The Impact of Histological Variants on Oncological Outcomes in Patients with Muscle Invasive Bladder Cancer Treated with Radical Cystectomy.

OBJECTIVE: Bladder cancer is a heterogeneous entity characterized by a wide range of different morphologies. The aim of this study was to investigate the prognostic effect of bladder tumor with variant histology that is treated with radical cystectomy on oncological outcomes. METHODS: One hundred eighty-six patients who underwent radical cystectomy between September 2001 and June 2020 were included in the study. The patients were divided into 2 groups variant histology group (n = 54) and transitional cell cancer group (n = 132). Clinicopathologic data were compared between the two groups. RESULTS: The groups were similar in terms of demographic characteristics. In the mul- tivariate analysis of cancer-specific survival in transitional cell cancer against variant histology, high-grade detection of primary transurethral bladder tumor pathology, cystectomy pT, cystectomy positive lymph node, and positive surgical margin in cys- tectomy were determined to be statistically significant. Diagnosis of pT2 and high grade of primary transurethral bladder tumor pathology, cystectomy ≥ pT3, cystec- tomy positive lymph node, and positive surgical margin in cystectomy were statis- tically significant in multivariate analysis of overall survival. Cancer-specific survival time was estimated at 65.1 ± 8.3 months for variant histology and 134.2 ± 10.4 months for transitional cell cancer (P=.004). The estimated overall survival time was 61.9 ± 8.0 months in variant histology and 119.0 ± 9.8 months in transitional cell cancer (P = .014). CONCLUSION: Pathological features and prognosis of bladder cancer with variant histol- ogies are worse than those of pure urothelial bladder cancer. Overall survival and can- cer-specific survival are shorter in bladder cancer with variant histology than in pure urothelial bladder cancer. Following the diagnosis of variant histology in transurethral bladder tumor, poor prognosis must be considered in the treatment plan.

The Relationship Between Lymphocyte Subtypes with Clinicopathological Features and Prognosis of Prostate Cancer in Patients Undergoing Radical Prostatectomy.

OBJECTIVE: The immune system has an essential role in the development of cancer by showing both anti-tumor and pro-tumor activities. Understanding the immune func- tion of patients with malignancy is of clinical importance for the evaluation, treatment, and prognosis of the disease. We aimed to evaluate lymphocyte subtypes in peripheral blood samples of prostate cancer patients and their relationship with clinicopathologi- cal features and prognosis. METHODS: One hundred thirty-seven patients who underwent open radical prosta- tectomy were included in our study. The percentages of CD3+T lymphocyte, CD19+ B lymphocyte, CD16/56 natural killer cells, CD4+ helper T lymphocyte, CD8+ cytotoxic T lymphocyte, and CD45 total lymphocyte were evaluated for each patient using the blood sample taken into a hemogram tube before surgery. RESULTS: The pathological stage was T2 for 64 of the cases and T3 for 73. The mean follow-up period of the patients was 12.81 ± 6.20 months. The CD3+/CD4+ counts of the patients with pathological stage T2 were found to be statistically significantly higher than stage T3. There was a statistically significant negative correlation between the prostate-specific antigen levels and CD3+/CD4+ percentages of the patients. There was no statistical significance between the percentages of lymphocyte subtypes and the presence of surgical margin, biochemical recurrence, adjuvant therapy, and cancer upgrade. CONCLUSION: We consider that the increase in the pathological stage and prostate-spe- cific antigen value and the decrease in the number of CD4+ T lymphocyte subtypes may be prognostic markers in prostate cancer patients.

Oncologic outcomes of postoperative adjuvant versus salvage radiotherapy in prostate cancer.

Introduction: The aim of this study was to compare the long-term oncological results of patients with the diagnosis of prostate cancer who underwent open radical retropubic prostatectomy (RRP) and subsequent adjuvant (ART) or salvage radiotherapy (SRT). Material and methods: A total of 145 patients underwent open RRP for prostate cancer and subsequent ART or SRT postoperatively between 2010 and 2019. ART (n = 56) is defined as the group of patients with prostate-specific antigen (PSA) <0.2 ng/mL or with positive lymph nodes without PSA increase who received radiotherapy within the first 6 months of urinary continence. SRT (n = 89) is defined as the group of patients with PSA >0.2 ng/mL who received RT before PSA amounted to 0.5 ng/mL. Results: Statistically no significant difference was found between groups in terms of age, prostate volume, final pathology Gleason scores, lymphadenectomy, duration of androgen deprivation therapy (ADT), time to relapse after radiotherapy, development of biochemical recurrence and disease progression. Extraprostatic extension, seminal vesicle invasion and surgical margin positivity were significantly higher in the ART group. No difference was found between the groups in terms of biochemical recurrence-free survival, while cancer-specific survival and overall survival rates were significantly higher in the SRT group. Conclusions: It was found that cancer-specific and overall survival was better in the SRT group. It will be more appropriate to follow-up until the recurrence and then to perform SRT after the relapse in the postoperative period.

