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Amaç:Bu çalışmada prostat kanseri şüphesi nedeniyletransrektal ultrasonografi kılavuzluğunda prostat iğne biyopsisi uygulananhastaların, vücut kitle indekslerine göre kanser tespit edilme oranlarınınkarşılaştırılması amaçlanmıştır. Gereçve Yöntem: Retrospektif özellikteki bu çalışmaya serumPSA değeri 20 ng/ml altında olan ve prostat kanseri şüphesi nedeniyle TRUS-Buygulanan hastalar çalışmaya dahil edilmiştir. Hastaların yaş, boy, kilo, vücutkitle indeksi gibi demografik verilerinin yanı sıra serum PSA düzeyleri,prostat hacimleri, kanser tespit edilme oranları gibi klinik verileriincelenmiştir.Bulgular: Hastaların 78 tanesi grup-1 (VKİ

Robotic surgery is increasingly being performed worldwide in the surgical treatments of various diseases. Radical prostatectomy provides long-term cancer control in patients with localized prostate cancer. Robotic radical prostatectomy (RARP) has increasingly become a preferred treatment of choice both by patients and urologists since its introduction in 2001. The training of this surgical approach is a very important subject. This paper was prepared following reviewing the published literature on training on RARP, an internet bases search related with robotic prostate cancer surgery training and reviewing the training programs of the centers who offer training in robotic urology. In the present paper, we summarized the training modalities in RARP including; I. Video based learning: watching edited and non-edited surgical videos, II. Attending courses, symposiums and meetings related with robotic surgery, III. Watching live robotic surgical cases in the operating room, IV. Training with simulators, V. Training with the surgical surgical robot on training materials, VI. Training with the surgical robot on live animals under anesthesia in the laboratory, VII. Patient site assisting during robotic surgical procedures, VIII. Performing robotic surgery as a console surgeon under the supervision of a experienced mentor (fellowship program), IX. Assessing outcomes of the robotic surgical procedures (learning curve) and X. Ankara Ataturk Hospital Robotic Radical Prostatectomy Training Model. Training in robotic prostate cancer surgery includes a variety of modalities. Effective and sufficient training could be obtained with the combination of the suggested training modalities.Keywords: Training modalities, robotic surgery, prostate cancer surgery., Robotik cerrahi, tüm dünyada çeşitli hastalıkların cerrahi tedavisinde giderek artan sıklıkta uygulanmaktadır. Lokalize prostat kanseri tedavisinde radikal prostatektomi uzun süreli kanser kontrolü sağlamaktadır. İlk kez 2001 yılında uygulanmaya başlaması ile birlikte robotik radikal prostatektomi (RARP), hem hastalar hem de ürologlar tarafından prostat kanserinde tercih edilen ameliyat yöntemi haline gelmiştir. Bu modern ameliyat yönteminin eğitimi de oldukça önemli bir konudur. Bu makale, RARP ameliyat yönteminin eğitimi ile ilgili uluslararası literatür incelenerek, internet üzerinden robotik prostat kanseri cerrahisi eğitimi araştırılarak ve bu konuda eğitim veren merkezlerin eğitim programları incelenerek hazırlanmıştır. Robotik prostat kanseri cerrahisi eğitimi ile ilgili şu basamaklar özetlenmiştir; I. Ameliyatlara ait video izlemeye dayalı eğitim, II. Robotik cerrahi ile ilgili kurslara, sempozyumlara ve toplantılara katılmak, III. Ameliyathanede robotik cerrahi ameliyatlarını izlemek, IV. Simülatörler üzerinde eğitim almak, V. Çeşitli eğitim materyalleri üzerinde cerrahi eğitim ile eğitim yapmak, VI. Anestezi altındaki çeşitli hayvan modelleri üzerinde laboratuvarda cerrahi robot ile eğitim yapmak, VII. Robotik cerrahi ameliyatlarında hasta başında asistanlık yapmak, VIII. Bu konuda deneyimli bir cerrahın gözetiminde konsol başında bire bir cerrahi eğitim almak, IX. Öğrenme eğirişi döneminde cerrahın kendi sonuçlarını değerlendirmesi ve X. Ankara Atatürk Hastanesi Robotik Radikal Prostatektomi Eğitim Modeli. Robotik prostat kanseri eğitiminde birçok yöntem kullanılabilmektedir. Bu yöntemlerin bir arada kullanılması ile etkili ve yeterli eğitim sağlanabilmektedir

