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To assess outcomes of pre-stenting versus non-pre-stenting in children undergoing retrograde intrarenal surgery (RIRS) for intrarenal stones.Children/adolescent with kidney stones undergoing RIRS in 9 centers between 2015 and 2020 were retrospectively reviewed.ureteral lithotripsy, bilateral procedures. Stone-free status was evaluated at 3-month and defined as a single residual fragment (RF) ≤2 mm/absence of multiple fragments. Patients were divided into two groups (Group 1 no-prestenting; Group 2 prestenting). Student's, Chi-square and Fisher's exact test was used to assess difference between groups. Univariable and multivariable logistic regression analysis were performed to predict RF. Statistical significance: P-value0.05.Three hundred eighty-nine children/adolescents were included (192 patients in Group 1). Prestented patients were younger compared with non-prestented (mean age 8.30 ± 4.93 vs 10.43 ± 4.30 years, P0.001). There were no differences in stone characteristics (number, size, locations). Lasing and total surgical time were similar. Urinary tract infections were more prevalent in Group 2 (10.7%) compared to Group 1 (3.7%, P = 0.016). Sepsis occurred in 2.1% of patients in Group 2 and no patient in Group 1 (P = 0.146). 30.7% patients in Group 1 and 26.4% in Group 2 had RF (P = 0.322). In univariate logistic regression analysis, stone size was associated with RF (OR 1.12 95%CI 1.06-1.18, P0.001), whereas Thulium fiber laser with a lower incidence (OR 0.24 95%CI 0.06-0.69, p=0.020). Multivariate logistic regression analysis showed that stone size was associated with RF (OR 1.20 95%CI 1.08-1.36, P = 0.001).RIRS showed similar stone-free rate in pre and non-prestented children/adolescents, although prestented patients were younger. A higher risk of post-operative infections was reported in prestented patients.

To assess the degree of psychological impact among surgical providers during the COVID-19 pandemic.The COVID-19 pandemic has extensively impacted global healthcare systems. We hypothesized that the degree of psychological impact would be higher for surgical providers deployed for COVID-19 work, certain surgical specialties, and for those who knew of someone diagnosed with, or who died, of COVID-19.We conducted a global web-based survey to investigate the psychological impact of COVID-19. The primary outcomes were the Depression Anxiety Stress Scale-21 (DASS-21) and Impact of Event Scale-Revised (IES-R) scores.4283 participants from 101 countries responded. 32.8%, 30.8%, 25.9% and 24.0% screened positive for depression, anxiety, stress and Post-Traumatic Stress Disorder (PTSD) respectively. Respondents who knew someone who died of COVID-19 were more likely to screen positive for depression, anxiety, stress and PTSD (OR 1.3, 1,6, 1.4, 1.7 respectively, all p0.05). Respondents who knew of someone diagnosed with COVID-19 were more likely to screen positive for depression, stress and PTSD (OR 1.2, 1.2 and 1.3 respectively, all p0.05). Surgical specialities that operated in the Head and Neck region had higher psychological distress among its surgeons. Deployment for COVID-19-related work was not associated with increased psychological distress.The COVID-19 pandemic may have a mental health legacy outlasting its course. The long-term impact of this ongoing traumatic event underscores the importance of longitudinal mental health care for healthcare personnel, with particular attention to those who know of someone diagnosed with, or who died of COVID-19.

Objective:To report the outcomes of percutaneous nephrolithotomy (PCNL) in horseshoe kidneys (HSK) in 12 institutions worldwide and evaluate the impact of patient position during operation. Methods:We carried out a retrospective analysis of PCNL procedures performed between 2008 and 2018 in patients with HSK. Pre-, peri-, and postoperative data were collected, and a subgroup analysis was performed according to patient position. Success was defined as an absence of >4-mm fragments. Values ofp < 0.05 were considered significant. Results:We analyzed 106 procedures. The transfusion, complication, and immediate success rates (ISRs) were 3.8%, 17.5%, and 54.7%, respectively. The final success rate (FSR) increased to 72.4% after a mean of 0.24 secondary procedures. Logistic regression showed that higher body mass index (BMI) and stone size were significantly associated with residual fragments >= 4 mm. Sixty-seven patients (63.2%) were treated in prone and 39 (36.8%) in supine position. The prone group had a significantly higher BMI than the supine group (30.1vs27.7,p = 0.024). The transfusion, complication, and ISRs between the prone and supine groups were 4.5%vs2.6% (p = 0.99), 16.9%vs18.4% (p = 0.99), and 52.5%vs69.2% (p = 0.151), respectively. Surgical time was significantly longer in the prone group (126.5vs100 minutes,p = 0.04). Upper pole was the preferred access in 80.3% of the prone group and 43.6% of the supine group (p < 0.001). The prone group had significantly more Clavien 2 complications than the supine (p = 0.013). The FSR in the prone and supine groups increased to 66.1% and 82.1% after 0.26 and 0.21 secondary procedures, respectively. No complications higher than Clavien 3 occurred. Conclusion:PCNL in patients with HSK is safe and effective with a low complication rate. Higher BMI and stone size negatively impacted outcomes. Supine PCNL may be an option for treating kidney stones in patients with HSK.