Comparison of Biparametric and Multiparametric Prostate Magnetic Resonance Imaging in Predicting Oncologic Outcomes After Radical Prostatectomy.

Objective: This study aimed to evaluate the difference in predicting the pathological stage of retropubic radical prostatectomy (RRP) and biochemical recurrence (BCR) in patients with Prostate Imaging Reporting and Data System (PIRADS) scores of 3 and 4 on biparametric prostate magnetic resonance imaging (bpMRI) compared to patients who upgraded from PIRADS 3 to PIRADS 4 based on the contrast-enhanced PIRADS version 2.1. Methods: This study evaluated 107 patients who underwent RRP and had preoperative multiparametric prostate magnetic resonance imaging (mpMRI) and were followed regularly. Group 1 included 31 patients evaluated as PIRADS 3 in both bpMRI and mpMRI, group 2 included 31 patients evaluated as PIRADS 3 in bpMRI and PIRADS 4 in mpMRI, and group 3 included 45 patients evaluated as PIRADS 4 without contrast. Comparisons were made between groups 1 and 2 and between groups 2 and 3. Results: No significant difference was found between the groups in terms of demographic data, preoperative or postoperative radiology, and pathology findings. Extraprostatic extension positivity and BCR were more common in group 2 compared to group 1 although not significant. Multivariate regression analysis was performed to determine the risk factors in predicting BCR, which revealed the positivity of seminal vesicle invasion and high pathological stage in the pathology report as significant factors. Prostate-specific antigen (PSA) and PSA density were higher in group 3 than in group 2, but without significance. Conclusions: This study revealed that mpMRI did not contribute in predicting BCR after RRP compared to bpMRI.

Effects of androgen deprivation therapy on metabolic markers and bioelectrical impedance analyze in prostate cancer patients / Efectos de la terapia de privación de andrógenos sobre marcadores metabólicos y análisis de impedancia bioeléctrica en pacientes con cáncer de próstata

Introduction and Objectives: Prostate cancer (PCa) is the most widespread malignancy within men. Androgen deprivation therapy (ADT), which is the central component of advanced PCa treatment, causes side effects. The goal of this study was to examine the metabolic changes and bioelectrical impedance analysis differences in PCa patients who received ADT.Materials and methods: After age-related match-pair analysis, a total of 519 patients with PCa and control group who had benign disease were enrolled in the study. Biochemical blood parameters and TANITA measurements were recorded for all patients. Patients were categorized into three groups, ADT group (Group 1, n=124) and non-ADT group (Group 2, n=248), control group (Group 3, n=147).Results: The mean age of groups was similar. Body mass index, waist circumference, body fat mass and fat ratio, which were among the TANITA parameters, were higher in group 1 (p<0.05). Total cholesterol, high density lipoprotein, non- high density lipoprotein, triglycerids and fasting blood glucose values were also higher in group 1 (p<0.05). Myocardial infarction and metabolic syndrome rates were also higher in this group.Conclusions: While the use of ADT is manifested by an increase in fat mass and fat ratio in body composition, it negatively affects waist circumference measurements. It is associated with metabolically unfit body composition changes that predispose to diabetes mellitus and may increase cardio-vascular disease. For this reason, it is necessary to be careful about metabolic and endocrinological diseases in long-term therapy. (AU)

