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Introduction: In this study, we aimed to explore using the predictive role of systemic immune inflammation index (SII) for responses of intravesical Bacillus Calmette-Guérin (BCG) therapy in patients with intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC). Methods: From 9 centers, we reviewed the data of patients treated for intermediate- and high-risk NMIBC between 2011 and 2021. All patients enrolled in the study presented with T1 and/or high-grade tumors on initial TURB had undergone re-TURB within 4–6 weeks after initial TURB and had received at least a 6-week course of intravesical BCG induction. SII was calculated with the formula SII = (P × N)/L, where P, N, and L refer to peripheral platelet, neutrophil, and lymphocyte counts, respectively. In patients with intermediate- and high-risk NMIBC, the clinicopathological features and follow-up data were evaluated to compare SII with other systemic inflammation-based prognostic indices. These included the neutrophil-to-lymphocyte ratio (NLR), platelet-to-neutrophil ratio (PNR), and platelet-to-lymphocyte ratio (PLR). Results: A total of 269 patients were enrolled in the study. Median follow-up time was 39 months. Disease recurrence and progression were observed in 71 (26.4%) and 19 (7.1%) patients, respectively. For groups with and without disease recurrence in terms of NLR, PLR, PNR, and SII calculated prior to intravesical BCG treatment, no statistically significant differences were observed (p = 0.470, p = 0.247, p = 0.495, and p = 0.243, respectively). Moreover, there were also no statistically significant differences between the groups with and without disease progression in terms of NLR, PLR, PNR, and SII (p = 0.504, p = 0.165, p = 0.410, and p = 0.242, respectively). SII did not show any statistically significant difference between early (p = 0.492) and progression groups (p = 0.216). Conclusion: For patients with intermediate- and high-risk NMIBC, serum SII levels do not present as an appropriate biomarker for the prediction of disease recurrence and progression following intravesical BCG therapy. A possible explanation for the failure of SII to predict BCG response may be found in the impact of Turkey’s nationwide tuberculosis vaccination program.

A 36 year old woman with 2 pregnancies which one ofthem is delivered by cesarean section 7 year ago and the other one was abortusapplied for periodic hematuria (menuria) and chronic pelvic pain. Cystoscopywas performed and bladder mucosal biopsy was obtained because of suspiciousbladder mass in abdominopelvic ultrasonography. Pathological diagnosis wasbladder endometriosis. Gonadotrophin releasing hormon analog ( leuprolideasetat) treatment was used for 6 months. 2 months after therapy she appliedagain with pelvic pain. Diagnostic laparoscopy and second look cystoscopy wasperformed and regression of the endometriotic foci were seen. Pain and palpablemass out of pelvis may be a symptom of extrapelvic endometriosis although it isfrequently asymptomatic. Urinary endometriosis is an unrecoverabledisease, and collective approach of the gynecologist and urologist is necessaryfor treatment options.Theseverity of symptoms, spread of disease, probability of recurrences and cost oftreatment shoud be considered and accurate modality of the treatment shoud beoffered to the patient., Otuz altı yaşında, gebelik 2 doğum 1 abortus 1 ve 7yıl önce sezeryan öyküsü bulunan hasta siklik hematüri (menüri) ve kronikpelvik ağrı yakınması ile başvurdu. Abdominopelvik ultrasonografide mesanedekitle şüphesiyle sistoskopi yapılarak biopsi alındı. Patolojik tanı mesanedeendometriozis idi. Gonadotropin releasing hormon analoğu yakınması (leuprolideasetat) tedavisi 6 ay uygulandı. Tedaviden 2 ay sonra kasık ağrısı şikayeti iletekrar başvurdu. Tanısal laparoskopi ve ikinci bakış sistoskopisi yapıldı veendometriozis odaklarının regrese olduğu saptandı. Sıklıkla asemptomatik olsada, ağrı ve pelvis dışında ele gelen bir kitlenin varlığı ekstrapelvikendometriozisin semptomları olabilir. Üriner endometriozis gibi sağaltımı zorbir hastalıkta tedavi basamaklarına kadın doğum ve üroloji uzmanları birliktekarar vermelidir. Yakınmaların şiddeti, hastalığın yaygınlığı, tekrarlamaolasılığı ve tedavi maliyeti göz önüne alınarak doğru tedavi yöntemi hastayaönerilmelidir.