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Objective: The Cancer of the Bladder Risk Assessment (COBRA) score is a practical method that can be used to predict survival in patients who have undergone radical cystectomy (RC). We aimed to evaluate COBRA scores in our patient group. Materials and Methods: Patients were classified according to tumor stage and lymph node (TLN) involvement; mortality rates and survival were analyzed according to both the TLN classification and COBRA score from the Turkish Urooncology Association database. The chi-square test and Fisher-Freeman-Halton Exact chi-square test were used to compare qualitative data as well as descriptive statistical methods. Cox regression analysis was used for multivariate analysis. Kaplan-Meier and log-rank tests were used for survival analysis. Results: There was a statistically significant difference between the COBRA scores and survival rates in terms of cancer-specific mortality according to TLN classification (p=0.000; p<0.05). A COBRA score of 6 was associated with a lower mortality rate than a COBRA score of 5. In the Cox regression analysis of cancer-related death, a one-unit increase in the COBRA score increased the cancer-related death rate 1.54-fold [hazard ratio (HR)=1.540; 95% confidence interval (CI)=1.402-1.691] (p<0.05). When the COBRA score was compared to 0, the highest risk was observed for COBRA 5. If the COBRA score was 5, the risk of cancer-related death increased 14.63 times (HR=14.627; 95% CI=7.041-30.385) (p<0.05). If the COBRA score was 6, the risk of cancer-related death increased by 11.54 times (HR=11.547; 95% CI=5.270-25.278) (p<0.05). Conclusion: The COBRA score increased, the prognosis worsened, and our results are consistent with the first validated study. [ABSTRACT FROM AUTHOR]

Objective: Diagnoses of variant histopathology (VH) in bladder cancer (BC) are increasing, and although there is a standard treatment algorithm for BC, the guidelines lack a standardized approach for treating VH in BC. We aimed to compare the survival results of the treatment algorithm applied to patients with BC with VH in the first transurethral resection of the bladder (TUR-B) procedure. Materials and Methods: We retrospectively assessed data on patients with VH of BC in the first TUR-B between January 2000 and January 2021. After the first TUR-B, we determined TUR-B+/-BCG, radical cystectomy (RC), and trimodal therapy (TMT) as the three potential treatments for patients according to the initial plans applied by the clinics. Results: A total of 289 patients with VH of BC in the first TUR-B were included in the study. Their mean age was 66.7±10.1 years, and most (246, 85.1%) were male. We found that TMT was associated with lower survival, and BCG administration offered no advantage in terms of overall survival (OS) or cancer specific survival (CSS) among patients with non-muscle-invasive bladder cancer (NMIBC). In patients with MIBC, immediate RC provided a significant advantage over other treatment methods in terms of both OS and CSS. Conclusions: There is still no standard treatment for patients with VH of BC. Patients are less likely to survive TMT than other treatment modalities. [ABSTRACT FROM AUTHOR]

Purpose: We designed a multicenter, retrospective study to investigate the current trends in initial management of reflux with respect to European Association of Urology (EAU) Guidelines in Urology clinics of our country.Materials and Methods: The study group consisted of 1988 renal units (RU) of 1345 patients treated surgically due to vesicoureteral reflux (VUR) (between years 2003 and 2017) in nine different institutions. Patients were divided into two groups according to time of initial treatment and also grouped according to risk factors by "EAU guidelines on VUR."Results: In this series, 1426 RUs were treated initially conservatively and 562 RUs were initially treated with surgery. In initially surgically treated group, success rates of surgery decreased significantly in low and moderate risk groups after 2013 (P = .046, P = .0001, respectively), while success rates were not significantly different in high risk group (P = .46). While 26.6% of patients in low risk group were initially surgically treated before 2013, this rate has increased to 34.6% after 2013, but the difference was not statistically significant (P = .096). However, performing surgery as the initial treatment approach increased significantly in both moderate and high risk groups (P = .000 and P = .0001, respectively) after 2013. Overall success rates of endoscopic treatments and ureteroneocystostomy (UNC) operations were 65% and 92.9% before 2013 and 60% and 78.5% after 2013, respectively. Thus, the overall success rate for surgery was 72.6%. There was significant difference between success rates of UNC operations before and after 2013 (P = .000), while the difference was not significant in the injection group (P = .076).Conclusion: Current trends in management of reflux in our country do not yet follow the EAU guidelines on VUR in low and moderate risk groups despite these reliable and accepted guidelines were expected to influence our daily approach. [ABSTRACT FROM AUTHOR]

