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Objectives: T1 bladder cancer has a wide range of tumor behavior and lamina propria invasion depth has a high potential risk of disease progression. To evaluate the patient outcome according to the tumor invasion to the muscularis mucosae-vascular plexus (MM-VP) in pT1 bladder urothelial carcinoma (BUC). Materials and methods: This study is a retrospective analysis of patients consecutively recorded from 2007 to 2013. A total of 93 patients with a history of primary pT1 BUC and complete follow-up were included. We used a pathological substaging system according to the tumor invasion regarding the MM-VP: pT1a (invasion above MM-VP) and pT1b (MM-VP invasion). We evaluated recurrence-free survival (RFS), progression- free survival (PFS), disease-specific-survival (DSS) based on this sub-staging system. Results: Pathological evaluation regarding the MM-VP invasion revealed 53 patients (57%) as pT1a BUC and 40 patients (43%) as pT1b BUC. The mean follow-up was 78.8 months. During the follow-up period; 60 patients (64.5%) had tumor recurrences, 32 patients (34.4%) had progression to invasive disease, 18 patients (19.4 %) died during follow-up related to the BUC. In 29 (54.7%) of pT1a and in 31(77.5%) of pT1b tumors, the recurrent disease was recorded during the followup period (p = 0.023). DSS rates at 5 years for pT1a and pT1b were 80.2% and 60.8%, respectively. PFS, RFS, and DSS rates were similar for pT1a/pT1b and did not reach statistical significance (p > 0.05). Conclusions: Sub-staging of pT1 BUC according to the MM-VP invasion showed a limited impact on the outcome in our patient cohort. However, the presence of pT1b disease caused a significantly higher rate of recurrence.

This study delves into EFL instructors’ perceptions of integrating video games as extracurricular activities. Combining quantitative and qualitative data collection methods, a mixed method was employed. The data were collected through a questionnaire and semi-structured interviews. 147 EFL instructors who work at universities in Turkey took part in the quantitative phase of the study, and 10 instructors volunteered to participate in the interview sessions. The quantitative data were analysed via SPSS 23, and for the qualitative data analysis MAXQDA software program was utilised. The results revealed that EFL instructors have generally positive perceptions of integrating video games as extracurricular activities, with a minority actively using them in their teaching. Moreover, there was a consensus that video games could be more effective when utilized as extracurricular tools rather than main instructional tools. Notable concerns expressed by the participants included time limitations, a busy curriculum, and a lack of knowledge about video games. Despite these concerns, it was found that the EFL instructors are willing to use video games in their teaching practices and learn more about them. These findings point out the importance of targeted professional development programs for the effective integration of video games into language teaching as extracurricular activities.

The study looked into the perceptions of EFL instructors working at schools of foreign languages at various universities throughout Turkey in order to better understand the effects of Online Extensive Reading (OER) on language learning and the difficulties regarding its implementation. A mixed-type descriptive study design was used to achieve the aim of the study, and the data were collected through semi-structured interviews and an online questionnaire. The questionnaire was completed by 181 EFL instructors, and 10 of them took part in the interviews. The quantitative data analysis was performed via SPSS.23 and frequencies and percentages were calculated. The qualitative data analysis which resulted in the formation of various themes and codes was carried out via MAXQDA. The results revealed that while the instructors held favourable perceptions towards the effects of OER on language learning including its benefits on reading, writing, and vocabulary, they were worried about certain difficulties including hectic schedules, student motivation, school curriculums, exams, and their technical expertise. Overall, it was concluded that despite the instructors' favourable perceptions of OER, it is not a practice that is frequently used in higher education in Turkey due to the instructors' lack of knowledge of OER and the difficulties they mentioned.

INTRODUCTION: Surgical experience and tumor characteristics are extremely important in laparocopic partial nephrectomy surgery (LPN). Most of the studies examining the relation of R.E.N.A.L.nephrometry score to surgical success have examined the results of experienced surgeons. In this study, we investigated the effectiveness of R.E.N.A.L. nephrometry score (RNS) in predicting complications and success for urologists who are at the beginning of the learning curve for laparoscopic partial nephrectomy. METHODS: The first 30 cases of LPN performed by a single surgeon were evaluated, retrospectively. The patients were grouped according to the RNS as low-risk and medium-high risk. Operation time, warm ischemia time and were recorded. Postoperative blood transfusion rate, hospital stay, hemogram levels and pathology results (surgical margin and tumor type) were evaluated. The comparison of perioperative values of the two groups was done by Mann-Whitney U test. RESULTS: There was no statistically significant difference between operation time, warm ischemia time, hospital stay time, and intra-operative bleeding amount (p> 0.05) between the low risk group and medium-high risk group patients. The total complication rate was 33.3%. The compliction rate for the low risk group was 27% (n = 5) (major complication 5.5% (n = 1)) and 41.6% (n = 5) for the medium-high group (major complication 8.3% (n = 1)). In comparing the two groups for complications, no significant difference was found (p = 0.46). DISCUSSION AND CONCLUSION: The R.E.N.A.L.nephrometry score does not affect the success and complication rates of urologists at the beginning of the learning curve in LPN surgery.