Amaç: Bilateral testisi olan hastalarda, tek taraf testis tümörü için standart tedavi olan radikal inguinal orşiektominin yerini, özellikle küçük tümörlerde parsiyel orşiektominin alıp alamayacağı konusunda veri elde ederek fikir yürütmek ve ileride yapılacak çalışmalara ışık tutmak amacıyla çok merkezli bir çalışma gerçekleştirdik.Materyal ve Metod: Mart 2000- Ekim 2014 yılları arasında testiküler cerrahi geçirmiş hastaların, ülkemizden 11 ayrı merkezden toplanan patoloji sonuçları arasından 3 cm ve daha küçük boyuttaki testis kitlesine sahip 291'inin sonuçları derlendi. Tümör boyutu 3 ve altında olan bu hastalar kendi içinde kitle boyutu 0-1 cm (Grup 1, n=44), 1.1-2 cm (Grup 2, n=125), 2.1-3 cm (Grup 3, n=122) olarak 3 ayrı gruba ayrıldı. Hastaların sonuçları arasından benign olarak raporlananlar yanı sıra malign olarak raporlananların tümör çevresindeki normal testis parankiminde eşlik eden intratubüler germ hücreli neoplazi (ITGHN) veya malign tümör varlığı değerlendirildi. Patoloji sonuçlarından 112 tanesi bu merkezlerde bulunan uzman patologlar tarafından tekrar değerlendirildi.Bulgular: Ortalama hasta yaşı 32.3 (min 1, maks 79) idi. Radikal inguinal orşiektomi yapılan hastalarda tümör dışı testis parankiminde ITGHN saptanma oranı Grup 1'de (%20) Grup 2 (%42.4) ve Grup 3'e (%41.5) oranla anlamlı olarak daha düşük saptanmıştır (sırasıyla, p=0,031 ve p=0,034). Patolojik olarak tekrar incelenen hastalar arasında, kitle dışı testis parankiminde ITGHN oranlarına bakıldığında, ilk yapılan patolojik incelemede %48 olan ITGHN oranı tekrar yapılan patolojik inceleme sonrasında %55 olarak saptanarak artış saptanmıştır ancak bu fark anlamlı bulunmamıştır. (p=0.285). Tüm hastalar içinde, testisdeki kitlenin benign tümör saptanma oranı, patolojik boyutu 2 cm ve altında boyuta sahip tümörlerde anlamlı olarak daha yüksek saptanmıştır.Sonuç: Küçük testiküler kitlelerde, dikkatli seçilmiş hastalarda, testis koruyucu cerrahinin genel kurallara uyularak yapılması gündeme gelebilir.Anahtar kelimeler: Testis tümörüleri; parsiyel orşiektomi; testis koruyucu cerrahi; tümör boyutu. Purpose: The standart treatment of unilateral testicular tumours for patients with bilateral testis is radical inguinal orchiectomy. We aimed to determine if partial orchiectomy could take radical orchiectomy's place in small tumours. For this purpose we performed a multicenter study.Materials and Methods: Pathology results of the patients were included from 11 different centers in our country who underwent testiculer surgery between March 2000 and October 2014. Overall, 291 patients'results were included. Patients with tumor size of 3 cm or less were divided into 3 groups including 0-1 cm (Group 1, n=44), 1.1-2 cm (Group 2, n=125) and 2.1-3 cm (Group 3, n=122). In addition to benign pathology results, normal testicular parenchyma surrounding the tumor in malignant testis cancer were investigated for the presence of intratubuler germ cell neoplasia (ITGCN) or malignant tumor. 112 of the pathology reports were re-evaluated by the pathologist in these centers.Results: Mean patient age was 32.3 (min 1, max 79). In patients who underwent radical inguinal orchiectomy, at non-tumoral testis parenchyma, ITGHN detection rate was found significantly lower in Group 1 (20%) than Group 2 (42.4%) and Group 3 (41.5%) (p=0,031 and p=0,034, respectively). For the patients whose pathological reports were re-evaluated, ITGHN rate at the non-tumor testis parenchyma at first pathologic examination was 48%. After second pathologic examination this rate was found as 55%. ITGHN rate was higher in second examination but it was not statistically significant (p=0.285). In all patients, benign tumor detection rate was found significantly higher for 2 cm or smaller tumors.Conclusion: In carefully selected patients, testis sparing surgery can be performed for small testicular masses by complying general rules.Key Words: Testis tumors; Partial orchiectomy; testis sparing surgery; tumor size. 73