Surgical trauma due to vaginal wall incision to extract the specimen during transvaginal hybrid Natural-Orifices-Transluminal-Endoscopic-Surgery (NOTES) nephrectomy can result in sexual dysfunction and have traumatic psychological impacts. We evaluated the alteration of sexual functions in the postoperative period.Patients who underwent a transvaginal NOTES nephrectomy were prospectively enrolled. Patients and their partners were evaluated with the Golombok-Rust Inventory of Sexual Satisfaction (GRISS) questionnaire pre- and post-operatively. Surgical characteristics were recorded.Fifty-three patients (mean age: 52.72 ± 2.39 years; mean tumor size 4.77 ± 2.55 cm) were included. The total GRISS scores of all patients were similar in pre- and post-operative periods. Although females reported no change in the GRISS score, 60.4% of partners showed a drop in the total score. Non-communication and avoidance subdomains showed significant changes for females; males showed a significant change in avoidance, non-sensuality and dissatisfaction subdomains. Subgroup analyses showed that neither tumor stage nor nulliparous status did not affect total score changes for both genders. The trocar number and perioperative complication rates had no significant effects on total score changes.Sexual function can be affected after transvaginal NOTES nephrectomy and care should include a stringent approach to addressing sexual dysfunction. We support the transvaginal NOTES nephrectomy technique if adequate secondary measures to protect sexual function are taken.

© 2022 Editorial Office of Asian Journal of UrologyObjective: To scrutinize the definitions of minimal invasive surgical therapy (MIST) and to investigate urologists’ knowledge, attitude, and practices for benign prostatic obstruction surgeries. Methods: A 36-item survey was developed with a Delphi method. Questions on definitions of MIST and attitude and practices of benign prostatic obstruction surgeries were included. Urologists were invited globally to complete the online survey. Consensus was achieved when more than or equal to 70% responses were \"agree or strongly agree\" and less than or equal to 15% responses were \"disagree or strongly disagree\" (consensus agree), or when more than or equal to 70% responses were \"disagree or strongly disagree\" and less than or equal to 15% responses were \"agree or strongly agree\" (consensus disagree). Results: The top three qualities for defining MIST were minimal blood loss (n=466, 80.3%), fast post-operative recovery (n=431, 74.3%), and short hospital stay (n=425, 73.3%). The top three surgeries that were regarded as MIST were Urolift® (n=361, 62.2%), Rezum® (n=351, 60.5%), and endoscopic enucleation of the prostate (EEP) (n=332, 57.2%). Consensus in the knowledge section was achieved for the superiority of Urolift®, Rezum®, and iTIND® over transurethral resection of the prostate with regards to blood loss, recovery, day surgery feasibility, and post-operative continence. Consensus in the attitudes section was achieved for the superiority of Urolift®, Rezum®, and iTIND® over transurethral resection of the prostate with regards to blood loss, recovery, and day surgery feasibility. Consensus on both sections was achieved for EEP as the option with the better symptoms and flow improvement, lower retreatment rate, and better suitable for prostate more than 80 mL. Conclusion: Minimal blood loss, fast post-operative recovery, and short hospital stay were the most important qualities for defining MIST. Urolift®, Rezum®, and EEP were regarded as MIST by most urologists.

