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WOS:000730954400001 PMID: 34913804 Introduction We aimed to evaluate the impact of the resection technique (tumor enucleation (TE) or standard partial nephrectomy (SPN)) on trifecta outcomes in patients having undergone partial nephrectomy (PN). Materials and Methods We retrospectively analyzed the clinical and pathologic parameters in patients with localized renal cell carcinoma (pT1-2N0M0) who had undergone PN between January 2001-December 2018 at one of 15 different tertiary referral centers. Multivariable logistic regression analysis was applied to investigate independent predictors of trifecta failure, decreased postoperative renal functions (decreased estimated glomerular filtration rate (eGFR) > 10%), perioperative complications (Clavien-Dindo > 1), and positive surgical margins. Results A total of 1070 patients with a mean age 56.11 +/- 11.88 years were included in our study. PN was performed with TE in 848 (79.25%) and SPN in 222 (20.75%) patients. Trifecta failure rate was 56.2% for TE and 64.4% for SPN (p = 0.028). On multivariable analysis, TE was associated with less trifecta failure (p = 0.025) and eGFR decrease >10% rates (p = 0.024). On the other hand, there was no statistically significant difference between TE and SPN according to positive surgical margins (p = 0.450) and complication > Clavien-Dindo grade 1 (p = 0.888) rates. The only independent predictive factor for complications > Clavien-Dindo 1 was the Charlson comorbidity index (CCI) (p = 0.001). Conclusion TE is associated with less trifecta failure than SPN. This result is mainly due to better preservation of renal function with TE.

ABTRACTWe aimed to assess the correlation between ISUP 2014 grades of needle biopsy (NB) and radical prostatectomy (RP) specimens and the parameters effecting this correlation. A total of 353 patients, who underwent a radical prostatectomy with diagnose of prostate cancer, were included in the study. Especially, the maximum percentage of core involved by cancer (MPCI) of upgraded group was significantly higher than those of correlated group and downgraded group. MPCI might be used as a preoperative value to determine risk classification and to help counsel patients with regard to treatment decision and prognosis of disease.

Objective To find parameters for differential diagnosis between Brucella epididymo-orchitis (BEO) and non-brucella epididymo-orchitis (NBEO) cases with comparison of BEO and NBEO in terms of inflammatory markers, full urinalysis (FU) for pyuria, and abscess formation (AF). Study design Descriptive study. Place and duration of study Agri State Hospital Urology and Infectious Disease Clinics, between January 2014 and November 2017. Methodology Data of the patients, who were diagnosed with epididymo-orchitis, were divided in BEO and NBEO groups on the basic of serum agglutination test. Parameters including age, white blood cell neutrophil, lymphocyte, monocyte, platelet, mean platelet volume, C-reactive protein (CRP), neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, platelet / lymphocyte ratio, and FU. The values were statistically compared. Results One hundred and thirty-eight (138) patients were found eligible for the study. Twenty-three (23) of these patients (16.66%) had BEO, and 115 (83.33%) had NBEO. BEO vs. NBEO cases were significantly different regarding mean age (26.17 ±8.15 vs. 48.53 ±21.78 years, p=0.0001) and frequency of pyuria (3,13.04%) vs. 89 (77.39%, p=0.001). However CRP values i.e. 6.07 ±6.59 vs. 6.07 ±5.85 mg/dl (p=0.999) was not significantly different. Conclusion BEO cases are often younger and do not have pyuria or abscess formation. High frequency of pyuria was found in NBEO cases. CRP levels cannot be used in the differential diagnosis between BEO and NBEO cases. Key Words: Abscess formation, Brucella epididymo-orchitis, C-reactive protein, Orchiectomy, Pyuria.

Primer mesane endometriozisi nadirdir ve sebebi tam olarak bilinememektedir. Bu makalede primer mesane endometriozisi nedeniyle transüretral rezeksiyon uygulanmış 37 yaşındaki bir bayan hastayı sunuyoruz. Hastanın başvuru şikâyetleri 4 aydır menstrüel siklusla ilişkili hematüri, disüri ve pollaküriydi. Kliniğimizde yapılan sistoskopik ve radyolojik değerlendirme sonrasında kitlenin transüretral olarak rezeksiyonuna karar verildi. Operasyonda 23*21 mm’lik solid kitle eksize edildi. Hastanın sistoskopi ile yapılan postoperatif izleminde 6. aya dek nüks izlenmedi., Primary bladder endometriosis is rare and the cause is not fully known. In this article, we present a 37-year-old female patient who underwent transurethral resection for primary bladder endometriosis. The patient’s complaints were hematuria, dysuria and pollakuria associated with menstrual cycle for 4 months. After cystoscopic and radiological evaluation in our clinic, transurethral resection of the mass was decided. A 23*21 mm diameter solid bladder mass was excised by transurethral resection. In the postoperative follow-up of the patient by cystoscopy, no recurrence was observed until 6 months.

II. Meşrutiyet dönemiyle birlikte toplumsal hayatta görece özgürlükçü siyasi bir hava hâkim olmuştur. 24 Temmuz 1908 tarihinde gazeteler yazılarını sansüre göndermediler. Artık basın özgürlüğünün, ifade özgürlüğünün, farklı siyasal düşüncelerin cemiyetlerce temsil edilmesinin ve görünür olmalarının önünde bir engelin kalmadığı düşünülmüştür. Bu anlamda istisnai, parlak; fakat kısa bir dönemin yaşandığı söylenebilir. Şöyle ki, “iktidarın yozlaştırdığı” önermesi çok sürmeden karşılık bulmuş, dolayısıyla bir “çözüm yöntemi” olarak, muhalif gazetecilerin susturulmasıyla işe başlanmıştır. Serbesti gazetesi yazarı Hasan Fehmi’nin 6 Nisan 1909 tarihinde Galata Köprüsü’nde, üç kurşunla öldürülmesinin sonrasında, 31 Mart Olayı ve İttihat ve Terakki Cemiyeti’nin iktidarını tamamen tesis etmesiyle başlayan, iktidarın toplumun her kesimine ve kurumuna sirayet etme çabaları… İşte böyle bir siyasi iklimde, Ahmet Samim iktidarın ve iktidar taraftarlarının dolayısıyla İttihat ve Terakki Cemiyeti’nin politikalarını, öldürüleceğine dair malumata sahip olmasına rağmen, Sada-yı Millet gazetesinde eleştirel yazılarını sürdüren, genç ve yürekli bir gazetecidir. Ahmet Samim cinayeti, 31 Mart Vakası’ndan sonra yeni muktedirin, adım adım iktidarı ele geçirdiğini hatırlatma ve biat etmeyenlerin sonunun ne olacağını gösterme kabilinde, iktidarın muhalefete gönderdiği bir mesaj olarak okunabilir. 9 Haziran 1910’da, İstanbul Bahçekapı’da vuku bulan Ahmet Samim cinayetinin öncesi, sonrası ve Ahmet Samim’in bugüne bıraktığı hür “sada”sının kıymeti çalışmanın konusunu oluşturmaktadır., A relative libertarian political environment had been dominated in social life with The Second Constitutionalist Monarchial Period. Newspapers did not submit their dams to censorship mechanism, in 7th July 1908. It was thought that there had been no any obstacles for realization of freedom of speech, freedom of prees, representation and visibility of different thoughts by different associations, no longer. In this sense, it can be said that there had been lived such a bright but a short period, as well. That is to say, “power leads to corruption” proposition had been verified soon, accordingly started to reduce the journalists to silence as “solution method”. After shooting Hasan Fehmi, newspaperman of Serbesti newspaper (Freedom newspaper), to death by three bullets on The Galata Bridge, in 6th April 1909, there occured The 31 March İncident and efforts of Union and Progress Association to penetrate its effect on all segments and institutions of society, as well. In such a political circumstance, despite being knowledgeable with he would have been being killed by someone, Ahmet Saim, a young and bold newspaperman of Sada’yı Millet (People Voice), had continued to write and criticize The Union and Progress Association, its supporters and its policies. This murdering can be read as a challenge to those who had not intend to obey to Union and Progress Association the new governing power elits, and as reminding signs to dissents that Union and Progress Association gradually seizing power over all aspects of society. The work item of this study are background of and post-event of Ahmet Samim assasination which had been occured at Bahçekapı, Istanbul, in 9th June 1910, and great importance of his “free voice.