Abdullah Erdem Canda,1 Ali Fuat Atmaca,1 Muhammed Ersagun Arslan,2 Murat Keske,2 Ozer Ural Cakici,2 Serdar Cakmak,2 Davut Kamaci,2 Emre Urer21Department of Urology, School of Medicine, Ankara Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey; 2Department of Urology, Ankara Ataturk Training and Research Hospital, Ankara, TurkeyAbstract: Open radical cystectomy (RC) is the gold standard surgical approach in the management of muscle invasive bladder cancer in addition to high-grade, recurrent, noninvasive tumors. With the development of surgical robotic technology, robotic-assisted laparoscopic radical cystectomy (RARC) is increasingly being performed as a minimally invasive surgical approach. A learning curve exists with a recommended case number of at least 20 RARC procedures in order to achieve satisfying outcomes in terms of operation time, complication rate, and oncological outcomes, including positive surgical margins (SMs) and lymph node (LN) yield. In the current literature, long-term outcomes of RARC are not yet available. Due to the outcomes of the published literature, RARC seems to have satisfactory oncologic and functional outcomes in addition to acceptable complication rates. Intraoperative blood loss and transfusion rates seem to be decreased in RARC series when compared to open approaches. On the other hand, a number of authors have reported decreased complication rates but increased operation time in the robotic approach. Similar oncologic results including positive SM rates and LN yields were detected in most comparative publications. Totally intracorporeal RARC with urinary diversion is a complex procedure and the number of centers performing this type of surgery is currently very limited. Although, it is still too early to make strict conclusions about RARC, RARC with intracorporeal urinary diversion has the potential to be the future of robotic bladder cancer surgery. Therefore, further prospective and randomized studies with increased numbers of patients and with longer follow-up are needed. Lastly, RARC may be related to increased cost when compared to open surgery, although controversial reports exist about this issue.Keywords: intracorporeal urinary diversion, outcomes, open versus robotic, robotic surgery

İntroduction: Mondor, first described a sclerosing thrombophlebitis of the veins of the anterior chest wall in 1938. Despite the etiology is unknown in most cases, various authors have proposed some new etiologies indicating trauma during sexual intercourse as causative factors. In this case report, it has been aimed to remind the thrombophlebitis of the superficial dorsal vein of the penis. Case report: A 36 years old patient with Mondor's disease, was treated with heparin pomades and limiting of sexual intercourse successfully. Discussion: Superficial penile dorsal vein trombosis is a benign pathology and it is not associated with any systemic and malign disorders. Diagnosis depends on a detailed patient history and physical examinatiton. Thus Mondor's Disease is self limited, it is thought that many of the patients with this disease are healed without applying to a hospital., Giriş: Yüzeyel venlerin trombozu, ilk kez Mondor tarafından 1938'de göğüs duvarında tanımlanmıştır. Mondor Hastalığı'nda çoğu kez etyoloji bilinmemekle beraber, cinsel ilişki sırasında peniste oluşan travma sorumlu gösterilmektedir. Bu olgu sunumunda, penisin yüzeyel dorsal veninin tromboflebitinin tekrar hatırlatılması amaçlanmıştır. Olgu sunumu: Polikliniğimize başvuran ve Mondor hastalığı tespit edilen 36 yaşındaki erkek hasta heparin içeren jel ve cinsel ilişki kısıtlanması ile başarılı bir şekilde tedavi edildi. Tartışma: Yüzeyel penil dorsal ven trombozu benign bir patoloji olup, sistemik ve malign hastalıklarla hastalıklarla bir ilişkisi bulunmamaktadır. İyi bir anamnez ve fizik muayene ile kolayca teşhis edilebilen bir hastalıktır. Kendi kendini sınırlayan bir hastalık olması nedeniyle, Penisin Mondor Hastalığı gelişen birçok hastanın polikliniğe başvurmadan iyileştiği düşünülmektedir.

