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Objective:The objective of this study is to investigate the results of contraction- and relaxation-based biofeedback (BF) in children with lower urinary tract dysfunction (LUTD).Materials and Methods:Between 2007 and 2017, we randomly directed children with the diagnosis of LUTD and refractory to standard urotherapy modifications via BF by using two different animations: animation A with relaxation nature BF (RBF) and animation B with contraction nature BF (CBF). The categories of non-response, partial response, and full response were defined as a 0-49% decrease, 50-99% decrease, and 100% decrease in the LUTD Symptom score, respectively. Results of biofeedback using RBF or CBF were compared.Results:There were 100 and 70 children in the RBF and CBF groups, respectively. Patients with an abnormal voiding pattern (abnormalVP) and a positive electromyography (EMG) activity (positive EMG) had a better resolution with RBF (p=0.001), whereas patients with abnormalVP and a negative EMG activity (negative EMG) had a better resolution with CBF (p=0.039). Despite being statistically insignificant, patients with a normal voiding pattern (normalVP) and positive EMG had a better resolution with CBF (p=0.452), whereas patients with normalVP and negative EMG had a better resolution with RBF (p=0.083).Conclusion:The EMG activity identifies the BF nature in children with LUTD and abnormalVP. Importantly, positive EMG had better results with RBF, whereas negative EMG had better results with CBF.

Objective: Benign prostatic hyperplasia is one of the biggest problems of aging men. Prostate surgery is now well defined in the case of failure of medical therapy. Robotic simple prostatectomy is a minimally invasive surgical method with an alternative to open simple prostatectomy in large prostate volumes. We present our simple prostatectomy technique with robot, perioperative, and short-term functional result in our clinic. Material and methods: Between January 2017 and January 2021, 42 patients underwent simple robotic prostatectomy were retrospectively evaluated. Preoperative, perioperative, and post-operative clinical data were analyzed. Post-operative continence status, voiding, and erectile functions were evaluated using uroflowmetry and international prostate symptom score (IPSS) at sixth week and third month. Results: The mean age of the patients was 71 (66–78) years. No major complications were observed in any of the patients. Urethral catheters were removed on the fourth post-operative day. Except for one case, all of the cases urinated spontaneously after the catheter was removed. One case could not urinate spontaneously, and urethral catheter was placed again. Three days later, the urethral catheter was removed, and patient urinated spontaneously. None of the patients reported stress urinary incontinence or erectile dysfunction. The mean operative time was 112 minutes, the mean hospital stay was 1.6 days, the mean post-operative IPSS was 6, and the mean post-operative Q max was 24.4 mL s(−1). Conclusion: Robotic simple prostatectomy may be an effective and safe alternative minimally invasive technique in the treatment of large-volume benign prostatic hyperplasia.

Prostate or bladder metastases of malignant melanoma (MM) are rarely encountered in clinical practice. To our knowledge, coexistence of prostate and bladder metastasis of MM has not been reported to date. We present the case of a 58-year-old male who was diagnosed with MM of the umbilical skin 2.5 years earlier and who presented to us with intermittent painless macroscopic hematuria and lower urinary tract symptoms. The prostate and bladder lesions were removed as completely as possible by transurethral resection. Pathological examination demonstrated simultaneous prostate and bladder metastases of MM.

OBJECTIVE: We have reviewed the data of the patients in order to evaluate the effectiveness of our ureterocystoplasty technique in augmentation cystoplasty operation. MATERIAL AND METHODS: Data of a total of 16 patients with bilateral functional kidneys who had undergone augmentation ureterocystoplasty between January 1995 and June 2018 which were retrieved during the retrospective archive scanning were included in the study. Ultrasonography (USG), serum blood urea nitrogen and creatinine values and Technetium-99 DTPA (Tc-99 DTPA) scan were used to evaluate the renal function of the patients. Intravenous pyelography (IVP) and USG were used to evaluate the ureters before surgery. Magnetic resonance (MR) urographies were performed in our center. RESULTS: Of the total 16 patients, 10 were male and 6 were female, while ages ranged from 1 to 24 years. Among 16 patients, the most common cause of neurogenic bladder etiology was meningomyelocele. In the urodynamic studies performed before the operation, it was determined that the bladder capacities of the patients were between 40–180 mL and the bladder compliances were 1.0–4.0 cc/cmH(2)O. At postoperative 3(rd) months, it was determined that the bladder capacities of the patients were between 180–330 mL and the bladder compliances were between 6.0–24.0 cc/cmH(2)O. CONCLUSION: Augmentation ureterocystoplasty seems to be an appropriate technique in which successful results are obtained with appropriate patient selection. Besides, complications that may occur due to use of ileal segment are avoided.