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.

Introduction To determine the factors affecting the success of distal hypospadias repair in adults. Material and methods Medical records of adult patients who underwent distal hypospadias repair in our clinic were reviewed. Patient's age, external urethral meatus location, hypospadias status, anesthesia type, diversion type, nelaton diameter and surgeons were recorded as factors affecting surgery success. Only patients, operated with tubularisation incised plate urethroplasty (TIPU) technique, were included. Results were classified as successful, stricture, fistula and slough. We compared the factors affecting the success. SPSS 16.0 were used for statistical assessment and logistic regression analysis was used to determine success. p Results One hundred and eight patients underwent distal hypospadias repair in our clinic. Mean age was 21.44 ± 2.0. 38 patients had distal penile, 67 patients had subcoronal, 2 patients had coronal and 1 patient had glandular hypospadias. Eighty eight patients had primary, 12 secondary, 5 tertiary and 3 cripple hypospadias. Seventy eight patients underwent TIPU under local anesthesia, and 30 patients underwent under spinal anesthesia. Suprapubic catheter was used in 92 patients and transurethral catheter was used in 16 patients. Sixteen different surgeons performed the operations. Seventy operations were successful. Three stricture, 24 fistula, and 11 slough were determined. Overall success rate was 64.81%. Patient's age, external urethral meatus location, anesthesia type, diversion type, nelaton diameter and the surgeon difference did not affected surgical outcomes. Only hypospadias status (primary/redo) affected the success (p = 0.037). Conclusion The only factor affecting surgical outcomes of distal hypospadias repair in adults seems to be hypospadias status. It might be due to the lack of second layer in the redo operations.

Objectives Our aim was to examine correlation between Post-void residual urine (PVR) after uroflowmetry and random PVR. Methods Male patients reporting to the Urology outpatient clinic with LUTS were selected. Patients' age, prostate volume, bladder capacity, voided volume, maximum flow rate, average flow rate, random PVR and PVR after uroflowmetry were recorded. We evaluated the correlations between these parameters. Also we assessed if there was a difference between random PVR and PVR after uroflowmetry. We divided PVR after uroflowmetry and random PVR into three groups: Group 1: 0–50 mL, Group 2: 51–100 mL and Group 3: >100 mL. Also we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2: >400 mL. We compared these groups to determine whether a significant difference. Results Seventy-seven patients applying to the urology outpatient clinic were assessed between 2013 and 2014. PVR after uroflowmetry was significantly higher than random PVR (P 400 mL, PVR after uroflowmetry was different, but random PVR was similar (P

espanolIntroduccion El objetivo del presente estudio fue evaluar la relacion entre la longitud del pene y los parametros somatometricos, especialmente la caquexia. Materiales y metodos El peso y la altura de todos los pacientes fueron medidos y registrados por un especialista en medicina interna. Los estados flacidos y estirados del pene se midieron a partir del hueso pubico hasta la punta del glande a lo largo del dorso del pene, utilizando una regla metrica rigida, por un unico especialista en urologia. Los pacientes con anormalidades urogenitales fueron excluidos del estudio. Se registraron la longitud del pene, la edad, el peso y las alturas. El indice de masa corporal (IMC) se calcula como el cociente entre el peso y el cuadrado de la altura. Los pacientes fueron divididos en 3 grupos segun el IMC: caquexia, peso normal y obesidad. Se definieron los grupos: Grupo 1: caquexia, IMC 30. Se calcularon las longitudes del pene media y mediana. Estos 3 grupos fueron evaluados en terminos de si habia diferencia entre la longitud del pene flacido y estirado. Tambien se determino la correlacion entre el peso, la altura y la longitud del pene. Los analisis estadisticos se realizaron con el programa SPSS® para Windows ver. 16.0 (SPSS Inc., Chicago, IL, EE.UU.). La significacion estadistica se establecio en p Resultados Ciento veinticuatro pacientes fueron incluidos en el estudio. Catorce pacientes estaban en el grupo de la caquexia. Cincuenta y seis pacientes estaban en el grupo de peso normal. Cincuenta y cuatro pacientes estaban en el grupo obeso. Ambas longitudes del pene flacido y estiradas fueron estadisticamente diferentes en estos grupos (p Conclusion El presente estudio es el primero en evaluar la relacion entre la caquexia y la longitud del pene. Como resultado, la caquexia puede ser una ventaja para la longitud del pene. EnglishIntroduction The aim of the present study was to assess the relationship between penile length and somatometric parameters, especially cachexia. Material and methods Weight and heights of all patients were measured and recorded by an internal medicine specialist. Flaccid and stretched states of penis were measured from pubic bone to tip of glans along the dorsum of the penis using a rigid metric ruler by a single urology specialist. Patients with urogenital abnormalities were excluded from the study. Penile length, age, weight and height values were recorded. Body mass index (BMI) was computed as the ratio of weight to the square of height. Patients were divided into three groups according to BMI cachexia, normal weight and obesity. Groups were defined: Group 1: Cachexia, BMI 30. Mean and median penile lengths were calculated. These three groups were evaluated in terms of whether there is a difference between flaccid and stretched penile length. Also correlation between weight, height and penile length was determined. Statistical analyses were performed using the SPSS for windows ver. 16.0 (SPSS Inc., Chicago, IL, USA). Statistical significance was set at p Results One hundred and twenty four patients enrolled in the study. Fourteen patients were in the cachectic group. Fifty six patients were in the normal weight group. Fifty four patients were in the obese group. Both flaccid and stretched penile lengths were statistically different in these groups (p Conclusion The present study is the first one assessing the relationship between cachexia and penile length. As a result, cachexia may be an advantage for penile length.

