date education model for urology residents in our country. We aimed to describe our National E-learning education model for urology residents. METHODOLOGY: The ERTP working group; consisting of urologists was established by the Society of Urological Surgery to create E-learning model and curriculum in April 2018. Learning objectives were set up in order to determine and standardise the contents of the presentations. In accordance with the Bloom Taxonomy, 834 learning objectives were created for a total of 90 lectures (18 lectures for each PGY year). Totally 90 videos were shot by specialised instructors and webcasts were prepared. Webcasts were posted at uropedia.com.tr, which is the web library of the Society of Urological Surgery. The satisfaction of residents and instructors was evaluated with feedbacks. An assessment of knowledge was measured with the multiple-choice exam. RESULTS: A total of 43 centres and 250 urology residents were included in ERTP during the academic year 2018/2019. There were 93/55/43/34/25 urology residents at 1st/2nd/3rd/4th and 5th year of residency, respectively. Majority of the residents (99.1%) completed the ERTP. The overall satisfaction rate of residents and instructors were 4.29 and 4.67 (min: 1 so bad, max: 5 so good). An assessment exam was performed to urology residents at the end of the ERTP and the mean score was calculated as 57.99 points (min: 20, max: 82). CONCLUSION: As a result of the COVID-19 pandemic, most of the educational programmes had to move online platforms. We used this reliable and easily accessible e-learning platform for the standardisation of training in urology on national basis. We aim to share this model with international residency training programmes.

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.

Evaluation of lower urinary tract symptoms in children with Down syndrome: A prospective, case-controlled cohort study.

AIMS: In children with Down syndrome (DS) which causes cognitive impairment and intellectual disability (ID), dysfunctional voiding is proposed to be more common than in the normal population. In this study, we aimed to compare the voiding symptoms of DS children with a control group by validated questionnaires. METHODS: Thirty-seven DS children without any previous urological complaints and 59 non-DS healthy children as control group was included in the study. Overactive bladder symptoms and dysfunctional voiding were evaluated with validated Overactive Bladder Questionnaire (OAB-V8) and Dysfunctional Voiding Symptom Score (DVSS) questionnaire, respectively. Data were arranged, descriptive and comparative statistical analysis were performed. RESULTS: Demographic data of the two groups were similar except age of completing toilet training being higher in DS group. Total OAB-V8 and DVSS scores were significantly higher in the DS group. The mean scores of questions regarding voiding frequency, urgency and urgency incontinence in OAB-V8 were significantly higher in the DS group. The mean daytime incontinence, urgency, urgency incontinence, and quality of life scores in the DVSS were also significantly higher in the DS group. CONCLUSIONS: DS children have more frequent dysfunctional voiding than the normal population. ID of these children may prevent the expression of these symptoms. Awareness and early detection of these symptoms are crucial to prevent devastating complications such as renal failure. Therefore, validated questionnaires are simple, useful, and noninvasive methods.

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.