Introducción y objetivos: El cáncer de próstata (CaP) es la neoplasia maligna más extendida en los hombres. La terapia de privación de andrógenos (ADT), que es el componente central de su tratamiento avanzado, causa efectos secundarios. El objetivo de este estudio fue examinar los cambios metabólicos y las diferencias de análisis de impedancia bioeléctrica en pacientes con CaP que recibieron ADT.Materiales y métodos: Después del análisis de pares de parejas relacionados con la edad, un total de 519 pacientes con CaP y un grupo de control con enfermedad benigna se inscribieron en el estudio. Se registraron parámetros sanguíneos bioquímicos y mediciones de TANITA para todos los pacientes. Los pacientes se clasificaron en 3 grupos: grupo ADT (grupo 1; n=124), grupo no ADT (grupo 2; n=248) y grupo control (grupo 3; n=147).Resultados: La edad media de los grupos fue similar. El índice de masa corporal, la circunferencia de la cintura, la masa de grasa corporal y la proporción de grasa, que se encontraban entre los parámetros de TANITA, fueron mayores en el grupo 1 (p<0,05). El colesterol total, las lipoproteínas de alta densidad, las lipoproteínas de baja densidad, los triglicéridos y los valores de glucosa en sangre en ayunas también fueron más altos en el grupo 1 (p<0,05). Las tasas de infarto de miocardio y síndrome metabólico también fueron más altas en este grupo.Conclusiones: Si bien el uso de ADT se manifiesta por un aumento en la masa grasa y la proporción de grasa en la composición corporal, en cambio, afecta negativamente las mediciones de circunferencia de la cintura. Se asocia con cambios en la composición corporal metabólicamente inadecuados que predisponen a la diabetes mellitus y pueden aumentar la enfermedad cardiovascular. Por esta razón, es necesario tener cuidado con las enfermedades metabólicas y endocrinológicas en la terapia a largo plazo. (AU)

Effects of androgen deprivation therapy on metabolic markers and bioelectrical impedance analyze in prostate cancer patients.

INTRODUCTION AND OBJECTIVES: Prostate cancer (PCa) is the most widespread malignancy within men. Androgen deprivation therapy (ADT), which is the central component of advanced PCa treatment, causes side effects. The goal of this study was to examine the metabolic changes and bioelectrical impedance analysis differences in PCa patients who received ADT. MATERIALS AND METHODS: After age-related match-pair analysis, a total of 519 patients with PCa and control group who had benign disease were enrolled in the study. Biochemical blood parameters and TANITA measurements were recorded for all patients. Patients were categorized into three groups, ADT group (Group 1, n=124) and non-ADT group (Group 2, n=248), control group (Group 3, n=147). RESULTS: The mean age of groups was similar. Body mass index, waist circumference, body fat mass and fat ratio, which were among the TANITA parameters, were higher in group 1 (p<0.05). Total cholesterol, high density lipoprotein, non- high density lipoprotein, triglycerids and fasting blood glucose values were also higher in group 1 (p<0.05). Myocardial infarction and metabolic syndrome rates were also higher in this group. CONCLUSIONS: While the use of ADT is manifested by an increase in fat mass and fat ratio in body composition, it negatively affects waist circumference measurements. It is associated with metabolically unfit body composition changes that predispose to diabetes mellitus and may increase cardio-vascular disease. For this reason, it is necessary to be careful about metabolic and endocrinological diseases in long-term therapy.

Thermal intravesical chemotherapy in adjuvant treatment of high risk non-muscle invasive bladder cancer. / Quimioterapia intravesical térmica como tratamiento adyuvante en pacientes de cáncer de vejiga alto riesgo no-musculoinvasivos.

OBJECTIVES: To evaluate the oncological results of hyperthermic Mitomycin C (MMC) in adjuvant treatment of high-risk non-muscle invasive bladder cancer and to assess its side-effect profile. METHODS: Patients who were followed up in two reference university hospitals due to high-risk non-muscle invasive bladder tumors were included in the study. High-risk patients according to the EAU non-muscle invasive bladder cancer guideline, patients who were rejected early cystectomy, patients who could not be treated with BCG due to a shortage, and patients for whom the cystectomy would be too risky due to their comorbidities were included in the study. All patients were followed up forat least 24 months with physical examination, cystoscopy, and urine cytology at 3-month intervals. Transurethral tumor resection was performed in all patients and a non-muscle invasive urothelial carcinoma was diagnosed pathologically. Hyperthermic MMC was administered with Synergo system SB-TS 101. Records were kept prospectively and evaluated retrospectively. RESULTS: Fifty-eight high-risk group patients 18 (31%) of whom were at pTa stage and 40 (69%) at pT1 stage were included in the study. During a mean follow-up of 42 months, 34 (58%) patients had recurrence, while 5 (8%) patients progressed to muscle-invasive disease. Eleven (19%) of the patients under went radical cystectomy. The mean time to relapse was 10 months (3-34 months), and the mean time to progression was 41 months (6-87 months). Five-year overall survival, cancer-specific survival, progression-free survival, and relapse-free survival of the patients were 76%, 88%, 90% and 38%, respectively. Multifocality alone was found to be an independent risk factor (HR: 0.26; 95% Cl: 0.08-0.78; p=0.016) affecting recurrence. The observed side effects included tachycardia, cystitis, dysuria, macrohematuria, procedure-related pain, and allergic skin reactions. Treatment had to be discontinued in one patient due to a diffuse skin reaction. CONCLUSIONS: Thermal intravesical MMC therapyis a safe treatment and it could be effective treatment option in preventing disease progression in patients with high risk and non-muscle invasive bladder cancer with unsuccessful Bacillus Calmette-Guérin (BCG) or who could not be treated with BCG for other reasons.