Summary Background Attention deficit hyperactivity disorder (ADHD) is characterised by a range of symptoms, such as excessive mobility, difficulty in maintaining attention and inadequate impulse control. Methylphenidate (MPH) is widely prescribed as a treatment for ADHD. In the literature, studies investigating the effects of MPH on the lower urinary tract (LUT) are limited. Objective The aim of the study was to evaluate MPH-induced LUT symptoms (LUTSs) in patients with ADHD without a diagnosis of voiding dysfunction (VD). Study design After ethical committee approval, volunteers aged 7–17 y were divided into two groups, with group 1 composed of individuals diagnosed with ADHD but not VD and group 2 (control) composed of healthy individuals. Lower urinary tract symptoms and quality of life, in addition to uroflowmetry test results and postvoiding residual volume (PVRV), were evaluated in both groups at baseline and again 4 wk later. The individuals in group 1 were treated with MPH after baseline screening. The dysfunctional voiding scoring system questionnaire was used for scoring LUTSs. Postvoiding residual volume was measured by ultrasound. Bladder capacity (BC) was calculated as the sum of voided volume (VV) and PVRV. The means of the maximum flow rate (Q max), mean flow rate (Q mean), VV, PVRV and BC were recorded. Results After exclusions, there were 43 participants in group 1 and 39 participants in group 2. There was no significant difference between the mean age of groups (p = 0.727). Compared with the baseline, VV and BC increased significantly in group 1 (p = 0.001 and p = 0.002, respectively) at the 4-wk follow-up. There was no significant difference in these parameters in group 2. Discussion This study demonstrated that VV and BC increased after MPH treatment in patients with ADHD without a diagnosis of VD. The mechanism underlying this effect is unclear, but it may be associated with dopaminergic and noradrenergic effects. Conclusion The findings of the present study can inform further studies on the mechanism underlying the effect of MPH on the LUT. In a future study, the authors suggest evaluating the effects of MPH in a urodynamic study in patients with ADHD diagnosed with VD. Summary Table . The significant results of the study group (group 1). Evaluated parameters Initial (mean ± SD); (n = 43) 4th week (mean ± SD); (n = 43) p value VV (ml) 216.86 ± 36.63 232.09 ± 37.48 0.001∗ BC (ml) 222.79 ± 38.85 237.09 ± 39.45 0.002∗ VV = voided volume; BC = bladder capacity; SD = standard deviation. ∗ Bolded results are statistically significant p values.

OBJECTIVE To compare two different doses of lidocaine used for periprostatic nerve block on pain perception during transrectal ultrasound (TRUS) guided prostate biopsy. MATERIAL AND METHODS A total of 288 patients with elevated prostate specific antigen (PSA) levels and/or abnormal digital rectal examination who underwent TRUS-guided prostate biopsy were included in the study. The patients were divided into 3 groups: Group 1 (n=103) prostate biopsy were performed after administering perianal intrarectal application of 10 mL 2% lidocaine gel, Group 2 (n=98) 2 mL of 2% lidocaine injection on each side following rectal installation of lidocaine gel and Group 3 (n=87) 4 mL of 2% lidocaine injection on each side after rectal instillation of lidocaine gel. Patients' pain scores during biopsy procedure were reported using visual analogue score (VAS). Independent sample t test, ANOVA test and Tukey test were used for statistical evaluation. RESULTS The mean age, prostate volume and PSA level were 65.6±8.4 years, 58.2±34.8 mL, and 11.8±3.4 ng/mL respectively. There were no statistically significant differences in baseline characteristics between the groups. The mean VAS scores were 2.4±1.8 in Group 1, 2.5±1.9 in Group 2 and 1.6±1.6 in Group 3. Patients in Group 3, reported significant pain reduction compared with patients in Groups 1 and 2 (p=0.002, and 0.001, respectively). However, there was no statistically significant difference in VAS scores between Groups 1 and 2 (p=0.815). CONCLUSION According to our results we recommend the use of perianal intrarectal lidocain gel application, and periprostatic nerve block with injection of 4 ml 2% lidocaine per side combination in TRUS-guided prostate biopsies. Further large-scale randomized control studies are needed to validate these finding.

Objective: Our aim was to evaluate and determine the frequency of Transmembrane protease, serine 2 (TMPRSS2)-ERG fusion in Turkish patients with clinically localized prostate cancer by using immunohistochemistry and reveal its relationship with clinicopathologic variables. Material and methods: Radical prostatectomy specimens of 99 patients, who underwent radical retropubic prostatectomy for localized cancer, between January 2002 and December 2011 were analyzed in the study. To detect ERG fusions, monoclonal ERG antibodyclone ID: EPR3864 (Epitomics, San Diego, CA, USA) and monoclonal anti-ERG antibody (9FY) (BiocareMedical, LLC, USA) were used. The immunistochemical expression of ERG protein was assessed as positive or negative regardless of stain intensity. Patients’ age, total and primary Gleason scores, PSA levels, prostate volumes, tumor volumes, tumor stages and perineural invasion status were analysed retrospectively. Total fusion rate and correlation between the variables and fusion were evaluated. Results: Mean age, prostate volume, tumor volume, PSA value of 99 patients were 62.02 years (±5.93), 50.02 cc (±20.67), 3.19 cc (±4.16), and 9.34 ng/mL (±3.37) respectively. TMPRSS2-ERG fusion was seen in 46 (46.5%) of 99 patients. When the variables analysed with independent samples t test to predict fusion (+) status, none of them was found to be statistically significant. When evaluated by logistic regression analysis for (+) or (-) status, only tumor stage was found to be statistically significantly correlated with fusion (p=0.049). Conclusion: The incidence of TMPRSS-ERG fusion in patients with localised prostate cancer in our study with Turkish population was found as 46.5%. Only tumor stage correlated with TMPRSS2-ERG fusion.

Introduction Although shock wave lithotripsy (SWL) is a common noninvasive procedure, it can be very painful and a serious source of anxiety which may affect pain perception. The aim of this study was to evaluate the association between patient’s anxiety and SWL-related pain. Materials and Methods A total of 54 patients, who underwent the first session of SWL treatment between January and April 2014 due to a single renal pelvic stone with a diameter less than 20 mm, were included in the study. All patients were particularly informed about the procedure and, then, the validated Hospital Anxiety and Depression scale was administered in order to identify the anxiety level before the procedure. All relevant data, such as age, sex, stone size, body mass index (BMI), anxiety score, visual analog scale (VAS) score, skin-to-stone distance, and total energy were recorded. Results The mean age of the study population was 41.11±16.35 years. The mean stone size, anxiety level before procedure, VAS score during SWL, BMI, skin-to-stone distance and energy level were 10.69±4.75 mm (5-20 mm), 5.2±3.87; 6.5±2.46; 25.77±4.16; 7.23±2.10 cm; 56.53±16.74 joule, respectively. Anxiety prior to procedure, energy level and the number of total shock wave had a significant effect on VAS score (p0.05). Conclusion According to our results, reducing patient anxiety, if any, can provide some additional pain control during SWL procedure and can improve patient compliance

