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Purpose: Despite the significant role of varicocele in the pathogenesis of male infertility, the impact of varicocele repair (VR) on conventional semen parameters remains controversial. Only a few systematic reviews and meta-analyses (SRMAs) have evaluated the impact of VR on sperm concentration, total motility, and progressive motility, mostly using a before-after analytic approach. No SRMA to date has evaluated the change in conventional semen parameters after VR compared to untreated controls. This study aimed to evaluate the effect of VR on conventional semen parameters in infertile patients with clinical varicocele compared to untreated controls. Materials and Methods: A literature search was performed using Scopus, PubMed, Embase, and Cochrane databases following the Population Intervention Comparison Outcome (PICOS) model (Population: infertile patients with clinical varicocele; Intervention: VR [any technique]; Comparison: infertile patients with clinical varicocele that were untreated; Outcome: sperm concentration, sperm total count, progressive sperm motility, total sperm motility, sperm morphology, and semen volume; Study type: randomized controlled trials and observational studies). Results: A total of 1,632 abstracts were initially assessed for eligibility. Sixteen studies were finally included with a total of 2,420 infertile men with clinical varicocele (1,424 patients treated with VR vs. 996 untreated controls). The analysis showed significantly improved post-operative semen parameters in patients compared to controls with regards to sperm concentration (standardized mean difference [SMD] 1.739; 95% CI 1.129 to 2.349; p<0.001; I2 =97.6%), total sperm count (SMD 1.894; 95% CI 0.566 to 3.222; p<0.05; I2 =97.8%), progressive sperm motility (SMD 3.301; 95% CI 2.164 to 4.437; p<0.01; I² =98.5%), total sperm motility (SMD 0.887; 95% CI 0.036 to 1.738; p=0.04; I² =97.3%) and normal sperm morphology (SMD 1.673; 95% CI 0.876 to 2.470; p<0.05; I2 =98.5%). All the outcomes showed a high inter-study heterogeneity, but the sensitivity analysis showed that no study was sensitive enough to change these results. Publication bias was present only in the analysis of the sperm concentration and progressive motility. No significant difference was found for the semen volume (SMD 0.313; 95% CI -0.242 to 0.868; I² =89.7%). Conclusions: This study provides a high level of evidence in favor of a positive effect of VR to improve conventional semen parameters in infertile men with clinical varicocele. To the best of our knowledge, this is the first SRMA to compare changes in conventional semen parameters after VR with changes in parameters of a control group over the same period. This is in contrast to other SRMAs which have compared semen parameters before and after VR, without reference to a control group. Our findings strengthen the available evidence and have a potential to upgrade professional societies’ practice recommendations favoring VR to improve conventional semen parameters in infertile men. [ABSTRACT FROM AUTHOR]

Objective: To evaluate pediatric patients with lower urinary tract dysfunction (LUTD) who received bladder or external sphincter botulinum toxin A (BTX) injection in terms of effectiveness and permanence. Materials and Methods: We analyzed 80 patients treated with intradetrusor (n=48) n or intrasphincteric (n=32) BTx injection between May 2007 and December 2019. We divided the patients into 2 groups: Neurogenic bladder (NB) and LUTD. Clinical assessment of results was mainly done with Dysfunctional Voiding and Incontinence Symptoms Score (DVISS) and quality of life questionnaires and dryness status. Uroflowmetry with electromyography and video-urodynamic study was performed postoperatively. Results: Mean age and follow-up time were 123.0±48.3 and 30.1±5.8 months. For bladder BTx (NB: 18 patients; LUTD: 30 patients), the response rate was 79.1% (n=38). NB patients' response duration was shorter (32 vs 87 weeks) and required subsequent multiple injections more (55% vs 23%) than the LUTD group. For sphincter BTx (NB: 13 patients; LUTD: 19 patients) clinical improvement was found in 75% (n=24) n of the patients. There was no significant difference between the NB and LUTD groups. DVISS and quality of life questionnaires showed substantial decrease in the LUTD groups after bladder (p<0.001) and sphincter (p<0.05) BTx injection. NB patients showed significant dryness status in both BTx-B (pre: 3.2%, post: 82.1%, p<0.05, chi-square test) and BTx-S (pre: 0%, post: 100%, p<0.05, chi-square test) patients postoperatively. Conclusion: This study demonstrated that BTx injection is an effective and safe treatment in pediatric patients with NB and LUTD. With its benefits, this endoscopic treatment should be kept in mind before major constructive surgeries. [ABSTRACT FROM AUTHOR]