OBJETIVOS: Evaluar los resultados oncológicos de Mitomicina C hipertérmica en tratamiento adyuvante para el cáncer de vejiga de alto riesgono-musculoinvasivo y para evaluar el perfil de efectos secundarios.MÉTODOS: Se incluyeron en el estudio pacientes evaluados en dos centros universitarios de referencia por cáncer de vejiga no-musculoinvasivo de alto riesgo. Fueron incluídos en el estudio los pacientes de alto riesgo según las guías europeas de cáncer de vejiga no-musculoinvasivo, pacientes que no aceptaron la cistectomía precoz o pacientes en los que la cistectomía implicaría demasiado riesgo quirúrgico debido a las comorbilidades. Todos los pacientes fueron seguidos como mínimo por 24 meses con exploración física, cistoscopia y citología de orina en intervalos de 3 meses. La resección transuretral de tumores se realizó en todos los pacientes y el diagnóstico anatomopatológico de carcinoma urotelial no-musculoinvasivo fue determinado. La MMC hipertermia se administró con el sistema Synergo SB-TS101. Los datos se reportaron prospectivamente y retrospectivamente. RESULTADOS: 58 pacientes de alto riesgo, 18 (31%) de los cuales fueron pTa y 40 (69%) pT1 fueron incluidos en el estudio. Durante la media de seguimiento de 42 meses, 34 (58%) recurrieron, mientras que 5 (8% )progresaron a musculo-invasivo. 11 (19%) de los pacientes recibieron una cistectomía radical. La mediana de tiempo a la recidiva fue de 10 meses (3-34 meses) y la mediana a la progresión fue de 42 meses (6-87 meses). La supervivencia global, cáncer-especifica, libre de progresión y libre de recurrencia a 5 años fue de 76%, 88%, 90% y 38%, respectivamente. La multifocalidad fue un factor de riesgo independiente (HR:0,26; 95% Cl: 0,08-0,78; p=0,016) afectando la recurrencia. Los efectos secundarios observados fueron la taquicardia, cistitis, disuria, macrohematuria, dolor con el procedimiento y reacción alérgica. El tratamiento tuvo que pararse en un paciente debido a una reacción cutánea difusa. CONCLUSIONES: La terapia con Mitomicina C térmica es un tratamiento seguro y puede ser un tratamiento efectivo para la prevención de la progresión en pacientes de alto riesgo no-musculoinvasivo en los que la BCG ha fallado o que no se pueden tratar con BCG por otras razones.

Prognostic and clinicopathologic value of ki-67 and profilin 1 immunohistochemical expression in primary pT1 urothelial bladder cancer.

PURPOSE: To investigate the prognostic and clinicopathologic value of Ki-67 and profilin 1 immunohistochemical expression in primary pT1 papillary urothelial bladder cancer. MATERIALS AND METHODS: This study included 88 male and 13 female pT1 primary bladder cancer patients. Demographic characteristics, tumor histological grade, tumor number, presence of concomitant carcinoma in situ, tumor size, and status of recurrence or progression were recorded for each patient. Expression of Ki-67 and profilin 1 was evaluated by immunohistochemical analysis of paraffin-embedded tumor tissues. The Pearson's Chi-square test was used for the analysis of qualitative data, and the Kaplan-Meier method and the log-rank test were used for the survival analysis. RESULTS: In the mean follow-up period of 52 months, 52 (51.5%) patients experienced recurrence, 24 (23.8%) patients experienced progression, and 17 (16.8%) patients died from bladder cancer-related causes. Ki-67 expression was significantly associated with tumor histological grade (P = 0.001). In multivariate analysis, Ki-67 positivity had significantly worse outcome for recurrence (P = 0.006) and mortality (P = 0.022). Ki-67-positive (Ki-67 index ≥15%) patients had shorter recurrence-free (P = 0.003), progression-free (P = 0.002), and cancer-specific (P = 0.003) survival. However, no statistically significant relationship was found between profilin 1 expression and clinicopathologic features and prognosis. CONCLUSIONS: Ki-67 is a highly predictive biomarker for recurrence-free, progression-free, and cancer-specific survival in pT1 bladder cancer patients, in whom prediction of recurrence and progression are difficult. Ki-67 expression can be safely combined with other prognostic factors. However, in pT1 bladder cancer patients, no significant relationship was found between profilin 1 expression and tumor characteristics or prognostic parameters.