Fifteen patients with small testicular masses not suspected to be malignant were included in the study, and permanent and frozen section analyses were evaluated. As a result frozen analysis, preoperative externalization of the suspected malignancy with a physical examination, ultrasonographic evaluation, and serum tumor marker analysis were concluded as key points for accurate decision making between TSS and radical orchiectomy.We aimed to determine the safety, efficacy, and the concordance of permanent and frozen section analysis (FSA) of testis-sparing surgery (TSS) in patients who had small testicular masses that were not suspected to be malignant.Fifteen patients who underwent TSS were included in the study. TSS was performed for the patients who had testicular lesions25 mm and testicular lesion volume30% of the whole testis. All patients had normal serum tumor marker levels and ultrasonographic evaluation did not indicate malignancy. Surgery was performed via an inguinal approach with temporary cord occlusion and FSA of the lesions. Benign findings allowed for TSS, and cancer prompted total orchiectomy.The mean patient age was 25.33 (range, 20-36) years. The predominant complaint was swelling (9 patients). The mean lesion diameter was 16 mm (range, 5-26 mm). Fourteen of all cases (93%) had benign pathology and underwent TSS. Only 1 patient, whose FSA revealed malignant formation, underwent radical orchiectomy. Final pathology of this patient was seminoma. Complete histopathologic concordance was observed between the results of frozen and permanent sections. TSS was performed with no intra- or postoperative complications. After a mean follow-up of 23 months (range, 6-44 months) all patients, except 3 who were lost to follow-up, were free of disease.The main key points for accurate decision-making between TSS and radical orchiectomy are intraoperative FSA and preoperative externalization of possible suspected malignancy with physical examination, ultrasonographic evaluation, and serum tumor marker analysis.

Lower pole calyceal stones (LPS) represent lower spontaneous passage rates and, therefore, require several interventional treatment approaches. The aim of this survey study was to investigate the attitudes of the urology practitioners and the factors affecting their decision making in the management of small asymptomatic LPS. A total of 149 urologists participated to the study via email through the internet-based website. Participating urologists were asked to complete a 29-question survey including personal and academic data, level of surgical experience, available equipment for interventional approaches, which treatment do they prefer for small LPS (≥5 mm and 1 cm), and factors affecting their treatment decision. All data were analyzed to make inferences related with treatment decision and factors affecting decision-making. Mean participant age was 41.57 (26-62) years. The most preferred approach was observation/medical treatment option (52.3 %), subsequently SWL (25.5 %), RIRS (16.1 %), miniPNL (5.4 %) and standard PNL (0.7 %) were chosen by the participants. On the other side, SWL and medical treatment were at the forefront (52 and 16.1 %) among children. In the multivariate analysis of participants' age, academic status, surgical experience and institution, none was significantly associated with treatment decision-making (p 0.05). The most important factors associated with decision making were calyceal dilatation (85.9 %) and patient preferences (81.2 %). The other factors effecting treatment decision were reported to be recurrent disease (70.5 %), the duration of the stone (74.5 %), patient age (95.3 %), current guidelines (87.9 %), stone density (50.3 %), body mass index (BMI) (73.8 %) and other morbid diseases (91.9 %). Our surveys' greatest value is in demonstrating the preferred treatment options and factors effecting decision-making in the treatment of LPS. The most preferred option in our population was follow-up and medical treatment. The most influencing factors on decision-making were age, patients' preferences, presence of calyceal dilatation, body mass index, comorbid conditions, available options for stone treatment and the surgeon's experience on the existing opportunities.

Objective To analyze the contribution of multiparametric MRI and PCA3 assay, pre- decision of initial biopsy in PSA level between 3-10 ng/mL patients with normal digital rectal examination(DRE). Materials and Methods PSA level 3-10 ng/mL ,patients, with normal DRE results and no previous prostate biopsy history, were included in this study. Each patient underwent multiparametric MRI one week before biopsy. Urine sample taking for PCA3 examination preceded the biopsy. Systematic and targeted biopsies were conducted. Patients with high PSA levels were seperated into two groups as: high PCA3 scored and low PCA3 scored. Then each group was divided into two sub-groups as: MRI lesion positive and negative. Tumor incidence, positive predictive values(PPV) and negative predictive values(NPV) were calculated. Results 53 patients were included between February 2013 and March 2014.Mean age 61.22 ± 1.06. Mean PSA value 5.13 ± 0.19 ng / mL. Mean PCA3 score 98.01 ± 23.13 and mean prostate size was 48.96 ± 2.67 grams. Fourty nine patients had both PCA3 score and multiparametric MRI. The PCA3’s PPV value was 58.33%. If multiparametric MRI lesions are added to high PCA3 scores , the PPV appears to elevate to 91.66%. NPV of PCA3 was 96%. NPV was 95% when there was no lesion in the multiparametric MRI with low PCA3 scores. Sensitivity was 91.66% , specificity was 95% respectively. Conclusion Adding multimetric MRI can also support biopsy decision for patients with high PCA3 value. When PCA3 value is low, patients can be survailled without any need to take a MRI.

BACKGROUND The diagnostic benefit of prostate specific antigen (PSA) is limited, owing to its lack of specificity, particularly in men with PSA levels of 4.0 to 10.0 ng/mL. Therefore, there is a need for more specific and sensitive biomarkers to improve diagnostic accuracy and to predict prostate cancer (PCa) progression. Assessing the expression levels of specific microRNAs (miRNAs) in patients with PCa may be helpful in detecting cancer and predicting the cancer prognosis and its evolution, and may serve as markers to decide the treatment. We examined the expression levels of five miRNAs (let-7c, miR-21, miR-145, miR-185, and miR-221) on patients with low-risk PCa who had been eligible for active surveillance but underwent radical prostatectomy. We investigated the correlation between the relative expression of miRNAs and clinicopathologic parameters to evaluate their clinical significance. MATERIALS AND METHODS Total RNA was isolated from the tumor and the corresponding non-neoplastic prostate tissue of 45 patients who underwent radical prostatectomy. Quantitative reverse transcriptase-polymerase chain reaction was used to measure the levels of let-7c, miR-21, miR-145, miR-185, miR-221, and RNU6B expression, using TaqMan MicroRNA Assays. miRNA expression was examined in low-risk PCa, and miRNAs' association with Gleason upgraded (GU) and biochemical recurrent (BR) patients was evaluated. RESULTS We observed that miR-21 and miR-182 were overexpressed; conversely, let-7c, miR-145, and miR-221 were underexpressed in patients with low-risk PCa. GU patients (n = 16) and non-upgraded patients (n = 28) were compared. miR-145 was downregulated significantly in the GU group (P = 0.03). Similarly, miR-221 was downregulated significantly in patients with BR (n = 14) compared with non-recurrent patients (n = 30) (P = 0.04). Receiver operator characteristics (ROC) curve analysis revealed that miR-221 levels were significantly associated with BR in patients with a cut-off