Introduction: To compare percutaneous nephrolithotomy (PCNL) outcomes between the elderly and young age groups and examined differences between young-old, old-old, and oldest-old patients. Methods: A retrospective analysis was conducted on 8191 renal units that underwent PCNL between September 1997 and March 2020 at three Turkish academic institutions. Patients were classified into young (18-64 years) and elderly (65+ years) age groups. The elderly age group was classified into young-old (65-69 years), old-old (70-79 years), and oldest-old (80+ years). Demographics, stone features, and perioperative and postoperative outcomes were compared between groups. The factors affecting stone-free rates and complications were determined in the elderly age group. Results: The patients' median age was 47 years (18-100) and the female to male ratio was 1:1.72. The stone-free and complication rates were 78.9% and 16.4%, respectively. General complications, blood transfusion, postoperative urinary tract infections, and major complications rate were similar between the young and elderly age groups (P = .902, P = .740, P = .659, P = .219, respectively). The stone-free rate was higher in the elderly age group (P = .002). Presence of partial or complete staghorn stones and number of stones were independently associated with stone-free rates for elderly age group patients (P = .006, P < .001, respectively). Stone burden (≥400 mm2) and presence of partial or complete staghorn stones were significantly associated with complications for the elderly age group patients (P = .038, P = .014, respectively). Conclusions: In the young-old, old-old, and oldest-old age group, PCNL appears like the preferred treatment with high stone-free rates but similar complication rates compared to their younger counterpart. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the effects of continuous positive airway pressure (CPAP) and surgical treatment of Obstructive Sleep Apnoea syndrome (OSAS) on nocturia. Materials and Methods: Forty-eight patients who received treatment for OSAS and had nocturia between January 2019 and December 2019 were included in the study. Questionnaires of the International Prostate Symptom score, Overactive Bladder Symptoms score, International Consultation on Incontinence Questionnaire-Male Lower Urinary Tract Symptoms and International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms were administered to all patients. The number of nocturia was evaluated by the mean number of nocturia episodes in the bladder diary. Results: Thirty-two (66.6%) patients received CPAP therapy, and 16 (33.3%) patients underwent surgical treatment for OSAS. The mean number of nocturia episodes of all patients before and after treatment was 2.3±1.4 and 1.7±2.2, respectively, and the difference was significant (p=0.032). However, surgical treatment and CPAP therapy were not superior to each other in terms of improving nocturia (p=0.901). Conclusion: Regardless of treatment modalities, i.e., CPAP therapy or surgical treatment, treating OSAS improves nocturia. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate the reliability and effectiveness of laparoscopic adrenalectomy (LA) in large adrenal masses by comparing LA results for large- and small-volume (<5 cm) masses. Materials and Methods: Patients who underwent LA due to adrenal mass between February 2004 and December 2018 in our clinic were retrospectively analyzed. The patients were divided into two groups as mass size <5 cm (group I) and ≥5 cm (group II). Patients who underwent open adrenalectomy and whose data were not available were excluded from the study. Perioperative data, postoperative results, complications, and histopathological results were examined. Results: There were 62 patients who underwent LA. Thirty-three patients (53.2%) had a left adrenal mass, and 29 patients (46.8%) had a right adrenal mass. Of the 62 adrenal masses, 46 (74.2%) had a diameter of <5 cm (group I), and 16 (25.8%) were ≥5 cm (group II). The mean tumor size was 3.2±0.15 and 6.4±3.5 cm in group I and group II, respectively. There was no statistically significant difference between the groups in terms of age, operative time, and blood loss. The average length of hospital stay was 37.6±20.9 hours in group I, while it was 49.8±22.9 hours in group II and was significantly longer in group II (p<0.05). Intraoperative blood pressure elevation occurred in one patient in group I and II. In a patient with suspected malignancy in group II, the surgery was shifted to open surgery as the capsule over the mass was opened. Hypopotasemia was observed in one patient, and atelectasis was observed in one patient in group I, and pneumonia was observed in one patient in group II. Conclusion: LA is a minimally invasive surgical method that can be applied safely in experienced centers in masses larger than 5 cm with no suspected invasion in preoperative imaging. [ABSTRACT FROM AUTHOR]