Background: To report the first case of the spontaneous appendicovesical fistulas' (AVF) repair with robot assisted laparoscopy. Case Presentation: A 29-year-old male patient with urgent persistant bacteriuria and dysuria was referred to our clinic. Physical examination and blood tests were normal. He had used various antibiotics due to recurrent UTI for about 20 years. Computed tomography revealed the fistula tract between the distal end of the appendix and right lateral wall of the bladder dome. He was successfully treated with robot-assisted laparoscopic repair. Following this surgery, the patient's complaints were resolved completely. Conclusion: AVF is the rare condition. Robot-assisted laparoscopy repair of AVF is safe and effective treatment option.

Introduction: We aimed to evaluate whether or not mitomycin-C (MMC) has an antifibrotic effect on transforming growth factor-beta (TGF-β)-induced Peyronie’s disease (PD) in a rat model.Methods: Eighteen 12-week-old male Sprague-Dawley rats were divided into three groups: Group 1=TGF-β1 (n=7); Group 2=TGF-β1+MMC (n=7); and Group 3=Sham group (0.25 ml bovine serum albumin injected) (n=4). All groups were sacrificed on the sixth week of the procedure and their penises were excised. All penis specimens were evaluated semi-quantitatively and quantitatively with histochemical, immunohistochemistry, and image analysis.Results: Both Group 1 and Group 2 had significantly higher fibrosis scores and lower elastic fibers in both outer surface of tunica albuginea (TA) and subsinusoidal area compared with Group 3. When compared with Group 1, the amount of collagen was significantly decreased in Group 2. Intracavernosal MMC injection (Group 2) ended up with lower elastic fibers when compared with Group 1. According to the quantitative analyses, when compared with Groups 1 and 3, lower dorsal, ventral, and trabecular thickening values were seen in Group 2. These parameters were only statistically significant when compared with Group 1, suggesting the antifibrotic effect of TGF-β1-induced fibrosis. Both Groups 1 and 2 showed lower decorin staining levels in subsinusoidal areas of tunica albuginea (SATA) and subsinusoidal areas of trabecular wall (SATW) when compared with Group 3. The statistically significant difference was only detected between Group 1 and Group 3.Conclusions: Our study demonstrates the antifibrotic effects of MMC on PD. Further clinical studies are necessary to make inferences regarding its clinical use.

Introduction: Our goal was to evaluate benign and malignant lesions and testicular intraepithelial neoplasia (TIN) in the neighbouring normal- appearing testis tissue in men who underwent radical orchiectomy for testicular mass with a pathologic tumour size of ≤3cm.Methods: In this retrospective, multicentre study, data of 252 patients from 11 different institutions were included. Patients were divided into three groups based on tumour size: Group 1 (0‒1 cm; n=35), Group 2 (1.1‒2 cm; n=99), and Group 3 (2.1‒3 cm; n=118). Benign lesions and TIN were sought in the neighbouring testicular tissue and compared between groups.Results: Mean patient age was 32.3 years. Benign lesions were reported in 54.3%, 33.3%, and 14.4% of Groups 1, 2, and 3, respectively (p0.05 for Groups 2 vs. 3). Multifocality was detected in 8.6%, 4%, and 0% of Groups 1, 2, and 3, respectively (p0.05 for Group 1 vs. Group 2). A tumour cutoff size of 1.5 cm was found to be significant for detecting benign tumour. TIN and multifocality rates were similar in patients with a tumour size of ≤1.5 vs.>1.5 cm (p>0.05).Conclusions: Benign lesions and TIN in the neighbouring testis were significantly decreased and multifocality was increased in patients with a tumour mass size of ≤1 cm. Testis-sparing surgery should be performed with caution and a safety rim of normal tissue should also be excised.