Copyright of Acibadem Saglik Bilimleri Dergisi is the property of Acibadem University Medical School and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acibadem Saglik Bilimleri Dergisi is the property of Acibadem University Medical School and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The dissection of perirenal fat is of critical importance to kidney surgery and ease of dissection is more important when using minimally invasive approaches. This study aimed to determine the clinical, radiological, and pathological significance of adherent perirenal fat (APF). Materials and Methods: This prospective study included 22 patients scheduled for partial nephrectomy and 40 patients for donor nephrectomy. Intraoperative fat dissection time was recorded, and the complexity of perirenal fat dissection was surgeon‐classified as easy, moderate, and difficult. Perirenal fat and subcutaneous fat thickness were measured. Measurement of perirenal fat depth and the Hounsfield unit (HU) for both perirenal and subcutaneous fields were performed using computed tomography (CT) images. All specimens were submitted for histopatological analysis. Researchers in each arm were blinded to other researchers' data. Results: Mean age of the patients was 51.3 ± 12.7 years. Mean perirenal fat dissection time was 15.0 ± 13.5 minutes. Patient demographics, BMI, nor occupational status differed between the 3 complexity of perirenal fat dissection groups. Radiological findings showed that there was a significant correlation between perirenal fat depth and complexity of perirenal fat dissection (P <.05), but not with HU measurements or subcutaneous fat thickness. Surgeon classification of the complexity of perirenal fat dissection was in accordance with the duration of dissection (P <.05). Perinephric fat contained more fibrous tissue in the patients with histologically proven APF than in those without (P <.05). Conclusions: APF is a challenge during kidney surgery. Difficult dissection prolongs the duration of perirenal fat dissection and surgery. Perirenal fat thickness measured via preoperative CT might be used to predict APF. [ABSTRACT FROM AUTHOR]

Copyright of Bosphorus Medical Journal / Boğaziçi Tıp Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: The aim of the study is comparing the treatment results and showing the differences between periprosthetic joint infections and osteosynthesis-associated infections. Materials and Methods: We retrospectively reviewed the cases of orthopedic implant-associated infections. All patients were categorized into two groups; Group A has consisted of osteosynthesis-associated infections, and Group B has consisted of periprosthetic joint infection. The time interval between implantation and infection, length of hospitalization, number of operations, the status of preoperative and postoperative intensive care unit, and number of outpatient clinic applications were recorded. Culture data from intraoperative deep tissue samples were also recorded. Results: There were 28 patients in Group A and 20 patients in Group B. The age distributions and operation numbers were significantly different between the two study groups (p=0.000 and p=0.05, respectively). There was a significant difference between the number of outpatient clinic applications and the success of treatment (p=0.016). There was a significant difference between the postoperatively intensive care unit status and success of treatment (p=0.002). Conclusion: Periprosthetic joint infection patients were older and had a higher number of operations, however orthopedic implantassociated infections were more likely outpatient clinic applications and post-operatively intensive care unit status. [ABSTRACT FROM AUTHOR]

