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Entrapment or strangulation of the penis is an uncommon condition that requires prompt medical intervention to avoid mechanical and/or vascular injuries. Severe complications such as edema, necrosis, skin infection, penile amputation, and urethral fistula may occur. There is no universally accepted method for treatment, and medical treatment can be delayed due to feelings of humiliation or self-attempt to release the entrapment. Intracavernosal aspiration is a surgical procedure used to evacuate blood from the obstructed corpus cavernosum. This procedure reduces penile size making it easier to remove the ring. However, it does not alleviate the inflammatory idea in the interstitial spaces and penile skin. This paper describes a case study of a 34-year-old male patient who was evaluated in the department of emergency with penile entrapment in a thick steel ring that was placed for prolonged erection. Removing the ring manually was attempted in the emergency department but failed, causing more engorgement in the distal part of the penis. The following admission, the patient was expeditiously transferred to the operating room where the surgical team interposed a wooden tongue depressor between the penile shaft and the ring. Subsequently, a manual hacksaw was used to excise the constriction device. Nevertheless, owing to the substantial diameter of the ring, the hacksaw became fractured and subsequently, a micromotor was employed for the ring removal procedure. Throughout the cutting process involving the micromotor, the ring was continuously cooled with an iced isotonic solution. Within thirty minutes, the ventral and dorsal sides of the steel ring were cut, and it was removed in two pieces.

Objective:Voiding dysfunction is a commonly encountered problem in children. If a patient has a history of urinary tract infection (UTI) and presents with fever, voiding cystourethrography (VCUG) is frequently used. Proximal urethra dilatation in VCUG was determined to be an indication of voiding dysfunction. Studies in literature have been the ones assessing the correlation between the presence of proximal urethra dilatation and voiding dysfunction. In our study, however, we analyzed the relationship between the proximal urethra diameter determined in VCUG of children with voiding dysfunction, the severity of the disease, the presence of reflux, and uroflowmetry parameters.Materials and Methods:Of the 522 VCUG-received patients 96 between the ages of 6-8 with voiding dysfunction concomitant with febrile UTI were evaluated. Dysfunctional voiding incontinence scoring (DVIS), uroflowmetry parameters, post-void residual measurements (PVR), proximal urethra diameter noted in VCUG, and presence of reflux in the patients were analysed.Results:The mean age was 7.2±0.66. The average proximal urethra diameter was 7.6±1.8 mm. Regarding the diameter, the patients were divided into two groups: Group 1 (7.6 mm and below) and group 2 (above 7.6 mm). DVIS was higher but vesicoureteral reflux (VUR) was lower in group 2 (p=0.017, p=0.008; respectively). For uroflowmetry parameters and PVR, no significant differences were noted.Conclusion:In the group with the high-proximal urethra diameter, DVIS was observed to be high. However, a negative correlation was determined between high-proximal urethra diameter and VUR.

Objective: Voiding dysfunction (VD), which encompasses many urinary symptoms that are not caused by neurological or anatomical anomalies, is a frequently encountered functional urinary bladder disorder in children. It was reported that there was an association between lower urinary tract symptoms and fecal microbiota in adult patients. Therefore, we aimed to investigate the differences in fecal microbiota between children with or without VD. Methods: Two patient groups, including 30 patients, were compared. Group 1 included patients with VD, while Group 2 consisted of healthy children. All study participants were asked to fill lower urinary tract and voiding dysfunction symptom score forms with the assistance of their parents. Subsequently, uroflowmetry tests and postvoiding residual urine measurements were performed. Fresh stool samples were collected from all children and analyzed by polymerase chain reaction. General bacterial load and presence of Roseburia intestinalis, Clostridium difficile, Fusobacterium nucleatum, and Bacteroides clarus were tested. Results: The two groups were significantly different regarding general bacterial load; the presence of Fusobacterium nucleatum. Clostridium difficile and Bacteroides clarus was not detected in the fresh stool samples of the patients in Group 2; the counts of Roseburia intestinalis were less in Group 1 than in Group 2, although there was no statistically significant difference. There was a negative correlation between symptom scores, general bacterial load, and the presence of Fusobacterium nucleatum. However, there was no correlation between the presence of Roseburia intestinalis and symptom scores. Conclusions: There is a potential relationship between VD and a deviation in the fecal microbiota in the pediatric population.

Toxic leadership is becoming increasingly common in healthcare organizations and there is strong need for studies focusing on organizational factors that can trigger revenge. Additionally, how psychological well-being functions in shielding against toxicity has not been adequately studied. Hence, this study aims to examine the relationship between toxic leadership and vengeful behaviors of nurses, along with the contingency of psychological well-being on the relationship during the COVID-19 pandemic. In this exploratory cross-sectional study, we attempt to examine the antecedent effect of toxic leadership on vengeful behaviors based on self-reports from 311 nurses. Using partial least squares and moderation analyses, the results show that toxic leadership is an important antecedent of vengeful behaviors among nurses. However, the results provide no statistical evidence to support a moderating role of psychological well-being in the relationship between toxic leadership and vengeful behaviors. This study reveals that nurses exposed to toxic behaviors by their superiors are more likely to engage in vengeance and highlights the fact that nurses are suffering psychologically during the pandemic.