Aim: Robotic assisted laparoscopic partial nephrectomy (RALPN) is promising option for RCC treatment with favorable outcomes. In this present study we aimed to compare the incidence of (AKI) acute kidney injury measured by AKIN (Acute Kidney Injury Network) criteria between open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN) and RALPN procedures with zero ischemia periods. Material and Methods: The medical records of 88 patients with renal mass who underwent OPN, LPN and RALPN at our institution [24 female/64 male; median age of 55 (IQR: 46–65) years] were evaluated retrospectively. AKI was defined by AKIN criteria. Results: Twenty-six patients underwent OPN, 32 LPN and 30 patients RALPN. Mean preoperative creatinine was 0.92 ±0.43 mg/dl, mean hemoglobin level was 14.0±1.9 g/dl. Total of 19 patients developed AKI according to the AKIN criteria, all of those had stage 1 AKI, 10 (53%) in OPN, 7 (3%) in LPN and 2 (11%) in RALPN group (p=0,004). Multivariate regression analysis adjusted by age and gender showed that operation time per minute [1.02 (CI 95%, 1.00, 1.04) p=0.04], fluid administered as ml/kg/hour [1.003 (CI 95%, 1.000, 1.006) p=0.04], red blood cell transfused as unit [1.27 (CI 95%, 1.07, 1.52) p=0.006] and operation type as RALPN surgery versus OPN and LPN [0.11 (CI 95%, 0.02, 0.58) p=0.01] were significantly associated with development if AKI.Conclusion: Robot assisted partial nephrectomy is more favorable approach compared to OPN and LPN with lower operation time and lower hemoglobin loss.

OBJECTIVE: To determine a paradigm that will be helpful for urologists to manage fibrous pseudotumors, which are a very rare condition of the testis. MATERIAL AND METHODS: We retrospectively evaluated the patients with fibrous pseudotumors in our uropathological database from 1995 to 2013. Patients who had tumor markers and ultrosonography (USG) screening before surgery and a final pathology report of a fibrous pseudotumor were included in the study. RESULTS: In total, 838 patients with a testis mass were evaluated. Only 6 of these patients met the inclusion criteria. The mean age was 34 years (min: 20, max: 72). Serum tumor markers were in the normal range for all patients. The scrotal tumors were not clearly related to the testis parenchyma, and the radiologists could not definitively determine the nature of the masses (benign or malignant). A concomitant hydrocele was detected in 2 patients. After inguinal exploration, radical orchiectomy was performed in one patient with an ipsilateral atrophic testis, and biopsies were taken from the lesions for frozen section analysis in the other 5 patients. Pathologists reported benign tumors for all of these patients based on the frozen sections, and testicular sparing surgery was then performed in these 5 patients. CONCLUSION: If scrotal tumors are detected by ultrasonography in patients with normal tumor markers, and the tumor cannot be clear distinguished from the testis, these patients might have a fibrous pseudotumor, and organ-sparing surgery can be performed on these patients.

OBJECTIVE Robotic surgery is a leading treatment option for minimally invasive surgery and has an increasing popularity in pediatric population, as well. In this article, we reported our case series of robot-assisted laparoscopic surgery in pediatric population. MATERIAL AND METHODS We retrospectively reviewed 29 consecutive pediatric patients who underwent robot- assisted procedures between May 2014 and October 2016. Patient demographics, hospitalization time, estimated blood loss, robotic time and total operative and peri-, and post-operative complications were evaluated. RESULTS A total of 24 ureter units (18 patients) with grade 1-5 vesicoureteral reflux in 13 female and 5 male, 1 male patient with vesicoureteral stenosis were underwent robot- assisted laparoscopic ureteral reimplantation (RALUR). All patients had complete resolution after surgery. Robot-assisted laparoscopic pyeloplasty (RALP) was performed in 6 patients with ureteropelvic junction obstruction. All patients had complete resolution after surgery. Completely intracorporeal robotic assisted laparoscopic augmentation ileocystoplasty (RLAIC) was applied to two patients with neurogenic bladder. The symptoms and preoperative hydronephrosis were regressed on the first month of follow-up. Robot-assisted laparoscopic reduction cystoplasty (RALRC) was performed in 14-year-old boy with a bladder diverticula and recurrent urinary tract infection. The last case was eleven- year-old female patient with non-functioning kidney. She had recurrent urinary tract infections and was treated with robotic assisted laparoscopic nephrectomy (RALN). CONCLUSION Robot-assisted laparoscopic surgery is safe and efficient in pediatric population. Although open surgery is still the gold standard for many pediatric diseases, inherent reconstructive advantages of robotic assisted laparoscopy have a chance to change this view.