OBJECTIVE To analyze the trends and outcomes of retrograde intrarenal surgery for treatment of urolithiasis in anomalous kidneys in a large international multicenter series. MATERIALS AND METHODS We designed a multicentric retrospective study. Nineteen high-volume centers worldwide were included. Pre-, peri- and postoperative data were collected, and a subgroup analysis was performed according to renal anomaly. RESULTS We analyzed 414 procedures: 119 (28.7%) were horseshoe kidneys, 102 (24.6%) pelvic ectopic kidneys, 69 (16.7%) malrotated kidneys and 50 (12.1%) diverticular calculus. The average size (SD) of the stone was 13.9 (+/- 6) millimeters and 193 (46.6%) patients had a pre-operative stent. In 249 cases (60.1%) a disposable scope was used. A UAS (ureteral access sheath) was used in 373 (90%) patients. A Holmium laser was used in 391 (94.4%) patients. The average (SD) operating time was 65.3 (+/- 24.2) minutes. Hematuria, caliceal perforation and difficulty in stone localisation were mostly seen in diverticular stones and difficulty in UAS placement and lithotripsy in the cases of renal malrotation. The overall complication rate was 12%. Global stone-free rate was 79.2%. Residual fragments (RF) were significantly lesser in the pre-stented group (P

Background and Objectives: There is no consensus on an ideal abdominal entry in laparoscopic surgery; as such, we aimed to assess the feasibility of the fingertip technique for safe entry and the establishment of pneumoperitoneum in transperitoneal laparoscopic surgery. Methods: We prospectively assessed 96 consecutive patients who underwent laparoscopic transperitoneal surgery between December 2018 and September 2019. For all patients, pneumoperitoneum was performed using the fingertip technique, which we recently defined. The duration of time for initial entry, the occurrence of gas leakage, and the complications were evaluated. Results: The median duration of initial entry was 90 (75 – 145) seconds. Pneumoperitoneum was established on the first attempt in all patients. Some events were encountered at the time of implementation of the fingertip technique, such as subcutaneous minor bleeding (5.2%) and gas leakage (4.1%). These events were controlled with cauterization and suturing. There was no visceral or major vascular injury in any patient case. Conclusions: The fingertip technique is a fast, safe, and feasible method for establishing pneumoperitoneum in transperitoneal laparoscopic surgery.

Objective: This study aims to investigate the neurourological and urodynamic findings of children with cerebral palsy (CP) that referred for dorsal rhizotomy surgery (DRS). Materials and Methods: All children with CP who were scheduled for selective DRS were assessed with a detailed medical history, physical exam, urinalysis and urodynamic studies to assess bladder function and urinary problems. Urodynamic studies included filling and voiding cystometry, detrusor leak point pressure, external anal sphincter electromyography, flow rate and residual urine volume. All investigations and definitions relied on the standardisation of the International Continence Society. Results: Overall, 24 boys and 10 girls were evaluated. The mean age of boys, and girls and the study group was 6.6 (1.7-9.8), 6.5 (3.5-11.4) and 6.6 (1.7-11.4) years, respectively. The most common complaints of the study group were urinary incontinence (58.8\%), encopresis (32.4\%) and constipation (17.6\%) and 41.2\% of patients needed diapers due to these problems. Twenty-five per cent (n=5) of male patients had an undescended testis. The most common clinical conditions at urodynamics, were low bladder compliance (85.3\%), detrusor overactivity (67.6\%), hyposensitive bladder (52.6\%) and low bladder capacity (41.2\%). Conclusion: Upper motor neuron lesions, like CP, may present with various urodynamic findings. However, patients with CP are not routinely seen by urologists. Our findings revealed serious neurological problems in children referred for DRS. Therefore, every child with CP who has a DRS plan should undergo a detailed urological examination at least once before the procedure.

Introduction: This study aims to investigate the outcomes and complication rates of patients undergoing retrograde intrarenal surgery (RIRS) at the live surgery events organized as boutique course series. Materials and Methods: Eight RIRS courses were organized between November 2017 and February 2020. Data of 24 patients who were operated in the live surgery events (as LSE group) for renal stone were matched with the data of 24 substitute patients (as control group) who underwent regular RIRS on the same period at the same centers.. Results: Stone free status of groups was similar (88% in LSE and 79% in the control group; p=1). There was no significant difference in terms of complication and need for additional procedure rates, operation and fluoroscopy and hospitality times between the two groups (p=1, p=1, p=0.12, p=0.58 and p=0.94, respectively). Fifty-four % (13/24) of LSE operations were performed by guest surgeons. No statistically significant difference was found between the patients who operated by host and guest surgeons. However, the operation times of the operations performed by guest surgeons were longer than those performed by the host surgeons (96.5±28 and 66.5±30 minute, respectively, p=0.07). Conclusion: Our study is the first report on this area. RIRS live surgery can be performed with low complication and high stone-free rates without jeopardizing patient safety. If the surgeon is not familiar with the operating room set-up or staffs, the live surgery must performed by the host surgeon to avoid extended operating time.