Amaç: Monopolar transüretral prostatektomi TURP ’de 120 watt ve 160 watt enerji kullanımının, ereksiyon üzerine olan etkilerini incelemeyi amaçladık. Gereç ve Yöntemler: Benign Prostat Hiperplazisi BPH nedeniyle monopolar TURP yapılan, cinsel yönden aktif 47 hasta, kesme için kullanılan enerji miktarına göre 120 watt n=21 ve 160 watt n=26 , gruplarına randomize edildi. Hastalar, preoperatif ve postoperatif 3. ayda, IIEF-5 ve IIEF-15 sorgulama formları ile cinsel disfonksiyon yönünden değerlendirildi. Bulgular: Hastaların yaş ortalaması, sırasıyla 120 watt grubunda 64.2±5.3, 160 watt grubunda ise 62.7±0.9 yıl idi. TURP sonrasında her 2 gruptaki hastaların işeme parametreleri, istatistiksel olarak anlamlı düzelme gösterdi. Bununla beraber, TURP sonrası 3. ayda, her 2 gruptaki hastaların IIEF-5 ve IIEF-15 skorları, ameliyat öncesi döneme göre anlamlı olarak azaldı. Sonuçlar: Monopolar TURP sonrası IIEF5 ve 15 skorları, kullanılan enerji miktarından bağımsız olarak 3. ayda azalmakla beraber, BPH tedavisinde etkin bir yöntem olan TURP’nin, erektil disfonksiyon oluşturup oluşturmadığı halen tartışmalı bir konudur., Objective: We aimed to analyze the effect of 120 watt and 160 watt energy on erectile function used during monopolar transurethral prostatectomy TURP . Material and Methods: A total of sexually active 47 male patients, undergoing monopolar TURP because of Benign Prostatic Hyperplasia BPH , were randomised into 120 watt n=21 , and 160 watt n=26 groups, in terms of the amount of energy used for prostatic tissue cutting. The patients were evaluated with IIEF-5 and IIEF-15 questionnaires, preoperatively and in the postoperative 3rd month concerning erectile function. Results: The mean age of the patients was 64.2±5.3 and 62.7±0.9 years, in the 120 watt and 160 watt groups respectively. The voiding parameters showed statistically significantly improvement in both groups after TURP. Nevertheless, 3 months after the TURP, IIEF-5 and IIEF-15 scores of the patients decreased significantly in both groups compared with the preoperative period. Conclusions: Although, in the 3rd month evaluation after monopolar TURP, IIEF-5 and IIEF-15 scores of the patients decrease, regardless of the amount of energy used, it is still a debated issue, whether TURP causes erectile dysfunction as an effective treatment option for BPH

Objective: this study presents the surgical, oncological, and functional outcomes of the first 93 robotic radical prostatectomy (RARP) procedures performed in Erzurum, Turkey. These procedures were performed by a single surgeon who had completed the European Association of Urology Robotic Urology Section (ERUS) RA RP curriculum in an ERUS-certified training center in Ankara. Material and methods: The study present the results of 93 RARP procedures performed by a single surgeon. The surgeon performing the operations completed an ERUS training program structured for RARP by two robotic surgeons holding ERUS training certificates in an ERUS-approved academic robotic surgery training center in Ankara.The RARP cases performed by the surgeon after completion of the training between April 2016 and August 2018 were retrospectively evaluated. Results: the mean patient age was 63.62 +/- 7.04 years, and the mean preoperative serum prostate-specific antigen level was 8.34 +/- 496 ng/mL. Preoperatively, 82 and 4 patients had prostate biopsy Gleason scores of 3+3 and 4+3, respectively. Bilateral neurovascular bundle (NVB) sparing, unilateral NVB-sparing, and non-NVB-sparing surgery were performed in 21, 13, and 59 cases, respectively. The mean