Objective: To present a step-by-step video of laparoscopic radical nephrectomy and inferior vena cava (IVC) thrombectomy. Patient and surgical procedure: A 55 year-old female diagnosed with a right renal mass with inferior vena cava extension, underwent laparoscopic radical nephrectomy and IVC thrombectomy. Magnetic resonance imaging (MRI) examination revealed an approximately 9 cm mass in the right kidney, combined with a 4 cm mass extending to the right renal vein and IVC. Graded by the thrombus level system, the IVC thrombus of this patient was at level I. The patient was placed in a left decubitus position, and four laparoscopic ports were used. Results: The total duration of the surgery was 2 h and 10 min. The total IVC clamping time was 21 min. Estimated blood loss was 590 mL, and no major intraoperative or postoperative complications occurred. Time to discharge was four days. There was no complication during 12 months of follow-up. Pathological evaluation revealed clear cell renal cell carcinoma with a negative surgical margin. After 12 months of follow-up, there was no recurrence or distant metastasis. Conclusion: We believe that a laparoscopic approach should be offered to selected patients diagnosed with RCC and vena cava tumor thrombus as a minimal invasive option. Optimal patient selection, extensive laparoscopic experience, and multidisciplinary support are crucial for effective surgical treatment.

Objective:To evaluate the clinical risk factors contributing to the development of extended spectrum beta-lactamase (ESBL)- producing asymptomatic bacteriuria in myelodysplastic children performing clean intermittent catheterization (CIC).Materials and Methods:The clinical risk factors for ESBL-producing bacteriuria were retrospectively investigated in 60 myelodysplastic children who had asymptomatic bacteriuria and were performing CIC. A total of 60 children were included in this study, 30 children (17 females, 13 males) with ESBL-positive bacteriuria in urine culture were identified as the study group and 30 age- and gender-matched ESBL-negative children (16 females, 14 males) served as controls. All children had neurogenic bladder due to myelodysplasia and had been used anticholinergics. The two groups were compared in terms of age, gender, presence of constipation and motor deficit, antibiotic prophylaxis, number of hospital admission, ultrasound findings, and presence of renal scarring in dimercapto succinic acid scintigraphy and urodynamic findings.Results:The mean age of the children was 77±50 months in study and 78±69 months in control groups. There was no statistically significant difference in terms of maximum bladder capacity, leak point pressure, constipation status and scarring. In study and control groups, 83% and 46% of children were on antimicrobial prophylaxis, respectively (p=0.007).Conclusion:ESBL-producing bacteriuria was found to be associated with long-term antibiotic prophylaxis. Thus, it was concluded that the use of antibiotics for asymptomatic bacteriuria should be kept to a minimum.

Objective:Since microscopic hematuria and pyuria can be observed in patients with a ureteral double-J (DJ) stent in place, urinalysis findings are not considered significant in terms of predicting stent-related infections. This study evaluates the presence of bacterial colonization and the value/ effectiveness of urine tests in predicting the results of DJ stent cultures.Materials and Methods:In the present prospective study, we analyzed data from patients who were treated with a DJ stent placement following endourological surgery due to ureteral stones. DJ stents were removed only after the urine cultures appeared sterile or after a period of empiric antibiotic use. The relationship between urinalysis results and stent cultures was assessed.Results:A total of 65 patients (mean age, 42.6±13.5 years; 16 females and 43 males) were evaluated. Bacterial colonization was detected in 12 (18%) DJ stent cultures with Enterococcus faecalis (n=4), extended-spectrum beta-lactamase producer (ESBL (+) Escherichia coli (n=4), Corynebacterium urealyticum (n=2), candida (n=1) and methicillin-resistant Staphylococcus aureus (n=1) growth being reported. The antibiogram results of the patients that showed colonization in their cultures demonstrated penicillin (n=4), ampicillin (n=4), tetracycline (n=3), imipenem (n=2), and linezolid (n=1) sensitivity. The rate of leukocyte esterase- and nitrite-positive patients, of those having significant number of leukocytes, and urine culturepositive patients in the groups with and without positive urine culture was 58.5%, 32%, 49%, and 7.5% vs 50%, 16.6%, 50%, and 8.5%, respectively. There were no statistically significant differences between the groups (p=>0.05). None of the study patients applied to our hospital with active infection following DJ stent removal.Conclusion:Urinalysis is insufficient in predicting catheter culture results. Based on the results of this study, we assume that stent culture for removed DJ stents is not a necessity; empirical antibiotic therapy with ampicillin-tetracycline should be started in patients with postoperative infection.

