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Objectives: To analyze the management strategies in the children who had treatment‐resistant dysfunctional voiding (DV). Methods: Among 75 children with DV who underwent pelvic floor biofeedback therapy (BF) between 2013 and 2020, 16 patients (14 girls, 87.5%) with a mean age of 9.81 ± 2.53 years that showed incomplete clinical response following urotherapy and initial BF sessions were retrospectively reviewed. The demographic and clinical characteristics, DVSS, and uroflowmetry parameters were recorded before and after the initial BF sessions. Subsequent treatments after initial BF and clinical responses of patients were noted. Results: Clinical success was observed in one patient by addition of an anticholinergic and in three patients with combination of salvage BF sessions and anticholinergics, whom had predominant overactive bladder (OAB) symptoms. The success rate of TENS alone and in combination with other treatment modalities was 88.8% (8/9 patients). In addition, salvage BF sessions (range 2 to 3) enabled clinical success in five (50%) of 10 cases as a combination with anticholinergics or TENS. In case of incomplete emptying without OAB, adequate clinical response to Botulinum‐A was observed during an average follow‐up of 29 months in two boys who did not respond to alpha‐blockers, even though one required repeat injection after 10 months. The total clinical success rate was 87.5% (14/16 patients) after a median follow‐up of 24 months. VV‐EBC and Qmax increased by a mean of 30.89% and 7.13 mL/min, respectively, whereas DVSS decreased by a mean of 8.88 points and PVR‐EBC decreased by a median of 19.04%. Conclusions: Our findings showed that clinical success in resistant DV was achieved by various combination treatments in the majority of children. However, a small group may still have persistent, bothersome symptoms despite multiple treatment modalities. [ABSTRACT FROM AUTHOR]

The iliac fossa is the most commonly used site to place the graft in renal transplantation in adults. However, iliac fossa may not be used in various conditions. Thus, orthotopic renal transplantation becomes a viable alternative for these selected patients. Given the technically challenging surgery and limited number of patients, data on the long‐term outcomes on this regard are scarce. This narrative review serves as an update on the clinical outcomes after orthotopic renal transplantation, focusing on overall recipient survival and renal graft survival, as well as postoperative complications. We found that studies to date showed a comparable survival rate in both recipients and renal grafts in the postoperative follow‐up period after orthotopic renal transplantation with a lower complication rate compared to the published data on heterotopic renal transplantation. The results of our review may encourage transplant centers to reevaluate their policies to consider orthotopic renal transplantation as an alternative technique in cases where heterotopic kidney transplantation is not possible. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study is to analyze the long‐term clinical outcomes in children who were treated with biofeedback therapy (BF) for dysfunctional voiding (DV) and to determine the need for maintenance of BF due to clinical relapse. Methods: Files of children with DV who underwent BF between 2013 and 2020 were retrospectively reviewed. Patients with neurological or anatomical problems were excluded. A total of 64 patients (52 girls, 12 boys) with a mean age of 8.89 ± 2.48 years who completed the initial BF sessions were included in the study. The demographic and clinical data, dysfunctional voiding symptom scores (DVSS), and uroflowmetry parameters were recorded before and after the initial BF sessions. Clinical success was regarded as the cessation of electromyography activity as well as concurrent resolution of lower urinary tract symptoms and improvement in uroflowmetry parameters. After the initial BF sessions, children who had initial success showed DV relapse at any time during follow‐up received the maintenance BF sessions. Therefore, the patients with successful initial BF were divided into two groups: the group that needed maintenance BF, and the group which required no maintenance BF. Results: Clinical success was achieved in 48 (75.0%) of 64 children following a median of 6 sessions (range 2–8). At the follow‐up, 10 (20.8%) out of 48 patients showed symptom relapse at a median of 8 months (range 2–24 months). After a median of 3.5 maintenance BF sessions (range 1–6), clinical success was observed in all patients. Both groups showed a significant DVSS decrease after initial BF, however, those who needed maintenance had significantly higher DVSS (6.80 ± 2.53 vs. 3.61 ± 1.12, p < 0.001). At admission, DVSS <17.5 (odds ratio [OR]: 4.31, p = 0.025) and post‐voiding residual volume as a percentage of estimated bladder capacity for age <28.9 (OR: 5.00, p = 0.009) were found as the predictive factors for initial BF success. The need for maintenance BF was 2.56‐fold higher with a DVSS above 5.5 after initial BF sessions. Conclusions: Our results show that despite a clinical success rate of 75% after the initial BF, relapse can be seen within 2 years in approximately 20% of the patients. Nevertheless, maintenance of BF may provide clinical success in all patients. Relatively higher DVSS after initial BF can be used as a predictor of the need for maintenance BF. [ABSTRACT FROM AUTHOR]