The effects of shock wave lithotripsy and retrograde intrarenal surgery on renal function.

INTRODUCTION: The aim of this study was to compare the early effects of shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRS) on renal function using the cystatin C levels. MATERIAL AND METHODS: Serum samples were taken from each of the patients preoperatively, on the first postoperative day, and on the 30th postoperative day in order to evaluate the renal damage. The cystatin C level was determined using a particle-enhanced turbid metric immunoassay with a clinical chemistry analyzer. RESULTS: In the comparison between the preoperative and postoperative cystatin C levels on day 1, there was an increase in the SWL group (p = .001); however, the decrease in the RIRS group was statistically significant (p = .007). There were statistically significant differences in the cystatin C levels on the first postoperative day in both groups (p = .001). In the SWL group, there was a statistically significant increase between the preoperative and the 30th postoperative day cystatin C levels (p = .006), but no differences were found between these levels in the RIRS group or between the two groups (p = .255). CONCLUSIONS: RIRS may be the preferred procedure for patients who need more renal function protection when treating renal stones <2 cm.

Aberrant SOCS3 Promoter Methylation as a Noninvasive Diagnostic Biomarker for Locally Advanced Prostate Cancer.

OBJECTIVE: The aim of this study was to investigate the promoter methylation status of Rasassociated domain family 1A (RASSF1A), O-6-methylguanine-DNA methyltransferase (MGMT), Phosphatase with tensin homology (PTEN) and Suppressor of cytokine signaling 3 (SOCS3) tumor suppressor genes and evaluate the clinical utility of these genes as noninvasive, blood-based epigenetic biomarkers for the diagnosis of Prostate Cancer (PCa). METHOD: A total of 41 consecutive patients and 10 healthy control groups were enrolled in the study. Pyrosequencing was performed to analyze the methylation levels of the promoter regions of the four tumor suppressor genes in patients compared to healthy controls. RESULTS: The promoter methylation levels of RASSF1A, MGMT, PTEN and SOCS3 did not differ between the patient and control groups. However, SOCS3 promoter methylation level was significantly higher for patients having locally advanced PCa compared to those having localizedPCa (p<0.05). CONCLUSION: Our results indicated that SOCS3 could be a useful, noninvasive blood-based epigenetic biomarker for the diagnosis of locally advanced PCa.

Role of serum and urine transforming growth factor beta 1, matrix metallopeptidase 9, tissue inhibitor of metalloproteinase 2, and nerve growth factor beta levels and serum neutrophil-to-lymphocyte ratio in predicting recurrence and progression risks in patients with primary non-muscle invasive bladder cancer.

OBJECTIVE: The current study aimed to examine the correlation between serum and urine transforming growth factor beta 1 (TGF-ß1), matrix metallopeptidase 9 (MMP-9), tissue inhibitor of metalloproteinase 2 (TIMP-2), and nerve growth factor beta (NGF-ß) levels and serum neutrophil-to-lymphocyte ratio (NLR) as well as the recurrence and progression risks of non-muscle invasive bladder cancer (NMIBC). MATERIAL AND METHODS: The current study included 89 individuals: n=47, patients with primary NMIBC (patient group) and n=42, healthy controls (control group). The TGF-ß1, MMP-9, TIMP-2, and NGF-ß levels in the blood and urine samples were assessed using an enzyme-linked immunosorbent assay. Moreover, the serum NLR was evaluated. For the statistical analysis, a generalized linear model was used to compare the groups. In the analysis, gender and use of cigarettes were used as the secondary factors, and age was included as the covariate in the generalized linear model set for the intergroup evaluations. Meanwhile, a logistic regression model was utilized to evaluate the impact of the biomarkers on the risk of recurrence and progression. RESULTS: The serum NLR was higher in the patient group than in the control group (p=0.033). The patients with disease recurrence had higher body mass index and MMP-9 levels, but the results were not statistically significant. Moreover, the patients with a high NLR had a high risk of disease progression (odds ratio [OR]=13.046, 95% confidence interval [CI]=1.057-161.18, p=0.045), whereas the patients with a high serum TGF-ß1 level (OR=0.972, 95% CI=0.945-0.999, p=0.047) had a low risk of disease progression. CONCLUSION: High NLR and low TGF-ß1 values were associated with an increased risk of disease progression in patients with NMIBC. However, no relationships were found between TGF-ß1, MMP-9, TIMP-2, and NGF-ß values and the recurrence of NMIBC.