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

Objectives: To assess if a standard hydration protocol will achieve voided volumes over 150 mL and more reliable uroflowmetry results. Methods: This is a single‐blinded crossover study of 40 patients with benign prostatic obstruction and 34 healthy volunteers. Subjects were enrolled prospectively between January and March 2019. All subjects performed two randomly ordered uroflowmetry tests. One test was performed when subjects sensed their bladder was full and had the urge to void and another one after emptying the bladder and ingesting 1.5 L of water within 1 hour (prehydration). Uroflowmetry parameters were compared between the benign prostatic obstruction group and the healthy volunteers. Uroflowmetry results were categorized as reliable, residual, and suboptimal with respect to voided volumes. This study has been registered in the UMIN Clinical Trials Registry (UMIN000035446). Results: The benign prostatic obstruction group and the healthy volunteer group presented no difference in respect of uroflowmetry test reliability (P =.459). Uroflowmetry results were reliable in 58 (78.4%) subjects in the prehydrated group and was reliable in 30 (40.5%) subjects in the non‐prehydrated group. The difference was statistically significant (P <.05). In the benign prostatic obstruction group and healthy volunteer group, the rate of reliable uroflowmetry tests was significantly higher with prehydration (P <.05). The comparative analysis of uroflowmetry parameters between tests performed with and without prehydration revealed higher values in the prehydrated group (voided volume, maximum flow rate, average flow rate, and postvoiding residual volume; P <.05). Conclusion: Prehydration of patients with 1.5 L of water within 1 hour before uroflowmetry improves uroflowmetry outcomes. By this hydration protocol, the chance to obtain a voided volume over 150 mL is increased significantly. [ABSTRACT FROM AUTHOR]

Aims: To assess the efficacy of transcutaneous posterior tibial nerve stimulation (TPTNS) on functional voiding disorder (FVD) and investigate the utility of urine biomarkers (UBs: nerve growth factor, transforming growth factor‐beta 1, and tissue inhibitor of metalloproteinases 2) in diagnosis and follow‐up. Methods: A total of 44 children were included to this randomized controlled trial prospectively. After randomization, 20 of 30 children with storage phase dysfunction those were unresponsive or noncompliant to medical treatment received TPTNS treatment (test group) and 10 children underwent TPTNS with no current (sham group) for 12 weeks. Fourteen healthy children constituted the nonsymptomatic group. UB levels, dysfunctional voiding and incontinence scoring system (DVISS), voiding diary, and quality of life (QoL) scores were assessed before and after treatment in the treatment groups. Results: QoL scores, overall and day‐time DVISS scores were significantly decreased in both sham and test groups (p < 0.05). In addition to these findings, the frequency of incontinence and urgency episodes were also significantly reduced (p < 0.05) in the TPTNS treatment group. This effect in the test group was still valid 2 years after intervention. There was no significant difference in UBs measurements between treatment and nonsymptomatic groups and between pretreatment and posttreatment measurements of test and sham groups. Conclusions: TPTNS is an efficient minimally invasive treatment in children with FVD who do not respond to medical treatment. TPTNS provides a significant improvement on episodes of frequency, episodes of incontinence, overall and day‐time DVISS scores, and QoL scores. The effectiveness of treatment continues even at the end of the second year of intervention. UBs were not found to be predictive in terms of diagnosis and evaluating the treatment response. [ABSTRACT FROM AUTHOR]