Ongün, Şakir (Balikesir 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.

Objective: Clinical presentation of ureteral stones during pregnancy is generally with renal colic pain. The aim of this study is to present our experience in the management of renal colic during pregnancy in emergency settings. Materials and methods: 208 pregnant patients who presented to emergency department with renal colic pain and underwent ureteroscopy (URS) due to failed conservative therapy were enrolled in the study. Urinary tract stones were diagnosed either with ultrasound (US) examination or during URS. Laser lithotripsy and double J (DJ) stent placement were routinely done in all patients with ureteral stones. The incidence of infective complications and premature uterine contractions (PUC) due to URS were compared. Results: No stone was identified in 36.1% (n = 75) of patients with using US and diagnostic URS. Of the remaining 133 patients, 30 (22.6%) had no stone at US but stones were diagnosed during diagnostic URS. The type of anesthesia had no significant effect on PUC. An increased risk of sepsis and PUC was found in patients with fever at the initial presentation. Interestingly, PUC was more frequent in patients with lower serum magnesium levels. There was a significant correlation with time delay until the intervention and the risk of urosepsis and PUC, individually. Conclusions: Ureteroscopy is a safe option for evaluation of pregnant patients with unresolved renal colic. According to the current findings, timing of the operation is the most important factor affecting the septic risks and abortion threat. Surgical intervention with URS must be planned as soon as possible.

Objective To evaluate our experience in patients undergoing hybrid transvaginal natural orifices transluminal endoscopic surgery (NOTES) nephrectomy and evaluate the sexual functions in the postoperative period. Materials and Methods Prospective data of 71 patients with renal tumors who underwent hybrid NOTES radical nephrectomy in three different centers were collected from March 2010 to October 2015. Patient and surgical characteristics were recorded. Sexual function was evaluated using the Female Sexual Function Index questionnaire the day prior to the operation and 3 months after. Results The mean age, tumor size, and operation duration were 66.16 ± 11.21, 8.51 ± 3.31 cm, and 119.94 ± 21.38 minutes, respectively. Five patients were immediately reoperated due to bleeding from uterine veins. The complication risk increases significantly with increasing tumor size. Among the whole cohort, even the Female Sexual Function Index score differences are small; there is a statistically significant decrease in the postoperative period in all domains except sexual satisfaction. In fact, the patients reported unaltered sexual function after surgery and satisfaction with the result when asked directly. In subgroup analyses, in nulliparous patients (n = 60), arousal, sexual desire, orgasm, and satisfaction domains have no significant differences in pre- and postoperative periods. Conclusions Hybrid NOTES nephrectomy is a feasible, safe operation that can be performed for large renal tumors. Due to incisions in the vaginal wall for specimen retrieval, sexual function can be altered in the postoperative period. So patient selection, preoperative evaluation, and close follow-up are mandatory. With this in mind, we strongly support the use of hybrid transvaginal NOTES nephrectomy for large renal tumors especially in nulliparous patients.

Purpose The purpose of this study, is to find out the most accurate cut-off level for the detrusor leak point pressure (DLPP) in terms of upper urinary tract (UUT) protection in a cohort of children with myelodysplasia. Materials and methods One hundred and ninety-three children with myelodysplasia were included in the study based on the availability of urological evaluation at age of 3 years. Children were assigned to one of two groups-those who had UUT damage at age 3 (group 1, n: 70) and those without UUT changes (group 2, n: 123), and compared. Results Urological follow-up data revealed higher incidences of febrile urinary tract infections and secondary tethering of the spinal cord in group 1. No statistically significant difference was determined between group 1 and group 2 in terms of DLPP values (median 42.5 vs. 39.5 cm H2 O, respectively, P = 0.087). Analysis of different cut-off values showed that DLPP above 20 cm H2 O had a higher sensitivity for UUT damage (91.4%). A normal UUT was found in 56.5% and 62.2% of children with DLPP between 20 and 40 cm H2 O, and with DLPP over 40 cm H2 O, respectively. Conclusions Present study showed that more than half of the children with myelodysplasia had normal UUT function even with a DLPP of 40 cm H2 O and over. Thus, DLPP, is not the sole decision making parameter to rely for more invasive therapies in children with myelodysplasia. On the other hand, a DLPP cut-off value of 20 cm H2 O showed a higher sensitivity to predict UUT damage instead of 40 cm H2 O. Neurourol. Urodynam. 36:759-763, 2017. © 2016 Wiley Periodicals, Inc.