prostate weight was 85.34 +/- 47.57 g Posterior rhabdosphincter reconstruction was performed in 60 (64.5%) cases. Mean console time, intraoperative blood loss, duration of hospital stay, and urethral catheter removal time were 170.49 +/- 36.50 min, 100.70 +/- 34.08 cc, 6.84 +/- 2.28 days, and 7.40 +/- 3.11 days, respectively. During the perioperative period (0-30 days), five minor (prolonged drain output, n=3; rectocele, n=1; gout arthritis, n=1) and six major (inguinal hernia, n=1; incisional hernia, n=2; anastomotic urinary leakage, n=2; myocardial infarction, n=1) complications were identified. No complication was detected during postoperative days 31-90. Postoperative pathological stages included pT'2a, pT2b, and pT2c disease in 77 (82.8%), 9 (9.7%), and 7 (7.5%) patients, respectively. The positive surgical margin (SM) rate was 10.7% (n=10), including patients with pT2a (n=6) and pT2c (n=2) diseases. Eleven (11.8%) patients underwent pelvic lymph node (LN) dissection. The mean LN yield was 16.45 +/- 429. The mean length of follow-up was 11.17 +/- 8.01 months. Biochemical recurrence was observed in two patients, one of whom received maximal androgen blockage (MAB), and the other one received pelvic radiotherapy+MAB. All the patients with at least one-year follow-up (n=48, 51.6%) were fully continent (0 pads/day). Of the 40 (43%) patients with no preoperative erectile dysfunction (ED) and with at least three-month follow-up, 18 (45%) had no ED, with or without any additional medication including phosphodiesterase-5 (PDES) inhibitors. Conclusion: RARP is a safe minimally invasive procedure with acceptable morbidity, excellent operative, pathological and oncological outcomes, and satisfactory functional results. The ERUS RARP curriculum provides effective and sufficient training., NA

Introduction: we present oncological and functional outcomes of patients who underwent testis-sparing surgery (TSS). Methods: overall, 13 patients were included. Mean patient age was 29.9 +/- 12.5 years. In five patients, TSS was performed for sequential bilateral testicular tumours. One patient underwent concurrent left radical orchiectomy and right TSS. In eight patients with normal contralateral testis, seven underwent left and one underwent right TSS. Results: mean pathological tumour size was 14.6 +/- 12.5 mm. lntraoperative frozen section evaluation of the mass was performed in eight patients that revealed benign lesions. No intraoperative tumour bed biopsies were taken in this patient group. Regarding the remaining five patients, intraoperative tumour bed biopsies were taken and testicular intraepithelial neoplasia (TIN) was reported in two (40%) patients; no local testicular radiotherapy was given postoperatively. Tumour pathology was malignant in all but one lesion, including Leydig cell tumour (n=1), seminoma(n=2), embryonal carcinoma (n=1), and adenomatoid tumour (n=1). During 47.2 +/- 22.5 months of followup, local recurrence was detected in one patient who underwent radical orchiectomy. No additional local recurrence or systemic metastasis was identified in other patients with malignant lesions. For patients with malignant tumours, of the three patients with a normal preoperative testosterone levels, testosterone level was normal in one patient (with no erectile dysfunction [ED]) and was decreased in two patients (with ED) following TSS. No ED was reported in the nine patients with benign lesions. Conclusions: in carefully selected cases, TSS appears to be a safe, feasible procedure with adequate cancer control that could preserve sexual function., NA