Objectives: The aim of this study is to evaluate prediction of postoperative ureteral obstruction needing ureteral stent insertion by evaluating the resistive index (RI) values and the grade of hydronephrosis. Material and Methods: A total of 66 adult patients undergoing stentless endoscopic ureteral stone treatment (URS) between January 2018 and January 2019 were included in this prospective study. Preoperative patient and stone characteristics were noted. All patients were evaluated with renal Doppler ultrasonography study to assess degree of hydronephrosis and RI values. A renal Doppler ultrasonography was repeated at postoperative 1st, 3rd and 7th days. Changes in both RI and hydronephrosis levels before and after the procedures were noted. On the postoperative 7th day, patients were divided into two groups including obstructive and non-obstructive cases according to RI values assessed where a RI value of 0.7 was accepted as the cut-off for obstruction. The preoperative and perioperative characteristics of both groups were evaluated in a comparative manner. Results: The mean patient age was 43.6 ± 1.72 years. Significant improvements were noted in RI and grade of hydronephrosis after the operation. The grade of hydronephrosis and RI values were found to improve more significantly on postoperative 3rd day when compared to the postoperative 7th day (p < 0.01 and p < 0.01). A significant correlation was detected between the grade of hydronephrosis (>grade 2) and obstructive RI values (> 0.7) in each postoperative visits (p: 0.001). RI values (> 0.7) at postoperative seventh days were correlated with larger mean stone size, increased ureteral wall thickness, increased diameter of the ureter proximal to the stone, and longer duration of the operation. Preoperative high-grade hydronephrosis indicated obstructive RI values at postoperative seventh day (p = 0.001) Conclusion: Changes in RI values on Doppler sonography and the grade of hydronephrosis may be a guiding parameter in assessing postoperative ureteral obstruction.

Although the standard treatment for testicular tumors is radical orchiectomy in children, testis-sparing surgery (TSS) is an alternative method in selected cases according to tumor size, tumor markers and histopathological findings. In this paper, we present two patients aged 11 and 12 years who underwent TSS in our clinic. Frozen section examination was performed in both patients. Intraoperative ultrasound-guided mass excision was performed in one patient. Histopathological examination revealed an epidermoid cyst in one patient and Leydig cell hyperplasia in the other. TSS may be performed in children with a small testicular mass and negative tumor markers.

Objective: The aim of this study was to determine the significance of contralateral testis size in predicting monorchism in pediatric patients with unilateral undescended testis. Materials and Methods: The data of patients who underwent surgical operation by a single pediatric urologist for undescended testis between 2013 and 2016 was evaluated retrospectively. The patients were grouped as having monorchism (M), nonpalpable intra-abdominal testis (NPIAT), and palpable undescended testis (PUDT). The dimensions of the testes were measured ultrasonographically and recorded before operation. Patients with nonpalpable testis underwent diagnostic laparoscopy and patients with PUDT underwent inguinal orchiopexy. Results: A total of 57 children with a mean age of 31 (11-60) months were evaluated. Of the children, 12 had M, 9 had NPIAT and 36 had PUDT with a similar mean age (p>0.05). The size of the descended testis was found to be significantly small in NPIAT* and PUDT** groups compared to the M group (*p0.05). Conclusion: The size of the testis in the scrotum might help to localize the position of the undescended testis.

Objective: This study aims to validate the “Marmara post-prostatectomy incontinence symptom score (M-PPISS)” designed for the assessment of post-prostatectomy incontinence (PPI). Materials and Methods: The questionnaire consists of 3 sections including 8 questions (4 questions examining the type and degree of PPI, 3 questions examining the effect of PPI on quality of life (QoL) and 1 question examining bladder emptying) and an analogue scale to assess the impact of PPI on the QoL. The questionnaire was completed by 106 patients, who underwent radical prostatectomy (RP) in our clinic between 2007 and 2015, at the end of the first week, first month and at 3-month intervals up to one year after RP. Results: The mean score of 106 patients at the end of the first week after the operation was 6.57 (minimum: 0, maximum: 24). The internal consistency coefficient measured for our questionnaire was found to be higher (Cronbach’s alpha: 0.887). When an item was deleted, Cronbach’s alpha was not lower than 0.85 for any value. According to the 27% rule, p value was calculated as 0.0001. In the numerical evaluation of total score and the analogue scale considering QoL (satisfaction and dissatisfaction); patients with a total score of 0-4 were accepted as “satisfied with QoL”, while patients with a total score of ≥5 were included in the dissatisfied group (cut-off value: 5). Conclusion: The M-PPISS was found to be a reliable and valid instrument in the evaluation of urinary incontinence after RP.