Objective: We aimed to share our experience about the super-selective embolization of the vesical artery performed with micro-catheter technique which was used as a palliative approach to control intractable hematuria in patients with bladder cancer. Materials and Methods: Super-selective embolization of the vesical artery with micro-catheter technique was performed in 12 bladder cancer patients whose hematuria could not be controlled with other palliative methods in our clinic. Hemoglobin levels, blood transfusion amounts, complications and urethral catheter removal duration before and after embolization were evaluated. Results: The average age of the patients was 73.3 (65-85, range) years. For the embolization process, n-butyl-2cyaboacrylate (glue) was used as the primary method in 3 patients and polyvinylalcohol (PVA) particle was used in the remaining 9 patients. In two of the patients whose hematuria could not be controlled after PVA embolization glue embolization was performed as the secondary procedure within one week. Super-selective embolization of the vesical artery with micro-catheter technique was performed in all of our cases. In 4 cases, embolization of the vesical artery was performed only to the side of the tumor, which was determined with cystoscopy. Bilateral embolization was performed to the remaining 8 cases. The average hemoglobin value before and after the embolization procedure was 7.9 g/dL and 9.2 g/dL, respectively. The average blood transfusion amounts before and after the procedure were 4 (2-15) and 2.3 (1-4) units erythrocyte/whole blood, respectively. The average urethral catheter duration after the procedure was 7 (2-16) days in 10 patients, who were treated one single embolization session. Urethral catheters were removed once the hematuria dissolved completely. There were no major complications or mortality related to the treatment after the embolization procedure. Conclusion: Super-selective embolization of the vesical artery performed with micro-catheter technique is a safe and effective alternative in patients with intractable hematuria due to bladder cancer whose hematuria could not be controlled with other palliative methods.

Purpose Thulium vaporesection of the prostate (ThuVARP) is a new and safe approach for patients receiving anticoagulant therapy in whom transurethral resection of the prostate (TURP) may possess a high bleeding risk. We aimed to demonstrate the efficacy and safety of ThuVARP in patients receiving oral antiplatelet/anticoagulant (OAP/OAC) therapy. Materials and methods A total of 103 patients who underwent ThuVARP between 2011 and 2013 were enrolled in the study. Patients were divided into 2 groups. Group A consisted of 47 patients who underwent low molecular weight heparin (LMWH) bridging and group B consisted of 56 patients who were operated on while receiving OAP/OAC therapy. Results The drop in hemoglobin levels in the pre- and postoperative periods was significantly higher in group A than in group B. When subgroups were analyzed, the mean drop in hemoglobin was significantly lower in the warfarin and ticlopidine subgroups of group B than in group A. International Prostate Symptom Scores were significantly lower 3, 12, 18, and 24 months after surgery in group A than in group B. Quality of life scores, maximal flow rate values, and postmicturition residual urine volumes (mL) were similar between the 2 groups. A total of 38 and 41 patients in groups A and B, respectively, had no complications. Conclusions Our study showed the safety profile of continuing different OAP/OAC therapies in terms of bleeding problems in patients undergoing ThuVARP. We strongly recommend abandoning LMWH bridging and maintaining the OAP/OAC regimen patients are already receiving.

Objectives: To evaluate the presence of upper urinary tractdeterioration (UUTD) and accompanying pathologies in childrentreated with the diagnosis of non-neurogenic bladder-sphincterdysfunction (NNBSD).Patients and Methods: We retrospectively reviewed themedical records of 316 consecutive patients with NNBSDwho were treated. All cohort were grouped into two: Group I(Treatment success; n=284), Group II (Treatment failure with anyform of occult spinal pathology; n=32). Thirty-four children withtreatment-failure and normal magnetic resonance imaging (MRI)findings were excluded. Groups were compared for pre- and posttreatmentpediatric lower urinary tract symptom score (PLUTSS),presence of UUTD and urodynamic findings.Results: The mean PLUTSS was significantly less in Group Icompared with Group II at pre-treatment and 3 months thereafterthe initial treatment (12.20 ± 5.90 and 5.20 ± 4.90 vs 20.3 ± 2.14and 18 ± 3.4, respectively p20 cmH2O and presence of vesicoureteral reflux (VUR)., Amaç: Nörojenik olmayan mesane–sfinkter fonksiyon bozukluğu(NOMSFB) tanısıyla tedavi edilen çocuklarda üst üriner sistemhasarı (ÜÜSH) ve eşlik eden patolojilerin araştırılmasıdır.Hastalar ve Yöntemler: NOMSFB nedeniyle kliniğimizdetedavi edilen 316 çocuğun tıbbi kayıtları retrospektif olarakincelendi. Çocuklar, tedavi yanıtına ve magnetic resonansgörüntüleme (MRG) bulgularına göre iki gruba ayrıldılar: GrupI (Tedaviye yanıt verenler; n=284) ile Grup II (Tedaviye dirençliolup, lomber MRG’sinde gizli spinal disrafizm bulgusu olanlar;n=32). Tedaviye dirençli olup lomber MRG’sinde patolojisaptanmayan 34 çocuk çalışma dışı bırakıldı. Gruplar tedavi öncesive sonrası semptom skoru (SS), ÜÜSH ile ürodinami bulgularıaçısından karşılaştırıldı.Bulgular: Tedavi öncesi dönemde ve tedavi başladıktan üçay sonra, Grup I’in ortalama SS’si Grup II’ye göre anlamlı olarakdüşük saptandı (sırasıyla 12,20 ± 5,90 ve 5,20 ± 4,90 karşın 20,3± 2,14 ve 18 ± 3,4; p