Objective: Lumbosacral transitional vertebrae (LSTV) are commonly seen congenital anomalies of the lumbosacral spine, and named according to the transition type as sacralization or lumbarization. The aim of this study was to determine whether LSTV have influence on sagittal spinal alignment and coronal spinal asymmetry. Materials and Methods: Anteroposterior and lateral full-length standing X-rays of young adult army officer candidates, who were admitted for health screening between January 2018 and January 2019, were extracted from the medical electronic database. Among these X-rays, those belonging to participants with sacralization and lumbarization were identified. The cervical lordosis, thoracic kyphosis and lumbar lordosis were measured on lateral X-rays and coronal spinal angle, if exist, were measured on anteroposterior X-ray with Cobb angle. Sagittal and coronal parameters were compared among participants with lumbarization, participants with sacralization and that of age- and sex-matched controls without LSTV. Results: Of the 179 X-rays extracted from the database, 30 (16.8%) were participants with sacralization, 69 (38.5%) were participants with lumbarization and 90 (50.3%) were controls. Participants with lumbarization had significantly greater cervical and lumbar lordosis angles than those without LSTV (controls). However, thoracic kyphosis angle did not differ among three groups. Based on coronal spinal measure, controls had higher spinal asymmetry values than participants with sacralization and participants with lumbarization. Curve patterns found in this study were single thoracic and single lumbar patterns. Conclusion: The finding of this study demonstrated that individuals without LSTV were more likely to develop coronal spinal asymmetry. This study also suggested considering lumbarization for increase in physiological cervical and lumbar sagittal angles. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Ankara University Faculty of Medicine / Ankara Üniversitesi Tip Fakültesi Mecmuasi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Percutaneous nephrolithotomy is not pain-free due to the procedure itself and presence of post-operative diversion. Our purpose was to evaluate the efficacy of local anesthetic infiltration in postoperative analgesia in children who undergo percutaneous nephrolithotomy. Materials and Methods: Forty-two renal units were included to our study. Local anesthesia group received prilocaine and bupivacaine injection through the percutaneous access line where patients received no local anesthetic constituted the control group. All patients received the same anesthesia protocol and 15 mg/kg paracetamol infusion postoperatively four times a day. Post-operative pain scores of patients were evaluated by using FLACC-FPS scales. Patients with pain scores ≥4 received meperidine 1 mg/kg as rescue analgesic. Results: Between the two groups there was no significant difference in pain scores except 24th hour, where the local anesthesia group found to be favorable. The need (p=0.040) and total number (p=0.018) of rescue analgesic was significantly less in local anesthesia group. According to need for repetitive analgesic dose, the local anesthesia group was founded to be more advantageous (p=0.017). The postoperative analgesic satisfaction of parents’ was favorable in local anesthesia group (p=0.002). Conclusion: In pediatric percutaneous nephrolithotomy, preemptive local anesthetic infiltration reduces postoperative pain, the need for analgesics, the number of analgesics used and also improves patient comfort and analgesic satisfaction. [ABSTRACT FROM AUTHOR]

Background/aim: To determine whether or not there is a difference between the version of the bone and cartilage surfaces of the glenoid. Axial magnetic resonance imaging (MRI) slices were examined in order to evaluate the measurements taken based on both the cartilage and bone joint surfaces. Materials and methods: A retrospective evaluation was made of the MRI scans of 182 patients. All of the reviewers independently measured the glenoid version angles of all of the patients from 1-182. The process was then repeated, with each reviewer taking second measurements of the angles from 1-182. Pearson correlation coefficient analysis was applied to evaluate the interaction and relationships between the measurements taken from the bone and cartilage. The intra- and interobserver interclass correlation coefficients (ICCs) were assessed. Analysis of variance was applied to determine any interobserver significant differences. Results: The mean glenoid version was determined as -3.58 ± 4.08° in the bone-based measurements and -5.81 ± 4.30° in the cartilagebased measurements. The cartilage- and bone-based measurements were found to have inter- and intraobserver reliability. A statistically significant difference was observed between the mean cartilage-based version and the mean bone-based version. Changes in the cartilage- and bone-based measurements were correlated; however, this change was not linear. Conclusion: The cartilage-based version showed a significant difference from the bone- based version. Therefore, in the preoperative planning and evaluation of glenoid-based pathologies, it would be more appropriate to evaluate both the bone and cartilage surface on MRI. [ABSTRACT FROM AUTHOR]

To draw attention to the disregarded malignancy risk after ileocystoplasty, we present two cases of adenocarcinoma. The first case was metastatic at initial diagnosis. Despite chemotherapy, the condition progressed and the patient died at the 9th month. The second patient has received cystectomy followed by chemotherapy and radiotherapy. Although the second patient was an immunosuppressed renal transplant, she was disease-free at the 27th month. As the malignancy risk after bladder augmentation is a proven fact, until the discovery of a proper diagnostic method, we recommend doing routine annual cystoscopic biopsy starting after the 10th year of ileocystoplasty. [ABSTRACT FROM AUTHOR]

Osteochondral defects of the femoral head are rare and principles of treatment include anatomic reduction, rigid fixation, enhancement of blood supply, and restoration of articular congruity. In this report, we present a case where the defect of the femoral head was treated with surgical dislocation of hip anteriorly and mosaicplasty. At 3-year follow-up, the patient was symptom free with near complete incorporation of the graft radiographically. Our observations in this case suggest that mosaicplasty with an open approach is an alternative treatment in the osteochondral defects of the femoral head. [ABSTRACT FROM AUTHOR]