Changes in Antimicrobial Resistance of Urinary Tract Infections in Adult Patients over a 5-Year Period.

OBJECTIVES: We aimed to determine the most common bacteria that cause urinary tract infections (UTIs), the rate of antibiotic resistance of these uropathogens, and the changes in resistance rates over the years for adult patients diagnosed with UTIs. METHODS: We retrospectively reviewed urine cultures and antibiotic susceptibility results of patients >17 years of age from our outpatient clinic between 2014 and 2018. The most common uropathogens and their antibiotic resistance rates were identified in different age groups (18-39, 40-59, and ≥60 years) and with respect to gender and date of admission. In addition, the change in antibiotic resistance of Escherichia coli between 2014 and 2018 was also examined. RESULTS: A total of 9,556 positive urine cultures were included. The most common uropathogen was E. coli, and its prevalence was higher in females than males (70.6 vs. 53.4%, respectively). The majority of isolates were from patients ≥60 years of age. E. coli resistance was most pronounced for ampicillin (61.56%), followed by trimeth-oprim-sulfamethoxazole (49.80%), amoxicillin-clavulanic acid (34.69%), and cefazolin (30.72%). E. coli resistance to ampicillin, nitrofurantoin, cefepime, ciprofloxacin, fosfomycin, and amoxicillin-clavulanic acid increased significantly with time (all p = 0.001). For E. coli, resistance to ciprofloxacin, one of the most commonly used antibiotics for UTI, increased from 17 to 43% from 2014 to 2018. CONCLUSION: Most of the uropathogens displayed high resistance to ampicillin, tri-methoprim-sulfamethoxazole, and amoxicillin-clavulanic acid, and were susceptible to meropenem, ertapenem, and imipenem. Fosfomycin and cefepime were useful in the empirical treatment of community-acquired UTIs. A surprisingly high increase was observed in the resistance of E. coli to antimicrobial agents from 2014 to 2018.

Reasons for early readmission after percutaneous nephrolithotomy and retrograde intrarenal surgery.

INTRODUCTION: Hospital readmissions are frequent and costly. In many countries health governors focus on unplanned postsurgical hospital readmissions as an objective metric for quality of care. AIM: To investigate the rate of readmissions after retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) operations, classify these factors, define the higher risk patients for readmission and develop prevention strategies. MATERIAL AND METHODS: A historical cohort study was conducted for a period of 36 months, between 2013 and 2016. A total of 471 consecutive patients, of whom 177 had PCNL (37.6%) and the remaining 294 had RIRS (62.4%), were included. The two groups were compared in terms of stone burden, previous stone treatments, initial symptoms, ASA class, intra-operative complications, post-operative stenting, and drugs prescribed at discharge, so as to find the factors influencing the readmission rate for both groups. RESULTS: The PCNL operation was found to have a significantly higher risk for readmission when compared to RIRS (27.1% vs. 20.4%, respectively, p = 0.0041). Perioperative complications (p = 0.002 for PCNL and p = 0.001 for RIRS), residual stone(s) or fragments after the operation (p = 0.002 for PCNL and p = 0.001 for RIRS) significantly increased the readmission rate in both groups. The readmission rates were individually affected by postoperative JJ stent placement in the PCNL group (p = 0.001) and previous stone treatments for the RIRS group (p = 0.001). CONCLUSIONS: Readmission rates were higher in the PCNL group, but the influencing factors were similar for both groups. The presence of multiple stones preoperatively and residual stones or fragments postoperatively are the most important risk factors for early re-admission after PCNL and RIRS.

The factors predicting upgrading of prostate cancer by using International Society for Urological Pathology (ISUP) 2014 Gleason grading system.