Pulmonary embolism is a frequent and mortal situation especially in high-risk patients. Although thrombolytics and anticoagulants are the main options in treatment, substantial portion of patients also have high bleeding risk. Therefore, new catheter-directed treatment strategies, such as ultrasound-assisted transcatheter thrombolysis, gain importance in treatment options for intermediate and high-risk patients. Here, we report a case of massive pulmonary embolism due to the iatrogenic lymphocele after a radical retropubic prostatectomy procedure. The usage of ultrasound-assisted transcatheter thrombolysis was successful in such a high-risk patient.

Objective: The aim of this study was to evaluate the safety and efficacy of retropubic (RP) or transobturator (TO) midurethral slings (MUS) in a prospective randomized cohort of Turkish women. Patients and Methods: A total of 54 women with urodynamic stress urinary incontinence (SUI) were randomized to undergo either RP or TO MUS between August 2006 and February 2013 in a tertiary referral center by a single surgeon. All patients had history, physical examination, urodynamic evaluation and quality of life assessments. The validated Turkish versions of the SEAPI, ICIQ-SF and OAB-V8 questionnaires were used. The Advantage® RP and the Obtryx® TO MUS Systems were used for all RP and TO procedures. Results: Twenty-seven patients were randomized to each group. The median follow-up was 48.5 ± 21.8 months. The median hospital stay was 24.0 ± 4.8 h and median operative time was 35.0 ± 19.9 min. The overall objective and subjective cure rates were 92.6 and 79.6%, respectively. The quality of life of all patients significantly increased after the operation compared to their preoperative status. Patients with a poorer subjective cure rate were those with mixed urinary incontinence, whose preoperative SEAPI and OAB-V8 scores were significantly higher. Conclusion: MUS surgery is highly effective and could safely be performed in a cohort of Turkish women with SUI in subspecialty centers by experienced surgeons. There is no significant difference between RP or TO applications in terms of safety and efficacy. Further studies with long-term follow-up data are required.

Epithelioid sarcoma is a rare soft-tissue sarcoma which classically presents as a subcutaneous or deep dermal mass in distal extremities of adolescents and young adults. A more aggressive \"proximal\" or \"large-cell\" type has been described in rare cases to occur as a deep soft-tissue mass at proximal body sites which tends to recur and metastasize earlier than the conventional epithelioid sarcoma. The correct diagnosis of this type is essential since these lesions can easily be misdiagnosed as other epithelioid lesions. Its prognostic factors also have not yet been fully investigated. We herein report a case of metastatic proximal-type epithelioid sarcoma arising from the scrotum of a 50-year-old man managed by radical surgery and adjuvant chemotherapy.

Fikret Fatih Onol *, Yiloren Tanidir , Esin Kotiloglu , Mehmet Bayramicli , Serdar Turhal , Levent N. Turkeri a Department of Urology, Marmara University School of Medicine, Marmara University Hospital, Altunizade, Istanbul, Turkey Department of Pathology, Marmara University School of Medicine, Marmara University Hospital, Altunizade, Istanbul, Turkey Department of Plastic & Reconstructive Surgery, Marmara University School of Medicine, Marmara University Hospital, Altunizade, Istanbul, Turkey Department of Oncology, Marmara University School of Medicine, Marmara University Hospital, Altunizade, Istanbul, Turkey