Objective:The aim of the study was to investigate gender-specific differences in the Turkish patients with renal cell carcinoma (RCC) undergoing radical or nephron-sparing nephrectomy and compare the results with those in other regions.Materials and Methods:Data of 76 patients, who were clinically diagnosed with RCC and underwent radical or nephron-sparing nephrectomy from January 2011 to August 2017, were retrospectively evaluated. Age and gender of the patients and the size, histological type, grade and pathological stage of the tumors were recorded. A chi-square test was used for comparing categorical variables, whereas the Student’s t-test was used for the same purpose in the continuous variables.Results:Of the 67 patients, 39 (58.2%) were male and 28 (41.8%) were female; male-to-female ratio was 3:2. The mean age of the male and female patients was 63.4±11.7 years and 59.3±14.3 years, respectively and the mean tumor size was 5.7 and 5.3 cm, respectively. There were differences in mean age, tumor size and Fuhrman grade, however, none of them reached the level of statistical significance. Twenty four of the male and 25 of the female patients had low-stage, 15 of the male and 3 of the female patients had high-stage disease. Thus, the male patients had higher stage disease than the female patients and the difference was statistically significant (p=0.011).Conclusion:Turkish women with RCC had significantly lower stage disease than Turkish men, although grade and size of the tumor did not present a statistically significant difference. The results were similar with other European studies.

Renal angiomyolipoma (R-AML) is one of the most common benign neoplasms of the kidney. It is usually asymptomatic and rarely becomes symptomatic. Management of R-AML is still controversial. Generally, follow-up is enough for the management of the disease but rarely, life-threatening complications may develop. Here, we would like to present a case of huge R-AML with life-threatening bleeding with literature review.

Aim: There is still uncertainty today regarding the prostate specific antigen (PSA) threshold for prostate biopsy. From this point of view, we aimed to investigate the PSA threshold for prostate biopsy in this study. Methods: We retrospectively evaluated medical records of 375 patients, who underwent 12-16-core transrectal ultrasound-guided prostate biopsy between September 2012 and November 2015. The patients were divided into three groups according to the PSA values: group 1: 2.5-4ng/mL, group 2: 4.1-10 ng/mL and group 3: >10 ng/mL. Age, prostate volume, prostate cancer detection rate, Gleason score, the average core length and the core length obtained per cc of prostate volume were compared between the groups. Results: The mean age of the patients was 64.39±7.62 years and the mean cancer detection rate was 26.7%, namely 11.5% (3/26), 17.4% (43/247) and 52.9% (54/102) in the groups 1, 2 and 3, respectively. Prostate cancer was not detected in any patient with a PSA value of

Splenogonadal fusion, which can be clinically confused with testicular neoplasms as they present with testicular swelling, is a rare abnormality in young adults. Intraoperative frozen section analysis can be helpful in diagnosing such cases and preventing unnecessary orchiectomies. We report a case in which frozen section analysis was done and testis-sparing surgery could be performed.

Urothelial bladder carcinoma is a rare condition in young patients. Clinicians have less inclination to perform cystoscopy in this age group because benign causes of hematuria are more common. Thus, diagnostic delays of up to one year may occur. We report a 24-year-old male patient with urothelial bladder cancer. Clinical behavior and prognosis in young individuals are controversial. The definitions of “young patient” are highly variable and different World Health Organization pathological classification systems are used for reporting. Generally, it presents as a low-stage and low-grade disease, nevertheless, it may present with high-grade tumors, even with muscle-invasive cancer.

To compare changes in collagen type 3, elastin, fibrosis and cajal cells through histopathological examination of the ureteropelvic junction (UPJ) segments of pediatric and adult patients who had undergone AndersonHynes pyeloplasty for ureteropelvic junction obstruction (UPJO). Materials and Methods Histopathological evaluation was made of the UPJ segments of 52 patients who underwent Anderson-Hynes pyeloplasty for UPJO between January 2005 and January 2008. Patients were separated into 2 groups as pediatric, aged ≤15 years (group 1, n=10) and adult, aged >15 years (group 2, n=42). UPJ segments of both groups were compared histopathologically (collagen type 3, elastin, fibrosis and cajal cells). Radiographic evaluations were made with diuretic renogram and/or intravenous pyelography. Results Mean age of group 1 patients was 8.12±2.6 years (1-12 years) and of group 2 patients, 38.16±5.91 years (16-62 years). Mean follow-up period was 18 months (9-24 months). No statistically significant difference was determined between the groups in respect of collagen type 3, elastin, fibrosis or cajal cells (p>0.05). Conclusion As the pathology in the UPJ obstruction is a congenital defect, the histopathology does not change with age.

Purpose Neurogenic detrusor overactivity (NDOA) is characterized by involuntary detrusor muscle contractions during bladder filling in patients with neurological disorders. Anticholinergic therapy is the primary treatment; however, the reasons for treatment resistance in NDOA are not well understood. This study aimed to identify predictors of treatment failure by comparing urodynamic and frequency-volume chart data between patients with NDOA who respond and patients who do not respond to anticholinergic therapy. Methods We reviewed the records of 362 patients presenting with lower urinary tract symptoms and selected 85 who had NDOA and were on anticholinergic therapy. Ultimately, 67 patients were analyzed. We categorized these individuals into responders (group R) and nonresponders (group NR) based on clinical and urodynamic improvements. Three-day frequencyvolume charts and urodynamic study results were retrospectively reviewed. Results Of the 85 initial patients, 12 refused medication, and 6 were lost to follow-up. Pre- to posttreatment changes differed significantly between groups in the number of urgency urinary incontinence (UUI) episodes per 24 hours (P=0.001), maximum cystometric capacity (mL, P=0.003), NDOA frequency (P=0.004), and bladder compliance (mL/cm H2O, P=0.003). Multivariate analysis revealed that NDOA frequency (P=0.014) and UUI episodes per 24 hours (P=0.002) were significant factors associated with treatment failure. Conclusions NDOA varies according to underlying neurological conditions. The frequencies of UUI episodes and NDOA in urodynamic studies can predict resistance to initial anticholinergic treatment.