Introduction: Symptom Scales (SS) are questionnaires for evaluating and following up of special illnesses. SS used for the diagnosis and follow-up of Lower Urinary Tract Dysfunction (LUTD) in children is called LUTD Symptom Scale (LUTDSS). Aim: Aim of the present study was to identify the questions which are more important for the diagnosis of LUTD in children and create a simpler SS. Materials and Methods: From January 2005 to March 2015, 631 children between the age 5 and 15 were enrolled in this study. Eleven children with active urinary tract infections were excluded from the study. Two hundred sixty three children from the nursery and secondary school saying that they have no urinary complaints and having LUTDSS

Skrotumda yer almayan testis icin kriptorsidizm terimi kullanilir. Kriptorsid testisler ya yoktur veya inmemistir. Kriptorsidizm, konjenital hastaliklari olan bebeklerde daha sik gorulur ve en sik inmemis testis seklinde karsimiza cikar. Miadinda dogan erkek bebeklerin %2 ile %5\'inde ve erken dogan bebeklerin ise %30\'unda inmemis testis bulunmaktadir. Inmemis testislerin yaklasik olarak %10\'u cift tarafli olup en sik bulundugu bolge eksternal inguinal halkanin hemen agzidir. Inmemis testise en sik eslik eden bozukluk inguinal herni olup, olusumunda temel etken prosesus vajinalisin (PV) acik kalmasidir. Primer inguinal herni, tum yenidoganlarin yaklasik olarak %1 ile %5\'inde gorulur ve bu oran prematur dogan bebeklerde %9 ile %11\'e kadar yukselir. Fitigi olan bebeklerde genellikle semptom yoktur ve tedavi gerekiyorsa cerrahi islem uygulanmalidir. Inkarsere veya strangule olan kasik fitigi icin acil ameliyat gerektiginde, es zamanli inmemis testis de eslik ediyorsa orsiyopeksi yapilmalidir. Ayrica rutin orsiyopeksi yapiliyor ve inguinal herni de mevcutsa es zamanli herni tamiri de yapilmalidir. Tedavi edilmeyen inmemis testise eslik eden bilinmeyen inguinal herniler, ilerleyen zamanda sikisarak veya bogularak semptomatik hale gelebilirler. Kriptorsidik hastalarda gorulen herni orani tartismali bir konu olup degisik serilerde degisik yuzdeler bildirilmistir. Yaptigimiz literatur taramasinda inmemis testisli hastalara eslik eden PV acikligi ve inguinal herni oranlarinin sirasiyla % 50 ve % 20 dolayinda oldugunu gorduk.

Objective: The aim of this study is to compare the effect timolol/brinzolomid fixed-combination drugs on intraocular pressure. Materials and Methods: This is a retrospective study. The primary open angle glaucoma patients that were switched to fixed-combination drugs due to high intraocular pressure despite monotherapy were included to the study. The intraocular pressure records of 4.week and 4.month were compared. Results: The baseline intraocular pressure levels were timolol/dorzolamid group and 23,1±2,8 (17-28 mmHg) in timolol/brinzolamid group. After 4.weeks of combination treatment intraocular pressure levels were 15,3 ±2,3 mmHg (1120mmHg) in timolol/ dorzolomid and 15,8±2,7(1119mmHg) in timolol/brinzolomid. After 4.nmonths of combination treatment intraocular pressure levels were 15,8±3,1 (11-21mmHg) in timolol/dorzolamid group timolol/brinzolomid group. There statistically significant difference between the groups. Conclusion: Both fixed combination drugs decreased the intraocular pressure successfully but there was no statistically significant difference between intraocular pressure levels at 4.week and 4.month. Key dorzolamid, Amaç: Bu çalışmanın amacı timolol/dorzolamid vetimolol/brinzolamid sabit kombinasyon ilaçlarınıngöz içi basıncı üzerine etkisini karşılaştırmaktır.Gereç ve Yöntem: Bu retrospektif bir çalışmadır.Monoterapiye rağmen intraoküler basıncı yüksekolan ve kombinasyon tedavisine geçilen primer açıkaçılı glokom hastaları çalışmaya dahil edildi. .Toplam 50 hastanın 50 gözü çalışmaya alınmıştır(timolol /dorzolamid grubunda 26, timolol/brinzolamid grubunda 24 hasta). İridokorneal açıdasineşi olmayan, hikayesinde başka herhangi bir gözhastalığı olan veya herhangi bir göz ameliyatıgeçiren hastalar çalışmaya dahil edilmemiştir.Kaydedilmiş olan 4.hafta ve 4.ay göz içi basınçdeğerleri karşılaştırıldı.Bulgular: Bazal intraoküler basınç değeritimolol/dorzolamid grubunda 23,2±3,3 (17-28mmHg), timolol/brinzolamid grubunda ise 23,1±2,8(17-28 mmHg) olarak bulundu. 4.hafta sonundaelde edilen intraoküler basınç değerleri timolol/dorzolomid grubunda 15,3 ±2,3 (11-20mmHg),timolol/brinzolomid grubunda ise 15,8±2,7(11-19mmHg) idi. Bu değerler arasında istatistikselolarak anlamlı fark bulunamadı. 4.ay sonunda eldeedilen İOB değerleri timolol/dorzolamid grubunda15,8±3,1 (11-21mmHg), timolol/brinzolomidgrubunda ise 16,1±2,8 (12-22mmHg) olarakbulundu. Bu değerler arasında istatistiksel olarakanlamlı fark bulunamadı.Sonuç: Her iki ilaçta intraoküler basıncı başarılı birşekilde düşürmüştür fakat 4.hafta ve 4.ay değerleriarasında istatistiksel olarak anlamlı bir fark yoktur.Anahtar Kelimeler: Timolol/Brinzolomid,Timolol/Dorzolomid, Göz Tansiyonu