Objective To investigate the differences between the results of percutaneous nephrolithotomy (PCNL) for stone relapse in patients who previously underwent open surgery for renal stones and those in patients undergoing surgery for the first time. Materials and Methods Patients who underwent PCNL for renal stones bigger than 2 cm between the years 2009 and 2012 were evaluated. Stone size, length of the procedure, number of access, period of catheterization, length of hospital stay, complications, and stone-free rates were evaluated. Results A total of 64 patients included in the study. Twenty-seven had previously undergone open surgery for renal stones (group 1) and 37 underwent surgery for the first time (group 2). There was no significant difference between the groups in age and stone size. Seven (25.9%) patients in group 1 and 6 (18.2%) patients in group 2 had more than one access (p=0.628). In group 1; 2 patients (7.4%) had grade 2 and 3 patients (11.1%) had grade 3 complications. In group 2; 4 patients (10.8%) had grade 2 and 7 patients (18.9%) had grade 3 complications. The stone-free rate was 14 (51.8%) in group 1 and 23 (62.2%) in group 2. The rate of clinically insignificant residual stones was 8 (29.6%) in group 1 and 5 (13.5%) in group 2. The success rate of PCNL procedure in group 1 was 81.5% and 75.7% in group 2 (p=0.161). Conclusion PCNL is a good option for patients who had a previous open surgery for renal stones as well as for patients undergoing surgery for the first time.

Objective Radical prostatectomy may have a significant impact on quality of life (QoL) because of erectile dysfunction, depression and incontinence. In this study, the mood and QoL of patients who underwent radical prostatectomy due to localized prostate Ca and were non-relapsed at least 12 months after operation were evaluated. Materials and methods We evaluated 35 patients who underwent radical prostatectomy operation between 2000 and 2011 and showed no reduction during 12 months observation. IIEF, Beck Depression test, and EORTC 3.0 quality of life were given and scored. In this study, the effects of erectile dysfunction according to Beck depression test and QoL scores and correlation between the mood and QoL are evaluated. Results In our study, ED groups categorized as mild, moderate and severe had no correlation with Beck depression scores ( p = 0.874). But only the patients with severe and moderate erectile dysfunction had moderate and severe depression scores. Negative correlation was determined ( p = 0.013) when Beck Depression scores with IIEF scores without categorizing ED groups. Correspondingly, negative correlation was determined ( p = 0.048) between QoL and IIEF scores, whereas positive correlation was determined ( r = 0.756 and p Conclusions We observed that an increase of erectile dysfunction elevated depression symptoms and resulted in bad quality of life. During tumor control, it is important to use methods that do not affect QoL.

Introduction Our aim was to assess our TIP urethroplasty results in adults with local anaesthesia. Materials and methods Medical records of adult patients who underwent TIP urethroplasty due to distal hypospadias in our clinic between April 2006 and May 2013 were reviewed. Patient's age, external urethral location, preoperative calibration size of urethra, primary or secondary or more, circumsized or uncircumsized conditions were recorded. The records were categorized as circumcised–uncircumcised, urethral stent calibration 16 Fr and above or 14 Fr and below, primer or seconder and above, special group or the others. SPSS 16.0 were used for statistical assessment and chi-square test was used to determine success. p Results 51 patients underwent distal hipospadias repair under local anaesthesia in our clinic between April 2006 and May 2013. Mean age was 21.3. 24 patients had coronal, 26 patients had subcoronal, 1 patient had glanuler hypospadias. 40 patients were primary, 7 secondary, 4 tertiary. 38 patients were circumsized. 13 patients were uncircumsized. Mean preoperative calibration was 14.8 Fr, mean urethral stent calibre was 15, 1 Fr, mean stent duration time was 5.9 day. Suprapubic catheter was used for drainage at 48 patients. 22(52.3%) were successful, 20(47.6%) were unsuccessful of 42 patients with follow up. 13 patients that had fistula underwent fistula repair after 3 months later under local anaesthesia. 2 patients had stricture and they underwent meatotomy and dilatation. On one patient, second TIP urethoplasty operation was performed because the first operation was unsuccessful. Operation was very successful and it upgraded our over all success to 90.4%. An optimal group as primary, uncircumcised, 16 Fr neourethra was formed and were compared with the other groups. Success rate between optimal group and others was not different statistically. Conclusion Our success rate was similar to literature. This survey reveals that distal hypospadias repair can be performed under local anaesthesia.

Introduction Our aim was to evaluate and share our urethrocutaneus fistula repair results in adult patients who had been operated for hypospadias in their childhood. Material and methods The data of totally 48 patients who had been treated for urethrocutaneous fistula after hypospadias surgery in our department from May 2008 to January 2015 analyzed retrospectively. Patients’ age at fistula repair, age at first hypospadias surgery, fistula size, localization and number, distal urethral obstruction status and surgical outcomes of fistula repairs were recorded. All patients were controlled three months after the repair for surgical outcomes. Results Fistula repair performed in 45 patients. Mean age was 21.46 (20–26). Nineteen patients (42.2%) underwent first hypospadias surgery under the age of 7 years; 8 patients (17.7%) between 7 and 15 years, 18 patients between 15 and 20 years. Tubularized incised plate urethroplasty (TIPU) was performed in 40 patients (88.9%), extragenital tissue was used in 5 patients (11.1%). Twenty two patients (48.9%) had 1 or 2 operations, 17 patients (37.8%) had 3–5 operations and 6 patients (13.3%) had 6 or more operations. Thirteen (28.9%) coronal, 24 (53.3%) subcoronal, 6 (13.3%) penile and 2 (4.4%) penoscrotal fistulas were observed. While a single fistula was observed in 35 patients, multiple fistulas were seen in 10 patients. A fistula diameter les than 5 mm was detected in 37 patients, and larger than 5 mm in 8 patients. Fistula recurrence was observed in 3 patients at follow-up examinations carried out at 3 months postoperatively. The number of operations was more than 5, the fistula diameter was larger than 5 mm and the fistulas were coronal in all three recurrent fistulas. Conclusion According to our results fistula size, previous surgery and well-vascularised, one or two layer tissue were the important factors in the success of fistula repair after hypospadias surgery.