OBJECTIVE: To investigate the factors to predict Gleason score upgrading (GSU) of patients with prostate cancer who were evaluated by using the International Society for Urological Pathology (ISUP) 2014 Gleason grading system. MATERIAL AND METHODS: Between January 2008 and December 2015, we retrospectively investigated patients who had undergone radical prostatectomy and followed up in the uro-oncology outpatient clinic. The pathologic specimens of the patients were evaluated based on the ISUP 2014 classification system. The patients were divided into two groups with or without upgraded Gleason scores. Factors that could be effective in predicting upgrading such as age, prostate-specific antigen (PSA), prostate volume, D'Amico risk classification, PSA density, cancer of the prostate risk assessment (CAPRA) scores, biopsy tumor percentage, body mass index, and clinical stage parameters were compared between both groups. RESULTS: Of the 265 patients who could be evaluated and followed up regularly, Gleason score upgrades were observed in 110 (41.5%) patients. Advanced age (p=0.009), PSA >20 ng/mL (p=0.036), PSA density >0.35 (p=0.005), high CAPRA score (p=0.031), and high biopsy tumor percentage (p=0.009) were discovered to be correlated with Gleason score upgrade in univariate logistic regression analysis. Advanced age alone was a predictor for GSU in multivariate logistic regression analysis (p=0.002). Five-year biochemical recurrence-free survival rate was 86% in the non-GSU group and 55% in the GSU group (p<0.001). CONCLUSION: GSU risk should be taken into consideration in making therapeutic decisions for older patients with prostate cancer, and precautions should be taken against development of aggressive disease.

The Fate of Residual Fragments After Retrograde Intrarenal Surgery in Long-Term Follow-up.

PURPOSE: We aimed to describe the natural history of stone fragments ? 7 mm that remained after retrograde intrarenalsurgery (RIRS) in long-term follow-up. MATERIALS AND METHODS: We retrospectively reviewed 142 medical records of patients who had residual fragments (RFs) ? 7 mm after RIRS. Patients were divided into 2 groups according to the size of RFs as ? 4 mm (group 1) and 5 - 7 mm (group 2). Patients' demographic data, stone characteristics, perioperative data and complications were recorded. Re-growth of RFs, spontaneous passage, renal colic, infection and re-operation rates were our main variables. RESULT: A total of 142 patients (86 in group 1 / 56 in group 2) were followed for mean 54.45 ± 14.24 and 56.22 ± 10.28 months. Mean size of RFs was 2.85 ± 1.22 mm in group 1 and 6.81 ? 2.21 mm in group 2. Mean number of RFs were 1.1 ± 0.2 in group 1 and 2.4 ± 1.6 in group 2 (P = .035). Spontaneous passage rate of RFs were 30.23% and 17.85% in group 1 and 2, respectively (P = .032). No difference was observed in the re-growth rate of RFs between the two groups (P = .094). Although no difference was observed in re-growth of RFs between the groups, patients in group 2 were more likely to experience stone-related events such as renal colic and re-intervention rate (P = .034, P = .029; respectively). CONCLUSION: Our results demonstrate that RFs > 4 mm take higher risk in terms of stone-related events and shouldbe followed up more closely.

Can intervals in extracorporeal shock wave lithotripsy sessions affect success in the treatment of upper ureteral stones?

INTRODUCTION: Managing upper ureteral stones with shock wave lithotripsy (SWL) has been done for many years. However, no conclusive data have been found on the intervals required between repeated SWL sessions. AIM: To identify the most optimal intervals between SWL sessions. MATERIAL AND METHODS: Between September 2015 and December 2016, 80 patients undergoing elective outpatient lithotripsy who required repeated SWL sessions for ureteral stones were evaluated. These patients were categorised into two groups according to different SWL session intervals. The intervals between SWL sessions (n = 40) for the first group lasted one day, whereas those for the second group (n = 40) lasted 1 week. The data recorded during SWL included visual analogue scale (VAS) scores, total number of shocks, total energy used and number of sessions. The stone clearance rates, number of urinary tract infections, complication rates and VAS scores were compared between the two groups. RESULTS: All patients' clinical outcomes after SWL therapy are shown in Table I. The stone clearance rate for group 1 was 70%, whereas that for group 2 was 72.5% (p = 0.805). Additionally, the number of urinary tract infections, complications and VAS scores were similar for both groups. In group 1, 3 patients had steinstrasse, two suffered from severe renal colic, and one had a urinary tract infection. In group 2, 3 patients endured steinstrasse, and 2 patients experienced severe renal colic during the study. CONCLUSIONS: Short-interval SWL sessions are safe and effective for treating upper ureteral stones, and such sessions do not increase complication rates.