Objective: We aimed to compare the safety and efficacy of upper, middle and lower calyx accesses obtained as isolated and single access in percutaneous nephrolithotomy (PCNL) operation which is performed for treating renal stones. Materials and Methods: The records of patients who had undergone PCNL via isolated single pole access due to renal stone between September 2007 and June 2018 were retrospectively evaluated. The patients were divided into three groups as isolated single upper calyceal access patients (group 1), isolated single middle calyceal access patients (group 2) and isolated single lower calyceal access patients (group 3). The patient groups were compared in terms of patient characteristics, stone size and location, operative data, postoperative outcomes and complications. Results: Fifty-seven (2.8%) patients who underwent isolated single calyceal access PCNL were included in group 1 (upper calyx), 542 (26.9%) in group 2 (middle calyx) and 1427 (70.4%) were included in group 3 (lower calyx). The mean age of the patients in groups 1, 2 and 3 was 43.09±15.00, 38.23±22.47 and 39.40±19.93, respectively. A thousand hundred and seventy-six (58%) patients were male and 850 (42%) were female. The mean stone burden was 367.19±266.48, 335.7±301.85 and 353.73±346.47 mm2 in groups 1, 2 and 3, respectively and there was no statistically significant difference between the groups (p=0.45, p=0.77, p=0.29, respectively). The mean operative time, mean fluoroscopy time, and mean nephrostomy time, and the mean length of hospitalization were statistically significantly longer in group 2 than in group 3. Stone-free rates in patients with clinically insignificant stones (SF + CIRF) were 89.5%, 89.6% and 91.6% in group 1, 2 and 3, respectively and there was no statistically significant difference between the groups (p=0.25, p=0.43 and p=0.6 respectively). There was no significant difference between the three groups in terms of postoperative fever, blood transfusion and overall complications. Conclusion: As a result, different isolated single calyceal accesses do not have superiority over each other in terms of stone-free rate and complications. A proper access is required while performing PCNL to remove the stones, decrease the comorbidity rates and prevent complications and the ideal way is the way that provides the shortest and the smoothest reach all stones [ABSTRACT FROM AUTHOR]

Introduction: To identify the predisposing factors, etiological and clinical characteristics as well as the Fournier's gangrene (FG) severity index (FGSI) in the outcomes of patients with FG. Materials and Methods: The data from 71 patients diagnosed with FG in a period of 17 years were retrospectively reviewed for the age of the patient, their history, predisposing factors, etiology, prodromal symptoms, FGSI, culture results, hospitalization period, surgical interventions, responses to the therapy and complications. Results: All of the patients were Caucasian males, and the mean age was 61.3 (range 36-92) years. The mean duration from the onset of symptoms to surgery was 7.5 days. The mean hospitalization time was 27.4 days and the most common etiological factor for FG was a perineal abscess. The overall mortality rate was 29.6%. The relationship between the number of predisposing factors and mortality rates in patients with FG was the most statistically significant parameter (p = 0.001). Conclusions: Multiple predisposing factors predict a poor prognosis and correlate significantly with mortality. Extension of the disease and the FGSI score were not predictive of outcome. The most essential intervention for stopping the rapidly progressing infectious process of FG consists of early recognition of the disease, proper management of the predisposing factors and aggressive surgical debridement. Such an intervention can improve clinical outcomes. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Purpose: We aimed to compare oncological outcomes in the two rare subtypes, unclassified renal cell cancer (un-RCC) and translocation RCC (tRCC), vs clear cell RCC (ccRCC). Materials and Methods: Between 2004 and 2019, from Turkish Urooncology Society Database, we identified 2324 patients for histological subtypes including 80 unRCC (3.4%), 19 tRCC (0.8%) and 2225 ccRCC (95.8%). Results: The overall (15.8%) and cancer-specific mortalities (11.1%) were found to be higher in tRCC group and the recurrence free mortality (13.8%) was found to be higher in unRCC group. Larger pathological tumor size (p = 0.012) and advanced pathological T stage (p = 0.042) were independent predictive factors on overall mortality in patients with unRCC tumors. Conclusion: The oncological outcomes of the unRCC and tRCC are worse than ccRCC and pathological tumor size and pathological stage are predictive factors for mortality in the unRCC. [ABSTRACT FROM AUTHOR]