Amaç: Bu çalışmada, üriner sistem taşlarının analizinde kullanılan kimyasal yöntemin güncel taş hastalığı kılavuzlarında yer alan taş tip ve bileşenlerini kategorize etmedeki etkinliği araştırıldı. Gereç ve Yöntem: Mart 2014 ile Eylül 2015 tarihleri arasında toplam 198 üriner sistem taşının kimyasal incelemesi yapıldı. Kimyasal yöntemde taş içeriğinde bulunan kalsiyum, oksalat, ürik asit, magnezyum, fosfat, sistin, amonyum ve karbonat tespit edilebilmektedir. Bu yöntemle tespit edilen taş mineral içerikleri tek, iki, üç ve daha fazla komponent olarak gruplandırıldı. Elde edilen taş bileşenleri kılavuzlarda evrensel olarak sınıflandırılmış taş çeşitleri ile uygunluğu açısından kıyaslandı.Bulgular: İnceleme sonunda 65 (%32.9) örnekte tek mineral, 133 (%67.1) örnekte ise birden fazla mineral içeriği saptandı. 45 (%22.7) kalsiyum oksalat, 22 (%11.6) kalsiyum fosfat, 11 (%6.1) kalsiyum + ürik asit, 10 (%5) ürik asit, 7 (%3.5) sistin, 7 (%3.5) karbonat apatit, 4 (%2) amonyum ürat, 1 (%0.5) magnezyum amonyum fosfat olmak üzere 107 (%54) örnek EAU (European Association of Urology) kılavuzundaki taş çeşitlerinde adı geçen örneklerle uyum gösteriyordu. Ancak 91 (%46) örnekteki taş analizleri bu kılavuzda yer almayan kombinasyonlardan oluşuyordu.Sonuç: Kimyasal taş analizi literatürde belirtilen eksikliklerinin yanında taş kılavuzlarında yer alan taş tip ve bileşenlerini kategorize etmede yetersiz olarak değerlendirildi. Kimyasal yöntem özellikle ilk tanı esnasında taşın değerlendirilmesi amacıyla tercih edilecek bir yöntem gibi görünmemektedir Background: The present study evaluated use of chemical method to determine components and category of urinary stones described in current stone disease guidelines.Methods: Chemical analysis of total of 198 urinary stones was performed between March 2014 and September 2015. Calcium, oxalate, uric acid, magnesium, phosphate, cysteine, ammonium, and carbonate were among components detected in stone composition. Stones were divided into groups based on presence of 1, 2, or 3 or more components. Composition results were compared with stone composition data provided in global guidelines.Results: Sixty-five (32.9%) samples consisted of 1 mineral and 133 (67.1%) contained more than 1. Of the total, 107 (54%) compositions were included in European Association of Urology (EAU) guidelines. The 107 samples included 45 (22.7%) with components of calcium oxalate, 22 (11.6%) of calcium phosphate, 11 (6.1%) of calcium and uric acid, 10 (5%) of uric acid, 7 (3.5%) of cysteine, 7 (3.5%) of carbonate apatite, 4 (2%) of ammonium urate, and 1 (0.5%) of magnesium, ammonium, and phosphate. However, 91 (46%) stones consisted of components that are not in current EAU guidelines.Conclusion: Chemical analysis was found insufficient to categorize stone types and components seen in EAU guidelines. There is also a lack of information on the process in the literature. It was concluded that chemical analysis is not the best method to evaluate urinary stones

Objectives: We aimed to evaluate the circumcision status and complications, and the value of penile visibility index in predicting circumcision complications among elementary school children. Patients and Methods: Elementary school students were evaluated with physical exam in terms of circumcision complications. Visible penile length/stretched penile length ratio was calculated for each subject and recorded as penile visibility index (PVI). Data were assessed with SPSS 15.0 software. Results: Average age was 9.04 (5 - 14) years. Circumcision complications were detected in 84 of 361 circumcised subjects (23.2%). There was no relationship between age at circumcision and complications (p > 0.05). Concealed penis was detected in 3.6% of all subjects. Mean PVI was significantly different between cases with and without glanular adhesion, and between cases with and without residual prepuce. On the overall, mean PVI in complication and no complication groups were 0.52 and 0.59 respectively, and the difference was statistically significant (p

We reported two cases of microinvasive seminoma. One is alone and one is with classical seminoma. There was no macroscopic palpable mass. Both of them had risk factors as undescended testicle and microlithiasis. Both of them treated with orchiectomy. None of them had relapse after. Herein we reported two cases after getting written consent. We also reviewed the literature.

Inflatable penile prosthesis (IPP) implantation is a successful method for treatment of erectile dysfunction. IPP placements have rare complications. In this paper, we present a highly unusual case of an inguinal hernia as a short-term complication of a 3-piece IPP implantation. The patient was a 55-year-old man with erectile dysfunction due to diabetes mellitus. He presented 3 weeks after implantation with a strong cough. On exploration, the reservoir was seen in direct inguinal hernia sac. After removing the reservoir from the sac, the hernia was repaired with mesh and the reservoir was placed in the space of Retzius again. The patient is symptom free at follow-up.

OBJECTIVE: Active surveillance has become a management option for low-risk prostate cancer patients, while keeping the curative treatment option available. In this study, we evaluated the our results of active surveillance for localized prostate cancer patients. MATERIAL AND METHODS: Patients diagnosed with localized prostate cancer who chose an active surveillance protocol were followed with PSA measurements, digital rectal examinations, and TRUS-guided biopsies. The patients' data and rebiopsy results were evaluated. The results were compared with the results of the patients who had definitive treatment. RESULTS: Forty-one patients on active surveillance and 34 patients with at least one rebiopsy were included in the study. Twenty-seven patients who had more than one rebiopsy were followed for an average of 27.7 (12-78) months. Twelve patients (44.4%) had undergone definitive treatment including radical prostatectomy (n=9), and radiotherapy (n=3). There were 17 patients under surveillance after a second biopsy, and 9 (33%) of them had a third biopsy. Among these 9 patients, 7 patients were kept under surveillance, and 2 (7%) them had a fourth biopsy. Active surveillance of 15 out of 17 patients who have not undergone definitive treatment is still ongoing. CONCLUSION: Active surveillance is a treatment option refrains low-risk prostate cancer patients from the complications of an early or unnecessary definitive treatment and related reduction in the quality of their lives. while keeping the curative treatment option available. Active surveillance can be applied safely with the appropriate patient selection, regular examinations and tests.

This work aimed to assess malondialdehyde (MDA) and catalase (CAT) levels in semen, blood and tissue and to investigate their relationship with spermiogram parameters in the presence of grade 3 varicocele patients. Following the partial removal of the varicose vein during varicocelectomy, both MDA and CAT levels were assessed in the tissue and semen fluid. Additionally MDA levels were measured in blood samples collected from varicose veins during varicocelectomy. A total of 88 patients, mean age 21.8, were enrolled in the study. While progressive motility (A + B) was

Objective To evaluate the clinical and histopathological results of adult unilateral cryptorchidism patients. Material and methods Data from adult unilateral cryptorchidism patients that underwent orchiectomy in our clinic between between January 2004 and March 2013 were retrospectively evaluated. Patients were divided into three groups as intra-abdominal, inguinal canal and superficial inguinal region according to the location of the undescended testes. Patients were also grouped according to their testicular volume ( 12 cc). Histopathology results of orchiectomy specimens were classified as follows: 1. Sertoli cells only, testicular atrophy and vanished testis (anorchia) 2. Hypospermatogenesis, and 3. Maturation arrest. Patients were grouped as normospermia, azoospermia and oligo/astheno/teratospermia groups according to semen analysis results. Correlations between testicular localization, testicular size, semen analysis and pathology results were evaluated. Incidental tumor detection rates were also calculated. Results Two hundred and forty-four adult unilateral cryptorchidism patients underwent orchiectomy in our clinic. There was no a significant relationship between location of the testis and testicular pathology results (p=0.707). Most common semen analysis results was normospermia in patients with high testicular volume group however azoospermia and oligoasthenospermia observed commonly in patients with low testicular volume group. There was a significant relationship between testicular volume and semen analysis results (p=0.023). No significant relationship was observed between semen analysis and pathological results (p=0.929). After an evaluation of all factors with possible effects on the semen analysis results, only testicular volume (p=0.036) was found to have a significant impact. Only one case (0.4%) was incidentally diagnosed seminoma after a review of 233 patients with available histopathological results on record. Conclusion Adult unilateral cryptorchidism has a minimal effect on male fertility or even this effect can be overlooked. Low detection rates of incidental germ cell tumors also make an orchiectomy decision questionable in such cases.