Ectopic kidneys, with a prevalence of 1/1000-4000, often manifest in the pelvic region, can be complicated with problems such as ureteropelvic junction (UPJ) obstruction. This video article presents a case of open pyeloplasty in a 15-month-old infant with a pelvic kidney, emphasizing technical details for educational purposes. The patient was prenatally diagnosed with pelvic kidney hydronephrosis at 22 weeks of gestation, progressing to grade 4 postnatally. MAG-3 scintigraphy confirmed UPJ obstruction, warranting open pyeloplasty. A Pfannenstiel incision provided access to the Retzius space. The ureter was dissected, revealing the adhered renal pelvis. Stay sutures facilitated dissection, and 5/0 polyglactin sutures were strategically placed due to anatomical anomalies. Ureteropelvic anastomosis was performed using 6/0 PDS sutures. A 3-Fr Double J catheter preceded the closure of the renal pelvis. The procedure was concluded with meticulous layer closure. The operation lasted for 50 min, with minimal blood loss (10 mL). Drain was removed on postoperative day 2, and the patient was discharged. Ureteral stent was removed at 4 weeks. A 3-month follow-up ultrasound revealed a notable reduction in hydronephrosis, with an anteroposterior diameter of 6 mm. This video article elucidates the nuances of open pyeloplasty in pelvic kidneys and serves as a valuable resource for residents and fellows. The concise procedure, with a brief operative time and minimal blood loss, indicates the efficacy of the surgery. [ABSTRACT FROM AUTHOR]

Case: Since the declaration of COVID‐19 as a pandemic, other unexpected symptoms related to the infection besides the respiratory system have been reported. Although a few case reports have revealed that adult patients with COVID‐19 also complained of urinary frequency and nocturia, the exact pathophysiology is still unclear. In this case series, we present three children aged 14 to 17 years with urodynamically proven lower urinary tract dysfunction (LUTD) following COVID‐19. Outcome: None of the patients had constipation or bowel disorder before the diagnosis of COVID‐19. In addition, neurological examination and related imaging revealed no signs of etiological factors. The median time from diagnosis of COVID‐19 infection to the onset of lower urinary tract symptoms was 3 months. Incomplete bladder emptying/urinary retention supported by increased bladder compliance, high post‐micturition residual urine volumes, and absence of detrusor pressure increase during the voiding phase in the pressure flow study (acontractile detrusor in two patients and hypocontractile detrusor in one patient) were observed. Conclusion: We observed that LUTD (eg, incomplete bladder emptying, urinary retention) can be prominent some time after the diagnosis of COVID‐19. Even though psychogenic or neurogenic causes may not be excluded completely, clinicians should be aware of a recent COVID‐19 infection in children with sudden‐onset LUTD. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate more comprehensively the presence of an association between childhood lower urinary tract symptoms and development of adulthood overactive bladder, to determine the group at most risk of overactive bladder in adulthood, and to assess its effects on daily life. Methods: A total of 264 patients who were followed up for lower urinary tract symptoms in childhood between 2000 and 2005 were included in this retrospective, cohort study. After a median period of 20 years, these patients with a median current age of 29 (27–35) years were re‐evaluated and divided into two groups: those currently with overactive bladder (n = 102, 23.0%), and those without overactive bladder (n = 162, 36.5%). In addition, 180 age‐matched overactive bladder patients without a history of childhood lower urinary tract symptoms (n = 180, 40.5%) were included. The primary endpoint was to determine which children are at higher risk of adulthood overactive bladder. The secondary endpoint was to evaluate the effect of history of childhood lower urinary tract symptoms on quality of life in adulthood. The eight‐item Overactive Bladder questionnaire, the Pittsburgh Sleep Quality Index, and the Short‐Form 36‐item Health Survey were administered to all participants. Voiding Dysfunction Symptom Score was evaluated according to childhood medical records. Results: Overactive bladder in adulthood was observed in 38.6% of patients recovering from childhood lower urinary tract symptoms. They had worse overactive bladder symptom scores and quality of life than those without childhood lower urinary tract symptoms (P < 0.001). Voiding Dysfunction Symptom Score ≥13 (odds ratio 2.54), daytime incontinence (odds ratio 2.01), holding maneuvers (odds ratio 1.82), nocturnal enuresis (odds ratio 1.75) in the pediatric period, and recovery age from all these symptoms of ≥12 years (odds ratio 1.95) were the most unfavorable determinants of development of adulthood overactive bladder. Conclusions: Our findings show that children with the above characteristics are at risk of developing overactive bladder later in their lives even if their symptoms improve in childhood. [ABSTRACT FROM AUTHOR]