Objective: The aim of this study was to determine the effectiveness of the voiding dysfunction symptom score (VDSS) in evaluation of children with nocturnal enuresis. Materials and Methods: Four hundred children with nocturnal enuresis were included in the study. They were evaluated with VDSS, physical examination, urinalysis and 2-day voiding diary. All children with nocturnal enuresis symptoms were treated with desmopressin and/or urotherapy. However, children with overactive bladder symptoms were also treated with anticholinergics. Treatment success and change in VDSS were compared and assessed between different treatment methods. Results: Two hundred forty-five children (61.25%) were male and 155 (38.75%) were female. The mean age was 7.6±3.0 years (range: 5-18). The mean VDSS was 9.2±6.3. 35% of children with nocturnal enuresis had concomitant daytime symptoms. 126 children (31.5%) had a VDSS of nine or above and majority of these children were treated with anticholinergic therapy. VDSS questionnaire could not help determine treatment success in children with non-monosymptomatic nocturnal enuresis. However, children treated with urotherapy and desmopressine showed significant difference in VDSSs according to their treatment response. Conclusion: VDSS has shown to decrease after treatment in children with mono-symptomatic nocturnal enuresis. The treatment strategies should be checked and modified if VDSS does not decrease after proper therapy as this would increase the success of treatment.

Objective Nuclear imaging techniques such as 99mTc-dimercaptosuccinic acid (DMSA) and 99mTc-mercaptoacetyltriglycine (MAG-3) are widely used for the diagnosis and follow-up of urinary tract obstructions. Both imaging techniques provide the differential renal function (DRF) in slightly different ways. The aim of this study was to assess the MAG-3 scan as an adjunct or alternative to DMSA for evaluating DRF in children with hydronephrosis. Materials and Methods Eighty-one patients with hydronephrosis were enrolled in this study. Patient age, sex, anteroposterior renal pelvis diameter (RPD) at the time of diagnosis, parenchymal thickness and the DRF percentage found by both DMSA and MAG-3 were recorded. DMSA scintigraphy was used for detecting renal scars and estimating DRF. MAG-3 scintigraphy was used for evaluation of renal clearance, the collecting system’s outflow pattern and estimating DRF. Results A total of 102 renal units (38 left, 22 right and 21 bilateral) were evaluated. High correlation rates were found when we compared both tests’ DRF values according to antero-posterior renal pelvic diameter and patient age (p>0.05). In all groups compared in the present study, both tests demonstrated very similar results and DRF values. Statistical analysis of cut-offs (45%, 40%, 10%) were also similar in both methods (p>0.05, kappa >0.7, r=0.926 Pearson). Conclusion DMSA and MAG-3 are tests that are of assistance in the evaluation of hydronephrosis. Compared to DMSA, MAG-3 also provides valuable information to evaluate DRF values in hydronephrotic renal unit (RU). Avoiding unnecessary DMSA imaging will save time and cost and prevent over-radiation of the pediatric population.

Objective “Traditional subureteral transurethral injection” (STING) and “Double hydrodistention-implantation” (Double-HIT) injection techniques for vesicoureteral reflux (VUR) treatment are a less invasive, yet very effective options. The influence of injection techniques in treatment success is not adequately searched in children with overactive bladder syndrome (OAB). The objective of this study to compare the short-term success rates of STING and Double-HIT techniques in children with OAB-VUR complex. Materials and Methods Children who underwent endoscopic injection for VUR between 2010 and 2013 were retrospectively evaluated. Patients were grouped into two groups according to the surgical techniques (STING or Double-HIT). Success of the treatment was defined with a negative voiding cystourethrogram at the 6th postoperative week. Patients were evaluated according to sex, age, pre- and postoperative reflux grades, laterality, type and volume of bulking agent and presence of OAB. Results Both groups were similar in terms of sex, age, lower urinary tract dysfunction, reflux grade and success rates. Surgical technique, score of pediatric lower urinary tract symptom questionnaire, age, sex, laterality of reflux and type of the bulking agent found to have no effect on the overall success rates (p>0.05). Presence of OAB and/or a high grade reflux were identified as statistically significant predictive factors that could affect the treatment results. Conclusion The short-term surgical success of the double-HIT and STING techniques showed no difference in children with OAB. The presence of a high grade reflux and/or OAB seemed to be the main factors for overall success in endoscopic VUR surgery.