Safety and efficacy of PNL vs RIRS in the management of stones located in horseshoe kidneys: A critical comparative evaluation.

AIM: To assess the efficacy and safety of two different techniques (Percutaneous nephrolithotomy (PNL) vs Retrograde intrarenal surgery (RIRS)) in the management of stones in patients with horseshoe kidneys (HSK). PATIENTS AND METHODS: Departmental files of 88 cases with radiopaque kidney stones in horseshoe kidneys undergoing two different approaches (PNL vs RIRS) were evaluated with respect to the success and complication rates of in a retrospective manner. In addition to the factors related with the procedures (success and complication rates, additional procedures), patient and stone characteristics were all well evaluated. Findings obtained in both groups were evaluated in a comparative manner with respect to the statistical significance. RESULTS: Stone free rates were comparable in both groups after 1-week period (81.6% PNL vs 80% RIRS). As well as 3 months evaluation (84.2% PNL and 82.0% RIRS). The percentage of the cases with residual fragments (> 4 mm) were similar in both groups and while all PNL procedures were completed in one session, mean number of RIRS sessions was higher (1.22 ± 0.05). Mean duration of the procedure was slightly higher in RIRS group and based on Clavien scoring system, despite a higher risk of Hb drop noted in patients treated with PNL, all complication rates were found to be similar in both groups. CONCLUSION: Our results demonstrate that of the available minimally invasive treatment alternatives, both PNL and RIRS could be safe and effective alternatives for renal stone removal in patients with HSK.

Kidneys with small renal masses: Can they be utilized for kidney transplantation in the era of partial nephrectomy?

OBJECTIVE: To retrospectively evaluate our database to determine our partial nephrectomy and radical nephrectomy rates and to see percentage of the discarded kidneys which were suitable for transplantation after radical nephrectomy. MATERIAL AND METHODS: Patients who underwent radical or partial nephrectomy between January 2000 and December 2016 were identified. Only stage I tumors according to tumor, node, metastasis classification were included in this review. Tumor size, location, proximity to renal collecting system and hilum were considered while deciding the suitability of a kidney for transplantation. RESULTS: A statistically significant gradual increase in the number of patients treated with partial nephrectomy was observed (p=0.00001). Only 17 out of 181 kidneys with a tumor size smaller than 3 cm could be an appropriate candidate for a renal transplantation if they were to be transplanted. CONCLUSION: Exact number of the discarded kidneys with small renal masses which can be used for kidney transplantation should be determined by large scale studies. A national or governmental policy may only be developed to utilize these discarded organs after the magnitude of the wasted kidneys can be determined.

Comparative differences between T1a/b and T1e/m as substages in T1 urothelial carcinoma of the bladder

ABSTRACT Objective To evaluate the prognostic value of the depth of lamina propria invasion in patients with T1 bladder cancer and to display comparative differences between the T1a/b and T1e/m substaging systems. Patients and Methods This study included 106 patients with primary stage T1 urothelial bladder tumours who underwent surgery between January 2009 and December 2014. Pathologic specimens were re-evaluated to confirm the diagnosis of T1 and substaging by the same pathologist using two systems: T1a and T1b, and T1m and T1e. Age, tumour size, multiplicity, associated carcinoma in situ, tumour grade, and T1 substaging system were investigated to detect the relation between disease progression and recurrence. Results The recurrence rate was 52% for T1a (n=42) vs. 76% for T1b (n=20) (p=0.028) and 55% for T1m (n=32) vs. 62% for T1e (n=30), respectively (p=0.446). There was no significant difference between the substaging groups for disease progression: T1a (n=12, 15%) vs. T1b (n=7, 27%), and T1m (n=8, 13.8%) vs. T1e (n=11, 23%) (p>0.05). In the multivariate analysis, tumour size >3 cm (p=0.008), multiplicity (p=0.049), and substaging T1b (p=0.043) were independent predictive factors for tumour recurrence. According to the Kaplan-Meier actuarial method, recurrence-free survival was significantly different in patients with pT1a tumours compared with those with pT1b tumours (p=0.033). Conclusions Substaging T1 provides a prediction of disease recurrence. Regarding recurrence, T1a/b substaging can provide better knowledge of disease behaviour because it is predicted as more superior than T1 m/e, and it can help in determining the requirement for early cystectomy.