Our aim was to examine correlation between Post-void residual urine (PVR) after uroflowmetry and random PVR.Male patients reporting to the Urology outpatient clinic with LUTS were selected. Patients' age, prostate volume, bladder capacity, voided volume, maximum flow rate, average flow rate, random PVR and PVR after uroflowmetry were recorded. We evaluated the correlations between these parameters. Also we assessed if there was a difference between random PVR and PVR after uroflowmetry. We divided PVR after uroflowmetry and random PVR into three groups: Group 1: 0-50 mL, Group 2: 51-100 mL and Group 3:100 mL. Also we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2:400 mL. We compared these groups to determine whether a significant difference.Seventy-seven patients applying to the urology outpatient clinic were assessed between 2013 and 2014. PVR after uroflowmetry was significantly higher than random PVR (P 0.001). When we divided PVR after uroflowmetry and random PVR into three groups there was a significant difference between the groups (P = 0.02). When we divided the patients into two groups according to bladder capacity as Group 1: ≤400 mL and Group 2:400 mL, PVR after uroflowmetry was different, but random PVR was similar (P 0.001, P = 0.72).PVR after uroflowmetry seems to be incorrectly high in patients whose bladder capacity is above 400 mL.

Extracorporeal shock wave (ESW) lithotripsy is the preferred treatment modality for uncomplicated kidney stones. More recently free oxygen radical production following ESW application has been considered to be crucial in shock wave-induced renal damage. It has been shown that ozone therapy (OT) has ameliorative and preventive effects against various pathological conditions due to increased nitro-oxidative stress. In current study, we aimed to evaluate the efficacy of OT against ESW-induced renal injury.Twenty-four male Sprague-Dawley rats were divided into three groups: sham-operated, ESW, and ESW + OT groups. All groups except sham-operated group were subjected to ESW procedure. ESW + OT group received 1 mg/kg/day of oxygen/ozone mixture intraperitoneally at 2 h before ESW, and OT was continued once a day for consecutive three days. The animals were killed at the 4th day, and kidney tissue and blood samples were harvested for biochemical and histopathologic analysis.Serum ALT and AST levels, serum neopterin, tissue nitrite/nitrate levels, and tissue oxidative stress parameters were increased in the ESW group and almost came close to control values in the treatment group (p 0.05, ESW vs. ESW + OT). Histopathological injury scores were significantly lower in treatment group than the ESW group (p 0.05, ESW vs. ESW + OT). Immunohistochemical iNOS staining scores in ESW group were higher than those of sham-operated group (p 0.05, ESW vs. sham-operated), iNOS staining scores in OT group were significantly lower than the ESW group (p 0.05, ESW + OT vs. ESW).OT ameliorates nitro-oxidative stress and reduces the severity of pathological changes in the experimental ESW-induced renal injury of rat model.

The utility of a nomogram is based on the patient population it is designed for-and their inherent properties and biases. Our aim was to demonstrate the variability in predictive model accuracy and utility between different populations.Our model is based on 761 men who underwent initial TRUS biopsy at a single institution in Turkey. Patients were included if they had at least 10 cores on biopsy and PSA level20 ng/ml. Multivariable logistic regression models were used to develop a new nomogram. External validity was tested with two different cohorts one from another institution in Turkey (N = 136) and cohort from USA (N = 2242).Prostate cancer (PCa) and high-grade PCa was diagnosed in 249/761 (32.7 %) and 101/761 (13.3 %) patients from Ankara, Turkey, respectively. Predictors of PCa were age (p 0.0001, OR 2.11), PSA (p = 0.044, OR 1.44), PV (p 0.0001, OR 0.38), %fPSA (p = 0.016, OR 0.72), and abnormal DRE (p 0.0001, OR 2.05). The predictive accuracy (c-index) of our nomogram was 73 %. C-indices of 71 and 70 % were recorded in external validation cohorts from Turkey and the USA, respectively. Virtually ideal calibration was recorded for the internal validated predictive model, and good calibration was recorded when applied to the Istanbul cohort. However, the model/nomogram underestimates PCa risk in the US cohort.This is the first nomogram predicting the risk of PCa at initial biopsy in a Turkish population and provides a good risk estimation tool with good predictive accuracy and calibration in the Turkish populations. However, our study demonstrates the poor transferability of predictive tools to widely different populations.

Objectives. To investigate peripheral, seminal and varicose venous wall prolidase enzyme activities and their relationships between sperm parameters in patients with varicocele. Design and methods. Prolidase enzyme activities were determined in blood, seminal fluid and varicose vein walls in patients with grade 3 varicocele. Sperm parameters were also measured and the relationships between prolidase enzyme and sperm parameters were assessed by statistical correlation analysis. Results. There was a significant and negative correlation between sperm counts and varicose venous wall prolidase enzyme activities (r = −0.618, p < 0.001) and a positive significant correlation between sperm counts and seminal fluid prolidase enzyme activities (r = 0.676, p < 0.001). None of the parameters were correlated with sperm motility indices. Conclusion. Varicose venous wall prolidase enzyme activity could be an important factor in progression of azoospermia and infertility in patients with varicocele.

Genital development is affected by pubertal process to a great extent, and puberty is a complex phenomenon that is influenced by multiple factors resulting in individual differences. We studied penile length and its relationship to pubertal stage in boys 13 to 15 years old.Healthy boys who were candidates for military high school were evaluated between June and July 2011. Age, residence and body mass index were recorded. Stretched penile length was measured. Pubic hair was assessed according to Tanner and Marshall staging. Genital puberty stage was defined by measurement of testicular volume with Prader orchidometer. Relationship of penile length to age, residence, pubertal stages and body mass index was evaluated statistically.A total of 1,539 boys were included in the study. Mean ages and number of patients according to genital stage were as follows. Mean age was 14 years for genital stage 1 (5 patients), 13.9 years (range 13 to 15) for stage 2 (194), 14.07 years (13 to 15) for stage 3 (965) and 14.11 years (13 to 15) for stage 4 (375). Linear regression analysis revealed a significant effect of body mass index, genital stage and pubic hair stage on penile length (p0.001) but no significant effect of age or residence. Mean penile length was significantly different among different age groups and among pubertal stages. However, mean penile lengths of different age groups within the same pubertal stage were similar.Penile length during puberty should be evaluated individually according to the current pubertal stage. Our study offers a reliable reference table of penile length for pubertal age group.