Objective: Various recommendations are being offered in order of priority in the diagnosis and treatment of urological diseases during the coronavirus disease 2019 (COVID-19) period. Since it may not be possible to provide information to all patients through telemedicine, additional methods are needed to reach all patients. This study aimed to determine the reliability and quality of YouTube videos that provide information on urological disorders during the COVID-19 period. Another aim was to assess the most shared and most viewed videos on urological disorders on YouTube and their usability as an additional resource in telemedicine during the pandemic. Materials and Methods: From 17 February 2020, to 31 July 2020, the following keywords were used to search videos on YouTube: “covid urology”, “covid andrology”, “covid fertility”, “covid male infertility”, “covid prostate”, “covid bladder”, “covid kidney”, “covid renal”, “covid testis”, “covid cancer”, “covid coitus”, “covid sex”, “covid sperm” and “covid erectile”; “coronavirus” was also used instead of “covid”. In total, 232 videos were evaluated by two urologists according to video characteristics. The number of total views, views per day, likes, dislikes, comments, video length, date of video upload and duration on YouTube was recorded. Finally, a total of 136 relevant English videos were included in the study. A 5-point modified DISCERN tool was used to assess reliability, whereas a 5-point Global Quality score (GQS) was used to evaluate quality. Cohen’s kappa score was used to determine inter-rater agreement, while the intraclass correlation coefficient was used to evaluate inter-observer reliability. Results: All videos had a high DISCERN score [4, interquartile range (IQR) (3-5)] and GQS [5, IQR (4-5)] in general. Moreover, 20 (14.7%) videos containing information about “sexual life” and “effects of COVID-19 on sperm” were described as debated. Videos uploaded by “universities/ professional organisations/non-profit physician/physician groups” had higher scores (p<0.001). However, their rates of “number of views per day” (p=0.036) and “likes” (p<0.001) were lower. The majority of videos related to urology (63.9%) included conversations about andrological disorders. The median number of total views and number of views per day were also highest for videos related to andrology. Conclusion: Although andrological disorders are classified as a non-essential issue and andrological consultations are postponed during the COVID-19 period, the results show that the rate of YouTube videos related to andrology is even higher than uro-oncological diseases during this period. Therefore, it is important to share accurate and reliable information in this field. Our analysis shows that informative, easy-to-understand YouTube videos uploaded by “universities/professional organisations/non-profit physicians/physician groups” can be used as an additional method to telemedicine, especially for andrological disorders that do not require follow-up. [ABSTRACT FROM AUTHOR]

Objective: The incidence of non-urothelial bladder cancers is very low, so our knowledge about their treatment protocols and prognosis is limited. We evaluated the clinicopathological characteristics of 26 patients in three different clinics and aimed to determine the prognostic factors affecting oncological outcomes. Materials and Methods: Between January 2012 and October 2019, we retrospectively analyzed the data of twenty-six patients aged between 44-75 years who were diagnosed and treated due to non-urothelial bladder carcinomas in three clinics. Results: Among twenty-six cases, nineteen (73.1%) were male and seven (26.9%) were female. The mean age at diagnosis was 60.77±8.52. The most common presenting complaint was gross hematuria (84.6%). It was followed by lower urinary tract symptoms (38.4%). Histological types of tumors were squamous cell carcinoma (9 cases, 34.8%), adenocarcinoma (eight cases carrying different histopathologic subtypes: Mucinous, signet ring cell, plasmacytoid/signet ring cell mixed variant and signet ring cell containing osteoclast-like giant cell, 30.8%), small cell carcinoma (3 cases, 11.5%), large cell neuroendocrine carcinoma (2 cases, 7.7%), extra-gastrointestinal stromal tumor (1 case, 3.8%) and malignant undifferentiated mesenchymal tumor (1 case, 3.8%) and leiomyosarcoma (2 cases, 7.6%). At a median follow-up of 13 (2-42) months, the progression-free survival rate was 61.5%, while the overall survival rate was 46.1%. In Kaplan-Meier analysis, the median survival of all cases was found to be 16 (9-33) months. Overall survival times were lower in the presence of advanced (3-4) pathological stages (p=0.006) and higher (≥2) ECOG scores (p=0.005). Conclusion: In our cases, we observed that overall survival rates increased in patients undergoing multimodal treatments involving radical cystectomy compared to the bladder-sparing approach. The survival rates were higher in squamous cell carcinomas, while the rate of metastasis was higher in adenocarcinoma and neuroendocrine tumors. Up-staging rates after cystectomy were higher in adenocarcinomas, sarcomas and squamous cell carcinomas. [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]