A 21-y-old man applied to hospital with a complaint of erectile dysfunction, which started soon after a gunshot injury. The entry of the bullet was at the middle right gluteal region without any exit hole. A pelvic X-ray revealed the bullet and the scattered particles. On penile Doppler ultrasonography, the peak systolic velocities (PCV) of the right and the left cavernosal arteries were 19 and 29 cm/s, respectively. Pudendal angiography revealed poor visualization of the right pudendal artery below the level of the bullet. The patient underwent a right-sided Alcock's canal releasing surgery. After the operation, on control penile Doppler ultrasonography, PCV on the right and the left cavernosal arteries were 53 and 35 cm/s, respectively. The control angiography revealed a normal right pudendal artery. The patient was fully potent 2 y after the operation. Not only the entrapment of pudendal nerve but also the pudendal artery may cause Pudendal canal syndrome. A gunshot injury may cause such a condition due to the reaction caused by the bullet. Pudendal canal decompression is a simple and effective treatment for pudendal canal syndrome.

Urinary tract infection (UTI) is the most commonly diagnosed bacterial infections of child‐ hood, and have a significant healthcare impact. Renal parenchymal infection and scarring are well-established complications of UTI in children and can lead to renal insufficiency, hy‐ pertension and renal failure. Although frequently encountered and well researched, diagno‐ sis and management of UTI continue to be a controversial issue with many challenges for the clinician [1].

Urinary tract infection (UTI) is the most commonly diagnosed bacterial infection of childhood, and has a significant healthcare impact. Renal parenchymal infection and scarring are well-established complications of UTI in children and can lead to renal insufficiency, hypertension and renal failure. Although frequently encountered and well researched, diagnosis and management of UTI continue to be a controversial issue with many challenges for the clinician. The evolving state of knowledge about pediatric UTI leaves many questions and controversies. The goal of this chapter is to provide an up-to-date summary of the literature with particular attention to practical questions about diagnosis and management for the clinician. This chapter reviews also recent evidence regarding the epidemiology and evaluation of children with UTI.

This study addresses the diagnostic value of the Nuclear Matrix Protein 22 (NMP22) test and the Urinary Bladder Cancer (UBC II) test, in comparison to bladder wash cytology for the detection of early recurrence of bladder cancer. Patients with transitional cell carcinoma of the bladder (TCC, n = 60) and patients with benign urological diseases (n = 30) were included in this study. Voided urine samples were divided into 2 aliquots: aliquot 1 was assayed for NMP22 and aliquot 2 was tested for UBC II. Saline bladder washings were used for cytologic examination. Urine samples from TCC patients were collected before transurethral resection and on postoperative day 10. On day 10, 15 NMP22 results and 7 UBC II results exceeded the normal ranges; 4 of the cytology samples were positive for malignancy. Based on cystoscopic findings at 3 mo post-resection, 21 of the cases were classified as early recurrence; 11 of the early recurrences had been in the elevated NMP22 group, 4 in the elevated UBC II group, and 3 in the positive cytology group at 10 days post-resection. The NMP22 test gave the highest sensitivity for detecting early recurrent tumors (11 of 21, 52%). Such high sensitivity did not occur with the UBC II test (4 of 21, 19%) or cytology (3 of 21, 14%). These differences were significant (p = 0.024 and 0.009, respectively). Thus, the NMP22 test showed superiority over the other tests for detection of early recurrence of bladder cancer.

Bladder hemangiomas are exceedingly rare benign tumors of the urinary bladder that account for 0.6% of bladder tumors [1]. Although this tumor can occur at any age, hemangioma in childhood is relatively rare [2]. Hemangiomas are classified as cavernous, capillary, or arteriovenous. Most hemangiomas of the bladder are of the cavernous type. In the literature arteriovenous hemangiomas have been described only in adults [3]. We report a case of arteriovenous hemangioma of the urinary bladder in a 14-year-old young boy. To our knowledge, this is the first reported case of an arteriovenous hemangioma in a child causing macroscopic hematuria.