The etiology of both adult-type ADHD and PE is not completely understood, but the studies revealing common etiologic factors for both conditions suggest a high likelihood of coexistence. We aimed to find out the prevalence of ADHD among adult males with lifetime PE.The patients with lifetime PE were included in the study. Both patients and controls were evaluated with the 10-item premature ejaculation index of Althof and Rosen for premature ejaculation, Wender Utah rating scale (WURS) and Conner's adult ADHD rating scales (CAARS) for determining the presence of attention-deficit hyperactivity disorder syndrome.A total of 38 patients and 27 controls were included in the study. Patient and control groups were similar in terms of age and (p0.878), but different IELT (p0.001). ADHD was detected in 16 (42.1 %) of patients with PE, while ADHD symptoms were detected in only 1 (3.7 %) of control patients. Distribution of patients in the study group according to ADHD types was as follows: Type 1, Type 2, Type 3 in 2 (5.3 %), 4 (10.5 %), and 10 (26.3 %) patients, respectively.ADHD is significantly more frequent among patients with PE than controls. The close relationships between these two diseases must be examined by prospective studies.

Objective To determine possible acute kidney injury with new marker neutrophil gelatinase-associated lipocalin (NGAL) in urine and to show the relationship between changes of this marker and conventional markers in patients undergoing shock wave lithotripsy (SWL). Methods In patients with kidney stones, serum urea, creatinine, urine microalbumin, and NGAL levels were determined before SWL and at the first, second, and seventh days after SWL. In addition, patients who had undergone SWL were evaluated with Technetium-99m (Tc99m)-dimercaptosuccinic acid (DMSA) and Tc99m-diethylenetriaminepenta acetate renal scintigraphy 1 week before and 3 months after SWL. Results and Limitations Forty patients were included in the study. All patients had a single stone in the kidney with an average size of 9.25 mm (range 5–15). No statistical change was found in the levels of average serum urea and creatinine levels, urine microglobulin, and NGAL levels, which were measured before SWL and after SWL. No significant difference was identified in urine NGAL and microalbumin levels of the groups, which were separated by shock wave number and shock energy amount on the first, second, and seventh days after SWL. In the high-energy SWL group, 3 patients had a statistical decrease in their differential kidney function measured with Tc99m difference between differential function rates of the kidney before and after SWL (DMSA) after 3 months after SWL. Conclusion Our study found that, using both new and conventional parameters in the acute stage and 3 months later, SWL treatment does not cause acute kidney damage.

The objective is to compare immediate and delayed SWL as a treatment for ureter stones between 5 and 20 mm. Patients who applied to the emergency department with single, radio opaque ureteric stone of 5-20 mm size were included in the study. Patients were randomized into immediate and delayed SWL groups. SWL were carried out after pain relief in the delayed group. Maximum of three SWL sessions were applied to the patients with stones of 5 mm or bigger in diameter, leaving at least 3 days interval in-between. Stone-free rate after first session was similar in two groups. When CIRF was also considered as success, the success rate of SWL in the immediate SWL group was higher after first session (p = 0.02). Immediate SWL had a greater success rate in upper ureteric stones (p = 0.019). Overall average time required for elimination of stones was shorter in immediate SWL group than delayed SWL group (p = 0.033). The success rate after first SWL session (including CIRF) was 59 % for patients with chronic pain in the delayed group and 100 % for patients with acute pain in the immediate group. According to the hydronephrosis grade, success rates were 71 and 44.4 % for patients with grade 1 or no hydronephrosis in the immediate SWL group, and for patients with grade 2 or larger hydronephrosis in the delayed SWL group, respectively, after first SWL session. Immediate SWL insures stone-free status in a shorter time in cases with renal colicky pain and ureteral stones, particularly upper ureteral stones.

Many studies have shown that skin tissue extracted by circumcision can cause differences in sexual function, especially at the time of ejaculation. Sensitivity changes in penile skin and sexual satisfaction deriving from circumcision starting from premature ejaculation (PE) are discussed. Furthermore, most of these studies rely on questionnaires. Extracted free nerve endings (FNE) on the foreskin, which can detect temperature, mechanical stimuli (touch, pressure, stretch) or pain (nociception), have not been researched. Our aim is to determine FNEs in foreskin and the affects on sexual function, especially PE. This prospective study was done on adults who voluntarily applied to be circumcised between September 2010 and October 2011. The ejaculation latency times (ELT) before circumcision have been assessed, and a PE diagnostic tool (PEDT) form was filled out by the urologist according to the answers given by the volunteers. The proximal and distal ends of the foreskin were marked before circumcision, and the extracted foreskin was sent to the pathology department to determine FNEs. Twenty volunteers (average age 21.25 ± 0.44 years) were included in the study. The average ELT was 103.55 ± 68.39 seconds, and the average PE score was 4.35 ± 3.13. Proximal, middle, and distal tip nerve densities were compared. Proximal and distal (P = .003) and proximal and middle (P = .011) segments differed from each other, whereas middle and distal were similar (P = .119). There were not any correlations between PEDT scores and total nerve endings number (r = .018, P = .942). Also there were not any correlations between mean ELT and PEDT scores (r = .054, P = .822). The tissue extracted by circumcision has intensive FNEs, yet FNE intensity has no relation to PE.

Purpose: We tried to establish the predictive factors influencing the initial response, as well as its duration, and time to castration resistance (CR) for primary advanced prostate cancer (PC) with bone metastasis. Methods: We evaluated all patients initially receiving androgen deprivation therapy (ADT) for primary advanced PC with bone metastasis. A total of 982 patients with complete medical records available for analysis from 18 centers were included in this study. Age, initial PSA, Gleason score (GS) and extent of bone involvement (EBI) were recorded in a database. Results: Among all the patients, 896 (91.2%) responded to ADT initially. Pretreatment PSA and EBI were significant predictors in the multivariate model. Among the 659 patients who progressed into a CR state, the mean duration of response was 22.4 months. There was a significant correlation between the CR state and nadir PSA (nPSA) level and time to nPSA. Pretreatment PSA, EBI, GS, highest tumor volume in biopsy cores (%), number of positive biopsy cores, percent positive biopsy cores and time to nPSA were proven to be significant to predict a nPSA. Pretreatment PSA, GS and EBI were statistically significant predictors of PSA normalization in multivariate analysis. The limitation of the study depends on the retrospective design and a model was developed for low standardization as a result of using multicenter data. The patients enrolled in this study were from a relatively long period of time (1989–2008). Conclusions: The results of this study indicate that it is possible to predict the initial response to ADT by pretreatment PSA levels and EBI, while the duration of response can be reflected by a multitude of clinical factors including nPSA, TTnPSA, percent positive cores, biopsy GS and EBI.