We aimed to investigate the association between erectile dysfunction and severity of cardiovascular morbidity and to assess clinical responses to tadalafil of patients in different cardiovascular risk groups. Between November 2019 and August 2020, a total of 258 male patients aged 45–70 years with ED were included. They were divided into three groups according to the Framingham risk score: low‐risk (n: 86, 33.3%), intermediate‐risk (n: 103, 39.9%) and high‐risk (n: 69, 26.8%). At admission, all domains of the International Index of Erectile Function score were worse in high‐risk group compared to other risk groups (p <.001). After a 12‐week follow‐up, a more significant improvement was observed in all domains of erectile function in all risk groups, but high‐risk group had lower sexual scores (p <.001). The lowest rate for complete responsiveness to tadalafil was observed in the high‐risk group (37.7%). The rate of failure in complete responsiveness was found to be 4.127 times greater with higher Framingham score and 3.102 times greater with higher erectile dysfunction severity at admission. Our preliminary findings show that more severe sexual disorders are observed in high‐risk patients with cardiovascular morbidity. Individualised treatment may be important in high‐risk group since they may benefit less from tadalafil, and failure in complete responsiveness can be more common in this group. [ABSTRACT FROM AUTHOR]

Objective: The incidence of bilateral testicular germ cell tumours (TGCT) is low and constitutes 0.5%-7% of all testicular tumours. We aimed to evaluate the clinical and pathological features of unilateral and bilateral TGCT, as well as prognostic factors in bilateral cases that may have an impact on oncological outcomes. Materials and Methods: Bilateral TGCT were detected in 10 (11.4%) of 87 patients between January 2010 and July 2016. Patients with 68 unilateral and 10 bilateral tumours (4 synchronous, 6 metachronous) had completely accessible data. We retrospectively evaluated their clinical-pathological data and postoperative follow-up results. Results: Four patients with bilateral synchronous tumours had a seminoma and three (75%) of them had a stage III disease. At a median follow-up of 31.50 (29-37) months, local recurrence, distant metastasis and death were observed in two patients with stage III disease. No recurrence or metastasis was seen in six patients with unilateral TGCT at 33 (24-50) months of follow-up, but metachronous tumours occurred in the contralateral testicles. At a median follow-up of 25 (11-39) months after metachronous tumour development, local recurrence, distant metastasis and death were observed in the contralateral testis of patients with stage III disease. There was no significant difference in bilateral and unilateral cases for disease-free survival, progression-free survival (PFS) and overall survival (OS). PFS and OS were significantly shorter (p=0.039) in bilateral synchronous tumours than in metachronous tumours. Moreover, stage III disease was more common (75% vs 33.3%) in synchronous tumours. Family history (OR: 6.556, p=0.035), testicular dysgenesis syndrome (OR: 3.876, p=0.031), disorders of semen parameters (OR: 2.879, p=0.037), undescended testis (OR: 2.561, p=0.026), monocyte/lymphocyte ratio >0.31 [odds rotio (OR): 2.234, p=0.022], testicular microlithiasis (OR: 2.015, p=0.015) and neutrophil/lymphocyte ratio >3.23 (OR: 1.348, p=0.025) increased the risk of contralateral tumour development. Conclusion: Bilateral synchronous tumours are detected at a more advanced stage and have lower PFS and OS durations, but survival rates are similar to those of unilateral tumours. Long-term follow-up is necessary for patients with unilateral TGCT having certain risk factors due to the possibility of metachronous tumour development in the contralateral testis. [ABSTRACT FROM AUTHOR]